Search PubMed⌕ Search

Biomedical subjects

F Levy

Publications and source records attributed to F Levy.

151 records · Page 9Linked to original sources
PubMedDate not supplied

A risk assessment scoring system predicts survival following the Norwood procedure.

No one set of characteristics has been consistently predictive of perioperative mortality and morbidity associated with the Norwood procedure. The purpose of the current study is to further validate a scoring system shown to be predictive of mortality following the Norwood procedure. We performed a retrospective review of all infants with the diagnosis of hypoplastic left heart syndrome (HLHS) who underwent the Norwood procedure at St. Louis Children's Hospital from July 1, 1994, to December 31, 2002. A weighted score for each of six factors comprised the scoring system. The factors included ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. A score of > or = 7 points indicated lower reconstructive mortality risk, and a total score of < 7 points indicated a higher mortality risk. A total of 57 patients were analyzed. Twenty-five infants (44%) had a low risk score. These infants had a significantly greater survival at 48 hours compared to infants with a score of < 7 (92 vs 75%, p < 0.05). Infants with a high risk score had a significantly greater relative risk of mortality at 48 hours [OR = 2.04; confidence interval (CI) 1.04-4.00; p = 0.036]. The area under the receiver operating characteristic (ROC) curve is 0.8534 (95% CI, 0.78-0.922). This suggests that the scoring system has a very good degree of discriminatory power in selecting children who did not survive. Based on the results of the ROC, a cutoff score of >7 gives the best sensitivity and specificity for survival. When applied retrospectively, the survival outcomes predicted by our scoring system significantly correlated with actual outcomes. This supports the conclusion that a specific population of HLHS patients may have a higher mortality risk independent of surgical technique and postoperative care based on factors that can be assessed preoperatively.

Age Factors↗
PubMedDate not supplied

Spontaneous esophageal perforation presenting with right-sided pleural effusion.

Boerhaave's Syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. Misdiagnosis is the most important contributing factor in the continuing high morbidity and mortality of this disease. We report an atypical presentation of Boerhaave's Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. A chest radiograph revealed massive right hydropneumothorax. After placement of a chest tube, the patient was admitted to the intensive care unit. Only 36 hours after admission did the diagnosis of Boerhaave's Syndrome become evident. She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 3 months after her admission. The absence of vomiting prior to presentation and the right sided effusion are the distinguishing features of this particular case.

Emergencies↗
PubMedDate not supplied

Flounder health status in the Seine Bay. A multibiomarker study.

The Seine Bay is used as a pilot area to assess the usefulness of monitoring programmes using a suite of biological measurements. These biomarkers included ethoxyresorfin-O-deethylase (EROD) and acetylcholinesterase (AChE) activities, multixenobiotic resistance (MXR) protein expression level assessment and gonad histopathology. Samples of European flounder collected in three sites close to the Seine Estuary in late September 1998 showed that 8% of the males were intersex, i.e. had gonads with both male and female tissues. Another 10% of individuals, identified as male by morphological observation during sampling, showed only female tissues on histological sections. These dramatic changes were associated with different patterns of EROD activity, MXR expression or AChE activity inhibition that might reflect shorter time effects of xenobiotics and constitute a starting point to integrate biological responses for the assessment of the health status of flounder in the Seine Bay.

Acetylcholinesterase↗
PubMedDate not supplied

[30 years' development of economic theories in confrontation with facts].

In 1969, R. Frish and J. Tinbergen received the first Nobel Price in Economics. 200 years after Quesnay's "economic tables", economics were at last considered as a science. During the last thirty years, economics haven't lost their scientific reputation, but, confronted with different situations in the world and in France, economics have been unable to bring appropriate solutions to every problem. Nowadays, economics are quite far from the promises born after the Second World War: indeed, until the 1974 world crisis, Keynes' theory (from a macro-economic point of view) and Walras' formalisation of the markets (from a micro-economic point of view) were sufficient to give satisfying representations of any economic reality and mechanism. Nevertheless, these theories were unable to deal with both growing unemployment and raising inflation in the late 70's and early 80's. Today, economics present a wide variety of efficient analysis of society. Game theory, behaviour theory or econometrics are new means used to found new kinds of reality representation. Therefore, if economics can no longer be considered as an exact science, it remains nevertheless scientific.

Economics↗
PubMedDate not supplied

[New technological equipments and their economical impact in ambulatory care].

The 1st Part of the study, based on 3 opinion surveys among ambulatory care providers (French physicians in private practice) shows a steady increase of prescribed technological "acts". However, the number of physicians having high-tech devices in their office is much lower. Ownership is understandably less frequent than equipment leasing or renting. In the French context, turnover of physicians for using high-tech equipment is outpaced by turnover of patients: as a rule, general practitioners send their patients to the specialist's offices or to hospitals (in France, the specialists practice both in ambulatory and institutional settings). The 2nd Part of the study, based on 4,471 physicians' tax files, attempts to identify the investment behavior of doctors in private practice regarding new technological devices. The specialty and the obsolescence speed of the equipment play both an important role. However, the choice between renting/leasing and purchasing depends also whether the doctor has a long run or a short term perspective. Such a choice is clearly evidenced through the French mechanisms of income taxation. It explains why the doctor's annual income (gross or net) is not significantly related to his investment behavior.

Ambulatory Care↗