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Biomedical subjects

F Piette

Publications and source records attributed to F Piette.

At least 163 records · Page 9Linked to original sources
PubMed1975

[Conduction disorders in aortic valve diseases].

Among 304 cases of aortic valvulopathies studied for surgical selection, the authors have found a high incidence of conduction disturbances (16% in aortic stenosis and 18,4% in aortic regurgitation). The conduction defects are mostly intraventricular among stenosis isolated or associated to regurgitation and mostly atrio-ventricular among pure aortic insufficiencies. The highest incidence (30%) being found in patients with bacterial endocarditis acute or healed. The incidence of conduction disturbances increases with age, with the presence of valvular calcifications, of left ventricular strain or failure, of coronary insufficiency and angina... practically with the duration and the severity of the valvular disease. Surgical risk is heavier and natural prognosis poorer in valvulopathies with conduction disturbances. But these disturbances never contraindicates surgery : it is sometimes necessary to insert a pacemaker with or without valvular replacement mostly in aortic stenosis with infrahisian conduction defects. During hemodynamic investigation of such cases one must be ready to stimulate the heart, particularly during right heart catheterization of patients with complete left bundle branch block.

Adult↗
PubMed1970

Hemodynamic determinants of exercise ST-segment depression in coronary patients.

Eight patients with coronary heart disease were studied during two periods of exercise separated by 30 min of rest; workload was increased in a stepwise fashion every minute of exercise up to a level that produced limiting symptoms of angina, fatigue, or dyspnea. The magnitude of ST-segment depression and the central aortic pressure were measured during exercise and recovery periods, and myocardial oxygen requirements were estimated by the pressure-time index (systolic aortic pressure x heart rate x ejection time). Seven of the eight patients exhibited a close relationship (r ranged from 0.74 to 0.98) between magnitude of exercise ST-segment depression and indices expressing myocardial oxygen requirements; heart rate, blood pressure, and ejection time were also related to magnitude of exercise ST-segment depression. These relationships were reproducible during two consecutive exercises. Like onset of angina, magnitude of exercise ST-segment depression is usually related to hemodynamic factors influencing myocardial oxygen needs. Consequently, comparisons of exercise-induced ST depression before and after therapy (drugs, physical training, and surgery) are valid only if ECG findings are compared at the same level of myocardial oxygen requirements. In contrast, absence of such a relationship during recovery suggests an important difference in mechanisms of the post-exercise electrocardiogram.

Coronary Disease↗
PubMedDate not supplied

[Giant primitive neuroendocrine cutaneous carcinoma of the leg].

INTRODUCTION: Primitive cutaneous neuroendocrine carcinoma or Merkel cell carcinoma is a tumor characterized by rapid evolution. The size at the time of diagnosis is a mean of 2 to 3 centimeters. We report a case of a particular clinical and anatomopathological presentation. OBSERVATION: A 76 year-old woman had a voluminous tumoral plaque on the left leg with multiple ulcero-necrotic lesions involving the bone structure without palpable, inguinal lymphadenopathy. The histological and immunocytochemistry examination led to the diagnosis of cutaneous neuroendocrine carcinoma. The normality of the chest, abdominal and pelvis investigations confirmed the primitive cutaneous origin. The patient died a few months later without lymph involvement. DISCUSSION: To the best of our knowledge, such a presentation of primitive cutaneous neuroendocrine carcinoma has never been reported. The absence of lymphadenopathy despite the tumor volume and extensive skin involvement suggest the hypothesis of a non lymphophilic form of primitive cutaneous neuroendocrine carcinoma. This case report shows that lymphophily depends neither on the tumoral size nor to the degree of differentiation of tumoral cell proliferation, but on biological factors that require specification.

Aged↗
PubMedDate not supplied

[Skin diseases observed in the dermatology departments of three French university teaching hospitals].

BACKGROUND: We recently carried out a study concerning consultations by French dermatologists in private practice. We evaluated consultations at the dermatology departments of 3 university teaching hospitals in France. MATERIALS AND METHODS: This was a 2-month prospective study conducted in 2003 at the dermatology departments of the university teaching hospitals of Amiens, Lille and Rouen. Each consultant completed a questionnaire covering the duration of the study. The following data were recorded: consultation date, function of the consultant, study centre, type of consultation, type of disease, and whether or not the patient was hospitalised after the consultation. RESULTS: 7296 files were examined during the study. 38% of the consultations were performed by part-time hospital consultants, 29% by dermatology interns, 18% by hospital practitioners, 9% by university professors and 6% by clinical heads or assistant heads. The most commonly encountered diseases were allergies (17%), cancer (16%), arteriovenous disease (15%) and infectious disease (11%). Three types of consultation were identified: emergency consultations without an appointment, consultations by appointment for a specific problem and consultations by appointment without a specific problem. The number of resulting hospital admissions ranged from 2 to 10% of consultations, depending on the type of consultation and the role of the consultant in question. DISCUSSION: This study shows that in France, consultations at hospital dermatology departments differ greatly from those of dermatologists in private practice. The main diseases seen (cancer, arteriovenous disease, allergy, infectious dermatosis) accounted for the majority of hospitalisations in these departments. The organisation of hospital consultations is increasingly tending both towards treatment of highly specialised diseases through specifically oriented consultations and also towards the emergency treatment of certain forms of acute dermatosis.

Appointments and Schedules↗
PubMedDate not supplied

Modeling the relation between neurofibrillary tangles and intellectual status.

The relationship between the neurofibrillary tangles and the intellectual deficit observed in senile dementia of the Alzheimer type was studied in 27 patients over the age of 75. The presence and density of tau positive tangles were assessed in six areas including limbic, paralimbic, and isocortical cortices. In the isocortical areas, the presence [1] or absence [0] of neurofibrillary tangles was better correlated with the Blessed test score than the density of the neurofibrillary tangles profiles. Multivariate analysis showed that the number of areas containing at least one neurofibrillary tangle was the best explanatory variable of the intellectual status. The cortical areas were ranked according to the prevalence of their involvement. The presence of tangles in an area of a given rank took place only if the areas of lower ranks were also involved. It is proposed that the presence of tangles in a given area is a more significant information than the value of their density. These data may lead to new diagnostic procedures.

Aged↗
PubMedDate not supplied

Juvenile xanthogranuloma: a congenital giant form leading to a wide atrophic sequela.

Juvenile xanthogranuloma is the most common non-Langerhans cell histiocytosis of infancy and childhood. It is a benign disorder that usually regresses spontaneously, more often without or with limited skin changes. The clinical features are very pleomorphic and recognition of the atypical presentations should facilitate the diagnosis. We report a 9-month-old boy who had an extensive, atrophic lesion on the proximal thigh that followed the course of the congenital giant form. The large size of the lesion does not alter the clinical course or result in extracutaneous involvement, which remains rare. However, uncommon clinical presentations raise the problem of differential diagnosis, requiring biopsy to eliminate other tumors with a less favorable prognosis.

Atrophy↗
PubMedDate not supplied

[Iron deficiency in patients over 60 years. Descriptive study in the consultant population of health screening centers].

AIM: The aim of the study was to evaluate the frequency of iron deficiency with serum ferritin in elderly population, and to appreciate the opportunity of early screening according to digestive diseases. SUBJECTS AND METHODS: Data were collected from 3524 men and 3120 women aged 60 to 75 years during a health screening examination. Evaluation of diagnosis and treatment were obtained through questionnaire completed by treating physician. RESULTS: The frequency of hypoferritinemia was about 2.3% in our population (hypoferritinemia was defined by serum ferritin<20 microg/L or between 20-40 microg/L if C reactive protein was > 12 mg/L). Anemia was found in 3.3% of patients. Logistic regression model adjusting for multiple variables was used to examine factors associated with hypoferritinemia. The probability was greater among non-anemic patients with chronic digestive bleeding (odds-ratio: 2.3), or with positive occult blood testing (odds-ratio: 2.3). Information about the medical follow-up was obtained in 81% of patients with hypoferritinemia. A digestive exploration was made in 38 cases. Digestive disease was found among 24.3% patients with hypoferritinemia, and three colorectal cancers were observed. CONCLUSION: The screening of hypoferritinemia in elderly population examined in health screening centres could not be recommended as its frequency was low in this population, despite a strong correlation between hypoferritinemia and digestive diseases.

Aged↗
PubMedDate not supplied

[Aging and cognitive slowing: example of attentional processes--evaluation procedures and related questions].

Slowing is generally associated to ageing. It appears in motor's functions and in cognitive tasks. What is the real nature of this slowing? Is it a general slowing concerning every cognitive processes with the same scale or is this slowing specific of only processes. Or, at least, is it of different magnitude for each cognitive processes? The aim of this paper is to present the state of this debate from results obtained in studies orientated toward attentional processes. Attention allows us to adapt oneself to environment that require in one hand selective mechanisms for pertinence events and in other hand inhibitory mechanisms for interferences. To evaluate these mechanisms priming and cueing procedures are used. Using primes (semantic or conceptual) results in shorter reaction time than for conditions without prime. In some experimental conditions, negative primes can be observed which results for longer reaction time. In these procedures, we need to be careful to the SOA's value (Stimulus Onset Asynchrony) (it represents the time between the end of the prime or cue presentation and the beginning of the stimulus presentation). The longer is the SOA, the shorter is the reaction time increase with a SOA between 200 ms and 400 ms. In these procedures, we now have to understand in the field of information processing what causes this reaction time modification. In other words, increase of reaction time with SOA could be explain increase of all stages of treatment or may be also the consequence of some abolition's of stages? In attentional procedures, we have to consider the automatic or controlled nature of cognitive processes. In target research tasks that implies selective attention, several authors have showed a distinction between automatic and controlled processing. Time to detect prompts increase generally with the distractor number excepted when the prompt is prominent for the subject (because of physical or emotional characteristics). In this second case, the pop out effect, reaction time does not depend from the number of distractors and this effect performs to be supervised by automatic processes. By contrast, reaction time variation is considered to be linked with controlled processes activation. What's about ageing? Myerson et al. (1992) don't show reaction time distinction between young and old in their meta analyse which really results from lexical decision tasks from 1980 to 1990. If you now consider the SOA values, results are less clear and contradictions existing between studies. Using negative priming procedures implies different results too, but one is main: it seems that elders take as much time to denote a prompt in conditions when prompt was distractor compared to neutral condition, by contrast to younger who take more time to denote the prompt where it was distractor compared to condition where it was not. Ageing effects on inhibition intensity and length could be expanded. Nissen and Corkin (1985) showed a facilitator effect with cueing in young and in old people, and this appears more important in old people. Hartley et al. (1990) show this results too and control the SOA: the facilitation size effect seems to depend from the SOA size. On top of that, some authors show the presence of the popout effect in elders but a reaction time lengthening when conditions imply controlled processing (visual or memory research tasks). In summary, the most studies show a slowing in old people whatever attentional tasks but the lengthening size doesn't vary systematically with conditions: facilitatory effects and automatic processing are possible but inhibitory processing are more probably impaired. Several hypotheses can explain these results. Some authors think there is a general slowing factor that slows with age. For others slowing depends from tasks, and mainly from several implied processing. Nevertheless, no one study show a regular relation between reaction time and priming or cueing effects. Few results, which we've presented in this article, are really compatible with the general slowing theory. Finally, McDowd and Birren (1990), or Hasher and Zacks (1988) suppose that there is an incapacity to ignore non pertinent information with ageing, but there are limit in this hypothesis too. In summary, we don't know at this time the real nature of slowing with age but experimental values seem to be in favour with slowing, which significance depends from cognitive processes. We now have to describe precisely slowing in old people, and more exactly with exact timing between prime and target could be a beginning of task.

Aged↗
PubMedDate not supplied

Cutaneous granulocytic sarcoma arising at the site of radiotherapy for breast carcinoma.

Carcinogenic effects of radiotherapy in breast cancer are well-known. Long-term follow-up of these patients shows a significantly increased risk of leukemia. Cutaneous granulocytic sarcoma is an uncommon leukemia cutis that usually occurs in association with acute myelocytic leukemia or myeloproliferative disorders. We report a case of cutaneous granulocytic sarcoma in a 44-year-old woman who had been treated six months earlier for breast adenocarcinoma. The treatment had associated lumpectomy, axillary lymph node dissection and radiotherapy. Skin lesions appeared firstly and predominantly on the irradiated area. Haematological investigations were normal and the diagnosis of isolated sarcoma was made. The uncommon features of this case were the short interval between radiotherapy and the occurrence of leukemia skin lesions and the fact that, to our knowledge, this is the first report of leukemia cutis localised on the irradiated area. The responsibility of radiation in the distribution of cutaneous lesions of granulocytic sarcoma is discussed.

Adult↗
PubMedDate not supplied

[Drug effects in elderly subjects: from the pharmacologic target to the risk-benefit. Round Table #5 of the 16th National Clinical Pharmacology Workshop].

In addition to being a fast-growing subpopulation, the elderly also receive large quantities of medication and are particularly exposed to iatrogenic effects. In France, 8.6 per cent of hospitalizations of patients over the age of 70 are due to an adverse event. This workshop comprising pharmaceutical companies, pharmacologists, geriatricians and health authorities aimed to make propositions for improving drug research in the elderly in order to prevent iatrogenic drug reactions by encouraging more rigorous application of existing guidelines. In addition to information extrapolated from clinical trials conducted on young or healthy people, it is imperative to include in clinical trials a sufficient number of elderly patients and to take into consideration specific criteria such as multiple medication regimens, concomitant diseases, cognitive impairment and motor disturbances. The assessment of drugs used in the elderly must be based on a specific and validated geriatrics scale and in some cases (postmarketing studies) may be based on specific trials (those called 'conducted in the real world').

Aged↗