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Biomedical subjects

G Vidal-Trecan

Publications and source records attributed to G Vidal-Trecan.

16 recordsLinked to original sources
PubMed2001

Venous thromboembolism in medical inpatients: prophylaxis with low-weight heparin in a university hospital and prevalence of thromboembolic events.

The aim of this study was to determine the prevalence of venous thromboembolism (VT) in current prophylactic practice with low-molecular-weight heparin (LMWH) among medical inpatients and to analyze associated risk factors for VT. A cross-sectional survey on five given days was conducted in the medical departments of a university hospital. The prevalence of prophylaxis and confirmed VT was measured. Risk markers for receiving high doses of LMWH and for VT under prophylaxis were assessed by logistic regression models. Of 1,194 inpatients, 1.4% suffered VT. The mean proportion of patients with LMWH prophylaxis was 24% (range: 4-64%). The prevalence of VT was higher among inpatients receiving prophylaxis than among those patients not receiving prophylaxis (3.5% vs. 0.7%, p = 0.002). Under prophylaxis, independent risk markers for thrombosis were history of vein thrombosis (odds ratio [OR]: 4.03; confidence interval [95%CI]: 1.04-15.62) and age (OR: 1.08; 95%CI: 1.01-1.15). Two factors were independently associated with the prescription of high doses of LMWH: obesity was positively associated (OR: 7.50; 95%CI: 2.97-18.92; p < 0.0001) and respiratory insufficiency was negatively associated. In medical departments, current prophylaxis practice leads to many patients being given LMWH. LMWH doses and other preventive measures should be adapted in high-risk inpatients.

Age Factors↗
PubMed2000

Differences between burns in rural and in urban areas: implications for prevention.

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.

Accidents↗
PubMed2000

[Risks incurred by first-injection intravenous drug users] [In Process Citation]

Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

Journal Article↗
PubMed1999

[Elements for a cost/utility analysis of long term intravenous devices].

Three long-term intravenous infusion strategies were compared, namely an implantable port (IP), a tunneled central catheter (TCC), and repeated peripheral catheterization (RPC). A decision analysis model was used in which the sequence of decisions and their possible consequences was described as a decision tree for each of the three strategies. The likelihood of each event occurring was determined based on a literature review. Each event was assigned a cost and a utility. Direct medical costs for the society include the cost of the material, the cost of implantation and removal of the device in the operating room, and the cost of treating complications directly ascribable to the strategy used. Utility is a combination of efficacy (as evaluated based on the likelihood of use of the strategy for one year) and quality of life (as evaluated by experts). In the basic analysis, RPC was the most cost-saving method but had an adverse effect on quality of life (0.82). The cost of using IC or TCC for one year was higher, with the main contributors to the excess cost being the insertion procedure and the management of complications (primarily deep vein thrombosis and infection). Quality of life was better with IC (0.98) than with TCC (0.93). IC also had a higher cost-utility ratio (11,738 French francs [FF]) versus 17,393 FF). A one-way sensitivity comparison of IC and TCC showed that the only realistic change capable of reversing the order between these two methods was a decrease by one-third in the risk of infection with TCCs. This model, used here for the first time, establishes that IC is superior over TCC.

Catheterization↗
PubMed1989

[Hospital epidemiology of HIV infection in the Parisian public hospitals].

The evolution of hospitalization for patients with HIV infections in Parisian public hospitals (Assistance Publique de Paris) can be analyzed from the data base containing discharge diagnoses and from the results of a cross-sectional survey "on a given day". At present, the activity associated with HIV infection represents more than 2% of the total activity of this institution. From 1982 to 1987, HIV-associated activity increased extremely rapidly, treating patients in acute care hospitals and clinical departments and concomitantly developing home care and day hospitalizations. The latter were responsible for the substantial decrease in the average length of hospitalization. Home care and day care hospitalizations for HIV infection continued to increase during 1988, while longer-term hospitalizations decreased.

France↗
PubMed1989

[HIV infection in the Public Assistance Hospitals in Paris. Cross-sectional survey on a given day per trimester, a hospital indicator of morbidity].

Many patients with Acquired Immunodeficiency Syndrome (AIDS) and the other forms of human immunodeficiency virus infection are treated in the Assistance Publique hospitals of Paris (AP). A cross-sectional survey to be repeated on a given day of each trimester was designed to obtain rapidly and anonymously the number of inpatients treated. A questionnaire was sent to the head of every department treating acute inpatients, asking for the number of patients with AIDS, AIDS-related Complex, pre-AIDS... and asymptomatic carriers of HIV. In 1986, a regular increase was observed from 252 (139 AIDS patients) in March to 318 (170 AIDS patients) in December. On the average, approximately two-thirds of the AIDS patients were hospitalized in three hospitals; however, their number remained stable over the year so these three hospitals' proportion tended to decrease. An estimation of the annual number of inpatients with HIV infection was drawn from the mean of the cross-sectional survey's results. This survey makes it possible to evaluate on an almost continuous basis the impact of AIDS and related conditions on hospitalization figures.

AIDS-Related Complex↗
PubMed1988

[Human immunodeficiency virus infections and hospital structures: trends in the Public Assistance of Paris].

The evolution of the number of patients with the AIDS virus admitted to the Paris hospitals is monitored by two index systems, one based on the discharge diagnosis and the other a transverse inquiry on a given day, updated every three months since its conception at the beginning of 1986. This index also allows an evaluation of the number of patients consulting for this condition. In 1986, AIDS and AIDS related complexes (ARC) represented 1 p. 100 of the activity of the Assistance Publique Paris hospitals including all in- and outpatients. These conditions will probably account for 2 p. 100 of the activity in 1987. The duration of cumulated hospital stay is on average 30 days per year for AIDS and ARC, divided into roughly 3 admissions, with a tendency towards more under-24 hour stays and domiciliary care. The clinical departments looking after these patients are varied and increasing in number, but most of the work is carried out by Departments of Infectious and Parasitic Medicine.

AIDS-Related Complex↗
PubMed1984

[Rapid beta 1-24-corticotropin test in the exploration of the corticotropic axis. 71 cases].

The reliability of the beta 1-24 corticotropin test, which is both cheap and safe, in the assessment of the hypothalamic-pituitary-adrenocortical function was re-evaluated by comparing its results with those of the metyrapone test in 71 subjects: 30 controls and 51 patients with suspected pituitary-adrenal dysfunction. Response to a 500 micrograms intramuscular injection of beta 1-24 corticotropin was evaluated by measuring the 60 min plasma cortisol levels; 4.5 g of metyrapone divided into 6 doses were then administered orally and response was evaluated by measuring plasma 11-desoxycortisol levels. A highly significant correlation (r = 0.79; p less than 0.001) was observed between plasma cortisol and plasma 11-desoxycortisol levels. The results were best interpreted by expressing the values obtained as plasma cortisol concentrations which, in normal subjects are at least 21 micrograms/100 ml. The rapid beta 1-24 corticotropin test was found to be very reliable (sensitivity 90%, specificity 100%) to detect adrenal insufficiency, irrespective of the organs affected on the hypothalamic-adrenocortical axis.

Adolescent↗
PubMed1984

[Paraneoplastic hypercorticism].

Paraneoplasic hypercorticism results from ectopic corticolipotropic secretion. Its incidence remains underestimated because of the latent clinical forms of Cushing's disease. In some cases the primary tumour (bronchopulmonary, thymic, pancreatic or other) presents late. The variability of hormonal secretion makes it difficult to interpret dynamic tests. Measurement of ACTH and LPH are useful diagnostic aids; more specific markers of ectopic secretion have recently been reported. When the primary tumour cannot be directly treated, the quality of survival may be improved by the use of synthetic anticortisol drugs.

Adrenocortical Hyperfunction↗
PubMed1983

[Hypertension and Cushing's disease].

Over two thirds of patients with Cushing's disease suffer from hypertension. An analysis of 155 patients with Cushing's syndrome was undertaken to study its incidence and effects, and the biological profile and prognosis of the patients. The renin-angiotensin-aldosterone system was given particular attention in 5 patients. Serum angiotensin was raised and a positive correlation was observed with the serum cortisol. Serum aldosterone did not respond as normal to the usual stimuli and the normal plasma renin activity did not vary during the 24 hour period. The physiopathogenesis of hypertension in Cushing's disease is still not fully understood, especially with regard to the mode of action of the hypercortisolism, the essential factor. A mineralocorticoid type of behaviour, especially in the severe forms, may be associated with that of the ACTH-dependent precursors, a permissive action on certain pressor substances, the increase in secretion of angiotensin in parallel to that of the cortisol and finally, the increase in the risk factors probably play a role. The outcome of the hypertension after specific treatment of Cushing's disease is usually favourable. However, hypertension persists in a third of cases.

Adult↗
PubMed1983

[Therapeutic strategy in the hypertension of Cushing's disease].

The hypertension of Cushing's disease regresses in about two thirds of cases after specific treatment of this condition. The therapeutic possibilities available at present include the synthetic anticortisol drugs (OP'DDD, aminoglutethimide) adenomectomy and hypophyseal radiotherapy and, finally, bilateral adrenalectomy. The indications of one or the other forms of treatment depend on the presence of a patent hypophyseal tumour, the age of the patient and the stage of the disease. The hypertension requires treatment either because of its severity from the outset or its persistence after treatment of the Cushing's disease. Betablockers or central sympatholytic drugs like clonidine, are then used in monotherapy of first intention. Diuretics should be avoided whenever possible because of the risk of adrenal insufficiency after reduction of the hypercorticism.

Adrenal Glands↗
PubMed1982

[Results of surgical treatment of Basedow's disease].

Diffuse hyperthyroidism occurred in 88 patients (82 women and 6 men), aged 14 to 74 years, and was due to Graves disease in 65 cases and heteromultinodular goiter in 23 cases. After medical preparation, the surgical procedure was subtotal thyroidectomy for Graves disease and total unilateral with partial controlateral lobectomy for heteromultinodular goiter. The immediate postoperative course was uneventful except for two transient acute episodes of thyrotoxicosis. One to eight years after surgery, 53 patients are euthyroid, 34 are hypothyroid and one has recurrent hyperthyroidism. A TRH test was done in each of the 53 euthyroid patients. Three kinds of responses were demonstrated: a normal response in 22 cases, evidencing true euthyroidism; an excessive response in 24 cases, reflecting partial compensated hypothyroidism; an insufficient response in 7 cases.

Adolescent↗
PubMedDate not supplied

[Cushing's disease. Current data on its course and treatment].

Recent developments in the treatment of Cushing's disease, particularly the trans-sphenoidal microadenomectomy, have prompted a survey of the pathophysiological theories of ACTH hypersecretion in this condition. The results of the trans-sphenoidal approach are reported and the post-surgical evolution (success failure or recurrence) are discussed. It is emphasized that a long fellow up is essential to assess the efficacy of this therapeutic approach.

Adenoma↗