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Biomedical subjects

J C Meurice

Publications and source records attributed to J C Meurice.

At least 19 recordsLinked to original sources
PubMed2000

[Importance of allergologic consultation after a ++perianesthetic complication. Report on a year of activities at the Poitiers University Hospital Center].

OBJECTIVE: Patients who present an accident during general anesthesia must be tested 4 to 8 weeks later in order to determine the exact cause and prevent any further acute accidents. We report the results of a prospective study based on a 1-year period of allergology consultations after peroperative accidents in the Poitiers University Hospital. PATIENTS AND METHODS: Previous history, surgical procedure, the nature and gravity, of the reaction, risk factors and tests results were recorded. All observations were transmitted to the Regional Pharmacovigilance Center. The level of causality of the administered drug was determined from these data which were integrated into the national computer bank of side effects. RESULTS: After 2,500 general anesthesia procedures, a total of 21 patients had been referred to the allergology consultation. Eighteen were positive for at least 1 test (skin tests or laboratory tests). Among the substances administered, causality was probable for 16, possible for 4 and doubtful for 1. CONCLUSION: Our findings demonstrate the importance of allergy tests and the need for close collaboration between anesthetists, allergologists and pharmacologists.

Adjuvants, Anesthesia↗
PubMed2000

[Titration of an effective positive pressure level in the treatment of obstructive sleep apnea syndromes using continuous positive pressure ventilation].

The efficacy of continuous airway positive pressure ventilation with a nasal mask mainly depends on the appropriateness of the effective positive pressure level. Conventionally, this level is determined from polysomnographic recordings using progressively increasing pressure levels to determine the point where episodes of apnea, hypopnea and snoring regress in all sleep phases and in all body positions. Since the first description of this method, many other titration methods have been proposed. Some use sophisticated signals such as the analysis of respiratory exertion level or limitation of inspiratory flow to provide a more precise titration which is particularly useful in cases where the classical titration method is insufficiently effective. Inversely, simplified methods have been examined from an economic point of view. These methods do not require the presence of a technician in a specialized laboratory where the waiting list for diagnostic tests is often long. Recordings during naps or short nights have been proposed for the more severe cases. Likewise titrations during simple polygraphy recordings or with an autoCPAP device have been shown to be effective in one-night laboratory recordings. Much work remains to be done to determine the effectiveness of these methods when used in the patient's home as well the long-term effects.

Humans↗
PubMed2000

[Titration of the level of effective positive pressure in the treatment of obstructive sleep apnea syndromes with continuous positive pressure].

The efficacy of continuous airway positive pressure ventilation with a nasal mask mainly depends on the appropriateness of the effective positive pressure level. Conventionally, this level is determined from polysomnographic recordings using progressively increasing pressure levels to determine, the point where episodes of apnea, hypopnea and snoring regress in all sleep phases and in all body positions. Since the first description of this method, many other titration methods have been proposed. Some use sophisticated signals such as the analysis of respiratory exertion level or limitation of inspiratory flow to provide a more precise titration which is particularly useful in cases where the classical titration method is insufficiently effective. Inversely, simplified methods have been examined from an economic point of view. These methods do not require the presence of a technician in a specialized laboratory where the waiting list for diagnostic tests is often long. Recordings during naps or short nights have been proposed for the more severe cases. Likewise titrations during simple polygraphy recordings or with an autoCPAP device have been shown to be effective in one-night laboratory recordings. Much work remains to be done to determine the effectiveness of these methods when used in the patient's home as well the long-term effects.

Home Care Services↗
PubMed1999

[Thyroid manifestations of sarcoidosis: a case report].

Sarcoidosis is a systemic disease with many localizations. Thyroid involvement has been often described but rarely confirmed histologically. A common immune mechanism appears to be the cause. Thyroid sarcoidosis should be envisaged in patients with a thyroid nodule and mediastino-pulmonary involvement. We report the case of a 63-year-old woman with no past history who was hospitalized for dyspnea. Explorations evidenced a cold thyroid nodule associated with diffuse interstitial lung disease and mediastinal node enlargement. Pathology examination disclosed the sarcoid nature of the thyroid nodule and the lung lesions.

Biopsy↗
PubMed1998

[Distinctive features of tuberculosis in the aged].

INTRODUCTION: Current recrudescence of human tuberculosis is ascribed to HIV. Nevertheless, other at-risk individuals, particularly the elderly, have been reported. METHODS: A retrospective study aimed at defining distinctive features of tuberculosis in the elderly was conducted. Eighty-two records of patients aged 18 to 64 years were compared to those of 58 patients of 65 years of age and over. RESULTS: In the French area considered in this study, the elderly represent the most at-risk group. Institutionalization is a significant risk factor for tuberculosis (RR = 4). Despite a past history of tuberculosis and public awareness campaigns, first-intent diagnosis was evoked in only 22% of the older patients. The mean number of infectious localizations was higher in the elderly (1.3/patient) than in younger patients (1.1/patient). Results of tuberculin skin tests are unreliable. Prognosis is poor in the elderly. In the present study, 14 of the 18 encountered deaths occurred in the elderly, of which eight were due to tuberculosis. CONCLUSION: To decrease the current incidence of tuberculosis, evaluations of preventive measures in the elderly should be validated and implemented, especially in institutionalized patients.

Adult↗
PubMed1998

Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome.

We evaluated the efficiency of two different treatment procedures with continuous positive airway pressure (CPAP) on sleep, nocturnal breathing characteristics and daytime vigilance in 18 newly diagnosed patients with untreated sleep apnoea/hypopnoea syndrome (SAHS) randomly allocated to two different groups. In group I, the positive pressure (PP) level was set to suppress flow limitation (PFL), while in group II the PP was set at a level that eliminated only apnoea/hypopnoea and snoring (PAHS). At the end of a 3 week period of home CPAP therapy, a follow-up sleep study, vigilance and cognitive tests were made. Overall, PFL was significantly higher than PAHS values (PFL: 10.42.6 cmH2O; PAHS: 8.9+/-2.6 cmH2O; p<0.01, mean+/-SD). We found no difference in sleep quality, nocturnal saturation and apnoea/hypopnoea index, or in daytime vigilance tests between the two groups at the end of the treatment period. However, there was a significantly greater scattering in the changes of sleep latency in group II than in group I. This was associated with a significant difference in the daily duration of nasal CPAP use between the two groups (group I: 7.29+/-0.95 h x day(-1); group II: 6.01+/-0.94 h x day(-1); p=0.01) and with a positive correlation between final maintenance of wakefulness test values and the duration of CPAP use (p<0.05; r=0.55). These results tend to show that correcting flow limitation is associated with a higher observance and a more important efficiency in normalizing daytime vigilance than with conventional nasal continuous positive airway pressure.

Aged↗
PubMed1998

Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome.

ResMed Autoset (AS) is a simplified diagnosis system for obstructive sleep apnoea/hypopnoea syndrome (OSAS) based on the respiratory flow/time relationship by pressure variation measured through simple nasal prongs. A multicentre prospective trial was used to compare AS and polysomnography (PSG) for diagnosing 95 patients, with suspected OSAS. Physicians gave a pretest probability of the patient having OSAS. The apnoea/hypopnoea index (AHI) was compared between the two methods of diagnosis for the whole population and for subgroups according to the pretest probability. Twenty-four patients had AHI < 15 events x h(-1) on PSG and 19 AHI 15-30, and 52 patients had AHI > or = 30. Correlation between AHI assessed by AS and PSG was r=0.87 for total sleep time (TST), p<0.0001. A Bland and Altman plot gave an agreement between the two methods of +/-40%. For a threshold of AHI > or = 15 events x h(-1) to diagnose OSAS, AS has a sensitivity of 92%, specificity of 79%, positive predictive value of 93% and negative predictive value of 76%. With a pretest probability > or = 80%, sensitivity and positive predictive value were 98 and 100% respectively. Of six false negative, four had a high pretest probability (> 80%) or Epworth score > or = 10. Using these parameters as a criterion for proceeding to PSG after a negative AS study would mean that two apnoeic patients (AHI 20 and 17 events x h(-1) by PSG) would escape detection. The Autoset is useful for the detection of obstructive sleep apnoea but with high pretest probability and a negative Autoset result polysomnography should be performed.

Adult↗
PubMed1998

Acute Q fever pneumonia: a review of 80 hospitalized patients.

STUDY OBJECTIVES: To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and to enhance therapeutic efficacy. PATIENTS: Eighty hospitalized patients from 1982 to 1996. DESIGN: The diagnosis of Q fever infection was serologically confirmed in all the patients (phase II Coxiella burnetii antibody) using the complement fixation test and/or the indirect immunofluorescence antibody test. RESULTS: Patients from rural and urban areas were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% of the patients. Mean age+/-SD was 49+/-20 years, and there was a higher sex ratio of male to female patients (1:3.44). We found a specific seasonal distribution since 80% of the cases occurred between February and May. Delay before referring to hospital was 8.2+/-7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin. The dominant clinical features were dry cough and high fever, as the maximal temperature reached more then 40 degrees C in 58% of the patients. Digestive symptoms were rare. WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentation rate was usually elevated (55+/-34 mm). Altered liver function consisted more frequently in an elevated level of alkaline phosphatase (70% of the cases) than transaminases, while hyponatremia was frequently mentioned (28.2% of the patients). We found radiologic evidence of unique lobar or segmental alveolar opacity involving more likely the lower lobes in 55 patients, and multiple or interstitial opacities in the others. Chest radiographs were considered normal in eight patients. The clinical response was favorable in all the patients with a reduction in fever 4.8+/-3.9 days after the start of treatment with the second antibiotic that included mainly erythromycin or quinolones, and chest radiographs returned to normal in 81% of the patients within the first month.

Acute Disease↗
PubMed1998

[Desquamative interstitial pneumopathy: a rare form of diffuse interstitial pneumopathy].

Desquamative interstitial pneumonia (PID) is a rare disorder initially described by Liebow in 1965. It is characterised by the presence of an interstitial pneumonia consisting of minimal lesions of interstitial fibrosis and by the accumulation of a rich intraalveolar cellular material principally composed of macrophages. Numerous aetiologies have been found particularly that due to long term Nitrofurantoin. We report the observation of a 57 year old patient, a cigarette smoker, in whom the diagnosis of PID was made after histological examination of a lung biopsy. Based on this observation the pathogenesis and possible different aetiologies of PID are discussed.

Anti-Infective Agents, Urinary↗
PubMed1997

Long-term evolution of daytime somnolence in patients with sleep apnea/hypopnea syndrome treated by continuous positive airway pressure.

We demonstrated in a previous study that excessive daytime sleepiness (EDS) in patients who have sleep apnea/hypopnea syndrome (SAHS) and are undergoing continuous positive airway pressure (CPAP) treatment improved differently in two groups of patients: in group I, multiple sleep latency tests (MSLT) were normalized after 50 days of treatment (individual value > 10 minutes), whereas they remained low (individual value < 10 minutes) in group II, with a significant difference between groups. To evaluate the long-term evolution of daytime somnolence under nasal CPAP treatment, five patients from group I and seven patients from group II underwent a new polysomnography and MSLT 4 years after the previous study. Clinical, polysomnographic and MSLT results obtained at baseline before treatment (T1), after the initial 50-day period of CPAP treatment (T2), and after 4 years (T3) were compared. The significant difference in mean MSLT value between the two groups previously observed at T1 and T2 disappeared at T3 (group I: 12.4+/-5.9 minutes; group II: 9.7+/-5.9 minutes). We found that this long-term improvement in excessive daytime somnolence was independent of the initial MSLT value, the severity of SAHS, and the initial MSLT changes under nasal CPAP. Long-term MSLT evolution was significantly correlated to CPAP compliance. These results demonstrate that even in the absence of a significant increase in MSLT at the beginning of CPAP treatment, further improvement is still possible several years later, which may encourage the regular, long-term use of nasal CPAP by patients.

Aged↗
PubMed1996

Effects of naloxone on upper airway collapsibility in normal sleeping subjects.

BACKGROUND: To evaluate the possible influence of endorphin release on upper airway collapsibility the effects of naloxone, an opiate receptor antagonist, were measured. METHODS: The effects of naloxone on upper airway collapsibility were studied in five normal sleeping men in a pilot study. During a sleep fragmentation night the subjects received either naloxone or a volume matched saline placebo in a double blind crossover design. Critical pressure (Pcrit) was measured during a morning nap following sleep fragmentation. RESULTS: The plasma levels of endorphins increased during sleep fragmentation nights. Pcrit was significantly greater after placebo than after naloxone infusion. CONCLUSIONS: Naloxone may reduce upper airway collapsibility in normal sleeping subjects following sleep fragmentation.

Adult↗
PubMed1996

Effects of mouth opening on upper airway collapsibility in normal sleeping subjects.

We investigated the influence of mouth opening on upper airway (UA) collapsibility in six healthy sleeping volunteers. UA collapsibility was measured during continuous negative airway pressure trials that consisted of the progressive decrease in pressure in a nasal mask, with simultaneous recording of esophageal pressure and instantaneous flow. Measurements were made under two experimental conditions: mouth closed (MC), and mouth open (MO). Cephalometric measurements were obtained with subjects awake in the same position for both experimental conditions. UA critical pressure (Pcrit) was derived from the relationship between the breath-by-breath values of the maximal inspiratory airflow and the corresponding mask pressure. Pcrit was significantly less negative during MO than during MC (MO, -12.7 +/- 4.8 cm H2O; MC, -16.4 +/- 6 cm H2O, mean +/- SD; p = 0.03). Mouth opening was associated with a significant increase in the total respiratory resistance (MO, 3.8 +/- 1.6 cm H2O/ml/s; MC, 3.0 +/- 1.6 cm H2O/ml/s-1, p = 0.03). Besides an increase in the distance between the teeth and a reduction in the distance between the hyoid bone and the mandible, no significant changes in cephalometric parameters were found between MO and MC. We conclude that mouth opening increases UA collapsibility during sleep and that mouth opening may contribute to the occurrence of sleep-related breathing abnormalities.

Adult↗
PubMed1996

Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome.

The auto-CPAP (Morphée Plus) is characterized by its ability to modify the positive-pressure level applied during the night for the presence or absence of sleep-induced respiratory disorders. The aim of the study was to compare the efficacy of this new mode of CPAP therapy with that of conventional constant-CPAP in the treatment of sleep apnea/hypopnea syndrome (SAHS). Sixteen patients with SAHS were randomly allocated to two groups that were paired for age, apnea/hypopnea index, and mean sleep latency. In the auto-CPAP group, the pressure level could change within fixed limits in both directions (+2 to -4 cm H2O) of the previously determined effective pressure level (Peff). In the constant-CPAP group, patients used the same apparatus (Morphée Plus) in a constant mode at Peff level. At the beginning of the study, the Peff level was determined during a polysomnographic recording. Day-time vigilance was measured subjectively by a standardized questionnaire and objectively by the maintenance of wakefulness test (MWT); Trailmaking tests (TMT) were used to evaluate cognitive functions. After 3 wk of home CPAP therapy, a control sleep study was done with the CPAP machine used in the protocol, and daytime vigilance and cognitive function tests were obtained. Baseline sleep and nocturnal breathing disorders characteristics did not differ between the two groups, and daytime vigilance and cognitive function abnormalities were similarily altered. In both groups, the apnea/hypopnea index was within normal range at the final CPAP sleep study. In the auto-CPAP group, 49.3 +/- 14.9% (mean +/- SD) of home treatment time was spent at a pressure < or = Peff. Home amount of use estimated by the number of sleeping hours with a positive pressure applied was 6.5 +/- 1.0 h in the auto-CPAP group and 5.1 +/- 1.1 h in the constant-CPAP group (p = 0.02). During the control CPAP sleep study, the positive pressure level was significantly lower during Stage III-IV than during the other sleep stages (p = 0.004). The improvement in the MWT and the TMT observed with CPAP therapy was identical in both groups. We conclude that (1) the amount of use during CPAP treatment is higher with auto-CPAP than with constant-CPAP, and (2) Morphée+auto-CPAP is an efficient as conventional CPAP in correcting nocturnal breathing disorders, daytime sleepiness, and cognitive impairment in SAHS.

Arousal↗
PubMed1995

Habitual snoring as a risk factor for brain infarction.

The association of habitual snoring with cerebral ischaemia was studied, in a case control-study, in 133 patients aged 45-75 years (103 men and 30 women) and 133 controls matched for sex and age. Ischaemic stroke was confirmed by brain computed tomography or magnetic resonance imaging. History of risk factors, especially of snoring and sleeping habits was recorded with structured questionnaire during interview. Prevalence of habitual snoring significantly differs between patients with stroke and controls: 31/133 (23.3%) vs 11/133 (8.3%) (Odds ratio 3.4, 95% confidence interval 1.5 to 7.6, p < 0.001). Even after adjusting for matching variables and confounding risk factors (arterial hypertension, cardiac arrhythmia, and obesity), habitual snoring carries a significant risk factor for stroke (odds ratio: 2.9, 95% confidence interval 1.3 to 6.8 (p = 0.01)). The risk of ischaemic stroke was higher among older male patients with arterial hypertension who always snored. Habitual snoring was not significantly linked with sleep-related stroke nor with the pathophysiology of strokes. Inquiring about habitual snoring should become a routine practice, especially among older male patients with arterial hypertension, and specific preventive measures should be instituted at an earlier stage.

Adult↗