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Biomedical subjects

J F Viel

Publications and source records attributed to J F Viel.

At least 55 records · Page 3Linked to original sources
PubMed1996

Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and outcome.

During the first hours after acute ischemic stroke, the CT usually shows no abnormalities. Therapeutic trials of ischemia in the middle cerebral artery (MCA) territory involves decision-making when the CT may not show obvious ischemic changes. We reviewed 100 consecutive patients, admitted within 14 hours after a first stroke. Selective criteria were clinical presentation with MCA ischemia and at least two CTs (1 initial and 1 control). All CTs were retrospectively analyzed by at least two physicians blinded to the patient's status. On the first CT, early signs were hyperdense MCA sign (HMCAS), early parenchymatous signs (attenuation of the lentiform nucleus [ALN], loss of the insular ribbon [LIR], and hemispheric sulcus effacement [HSE]), midline shift, and early infarction. Subsequent infarct locations were classified according to total, partial superficial (superior or inferior), deep, or multiple MCA territories. Clinical features, etiology, and Rankin scale were collected. There were 52 women (mean age 70.8). The CTs were performed at mean 6.4 hours (1 to 14 hours) and before the sixth hour in 62% of the patients. Early CT was abnormal in 94% of the cases, and the abnormalities found were an HMCAS in 22 patients, ALN in 48, LIR in 59, HSE in 69, midline shift in 5, and early infarct in 7. CT was normal in six patients where it was performed earliest (mean 4.5 hours) and in the oldest patients (mean age 80.1). Early parenchymatous CT signs were significantly associated with subsequent MCA infarct location and extension: ALN and deep infarct, HSE and superficial infarct, LIR and large infarct. HMCAS was never found in isolation and was always associated with the three other signs in extended MCA infarct. The presence of two or three signs (ALN, LIR, or HSE) was associated with extended MCA infarct (p < 0.001) and poor outcome (p < 0.001). Our findings suggest that CT frequently discloses parenchymal abnormalities during the first hours of ischemic stroke. Early signs allow the prediction of subsequent infarct locations; CT may provide a simple tool in evaluating the early prognosis of MCA infarction and thus may be useful in selecting better treatments.

Adult↗
PubMed1996

Variation factors of pregnancy rates after oestrus synchronization treatment in French Charolais beef cows.

An epidemiological study was conducted in Bourgogne (France) in Charolais herds sampled in 1990 (sample 1:54 herds) and from 1991 to 1993 (sample 2:33 herds). The aim was primarily to quantify, at both herd and individual levels, the factors that result in variations in the response to synchronization treatment as estimated by pregnancy rate after first insemination. The second goal was to test a similar model in sample 2, which included only primiparous cows. In sample 1,329 cows of the 627 studied (52%) became pregnant compared with 122 primiparous cows of the 249 studied (49%) in sample 2. Pregnancy rates after treatment per herd ranged from 0-100% across the herds. Mixed logistic regression was used to calculate the odds ratio (OR) and to take into account both individual and herd level variables for each sample. In the first sample, multiparous cows were more likely to become pregnant after synchronization treatment than primiparous cows (OR = 2.4, P < 0.001). The following individual variables also influenced the response to synchronization: body weight at implant insertion (OR = 1.006, P = 0.017) and calving difficulty (OR = 0.33, P = 0.008). In the second sample, results varied with the year of data collection (OR = 3.46, P = 0.016) and with two herd-level variables: presence of a bull (OR = 0.48, P = 0.047) and type of housing (OR = 2.5, P = 0.004). In conclusion, the results after synchronization depended on both herd-level and individual variables and it was necessary to take into account two levels of factors to reduce variability after treatment.

Animals↗
PubMed1995

Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii.

A six-month prospective survey was carried out in a university hospital to assess the incidence of Acinetobacter baumannii cross-contamination and to identify risk factors for colonization. Clinical isolates obtained during the study period were biotyped and genotyped by pulsed-field gel electrophoresis after ApaI macrorestriction of total DNA. Case-control univariate and multivariate analyses were performed to identify risk factors for Acinetobacter baumannii colonization. One hundred forty-seven patients hospitalized in 36 units were colonized or infected, of whom 52 were in three intensive care units. The urinary (29%) and bronchopulmonary tracts (26%) were the most frequently colonized sites. Nine major restriction patterns were identified: two were exhibited by epidemic multi-resistant strains of biotype 9 which were isolated from 65 patients hospitalized in ten units. Multivariate analysis showed that case-patients were (a) more likely than non-infected controls to be male, to have been previously hospitalized in another unit and to have had longer stays in the unit before colonization and hyperalimentation; and (b) more likely than controls colonized with other gram-negative bacilli to be male, to have had longer hospitalization, to have received treatment with third-generation cephalosporins and to have had a urinary catheter. The high incidence of colonization with Acinetobacter baumannii can thus be attributed to frequent cross-contamination and the use of broad-spectrum antibiotics. Colonized patients appear to be the major source of cross-contamination as epidemic strains spread throughout the hospital.

Acinetobacter Infections↗
PubMed1995

Multivariate approach to differential diagnosis of acute meningitis.

A previously reported statistical model based on a combination of four parameters (total polymorphonuclear cell count in cerebrospinal fluid (CSF), CSF/blood glucose ratio, age and month of onset) appeared effective in differentiating acute viral meningitis (AVM) from acute bacterial meningitis (ABM). The objectives of this study were to validate this model on a large independent sample of patients with acute meningitis and to build and validate a new model based on this sample. Of 500 consecutive cases of community-acquired meningitis reviewed retrospectively, 115 were ABM, 283 were AVM and 102 were of uncertain etiology. For each of the ABM and AVM cases, the probability of ABM versus AVM (pABM) was calculated for both models. Sensitivity, specificity and predictive values as well as areas under the receiver operating characteristic (ROC) curves were calculated for both models. The original model proved an accurate and reliable diagnostic test. Its area under the ROC curve was 0.981. For pABM = 0.1, its negative and positive predictive values were 0.99 and 0.68, respectively. The new model retained four slightly different independent variables: CSF protein level, total CSF polymorphonuclear cell count, blood glucose level and leukocyte count. Its area under the ROC curve was 0.991 and, for pABM = 0.1, its negative and positive predictive values were 0.99 and 0.85, respectively. In conclusion, both models provide a valuable aid in differentiating AVM from ABM. They should be further evaluated in a prospective appraisal of their contribution to therapeutic decision making.

Acute Disease↗
PubMed1995

Bladder cancer among French farmers: does exposure to pesticides in vineyards play a part?

OBJECTIVE: To appraise the potential contribution of pesticides sprayed on vineyards to the genesis of bladder cancer among agricultural workers. METHODS: A pesticide exposure index (PEI), based on labour time and the proportion of agricultural land used as vineyards, was constructed for 89 French geographical units (départements). The standardised mortality ratios (SMRs) for bladder cancer, as well as tobacco consumption and economic status of male farmers and farm labourers aged 35-74 in the same areas were estimated for the period 1984-6. Models were fitted to the geographical data with Poisson regressions and extra-Poisson models with geographically structured and unstructured random effects. RESULTS: Mortality from bladder cancer among farmers was lower (but not significantly so) than within the overall population (SMR 0.96, 95% confidence interval (95% CI) 0.85-1.08), but there was a significant link with exposure to pesticides in vineyards by univariate analysis (relative risk (RR) 1.17, 95% CI 1.10-1.24) and by multivariate analysis (RR 1.14, 95% CI 1.07-1.22). CONCLUSION: These results add some evidence to the view that pesticides in vineyards cause mortality from bladder cancer among farmers, and could explain the French south-north gradient in bladder cancer, as vineyards are mainly located in Southern France.

Adult↗
PubMed1995

Hepatitis B virus infection on a tropical island: sociodemographic and geographic risk factors in Guadeloupe.

A seroepidemiologic study on a cross-sectional sample of blood donors was carried out in Guadeloupe, a French West Indies island, to estimate the prevalence of hepatitis B virus (HBV) markers, and to investigate the influence of age, socioeconomic, and geographic factors on prior HBV infection. Blood specimens and sociodemographic data were collected in 1989 from 2,339 blood donors residing on the island. A total of 73 (3.1%) of 2,339 were found to be HBV surface antigen carriers, and 518 (22.1%) were positive for antibody to HBV core antigen. Among them, 61 were positive for both markers and consequently 530 persons (22.7%) were considered to have evidence of prior HBV infection. Multivariate logistic regression analyses identified age and low socioprofessional status as being related to HBV infection, as in many endemic areas. In addition, some major geographic risk factors were highlighted, reflecting a strongly hyperendemic situation in specific areas and the potential influence of horizontal transmission or unknown environmental factors on these particular populations.

Adolescent↗
PubMed1995

Aortic valve replacement in the elderly: a comparative assay of potential risk factor modification.

From January 1989 to October 1992, 208 consecutive patients underwent isolated aortic valve replacement for calcified aortic stenosis in our department. Since the mean age of this patient population was 70 +/- 9 years, a retrospective clinical study was completed to assess the potential influence of advanced age on the independent predictors of early and late mortality. Hospital mortality was 6.2% (13 patients). Total follow up was 422.5 patient-years with a mean of 26 months. Nineteen patients died during the follow up period, equivalent to 4.5% per patient-year late mortality rate. Survival including hospital death was 88 +/- 2%, 86 +/- 2% and 79 +/- 4% at one, two and three years respectively. Eighteen variables as potential predictors of early and late mortality were studied. Predictors of hospital mortality were determined by logistic regression analysis, and those of late mortality by Cox proportional hazard model. Results were expressed as odds ratio (OR) or relative risk (RR). Age greater than 70 years (OR = 9.8, 95% CI = 1.2 to 80) and emergency surgery (OR = 8, 95% CI = 2.1 to 31) appeared as independent predictors of hospital mortality in multivariate analysis. Age above 75 years (RR = 3, 95% CI = 1.1 to 8.3), preoperative acute pulmonary edema (RR = 2.9, 95% CI = 1.1 to 7.7) and emergency surgery (RR = 4.2, 95% CI = 1.2 to 15) were independently associated with decreased late survival. Advanced functional class (NYHA III-IV) was shown to be an independent predictor of early or late mortality only in univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

The B7 cross reactive group and spondyloarthropathies: an epidemiological approach.

OBJECTIVE: To study the association between the B7 cross reactive group (B7, B40) and spondyloarthropathy (SpA), taking into account patients with atypical features. METHODS: We studied the main clinical and paraclinical features of 51 patients with rheumatoid arthritis, 55 with SpA, 120 with mechanical diseases, and 160 with inflammatory rheumatism not fulfilling the diagnostic criteria currently used. This descriptive analysis was performed using multiple correspondence factorial analysis to identify subgroups among unclassified patients and select SpA variants. We compared HLA frequencies among these groups versus a control group. RESULTS: We identified a subgroup close to the axial SpA and related to B7 (OR:5.91, p = 0.0008), whereas B40 is related to patients close to the peripheral SpA. CONCLUSION: B7 is related to axial SpA variants manifested by inflammatory low back pain according to Calin's criteria, with either extraarticular signs or sacroiliitis. Followup of such patients is required to determine whether their disease is a new entity or can be considered SpA.

Adult↗
PubMed1994

[Leukocyte expression of the LFA-1 adhesion molecule in spondylarthropathies].

The expression of adhesion molecule Leukocyte Function Antigen-1 (LFA-1) on peripheral blood leukocytes was evaluated (using a monoclonal antibody anti CD11a/LFA-1) in 52 spondylarthropathies (SA) (35 HLA B27 positive), 12 healthy patients, 24 active rheumatoid arthritis (RA) and 12 systemic lupus (SLE) patients. LFA-1 expression on lymphocytes was similar in the different groups of patients, but LFA-1 expression on granulocytes was higher in SA than in controls (p < 0.05) or in RA or SLE. Fluorescence intensity of anti LFA-1 staining on SA granulocytes correlated with serum IgA levels. There was no difference between HLA B27 positive/negative, biologically inflammatory (CRP > 21 mg/l)/non inflammatory SA patients. This study seems to confirm the granulocyte and IgA involvement in immunopathogenesis of spondylarthropathies.

Adolescent↗
PubMed1994

[The framework Prospective Payment Information Systems: bias, sources of errors and consequences].

This paper reviews: 1) the biases linked to the definition method of the Diagnosis Related Groups (DRG), and the biases due to the implicit hospital model of the French programme medicalizing hospital information system (PMSI) which limit its use in hospital management; 2) the sources of errors met in use in the different kinds of data networks when collecting administrative data from medical discharge abstracts, which can induce mistakes in patient hospitalization counts and in the representation of medical units contribution to patients care; 3) the sources of errors in collecting medical informations from medical discharge abstracts can make the patient hospitalizations classified in DRG unrepresentative or uninterpretable; 4) the problems linked to the interpretation of the indicators estimated from the DRGs in hospital management and financial allocation.

Bias↗
PubMed1994

[Poisson regression in epidemiology].

The goals of Poisson regression are to estimate the effects of risk factors on incidence or mortality rates and to evaluate the dose-response relationship for variables representing quantitative levels of exposure. This statistical model presents, over standardization techniques, several advantages which are recalled here. The Poisson assumption, approximating the exact sampling distribution of rates is discussed. The model equation with internal and external standard rates is introduced, as well as summary measures of fit. Two examples are given: one from a cohort study, the other one from a geographical study, to help in the interpretation of Poisson regression results. Lastly, recent and on-going developments of these models are briefly considered.

Adult↗
PubMed1993

Childhood leukemia incidence in the vicinity of La Hague nuclear-waste reprocessing facility (France).

The incidence of leukemia is examined in young people (aged under 25 years) living within a 35 km radius of the French nuclear-waste reprocessing plant operating in La Hague, Normandy. During the period 1978-90, a total of 23 cases was diagnosed, giving an incidence rate of 2.99 per 100,000 which is close to the expected rate. In the 'canton' in which the nuclear plant is located, three cases of leukemia were observed compared with 1.2 expected, giving a standardized incidence ratio of 2.5. This nonsignificant finding is compatible with no increased risk and also with a sevenfold excess risk. Therefore, it reinforces the necessity of conducting a case-control survey, which is now planned, to assess the part played by occupational radiation exposure in leukemia incidence for this French area.

Acute Disease↗
PubMed1993

Event-related potentials in Parkinson's disease: a 12-month follow-up study.

Auditory event-related potentials were recorded using the oddball paradigm in 26 patients with Parkinson's disease, all treated with L-Dopa. The latency of the P3 wave was significantly greater than in an age-matched controls, and was also correlated with the disease duration, but not with scores on two scales measuring cognitive deficit. One year later, when treatment with a dopaminergic agonist, bromocriptine 20-30 mg/day, had been added to the therapeutic regimen, N2 and P3 latencies had increased, whereas several clinical parameters had improved. Thus a longer P3 latency does not seem to be linked to a global cognitive deficit. The use of neuropsychological tests exploring more limited tasks should show the prospective utility of event-related potentials in Parkinson's disease.

Adult↗
PubMed1993

Lymphoma, multiple myeloma and leukaemia among French farmers in relation to pesticide exposure.

Lymphoma, multiple myeloma and leukaemia mortality among French male farmers and farm laborers (1984-1986) has been studied geographically. In each geographical area (89 "départements") exposure to pesticides in arable land has been characterized by an index taking into account different practices in the treatment of various crops as well as an estimate of the time per farmer spent cultivating each crop in 1970. The farmers population as a whole presented an increased mortality for multiple myeloma (SMR = 1.59, 95% CI = 1.32-1.89) and leukaemia (SMR = 1.33, 95% CI = 1.19-1.49) but not for lymphoma (SMR = 1.09, 95%, CI = 0.94-1.26). Using Poisson regression, leukaemia mortality appeared significantly linked to the pesticide exposure index (P = 0.04), after adjustment of farmers' economic status and a linear geographical gradient, whereas no significant relationship was found for lymphoma or multiple myeloma. This result reinforces a similar link reported from a previous French geographical study conducted at a smaller scale within a region.

Adult↗
PubMed1993

Radon exposure and leukaemia in adulthood.

Positive associations between leukaemia and radon concentrations have been observed in England, Scotland and Wales, and Canada. Results of a similar study for the populations of 41 French administrative areas ('départements') are reported for 1984-1986. The average indoor radon and gamma ray concentrations per 'département' range from 12 to 147 Bq.m-3 and from 28 to 142 nG.h-1, respectively. Acute lymphoid leukaemia mortality rate is similar to the national level, whereas an excess of acute myeloid leukaemia deaths is observed. According to Poisson regression models and modified tests for partial correlation, acute myeloid leukaemia mortality is significantly and positively related to indoor radon concentration whether or not adjustment is made for indoor gamma ray dose, socioeconomic status and linear gradient. This result reinforces the evidence that indoor exposure to high levels of radon is a leukaemic environmental hazard.

Acute Disease↗
PubMed1993

Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors.

OBJECTIVES: The mortality due to pneumococcal meningitis remains high, ranging from 15 to 60%. The purpose of this study was to analyze the prognosis of pneumococcal meningitis using a multivariate approach. The objectives were to select the most accurate initial mortality risk factors in pneumococcal meningitis and to determine an individual probability of death according to these prognostic factors. METHODS: The records of 105 consecutive cases of proven pneumococcal meningitis were retrospectively reviewed. The following parameters, recorded at presentation were considered for prognostic analysis: age, sex, duration of symptoms and antimicrobial chemotherapy before admission, underlying debilitating conditions, occurrence of seizures, pneumococcal bacteraemia or pneumonia, Glasgow coma scale score, Simplified Acute Physiological Score (SAPS), Cerebral Spinal Fluid (CSF) leucocyte count, CSF protein level, CSF glucose level and CSF/blood glucose ratio. Those parameters having a prognostic value after univariate logistic regression analysis were then entered into a multivariate stepwise logistic regression model. RESULTS: In multivariate analysis, a fatal outcome was best predicted by 4 variables. In descending order, these were the Glasgow coma scale score, age, CSF glucose level and concomitant pneumonia. The risk of dying was ten times higher in patients with Glasgow coma scale score < 7, seven times higher in patients older than 45 or having a CSF glucose level lower than 0.6 mmol/L and 4 times higher in patients with pneumonia. The logistic model provided an equation for the probability of dying that proved to have predictive values greater than 80% in determining the individual prognostic of pneumococcal meningitis. CONCLUSIONS: Our results are in agreement with most of previously published findings. We further demonstrated that the individual prognosis of pneumococcal meningitis could be accurately predicted with only 4 variables and highlighted the preeminent prognostic value of Glasgow coma scale score.

Adolescent↗
PubMed1993

A unique seroepidemiologic situation for hepatitis B markers in Guadeloupe. Results of a prospective study in blood donors.

Screening for HBsAg, anti-HBc, anti-HCV and ALAT levels is now performed on donated blood to prevent post-transfusion hepatitis. A prospective study of 2,368 blood donors was performed in Guadeloupe (French West Indies) to determine risk factors associated with serologic abnormalities: 571 donations (24%) were positive for at least 1 of the 4 analyzed markers with 3.2% positive for HBsAg, 22% for anti-HBc, 0.8% for anti-HCV and 1.4% with ALAT > or = 45 IU/L. The anti-HCV prevalence was significantly different according to ALAT levels (P < 10(-4)). Transfusion history and work status (worker or serviceman) were found to be risk factors, with an odds ratio of 1.94 for serviceman population. Other unexpected risk factors were: number of years residency in Guadeloupe (progressively increased risk with the number of years), birthplace and residence in southern part of the island as well as the existence of gastrointestinal discomfort unrelated to viral hepatitis (odds ratio = 2.91). The results of this study show a unique epidemiologic situation for hepatitis B virus in Guadeloupe necessitating careful selection of blood donors.

Adult↗