Search PubMed⌕ Search

Biomedical subjects

J Michel

Publications and source records attributed to J Michel.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Risk factors for post-operative wound infection in cardiac surgery patients.

In a prospective study of 372 patients undergoing cardiac surgery, we evaluated the relative contribution of host factors and patient care variables to the risk of post-operative wound infection. Host factors studied were age, sex, country of origin, the diagnosis for which the operation was performed and, for coronary artery by-pass operations, the functional cardiac status according to modified New York Heart Association criteria. The performance of more than one operation during a single admission carried the highest risk for infection, followed by a coronary artery by-pass operation lasting for more than six hours or performed on patients 65 years or older. In patients undergoing coronary artery by-pass surgery, host factors (age and cardiac function) were associated with infections in the chest wound, while the length of the operation was found to affect the occurrence of infections at the "donor" site.

Adolescent↗
PubMedDate not supplied

Effects of chronic heat exposure and protein intake on growth performance, nitrogen retention and muscle development in broiler chickens.

The respective effects of ambient temperature, dietary crude protein and feed intake were investigated in finishing chickens and the consequence of protein supplementation under high temperature conditions was analysed in particular. Heat-related reduction in growth was associated with decreased nitrogen retention (-30 or -35% according to the diet), which could not be explained by the observed lower feed intake alone. Tissue samples performed in 5- to 6-week-old chicks showed varying effects of heat according to the muscles studied: at 32 degrees C, the proportion of Pectoralis major muscle (in percentage of body weight) appeared slightly reduced (reduction lower than 10%), whereas the proportion of two leg muscles were increased (+10 to +15% for the Sartorius muscle; +5% for the gastrocnemius muscle). At 32 degrees C, providing a high protein diet significantly (P < 0.05) increased weight gain and feed efficiency, and slightly improved whole body protein deposition.

Animal Nutritional Physiological Phenomena↗
PubMedDate not supplied

Multivariate analysis of determinants of postoperative wound infection: a possible basis for intervention.

Multivariate analysis of variables hypothetically associated with the development of postoperative wound infection was attempted with use of large groups of patients undergoing certain surgical procedures over periods of 12-36 months. The data were obtained through prospective surveillance by specially trained nurse-epidemiologists. For patients who had colon surgery (n=261), the multivariate analysis showed that only four variables were independently associated with postoperative wound infection: more than one operation during a single episode of hospitalization (adjusted odds ratio, 7.3); Arab ethnicity (adjusted odds ratio, 6.1); prophylaxis according to the recommended protocol not given (adjusted odds ratio, 2.4); and opening of a colostomy as the specific operation (adjusted odds ratio, 2.3). Of all the variables analyzed, more than one operation during an admission was consistently associated with the highest risk of infection in patients who had cardiac and neurosurgery as well as colon surgery. On the other hand, a traditional risk factor, e.g., the presence of drains at the site of the operation, was not found to be independently associated with an increased risk of infection in any of the groups tested. This type of analysis is essential to facilitate the introduction of a more meaningful program for intervention based on proved rather than hypothetical risk factors

Analysis of Variance↗
PubMedDate not supplied

Antibiotic use on the surgical services of two Jerusalem hospitals, as determined by surveillance and influenced by an intervention program.

The use of antimicrobial drugs on the surgical services of two hospitals in Jerusalem, Israel, was surveyed prospectively. At one hospital (C), the use of these drugs was controlled: at the other (N), the use was not controlled. At both hospitals the cephalosporins accounted for approximately 21% of the antimicrobial drug-group courses (AMDGCs), however, they accounted for only 11% of the antimicrobial days (AMDs) at C but 22% at N. Prophylaxis after surgical procedures accounted for the initiation of 36% and 33% of the AMDGCs at C and N, respectively. The geometric mean of the duration of prophylactic courses of drug therapy was 3.2 days at C and 3.9 days at N (P less than 0.01). Excessively prolonged prophylaxis accounted for approximately 61% (388 AMDs) of prophylactic use at N and 55% (646 AMDs) at C. At C the proportion of patients receiving prophylaxis in high-risk surgical operations increased from 39% to 97% after the introduction of protocols for prophylaxis, but the average quantity of antimicrobial drugs administered per patient decreased by 38%.

Adolescent↗
PubMedDate not supplied

[Solitary congenital histiocytoma: two cases].

BACKGROUND: Solitary histiocytoma is an uncommon form of Hashimoto-Pritzker syndrome and an exceptional type of histiocytosis with cells of undetermined origin. A solitary often ulcerated congenital nodule is generally observed. We report two cases, one of each form. CASE REPORTS: Both cases presented an ulcerative budding congenital tumefaction of the plantar aspect of the right foot for the first child and the parieto-axillary region in the second. Histology disclosed a granulomatous infiltrate of histiocytes positive for specific immunolabels (protein S100 and CD1a). In the first case, electron microscopy revealed histiocytes devoid of Birbeck granules and myelinoid bodies leading to the diagnosis of Langerhans histiocytosis with cells of unknown origin. In the second case, 18 p. 100 of the cells contained Birbeck granules. There has been no recurrence after a 5-year follow-up in a case. DISCUSSION: These cases recall the congenital nature of some types of solitary histiocytomas. Indeed, congenital Langerhans histiocytoma can occur as a unique nodule. The tumefaction may lie in any localization. Histological diagnosis is required. The benign nature of these lesions is confirmed by the absence of distant lesions and the lack of recurrence after complete excision. About a dozen cases have been reported. Most have been Hashimoto-Pritzker syndromes. Only one case has been reported with cells of undetermined origin. The diagnosis of histiocytosis with cells of undetermined origin is made when the ultrastructure study demonstrates the vacuity of the histiocyte cytoplasm. This condition is similar to Hashimoto-Pritzker syndrome by the absence of recurrence and systemic diffusion. It can however be observed in adults. The undetermined cell types would correspond different phases of Langerhans cell maturation or involution.

Adult↗
PubMedDate not supplied

Oral versus intramuscular high-dose medroxyprogesterone acetate (HD-MPA) in advanced breast cancer. A randomized study of the Belgian Society of Medical Oncology.

Ninety postmenopausal women with advanced breast cancer were randomly assigned to be treated with HD-MPA administered either by oral route (daily dose 900 mg) or by intramuscular injections (1 g IM daily X 5 q w during 4 consecutive weeks followed by maintenance with 1 g twice weekly). Among 78 evaluable cases, most heavily pretreated, remissions, lasting for a median duration of 11 months, were more frequent on oral (8/37 = 22%) than on IM therapy (5/41 = 12%). In both arms, high estrogen receptor levels and various clinical factors were associated with higher response rates i.e., age greater than 60, Karnofsky greater than 70, light prior systemic treatment. Side-effects, consisting mainly of weight gain, hypertension and tremor occurred with equal frequency on oral or IM treatment. Five patients complained of pain at the sites of IM injections. Thus, we recommended that, whenever possible, the oral route should be preferred. During the same study, in 20 patients (11 on oral and 9 on IM therapy), blood was drawn at 0, 30, and 60 days of treatment for the assessment of MPA and hormone levels. In both arms, at 60 days, comparable levels of circulating MPA were obtained, with a very significant drop of cortisol, androstenedione, and estrone. These endocrine results, together with our clinical data, indicate that HD-MPA therapy is active on estrogen-dependent tumors with the same specificity as that of other modalities aiming to suppress the adrenal function. Its antineoplastic action in humans could be ascribed at least in part to its suppressive action on the adrenals, resulting in a severe estrogenic deprivation in postmenopausal women.

Administration, Oral↗
PubMedDate not supplied

[Bilateral adrenal pheochromocytoma associated with pregnancy. Simultaneous cesarean section and adrenalectomy].

An-25-year-old primigravida with bilateral phaeochromocytomas was managed from 6 weeks' gestation until 2 years following combined caesarean section and removal of adrenal tumours. Preoperative alpha-blockade was achieved by oral prazosin without deleterious effects. Intraoperative management comprised neuroleptanalgesia, arterial and pulmonary pressures monitoring, adequate heart loading with fluid replacement and sodium nitroprusside. Postoperatively mother and baby remained normotensive.

Adrenal Gland Neoplasms↗