Biomedical subjects
Publications and source records attributed to J Sternon.
The author answers to six questions relating to the cerebral transitory ischémic attacks, namely definition, significance, frequency, diagnosis, causes and prevention. Within this context, the actualization of antiagregation, anticoagulation and endarterectomy is presented.
Presentation of three controversial drugs with unequal value and of new anticoagulation strategies. The renewal of interest in oral anticoagulants is striking; it is the consequence of the better measure of the hypocoagulability and a diminution of the risk of haemorrhage. Also as striking, is the extension of the preventive and curative indications of the low molecular weight heparins.
Updating of several main themes concerning the infectious endocarditis with the aim to denounce various old myths and to precise different actual concepts. The authors consider principally the echocardiographic revolution and the new diagnostic criteria, the bacteriologic pitfalls and the preventive strategies.
Firstly the authors remind the reader of the geriatric paradoxe consisting in an overprescription of drugs despite the fact that the side effects are more frequent and also the common inadequacy of the polymedications resulting from time to time in hospitalisations which otherwise would not have occurred. Secondly, the authors focus on 9 families of drugs potentially dangerous to the health and 5 interactions with deadly consequences. Finally, they underline the importance of some preliminary evaluation before any prescription and of various recommendations.
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The authors present the pharyngo-tonsillitis in four fields: clinical, bacteriology, serology and treatment. They insist on the danger of the beta-hemolytic Strep A, the failures of the ASLO detection and stress the execution of the rapid antigenic test at the office. They suggest the limitation of the administration of antibiotics and the prescription of a penicillin which is much better than macrolides or cephalosporins of second or third generation.
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Prevention and treatment of venous thrombosis and pulmonary embolism have improved dramatically in the last few years owing to: 1) better control of the coumarin activity with the International Normalized Ratio system; 2) appearance on the market of the low-weight molecular heparins and enlargement of their field of prescription; 3) indications of thrombolysis in severe pulmonary embolism; 4) availability of inferior vena cava filters, effective in preventing recurrent pulmonary embolism.
International consensus has been reached on the guidelines of prevention programmes of bacterial endocarditis in patients bearing a valvulopathy and submitted to various diagnostic or surgical procedures. They are presently characterised by: 1) targeting of indications: less procedures have to be covered by an appropriate antibiotic and owing to progresses made in ultrasonography, less patients with mitral valve prolapse have to be protected; 2) simplification of the administration of the antibiotics: priority is given to the oral route and two doses are sufficient, one before, and one after the procedure; 3) the dropping of penicillin V and the questioning of erythromycin: amoxicillin becomes the first-choice drug, more often administered orally than parenterally; in case of allergy to beta-lactams, clindamycin takes precedence over macrolides. Those new strategies for antibiotic prophylaxis should reveal themselves better followed, more performant and less expensive.
NSAID induced gastropathy is linked to the inhibition of endogenous synthesis of prostaglandins. Gastropathies are made of erythematous, erosive or ulcerative lesions. Their localization is mainly antral or prepyloric. Their incidence is quite large and very severe in the elderly patient treated for long time with NSAID. The author presents several strategies either to prevent (with administration of misoprostol) or to treat (with prescription of omeprazole) this iatrogenic gastropathy.
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The authors observed a case of asymptomatic toxocariasis in a lady aged 60, engaged in dog-breeding since twenty years. The various causes of hypereosinophilia are discussed. The epidemiology of Toxocariasis and the essential role of serologic tests--in particular ELISA detection of a larval antigen--are recalled. In this particular case, therapeutic abstention is justified.
Presentation of an observation of alarming thoracic pain, during a panic attack. Actualization of this psycho-somatic pathology concerning the epidemiologic, etiopathogenic and therapeutic aspects as well as its cardiovascular repercussion.
The authors evoke how the corticosteroids work (as antiinflammatory and immunosuppressive agents) and how to prescribe them, orally, intravenously, in association with an antimitotic drug. They insist on the suspended and non curative effects of corticotherapy, its side effects and the additive effect of the antimitotic drugs. They suggest different therapeutic programs against rheumatoid arthritis, Still's disease, lupus, dermatomyositis, Behçet's disease, Horton's disease and polymyalgia rheumatica.
A multicenter study was performed in 919 hypertensive patients, 780 of whom could be evaluated. Patients in group I (n = 482) were treated with Aldactazine alone (altizide + spironolactone, 2 tablets per day). The other 298 patients (group II) were treated with 1 or 2 tablets per day of Aldactazine plus a conventional antihypertensive agent, e.g., a beta blocker, alpha-methyldopa or clonidine. After 45 days of treatment with Aldactazine alone, mean systolic and diastolic blood pressure (BP) decreased by 15 and 14%, respectively, vs baseline values. The addition of the other antihypertensive agent decreased BP further; however, the best results were obtained with the combination of Aldactazine and clonidine. With this combination, systolic and diastolic BP decreased by 16.6 and 18%, respectively, vs baseline. In terms of adverse effects, a few cases of gastrointestinal disturbances and orthostatic hypotension were reported.
Sudden death before the age of 35 is often the consequence of a congenital heart disease. The principal congenital causes are hypertrophic cardiomyopathy and congenital abnormalities of the coronary arteries. The authors propose a programme for detecting those sportsmen who are at risk, giving indications and contra-indications about taking part in competitions. Finally they suggest strategies to prevent the occurrence of sudden death in our young sportsmen.
Irritable bowel syndrome represent the most common gastrointestinal disease. It is characterized by abdominal pain, distension and abnormalities of intestinal transit. It is a functional disorder determined by emotional stress and by diet. The treatment is polyvalent, dietary, medicinal and psychological. In the medicinal domain the anti-spasmodics (anti-nicotinic and musculotropic), represent the first choice weapons in association or not with an anxiolytic, an anti-depressor, even an antalgic in the acute phase.
New prophylactic strategies for arterial thrombosis are built up following new discoveries about the thrombo-resistance of the vascular endothelium. To cope with the complexity of the interactions between platelets, erythrocytes and endothelium, it is logical to propose a multivalent prophylaxis, potent enough to control the multiple thombogenic factors. In this prospect, the combination acetyl-salicylic acid with dipyridamole presents an obvious complementarity, until confirmation of the clinical activity of other combinations.