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Biomedical subjects

P Bourgeois

Publications and source records attributed to P Bourgeois.

At least 37 records · Page 2Linked to original sources
PubMed2003

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial.

OBJECTIVE: To determine the efficacy of epidural corticosteroid injections for sciatica. METHODS: Three epidural injections (two day intervals) of 2 ml prednisolone acetate (50 mg) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15-180 days. Self evaluation was the main judgment criterion at day 20. Patients who recovered or showed marked improvement were considered as success. Pain measured by VAS, the SLR test, Schober's test, Dallas pain questionnaire, and the Roland-Morris index were evaluated at days 0, 5, 20, and 35. Only analgesics were authorised, patients requiring non-steroidal anti-inflammatory drugs (NSAIDs) before day 20 were considered as failure. RESULTS: 42 patients were included in the control group (CG), 43 in the steroid group (SG). On an intention to treat analysis 15/42 (36%) in the CG and 22/43 (51%) in the SG (p=0.15) were considered as success (difference 15.5%, 95% CI (-5.4 to 36.3)). Among the 48 failures, 14 patients (6 CG, 8 SG) required NSAIDs, 3 (2 CG, 1 SG) required surgery, and 7 (3 CG, 4 SG) other treatments. On analysis according to protocol, in 74 remaining patients 12/35 (34%) in the CG and 22/39 (56%) in the SG (p=0.057) were considered as success (difference 22.1%, 95% CI (0.0 to 44.2)). For all secondary end points intragroup improvement with time was significant, but intergroup differences were not. CONCLUSION: The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

Adult↗
PubMed2003

[Limb edema and lymphoscintigraphy].

Lymphoscintigraphic investigations represent techniques of nuclear medicine very contributive for the management and treatment of the limb edemas, either primary or secundary. Their principle is presented and methodologies proposed in the literature are reviewed. Their diagnostic contributions are detailed. The sensitivities and specificities of several protocols of investigation are reported. Some limitations of these examinations are analyzed and discussed. Clinical indications for their use are proposed and their interest with regard to the various treatments that can be applied to these limb edemas is discussed.

Adult↗
PubMed2003

[Lower limb edema and steatorrhea: value of scintigraphic technics].

The authors report the case of a young woman with right lower limb edema who also presented one steatorrhea. Her clinical history is typical for one primary lymphedema and the lymphoscintigraphic investigation of the lower limbs confirms the diagnosis. The scan showed the absence of the right iliac and lomboaortic lymph nodes but also that the thoracic duct was normally present. One C14-triolein breath test is pathological and proves the malabsorption of the fats. The authors discuss the interest of the scintigraphic techniques in such case and review the problem of the association between lower limb lymphedemas and fatty malabsorption.

Adult↗
PubMed2002

Effects of age and lateralization on lymphoscintigraphic interpretation.

The present study was undertaken to find out if ageing and lateralization might influence the results of lymphoscintigraphic investigations. Axillary lymphoscintigrams obtained in 756 women after subcutaneous intercostal (IC) injection of 99mTc-labelled colloids at the level of the chest wall were reviewed and analysed according to age (<41 years, 41-50 years, 51-60 years, 61-70 years, 71-80 years, >80 years) and the side injected (right or left). No axillary nodes were visualized (IC-) in 34% of the population, and IC- cases were somewhat, but not significantly (0.10 80 years, four out of seven), and the absence of drainage was more common in patients over 50 years old (overall, 38.2%; right, 36%; left, 40.2%) than in younger cases (overall, 27.9%; right, 24.1%; left, 30.3%). From a statistical point of view, the differences between these two age-discriminated populations were significant both when considering the series of injections as a whole (0.01>2P>0.001) and injections in the right side only (0.01<2P<0.02). In conclusion, ageing and lateralization influence lymphoscintigraphic investigations and have to be taken into account when analysing results.

Adult↗
PubMed2002

[Frontal sinus osteomas: neuro-ophthalmological complications].

Osteomas are the most frequent benign tumors of the paranasal sinuses. They often grow in the frontal sinus near the nasofrontal duct. They remain frequently asymptomatic and they tend to be an incidental finding on radiographic studies. Rarely, they extend out of the sinus limits. Two cases with neuro-ophthalmological complications are reported and discussed. A 19-year-old female presented with a progressive left visual impairment and orbital bone deformity. A CT-scan revealed a large calcified mass in both frontal sinuses, with left intraorbital and frontobasal extension. A 21-year-old man suffered from acute frontoethmoidal sinusitis. Radiological exams revealed a right frontal sinus osteoma with bilateral nasofrontal ducts obstruction. The frontal sinus cavities were filled with a large mucocele with intracranial extension. Both patients were successfully treated using frontobasal craniotomy with complete osteoma and mucocele removal and cranio facial bone reconstruction. Neuro-ophthalmological or intrasinusal complications of osteomas lead to radical treatment. CT-scan and MRI analysis for surgical purpose and strategy are emphased.

Adult↗
PubMed2001

Health education groups for caregivers in an HMO.

The short-term effectiveness of a Health Education Group (HEP) intervention program for spouses of frail older adults was compared to the usual care (UC) offered to the spouses of frail older persons in a staff model health maintenance organization. HEP is a multicomponent group program offered in eight weekly, two-hour group sessions, and ten monthly, two-hour follow-up group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. One-hundred and five spouses were recruited and randomly assigned to HEP (n = 58) or UC (n = 47). Spouse caregivers and care recipients were assessed within two weeks of intervention and within two weeks after the completion of the eight weekly group meetings. The results indicate that, for caregivers, HEP was more effective than UC in reducing depression, maintaining social integration, increasing effectiveness in solving pressing problems, increasing knowledge of community services and how to access them, changing caregivers' feelings of competence, and the way they respond to the care giving situation. No significant differences, however, were found between care recipients in the two arms of the study on any of the outcome measures.

Aged↗
PubMed2001

[Sentinel node involvement in T0-T1 breast cancers].

STUDY AIM: Determination of axillary lymph node status is crucial in diagnosis of early breast cancer. However thanks to an early diagnosis, an increasing number of axillary lymph node dissections are free of disease. This raises questions about the need for this procedure. The study aim was to report an experience with lymphadenectomy and sentinel node mapping in patients with T0-T1 carcinoma of the breast. METHODS: Between November 1997 and December 1999, 84 consecutive women (T0-T1 N0 according to the 1987 UICC classification) with recently diagnosed breast cancer, were included in this study for identification of the sentinel lymph node (SLN). The SLN was removed and submitted for histological examination. All patients underwent axillary dissection; nodes from levels I and II (Berg's classification) were excised and submitted to histological examination. RESULTS: The average tumor diameter was 12.7 mm (range, 3 to 25 mm). The lymphatic mapping technique was obtained after injection of the isotope into the breast around the tumor in 53/84 patients: the sentinel lymph node was the only positive node in 10 patients and it was positive in 5 patients with other axillary nodes. In 15/84 patients, an intradermal injection of blue dye was used; two sentinel nodes were positive and one falsely negative. In 16/84 patients, an interdermal injection of blue dye was used to make up for. In this study, the sentinel node was positive in three patients and falsely negative in one patient. The discrepancy was due to an important involvement of an axillary area excluded from the lymphatic channels. 22/84 patients (26%) had a metastatic spread to the axillary nodes. 30/84 patients had also an isotopic captation in another lymph node group (internal mammary). CONCLUSION: This study confirms that lymphatic mapping is technically possible in the patients with T0-T1 breast cancer and that the histological characteristics of the sentinel node probably reflect the histological characteristics of the rest of the axillary lymph nodes, but do not provide any information about the other lymph node sites.

Adult↗
PubMed2001

Relapse of Wegener's granulomatosis. Concerning a case after 20 years of remission.

Immunosuppressive drugs have transformed the prognosis of systemic Wegener's granulomatosis. Nowadays, the main residual problem is illness relapses, for which management is largely undefined. We describe the case of a patient, aged 47 in 1977. The diagnosis of Wegener's granulomatosis was made when faced with polyarthralgias, cutaneous vasculitis, rhinitis, dyspnea, hemoptysis and global decline of her physical condition. The treatment associated high-dose corticotherapy and intramuscular cyclophosphamide for 1 year. This treatment led to a complete remission. Twenty years later, the patient was hospitalized for reoccurrence of rhinitis, dyspnea and right knee effusion associated with biological inflammatory syndrome, renal insufficiency and antibodies against polymorphonuclear neutrophil cytoplasm, type c-ANCA. Chest CT-scan disclosed parenchymal infiltrates. Wegener relapse was diagnosed and the combination of three methylprednisolone perfusions followed by oral prednisone (1 mg/kg/d) and a monthly bolus of cyclophosphamide led to a new remission. Nevertheless, 4 months after beginning the treatment the patient died from an infectious complication (Pneumocystis carinii and aspergillosis). Relapses of Wegener's granulomatosis are frequent and difficult to predict. Moreover, some cases occur very early. The remarkable efficiency of cyclophosphamide to induce remission is however shaded by the high rate of relapse. Other drugs are studied to identify more efficient therapy, able to both induce remission and prevent relapses, but reliable data are still missing to determine the best therapeutic regimen.

Anti-Inflammatory Agents↗
PubMed2001

Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study.

OBJECTIVE: To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles (used as control) in patients with medial femoro-tibial knee osteoarthritis (OA). DESIGN: 6-month prospective randomized controlled study. PATIENTS: outpatients with painful medial femoro-tibial knee OA. OUTCOME MEASURES: patient's overall assessment of disease activity (5 grade scale), WOMAC index subscales and concomitant treatments. STATISTICAL ANALYSIS: Performed as an intention-to-treat analysis. Main criterion: improvement in the patient's assessment of activity (defined as a reduction of 1 grade or more at month 6 compared to baseline, and no intraarticular injection or lavage during the study). Secondary criteria for assessment: (a) improvement in the patient's assessment of activity at months 1 and 3 compared to baseline, (b) improvement in the WOMAC subscales at months 1, 3 and 6, compared to baseline (defined as an improvement of at least 30%, and no intraarticular injection or lavage during the study) and (c) concomitant therapies (analgesics and NSAIDs). RESULTS: The baseline characteristics of the 156 recruited patients (41 males, 115 females, mean age 64.8 years) were not different in the two treatment groups. At months 1, 3 and 6 the percentages of patients with improvement in assessment of disease activity, in WOMAC pain, joint stiffness, and physical functioning subscales were similar in the two groups. The number of days with NSAIDs intake during the previous 3 months was decreased at month 6 compared with baseline in the group furnished with laterally wedged insoles (14.1 days+/-28 vs 9.9 days+/-27, P=0.04, Wilcoxon paired test), while it remained unchanged in the other group (15.5 days+/-24 vs 15+/-28, P=0.56). Compliance and tolerance were satisfactory. Compliance was different between the two groups at month 6, with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group (87.8% vs 74.3%;P=0.032). CONCLUSION: This study failed to demonstrate a relevant short-term symptomatic effect of laterally-wedged insoles in medial femoro-tibial OA. However, the decrease in NSAIDs consumption together with better compliance in the treated group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA.

Aged↗
PubMed2001

Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease.

OBJECTIVE: To determine the usefulness of serum ferritin and glycosylated ferritin (GF) levels in diagnosing adult onset Still's disease (AOSD). METHODS: We performed a retrospective multicenter study of 205 patients who had ferritin and GF assays in one hospital laboratory. Records of all patients were reviewed, and a standardized questionnaire used to extract all data available at the time of the assay. The clinicians' final diagnosis was also recorded. Patients were classified as having "certain AOSD" (based on Yamaguchi's criteria) or a control disease. The concordance of ferritin and GF levels with final diagnosis was evaluated. RESULTS: In total 49 AOSD and 120 control patients were eligible. The mean ferritin value was significantly higher in the AOSD group (4,752 +/- 9,599 microg/l) than in the control group (1,571 +/- 3,807 microg/l), p = 0.029. GF was significantly lower in AOSD patients (15.9 +/- 11.9%) than in the control group (31.5 +/- 18.7%), p < 0.001. The combination of a GF level of < or = 20% with ferritin above the upper limit of normal yielded a sensitivity of 70.5% and specificity of 83.2%. The combination of a GF level < or = 20% with ferritin 5 times normal produced a sensitivity of 43.2% and specificity of 92.9%. This latter combination allowed an AOSD diagnosis to be ruled out for 6 of the 8 control patients who met Yamaguchi's positive criteria. CONCLUSION: Ferritin and GF levels are powerful diagnostic markers of AOSD. They may be helpful in clinical practice for excluding differential diagnoses.

Adult↗
PubMed2001

[Diagnostic problems in brain abscess: 45 cases].

BACKGROUND AND PURPOSE: We analysed the difficulties encountered in the differential diagnosis between brain abscess and brain tumor and their influence on treatment and outcome. METHODS: - Forty-five adults with brain abscess operated on between 1993 and 1999 were retrospectively reviewed. We studied preoperative diagnosis, clinical, radiological, bacteriological findings, surgical procedure, primary sources of infection and outcome. RESULTS: Preoperative diagnosis was right in 55.6% (25/45), wrong in 22.2% (10/45) and doubtful in 22.2% (10/45). Diffusion-weighted MR imaging was successfully used in 4 doubtful cases to make the differential diagnosis between abscess and tumor. When the preoperative diagnosis was right, the surgical procedure was a burr-hole aspiration in 73.3% (22/25) whereas when it was wrong, an excision was performed in 60% (6/10) of the cases. Aspiration was the last diagnostic investigation in 80% (8/10) of doubtful cases. Microbacterial organisms were identified in 75.5% (34/45) of the cases and primary cause of infection in 62.2% (28/45). The outcome depended on clinical status on admission, preoperative diagnosis and surgical procedure. In four cases, diffusion-weighted MRI allowed differential diagnosis between brain abscess and tumor through calculation of the Apparent Diffusion Coefficient which is low in abscess and high in cystic tumor. CONCLUSION: The diagnosis of brain abscess remains difficult in certain patients. Correct preoperative diagnosis influences the decision on the appropriate surgical procedure and helps improve outcome.

Adult↗
PubMed2000

[Suprasellar arachnoid cyst associated with syringomyelia. Case report].

We present a case of suprasellar arachnoid cyst which was revealed by visual impairement and hypopituitarism. Neuroradiological imaging showed the peculiar association of the suprasellar cyst with cerebellar tonsillar herniation and a large asymptomatic cervical syringomyelic cavity. Surgical treatment of the suprasellar cyst allowed the reduction of both the cyst and the syrinx. A common pathophysiological mechanism of these lesions is discussed. We suggest the possibility that an initial obstruction of the basal cisterns caused the suprasellar cyst formation which led to medullar cavity formation.

Arachnoid Cysts↗
PubMed2000

[Rheumatic disorders. Overview].

Of all rheumatic diseases, osteoarthritis (OA) and rheumatoid arthritis (RA) are the most frequently occurring. Although they differ in pathophysiology and the molecular mechanisms responsible for the destruction of cartilage (since RA is an inflammatory disease and OA is not), there are, however, a certain number of similarities and common pathways in the inflammatory processes of both diseases: mild inflammatory phenomena have been observed during OA, and both interleukin-1 and tumour necrosis factor-alpha seem to play key roles, as in RA. Although there is a dramatic difference between the 2 diseases in the intensity of inflammation, the inflammatory process is responsible for the synthesis of metalloproteinases and free oxygen radicals, and, subsequently, for progressive cartilage destruction. Both OA and RA engender important costs for the healthcare system. Direct costs result from practitioner visits, drug purchase and management, drug-related adverse effects, management or hospital care; indirect costs are linked to progressive functional disability. Although RA leads to significant individual costs, OA is more problematical for the healthcare system, since its prevalence is far higher than that of RA. Thus, rheumatic diseases have become a major public health problem. Optimal therapeutic strategies need to be determined in order to define the most effective procedure for controlling disease symptoms such as pain, stopping or slowing down disease progression and, finally, keeping patients active. But it is of paramount importance that the gain in efficacy be associated with a gain in drug safety.

Animals↗
PubMed1999

[Complications of colonic diverticular disease during rheumatoid polyarthritis: 7 cases].

INTRODUCTION: Among the gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs (NSAID) and corticoids are mentioned complications of colonic diverticular disease. However, very few studies have described their consequences in rheumatoid arthritis. EXEGESIS: We report on seven patients who were admitted in our department between 1984 and 1997. All patients received corticoids and another antirheumatic drug (gold salts, hydroxychloroquine, immunosuppressive drugs); treatment also included NSAID in four cases. Two patients had a necrotizing vasculitis accompanying rheumatoid arthritis. Intestinal accompanying diseases were the following: one diverticulitis, three colonic perforations with pelviperitonitis, one colovesical fistula, one pelvic abscess, and one diverticular hemorrhage. All patients underwent surgery with positive results. CONCLUSION: Combination of the four following symptoms: fever, abdominal pain, diarrhea, and hemorrhage, can uncover a complication of colónic diverticular disease occurring in the course of rheumatoid arthritis. It should be investigated, even if no history of diverculosis may be evidenced.

Abscess↗