Biomedical subjects
Publications and source records attributed to P Boyer.
The authors report the case of a patient presenting with isolated left superior vena cava, for which intracardiac implantation of a cardiac pacemaker was facilitated by intraoperative transthoracic ultrasonographic detection of the course of the ventricular catheter. Transoesophageal ultrasonography confirmed the diagnosis and eliminated a possible associated malformation.
Our study consisted of a population of 100 women who represented an insufficient response to the induction of ovulation. We researched to find out which therapeutic approach, of the subsequent attempts to IVF would give greater hope to a better response. Two groups were individualized: in the first group (62 women) we obtained at least once, 3 oocytes (288 attempts), in the second group (38 women) we always obtained less than 3 oocytes. In the first group, in order to raise the pregnancy rate it was necessary to raise the rate of E2/oocyte. There fore raising the duration of stimulation and the quantity of ampullage of hMG. The long protocol, hMG, produced the best results. In the second group, the results were always worse it was more than a problem of protocol, it was a problem of the patients. In reality, the future of therapy for lower responsive patients is probably biological with hatching today and the possibilities with oocytary maturation in vitro in the near future.
Initially based on empirical observations, the concept of RBD has led to operational diagnostic criteria allowing further studies in various and large populations. In line with the hypothesis of a continuum from normal sad mood to major depression, the spectrum of affective disorders is thus probably more in agreement with everyday clinical practice. Moreover, recurrent and so-called subthreshold conditions have been concurrently investigated in other fields of psychopathology. Nevertheless, many methodological problems and clinical implications of RBD still require further research. The question of a precise definition of the disorder, even if a consensus seems to be obtained about some key points, remains partially to be addressed, for example, concerning the problem of the reliability of assessment. The possibility of a seasonality of the episodes needs further investigations, as do the relationships between RBD and personality disorders such as borderline personality disorder. Finally, the important question of prophylactic treatment of RBD remains unsolved, as antidepressants have failed to demonstrate any efficacy and some neuroleptics have been proposed in particular conditions. Angst's prediction that clinical relevance, impairment, distress and public health impact of affective disorders could be related not only to the duration of an episode but also to the recurrence of episodes, possibly referring to a kindling model, has therefore been confirmed. His major contribution has been to underline, in various forms of affective disorders, the importance of conducting longitudinal clinical as well as epidemiologic studies to refine our psychopathological knowledge.
BACKGROUND: The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia. METHOD: The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM-III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study. RESULTS: Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms. CONCLUSIONS: Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.
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This report describes the early diagnosis, due to an acute increase of jugular venous oxygen saturation occurring 20 hours after trauma, of a traumatic carotid-cavernous sinus fistula after severe head injury. Hyperemia in severe head injury should be treated only after an intracerebral arteriovenous communication has been excluded.
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This work presents a study of 221 healthy subjects among whom we have assessed the capacity to feel pleasure or displeasure through two rating scales, the FCPCS-PP and the HDCS-PD. We have observed a significant correlation between the scores, which shows that the more pleasure the subject feels, the more displeasure he feels. These results seem to confirm the existence of an overall dimension of emotional experience.
The relationship between anhedonia and sensation seeking has been studied in 56 normal subjects of both sexes (33 males, 23 females). Anhedonia and sensation seeking were respectively defined by two reliable rating scales: Physical Anhedonia Scale of Chapman (PAS), Zuckerman's Sensation Seeking Scale (SS form V -40 items). The results have shown a negative correlation between this scales for males but not for females. These finding suggest that lowered levels of sensation seeking could constitute for males, like anhedonia, a risk factor of schizophrenia.
Like its predecessors, DSM IV allows the prospective study population for clinical trials to be defined as accurately possible. The inclusion and exclusion criteria allow clear definition of the diagnostic category to which patients belong, and the simplest way of allowing the clinician to find his way through the criteria under consideration is to place the latter in a "checklist". The clinician then checks whether or not a given criterion is present, and after completing the checklist calculates whether the checked criteria are sufficient to warrant inclusion of a given patient. This approach, though methodical nevertheless, contains a significant drawback. The diagnostic criteria of DSM IV are at once "positive" (symptoms which a patient must present to qualify for inclusion in a diagnostic category) and "negative" (symptoms which the patient must not present in order to qualify for inclusion). In some cases it is relatively simple to establish the existence of such negative criteria (e.g. cases in which it must be ascertained that symptoms are due neither to ingestion of a toxic substance nor to recent bereavement). However, very often these negative symptoms are not presented one by one in the list of criteria, but are instead grouped together in an allusive phrase such as: "the symptoms must not be due to any associated disorder", or, "the symptoms must not occur exclusively during episodes of an associated disorder", or again, "the criteria of such and such a disorder are not met". Thus, in theory, each time a negative criterion of this type is encountered, the investigator must refer to the disorder for which diagnosis constitutes an exclusion criterion and verify that the conditions of this disorder are not met. For example, criterion B for major depressive episodes states that "the symptoms do not meet criteria for a mixed episode". It is therefore necessary to verify that the exclusion criteria are indeed absent. This type of "Chinese box" procedure thus implies that checklists should not only contain the diagnostic criteria for the particular disorder being sought, but that they should include a complete list of diagnostic criteria for all other disorders requiring exclusion. Since such an awkward procedure would make it impossible to draw up reasonable case report forms, a selection of exclusion criteria is generally made, often on a somewhat arbitrary basis. It might in fact prove more useful to adopt diagnostic algorithms.
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Descriptions of mentally ill inpatients have strongly influenced current classifications of mental disorders. Primary care patients may therefore present a substantially different pathology. Some diagnoses, infrequent in psychiatric settings but common in the general population or in primary care, have been described, such as the concept of recurrent brief depression (RBD) proposed by Jules Angst. RBD refers to frequent but short-lasting (usually only a few days) severe depressive episodes. In parallel with a study organized by the World Health Organization aimed at defining the psychological disorders encountered in primary care, we investigated the prevalence of RBD, its severity, and comorbidity with major and well-defined disorders using a structured interview (CIDI). The current prevalence of RBD in a general practice population was found to be about 10%. The average duration of the episodes is 3-4 days. Ours results confirm the severity of this disorder; in particular, a history of suicide attempts is frequent (23.3%). Among RBD patients, 26% do not present any other psychiatric disorder. When a comorbidity is reported, depressive episodes (lasting at least two weeks, according to ICD-10) and generalized anxiety disorder are the main associated disorders. Our results are in favor of the existence of RBD as a separate and original nosological entity.
In the preparatory phase of a randomised controlled trial data were collected to assess the magnitude of changes on cognitive functions in 1628 volunteers (age range 45-75 years) that were recruited from general practitioners' patient population. Subjects were administered a short neuropsychological battery of tests including three paper-and-pencil tests, which assessed immediate recall, delayed memory, and attention. Being on antihypertensive medication was associated with low results for all three tests in every age group, and in all strata according to blood pressure levels. Psychotropic drug use was correlated with low results for all three tests. Differences between psychotropic drug users and nonusers increased with age. Antihypertensive treatment and psychotropic drug use seem to be important to consider in longitudinal studies of cognitive decline in aging.
The authors compare the limited removal of the ruptured disc to discectomy for lumbar disc herniation. Analysis of results during a four years period demonstrates a twice higher recurrence rate with limited removal than with discectomy and a more frequent residual low back pain, after limited removal of the ruptured disc. These data made then limit the indications of the simple ruptured disc removal technique, with the exception of some specific anatomical locations: the migrated disc situated anterior or posterior to the ligament, without an associated discal bulging.
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Attentional, information-processing and learning deficits can be evidenced in a significant number of schizophrenic patients. Nevertheless these deficits don't seem to characterize automatically a subgroup of negative patients; they can be as well encountered in positive form of schizophrenia or in non psychotic disorders. Often these deficits are preexisting to the development of the disease; they are considered by some authors as being inherited within the spectrum of schizophrenic disorders, schizotypic personality being part of it. Such cognitive disturbances are probably linked with multiple dysfunctions located in cortical and subcortical dopaminergic structures.
This work presents a second study of validation of the French version of the Physical Anhedonia Scale (PAS) in four groups (221 and 32 normal subjects, 61 schizophrenics (RDC) and 42 major depressives (RDC). The internal consistency was determined by the Kuder-Richardson coefficient (KR 20) which values was 0.75 in the normal group and 0.82 in the schizophrenic group. The mean of the correlations between each item and the total score was 0.25. The concurrent validity was studied by the correlation coefficient between the PAS score and a sub-scale of physical pleasure (FCPCS-PP) extracted from the Fawcett Clark Pleasure Capacity Scale. The values were -0.39 (p < 0.01) in the normal groups, -0.37 (p < 0.01) in the schizophrenic group and -0.56 (p < 0.01) in the depressive group. A test retest have shown a value of 0.76 (p < 0.01) between two passations (3 weeks) of the PAS. The norms of PAS in the French population were given.