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Biomedical subjects

P Degoulet

Publications and source records attributed to P Degoulet.

At least 91 records · Page 5Linked to original sources
PubMed1988

Long-term metabolic effects of spironolactone and thiazides combined with potassium-sparing agents for treatment of essential hypertension.

By using information prospectively collected in the computerized ARTEMIS databank, the long-term metabolic consequences of spironolactone, hydrochlorothiazide-amiloride combination and cyclothiazide-triamterene combination were evaluated in 100 patients for each group matched according to sex, age and blood pressure (BP). Spironolactone was prescribed at a mean dose of 98 mg, hydrochlorothiazide at 36 mg and cyclothiazide at 2 mg, during a mean follow-up of 20 months. Compared with the pretherapeutic values, BP decreased equally in both treatment groups (18/9 mm Hg on average). Creatinine increased significantly in the 3 groups (9, 8, 14 mumol/liter, p less than 0.001) as did uric acid (18, 31, 42 mumol, p less than 0.001). Plasma potassium increased with spironolactone (0.7 mmol/liter, p less than 0.001) and remained stable with the combinations of the thiazide-potassium-sparing agents. For the 3 groups, the slight and nonsignificant variations of fasting blood glucose and cholesterol were mainly the results of a phenomenon of regression to the mean. However, when both groups of thiazide-treated patients were considered, the reduction of plasma potassium was accompanied by a slight increase in glucose (0.1 mmol/liter) and cholesterol levels (0.2 mmol/liter) compared with when kalemia decreased (-0.1 and -0.1 mmol/liter, respectively, p less than 0.05 and p less than 0.05). It is concluded that in a clinical daily practice of a hypertension clinic low doses of spironolactone or of thiazides combined with potassium-sparing agents reduced BP without alteration in lipid or carbohydrate metabolism on long-term follow-up.

Amiloride↗
PubMed1988

Alcohol consumption and impaired glycoregulation results in a population of 6665 salaried employees.

Alcohol consumption and glycosuria were found to be associated (p less than 0.001) in a population of 6571 salaried employees who underwent a systematic examination. The prevalence of glycosuria was found to range from 1.3% among 2609 non-drinkers to 5% among 816 heavy drinkers (six glasses or more of alcoholic beverage daily). This association was still significant after adjustment for age, sex and body mass index. Similarly, a positive association was observed between fasting glycemia and alcoholic intake in a subgroup of 998 subjects when such a result was available (p less than 0.05).

Adolescent↗
PubMed1988

[Experience of decentralized informatics at a nephrology unit of a general hospital].

The computerized medical specialized records covering the follow-up of hypertension (ARTEMIS), diabetes (MELLITEE), chronic renal failure and the minimum medical record of Nephrology (THESEE) using the temporal database management system LIED, have been developed in several units of University Hospitals. The authors show that these computerized records are usable in a Nephrology Unit in a General Hospital.

Diabetes Mellitus↗
PubMed1987

Relationship between alcohol consumption and hypertension prevalence and control in a French population.

Six thousand six hundred thirty two subjects, employed in 420 small and medium-sized companies in the Paris region were examined in a cross-sectional study. Their alcohol consumption, as obtained by interview was found to be higher among males than among females, among workers than among managers, executives, and clerks. Alcohol consumption was positively associated with age, body mass index, coffee and cigarette consumption, occupational exposure to noise and working nights or alternating shifts. A positive, continuous, relationship was observed, for men and women, between alcohol intake and both systolic and diastolic blood pressure. This association was highly significant in the multivariate analysis (multiple linear regression) where alcohol intake, following age and body mass index, was the third predictive factor of blood pressure level in the stepwise regression. The positive association between alcohol consumption and prevalence of arterial hypertension was aggravated by the poor control of hypertension which was found among drinkers. Awareness of hypertension, compliance with an antihypertensive treatment and its efficacy, were negatively associated with alcohol intake. The findings stress the importance of alcohol consumption which was found to be a major risk factor for arterial hypertension and noncompliance with antihypertensive treatment in this population.

Adolescent↗
PubMed1987

Acetate metabolism and bicarbonate generation during hemodialysis: 10 years of observation.

The capacity of chronically hemodialyzed patients to metabolize acetate during conventional hemodialysis was evaluated using a retrospective study in 219 patients dialyzed for up to ten years under similar dialysis conditions. For each patient, and using all available data, a regression line relating the changes of plasma total CO2 during dialysis as a function of the pre-dialysis value was calculated. The intercept of this function indicates the plasma concentration where the losses of bicarbonate in the dialysate is matched by the generation of bicarbonate arising from the metabolism of acetate. This value therefore represents an individual index of the capacity of each patient to metabolize acetate. A value for this index smaller than 18.0 mM was considered abnormal. It was shown that around 10% of chronically hemodialyzed patients are clearly unable to metabolize acetate optimally. This defect is not related to the duration of dialysis, body weight or quality of hemodialysis treatments but is strongly related to sex, 19 of the 22 "acetate intolerant" patients being women. In a prospective study, all the 60 patients of the same population undergoing active dialysis were studied, and this index identified 12 abnormal (11 women, 1 man) patients and 48 normal patients. Plasma acetate measured at the end their dialysis treatments were significantly higher in abnormal than in normal patients. It is concluded: that this index is useful to identify the patients unable to metabolize acetate optimally; that only around 10% of hemodialyzed patients present a severe problem when dialyzed against acetate and should be dialyzed against bicarbonate; that dialysis against acetate does not fully correct the metabolic acidosis even in "normal" patients.

Acetates↗
PubMed1987

[Predictive factors of resistance to antihypertensive treatment].

Results of antihypertensive treatment were analyzed in a group of 5,209 hypertensive patients referred in two hypertension Clinics in Paris from 1976 to 1985. Patients were included in the study if they fulfilled the following criteria: 1) at least four visits in the clinic, 2) follow-up period greater than 6 months, 3) initial diastolic blood pressure greater than or equal to 90 mmHg and/or presence of an antihypertensive treatment. After a mean follow-up period of 43 months, blood pressure was reduced from 177/105 mmHg to 148/89 mmHg. However, in spite of at least two antihypertensive drugs, 16.7 p. 100 of these patients had a diastolic blood pressure above 95 mmHg at the end of the follow-up period and were defined as uncontrolled hypertensives (UH). By comparison with controlled hypertensives (CH), UH patients were more frequently males (67.9 vs 56.6 p. 100, p less than 0.001), had a greater known duration of hypertension (11.6 vs 8.7 years, p less than 0.001), and presented at the first visit with higher blood pressures (188/113 vs 174/103 mmHg, p less than 0.001/p less than 0.001), despite a higher rate of antihypertensive treatment (66.6 vs 53.8 p. cent, p less than 0.001), a higher ponderal index (26.3 vs 25.3/kg/m2, p less than 0.01) and a higher prevalence of end-organ damage (23.2 vs 16.3 p. 100, p less than 0.001). Sokolov index, serum creatinine and uric acid levels were higher among UH than among CH patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1987

[Decentralization of the ARTEMIS system in a nephrology service in a general hospital].

"ARTEMIS" is a standardized and computerized medical file which is intended for improving the follow-up of hypertensive patients, the efficacy of treatment and for realising national-wide surveys. The software "LIED" of data base for "ARTEMIS" is nowadays transposable on mini-computer. In Nephrology Unit of General Hospital from Colmar, the system has been working since September 1985 with MICRO-MEGA E 32 (Thomson). The administrative and medical data are directly acquired by the doctors and secretaries of the Unit on a conversational mode from six terminals. There is no writing collecting of data. An evaluation of the system was realized with the 113 first hypertensive patients. The results were compared to those obtained from patients of Paris area.

Follow-Up Studies↗
PubMed1987

Artificial intelligence--its use in nephrology.

Artificial intelligence techniques and expert systems are graduating from research laboratories to enter many human domains of activities. However, initial expectations of the seventies have been transformed with time to a more sober reality. Starting from examples in nephrology, this paper tries to give a balanced view of this new technology. Justification, indication and limitation of present expert systems are discussed as regards their possible goals. The respective roles of the experts and knowledge engineers are described. The need to integrate the artificial intelligence approach into present patient database management systems in order to build up expert database systems is evaluated.

Database Management Systems↗
PubMed1987

Integrating management and expertise in a computerised system for hypertensive patients.

An expert system has been integrated to the data management system of the ARTEMIS programme for hypertensive patients. The patient database, which has been used since 1975, contains the medical records of about 20,000 patients. Information is interactively entered by physicians, nurses and secretaries on video display units. The computerised medical record has replaced the traditional handwritten medical record. The database management system is used to produce different summary reports (inpatient and outpatient care) and personalized recall letters which are mailed to the patients before their appointments. Suggestions provided by the expert system include additional information to be obtained (complementary patient interrogation, biological or radiological investigations, etc.), possible causes of hypertension, and medical prescriptions. The information base allows the description of both static knowledge (in the form of a semantic network) and dynamic knowledge (in the form of production rules). The inference system sequentially uses a combination of forward and backward chaining and performs both exact and approximate reasoning. The diagnostic performance of the expert system was evaluated in 100 cases of hypertension (50 of essential hypertension and 50 of secondary hypertension. Concordance between the diagnosis proposed by the expert system and the one proposed by the specialist was achieved in 92% of secondary hypertension cases and 88% of essential hypertension cases. It is suggested that the integration of data and knowledge management might enhance the overall acceptance by medical staff of a computerised system, and facilitate the validation of a knowledge base.

Database Management Systems↗
PubMed1987

[A computerized file for the surveillance of diabetic patients: the MELLITEE system].

Taking over a chronic disease like diabetes in a hospital clinic raises multiple problems. Large numbers of diabetic patients and prolonged follow-up periods result in a mass of data that only computers can control. MELLITEE is a computerized system developed to facilitate the longterm management of patients and to help in maintaining a high standard of care. It includes a structured and standardized medical record. Physicians of three Parisian hospital clinics agreed on the minimum content of the record. MELLITEE is operated at the Saint-Louis Hospital on a 68,000 based mini-micro computer (Fortune/Thomson Micromega-32), running under the Unix operating system and with the Lied data base management system. Data are keyed directly into the computer by physicians, nurses and dietitians from throughout the department. On-line registration of information allows the suppression of the corresponding part of the usual paper record. The clinical data base obtained from administrative and medical information can be used to facilitate more effective patient follow-up and clinic management. The system is to be set up in the other collaborating centres in the near future, allowing pooling of data. It will also provide long-term information which can be used for evaluation of care and epidemiological research.

Diabetes Mellitus↗
PubMed1986

Peritonitis in continuous ambulatory peritoneal dialysis: a role for the dialysate?

Three groups of CAPD patients with different dialysis fluids showed a different risk of peritonitis according to the brand of the dialysate and the buffer acetate or lactate they used. Aseptic peritonitis was more frequent with patients who received lactate-buffered peritoneal fluids. According to the manufacturer of the dialysate, however, different results in terms of risk and type of peritonitis are obtained also within one type of lactate-buffered solution. The factors responsible for the difference in the risk of peritonitis according to the dialysis fluids used are unknown.

Adult↗
PubMed1986

[Testing an expert system for hypertension].

An Expert System (ES) has been connected to a database management system for the management and follow-up of hypertensive patients. The patient data base, called Artemis, contains approximately 18,000 medical records. About 90% of the initial informations used by the ES is contained in the medical records of the Artemis data base. The knowledge base consists of 870 rules. A first group of rules allows the description of knowledge structures (hierachies, graphs and mutual exclusions). The second group consists of production rules which describe the dynamic reasoning of the expert. The inference engine uses a combination of forward and backward chaining. The ES produce diagnostic hypotheses (possible causes of hypertension) and therapeutic suggestions before and after requiring additional information (patient supplementary interrogation, biological or radiological investigations). The evaluation of the diagnostic performance of the ES was made on 40 confirmed cases of secondary hypertension (SH) and 40 cases of essential hypertension (EH). The initial initial diagnosis, just after the forward chaining step, was correct in 17 cases of SH and 32 cases of EH. The final diagnosis proposed after several steps of forward and backward chaining was correct in 37 cases (92%) of SH and 36 (90%) of EH. Averages of 5 (EH) and 8 (SH) questions were formulated by the ES to reach the final diagnosis. The integration of the ES to the database is expected to facilitate the validation of the knowledge base and to enhance its overall acceptability. Whether or not such an integration will be useful and accepted as a complementary tool by physicians remains however an open question.

Decision Making, Computer-Assisted↗
PubMed1986

[Alcohol consumption and treatment of hypertension. Results of an occupational medicine survey].

The results of a cross-sectional study were analysed in order to assess the therapeutic control of hypertension in relation to alcohol consumption. 6,665 subjects, employed in small and medium-sized companies of the Paris region were examined in a cross sectionnal study. Among the 1,008 hypertensive subjects, awareness of hypertension decreased with increasing alcohol consumption, from 72% among the 304 non-drinkers to 59% among the 201 heavy drinkers (six glasses/day and more) (p less than 0.05). Similarly, the percentage of subjects under current antihypertensive medication on the day of examination was lower in heavy drinkers, 19%, than among tetotalers, 42% (p less than 0.001). An antihypertensive treatment had been prescribed to 510 subjects. Among them, compliance, as stated by the interview, decreased with increasing alcohol consumption, from 70% to 34% (p less than 0.001). Using a logistic regression, the adjusted relative risk of non-compliance among heavy drinkers (6 glasses/day or more) was found to be 1.9. Among the 344 subjects under antihypertensive treatment on the day of examination, systolic and diastolic blood pressure were higher among heavy drinkers, 167/102 mmHg, than among teetotallers, 154/95 mmHg (p less than 0.01 both). The relative hypertension awareness, treatment and control status was thus poorer among, moderate and heavy drinkers than among the light and non-drinkers (table I). (Table: see text). The importance of the problem of alcoholism is thus emphasized, in both the fields of hypertension prevalence and control.

Adolescent↗
PubMed1986

[Occupational exposure to noise, hearing loss and arterial hypertension].

Clinical examinations and audiograms were conducted in a group of 249 men working in a foundry of the Paris area. Before and after adjustment for age, systolic blood pressure levels were positively associated with the duration of the occupational exposure to a noise greater than 85 dBA: 127.8 mmHg in the non-exposed group, 128.6 mmHg when the exposure lasted less than 10 years, 130.1 mmHg from 10 to 19 years, and 140.1 mmHg over 20 years (p less than 0.001). The odds-ratio of arterial hypertension associated with an occupational exposure over 20 years was 1.6 (p less than 0.05). There was no relationship between noise-induced hearing loss and blood pressure levels. These results suggest that there may be a population at increased risk of high blood pressure. However, the causal relationship between noise exposure and high blood pressure should be confirmed.

Adolescent↗
PubMed1985

Influence of educational and sociocultural factors on hypertension care.

The influence of occupational category (OC) on the prevalence of hypertension (HT) and cardiovascular risk factors and on their management was studied in Paris in a general population and in a series of patients followed up in two university hospital hypertension clinics. Three OCs were defined as follows: high executives and members of liberal professions middle executives and clerks and manual workers. In the general population, the prevalence of HT was positively associated with OC, and ranged from 12.8% (1) to 19.3% (3). Body Mass Index (BMI) and tobacco and alcohol consumption were higher in category 3. Exposure to noise and assembly-line work raised blood pressure. Of the hypertensive subjects, 60% were aware of their illness, independently of OC, but the percentage of treated hypertensive subjects at examination and their compliance with treatment were significantly and negatively correlated with OC. In the hypertension departments, more category 1 and 2 patients were examined than expected for a theoretical French population of similar sex, age and geographical distribution. By contrast, clerks and manual workers were under-represented. BMI was higher in OC 3 than in OC 1, in both sexes. Cigarette consumption was higher in OC 1 than in OC 3 in males only. Permanent teaching staff members examined more people from OC 1 than the other physicians did. Drop-out rates at 1, 2 and 3 years were higher in OC 3 than OC 1. The problems of compliance with antihypertensive treatment were more frequent in OC 3 patients than in those in the other categories.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Alcohol and arterial hypertension].

The positive association between alcohol consumption and arterial pressure has been shown in several epidemiological surveys. This strong relationship has been demonstrated in many countries, independent of the known risk factors for hypertension; the dose-response appears to be linear in most studies. The lowering of blood pressure after stopping alcohol consumption and its rise after starting to take alcohol again are good evidence of a causal relationship. The pathophysiology of the hypertensive effect of alcohol is uncertain. Alcohol consumption seems to be a factor to be taken into account in the prevention and treatment of hypertension.

Alcohol Drinking↗