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Biomedical subjects

P Levy

Publications and source records attributed to P Levy.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Early implant treatment of a child with anhidrotic ectodermal dysplasia. Apropos of a case].

The purpose of this article is to report the clinical course and follow-up of a child with ectodermal dysplasia who was treated with implants surgery very early. Different possibilities for prosthetic restoration in the anodontic child are reviewed. Tolerance was excellent. Good cover of the implant was achieved at four years. We propose early implantation reconstruction surgery for these exceptional cases. A prospective multicentric study of this condition would be useful.

Anodontia↗
PubMed2000

Rapid and sensitive PCR detection of Vibrio penaeicida, the putative etiological agent of syndrome 93 in New Caledonia.

Experimental infections of Penaeus (Litopenaeus) stylirostris were performed with a Vibrio penaeicida strain (AM101) isolated in New Caledonia from Syndrome 93 diseased shrimp. Cumulative mortalities resulting from intramuscular injection or immersion of shrimp in bacterial suspensions demonstrated high virulence for this bacterial strain and suggested that V. penaeicida could be the etiological agent of Syndrome 93. The median lethal dose (LD50) for AM101 was 1.3 x 10(4) CFU (colony forming units) ml-1 by immersion and less than 5 CFU shrimp-1 by intramuscular challenge, with mortality outbreaks at 48 and 22 h after challenge, respectively. A polymerase chain reaction (PCR) detection assay using a primer set designed from the 16S ribosomal RNA gene of V. penaeicida was developed. It gave an expected amplicon of approximately 310 bp in ethidium bromide-stained agarose gels. The specificity of these primers was assessed with different Vibrio species. Furthermore, DNA extracted by the Chelex method could be used to detect fewer than 20 cultured Vibrio cells in sea-water or shrimp hemolymph by this assay. It appears to be a reliable screening method for detecting V. penaeicida in shrimp and from the aquatic environment.

Animals↗
PubMed2000

Pancreatic pseudocyst located in the liver: a case report and literature review.

Pancreatic pseudocyst in the liver is a rare complication of acute or chronic pancreatitis. However, its frequency seems to be increasing with modem imaging procedures. The authors report a case of pancreatic pseudocyst involving the left lobe of the liver that occurred in a patient who never showed clinical evidence of pancreatitis or pancreatic injury. Complete screening led to the discovery of alcoholic chronic pancreatitis. The pseudocyst was treated successfully by radiologic drainage. The pancreatic pseudocyst location and therapeutic approaches are discussed. A literature review uncovered 26 cases of hepatic pancreatic pseudocysts. Clinical presentation, imaging characteristics, and treatment of these cases are analyzed.

Drainage↗
PubMed2000

Characterization of pharyngeal resistance during sleep in a spectrum of sleep-disordered breathing.

Aims of the study were 1) to compare Hudgel's hyperbolic with Rohrer's polynomial model in describing the pressure-flow relationship, 2) to use this pressure-flow relationship to describe these resistances and to evaluate the effects of sleep stages on pharyngeal resistances, and 3) to compare these resistances to the pressure-to-flow ratio (DeltaP/V). We studied 12 patients: three with upper airway resistance syndrome (UARS), four with obstructive sleep hypopnea syndrome (OSHS), three with obstructive sleep apnea syndrome (OSAS), and two with simple snoring (SS). Transpharyngeal pressures were calculated between choanae and epiglottis. Flow was measured by use of a pneumotachometer. The pressure-flow relationship was established by using nonlinear regression and was appreciated by the Pearson's square (r(2)). Mean resistance at peak pressure (Rmax) was calculated according to the hyperbolic model during stable respiration. In 78% of the cases, the value of r(2) was greater when the hyperbolic model was used. We demonstrated that Rmax was in excellent agreement with P/V. UARS patients exhibited higher awake mean Rmax than normal subjects and other subgroups and a larger increase from wakefulness to slow-wave sleep than subjects with OSAS, OSHS, and SS. Analysis of breath-by-breath changes in Rmax was also a sensitive method to detect episodes of high resistance during sleep.

Adult↗
PubMed2000

Constant vs. automatic continuous positive airway pressure therapy: home evaluation.

STUDY OBJECTIVES: To compare the efficacy and patient tolerance, compliance, and preference between auto-continuous positive airway pressure (CPAP) and constant CPAP. DESIGN: Single-blinded, crossover, cohort study of consecutive patients with obstructive sleep apnea syndrome, with two treatment periods of 2 months each. PATIENTS: Twenty-five patients (22 men, 3 women) with sleep apnea syndrome confirmed by ambulatory polysomnography. MEASUREMENTS AND INTERVENTIONS: After baseline polysomnography, patients underwent in-laboratory polysomnography for titration of constant CPAP. The order of treatment was randomly allocated, either auto-CPAP and then constant CPAP, or vice versa. The auto-CPAP pressure range was 6 to 16 cm H(2)O. At the end of each 2-month period, patients underwent a control ambulatory polysomnography and received a questionnaire on subjective well-being and device evaluation. Duration of use was checked through CPAP device monitoring. RESULTS: No differences were found in apnea/hypopnea index (constant CPAP, 9.7+/-1.9 events/h vs auto-CPAP, 10.6+/-9.3 events/h), awakening/arousal index (constant CPAP, 13.7 +/- 8.0 events/h vs auto-CPAP, 15.5 +/- 8.9 events/h), slow-wave sleep duration, nocturnal saturation, or complaint of daytime sleepiness. The mean pressure required was significantly lower during auto-CPAP than during constant CPAP (8.8+/-1.8 cm H(2)O vs. 9.7+/-2.6 cm H(2)O, respectively). Patient tolerance, compliance, and duration of use were similar with both treatments. CONCLUSIONS: Auto-CPAP is as effective as constant CPAP. A wide pressure range for auto-CPAP can be used in all patients, suggesting that, in the future, use of a broad pressure range in the auto-CPAP mode could obviate the need for the titration night.

Circadian Rhythm↗
PubMed2000

The sleep tutorial.

A multimedia Sleep tutorial for General Practitioners was implemented from scratch. The implementation had into account the following features: 1) Specific needs of GPs evaluated in 3 different countries, related with Tutorial contents and technical features; 2) Multinational authorship from European experts; 3) Multilingual possibilities; 4) User friendliness and easy navigation. The tutorial was implemented and tested and its gama version is now available for commercialization.

Adolescent↗
PubMed1999

Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

Aged↗
PubMed1999

Assessing prenatal hepatitis B screening in Illinois with an inexpensive study design adaptable to other jurisdictions.

OBJECTIVES: This study estimated, using an economical survey design adaptable to other jurisdictions, the proportion of birth admissions in Illinois hospitals in which mothers were not screened for hepatitis B surface antigen prior to delivery. It also identified factors associated with lack of screening. METHODS: Based on a cluster sampling design, 1372 birth records were sampled, and data were abstracted by local personnel at 56 hospitals. Selected data elements were reabstracted on a subsample to evaluate recording errors. RESULTS: Reabstracted data demonstrated 95% agreement among reviewers. Hepatitis B surface antigen screening was documented for 90.7% of mothers; 11% of responding hospitals accounted for 45% of nonscreened mothers. Risk factors for not being screened included no prenatal care, Medicaid or no insurance, and delivery at a hospital lacking a written hepatitis B surface antigen policy. CONCLUSIONS: In Illinois, prenatal hepatitis B surface antigen screening rates were high and similar to those in other states. Births without screening or transferred information clustered in a few hospitals. The methods used here can economically identify underscreened populations by sampling a large number of hospitals within designated areas.

Cluster Analysis↗
PubMed1999

[Malignant pancreatic non-hodgkin's lymphoma manifesting as severe acute pancreatitis].

Primary non-Hodgkin's lymphoma of the pancreas is a rare disease. Its diagnosis is difficult without histological examination. In fact, clinical and imaging findings are not pathognomonic. Acute pancreatitis associated with pancreatic lymphoma is extremely rare. We have found only 7 case reports in literature. We report herein a new case of pancreatic lymphoma which was revealed by a severe pancreatitis.

Acute Disease↗
PubMed1999

Pharmacoeconomic evaluation of medical treatment of epilepsy: where do we stand?

Qualitative and quantitative improvements of pharmaco-economic evaluation of antiepileptic drugs have been realized during the last decade. Assessment of medical treatments is mainly performed through cost-minimization studies, owing to similar effectiveness of AED. Studies recently published generally consider hypothetical cohorts of patients and assess resource utilization and medical effects on the basis of clinical trials and expert panels, limiting evaluation to direct costs. But they differ in numerous ways due to: the type of patients and treatment considered, the time span of evaluation, and cost measurement. Comparison between studies is therefore tricky but it seems that, when considering monotherapy treatments, carbamazepine and phenytoin are somewhat cheaper than valproate while lamotrigine is much more expensive but no more effective. However, these and other antiepileptic agents appear as close substitutes when prescribed as adjunctive treatments. Refined tools have been developed to take into account slight differences exhibited on certain outcomes. One direction currently under evaluation relates to quality of life, and this will probably leads to an increasing number of cost-utility studies. Some advances, regarding information on medical resources consumed and outcomes associated with alternative drugs, as well as methodological options, are still needed to fully develop pharmacoeconomic evaluation of antiepileptic treatments.

Anticonvulsants↗
PubMed1998

Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment.

We have previously described impairments of cognitive executive functions in 17 patients with OSAS in comparison with 17 normal controls, as assessed by various frontal-lobe-related tests. In the present study, 10 of these OSAS patients treated with continuous positive airway pressure (CPAP) were reevaluated after 4-6 months of treatment. Neuropsychological tasks explored attention, short-term memory span, learning abilities, planning capacities, categorizing activities, and verbal fluency. Patients were found to have normalized most of their cognitive executive and learning disabilities, but all the short-term memory tests remained unchanged. These findings are discussed in light of the contribution of the frontal-lobe-related systems to short-term memory functions, and the eventual pathogenic role played by sleep fragmentation and nocturnal hypoxemia, which are related to the occurrence of apneic and hypopneic events. In conclusion, short-term memory impairment was persistent in OSAS patients despite CPAP treatment for 4-6 months.

Adult↗
PubMed1998

A cost-minimization of heart failure therapy with bisoprolol in the French setting: an analysis from CIBIS trial data. Cardiac Insufficiency Bisoprolol Study.

Beta-blocker-induced benefit in heart failure is under intense evaluation. Several large-scale mortality trials are currently being performed, with CIBIS II evaluating bisoprolol. The economic impact of beta-blocker therapy in heart failure has not been previously determined. The present study is a cost-effectiveness evaluation of bisoprolol treatment based on CIBIS I data. It considers direct costs, that is, the bisoprolol medication cost and the cost of hospitalization related to heart failure and its complications. Hospitalization costs were calculated from the French system of classification (PMSI), which provides costs according to homogeneous groups of patients (GHM). The cost difference between bisoprolol and placebo in the entire CIBIS population and the trial duration result from an increase in cost caused by bisoprolol treatment (+ 2018 Frs/patient) and a decrease in cost related to reduced hospitalization (6349 Frs/patient). A total savings per patient of about 4330 Frs was produced by bisoprolol. Cost reduction is still more pronounced in patients not having a history of myocardial infarction. We conclude that heart failure therapy with bisoprolol lowers medical healthcare costs, mainly due to the reduced rate of hospital admissions for heart failure.

Adrenergic beta-Antagonists↗