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Biomedical subjects

P Michaud

Publications and source records attributed to P Michaud.

At least 37 records · Page 2Linked to original sources
PubMed1999

Frequency and prognostic value of cardiac troponin I elevation after coronary stenting.

Mild myocardial injuries after coronary angioplasty are associated with adverse late outcomes. The incidence and prognostic value of this phenomenon when using cardiac troponin I (cTnI) after stent implantation is unknown. We studied cTnI and creatine kinase (CK) release in 109 patients after stenting. Clinical success was achieved in 103 patients (94%). In-hospital major adverse coronary events were: death in 1 patient, Q-wave myocardial infarction in 1 patient, and non-Q-wave myocardial infarction in 2 patients. Twenty-nine patients (27%) had postprocedural cTnI increase, 16 (15%) had CK elevation. No preprocedural variables predicted marker elevation. Marker release was related to the occurrence of in-lab complications (59% vs 29% [p = 0.004 for cTnI] and 69% vs 32% [p = 0.011 for CK]). In 34% no explanation was found for cTnI increase. Success was more frequent in patients without cTnI elevation (100% vs 86%, p <0.001). The negative predictive value of cTnI increase was 100% for in-hospital major adverse coronary events (MACE), whereas its positive predictive value was 14%. cTnI and CK concordant elevation was associated with more intra- and postprocedural adverse events. During a mean follow-up of 8+/-3 months, major adverse coronary events were: death in 2 patients, myocardial infarction in 2 patients, and repeat PTCA in 8 patients. cTnI elevation was not predictive of these late MACE. cTnI elevation is common after stenting, and is related to the occurrence of in-lab complications. Its isolated elevation is not a good predictor of MACE. Patients with concordant cTnI and CK elevation seem to be at higher risk of in-hospital MACE.

Adult↗
PubMed1999

Late results of percutaneous mitral commissurotomy in a series of 1024 patients. Analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors.

BACKGROUND: The optimal use of percutaneous mitral commissurotomy (PMC) in a wide range of patients requires accurate evaluation of late results and identification of their predictors. METHODS AND RESULTS: Late results of PMC were assessed in 1024 patients whose mean age was 49+/-14 years. Echocardiography showed that 141 patients (14%) had pliable valves and mild subvalvular disease, 569 (55%) had extensive subvalvular disease, and 314 (31%) had calcified valves. A single balloon was used in 26 patients, a double balloon in 390, and the Inoue Balloon in 608. Good immediate results were defined as valve area >/=1.5 cm2 without regurgitation >2/4 (Sellers' grade) and were obtained in 912 patients. Median duration of follow-up was 49 months. The 10-year actuarial rate of good functional results (survival with no cardiovascular death and no need for surgery or repeat dilatation and in New York Heart Association [NYHA] class I or II) was 56+/-4% in the entire population. Follow-up echocardiography was available in 90% of the patients who experienced poor functional results after good immediate results and showed restenosis in 97% of these. In multivariate analysis, the predictors of poor functional results were old age (P=0.0008), unfavorable valve anatomy (P=0.003), high NYHA class (P<0.0001), atrial fibrillation (P<0.0001), low valve area after PMC (P=0.001), high gradient after PMC (P<0.0001), and grade 2 mitral regurgitation after PMC (P=0.04). CONCLUSIONS: PMC can be performed with good late results in a variety of patient subsets. Prediction of late events is multifactorial. Knowledge of these predictors can improve patient selection and follow-up.

Adult↗
PubMed1999

Assessment of adolescent food habits in Switzerland.

Several physical, psychological and behavioural changes may affect food habits during adolescence and have long-term consequences on adult health status. Also, as food habits are related to lifestyle and physical activity, all should be assessed together. This paper describes a self-administered food frequency questionnaire (FFQ) designed to assess semi-quantitatively food habits of adolescents, and evaluates its use in a study of lifestyle and physical activity. A FFQ was developed, tested in 20 adolescents and compared with a modified version of the diet history method (a combination of a 3-day dietary record and an interview with a dietitian). This validated semi-quantitative questionnaire was later included in a larger questionnaire on lifestyle and physical activity in a study of 3540 adolescents aged 9-19 years. In the validation study with 20 adolescents, the FFQ showed a good agreement with the modified version of the diet history. During the survey several consumption frequencies were found to be low. In the group of adolescents aged 14-19 years old, dairy products were consumed daily by less than 50% of the sample. About 53% girls but only 33% boys consumed one fruit daily. For one vegetable portion, these proportions were 17 and 8%, respectively. The self-administered food frequency questionnaire correctly describes food consumption in adolescents. Moreover, it was well accepted by the target group, easily understood and completed with very few problems. The results show that a significant proportion of adolescents didn>>t consume milk, fruit and vegetable on a daily basis.

Adolescent↗
PubMed1999

Results of IIb/IIIa receptor blockade in patients with unstable angina.

The efficacy of GPIIb/IIIa inhibitors has now been evaluated in over 20 000 patients with unstable angina and non-Q MI. These agents have shown great efficacy in patients undergoing percutaneous coronary intervention. They are also effective, even if to a lesser degree, as an addition to medical treatment. The safety profile is satisfactory. Several issues have to be investigated in the future: comparison of agents, use of oral inhibitors, associations with Heparin, consequences on management, and cost efficacy. As of now, it is clear that GPIIb/IIIa inhibitors represent a significant progress in the treatment of patients with acute coronary syndromes.

Angina, Unstable↗
PubMed1999

Effects of cigarette smoking on short-term variability of blood pressure in smoking and non smoking healthy volunteers.

The present trial was planned to study the effects of smoking on short-term variability of blood pressure and on haemodynamic parameters after an overnight cessation and after one day of repeated smoking in healthy cigarette smoking volunteers, compared to a control group of non-smokers who were not asked to smoke. 40 healthy male volunteers, 20 smokers and 20 non-smokers, participated in an open study with two period of measurements over a single day (morning and afternoon). Blood pressure and heart rate were measured using standard and finger recordings over 6 min before and 10 min after smoking one cigarette (in smokers only). During the two periods, smokers were asked to smoke 4 cm of a cigarette containing 1 mg of nicotine in 2 min, and a blood sample was taken for a plasma nicotine assay. In the smoking group, smoking the first cigarette of the day caused a significant increase of systolic blood pressure (+7%), diastolic blood pressure (+10%) and heart rate (+25%). The blood pressure variability in the frequency range of the Mayer waves (66-129 mHz) was increased after an overnight cessation of smoking in the smoking group in comparison to the non-smokers, and decreased significantly after the first cigarette of the day (7.1 +/- 4.0 to 3.2 +/- 1.8 mmHg2; P < 0.01). The changes observed in the afternoon after continuous smoking were significantly less important (3.8 +/- 1.9 to 3.2 +/- 1.9 mmHg2; NS). In the non-smoking group, the different parameters remained stable between the different measurements. These results suggest that an overnight cessation of smoking in smoking subjects is associated with a increase in sympathetic activity to the vascular system in the morning, which is released by smoking the first cigarette. This effect of smoking is reduced in the afternoon after a continuous nicotinic impregnation.

Adult↗
PubMed1998

[Thyroid function in a population with an extra iodine intake].

BACKGROUND: After 20 years of iodine salt fortification, the prevalence of goiter has decreased significantly in the rural area of Pirque, central Chile. In this location, equipment has been installed that efficiently and economically adds 0.5 mg of elemental iodine per liter of water to render it potable. AIM: To study thyroid function and urinary iodine excretion in school age children of this zone, after two years of extra iodine intake. MATERIAL AND METHODS: One hundred thirty four children aged 6 to 12 years old were examined. In 56 randomly chosen children a morning urine sample was obtained to measure iodine excretion. In 45 children without goiter, a blood sample was drawn to measure TSH and thyroxin. RESULTS: In nine children (7%) a diffuse goiter was found. Median urinary iodine excretion was 158 micrograms/dl. Thyroxin and TSH levels were within normal limits (8.4 +/- 1.1 micrograms/dl and 2.2 +/- 1.5 microU/ml respectively). During the period of iodine water supplementation there were 47 births in the zone. All newborns had normal TSH values and none had goiter. CONCLUSIONS: When present results are compared with the period before water iodination (when the prevalence of goiter was 9.6% and mean urinary iodine excretion was 57.6 micrograms/dl), it can be concluded that extra iodine intake in this rural population has not caused additional thyroid problems.

Child↗
PubMed1998

[Diffuse sclerosing papillary thyroid carcinoma. Report of two cases].

Unlike classical papillary carcinoma, diffuse sclerosing papillary thyroid carcinoma presents as a diffuse goiter with a discretely irregular surface, associated to hypo or hyperthyroidism, specially in young women. We report two women aged 41 and 23 years old with this disease, one with normal thyroid function and the other with hyperthyroidism. It is concluded that diffuse sclerosing papillary thyroid carcinoma must be suspected in patients with rapidly growing goiter with irregular surface or diffuse minute calcifications, specially in the presence of hypo or hyperthyroidism. Fine needle aspiration is a good diagnostic procedure.

Adult↗
PubMed1998

[Consensus proposal on the use of 131I in the treatment of thyrotoxicosis and thyroid cancer].

A consensus meeting held by the Chilean Endocrinological Society reached to 22 consensus proposals on the use of iodine-131 in hyperthyroidism and thyroid cancer, that are reported in this paper. Some of these propositions are: 1) Hyperthyroidism: A previous 131I uptake test must be performed. A calculated or an ablative dose should be administered. Hypothyroidism must be considered an objective rather than a complication. In patients with cardiovascular risk, normal thyroid function must be attained with prophythioturacil. In cases of treatment failure, the dose should not be repeated before six months. It must be used with used with caution in children and teenagers. 2) Thyroid cancer: A iodine free diet is recommended prior to the therapeutic dose. A 100 mCi complementary ablative dose should be given after surgery, with a posterior exploration. This examination must not be done routinely, and if required, a 5 mCi dose should be used. For the treatment of metastases, a dose of 150 to 200 mCi is recommended. There is no radiation risk in hyperthyroidism or thyroid cancer. The only absolute contraindication is pregnancy. Recommendations for radiological protection are formulated. Hospitalization is suggested to protect other people from radiation exposure.

Humans↗
PubMed1997

Falsified or forged medical prescriptions as an indicator of pharmacodependence: a pilot study. Community pharmacists of the Midi-Pyrénées.

OBJECTIVE: While data on drug abuse liability have been determined for selected drugs in experimental studies, there is limited information available about drug abuse in real life. This study presents the results of a simple experimental epidemiologic survey of prescription forgeries in community pharmacies in the Midi-Pyrénées area (southwest France). During four periods (September-October 1991, January-June 1992, September-October 1992 and January-June 1993), resident pharmacy students in several volunteer pharmacies were asked to complete a specific report form for each suspect prescription request. The main criteria used to identify forgeries were: inadequate dosage, multiple use of the prescription form, drafting not in accordance with the rules of prescription or false prescription forms (stolen prescription forms, photocopies). RESULTS: A total of 165 falsified prescriptions were collected. The 305 drugs involved in these forged prescriptions were opiate analgesics, benzodiazepines, amphetamines and minor opiate analgesics. Medications were essentially buprenorphine, flunitrazepam (in 2 mg dosage), phenobarbitone+amphetamine and chlorazepate. CONCLUSION: These results suggest that forged prescriptions can be used as an indicator of potential abuse liability of marketed psychoactive drugs. Although this survey cannot describe the real prevalence of the misuse or abuse of drugs, it constitutes a useful warning epidemiologic system to elicit early observations regarding new misuses of drugs as they are requested at the pharmacy.

Drug Prescriptions↗
PubMed1997

Identification of glucuronan lyase from a mutant strain of Rhizobium meliloti.

The Rhizobium meliloti M5N1CS (NCIMB 40472) mutant strain wich induces nodule formation on alfalfa roots, produces a (1 --> 4)-beta-D-glucuronan partially acetylated. During fermentation under specific conditions, the molecular weight of the polymer decrease, the presence of polysaccharide degrading enzyme was suspected. A glucuronan lyase was identified, this new bacterial lyase produces d.p. 4 oligoglucuronans, substituents (acetates) present on the substrate reduced the enzyme activity.

Acetylation↗
PubMed1996

[Prevalence of goiter in school-age children in the Pirque Zone. Effects of salt iodination].

BACKGROUND: Twenty years ago, Pirque was a zone with a goiter prevalence of 39%. AIM: To assess the effects of salt iodination on the prevalence of goiter in school-age children of this zone. SUBJECTS AND METHODS: School age children from four public schools in Pirque were examined, following WHO criteria for the diagnosis of goiter. Urinary iodine excretion was also measured. RESULTS: Five hundred ninety one males and 298 females aged 12.1 +/- 2.5 years were examined. Fifty seven children (9.6%) bad goiter. In 53 the goiter was grade I and in 4, grade II. No sex differences were observed. Minimal and median urinary iodine excretion values were 12.6 and 57.6 micrograms/dl respectively. CONCLUSIONS: Goiter prevalence dropped from 39 to 10%. The fact that iodine intake is over minimal recommendations, underscores the effectiveness of salt iodination.

Adolescent↗
PubMed1996

[Diffuse fatty infiltration of the thyroid gland associated to amyloidosis in a patient with chronic renal failure].

We report a 26 years old male with secondary amyloidosis and chronic renal failure who consulted due to a rapidly growing goiter associated with coarseness and dysphagia. Serum levels of thyroid hormones and TSH were normal and a neck CT scan showed a big mass in the anterior and lateral regions, that compressed neighboring structures. The patient was subjected to a total thyroidectomy and the pathological study revealed a diffuse fatty and amyloid infiltration of the thyroid gland. There was no evidence of malignancy.

Adipose Tissue↗
PubMed1995

Effects of salts on production and on O-acetylation of glucuronan excreted by the Rhizobium meliloti M5N1 CS strain.

Acetylation determined by 1H-nuclear magnetic resonance spectroscopy and production of the glucuronan excreted by the Rhizobium meliloti M5N1CS strain during cultivation in RCS medium with and without added magnesium salts have been studied. These salts induce an increase in the degree of substitution and the molar ratio of 2,3-di-O-acetyl residues. A decrease in production is observed after 75 h of fermentation as the magnesium salt concentration increases. The presence of manganese and sodium salts in the culture induces inhibition of exopolysaccharide (EPS) production. However, the structure of the EPS is similar to that of the EPS produced by standard fermentation, without modification in the degree of substitution.

Acetylation↗
PubMed1995

Cyclic (1-->2)-beta-D-glucans excreted by the glucuronan-producing strain Rhizobium meliloti M5N1CS (NCIMB 40472) and by the succinoglycan-producing strain Rhizobium meliloti M5N1.

During fermentation, the mutant strain Rhizobium meliloti M5N1CS, which induces nodule formation on alfalfa roots, produces a partially acetylated (1-->4)-beta-D-glucuronan. In addition to this exopolysaccharide of high molecular weight, the mutant strain produces oligoglucoronates and cyclic (1-->2)-beta-D-glucans with degrees of polymerization from 17 to 30. Under the conditions applied, magnesium has no effect on cyclic glucan production by the mutant strain, but the succinoglycan production by the wild-type strain Rhizobium meliloti M5N1 increases.

Acetylation↗
PubMed1995

Surgical treatment of infective endocarditis.

Optimal timing of surgery in infective endocarditis (IE) depends mainly on the haemodynamic tolerance of the patient. Emergency surgery is required in cases of refractory heart failure due to valvular lesions, intracardiac fistulas and high grade cardiac conduction abnormalities caused by septal abscesses. Surgery must be considered in all patients who have undergone a transient episode of heart failure such as a pulmonary oedema and it must be early--within 2 or 3 weeks of starting antibiotic therapy in patients with aortic regurgitation. Bacteriological indications are less frequent: persistent sepsis beyond the first week in spite of medical therapy, mycotic IE or prosthetic valve endocarditis caused by Gram-negative or staphylococcal organisms. Some complications may swing the argument in favour of surgery: detection of root abscesses or mycotic aneurysms using transoesophageal echocardiography, and systemic embolisms with persistent, large and mobile vegetative lesions. Mortality rate depends on the haemodynamic status but also on the severity of anatomical lesions, on the type of endocarditis (native or prosthetic valve), on the type of surgery and on bacterial aetiologies. It varies between 5% and 30%. The late postoperative outcome is good. The actuarial survival rate at 8 years was 70% in our series of 31 patients with aortic regurgitation and early surgery. In mitral regurgitation, conservative surgery is possible in most cases. In our department, 48 patients with mitral bacterial lesions have been operated on with conservative surgery without operative mortality. IE was active in 14, recent in 12 and had occurred earlier in 22.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocarditis, Bacterial↗
PubMed1995

Negotiated and nonnegotiated nurse-patient interactions: enhancing perceptions of empowerment.

Ninety-eight students with upper respiratory symptoms participated in a study to determine differences in patient perceptions of two types of nurse-patient interactive styles. Subjects participated in either an actively negotiated process of decision making (n = 53) or a nonnegotiated approach (n = 45) with a nurse. Findings revealed that subjects in the negotiated group perceived significantly greater feelings of control and power in the nurse-patient relationship than did the nonnegotiated group. No significant correlations were found between motivation and patient perceptions of the interaction. Study results demonstrate that nurses can engage in an active negotiation process with patients and strongly influence feelings of control in decision making.

Adolescent↗