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Biomedical subjects

R Dumas

Publications and source records attributed to R Dumas.

At least 235 records · Page 13Linked to original sources
PubMed1989

[Cerebral vascular complications in the population of Dijon. Incidence-breakdown-mortality].

Since 1985, a stroke registry has registered every stroke in this town, of about 140,000 inhabitants. A CT Scan and numerous sources of information have allowed to achieve an exhaustive survey. The annual incidence of stroke has been 145/100,000. The annual specific incidence for age is 170/100,000 in men, 126/100,000 in women. The annual specific incidence for age and sex has shown a female preponderance until 30 and a male preponderance after this age. At 80, the rates became equal. Sixty-eight per cent of stroke were due to an infarct, 12 p. 100 to lacunae, 5 p. 100 to subarachnoid hemorrhage and 15% to cerebral hemorrhage. A preponderance of young people was found in subarachnoid hemorrhage, of the fifth decade in cerebral hemorrhage, while infarct rose up with age in the 2 sexes. Infarcts appeared predominantly during winter, while transient ischemic attacks appeared more often during summer. Cerebral hemorrhage had a constant incidence over the year. Mortality was high, mainly during the first month with 12.5 p. 100 during the first week, 21.5 p. 100 during the first month, and 30 p. 100 the first year. Our results appear to set in the mean of white occidental countries as opposed to Japan. They emphasize the important and underestimated place of lacunae and the seasonal variations of several causal varieties of stroke.

Age Factors↗
PubMed1989

[Interobserver and intercenter agreement of gastro-esophageal endoscopic signs in cirrhosis. Results of a prospective multicenter study].

Because of the diagnostic and prognostic value of gastroesophageal endoscopic signs in cirrhosis, we studied their interobserver and intercenter agreement. Fifty cirrhotic patients without previous digestive bleeding were included in this study. The gastroesophageal endoscopic examinations of these patients, recorded on video tape, were independently viewed by 12 observers belonging to different hospitals. Agreement was evaluated by the kappa index (k), the values of which were given with p less than 0.001. Agreement was good for the presence (k = 0.40) or the size (k = 0.51) of esophageal varices as well as for red signs on the mucosa overlying esophageal varices, but it was poor for the color (k = 0.10) or the extent (k = 0.20) of esophageal varices. Agreement was poor for all gastric signs: fundic varices (k = 0.35), red spots (k = 0.28), associated lesions (k = 0.27), mosaic pattern (k = 0.27), gastropathy (k = 0.11). The mean diameter of esophageal varices, evaluated without any scale, varied from 3.5 +/- 1.4 to 7.5 +/- 4.0 mm between the 12 observers (p less than 0.001). Agreement was maximum for the more developed grade of a sign and minimum for the intermediate grade. The value of kappa indexes in this intercenter study was compared to that obtained in a previous study from one institution: interobserver agreement was significantly better within one center than between different centers. In conclusion, intercenter agreement is good for the size of esophageal varices and the presence of red signs, and poor for all the other signs. The millemetric measurement of esophageal varices diameter, without any scale, appears to be unreliable.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal and Gastric Varices↗
PubMed1989

[Dermatomyositis in children].

Dermatomyositis in childhood is an uncommon disease, affecting muscle and skin. The disease usually has an insidious onset; the proximal muscle groups are classically more affected than the distal group. If left untreated, the disease will either spontaneously arrest or will progress until the child is completely bedridden, with death secondary to hypoventilation and aspiration. For a definitive diagnosis 3 or 4 of the following criteria (plus rash) are required: 1) symmetrical limb girdle weakness; 2) muscle biopsy evidence of myositis and muscle necrosis; 3) elevation of muscle enzymes; 4) electromyographic changes of myositis. The main pathologic feature of juvenile dermatomyositis is vasculitis affecting small arteries and veins of muscle, skin and gastrointestinal tract. Whether muscle from patients with polymyositis contains a specific auto antigen or is contaminated with an immunogenic infectious agent such as a virus (coxsackie virus, for instance) remains unclear. Childhood dermatomyositis is almost uniformly responsive to steroid treatment; there is a good chance of remission with minimal risk of secondary complications with an initial low dosage of prednisone (1 mg/kg/day). The use of additional drugs such as azathioprine, methotrexate or cyclophosphamide is reserved for patients who are either not completely responsive to steroids or difficult to wean off steroids. Cyclosporine A has been proposed to achieve a reduction in steroid dosage.

Child↗
PubMed1989

[Urinary calculi in children. Etiologic survey].

Thirty-three children with urinary calculi were studied. In 12, a metabolic cause of calculi was identified (4 hyperoxaluria, 6 hypercalciuria, 2 cystinuria). In 14 children, lithiasis was associated with a urinary tract infection. No identifiable cause could be found in 7 children. A protocol for metabolic evaluation is proposed.

Adolescent↗
PubMed1988

Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant.

The authors report the case of a 2-year-old infant who presented with paroxysm and short changes characterized by acute drowsiness, cold sweats, ocular reversion, facial cyanosis, and bradycardia. Between these attacks, the condition was normal, suggesting diencephalic seizures. Over 2 months five fits were observed by the parents when some to-and-fro bobbing of the head onto the trunk appeared during drowsiness. One electroencephalogram was normal without a slow background or spikes discharges. As the skull radiographs showed erosion of the jugum and chronic intracranial hypertension features, a CT scan was performed and showed hydrocephalus associated with a congenital suprasellar cyst. The cyst was opened into basal cisterns with cystoperitoneal shunt. The histological examination revealed that it was an arachnoid cyst. Six months later, the infant was free of diencephalic seizures and head bobbing. Thus, we can assert that there was a direct relationship between this cyst and the diencephalic seizures. From this case, the authors make a review of the clinical features of diencephalic epilepsy, and their different causes and show that both diencephalic epilepsy and suprasellar arachnoid cysts are not common.

Child, Preschool↗
PubMed1988

[Treatment of status epilepticus by sodium valproate].

The authors studied the action of valproate with single loading dose of 25 mg/kg, by oral or rectal way, in the treatment of a status epilepticus occurring in 22 patients: 12 patients with generalized status epilepticus, 2 patients with myoclonic status, 2 patients with absence status and 6 patients with motor partial status. In 8 cases, an EEG was performed during the treatment. Results were satisfactory: the status was controlled in 16 cases (73%) in a mean time of 19 min. Plasma levels of valproate approached 55 mg/l at the 20th min after the loading dose. In 6 cases (27%), the status was not controlled, with a plasma level of 33 mg/l at the 20th min. No side effect was observed. This work shows that, for the treatment of status epilepticus, a loading dose of valproate by oral or rectal way is therapeutically equivalent to diazepam and clobazam.

Administration, Oral↗
PubMed1988

Congenital adrenal hyperplasia associated with hyperphosphatemic rickets.

The authors describe a boy with precocious puberty due to adrenal hyperplasia associated with rickets, hypocalcemia, hyperphosphatemia, elevated PTH and alkaline phosphatase levels, and concentrations of 25-OH-D and 1,25-(OH)2D at the upper limit or above normal range. Treatment with hydrocortisone for 9 months did not normalize hypocalcemia and hyperphosphatemia. The addition of 1,25-(OH)2D3 (0.5-2 micrograms/day) to the corticoid treatment for 1 year was followed by a progressive normalization of plasma calcium, phosphorus, PTH and alkaline phosphatase concentrations with improvement of the osteomalacia on bone biopsy.

Adrenal Hyperplasia, Congenital↗
PubMed1988

[Congenital heart diseases and urinary malformations].

The purpose of this study was to evaluate the advisability of a systematic search for uropathy in patients with malformative heart disease. Thirty-three cases of urinary tract malformation associated with congenital cardiopathy are reported. These cases represent 2.8 p. 100 of all cardiac patients seen during the same period. The congenital heart diseases were varied, with a predominance of ventricular septal defect (48 p. 100) followed by dextrocardia, single ventricle and coarctation of the aorta. UT abnormalities included vesico-ureteral reflux (36 p. 100), renal agenesis (5 cases), renal dysplasia or hypoplasia (4 cases), upper UT obstruction (4 cases), hypospadias (3 cases), renal ectopia (3 cases), lower UT obstruction (2 cases), polycystic kidney, megaloureter, horseshoe kidney and supernumerary kidney (1 case each). A study of the literature showed that the two uropathies with a risk of associated cardiopathy are renal agenesis and horseshoe kidney. The cardiopathy-uropathy association was found in isolation (11 cases) or combined with cryptorchidism (2 cases) or with multiple malformations (20 cases). The malformations were diverse, the most frequent being neurosensorial malformations (70 p. 100), followed by skeletal malformations (55 p. 100) equally divided between apine and limbs, genital malformations (35 p. 100) and digestive tract malformations (25 p. 100). A study of the cardiopathy-uropathy concordances failed to elicit any predominant association; in the literature, ventricular septal defect is usually associated with horseshoe kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1988

[Cardio-respiratory anomalies in disseminated sclerosis].

A case of acute pulmonary edema without cardiac failure, infectious or toxic cause, revealing a Multiple Sclerosis (M.S.), one case of bradycardia during a bout in a known M.S. and one case of orthostatic hypotension without change of cardiac frequency, during a bout of a known M.S. are reported. The common point of these 3 cases is that during their autonomic failure, there were disorders pointing to the medulla oblongata: swallowing difficulties, rotatory nystagmus, vestibulo-cerebellar syndrome, sensory and motor defect of upper limbs. A plaque of M.S. in the medulla oblongata, particularly near the tractus solitarius could explain these cardio-pulmonary abnormalities unusual in M.S.

Adult↗
PubMed1988

[Incidence of cerebrovascular accidents in a medium-sized French town].

Beginning in 1985, the Dijon Stroke Registry has identified every case of stroke occurring in this city of 140,000 inhabitants. The systematic use of a CT scan and multiple other sources of information ranging from hospital doctors to general practitioners make it possible for us to have virtually exhaustive data on stroke incidence. The gross incidence was 170 per 100,000 among men and 126 per 100,000 among women. Specific incidence by age and sex shows female predominance up to 30 years of age, and male predominance among victims from 30 to 80 years old. Beyond 80, rates were identical for both sexes. In 68% of the cases, the strokes were caused by infarct; in 12%, by lacunae; in 15%, by cerebral hemorrhage; in 5%, by subarachnoid hemorrhage. Significant differences existed in this distribution according to age, with a clear predominance of young people among those having subarachnoid hemorrhage, while, for those over 40, cerebral hemorrhages were frequent; the proportion of infarct increased with age for both sexes. A peak of incidence for infarct appeared during winter, while transient ischemic accident was more frequent in summer. Cerebral hemorrhage had a similar incidence throughout the year. Mortality was high during the first month (12.5% during the first week, 21.5% during the first month), and reached 30% during the first year. These results are comparable to those generally observed among white occidental populations. They confirm the limited incidence of hemorrhages (contrary to what has been observed in Japan), emphasize the important and often underestimated role of lacunar syndromes, and the seasonal variations specific to each mechanism.

Adolescent↗
PubMed1988

[Parkinsonian syndrome caused by traumatic hematomas in the basal ganglia].

A 61 year old man, without neurological history, has a coma after a facial concussion. While the consciousness is improving, parkinsonism feature is observed with tremor at rest, rigidity and bradykinesia. From the radiological point of view, hematoma of right and left basal ganglia is observed on C.T. Scan performed 6 hours after cranial trauma. The authors study the role of these 2 hematomas in genesis of parkinsonism through literature data and they bring a mean piece in pathophysiology of parkinsonism reported in boxers.

Basal Ganglia Diseases↗