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R Lebeau

Publications and source records attributed to R Lebeau.

At least 19 recordsLinked to original sources
PubMed2006

[Acute intestinal intussusceptions in adults: analysis of 20 cases].

AIM OF THE STUDY: To report our experience in the management of acute intestinal intussusceptions in adults. PATIENTS AND METHODS: Retrospective study of data of patients older than 15 years who were operated on for acute intestinal intussusceptions from January 1997 to December 2001. RESULTS: Twelve of the patients were males and eight females with an average age of 41 years (range: 16-71). The clinical and radiological findings were suggestive of bowel obstruction (N = 14), peritonitis (N = 5) and appendicular abscess (N = 1). Correct preoperative diagnosis of acute intestinal intussusceptions was established in 6 cases. Type of intussusception was jejunojejunal (N = 1), ileo-ileal (N = 8), ileocolic (N = 1), ileocecocolic (N = 7) and colocolic (N = 3). Necrosis was found in the intussusceptum in 10 cases and a tumor on the lead point in 14 cases (5 benign lesions and 9 malignant ones). For intussusception involving the colon, all patients underwent en bloc resection with immediate anastomosis, while intussusception located on the small bowel were treated by surgical reduction (N = 1), en bloc resection (N = 8) with immediate (N = 7) or delayed (N = 1) anastomosis. The mortality rate was 15%. CONCLUSION: In our experience, intussusceptions in adults is not an uncommon clinical entity but correct diagnosis is often established peroperatively. En bloc resection is recommended because of the frequency of neoplasms and bowel ischemia.

Acute Disease↗
PubMed2006

[Rectal and colonic injuries induced by enemas: a 10-case series at the university hospital center in Bouake, Ivory Coast].

The purpose of this study is to report our experience in the management of rectal and colonic injuries induced by enemas. A retrospective analysis was carried out in a series of 10 patients treated at the Bouake, Ivory Coast University Hospital Centre for rectal and colonic injuries induced by enemas between January 1, 1997 and December 31, 2001. There were 6 men and 4 women with a mean age of 26.2 +/- 5.6 years. Based on history taking five enemas involved criminal intent. The other five were carried out for abortion (n=3), therapy (n=1) or autolysis (n=1). The injurious product was known in 7 cases, i.e., sulphuric acid (n=4) and hot pepper (n=3). The mean quantity administered was 158 +/- 64 ml. The presenting picture involved diffuse acute peritonitis in 7 cases and abdominal pain with bloody mucoid rectal discharge in 3. One patient died at the time of admission. The remaining patients underwent either operative (n=6) or medical (n=3) treatment. Prognosis was unfavourable. Four patients died and one patient required colostomy that could not be removed due to sclerosis of the anal sphincter. Management of rectal and colonic injuries induced by enemas requires differential diagnosis to distinguish patients that require emergency laparotomy from patients that can be treated medically. For patients treated medically, close surveillance based on imaging and repeated clinical examination is of paramount importance to allow diagnosis of complications requiring surgical treatment.

Abdominal Pain↗
PubMed2006

[Acute peritoneal tuberculosis in HIV-infected patients. Study of 4 cases in Abidjan, Côte-d'Ivoire].

This paper presents 4 cases of histologically verified peritoneal tuberculosis in HIV-infected patients followed in a 18 month-period. The patients were admitted in emergency and were suspected of present acute appendiceal peritonitis. There were 3 females of 18, 22 and 27 years old, and a 41-year-old male. The main symptoms were acute abdominal pain (4 cases), fever superior to 38 degrees C (4 cases) and abdominal defence (4 cases). Laboratory findings were hyperleucocytosis with lymphocytic predominance, anemia and CD4+ rate variable from 250 to 460/mm3. They underwent emergency laparotomy which led to diagnosis of peritoneal tuberculosis by histopathological analysis of peritoneal biopsies. Two patients died from surgery at days 3rd and 10th. The 2 remaining patients were successfully treated by tuberculostatic tritherapy with rifampicin, isoniazid, and pirazinamid. Acute peritoneal tuberculosis in HIV-infected patients is not to be missed in our practice. It must be considered in differential diagnosis of acute abdomens.

Acute Disease↗
PubMed2005

[Appendicitis and pregnancy: 21 cases].

OBJECTIVE: Describe the epidemiological, diagnostic and therapeutic features of acute appendicitis in pregnant women. MATERIAL AND METHODS: Retrospective analysis of a series of 21 cases of appendicitis in pregnant women who underwent surgery between January 1997 and June 2001. RESULTS: The association of acute appendicitis with pregnancy was noted in 0.2% of the pregnant women. Ten patients were in the first trimester of pregnancy, ten in the second and one in the third. Abdominal pain was noted in all patients. The localization varied with gestational age. Abdominal ultrasound contributed to the diagnosis in twenty patients who underwent the examination. Diagnoses retained were: acute uncomplicated appendicitis (n=18), acute appendicitis with focal induration (n=1) and acute diffuse peritonitis (n=2). Appendectomy was performed in all cases. Intensive care, peritoneal cleaning and drainage were associated in cases with appendicitis. In cases with focal induration, medical treatment was followed by appendectomy performed after delivery. Tocolysis was instituted in all cases. Twelve pregnancies continued to delivery: one fetal death, one premature delivery and ten term deliveries of live infants. CONCLUSION: Pregnancy makes it difficult to confirm the diagnosis of appendicitis. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.

Acute Disease↗
PubMed2005

Physicians' attitudes to the pharmacological treatment of patients with stable angina pectoris.

BACKGROUND: Little is known about how physicians' knowledge of and attitudes to practice guidelines for stable angina may influence their implementation. AIM: To explore the association between physicians' demographics, their knowledge, and opinions about stable angina and their self-reported adherence to guideline recommendations. DESIGN: Questionnaire-based survey. METHODS: We surveyed 1228 Quebec physicians using a questionnaire based on the 'awareness-to-adherence' conceptual framework to measure their adherence with recommendations for the pharmacological treatment of stable angina. Independent predictors of adherence with the targeted recommendations were determined by stepwise linear regression analysis. RESULTS: We received 877 (71.4%) responses from the 1228 eligible physicians. More than 90% of respondents were aware of and agreed with the targeted recommendations. However, the adoption rate varied, even among physicians who generally agreed with the guidelines. Factor analysis indicated that most physicians agreed with recommendations concerning ASA. More negative attitudes were expressed toward beta-blockers and hypolipaemic drugs. Respondents trusted the recommendations of a variety of scientific and professional organizations. Awareness, agreement, and adoption were the strongest predictors of adherence for the three recommendations. Physician demographics and practice characteristics did not predict adherence. DISCUSSION: Physicians were aware of and agreed with the recommendations, so additional large-scale dissemination of the guidelines would be unlikely to improve prescription patterns. However, negative attitudes about beta-blockers and hypolipaemic therapy affected adherence to recommendations for these drugs. Continuing medical education interventions involving local opinion leaders might address some of the obstacles identified.

Adrenergic beta-Antagonists↗
PubMed2004

Drug treatment of stable angina pectoris and mass dissemination of therapeutic guidelines: a randomized controlled trial.

BACKGROUND: Public agencies responsible for implementing health care policies often adapt and disseminate clinical practice guidelines, but the effectiveness of mass dissemination of guidelines is unknown. AIM: To study the effects of guideline dissemination on physicians' prescribing practices for the treatment of stable angina pectoris. DESIGN: Randomized controlled trial. METHODS: A sample of 3293 Quebec physicians were randomly assigned to receive a one-page summary of clinical practice guidelines on the treatment of stable angina (in February 1999), to receive the summary and a reminder (in February and March 1999, respectively), or to receive no intervention (controls). The prescribing profiles of participants, as well as sociodemographic characteristics of the physicians and their patients, were examined for June-December 1999. RESULTS: The intervention had no effect on prescription rates of beta-blockers, antiplatelet agents, or hypolipaemic drugs. Compared to 1997 data for the same physicians, there was an overall 10% increase in appropriate prescription rates, irrespective of the intervention. DISCUSSION: In-house production and dissemination of clinical practice guidelines may not improve physicians' practice patterns if there is pre-existing substantial scientific consensus on the issue.

Adrenergic beta-Antagonists↗
PubMed2001

Loyalty to the regular care provider: patients' and physicians' views.

BACKGROUND: Changes in the organization of primary care practices are likely to have repercussions on the manner in which patients and physicians perceive loyalty to a regular source of care. A better understanding of their views will contribute to conceptual reflections on this poorly documented topic and, where needed, will reinforce efforts to adapt services to patient expectations. OBJECTIVES: The aims of this study are to document and compare the views that patients and GPs have of loyalty to the regular care provider. METHODS: This exploratory study uses the focus group technique. In 1997, we set up three groups of patients and three groups of physicians practising in Montreal. A total of 23 patients and 14 physicians participated in the study. The meetings investigated the participants' points of view on various aspects of the notion of loyalty. Analysis was based on transcripts of the meetings. The emerging themes were identified and the viewpoints were coded independently and then revised (when necessary) in order to obtain a consensus. RESULTS: Patients and physicians have a relatively congruent vision of the notion of loyalty. This tendency to use the regular source of care over time appears to be rooted in a formal or informal contract between patients and their physicians and implies a sustained partnership and a strong interpersonal relationship. The relationship established is neither exclusive nor permanent. Patients periodically reconsider it by evaluating their physician's technical and interpersonal skills. CONCLUSIONS: This study highlights the dynamic and multidimensional nature of the notion of loyalty. It shows that patients clearly identify with a particular physician rather than a clinic. The results challenge the prevailing methods of assessing longitudinality of care.

Adult↗
PubMed2001

Are patients suffering from stable angina receiving optimal medical treatment?

There is good evidence for the use of antiplatelet, beta-blocker and lipid-lowering drugs in the treatment of ischaemic heart disease, but few data on how these medications are used in treating stable angina pectoris. We examined prescription profiles for a sample of patients aged > or =65 years with stable angina, to compare the profiles to local guidelines and to explore the determinants of these profiles, in a cross-sectional study. We identified 11 141 individuals from the Quebec provincial out-patient pharmaceutical database for the period 1 June 1996 to 31 May 1997, and examined the percentage of these patients with and without associated co-morbidities receiving antiplatelet, beta-blocker and lipid-lowering medications. We used hierarchical modelling to examine the role of patient and physician characteristics in explaining the variation in the use of these medications. Calcium-channel blockers were the class of anti-ischaemic drugs most prescribed (63%). Beta-blockers were prescribed in 52.1% of patients. Antiplatelet and lipid-lowering drugs were prescribed to 56.8% and 32.6%, respectively. Increasing age and female gender made patients less likely to be prescribed these treatments. General practitioners were less likely than cardiologists to prescribe beta-blockers and lipid-lowering drugs (OR 0.79, CI 95% 0.68-0.91 and OR 0.77, CI 95% 0.66-0.91, respectively). There is a general under-use of antiplatelet, beta-blocker and lipid-lowering medications in the treatment of stable angina pectoris patients, possibly leading to adverse patient outcomes.

Adrenergic beta-Antagonists↗
PubMed1998

Effects of procainamide on the excitable gap composition in common human atrial flutter.

The composition of the excitable gap (EG) in common atrial flutter (AF1) was determined before and during infusion of procainamide (PA) in 9 patients (6 men and 3 women; age 70 +/- 7 years). The EG was determined by introducing a premature stimulus after every 20th AF1 complex detected using a quadripolar electrode catheter placed just above the tricuspid valve. Diastole was scanned in 2- to 4-ms decrements to the atrial effective refractory period (ERP). The relationship between the coupling interval and the return cycle length (CL) determined a reset-response curve (RRC), which described the EG. PA (15 mg/kg) was administered during AF1 over 30 minutes and RRC was repeated at maximum AF1 CL. PA prolonged AF1 CL from 227 +/- 29 to 296 +/- 62 ms (P < 0.01) but did not terminate AF1. ERP during AF1 prolonged from 169 +/- 24 to 219 +/- 41 ms (P < 0.01). Control EG was 57 +/- 16 ms or 25% +/- 6% of AF1 CL and on PA EG was 77 +/- 30 ms (P = 0.01), which was still 26% +/- 7% of the CL. Without drug, RRC was mixed in eight cases demonstrating an EG composed of fully excitable tissue (10 +/- 4 ms or 19% +/- 10% of the EG) and partially refractory tissue (48 +/- 18 ms). PA did not change the duration of the fully excitable region (13 +/- 10 ms or 19% +/- 15% of EG). Peak PA plasma concentration was 47 +/- 20 mumol/L. PA prolonged AF1 CL, ERP, and EG duration but did not change the proportion of AF1 CL occupied by the EG. The persistance of fully excitable tissue at the head of the wavefront in the presence of PA may largely explain its inefficacy in the acute termination of common AF1.

Aged↗
PubMed1998

Mitral valve repair: Intermediate to long-term echocardiographic follow-up.

OBJECTIVE: To review intermediate to long term echocardiographic follow-up after mitral valve repair for mitral regurgitation. DESIGN: Nonrandomized, retrospective and prospective observational study. SETTING: Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec. PATIENTS: Echocardiographic findings in 37 patients (mean age 62.1 +/- 10 years) three to 197 months (median 45) after mitral valve repair were reviewed. INTERVENTIONS: Preoperative data were collated from hospital records. Between October 1994 and March 1995, all patients had a clinical evaluation and a complete transthoracic echocardiogram done by a cardiologist. RESULT: There was a significant reduction in the dimensions of the left-sided cavities compared with preoperative data. Left atrial diameter decreased from from 50.9 +/- 7.7 to 46.3 +/- 8.1 mm (P = 0.01), left ventricular end-diastolic diameter from 59.6 +/- 7.1 to 51.2 +/- 6.3 mm (P < 0.001) and left ventricular end-systolic diameter from 35.3 +/- 7.9 to 32.8 +/- 7.8 mm (P = 0.07). On colour Doppler echocardiography, nine patients had no mitral regurgitation, 25 had mitral regurgitation grade I to II/IV, and three had grade III/IV. The mean mitral valve gradient was 4.2 +/- 1.8 mmHg and the pressure half-time 121.9 +/- 48 ms. There was no difference in gradient, mitral valve area and mitral regurgitation in patients with degenerative (29) compared with rheumatic (five) mitral valve disease. CONCLUSIONS: Mitral valve repair is highly effective in reducing mitral regurgitation in the long term and is associated with a reduction in the dimensions of the left atrium and the left ventricle. However, it leaves a mild degree of mitral valve obstruction.

Aged↗
PubMed1994

Effects of trandolapril on the sympathetic tone and reactivity in systemic hypertension.

Hemodynamic and autonomic evaluations were carried out after 2-3 weeks of treatment with placebo and at the end of 4 weeks of treatment with an angiotensin converting enzyme (ACE) inhibitor, trandolapril, 2 mg/day in 18 hypertensive patients (average age, 48 +/- 2 years) of either sex. This treatment lowered the mean arterial pressure in the whole group from 112 to 105 mm Hg (p < 0.05) without significant changes in basal heart rate or norepinephrine (NE) and epinephrine plasma levels. Based on daytime ambulatory blood pressure monitoring, the patients were separated into 2 equal groups of 9 patients: the better responders (R), with an average decrease in mean arterial pressure of 12 mm Hg, and the lesser responders (NR), with an average fall of mean arterial pressure of 2 mm Hg. Before treatment, the R group had a higher resting heart rate, a lower cardiac output (-16%), and a higher peripheral resistance (+22%) than the NR group (difference not significant). Moreover, the R group was also observed to have a 33% higher plasma NE level (p < 0.05) in the supine position, associated with a 52% higher NE response to standing (p < 0.05), and a 40% lower number of beta-adrenergic receptors on lymphocytes, suggesting a higher sympathetic tone and reactivity in that group. Following treatment with the ACE inhibitor, heart rate and plasma NE levels were not altered significantly in either group, suggesting a blunting of the baroreflex response concomitant with the lowered blood pressure, especially in the R group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Traumatic tricuspid insufficiency with a right-to-left shunt and heart luxation].

Traumatic tricuspid insufficiency (TTI) with a right-to-left shunt through a patent foramen ovale associated with a cardiac herniation was identified in a 39-year-old man with severe hypoxemia. All reported cases of TTI with a right-to-left shunt are reviewed, the technical aspects of repair described and the physiologic mechanisms discussed.

Adult↗
PubMed1992

[Heart-skin syndrome and cardiac myxoma: presentation of a case and clinical experience of 17 years].

Between 1971 and 1988, cardiac myxoma was identified in 13 (0.003%) of 4000 patients who underwent open-heart surgery at the hôpital du Sacré-Coeur in Montreal. One patient with multiple right atrial tumours also had abnormal cutaneous pigmentation compatible with the recently identified syndrome of "Carney's complex." This syndrome has also been associated with endocrine abnormalities such as primary nodular adrenal hyperplasia, with or without Cushing's syndrome. The authors review the literature and compare the findings with their experience in the surgical treatment of cardiac myxomas.

Adult↗
PubMed1991

Abnormal cardiovascular reactivity in borderline and mild essential hypertension.

Cardiovascular and hemodynamic reactivity was evaluated with M-mode echocardiography, phonocardiography, and carotidography in correlation with circulating catecholamine levels in 25 normotensive subjects, 15 borderline hypertensive patients, and 42 mildly hypertensive patients during isometric exercise at 30% of the maximum force for 3 minutes. At rest, norepinephrine and epinephrine levels were significantly higher, and the cardiac index was similarly increased in both groups of hypertensive patients, but the cardiac mass index was significantly increased only in the mildly hypertensive group. During isometric exercise, the sympathoadrenal reactivity as well as the pressor and chronotropic responses were similar in normotensive subjects and both groups of hypertensive patients. However, the variations in blood pressure were achieved through totally different hemodynamic mechanisms in normotensive subjects and hypertensive patients. In normotensive subjects, the increase in blood pressure could be linked mainly to an increase in cardiac contractility and performance, whereas in either group of hypertensive patients, the increase in blood pressure was mainly associated with an increase in peripheral resistance. These observations are consistent with the hypothesis of a blunted beta-adrenergic reactivity and a predominance of alpha-adrenergic vascular reactivity in borderline and mildly hypertensive patients. This phenomenon, which appears to be unrelated to age or severity of hypertension, could be an important mechanism underlying the development of hypertension in humans.

Epinephrine↗
PubMed1991

Chronic effects of diltiazem on the hemodynamic and sympathoadrenal tone in responsive and nonresponsive hypertensive patients at rest and during isometric exercise.

The objective of this study was to identify hemodynamic and sympathetic parameters that could be predictive of the hypotensive response to diltiazem (DTZ). Parameters of cardiovascular functions were measured from M-mode echocardiography and the index of sympathoadrenal tone was given by circulating catecholamine levels in 25 normotensive subjects and in 19 mild-to-moderate hypertensive patients before and after 2 months as well as 12 months (responders only) of treatment with DTZ (SR 120 or 180 mg b.i.d.). The responder (R) subgroup (63% of total population) consisted of patients who showed a decrease in mean arterial pressure (MAP) greater than or equal to 5 mm Hg (day average) by ambulatory blood pressure (BP) monitoring. Before treatment, R patients were characterized by higher circulating norepinephrine (NE) levels and by hyperkinetic cardiac functions [increased heart rate (HR), cardiac index (CI), and mean velocity of circumferential fiber shortening, p less than 0.05] while peripheral resistance was normal. In contrast, nonresponders (NR) were characterized by higher peripheral resistance (p less than 0.05) and normal cardiac functions. Following treatment, hyperkinetic cardiac functions were normalized but the peripheral resistance was unchanged in the R subgroup whereas in the NR subgroup, cardiac parameters were slightly increased and the peripheral resistance was normalized. During isometric exercise, cardiac performance was found to be impaired (p less than 0.05) and the increase in peripheral resistance was greater (p less than 0.05) in the R subgroup before treatment, whereas those responses were normal in the BR group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Glands↗
PubMed1990

Sustained beneficial effect of a seventy-two hour intravenous infusion of nitroglycerin in patients with severe chronic congestive heart failure.

To determine whether a 72-hour infusion of nitroglycerin produces hemodynamic improvement in patients with severe congestive heart failure and to assess the contributing role of various possible causes of hemodynamic tolerance to nitroglycerin, 19 patients received an infusion of nitroglycerin 1.5 micrograms/kg/min for 72 hours. In a subgroup of patients (n = 10), there was an increase in stroke work index and a decrease in ventricular filling pressures throughout the infusion and even after it was discontinued. Tolerance to the hemodynamic effects of nitroglycerin was partially reversed 8 hours after the infusion was stopped. Neurohumoral changes occurred but appeared to play only a minor role in the development of nitroglycerin tolerance. However, hematocrit fell 9 +/- 5%, which suggests that an increased intravascular volume contributed to tolerance. In summary: (1) a 72-hour infusion of nitroglycerin improves ventricular function in some patients with severe heart failure; (2) volume shifts from the extravascular to the intravascular compartments may, at least in part, be responsible for nitroglycerin tolerance; and (3) reflex neurohumoral activation may also play a small role in nitrate tolerance.

Administration, Sublingual↗
PubMed1989

The sympatho-adrenal tone and reactivity in human hypertension.

In the last two decades, remarkable advances have permitted a better understanding of the modulation of sympathetic tone and reactivity at the sympathetic nerve and at the effector cell levels. In man, several indirect approaches have permitted to suggest the possibility of increased sympathetic nerve activity and reactivity in an important subgroup of essential hypertensive patients. The demonstration of significant correlations between circulating levels of sympathetic transmitters and various parameters of cardiovascular functions supports the hypothesis of a participation of the sympathetic system in the maintenance of an elevated blood pressure in those patients. Moreover, several experimental evidences have indicated that the sensitivity of cardiovascular effector cells may be altered in hypertensive patients. The blunted beta receptor responsiveness and the normal or enhanced alpha receptor responsiveness which were observed suggest the possibility of an imbalance between adrenergic receptor functions in hypertension, which may explain the preferential alpha 1 modulation of blood pressure through changes in peripheral resistance in hypertensive patients. Such an abnormality could contribute to the development of cardiac and vascular wall hypertrophy during the evolution of hypertension. These studies therefore suggest that a variety of sympathetic dysfunctions could play a role in the development, maintenance and evolution of human essential hypertension.

Adrenal Glands↗