Biomedical subjects

X Thirion

Publications and source records attributed to X Thirion.

At least 55 records · Page 3Linked to original sources

PubMed1997

Changing patterns and surgical results in adenocarcinoma of the oesophagus.

BACKGROUND: Prognosis of oesophageal adenocarcinoma is notoriously dismal. To examine the changing patterns of and treatment strategies for this disease, the longitudinal experience of a single institution over 16 years is reported. METHODS: The study comprised a retrospective review of 551 consecutive patients operated on for oesophageal cancer between 1979 and 1995, of whom 164 had adenocarcinoma. There were 13 women and 151 men whose mean age was 61 (range 17-82) years. RESULTS: The prevalence of adenocarcinoma (P = 0.002), that of early tumours (P < or = 0.10), and the resectability rate (P < or = 0.05) increased throughout the period whereas operative mortality rate decreased (P < or = 0.10). Surgical approach changed without influence on long-term survival. Patients referred from endoscopic surveillance programmes for Barrett's oesophagus (n = 16) had an improved survival rate compared with that of non-surveyed patients (P < or = 0.01). Overall 5-year survival after oesophagectomy (17 per cent) improved for the period 1991-1995 when compared with 1979-1982 (P < or = 0.02). Univariate analysis identified tumour node metastasis (TNM) stage, number of diseased lymph nodes, invasion of the oesophageal stump and occurrence of a postoperative complication as significant prognostic variables (P < or = 0.05). Multivariate analysis demonstrated that T stage (P = 0.0002) was the main independent predictor. CONCLUSIONS: Recent improvement of results reflects patient selection, increased prevalence of early tumours, and dramatic reduction of the risks from oesophagectomy. New therapeutic directions should be investigated for locally advanced tumours.

Adenocarcinoma↗

PubMed1996

Quantitative scale of oral mucositis associated with autologous bone marrow transplantation.

Acute oral complications are serious and disabling secondary effects for patients undergoing cancer therapy. Therefore, the authors wanted to develop a sensitive and specific method to measure oral mucosal changes associated with autologous with autologous bone marrow transplantation. 14 patients, all volunteers, 18-56 years old, receiving conditioning regimens of cyclophosphamide and total body irradiation were included. The clinical changes of the oral mucosa and functional modifications were scored daily, over 21 days with a 16 item scale, ranging from 0 to 3. A daily index of mucositis (DIM) was established by adding the scores obtained for the 16 items and a cumulative score of oral mucositis was obtained by the addition of the 21 DIM for assessing the severity of oral mucositis throughout its duration. The internal consistency measures (Chronbach alpha) were strong (range 0.80-0.97). A scale of equivalence, pre-established in comparison with pre-existing general mucositis rating scales, permitted a day by day simple classification in a 4-grade scale, to be obtained. Support for the validity of the suggested scale is presented. This scale may help to improve the study of oral complications of cancer therapy.

Adolescent↗

PubMed1996

A randomized, single-blind crossover comparison of the effects of chronic DDD and dual sensor VVIR pacing mode on quality-of-life and cardiopulmonary performance in complete heart block.

The aim of this study was to compare DDD and dual sensor VVIR (activity and QT) pacing modes in complete AV block (CAVB). Eighteen patients (14 men and 4 women, aged 70 +/- 6.5 years) implanted with a dual chamber, dual sensor pacemaker for CAVB with normal sinus node chronotropic function were studied. A quality-of-life and cardiovascular symptom questionnaire, and a treadmill exercise test were completed after a period of VVIR and a period of DDD pacing, each lasting 1 month. Overall quality-of-life and cardiovascular symptoms did not significantly differ, though three patients felt discomfort during VVIR mode. There was no significant statistical difference in cardiopulmonary parameters. DDD and VVIR modes yielded the following respective data: maximum heart rate = 105.7 +/- 21.8 beats/minute versus 107.6 +/- 21.6 beats/minute (NS); maximum workload = 60 +/- 33.4 W versus 59.3 +/- 37.8 W (NS); treadmill duration = 10.1 +/- 3.8 minute versus 10.1 +/- 3.6 minute (NS); oxygen consumption at anaerobic threshold = 14.6 +/- 4.1 mL/kg per minute versus 14.9 +/- 4.6 mL/kg per minute (NS); maximum minute ventilation = 49.6 +/- 9L/min versus 46 +/- 12 L/min (NS); and respiratory quotient = 1.08 +/- 0.15 versus 1.08 +/- 0.13 (NS). We conclude that, during a 1-month follow-up period, no difference was found between DDD and dual sensor VVIR (QT and activity) pacing modes in CAVB patients with regard to quality-of-life and cardiopulmonary performance, though a trend toward an increased sense of well being was noted with the DDD mode.

Aged↗

PubMed1996

Effect of ventilator-associated pneumonia on mortality and morbidity.

The aim of this study was to evaluate the attributable mortality and excess intensive care unit (ICU) stay as linked to ventilator-associated pneumonia (VAP) in a medical-surgical ICU. We performed a matched cohort study. The diagnosis of VAP was established when clinical, biologic, and radiologic signs of VAP were associated with the presence of at least one microorganism at a concentration > or = 10(3) CFU/ml on the protected specimen brush sample. Each case patient with VAP was matched to one control patient on the basis of the following potential confounding factors: same diagnosis and same indication for mechanical ventilation, same age +/-5 yr, same sex, same APACHE II score +/-5 on admission. In addition, control patients had to be ventilated for at least as long as the case patient prior to the onset of VAP, and date of admission of the case and control patients had to be matched within 1 yr. In 85 of the 97 patients with VAP, we were able to match one case patient with one control patient. Mortality was similar in both case (40%) and control (38.8%) patients. The duration of mechanical ventilation was increased in survivor case patients (27.2 +/- 24.7 d) compared with survivor control patients (18.5 +/- 15.7 d) (p < 0.01). The duration of hospitalization in ICU was increased in survivor case patients (34.9 +/- 23.6 d) compared with survivor control patients (26.1 +/- 18.6 d) (p < 0.02). When confounding factors were controlled, VAP did not appear to increase mortality.

APACHE↗

PubMed1996

[Mid-term outcome of escape rhythm after radiofrequency ablation of the atrioventricular junction].

UNLABELLED: Mid-term outcome of the underlying escape rhythm developed after radiofrequency ablation of the atrio-ventricular junction was studied in 50 consecutive patients (28 women and 22 men with a mean age of 66.2 +/- 9.6 years). The escape rhythm was assessed immediately after ablation and after 13.7 +/- 8 months. At the end of ablation: an escape rhythm was present in 38 patients (76%), with a mean rate of 40.7 +/- 9.7 beats/min and a QRS morphology identical to the preablation QRS morphology in 22 patients (58%). At follow-up: an escape rhythm was present in 37 patients (74%), with a slower mean rate of 36.4 +/- 6.8 beats/min (p < 0.05) and an unchanged QRS morphology in 87.5% of the patients. Patients presenting with an escape rhythm at follow-up were more frequently found to have a postablation escape rhythm (p < 0.01). Escape rhythm presence at follow-up was not influenced by age, presence of a cardiac disease, continuation of an antiarrhythmic treatment after ablation, use of a bilateral approach for ablation or number of radiofrequency applications. CONCLUSION: after abrupt inhibition of the stimulation, an escape rhythm was present only in 74% of the patients 13.7 +/- 8 months after atrio-ventricular junction radiofrequency ablation. QRS morphology was identical to the preablation morphology in 57% of the patients.

Aged↗

PubMed1996

[Entero-mesenteric infarction: diagnostic and predictive criteria of severity. Therapeutic implications. Multifactor prospective study of a series of 61 cases].

The study includes a group of 61 patients (31 males, 30 females), mean age 72 +/- 13 years with entero-mesenteric ischemia. The authors studied prospectively clinical, biological and radiological parameters in order to reinforce the diagnostic of the disease. Correlations between these parameters and peroperative findings and anatomopathology after resection were able to point out factors of severity. These factors should have a therapeutic incidence in order to improve the outcome usely bad.

Adult↗

PubMed1996

Neurologic decompression illness: a gravity score.

Treatment of neurologic decompression accidents consists of various hyperbaric oxygen (HBO) protocols. To facilitate such comparisons between different protocols we developed a gravity score. A group of 96 divers was used to establish the score. On admission we first identified signs and symptoms that had possible predictive value (chi 2 test). The parameters included were repetitive dive, clinical course before HBO, objective sensory disorder, motor impairment, and urinary disturbances. Each parameter was assigned a coefficient. The sum of the coefficients for each accident, based on the most severe manifestations before decompression therapy, yielded a score for each diver. A multivariate analysis was used to evaluate the overall agreement between the model prediction and clinical observations, which was 78.7%. A second group (66 divers) was used to validate the score; this group showed a significant difference in the gravity score between the divers who had sequelae and those who did not (P = 0.0001), and between the divers who had incapacitating sequelae and those who had mild sequelae (P = 0.04). Eighty-six percent of the divers with a score above 7 developed sequelae. This index remains to be validated in a prospective multicenter study. If endorsed, valid comparisons can be made between the different therapeutic protocols.

Adult↗

PubMed1995

Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.

BACKGROUND: There is no agreement about surveillance after resection of a stage I melanoma. OBJECTIVE: We assessed the cost-effectiveness of this surveillance. METHODS: Out of 912 patients with stage I (and Clark's level > or = II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department. RESULTS: 115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases. CONCLUSIONS: In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.

Cost-Benefit Analysis↗

PubMed1995

Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia.

The purpose of this prospective postmortem study was to assess the diagnostic accuracy of bronchoscopic techniques (bronchoalveolar lavage [BAL] and protected specimen brush [PSB]) and nonbronchoscopic techniques (blind bronchial sampling [BBS] and mini-BAL) in the diagnosis of ventilator-associated pneumonia (VAP). The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 38 patients who died after at least 72 h of mechanical ventilation. Histology was positive for VAP in 18 patients and negative in 20 patients. There were 12 definite VAP (positive histology and positive lung cultures) and 6 histologic VAP (positive histology and negative cultures). Clinical pulmonary infection score (CPIS) at a threshold of 6 achieved a sensitivity of 72% and a specificity of 85%. When the CPIS was combined with the logarithmic concentration of the predominant microorganism obtained from the BBS sample culture, specificity was increased to 95%, for a threshold of 10. Using 10(3) cfu/ml as the threshold of positivity for cultures obtained with PSB and mini-BAL samples and 10(4) cfu/ml for cultures obtained with BBS and BAL, the respective sensitivities of these techniques for definite VAP were 42, 67, 83, and 58%. The sensitivity of BBS was significantly higher than that of PSB (p < 0.05). The area under the receiver operator characteristic curve was significantly greater for BBS than PSB (p < 0.05). Given that it is more sensitive and noninvasive, BBS is preferable to PSB for the diagnosis of VAP.

Aged↗

PubMed1995

[Current place of thr perihepatic absorbable mesh. Apropos of a series of 105 traumas of the liver].

From October 1987 to June 1993, 105 patients with liver trauma including 71 patients with multiple trauma were admitted to the emergency unit of the Hôpital Sud in Marseilles. Mean age was 32 +/- 15 years, ranging from 16 to 77 years. 77 were male and 28 were female. 83 cases presented with closed trauma, and there were 11 by knife wounds and 11 gun shot injuries. 22 patients, including 10 with multiple trauma, were not operated. Operation was decided immediately in 38 cases for hypovolemia or during the following six hours because of unstable blood pressure after four units of blood transfusion. The absorbable perihepatic mesh was used by 3 surgeons and 3 others used classical procedures (sutures, packing). Global mortality was 15%. The morbidity (31%) was not different from other reports but was significantly lower when using the mesh (p = 0.002). This technique can achieve rapid and lasting hemostasis and bilistasis without any increase of cholestasis or hepatic cytolysis compared to conventional procedures, and without any alteration of laboratory parameters, as shown by specific laboratory tests and follow-up liver biopsies. The mesh also avoids compression of the adjacent organs, compared to packing, thereby avoiding respiratory and renal impairment and reoperation. It can be used in a septic context and in combination with all kinds of radiologic follow-up and percutaneous aspiration and drainage.

Adolescent↗

PubMed1995

[Occlusions by colonic cancers: emergency treatment (62 cases)].

Sixty two patients (38 men, 24 women) were operated in emergency for colic occlusion from neoplasia. The mean age was 69.6 (+/- 12.71). Fourty four (70%) had an history of cardiovascular disease. Tumor resection has been possible in 95% of cases. The mortality was 24.19% in the first two months postoperatively and 11% between the second and the fourth month. The morbidity was 32.2% and the mean length of stay in hospital was 22 days (+/- 16.6). The morbidity was less in case of right hemicolectomy (17.3 days) than for left colic resections (26 days). The postoperative mortality was not correlated to age but to lost of weight more than 10 kg (p < 0.0001) and to a mean central preoperative temperature more than 37.5 degrees C (p < 0.002). Reducing the number of surgical procedures is beneficial in patients older than 70 years.

Aged↗

PubMed1994

Treatment of hepatic trauma with perihepatic mesh: 35 cases.

In a series of 61 trauma cases, 35 liver injuries (Moore's classes 2 to 5) were repaired using a polyglactin 910 perihepatic prosthesis. Two deaths (one coma, one avulsion of the inferior vena cava) were observed. Two centrohepatic hematomas were successfully treated by percutaneous needle aspiration. No hemobilia and no abscess of the liver occurred. Rapidly obtained hemostasis and cholestasis result in a large savings of blood. Progressive disappearance of the lesions was observed with repeat CT scanning until full recovery of the parenchyma was achieved. This was verified by biopsy and histologic examination and also by means of specific hepatic function tests.

Adult↗

PubMed1994

Q fever serology: cutoff determination for microimmunofluorescence.

Q fever, a worldwide zoonosis caused by Coxiella burnetii, lacks clinical specificity and may present as acute or chronic disease. Because of this polymorphism, serological confirmation is necessary to assess the diagnosis. Although microimmunofluorescence is our reference technique, the cutoff titers that are currently used to make a diagnosis of active or chronic Q fever were determined years ago with limited series of patients and sera. We determined the titers of immunoglobulin G (IgG), IgM, and IgA against both phases (I and II) of Coxiella burnetii. Rheumatoid factor was removed before testing IgM and IgA. We report here the various cutoff titers and the kinetics of antibody development from 2,218 first serum samples of patients, among whom 208 suffered from acute Q fever and 53 had chronic Q fever. In active Q fever, we have defined a low cutoff (phase II IgG titer < or = 100) below which the diagnosis cannot be made and would need further confirmation and confirmed a high cutoff (phase II IgG titer > or = 200 and phase II IgM titer > or = 50) over which the diagnosis can be made. For chronic Q fever diagnosis, phase I IgA titers are not contributive despite previous works claiming their usefulness; a phase I IgG titer of > or = 800 is highly predictive (98%) and sensitive (100%). We have also studied the possibility of rejecting or evoking the diagnosis of chronic Q fever by phase II IgG and IgA titers. This method is useful when phase I testing is not available, but the sensitivity remains low (57%).

Acute Disease↗

PubMed1994

[Complications of colonic diverticulosis and emergency surgery. Prospective study of 56 cases].

Fifty six patients, 26 men (69.7 +/- 11.2 years) and 30 women (77.4 +/- 9.2 years) were admitted in the emergency unit for diverticulosis sigmoiditis. In 75% of cases an other pathology was associated. Excepted 11 extended peritonisis, 7 criterae of operation were required to operate on 17 men and 18 women (mean age = 73.7 +/- 12.5 years) in a delay less than 8 days. Reasons were: 12 occlusive forms, 9 peri-sigmoidis abcedations, 3 hemorrhages. Surgical procedures were: 11 Hartmann procedures, 21 resections with anatomosis of the sigmoid colon with 10 non protected and 3 subtotal colectomy. Postoperative mortality was been 11.4%. The global rate of complications was 28.5 and the mean hospital stay was 18.8 +/- 6.3 days. Application of operative criteriae is usefull to shorter significantly the delay of operation and then the length of evolution of the intraperitoneal infection site.

Aged↗

PubMed1993

Effect of bolus doses of midazolam on intracranial pressure and cerebral perfusion pressure in patients with severe head injury.

We have studied the effects of bolus doses of midazolam 0.15 mg kg-1 i.v. on intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) in 12 patients with severe head injury (Glasgow Coma Scale score < or = 6). The study was performed in patients aged 17-44 yr who were sedated (phenoperidine 20 micrograms kg-1 h-1) and paralysed (vecuronium 2 mg h-1). Midazolam reduced MAP from 89.0 mmHg to 75.0 mmHg (P < 0.0001), while CPP decreased from 71.0 mmHg to 55.8 mmHg (P < 0.0001). During the study, CPP decreased to less than 50 mmHg in four patients. Midazolam induced small, non-significant changes in ICP. However, when control ICP was less than 18 mmHg (n = 7 patients), an increase in ICP was observed. The remaining five patients (control ICP > or = 18 mmHg) exhibited a slight decrease in ICP. These findings suggest that bolus administration of midazolam should be performed with great caution in patients with severe head injury, especially when ICP is less than 18 mmHg.

Adolescent↗

PubMed1993

Acute insulin response to glucose and glucagon in subjects at risk of developing type I diabetes.

OBJECTIVE: To determine if knowledge of characteristics of insulin response to various secretagogues during the preclinical phase of type I diabetes may facilitate the diagnosis of subjects at risk. RESEARCH DESIGN AND METHODS: A test consisting of sequential intravenous challenge with glucose (0.3 g/kg) and glucagon (1 mg, 10 min after the end of glucose injection) was performed on 171 ICA- relatives of type I diabetic patients, 18 ICA+ relatives of type I diabetic patients, and 5 transiently hyperglycemic subjects. Acute response to glucose was expressed as the sum of plasma insulin at 2 and 5 min and response to glucagon as the increase in plasma insulin after 10 min. RESULTS: Responses below the lower 95% confidence interval in the ICA- population (40 and 43 microU/ml for glucose and glucagon, respectively) were considered abnormal. The two values were correlated (r = 0.62). Abnormalities coexisted in 2.3% of the ICA- group, 11% of the ICA+ group, and 100% of the transiently hyperglycemic group. All the relatives who subsequently developed diabetes or hyperglycemic subjects who required insulin exhibited combined abnormalities. Some ICA- and ICA+ relatives were tested repeatedly over a follow-up period of 1.5-4 yr. Although the intraindividual coefficient of variation for the two responses was high (28 and 30%), values tended to run parallel in both ICA+ and ICA- relatives. In 2 patients monitored for 2 and 4 yr before diabetes developed, both responses declined at the same rate. In terms of prediction of diabetes, sensitivity of combined abnormalities was high (100%). But compared with the intravenous glucose tolerance test, improvement of specificity by the double challenge was not statistically significant. CONCLUSIONS: Both insulin responses to glucose and glucagon are related. They depend on the secretory capacity of beta-cells and simultaneously become abnormal in the prediabetic phase.

Adolescent↗

PubMed1992

[Buprenorphine abuse in a series of 50 drug addicts hospitalized at a Drug Dependence Evaluation hospital in Marseille].

Buprenorphine, a synthetic central analgesic, marketed since 1987, was rapidly suspected to be subject to abuse. We tried to confirm this abuse in the context of our analytical activity at the Drug Dependence Evaluation and Information Centre. The study was based on 50 drug addicts admitted to Marseille Hospital between June and October 1992. Buprenorphine and its N-dealkylated metabolite were identified in the urine by high performance liquid chromatography equipped with a diode array detector. Nine (18%) of the 50 samples analysed were positive for buprenorphine and/or norbuprenorphine, with a confidence interval of 8 to 28%, which confirms the existence of abuse of this analgesic.

Adult↗

PubMed1992

[Gangrene of the perineum. Plea for a standardized therapeutic management apropos of 50 cases].

From 1988 to 1992, 50 cases of perineal gangrene were treated with a therapeutic protocol combining: a) repeated extensive excisions, b) hyperbaric oxygen therapy, even before surgery if this was possible, and c) intensive care. The mortality rate was 24% (12/50). It was even higher in patients admitted more than 6 hours after diagnosis. The average stay in hospital was of 20 (+/- 2) days. Four patients presented with residual signs. Twenty-eight (56%) had had colostomy for lesions originating in the rectum or threatening the anal margin; 9 of these patients died, while gastrointestinal continuity was restored in another 17 cases. There were three predictive factors of survival in this series: a) early diagnosis and treatment, b) severity index on admission, c) some associations of bacteria.

Adult↗