Search PubMed⌕ Search

Biomedical subjects

Y Gerard

Publications and source records attributed to Y Gerard.

At least 19 recordsLinked to original sources
PubMed2002

Prevention of human immunodeficiency virus-related opportunistic infections in France: a cost-effectiveness analysis.

A simulation model of human immunodeficiency virus (HIV) disease, which incorporated French data on the progression of HIV disease in the absence of antiretroviral therapy and on cost, was used to determine the clinical impact and cost-effectiveness of different strategies for the prevention of opportunistic infections in French patients who receive highly active antiretroviral therapy (HAART). Compared with use of no prophylaxis, use of trimethoprim-sulfamethoxazole (TMP-SMZ) increased per-person lifetime costs from euro 185,600 to euro 187,900 and quality-adjusted life expectancy from 112.2 to 113.7 months, for an incremental cost-effectiveness ratio of euro 18,700 per quality-adjusted life-year (euro/QALY) gained. Compared with use of TMP-SMZ alone, use of TMP-SMZ plus azithromycin cost euro 23,900/QALY gained; adding fluconazole cost an additional euro 54,500/QALY gained. All strategies that included oral ganciclovir had cost-effectiveness ratios that exceeded euro 100,000/QALY gained. In the era of HAART, on the basis of French data, prophylaxis against Pneumocystis carinii pneumonia, toxoplasmic encephalitis, and Mycobacterium avium complex bacteremia is cost-effective. Prophylaxis against fungal and cytomegalovirus infections is less cost-effective than are other therapeutic options for HIV disease and should remain of lower priority.

AIDS-Related Opportunistic Infections↗
PubMed2000

Simultaneous detection of 6 human herpesviruses in cerebrospinal fluid and aqueous fluid by a single PCR using stair primers.

A Herpes Consensus allows the simultaneous detection of 6 human herpesviruses: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), human cytomegalovirus (HCMV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and human herpes virus 6 (HHV-6). This technique was used first to examine retrospectively 100 DNA extracts from 95 CSF and 5 aqueous fluids, prepared by treatment by saturated NaCl followed by ethanol precipitation (n = 63) or by simple boiling (n = 37) and stored at -80 degrees C, and secondly to test prospectively 38 CSF samples for which two DNA extracts were prepared with commercially available DNA extraction kits. In all cases, the results were compared with those of an "in-house" PCR. Concordant results between both PCR and the Herpes Consensus techniques were obtained in 61 of 63 DNA extracts prepared by treatment by saturated NaCl (97%) and in only 31 of 37 boiled samples (84%). Both commercially available methods of DNA extraction examined appear to be suitable for Herpes Consensus PCR, although they cannot remove completely PCR inhibitors that must be sought in case of negative results. This preliminary study shows that the Herpes Consensus method should be of value for rapid diagnosis of herpesvirus infections on condition that it is performed on purified DNA extracts.

Aqueous Humor↗
PubMed1998

Tolerance, compliance and psychological consequences of post-exposure prophylaxis in health-care workers.

Our objectives were to evaluate tolerance and compliance of post-exposure triple therapy in health-care workers (HCWs) by retrospective observational study. Structured telephone interview of HCWs identified through data from antiretroviral prescribing centres. Twenty HCWs who received triple prophylaxis were identified over one year. Sixteen agreed to participate in the study. All but one source patient had documented HIV infection. Half HCWs were not aware of post-exposure therapy. Most HCWs received a zidovudine, lamivudine and indinavir combination. All completed at least 4 weeks of therapy. Only 50% received their first dosage less than 4 h after exposure. Nearly all experienced adverse events, mostly digestive (nausea and abdominal pain n=15) or psychological (anxiety and depression n=15), none resulting in therapy discontinuation. Most events occurred 2 to 7 days after therapy initiation. Most modified their sexual life with abstinence or condom use. Compliance was excellent. Half HCWs did not miss any tablet, 4 forgot one dosing a month and 4 one dosing a week. Follow up is over 6 months in all but one HCW. No HIV seroconversion has been observed to date. In France, post-exposure triple antiretroviral therapy is widely available 24 h a day in every emergency room but further training and development of HCWs is needed to decrease consulting time and increase referral to specialized physicians. Notable moderate adverse events, both physical and psychological are noted, however, compliance is excellent.

Adult↗
PubMed1991

[Pseudarthrosis of the humeral shaft. Apropos of 58 cases].

We report 58 cases of humeral shaft non union following 28 times an orthopaedic treatment where persisted a space between the two fragments and 30 times an osteosynthesis but only 6 where satisfying. The sery contains 2 infected non union, dried in several months and 3 pseudarthrosis we did not operate because they were not inconvenienced. Among the 53 aseptic pseudoarthrosis the union has been to obtained after one operation for 42, two operations for 6 and three operations for 5. We analyse the consecutive mistakes having brought to the failures. We confirm that only an osteosynthesis not sufficient and that an associate graft is necessary. It could be an osteoperiosteum decortication, a spongious graft or a tibial graft (this last one is more safe but reserved to the iterative cases of the one with a big defect). The long evolution (more than a year for half at the cases) explains the fragment repercussions on shoulder or elbow.

Adolescent↗
PubMed1986

Necrotizing fasciitis precipitating diabetic ketoacidotic coma.

Necrotizing fasciitis is a rapidly spreading infection of the subcutaneous tissue and fascia; diabetes mellitus appears to be the most frequent underlying disease. Early diagnosis and immediate aggressive surgical therapy are paramount to curtail morbidity and mortality, but diagnosis is often difficult and unnecessarily delayed. We describe a case of necrotizing fasciitis precipitating diabetic ketoacidotic coma where correct diagnosis was not made until the 14th hospital day. We stress the fact that physicians caring for critically ill patients should be keenly aware of the possibility of necrotizing fasciitis when tending diabetic patients with unexplained fever; failure to recognize the disease can have devastating results. Finally, we believe this to be the first reported case of diabetic ketoacidotic coma precipitated by necrotizing fasciitis.

Adult↗
PubMed1985

Beta hemolytic streptococcal infection in red foxes (Vulpes vulpes L.) in France: the natural disease and experimental studies.

Beta hemolytic streptococcal infections, usually of group G and C, were identified in red foxes in France. In a study of 31 animals, septicemia and jaundice were found to be the main signs of the disease. Gross and microscopic lesions consisted of generalized inflammation of viscera and joints, jaundice, cellulitis and abscesses of spleen, liver, lungs and kidneys. The disease was reproduced in foxes by intramuscular inoculation of less than the minimal quantity of bacteria lethal to mice. When challenged, recovered animals were resistant to infection that proved to be lethal to control animals.

Animals↗
PubMed1983

Arthroplasty of the rheumatoid wrist by silicone implants. Experience with forty cases.

The authors report their first evaluation of 40 arthroplasties of the wrist with the Swanson implant. The indication for this procedure was principally severe damage to the wrist joint. The radiologic findings have been summarized. In regard to operative technic, there have been no major problems. In 20 cases also arthroplasty of the head of the ulnar was done. There were no significant early complications. The clinical results after 14 months, with a range of 6 to 45 months, was always satisfactory in regard to pain and the preservation useful flexion and extension. So far, tolerance to the implant seems to be satisfactory. The joint narrowing, regularily found in the new articulation, does not detract from the long-term results. Thus the authors retain a favorable impression of this arthroplasty which should find a place in the treatment of badly damaged rheumatoid wrists. In addition to relieving the pain, it preserves mobility that would be sacrificed with an arthrodesis. Among the associated procedures, the authors have been disappointed with arthroplasty of the head of the ulna and have given it up.

Adult↗
PubMed1983

Isolated traumatic dorsal dislocation of the distal radio-ulnar joint. Report of seven cases.

The authors report seven cases of isolated dorsal dislocations of the distal radio-ulnar joint. Four were recent dislocations and three were old, chronic dislocations. Acute dislocations were treated surgically. An anatomic study on human cadavers enabled us to define the injuries responsible for radio-ulnar dislocations. An electromyographic study of the extensor carpi ulnaris confirmed its role as a dynamic stabilizer of the ulnar head. Two of the three old dislocations were revised after an attempt at ligamentous reconstruction. These patients benefitted from a resection of the ulnar head. The third patient one underwent a Sauve-Kapandji procedure. Cadaver studies underline the fact that ligamentous reconstruction procedures are actually tenodeses.

Acute Disease↗
PubMed1983

[Dynamic radiologic examination of the wrist].

Several possible lesions of ligaments may be diagnosed using dynamic radiographs in radial or ulnar deviation, with stressing in torsion, traction, or radial, ulnar, anterior or posterior displacement. The initial position is strictly defined in the front and sagittal planes. The shapes of the bones, their relationship and the joint lines are observed. The authors have made a complete study of the normal wrist and describe some pathological conditions including dislocations, disjunctions between the scaphoid and lunate, mid-carpal sprains and radio-carpal sprains. Descriptions are given as to how to obtain standard radiographs in a painful wrist. Five views are necessary, four in the frontal plane, (radial and ulnar angulation, radial and ulnar displacement) and one in the sagittal plane.

Adult↗
PubMed1982

Dislocations of the proximal interphalangeal joints of the long fingers. Anatomo-clinical study and therapeutic results.

The authors report an anatomo-clinic study on dislocations of the PIP joint in order to point out the lesions and the adequate treatment. This study is composed of two parts: first an anatomoclinical study of 29 dislocations all of which were operated on principle after a clinical and radiographic examination. The second part is a complementary anatomical study of 20 cadaveric joints based on an analysis of the different stabilizing structures of the joint. The study showed that, in order to get a dislocation of the PIP joint, it is necessary that two stabilizing formations be damaged. There is a major lesion and a minor one. The major lesion is characteristic of the type of the dislocation. Anterior dislocations were very rare in this study. The major lesion is a rupture or desinsertion of the central slip of the extensor tendon and the minor lesion is a tear in the collateral ligament. The treatment must be surgical because of the major lesion of the extensor apparatus. Quite different from the anterior lesions are the posterior and the lateral dislocations. They are more frequent. Although they have some similarities, they are, in fact, very different from an anatomoclinical and a therapeutic point of view. In posterior dislocations the major lesion is a rupture of the volar plate. The minor lesion is a partial desinsertion of the collateral ligament. These dislocations are stable after reduction. According to the authors, the best treatment is orthopedic, with a partial immobilization preventing the last degrees of extension. The major lesion in lateral dislocations is a rupture or avulsion of the collateral ligament and the minor lesion is a partial tear of the volar plate. After reduction they are unstable, and thus justify, according to the authors, an operative treatment, especially as they are often associated with cartilaginous lesions.

Adult↗
PubMed1975

[Treatment of idiopathic femur head necrosis with an appropriate cup with cylindrical support].

The objective of treatment of necrosis of the femoral head by means of an appropriate cup is to protect the sequestrum and to avoid secondary arthrosis. Hemispherical cups have a tendency to be easily deformed; cups with cylindrical support should be used in preference as they are mechanically stable and make it possible to cover the femoral head in cases of relatively extensive necrosis. Good results are obtained quickly and are often spectacular : in 90 percent of the cases operated on, pain disappeared or was reduced and normal socio-professional activity was again possible. A clinical and radiological study of 30 hips treated at least 2 years previously, established that the result was stable in the majority of cases : there was one real clinical and radiological deterioration, two cases of pinching of the interspace. This operation is thus worth while in all cases of necrosis, at the stage when the sequestrum is clearly delimited and when there is clear deformation of the contour of the femoral head. It also seems to be worth while at the "eggshell" stage, when the lesions detected at the time of an operation are aften considerable and appear non-reversible : the quality of the results obtained mean that the criteria of tolerance should be much more severe.

Adolescent↗