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Biomedical subjects

A Brut

Publications and source records attributed to A Brut.

6 recordsLinked to original sources

[Value and limitations of pulmonary scintigraphy/venous duplex Doppler echography in the management of pulmonary embolism].

PURPOSE: To assess the accuracy of diagnostic strategy of pulmonary embolism (PE) based on clinical examination, lung scan and venous duplex US findings. METHODS: 1,819 patients have been included in a prospective study (mean age: 66, range: 6-102, F 54% H 46%) over a 13 month period. RESULTS: To decide the opportunity of anticoagulant therapy, lung scan alone is decisive in 30.6% of the cases. When taking into account clinical examination, lung scan and venous duplex US findings in a combined diagnostic strategy, a therapeutic decision can be made for 74.2% of the patients. The decisive characteristics of this strategy were influenced by two factor: age (therapeutic decision can be reached for 83% of the patients aged 30 to 50 vs 65% when they are over 85, p < 0.01); history of heart or pulmonary disease (therapeutic decision reached in 62% of the cases with history vs 78% without, p < 0.01). CONCLUSION: Pulmonary angiography seems theoretically necessary in less than 26% of the patients with suspected PE when they have undergone lung scan and venous duplex US. In this case, and when these strategies are not very decisive, it would be important to assess the diagnostic value of spiral CT scanning.

Adolescent↗

[Food-related fungal infection risk in agranulocytosis. Mycological control of 273 food items offered to patients hospitalized in sterile units].

In sterile hospital units filamentous fungal infections are an unacceptable risk in patients with prolonged agranulocytosis. The occurrence of 3 successive cases in the Sterile unit of University Hospital of Grenoble prompted us to investigate in all elements of sterile unit, and notably food-processing. Two cooked rice dishes given to these patients were found to contain a substantial amount of Aspergillus fumigatus and were probably responsible for these infections. A more detailed study was carried out to evaluate the degree of food contamination by fungi in sterile unit. The study included 97 cooked dishes which had been sterilized in a 250 degrees oven for 40 minutes and 176 industrially packed foods delivered in single packs (e.g. milk and its derivatives, sweets and drinks). Each foodstuff was mycologically examined 3 to 5 times in different packs according to a procedure used in food analysis laboratories and raised to the standards of mycological examination. In this way, a 3-monthly food testing protocol in sterile unit could be set up. This protocol has a dual purpose: regular checking of the cooked dishes chain and maximum diversification of the dishes.

Agranulocytosis↗

[Pump and muscle functions and the index of perfusion of the subendocardium in severe aortic stenosis in adults].

47 patients with severe aortic stenosis (AS) (valve area less than 0.7 cm2) and normal coronary angiography were divided into three groups, according to their functional class (NYHA classification): - Group 1 (n = 21): Classes 1 and 2 - Group 2 (n = 18): Class 3 - Group 3 (n = 8): Class 4. Haemodynamic and angiographic parameters and the index of subendocardial perfusion (ISEP) defined by Buckberg's method were compared with a control group (n = 14). In group 1, pump function was normal without end diastolic dilatation. Moderate hypertrophy was compensatory and isofunctional (SW/mass = normal). Despite normal EF and VCF, contractile function was reduce (dp/dt/p, % shortening, % thickening and velocity of systolic thickening were lower than the control group (p less than 0.05)), and there was chronic subendocardial ischaemia (ISEP = 0.58 +/- 0.2, p less than 0.01). In groups 2 and 3, pump function was depressed (Group 2: CI = 2.5 +/- 0.5 1/min/m2 (p less than 0.05)) (Group 3: CI =2.0 +/- 0.6 1/min/m2, p less than 0.01)) despite an increased preload (LVEDP and EDV increased), and a greater degree of hypertrophy (Mass Index, Group 1 = 130 +/- 30 g/m2, Group 2 = 190 +/- 30 g/m2 (p less than 0.01), Group 3 = 210- +/- 30 g/m2 (p less than 0.01)). (SW/mass decreased, p less than 0.01). EF and VCF and all other indices of contractility were depressed and subendocardial ischaemia was the same (0.5 +/- 0.2). The complete lack of adaptation of the preload, non-compensatory hypertrophy, decreased contractility and chronic subendocardial ischaemia, all affect the operative prognosis and the long-term result after valve replacement. This data is in favour of early surgical correction of severe AS before the appearance of signs of cardiac failure.

Aged↗

[What's bugging him?].

The purpose of this study is to report the case of a 34 year old patient, from Zaïre for whom a wrong diagnosis could have been fatal. Recent events in his affective and professional life, associated with typical symptoms, suggested a major depression. However after two months of being admitted a psychiatric ward, the resistance to treatment together with some biological data suggested further investigations. They revealed a subacuse meningo-encephalitis of parasitological etiology. The psychiatric aspects of trypanosomiasis commonly known by clinicians in Africa justifies, in patients from that continent, a systematic test for trypanosomiasis.

Acute Disease↗