Biomedical subjects

A Duhamel

Publications and source records attributed to A Duhamel.

At least 19 recordsLinked to original sources

PubMed2005

Anti-Saccharomyces cerevisiae antibodies in twins with inflammatory bowel disease.

BACKGROUND AND AIMS: An increased occurrence of anti-Saccharomyces cerevisiae antibodies (ASCA) is reported in unaffected members of families with Crohn's disease. Whether ASCA is a familial trait due to genetic factors or is caused by exposure to environmental factors is unknown. To assess the genetic influence of ASCA we studied its occurrence in a twin population. PATIENTS AND METHODS: ASCA were analysed in 98 twin pairs with inflammatory bowel disease and were related to clinical phenotype and CARD15/NOD2 genotype. RESULTS: ASCA were more common in Crohn's disease than in ulcerative colitis (40/70 (57%) twins v 5/43 (12%) twins). Associations with ileal Crohn's disease, stricturing/penetrating behaviour, and young age, but not CARD15/NOD2 were confirmed. ASCA were found in 1/20 (5%) healthy siblings in discordant monozygotic pairs with Crohn's disease compared with 7/27 (26%) in discordant dizygotic pairs. Using the intraclass correlation coefficient (ICC), no agreement in ASCA titres was observed in discordant twin pairs with Crohn's disease, in monozygotic (ICC = -0.02) or dizygotic (ICC = -0.26) pairs. In contrast, strong agreement was seen within concordant monozygotic twin pairs with Crohn's disease (ICC = 0.76). CONCLUSIONS: These findings question the concept of ASCA as a marker of genetic susceptibility for Crohn's disease. The agreement in ASCA titres within concordant monozygotic twin pairs with Crohn's disease, suggests that the level of increase is genetically determined. We propose that ASCA are a marker of a response to an environmental antigen and that a specific gene(s) other than CARD15/NOD2 determines the level of response and perhaps also specific phenotypic characteristics.

Adult↗

PubMed2005

Influence of social class on time trends in BMI distribution in 5-year-old French children from 1989 to 1999.

AIMS: To assess the prevalence of obesity and changes in body mass index (BMI) distribution between 1989 and 1999 in 5-y-old children, and to study the influence of parental socioeconomic status on these parameters. METHODS: Two cohorts of children in the final year of nursery school (in the city of Lille, France) were enrolled in 1989 (705 children: mean age=5.6+/-0.4 y) and 1999 (1258 children: mean age=5.6+/-0.5 y). Weight and height were measured, and data about parental occupation were collected during a school medical examination. International Obesity Task Force cutoff points were used to define overweight and obesity. Parental occupation was classified into four categories. RESULTS: The prevalence of obesity increased from 1.8 to 4.9%, and the prevalence of overweight rose from 9.6 to 16.9%. Mean-difference plots allowed qualitative comparisons of the BMI distribution between the surveys: for children from the highest social classes, there was no change in BMI; for children from intermediate classes, there was a up-shift only in the upper part of the distribution with the heaviest children becoming heavier still; finally, for children from the lowest class, there was an increase in BMI across the entire population. CONCLUSIONS: This study of the changes in BMI distribution gives greater insight into the 'obesity epidemic'. Our results show the influence of an interaction between genetic and environmental factors. The increase in BMI in the upper part of the distribution suggests that this is a population with a high degree of susceptibility, whereas the increase in BMI across the whole population in the lowest social class suggests a strong influence of the environment on this group and thus the necessity of appropriate, preventive measures.

Age Distribution↗

PubMed2004

Treatment of progressive forms of multiple sclerosis by cyclophosphamide: a cohort study of 490 patients.

There are no generally effective disease-modifying drugs for progressive forms of multiple sclerosis (MS). Some MS centres use cyclophosphamide (CYC) in secondary progressive (SP) forms of MS, especially after interferon beta-1b (INFbeta-1b) treatment failure. Moreover, there are currently no approved drugs for primary progressive (PP) MS. Using the collected data of patients with progressive MS, we studied clinical patterns that predicted a good response to CYC treatment. Secondly, we compared the therapeutic response of SPMS and PPMS patients to the treatment. Data from 490 MS patients were collected. All patients presented an SP (n = 362) or PP (n = 128) form of the disease and 476 had been treated for at least one year with a monthly pulse of CYC associated with methylprednisolone (MP). CYC treatment was justified because of at least a 1-point worsening on the Expanded Disability Status Scale (EDSS) during the previous year. The EDSS score was assessed at baseline and after 6 months (M6) and 12 months (M12) of treatment. After 12 months of CYC treatment, 78.6% of SPMS and 73.5% of PPMS patients had stabilised or had an improved EDSS score. Response to CYC was not significantly different in the two progressive forms of MS. Twenty-two patients presented noticeable drug side effects, one of whom withdrew from the treatment due to intolerance. Patients with an improved EDSS at M12 had a shorter mean progressive time course (5.1 years) than patients who stabilised or worsened (7.1 years) (p = 0.02). We also observed that poor responders at M6 were also poor responders at M12 (p < 0.001). This large cohort study showed that CYC treatment was well tolerated and suggested that a better response occurred in cases with a short progressive time course. We did not find any difference in treatment response between the two progressive forms of MS. To date, no treatment is approved for PPMS and we therefore propose a trial to test the use of CYC treatment early in the course of the disease in PPMS patients with disability progression.

Adult↗

PubMed2004

Statistical tools for clinical gait analysis.

Gait analysis studies involve continuous curves of data measured over a gait cycle. Curve analysis and interpretation require adequate statistical methods. Three principal problems may be encountered in clinical practice: (i) the reliability of gait curves for a given patient, (ii) classifying a new subject as belonging to a given population or not and (iii) comparison of two populations (independent or paired). This paper presents three statistical tools for solving these problems: (i) intra-class correlation coefficients, (ii) confidence bands for a population (iii) a combination of analysis of variance and confidence bands for the difference between the means and shows how they can be used in clinical practice.

Adult↗

PubMed2004

[Histological diagnosis after Pap smears detecting cancer or high-grade lesion of the cervix].

OBJECTIVE: The aim of the study is to analyze the histological-cytological correlations for Pap smears having detected cancer or high-grade squamous intra-epithelial lesion (HSIL) of the cervix. PATIENTS AND METHOD: The study about 311 women is retrospective. The average age is 36.4 years. Group 1 (histological diagnosis of high-grade or invasive lesion) includes 244 women (77.5%). Group 2 (histological diagnosis other than high-grade or invasive lesion) includes 37 women (11.9%) with a presumed diagnosis of HSIL. Group 3 (absence of histological follow-up) includes 30 women (9.6%) with a presumed diagnosis of HSIL. RESULTS: In group 1, the presumed cytological diagnosis is HSIL in 229 cases, squamous carcinoma in 11 cases and adenocarcinoma in two cases. In this group, the average delay between the Pap smear and the first histology is equal to two months. It is longer than 6 months in seven cases. The diagnosis of cancer or high-grade lesion is confirmed histologically on a first biopsy of the cervix in 196 cases, a second or a third biopsy in 10 cases, an endocervical curettage in six cases and a surgical specimen in 32 cases. In the group 2, the histological diagnosis is normal-benign in 14 cases (presumed cytological false positives) and condyloma-CIN 1 in 23 cases (presumed overevaluations). DISCUSSION AND CONCLUSION: Results highlight benefits of interactive exchanges between clinicians and pathologists, and the necessity of review of discordant cases by several pathologists in due time, with written comments and coding of the conclusions of the review. Histological follow-up is late or not done in some women.

Adolescent↗

PubMed2003

Double-blind crossover study with dolasetron mesilate, a 5-HT3 receptor antagonist in cerebellar syndrome secondary to multiple sclerosis.

Cerebellar syndrome is one of the most disabling developments in multiple sclerosis (MS). In neurodegenerative disorders, cerebellar syndrome is thought to be related to a neurochemical deficit of 5-hydroxytryptamine (5-HT). Previous studies found that a levorotatory form of 5-hydroxytryptophan, a 5-HT precursor, and ondansetron, a 5-HT(3) receptor antagonist, decreased cerebellar symptoms in Friedreich's ataxia and MS. We studied the effect of another 5-HT(3) receptor antagonist, dolasetron mesilate, on cerebellar syndrome in MS patients.Thirty-four MS patients were included in a placebo-controlled double-blind crossover study. They received a single dose of intravenous dolasetron mesilate or placebo. A quantitative evaluation of cerebellar syndrome using the nine-hole peg test and an ataxia score comprising static and kinetic parameters were performed before and after each treatment. No statistical difference was observed in the dolasetron mesilate group, compared with the placebo group. There was, however, inter-individual variability in the treatment response. This double-blind study on cerebellar syndrome in MS patients did not confirm the positive effect of dolasetron mesilate suggested by previous studies.

Adolescent↗

PubMed2003

A preprocessing method for improving data mining techniques. Application to a large medical diabetes database.

The Knowledge Discovery in Databases (KDD) methodology seems to be attractive on the analyze of large clinical databases. In the KDD process, the preprocessing step (data cleaning and handling of missing values) is paramount since it conditions the quality of the results obtained by data mining procedures and represents about 80% of the whole project time. The aims of the present study were to analyze this step and provide tools to handle inconsistent data and missing values. We have broken down the process into 3 main stages: data cleaning--explanatory study of missing values--choice of the procedure used for handling missing values. The data cleaning stage was based on a system of logical rules to correct mistakes and on cluster analysis to discard the poorly filled files. The missing-data mechanism was analyzed by means of multivariate statistical procedures. Two methods to deal with missing values were compared: imputation by the most common value (mode) and imputation using decision trees. This study was performed on a large medical diabetes database (23,601 patients) including numerous missing values. A system of logical rules allowed to correct mistakes on essential parameters (for example, the type of diabetes). Cluster analysis allowed to identify 10% of poorly filled files. After multivariate analysis, the missing-data mechanism could be considered as random. For variables with low number of missing values (< 10%) and categories (< 4), imputation using decision trees provided better results than imputation by mode.

Data Interpretation, Statistical↗

PubMed2001

Signal-averaged electrocardiography in children with anthracycline-induced cardiomyopathy.

The aim of the present study was to determine if signal-averaged ECG of patients with anthracycline-induced left ventricular dysfunction could differentiate between patients with anthracycline-induced cardiotoxicity and those without. Sixteen children with anthracycline-induced cardiomyopathy, aged 6.5 to 15.5 years (anthracycline dose = 198-737 mg/m2), and 31 patients aged 5.0 to 16.7 years, who received anthracyclines without evidence of left ventricular dysfunction (anthracycline dose = 120-517 mg/m2), were studied with signal averaged ECG. The two groups were comparable in age, body surface area, and time since completion of chemotherapy. Signal averaged ECG parameters of the patients were compared with data obtained from 530 healthy children. These parameters were converted to z-scores to account for growth-related changes in signal averaged ECG recordings. Z-scores for filtered QRS duration and low amplitude terminal signal < 40 microV were significantly lower (p = 0.002 and p = 0.015, respectively), and Z-score for root mean square voltage of the last -30 ms of filtered QRS tended to be higher (p = 0.06) in patients with left ventricular dysfunction. Filtered QRS duration lower than -1.5 SD was found in 4 of 16 patients with left ventricular dysfunction and in only 1 of 31 patients without (p < 0.05) yielding a sensitivity of 25% and a specificity of 97% to detect left ventricular dysfunction. Only 1 patient had late potentials; his left ventricular function was normal. Left ventricular mass index tended to be lower in patients with left ventricular dysfunction (p = 0.07), whereas left ventricular diastolic diameter was similar in the two groups. The mechanism that accounted for the difference in signal averaged-ECG between the two groups of patients could be linked with the decrease in left ventricular mass in patients with left ventricular dysfunction. In conclusion, children with left ventricular dysfunction following anthracycline therapy have a SA ECG different from those without left ventricular dysfunction, which is mainly characterized by a lower filtered QRS duration. A prospective study is needed in order to determine if this modification of SA ECG recordings precedes alteration of left ventricular function, and, therefore, if it could help in early detection of cardiac toxicity of anthracyclines.

Adolescent↗

PubMed2001

Chronic bilateral pallidal stimulation and levodopa do not improve gait in the same way in Parkinson's disease: a study using a video motion analysis system.

Chronic bilateral internal globus pallidus (GPi) stimulation allows control of levodopa induced dyskinesias (LID) and motor symptoms in severe Parkinson's disease (PD). The effect on gait has not been clearly established. Different results have been reported, mostly consisting of clinical data. The aim of this study was to evaluate, by means of a video motion analysis system (optoelectronic VICON system), the influence of bilateral GPi stimulation on gait in PD. Five patients underwent bilateral GPi stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances (items 29 and 30 of the motor UPDRS), as well as spatial and temporal gait measurements (namely cadence, velocity, stride and step times, single and double limb support times, stride and step lengths) were analysed in off condition (the patient had received no treatment for 12 hours or merely the lowest dose of levodopa allowing him to walk for the gait analysis) and in the on drug condition (after administration of 200 mg of levodopa). The gait analysis was performed with the VICON system. In off condition, there was a statistically significant improvement after surgery for UPDRS III and gait (clinically assessed). In on drug condition, there was a significant improvement for LID whereas UPDRS III and clinical assessment of gait were unchanged. The VICON system also showed that surgery improved gait especially in off condition, but also in on drug condition. Our method allowed exact quantification of the influence of surgery on gait characteristics. As compared with levodopa treatment, the effect of stimulation seems to be different. Indeed, the results suggest only limited effects of pallidal stimulation on the control of stride length and rather point to compensatory additional mechanisms.

Aged↗

PubMed2001

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.

Adult↗

PubMed2001

Assessing the Cox model assumption as a statistical tool for classifying lymphomas.

INTRODUCTION: The Cox model is widely used in medical research for comparing survival. Lymphomas might exhibit important differences in long-term cure rate despite a similar survival. METHODS: Using log-rank test, we compared event-free survival (EFS), and the survival of 64 patients with mantle cell lymphoma (MCL), 525 patients with follicular lymphoma, and 1136 patients with diffuse centroblastic lymphoma (CB). RESULTS: Although EFS and survival of MCL were significantly shorter than those of follicular lymphoma, checking the validity of the proportional hazards assumption shows that the distribution of rates of events and deaths over time did not differ in MCL and follicular lymphoma. In contrast, the ratios of hazards (events and deaths rates) did not remain constant over time in MCL and CB, because of a decrease in late events and deaths rates in the latter histological type. CONCLUSION: Checking the validity of the Cox model hypothesis might be a useful tool for assessing long-term cure rate in seldom lymphoma subtypes. Despite a short overall survival, MCL should not be considered to be an aggressive lymphoma, in which available chemotherapy may cure a subset of patients.

Adult↗

PubMed2001

Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis?

PURPOSE: To analyze the influence of multi-detector row spiral computed tomography (CT) on identification of peripheral pulmonary arteries. MATERIALS AND METHODS: Peripheral pulmonary arteries were analyzed on optimally opacified contrast material-enhanced spiral CT angiograms in 30 patients devoid of pleuroparenchymal disease who underwent scanning with multi-detector row CT (collimation, 4 x 1 mm; pitch, 1.7-2.0; scanning time, 0.5 second). Two series of scans were systematically generated from each data set, 1.25-mm-thick (group 1) and 3-mm-thick (group 2) sections, leading to the analysis of 600 segmental (20 arteries per patient), 1,200 subsegmental (40 arteries per patient), 2,400 fifth-order (80 arteries per patient), and 4,800 sixth-order (160 arteries per patient) pulmonary arteries in each group. RESULTS: Multi-detector row CT with reconstructed scans of 1.25-mm-thick sections (group 1) allowed (a) analysis of a significantly higher percentage of subsegmental arteries (94% in group 1 vs 82% in group 2; P <.001) and (b) a significantly higher percentage of fifth- and sixth-order arteries, respectively, identified in 74% and 35% of cases in group 1 and 47% and 16% in group 2 (P <.001). The causes for inadequate depiction of subsegmental branches in group 1 were partial volume effect (43%), anatomic variants (39%), and cardiac (17%) and respiratory (1%) motion artifacts. CONCLUSION: Multi-detector row CT with reconstructed scans of 1.25-mm-thick sections enables accurate analysis of peripheral pulmonary arteries down to the fifth order on spiral CT angiograms.

Angiography↗

PubMed2001

Social and health status of arrivals in a French prison: a consecutive case study from 1989 to 1995.

BACKGROUND: To assess the demographic, socioeconomic and health status of male arrivals in French jails and to analyze the time trends of these characteristics. METHODS: The study was carried out in a prison for detained persons and short term prisoners. Using a standardized questionnaire, we recorded the characteristics of all male detainees and prisoners arriving in the prison between 1989 and 1995. The information collected concerned: demographic data, level of education and professional status, reasons for detention or imprisonment, social and family background, lifestyle, medical and psychiatric history, suicide attempts and illicit use of drugs. The characteristics of the study population were compared with those found in the general regional population. We analyzed developing trends in the health status of the prison population as well as their socio-economic profile over a period of seven years (1989 to 1995). RESULTS: A total of 14,785 questionnaires were analyzed. Of the study population, 56% had no professional qualification, and 62% was unemployed. About two-thirds of the inmates presented psychiatric problems or problems with illicit drug use (one or several drugs). Amongst these, 70% had not had any form of care -neither therapeutic nor educational- before their arrival in prison. Between 1989 and 1995, the proportion of drug users increased by 30%. A parallel increase was observed in the level of unemployment and in the frequency of mental problems. CONCLUSIONS: Our results suggest a need for therapeutic and educational care to be provided for prison inmates. This poses a problem which needs to be addressed in terms of public health. The study also illustrates the usefulness of a standardised questionnaire for each arrival. The systematic use of such a tool would make it possible to identify inmates'needs and to propose adapted care solutions.

Adolescent↗

PubMed2001

From data collection to knowledge data discovery: a medical application of data mining.

Prison inmates are exposed to a variety of major risk factors (psychiatric disorders, suicide attempts, illicit drug use). From 1986 to 1996, the USA prison population more than doubled while in France, it increased from 35655 in 1980 to 51623 in 1995. In spite of these findings, very little information concerning the inmates population is available. At the present time, there is a desire to adopt a policy based on the prevention of recidivism, on adequate release planning and referrals to community-based services. The aim of the RAPPEL project was to build an information system for assessing the social and health status of prison inmates. The pilot project was set up at the prison of Loos and allowed the collection and analysis of nearly 15000 records. The aim of this paper is to present the extension of the project consisting in developing a regional network grouping 11 jails. Information locally available will serve as the basis for the information system of regional jails. Data mining techniques will provide solutions for the extraction of new information. Three data mining tools were experimented : association rules, classification trees and clustering. Further extension consists in a distributed approach allowing direct access to the information system by WEB tools.

Classification↗

PubMed2000

Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries.

The objective of this study was to analyze the influence of collimation on the identification of peripheral pulmonary arteries on helical CT scans. Three hundred sixty of 370 consecutive helical CT angiograms of the pulmonary circulation obtained during an 18-month investigation period were considered as technically acceptable for the detection of acute pulmonary embolism and were retrospectively analyzed. Patients in group A (n = 274) underwent CT with 2-mm collimation and pitch of 2; those in group B (n = 86) underwent CT with 3-mm collimation and pitch 1.7; a 0.75-s rotation time was systematically used. A total of 2160 segmental (six arterial zones per patient) and 2160 subsegmental (six arterial zones per patient) arterial zones were assessed. Whereas the percentage of segmental arteries was not significantly different between group A (86%) and group B (89%), the percentage of analyzable subsegmental arteries was greater in group A (65%) than in group B (43 %) (P<0.001). The causes of inadequately depicted subsegmental arterial zones were partial-volume effects (group A, n = 302; 52%; group B, n = 197; 67%; P<0.001), suboptimal enhancement (group A, n = 145; 25%; group B, n = 43; 15%; P<0.05), motion artifacts (group A, n = 113; 20%; group B, n = 30; 10%), and unincluded arteries (group A, n = 20; 3%; group B, n = 25; 8%). Helical CT with 2-mm collimation at 0.75 s per revolution enables marked improvement in the analysis of subsegmental arteries in routine clinical practice.

Adolescent↗

PubMed2000

Serum levels of inhibins are differentially altered in patients with polycystic ovary syndrome: effects of being overweight and relevance to hyperandrogenism.

OBJECTIVE: To explore the abnormalities of serum inhibin isoform concentrations in a large group of patients with polycystic ovary syndrome (PCOS) and to evaluate the influence of body mass index (BMI), age, LH, and androgens on serum inhibin levels. DESIGN: Prospective study. SETTING: Reproductive endocrinology unit of an academic medical center. PATIENT(S): Forty-one women with PCOS were compared with 24 healthy women. INTERVENTION(S): Blood sampling was performed in the early follicular phase in patients and in control women. MAIN OUTCOME MEASURE(S): Serum levels of inhibin A, inhibin B, alpha-inhibin, pro-alphaC (alpha-inhibin precursor proteins), LH, FSH, E(2), T, and androstenedione (A) were assessed in all subjects. RESULT(S): Serum alpha-inhibin levels together with LH, T, and A levels were significantly increased in women with PCOS. Serum inhibin A levels were lower in patients with PCOS than controls (median +/- SD: 7.35 +/- 2.9 vs. 9.4 +/- 4.7 pg/mL), pro-alphaC levels were higher (264 +/- 136.7 vs. 127 +/- 81.5 pg/mL), and inhibin B levels did not differ between the groups (110.5 +/- 51.5 vs. 108 +/- 47.5 pg/mL). Simple regression analysis showed that inhibin A and B levels were negatively correlated with BMI in patients with PCOS (r = -0.43 and r27 kg/m(2)) displayed significantly lower inhibin A and inhibin B levels and a higher pro-alphaC-inhibin A ratio than nonobese patients with PCOS (BMI </=27 kg/m(2)). In this last subgroup, the mean inhibin B level was significantly higher than in controls (median +/- SD: 144 +/- 53.5 vs. 108 +/- 47.5 pg/mL). Partial regression analysis, after controlling for age and BMI, demonstrated that in patients with PCOS, pro-alphaC levels were positively and independently correlated with LH and A levels. CONCLUSION(S): Among women with PCOS, the trend toward an excess serum inhibin B level is observed exclusively in nonobese patients. The higher pro-alphaC levels and the lower inhibin A levels might reflect a defect in the processing of inhibins specific to polycystic ovaries. In addition, our data suggest that pro-alphaC originates from the theca-interstitial cells and could participate in control of the androgen production by these cells.

Adolescent↗

PubMed2000

Alzheimer's disease and frontotemporal dementia are differentiated by discriminant analysis applied to (99m)Tc HmPAO SPECT data.

OBJECTIVE: Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most frequent neurodegenerative cognitive disorders. However, FTD remains poorly recognised clinically. The use of (99m)HmPAO-single photon emission computed tomography (SPECT) has been demonstrated in the differentiation of AD and FTD. Nethertheless, there are very few comparative studies designed to assess its precise value in this differential diagnosis. The aim was to determine a simple decision rule, deduced from statistical analysis, which, if applied to regions of interest (ROIs) and mini mental state examination (MMSE), could improve the predictive value of SPECT in differential diagnosis between AD and FTD. METHODS: Forty patients, 20 with probable AD and 20 with probable FTD were included. All patients underwent brain SPECT imaging, after an intravenous injection of (99m)Tc HmPAO-(555mBq). For each patient, 20 ROIs were determined on the Fleishig's slice and their activity was normalised to the mean cerebellar activity. Bivariate analysis (Wilcoxon rank tests) and multivariate analysis (stepwise discriminant analysis) were performed to determine the subgroup of variables able to give the highest predictive value for this differential diagnosis. A simple decision rule was built from a predictive score derived by factorial discriminant analysis. RESULTS: As previously described, the fixation defect was found in frontal regions of interest (ROIs) in FTD and in the left temporoparietal-occipital ROIs in AD. Among the 21 variables, five were finally selected: right median frontal, left lateral frontal, left tempoparietal, left temporoparietal-occipital areas, and MMSE. One hundred per cent of patients with FTD were correctly classified by the decision rule (20/20 patients) and 90% of patients with AD (18/20). CONCLUSION: AD and FTD are differentiated by SPECT. Automatic classification based on a decision rule deduced from factorial discriminant analysis could enhance its performance.

Alzheimer Disease↗

PubMed2000

Helical CT angiography of thoracic outlet syndrome: functional anatomy.

OBJECTIVE: The objective of this study is to determine the anatomic characteristics of the thoracic outlet in symptomatic patients before and after postural maneuver. SUBJECTS AND METHODS: Seventy-nine symptomatic patients (61 female patients [group 1]; 18 male patients [group 2]; mean age, 38 years) underwent helical CT angiography of the thoracic apices in the neutral position and after a postural maneuver, enabling the evaluation of the functional anatomy of the musculoskeletal and arterial structures of the ipsilateral thoracic outlet. RESULTS: A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in the neutral position and after postural maneuver in groups 1 and 2. The median value of these distances was smaller after postural maneuver in groups 1 and 2. A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in patients of group 1 with arterial stenosis and in patients of group 1 without arterial stenosis. A slight indentation of the anterior wall of the subclavian artery when it arches around the anterior scalene muscle was observed in 39 patients (64%) in group 1 and in 11 patients (61%) in group 2 in the neutral position, in 19 patients (31%) in group 1 and in six patients (33%) in group 2 after the postural maneuver. The predominant positional changes of the vascular structures were the posteroanterior displacement of the subclavian vessels observed in groups 1 and 2, the arch made by the subclavian artery above the first rib in 40 patients (66%) in group 1 and nine patients (50%) in group 2, and the posterior displacement of the axillary artery observed in 36 patients (59%) in group 1 and in 12 patients (67%) in group 2. CONCLUSION: Helical CT shows significant narrowing of the costoclavicular space after postural maneuver in symptomatic patients.

Adolescent↗