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Biomedical subjects

A Ellrodt

Publications and source records attributed to A Ellrodt.

At least 19 recordsLinked to original sources

Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study.

BACKGROUND: Recent guidelines have enabled doctors to establish accident and emergency department management strategies for acute asthma on the basis of severity of exacerbations at presentation. However, there is no available information on acute asthma patients classified according to severity of disease. Our aim was to describe the severity of such exacerbations at presentation, and the adequacy of treatment and management. METHODS: We did a 12-month multicentre cross-sectional observational cohort study in adult patients with acute asthma who attended one of 37 accident and emergency departments in France. The doctors who examined the patients obtained information using a formatted chart. We classified exacerbations according to severity (life-threatening, severe, or mild to moderate), on the basis of clinical findings and peak expiratory flow value, as defined by currently used guidelines. FINDINGS: Of 3772 patients with acute asthma, 975 (26%) had life-threatening attacks, 1834 (49%) had severe exacerbations without life-threatening features, and 963 (26%) had mild to moderate exacerbations. Initial treatment included nebulised b2 agonists, anticholinergics, and systemic corticosteroids in 3492 (93%), 1841 (49%), and 2252 (60%), respectively. According to severity classification, anticholinergics were used in 494 (51%), 913 (50%), and 434 (45%) of patients in life-threatening, severe, and mild to moderate exacerbations groups, respectively; corticosteroids were given in 666 (68%), 1117 (61%), and 468 (49%), respectively. The overall admission rate was 54.2%, and mean stay was 6.1 (SD 6.0) days. Patients were admitted in 747 (77%), 1018 (55%), and 278 (29%) of cases in life-threatening, severe, and mild to moderate groups, respectively. Three patients died in hospital. INTERPRETATION: Acute asthma exacerbations are often life-threatening in patients who attend accident and emergency departments, and management of patients is not ideal, mainly because of underuse of corticosteroids and inappropriate admission rates according to severity.

Acute Disease↗

[Evaluation of plain abdominal radiography prescriptions in a university hospital center].

OBJECTIVES: The aim of this study was to evaluate the prescription, impact and diagnostic utility of plain abdominal radiography in a University Hospital. METHODS: Plain abdominal radiography series performed over 15 consecutive days were evaluated for quality and agreement with the patient's clinical status. Agreement between the final diagnosis and the radiographic findings were also compared. Contribution of plain abdominal radiography to final diagnosis was assessed on the basis of the conclusions on the hospital discharge report or from those drawn from a telephone survey. The same relationship was also assessed in terms of clinician status (medical student, resident physician, senior physician). RESULTS: The series included 175 radiography series (11.6 per day). In 86% of the cases, the choice of views was adapted to the clinical context. In 14% it was not. The quality of the x-rays was found to be unsatisfactory in 17%, good in 63% and excellent in 20%. The radiography was considered to be contributive to the final diagnosis in 13% of the cases and non-contributive in 87%. Clinician status was not correlated with the degree of usefulness for final diagnosis. Finally, the prescription was in agreement with standard guidelines in 28% of the cases and not in agreement in 72%. CONCLUSION: Plain abdominal radiographs are neither sensitive nor specific, frequently misleading, and costly per specific and correct diagnosis. Better physician awareness is required to limit the number of unnecessary examinations.

Abdomen↗

[Evaluation of radiological medical practice at a hospital during night duty].

PURPOSE: To evaluate the radiological activity during night duty, in a University Hospital. Materials and methods. During 100 days, the radiological activity has been evaluated from examinations requiring radiologist (including US and CT, special X-ray examinations). The urgent nature and the agreement between the suspected disease and the final diagnose have been compared with the level of the clinician (medical student, resident, senior). RESULTS: 981 radiological examinations were performed on an emergency basis. In 39%, the examination was urgent or very urgent and for 61%, little urgent or non-urgent. The level of the clinician was correlated with the degree of emergency evaluated by the radiologist and with the agreement between suspected disease and the final diagnose (p<0. 0001). CONCLUSION: During night duty, the medical activity in radiology is not justified only by emergency, but also by the continuous hospital activities. Better formation of the physician is required to limit the number of examinations.

Emergency Service, Hospital↗

Assessment of vitamin A status in an elderly French population using impression cytology with transfer.

The vitamin A status of 105 elderly French people was assessed by ocular impression cytology with transfer (ICT). 5 patients (4.8%) had a negative ICT defined by the absence of goblet cells and the enlargement of the epithelial cells (deficient vitamin A status). 100 patients had a positive ICT with goblet cells and small, numerous epithelial cells (sufficient vitamin A status). ICT results were compared to serum biochemical parameters. Mean serum levels of retinol, retinol-binding protein (RBP) and transthyretin (TTR) were significantly lower while C-reactive protein (CRP) and orosomucoid were significantly higher in negative ICT than in positive one. The etiology of vitamin A deficiency is difficult to conclude (malnutrition, vitamin A deficiency, inflammation). ICT is a good indicator of peripheral vitamin A deficiency in our experience.

Aged↗

Impression cytology with transfer: an easy method for detection of vitamin A deficiency.

We described a new method to stain epithelial cells harvested by ocular impression. The cells are immediately transferred on a glass slide after the sampling; this transfer permits a very simple staining and easier reading by light microscopy. The results are compared with those obtained with the previous techniques and confirm ocular impression as a good help for vitamin A status determination.

Conjunctiva↗

Multifocal central nervous system lesions in three patients with trichinosis.

Three patients with trichinosis developed central nervous system complications. Cerebral computed tomography showed multifocal hypodense lesions in two patients. The lesions were associated with contrast enhancement and cortical gyral enhancement in the first case, suggesting hypoxia and infarction. In the second patient, magnetic resonance imaging showed multiple high-signal-intensity lesions. Early cerebral computed tomography was normal in the third patient. All patients recovered after treatment with antiparasitic drugs and corticosteroids. We suggest that neurologic complications of trichinosis should be treated by corticosteroids and flubendazole.

Adult↗

Erosive arthritis of the costovertebral joint in seronegative spondyloarthropathy.

A 50-year-old male presented with polyarthritis and pain of the right costovertebral angle in the cervicothoracic area. Radiological findings in a sacroiliac joint, the presence of a syndesmophyte, the HLA B-27 phenotype and negative serological studies prompted the diagnosis of HLA-B27 related seronegative spondyloarthropathy. Conventional and computerized tomograms disclosed an erosive arthritis of the 1st right costovertebral joint that was responsible for the pain in the costovertebral angle. We are unaware of previous CT scan documentation of such lesions.

Arthritis↗

Isolation of human T-lymphotropic retrovirus (LAV) from Zairian married couple, one with AIDS, one with prodromes.

A Zairian married couple had been living in France since 1981. The man had acquired immunodeficiency syndrome (AIDS) and his wife had prodromes of the disorder. Infection with a human T-lymphotropic retrovirus (lymphadenopathy-associated virus) was demonstrated in both by isolation of the virus from their cultured lymphocytes and the detection of specific antibodies in serum samples. Since this virus has been isolated from patients in other AIDS risk categories, the finding of the virus in AIDS patients from the African group adds further support to the hypothesis that this human retrovirus is the AIDS aetiological agent.

Acquired Immunodeficiency Syndrome↗

Spermatozoa as potential carriers of HIV.

In order to investigate the role of germ cells in the sexual transmission of immunodeficiency virus (HIV), spermatozoa from healthy HIV-seronegative men were incubated in vitro with HIV1. After washing, they were cocultured with peripheral blood leukocytes from seronegative blood donors. Reverse transcriptase assays and p24 antigen tests were performed in culture supernatants. Electron microscopy examination of these HIV-incubated spermatozoa was carried out, as well as the search for CD4 molecules on their surface. Although virus bound to and seemed to enter spermatozoa despite the absence of detectable CD4 epitopes on their surface, no replication of HIV was apparent. However, HIV particles on the surface of spermatozoa were capable of infecting CD4 T lymphocytes. Present results would seem to preclude artificial insemination between an HIV-seropositive man and an HIV-seronegative woman.

Adult↗