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Biomedical subjects

A Rochette

Publications and source records attributed to A Rochette.

At least 19 recordsLinked to original sources
PubMed2004

[A comparative study of the feasibility and limits of ambulatory surgery in infants under and over one year of age].

OBJECTIVE: Outpatient surgery in pediatrics is attractive for several reasons. Although 6-8 months has been generally acknowledged as the lower age limit, no minimal age has been clearly established. This study evaluated the outcomes and limits of outpatient surgery in infants from 4 months to 1 year of age. MATERIAL AND METHODS: Between 1996 and 2003, 935 patients were admitted to our hospital for outpatient surgery; of these, 152 were between 4 months and 1 year (mean: 6 months). The indications were essentially surgery to the external genitalia and surgery to remove hernias. The following were exclusion criteria: age below 4 months, ASA scores equal to or above 3, and premature birth with either respiratory distress syndrome or a near-miss of sudden death. RESULTS: More than 98% of the infants met the criteria for outpatient surgery. Cancellations (1.97 vs. 0.51%, P > 0.05), conversions to classic hospitalization (0.65 vs. 0.37%, P > 0.05), postoperative complications (0.65 vs. 0.25%, P > 0.05), rehospitalization (0.65 vs.0.25%, P > 0.05) and relapse of the initial pathology (0.65 vs. 0.63%, P > 0.05) were not more frequent in these infants than in infants over 1 year. CONCLUSION: Pediatric outpatient surgery can be proposed from the age of 4 months without increasing the postoperative risk, either anesthetic or surgical, included for selected former premature infants.

Age Factors↗
PubMed2004

Continuous psoas compartment blocks after major orthopedic surgery in children: a prospective computed tomographic scan and clinical studies.

UNLABELLED: Femoral shaft or hip surgeries are very painful for children. We conducted both computed tomographic (CT) and clinical prospective studies to define new landmarks in children and to evaluate the effectiveness of continuous psoas compartment blocks (CPCBs) using disposable elastomeric pumps. In a preliminary CT scan study of 20 patients, the plexus depth was correlated to patient age and the optimal point of puncture for CPCB was three-quarters of the distance from the spinous process of L4 to a line parallel to the spinal column passing through the posterior superior iliac spine. In a subsequent prospective series, a CPCB was administered before surgery to 15 children for pain relief after femoral and hip osteotomies. After general anesthesia, a 0.5 mL/kg bolus of a mixture of 1% lidocaine with epinephrine (1/200.000) and 0.5% ropivacaine was injected through the CPCB catheter. After contrast media assessment of the catheter location, a disposable pump (Infusor LV); Baxter, Paris, France) with 0.2% ropivacaine was connected and pump flow was adjusted to the patient's weight (0.2 mg x kg(-1) x h(-1)). Postoperative pain was evaluated using a visual analog scale or the Children and Infants Postoperative Pain Score at hour H1, H6, H12, H18, H24, H36, and H48, and in terms of rescue analgesia, adverse events, and motor blocks. All blocks were effective during surgery. Postoperative analgesia was excellent. The median pain scores were 1 for H1 and 0 beginning H6. The motor blockade was minimal before 24 h and absent thereafter. No major adverse event was noted. Parents of 93% of the children were satisfied. We conclude that postoperative analgesia with CPCB is a very effective technique in children after major proximal lower limb orthopedic surgery. The CT scan landmarks described in this study were more medial than the conventional landmarks used in the literature. IMPLICATIONS: Continuous psoas compartment blocks provide optimal pain relief in children after major orthopedic surgery without major adverse events. The landmarks used, defined in a preliminary computed tomographic scan study, were more medial than conventional landmarks.

Adolescent↗
PubMed2002

Predictors of handicap situations following post-stroke rehabilitation.

PURPOSE: Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme. METHODS: At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H). RESULTS: One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%). CONCLUSIONS: In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Aged↗
PubMed2002

Coping with the consequences of a stroke.

BACKGROUND AND PURPOSE: Having a stroke constitutes a major life event which engenders some types of adaptation in order to try to resume to a "normal" life. The objectives of this study were (1) to explore the type of coping strategies used following a stroke; (2) to verify if coping strategies change over time, and (3) to verify if the coping strategies used are related to age, gender, actualization of potential, handicap level and depression. METHODS: A convenience sample of 76 participants who had had a stroke was recruited upon discharge from a functional intensive rehabilitation unit. Data were collected 2 weeks later and 6 months later in their own home. Coping strategies were measured using a modified version of the Ways of Coping Questionnaire. Actualization of potential was measured using the Measure of the Actualization of Potential and handicap level was quantified with the LIFE-H. Finally, the Beck Depression Inventory was used to evaluate the presence of depressive symptoms. CONCLUSION: The results suggest that long after the end of an intensive rehabilitation programme, some coping strategies might be more effective in dealing with the consequences of a stroke whereas others might be related to some form of inadaptation. However, the results should be treated with caution. More research on coping following a stroke using mixed methodologies is needed.

Adaptation, Psychological↗
PubMed2001

Association between personal and environmental factors and the occurrence of handicap situations following a stroke.

BACKGROUND AND PURPOSE: Little is known about the potential role of environmental factors in the handicap creation process following a stroke. The objective of this study was to explore the presence of a relationship between environmental factors and the occurrence of handicap following a stroke, taking into consideration age and the level of impairments and disabilities. METHODS: This is a cross-sectional study where data were collected 6 months after discharge from an intensive functional rehabilitation unit. A convenience sample of 51 participants was recruited at the time of their admission to the rehabilitation unit for rehabilitation post-stroke. Perceived influence of environmental factors was measured using the Measure of the Quality of the Environment (MQE). Handicap situations were measured with the Assessment of Life Habits (LIFE-H). Impairments and disabilities comprised six domains (cognition, perception. depression, communication, sensorimotor function and comorbidity) assessed using a variety of measuring tools from which a composite score was derived. RESULTS: Fifty-one participants aged 40-97 years old took part in this study. Perceived obstacles in the environment, together with age and the level of impairments and disabilities, explained 58.9% of the variation in the LIFE-H (handicap level). Taken alone, the perceived obstacles (total score) explained 6.2%. The perceived facilitators (total score) in the environment were not found to be related to the presence of handicap situations. CONCLUSION: Increased level of impairments and disabilities. advanced age and perceived barriers in the physical and social environment contribute to the handicap creation process following a stroke.

Activities of Daily Living↗
PubMed2001

Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke.

BACKGROUND AND PURPOSE: Using confirmatory factor analysis, this study evaluates the relative impact of motor, cognitive, and perceptual deficits on functional autonomy with 100 elderly (aged 55 to 79 years) victims of stroke. METHODS: Two different approaches were used for measuring functional autonomy: the Functional Autonomy Measurement System (Système de Mesure de l'Autonomie Fonctionnelle [SMAF]) and the Assessment of Motor and Process Skills (AMPS). RESULTS: The results of the confirmatory factor analysis show that motor, cognitive, and perceptual factors all make a significant contribution to the variation in functional autonomy and confirm the accuracy of the model (93% of the variance is explained when the SMAF is used to measure functional autonomy, and 64% of the variance is explained when the AMPS is used). CONCLUSIONS: The factors that make the greatest contribution in explaining the variance in functional autonomy are, in order of importance, the motor factor, the perceptual factor, and the cognitive factor.

Aged↗
PubMed1999

Preoperative screening for von Willebrand disease type 1: low yield and limited ability to predict bleeding.

Type 1 von Willebrand disease (vWd) is the most common hereditary bleeding disorder. The objective of this study was to measure the von Willebrand factor antigen (vWf:Ag) in a large cohort of patients who underwent surgery to assess the role of a new rapid immunoassay in a screening procedure for vWd in preoperative conditions. We studied 832 consecutive patients (540 children, 292 adults) referred to the surgical departments. For each patient we determined the vWf:Ag level with two different assays, an enzyme-linked immunosorbent assay (ELISA)(Asserachrom vWf:Ag; Diagnostica Stago, France) and a rapid immunoassay (Liatest vWf:Ag; Diagnostica Stago). Using the reference test, we found 30 of 832 patients with a vWf:Ag value below the lower limits (21 U/dL to 46 U/dL). The coefficient of correlation between the two tests was 0.77 (P = .001). When receiver operating characteristic curves were used, the cutoff value calculated to detect vWf:Ag defect with the rapid assay was 68.5 U/dL, leading to 0.36% false negatives and 9.7% false positives. Thus the rapid immunoassay appears to be a useful and easy method that is adaptable to urgent situations. Among the 30 patients with low values in ELISA, 8 had personal or familial bleeding history. Repeat blood samples confirmed the diagnosis of vWd in 5 cases, leading to a prevalence of vWd type 1 of 0.6%. However, in our series the absence of severe bleeding complications raises the question of the screening and the management of patients bearing a type 1 Willebrand disease during surgery.

Adolescent↗
PubMed1999

Age-related changes in upper extremity performance of elderly people: a longitudinal study.

The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.

Aged↗
PubMed1999

[Anaphylactic shock after a test-dose of aprotinin in pediatric orthopedic surgery].

A case of severe anaphylactic shock in a 28-month-old child following a testing-dose of aprotinin during major orthopaedic surgery is reported. Two months earlier, aprotinin had been administered during a similar controlateral surgical procedure. The grade III anaphylactic accident required a 48 h treatment in an intensive care unit. The outcome was favourable. The pin-prick tests were positive for aprotinin, substantiating the diagnosis of anaphylactic shock, whereas the test with specific IgE was negative. The value of current diagnostic tools for aprotinin allergy is discussed. The administration of a testing-dose in a patient previously treated with aprotinin cannot be recommended. Considering the risk for allergy, aprotinin should only be administered for recognized indications such as major orthopaedic surgery. Before any readministration of this agent an assessment by an allergist-anaesthetist is essential for determination of the risk-benefit ratio.

Anaphylaxis↗
PubMed1999

[Test-retest and inter-rater reliability of the French version of the Ontario Society of Occupational Therapy (OSOT) Perceptual Evaluation].

This article presents the results of a study conducted to verify the test-retest and inter-rater reliability of the French version of the Ontario Society of Occupational Therapy (OSOT) Perceptual Evaluation. Designed to evaluate the perceptual deficits in patients with brain injuries, this tool uses a 5-points scale (0-4) to measure 18 different tasks. The scores obtained for each task are added to establish a total score. In the early 90s, the instruction manual of the OSOT Perceptual Evaluation was translated in French by a group of occupational therapists from l'Institut universitaire en gériatrie de Sherbrooke. To ensure the reliability of this version, a study was conducted to determine the test-retest reliability and the simultaneous inter-rater reliability. Thirty-two francophone subjects with brain injuries were each evaluated twice by the same therapist to determine the test-retest reliability of this tool. At one of the two encounters, a second therapist completed the score sheet to verify the simultaneous inter-rater reliability. The results show that, despite a few weak kappas' scores for certain tasks, the test-retest reliability and the inter-rater reliability of the total score were excellent (test-retest reliability: intra-class correlation coefficient = 0.93, with a confidence interval of 0.87 to 0.97; and inter-observer reliability: = 0.98, with a confidence interval of 0.97 to 0.99). The findings of this study show that the French version of the OSOT Perceptual Evaluation can therefore be used confidently by francophone occupational therapists.

Brain Injuries↗
PubMed1998

Comparison of cross-sectional and longitudinal designs in the study of aging of upper extremity performance.

The purpose of the study was to compare two research designs, namely the cross-sectional design and the longitudinal design, in the context of upper extremity performance and age-related changes. Upper extremity performance of 360 randomly recruited healthy, community-dwelling elderly persons was evaluated with reliable and valid sensori-motor tests. Three years later, survivors (n = 264) were reevaluated with the same tests. In many tests, cross-sectional and longitudinal designs were comparable for estimating the changes in upper extremity performance with age. However, in some tests, the decline with age using a cross-sectional design was underestimated. The upper extremity performance decline observed with the longitudinal design was larger than the decline predicted with the cross-sectional design. The withdrawal and survivor biases related to the longitudinal design and the cohort bias associated with the cross-sectional design may, in part, explain these results.

Aged↗
PubMed1997

Determination of nalbuphine in human plasma by high-performance liquid chromatography with electrochemical detection. Application to a pharmacokinetic study.

A high-performance liquid chromatographic procedure has been developed for the measurement of nalbuphine in plasma. Separation is performed on a reversed-phase analytical column (Ultrasphere ODS, 250 x 4.6 mm I.D., particle size, 5 microns). Mobile phase consisted of methanol-phosphate buffer (20:80, v/v) (pH 3.4). Electrochemical detection was performed using an ESA Coulochem II Model 5200 electrochemical detector equipped with a Model 5020 guard cell working at 550 mV and a Model 5021 analytical cell operating in the oxidation screening mode, with the potential of the first electrode set at 60 mV and the second electrode set at 450 mV. The method involves sample clean-up by liquid-liquid extraction using a chloroform-isopropanol mixture. After centrifugation, the organic phase was back-extracted with 17 mM phosphoric acid and then the aqueous phase was injected onto the column. The limits of quantitation and detection were 0.3 and 0.1 ng/ml, respectively. The extraction recovery was 91.1 +/- 3.7%. The intra- and inter-assay coefficients of variation were below 10%. Stability tests under various conditions have been performed. This method has been used to determine the pharmacokinetic parameters of nalbuphine in children.

Analgesics, Opioid↗
PubMed1996

Spinal anaesthesia in newborns: total and free bupivacaine plasma concentration.

This study was designed to measure total and free bupivacaine (B) after spinal anaesthesia in newborns and to evaluate a possible influence of adrenaline on B absorption. Twenty-two newborns were randomly allocated to receive either plain B (group 1) or adrenaline added to B (group 2) for spinal anaesthesia. A single blood sample was collected ten min after spinal injection. Total B concentration was found 0.31 +/- 0.17 microgram ml-1 in group 1 and 0.25 +/- 0.09 microgram ml-1 in group 2. Bound B concentration was 0.27 +/- 0.17 microgram ml-1 in group 1 and 0.22 +/- 0.09 microgram ml-1 in group 2. No difference was found between the two groups for these parameters. Albumin but not alpha 1-acid-glyco-protein correlated to age and weight, bound B correlated to alpha 1-acid-glyco-protein but not to albumin. Despite the low plasma concentration of binding proteins in newborns, spinal anaesthesia with B does not result in a high level of free drug. Adrenaline does not have any pharmacological advantage in these patients.

Absorption↗
PubMed1992

[Local analgesic action by direct effect of pethidine on the nervous trunks].

The aim of this paper is to study the analgesic effects of meperidine (pethidine) on nervous trunks. First we compared the analgesic effect of pethidine in surgery of knee and femur. Meperidine was randomly administered either by femoral block or intravenously. The onset of analgesia was shorter with femoral block (5 minutes against 146 minutes). In the surgery of shoulder, nerve block with meperidine was performed using intersclalenic block. Plasma concentrations ar lower (maximum of 0.29 mg per liter) than intravenous therapeutic concentrations (between 0.5 and 0.7 mg per liter). So we can conclude as do other papers, there is a direct effect of meperidine on nervous trunks. This effect is probably mediated by receptors located on nervous trunks.

Female↗
PubMed1990

[Voluntary drug poisoning: epidemiology, performance and limits of the emergency laboratory].

The aim of this study is to determine the efficiency ot toxicologic screening (detection of barbiturates, benzodiazepines, tricyclic antidepressants, salicylates, phenothiazines, meprobamate and ethanol assay), during acute drug poisoning. In 1988, 898 patients are enclose in this study. Screenings are negative in 17% of cases; benzodiazepines, alcohol and antidepressants are often found. The recovery is very good for barbiturates and salicylates but it's not perfect for benzodiazepines, particularly flunitrazepam triazolam, loflazepate, oxazepam, and non tricyclic antidepressants. This failure probably depends on these emergency methods.

Clinical Laboratory Techniques↗
PubMed1988

[Sensitivity to antibiotics of 64 strains of Stomatococcus mucilaginosus isolated in human clinical cases. Demonstration of erythromycin resistance].

Susceptibility to fifteen antibiotics of 64 stains of Stomatococcus mucilaginosus isolated from bronchial secretions was tested by susceptibility antibiotics diffusion and MIC method. Sixteen phenotypic profiles were determined by MIC. Some of these profiles and the spontaneous loss of resistance to erythromycin indicate plasmidic origin of this resistance.

Ampicillin Resistance↗