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Biomedical subjects

A Weill

Publications and source records attributed to A Weill.

At least 19 recordsLinked to original sources
PubMed2006

Assessment of diabetes screening by general practitioners in France: the EPIDIA Study.

AIM: To audit Type 2 diabetes screening in general practice in France and to determine the frequency of undiagnosed diabetes in patients at high risk, after systematic screening and diagnosis. METHODS: For this study, 288 general practitioners volunteered to include all consecutive non-diabetic patients aged < 65 years who had at least two risk factors for diabetes, whatever the reason for consultation. If a plasma glucose had not been recorded in the previous 12 months, a fasting plasma glucose (FPG) was performed, with a second test if FPG >or= 7.0 mmol/l. RESULTS: There were 5950 patients included. The most frequent diabetes risk factors were: age >or= 40 years, 92%; overweight [body mass index (BMI) >or= 27 kg/m2], 59%; treated hypertension, 48%; treated dyslipidaemia, 37%; family history of diabetes, 24%. Of these subjects at high risk for diabetes, 88% had a FPG measurement in their medical record (75% measured during the preceding 12 months). In the 1499 patients in whom FPG was measured, diabetes was diagnosed in 40 patients (2.7% 95% CI 1.9-3.5) and 22% had impaired fasting glucose (IFG). Thus, the frequency of undiagnosed diabetes in the 5950 high-risk patients was 0.67% (0.46-0.88). CONCLUSION: Screening for diabetes by general practitioners in France appears to be adequate and undiagnosed diabetes is rare in patients with risk factors for diabetes, at least in those consulting the general practitioners studied.

Blood Glucose↗
PubMed2004

[Screening for diabetes in France: data from the 2000-2001 cohort of the national medical insurance system].

BACKGROUND: Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test. METHODS: We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (2000-2001). We used the administrative EPAS cohort from the employee National Health Insurance System which covers 70% of the total population in France. The data are based on reimbursements of glucose testing and hospitalization among people who did not received reimbursements of treatment for diabetes but used medical services during the 2 Years. RESULTS: The opportunistic screening rate within 2 Years was 48.6% overall and increased with age. Among those 45 Years old or older, it was 71.2%. The screening rate was higher among women than men. CONCLUSION: Opportunistic screening for diabetes is commonly practised in France, despite the lack of official guidelines. Several hypotheses may explain the discrepancy between common opportunist screening and high prevalence of undiagnosed diabetes: 1). undiagnosed diabetes is mostly present in people who do not use medical services; 2). opportunistic screening is not performed among the most at-risk population; 3). testing is not performed on fasting samples or results are neglected; 4). results of testing are overlooked by doctors/patients; 5). epidemiological studies based on self-report of diagnosis and only one testing overestimate undiagnosed diabetes.

Adolescent↗
PubMed2003

The prevalence and cost of diabetes in metropolitan France: what trends between 1998 and 2000?*.

OBJECTIVES: Our aim was to update available data concerning the prevalence and cost of diabetes in metropolitan France. METHODS: We performed a retrospective study using patient reimbursement data from all the 128 local health offices (CPAM) in metropolitan France. We selected patients who received reimbursements for an oral hypoglycemic agent or insulin. Thus, 704,423 patients were studied by using 1998 data and 1,145,603 patients were studied by using data from 2000. The expenditures studied represented the total amount reimbursed by national health insurance to diabetic patients. The cost differential which could be attributed to diabetes was calculated by determining the difference between costs generated by diabetic patients to those generated by the rest of the population of the same age. RESULTS: Between 1998 and 2000, the prevalence of diabetes treated in the population of affiliates covered by the general scheme increased from 2.78% to 2.96%. The total amount paid by the general scheme for care to diabetic patients (related to diabetes or not) was 5.710 billion euros in 2000 compared to 4.862 billion euros in 1998. The amount which can be attributed to diabetes alone can be estimated to be 2.414 billion euros in 2000 compared to 2.021 billion euros in 1998. After considering the impact of the increase in the number of treated diabetics, a modification in the modalities of medical care probably accounts for 183 million euros of the cost increase. Medical equipment (self blood glucose monitoring devices, reagent strips, finger lancets...) accounts for 39.3% (72 million euros) of this cost differential, medications account for 34.4% (63 million euros) and nursing care 16.9% (31 million euros). There was no change in the cost of diabetes with relation to expenses for medical consultations.

Costs and Cost Analysis↗
PubMed2001

Arteriovenous malformation of the mandible: embolization and direct injection therapy.

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that can be potentially fatal as a result of massive hemorrhage. Traditional treatment involved extensive surgical resection of the mandible. With the advent of improved endovascular techniques, interventional radiology is now the best method to control active hemorrhage and ultimately cure these lesions. The authors describe three cases of successfully treated mandibular AVM by percutaneous and/or endovascular techniques.

Adolescent↗
PubMed2001

Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment.

PURPOSE: To evaluate the results of endovascular treatment of patients having both arteriovenous malformations and aneurysms. MATERIALS AND METHODS: Two hundred seventy consecutive patients underwent pretherapeutic selective and superselective angiography. In each patient, the following were recorded: demographic information; clinical symptoms; location of the arteriovenous malformation, including presence of aneurysms; therapeutic interventions and immediate anatomic results; and clinical and angiographic follow-up data. Every patient who had at least one angiographically confirmed arterial aneurysm at presentation was included in the study. RESULTS: Arterial aneurysms were found in 30 (11%) of 270 patients in the population with arteriovenous malformations. Fifteen (50%) of 30 patients with aneurysms had a hemorrhage at presentation. Only 66 (27.5%) of 240 patients without aneurysms had a hemorrhage at presentation. The coexistence of arteriovenous malformations and aneurysms correlated significantly with intracranial hemorrhage at presentation (P <.05). When an aneurysm was believed to be responsible for a hemorrhage and whenever possible, it was treated before the arteriovenous malformation was treated. Treatments were protective against hemorrhage or recurrence of hemorrhage in all cases. Five of 30 patients had neurologic deficits as a result of endovascular treatment of both aneurysms and arteriovenous malformations. CONCLUSION: Findings in this study highlight the importance of recognizing aneurysms in patients with arteriovenous malformations. A strategic focus on the circulatory exclusion of associated aneurysms, especially when such lesions have been responsible for a hemorrhagic episode, is recommended.

Adult↗
PubMed2001

Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents.

OBJECT: The authors describe their preliminary clinical experience with the use of endovascular stents in the treatment of traumatic vascular lesions of the skull base region. Because adequate distal exposure and direct surgical repair of these lesions are not often possible, conventional treatment has been deliberate arterial occlusion. The purpose of this report is to demonstrate the safety and efficacy as well as limitations of endovascular stent placement in the management of craniocervical arterial injuries. METHODS: Six patients with vascular injuries were treated using endovascular stents. There were two arteriovenous fistulas and two pseudoaneurysms of the distal extracranial internal carotid or vertebral arteries resulting from penetrating trauma, and two petrous carotid pseudoaneurysms associated with basal skull fractures. In one patient a porous stent placement procedure was undertaken as well as coil occlusion of an aneurysm, whereas in the remaining five patients covered stent grafts were used as definitive treatment. There were no procedural complications. One patient in whom there was extensive traumatic arterial dissection was found to have asymptomatic stent thrombosis when angiography was repeated 1 week postoperatively. This was the only patient whose associated injuries precluded routine antithrombotic or antiplatelet therapy. Follow-up examinations in the remaining five patients included standard angiography (four patients) or computerized tomography angiography (one patient), which were performed 3 to 6 months postoperatively, and clinical assessments ranging from 3 months to 1 year in duration (mean 9 months). In all five cases the vascular injury was successfully treated and the parent artery remained widely patent. No patient experienced aneurysm recurrence or hemorrhage, and there were no thromboembolic complications. CONCLUSIONS: The authors' experience demonstrates that endovascular treatment of traumatic vascular lesions of the skull base region is both feasible and safe. The advantages of minimally invasive stent placement and parent artery preservation make this procedure for repair of neurovascular injuries a potentially important addition to existing methods.

Adolescent↗
PubMed2000

Basilar artery occlusion in a child: "clot angioplasty" followed by thrombolysis.

Basilar artery occlusions are rare but have a very poor prognosis. Intra-arterial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusion in an 8-year-old child, which was treated by "clot angioplasty" followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed by placing a balloon catheter within the thrombus and inflating it several times in the occluded segment of the basilar artery. Thrombolysis was then performed through the balloon catheter. The basilar artery was only partially recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the very poor natural prognosis of basilar artery occlusion requires aggressive management. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization, which may increase the efficiency of thrombolysis.

Acute Disease↗
PubMed2000

Endovascular treatment of distally located giant aneurysms.

OBJECTIVE: Because giant aneurysms (GAs) can be technically difficult to clip, the endovascular approach is becoming increasingly popular. Endovascular treatment of distally located GAs, which often requires parent vessel occlusion, is particularly challenging because limited pathways are available for collateral flow. We aimed to determine the outcomes of endovascular attempts to treat GAs downstream from the circle of Willis. METHODS: Between 1991 and 1998, 27 patients with 27 distally located very large aneurysms or GAs were evaluated for possible endovascular treatment. Ten underwent selective embolization and 9 were treated with primary parent vessel occlusion, with or without distal bypass. Eight patients could not be treated endovascularly. RESULTS: Selective embolization resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage during the follow-up period. One coil-treated patient, who underwent subsequent spontaneous parent vessel occlusion, and all nine patients treated primarily with parent vessel occlusion were considered cured after their treatments. Only two patients treated with parent vessel occlusion experienced periprocedural ischemia, which did not result in a major deficit in either case. Of the eight patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up monitoring. CONCLUSION: Selective aneurysm embolization is usually not curative in these situations. For selected patients, however, endovascular parent vessel occlusion is usually safe and effective in preventing the progression of symptoms and bleeding.

Adult↗
PubMed2000

The retrograde approach: a consideration for the endovascular treatment of aneurysms.

BACKGROUND AND PURPOSE: The traditional endovascular approach to a cerebral aneurysm is anterograde, with the embolization and balloon protection catheters introduced via the parent vessel. Unfortunately, this approach may be restrictive, because these catheters cannot always be navigated at an optimal angle into the arterial branch that needs balloon protection or the part of the aneurysm that needs coiling. The purpose of this study was to determine the efficacy of a retrograde approach. METHODS: Twelve patients, seven women and five men, 28 to 65 years old (mean age, 45 years), were treated via the retrograde approach between March 1998 and February 1999. Three patients were treated for acutely ruptured aneurysms following subarachnoid hemorrhage. The rest had asymptomatic, unruptured aneurysms. RESULTS: We were able to accomplish endovascular treatment in 10 cases. In the other two, the attempted retrograde route of access could not be achieved. The treatment afforded complete embolization in nine of the 10 patients. Symptomatic distal clot embolization occurred in one patient who had some residual, albeit improving, deficits at discharge. No other patients worsened with the treatment. There were two intraprocedural aneurysmal ruptures. None of the aneurysms restudied within 6 months (eight of 12) showed evidence of recanalization. CONCLUSION: Our results indicate that it is possible to safely and effectively access a cerebral aneurysm via a retrograde approach. We believe that the anatomic benefits afforded by this technique outweigh the potential risks associated with the catheterization of another major cerebral arterial feeder.

Aneurysm, Ruptured↗
PubMed2000

Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis.

BACKGROUND AND PURPOSE: Percutaneous transluminal angioplasty (PTA) for significant stenosis involving the origin of the vertebral artery is now a well established treatment for selected patients when posterior cerebral arterial circulation is compromised. Arterial spasm, dissection, and restenosis may occur in some instances, with subsequent hemodynamic compromise. To prevent these potential complications, we combined PTA of the vertebral artery with primary stenting, using coronary stents, in seven patients. We herein present our short- and intermediate-term results. METHODS: A total of seven lesions affecting the origin of the vertebral artery were treated by primary trans-stenotic coronary stent placement. All patients were symptomatic, fulfilling the general criteria for vertebral artery angioplasty. Patients were followed for up to 36 months after treatment. RESULTS: All seven lesions were successfully dilated. Residual stenosis was never greater than 20% in diameter. No perioperative complications occurred. Clinical follow-up showed immediate resolution or improvement of symptoms in all patients. One patient's condition deteriorated 15 months after stent placement because of atheromatous stenosis of the prevertebral segment in the ipsilateral subclavian artery. CONCLUSION: Stent placement to treat significant stenosis involving the origin of the vertebral artery is safe and effective for alleviating symptoms and improving blood flow to the posterior cerebral circulation. Coronary stent design seems to be particularly well suited to cover atherosclerotic lesions of the origin of the vertebral artery. The stent mesh probably prevents elastic recoil and early restenosis after PTA, as it does in coronary arteries.

Aged↗
PubMed2000

[Epidemiology of diabetes in metropolitan France].

The statistical analysis of French HealthCare's database, containing total reimbursements to affiliates and a listing of delivered drug prescriptions in the form of specific drug codes, allowed us to update data on the epidemiology of diabetes. This study, performed during the first trimester of 1999 on the entire population of metropolitan France, found an overall prevalence of 2.78 % for diabetes in all affiliates of the regimen (Régime général) stricto sensu (3.06 % in the general population), 0.41 % corresponding to diabetic treated exclusively with insulin (0.44 % in the overall population) and to 0.12 % receiving both insulin and oral hypoglycemic agents concomitantly (0.13 % in the general population). The average age of diabetics, irrespective of the treatment they were receiving, was 63.1 years with a sex ratio M/F of 1.04. These findings confirm epidemiological forecasts which had predicted a significant increase in the prevalence of diabetes over the past few years. The study also confirmed data from the medical literature concerning geographic disparities in the epidemiology of this disease except for the results obtained in the north of France, a region generally thought to have a lower prevalence of diabetes, and which was found to have a prevalence equal to even greater than the national average.

Adolescent↗
PubMed2000

[The cost of diabetes in metropolitan France].

The statistical analysis of French HealthCare's database, containing total reimbursements to affiliates and a listing of delivered drug prescriptions in the form of specific drug codes, allowed us to update data of the cost of diabetes. This study, realized during the first trimester of 1999, used the combined databases of 110 local healthcare offices (CPAM) among the 128 existing in metropolitan France. French Social Security spent a total of 31.9 billion francs (4.9 billion euros) in care given to diabetics (or 24,137 francs per patient) comprised by 14.2 francs (2.2 billion euros) for in-hospital care and 17.7 billion francs (2.7 billion euros) for outpatient services. The total expenses for diabetic patients represented 4.7% of French Social Security's overall expenses for all its affiliates. The differential cost of diabetes (the difference, at equivalent ages, between cost generated by diabetic patients and those attributable to the remainder of the affiliated population) was estimated, for the generalized health-care regimen (régime général) in 1998, to be 13.3 billion francs (2.0 billion euros). These figures underscore the need to reinforce prevention and screening for end-organ complications since it is generally admitted that the disease's high cost is essentially related to its complications.

Adolescent↗
PubMed2000

[Modalities of follow-up on non-insulin treated diabetics treated in metropolitan France in 1998].

The statistical analysis of French HealthCare's database allows a retrospective evaluation of the overall clinical care given to diabetics in the light of the guidelines (RBPC) promulgated by the National Agency of Health Accreditation and Evaluation (ANAES). This database contains no information on the stage of the disease process, the completeness of the clinical evaluation (neurological or foot examination) or the results of significant blood tests. We studied the follow-up care given to diabetics whom we were able to identify by isolating reimbursements for hypoglycemic agents using their corresponding drug codes. Considering the time needed for this new drug-coding system to become fully operational, the results can be extrapolated to the entire population of non-insulin treated diabetics. In 1998, almost all follow-up care was provided by general practitioners since only 5.5 % of the patients consulted an endocrinologist during the year studied. Blood sugar was generally monitored with fasting blood sugars rather than HbA1c which was only prescribed in 41.3 % of the patients during the final six months of the period under consideration. Screening and follow-up for degenerative complications were insufficient. Fewer than 40 % of the patients had received reimbursement for an ophtalmological consultation during the preceeding year and fewer than 30 % had an ambulatory resting EKG over the same time period. A certain number of factors were studied in order to determine if they were correlated to better clinical follow-up. The best follow-up was encountered in patients who had a consultation with an endocrinologist at least once during the year, those who were exonerated from co-payments (ALD 30) and finally, those aged between 40 and 59 years (at least with respect to appropriate laboratory tests).

Blood Glucose↗
PubMed2000

[Analysis of health insurance benefits: material and methods].

The statistical analysis of national health insurance's database, containing a record of the care reimbursed to affiliated members and delivered drugs in the form of special pharmacy codes, enable us to evaluate the follow-up care given to diabetics, to update epidemiological information and to determine the actual cost of diabetes. The method used consisted in the identification of diabetics by isolating patients who received hypoglycemic agents during the 3-month inclusion period followed by a retrospective determination of total reimbursements made through the 128 local health offices (CPAM) located in metropolitan France in order to study the reimbursed care (medical consultations, procedures and drug prescriptions) given to diabetics over the preceding 12 month period. Considering that the pharmacy coding system was still incomplete at the time the study was undertaken, we had to verify that the population selected by the coding system was only partially operational, requiring a calculation involving weighted coefficients. Finally, we needed to take into account the fact that the resulting data contained virtually no information on facilities receiving a once a year total budget allocation (all public hospital).

Adolescent↗
PubMed1999

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils.

PURPOSE: To evaluate the stability of aneurysm occlusion at follow-up angiography after endovascular treatment (EVT) with detachable coils in intracranial berry aneurysms. MATERIALS AND METHODS: A total of 203 berry aneurysms (< 1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases. RESULTS: Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred. CONCLUSION: A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.

Cerebral Angiography↗
PubMed1999

Facial diplegia complicating a bilateral internal carotid artery dissection.

BACKGROUND AND PURPOSE: We report a case of facial diplegia complicating a bilateral internal carotid artery dissection. CASE DESCRIPTION: A 49-year-old patient presented with unilateral headache and oculosympathetic paresis. Cerebral angiography revealed a bilateral internal carotid artery dissection. A few days later, the patient developed a facial diplegia that regressed after arterial recanalization. An arterial anatomic variation may explain this ischemic complication of carotid dissection. CONCLUSIONS: Double carotid dissection should be included among the causes of bilateral seventh nerve palsy.

Aortic Dissection↗
PubMed1999

Treatment of distal aneurysms of the cerebellar arteries by intraaneurysmal injection of glue.

Distal aneurysms of the cerebellar arteries are associated with a poor prognosis, as surgery or embolization with GDCs is very difficult. We report our experience with a new therapeutic method involving intraaneurysmal injection of glue. Three aneurysms were catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysms. In two cases, treatment resulted in total occlusion of the aneurysm with preservation of the parent artery. In one case, the aim was to occlude both the aneurysm and parent artery.

Adult↗