Biomedical subjects

Alain-Ferdinand Le Blanche

Publications and source records attributed to Alain-Ferdinand Le Blanche.

5 recordsLinked to original sources

PubMed2006

Long-duration temporary vena cava filter: a prospective 104-case multicenter study.

BACKGROUND: Nonpermanent caval filters are placed in critical thromboembolic situations in which anticoagulation therapy is transiently contraindicated, ineffective, or the source of complications. The purpose of this study was to assess the safety and effectiveness of a second-generation long-duration temporary caval filter in these situations and compare its utility with that of other temporary filters. METHODS: This prospective study, including patients who underwent temporary caval filtration with the Tempofilter II, was conducted in nine European centers. All filters were successfully implanted. The filter was removed when the indication for caval filtration ceased. RESULTS: A total of 104 filters were inserted in 103 patients with an average age of 60 +/- 15.5 years (range, 22-92 years). Most patients (85%) had pulmonary embolism, deep venous thrombosis, or both. The main indications for caval filter placement were complications of or contraindications to anticoagulation therapy (n = 85; 82.5%) or for ineffectiveness of anticoagulation therapy (n = 12; 11.7%). The average duration of implantation was 29.5 +/- 14.0 days (range, 2-86 days). One filter migrated in the right atrium, followed by pulmonary embolism. No other case of pulmonary embolism or of infectious or mechanical complications related to the filter was observed. Thrombus was trapped within the filter in 24 cases (23.3%). All filters but one were removed, regardless of whether thrombus had been trapped. Retrieval was always successful after implantation periods up to 12 weeks. In 16 cases (15.5%), the filter was replaced by a permanent filter. CONCLUSIONS: The Tempofilter II is safe, effective, and useful in critical thromboembolic situations. It offers a valuable alternative to retrievable optional filters.

Adult↗

PubMed2004

Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study.

OBJECTIVES: To identify independent risk factors of symptomatic deep vein thrombosis (DVT) in geriatric inpatients and to define high-risk patients likely to benefit from preventive treatment. DESIGN: Hospital-based case-control multicenter study with prospective data collection. SETTINGS: Geriatric university hospitals with long-, intermediate-, and short-term care facilities. PARTICIPANTS: All patients aged 65 and older in 19 geriatric departments were submitted to clinical surveillance over a 16-month period. MEASUREMENTS: Twenty-three potential risk factors of phlebitis were screened for. Comparison using logistic regression of 310 consecutive patients with symptomatic DVT versus 310 randomly selected controls was performed. The risk for symptomatic DVT in geriatrics was then scored from the clinical risk factors identified using multivariate analysis. This score is defined by the sum of the odds ratio (OR) of each risk factor present. RESULTS: Six factors were identified as independently related to the development of DVT: restriction of mobility (from OR=1.73, limited mobility without immobilization, to OR=5.64, bedridden during <15 days), aged 75 and older (OR=1.5/10 years), history of DVT or pulmonary embolism (OR=3.38), acute heart failure (OR=2.52), chronic edema of the lower limbs (OR=2.51), and paresis or paralysis of a lower limb (OR=2.06). The defined score of 8 or higher corresponded to an 88.7% probability of having symptomatic DVT. CONCLUSION: Treatments to prevent symptomatic DVT in hospitalized elderly should be evaluated on patients with these factors.

Age Factors↗

PubMed2003

Risk factors for nosocomial pneumonia in a geriatric hospital: a control-case one-center study.

OBJECTIVES: To determine the risk factors (RFs) and the incidence of nosocomial pneumonia (NP). DESIGN: Control/case study conducted from January 1 to April 15, 1999. Prospective enrollment. SETTING: Geriatric university hospital with long-, intermediate-, and short-term care facilities. PARTICIPANTS: Inpatients aged 65 and older with NP. MEASUREMENTS: NP diagnosis relied on at least two clinical signs of respiratory infection and on chest radiography. Each NP case was randomly paired with two controls and followed up for 30 days to determine complication and mortality rates. RFs between cases and controls were compared (chi-square test, odds ratio (OR), 95% confidence interval, significance level P =.05). RFs that were significant in univariate analysis were tested using multivariate analysis and logistic regression. RESULTS: Seventy-five cases of NP were diagnosed in 2,142 patients. The average incidence rate was 3.5% (short-term facilities = 0.5%; intermediate-term facilities = 8.3%; long-term care facilities = 5.3%). The complication rate was 58.1%. The most frequent complications were recurrent NP, heart and respiratory failure, phlebitis, and pressure ulcers. The NP mortality rate was 12.2%. The independent RFs of NP were a history of NP during the previous 6 months (OR = 4.50) and oxygen therapy (OR = 16.15), P <.001. Additional RFs were severe malnutrition, heart failure, prescription of antibiotics during the month preceding the emerging NP, eating dependency, and feeding by nasogastric tube. CONCLUSION: The main RF for NP is a history of pneumonia. NP prevention in geriatrics should rely on early management of respiratory infections and malnutrition, surveillance of oxygen therapy and enteral feeding, rational use of antibiotics, and adaptation to the patient's dependency.

Aged↗

PubMed2002

Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.

RATIONALE AND OBJECTIVES: Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia. METHODS: During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation. RESULTS: One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03). CONCLUSIONS: Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.

Aged↗

PubMed2002

Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach.

OBJECTIVE: The aim of our study was to evaluate the feasibility, safety, and potential role of the contrast agent gadoterate meglumine for digital subtraction angiography as a single diagnostic procedure or before percutaneous transluminal angioplasty of malfunctioning native dialysis fistulas. MATERIALS AND METHODS: Over a 20-month period, 23 patients (15 women, eight men) with an age range of 42-87 years (mean, 63 years) having end-stage renal insufficiency and with recent hemodialysis fistula surgical placement underwent gadoterate-enhanced digital subtraction angiography with a digital 1024 x 1024 matrix. Opacification was performed on the forearm, arm, and chest with the patient in the supine position using an injection (retrograde, n = 14; anterograde, n = 8; arterial, n = 1) of gadoterate meglumine into the perianastomotic fistula segment at a rate of 3 mL/sec for a total volume ranging from 24 to 32 mL. Percutaneous transluminal angioplasty was performed in three patients and required an additional 8 mL per procedure. Examinations were compared using a 3-step confidence scale and a two-radiologist agreement (Cohen's kappa statistic) for diagnostic and opacification quality. Tolerability was evaluated on the basis of serum creatinine levels and the development of complications. RESULTS: No impairment of renal function was found in the 15 patients who were not treated with hemodialysis. Serum creatinine level change varied from -11.9% to 11.6%. All studies were of diagnostic quality. The presence of stenosis (n = 14) or thrombosis (n = 3) in arteriovenous fistulas was shown with good interobserver agreement (kappa = 0.71-0.80) in relation to opacification quality (kappa = 0.59-0.84). No pain, neurologic complications, or allergiclike reactions occurred. Three percutaneous transluminal angioplasty procedures (brachiocephalic, n = 2; radiocephalic, n = 1) were successfully performed. CONCLUSION: Gadoterate-enhanced digital subtraction angiography is an effective and safe method to assess causes of malfunction of hemodialysis fistulas. It can also be used to plan and perform percutaneous transluminal angioplasty.

Adult↗