[Meningo-encephalic complications of chronic cholesteatomatous otitis].
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Brain↗
Biomedical subjects
B Lemaire
Publications and source records attributed to B Lemaire.
Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: the Lille-World Health Organization MONICA project (Monitoring trends and determinants in cardiovascular disease).
BACKGROUND: Associations between an increase in coronary heart disease occurrence and low atmospheric temperatures have been reported from mortality data and hospital admission registries. However, concomitant increases in noncardiovascular case fatality rates and selection bias of hospital cases may weaken this observation. In this study, we addressed the question of the relationships between fatal and nonfatal coronary diseases and meteorological variables in 10-year data (1985 to 1994) collected in a morbidity registry (Lille-WHO MONICA Project) monitoring 257 000 men from 25 to 64 years of age. METHODS AND RESULTS: The impacts of atmospheric temperature (in Celsius) and pressure (in millibars) on daily rates of myocardial infarction (MI) and coronary deaths were studied. Percentages of variation of event rates according to meteorological variations were derived from the relative risks estimated with a Poisson regression model. During the 10-year longitudinal survey, 3616 events occurred. Rates of events decreased linearly with increasing atmospheric temperature. For atmospheric pressure, we detected a V-shaped relationship, with a minimum of daily event rates at 1016 mbar. A 10 degrees C decrease was associated with a 13% increase in event rates (P<0.0001); a 10-mbar decrease <1016 mbar and a 10-mbar increase >1016 mbar were associated with a 12% increase (P=0.001) and an 11% increase (P=0. 01) in event rates, respectively. These effects were independent and influenced both coronary morbidity and mortality rates, with stronger effects in older age groups and for recurrent events. CONCLUSIONS: This longitudinal study is the first to estimate the attributable effect of meteorological variables on MI morbidity in population and strongly argues for a systematic fight against cold in cardiovascular disease prevention, particularly in older ages and after a first MI.
Adult↗
Evaluation of surgical gamma probes for radioguided sentinel node localisation.
By using a surgical gamma probe after peritumoral injection of a radioactive tracer, the surgeon can identify the sentinel, or first, nodal site of regional metastasis in clinically node-negative patients. In the near future, the pathological status of this node will have an important impact on the treatment strategy in breast cancer and melanoma patients. This article reviews the necessary requirements for the instrument, such as: absolute sensitivity, spectral resolution, angular sensitivity and response ratio to the radioactive source at depth. In addition, ergonomic characteristics are important. The surgeon must consider the above characteristics, as they influence operational handling. Four commercially available surgical gamma probes were subjected to laboratory tests to appraise the extent to which they fulfilled these criteria. The results for each gamma probe are summarised and discussed.<
Breast Neoplasms↗
[Secondary prevention of coronary disease in France. Result of the EUROASPIRE study: the Lille register of ischemic cardiopathies].
The EUROASPIRE study was initiated to assess the impact of recommendations concerning secondary prevention of coronary artery disease in Europe published in 1994 by the European Societies of Cardiology, Hypertension and Atherosclerosis. France and eight other countries are involved in this project. The authors report the French data. A total of 546 men and women, aged less than 71, divided into 4 diagnostic groups (coronary bypass, angioplasty, myocardial infarction, acute ischaemia) were selected in different departments of cardiology. Data concerning their main risk factors and management were noted from the hospital files. At least 6 months after their hospital admission, 396 patients were systematically interrogated and examined. The availability of information on the risk factors in the hospital files varied according to the risk factor and diagnostic group from 61 to 97%. At the time of hospital admission, 42% of patients were considered to be smokers and 23% to be obese. Six months after hospital admission, 28% of patients were still smoking, 34% were obese, 49% had total cholesterol levels greater than 5.5 mmol/L (2.10 g/L) and 48% had blood pressure readings of over 140/90 mmHg. In France, as in other European countries, the prevalence of modulable risk factors of coronary artery disease is high at least 6 months after hospital admission. Systematic application of the recommendations of scientific societies should result in a significant decrease in recurrences and in mortality after an initial coronary event.
Coronary Disease↗
[Effects of ambulatory respiratory rehabilitation on exercise tolerance and quality of life in chronic obstructive lung disease patients].
Respiratory rehabilitation is a multidisciplinary medical approach which allows a total care of patients suffering from COPD. Optimisation of bronchodilator treatment, health education, cessation of smoking, dietetic, relaxation and re-entrainment to effort. We report out experience concerning 88 BPCO (mean age 62.1, FEV1 of 1.4 litres; or 48% of predicted normal); these 88 patients were cared for on an ambulatory basis at our centre for two hours per session, three times per week for seven weeks. The objective results were analysed on exercise tests before and after treatment. For ventilation, there was a significant improvement in the power developed (from 45.5+/-17.1 to 53.4+/-23 watts; p<0.001) without any change in the oxygen consumption (VO2), ventilation (VE) or heart rate (FC) and of oxygen pulse (VO2/FC). For the same level of power (80% of maximum power for the initial exercise test) there was a significant lowering of ventilation (V=33.5+/-9.4 to 30.7+/-7.4 litres per minute, p<0.001), cardiac frequency (FC: from 116.9+/-16 to 111.1+/-13.1 beats per minute, p<0.001) as well as the oxygen pulse (VO2/FC: from 7.9+/-2.7 to 8.3+/-3.7). At the maximum on the exercise test all the parameters studied were significantly better: watts, VO2, VE, cardiac frequency and VO2/FC. A study of the visual analogue scale (EVA), analysing sleep, anxiety, dyspnoea and the physical aspects showed a significant improvement in the four subjective parameters. Respiratory rehabilitation of BPCO practiced as an out patient has shown an improvement in exercise tolerance in every day activities and improvement in dyspnoea and in the quality of life.
Aged↗
Incidence of inflammatory bowel disease in northern France (1988-1990).
There were no data concerning the incidence of inflammatory bowel disease (IBD) in France. The aim of this study was to investigate the incidence of Crohn's disease and ulcerative colitis in northern France. This prospective population based study was realised through the gastroenterologists of the region Nord-Pas de Calais and the Somme Department. Each gastroenterologist referred patients consulting for the first time with clinical symptoms compatible with IBD. Data were collected by an interviewer practitioner present at the gastroenterologist's consulting room. Two independent expert gastroenterologists assessed each case in a blind manner and made a final diagnosis of Crohn's disease, ulcerative colitis, ulcerative proctitis, or unclassifiable chronic colitis. From 1988 to 1990, 1291 cases of IBD were recorded: 674 (52%) Crohn's disease, 466 (36%) ulcerative colitis including 162 proctitis (35%), and 151 (12%) unclassifiable chronic colitis. The mean annual incidence was 4.9 per 100,000 for Crohn's disease and 3.2 for ulcerative colitis. The sex ratio F/M was 1.3 for Crohn's disease and 0.8 for ulcerative colitis. The highest age specific incidence rate for Crohn's disease was between 20 and 29 years: 13.1 for women and 9.8 for men. The highest age specific incidence rate for ulcerative colitis was between 20 and 39 years: 5.5 for women and 6.5 for men. This first French prospective study has shown an incidence rate for Crohn's disease comparable with that seen in north European studies but lower than that seen for ulcerative colitis. These results could be related to the different environmental factors or the genetic background of the population studied, or both.
Adolescent↗
[Laparoscopic vascular exclusion of complicated uterine leiomyoma].
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Adult↗
[Treatment of severe rhesus isoimmunization by repeated transfusions in utero].
Repeated transfusions in utero by umbilical cord puncture enable the treatment of severe forms of rhesus incompatibility. The two cases reported, including one involving seven transfusions between twenty and thirty seven weeks since the LMP, form the basis of a review of the literature defining the advantages and results of this technique.
Blood Transfusion, Intrauterine↗
[Sclerosing intravascular bronchiolo-alveolar tumor].
We report the case of a 56 year old female who was admitted to hospital in 1980 for assessment of disseminated nodular pulmonary opacities. The histological examination of a prescalene node biopsy showed features which were compatible with sarcoidosis. No treatment was given. In 1987 a discrete increase in the pulmonary nodules was noted. In 1989 effort dyspnoea occurred and there were pains in the right lower chest and an evening fever. The chest X-ray showed a right sided pleurisy and an increase in the size of the nodules with mediastinal lymphadenopathy. A histological examination of a pulmonary nodule, which was taken at an open lung biopsy enabled the diagnosis of a broncho-alveolar sclerosing intravascular tumour to be established. This is a rare tumour which has a slow evolution occurring most often in middle aged females. In 50% of cases the discovery is fortuitous. Besides patients present with non-specific symptoms. The radiological examination reveals multiple nodular opacities which are diffuse and 0.5 to 1.5 cm in diameter. Currently these tumours do not benefit from any particular therapy.
Diagnosis, Differential↗
[Surgical treatment of vulvar stenosis. Technic description].
A surgical technique for the treatment of vulvar stenosis is described. The recto-vaginal space is approached by the cutaneous route, starting with incisions for resection of 2 skin triangles arranged as butterfly wings on either side of the midline. The sclerous cicatricial tissue between rectum and vagina is widely exposed and incised so that the lower part of the posterior vaginal surface can be dissected and mobilized without any risk of damaging the mucosa, since the tractions required for cleavage are exerted on the cutaneous side of the bridle. It is only at this stage that a median sagittal cutaneo-mucosal incision of the bridle is carried out, followed by a transverse suture without tension. This easily performed technique has been used in 11 cases without complication and with satisfactory long-term functional results.
Constriction, Pathologic↗
[Placental villitis].
Placental villitis, which is defined by the presence of lymphocytic or macrophagic inflammatory cells within the villosities, constitutes a recently-described histopathological entity. This condition is the consequence of an immune response of the feto-placental unit towards a non-specific, multiple aggression and the incidence is very low. The extent of the inflammatory reaction may culminate in placentitis, resulting in miscarriage. Although a large number of infecting agents are known to be responsible for the pathogenesis of villitis, in most cases the etiology remains unknown. The hypothesis of a failure of the mechanisms of immunotolerance during pregnancy is suggested by many authors to explain their origin.
Chorionic Villi↗
[Epithelialization of a new vagina after nymphoplasty and salpingoplasty].
The association of salpingoplasty to the previously described nymphoplasty improves the result of the vaginoplasty of the Rokitansky-Kuster-Hauser syndrome. The pediculate mucous flaps obtained by cleavage of the labium minus are linked with the vascularized tubal flaps from the lumbo-ovarian ligament. In the present observation, this dressing up technique of the new vagina has enabled a quick and complete epithelialization, avoiding a progressive obturation from inwards towards the surface, without the use of a mandrin in the long run.
Adult↗
[Surgical treatment of genital prolapse by vesicovaginal interposition of the myometrium].
The authors propose a new technique for the surgical treatment of uterine prolapse. The technique consists of placing the myometrium between the bladder and the vagina after amputation of the cervix uteri and total excision of the endometrium. The bladder is then supported by a strong and well vascularized muscular tissue. Anterior transposition of the cervical pedicles and fixation of the myometrium to the anterior vagina ensure that the fitting is solid and in the correct direction. These modifications of the old technique of vesico-vaginal uterine interposition suppress the drawbacks which have gradually led to the rejection of the Wertheim-Schauta operation.
Endometrium↗
[Neonatal death following injuries in utero, in the absence of maternal lesions].
The authors report a case of neonatal death at 24 hours following maternal trauma during a traffic accident. The abdominal trauma did not result in any maternal injury. Caesarean delivery was justified by fetal rhythm disorders. A wide variety of fetal injuries, in the absence of maternal injuries, are reported in the literature. Some benefit from an early diagnosis, improving therefore the fetal prognosis.
Abdominal Injuries↗
[Retroplacental hematoma and factor XI deficiency].
The authors report a case of premature separation of a normally located placenta at 28 weeks, associated with factor XI deficiency. The deficiency became known 6 weeks before the acute episode. In this particular case the deficiency did not occur in the context of congenital abnormalities, hepatocellular insufficiency nor any autoimmune disease. This rare case raises the problem of the role of a coagulation disorder in the etiopathogenesis of retroplacental hematoma.
Adult↗
[Urinary tract infection in gynecology-obstetrics: resistance to beta-lactam antibiotics and previous antibiotic therapy].
From June 1988 to October 1989, 190 women from the department of Obstetrics-Gynecology with bacteriuria due to Gram-negative rods were studied. One hundred and three were investigated as ambulatory patients. Fifty three had received treatment with a bêta-lactam antibiotic during the past three months and 11 between three and six-months before sampling. The organisms causing bacteriuria were 163 E. coli, 12 P. mirabilis and 15 were due to other species. Thirty three E. coli and the 15 other species were resistant to amoxicillin and/or to cefalotin. When comparing previous treatment and resistance to amino-penicillins it appears that: of the women who had received a beta-lactam antibiotic within the three months before testing, 57% of the strains recovered were found resistant for amino-penicillins; of the women without treatment during the past six months, 89% of the strains recovered were sensitive and six per cent of E. coli plus five per cent of another Gram negative rod were resistant to amino-penicillins.
Anti-Bacterial Agents↗
[Clinically localized cancers of the breast. Therapeutic consequences of the evaluation of extension].
The therapeutic modifications induced by pretreatment evaluation were studied in a consecutive series of 852 asymptomatic women with newly diagnosed primary breast cancer attending our center between 1980 and 1984. Staging tests included chest X-rays in 851 patients, bone X-rays in 831, alkaline phosphatase in 826, hepatic enzymes in 818, liver echography in 750 and bone scintigraphy in 504. The intended local treatment was changed for a systemic one in 8 patients due to suspicious abnormalities. The follow-up confirmed evidence of metastases in 6 out of 8 patients (bone: 4; liver: 1; lung: 1). Mastectomy, initially avoided in these 6 patients, was subsequently performed in 2 of them owing to slow progression of distant metastases. On the basis of the current study, pretreatment staging in asymptomatic primary breast cancer cannot be recommended due to the low prevalence of detectable metastases.
Adult↗
Incidence of inflammatory bowel disease in northwestern France. Preliminary results in region Nord-Pas-de-Calais.
A prospective study in the region Nord-Pas-de-Calais between 1 February and 15 November 1988 identified 166 cases of Crohn's disease, 116 of ulcerative colitis, and 31 of proctitis. The incidence of ulcerative colitis was 2.96 cases/10(5)/year and of Crohn's disease, 4.23/10(5)/year.
Adult↗