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Biomedical subjects

B Rey

Publications and source records attributed to B Rey.

17 recordsLinked to original sources
PubMed1992

[Mono-arthritis of uncertain etiology--a follow-up study].

78 patients in whom the cause of a monoarticular arthritis remained unclear after an initial workup were contacted for a follow-up interview (and an additional clinical examination in 64 cases) after 6 to 11 years (mean 8 years). The mean age at the onset of symptoms was 39 years, with 51% of the patients presenting in the range between 20 and 40 years. There was a slight male preponderance (56%). Large joints, mainly the knee, and less often the wrist, ankle or hip, were affected in 79%. Finger, toe and other small joints were involved in only 21%. During the course of the disease 14% of the cases developed arthritis in other joints. At the time of follow-up an etiologic or nosologic diagnosis was possible only in 5%: 1 infectious Pneumococcus pneumoniae arthritis, 1 Lyme arthritis (Borrelia burgdorferi), 1 gouty arthritis and 1 erosive seronegative rheumatoid arthritis. 95% of all cases remained unclear. However, 91% of all patients became free of symptoms after 6 years. The remaining patients (9%) suffered from arthralgia of undetermined origin (n = 5), from nonclassified destructive coxitis with consecutive development of unclear gonarthritis (n = 1), or from erosive seronegative rheumatoid arthritis (n = 1). 10 patients (13%) underwent a total of 16 invasive procedures related to their arthritis, such as synoviorthesis, synovectomy or arthrodesis. The result of the erythrocyte sedimentation rate had no influence on the outcome. The following conclusions are offered: monoarticular arthritis initially should prompt a thorough investigation in order to exclude infectious or metabolic etiologies for their destructive potential.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Postmenopausal osteoporosis: are there alternatives to estrogen/gestagen substitution?].

This review on non-estrogen measures against postmenopausal osteoporosis first deals with primary prevention in young women, such as calcium rich nutrition and physical training in sedentary young women. For the case of acute osteoporotic vertebral fracture, analgetic, physiotherapeutic and ergonomic measures are highlighted. A more profound discussion covers those possible measures against established osteoporosis, which have been evaluated in prospective controlled trials: calcium, Vitamin-D, fluorides, bisphosphonates, calcitonin, anabolic steroids and exercise. From the currently available studies, the following against established osteoporosis are preferred: Nutrition counselling, motivation for physical exercise and back schooling are sensible in every case. All the other possible interventions, however, are not yet sufficiently substantiated for routine prescription in every case, whether due to lack of proof efficacy for possible adverse side effects, disproportionate costs or other reasons. Thus, for the time being, calcium supplements, Vitamin-D, fluorides, bisphosphonates, calcitonin and anabolic steroids should be reserved for selected, defined cases or for properly controlled prospective studies.

Adult↗
PubMed1991

[Non-drug and non-surgical measures in chronic polyarthritis].

Therapy of rheumatoid arthritis requires a treatment plan which coordinates the different therapeutic measures within the framework of a long-term strategy. By detailed information the patient is to be gained for cooperation in the fight against the disease. Physiotherapy and a daily home program represent an important part of the treatment. Other decisive measures are ergotherapy, counselling on resources, prescription of splints, counselling on shoes, matching of walking aids, and sociomedical counselling. The treatment of the patient in a well coordinated team offers optimal conditions for therapeutic success.

Arthritis, Rheumatoid↗
PubMed1990

[Cholestatic hepatitis induced by the amoxicillin-clavulanic acid combination. A case and review of the literature].

We report the case of a patient who developed jaundice after receiving amoxicillin-clavulanic acid for 7 days. Laboratory features were consistent with acute cholestatic hepatitis. Histopathological examination of a liver specimen showed cholestasis. Complete recovery occurred within 2 months after withdrawal of the drug. Analysis of the 24 reported cases of amoxicillin-clavulanic acid induced hepatitis revealed a predominantly cholestatic syndrome occurring soon after drug administration. In all cases, hepatic dysfunction disappeared within 1 to 3 months after discontinuation of the drug. Because of the small number of cases in contrast with the widespread use of this drug, associated with blood hypereosinophilia or eosinophilic infiltration of portal triads in some cases, a hypersensitivity phenomenon is suggested.

Amoxicillin↗
PubMed1989

[Comparison of blood pressure profiles with flunitrazepam/fentanyl/nitrous oxide vs cervical epidural anesthesia in surgery of the carotid artery].

A study was carried out to compare the evolution of arterial blood pressure during carotid endarterectomy performed under either general anaesthesia (GA) or cervical epidural anaesthesia (CEA). 20 patients were randomly assigned to two equal groups. In the CEA group, 15 ml of 0.375% bupivacaine and 150 micrograms fentanyl were injected into the epidural space at C7-D1 level. In the GA group, patients were anaesthetized with 0.2 mg.kg-1 flunitrazepam and 5 micrograms.kg-1 fentanyl; intubation was carried out using 0.08 mg.kg-1 vecuronium, and the patients were ventilated with a mixture of nitrous oxide and oxygen (50% of each). Further injections, every 30 min, of 2 micrograms.kg-1 fentanyl were given to the patients in group GA. Blood pressure was monitored continuously, up to 4 h postoperatively, with a radial arterial catheter. Per- or postoperative hypertension was defined as a rise in systolic arterial blood pressure (Pasys) over 180 mmHg for greater than 3 min; this was treated with 20 mg nifedipine intranasally (group CEA) or 100 micrograms fentanyl with 0.5 mg flunitrazepam with or without nifedipine (group GA). Per- or postoperative hypotension was defined as a fall in Pasys below 100 mmHg and or a 30% fall in mean arterial blood pressure for greater than 3 min; this was treated, in both groups, with an intravenous bolus of 3 mg ephedrine. Patients in group CEA experienced more frequent episodes of peroperative hypertension (8/2; p less than 0.02) and postoperative hypotension (5/1) than group GA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Abnormalities in myocardial segmental wall motion during lumbar epidural anesthesia.

The effect of lumbar epidural anesthesia on myocardial wall motion was compared in two groups of patients using precordial two-dimensional echocardiography (2DE). All patients were scheduled to undergo lower abdominal or peripheral surgery. Group 1 included five healthy ASA PS 1 subjects and group 2 included 10 patients with coronary artery disease (CAD). In all patients 12.5 ml of 2% lidocaine HCl was injected into the lumbar epidural space, and systolic and diastolic blood pressures, and heart rate were continuously monitored. 2DE evaluation was performed before and at 10, 20, 30, and 60 min (T10-T60) after epidural lidocaine injection. The left ventricular wall was divided into 16 segments for parasternal long-axis, short-axis and apical four-chamber views. The wall motion of each segment was graded on a scale from 1 (dyskinesia) to 6 (hyperkinesia), with 5 representing normal motion. A decrease in segmental wall motion greater than or equal to 2 grades was considered indicative of ischemia. Plasma lidocaine and catecholamine levels were measured before and 10, 20, and 60 min after epidural lidocaine injection. Peak plasma lidocaine levels in groups 1 and 2 were 2.79 +/- 1.06 micrograms/ml (mean +/- SD) and 2.58 +/- 1.48 micrograms/ml at 10 min, respectively (NS). Plasma epinephrine and norepinephrine levels were unchanged from baseline. Systolic pressures decreased significantly in group 2 from T10 to T60. Diastolic pressure decreased significantly in the same group from T20 to T60, and in group 1 only at T10. Mean arterial pressure decreased significantly in both groups at T30, without change in heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Comparative development of sympathetic and sensitive blocks during spinal anesthesia].

The extent and duration of sympathetic and sensory blockade were compared in 13 patients after spinal anaesthesia with 0.5% tetracaine (20 mg) in either isobaric (n = 6) or hyperbaric solution (n = 7). Sensory blockade was assessed by pin-prick and sympathetic blockade by the sympathogalvanometric method respectively at L5/S1, L2, T8 and C8/T1 levels. The time to onset and the duration of sensory or sympathetic blockade was identical. The mean extent of sympathetic blockade was 6 segments greater than that of sensory blockade. Hypotension was related to the extent of sensory but not sympathetic blockade. This study confirms that sympathetic blockade is more extended than sensory blockade during spinal anesthesia but does not allow to predict the occurrence of hypotension.

Adult↗
PubMedDate not supplied

[False diagnosis of post-operative massive pulmonary embolism. Nine observations (author's transl)].

After having studied nine observations about patients referred to them for embolectomy under CEC on suspicion of massive pulmonary embolism, the authors describe five differential diagnosis and how they can be reached. A low central venous pressure, an hypoxaemia sensitive to oxygenotherapy, a high pulmonary wedge pressure or the lack of diastolocapillary gradient, and, last of all, a real hypocoagulability attained by the use of low and daily doses of heparin must make one cautious. Yet, if a doubt should persist, an angiography and/or a scintigraphy will be asked for.

Adult↗