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C Clement

Publications and source records attributed to C Clement.

43 records · Page 3Linked to original sources
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Value of assessment of pretest probability of deep-vein thrombosis in clinical management.

BACKGROUND: When ultrasonography is used to investigate deep-vein thrombosis, serial testing is recommended for those who test negative initially. Serial testing is inconvenient for patients and costly. We aimed to assess whether the calculation of pretest probability of deep-vein thrombosis, with a simple clinical model, could be used to improve the management of patients who present with suspected deep-vein thrombosis. METHODS: Consecutive outpatients with suspected deep-vein thrombosis had their pretest probability calculated with a clinical model. They then underwent compression ultrasound imaging of proximal veins of the legs. Patients at low pretest probability underwent a single ultrasound test. A negative ultrasound excluded the diagnosis of deep-vein thrombosis whereas a positive ultrasound was confirmed by venography. Patients at moderate pretest probability with a positive ultrasound were treated for deep-vein thrombosis whereas patients with an initial negative ultrasound underwent a single follow-up ultrasound 1 week later. Patients at high pretest probability with a positive ultrasound were treated whereas those with negative ultrasound underwent venography. All patients were followed up for 3 months for thromboembolic complications. FINDINGS: 95 (16.0%) of all 593 patients had deep-vein thrombosis; 3%, 17%, and 75% of the patients with low, moderate, and high pretest probability, respectively, had deep-vein thrombosis. Ten of 329 patients with low pretest probability had the diagnosis confirmed, nine at initial testing and one at follow-up. 32 of 193 patients with moderate pretest probability had deep-vein thrombosis, three diagnosed by the serial (1 week) test, and two during follow-up. 53 of 71 patients with high pretest probability had deep-vein thrombosis (49 by the initial ultrasound and four by venography). Only three (0.6%) of all 501 (95% CI 0.1-1.8) patients diagnosed as not having deep-vein thrombosis had events during the 3-month follow-up. Overall only 33 (5.6%) of 593 patients required venography and serial testing was limited to 166 (28%) of 593 patients. INTERPRETATION: Management of patients with suspected deep-vein thrombosis based on clinical probability and ultrasound of the proximal deep veins is safe and feasible. Our strategy reduced the need for serial ultrasound testing and reduced the rate of false-negative or false-positive ultrasound studies.

Algorithms↗
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Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia.

BACKGROUND: Respiratory muscle weakness is one of the most important causes of hypercapnia in patients with COPD. There is evidence that stable hypercapnic patients will benefit from long-term oxygen therapy (LTOT). OBJECTIVES: The prognostic role of reversible hypercapnia in COPD is still unclear. Early implementation of LTOT in these patients may influence endurance time and mortality. METHODS: In this pilot study, we investigated 28 patients (26 males, 49-74 years) with COPD, advanced airflow limitation [forced expiratory volume in 1 s (percentage of predicted value) 40.8 +/- 10.2] and mild hypoxaemia (pO(2) 66.5 +/- 6.3 mm Hg). All patients had developed a moderate reversible hypercapnia during an acute exacerbation or during exercise testing (peak pCO(2) 48.0 +/- 2.5 mm Hg). Patients were allocated randomly to a control group (n = 14) or an LTOT group (n = 14). The two groups were well matched in terms of physiological data. Lung function, endurance time (cycle ergometer), dyspnoea score, blood gases and LTOT compliance were measured at baseline and every 6 months over a period of 3 years. RESULTS: Endurance time increased from 6.4 +/- 2.7 min at baseline to 7.1 +/- 2.7 min after 1 year in the LTOT group and decreased from 6.1 +/- 3.0 to 4.9 +/- 3.8 min in the controls (p < 0.05). After 1 year, the end-exercise dyspnoea score was significantly lower in the LTOT group (4.5 +/- 1.5) than in the controls (5.7 +/- 1.9). CONCLUSION: COPD patients with reversible hypercapnia and mild hypoxaemia benefit from LTOT in terms of endurance time and a reduction of exertional dyspnoea after 1 year.

Aged↗
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[Clinical imaging correlations in lacunar infarcts].

PURPOSE: This paper is a study concerning the clinical-imagistic correlations in lacunar infarcts causes and associated lesions in these ones. We made an attempt to find out and emphasize the risk factors, causes and pathogenic mechanisms involved in lacunar syndromes. MATERIALS AND METHODS: We studied 138 patients with lacunar infarcts diagnosed by clinical examination and computer tomography. The investigation of risk factors evidenced arterial hypertension in 75 cases (54%). The clinical features of lacunar syndromes were: 1) pure motor stroke 41c; 2) pure sensory stroke 8c; 3) ataxic hemiparesis 9c; 4) dysarthria-clumsy hand 1c; 5) sensorimotor stroke 21c; 6) Landry syndrome 1c. RESULTS: We correlated the clinical manifestations and complementary investigations what enabled us to charge in determining of lacunar infarcts: focal microangiopathy-small artery disease (75c), cardio-embolic mechanism (12c), arterio-arteriolar embolic mechanism (15c). The risk factors and pathogenic mechanisms need more adequate research in order to find appropriate prevention and medical attendance.

Adult↗
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CD138.

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Amino Acid Sequence↗
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Condom use and attitudes among heterosexual college students.

INTRODUCTION: This paper analyzes differences between heterosexual male and female college students' behaviour, attitudes and knowledge about condom use. METHOD: A convenience sample of 707 students were recruited at sexual health displays to complete an anonymous questionnaire. RESULTS: Based on reported sexual partners in the previous year, 486 students (51.2% male and 48.8% female) were classified as heterosexual. No significant differences were found between the sexes in reported risk behaviour. Females reported more appropriate condom use techniques than males, and more positive attitudes toward condoms. Males rated sexual enjoyment to be more important. A greater proportion of males than females gave reasons for not using condoms. CONCLUSION: Differences between male and female attitudes and behaviour are important to address in AIDS prevention. Along with an emphasis on the improvement of condom use techniques, it is critical to focus on gender issues of assertiveness, power and trust.

Adolescent↗