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Biomedical subjects

C Colin

Publications and source records attributed to C Colin.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Perioperative artificial nutrition in elective surgery. A descriptive study of practice patterns in France].

OBJECTIVE: To analyse the practice patterns of perioperative artificial nutrition in France before the Consensus Conference held on 16 december 1994 and to compare them with the recommendations produced by this Conference. STUDY DESIGN: Retrospective cross-sectional practice patterns study. PATIENTS: Sample of patients collected from general or digestive tract surgeons, including for each one the last two patients having had before 10 December 1994 either elective upper (oesophagectomy, duodenopancreatectomy) or elective lower (colectomy) abdominal surgery. The response rate to the 2, 150 circulated questionnaires was 14% (309), producing a sample of 601 patients (49% with upper abdominal surgery, 51% with lower abdominal surgery). RESULTS: The geographical distribution of surgeons who replied and their type of activity (private or public) was similar to the national pattern, however with some underrepresentation of the larger Paris area. The duration of pre- or postoperative artificial nutrition was bellow seven days in 36% of the cases, and above this delay in 64% of the cases. Artificial feeding rates for upper abdominal surgery, were 9 and 75%, respectively (duration of artificial feeding of 7 days and more being only considered). For lower abdominal surgery, these rates were 5 and 41%, respectively. Enteral nutrition was given in 13% of preoperative cases and 19% of postoperative ones; the others received parenteral nutrition. When compared to the recommendations by the Consensus Conference, these results show an insufficient use of preoperative artificial nutrition in patients with malnutrition (only 22% of them received it) and an excessive use in postoperative patients, particularly after lower abdominal surgery. Furthermore, the caloric intake was in accordance with the recommendations in only 20% of the cases. It was too high in 38% of the cases and insufficient in 47% of them. Similarly, the postoperative nitrogen intake complied with the recommended figures in only 5% of the cases. CONCLUSION: This study highlights large discrepancies between the recommendations by the Consensus Conference and current practice patterns. It questions the efficiency of this therapy as it is implemented today and generates high and unwarranted expenses.

Digestive System Diseases↗
PubMed1996

[Decision analysis of congenital toxoplasmosis in the absence of exact knowledge of the treatment benefits and secondary effects].

Decision analysis seemed the appropriate method to bring out the interest of toxoplasmosis serology in children born from mothers who seroconverted during pregnancy. In particular it provides the possibility to choose between IgA serology, recently introduced in hospital practice, and IgM serology that is the reference test. We study a series of 96 children suspected of having congenital toxoplasmosis who were followed up until the age of one. A decision analysis is thereafter conducted by synthesizing data about clinical efficacy with the RBNCN ratio that is the net benefit of treating an affected person divided by the net cost of treating an unaffected person; these costs and benefits are clinical. The effectiveness of the treatment (sulphonamides in most cases) was not quantified. Therefore, we used the fact that the RBNCN ratio is equal to the number of healthy children likely to be treated unnecessarily in order not to leave untreated a contaminated child. Although data available in the literature and data from our study still remain insufficient to draw a final conclusion, IgA antibodies are significantly more sensitive than IgM antibodies (p < 0.01). Conversely, IgA antibodies are significantly less specific than IgM antibodies (p < 0.001). The sensitivity analysis shows that the IgA test is preferred to the IgM test if the mother is contaminated during the third trimester. On the other hand, for low prevalences, as observed in the first trimester, the IgM serology is more useful.

Anti-Infective Agents↗
PubMed1996

[Medical and economic evaluation of donated blood screening for hepatitis C and non-A, non-B, non-C hepatitis].

The aim of this study was to evaluate the cost of hepatitis C and non-A non-B non-C screening strategy in donated blood, currently used in French transfusion centres and to assess the effect in the blood transfusion centres according to the prevalence of the disease and the intrinsec values of tests. This screening strategy was based on alanine aminotransferase assay, and HBc and HCV antibodies detection. In 1993, a survey was conducted in 26 French transfusion centers to estimate the costs of the screening strategy currently used. Average expenditure on diagnostic sets, equipment, staff and administration charges for hepatitis C and non-A non-B non-C screening were calculated. From these results, we estimated the cost of the previous strategy which did not involve HCV antibody testing, so as to determine the incremental cost between the two strategies. We used clinical decision analysis and sensitivity analysis to estimate the incremental cost-effectiveness ratio with data gathered from the literature and examine the impact on blood transfusion centre. Implemented for 100,000 volunteer blood donations, the incremental cost of the new strategy was FF 2,566,111 (1992) and the marginal effectiveness was 180 additional infected donations detected. The sensitivity analysis showed the major influence of infection prevalence in donated blood on the incremental cost-effectiveness ratio: the lower the prevalence, the higher the cost-effectiveness ratio per contaminated blood product avoided.

Adult↗
PubMed1996

[Hierarchy of breast examinations after twenty years experience].

OBJECTIVE: To reassess the interest to establish a qualitative hierarchy of explorations for breast lesion diagnosis. MATERIALS AND METHODS: The medical files stored on perforated cards concerning 6866 patients examined in our breast disease clinic from 1974 to 1976 was compared to the computerized medical files of 14747 patients followed in the same clinic from 1990 to 1992. The hierarchy took into account, by decreasing order of importance, the significant results of cytology and radiography, clinical examination and finally thermography for the 1974-1976 patients and ultrasonography for the 1990-1992 patients. RESULTS: Comparing the two groups of patients showed a stabilization of the number of cancers (100%) among the diagnoses positive for malignant lesions and of the number of benign lesions (16%) among the lesions evaluate as suspect of malignancy. There was an increase in the cancers (13%) among lesions evaluated as dubious and a decrease in the numbers of cancers (0.1%) among the lesions evaluated as benign. These improvement resulted from technical advance in mammography and the routine use of ultrasonography. CONCLUSIONS: These findings confirm the importance of cytological and radiological exams for the diagnosis of breast cancer and points out the interest of routine ultrasonography of the breast.

Biopsy↗
PubMed1995

Mineral bioavailability and bone mineral contents in pigs given calcium carbonate postprandially.

We have further investigated the "meal effect" on mineral bioavailability in pigs by mineral balance studies and measurements of bone ash contents and bending moment. A group of seven pigs (CAA) was given all its dietary Ca as CaCO3 5 h after the first daily meal for 8 weeks. The control group of seven pigs received CaCO3 in the meal. Both groups were given normal P within the meals. Ca and P absorption and retention were evaluated by a 10-day balance trial. Several bones were collected at slaughter to determine bone ash, Ca, and P contents and bending moment (three-point bending test). Ingesting Ca after the meal did not affect Ca bioavailability or phosphorus absorption, but did reduce P retention, which in turn decreased the bone scores. Osteopenia, indicated by decreased total mineral contents of bones (and decreased ash:bone volume ratio), was associated with elevated plasma osteocalcin in the CAA group. Thus, CaCO3 need not be incorporated into a meal for high Ca absorption, provided that Ca is given after a meal, but simultaneous intakes of Ca and P are required for the best mineral retention.

Absorption↗
PubMed1995

Fine structure of astroglial integration into host brain following xenografting.

Previous investigations showed that fragments of fetal rabbit brain transplanted into striatum of neonatal shiverer mouse give rise to cells that migrate through host tissue and differentiate into astroglia and oligodendroglia within 2 weeks. We studied the integration of transplanted astroglia at the ultrastructural level using pre-embedding labeling with a monoclonal antibody which recognizes an epitope associated with rabbit but not mouse glial fibrillary acidic protein. The morphology of early migrating donor cells does not distinguish them from cells arising in host germinal matrix. Once the cells complete their migration they integrate into host brain in a structurally normal manner. Transplanted astroglia form perivascular foot plates with host capillaries. They also send extensive processes into the neuropil where intimate contacts with neurons and synaptic structures are formed. Oligodendroglia send processes to nearby axons where they form normal-appearing myelin. During the rejection process, which may begin at 4 weeks, donor astroglia show evidence of reaction with increased intermediate filament content. Donor cells are attacked by leukocytes, including eosinophils, and subsequently degenerate. We conclude that cross-species transplantation of glial cells can result in entirely normal structural integration into host brain.

Animals↗
PubMed1995

[Management of myocardial infarction in the Rhone-Alps area. Are there many variations in practice?].

The aim of this study was to determine the diagnostic and therapeutic strategies after myocardial infarction and to examine variations in medical and surgical practice with respect to the severity of disease, status of the hospital and patients' characteristics. The method used was a prospective study with follow-up at 30 days and 18 months. The subjects came from an exhaustive cohort of all patients admitted to hospital for myocardial infarction during the month of April 1991 in 57 public and private hospitals in the Rhone-Alps region (n = 311). The patients were identified after admission by consulting physicians of the Department of Social Security. The study included all patients with acute myocardial infarction with at least two of the three usual diagnostic criteria (prolonged, constrictive chest pain, enzyme increases and electrocardiographic changes). The study excluded patients who were dead before arrival at hospital. The parameters analysed included the clinical management, use of echocardiography, exercise stress testing, myocardial scintigraphy, coronary angiography, thrombolysis, angioplasty and coronary bypass surgery in the first 30 days after admission. The severity of infarction was assessed by seven clinical, enzymatic and electrocardiographic criteria by physicians from the Department of Social Security (pain, syncope, shock, left ventricular dysfunction, elevation of CPK > 1000 IU, anterior or extensive necrosis, arrhythmias). The mortality rate of this cohort was calculated from hospital statistics and then by enquiring in the town halls of the region. The demographic features of the cohort were marked by a predominance of men (69.5%) and a relatively high mean age (69 years; 23% over 80 years). Complementary investigations were used with the following frequencies: echocardiography, 61.1%; coronary angiography, 26.4%; exercise stress testing 22.8%; myocardial scintigraphy, 5.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Effects of dietary vitamin D on magnesium absorption and bone mineral contents in pigs on normal magnesium intakes.

The effects of three dietary levels of vitamin D (500, 1500 and 3000 IU/kg diet) on magnesium metabolism and on some bone parameters related to bone mineralization were studied in vitamin D-repleted pigs fed normal magnesium intakes (0.2 per cent) for two months. Apparent absorption and retention was measured in 10-day balance studies (prior to slaughter) in three groups of four 10-week old pigs. Except for vitamin D, the pigs received the same diet which met the recommended dietary allowances for growing pigs. The highest vitamin D level used was only three times the recommended level in French pig husbandry. At slaughter, the fibula and two main metatarsals (right hind leg) were collected to determine bone breaking strength, apparent density and bone mineral (ash, calcium, magnesium) contents. Blood was collected to determine plasma concentrations of calcium, magnesium and vitamin D metabolites. Magnesium absorption increased linearly from 28-39 per cent intake with increasing dietary vitamin D. Urinary magnesium was not affected, thus magnesium retention also increased linearly as a function of vitamin D intake. Plasma calcium and magnesium were not altered by vitamin D. Plasma 25-hydroxycholecalciferol concentrations reflected vitamin D intakes, while plasma 1,25 dihydroxycholecalciferol was unchanged. Density, breaking strength and mineral contents of the bones were lower in the pigs fed 1500 or 3000 than in those fed 500 IU vitamin D/kg diet. This suggests that bone resorption was stimulated by the higher dietary vitamin D. Thus, vitamin D at physiological doses may enhance magnesium absorption in non previously vitamin D-depleted pigs fed diets with abundant magnesium. This nutritional situation may help explain the predominant bone-resorbing effect of vitamin D supplementation.

Absorption↗
PubMed1995

[Vaginal trial or repeat cesarean in a woman with a previous cesarean section? An example of analysis of medical decision making].

Decision making analysis is a probability-based quantitative method used for decision making in particularly uncertain circumstances. Such analysis can be used to develop a model for medical decision making and help to determine the best strategy for a given clinical situation. A decision tree includes all the necessary choices and the corresponding consequences. Statistical analysis of the decisional tree orients the decision to the one with the smallest risk and the greatest advantages. This work describes the basis of the methodology and the decision analysis using a simple example in obstetrics: repeat cesarean or uterus trial in women with a history of cesarean section. The analysis of the decision, based on data in the literature, demonstrates the choice for the uterin trial because of the lower maternal morbidity.

Cesarean Section↗
PubMed1994

Data quality in a DRG-based information system.

The aim of this study initiated in May 1990 was to evaluate the quality of the medical data collected from the main hospital of the "Hospices Civils de Lyon", Edouard Herriot Hospital. We studied a random sample of 593 discharge abstracts from 12 wards of the hospital. Quality control was performed by checking multi-hospitalized patients' personal data, checking that each discharge abstract was exhaustive, examining the quality of abstracting, studying diagnoses and medical procedures coding, and checking data entry. Assessment of personal data showed a 4.4% error rate. It was mainly accounted for by spelling mistakes in surnames and first names, and mistakes in dates of birth. The quality of a discharge abstract was estimated according to the two purposes of the medical information system: description of hospital morbidity per patient and Diagnosis Related Group's case mix. Error rates in discharge abstracts were expressed in two ways: an overall rate for errors of concordance between Discharge Abstracts and Medical Records, and a specific rate for errors modifying classification in Diagnosis Related Groups (DRG). For abstracting medical information, these error rates were 11.5% (SE +/- 2.2) and 7.5% (SE +/- 1.9) respectively. For coding diagnoses and procedures, they were 11.4% (SE +/- 1.5) and 1.3% (SE +/- 0.5) respectively. For data entry on the computerized data base, the error rate was 2% (SE +/- 0.5) and 0.2% (SE +/- 0.05). Quality control must be performed regularly because it demonstrates the degree of participation from health care teams and the coherence of the database.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1994

[Tamoxifen in the treatment of breast cancer].

Tamoxifen is the most often prescribed non steroidal antioestrogenic agent in the world for breast cancer. Worldwide collaboration. has centralized the results, of different trials throughout the world on oral adjuvant therapy in the early stages of breast cancer. A significative regression of the tumour was observed in most cases. Moreover, recent epidemiological studies suggest that tamoxifen could prevent new contralateral primary tumours. The risk of the disease should thus be reduced by the prophylactic use of antioestrogens such as tamoxifen. Investigations using a variety of models have evaluated the effect of tamoxifen on tumour promotion and cell growth. Tamoxifen-induced growth inhibition is associated with major changes in biochemical events in cultured human breast cancer cells including cell proliferation or growth factor production. Growth inhibition of oestrogen-responsive human breast cancer cells is associated with an induced secretion of autoinhibitory polypeptides (TGF beta) and an antagonistic effect on the synthesis of proliferative proteins (TGF alpha,...). The first step in the mechanism of action of the drug is binding of tamoxifen to the oestrogen receptors. Development of resistance to tamoxifen treatment is a great problem in treatment of breast cancer patients and the mechanism of resistance will require further study: under the influence of the drug, tumours could become remodelled as selected subpopulations emerge resistant-tamoxifen. The fact that some breast cancers which are oestrogen receptor-negative respond to antioestrogen suggests that parallel but separate pathways for oestrogen and antioestrogen action may exist. This paper summarizes the results of the most recent studies concerning this promising drug.

Breast Neoplasms↗
PubMed1994

[Treatment of cystic mastopathy with puncture and administration of an LHRH analogue].

Goserelin depot (Zoladex) was administered for 6 months to seven women with premenopausal gross cystic breast disease. For each patient at least three cysts were followed up by ultrasonography and radiography (21 cysts in total). Hormone assessments showed a suppression of serum oestradiol at 8-12 weeks. Two-thirds of the observed cysts continued to grow after 8-12 weeks, but two-thirds had decreased in size by 20-24 weeks and this decrease had continued 12 weeks after cessation of treatment. Cysts containing fluid with a higher Na+/K+ ratio (extracellular fluid type) responded earlier to treatment. These patients had received other hormone treatments without success. The LHRH analogue treatment seems to be a promising and effective adjuvant to aspiration in the management of gross cystic breast disease, although maximal efficacy was only observed after 20-24 weeks.

Adult↗
PubMed1994

Influence of exogenous porcine growth hormone on magnesium metabolism in intact pigs receiving normal magnesium intakes.

The magnesium balance and plasma magnesium levels of intact growing pigs treated with recombinant porcine growth hormone (100 micrograms/kg body weight/d) for 2 months were measured. Growth hormone treatment did not change plasma magnesium, but it markedly increased magnesium absorption and retention. This agrees with our finding of adequately mineralized newly formed bone in intact pigs given growth hormone.

Animals↗
PubMed1993

Stimulation of the secretion of latent cysteine proteinase activity by tumor necrosis factor alpha and interleukin-1.

OBJECTIVE: Cultured synovial fibroblast-like cells from 3 patients with rheumatoid arthritis (RA) and 3 patients with osteoarthritis (OA) were evaluated for their potential to secrete cysteine proteinases spontaneously and after stimulation by tumor necrosis factor alpha (TNF alpha) or interleukin-1 (IL-1). METHODS: Culture media and cell lysates were analyzed before and after high performance liquid chromatography (HPLC) using the enzymatic substrate, Z-Phe-Arg-AMC, and by immunoblotting with anti-cathepsin B antiserum. Immunolocalization of cathepsin B was studied on cell monolayers. RESULTS: Latent cysteine proteinase activity was found to be secreted spontaneously by cultured synovial fibroblast-like cells. This activity was increased after treatment with either TNF alpha or IL-1. Stimulated protease activity was eluted by HPLC at a peak coincident with that of purified cathepsin B. By immunoblot, cell supernatants contained a 43-kd form of cathepsin B, while cell lysates contained a 30-kd form, consistent, respectively, with cathepsin B before and after cleavage of its propeptide. An intracellular increase in cathepsin B after treatment with TNF alpha was also seen with immunohistochemical studies. CONCLUSION: TNF alpha (in the 6 cases studied) and IL-1 (in 4 cases) stimulated the secretion of a latent cysteine proteinase activity from synovial fibroblast-like cells, which appears to represent primarily cathepsin B.

Arthritis, Rheumatoid↗