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C Milan

Publications and source records attributed to C Milan.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Natural history of non-alcoholic chronic pancreatitis. Study of 37 cases and comparison with 319 cases of alcoholic chronic pancreatitis].

UNLABELLED: We studied the etiology, complications, need for surgical treatment and survival in patients with non-alcoholic chronic pancreatitis (n = 37, including 5 familial, 2 postradiation and 30 idiopathic cases of pancreatitis) and with alcoholic chronic pancreatitis (n = 319). The median follow-up was 6 years. There was a higher frequency of onset of the disease in the fourth decade in alcoholic patients and a more regular pattern with a peak in the third decade in the non-alcoholic patients. The comparison between the two groups showed, in non-alcoholic patients: a lower M/F ratio (non-alcoholics: 1, alcoholics: 9; P < 0.0001), less smokers (P < 0.0001), a lower cumulative probability for development of pancreatic calcification (P < 0.02), insulin-dependent diabetes mellitus (P < 0.02) and pseudocysts (P < 0.01). Frequency and type of surgery were not different in the 2 groups. The observed survival of non-alcoholic patients was better than the observed survival in alcoholic patients and than the expected survival in a matched French population. CONCLUSIONS: in this study, non-alcoholic chronic pancreatitis accounted for 10.4% of the disease; the comparison to alcoholic chronic pancreatitis shows that it is the same, however less evolutive, disease. Chronic pancreatitis by itself has no major influence on vital prognosis.

Acute Disease↗
PubMed1993

[Mortality of cerebral infarction with auricular fibrillation. Results of a population study].

To evaluate the relationship between atrial fibrillation (AF) and mortality of the cerebral infarction, we have studied in a population survey, 540 cerebral infarctions, whose 162 were with AF (30%) and 378 without AF (70%). The group with AF differs significantly from that without AF, by the higher frequency of women (62% versus 35%), older subjects (75.4 +/- 10.2 years old versus 69.1 +/- 9.7 years old), a severe loss of consciousness, a more frequent subcortical infarction on CT-Scan. During a period of 24 months, 139 patients died, 64 among the 162 patients with AF (40%), 75 among the 378 patients without AF (20%). Rates of death are different in the 2 groups with, in the group with AF, at 1, 6, 18 and 24 months a rate of 20, 24, 37 and 40 percent. To the opposite, in the group without AF, the rates are 8, 12, 16 and 20 percent. The authors try to research the factors that may explain the mortality linked to AF, and they insist on the necessity to look for AF on admission for a stroke, to identify a subgroup of stroke patients with a high risk of death.

Aged↗
PubMed1992

Risk factors for septic shock in the early management of bacteremia.

PURPOSE: Aggressive treatment of bacteremia in patients at high risk of septic shock may prove to be beneficial and cost-effective since these patients account for 50% of the mortality. The purpose of this study was to identify risk factors for septic shock in bacteremic patients. PATIENTS AND METHODS: We retrospectively collected clinical, biologic, and radiologic data from medical records of patients who experienced one episode of bacteremia between March 1 and December 31, 1990, at the University Hospital of Dijon, France. Statistical analysis was univariate and multivariate (logistic regression). RESULTS: During the survey, 331 patients experienced one episode of bacteremia. Bacteremia due to gram-negative species was more frequently found in surgical units. Septic shocks were equally attributed to gram-negative and gram-positive bacteria. The do-not-resuscitate order was associated with nearly half of the deaths secondary to underlying diseases or poor general condition. Neither hospital-acquired bacteremia nor underlying diseases were associated with a high risk of septic shock. Multivariate analysis showed the following to be risk factors for septic shock: male gender and age older than 75 years (odds ratio = 2.91), creatinine level greater than 20 mg/L (odds ratio = 4.52), prothrombin time less than 60% (odds ratio = 4.86), and presence of an interstitial pattern on the chest radiograph involving more than half of both lung fields (odds ratio = 4.1). Our logistic model with these selected parameters allowed an overall classification of 77% of the studied patients, with a positive predictive value of 55% and a negative predictive value of 89%. CONCLUSION: Our results provide a positive predictive value that is similar to that of the clinical scores of severity proposed by other authors in selected populations. Our classification, in conjunction with a clinical classification, would allow improvement in the prognosis of patients with bacteremia by early treatment of those at high risk for developing septic shock. Validation of these results with further studies involving a larger population that includes patients with suspected infections, as well as bacteremic patients, is needed.

Adolescent↗
PubMed1992

Views of a general population on mass screening for colorectal cancer: the Burgundy Study.

BACKGROUND: The success of a screening program depends on a number of factors, including the validity of the test, its efficacy, its feasibility, and the rate of compliance. Thus, it is important to determine the factors influencing compliance to the screening test in order to obtain a high participation rate. METHODS: A mass screening campaign for colorectal cancer using the Hemoccult test was conducted in Burgundy, France. One year later, a questionnaire was mailed to a random sample of the population to assess the views of the general public (870 persons who had not completed the Hemoccult test, 750 persons who had a negative test, and 100 persons who had a positive test). The compliance rate of this survey was 32.2% among persons who had not completed the screening test, 88.2% among persons with a negative result, and 98.0% among persons with a positive result. RESULTS: The main reason for not participating was not wanting to know more about their health status (34.3%). Of the factors credited with encouraging persons to perform the test, the most important ones were the practitioner's explanations (55.7%) and the leaflet sent by mail (42.5%). The impact of the media campaign was weak. A small portion of the population (4.3%) said that they were very anxious while waiting for the results. Among persons with a positive screening test, only 1.2% regretted having taken it. Among those who took the test, 94.2% said they were ready to do it again; and among those who did not take it, 36.7% would accept it at a second screening. CONCLUSIONS: The data suggest that overall the Hemoccult is well accepted, that the campaign did not upset the population, and that it is worthwhile at the second screening to include those who did not participate in the first screening test.

Aged↗
PubMed1992

Different multiple regression models for estimating survival: use in a population-based series of colorectal cancers.

Two additive models for estimating relative survival, recently available in statistical packages, were compared to the Cox model in order to define practical criteria for choosing one of these three models. The three models were applied to a series of 1062 colorectal cancer incident cases recorded at the "Registre des Tumeurs Digestives de Côte d'Or" to study the impact on survival of age, sex and socio-economic status. The respective advantages of each method and facilities of each program were identified. This study emphasized the importance of multiple regression models for estimating relative survival: from the epidemiologist's point of view, they reinforce the validity of international comparisons of survival statistics, from the clinician's point of view, they permit to identify the real prognostic significance of variables related to life expectancy in the general population.

Age Factors↗
PubMed1992

Plasma lipoproteins in cortical versus lacunar infarction with or without cardiac arrhythmia, and in transient ischaemic attacks: a case control study.

We investigated the relation of plasma lipids to the risk for cortical infarction with (22 cases) or without (38 cases) cardiac arrhythmias, for lacunar infarction (28 cases) and transient ischaemic attacks (TAI) (15 cases). In the group of cortical infarction with or without cardiac arrhythmias, we observed a maximum increase of total cholesterol, of very low density lipoprotein (VLDL) and low density lipoprotein (LDL), triglycerides, total Apolipoprotein (Apo) B, LDL-Apo B and Apo-A1. On the contrary, we observed a decrease of total ApoE, HDL-ApoE, a distribution of LDL in a single layer and the presence of LDL of small weight. TAI is different from the former group by a low level of HDL and the lack of abnormalities of Apo-A1, and on the distribution and the weight of LDL. Finally, lacunar infarction presents a normal plasma lipoprotein profile. These data suggest that previously demonstrated differences in LDL-cholesterol levels between patients with ischaemic stroke and control subjects may apply to patients with cortical but not lacunar infarction. The presence or not of a cardiac arrhythmia doesn't give a special lipoprotein profile, and TAI has no changes on the distribution and the weight of LDL. Therefore, separation of ischaemic strokes into types based on mechanism as large vessel atherosclerosis versus small vessel atherosclerosis may help clarify lipid-related risk factors in cerebrovascular disease.

Arrhythmias, Cardiac↗
PubMed1992

Frequency of transient ischaemic attacks in strokes: place for a preventive treatment.

Transient ischaemic attack (TIA) represents a neurological deficit during less than 24 hours, without any abnormality on CT scan. This symptom may have 2 risks: it may give place to a severe stroke, and it is not always linked to an ischaemic mechanism. This work rests on a population-based registry existing in Dijon since 1985 with a specific and exhaustive registration. CT scan allows the mechanisms of stroke to be identified: cortical infarct, lacunar infarct, cerebral haemorrhage, and TIA. TIA represent 15% of stroke. Survival rate of 80% is better than other strokes. A TIA may appear before a cerebral infarct in 48% of the cases, a lacunar infarct in 18% of the cases, another TIA in 28% of the cases, and a haematoma in 8% of the cases. Therefore TIA is an important symptom appearing before severe stroke, that may let place to a preventative action.

Aged↗
PubMed1992

[Prognosis of transient ischemic accidents disclosing infarction].

In a prospective study, thirty six out of 175 consecutive patients (21%) with transient ischemic attack (TIA), had cerebral infarction on CT-scan. This group of patients differed from the group without cerebral infarction by a higher age, a longer duration of neurological deficit, a greater frequency of neurological history, vertebro-basilar TIAs, cephalagia and, cardiac arrhythmia, and by a higher 2-year mortality rate. Due to their difference in etiological factors and prognosis, TIAs with cerebral infarction on CT-scan should be differentiated from those without cerebral infarction.

Cerebral Infarction↗
PubMed1992

[Cost of a mass screening program for colorectal cancer using the occult blood test].

The Cancer Registry of Burgundy, France, set up a controlled study involving 91,000 people aged 45 to 74 to ascertain the cost-effectiveness of mass screening for colorectal cancer with the Hemoccult test. The aim of this study was to estimate the cost of the first part of the screening campaign, which took place in 1988 and 1989. The overall cost of the campaign was 2,275,589 FF. The cost for the GPs' instruction course was 3.9 percent and the press campaign, 8.4 percent of total costs. The cost related to the distribution or prescription of tests by the GPs was 60.3 percent of the total cost of the campaign. The average cost per test was 39.8 FF when it was distributed by the GPs. The average cost per test was 116.4 FF when bought individually in drugstores or pharmacies. The average cost per test was 70.1 FF when mailing was used. The average cost per test for the analysis was 12.7 FF that is to say 13.7 percent of the total cost. The cost of scientific follow-up and analysis was 13.8 percent. The cost for one person completing the test averaged 92.7 FF. The preliminary results of the cost-effectiveness analysis make it possible to estimate the cost of the mass screening campaign for colorectal cancer. Better cost/effectiveness ratios have already been made according to these results.

Aged↗
PubMed1991

Incidence and survival rates during a two-year period of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks. The Stroke Registry of Dijon: 1985-1989.

The age- and sex-specific incidence and survival rates over two years of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks (TIA) in a town of 140,000 inhabitants, are reported. During the five years, (1985 to 1989), 984 patients suffering from first stroke were registered by the Dijon Stroke Registry. The diagnosis was established by a CT-Scan in 88% of cases. Intracerebral haemorrhages (ICH) account for 8.8% of strokes, subarachnoid haemorrhages (SH) for 1.5%, cortical infarcts (CI) for 45.6%, lacunes for 16.7%, TIA for 15.8%, and 11% were undetermined. The annual average incidence rates per 100,000 are 13.4 for ICH, 2.0 for SH, 69.0 for Cl, 30.0 for lacunes and 25.5 for TIA. The survival rates for the acute stage (up to four weeks) differ between ICH and SH (46% and 67%), and the other types of strokes: 77% for Cl, 90% for lacunes and 98% for TIA. The survival rates of unclassified stroke are similar to ICH rates. At two years, survival rates of lacune and TIA are the highest. The divergences between public hospital based data and population-registry data are discussed. A population registry is necessary for studying the natural history of stroke.

Adult↗
PubMed1991

Cerebral haemorrhage in a French prospective population study.

The incidence of cerebral haemorrhage was studied from a population-based stroke registry. The incidence was 12.3 per 100,000 per year in women and 13.9 per 100,000 per year in men, with a peak in the eighth decade and a male preponderance. Haemorrhages were deep seated and mostly due to hypertension. Recognised clinical characteristics of haemorrhage are acute onset, convulsion, vomiting, and disturbed consciousness. This study showed that cerebral haemorrhage may present with pure motor deficit or transient deficit preceding the stroke. The mortality was 51% in the first month, and 61% by two years.

Adolescent↗
PubMed1991

Participation in mass screening for colorectal cancer: results of screening and rescreening from the Burgundy study.

A controlled study was made in Burgundy (France) to assess the acceptability and efficiency of colorectal cancer screening using the Hemoccult test. A total of 91,000 people aged 45 to 74 years were included. The first screening campaign was made from January to July 1988 or 1989, and rescreening occurred from January to July 1990. During the first 4 months of the campaign, the General Practitioners (GPs) offered the test to their patients. It was then mailed to all subjects who had not completed it with a recall letter, if necessary, one month later. The overall compliance rate was 54.0% in the first campaign and 55.5% in the second campaign. A total of 63.7% subjects had completed at least one screening test over the two screening campaigns. Compliance was lower among men than women; compliance rate was also lower in the youngest and oldest age group than in the intermediate age groups. During the second screening campaign, the participation rate was 83.6% among participants in the first screening campaign and 20.9% among non-participants. Compliance during the medical offer phase was higher (81.4% during the first campaign, 82.9% during the second campaign) than during the postal offer phase (respectively, 33.8% and 28.5%). It was easier for GPs to propose the test when they had to offer it than when they had to prescribe it. These results suggest that a satisfactory participation rate can be obtained in France if GPs are actively involved in the screening programme. The final objective is to find a 25% difference in 5-year mortality by large bowel cancer between the screened and the test population.

Age Factors↗
PubMed1991

[Natural history of lacunar syndromes. Contribution of the Dijon registry of cerebrovascular complications].

In a consecutive series of 984 first-ever strokes (from 1985 to 1989) in a population based study, 165 (16.7%) had lacunar infarction confirmed by CT-scan or M.R.I. The annual incidence was 35.6/100,000 in women, and 47.8/100,000 in men. Survival rates were 90% at 1 month, and 78% at 2 years. The rate of recurrent strokes was 11% at 2 years. The natural history of lacunar infarction could be drawn in this study which was population-based; 29% of lacunar infarctions are indeed not managed in hospitals. Lacunar infarctions should be identified as such in therapeutic trials since their course is clearly different from other types of strokes.

Adult↗
PubMed1991

[Colorectal hyperplasic polyps in the population of Côte-d'Or, between 1976 and 1985].

The data of the polyp registry of the Côte d'Or was used to study the characteristics of hyperplasic polyps detected in a well defined-population. In the 1976-1985 10-yr period, 1,222 hyperplasic polyps were resected in 874 Côte d'Or residents. They represented 17% of all polyps. The incidence rate standardized according to the world reference population was 21.9/100,000 in males and 8.1/100,000 in female. The male predominance was observed in all age groups. The incidence of hyperplasic polyps increased by a mean of 19.8% per year in males and 26.6% in females (P less than 0.001). Hyperplasic polyps were discovered twice as often in patients living in an urban area than in patients living in a rural area (P less than 0.001). Hyperplasic polyps were smaller than 5 mm in 91.4% of cases and were located in the rectum in 59.4% of the cases. They were associated with an adenoma in 21.0% of the cases. In the case of a rectal hyperplasic polyp, 10.5% of the patients had an adenoma in the left colon and 2.8% in the right colon. A rectal hyperplasic polyp cannot be considered as a marker of the presence of a large bowel adenoma. The relationship between hyperplasic polyp and colorectal cancer needs to be established.

Adenoma↗
PubMed1991

[Postoperative mortality for colorectal cancer in the Côte-d'Or (France) from 1976 to 1985].

Postoperative mortality from colorectal cancers in the resident population of the department of Côte-d'Or was studied for the 1976-1985 period through the data collected by the Registry of Digestive Tumors of the Côte-d'Or (France). The overall postoperative mortality was 14.7 percent for colonic cancers and 11.2 percent for rectal cancers. After surgery with curative intent (n = 1,411), the corresponding figures were 10.3 percent and 6.8 percent, respectively. In patients operated with curative intent, postoperative mortality was slightly less in females than in males (NS), and in patients less than 65 than in older patients (P less than 0.001). It was higher when cancer was discovered through an acute event (20.0 percent) than in the other patients (7.7 percent; P less than 0.001). Stage at diagnosis, gross macroscopical appearance, and tumour size had no influence on postoperative mortality for colonic cancers. For rectal cancers, postoperative mortality was lower in tumors less than 3 cm in diameter (1.3 percent) than in larger tumors (7.5 percent; P less than 0.05). Postoperative mortality decreased by a mean of 9.7 percent per year between 1976 and 1985 (P less than 0.001). This trend was more pronounced after curative surgery: 10.9 percent (P less than 0.001) than after palliative surgery: 5.5 percent (P less than 0.05). After curative surgery, postoperative mortality decreased more in men (annual variation: 13.9 percent; P less than 0.001) than in women (6.3 percent; NS), before age 75 (20.2 percent; P less than 0.001) than in older patients (5.6 percent; NS), and for colonic cancers (13.1 percent; P less than 0.001) than for rectal cancers (9.1 percent; NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Preliminary results of a mass screening program for colorectal cancer].

The Digestive Tumours Registry of Burgundy set up a study to assess acceptability and results of colorectal cancers screening using the Hemoccult test. A total of 95,000 people, aged 45 to 74, were included, 55,000 in 1988 and 40,000 in 1989. The aim of this paper is to report the results of the first screening process in the population tested from January to July 1988, i.e. 27,421 subjects. Information on colorectal cancer was mailed to all homes in the screening areas and a news campaign was organized. During the first 4 months, the general practitioners (GPs) either prescribed the test which was then reimbursed (Autun area), or gave it free to their patients (other areas). After that phase, the test was mailed to all subjects who had not consulted their GP, and a second letter was sent 1 month later when the test had not been sent back. A total of 14,603 subjects performed the Hemoccult test (53.3 percent). Acceptability was higher in those areas there the test was initially given free by the GPs (57.3 percent) than in those where it was prescribed (40.0 percent). Acceptability was higher in women (55.8 percent) than in men (50.6 percent). A total of 57.8 percent of the performed tests were done during the medical offer phase, 29.1 percent after mailing and 13.1 percent after the recall letter. There was a positive test in 340 subjects (2.3 percent) and 288 (84.7 percent) had colonic investigations, a colonoscopy in 99 percent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗