Biomedical subjects

Dominique El Kouri

Publications and source records attributed to Dominique El Kouri.

4 recordsLinked to original sources

PubMed2004

[Non-justified visits to emergency units. Proposal of differentiated care].

OBJECTIVE: The number of visits to emergency units in public hospital settings in France increases every year. The adequation between admission to an SAU--Service d'accueil d'urgence (emergency unit) and the clinical status of the patient must be checked to improve handling upstream of the SAU. METHOD: A prospective study was conducted in the SAU of the University Hospital in Nantes to assess the proportion of patients who would benefit from direct hospitalisation, scheduled in a department of specialised or polyvalent medicine. RESULTS: This proportion was of 10%. Seventy-three percent of the patients were aged over 60. They were referred in 77% of cases by their treating physician and in 10.4% of cases by the physician on duty. Thirty-three percent of cases were non-specified organ diseases, 20% were dermatological affections, 12% broncho-pulmonary infections and in the same proportion rheumatological pathologies; other affections were rare. COMMENTS: The results of this study must be confirmed in a pilot study in which the general practitioner would refer any patient, that he would have sent to an SAU, directly to a medical department without passing through the SAU. To do so, using a cell phone, the practitioner would contact the hospital physician who would find a hospital bed. The impact of this new modality of hospitalisation on the SAU could be assessed in terms of the number of admissions avoided to the SAU.

Aged↗

PubMed2004

[Meningitis with direct negative bacteriological examination. Prospective assessment of a decision making tree].

OBJECTIVE: Elaboration of a decision-making tree for differential diagnosis of bacterial and viral meningitis, when initial Gram's staining is negative. Method One-Year prospective study in an adult emergency department. Comparison with the immediately-preceding period. RESULTS: 56 patients were included. Only 4 bacterial meningitis, but none misdiagnosed. 86% sensitivity and 83% specificity for viral meningitis (n=40). Rate of patients hospitalised more than 24 hours decreasing from 62.5 to 41% (p=0.05). Antibiotic chemotherapy decreasing from 55 to 16% (p<0.001). CONCLUSION: This decision-making tree safely allows emergency differentiation between bacterial and viral meningitis, when initial Gram's staining is negative. It consequently leads to decreased rates of useless hospitalisations and antibiotic treatments. We believe that this method can be helpful during outbreaks of viral meningitis.

Adult↗

PubMed2003

Temporal arteritis associated with systemic necrotizing vasculitis.

OBJECTIVE: To evaluate the clinical and laboratory characteristics of patients with systemic vasculitis associated with temporal artery involvement. METHODS: From a cohort of 120 patients fulfilling American College of Rheumatology criteria for temporal arteritis, we retrospectively identified 7 patients with systemic necrotizing vasculitis associated with histological temporal arteritis. RESULTS: Among the 7 patients, 2 had classic polyarteritis nodosa, one had unclassified systemic vasculitis, one had Wegener's granulomatosis (WG), and 3 had microscopic polyangiitis. The mean age of the patients was 70.2 years, and cranial symptoms revealed the disease in all but one patient. Temporal arteritis was generally associated with extracephalic manifestations suggestive of systemic vasculitis. Antineutrophilic cytoplasmic antibodies were positive in 3 of the 4 patients with small vessel vasculitis. Pathologically, the main temporal artery was involved in all but one patient, with inflammatory infiltrate of vasa vasorum and adventitia associated in 5 with small tributary involvement. Fibrinoid necrosis was rare, observed in 2 specimens; 2 patients with unclassified systemic vasculitis and WG had a classic giant cell arteritis (GCA) histologic pattern. Only one patient had exclusive involvement of small vessels, surrounding the spared main temporal artery. Muscle biopsies showed histopathological evidence of vasculitis in 2 patients, skin biopsy in one, and vein biopsy in the other. CONCLUSION: Temporal artery involvement in systemic necrotizing vasculitis was generally associated with extracranial clinical features suggestive of systemic vasculitis. Temporal artery biopsy is a simple tool for diagnosis of vasculitis, but the histopathological findings do not always discriminate between necrotizing vasculitis and classic GCA.

Aged↗

PubMedDate not supplied

[Maternal and obstetrical risk factors of placental vascular pathology (biologic and epidemiological data excluded)].

The purpose is to identify maternal and prenatal risks factors for placental vascular disorders. We excluded biologic and epidemiological data which are discussed in another chapter. Maternal risks factors are pre-existing vascular systemic diseases. Systemic lupus erythematosus (antiphospholipid antibodies are studied in another chapter) is a classical disease associated with unfavorable outcome, particularly when the disease is not quiescent and if the patient has a history of previous poor outcome. Obstetricians' awareness of the influence of inflammatory bowel diseases on pregnancy and fetal outcome is quite poor. These diseases, if they are not quiescent, can induce deleterious perinatal effects. Type 1 or even type 2 diabetes mellitus increases the risk of preeclampsia or hypertension in pregnancy, particularly when there is poor glycemic control early in pregnancy. The duration of type 1 diabetes affects the outcome of pregnancy more than type 2. Smoking during pregnancy is associated with many adverse events including spontaneous abortion, low birth weight and placental abruption. There are data about the dose-response relationship between the number of cigarettes smoked per day and the risk of abortion. Smoking during pregnancy is also protective against preeclampsia and this apparent paradox suggests the complexity of what is called vascular placental pathology. There is a significant relationship between pejorative perinatal vascular outcome and the non quiescence of renal disease. Mid-trimester uterine artery Doppler combining bilateral notches and increased uterine resistance index is the best criterion to predict the placental vascular risk of the pregnancy. Some promising studies suggest the feasibility of uterine Doppler ultrasound screening early in the pregnancy during the first trimester. Large studies are required to confirm this practice. Uterine artery Doppler in combination with other tests (elevated maternal serum hCG or ambulatory 24-hour blood pressure monitoring at 22 weeks gestation) could be a more efficient predictor of vascular complications. A large-scale evaluation is necessary before recommendations can be made. Multiple pregnancies increase the risk of preeclampsia 2- or 3-fold (RR 2.62; 95% CI: 2.03-3.38). A history of preeclampsia is the strongest predictor of unfavorable outcome for the second pregnancy.

Female↗