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Biomedical subjects

E Coche

Publications and source records attributed to E Coche.

At least 19 recordsLinked to original sources
PubMed1999

Effect of site and rate of contrast material injection on pulmonary vascular distention.

RATIONALE AND OBJECTIVES: The authors performed this study to determine if there were differences in vascular caliber measured on angiograms obtained with the injection protocol used for spiral computed tomography (CT) versus that used for pulmonary angiography. MATERIALS AND METHODS: The authors studied seven juvenile anesthetized pigs by using a prospective repeated measures experimental design. All pigs received injections of nonionic contrast material via catheters in the brachial vein, superior vena cava, main pulmonary artery, and left pulmonary artery. Weight-adjusted injection rates and volumes ranged from 0.05 mL/kg/sec (3.5 mL/sec, spiral CT protocol) to 0.56 mL/kg/sec (40 mL/sec, pulmonary angiography protocol). Heart rate and pulmonary artery and systemic artery pressures were recorded. During each injection, identically positioned pulmonary angiograms were obtained at full inspiration. Vessel diameters were measured at identical locations after each injection by two observers. The relationship between vessel diameter and hemodynamic parameters and injection site and rate was assessed with analysis of variance. RESULTS: At suspended full inspiration, no statistically significant difference (P > .05) in vessel diameter or hemodynamic parameters was found between the different injection sites or rates. There was no difference in vascular caliber between systole and diastole. CONCLUSION: The improved detection of subsegmental pulmonary emboli at pulmonary angiography compared with contrast material-enhanced spiral CT is not due to differences in vascular distention.

Angiography↗
PubMed1999

Calcifying fibrous pseudotumor (CFPT): a patient presenting with multiple pleural lesions.

Calcifying fibrous pseudotumor (CFPT) is a rare pseudotumoral lesion initially described in the subcutaneous and deep soft tissues. More recently, 3 cases were reported in the pleura. We report an unusual presentation associating miliary pleural lesions with a single soft tissue lesion in a 29-year old, asymptomatic female patient. The multitude of pleural lesions prevented complete excision. Although the present case confirms an indolent process, the pathogenesis and long-term prognosis remain undetermined.

Adult↗
PubMed1998

Expiratory CT scans for chronic airway disease: correlation with pulmonary function test results.

OBJECTIVE: The purpose of our study was to correlate findings on expiratory CT scans with results of pulmonary function tests (PFTs) and to determine whether these techniques may be complementary in assessing airway obstruction. MATERIALS AND METHODS: Seventy-four patients with suspected chronic airway disease and 10 healthy nonsmokers underwent inspiratory and expiratory CT scans and PFTs. An air trapping score, corresponding to the ratio of the cross-sectional air trapping area versus the total cross-sectional lung area on expiratory CT, and a reduction score, representing the change in cross-sectional lung area at inspiration and expiration, were calculated using a quantitative grid. The two scores were then correlated with the results of the PFTs. RESULTS: Expiratory air trapping was seen in 18 (51%) of 35 patients with severe airway obstruction (forced expiratory volume in 1 sec [FEV1]:vital capacity < 80%) (group A), in 21 (72%) of 29 patients with predominantly small airways obstruction (abnormal flow-volume curve and FEV1:vital capacity > or = 80%) (group B1), and in four (40%) of 10 patients with normal PFT results (group B2). Expiratory air trapping was never seen in the 10 healthy subjects. Air trapping scores were 27%, 12%, and 8% for groups A, B1, and B2, respectively, with significant negative correlations with FEV1 (r = -.45), FEV1:vital capacity (r = -.31), and forced expiratory flow at 25% of vital capacity (r = -.57). Reduction scores were 18%, 30%, 35%, and 43%, for the groups A, B1, B2, and the healthy group, respectively, with significant correlations with all the PFT indexes (r = .35 to .66) except total lung capacity. CONCLUSION: Air trapping may permit detection of airway obstruction in patients with clinically suspected chronic airway disease even when PFTs are normal. Furthermore, expiratory CT allows one to calculate a reduction score for a cross-sectional lung area that appears to be better correlated with the degree of airway obstruction measured on PFTs.

Adult↗
PubMed1998

[Spiral CT in pulmonary embolism].

Pulmonary embolism is a leading cause of morbidity and mortality that can occur in many clinical situations. For several years, spiral CT has represented a relatively non invasive modality for diagnosing this common disease. The present article is reviewing the CT features of acute and chronic pulmonary embolism, the technical aspects of spiral CT acquisition, the diagnostic accuracy and major limitations and pitfalls of the technique.

Acute Disease↗
PubMed1996

Fifteen years of inpatient care in an academic division of general internal medicine: 1980-1994. Trends over time in patient's diagnoses, case-severity, case-complexity and mortality rate.

We describe the trends over time in patient's diagnoses, case-complexity, case-severity, length of stay and mortality rate during the last 15 years in an academic division of general internal medicine (GIM). Our study shows that GIM patients presented with a broad spectrum of diseases. Moreover, important changes were observed in the patient characteristics, i.e. a progressive increase in urgent admissions, severe medical conditions and elderly population. This evolution was associated with a significant rise in case-severity and case-complexity which explains the observed increase in hospital mortality rate. These variables should be accounted for when analyzing processes and outcomes of inpatient medical care in internal medicine.

Academic Medical Centers↗
PubMed1996

Bronchiectasis: comparative assessment with thin-section CT and helical CT.

PURPOSE: To compare thin-section computed tomography (CT) and helical CT in the detection and assessment of the extent of bronchiectasis. MATERIALS AND METHODS: Both thin-section and helical CT scans were obtained in 50 consecutive patients with clinical symptoms suggestive of bronchiectasis. Thin-section CT was performed with 1.5-mm collimation and 10-mm intervals, and helical CT was performed with 3-mm collimation and a pitch of 1.6 during a 24-second breath hold. Three observers evaluated 593 segments on CT scans both independently and in consensus. Radiation dose was measured for both techniques. RESULTS: Bronchiectasis was noted in 77 segments (22 patients) on thin-section CT scans compared with 90 segments (26 patients) on helical CT scans. No findings were positive for bronchiectasis on only thin-section CT scans. Interobserver agreement was statistically significantly better (P < .05) in identification of segments that were positive for bronchiectasis on helical CT scans (kappa = 0.87) than on thin-section CT scans (kappa = 0.71). Total skin dose of radiation delivered with helical CT was 3.4 times greater than that delivered with thin-section CT. CONCLUSION: Helical scanning can improve CT depiction of bronchiectasis but with an increase in radiation exposure to the patient. It should be used in patients considered for surgery or for thin-section CT scans that are difficult to interpret.

Adult↗
PubMed1995

[Hyperthyroidism after lithium withdrawal: coincidence or not?].

A 59 year-old manic-depressive woman treated with lithium for 10 years, developed hyperthyroidism three months after lithium withdrawal. The usual side effects on lithium on thyroid function include hypothyroidism and/or development of a goiter. Hyperthyroïdism occurring during lithium therapy is more rarely described. Hyperthyroidism has been exceptionally reported after lithium withdrawal, as in this case (five cases are recorded). The role of lithium in this pathology is controversial. Well-designed prospective studies are needed to clarify this question. Nevertheless, the effects of lithium on the thyroid metabolism are not always harmless and must prompt the clinicians to control the thyroid hormones before, during and after lithium therapy.

Female↗
PubMed1995

To control or to be controlled? From health locus of control to morphine control during patient-controlled analgesia.

We postulated that patients with an internal locus of control, i.e. those who like to control their health problems themselves, would adapt more adequately to the 'patient-controlled analgesia' technique as compared to patients with an external health locus of control, who do not believe in their own control. Since contradicting studies have been published on this matter, we investigated relations between the demand for analgesics, perceived pain in the postoperative phase, and the health locus of control in the postoperative context of cardiac surgery. Findings demonstrate distinct utilization patterns between subjects with internal or external locus of control concerning total morphine consumption, number of unsatisfied demands and reduction of perceived pain.

Aged↗
PubMed1994

[Thrombus of the right atrium simulating myxoma in primary antiphospholipid syndrome].

Various thrombo-embolic complications have been related to the antiphospholipid syndrome. The authors report the case of a patient with a primary antiphospholipid syndrome associated with a right auricular mass highly suggesting a myxoma by both echocardiography and nuclear magnetic resonance imaging. Meanwhile, the histological examination of the operative specimen showed a well organized and calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of the antiphospholipid syndrome. The preoperative investigations can't differentiate such a thrombus with a myxoma and the diagnosis is usually made postoperatively.

Antiphospholipid Syndrome↗
PubMed1993

[Perverse effects of an apparently harmless habit...].

We report the case of a 47-year old woman with a long history of arterial hypertension. Because of a recent difficulty to control blood pressure values accompanied by hypokalaemia, a thorough investigation was performed, showing low renin and aldosterone blood levels and high urinary potassium levels. Repeated questioning revealed that the patient regularly consumed non-negligible quantities of liquorice-flavored chewing-gun. The physiopathogenic mechanisms of action of liquorice are reviewed.

Chewing Gum↗
PubMed1993

Acute cholestatic hepatitis with rash and hypereosinophilia associated with ranitidine treatment.

We report a case of acute cholestatic hepatitis associated with rash and hypereosinophilia, in which the absence of transfusion, intercurrent viral infection, alcohol consumption or other hepatotoxic drugs are suggestive of ranitidine-induced hepatotoxicity. The pathogenesis of the disorder is unknown, but the lack of a dose-effect relationship, the rarity and unpredictability of the reaction, as well as the clinical signs suggest that hypersensitivity is involved. Physicians should be aware of this rare and idiosyncratic side-effect of ranitidine.

Chemical and Drug Induced Liver Injury↗
PubMed1993

Haematological changes and infectious complications in anorexia nervosa: a case-control study.

To determine the prevalence of haematological abnormalities in patients with anorexia nervosa (AN), and assess the relationships between these changes, the severity of AN and the propensity to infections, we retrospectively studied 67 patients who met the DSM-III-R diagnostic criteria for AN. We recorded physical findings and routine haematological data on admission, and infectious events during hospitalization. The patients were compared with 67 normal controls matched for age and sex. Mean haemoglobin (Hb) was normal but lower in AN patients than in controls (131 +/- 19 vs. 137 +/- 11 g/l, p = 0.03) and the prevalence of anaemia (Hb < 120 g/l) was higher in the AN group (27% vs. 1.5%, p < 0.0001). Patients had a lower leucocyte count (4.94 +/- 1.9 vs. 6.78 +/- 2.4 x 10(9)/l, p < 0.0001), and increased prevalence of leucopenia (< 4 x 10(9) cells/l)(36% vs. 1.5%, p < 0.0001), neutropenia (< 1500 x 10(6) cells/l)(17% vs. 0%, p = 0.0015) and thrombocytopenia (< 150 x 10(9)/l) (10% vs. 0%, p = 0.03). Only 2 patients (3%) had pancytopenia, but 9/17 patients with anaemia (53%) also had leucopenia. There was a slight but significant correlation between body-mass index (BMI) and total leucocyte, neutrophil and red blood cell counts. Severe infectious complications occurred in 9% of AN patients vs. 0% in controls (p = 0.01); they were more frequent with neutropenia (relative risk, 15.1: 95% CI, 10-20.2) or low (< 12) BMI (relative risk, 11.6: 95% CI, 6.6-16.6) on admission. Compared with controls, AN patients thus had an increased prevalence of anaemia, leucopenia and thrombocytopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Hypothyroidism associated with myeloid neoplasia. About 2 cases.

We report 2 cases of hypothyroidism in whom the associated haematological disturbances (macrocytic anaemia in both cases, mild leukopenia and thrombopenia in one patient) failed to be corrected by thyroid hormone replacement therapy. Further investigations led to the diagnosis of acute myeloid leukaemia (AML) in the first patient and myelodysplastic syndrome (MDS) in the other. The reasons of the delayed diagnosis and the possible mechanisms explaining this rare combination are discussed. The hypothesis of a purely coincidental association seems most likely.

Aged↗
PubMed1991

Importance of accurate employment histories of patients admitted to units of internal medicine.

A study was undertaken to assess the importance of systematically recording occupational histories of patients admitted to an internal medicine unit of a university hospital. Detailed information on current and past employment was obtained with questionnaires and in personal interviews from 200 inpatients over a 12-month period. Twenty-one patients (10.5%) were considered to have a "primary illness" (condition causing hospital admission) probably (4.5%) or possibly (6%) related to their current or previous occupation. From the 786 primary and secondary illness and medical antecedents diagnosed for the 200 patients examined, 70 illnesses of 55 patients were considered probably or possibly related to current or previous occupation. This pilot study emphasizes the need for accurate occupational records for patients in an internal medicine ward. This task is best performed by an appropriately trained occupational physician.

Adult↗
PubMed1991

[Liver abscess and appendicular foreign body].

We report a case of liver abscess secondary to appendicitis which was due to a wire within the appendix. Appendicitis was asymptomatic, probably because of its retrocaecal position and/or previous antibiotic treatment. The abscess was treated with broad-spectrum antibiotics and percutaneous drainage, followed by a second stage appendicectomy. This case illustrates the value of gastrointestinal radiological investigations before considering the abscess as cryptogenetic.

Adult↗