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Biomedical subjects

E Jougla

Publications and source records attributed to E Jougla.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Deflation of breast implants, pre-filled with saline or hydrogel. Results and analysis of 650 treated patients].

SUBJECT: The main mechanical side effect of saline or hydrogel filled implants is deflation. The aim of this study was to analyse the prosthetic deflation rate in the last 7 years in the plastic surgery unit of Toulouse. PATIENTS AND METHODS: We tracked 650 patients operated on between july 1993 and july 2000 (representing 1117 primary implants) which we separated in two groups: the first group contained patients in need of breast reconstruction; the second group contained all the patients with implants placed for aesthetic or breast asymMetry reasons. For each of the two groups we determined the number and the type of implants, as well as the rate and the mean delay after which deflation occurred. RESULTS: During this period, we've determined that: rate of deflation of group 1 (reconstruction) is highest than group 2 (aesthetic), despite sort of implant; rates of deflation of pre-filled hydrogel implants are highest than rates of deflation of pre-filled saline implants. DISCUSSION: Only a few series concerning implants deflation have been described in the literature. We can find a large difference in results which vary from 2 to 76%. We were surprised by the result of our series with a rate of deflation up to 15% with a medium follow-up 5 years in both groups and a mean delay before the fourth year. Deflation's factors are numerous: type of sterilisation, rippling, texture, valve's incompetence, prosthetic patch, guarantee control and iatrogenic causes. Because the silicone gel implants (the one uncomplicated by deflation) were taken off the french market, the saline implants tried to supplant them but without satisfactory results. CONCLUSIONS: With the unacceptable rate deflation of implants in our study, the return in the french market of silicone gel implants seems us an acceptable alternative.

Adolescent↗
PubMed2002

[Factors associated with blood transfusion during anesthesia for scheduled hip or knee arthroplasty in France].

GOAL OF THE STUDY: To determine over a whole country what are the factors associated with an intraoperative homologous blood transfusion and with the use of autologous techniques (preoperative autologous blood donation: PABD; acute normovolemic hemodilution: ANVH; intraoperative red cell salvage: IRCS). STUDY DESIGN: National enquiry using a large representative sample (3 days of anaesthesia in France). METHODS: Univariate followed by multivariate analyses of data gathered in 1996 during the survey leaded by the French society of anaesthesia and intensive care (Sfar) and corresponding to 884 scheduled hip and knee prosthesis surgical procedures. RESULTS: Factors associated with a decreased use of PABD programme were: 1--old age and high ASA physical status; 2--procedures of short duration. By contrast, an increased use of PABD was associated with anaesthetics in which a closed circuit had been used. Except for a significant association with increasing age and with absence of PABD used, no additional factor was found to be linked with ANVH. No factor among those studied was found related to the use of IRCS. Homologous blood transfusion was more frequently used in ASA > or = 3 patients, in long duration surgeries while its use was decreased in patients with PABD (odds ratio--for reduction by PABD: 4.4 [95% confidence interval: 2.2-8.8]). Homologous blood transfusion was not related to the use of ANVH or IRCS. CONCLUSION: These data obtained from a large national survey confirm previously published studies and meta-analyses and are in agreement with current recommendations. An unexpected relation between PABD and closed circuit anaesthesia has been found.

Aged↗
PubMed2002

[Quality of suicide mortality data].

Prevention of suicide is a public health priority in France. Indicators of suicide mortality have been widely used to describe epidemiological situations or to evaluate public health actions. It is therefore essential to examine the quality of suicide mortality data. The purpose of this work was to identify potential biases affecting the quality of such data and their comparability between different countries as well as to determine how they can affect conclusions. Potential biases were identified by studying the characteristics of the death certificate system and analyzing the international literature on data quality. The impact of biases was assessed by analyzing the causes of "concurrent" death with suicide in the official statistics (trauma and poisoning caused in an undetermined way concerning intention and unknown causes). The proportion of suicides listed as "concurrent" causes of death, estimated from specific surveys was extrapolated to official data. This method was also used to correct the international data. Practices concerning death certificates for violent deaths vary considerably from one country to another: type of certifying physician, frequency of medicolegal investigations, frequency of autopsies, suicide definition criteria, confidentiality regulations, religious and culture context. These practical differences lead to variability in undetermined and unknown causes. The corrections made on the mortality data after taking into account for these potential biases showed that the rate of suicide determined from official data is considerably underestimated, but that sociodemographic and geographic factors of suicide change little after correction. Likewise, the order by country was similar after taking into consideration concurrent causes. A reliable evaluation of the rate of suicide for a given country is of course important. However, it is possible to characterize populations at risk and analyze the determinants of suicidal behavior without necessarily recording all suicides, as long as the declaration bias is stable. Statistical analysis of death by suicide in France shows that, despite under-reporting, the principal sociodemographic and geographic features and trends over time can be considered as valid. A series of recommendations is proposed however to improve data quality and homogeneity for death certificate reporting. Designing operational criteria for deciding when to declare suicide as the cause of death would be helpful to guide physicians who report deaths. Classical autopsies could be completed by "psychological autopsies" with friends and family of the deceased. The death certificate form could be improved to include items for complementary information favoring or not suicide.

Adolescent↗
PubMed2001

[Maternal mortality in France: frequency, trends and causes].

Ten years ago the first epidemiological surveys on maternal mortality in France were carried out on the national level. In 1995, a National Committee of Medical Experts was created to conduct confidential inquiries into maternal deaths. It is thus useful to examine the general picture of maternal mortality in France drawn by the routinely and permanently collected data. These statistics are collected independently of the procedure adopted by the National Committee on confidential inquiries into maternal deaths. National death and cause-of-death registries have recorded maternal death rates for several years with data by age, area of residence, nationality, and direct or indirect obstetric causes. The low and underestimated rate of 8.5 maternal deaths per 100,000 live births recorded in 1989 increased regularly up to 1992. Currently the rates have been around 9 to 13 with no evidence of a declining trend. The larger urban area around Paris (Ile-de-France) has shown a statistically significant higher rate over the last several years. Post-partum hemorrhage remains the leading cause of maternal death. Compared with other European countries, maternal mortality in France is in an average position, similar to Great Britain (12 per 100,000), but higher than in Scandinavian countries. The elevated mean age of mothers at delivery is one explanation for the lack of a decline in the rate of maternal deaths expected until 2005 although further actions should be implemented to attempt to lower the rate to that observed in Scandinavian countries. A pertinent classification of causes of maternal deaths allowing valid international comparisons would be useful for helping answer the questions raised by clinicians.

Cause of Death↗
PubMed2000

[Importance of medicolegal data for national cause of death statistics].

OBJECTIVE: The validity of French cause of death statistics largely depends on the transmission of the medical information reported on the dedicated part of the death certificate. Data referring to death causes are collected and analyzed at the Information Department on the cause of death (INSERM SC8). In major urban areas with one or more forensic institutions, it has been observed that the proportion of death certificates indicating ìno particular cause of deathî is higher than the national average. We therefore examined deaths occurring in 1996 in the Lyons region. METHODS: This retrospective study involved 5,208 deaths recorded in Lyons France in 1996. Complementary information on these deaths was obtained from INSERM SC8 and Lyons Medicolegal Institute. RESULTS: It was observed that a large portion of violent deaths occurring in this city in 1996 (more than 30%) were not recorded appropriately in the national statistics due to a lack of communication after autopsy. CONCLUSION: Considering the importance of epidemiology and suicide prevention in the national public health strategy, improved information transmission must be developed in the near future.

Accidents↗
PubMed2000

The use of the personalized estimate of death probabilities for medical decision making.

Data coming from the French national statistics on the cause of deaths are used to calculate the probabilities of death from pathologies. These probabilities are calculated according to age, sex, and place of residence of the patient to "personalize" the estimate. This individual prediction of the risk of death is proposed for pathologies for which the feasibility and the utility of prevention measures had been demonstrated. Relative risks of death according to the socioprofessional category, which are coming from the scientific literature, are used to adjust the probabilities of death as a function of the patient socioprofessional category. The aim of this work is to guide a scientist toward a prevention strategy according to the age and characteristics of patient. The use of computers by the scientists will make possible the diffusion of such tool of prediction to improve a personalized prevention.

Cause of Death↗
PubMed1999

French survey of anesthesia in 1996.

BACKGROUND: To identify the growth in the number of anesthetic procedures since 1980 and the changes in the practice of anesthesia, the present survey was designed to collect and analyze the anesthetic activity performed in France in 1996, from a representative sample collected in all French hospitals and clinics. METHODS: This study, initiated by the French Society of Anesthesia and Intensive Care, collected information that included the characteristics of patients (age, sex, American Society of Anesthesiologists status), the techniques of anesthesia, and the nature of the procedure for which anesthesia was required. All French private, public, and military hospitals were asked to participate in the survey. In each hospital in the country, all anesthetic procedures were documented and collected during 3 consecutive days, chosen at random during a 12-month period, to obtain a representative sample of the annual activity. All data were analyzed at the INSERM (National Institute of Health and MEDICAL RESEARCH: At the conclusion of the study, 5% of hospitals were randomly assigned to be audited to check for missing data and errors. The rate of anesthetic activity was calculated as the ratio between the annual number of anesthetic procedures and the number of the general population in the same age group. RESULTS: The participation rate of hospitals was 98%. The analysis of the 62,415 collected questionnaires allowed extrapolation of the anesthetic activity to 7,937,000 anesthetic procedures (95% confidence interval, +/- 387,000) performed in France in 1996. Thus, the annual rate of anesthetic procedures was 13.5 per 100 population, varying between 5.4 per 100 in girls aged 5-14 yr and 30.2 per 100 in men aged 75-84 yr. Surgery was involved in 71% of anesthesia cases. Regional anesthesia alone was performed in 20% of all surgical cases and was combined with general anesthesia in 3% of additional cases. Anesthesia for obstetric procedures represented 9% of all cases. Seventy-six percent of all anesthetic procedures started between 12:00 A.M. and 7:00 A.M. were related to obstetric activities. CONCLUSION: In comparison with a previous study, the present survey shows that the number of anesthetic procedures has increased by 120% since 1980, and the rate of anesthetic procedures increased from 6.6 to 13.5 per 100 population, the major changes being observed in patients aged > or = 75 yr and in those with an American Society of Anesthesiologists physical status of 3. In the same time period, the number of regional anesthetic procedures increased 14-fold. In obstetrics, the practice of epidural analgesia extended from 1.5% to 51% of all deliveries of the country.

Adolescent↗
PubMed1999

[Geographic differences of bronchopulmonary cancer mortality in France and spatial scales of analysis: significance of scale change in health geography].

BACKGROUND: It is important to choose a valid spatial scale to study health differences in a geographical perspective. Many scales can be valid and a combination is required to understand the spatial distribution of a given health problem. Geographic distribution of lung cancer was studied in France using different scales to illustrate the importance of changing scales in health geography. METHODS: Standardized rates (direct method) for lung cancer were calculated for the period 1988-92 and mapped at different scales. RESULTS: Original spatial structure was observed for each scale. This proved that different interactions occur at each scale between environmental and social factors. Changing the scale allowed a better understanding of variations in the spatial distribution of lung cancer. CONCLUSIONS: The validity of a regional scale to study health geographical distributions is questioned. Changing the scale would allow proposing action to improve health promotion.

Bronchial Neoplasms↗
PubMed1999

Analysis of mortality in French diabetic patients from death certificates: a comparative study.

This study was implemented in France to determine the causes of death in diabetic patients, whether diabetes was mentioned or not on the death certificate, and to assess the underestimation of the prevalence of diabetes at death. Two stratified random samples of death certificates were selected in the national mortality data base. The first included certificates mentioning diabetes as a cause of death (cases). The second, included certificates with no mention of diabetes (controls). For each certificate, a record form was sent to the certifying physician to ascertain diabetes in the first group and to trace unrecorded diabetes in the second group. In case of diabetes, the characteristics of the patient and his disease were collected (age at onset, treatment, complications ...). We obtained complete data for 325 cases and 959 controls. Among cases, 1% of the subjects were not confirmed as diabetic, while almost 10% of the controls were identified as having diabetes. The corresponding ratio of the corrected prevalence at death to that provided by the French statistics was estimated to 4.0 in men and 3.1 in women. Particular features are that 2% of the total diabetic decedents died from acute metabolic complications (diabetic or hyperosmolar coma, acidoketosis, or acute hypoglycemia), and that 33% of the unreported diabetic decedents under 45 died from trauma or poisoning. These results show that in France, the death rates published in the statistics for diabetes dramatically underestimate the impact of diabetes. A high risk of death is linked to this disease, particularly in people aged under 45, a problem that health deciders should address.

Adult↗
PubMed1999

[Angiomyoma of the hand: a post-traumatic tumor?].

A 69-year-old woman presented with a tumor of the lateral aspect of the proximal phalanx of the little finger of the right hand. The finger was injured by a ring during a handshake. Excision and histopathological examination revealed the diagnosis of angio-myoma, a benign vascular tumor originating from the smooth muscle cells of arterial or venous walls. Angiomyomas belong to the family of leiomyomas and rare, small tumors (less than one centimeter), preferentially occurring in women between the ages of 40 and 60 years. They may be painful. Only one case of sarcomatous degeneration has been described in the literature. Trauma has never been previously reported as a cause of angio-myoma, but in this case the traumatic origin of the tumor was not in doubt.

Aged↗
PubMed1998

[Epidemiology of adolescent suicide].

Among the more noticeable health and social indicators used for adolescents, the epidemiologic data on suicide point out one of the most serious risks in the present context of violence. In France, during the year 1995, 5,324 adolescent deaths from 14 to 24 of age were reported. The corresponding mortality rate is 66 for 100,000. The cause-of-death distribution shows the importance of violent deaths among adolescents. Actually, these deaths represent 70% of the 5,324 adolescent deaths. The proportion is higher for males (74%) than for females (60%). The most part of these violent deaths is due to accidents, especially transport accidents (38%). Deaths due to suicides are lower, however they constitute a significant part of the deaths concerning adolescents: 11% of the deaths that occurred from 15 to 19 of age, 17% of the deaths that occurred from 20 to 24 of age. At this time of life, the percentage of suicides is higher than for the whole population, where suicides are only responsible for 2% of the total deaths.

Adolescent↗