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Biomedical subjects

E Lévy

Publications and source records attributed to E Lévy.

At least 19 recordsLinked to original sources
PubMed1991

[Enteral feeding].

Explore the source record for details and available documents.

Enteral Nutrition↗
PubMed1990

[Cost effectiveness of inpatient hospital care, day hospital care and outpatient consultation in pneumology. Apropos of 162 patients].

The authors report the results of a non-randomised study comparing the efficacy (in terms of confirmation of the diagnosis, the extent of disease, and measurements of airflow obstruction, and of the therapeutic index), and the efficiency in 58 patients suffering from lung cancer as well as 62 patients suffering from chronic airflow obstruction, and 42 asthmatics. These patients were seen in one of three possible services of a respiratory medicine department of a university hospital. The possibilities were inpatient stay in hospital, day hospital, or outpatient consultation. All the patients except one were totally independent, and could be taken into anyone of the three hospital services. The diagnostic efficacy for lung cancer was independent of the type of service used. The day hospital was four times more efficient than inpatient care for lung cancer, and consultation was 3.5 and 4.6 times more efficient than the day hospital for asthma and chronic airflow obstruction respectively. The balance of efficiency and the index of satisfaction experienced by the patients on the service used accentuated these differences.

Ambulatory Care↗
PubMed1990

[Radiotherapy of epidemic Kaposi's sarcoma in patients with AIDS. Analysis of 149 cases treated by extended and/or localized cutaneous irradiation].

Between June 1986 and December 1988, 149 patients with AIDS-related Kaposi's sarcoma were treated by cutaneous irradiation in our department. According to Mitsuyasu's staging, 34 patients (23 p. 100) were stage I, 82 (55 p. 100) stage II and 33 (22 p. 100) stage IV; no stage III was reported. Fifty eight patients (39 p. 100) had previously presented with one or several opportunistic infections. Ninety four patients (63 p. 100) had previously received treatment with interferon in 85 (57 p. 100) and/or Velbe in 43 (29 p. 100). 319 cutaneous localisations were treated, 59 p. 100 by extended cutaneous irradiation, using 4 and/or 8 MeV electron beam energy, and 41 p. 100 by localized irradiation, using 45 kVX-ray energy, 2.5 Gy/fraction, 4 times a week by split course 20 Gy then 10 Gy two weeks later. Twenty patients (13 p. 100) with oedema of the lower limbs were treated, using 4 MV photon therapy with bolus, and 3 (2 p. 100) were treated for lesions in the ENT regions. Only 131 patients were evaluable (257 localisations); 62 p. 100 obtained complete remission and 31 p. 100 partial remission after a mean period of 1.5 months (0.5-3 months). The overall tolerance was acceptable. The complications were epidermitis with some necrosis (8 p. 100), exudative epidermitis (26 p. 100), moderate epidermitis (63 p. 100) and slight reactions in 4 p. 100. The mean recurrence time was 5 1/2 months.

Acquired Immunodeficiency Syndrome↗
PubMed1989

High-output external fistulae of the small bowel: management with continuous enteral nutrition.

Three hundred and thirty-five patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Median fistula output was 1350 ml/24 h. Eighty-two per cent of patients were referred from other institutions. The fistula opening was associated with evisceration in 165 cases (49 per cent). One or more severity factors were present in 75.5 per cent of the patients. Patients were divided into three groups according to their initial therapy: 21 patients (6 per cent) referred in a moribund state were not operated on (non-intervention); 80 patients (24 per cent) were operated on as an emergency, and the fistula was either exteriorized or defunctioned; 234 patients (70 per cent) were initially managed conservatively. Appropriate local care and nutrition were provided in all cases. Enteral nutrition was the exclusive nutritional support in 285 patients (85 per cent). In 92 cases with proximal fistulae, methods limiting the fistula output or allowing reinfusion of chyme were required. The overall mortality rate was 34 per cent: 100 per cent in the non-intervention group, 55 per cent after emergency surgery, and 19 per cent after conservative treatment. In the latter group, spontaneous closure was obtained in 88 patients (38 per cent). Overall mortality rate was reduced to 19 per cent in patients treated since 1980. Enteral nutrition with appropriate local care may be used in the majority of high-output enterocutaneous fistulae, with an acceptable rate of spontaneous closure. Conservative management is the treatment of choice in the initial period. Emergency surgery should be restricted to the treatment of haemorrhage or intra-abdominal abscesses associated with uncontrolled systemic sepsis.

Adolescent↗
PubMed1989

Relationship of decreased hepatic lipase activity and lipoprotein abnormalities to essential fatty acid deficiency in cystic fibrosis patients.

Polyunsaturated fatty acids are known to affect plasma lipids and lipoproteins but there is no information on the effect of essential fatty acid (EFA) deficiency on lipoprotein composition. The purpose of this study was to characterize lipoproteins from 17 cystic fibrosis (CF) patients in relationship to their EFA status (eicosatrienoic/arachidonic acid ratio) and compare them with those of 10 healthy siblings (SIB) and of 10 unrelated controls. In 7 EFA-deficient (EFAD) and 10 EFA-sufficient (EFAS) patients, hypocholesterolemia was associated with a decrease of HDL-cholesterol and of LDL-cholesterol which was more marked in the EFAD group. Similarly, although triglyceride enrichment of VLDL, LDL, HDL2, and HDL3 with a concomitant reduction of cholesteryl esters from all particles except HDL2 was observed in both CF groups, it was more sizable in the EFAD patients. These changes led to an increase in the particle size of VLDL, LDL, and HDL2 whereas the distribution of HDL3 was skewed to smaller particles. Alterations in the apoprotein composition of particles were greater in EFAD than in EFAS. A decrease of total postheparin lipolytic activity was observed in the two groups of CF patients as well as in siblings. It was entirely accounted for by hepatic lipase (mumol FFA/ml per h) which was more severely diminished in EFAD (2.8 +/- 0.6) than in EFAS (4.4 +/- 0.7) and SIB (5.1 +/- 0.5). Although the two groups of CF children differed in terms of growth, severity of malabsorption, and vitamin E status, these data suggest that disturbance of lipoprotein concentration, composition, size, and metabolism (hepatic lipase) may be in part related to EFA deficiency. Further studies are necessary to explore the effect of EFA deficiency on hepatic lipase activity.

Adolescent↗
PubMed1988

Septic necrosis of the midline wound in postoperative peritonitis. Successful management by debridement, myocutaneous advancement, and primary skin closure.

Wound management following laparotomy for postoperative peritonitis and varying degrees of parietal necrosis remains a challenging and controversial problem. Because maintained peritoneal integrity and primary wound closure offer the best opportunity for survival, an original technique involving bilateral incisions to relax skin and rectus fascia is proposed. This technique permits medial myocutaneous advancement and primary tension-free skin closure of midline laparotomy incisions. Sixty-nine patients with severe postoperative peritonitis were treated according from 1980 through 1985. Nine of these patients died of advanced multiple organ failure soon after referral, and eight more died after prolonged treatment. Fourteen patients had one or more reoperations for complications. Only nine wound failures resulted, including five eviscerations and four wound infections followed by progressive dehiscence. The bilateral relaxing incisions healed secondarily without complication. Survivors developed midline wound hernia; ten of the 52 surviving patients have had these repaired. This method of primary closure is safe when performed in conjunction with rigorous surgical care of intraperitoneal infection and may enhance survival. We recommend the technique to surgeons who treat severe postoperative peritonitis and septic necrosis of midline laparotomy wounds.

Debridement↗
PubMed1987

[Evaluation of numbers and cost of severe acne in France].

The number of patients with acne in France is unknown. During a Winter period (October, 1985 to January, 1986), 31 dermatologists in private practice in 5 different regions (Paris, Lyon, Marseille, Rennes and Strasbourg) saw 4,597 cases of acne among 28,714 patients (16.0 p. 100); 293 (6.4 p. 100) of these acne patients had severe acne as defined in the official authorization to launch the drug isotretinoin on the French market: "Nodular and/or cystic acne and severe chronic acne resistant to the main conventional treatments". The patients' mean age was 24.0 +/- 6.7 years, and 66 p. 100 were male (39 p. 100 were students or grammar school pupils); they had the disease for a mean period of 8.2 +/- 5.9 years, and they consulted a dermatologist 4.15 times per annum on average. By extrapolating these figures to the total number of dermatologists practising in France, it could be assumed that in any given year about 17,738 to 19,333 patients with severe acne consulted dermatologists in private practice. Each dermatologist selected at random the record-cards of 4 of his severe acne patients (in all, 121 records) and gave those who came to consult him a letter explaining the purpose of the study and asking them to accept being questioned on the cost and repercussions of their disease. Sixty patients were interrogated by a psychosociologist, 27 accepted to be interrogated every 2 weeks for 2.5 months. The data collected were: i) number of times the patient consulted a general practitioner, a specialist, a surgeon, or a member of the paramedical professions.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗
PubMed1979

[Automaton resuscitation (author's transl)].

The aim of the Automaton Resuscitation is execution, watching and maintenance of a programme of intricate resuscitation tying for the first time the therapeutic to extemporaneous outflow of biological spoliation. This apparatus executes permanently and automatically the taking of biological fluid, estimates its outflow, amounts its total and realizes or the reinstillation of the fluid in the digestive tract or the order of intravenous perfusion tied to fluid spoliation according to an adjustable connection. A first self acting regulator for the juice intestinal reinstillation has been made in 1974. The second one with 4 units of continuous aspiration, data integration, reinstillation and perfusion tied with security had waked for 6 months. Moreover it allows with fiability the reinstillation of the gastric, duodenal, bilious, pancreatic or intestinal juice, on the other hand an intravenous perfusion tied to spontaneous spoliation (digestive) or instigated spoliation (provocated diuresis) and in a fundamental way simplifies the work of the physicians and the nurses.

Adult↗