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Biomedical subjects

F Aime

Publications and source records attributed to F Aime.

18 recordsLinked to original sources
PubMed1993

[Cardio-respiratory complications of sleep apnea in obese patients].

The cardio-respiratory complications of sleep apnea syndrome have been prospectively assessed in 60 patients with massive obesity and free of chronic obstructive lung disease while the associated cardiovascular diseases and the alterations of pulmonary function were taken into account. These cardio-respiratory complications were observed only in patients with a number of apneas per hour of sleep greater than 20. The sleep apneas induced nocturnal hypoxemia that is frequently severe and independently correlated to the apnea index, diurnal hypoxemia and hypercapnia that are usually moderate, and presumably left ventricular hypertrophy that is not related to the development of daytime hypertension. However the nocturnal apneas were not associated with the development of an impairment of right or left ventricular function, or with the occurrence of cardiac arrhythmias or conduction disturbances. The absence of severe cardiac complications in this study may be related to the fact that the patients were relatively young and that the sleep apnea syndrome was diagnosed at an early stage of evolution. The findings of this study could help to define a more rationale approach in several therapeutic indications of sleep apnea syndrome.

Adult↗
PubMed1991

Endoscopic treatment by snare electrocoagulation prior to Nd:YAG laser photocoagulation in 85 voluminous colorectal villous adenomas.

The association of endoscopic resection with Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenomas. Eight-five patients were included: 49 with surgical contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five tumors had an axial extension between 1 and 3 cm, and 40 tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total tumor destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients. Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal villous adenomas.

Adenoma↗
PubMed1990

Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases.

From January 1975 to June 1988, 275 patients underwent mitral valve repair for mitral regurgitation, pure (148 patients) or associated with mitral stenosis (127 patients). Patients with pure mitral stenosis were excluded from this study. The cause of mitral regurgitation was rheumatic in 180 patients (aged 28.6 +/- 1.2 years, mean +/- standard error of the mean) and degenerative in 84 patients (aged 54.7 +/- 1.5 years). Fifty-nine percent of the patients were in New York Heart Association classes III and IV before the operation. Intraoperative assessment of the mitral valve led us to identify four major mechanisms of mitral regurgitation: (1) restriction of leaflet motion by fibrosis (group I, 63 patients); (2) enhancement of leaflet motion by leaflet and chordal extension and prolapse (group II, 139 patients), (3) combination of both (group III, 64 patients); and (4) isolated dilatation of the anulus (group IV, 10 patients). One hundred sixty-one patients had isolated mitral disease and 114 had associated aortic or tricuspid valve disease, or both. The hospital mortality rate was 4.0%. Follow-up was 96% complete and totaled 1247.47 patient-years. At 13 years' follow-up, the survival rate was 93.0% +/- 6.8% in group I, 90.0% +/- 6.0% in group II, and 96.6% +/- 4.6% in group III. Freedom from reoperation was 78.1% +/- 21.0%, 83.2% +/- 18.9%, and 79.6% +/- 16.2%, respectively. Freedom from embolism was 94.7% for the whole series. In patients with isolated mitral valve repair, the cumulative morbidity was significantly higher in groups I (6.3 +/- 2.0%/pt-yr) and III 6.3% +/- 1.7%/pt-yr) than in group II (2.5% +/- 0.9%/pt-yr, p less than 0.05). Multivariate analysis identified age and associated tricuspid valve disease as significant predictors of reoperation (p less than 0.01 for both factors). These results suggest that conservative surgery should be used with caution in group I and III patients. In contrast, indications for mitral valve repair should be extended in group II patients. This observation has important clinical implications since, in Western countries, valve prolapse tends to be a major cause of mitral regurgitation.

Actuarial Analysis↗
PubMed1988

Alcohol consumption and impaired glycoregulation results in a population of 6665 salaried employees.

Alcohol consumption and glycosuria were found to be associated (p less than 0.001) in a population of 6571 salaried employees who underwent a systematic examination. The prevalence of glycosuria was found to range from 1.3% among 2609 non-drinkers to 5% among 816 heavy drinkers (six glasses or more of alcoholic beverage daily). This association was still significant after adjustment for age, sex and body mass index. Similarly, a positive association was observed between fasting glycemia and alcoholic intake in a subgroup of 998 subjects when such a result was available (p less than 0.05).

Adolescent↗
PubMed1988

[Experience of decentralized informatics at a nephrology unit of a general hospital].

The computerized medical specialized records covering the follow-up of hypertension (ARTEMIS), diabetes (MELLITEE), chronic renal failure and the minimum medical record of Nephrology (THESEE) using the temporal database management system LIED, have been developed in several units of University Hospitals. The authors show that these computerized records are usable in a Nephrology Unit in a General Hospital.

Diabetes Mellitus↗
PubMed1988

[Psychosocial consequences of HIV infection].

A questionnaire survey of 103 patients of the Paris Pitié-Salpêtrière Hospital measures the changes in family life, work relations and in sexual behaviour occurring after an HIV infection diagnosis. Most patients choose to keep their diagnosis secret, an attitude that places them into a double bind situation. This silence, chosen as a mean of self-protection, prevents patients from making themselves understood and from mobilising the material and psychological help they need.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Relationship between alcohol consumption and hypertension prevalence and control in a French population.

Six thousand six hundred thirty two subjects, employed in 420 small and medium-sized companies in the Paris region were examined in a cross-sectional study. Their alcohol consumption, as obtained by interview was found to be higher among males than among females, among workers than among managers, executives, and clerks. Alcohol consumption was positively associated with age, body mass index, coffee and cigarette consumption, occupational exposure to noise and working nights or alternating shifts. A positive, continuous, relationship was observed, for men and women, between alcohol intake and both systolic and diastolic blood pressure. This association was highly significant in the multivariate analysis (multiple linear regression) where alcohol intake, following age and body mass index, was the third predictive factor of blood pressure level in the stepwise regression. The positive association between alcohol consumption and prevalence of arterial hypertension was aggravated by the poor control of hypertension which was found among drinkers. Awareness of hypertension, compliance with an antihypertensive treatment and its efficacy, were negatively associated with alcohol intake. The findings stress the importance of alcohol consumption which was found to be a major risk factor for arterial hypertension and noncompliance with antihypertensive treatment in this population.

Adolescent↗
PubMed1987

Integrating management and expertise in a computerised system for hypertensive patients.

An expert system has been integrated to the data management system of the ARTEMIS programme for hypertensive patients. The patient database, which has been used since 1975, contains the medical records of about 20,000 patients. Information is interactively entered by physicians, nurses and secretaries on video display units. The computerised medical record has replaced the traditional handwritten medical record. The database management system is used to produce different summary reports (inpatient and outpatient care) and personalized recall letters which are mailed to the patients before their appointments. Suggestions provided by the expert system include additional information to be obtained (complementary patient interrogation, biological or radiological investigations, etc.), possible causes of hypertension, and medical prescriptions. The information base allows the description of both static knowledge (in the form of a semantic network) and dynamic knowledge (in the form of production rules). The inference system sequentially uses a combination of forward and backward chaining and performs both exact and approximate reasoning. The diagnostic performance of the expert system was evaluated in 100 cases of hypertension (50 of essential hypertension and 50 of secondary hypertension. Concordance between the diagnosis proposed by the expert system and the one proposed by the specialist was achieved in 92% of secondary hypertension cases and 88% of essential hypertension cases. It is suggested that the integration of data and knowledge management might enhance the overall acceptance by medical staff of a computerised system, and facilitate the validation of a knowledge base.

Database Management Systems↗
PubMed1986

Peritonitis in continuous ambulatory peritoneal dialysis: a role for the dialysate?

Three groups of CAPD patients with different dialysis fluids showed a different risk of peritonitis according to the brand of the dialysate and the buffer acetate or lactate they used. Aseptic peritonitis was more frequent with patients who received lactate-buffered peritoneal fluids. According to the manufacturer of the dialysate, however, different results in terms of risk and type of peritonitis are obtained also within one type of lactate-buffered solution. The factors responsible for the difference in the risk of peritonitis according to the dialysis fluids used are unknown.

Adult↗
PubMed1983

Relation between coffee drinking and blood pressure: analysis of 6,321 subjects in the Paris region.

The possible link between coffee drinking and blood pressure (BP) was studied in a cross-sectional epidemiologic survey of 6,321 adults in the Paris region. Systolic and diastolic BP levels were higher among the 5,430 coffee drinkers than among the 891 nondrinkers (p less than 0.001 and p less than 0.01). BP levels adjusted for age by covariance analysis increased gradually from the non-coffee consumption category (125.6/79.8 +/- 15.0/10.5 mm Hg [mean +/- standard deviation]) to the highest consumption category (greater than or equal to 5 cups/day) (128.1/80.6 +/- 15.6/10.2 mm Hg) (p less than 0.001 for systolic BP and p less than 0.002 for diastolic BP). The positive association between coffee consumption and systolic, but not diastolic, BP remained significant in a multivariate analysis after controlling for age, sex, body mass index, alcohol consumption, tobacco consumption and socioeconomic category (p less than 0.02 for systolic BP and p = 0.16 for diastolic BP). It is concluded that coffee consumption is a significant but not strong contributor to the variation in BP levels.

Adult↗
PubMed1983

[Effect of socio-occupational category on iterative hemodialysis treatment of advanced chronic renal insufficiency. Results of the DIAPHANE computerized Dialysis Registry cooperative program].

The hypothesis that inequalities may be observed between patients of different socio-professional categories (S.P.C.) was assessed in a group of 1267 men treated by chronic haemodialysis (C.H.) in 34 dialysis centers throughout France and followed up in the computerized DIAPHANE Dialysis Registry. The percentages of manual workers and farmers were found lower than those calculated on the whole active french population. In contrast, the percentages of senior executives and patient with liberal professions were higher. Primary renal disease was detected sooner in patient of the higher S.P.C. than in other groups. Patients of the higher S.P.C. were more frequently treated in university or in private hospitals than in general hospitals. They were more likely on evening or night dialysis schedules than on daylight schedules; they more frequently received hypotensive drugs, vitamin D, calcium, iron, prescriptions of blood transfusions than patients of the lower categories. Survival rates were not correlated with the S.P.C., but the rehabilitation rate, expressed as the percentage of part or full time employments, was greater in patients of the higher S.P.C. Results indicate that, in patients treated by chronic haemodialysis, inequalities in favor of the patients of the higher socio-economic categories are observed and that these inequalities concern both the access and the delivery of care.

France↗
PubMed1983

Evolution of residual renal function in patients undergoing maintenance haemodialysis or continuous ambulatory peritoneal dialysis.

A study has been carried out to compare over an 18 month period the residual glomerular filtration rate (GFR) measured by the creatinine clearance in two matched groups of 25 patients with end-stage renal disease. One group was treated by continuous ambulatory peritoneal dialysis, the other one by maintenance haemodialysis. GFR was similar in both groups immediately before starting dialysis therapy, respectively 4.3 +/- 2.3 and 4.4 +/- 2.4 ml/min. From the beginning of the dialysis treatment to the eighteenth month there was a significant and progressive decrease of GFR in the group of patients treated by haemodialysis, while in the peritoneal dialysis group GFR and peritoneal clearances remained stable.

Adult↗
PubMed1979

[Society of Nephrology, Computer Technology Commission. Dialysis computer program. VI. - Survival and risk factors].

The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.

Adolescent↗
PubMed1977

[Dialysis-computer program. IV. Summary report. Epidemiology of complications].

The Diaphane-program instituted under the authority of the French Society of Nephrology has been steadily expanding since 1972. By December 1977, about 1500 patients treated in 30 public and private Dialysis Centres were followed up by this system. Full coverage of expenses is provided by the participating Centres. The statistical work presented in this report involves 1572 adult patients treated between June 1972 and December 1976 in 24 dialysis centres. The amount of collected data and the duration of the observation period permit to build up evolutive profiles of the population of patients treated in France by maintenance hemodialysis, of the various techniques and strategies used and of the main complications recorded in the patients. 1. Mean age of patients at start of dialysis is steadily increasing, from 40.1 years in 1972 to 48.2 years in 1976. 2. The predominance of male patients, constant over each year, may be explained by an increased proportion in man of chronic glomerulonephritis and renal vascular diseases. The sex-ratio in patients with chronic pyelonephritis is close to the one recorded in the French population. 3. The regular decrease of the mean plasma creatinine level at time of first dialysis recorded since 1972, is probably related to an earlier start of treatment. However, 10.6 per cent of the patients taken on treatment in 1975-1976 still had a plasma creatinine greater than or equal to 200 mg/100ml. 18.7 per cent had a diastolic blood pressure greater than or equal to 120 mmHg, and exsudative lesions at eye fundi examination were found in 33.5 per cent. The delay in initiating dialysis treatment may account for the frequency of early acute cardiopulmonary complications such as pulmonary oedema and pericarditis and also for the increase in the mortality rate recorded during the first year of treatment: 12.1 per cent instead of 6.2 per cent during the second year. This particularly relevant for the younger age group of patients. 4. There seems to be some social disparity concerning the detection of renal disease and the conditions under which dialysis treatment is started: chronic renal disease is detected at an earlier stage and dialysis treatment initiated for lower values of plasma creatinine and of diastolic blood pressure in patients belonging to the "higher income" group of population. 5. The percentage of patients dialysed twice a week is steadily increasing, whereas the average weekly dialysis time decreases, being about 15 hours in 1976. Day and evening dialysis replace overnight dialysis. Disposable flat-plate dialysers are used increasingly. 6. Episodes of hypotension and cramps are the incidents most frequently recorded during the dialysis sessions. Risk factors evidenced in the occurrence of hypotensive accidents are: the female sex, age greater than or equal to 55 years in males, orthostatic blood pressure drop at the end of previous dialysis, weight loss of more than 4 per cent of total body weight during dialysis...

Adult↗