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Biomedical subjects

F Borst

Publications and source records attributed to F Borst.

At least 55 records · Page 3Linked to original sources
PubMed1994

Medical office automation integrated into the distributed architecture of a hospital information system.

Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.

Archives↗
PubMed1994

Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases.

BACKGROUND: The purpose of this prospective study was to evaluate the immediate and late outcome of acute left colonic diverticulitis and to correlate it with age (younger and older than 50 years of age), gender, and initial computed tomography (CT) findings. METHODS: Analysis was made of data collected prospectively from all patients admitted because of acute colonic diverticulitis between October 1986 and January 1992. Diagnosis relied on results of operation, CT, and Gastrografin enema. Two hundred twenty-six patients were urgently hospitalized for acute left colonic diverticulitis; 47 were younger than 50 years of age (21%). RESULTS: Sixty-six patients (29%) were operated on during their first hospitalization. The remaining 160 patients treated conservatively underwent CT and an enema within 72 hours of admission. Fifty-nine of 179 patients (33%) older than 50 years of age required operation during their first attack, compared with 7 in 47 patients (15%) younger than 50 years of age (p = 0.02), although on CT severe diverticulitis was found in 36 of 141 patients (26%) older than 50 years of age and in 16 of 43 patients (37%) younger than 50 years of age (p = 0.13). Of the 160 patients treated conservatively, 11 of 40 patients (28%) younger than 50 years of age experienced recurrences or complications after their first discharge, compared with 16 in 120 patients (13%) older than 50 years of age (p = 0.04). CONCLUSIONS: Patients younger than 50 years of age were significantly more prone to recurrences and complications after conservative treatment of their diverticulitis, whereas older patients required operation significantly more often during their first hospitalization.

Acute Disease↗
PubMed1993

Adult bacterial nasopharyngitis: a clinical entity?

OBJECTIVE: To investigate bacterial nasopharyngitis as a cause of adult upper respiratory infection. DESIGN: Prospective case series. SETTING: Walk-in medical clinic of a university hospital. PATIENTS: 507 patients with cold or flu symptoms, sore throat, or recent cough; 21 control subjects without symptoms of upper respiratory infection. MEASUREMENTS AND MAIN RESULTS: After thorough history and physical examination, the patients underwent nasopharyngeal aspiration and throat culture. Nasopharyngeal specimens were cultured for both bacteria and viruses; antigens for influenza, parainfluenza, and respiratory syncytial virus were sought by enzyme-linked immunosorbent assay (ELISA); serum antibodies to viral respiratory pathogens were determined. Group A beta-hemolytic streptococci grew from the throat specimens of 39 of the 507 patients (8%) or 38 of 334 patients (11%) who had clinical diagnoses of pharyngitis. Thirty-three cases of influenza A, 20 cases of influenza B, and seven cases of parainfluenza infections were diagnosed. Bacteria were cultured from the nasopharyngeal secretions of 284 patients (56%). In contrast to pharyngeal culture, commensal mixed flora were rarely found in nasopharyngeal culture. Nasopharyngeal culture of bacteria usually considered to be respiratory pathogens was significantly associated with the presence of leukocytes. Streptococcus pneumoniae (odds ratio 6.0, 95% confidence interval 2.6-14.2), Moraxella catarrhalis (odds ratio 12.9, 95% confidence interval 3.1-79.5), and Hemophilus influenzae (odds ratio 3.0, 95% confidence interval 1.2-7.4) were all associated with the presence of leukocytes. In contrast, nasopharyngeal culture of coagulase-negative staphylococci, mixed flora, and the documentation of a viral infection were not associated with the presence of leukocytes. For none of 21 control subjects were "pathogenic" bacteria found. CONCLUSIONS: These data suggest that potentially pathogenic bacteria may have a causal role in adult nasopharyngitis, although further data are needed to confirm this hypothesis.

Adolescent↗
PubMed1993

[Surgery of digestive system cancers in patients over 80 years of age].

231 patients over 80 years old were operated at the Clinique de chirurgie digestive of Geneva University Hospital between 1981 and 1990 for a malignant tumor of the gastrointestinal tract. The following parameters were studied: intra- and postoperative morbidity and mortality, duration and quality of survival. Surgery proved valid in this age group given its low mortality (15%). Postoperative morbidity (44%) did not prolong hospital stay, since 90% of all patients were discharged within one month of surgery. Following surgery, quality of life was excellent: 75% of patients returned home, and 80% were better off than pre-operatively. Such operations provide better results in term of mortality and survival when performed on an elective basis and curatively.

Adenocarcinoma↗
PubMed1992

Postoperative pulmonary embolism after hospital discharge. An underestimated risk.

During a 10-year period (1980 through 1989), 28,953 patients were admitted to our Clinic of Digestive Surgery, Geneva, Switzerland. Two thirds of them were operated on, and one third were treated conservatively. Symptomatic pulmonary embolism (PE) was recorded in 90 patients (0.31%; 95% confidence interval, 0.25% to 0.38%) during their hospital stay. Within 30 days of hospital discharge, 29 patients were readmitted because of PE (incidence of delayed PE, 0.10%; 95% confidence interval, 0.07% to 0.14%; total incidence of PE, 0.41%; 95% confidence interval, 0.34% to 0.49%). In the operated-on group, the delayed embolic events occurred a median of 6 days (range, 2 to 25 days) after discharge and 18 days (range, 6 to 35 days) after surgery. Delayed PEs were more frequent after so-called low-risk surgery. Thus, the rate of postoperative PE increased by 30% when PEs occurring within 30 days of hospital discharge were considered, and this provides a useful basis for prolonged prophylactic measures after hospital stay.

Adult↗
PubMed1992

Prognostic factors from computed tomography in acute left colonic diverticulitis.

This prospective study examined factors which may predict a poor outcome (complications and recurrence) after a first attack of diverticulitis which has been successfully managed conservatively. Twenty-four of 107 patients who entered the study had a poor outcome: persistent diverticulitis (nine cases), recurrence (seven cases), colonic stenosis (six cases), residual parasigmoid abscess (one case) and colovesical fistula (one case). Eight of the 18 men aged 50 years or less had a poor outcome compared with 16 of the remaining 89 patients (P = 0.032). Twelve of 76 patients (16 per cent) with mild findings on computed tomography (CT) (localized thickening of colonic wall and inflammation of pericolic fat) had a poor outcome compared with 11 of 23 patients (48 per cent) whose CT was estimated as severe (abscess and/or extraluminal air and/or extraluminal Gastrografin) (P = 0.004). These results suggest that elective colectomy can be proposed after a first attack of acute left diverticulitis in men up to 50 years of age and/or in patients whose initial CT reveals findings of severe diverticulitis.

Acute Disease↗
PubMed1992

Incidence, outcome, and proposed management of isolated abscesses complicating acute left-sided colonic diverticulitis. A prospective study of 140 patients.

In a prospective evaluation of 140 consecutive patients with acute left-sided colonic diverticulitis demonstrated by computerized tomography (CT) in all cases, 22 (16 percent) were found to have an associated abscess without peritonitis. Thirteen of these 22 required surgery (seven during the first stay and six from 2 to 11 months after the acute episode; median, three months). Nine patients were treated conservatively, eight of whom are now totally asymptomatic 24 months after the initial attack (range, 10-47 months). There were 10 mesocolic abscesses (seven treated with antibiotics alone), nine pelvic abscesses (seven requiring surgery), and three intra-abdominal abscesses, all operated upon. These results suggest that mesocolic abscesses can usually be managed conservatively without drainage; should surgery be necessary, en bloc resection with immediate anastomosis can usually be safely performed. Pelvic and intraabdominal abscesses behave more aggressively and usually require a two-stage surgical procedure when initial percutaneous drainage cannot be performed or is felt to be hazardous.

Abdomen↗
PubMed1992

Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors.

Results of elective open cholecystectomy in 1252 patients treated in a North American and a European center were examined using a recent standardized classification of complications. Although there were significant differences between centers in population age, rate of concomitant disorders, and numbers of operators, the frequency and severity of complications were comparable. There were no deaths, but 12% and 14% of the patients developed complications in the two centers. About 6% of the patients developed grade I complications. Grade II complications were noted in 6% and 8%, and grade III in 0% and 0.3%. Using univariate and multivariate analysis, individual risk factors for developing complications were found to be different in the two centers. Two preoperative scoring systems, ASA and a simplified APACHE II, were predictive for complications in both centers, but did not account for all risk in these patients. Data from the two centers could not be combined because of significant interaction between risk factors and center. Elective open cholecystectomy is a safe procedure, particularly in terms of highly morbid complications and death. Generalization of risk factors identified in a particular center may be misleading because local conditions may significantly affect risk factors for complications. The data also demonstrate the advantages of a uniform way of reporting surgical complications, which may permit meaningful comparisons among centers.

Adolescent↗
PubMed1992

[Safety of cholecystectomy by laparotomy in elective situation and in emergency].

Cholecystectomy is the only effective treatment of gallbladder stones. A retrospective study was carried out on results of 658 cholecystectomies by laparotomy without choledochotomy performed between January 1987 and December 1989, to determine morbidity and mortality of elective and emergency surgery and by age. Operations for tumors of the gallbladder and choledolithiasis were not included in the analysis. During this period, cholecystectomy was performed electively in 387 cases and under emergency conditions in 261 patients. Mortality and post-operative morbidity were 0% and 14.7% respectively after elective surgery, increasing to 1.1% (Fisher = 0.0617) and 25.2 (p = 0.0004) respectively after emergency operations. This large increase in postoperative morbidity in urgent cases was due to an increase in systemic and not local complications, as a result of the higher proportion of emergency operations with advancing age. Since elective cholecystectomy is safe it can be proposed to patients with symptoms, including the elderly. It is difficult at present to compare results of cholecystectomy by laparotomy with those of laparoscopy since the average age of in the latter category is markedly lower and the number of acute cases still low. The principal advantage of celioscopy could be a long term reduction in systemic complications in emergency operations.

Adolescent↗
PubMed1991

Regulation of T-cell differentiation by CD2 and CD28 accessory molecules.

It was analysed to what extent the functional T-cell responses that result from T-cell receptor (TcR)/CD3 triggering differ from responses that are induced after simultaneous ligation of CD2 and CD28 accessory molecules. To allow a quantitative comparison of these activation pathways, purified lymphocytes were stimulated with either graded densities of immobilized anti-CD3 monoclonal antibodies (mAb) or with increasing amounts of anti-CD28 mAb in the presence of a constant concentration of anti-CD2 mAb. Both activation systems were sensitive to the regulatory properties of CD11a/CD18 molecules. T-cell stimulation via CD2/CD28 molecules induced a more potent release of interleukin-2 (IL-2) and more pronounced T helper (Th) cell responses than T-cell stimulation via the TcR/CD3 complex, whereas CD25 expression was more readily initiated after T-cell activation via the TcR/CD3 complex. Optimal Th cell differentiation was detected under conditions of suboptimal receptor occupancy whereas, in contrast, optimal cytolytic T lymphocyte (CTL) differentiation required optimal TcR/CD3 or CD2/CD28 engagement. The findings indicate that T-cell differentiation can be influenced in a qualitative manner by the strength of the activation signal provided, and suggest that antigen-specific T-cell responses might be regulated in a quantitative manner through CD2 and CD28 accessory molecules.

Antigens, CD↗
PubMed1991

TEXTINFO: a tool for automatic determination of patient clinical profiles using text analysis.

The clinical data contained in narrative patient documents is made available via grammatical and semantic processing. Retrievals from the resulting relational database tables are matched against a set of clinical descriptors to obtain clinical profiles of the patients in terms of the descriptors present in the documents. Discharge summaries of 57 Dept. of Digestive Surgery patients were processed in this manner. Factor analysis and discriminant analysis procedures were then applied, showing the profiles to be useful for diagnosis definitions (by establishing relations between diagnoses and clinical findings), for diagnosis assessment (by viewing the match between a definition and observed events recorded in a patient text), and potentially for outcome evaluation based on the classification abilities of clinical signs.

Databases, Factual↗
PubMed1990

[Registration of detailed data in the medical record or how to translate "impressions" into measurable observations].

Every medical case record represents a mass of data (texts, pictures, figures, etc.) in an unstructured form. The physician needs to retrieve this data via several access routes: temporal (dependent on date or sequences of events), type of data (diagnostic, treatment, clinical signs, laboratory findings, image descriptors, all with their interrelationships), or depending on the severity of the disease, etc. Retrieval of this data fulfils several functions: circulation of a case record among specialists, assistance in summarizing a long and complex clinical course, comparison of patients, research, and teaching. Three projects are described which have the same aim: structuring of the case record in order to retrieve detailed data on patients as individuals and describe clinical courses on the basis of measurable observations. This structure must be understandable to a computer (directly or indirectly) so that searches and comparisons can be performed automatically. The first project, entitled "indexed paragraph prototype" reproduces the structure of the problem-oriented case record and is designed to input the Medical Outpatients Department's follow-up notes into the computer. The second, "automatic language analysis", aims to exploit two characteristics of medical language, its omnipresence in the case record and its reliability, in view of its status as the spontaneous vehicle of communication between physicians. The third, "collection of clinical signs during consultation", is based on a prospective collection of all elements of clinical observation, structured temporally consultation by consultation. The purpose of precise collection of detailed and measurable observations in individual patients is to identify those among the clinical signs which display the greatest power of discrimination, i.e. those which best serve to predict the case's evolution.

Abstracting and Indexing↗
PubMed1989

Acute pancreatitis and normoamylasemia. Not an uncommon combination.

A consecutive series of 352 attacks of acute pancreatitis (AP) was studied prospectively in 318 patients. AP was ascertained by contrast-enhanced CT scan in all but four cases in which diagnosis was made at operation or autopsy. Sixty-seven of these cases (19%) had normal serum amylase levels on admission (i.e., less than 160 IU/L, a limit that includes 99% of control values), a figure considerably higher than generally admitted. When compared to AP with elevated serum amylase, normoamylasemic pancreatitis was characterized by the following: (1) the prevalence of alcoholic etiology (58% vs. 33%, respectively, p less than 0.01), (2) a greater number of previous attacks in alcoholic pancreatitis (0.7 vs. 0.4, p less than 0.01); and (3) a longer duration of symptoms before admission (2.4 vs. 1.5 days, p less than 0.005). In contrast AP did not appear to differ significantly in terms of CT findings, Ranson's score, and clinical course, when comparing normo- and hyperamylasemic patients, although there was a tendency for normoamylasemic patients to follow milder courses. Serum lipase was measured in 65 of these normoamylasemic cases and was found to be elevated in 44 (68%), thus increasing diagnostic sensitivity from 81% when amylase alone is used to 94% for both enzymes. A peritoneal tab was obtained in 44 cases: amylase concentration in the first liter of dialysate was greater than 160 IU/L in 24 cases (55%), and lipase was greater than 250 U/L in 31 cases (70%). Twelve of these 44 cases had low peritoneal fluid and plasma concentrations for both enzymes. Thus little gain in diagnostic sensitivity was obtained when adding peritoneal values (96%) to serum determinations. AP is not invariably associated with elevated serum amylase. Multiple factors may contribute to the absence of hyperamylasemia on admission, including a return to normal enzyme levels before hospitalization or the inability of inflamed pancreases to produce amylase. Approximately two thirds of cases with normal amylasemia were properly identified by serum lipase determinations. AP does not appear to behave differently when serum amylase is normal or elevated, and should therefore be submitted to similar therapeutic regimens in both conditions.

Acute Disease↗
PubMed1989

[Single-stage excision anastomosis of left colonic obstruction excision treated as an emergency].

The results of four different types of operation were compared retrospectively in terms of mortality, morbidity, duration of hospital stay. Eighty-eight consecutive patients suffering from left colonic obstruction underwent emergency surgery from December 1976 to January 1988. There were 36 male and 52 female patients, aged from 41 to 93 years (mean 71), 25% of them being 78 or older. Carcinoma was the most frequent lesion (75/88, 85%). 1) One-stage resection and anastomosis was carried out in 23 patients with only one temporary ileostomy; there were two fatalities (8.7%) and one clinical anastomotic leak (4%) treated conservatively with success; mean hospital stay was 21.5 days. 2) Thirty-six patients underwent a Hartmann procedure, with four fatalities (11%) and a mean hospital stay of 23.0 days; 17 of the surviving 32 (53%) later had the second stage procedure, with no fatality, one clinical leak (6%), and mean stay of 20.7 days. 3) Twenty-six patients had simple decompressing colostomies with nine fatalities (35%); eight of the surviving 17 (47%) had colectomy and colostomy closure during the same hospitalization, with one fatality (6%); mean hospital stay was 41.4 days. 4) Finally, subtotal colectomy imposed by caecal ischemia (twice) or a previous right colectomy (in one instance) was performed three times with no death. Since january 1986, resections and primary anastomoses have been performed 20 times for 26 consecutive obstructions (77%). Our overall results in terms of mortality, morbidity and duration of hospital stay appear to favor resection and primary anastomosis in the treatment of selected cases of left colonic obstruction.

Adult↗