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Biomedical subjects

J Belmin

Publications and source records attributed to J Belmin.

At least 19 recordsLinked to original sources
PubMed2000

[Prevention of cardiovascular disease in the elderly].

PREVENTION OF STROKE: Several preventive strategies have been found to be effective for the prevention of stroke in elderly subjects, including treatment of high blood pressure, oral anticoagulants in case of atrial fibrillation, aspirin for subjects at risk. PREVENTION OF MYOCARDIAL INFARCTION: Anti-hypertension treatment and aspirin for at risk subjects have been proven effective. For elderly subjects who have had a myocardial infarction, beta-blockers and converting enzyme inhibitors are effective in case of altered left ventricular function. The importance of lowering cholesterol levels in the elderly is a subject of debate. In coronary artery disease patients, at least up to the age of 75 years, statins can reduce the risk of a coronary event and stroke. GENERAL MEASURES: Exposure to tobacco smoke and sedentary lifestyle are associated with increased cardiovascular risk in the elderly. Stopping smoking and regular physical exercise should be advised for the elderly. The cardiovascular benefit of hormone replacement therapy after menopause is not clearly established and is the object of ongoing research.

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PubMed2000

Relation between endothelial cell apoptosis and blood flow direction in human atherosclerotic plaques.

BACKGROUND: Blood flow characteristics influence endothelial cell apoptosis. However, little is known about the occurrence of endothelial cell apoptosis in human atherosclerosis and its relation to blood flow. METHODS AND RESULTS: A total of 42 human carotid atherosclerotic plaques were retrieved by endarterectomy; they were examined in the longitudinal axial direction. Plaques were included in this study when upstream and downstream parts were clearly visible, occlusion was absent, and immunostaining for luminal endothelium was present all along the plaque. Using these criteria, 13 plaques were processed for further immunohistochemical studies (using anti-CD31, anti-Ki-67, and anti-splicing factor antibodies) and in situ detection of apoptosis (terminal dUTP nick end-labeling and ligase assay). Eight plaques showed > or =1 apoptotic endothelial cell at the luminal surface. Quantitative analysis of endothelial cell apoptosis in these plaques showed a systematic preferential occurrence of apoptosis in the downstream parts of plaques, where low flow and low shear stress prevail, in comparison with the upstream parts (18.8+/-3.3% versus 2.7+/-1.2%, respectively, P<0.001). Endothelial cell apoptosis was barely detectable in plaque microvessels. CONCLUSIONS: Our results suggest that in vivo local shear stress influences luminal endothelial cell apoptosis and may be a major determinant of plaque erosion and thrombosis.

Apoptosis↗
PubMed1999

[Clinical usefulness of screening for dysthyroidism with an ultrasensitive thyroid-stimulating hormone (TSH) assay in patients hospitalized in geriatric units].

OBJECTIVES: Thyroid disease is common in elderly subjects but as diagnosis is difficult, systematic screening is widely proposed. The clinical usefulness in terms of therapeutic impact has not been proven. PATIENTS AND METHODS: We investigated the clinical usefulness of screening for dysthyroidism using ultrasensitive TSH assay (TSHus) in 657 unselected patients hospitalized in a geriatric unit. TSHus was performed at admission in all patients and completed by a full laboratory work-up in case of abnormal results. Therapeutic decisions were recorded from the medical file. RESULTS: Mean patient age was 82 +/- 7 years, 74% were women. Prior history or current drug regimen were indications for TSHus assay in 144 patients (21.9%) who comprised group 2. In 513 other patients (group 1) the situation was one of true systematic screening. Hypothyroidism was diagnosed in 24 patients in group 1 (4.7%) and hyperthyroidism in 25 (4.9%). In group 1, few specific therapeutic measures were taken and involved only 6 patients (1.2%). Medical counseling was however provided for 37 patients (7.2%). CONCLUSION: Dysthyroidism is common in the elderly hospital population and systematic screening using TSHus is warranted at admission. However, the clinical impact of screening is minimal since few therapeutic measures are subsequently taken.

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PubMed1999

[Current aspects of arterial hypertension: hypertension in the aged].

HIGH PREVALENCE: In France, an estimated 5 million persons aged over 65 years have hypertension. Accepting a treatment threshold of systolic pressure 160 mmHg whatever the diastolic pressure, more than 3 million require antihypertension therapy. PATHOPHYSIOLOGY: During the aging process, the arterial trunks progressively loose their elasticity, becoming more and more rigid. Other age-related modifications of the vascular bed, as well as environmental factors (diet, sodium intake) also play a role. USEFUL TREATMENT: Several meta-analyses have demonstrated that active antihypertensive therapy can reduce overall mortality by 12%, the risk of cerebral vascular events by 36% and cardiac events by 25%. The risk of non-fatal cerebral vascular events can be reduced by 35%. POSITIVE DIAGNOSIS: Repeated blood pressure measurements are needed. Measurements should be made well after meals and take into account possible overestimation related to the rigidity of the humeral artery. THERAPEUTIC MODALITIES: Moderate salt intake and antihypertension drugs should be prescribed. A single drug regimen can be advised for initial treatment, avoiding long-action or high-dose regimens. Episodes of hypotension should be suspected if patients complain of malaise.

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PubMed1998

[Quality of the information collected during admission to a hospital geriatric service: importance of a structured medical record].

OBJECTIVES: The medical record (MR) is a key document for hospitalized patients. Several audits have however demonstrated that much important information is often missing in hospital MR. We conducted this survey with the aim of improving the quality of MR in a geriatric unit. PATIENTS AND METHODS: A structured MR was elaborated and implemented in order to guide and record the assessment of patients admitted in our geriatric ward. MR of 54 consecutive patients admitted after implementation of the structured MR were studied and compared to those of 108 consecutive patients admitted on the preceeding year (classical MR). Quality of data collected at admission was assessed using a 33-item guide, proposed by 3 experts in geriatric medicine unaware of the structured MR studies. For each item, a binary score (present/absent) and a precision score were used. A validation study was conducted using the same methods in another geriatric ward which has not participated to development of the structured charts MR studied. RESULTS: For most items studied, information was present in a significantly higher proportion in structured MR than in classical MR. Likewise, the precision score was significantly higher in structured MR. The validation survey found analogous results. CONCLUSION: Use of a structured MR significantly improves the quality of data collection at admission in geriatric units. This improvement appears to be related more to the use of the structured MR than the effect of developing a new tool.

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