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Biomedical subjects

J Chaperon

Publications and source records attributed to J Chaperon.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials].

OBJECTIVES: To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included. METHODS: The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review. RESULTS: Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test. CONCLUSIONS: This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

Endoscopy↗
PubMed1994

Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors.

BACKGROUND: Aortic stenosis is the most common valvular lesion occurring among elderly patients and has become extremely frequent because of changing demographics in industrialized countries. Surgical risk after the age of 70 has increased. The increasing older age of patients having surgery justifies an analysis of mortality predictive factors. METHODS AND RESULTS: Between 1976 and February 1993, we performed 2871 operations for aortic stenosis. This study concerns 675 patients (278 men and 397 women) who were > or = 75 years old. Mean age was 78.5 +/- 3 years. Associated lesions were found in 226 patients. A bioprosthesis was implanted in 632 patients (93.6%). Concomitant surgical procedures were performed in 133 patients. Surgical mortality was 12.4% (84 deaths). A longitudinal analysis has been carried out over four successive time periods to evaluate population evolution during these 17 years. Statistical analysis was performed on 46 variables. Multivariate analysis found age (P < .0001), left ventricular failure (P < .0001), lack of sinus rhythm (P < .01), and emergency status (P < .02) to be presurgical independent predictive factors of mortality. CONCLUSIONS: Risk-reducing strategy should both favor relatively early surgery to avoid cardiac failure and emergency situations and pay careful attention to the use of myocardial protection and cardiopulmonary bypass. Indications for surgery should remain broad since analysis failed to determine specific high-risk groups to be eliminated, and surgery remains the only treatment for aortic stenosis.

Age Factors↗
PubMed1994

P-glycoprotein (P-170) and CD34 expression in adult acute myeloid leukemia (AML).

We investigated the prognosis value of CD34 and P-170 expression in blast cells of adult patients affected by de novo acute myeloid leukemia (AML). CD34 antigen was analyzed by indirect immunofluorescence (IFI) and alkaline phosphatase-labeled streptavidin biotine (AP-LSAB) in 62 patients (median age: 51 years). P-170 expression was determined by AP-LSAB in 51 cases using JSB1 and C219 monoclonal antibodies. All patients were treated with conventional chemotherapy induction regimen. Follow-up was from 6 to 79 months. Complete remission (CR) rate was not statistically different between CD34+ and CD34- patients (67 vs. 84%, p = 0.2). The duration of CR and survival were not influenced by CD34 expression. Karyotype abnormalities were more frequent among MDR+ patients (65 vs. 21%, p < 0.01). CR rate was statistically lower in MDR+ patients as compared to MDR- patients (63 vs. 96%, p = 0.01). Median disease-free survival (DFS) was shorter for MDR+ patients but the difference was not significant (5 vs. 10 months, p = 0.09). Patients who were positive for both parameters CD34 and P-170, had a poor prognosis with a 50 vs. 100% CR rate for CD34/P-170 negative patients, (p = 0.002), a lower median DFS (3 vs. 12 months, p = 0.01) and overall survival (OS) (3 vs. 14.5 months, p = 0.01). Results of cytogenetic analysis did not influence CR rate but the relapse rate was higher, although not significant, for the patients with unfavorable karyotype (63 vs. 33%). The seven CD34+/MDR+ patients with poor prognosis karyotype had a statistically lower CR rate, median DFS and OS than the 7 CD34-/MDR- patients with normal or favorable karyotype (CR: 29% vs. 100%, p = 0.02), (DFS: 3 vs. > 12 months, p = 0.01), (OS: 4 vs. > 12 months, p = 0.02). Our data indicate that P-170 but not CD34 expression is predictive for a lower CR rate. The identification of a bad prognosis subgroup of CD34+/MDR+ AML patients (and especially those with poor prognosis karyotype) has to be confirmed on larger series using uniform methodology.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1994

[A study of predictive factors of the operative risk in the surgery of aortic valve stenosis in aged patients].

Aortic stenosis, the most extensive form of valvular disease in elderly subjects, has become very common because of demographic reasons in industrialised countries. The operative risk in patients over 70 years of age is significantly higher. The progressive rise in age of patients referred for surgery justifies this analysis of predictive factors of operative mortality. Between 1976 and February 1993, out of 2871 aortic valve replacements, 675 (278 men and 397 women) patients were over 75 years of age and were included in this study. The average age was 78.5 +/- 3 years. Associated pathology was present in 226 patients. A bioprosthesis was chosen in 632 cases (93.6%). An associated surgical procedure was required in 133 cases. The operative mortality was 12.4 +/- 1.3% (84 deaths). Longitudinal analysis was performed for 4 successive periods to assess the outcome of the study population over the 17 years. A statistical study was made of 50 variables and multivariate analysis showed age (p < 0.0001), left ventricular failure (p < 0.0001), non sinus rhythm (p < 0.0005) and emergency procedures (p < 0.02) to be independent preoperative predictive factors of mortality. In order to reduce this risk, the authors recommend early surgical referral to avoid emergency procedures and cardiac failure, and increased efforts of myocardial protection during cardiopulmonary bypass. Despite the risk, surgery is the only radical treatment of aortic stenosis, including elderly patients.

Age Factors↗
PubMed1994

[Acute cholecystitis in the elderly].

We retrospectively studied 150 patients aged over 65 years who had been operated for acute cholecystitis in order to define the surgical results and evaluate this treatment as a function of age. The patients were divided into two groups. Group I included patients between the age of 65 and 79 years, n = 99 (53 males and 46 females). Group II included patients aged 80 years and over, n = 51 (14 males and 37 females). The data were compared with the chi 2 test and the Kruskall and Wallis test. Associated affections were observed in 69 patients in group I and in 36 patients in group II (NS). The clinical picture was similar in the 2 groups with manifestations of pain in the right hypochondral region (group I, n = 97; group II, n = 50), fever (group I, n = 73; group 2, n = 38) and abdominal defence (group I, n = 62; group II, n = 35). Echography revealed the diagnosis in almost all cases in both groups. There was no statistical difference between the two groups in terms of mean operative delay and length of hospital stay. Age increased significantly the risk of exploration of the main bile duct (group I, n = 14; group II, n = 15, p < 0.05). Nevertheless, this exploration did not affect post-operative follow-up. Mortality was 6.7% with 4 deaths in group I and 6% in group II (NS). Post-operative complications were observed in 36 patients in group I and 28 in group II (p < 0.05) (43% overall including deaths).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[Intestinal-mesenteric lesions of closed abdominal traumas].

A retrospective series of 24 intestinomesenteric lesions after blunt abdominal trauma were investigated to determine the distribution of the lesions as a function of the type of accident and to establish diagnostic and therapeutic patterns based on observed post-operative results. The chi squared test was used for statistical analysis. There were 20 men and 4 women, mean age 39 +/- 15 years (range 17-74). Trauma was caused by a traffic accident in 16 cases (67%) including 12 victims under 40 (p < 0.01) and 14 drivers (87.5%) (12 wore a safety belt). Haemodynamic instability or generalized abdominal defense. Pneumoperitoneum was seen on only one of the 21 (5%) admission X-rays. Abdominal echography was often ordered (16 times). The mean interval between trauma and surgical intervention was 39 hours. Injury involved the mesentery (n = 15), the small intestine (n = 14), the colon (n = 7) and the colic mesenteriolum (n = 4). Lesions of the colon were observed more often in automobile accidents (p < 0.05). Injury to other abdominal organs was also observed in 12 patients: liver (n = 6), spleen (n = 5) and pancreas (n = 5). The thorax was involved in 14 patients including 11 under 40 (p < 0.01). Nine intestinal resections/anastomoses, 9 enterroaphies (including 4 colic injuries) and 1 Hartman were performed. Two patients died (8.3%) and follow-up was complicated in 14 (including the 2 deaths). Wearing the safety belt did not affect the greater number of intestinomesenteric lesions. In subjects wearing a safety belt, there were more injuries of the thorax but less neurological involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1994

[Hospital transfer of newborn infants in the Loire-Atlantic area (France)].

The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted. There were, 1.316 births and the referral rate was 10.3% with a range of 1 to 24% depending on the originating hospital. After adjustment for gestational age, multivariate analysis revealed that the medical variables were the main factors affecting referral rate (positive gastric smear, adjusted odds ratio, ORa = 62.6; disease, ORa = 37.7; Apgar score 1 min < 7, ORa = 9.4; monitoring abnormality, ORa = 3.2; coloured amniotic fluid, CORa = 2.7; birthweight, ORa = 0.3). A high risk of referral was observed in only one maternity hospital (ORa = 9.4) related to a poor environment index. This center was in close vicinity to another maternity hospital. In a regional referral programme, high risk neonates should be delivered in maternity hospitals near a special care centre. But, in order to keep the rate of referral, with its adverse effect on the mother-baby relation, low, care for neonates with minor disease or only slightly underweight at birth should be cared for in these centers without referral.

France↗
PubMed1994

[Experience in mass screening of breast cancer with mammography in France].

In the framework of the National Fund for Prevention, Health Education and Information, the setting-up in France, on an experimental basis, of mass breast cancer screening programs by mammography in ten departments leads to suggest a common protocol for the evaluation of these programs, before an eventual generalization to the whole country. These programs are based on common principles: local screening based on existing medical facilities, single view mammography with double reading. However, the screening organisation is different in each department according to the target population, the screening interval, the mode of invitation, the methods for arranging double reading, etc. The purpose of this article is to report on the work of the evaluation group of the ten programs, and to propose a methodology for comparing the screening experiences in order to measure the role of the organisation methods. It gives definitions and modes of calculations for the evaluation criteria in four fields: impact, quality, efficacy and cost (with details about the feasibility of data collection) and proposes a reflection on analysis techniques in order to develop an optimum mass screening strategy.

Aged↗
PubMed1994

[Predictive factors of nodular recurrence after thyroidectomy for goiter].

We report a retrospective series of 44 recurrences of nodular goitre following 430 partial thyroidectomies over a 10 years period. There were 40 women and 4 men with a mean age of 43 and 37 years respectively. Twenty-four recurrences were from our institution (6%) and 20 were referred to us. The median follow-up of primary thyroidectomies was 8.5 years for patients with recurrence and 4 years for patients free of recurrence (p < 10(-6)). The incidence of recurrence was analysed in a statistical and actuarial model considering clinical intra-operative and post-operative variables. The following risk-factors for recurrence were found: age < 50 years (p < 0.01), family history of goitre (p < 0.04), unilateral multinodularity (p < 0.0002), diffuse and bilateral distribution of nodules (p < 0.02), atypical resections with conservation of isthmus (p < 0.0001), scintigraphically "warm" nodules (p < 0.001). Interestingly, sex, heterogeneous thyroid parenchyma without macroscopic nodules and the use of post-operative levothyroxine did not modify the risk of recurrence. Thirty-three patients were non symptomatic. Thirty-four patients underwent re-operation. Three primary non suspected carcinomas were found. There was no mortality related to re-operation. There were not definitive vocal cord paralysis or hypocalcemia. There was no significant difference in vocal or parathyroid morbidity when total thyroidectomy for primitive goitre was compared to total thyroidectomy as re-operation. Long-term and periodic follow-up is necessary to detect non-symptomatic recurrences in a high-risk population. Total thyroidectomy is the treatment of choice for bilateral multinodular goitre.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Expression of the multidrug resistance-associated P-glycoprotein (P-170) in 59 cases of de novo acute lymphoblastic leukemia: prognostic implications.

Immunocytochemical detection of the multidrug resistance (MDR)-associated membrane protein (P-170) was performed at time of diagnosis in a series of 36 children and 23 adults with acute lymphoblastic leukemia (ALL) using two monoclonal antibodies JSB1 and C219. Immunophenotypes were obtained in all cases and karyotypes were analyzed in 37 cases. Detection with JSB1 or with C219 led to similar results in terms of positive cells and cases, but the intensity of staining was higher with JSB1. In the populations studied, the rate of first complete remission differed between MDR-positive and MDR-negative in adult patients only (56% v 93%, respectively, P = .05). Of the 16 MDR-positive patients who had presented a first complete remission, 13 (81%) relapsed, compared with 13 of 35 (37%) MDR-negative (P = .008) patients. A higher rate of relapse among MDR-positive compared with MDR-negative patients was observed in adults and in children taken separately (adults 100% v 46%; children 73% v 32%, respectively). The survival rates (Kaplan-Meier method) were significantly higher in MDR-negative compared with MDR-positive populations as a whole (P = .002) and among children (P = .05) and adults (P = .03) taken separately. Event-free survival curves followed this trend. The percentage of second complete remission was very low in the MDR-positive group (15%) compared with 38% for the MDR-negative group. These results were shown by multivariate analysis to be independent of age, immunophenotypes, and karyotypes and clearly show the importance of MDR phenotype detection in ALL.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1993

[Environment and malaria in Burundi. Apropos of a malaria epidemic in a non-endemic mountainous region].

In March 1991, an unusual increase of the consultations for fever and/or cephalgias was reported by the Health Centre of Muhanga. At the same time, the administrative authorities worried about the increase of death registration in some hills, located around the big swamp of Ruvubu, and next to this Health Centre. In this area, hypoendemic for malaria, the epidemic was belatedly recognized, entailing a gross death rate between 25.6 and 31.5/1000 person/year in 1991, in the three most hit hill-areas whereas this rate is 18/1000 person/year for the national level. The initiation of the epidemic was favoured by the set up of Anopheles funestus and gambiae because of the modification of the hydro-agricultural milieu at high altitude, due to the extension of the ricefields and piscicultural ponds. Otherwise, there was a light rise of the medium temperature in this area in March 1991. In a non-immune population, the bouts of malaria were severe, especially in the age group from 0 to 4 years and in the pregnant women. By modifying the environment, the leaders of socio-economic development programs must consider the consequences on the population's health and to make the health employees a partner in.

Altitude↗
PubMed1993

[Nodular goiter. Retrospective analysis of 608 cases].

A retrospective study was carried out on a series of 608 patients, of whom 430 had undergone partial and 178 total thyroidectomy for single or multinodular goitre. Statistical analysis of data for the 532 women (88%) and 76 men (12%), mean age 45 and 39 years respectively, included clinical and operative features, specific morbidity of the exeresis, incidence of cancer on multinodular goitre and the frequency of recurrence of nodular lesions. The men were significantly younger at time of diagnosis (p < 0.0006). Bilateral multinodular forms (n = 577) and hypofixing lesions (n = 515) predominated. The incidence of unsuspected thyroid cancer in the multinodular cases was 3% (15/444). Carcinoma development on single nodules in our series during the same period was 8% (n = 15/195), the difference being statistically significant (p < 0.02). Mortality was nil and non specific morbidity 2% (n = 12/608). No compressive hematoma was reported and tracheotomy was never required. A clinically detectable alteration in the voice was noted in 10% (n = 67/608), this persisting in 0.5% (n = 3) beyond the 6th postoperative month. No significant difference existed between general and vocal morbidity as a function of the type of exeresis. Hypocalcemia was observed in 11% of patients (n = 67/608), 49% (n = 33/67) being asymptomatic and the anomaly spontaneously reversible. Four percent (n = 7/178) were permanent after total thyroidectomy (including 15 cancers on multinodular goitre discovered fortuitously, 8 of which received lymph node dissection) and 3% (n = 2/68) after a "wide" subtotal thyroidectomy.

Actuarial Analysis↗
PubMed1993

[Epidemiological study of noted children under 6 years of age in danger in medicosocial services in a French department (Ille et Vilaine)].

An epidemiological study was conducted during 1 year (1989) in a French department (Ille et Vilaine) on children under 6 years of age reported by local medico-social services as being at risk of child abuse or neglect. This involved 786 children, ie an incidence of 1/80 children under 6. Among these children, 282 (35.9%) presented with clinical signs possibly related to abuse; only nine were hospitalized after being reported, showing the limits of the hospital to detect child abuse or neglect. The psycho-social characteristics of the families, the sources and motives of the reports, the criteria used to assess the risks run by the children, the care and protection measures were investigated through multifactor statistical analysis. Alcoholism, violence and parental immaturity were the most worrying factors. Social workers were at the origin of most reports and referrals (78%); most often they were alerted by socio-economic problems and parental immaturity. Physicians were in a better position to signal physical abuse, but they overlooked the situations of neglect. These were 388 children referred to the judiciary; 91 were removed from their families. Removal was ordered by courts in the presence of alcoholism, familial violence, disabled parents, offence records, insanitary housing, physical abuse or neglect, repeated hospitalizations. The perception of the risks was found to be a subjective notion depending upon the assessor's experience and tolerance thresholds, but also the quality of the professionals training and the organization of the services.

Child Abuse↗
PubMed1992

[Restoration of colonic continuity after Hartmann's operation].

A retrospective analysis of data from 69 patients treated by Hartmann's operation between 1981 and 1991 determined prognostic factors for colon continuity re-establishment and the mortality of this second intervention. The 15 patients who died during the first month after the Hartmann's operation were excluded from the study, the 54 survivors including 32 men and 22 women, mean age 68 +/- 12 years (range 19 to 87 years). The initial indication for surgery was: complicated sigmoid diverticulis (n = 26), cancer of colon (n = 14) or other site (n = 14). Colon continuity was re-established in 23 patients (42.6%), including 15 men and 8 women, mean age 60 +/- 10 years (range 38 to 78 years). In this latter group, 82.6% of the patients were under 70 years of age, indicative of a significant effect of age (p < 0.001) on re-establishment of continuity. Secondary anastomosis was obtained in 65.4% of cases of complicated sigmoid diverticulitis, whereas re-establishment of continuity was possible in only 7.1% of colon cancer patients (p < 0.001). The mean duration prior to re-establishment was 4.8 +/- 1.6 months (range 2.5 to 9 months). Morbidity was high (47.8%) and mortality 4.3% (1 patient). Hartmann's operation remains indicated for stages III and IV of complicated sigmoid diverticulosis, as well as for other benign affections (volvulus of sigmoid, perforation of sigmoid following injury), although it must be recognized that the possibilities of re-establishment are limited more in elderly patients and that fewer patients with colon cancer can benefit from the procedure. A period of 3 to 4 months appears sufficient to allow healing of the inflammatory phenomena of the initial operation, without the development of excessive retraction of the rectal stump.

Adult↗
PubMed1991

[Prognosis and prognostic factors of hemorrhage by rupture of varices in cirrhotic patients in the era of endoscopic sclerotherapy].

The aim of this study was to evaluate the prognosis and the determinants of survival in cirrhotics presenting with variceal bleeding. One hundred and ninety one consecutive patients with cirrhosis (alcoholic 93 percent) were enrolled between 1983 and 1988. Treatment was principally but not exclusively based on early endoscopic sclerotherapy. At admission all patients were classified according to Child-Pugh's classification (class A = 16 percent; class B = 53 percent; class C = 31 percent). The rebleeding rates at 48 hours and for the entire hospitalisation were 11 and 30 percent respectively. Actuarial survival rates were 45, 40, and 37 percent at 12, 18, and 36 months, respectively. Prognostic factors, as determined by uni- and multivariate analysis (Cox model), corresponded to Child-Pugh's score, to the five components, and the occurrence of early bleeding recurrence. This study also showed that: i) the role of Child-Pugh's classification on long-term prognosis is determined during the 3 months following index bleeding; ii) early rebleeding is a significant prognostic factor, particularly in Child-Pugh's class B patients; iii) there are few indicators of early rebleeding (serum albumin level, presence of gastric varices at initial endoscopy). Prognosis of variceal bleeding is still severe in cirrhosis but efforts made to prevent early bleeding recurrence seem to be fully justified.

Actuarial Analysis↗
PubMed1991

[Digestive hemorrhage following gastroduodenal ulcers caused by non-steroidal anti-inflammatory agents].

The aim of this retrospective study was to describe the clinical and prognostic characteristics of bleeding ulcers following gastrotoxic agent use. From 1984 to 1988, 244 patients were admitted in our Intensive Care Unit for bleeding ulcers; 133 (54.5 percent) were using gastrotoxic agents. Patients not taking gastrotoxic agents were compared with patients taking non steroidal antiinflammatory drugs (n = 77) or aspirin (n = 35). Patients receiving non steroidal antiinflammatory drugs differed (P less than 0.05) from patients not taking gastrotoxic agents: they were older, had less history of ulcer, hemorrhage, and alcohol abuse. Patients taking aspirin had less severe hemorrhage and took anticoagulant therapy less frequently than patients not taking gastrotoxic agents. Patients taking aspirin were younger, had less severe hemorrhage and had more frequent history of alcohol abuse and ulcer disease than patients taking non steroidal antiinflammatory drugs. There was no difference with regard to endoscopic data and mortality (7 percent). Two thirds of hemorrhages following non steroidal antiinflammatory drugs occurred during the month following the onset or the modification of treatment. The distribution of non steroidal antiinflammatory drugs in the group of patients who bled after non steroidal antiinflammatory drugs differed from that of regional sales. These results suggest that upper gastrointestinal tract bleeding associated with the use of gastrotoxic agent are frequent, particularly in elderly patients, are not associated with poor prognosis, and occur soon after the beginning of treatment.

Adult↗