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Biomedical subjects

J Coste

Publications and source records attributed to J Coste.

At least 91 records · Page 5Linked to original sources
PubMed1999

Pubic pain in athletes: a case due to an abscess in the obturator muscle.

Pubic pain is a common symptom in soccer players. Its cause can be difficult to determine. We report a case in a 19-year-old soccer player who had an abscess in the obturator internus muscle. We are aware of only one similar report in the literature. Painful limitation of internal rotation of the hip and evidence of infection suggested the diagnosis, which was confirmed by magnetic resonance imaging. In a soccer player, a fever and groin pain do not always indicate osteitis pubis. Limitation of internal rotation of the hip should suggest a lesion in the obturator internus muscle.

Abscess↗
PubMed1998

Pharmacological testing for the diagnosis of growth hormone deficiency.

Evaluation of growth hormone (GH) secretion using pharmacological GH stimulation tests (GHSTs) remains current practice, although the reliability of GHSTs has been questioned and many pitfalls have been pointed out. We have analysed all the 6,373 GHSTs which led to the initiation of GH therapy in 3,233 children treated in France from 1973 to 1989. Eleven different pharmacological tests were used, and 62 out of the 66 theoretical pairs of tests were used at least once. The most frequent combination of tests was used in 12.7% of patients. Reliability of GH peak measured by comparing the results of two tests in the same patient was poor, as measured by intraclass correlation coefficients (all under 0.8). Multivariate analysis identified several parameters positively or negatively associated with peak plasma GH. We believe that several of these factors (i.e. weight standard deviation score (SDS), genetic target height SDS and nature of the agent) identify biases in the diagnosis of GH deficiency (GHD). In addition, we re-evaluated GH secretion in 208 young adults formerly treated with GH for childhood onset GHD. Peak plasma was superior or equal to 10 ng/ml in 81% of patients with former idiopathic GHD. We conclude that the current use of GHSTs as well as the criteria for idiopathic childhood GHD should be questioned.

Adolescent↗
PubMed1998

Patterns of sexual and injecting risk behaviours in French intravenous drug users not reporting HIV and hepatitis C virus seropositivities.

AIMS: To characterize and identify determinants of risk behaviour patterns of intravenous drug users (IDUs) independently of changes due to knowledge of HIV or hepatitis C Virus (HCV) seropositivity. DESIGN: A cross-sectional survey using a structured questionnaire concerning sexual, injecting and HIV and HCV antibody testing practices. SETTING: IDUs were interviewed in the Paris region at 10 treatment or psychosocial centres. PARTICIPANTS: Six hundred and twelve consecutive sexually active IDUs over 18 years able to answer the questionnaire. MEASUREMENTS: Five hundred and ninety-five IDUs completed the questionnaire. The risk-behaviour patterns of the 328 IDUs not reporting HIV or HCV seropositivity were analysed by phi correlation. Risk factors for each risk behaviour were determined by regression logistic models yielding odds ratios (OR) and their 95% confidence intervals (95% CI). FINDINGS: Several risk behaviour patterns were suggested: (1) lending, borrowing; (2) not or inconsistently testing HIV and HCV serology and not or inconsistently using condoms; (3) having multiple partners and prostitution; and (4) not using clean equipment. Alcohol abuse was independently and specifically associated with lending (OR = 3.8; 95% CI: 2.1-7.0) and borrowing (OR = 3.3; 95% CI: 1.8-6.1); homelessness with injecting risk behaviours and with prostitution (OR = 2.7; 95% CI: 1.2-6.1); low educational level and having children with not or inconsistently using condom and serology testing; and cocaine use with not or inconsistently using condoms (OR = 0.4; 95% CI: 0.3-0.7) and serology testing and not using clean equipment (OR = 0.4; 95% CI: 0.2-0.8). Having multiple partners and prostitution had no common risk factors. CONCLUSIONS: Identifying specific risk factors could help to target drug harm reduction programmes for each risk behaviour pattern among IDUs not reporting HIV and HCV seropositivity.

Adult↗
PubMed1998

MBR rearrangement and P-glycoprotein expression are not independent prognostic factors like p53 protein in malignant lymphoma.

Non-Hodgkin's lymphomas (NHL) are B-cell malignancies which generally present molecular abnormalities, such as bcl-2 translocation t(14; 18) predominantly in the follicular subgroup. Other molecular events have been described in NHL, including p53 gene mutation and overexpression of one chemoresistance mechanism, the multidrug resistance system, P-glycoprotein (MDR 1/P-gp). In this study, we analysed samples from 44 NHL patients with the presence of the bcl-2 major breakpoint region (MBR) rearrangement in 29 and without in 15. Immunochemical analysis revealed that 39 samples were positive for bcl-2 protein expression in tumoral cells (88.6%). Seventeen (38.6%) patients expressed P-gp and 9 (20.5%) expressed p53 proteins. Eleven patients expressed both bcl-2 and P-gp proteins, four expressed bcl-2 and p53 proteins whereas four expressed bcl-2, p53 and P-gp proteins. Our results confirm the importance of p53 expression as a key prognostic factor, and no objective response (OR) was found in patients with p53 positivity. MBR rearrangement was not associated with poor response to chemotherapy (62.1% OR in MBR positive patients v. 60% OR in MBR negative patients). The clinical impact of P-gp cannot be identified because no relationship was observed between P-gp expression and prognosis (58.8% OR in P-gp positive patients v. 63% OR in P-gp negative patients).

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1998

Screening blood donations for viral genomes: multicenter study of real-time simulation using pooled samples on the model of hepatitis C virus RNA detection.

BACKGROUND: The systematic screening for several blood-borne viral genomes in blood donations is a complementary safety measure planned or discussed by the national authorities of several countries. STUDY DESIGN AND METHODS: To appreciate the feasibility of such screening using pooled samples, a multicenter study of real-time simulation has been performed on the model of hepatitis C virus (HCV) infection. Four blood transfusion center laboratories and two research and diagnosis laboratories simultaneously screened, by several HCV RNA polymerase chain reaction assays, a panel of plasma sample pools of different sizes (500, 100, and 10 samples), collected from HCV-infected or HCV-uninfected blood donors. One viremic plasma was introduced in each pool. HCV RNA was detected by in-house polymerase chain reaction procedures or by standardized manual or semi-automated polymerase chain reaction assays. RESULTS: The results indicate the feasibility of sample pooling, which renders the screening for viral genomes by molecular biology techniques applicable in the short term and the importance of the experience of laboratory personnel in the use of molecular biology tools. CONCLUSION: The improvement of standardized assays needs to be continued, and training of laboratory staff members appears to be a crucial step before systematic screening of blood donations for viral genomes by molecular biology techniques can occur.

Blood Donors↗
PubMed1998

In vitro infection of adult normal human hepatocytes in primary culture by hepatitis C virus.

In vitro infection of adult normal human hepatocytes in primary culture has been performed for investigating the replication cycle of hepatitis C virus (HCV) in differentiated cells. Hepatocytes were prepared from liver tissue resected from donors who tested negative for HCV, and inoculation was performed 3 days after plating with 33 HCV serum samples of different virus load and genotype. The presence of intracellular HCV RNA, detected by a strand-specific rTth RT-PCR assay, was used as evidence of infection. A kinetics analysis of HCV replication revealed that intracellular negative-strand RNA appeared at day 1 post-infection with a maximum level at days 3 and 5, followed by a decrease until day 14. At day 5, we estimated that the copy level of viral RNA was amplified at least 15-fold in infected cells. The level of intracellular HCV RNA in response to different serum samples was reproducible from one hepatocyte culture to another, suggesting that there is no inter-individual variability in the susceptibility of hepatocytes to HCV infection. These findings indicate that adult human hepatocytes in primary culture retain their susceptibility to in vitro HCV infection and support HCV RNA replication. This model should represent a valuable tool for the study of initial steps of the HCV replication cycle and for the evaluation of antiviral molecules.

Adult↗
PubMed1998

Detection of HIV-1 RNA in two consecutive blood donations screened negative for HIV antibodies.

BACKGROUND AND OBJECTIVES: An unusual serological pattern of HIV-1 seroconversion in a blood donor is described. The seroconversion panel was used to investigate the sensitivity of existing screening assays. MATERIALS AND METHODS: A volunteer blood donor who had given blood 79 times was diagnosed anti-HIV-1-antibody-positive. The heteroduplex mobility assay identified a subtype B HIV-1 strain. The frozen plasmas from the last four blood donations had been kept at -30 degrees C. They were thawed and aliquoted for subsequent testing. RESULTS: The last two blood donations contained HIV-1 RNA, 2,800 copies/ml (October 26) and 170 copies/ml (November 23). Weak anti-p24 antibodies were detected by Western blot in the October 26 sample, and a clear p24 reactivity along with a faint gp160 reactivity was observed on November 23. HIV p24 antigen was undetectable in both samples. Out of 13 screening assays, only 6 gave positive results on the November sample and 7 negative results which were obtained by 1 competitive enzyme immunoassay (EIA) and 6 of the 9 sandwich EIAs. CONCLUSION: Most sandwich EIAs gave prolonged false-negative results in the present case. p24 antigen testing was negative and would not have reduced the risk of HIV transmission.

Adult↗
PubMed1998

Short stature associated with intrauterine growth retardation: final height of untreated and growth hormone-treated children.

Short term studies have demonstrated the acceleration of growth velocity after the administration of GH in short children born with intrauterine growth retardation (IUGR). We report the final heights of 70 IUGR children whose short stature was attributed to idiopathic GH deficiency (peak plasma GH <10 ng/mL at 2 provocative tests) and treated with GH at a mean dosage of 0.4 +/- 0.1 U/kg x week during an average of 4.6 +/- 2.5 yr. They were compared to a control group of 40 untreated short children born with IUGR, without GH deficiency. At the time of evaluation, age, auxological data, and pubertal status were similar in the 2 groups (height, -2.9 +/- 0.8 and -2.8 +/- 0.7 SD score). Final heights were comparable in both groups of children (-2 +/- 0.7 and -2.2 +/- 1.1 SD score). A multivariate analysis identified 4 independent predictors of final height, namely target height, age and body mass index at evaluation, and GH treatment. Treatment was associated with a gain of 0.6 SD score, suggesting a final height gain of about 3.4 cm. Fifty-three of 70 treated children were reevaluated after completion of growth, and 43 of 53 had a peak plasma GH level of 10 ng/mL or more. Auxological characteristics of these 53 patients were not different from those of nonreevaluated patients. We believe that the transient character of the GH deficiency in most patients and the nonstringent initial criteria used for the diagnosis of GH deficiency render the spontaneous growth potentials identical in the 2 groups of patients. Our data, therefore, suggest that GH treatment at this dosage has a limited effect on the final height of short children born with IUGR.

Adolescent↗
PubMed1998

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.

Abortion, Induced↗
PubMed1998

Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography.

OBJECTIVE: The purpose of this study was to compare dual-phase helical CT and endosonography for the diagnosis and staging of pancreatic tumors. SUBJECTS AND METHODS: Thirty patients with suspected pancreatic tumors underwent endosonography and dual-phase helical CT. A pathologic diagnosis was obtained in all cases with surgery (n = 23) or biopsy (n = 7), resulting in 27 neoplasms. Dual-phase helical CT and endosonographic findings were correlated with surgical and pathologic findings to determine diagnosis and resectability of pancreatic tumors. RESULTS: Overall diagnostic sensitivity was 92% for dual-phase helical CT and 100% for endosonography (p = .45). Overall accuracy for staging of pancreatic tumors was 93% for both dual-phase helical CT and endosonography. Overall accuracy for predicting resectability was 90% for both dual-phase helical CT and endosonography. Accuracy of predicting unresectability was 100% for dual-phase helical CT and 86% for endosonography (p > .80). Differences were not considered statistically significant. CONCLUSION: Dual-phase helical CT and endoscopic sonography do not differ significantly for diagnosis and assessment of resectability of pancreatic tumors.

Adenocarcinoma↗
PubMed1998

Indicators for the automated analysis of drug prescribing quality.

Irrational and inconsistent drug prescription has considerable impact on morbidity, mortality, health service utilization, and community burden. However, few studies have addressed the methodology of processing the information contained in these drug orders used to study the quality of drug prescriptions and prescriber behavior. We present a comprehensive set of quantitative indicators for the quality of drug prescriptions which can be derived from a drug order. These indicators were constructed using explicit a priori criteria which were previously validated on the basis of scientific data. Automatic computation is straightforward, using a relational database system, such that large sets of prescriptions can be processed with minimal human effort. We illustrate the feasibility and value of this approach by using a large set of 23,000 prescriptions for several diseases, selected from a nationally representative prescriptions database. Our study may result in direct and wide applications in the epidemiology of medical practice and in quality control procedures.

Adult↗
PubMed1998

[Tobacco and ectopic pregnancy. Arguments in favor of a causal relation].

BACKGROUND: The risk associated with smoking has been studied for a long time in fertility epidemiology. This paper reviews the association between smoking and ectopic pregnancy (EP) using results collected in our previous studies. It provides arguments for a causal interpretation of this association. METHODS: Data came from three case-control studies performed between 1988 and 1996 and from the register of ectopic pregnancies in Auvergne (France) from 1992 to 1995. The methods are those classically used in the analysis of case-control studies. RESULTS: The risk of EP increased significantly with smoking (p < 0.01): the adjusted OR are 1.5 for 1-9 cigarettes a day, 2.0 for 10-19 cigarettes a day, and 2.5 for more than 20 cigarettes a day. The attributable risk of smoking ranged between 17% and 32% according to the study. Similarly, the risk of EP recurrence increased significantly with smoking (p < 0.02): after adjustment, OR = 1.3 for 1-9 cigarettes a day, OR = 1.5 for 10-19 cigarettes a day, and OR = 1.7 for more than 20 cigarettes a day. Finally, smoking was associated with the site of EP. CONCLUSIONS: Thus there is a large body of arguments towards a causal relationship between smoking and EP. This provides additional arguments to persuade women to stop or to reduce smoking, especially hypofertile women.

Case-Control Studies↗
PubMed1998

[Risk behaviors of intravenous drug users: are females taking more risks of HIV and HCV transmission?].

BACKGROUND: This work was aimed at identifying differences in HIV and HCV risk behaviors among intravenous drug users (IDUs) according to the gender and their determinants. METHODS: IDUs over 18 years, having had sexual intercourse and able to answer the questionnaire were interviewed in 10 drug abuse treatment centers or social institutions using a questionnaire adapted from the one used in the survey of sexual lifestyle in France. RESULTS: Over 612 eligible IDUs, 595 completed the questionnaire (women: 29%);37% had multiple partners with no difference according to the gender; 14% of the women and 7% of the men reported trading sex. More women reported inconsistent condom use (46% vs. 55%) and inconsistent clean equipment use (65% vs. 73%). A younger age, independently associated to sharing equipment (men: OR = 0.94; 95% CI = 0.90-0.99; women: OR = 0.92; 95% CI = 0.85-0.99) and inconsistent HIV serology testing, independently associated to inconsistent condom use (men: OR = 3.36; 95% CI = 2.02-5.60; women: OR = 10.72; 95% CI = 3.18-36.18), were the only risk markers common to both genders. For women, being HIV negative increased the risk of inconsistent condom use. Low educational level increased the risk of inconsistent clean equipment use. No risk marker among those analyzed was associated to having had multiple partners. For men, low socioeconomic status markers, a steady sexual partner or not living in couple and educational level were associated with sexual risk behaviors (inconsistent condom use and having multiple partners); low socioeconomic status markers were associated with injecting risk behaviors (inconsistent clean equipment use and sharing). CONCLUSIONS: Women were more likely to have both sexual and injecting risk behaviors; their significant risk markers are less numerous thus harm reduction could be more difficult than for men.

Adult↗
PubMed1998

[Predicting the risk of extra-uterine pregnancy. Construction and validation of a French risk scale].

This paper reports the construction and validation of a composite measurement scale to predict the risk of ectopic pregnancy in France. The data from three case-control studies of ectopic pregnancy conducted in France were used. Fourteen potential factors were found to be associated to ectopic pregnancy, which were grouped by multiple correspondence analysis in four dimensions: infection, pelvic surgery, smoking and induced conception. Logistic regression was further used to model the relationship between candidate risk factors (single or grouped as suggested by multiple correspondence analysis) and ectopic pregnancy. The regression coefficients of the final model were scaled and rounded to integers so as to make the scoring system simpler to use. The resulting composite measurement scale was finally validated on two independent samples. It allows simple determination (with a nomogram) of the absolute risk of developing ectopic pregnancy, for a given level of risk factors. This indicator for the risk of ectopic pregnancy could be used by clinicians to predict occurrence and provide an indication as to which type of early pregnancy follow-up and information should be given to women planning a pregnancy. It could also be used to provide earlier diagnostic screening in case of mild symptoms.

Case-Control Studies↗
PubMed1997

Long-term results of growth hormone treatment in France in children of short stature: population, register based study.

OBJECTIVES: To describe the growth of children treated with growth hormone and to evaluate the prognostic factors for height at the end of treatment. DESIGN: Register based cohort study. SETTING: French national register of all children treated with growth hormone. SUBJECTS: 3233 short stature children (3165 of whom were deficient in growth hormone) who were treated with growth hormone (excluding children with Turner's syndrome) and whose treatment started between 1973 and 1989, last data being recorded in December 1993. MAIN OUTCOME MEASURES: Annual changes in height, and height at the end of treatment. RESULTS: Mean height SD score at the end of treatment, after a mean of 4.3 years, was -2, corresponding to gain in mean height SD score of 1 and to a height SD score of 1.1 below target height. In all, 923 children prematurely stopped taking growth hormone treatment, mainly because of insufficient response (insufficient growth) or tiredness. Variables that predicted height at the end of treatment were age, target height, aetiology of short stature, use of puberty inhibitors, and type of growth hormone. CONCLUSIONS: The outcome of children of short stature with growth hormone deficiency who were treated with growth hormone has been less favourable than initially assumed. Growth hormone treatment has not restored normal growth to these children. The highly demanding nature and high costs of this treatment require an optimised prescription, and this remains to be determined.

Adolescent↗
PubMed1997

[Mitral surgery: prognostic and survival factors. Value of the French score].

OBJECTIVES: Conservative mitral surgery is the preferred treatment for mitral regurgitation whatever the etiology. Morbidity and mortality figures, both during hospitalization and after long-term follow-up, are better than for mitral valve replacement. This difference could result from a selection bias or express a specific effect of conservative mitral surgery on survival. In addition, concerns about cost-containment justify rigorous analysis of treatment quality. The "French" score can be used for preoperative assessment of individual and population operative risk and for inter-institution comparisons. Its value for assessing overall survival is unknown. METHODS: Using the French score, we compared the clinical features and laboratory data in 100 patients who underwent conservative mitral valve surgery and in 35 patients who had valve replacement. We looked for independent factors predicting overall survival. RESULTS: Overall survival tended to be better after conservative mitral surgery, reaching 86% at 4 years versus 72% after replacement (p = 0.08). The populations were different as the valve replacement group included more women, was more symptomatic (p = 0.022), had heart failure more often (p = 0.003) and tended to have a higher French score (p = 0.06). Inversely, the hemodynamic and echocardiographic parameters were not different between the two groups. DISCUSSION: Independent factors predicting late mortality were preoperative heart failure and the French score. The type of mitral surgery did not have any predictive value. CONCLUSION: In addition to its value for assessing operative risk, the French score appears to be useful for predicting overall survival after mitral surgery.

Aged↗