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J L Bosson

Publications and source records attributed to J L Bosson.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Inframalleolar bypass in limb salvage. Late results].

STUDY OBJECTIVE: The objective of this retrospective study was to report the long-term results of distal revascularization at the ankle in patients with critical ischemia. PATIENTS AND METHODS: From January 1989 to November 1999, 50 inframalleolar bypasses were performed in 49 patients (35 males and 14 females with a mean age of 75 years [range: 51 to 95 years]). Twenty-five patients (50%) were diabetics. All patients presented with critical ischemia of the lower limb. Distal anastomosis was performed at the retromalleolar posterior tibial artery in 28 cases (56%), pedal artery in 20 cases (40%) and distal fibular artery in two cases (4%). Bypasses were performed using a greater saphenous vein (n = 38), a cryopreserved arterial allograft (n = 9), or a PTFE graft (n = 2). A composite graft with greater saphenous vein and arterial allograft was performed in two cases. RESULTS: There were two early postoperative deaths. One patient presented a blow-out of the distal anastomosis that required bypass ligation and subsequent leg amputation. Early thrombosis of the graft occurred in four cases, leading to major amputation in three cases. No patients were lost to follow-up and mean follow-up was 26.7 months (range: 1 to 86 months). Graft thrombosis occurred in 15 patients and led to amputation in 6 cases. Bypass graft patency rate was 72% and 61% at 1 year and 3 years, respectively, yielding a 80% limb salvage rate at 3 years. The 3-year actuarial survival rate was 53%. CONCLUSION: Inframalleolar bypasses are a valuable tool in patients with critical ischemia. The lower limb salvage rate is satisfactory in this elderly population. Based on this experience, angiography with good run-off and, when necessary, a surgical approach to verify patency of the arteries at the ankle should always be performed before undertaking a major amputation.

Aged↗
PubMed2000

[Prospective national survey on alternatives to obstetrical peridural analgesia].

OBJECTIVE: To assess the type of an alternative technique for epidural analgesia for pain relief during labour, the reason of its choice and its efficiency. STUDY DESIGN: A one-year prospective survey in 34 french hospitals. MATERIAL AND METHODS: A questionnaire was filled for each request for a non-epidural technique during labour. The data recorded the reason for this non-epidural method, the technique used, the repeated visual analog scale (VAS) pain scores before (T0) and during the treatment (T30, T60 T120,...), the maternal and foetal side effects of the method, and the maternal satisfaction. RESULTS: 177 questionnaires were studied among the 270 collected. The lack of VAS measurements was the main reason for excluding questionnaires. Refusing the epidural by the obstetric patient was the most frequent reason for requesting a non-epidural method (39%). Five non-epidural methods were identified: nalbuphine (NAL, n = 75), sufentanil by patient-controlled analgesia (SUF, n = 44), nitrous oxide/oxygen inhalation (N2O, n = 22), pethidine (PET, n = 19), and spinal analgesia (SA, n = 17). The choice of the method was dependant on the prescribe (midwife or anaesthetist) and of the cervical dilation. The SA group exhibited the most pain relief compared to the other groups during the treatment. No difference in pain relief was noted between the 4 groups (SUF, NAL, PET, N2O). Only in the PET group did the VAS pain score remain unchanged at T30. There were 25 maternal side effects, with a significant maternal sedation in the NAL group, and pruritus in the SA group. There were 6 respiratory depressions in infants, unrelated with the analgesic method. Maternal satisfaction was higher in the SA, SUF and N2O groups than in the PET and NAL groups. Factors explaining lack of analgesic effect (i.e. no decrease in VAS pain score more than 10 mm during the treatment) were the use of pethidine, the VAS pain score at T0 and the induced labour. CONCLUSION: Epidural and spinal analgesia are the most efficient methods for pain relief during labour. The analgesic effect of non-regional methods during labour is minimal, associated with some maternal side effects. Due to its lack of analgesic effect, pethidine should be avoided in this indication.

Adult↗
PubMed2000

Toxoplasma gondii induces the secretion of monocyte chemotactic protein-1 in human fibroblasts, in vitro.

Secretion of Monocyte Chemotactic Protein-1 (MCP-1) by fibroblasts infected with Toxoplasma gondii was studied in vitro. A significantly higher MCP-1 secretion was observed 24 h after infection by live tachyzoites. Analysis of chemokine mRNA transcripts by RNase protection assay revealed that this MCP-1 secretion seems associated with increased MCP-1 mRNA expression. However, these increased levels of MCP-1 secretion and expression were not obtained after stimulation by heat-killed tachyzoites or parasites pre-treated by a specific inhibitor of phosphatidylcholine-specific phospholipase C (D609). Inhibition of parasite multiplication by pyrimethamine did not modify MCP-1 secretion. Thus, it appeared that the active penetration of T. gondii in cells was of major importance in the induction of MCP-1 secretion. None of the other chemokines studied by RNase protection assay (lymphotactin, RANTES, IP-10, MIP-1alpha, MIP-1beta, IL-8, and I-309) were expressed after infection by live tachyzoites. We also found that MCP-1 secretion induced by live T. gondii is blocked by inhibitors of nuclear factor (NF)-kappaB activation, ALLN and MG132. Such data indicate that NF-kappaB could be involved in T. gondii-induced MCP-1 production. MCP-1 secretion may contribute to the recruitment of monocytes and lymphocytes and thus participate in the control of T. gondii infection and in its pathogenesis.

Animals↗
PubMed2000

Benign abnormalities and carcinoid tumors of the central airways: diagnostic impact of CT bronchography.

OBJECTIVE: The purpose of this retrospective study was to determine the added diagnostic value, if any, of CT bronchography for the detection and characterization of benign abnormalities and typical carcinoid tumors of the central airways. MATERIALS AND METHODS: We used bronchoscopy and helical CT to examine 238 bronchial sections in 28 patients with 32 bronchial abnormalities and in five patients with normal bronchoscopy results. Postprocessing consisted of CT bronchography based on surface rendering. Images were interpreted independently by two observers (a radiologist and a pneumonologist) who were not informed of the bronchoscopy results. After initial interpretation of axial CT scans, the observers analyzed the axial CT scans with CT bronchograms. Results were evaluated for gain in diagnostic accuracy and in confidence. RESULTS: Mean sensitivity for detection of abnormal bronchial sections was 89% (range, 87-90%) for axial CT and 92% (range, 90-94%) for axial CT with CT bronchography (not significant). Mean specificity of both approaches exceeded 99%. A correct diagnosis of the nature of the bronchial abnormalities was proposed for 68% of the cases in which axial CT was used alone and in 76% in which both axial CT and CT bronchography were used (not significant). The addition of CT bronchography significantly increased the confidence of the pneumonologist in the diagnoses. CONCLUSION: Axial CT remains the technique of choice to detect and characterize benign abnormalities of the airways. CT bronchography provides little diagnostic gain but increases the confidence of chest physicians in the interpretation of CT scans for the assessment of benign abnormalities and typical carcinoids of the central airways.

Adolescent↗
PubMed1999

Auditory event-related potentials and clinical scores in unmedicated schizophrenic patients.

Event-related potentials (ERPs) have been widely examined in schizophrenic patients. However, although neuroleptic medication could be a potentially confounding variable, studies with unmedicated patients are relatively scarce. The present work was undertaken to determine whether ERP abnormalities persist in stabilized schizophrenic patients after drug withdrawal. In addition, ERP amplitudes and latencies were compared with clinical ratings (the Positive and Negative Syndrome Scale, PANSS) by means of Spearman rank order correlation coefficients. The P300 and N200 responses to rare tones and the P200 and N100 responses to frequent tones were recorded in 20 clinically stabilized drug-free schizophrenic patients and 19 age-matched control subjects during a two-tone discrimination task. Major findings were that the schizophrenic patients had reduced P300, N200 and N100 amplitudes and an increased P300 latency. The P300 amplitude was negatively correlated with age in patients. The P200 latency was negatively correlated with the PANSS positive syndrome score. The ERP abnormalities shown in this study appear to be enduring traits of the disorder as they persist in stabilized patients even after drug withdrawal.

Adult↗
PubMed1998

Short- and medium-term duplex sonography follow-up of deep venous thrombosis of the lower limbs.

PURPOSE: We conducted this study to assess the progression or regression of venous thrombi during and after treatment and to search for criteria of embolism risk. METHODS: We prospectively studied 75 patients with lower limb deep venous thrombosis. We used B-mode sonography for the diagnosis and follow-up of these thrombi. Pulmonary scintigraphy was performed at days 1 and 10. We evaluated the topography, echogenicity, and structure of the thrombus; the location and wall attachment of its head; and the vein diameter. Each venous segment was semiquantitatively scored as follows: 0, no thrombosis; 1, partially obstructive thrombosis; or 2, complete thrombosis. RESULTS: The decreases in the total thrombosis score were 4%, 11%, 51%, 72%, and 84% on days 5, 10, 30, 90, and 365 (1 year), respectively. Pulmonary embolism occurred in 27 patients, of whom 16 were asymptomatic. Thrombi in iliac veins exhibited a slower regression rate than those in calf and femoral veins. Pulmonary embolism occurred in 54% of patients with versus 24% of patients without a floating thrombus head. CONCLUSIONS: Sonography is useful for the early detection of thrombus progression and the evaluation of embolism risk, which seems to be greater in patients with a floating thrombus head.

Disease Progression↗
PubMed1998

Cytomegalovirus seroprevalence in French pregnant women: parity and place of birth as major predictive factors.

In this study we present data on cytomegalovirus (CMV) seroprevalence in pregnant women in France. One thousand and eighteen women were enrolled in a prospective study carried out in Grenoble. The overall rate of seropositivity, using a specific IgG ELISA test, was 51.5 % (95 % CI: 48.5-54.5). Among a homogeneous population of 873 women born in France with high or middle socioeconomic status, CMV seropositivity increased with age and parity. The seroprevalence according to age was found to depend on parity. It increased with age in women with no children or with only one; it was higher but no more age-dependent in women with two children or more. In addition, CMV seroprevalence was significantly higher in women born in southern France (51.6%) than in those born in northern France (37.4%), these findings being consistent with the existence, within France, of a gradient in seroprevalence rate, increasing from the North to the South. A logistic regression analysis reveals the place of birth in France as a major predictive factor of CMV antibody status (OR: 3.5) followed by age (OR: 2) and parity (OR: 1.7). In this study, we show an independent effect of parity on CMV seroprevalence, arguing for the importance of child-to-mother transmission; nevertheless, the latitude of the place of birth, even within a size-limited country such as France, appears to be a major predictive factor of CMV seroprevalence.

Adult↗
PubMed1998

ApoE polymorphism and albuminuria in diabetes mellitus: a role for LDL in the development of nephropathy in NIDDM?

BACKGROUND: Chronic hyperglycaemia stands with diabetes duration as the main predicting factor for the development of nephropathy in insulin dependent diabetes mellitus (IDDM). In contrast, nephropathy in non-insulin-dependent diabetes mellitus (NIDDM) presents with a different natural history and, as well as atherosclerosis, can precede diabetes diagnosis and even the onset of patent hyperglycaemia. The role of lipid abnormalities in this matter remains debated. METHODS: We studied the prevalence of nephropathy (N+ = urinary albumin excretion rate (UAE) > 20 mg/d) in 134 Caucasian NIDDM patients ranked according to alipoprotein E (apoE) genotype (same distribution in 132 controls). Age, diabetes duration and sex ratio did not differ between N+ and N-. A patient with E2E4 (n = 1) was excluded from the analysis. RESULTS: The prevalence of nephropathy was significantly reduced in E2 allele carriers (36%, 8/22) vs 69% (77/111) in E2 non-carriers (P < 0.01). Relative risk (RR) of E2 carriers developing nephropathy was 0.52 (95% CI = 0.35-0.80). Both groups were comparable in terms of age (55 +/- 11 vs 57 +/- 11 years), diabetes duration (15 +/- 9 vs 14 +/- 10 years) and prevalence of retinopathy (59 vs 48%). Similar results were observed when patients with diabetes duration longer than 8 years were studied (n = 94). CONCLUSIONS: It has been largely established that low-density lipoprotein (LDL)-cholesterol level in E2 allele carriers (whether diabetic or not) was lower than in E2 non-carriers. The 2-fold increase of nephropathy in E2 non-carriers with NIDDM argues for a role for LDL in the development of human nephropathy in NIDDM patients. This result is in agreement with previous data established both in vitro and in vivo in animal models. These findings support evidence for the pathogenic and morphologic similarities between kidney disease and atherosclerosis in NIDDM patients.

Adult↗
PubMed1998

Quality assessment of discharge letters in a French university hospital.

The quality of discharge letters has been evaluated in order to initiate a process of improved communications between the hospital and general practitioners. From each of 37 volunteer clinical departments of the hospital, a random sample of 30 stays was selected among the hospitalisations for one year. The quality of discharge letters was assessed according to recipients' needs and to French legislation. In total, 1,024 medical records were relevant and were analysed. This study showed deficiencies in management of discharge letters in the hospital. It constitutes the first step of a quality improvement process based on the awareness of concerned actors through information feedback and the follow-up of specific indicators.

Communication↗
PubMed1998

Early development of deep-vein thrombosis following hip fracture surgery: the role of venous wall thickening detected by B-mode ultrasonography.

Deep-vein thrombosis (DVT) remains the most frequent complication following hip surgery. This study was designed in order to evaluate the development of DVT after hip fracture surgery, and to determine if venous wall thickening detected before surgery predisposes patients to postoperative DVT. Systematic ultrasound examinations were performed on 100 consecutive patients undergoing hip fracture surgery on the day preceding the operation, and then postoperatively on days 2, 5 and 10. A total of 12 proximal, 28 distal deep-vein and four saphenous vein thromboses were detected. Of the DVT, 19 (43%) were detected at day 2. Five out of eight patients with venous wall thickening had a previous history of DVT. Venous wall thickening was positively correlated with proximal DVT development (62.5% versus 8% incidence in the group of patients with and without venous wall thickening respectively; p<0.001, relative risk = 7.8). This study highlights the high frequency of early major thromboembolic events following hip fracture surgery. It is considered that patients with a previous history of venous thromboembolic disease should undergo B-mode ultrasonographic examination before hip fracture surgery. Patients in whom venous wall thickening is detected should have repeated postoperative ultrasonographic examinations enabling early detection of DVT.

Adult↗
PubMed1998

Diameters of acute proximal and distal deep venous thrombosis of the lower limbs.

BACKGROUND: Duplex ultrasonography of the veins in the diagnosis of deep venous thrombosis (DVT) can be interpreted in a semi-quantitative mode by measuring the antero-posterior (AP) diameter of the thrombus. We report the values of the diameters of thrombi and the factors influencing these values. Therefore we propose a quantitative definition for DVT in duplex ultrasonography. METHODS: 1,017 patients (3,767 thrombosed venous segments), referred to the Emergency Angiology Unit from January 1994 to September 1996. Characteristics: 55% F, 45% M; mean age 68+/-18 years; 624 proximal DVT (61%) and 393 distal DVT (39%). Measurement by venous echography of the antero-posterior diameters of thrombi at 25 predetermined sites in the area of the vena cava. RESULTS: (In mm, median, 10th and 90th percentiles after regrouping of contiguous anatomical sites not statistically different): thrombus in the common iliac veins and the inferior vena cava (12 mm, 7-17); external iliac and common femoral veins (9 mm, 5-14); superficial femoral, deep femoral and popliteal veins (6 mm, 4-10); calf veins (5 mm, 4-8). The age of the patients, their sex, body mass index (BMI), whether they were in- or outpatients or the laterality of the thrombus never significantly influenced its diameter. CONCLUSIONS: It is very unusual to observe a diameter of under 5 mm in cases of DVT. For clinical research therefore, we propose 5 mm as the minimum threshold value for this diagnosis. This value could be used in the venous echographic definition of DVT, as a criterion for inclusion in a therapeutic trial, for example, or in an epidemiological study.

Aged↗
PubMed1998

[Deep venous thrombosis and severe burns].

Deep venous thrombosis (DVT) is a frequent and potentially serious complication in severely burned patients. We report the case of a burned patient (40% of total body surface burned), who had right femoral deep venous thrombosis and severe pulmonary embolism, although a prophylaxis was conducted with low molecular weight heparin, graduated compression stockings and rotating bed. This case shows that DVT early diagnosis and prophylaxis is difficult in severely burned patients. Systematic screening of DVT by duplex scan is possible only for femoral veins, which renders duplex scan more suitable for femoral catheter follow up than for systematic DVT screening. Computed tomography venography seems to be a valuable tool in the diagnosis of proximal thrombosis. Prophylaxis is best achieved with the use of preventive low molecular weight heparins, graduated compression stockings, and early mobilisation when possible. However, the place of low molecular weight heparins at high doses and external pneumatic calf compression needs to be evaluated by prospective studies.

Adult↗
PubMed1998

[Cytomegalovirus infection in pregnant women. Seroepidemiological prospective study in 1,018 women in Isere].

Cytomegalovirus (CMV) is the leading cause of viral congenital infections. In children, the consequences may be severe, especially in case of maternal primary infection during pregnancy. A prospective study was carried out in the department of Isère, in 1,018 pregnant women, in order to establish the seroprevalence of CMV, the frequency of primary infections during pregnancy and the associated risk factors. The overall seroprevalence was 51.5%; it increased significantly with age, parity, and low socioeconomic status. It was higher in women born in the South of France (51.6%) than in those born in the North (37.4%). Among a total of 878 women with serological follow-up, 7 primary infection cases (0.8%) were observed. Seventeen women (1.9%) presented border IgM values in the first serum, and these values were not related to recent infection. Extrapolation of the results to the whole department of Isère, suggests that each year about 100 pregnant women would be concerned by CMV primary infection, with 2 or 3 cases of death or severe sequelae in children. In light of these results, the interest of serological screening is discussed.

Adult↗
PubMed1998

[Puerperal thrombophlebitis and the ovarian vein with extension to the inferior vena cava].

PURPOSE: To assess US, CT and MR findings in women having puerperal ovarian vein thrombosis with clot protrusion into the inferior vena cava. PATIENTS, MATERIAL AND METHODS: We retrospectively reviewed the duplex US (n = 9), CT (n = 5) and MR (n = 5) examinations of 9 patients with 8 right ovarian vein thrombosis, and one left ovarian vein thrombosis. RESULTS: US findings allowed for the diagnosis of ovarian vein thrombosis in all patients in showing enlarged tubular echogenic thrombus within the retroperitoneum with clot protrusion in the IVC in all cases. CT scan and MRI demonstrated ovarian vein thrombosis in all the cases in which it was performed but failed to show a mobile thrombus within the IVC in one patient. CONCLUSION: Duplex US is a reliable technique to show puerperal ovarian vein thrombosis and its extension to the IVC. CT scan and MR imaging can be used to precise the extension to the IVC.

Adult↗
PubMed1998

[CT x-ray evaluation of abdominal and pelvic veins in patients suspected of acute pulmonary embolism with negative Doppler sonography].

PURPOSE: To address prospectively the potential of CT of the abdomen and pelvis to demonstrate deep vein thrombosis in patients suspected of acute pulmonary embolism and investigated with helical CT of the pulmonary arteries. MATERIAL AND METHODS: 197 patients presenting non-diagnostic scintigraphy and negative Doppler US of lower limbs and IVC were included. They had helical CT of the pulmonary arteries (5mm collimation, 1:1 pitch, reconstruction every 2.5 mm, injection of 120 mL of contrast media at a rate of 3 mL/sec). Ninety seconds after the end of the thoracic acquisition, abdominal and pelvic CT were acquired (7 mm collimation every 12 mm). RESULTS: 3 (1.5%) of 197 patients had an unknown thrombosis of the caval system (renal vein, ovarian vein, lilac veins). A fourth patient had an unknown thrombosis of the mesenteric vein. All these patients had a pulmonary embolism (4/40). None of the 157 patients without pulmonary embolism at helical CT showed deep venous thrombosis. CONCLUSION: In our study, CT of the abdomen and pelvis disclosed an unknown thrombosis of a deep vein of the abdomen and pelvis that can explain the pulmonary embolism in 7.5% of patients.

Abdomen↗