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J L Bosson

Publications and source records attributed to J L Bosson.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Deep venous thrombosis (DVT) after hip or knee prosthesis. Evaluation of practices for prevention and prevalence of DVT on doppler ultrasonography].

PURPOSE: Duplex ultrasound scanning was performed to detect deep venous thrombosis (DVT) after hip or knee arthroplasty and evaluate application of the postoperative thromboprophylaxis consensus. PATIENTS AND METHODS: A prospective multicenter study was conducted between April 1995 and April 1996 in 16 centers. Thirty angiologists included 505 patients (370 in private clinics and 135 in university hospitals). Mean patient age was 71 years. There were 288 women. Hip arthroplasty was performed in 396 patients (78%) and knee arthroplasty in 109 (22%), under general anesthesia in 323. The postoperative thromboprophylaxis consensus was recalled prior to study onset and DVT was detected 8 and 10 days after surgery by duplex ultrasonography. RESULTS: Thromboprophylaxis was prescribed by the anesthesiologist (57%), the surgeon (23%) or an angiologist (20%). Anticoagulation dosage was lower than the recommended dosage in 181 patients (36%). The prevalence of detected deep venous thrombosis was 14% (range 11-17%), including 21 cases of proximal DVT (4.2%), 33 of distal DVT (6.5%) and 17 of distal muscular DVT (3.4%). The risk of having a DVT was 1.6-fold higher in patients over 70 years of age (p = 0.04), 2.2-fold higher in case of general anesthesia (p = 0.03) and 2.1-fold higher in case of reduced mobility (p = 0.01). When heparin dosage was lower than the recommended consensus dosage, prevalence of DVT was 19% compared with 11% for patients who received the right dosage (RR = 1.7, p = 0.01). CONCLUSION: Much progress is needed in the application of the postoperative consensus on thromboprophylaxis. The high prevalence of DVT despite preventive treatment indicates that systematic detection of DVT is useful, particularly in high-risk patients or when the recommended thromboprophylaxis cannot be applied.

Adult↗
PubMed1997

A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire.

BACKGROUND: Low-molecular-weight heparin appears to be at least as effective and safe as standard, unfractionated heparin for the treatment of deep-vein thrombosis, but only limited data are available on the use of low-molecular-weight heparin to treat acute symptomatic pulmonary embolism. METHODS: We randomly assigned 612 patients with symptomatic pulmonary embolism who did not require thrombolytic therapy or embolectomy to either subcutaneous low-molecular-weight heparin (tinzaparin) given once daily in a fixed dose or adjusted-dose, intravenous unfractionated heparin. Oral anticoagulant therapy was begun between the first and the third day and was given for at least three months. We compared the treatments at day 8 and day 90 with respect to a combined end point of recurrent thromboembolism, major bleeding, and death. RESULTS: In the first eight days of treatment, 9 of 308 patients assigned to receive unfractionated heparin (2.9 percent) reached at least one of the end points, as compared,with 9 of 304 patients assigned to low-molecular-weight heparin (3.0 percent; absolute difference, 0.1 percentage point; 95 percent confidence interval, -2.7 to 2.6). By day 90, 22 patients assigned to unfractionated heparin (7.1 percent) and 18 patients assigned to low-molecular-weight heparin (5.9 percent) had reached at least one end point (P=0.54; absolute difference, 1.2 percentage points; 95 percent confidence interval, -2.7 to 5.1). The risk of major bleeding was similar in the two treatment groups throughout the study. CONCLUSIONS: Under the conditions of this study, initial subcutaneous therapy with the low-molecular-weight heparin tinzaparin appeared to be as effective and safe as intravenous unfractionated heparin in patients with acute pulmonary embolism.

Acute Disease↗
PubMed1997

[Assay of lactic acid in the cerebrospinal fluid for the diagnosis of bacterial meningitis. Strategies for the choice of discriminatory threshold].

OBJECTIVES: In search for a supplementary marker of bacterial meningitis in cases where conventional bacteriology, cytology and chemistry are insufficiently contributive to diagnosis, we assessed the value of cerebrospinal fluid lactate levels in children with bacterial meningitis. PATIENTS AND METHODS: Cerebrospinal fluid lactate levels were measured from all spinal taps performed in a pediatric emergency care unit over a two-year period. Of the 332 usable samples there were 32 cases of bacterial meningitis, 104 cases of viral meningitis and 196 other diagnoses (non meningitis). RESULTS: Average lactate concentration 7 +/- 4 mmol/l in bacterial meningitis versus 2.1 +/- 0.6 mmol/l in viral meningitis (p < 0.0001). The value of lactic acid concentrations in discriminating between bacterial and viral meningitis was found to be superior to that of other chemistry results: protein, glucose, chloride. The discriminatory threshold of cerebrospinal fluid lactate was 3.7 mmol/l with sensitivity of 80% and a specificity of 98%. CONCLUSION: We propose routine assay of cerebrospinal fluid lactate in all cases of suspected meningitis.

Adolescent↗
PubMed1997

[Value and limitations of pulmonary scintigraphy/venous duplex Doppler echography in the management of pulmonary embolism].

PURPOSE: To assess the accuracy of diagnostic strategy of pulmonary embolism (PE) based on clinical examination, lung scan and venous duplex US findings. METHODS: 1,819 patients have been included in a prospective study (mean age: 66, range: 6-102, F 54% H 46%) over a 13 month period. RESULTS: To decide the opportunity of anticoagulant therapy, lung scan alone is decisive in 30.6% of the cases. When taking into account clinical examination, lung scan and venous duplex US findings in a combined diagnostic strategy, a therapeutic decision can be made for 74.2% of the patients. The decisive characteristics of this strategy were influenced by two factor: age (therapeutic decision can be reached for 83% of the patients aged 30 to 50 vs 65% when they are over 85, p < 0.01); history of heart or pulmonary disease (therapeutic decision reached in 62% of the cases with history vs 78% without, p < 0.01). CONCLUSION: Pulmonary angiography seems theoretically necessary in less than 26% of the patients with suspected PE when they have undergone lung scan and venous duplex US. In this case, and when these strategies are not very decisive, it would be important to assess the diagnostic value of spiral CT scanning.

Adolescent↗
PubMed1997

Histological support for the difference between malignant hyperthermia susceptible (MHS), equivocal (MHE) and negative (MHN) muscle biopsies.

The aim of this study was to find, using modern techniques, any histological differences in muscle biopsies between malignant hyperthermia (MH) susceptible (MHS), MH equivocal (MHE) and MH negative (MHN) patients. On the basis of the European MH contracture test carried out in 83 patients, 23 were shown to be MHS, nine MHE and 51 MHN. Four lesions were found with a significantly high frequency in MHS and MHE biopsies: muscle fibre hypertrophy and atrophy, internal nuclei and myofibrillar necrosis. These four lesions were observed together in 35% of MHS but in none of the MHE or MHN biopsies. Three of these lesions occurred together in 57% of MHS, 33% of MHE and 4% of MHN biopsies. Our results support a histological difference between MHE, MHS and MHN biopsies and attempt to contribute towards a better definition of MHE status.

Adolescent↗
PubMed1997

Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs.

PURPOSE: To assess prospectively the clinical effectiveness of helical computed tomography (CT) in the evaluation of patients with unresolved suspicion for pulmonary embolism (PE). MATERIALS AND METHODS: Helical CT was performed in 164 consecutive patients suspected of having acute PE, intermediate probability at ventilation-perfusion (V-P) scintigraphy, and normal findings at duplex ultrasonography (US) of the legs. Fifteen patients also underwent pulmonary angiography. Helical CT results were analyzed immediately to help plan anticoagulant treatment. If helical CT did not show PE, anticoagulant treatment was not indicated. Clinical outcome for these patients was assessed during 3-month follow-up. RESULTS: In 40 (24.4%) of 164 patients, the diagnosis of PE was based on results at helical CT (n = 39) or pulmonary angiography (n = 1). Repeated Doppler US of the legs depicted one thrombus in the calf of three patients with normal results at helical CT that could have been responsible for PE. During 3-month follow-up, three patients experienced recurrent PE (one death, two recurrences). Therefore, PE occurred in six (5.4% [95% confidence interval, 1.3%, 9.7%]) of 112 patients with normal findings at helical CT who did not receive anticoagulant treatment. CONCLUSION: Findings at helical CT allowed accurate diagnosis of acute PE in patients with intermediate probability at V-P scintigraphy and without deep venous thrombosis at duplex sonography of the legs.

Acute Disease↗
PubMed1997

Psychological assessment of patients with idiopathic pruritus ani.

BACKGROUND: The purpose of this study was to compare psychological profiles in 17 patients suffering from idiopathic pruritus ani with a control group of 28 patients showing secondary pruritus ani. METHODS: The two groups completed the Mini-Mult personality test and results were compared using chi 2 test and analysis of variance. RESULTS: The mean hypomania and depression scale scores were greater and smaller respectively in the idiopathic pruritus ani group. Nevertheless, the percentage of abnormal psychological profiles was not significantly different between the two groups. CONCLUSIONS: It seems arbitrary to systematically ascribe psychogenic aetiologies to idiopathic pruritus ani even though psychological factors may be present in individual patients.

Adult↗
PubMed1997

Pulmonary embolus as a complication of femoral venous catheter removal.

The case of a 31 year old woman who developed asymptomatic pulmonary emboli after removal of a femoral venous catheter is reported. A deep venous thrombus had previously been shown to be associated with the catheter. Therefore it is argued that care should be taken when removing femoral lines especially in patients at high risk of thrombosis and that femoral venous duplex scan may be warranted prior to line removal in these high risk patients.

Adult↗
PubMed1997

[Non-invasive management of a serious acute pulmonary embolism].

Prompt diagnosis of a large pulmonary embolus is essential in order to initiate appropriate treatment early. We report a case of a large pulmonary embolus in which management was aided solely by noninvasive investigations. Transthoracic echocardiogram showed elevated right heart pressures which together with the patient symptoms suggested a major pulmonary embolus. Spiral computed tomography of the chest confirmed the diagnosis. The source of the embolus was shown by echodoppler. This case illustrates that a diagnosis of a major pulmonary embolus can be made using noninvasive techniques. Pulmonary angiography should be reserved for those rare cases in which diagnostic uncertainty remains rather than being used as a routine examination prior to consideration of therapeutic decision.

Acute Disease↗
PubMed1997

Expression of E-cadherin and alpha-,beta- and gamma-catenins in human bladder carcinomas: are they good prognostic factors?

E-cadherin, the epithelium-specific cadherin, is known to play a major role in tumor progression in many human carcinomas, via intercellular homophilic Ca2+-dependent adhesion. This adhesion is mediated by a group of cytoplasmic proteins, including the alpha-, beta- and gamma-catenins that link the E-cadherin to the actin cytoskeleton. Recent studies have shown that loss or reduction of either E-cadherin or catenin expression was strictly related to clinicopathological data in bladder tumors, and E-cadherin might constitute prognostic factors in bladder carcinogenesis. Here we continued a preliminary work on E-cadherin in bladder cancer. In an effort to evaluate their possible prognostic value, we investigated both E-cadherin and catenins in 99 bladder tumors by immunohistochemistry. E-cadherin and all the catenins were strongly expressed in normal urothelium. Regarding histopathological data, the tumors examined showed that the disrupted expression of each molecule, except for gamma-catenin, was directly related to increasing tumor grade (mainly for alpha- and beta-catenin) and deep invasion (p < or = 0.01). The aberrant expression of E-cadherin and beta-catenin was also correlated to the presence of distant metastasis (p < 0.05). However, only abnormal expression of a-catenin was associated with poor survival (p = 0.037). Therefore our results suggest that alpha-catenin is directly involved in tumor invasion and dedifferentiation and is the only protein of any prognostic value, albeit low in patients with bladder cancer.

Adult↗
PubMed1996

[Prospective evaluation of a nuclear magnetic resonance score in the screening of malignant hyperthermia susceptibility. Initial results].

A prospective study for the noninvasive diagnosis of malignant hyperthermia (MH) susceptibility was conducted in 30 patients using 31P magnetic resonance spectroscopy (MRS). A score of MRS muscle abnormalities was determined before the in vitro contracture test. The patients were classified as MH susceptible or MH negative, according to an algorithm of MRS score values. Twenty-three patients were correctly classified using the MRS test, five had inclusive MRS score values and two patients were false-positive. There were no false-negative patients. These preliminary results suggest that the MRS test could be useful as a possible noninvasive diagnostic test in MH susceptibility.

Adolescent↗
PubMed1996

Virtual echography. The simulation of ultrasonographic examination.

We present a Virtual Echographic System. Because this examination is particularly difficult, developing a simulator is very useful to give students some common databases of pathological samples on which they could experiment image acquisition and evaluate their understanding of clinical cases. We have applied our method to the simulation of thigh ultrasonographic examination for thrombosis diagnosis. A preliminary system, focusing on image generation, has been developed. Virtual echographic slices are generated using a particular interpolation technique and a deformation model of significant structures. Resulting images have a visual quality similar to usual ones.

Computer Simulation↗
PubMed1996

[Ophthalmologic manifestations of dialysis. Retrospective study on 81 patients].

In this work, we looked at the results of a retrospective study carried out in our unit on the ocular manifestations in the dialysed chronic renal failure patient. Eighty-one of our 189 patients had an ophtalmic examination. Thirty-six showed a retinopathy, 26 suffered from a corneoconjunctival alterations, 19 from a cataract, 6 a vascular thrombosis, 4 a glaucoma and one motor-ocular paralysis. There was no significant difference for age and sex between the 81 patients and the group of 108 who did not have an ophtalmic examination. But this difference was positive for duration of time on dialysis (p = 0.01). There is a correlation between the presence of a cataract and the age of the patients (p = 0.01). There was no link between the different types of ophtalmic problems on the one hand, and the age, sex, time on dialysis, type of dialysis, original nephropathy, hypertensive history or anterior renal transplantation on the other hand.

Cataract↗