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Biomedical subjects

J L Bosson

Publications and source records attributed to J L Bosson.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Chronic venous insufficiency 7 to 10 years after partial vena cava interruption with a clip].

In order to test the responsibility of inferior vena cava clips in post thrombotic venous disease, we performed a comparative retrospective study 7 to 10 years after vena cava interruption by clip. Patients were compared with patients matched for sex, age, and prior deep vein thrombosis (same period and same localisation) but without inferior vena cava partial interruption. The results show that 1) functional complaints were significantly higher in the vena cava clip group; 2) valvular incompetency, in the initially thrombosed leg, (tested by scanning duplex) was not different in the two groups: 3) inversely, on the other leg, valvular incompetency was greater in the vena cava clip group. Furthermore this valvular incompetency was principally located at a femoral level, suggesting that the vena cava clip may induce backward thrombosis; 4) complications were independent of vena cava thrombosis.

Adult↗
PubMed1996

[Short-term change in sural venous thrombosis in patients in surgical intensive care when anticoagulants are contraindicated].

Venous thrombo-embolic disease in neurosurgical and surgical intensive care units is a frequent disorder (between 4.3 and 43 per cent of patients according to studies). The treatment is often difficult. We carried out a retrospective study from January 1994 to September 1995 of 57 patients in neurosurgical and surgical intensive care who developed thrombosis of a sural vein and in whom anticoagulant at therapeutic doses was contraindicated. After a median follow up 14 days echography showed proximal extension of the thrombosis in 4 patients and distal extension in 3 others. Five cases of pulmonary embolism occurred during the follow up period, one of which led to death. No complications (pulmonary embolism or proximal extension of venous thrombosis) occurred in those patients receiving heparin at prophylactic doses (0/11 versus 8/46 in the non-heparin group; p = 0.13). No case of pulmonary embolus occurred in those patients with partial or complete regression of the thrombosis (0/21 versus 5/36 in the group with stable or extending thrombi, p = 0,05). Echographic monitoring enabled therapeutic modification in 5 cases. These results indicate that sural venous thrombosis in the context of neurosurgical and surgical intensive care is a potentially grave situation and that the prescription of anticoagulant therapy even at preventive dose should always be considered. Further, we propose regular echographic monitoring until the patient is mobile.

Adult↗
PubMed1995

[Partial interruption of the inferior vena cava using a Greenfield titanium percutaneous filter. Present indications and evaluation].

We report a prospective study of 39 patients who presented thromboembolic disease (TED) treated by partial interruption of inferior vena cava (PIIVC) with Greenfield Titanium filter. We observed 2 recurrent pulmonary embolisms, 1 symptomatic deep venous thrombosis and 2 asymptomatic filter thrombosis. With 1 year follow up, the survival probability is of 85%. Concerning the 12 last years evolution in our hospital, we note that the approach of TED diagnosis and treatment by a central, specialised team within the hospital care structure has lead to a reduction in the number of severe cases of TED, and consequently of PIIVC. So the use of percutaneous filters has not lead to an increase in the real rate of PIIVC performed but to a decrease (21% of patients with TED in 1982 vs 8% in 1993).

Adult↗
PubMed1995

Partial interruption of the inferior vena cava: ten-year evolution in protocols at Grenoble University Hospital. Study of 621 patients.

An evolution in protocols regarding indications and modalities for Partial Interruption of the Inferior Vena Cava (PIIVC) on 621 patients at Grenoble University Hospital is reported and the influence of new methods in diagnosis (vascular sonography) and therapy (percutaneous filters) is assessed. This comparative study covers the intervals from 1982-1984 (Period A - 333 patients), and 1989-1991 (Period B - 288 patients). The percentage of patients with venous thromboembolic disease who underwent PIIVC clearly decreased (21.8% in period A vs. 13% in period B, p < 0.01). The incidence of what are currently miscalled "prophylactic", but are in fact adjunctive indications also diminished (115 patients in period A, or 34.5% of the PIIVC cases vs. 60 patients in period B, or 20.8% of the PIIVC cases, p < 0.05). There was a reduction in the use of Miles caval clips (59 patients or 17.7% for period A vs. 34 patients or 11.8% for period B, p < 0.05). Although there has been an increase in the use of percutaneous caval filters, the use of percutaneous filters has not lead to an increase in the real rate of PIIVC performed by an Angiology Unit with a large experience in the diagnosis and follow-up of patients with venous thromboembolic disease.

Combined Modality Therapy↗
PubMed1995

[Manual fragmentation of deep vein thrombosis].

To preserve the venous function after deep vein thrombosis, physical treatment combines elastic stockings, active exercises, lower limbs elevation, ventilatory exercises and manual lymph drainage. When this traditional treatment is not sufficient, we use a new technique. It aims at fragmenting thrombus by compressing it between the physiotherapist's fingers and the patient's bone. In order to define the fragmentation sites we use the Triplex ultrasonography. This technique has been tested on ten patients with serious thrombosis, whom the thromboembolic risk was first controlled. The evaluation was performed by the clinical examination, echography and occlusive impedance plethysmography rheography. The improvement of the subjective and objective signs leads to use our technique. It has to be validated on a larger scale to extend its use.

Female↗
PubMed1995

[Pulmonary scintigraphy in the diagnosis of pulmonary embolism].

Venous thromboembolism (VTE) and pulmonary (PE) are difficult to diagnose. Pulmonary scintigraphy is a key investigation in the diagnosis of PE due to its innocuity and high sensitivity. A complete examination requires analysis of ventilation and perfusion (with at least four different views). The sensitivity of the method is excellent and a normal perfusion pulmonary scintigraphy excludes the diagnosis (10-15% of cases). On the other hand, the specificity is not nearly as good as only 10 to 15% of scintigraphies show changes which make the diagnosis of PE certain. In about 2 out of 3 cases, pulmonary scintigraphy alone is not decisional and only allows an estimation of the probability of PE this investigation must be integrated in the diagnostic strategy based on the "a priori" clinical probability, non invasive venous exploration and, in second intention, pulmonary angiography. The authors report the diagnostic strategy defined in Grenoble University hospital after multidisciplinary concertration. An evaluation in 103 patients with suspected PE showed a divergence from this diagnostic protocol in 38% of cases. However, when the protocol is respected, a therapeutic decision can be taken in 73% of cases based on clinical assessment scintigraphy and Doppler ultrasonography. Therefore, the diffusion and observance of these diagnostic strategies should be improved. In these conditions, pulmonary scintigraphy plays an essential role in the diagnosis of PE. The necessity of a control pulmonary scintigraphy and the value of systematic scintigraphy in the presence of proximal venous thrombosis are also discussed.

Adult↗
PubMed1994

Morphometric analysis of the peripheral nerve: advantages of the semi-automated interactive method.

A semi-automated interactive method (BIOCOM) was developed for the morphometric analysis of the peripheral nerve in routine histopathological examination. The human superficial peroneal nerve was used for myelinated fibre measurements. The precision and reproducibility of the results were validated using a manual morphometric method on a digitalizing table. Having compared the two methods, we believe that the semi-automated method constitutes an interesting alternative to traditional methods.

Humans↗
PubMed1994

[Detection of deep vein thrombosis of the limbs by ultrasound in orthopedic and traumatologic surgery. Results of 1647 studied patients].

INTRODUCTION: This study was undertaken to estimate the efficiency of duplex ultrasound scanning and its utility to detect deep vein thrombosis in orthopedic patients and to describe their features. MATERIAL AND METHODS: A total of 1647 in-patients, all receiving low-molecular-weight heparin, were investigated from 1989 to 1993, either for screening because of a high risk of thrombosis (asymptomatic group: 930 patients, mean age + SD: 63 + 17 years) or for clinical suspicion of deep vein thrombosis (symptomatic group: 717 patients, mean age + SD: 57 + 21 years). Difference between the two groups mean ages was significant (p < 10(-8)). An Hitachi EUB 450 duplex and an Acuson colour duplex 128 XP, with 3.5 MHz and 7.5 MHz linear probes were used. Veins were tested for compressibility in the transverse view from caval site to both ankles. Retrospective analysis of patients' database results was done. RESULTS: There was no significant difference in deep vein thrombosis rate between screening asymptomatic group (356/930: 38 per cent) and symptomatic group (2531717: 35 per cent). There was a linear relation, in the 2 groups, between age and deep vein thrombosis rate, from 10 per cent before twenty to 45 per cent after eighty years old. For a relative risk to have thrombosis detected before twenty definite at 1, it was 2.1 for 20-29, 4.9 for 40-49, 6.2 for 60-69 and 8.6 later than 80 years old. Proximal deep vein thrombosis was detected in only 5 per cent (87/1647) of patients. Distal muscular soleal veins were the most usual involved sites of thrombosis. Isolated soleal thrombosis were detected in 16 per cent (270/1647) of patients. There was no significant difference between the deep vein thrombosis rate after total knee or hip arthroplasty among selected patients for duplex scanning from 1989, and the true prevalence assessed among all the patients who have undergone total hip or knee arthroplasty during the last 6 months. DISCUSSION: Pessimistic results previously reported for duplex screening among asymptomatic patients are not confirmed. Calf vein thrombosis rate assessed with duplex exceeds by 15 to 20 per cent the rates assessed by contrast venography, among patients receiving low molecular weight heparins. That difference could be attributed to the isolated muscular soleal thrombosis usually missed at contrast venography. CONCLUSION: Deep vein thrombosis rate among orthopedic surgical patients, is much higher when detected with Duplex ultrasound scanning than detected with contrast venography, and is related to patient age. Soleal vein thrombosis is the most prevalent. Duplex ultrasound scanning is an efficient and useful screening method for deep vein thrombosis in orthopedic surgery. Mechanical calf venous pump stimulation in association with low molecular weight heparin, has to be evaluated in attempting to reduce those muscular soleal veins thrombosis.

Adult↗
PubMed1994

[Can early recurrent hemorrhage in gastroduodenal ulcer be predicted?].

OBJECTIVE: To evaluate clinical, biological and endoscopic predictive factors of early recurrent bleeding from gastric or duodenal ulcers. PATIENTS AND METHODS: Seventy six patients (26 females and 50 males) with a mean age of 65.9 years (SD = 17.2) were included in a prospective study. Among the 76 patients, there were 39 NSAIDs users (51.3%). An endoscopy was performed systematically until 12 hours after admission. Treatment modalities were identical for all patients. The predictive value of 11 factors was evaluated through an univariate and multivariate analysis. RESULTS: Three factors had independent significant predictive value: a) the number of blood units used to treat a shock and to increase the haemoglobin level up to 100 g/L (P < 0.05); b) "high endoscopic risk" of recurrent bleeding including Forrest Ia, IIa and IIb ulcers (P < 0.05); c) a non steroidal anti-inflammatory treatment was associated with no recurrent bleeding contrary to the other factors (P < 0.05). Based on a second multivariate analysis including clinical factors only, a predictive score was calculated: 5 + number of blood units -5 x (NSAID = 0/1). The cut off point with maximum discrimination was 6 (specificity = 79.6%; sensitivity = 77.2%). CONCLUSION: A combination of clinical and endoscopic factors is useful to predict ulcer recurrent bleeding. Our clinical predictive score is interesting because of its simplicity. Its predictive value is of interest but have to be evaluated in another sample of patients.

Adult↗
PubMed1994

[Computerized medical register of venous thromboembolic disease at the Grenoble University Hospital Center: description and evaluation].

The number of vascular exams for venous thromboembolic disease increases dramatically in the vascular medicine unit at the Grenoble University Hospital (France). In order to improve the efficiency and the homogeneity of all the medical staff involved, a computerized register has been created. It automatically provides a letter for the prescriber of the consultation. This database, working on a computer network, has three main functions: office automation (medical folder, report), education, and clinical research. The office automation evaluation is performed after a 6 month experience, comparing 100 medical reports about venous thrombosis assisted by the computer to 100 medical reports written before the installation of the system. The introduction of digitized register is real, still this evaluation has induced some modification in the system in order to be more efficient.

Aged↗
PubMed1994

[Echo-Doppler for early diagnosis of deep venous thrombosis in orthopedic surgery and traumatology. A retrospective study of 1,647 patients].

UNLABELLED: The authors report the results of duplex ultrasound scanning investigation for the detection of deep venous thrombosis after orthopedic surgery and compare asymptomatic and symptomatic populations. PURPOSE OF THE STUDY: To estimate the rate of deep venous thrombosis diagnosed by duplex scanning in those 2 populations and precise their features. MATERIAL: A total of 1,647 in-patients all receiving low-molecular-weight heparin and investigated from 1989 to 1993. either for screening because of high risk of thrombosis (asymptomatic group: 930 patients, mean age +/- SD 63 +/- 17 years) or for clinical suspicion of deep vein thrombosis (symptomatic group; 717 patients, mean age +/- SD: 57 +/- 21 years). Difference between the two groups mean ages were significant (p < 10(-8). METHODS: An Hitachi EUB 450 duplex and an Acuson colour duplex 128 XP, with 3.5 MHz and 7.5 MHz linear probes were used. Veins were tested for compressibility in transverse view from caval site to both ankles. Retrospective analysis of patients database results has been achieved. RESULTS: There was no significant difference in deep vein thrombosis rate between screening asymptomatic group (356/930:38%) and symptomatic group (253/717: 35%). There was a linear relation, in the 2 groups, between age and deep vein thrombosis rate, from 10% before twenty to 45% after eighty years old. For a relative risk to have thrombosis detected before twenty definite at 1, it was 2.1 for 20-29, 4.9 for 40-49, 6.2 for 60-69 and 8.6 later than 80 years old. Proximal deep vein thrombosis was detected in only 5% (87/1,647) of patients. Distal muscular soleal veins were the most usual involved sites of thrombosis. Isolated soleal thrombosis were detected in 16% (270/1,647) of patients. There was non significant difference between the deep vein thrombosis rate after total knee or hip arthroplasty among selected patients for duplex scanning from 1989, and the true prevalence assessed among all the patients who have undergone total hip or knee arthroplaty during the last 6 months. DISCUSSION: Pessimistic results previously reported for duplex screening among asymptomatic patients are not confirmed. Calf vein thrombosis rate assessed by duplex scanning exceeds by 15 a 20% usual rates assessed by contrast venography, among patients receiving low-molecular-weight heparins. That difference could be assigned to the isolated muscular soleal thrombosis usually missed at contrast venography. CONCLUSION: Deep vein thrombosis rate among orthopedic surgical patients, is much higher when detected with Duplex ultrasound scanning than detected with contrast venography, and is related to patient age. Screening for deep venous thrombosis by duplex scanning in orthopedic surgery is as efficient among asymptomatic as among symptomatic patients and could become soon a systematic screening. Soleal vein thrombosis are the most usual. Mechanical calf venous pump stimulation in association with low molecular weight heparin, has to be evaluated in attempting to reduce those muscular soleal veins thrombosis.

Aged↗
PubMed1993

Improved noninvasive diagnostic testing for malignant hyperthermia susceptibility from a combination of metabolites determined in vivo with 31P-magnetic resonance spectroscopy.

BACKGROUND: Phosphorus magnetic resonance spectroscopy (31P-MRS) in vivo has been suggested recently as a possible noninvasive diagnostic test in malignant hyperthermia (MH) susceptibility. However, differences between protocols and also within subjects may have led to inconsistent MRS abnormalities reported during and after exercise. The aim of the current study was to detect discriminant abnormalities in the leg muscles using in vivo 31P-MRS during the rest period. METHODS: Fourteen patients shown to be MH-susceptible and 22 patients MH-negative on the basis of in vitro caffeine/halothane contracture tests according to the European MH group protocol were compared to 36 control subjects using in vivo 31P-MRS during the rest period. A score of MRS combined abnormalities was calculated from a stepwise discriminant function analysis. RESULTS: The MH-susceptible group had a significantly (P < 0.01) higher inorganic phosphate (Pi) to phosphocreatine (PCr) (Pi/PCr) value (0.134 +/- 0.022) than either the MH-negative (0.097 +/- 0.016) or the control (0.101 +/- 0.017) group. The MH-susceptible group also exhibited a significantly (P < 0.01) higher phosphodiesters (PDE) to PCr (PDE/PCr) value (0.093 +/- 0.056) than either the MH-negative (0.034 +/- 0.021) or the control (0.029 +/- 0.019) group. Combining both MRS parameters, 13 of the 14 MH-susceptible patients demonstrated abnormal MRS test results (score value < 1.65). Conversely, 21 of the 22 MH-negative patients had normal MRS results (score value > or = 1.65). The sensitivity and specificity of this threshold value were 93 and 95%, respectively. CONCLUSIONS: This study confirms that 31P-MRS could be useful for distinguishing noninvasively between MH-susceptible and MH-negative patients if several MRS parameter are combined. Moreover, the present MRS approach appears to be more reliable and easier than that used during exercise.

Adolescent↗
PubMed1993

[Carotid stenoses. Non-invasive exploration].

Doppler flowmeter and ultrasound imaging techniques, currently associated (duplex), have made important contributions to the simple and early non invasive diagnosis of carotid stenosis lesions in the cervical region for more than 20 years. These exploratory methods are reliable when a significant degree of stenosis (greater than about 60%) exists. Moderate degrees of stenoses or plaques are evaluated morphologically, calcifications and ulcerations being enhanced by staining techniques. But the evaluations have not really demonstrated exact correlations between anatomicopathologic and ultrasound images. The intracranial arteries and the circle of Willis are explored indirectly during the cervical examination by cautious compressive maneuvers or directly by trans-cranial Doppler. Whereas angiography competes with ultrasound imaging as a standard examination in the neck region, it nevertheless remains effective for the study of the intracranial arteries. Newer techniques, such as high-field MRI angiography, tridimensional ultrasonography or ultrasound recording of vascular flow rate without Doppler, will doubtlessly transform the diagnosis of symptomatic or asymptomatic carotid stenosis. From the strategic point of view, ultrasound imaging techniques will retain their role of a decisional pivot, since they are simple to use and are of very wide accessibility to competent vascular physicians in the context of an organized care network.

Carotid Stenosis↗
PubMed1992

[Malignant cervical epithelial adenopathy from unknown primary source. Apropos of a series of 54 cases].

Fifty four patients with cervical lymph node metastasis from an unknown primary tumor underwent treatment from 1969 to 1988. Fourty five underwent radical neck dissection. 69% had node capsular effraction and 36% perinodal vascular embolism. Thirty four patients underwent postoperative radiotherapy including rhinopharynx, cervical oesophagus and all the bilateral cervical nodes. The primary tumor appeared after treatment in 7 cases. Total survival rate is 36% 5 years after treatment. Vascular embolism aggravates the prognosis. Radiosurgical association allow effective control of loco-regional cancer but does not improve survival rate. Prognosis is aggravated by metastases arising (18%).

Adult↗
PubMed1992

[Thrombosis, immunology and drugs].

Diagnosis of thrombopenia due to heparin in sometimes false. We present a case with venous thrombosis in whom the suspicion of thrombopenia induced by heparin finally proved to be a quinidine induced lupus. Related to this observation we emphasise the importance of immunological investigation in patient with venous thrombosis.

Diagnosis, Differential↗
PubMed1991

Formulas for threshold computations.

Given a continuous variable S, which density functions on two subgroups omega + and omega - of a population omega are known (with for instance a higher mean value on omega + than on omega -), we first define two strategies for classification in these groups; the first one (MWC) consists in determining a threshold alpha such that classifying in omega + when S greater than or equal to alpha, in omega - otherwise, leads to the highest percentage of well-classed elements. The second one consists in choosing the most probable group, given the observed value of S. We give mathematical formulas for the thresholds involved in these two strategies when the density functions, determined by the application of the maximum entropy principle, are those of normal distributions. These formulas prove that the two considered strategies are frequently equivalent, and we give simpler formulas when the partial variances of S on omega + and omega - are unknown or approximately equal. All the formulas are adapted to the case where a cost coefficient is introduced to display the unequal seriousness of the two possible errors (misclassification in omega + or omega -). Then we consider an example, where we see that the computed thresholds can be graphically validated from empirical curves and have the same performances on the learning sample and on a test sample.

Analysis of Variance↗