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Biomedical subjects

J L Pedinielli

Publications and source records attributed to J L Pedinielli.

At least 19 recordsLinked to original sources
PubMed1986

Three-month follow-up of arterial blood gas determinations in candidates for long-term oxygen therapy. A multicentric study.

One hundred seventeen patients with severe chronic obstructive pulmonary disease whose PaO2 in a stable clinical state ranged from 41 to 59 mmHg, were included in a multicentric controlled study on the effects of long-term O2 therapy (LTO), and the results of the 3-month probationary period are given here. Arterial blood gases were checked every month in order to assess the stability of hypoxemia. Time 0 represented the beginning and T3 the end of the probationary period. Patients whose PaO2 at T3 was still between 41 and 59 mmHg could be accepted for the long-term study (Group A), whereas patients whose PaO2 had increased over 59 mmHg were excluded (Group B). Only 77 patients could be followed up regularly from T0 to T3 (40 patients were lost to follow-up, missed some visits, or suffered from acute exacerbations of the disease) and 23 of them had a PaO2 at T3 that exceeded 59 mmHg (Group B), allowing the inclusion of 54 patients (Group A) in the long-term study. Patients in Groups A and B did not differ with regard to pulmonary volumes, PaCO2 at T0 or a past history of right heart failure. Arterial O2 tension at T0 was slightly and significantly (p less than 0.02) lower in Group A (51.3 +/- 5.5 mmHg) than in Group B (54.5 +/- 3.8 mmHg), but there was an important overlapping of individual results from one group to another.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[What does the painful "organ" represent in hypochondriasis?].

Hypochondriac patients defy medical practice, misuse medical language and discourage medical classifications. Their peculiar use of medical knowledge impoverishes the relational dimension, obscures the personal history as if the patient wanted to hold, to control and to maintain some obscure object within his body. When this hypochondriac defence is not powerful enough, the psychiatric condition becomes much worse. There must be some serious necessity to substitute to the obscure object of desire, the object of a universal knowledge; this necessity may happen in selective conditions. The psychodynamic study of such cases leads to the following hypothesis: decompensation occurs when the patient is no longer able to maintain simultaneously two antinomic positions toward the other: to keep his place and to keep the object of his desire. Consequently, he tends to materialize this object, in which he believes, wanting simultaneously to keep it inside and to reject it outside. Of course, this fundamental misunderstanding about desire leads the patient to ask impossible questions to medicine: naming the object (no longer of desire but indeed of faith) and expelling it (so asks he, but he does not really want). This constitutes, of course, a religious use of medicine: it is impossible for our knowledge to have a universal meaning and to respond exhaustively about each peculiar history.

Conversion Disorder↗
PubMedDate not supplied

[Alexithymia. Evaluation, quantitative and clinical data].

Alexithymia is a concept created by Sifneos in 1972 to describe a disturbance in affective and cognitive functions characterised by an inability to find words to describe feelings or emotions. The term "alexithymia" is derived from the Greek and means "no words for feelings". The salient clinical features of alexithymia include difficulties recognizing and verbalizing feelings, endless description of physical symptoms instead of emotions, concrete speech and thougth closely tied to external events, paucity of fantasy life. Precisely, alexithymia is an inability to associate one's visual image, thoughts and fantasies with a specific emotional state. For Sifneos, "emotions" and "feelings" are different facts. He differentiates "visceral emotions" (biologic side of the affect and lying in structures of the limbic system as the hippocampus and the amygdaloid complex) and "feelings emotions" (psychologic side of the affect). For him, animals experience "visceral emotion", but only human experience "feeling emotions". Alexithymia is regarded as one of several possible risk factors that seem to increase the susceptibility to physical disease. Alexithymia describes some psychological features which has been initially described by Marty and Psychosomatic French School: a specific cognitive style characterized by a lack of absence of fantasies and a preoccupation with the minute details of external events ("pensée opératoire"). Alexithymia is a difficult concept to operationalize and only few instruments are sufficiently reliable and valid. Several scales are used to measure alexithymia but only the Beth Israel Questionnaire (BIQ) and the Toronto Alexithymie Scale (TAS) can be regarded as having sufficient psychometric properties. The first questionnaire, the BIQ--a scale created by Sifneos--, is the most widely used instrument which is a 17-items forced-choice questionnaire completed by the interviewer. The TAS is a 26-items self-report measure rated on a five-point Likert scale. The Shalling Sifneos Psychosomatic Scale (SSPS) and the M.M.P.I. Alexithymia Scale lack of validation and reliability. Furthermore the SSPS and the MMPI AS show little or no relation with BIQ or with TAS, thus limiting the comparability and generalizability of results from the studies that use them. The TAS is considered as internally consistent and to have a stable, replicable factor structure. Other measures as content analysis test, projective test (Rorschach, T.AT., SAT9) or others self-assessment questionnaires are not frequently used.(ABSTRACT TRUNCATED AT 400 WORDS)

Affective Symptoms↗
PubMedDate not supplied

[Chronic respiratory insufficiency and "coping with the illness"].

Chronic pulmonary disease is an impairment of the respiratory function which leads to some somatic, social and psychological consequences. After a clinical analysis of 150 patients with chronic pulmonary disease, the authors define the psychological characteristics of the patients' reactions and their psychological working-through of the illness. Date analysis shows some transformations in the perception of time (more references to the past, lack of references to the future), and psychological elaborations of the illness which appear in the characteristics of the patients' language and in their personal etiological theories. The most common psychopathologies are anxious and depressive disorders, and confusion. The patients' elaborations about their suffering, their symptoms and their illness make it possible to reopen the discussion about the psychological and metapsychological analysis of respiration. The authors emphasize the characteristics of a "respiratory organization of the libido" and its discontinuity.

Humans↗
PubMedDate not supplied

[The "lethality" of attempted suicide].

It is possible to quantify medical severity of a suicide attempt ("lethality") and its relationships with other components of the suicidal gesture have to be analysed. Our study about 758 suicide attempts aims to define psychiatric and psychological factors which are linked to "lethality" as measured by Weisman and Worden scale. Results of factorial analysis show a strong relation between "lethality" and some variables proving the intensity of psychological difficulties. Those results suggest the existence of relationship between "high lethality" on one hand, and diagnosis of psychosis, depressive symptomatology, high suicidal intent, some conceptions of death, on the other hand. A "low lethality" is associated with hedonistic conception of death, lack of positive signs of depression, existence of impulsiveness, psychopathic behaviors or lack of established mental disorder. These results reinforce the hypothesis of a relation between severity of patients psychological difficulties and medical severity of suicide attempt.

Adolescent↗
PubMedDate not supplied

[Anticholinergics during neuroleptic treatment. Value and withdrawal].

In a study on 144 chronic psychotic patients treated with neuroleptics, the authors tried to define a therapeutic schedule for anti-cholinergic drugs use to control parkinsonism induced by anti-psychotic drugs. Systematic treatment by anti-cholinergic drugs seems to be useless, even dangerous, and, if they have to be employed, the treatment must not exceed six months. The authors emphasize and analyse through the literature, the problems of drug abuse, withdrawal and psychological dependence with anti-parkinsonian drugs and their neurochemical effects.

Adult↗
PubMedDate not supplied

[High-risk suicide attempts: intent and severity].

This study of 764 suicide attempts has for objective to define the factors which distinguish the "high-risk" group from other groups. The "high-risk" group is composed of people having scored more than 10 on Pierce's Intent Scale and more than 45 on the Weissman scale. Results show that the intensity and form of depressive symptomatology and some representations of death and age distinguish this group (n = 80) and that previous suicidal attempts, alcohol intake, chronic alcoholism and recent events have no statistical value.

Adolescent↗
PubMedDate not supplied

[Epidemiological knowledge and clinical truth: objectivity and clinical practice].

The authors analyse the difficulties of the knowledge given by epidemiological studies from the clinician's point of view. They propose three arguments to define the aid epidemiology can bring to clinicians: to give rise to hypotheses from clinical experience, validate some epidemiological results, and reflect on the integration of predictive knowledge in clinical practice. These arguments are illustrated by examples taken from the authors work and propositions of epidemiological studies of which the aim and the problematic could emanate from observation and clinical experiences.

Epidemiologic Methods↗
PubMedDate not supplied

[Preliminary report and indications of assisted ventilation at home (author's transl)].

Two uses of intermittent positive pressure can be distinguished: one supports inhalotherapy and the other longterm assisted ventilation. The apparatus can be connected to the patient either through mouth-piece or by tracheostomy. The main factors involved in the indication of assisted ventilation are the number of acute failures, hypoxemia, hypercapnia, cor pulmonale. In our department, 53 patients were kept under prolonged supervision before a decision was made to use assisted ventilation or not. This attitude seems absolutely necessary. An oxygen test of several hours provides very useful information. Finally, the authors review the indication of various ventilation methods (tracheostomy, oral) in relation to different chronic respiratory insufficiency etiologies (ie., chronic obstructive broncho-pneumonia, restrictive syndrome).

Home Nursing↗