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Biomedical subjects

J M Berthelot

Publications and source records attributed to J M Berthelot.

At least 19 recordsLinked to original sources
PubMed1998

[Tomodensitometric image of the lumbar spine. Study of 150 patients hospitalized for discal sciatica].

OBJECTIVES: There would be some discordance between patient expectations and expert recommendations concerning computed tomography (CT) of the spine for discal disorders. We analyzed patient opinion. PATIENTS AND METHODS: At admission, a 25-item questionnaire was given to 150 patients hospitalized in a rheumatology unit for discal sciatica. Patients were asked to express their expectations concerning the CT exploration. RESULTS: Seventy percent of the patients had already undergone CT explorations requested by a general practitioner (55%) or a specialist (45%), 20% had had two CT explorations and 20% magnetic resonance imaging. Seventy-five percent felt they should have had a CT scan earlier, 85% thought a CT should be performed for back pain of less than one month duration and 96% in case of sciatica for 2 months or more. Patients felt their exploration came "late" because the physician was under financial pressure (52%), had incorrectly appreciated the patient's need (28%) or was incompetent in the matter (22%). Nevertheless, 15% of the patients recognized that the CT scan could be useless and 89% knew that all cases of hernia are not operable. Thirty percent recognized that hernias can go undetected on the CT scan and 78% that they may remain asymptomatic. Finally, 56% of the patients thought that the CT scan would not change their treatment and only 23% expected to undergo surgery sooner because of the CT exploration. DISCUSSION: Several factors would explain what patients expect from CT exploration of the spine: patient understanding that causes other than discal hernia can cause back pain (98%) or sciatic (77%); their fear of having another disorder (56% wanted to be reassured, which would explain in part why 27% hoped the CT would improve pain, 50% wanted to "see" their discal hernia, and 30 wanted to eliminate another cause of their pain); patient distrust of clinical diagnosis which they felt was less pertinent than CT (80% of the patients for generalists and 70% for specialists). Patient expectations did not appear to be limited by fear of irradiation (unrecognized by 90% of the patients) nor the cost of the exploration which was overestimated by 70% of them.

Aged↗
PubMed1998

A profile of health care utilization of the disabled population in Manitoba.

OBJECTIVES: This study profiled health care utilization by disabled and nondisabled individuals in the Canadian province of Manitoba to evaluate the association between health care utilization and disability. METHODS: Age-standardized annualized utilization rates were calculated according to sex using longitudinal data on individual encounters with the Manitoba health care system from 1983 to 1990. Associations between severity of disability, number of prior chronic conditions, and prospective utilization were examined using multivariate regressions. RESULTS: Utilization patterns of the mildly disabled and the nondisabled differed only slightly. Severely disabled individuals had much higher rates of contact and consumed more resources, even after controlling for chronic conditions. The severely disabled accounted for 3% of the population and consumed 16% of hospital days and 7% of physician costs annually. CONCLUSIONS: The findings emphasize the importance of incorporating measures of disability in health services research. Both the severity of disability and the number of chronic conditions had independent value in predicting health care utilization. This has important implications for data collection and for the allocation of health care resources for research, which has traditionally been targeted toward fatal chronic conditions.

Adolescent↗
PubMed1998

Diagnostic value for rheumatoid arthritis of antiperinuclear factor at the 1:100 threshold. Study of 600 patients and meta-analysis of the literature.

Six hundred sera from patients with chronic rheumatic diseases including 429 with rheumatoid arthritis were tested in a blind fashion for IgG antiperinuclear factor using an indirect fluorescent antibody assay on buccal cells. Using the dilution of 1:100 found to be optimal in an earlier study, 283 of the 429 (66%) rheumatoid arthritis sera and 22 of the 171 (13%) control sera were positive for antiperinuclear factor. Titers were higher in the rheumatoid arthritis group than in the control group. A meta-analysis of studies that used sera diluted 1:80 or 1:100 (2853 sera including 939 from patients with rheumatoid arthritis, 1539 from patients with other rheumatic diseases and 375 from healthy controls or patients with unclassified rheumatic diseases) yielded a sensitivity of 0.75, a specificity of 0.93, and a positive predictive value of 0.87. These data demonstrate that antiperinuclear factor testing contributes usefully to the diagnosis of rheumatoid arthritis.

Adolescent↗
PubMed1998

Follow-up practices for patients with early stage breast cancer: a survey of Canadian oncologists.

The value of routine follow-up programs for patients with early stage breast cancer remains an area of controversy. In recent years, the cost-effectiveness of routine investigations has been questioned, and 2 prospective randomized clinical trials have shown no survival advantage to more intensive diagnostic follow-up approaches. Under the auspices of the Ottawa Regional Cancer Centre, a national survey of the practice patterns of Canadian surgical, radiation and medical oncologists was undertaken to measure current Canadian standards of care and to determine average costs of 5-year follow-up for patients completing primary treatment for stage I and II breast cancer. Standardized questionnaires were sent out to 130 surgeons, 59 radiation oncologists and 89 medical oncologists. The overall response rate was 44%. Based on the frequency of follow-up visits and investigations recommended by respondents, an average cost per patient for a 5-year follow-up plan was derived for each subspecialist group: $791, $911 and $904 for surgeons, radiation oncologists and medical oncologists respectively. Use of a less interventionist follow-up program was estimated to result in a cost saving of $300 per patient over 5 years. The results indicate that, for the most part, Canadian oncologists have been influenced by the available literature concerning follow-up practices and are ordering fewer routine tests. Further cost savings to the Canadian health care system could be achieved with the adoption of even less interventionist follow-up programs.

Breast Neoplasms↗
PubMed1998

Factors linked to disease activity in a French cohort of patients with spondyloarthropathy.

OBJECTIVE: To identify risk factors associated with disease activity, in a group of patients with spondyloarthropathy (SpA) living in France. METHODS: Patients fulfilling the ESSG or Amor criteria for SpA were enrolled in a cross sectional multicenter study. Disease activity was assessed using a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Univariate and multivariate analyses were used to identify a link between BASDAI and disease characteristics, genetic factors, and environmental factors such as infectious events, mental stress, working conditions, and dietary factors. RESULTS: We studied 293 patients. On multivariate analysis, BASDAI appeared to be mainly linked to disease duration (negative correlation), the absence of sacroiliitis, and the "frequency of meals taken out of home" (negative correlation). CONCLUSION: Disease activity in a French population of patients with SpA appeared to be linked mainly to a shorter disease duration and a peripheral pattern of arthritis, as well as to dietary habits. The underlying links between this last environmental factor and disease activity remained hypothetical and could only reflect a nontested social factor.

Adult↗
PubMed1997

Super-acute aseptic spondylitis as the first manifestation of round calcifying nucleopathy in a 77-year-old man. A case report.

STUDY DESIGN: This is a report of an unusual case of very late onset, symptomatic, round calcifying nucleopathy. OBJECTIVE: To describe this unusual case of calcifying nucleopathy in a 77-year-old man who had no previous back problems, but had a history of diffuse skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: The resorption of calcifying nucleopathy associated with reactional spondylitis is a classic occurrence in children but is rare in adults. METHODS AND RESULTS: Spondylitis was diagnosed on the basis of pain, a transient Babinski's sign, and systemic inflammation. Radiographs, a bone scan, and magnetic resonance imaging revealed a large calcified nucleopathy of the T12-L1 disc associated with spondylitis of T12. The calcification disappeared within 3 weeks, and recovery was clinically and biologically complete after treatment consisting of only rest and analgesics. CONCLUSION: A diagnosis of resorption of a round calcifying nucleopathy is not to be excluded in the elderly patient. This event can mimic an infectious spondylitis clinically and biologically.

Aged↗
PubMed1997

Age-specific education and income gradients in morbidity and mortality in a Canadian province.

While important age-related trends in the use of health care services over the past two decades in Canada have been well described, a comprehensive description of socioeconomic gradients in morbidity and mortality across age cohorts for a representative population has not been accomplished to date in Canada. The objective of this study was to describe age-specific socioeconomic differentials in mortality and morbidity for a representative sample of a single Canadian province. The study sample was formed from the linkage of individual respondent records in the 1986 census to vital statistics records and comprehensive records of health care utilization for a 5% sample of residents of the province of Manitoba. Using two measures of socioeconomic status derived from census responses, attained education and household income, individuals were stratified into age-specific quartile ranks. Based on diagnostic information contained on health care utilization records, the proportion of the sample in treatment during a 12-month observation period was calculated for 15 broadly defined categories of morbidity and tested for differences across socioeconomic quartiles. Mortality was inversely associated with both income and education quartile rank. In the analysis of morbidity, no association between socioeconomic status and treatment prevalence was observed in the majority, no association between socioeconomic status and treatment prevalence was observed in the majority of the 122 age- and disorder-specific strata tested. Of the observed associations, however, negative relationships were dominant, indicating a higher treatment prevalence among individuals of lower attained education or lower household income. Across the age course, negative relationships were most frequently present among young and middle aged adults, those aged 30-64, and were more consistently found for income than for education. The general findings of this study of a representative Canadian population support observations from other developed country settings that socioeconomic differences in relative rates of mortality and morbidity over the life course are greatest in the adult years.

Adolescent↗
PubMed1997

Antiperinuclear factors are present in polyarthritis before ACR criteria for rheumatoid arthritis are fulfilled.

OBJECTIVE: To show that antiperinuclear factor (APF) may be useful for the diagnosis of rheumatoid arthritis at a time when the American College of Rheumatology (ACR) criteria are not yet fulfilled. METHODS: Testing for APF-IgG (1:100 threshold) and rheumatoid factors (RF) was done in 60 patients with polyarthritis of recent onset during a three year follow up. RESULTS: At the end of the study, 21/40 rheumatoid arthritis were positive for RF and 31/40 for APF, including 18/40 cases (45%) in which ACR criteria were not yet fulfilled. CONCLUSIONS: APF are useful in the diagnosis of early rheumatoid arthritis.

Antibodies, Antinuclear↗
PubMed1997

Cost of combined modality interventions for stage III non-small-cell lung cancer.

PURPOSE: To evaluate the cost-effectiveness (CE) of new combined modality strategies in patients with stage III non-small-cell lung cancer (NSCLC). METHODS: Recent studies suggest that combined modality therapy confers a survival advantage for patients with stage III NSCLC. Using the Statistics Canada (Ottawa, Canada) lung cancer costing model, we have evaluated the CE of these interventions using 1993 Canadian health care costs and the perspective of the government as payer in a universal health care system. RESULTS: We estimate that the cost to treat a stage IIIa NSCLC patient with preoperative and postoperative chemotherapy would increase by $15,886, and a similar combined modality approach with the addition of postoperative radiotherapy would increase the cost by $22,963. Chemoradiotherapy for stage IIIb NSCLC would produce a smaller incremental cost of approximately $8,912 per case. However, these approaches are remarkably cost-effective, with cost per life-year gained (LYG) ranging from $3,348 to $14,958. Administering all chemotherapy in the outpatient department would improve CE. For sensitivity analysis, we reduced the survival gain that resulted from the three interventions by 25% and 50%, and increased the hospital per diem rates by 10%, 20%, and 30%. CONCLUSION: Even with the most adverse assumptions, the CE estimates were all considered acceptable for new health care technologies in Canada. Overall, it appears that neoadjuvant therapy for stage IIIa NSCLC and combined modality therapy for stage IIIb NSCLC are cost-effective. Economic considerations should not be a barrier to their adoption.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Joint manifestations in myelodysplastic syndromes. A report of three cases presenting as polymyalgia rheumatica.

We report three cases of polymyalgia rheumatica occurring after (n = 1) or shortly before (n = 2) a diagnosis of myelodysplastic syndrome. These cases demonstrate that: 1) inflammation and bleeding are not the only causes of anemia in patients with inflammatory joint disease; 2) side effects of drugs, Felty's syndrome and large granular lymphocyte expansion are not the only causes of neutropenia in this setting; 3) lymphomas and monoclonal gammopathies are not the only hematologic diseases that can present under the guise of polymyalgia rheumatica; 4) a high index of suspicion for a myelopoietic disorder should be maintained in patients who have not only joint symptoms and cytopenia, but also vasculitis, neurologic symptoms, thyroid disorders or protein electrophoresis abnormalities. Because myelodysplastic syndromes are due to clonal proliferation of abnormal stem cells, our cases are in line with recent investigations suggesting that abnormalities of bone marrow stem cells are involved in the pathogenesis of some inflammatory joint diseases. Studies of the clonality and karyotype of synovial cells from affected joints might lend further support to this hypothesis.

Aged↗
PubMed1997

Lumbar spinal stenosis: a review.

Neurologic compromise due to degenerative disorders of the lumbar spine are designated by the generic term "lumbar spinal stenosis". Differences in the interpretation of this term exist across the fields of pathology, radiology, and rheumatology, creating significant confusion. Rheumatologists view lumbar spinal stenosis as a functional rather than an anatomic entity and hold that its diagnosis should be based on clinical grounds. As in disk disease, imaging studies lack sensitivity and specificity, are poorly correlated with the level and severity of manifestations and are of no assistance for predicting the preoperative or postoperative outcome. A detailed history is the mainstay of the diagnosis and also carries great weight for estimating the level of impairment due to spinal stenosis. In contrast, "objective" physical findings have little predictive value and are poorly correlated with both quality of life indicators and postoperative outcomes. The effect of surgery remains unpredictable in the individual patient. Remarkable uniformity has occurred among published series regarding the rate of poor surgical outcomes (about one case in three), postsurgical worsening of symptoms (one case in six) and postsurgical complications (one case in ten). Accurate data are lacking on the short-term and long-term efficacy of conservative therapy (local corticosteroid injections and kinesiology). Randomized studies are needed to compare conservative therapy and surgery in terms of quality of life and other long-term outcomes in patients who fail initially to respond to conservative management. Improved knowledge of the natural history of this ill-defined syndrome is among the benefits expected from such studies.

Age Factors↗
PubMed1997

Evaluation of a French version of the Bath Ankylosing Spondylitis Disease Activity Index in patients with spondyloarthropathy.

OBJECTIVE: To develop a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and to determine its metric properties in patients with all forms of spondyloarthropathies (SpA). METHODS: A French version of BASDAI was obtained after a translation and back-translation process. Patients fulfilling the European Spondylarthropathy Study Group or Amor criteria for SpA were included. BASDAI of Day 0, Day 1, and, when treatment was changed, Day 8, and other clinical and biological disease activity variables were recorded, along with assessment of disease activity by the physician or the patient. Scalability, reproducibility, sensitivity to change, internal consistency and redundancy, and construct validity of the index were assessed. RESULTS: We studied 293 patients. Good scalability, reproducibility, construct, and internal validity were observed for BASDAI. Sensitivity to change could not be assessed. CONCLUSION: The French version of BASDAI exhibited good metric properties in patients with all forms of SpA, confirming its utility in further clinical research in SpA. However, sensitivity to changes due to drug therapy remains to be assessed.

Adult↗
PubMed1997

Enalapril-induced vasculitis resembling rheumatoid arthritis, lupus, sicca syndrome, and giant cell arteritis.

We report a case of vasculitis in a 67-year-old woman who successively developed over a four-month period clinical manifestations suggestive of rheumatoid arthritis, lupus, sicca, syndrome and finally giant cell arteritis. All her symptoms resolved promptly upon discontinuation of enalapril and none recurred over the five-year follow-up period. The only residual manifestation is Jaccoud's arthropathy of the hands.

Aged↗
PubMed1996

Selection of T cells reactive against autologous B lymphoblastoid cells during chronic rheumatoid arthritis.

The repertoire and Ag specificity of T cells infiltrating inflamed joints from a chronic rheumatoid arthritis (RA) patient were studied in detail. Repertoire analysis demonstrated a reduced clonality of joint-infiltrating lymphocytes (JIL) as compared with patient's PBL, which was presumably due to an intra-articular expansion of T cell clones with recurrent TCR features. Strikingly, a large fraction of these JIL T cell clones, which were predominantly CD8+, proliferated in vitro when exposed to autologous B lymphoblastoid cells (BLC), unlike randomly chosen PBL clones derived from the same patient. This proliferative response was HLA-restricted, which confirmed a classical TCR-mediated recognition of BLC and was not observed against autologous PHA blasts, suggesting recognition of either EBV or B cell-specific Ags. Finally, a preliminary analysis of synovial lymphocytes derived from another chronic RA patient demonstrated a similar enrichment for T cells reactive against autologous BLC within JILs as compared with patient's PBLs. Taken together, these results, which suggest frequent expansions of autologous BLC-reactive T cells within inflamed joints of chronic RA patients, provide a basis for future studies evaluating the fine specificity and pathogenicity of these lymphocytes.

Adult↗