[Therapeutic choice in complications of colonic diverticular disease. Apropos of 247 cases].
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Biomedical subjects
Publications and source records attributed to M Joubert.
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This paper presents Sphinx, an expert system for computer-aided diagnosis in diabetes therapeutic. This interactive program makes logic deductions, comprehensible for users and it is not necessary for them to know artificial intelligence methodology. An improvement of the first results is possible and necessary, but the reliability of the advice already expressed by the system makes it useful as a future physician's implement.
Two cases of encephalo-angiomatosis are reported. The clinical presentation and certain neurological findings and investigations confirm the diagnosis of a disease which is relatively rare among Blacks. The case reports were considered valuable because of the rareness of the condition. Up to 1962 only 145 cases had been reported in the world literature. Encephalo-angiomatosis or Sturge-Weber syndrome is one of the disease groups known as phakomatoses, and an attempt is made to characterize each phakomatosis condition.
A case of a 'partial Siamese twin' is discussed, and the neurological signs and operative findings are recorded. The operation was performed with the aid of a carbon dioxide laser, which not only facilitated and expedited the procedure but also ensured minimal loss of blood. The wound broke down in part, but complete healing occurred within less than a month. At the time of discharge the baby showed no abnormal neurological signs.
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Using a directional Doppler (4 MHz) coupled to a frequency analyser, authors investigate the supra-aortic trunks on 90 patients documented by arteriography. The analyser is made of a 16 filter bank system giving a spectrum composed of 16 frequency bands within range of 160 Hz to 4,800 Hz. Data analysis is made on a computer using the comparison means test and the discriminant analysis. Authors compare frequencies on normal common carotid arteries between a group (N = 102) with internal and external carotid arteries free of lesions on one hand, and a group (N = 75) with stenosis or occlusion of internal and/or external carotid arteries on the other hand. They don't note any significant difference for each on of the 16 frequency bands. Comparison of frequencies between normal subclavian arteries (N = 115) and subclavian arteries with proximal stenosis or occlusion (N = 24) shows a significant difference concerning the following bands : F12, F14, F15, F16 (p = 0.05), F13 (p = 0.01). Comparison of frequencies between normal internal carotid arteries (N = 108) and stenosed internal carotid arteries (N = 57) shows significant difference concerning : F11 (p = 0.05), F7, F8, F9, F12, F13, F14, F15, F16 (p = 0.01). On the other side, the discriminant function distinguishes a normal internal carotid artery from a stenosed internal carotid artery in 90% of cases, whatever the stenosis degree is. A discriminant function, added to this analyser, could obtain a frequency analysis easier and less expensive than by fast Fourier transform.
Three syndromes are presented in which major midline malformations of the central nervous system were associated with characteristic somatic and neurologic features in 2 or more sibs. The malformations may be suspected on clinical grouds but require confirmation by pneumoencephalography. In 3 French-Canadian sibships from the Saguenay-Lac St. Jean area of Quebec, patients with areflexia, muscular wasting and slowly progressive weakness in a paraparetic distribution were proved to have agenesis of the corpus callosum and anterior horn-cell disease, a syndrome not previously described. In another family, mental retardation, ataxia and episodic hyperpnea were associated with agenesis of the cerebellar vermis in 4 sibs. In yet another French-Canadian family, atrophy of the cerebellar vermis was associated with mental retardation, ataxia and a mild pyramidal syndrome. Because malformations of this nature are usually considered sporadic or multifactorial in origin, recognition of these specific clinical syndromes with probable autosomal recessive inheritance is important from the point of view of genetic counseling and prevention.
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The authors report their experience, over a 26-month period, in the management of 60 parkinsonian patients with the combination of levodopa and an inhibitor of peripheral dopa-decarboxylase, Ro 4-4602. This approach to Parkinson's disease is useful, safe, and at least as effective as levodopa alone. To date there have been no recognizable toxic effects attributable to Ro 4-4602. This agent appears to prolong the duration of action of levodopa, smoothing out its therapeutic effects. The percentage of patients obtaining a very good and excellent response is slightly increased. There is a possible diminution in the late-occurring bradykinetic and hypotonic freezing episodes. Nausea and cardiac arrhythmias are lessened, as are the incidence and severity of hypotension. Abnormal involuntary movements remain the limiting adverse side effect.
A double-blind cross-over study was carried out in 54 patients with Parkinson's disease to evaluate the efficacy of amantadine hydrochloride as compared to a lactose placebo in the management of this illness. Amantadine proved to be a useful and safe addition to the armamentarium when given in daily doses of 200 mg. Forty-eight per cent of patients experienced moderate to good results while 31% showed no measurable improvement. The quality of the improvement was inferior to that obtained with levodopa, but the side effects were fewer. The study could not demonstrate a useful synergistic action between the two drugs, nor could the response to amantadine be used to predict that with levodopa. On the other hand, the addition of amantadine was useful in a few instances where optimal therapeutic doses of levodopa could not be given because of side effects. The mechanism of action of amantadine is still conjectural, but there is strong evidence to indicate some interaction with central dopamine metabolism.
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