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Biomedical subjects

O Lamy

Publications and source records attributed to O Lamy.

At least 19 recordsLinked to original sources
PubMed2006

[Clinical research in general internal medicine: present and future perspectives].

The ultimate goal of research in general internal medicine is to produce knowledge that contributes to improving patient care. Internal medicine patients, particularly those with multiple chronic illnesses, need studies that help physicians to apply existing medical knowledge to achieve the greatest medical benefit, while conserving precious health care resources. In this article, we discuss what features general internal medicine research should include to meet the needs of practicing internists and their patients. We briefly describe research topics particularly relevant to general internal medicine such as health technology assessment, quality of care studies, and studies comparing the impact of different systems of care.

Biomedical Research↗
PubMed2006

[Everyday bioethics in general internal medicine].

The knowledge of the national legislation and the key concepts of bioethics are necessary for medical practice. The four principles of bioethics are autonomy, beneficence, non-maleficence, and justice. General internal medicine is the speciality of comprehensive care for often elderly patients with multiple chronic illnesses. This care is related to many ethically difficult decisions. In our article, we discuss common ethical problems in general internal medicine, including ethical aspects of the patient-physician relationship and medical decision making, the ethical significance of time management, research in bioethics and medical education.

Bioethical Issues↗
PubMed2006

[Spontaneous hemoperitoneum: diagnosis, prognosis and possible therapeutics].

We report the case of a 58-year-old diabetic man admitted to the hospital in a comatose state due to medicamentous hypoglycemia in a context of hypovolemic acute renal failure. Hypovolemia was due to hemoperitoneum in a alcoholic patient with cirrhotic hepatic failure. CT-scan and arterial angiographies revealed a voluminous isolated hepatic mass with active bleeding suggesting the diagnosis of spontaneous bleeding from a hepatocellular carcinoma. The hemorrhage resolved after selective arterial embolization, but the patient died two weeks later from an infectious cause. The differential diagnosis of a spontaneous hemoperitoneum and possibilities of treatment in the case of ruptured hepatocellular carcinoma are discussed.

Carcinoma, Hepatocellular↗
PubMed2006

[Microscopic polyangiitis: an unusual case report].

A 56-year-old woman was referred to our hospital because persistence of fever and inflammatory syndrome after antibiotic treatment for pneumonia. In the past, no special feature. Physical examination revealed only--at first--a pneumonia. Two weeks after, associated with the cough, she developed an acute renal failure. The laboratory revealed an inflammatory syndrome associated with proteinuria, hematuria and anti-neutrophil cytoplasmic antibodies. The CT of thorax shows aspecific infiltrations. The renal biopsy, in the context of the patient, diagnosed an microscopic polyangiitis. All the symptom resolved with the initiation of corticoid and cyclophosphamide treatment.

Autoimmune Diseases↗
PubMed2006

[Osteoporosis and digestive disease].

All patients receiving cortisone for more than 3 months should be offered not only calcium and vitamin D supplementation but also bisphosphonates in order to decrease the fractural risk. A screening for celiac disease should be performed in all patients with idiopathic osteoporosis. Following hepatic transplantation, the administration of bisphosphonates should be the rule.

Anti-Inflammatory Agents↗
PubMed2005

[Should we detect osteoporosis, and how?].

Osteoporotic vertebral and hip fractures, which are very frequent among elderly, are associated to an excess of mortality, as well as to an important morbidity. In Switzerland, annual costs of in-patients' treatments of osteoporosis are beyond CHF 700 millions. As several effective treatments against osteoporosis are available, a systematic screening is justified. The methodical search for risk factors of fracture and the recognized medical indications for bone densitometry are of prime necessity. The appreciation of clinical symptoms associated to prevalent vertebral fractures (wall-occiput distance, ribs-pelvis distance) is an essential component to patients' approach. Thanks to technological progress in the field of DXA, which allows a visualisation of the spine from L4 to T4, this screening should become easier.

Aged↗
PubMed2005

[Pulmonary infiltrates and peripheral blood eosinophilia].

A 43-year-old asthmatic woman was hospitalised because of fever, cough, expectorations and asthenia. Chest X-rays showed bilateral pulmonary infiltrates. Peripheral blood eosinophilia was greater than 9 G/l. Bronchoalveolar lavage revealed a massive eosinophilia. The clinical features were consistent with a chronic eosinophilic pneumonia. All the symptoms resolved with the initiation of prednisone treatment. The differential diagnosis of eosinophilic pneumonia is discussed.

Adrenal Cortex Hormones↗
PubMed2005

[Fever of unknown origin with granulomatous hepatitis, uveitis and acute renal failure].

A 46-year-old man was referred to our hospital because of fever of unknown origin (FUO). Two months before admission, he noted fever, weight loss, and asthenia. Physical examination revealed only mechanical pains of the right shoulder. In the past, patient's father had a tuberculosis. At the age of 29 years, Brucella granulomatous hepatitis and B hepatitis were diagnosed. The past three years, he developed two episodes of uveitis which resolved with local treatment. The hepatic biopsy revealed only a non specific granulomatous hepatitis. Few days after admission, the patient developed acute renal failure without proteinuria or hematuria. The renal biopsy confirmed the presence of noncaseating granulomas. In the context of the patient, we diagnosed a sarcoidosis. All the symptoms resolved with the initiation of prednisone treatment. The FUO differential diagnosis, and the different aspects of renal sarcoidosis are discussed.

Biopsy, Needle↗
PubMed2005

[Pancytopenia, haemolytic anaemia, schistocytes: a frequent pathology mimicking a rare and serious pathology].

A 83 years old woman presents to our hospital with fatigue and dyspnea since 2 weeks, followed by a painless icterus. On laboratory we discover a pancytopenia with severe haemolytic anaemia, thrombopenia and schistocytosis. This association suggest a thrombotic microangiopathy. In the presence of macrocytes, hypersegmented neutrophils and a low reticulocytes count, a vitamin screening was performed witch leads to the discovery of a vitamin B12 and folic acid deficiency. After initiation of a vitamin therapy we observe a reticulocytic crisis and thereafter the normalisation of the haematological parameters.

Aged↗
PubMed2004

[Effects of different treatments for osteoporosis on prevention of fractures: toward and individualized and economic approach].

The aim of this paper is to review the benefice of various antiosteoporotic treatment (calcium and vitamin D, raloxifene, bisphosphonates, calcitonin, PTH, strontium ranelate) and to discuss for which women with osteoporosis these treatments are efficient. The age, previous fractures, and bone mass measurement (T-score) identify women at high risk for subsequent fracture. The development of assessment tools for predicting fracture risk, the use of the NNT (number needed to treat), and economical analyses including QALY (quality-adjusted life-year) are particularly helpful. Economical analyses take into account the health care resources needed to get these benefits. At 50 years, only calcium and vitamin D are cost-effective, whereas at 70 years, bisphosphonates and raloxifene are also cost-effective.

Aged↗
PubMed2004

[Preventing of postmenopausal osteoporosis by hormone replacement therapy? Is the risk acceptable?].

Over the past two decades, multiple observational studies have suggested that hormone replacement therapy (HRT) reduced the risk of fracture, increased the quality of life and protected against the cardiovascular disease. HRT was often recommended, on the basis of this evidence, for that indications. But these recommendations were based entirely on observational evidence, which can sometimes be misleading. In the early 1990, several large randomized studies were initiated. The largest of these trials, the Women Health Initiative (WHI) was stopped prematurely last summer (only the group with estrogen plus progestin) because the disadvantages outweighted the advantages of treatment. The conclusions of that study were largely debated in the press and destabilised more than one patient or doctor. The Swiss menopausal society published some directive to precise the indications of HRT.

Age Factors↗
PubMed2004

[Vertebral fracture: a major risk factor for osteoporosis].

At the age of 50, a women has a lifetime risk of more than 30% to present a radiological vertebral fracture (vertebral deformity). Among the women of 50 to 79 years, 12 to 20% of them have one or more prevalent vertebral deformities. For Switzerland, it represents about 130,000 to 220,000 women. For men, the global prevalence of these fractures is the same. However, they usually happen in younger men who are exposed to greater trauma than women. The situation is more dramatic in patients hospitalised for a hip fracture, because about 3/4 of them have one or more vertebral deformities. It is important to detect these vertebral deformities because they represent a significantly higher risk to have subsequent fractures, particularly vertebral (approximately 5x), but also hip fractures (approximately 2x). This risk remains increased, whatever is the number or the grade of the deformities, although it is higher in patients with many fractures or with severe deformities. It is also important to detect vertebral deformities, because cost-effectiveness of treatments such as bisphosphonates, calcitonin, raloxifen, or PTH is the highest in patients with prevalent vertebral deformities. Unfortunately, only 1/3 of vertebral deformities are diagnosed. In consequence, it is of major importance to develop screening and diagnosis strategies for these deformities. Morphologic vertebral assessment by DXA should be an interesting approach for this purpose.

Age Factors↗
PubMed2004

Full-course oral levofloxacin for treatment of hospitalized patients with community-acquired pneumonia.

Most guidelines for the management of hospitalized patients with community-acquired pneumonia (CAP) recommend commencing therapy with intravenous antibiotics, primarily because of concern about absorption of oral antibiotics in acutely ill patients. However, patients who respond are rapidly switched to oral therapy, which has been shown to reduce costs and to shorten the length of stay. The aim of the present study was to determine whether a full course of oral antibiotics is as efficacious and as safe as intravenous-to-oral sequential antibiotic therapy for the treatment of hospitalized, non-ICU patients with CAP. In an open-labelled, controlled study, 129 hospitalized patients with CAP were randomly assigned in a 2:1 ratio to receive either a full course of oral levofloxacin (500 mg q12 h) or an intravenous-to-oral sequential therapy consisting of intravenous ceftriaxone (2 g q24 h) with or without clarithromycin (500 mg q12 h) followed by an oral antibiotic (a beta-lactam agent in the majority of patients). The primary study endpoint was the resolution of CAP; secondary endpoints included length of stay and overall mortality. CAP resolved in 72 of 79 (91.1%) patients in the levofloxacin group and in 34 of 37 (91.9%) patients in the intravenous-to-oral sequential therapy group (difference, -0.8%, 95%CI, -11.6-10.0). Median length of stay was 8 days (range, 2-74 days) in the levofloxacin group and 10 days (range, 3-29 days) in the intravenous-to-oral sequential therapy group ( P=0.28). Day 30 mortality rates were 1.3% (1 of 79) and 8.1% (3 of 37), respectively (difference, -6.8%, 95%CI, -16.0-2.3). Full-course oral levofloxacin is as efficacious and as safe as standard intravenous-to-oral sequential antibiotic therapy for the treatment of hospitalized patients with CAP.

Administration, Oral↗
PubMed2004

Cost-effectiveness of full-course oral levofloxacin in severe community-acquired pneumonia.

Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP). The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money. Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment. Direct and indirect costs were compared over a 30-day period from several perspectives. CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%). Patients' characteristics, treatment duration, hospital length of stay and mortality were similar in both groups. Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians' visits during follow-up and their total costs were lower. As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups. In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs. External factors linked with patients' characteristics and/or medical practice are likely to play a role and should be addressed.

Aged↗