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Biomedical subjects

P Janin

Publications and source records attributed to P Janin.

13 recordsLinked to original sources
PubMed2003

[Miliary pulmonary tuberculosis following intravesical BCG-therapy].

A patient given intravesical BCG immunotherapy developed miliary pulmonary tuberculosis. After resection of a superficial bladder tumor, the patient was given weekly intravesical BCG infusions. After the 4th session, the patient developed fever (40 degrees C), shivers, dry cough, profuse sweating, and weight loss. Initially, the chest x-ray was normal. The patient was given isoniazid (5 mg/kg) in a single-drug regimen. Rapid degradation of the general status led to a new chest x-ray, 10 days later, which demonstrated a reticulonodular syndrome. High-resolution thoracic CT confirmed the diagnosis of miliary pulmonary tuberculosis. A three-drug antituberculosis regimen associated with corticosteroids was followed by restoration of the general status. Antituberculosis therapy was continued for 9 months. The 9-month thoracic CT revealed a smaller number of micronodules in the pulmonary parenchyma. This case illustrates the discussion concerning the appropriate treatment for patients who develop a systemic infection after intravesical BCG-therapy.

Adjuvants, Immunologic↗
PubMed2000

Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study.

BACKGROUND: Hepatitis C virus (HCV) infection is highly prevalent among HIV-1-infected individuals, but its contribution to the morbidity and mortality of coinfected patients who receive potent antiretroviral therapy is controversial. We used data from the ongoing Swiss HIV Cohort Study to analyse clinical progression of HIV-1, and the virological and immunological response to potent antiretroviral therapy in HIV-1-infected patients with or without concurrent HCV infection. METHODS: We analysed prospective data on survival, clinical disease progression, suppression of HIV-1 replication, CD4-cell recovery, and frequency of changes in antiretroviral therapy according to HCV status in 3111 patients starting potent antiretroviral therapy. RESULTS: 1157 patients (37.2%) were coinfected with HCV, 1015 of whom (87.7%) had a history of intravenous drug use. In multivariate Cox's regression, the probability of progression to a new AIDS-defining clinical event or to death was independently associated with HCV seropositivity (hazard ratio 1.7 [95% CI 1.26-2.30]), and with active intravenous drug use (1.38 [1.02-1.88]). Virological response to antiretroviral therapy and the probability of treatment change were not associated with HCV serostatus. In contrast, HCV seropositivity was associated with a smaller CD4-cell recovery (hazard ratio for a CD4-cell count increase of at least 50 cells/microL=0.79 [0.72-0.87]). INTERPRETATION: HCV and active intravenous drug use could be important factors in the morbidity and mortality among HIV-1-infected patients, possibly through impaired CD4-cell recovery in HCV seropositive patients receiving potent antiretroviral therapy. These findings are relevant for decisions about optimum timing for HCV treatment in the setting of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2000

Clinical epidemiology and research on HIV infection in Switzerland: the Swiss HIV Cohort Study 1988-2000.

BACKGROUND AND OBJECTIVES: The Swiss HIV Cohort Study (SHCS) was initiated in 1988 and represented the main scientific component of the comprehensive response to the AIDS epidemic in Switzerland. It brought together physicians and scientists from five university hospitals (Basel, Berne, Geneva, Lausanne and Zurich) and two Cantonal hospitals (Lugano and St. Gallen). The objective of SHCS was, and still is, to produce rapid, high quality patient-oriented medical research in the field of HIV infection. METHODS: SHCS is a prospective population-based cohort study. Any HIV-infected person aged > or = 16 years is eligible to participate. Data collection and study procedures are standardised. Data quality and protocol monitoring are conducted at the coordination and data centre in Lausanne. Detailed information on demographics, income, mode of HIV acquisition, risk behaviours, clinical events, laboratory results, treatment and treatment tolerance is collected at registration and at 6-monthly intervals. RESULTS: Since 1996, 10,600 persons have been enrolled and the SHCS study population is considered fairly representative of the HIV-infected population in Switzerland, at least in terms of gender and mode of HIV acquisition. In 1999, 4600 patients were actively followed up and more than 70% of patients were receiving highly active antiretroviral therapy (HAART). As a consequence, mortality and the incidence of HIV-related opportunistic infections have decreased significantly in the recent past. Between 1996 and 2000, 91 original manuscripts have been published by SHCS scientists and physicians, almost exclusively in peer-reviewed journals. A wide range of scientific questions have been addressed, including HIV primary infection, the natural history of HIV infection, the clinical and biological impact of HAART, drug resistance, risk factors for disease evolution including the timing of treatment initiation, the role of CD4 receptors, the validity of HIV surveillance reports, determinants of treatment access and tolerance, clinical trials of new drug combinations, the interruption of prophylaxis following a favourable response to HAART and issues relating to quality of life and interaction between income, social level and disease evolution. CONCLUSION: The SHCS has had, and continues to have, a significant impact on medical practice, public health and research in Switzerland and beyond. It represents a network of excellence which has brought together and fostered intensive collaboration between physicians and institutions throughout this country and beyond. This was possible thanks to the support of the Federal Office of Public Health and the commitment of primary care physicians, researchers and patients. This project may be model for focused and prioritised multicentre and transdisciplinary research programmes.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Arteriovenous fistula with cardiac insufficiency disclosing kidney cancer].

A 66 year-old woman free of any coronary and valvular heart disease presented to our hospital with acute and severe congestive heart failure associated with increased blood flow-angiography showed an intraparenchymatous arteriovenous fistula of the left kidney and a kidney cancer. The patient was discharged after nephrectomy and complete heart recovery as assessed from the normality of the hemodynamic exploration of the right ventricle.

Aged↗
PubMed1996

Ureteral endometriosis revealed by an acute renal failure.

The authors report a case of an acute renal failure secondary to an obstructive bilateral ureteral endometriosis. They show the limits of the clinical diagnosis as well as the limits of additional explorations and discuss the therapeutic management at the time and in the after effects of the initial acute period.

Acute Kidney Injury↗
PubMed1995

[The frequency of surgery of benign prostatic hypertrophy].

OBJECTIVES: To calculate the incidence of surgical treatment of benign prostatic hyperplasia (BPH) in two French departments, Indre-et-Loire and C her, in order to deduce the incidence in France. METHODS: All patients operated for BPH by transurethral resection or transvesical prostatectomy were counted prospectively over a 6-month period by all surgeons of the Indre-et-Loire and Cher departments. Collection of case files was complete and based on BPH resection specimens sent to pathology. 506 patients were included in this survey. RESULTS: The mean age of the patients was 71.8 years. 78% of patients were operated by a private urologist, and 93% by a specialist urologist. The mean postoperative stay was 7.1 days and varied according to the patient's age, the weight of the prostate and the site of the operation (university hospital, private establishment and general hospital). This study allowed calculation of the annual incidence of surgery for BPH in these 2 departments: 822/100,000 men over the age of 50 years. The maximal incidence was observed during the 7th decade of life: 1,742/100,000. In our study, private urologists operated 76 patients for BPH per year. CONCLUSION: Extrapolation of these results to the French population indicates an annual incidence of surgery for benign prostatic hyperplasia in France of 776/100,000 men over the age of 50 years. On the basis of this incidence, an estimated 55,000 to 65,000 men are operated for BPH per year in France.

Adult↗
PubMed1990

[Descriptive epidemiology of tumors of the renal parenchyma in adults, in Indre-et Loire from 1980 to 1987].

296 solid renal tumors were studied retrospectively, i.e. the total number of renal tumours diagnosed in the Indre-et-Loire region between 1980 and 1987 inclusive. The crude incidence rate increased from 5.4 per 100,000 in 1980 to 8 per 100,000 in 1987. The standardised rates were 6.7 per 100,000 for men and 3.2 per 100,000 for women. These figures being quite high for France. The mean age at the time of diagnosis, 67 years for women and 65 years for men, decreased during the study, especially for women. Patients in whom the renal cancer was discovered accidentally, tended to be older than those in whom the tumour was symptomatic. The percentage of tumours discovered at stage I rose from 29 to 49% the percentage of tumours at stage IV fell from 45 to 23.5%. In parallel, the percentage of nephrectomies rose from 40 to 70%. The overall 5 year survival rate was 43.5%, rising to 71% for stage I tumours. It appeared that patients who consulted in the private sector tended to be younger and were therefore at an earlier stage in the natural history of the disease. From an epidemiological viewpoint, the introduction of ultrasonography in the Indre-et-Loire region and its more widespread use did not produce any change in the means of diagnosis of renal cancer.

Adenocarcinoma↗
PubMed1990

[Ureteral stenosis in pancreatitis. Role and value of the double J tube].

One case of right ureteral stenosis due to a flow of necrosis from an acute lithiasic pancreatitis, treated with the insertion of a double J tube, is reported. 14 cases of ureteral stenosis following pancreatitis have been found in the literature. They occur whatever the severity of pancreatitis and can either reveal it or, on the contrary, be asymptomatic. The ureteral lesions are of three kinds: compression by a pseudocyst of the pancreas, sheathing of the ureter and "ureteritis" in the flows of necrosis, necrosis of the ureteral wall. The management of these ureteral stenoses involves treating both the pancreatitis and the obstruction, according to its type. In cases of compression or sheathing of the ureter, ureteral endoprostheses inserted in an early stage allow maintaining the patency of the ureter during the healing phase. In case of ureteral necrosis, nephrostomy, then ureteral resection prove to be necessary.

Aged↗
PubMed1989

[Urologic surgery and risks of complaints in medical responsibility].

The card-index study of specialized insurance companies allowed the analysis of 82 cases concerning urological surgical procedures. Forty-two cases went to the Civil Court, 10 to the Penal Court and 5 to the Administrative Tribunal, while 5 cases were simply declared to insurance companies without judiciary consequences. Sixty-two cases concerned private plaintiffs surgeons and 34 cases concerned non specialist urologic surgeons. Sixteen plaintiffs were compensated, 9 after a conciliatory agreement and 7 after trial. There were no penal condemnations (one case on the waiting list). Impotence was the most frequent cause for complaint which was compensated. Next, came incontinence generally secondary to endoscopic resection. Retrospectively, 19 cases seemed to be unwarranted due to the dishonesty of patients (3 patients were prosecuted for unwarranted procedures). On the other hand, 32 cases seemed to be due to a lack of information given to the patients themselves or to their families, either before of after the incriminated act. The risk of prosecution is relatively low in urology. It could be decreased by careful management of the medical chart, by rapid analysis of complications and by a constant effort to inform the patient and his family.

France↗
PubMedDate not supplied

[Carcinoma in situ of the testis].

Carcinoma in situ (C.I.S.) of the testis is the only known precancerous lesion of germ cell tumours. The prevalence and the incidence of C.I.S. are both unknown, although predisposing factors have been identified: history of germ cell tumour of the contralateral testis, cryptorchidism or history of ectopic testis, decreased fertility or sterility. The incidence is higher in the presence of a combination of several of these factors. No complementary investigations have been demonstrated to be of any value in the detection of C.I.S. which can only be diagnosed, at the present time, by means of surgical biopsy. Once C.I.C. has developed, it never resolves spontaneously. In one half of cases the C.I.S. evolves into an invasive tumour over a period of 5 years. There is no consensus concerning the population in which testicular biopsy should be proposed looking for C.I.S. A large scale C.I.S. screening and detection programme has been proposed in Denmark. However, it is not clear that there is any major gain in testicular cancer morbidity and mortality in comparison with a surveillance programme of patients at risk. Apart from conservative follow-up, two types of treatment can be proposed: orchidectomy or external beam radiotherapy which appears to eradicate the C.I.S. while preserving endocrine function.

Carcinoma in Situ↗