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Biomedical subjects

R Maire

Publications and source records attributed to R Maire.

At least 19 recordsLinked to original sources
PubMed2005

[Chronic tinnitus].

Chronic tinnitus is a frequent symptom in the current medical practice. Patients presenting with chronic tinnitus have to be evaluated by comprehensive examination, including ENT status, audiometry and complete neuro-otological evaluation if required, to exclude an organic cause of tinnitus, as an external--or middle ear lesion, or a retro-cochlear process. Most often, chronic tinnitus is only associated with a sensorineural hearing-loss. Overall, no drug treatment can be proposed. However, the patient needs help and two techniques can be proposed to make the symptom more tolerable: the bio-psycho-social model, with a medical and psychological sustain, and the habituation auditory therapy, using noisers to mask the tinnitus.

Audiometry↗
PubMed2005

[True or false vertigo: a true or false question?].

Some practitioners ask on which criteria vertigo can be considered as "true" or "false". The goal of this paper is to explain why such a concept is misleading. Vertigo and imbalance are subjective symptoms caused by many possible factors, somatic or psychologic, which may cause, in turn, psychological distress in some patients. In all cases, the complain is "true", even in case of psychological disorder. To evaluate patients suffering from vertigo, knowledge in anatomy and physiology are necessary as well as knowledge of the interface between neuro-totologic and psychiatric conditions.

Diagnosis, Differential↗
PubMed2004

Visual vertigo: an observational case series of eleven patients.

BACKGROUND: Dizziness is a common symptom which is frequently due to either peripheral or central vestibular dysfunction. However, some patients may lack typical signs suggesting a vestibular or cerebellar lesion and they mostly complain of vertigo or posture imbalance induced by visual stimulation. The symptoms immediately improve either on cessation of the visual input or upon closure of the eyes. Such a presentation is typical of visual vertigo. PATIENTS AND METHODS: From 1993 to 2003, 242 patients were examined for either "vertigo" or "dizziness". The diagnosis of visual vertigo was based on both history and clinical examination and was present in 11 patients. RESULTS: Visual vertigo was diagnosed in 11/242 patients (4.5 %). Age range was 31 - 77 years (mean 47 years) with a sex ratio of 8 females for 3 males. Neuro-ophthalmological examination was normal in all cases. CONCLUSIONS: Visual vertigo is not a rare condition but the disease is underdiagnosed. The symptoms result from a mismatch between vestibular, proprioceptive and visual inputs. Neuro-ophthalmological, neurological and neuro-otological examination are often normal or not relevant and the diagnosis is largely based on history. It is important to recognize this entity because the symptoms might improve if the patients are treated with psycho-motor rehabilitation.

Adult↗
PubMed2000

Evaluation of the caloric test by combining 3 response parameters.

The slow-phase velocity of nystagmus is one of the most sensitive parameters of vestibular function and is currently the standard for evaluating the caloric test. However, the assessment of this parameter requires recording the response by using nystagmography. The aim of this study was to evaluate whether frequency and duration of the caloric nystagmus, as measured by using a clinical test with Frenzel glasses, could predict the result of the recorded test. The retrospective analysis of 222 caloric test results recorded by means of electronystagmography has shown a good association between the 3 parameters for unilateral weakness. The asymmetry observed in the velocity can be predicted by a combination of frequency and duration. On the other hand, no relationship was observed between the parameters for directional preponderance. These results indicate that a clinical caloric test with frequency and duration as parameters can be used to predict the unilateral weakness, which would be obtained by use of nystagmography. We propose an evaluation of the caloric test on the basis of diagrams combining the 3 response parameters.

Adolescent↗
PubMed2000

Dynamic asymmetry of the vestibulo-ocular reflex in unilateral peripheral vestibular and cochleovestibular loss.

OBJECTIVE: Rotatory tests in the horizontal plane have shown various degrees of vestibulo-ocular reflex (VOR) asymmetry in patients after surgical deafferentation of one labyrinth. The purpose of this work was to characterize dynamic horizontal VOR responses among patients presenting with a unilateral peripheral labyrinthine deficit of nonsurgical origin and to compare results in isolated vestibular loss versus cochleovestibular loss. STUDY DESIGN: This study included 40 patients who presented with an acute, spontaneous unilateral peripheral labyrinthine lesion. Twenty-two patients had vestibular loss alone (without associated hearing impairment) and 18 presented with a cochleovestibular deficit (sudden hearing loss with vertigo). The majority of these patients were part of a long-term protocol to evaluate vestibular compensation. METHODS: All patients underwent both the clockwise test and the counterclockwise rotatory test in the horizontal plane, using brief impulses of moderate intensity. Results were analyzed by a simplified model of vestibular function, allowing a parametric estimation of the response. RESULTS: A weak and transitory horizontal VOR asymmetry was observed in the 22 patients with vestibular loss. However, the 18 patients with cochleovestibular loss demonstrated a more severe and persistent asymmetry. CONCLUSIONS: This study revealed a difference in the dynamic characteristics of the horizontal VOR between patients with vestibular loss and those with cochleovestibular loss. Our results support the presence of an extensive labyrinthine lesion in cochleovestibular deficit that involves the otolith organs. The implications of this involvement on the central mechanisms of otolith-canal interaction are discussed.

Adult↗
PubMed2000

[Advantage of screening for for infection in suddden and progressive hearing loss].

OBJECTIVE: The aim of this retrospective study was to assess the advantage of systematic screening for infection in patients presenting with sudden or progressive sensorineural hearing loss. METHOD: 175 patients were included. 102 patients presented with unilateral sudden sensorineural hearing loss and 73 with progressive sensorineural hearing loss. Serologies tested were herpes simplex and zoster (IgM and IgG titres), Lyme disease (ELISA), syphilis (FTA-abs and MHA-TP) and HIV. RESULTS: Screening for infection was negative in 172 patients. 2 patients had positive serology for Lyme disease and one for syphilis. The case of serological syphilis was finally diagnosed as latent syphilis after ruling out neurosyphilis. Both cases of suspected Lyme disease were later invalidated by Western blot and lumbar puncture (2 false positives). CONCLUSION: Screening for infection was positive only in 1/175 patients (0.6%), rendering diagnosis of latent syphilis possible. These results suggest that, on grounds of cost-effectiveness, testing for infection should be limited to and focused on patients with a positive clinical evaluation.

Acute Disease↗
PubMed1999

Localization of static positional nystagmus with the ocular fixation test.

OBJECTIVE: Characteristics of static positional nystagmus (SPN) (i.e., persistency, direction fixed, direction changing) are observed in both peripheral and central disturbances and possess no localizing value for vestibular lesions. Our objective was to investigate whether the ocular fixation test as applied to SPN could assist in localizing vestibular lesions. STUDY DESIGN: A 3-year prospective study that included 43 patients with SPN. METHODS: All patients underwent a standard vestibular test battery and cerebral imaging (7, computed tomography scan; 36, magnetic resonance imaging). The ocular fixation index (OFI) was calculated by the ratio of the mean slow component velocity of SPN (measured with red light-emitting diode fixation) to that measured in darkness, multiplied by 100. An OFI less than 50 was considered normal. RESULTS: In 33 of 35 patients whose OFI was less than 50, the cerebral imaging was normal and a peripheral vestibular lesion was diagnosed (two benign tumors of the fourth ventricle were missed). In all eight patients whose OFI was greater than 50, the cerebral imaging was abnormal and a central vestibular lesion was noted. CONCLUSIONS: These results indicate that the visual suppression of SPN does, indeed, permit the localization of vestibular lesions. The predictive value of the ocular fixation test on the origin of SPN is greater than 94% for peripheral lesions and 100% for central disorders.

Adolescent↗
PubMed1999

[Evaluation of combined neurosurgical and trans-facial excision of extensive rhinosinus tumors infiltrating the anterior skull base].

Rhino-sinusal tumors are rare, representing approximately 0.3% of all cancers and 3% of tumors of the upper respiratory and digestive tracts. In cases in which the tumor has infiltrated the anterior cranial base, the treatment of choice is a surgical resection by combined neurosurgical and transfacial approach giving the best possible exposition for the excision. The resection is associated with various reconstruction techniques according to the extent of the defect. Sixteen patients with rhino-sinusal tumors extending to the anterior cerebral cavity were operated at the ENT clinic of the CHUV in Lausanne between 1977 and 1997. The transfacial and neurosurgical combined approach is rarely curative (30% 5 years survival rate, 80% local recurrence during follow-up), but is still justified, given that its disabling side-effects are scarce. It offers an acceptable quality of life and prevents complications inherent to the natural development of tumors. Pre- or postoperative radio- and chemotherapy, as well as skull base reconstructions using bone grafts or a micro-anastomosed flap give rise to complications which worsen significantly the overall prognosis and should therefore be avoided as much as possible. Still, this heavy surgery remains indicated, because it prevents the numerous complications of the natural course of the disease and offers an acceptable quality of life with only few side-effects.

Adult↗
PubMed1998

[Body fat distribution in a Swiss population: the AIR94 Study. Epidemiology and consequences for clinical practice].

Several recent studies reported a prevalence rate of overweight (25 < BMI < 30 kg/m2) of 4-30% as a function of age and gender. It is well known that the fat distribution pattern represents a major modifier of health risks associated with obesity. For clinical purposes the measurement of the waist to hip ratio represents one of the most valid tools for the assessment of the fat distribution pattern. During the air show AIR94 in Buochs (Nidwalden, Switzerland) 1568 visitors participated voluntarily in a study where several cardiovascular risk factors and behaviours were assessed with the help of a questionnaire, besides others the W/H ratio was measured. This study represents the first epidemiological study of the fat distribution pattern in a large population group in Switzerland. The mean (+/- SD) age of the whole population was 50.3 +/- 16.2 years, the mean body mass index (BMI) 25.5 +/- 3.7 kg/m2, the mean W/H ratio 0.89 +/- 0.09. The BMI and the W/H ratio for the different age decades was calculated. In women the normal value of 0.8 for the W/H ratio is bypassed in the 4th decade of age; the normal value of 0.95 for men is surpassed in the 6th decade of life. These findings are of great public health importance since they illustrate nicely the importance to control body weight and the fat distribution pattern early in life. The major modifiable risk factors for the abdominal accumulation of fat are the excess of calories (especially in form of fat), physical inactivity, smoking and alcohol consumption, stress and probably weight cycling. The control of these risk factors is strongly needed.

Adult↗
PubMed1998

[Rhino-orbito-cerebral mucormycosis: clinical presentation].

BACKGROUND: Rhino-orbito-cerebral mucormycosis is an opportunistic rapidly progressive infection affecting almost exclusively diabetic or immunocompromised patients. CASE REPORTS: Three cases are reported. For one patient mucormycosis was the first manifestation of juvenile diabetes and the evolution was favorable. In the second case the infection affected a known diabetic patient and the clinical course was fatal. The third patient was immunocompromised, showed mild clinical features and a rapidly fatal evolution, the diagnosis being made only postmortem. CONCLUSION: These three cases illustrate the wide clinical spectrum of rhino-orbito-cerebral mucormycosis, its serious nature and difficult diagnosis.

Adolescent↗
PubMed1997

Relationship between self-perceived stress and blood pressure.

OBJECTIVE: The importance of stress in the pathogenesis of essential hypertension is controversial. In this study we wanted to evaluate the relation between self-perceived stress and the blood pressure (BP) in a asymptomatic healthy population. SUBJECTS AND METHODS: A total of 1666 guests (mean +/- s.d. age 50 +/- 16 years) attending the air show AIR94 in Buochs, Switzerland volunteered to participate in a cross-sectional study. Using a self-administered questionnaire and visual analogue scales the individual stress perception and other cardiovascular risk behaviours/factors were assessed. BP, body weight, height, and the waist:hip ratio were measured. RESULTS: Individual stress perception was inversely related with the systolic BP (SBP) (r = -0.12, P < 0.001). The relationship was found in both men and women and was independent of age and/or body weight. No relation was found between the diastolic BP (DBP) and stress perception. Subjects with high normal BP according the JNC V classification showed a lower stress perception than did subjects with normal BP. In a multiple regression model the stress score was fourth most predictive of the SBP after body mass index, waist:hip ratio, and age followed by alcohol and fat intake. CONCLUSION: In this study we found an inverse association between the self-perceived stress and SBP. We suggest that the inverse association between BP and the self-perceived stress reflects a neuroendocrine and biochemical setting characterized by inadequate stress handling associated with a higher fat and alcohol intake and more abdominal fat tissue leading to a higher BP. Our data suggest that stress denial in combination with abdominal obesity, alcohol consumption, and smoking may be proxy for a high stress level.

Adult↗
PubMed1997

Age and sex related changes in heart rate to ventilation coupling: implications for rate adaptive pacemaker algorithms.

Minute ventilation (VE) controlled rate adaptive pacemakers determine the paced rate increase during exercise by measuring changes in transthoracic impedance that have been shown to correlate well with VE. To determine the normal coupling of heart rate (HR) to VE this relationship was evaluated in 30 younger and 25 older, healthy subjects using peak cardiopulmonary exercise testing. After determining the anaerobic threshold (AT), the linear HR to VE slope was determined both below and above the AT. In addition, the entire curve of the HR to VE relationship was assessed by a "best fit" regression analysis method. The relationship of HR to VE was more often logarithmic in younger as compared to older subjects. The HR to VE slope below the AT was always steeper than above the AT in younger subjects. Females of both age subgroups demonstrated a significantly greater slope below and above the AT. For the appropriate programming of VE controlled, rate responsive pacemakers, one should take into consideration age- and sex-specific differences in the HR to VE relationship throughout exercise. Therefore, age- and sex-specific programmable features for rate responsive parameters should be incorporated into pacemakers using VE controlled rate adaptive algorithms.

Adult↗
PubMed1996

[Enantioselectivity in the excretion of glucuronides of carprofen in man, dogs and horses].

After administration of the racemic drug, the stereoselective quantification of the enantiomers of free and conjugated carprofen was performed in human plasma and in plasma, urine and bile of dogs and horses. In humans, the plasma profile of free carprofen and its glucuronides is not stereoselective and the glucuronides excreted in urine are close to a racemate. In dogs and horses on the contrary, the R(-) enantiomer of the free drug is predominant in plasma, while urine and/or bile concentrations of the glucuronides are high in comparison to plasma with a strong selectivity for the S(+) enantiomer. Because glucuronidation of carprofen, as a carboxylic compound, is known to be the major metabolic pathway in most species, interspecies discrepancies in the stereoselective disposition of carprofen seem to be mainly related to the stereoselectivity in the excretion of the glucuronides. Finally, the high plasma concentrations of carprofen glucuronides in human in comparison to other animal species suggest that the former could be specifically subjected to immunological side effects in the time course of treatments by this type of compounds.

Animals↗
PubMed1995

Is an increased waist : hip ratio the cause of alcohol-induced hypertension? The AIR94 study.

OBJECTIVE: The mechanisms of alcohol-associated hypertension are not known. We tested the hypothesis that the alcohol-associated increase in blood pressure may be caused in part by an alcohol-induced accumulation of abdominal fat. SUBJECTS AND METHODS: A total of 842 non-smoking men (mean +/- SD age 52 +/- 16 years) attending the air-show AIR94 in Bouchs, Switzerland, volunteered to participate in a cross-sectional study. Four alcohol consumption frequency categories were self-reported, together with weight changes since the age of 20 and during the last 2 years. Blood pressure, body weight, height and the waist : hip ratio were measured. RESULTS: The results showed that 83% of the subjects were alcohol-consumers. Systolic (analysis of variance, P = 0.002) and diastolic (P = 0.009) blood pressure and the waist : hip ratio (P>0.0001) increased with increasing alcohol consumption. The self-judged dietary fat intake increased significantly with increasing alcohol consumption. Weight changes over time were positively associated with alcohol consumption. In a regression model alcohol consumption was the fourth most important contributor to systolic and diastolic blood pressure as well as to an increased abdominal fat mass. CONCLUSION: The alcohol-associated increase in blood pressure may be caused in part by an alcohol-induced accumulation of abdominal fat. Alcohol consumption favours the development of a positive energy balance and thus the abdominal deposition of fat, which is associated with an increased blood pressure. To reduce the risk of a positive energy balance and the abdominal deposition of fat, the intake of alcohol should be minimized and physical activity increased whenever possible.

Adolescent↗
PubMed1994

[Differential diagnosis of acute consciousness disorders].

The most important causes of syncope and coma are discussed. Syncope may be due to cardiac, vascular or cerebral disease. A cause of syncope is not established in up to 50% of cases. Where a diagnosis is possible the patient's history, physical examination, ECG and prolonged ECG monitoring serve to establish the underlying disease in most cases. Additional diagnostic tests should only be performed in patients with possible cardiac syncope, since these cases show a higher mortality rate than patients with non-cardiac syncope. Coma may be caused by metabolic disorders, intoxication or cerebral diseases, which are easily identified by history, physical examination and simple laboratory tests in most cases. Further evaluation of patients with unknown cause of coma depends on whether focal neurologic signs, meningeal irritation and fever are present.

Acute Disease↗
PubMed1994

Cardiac lesions after mediastinal irradiation for Hodgkin's disease.

We analysed the risk of myocardial infarctions in 339 patients with Hodgkin's disease treated with radiotherapy (rt) with or without chemotherapy. A total of 112 patients underwent cardiac testing with echocardiography, rest and exercise electrocardiogram and myocardial scintigraphy. Nearly all patients have been treated with < 2.0 Gy per fraction to the anterior cardiac region. A significantly increased risk of myocardial infarctions or of sudden death has been observed (10 patients). No cardia events have been observed in 215 non-smokers without hypertension and without coronary artery disease (CAD) already present before rt. In the heart study group (112 patients), there were 6 patients with probable or proven CAD. Five of these 6 patients had known risk factors for CAD. Echocardiography showed sclerosis of the aortic and or the mitral valves in 34 patients. Of these patients, 2 had a slight and 1 a moderate aortic stenosis, 5 had a slight and 1 a moderate mitral regurgitation. Evidence for a disturbance of the diastolic function has not been observed. No patient had a clinically relevant pericardial lesion. In patients without risk factors for CAD, there is only a low risk of ischaemic cardiac events after modern mediastinal rt for Hodgkin's disease. Patients should eliminate the known risk factors. There is a high incidence of sclerosis of the mitral and or the aortic valves developing into clinically important lesions in few patients. Decision on the treatment strategy and the rt technique should also involve consideration of the cardiac risk. For routine follow-up, we recommend inclusion of an echocardiography in intervals between 3 and 4 years.

Adult↗
PubMed1994

Abnormalities of left ventricular flow following mitral valve replacement: a colour flow Doppler study.

Left ventricular flow patterns were studied at rest by colour flow Doppler echocardiography in 33 patients with mitral tilting-disc prostheses (group 1), in 38 patients with mitral tissue prostheses (group 2) and in 18 healthy volunteers (controls). A 'crossed' flow pattern was seen in 14 patients with mechanical (42%) and in 15 patients with tissue prostheses (39%). The remaining patients and all controls had either 'parallel' or 'intermediate' flow patterns which were classified as 'normal'. There was a significant correlation between the type of flow pattern and the position of the mitral prosthesis in both study groups. The presence of a crossed flow pattern, however, was not related to functional status (assessed clinically by NYHA class) or to abnormalities on the electrocardiogram. Left atrial size was greater in patients with crossed flow than in those without, but all other echocardiographic parameters were similar. Eight patients with crossed and eight with normal flow patterns underwent treadmill exercise testing; there was no difference between the two groups with regard to exercise performance as determined by exercise duration, maximum oxygen consumption and the ventilatory response to exercise. The results of this study indicate that the pattern of blood flow within the left ventricle may be fundamentally altered by the orientation of both mechanical and tissue prostheses. The presence of a crossed flow pattern is not, however, accompanied by significant deleterious haemodynamic or functional consequences.

Adult↗