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Biomedical subjects

V Vandewalle

Publications and source records attributed to V Vandewalle.

7 recordsLinked to original sources
PubMed2004

[The costs of asthma in France: an economic analysis by a Markov model].

INTRODUCTION: In France about 3.5 million people suffer from asthma, with an estimated annual cost of 1.5 billion euros. Few data on the components of the cost are available. To develop a medico-economic model to identify the mean annual cost of a patient with asthma together with the components of the cost and the consequences of different modalities of management (out-patient and in-patient). METHODS: A first degree homogeneous Markov model was constructed, based on published data, to identify the different states of health of asthmatic patients, their development and probabilities of change from one to another. RESULTS: The mean annual cost of asthma is 631 +/- 299 euros; 298 euros for stable patients, 1,052 for those who have at least one acute attack and 3,811 for those hospitalised. Actions leading to better control of the disease in the community (prevention and management of attacks) would produce a larger reduction in mean costs than actions undertaken in patients seen as an emergency or admitted to hospital. CONCLUSIONS: From the point of view of society better control of asthma in the community is the most effective strategy to reduce expenditure.

Asthma↗
PubMed2000

99Tc(m)-ECD SPET perfusion changes by internal pallidum stimulation in Parkinson's disease.

High-frequency stimulation of the internal pallidum is an effective surgical approach for patients with advanced Parkinson's disease suffering from motor fluctuations and L-dopa induced dyskinesia. To study the acute effects of internal pallidum stimulation, changes in cerebral blood flow were measured by means of a single-day split-dose protocol using 99Tc(m)-ECD SPET. Nine patients with advanced Parkinson's disease and with a clinical picture predominated by tremor and drug-induced dyskinesia, were imaged before and immediately after electrostimulation. Brain perfusion data were mirrored to the same electrode side (five left and four right implants), co-registered and analysed statistically on a voxel-by-voxel basis (Statistical Parametric Mapping) and by an automated volume-of-interest approach. Acute stimulation of the internal pallidum induced a significantly decreased perfusion in the ipsilateral thalamus and striatum, as well as in the right parietal cortex. For the subgroup of seven patients with effective motor score improvements, a significant correlation between thalamic and striatal perfusion changes and UPDRS III motor score was present (P = 0.04). These results suggest that effective stimulation of the internal globus pallidus may produce symptom relief through decreased activity in pallido-thalamo-cortical circuits.

Adult↗
PubMed2000

Use of an implantable cardioverter defibrillator in a patient with two implanted neurostimulators for severe Parkinson's disease.

We report a patient with Parkinson's disease treated with two pectorally implanted neurostimulators (NSs) who presented with a life-threatening ventricular tachyarrhythmia in whom an abdominal ICD was implanted. Testing during implantation showed that the NS did not affect the bipolar sensing of the ICD, even when the NSs were set at a frequency of 130 pulses/s with an output of 5 V and pulse width of 0.21 ms in a bipolar and a unipolar configuration. The ICD shock, however, did affect both NSs: there was a reset to the output Off state and there was a reset of the electrode polarities.

Defibrillators, Implantable↗
PubMed1999

Changes in quality of life following unilateral pallidal stimulation in Parkinson's disease.

Twenty patients with Parkinson's disease (age range 38-70 years) completed the Sickness Impact Profile (SIP) 2 months before and 3 months after long-term high-frequency electrostimulation of the globus pallidus internus to improve clinical symptoms. The SIP provides an estimate of perceived quality of life on 12 health-status categories. Neurological assessment with the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale revealed a significant postoperative reduction in clinical symptomatology (p<0.001). The patients experienced a general improvement in self-reported quality of life that exceeded the purely motor and physical aspects of quality of life. The significant postoperative drop in perceived impairment of communication skills can be considered the most important subjective improvement. Longitudinal research on a larger sample of patients is necessary to evaluate the durability of the subjective improvement in quality of life after unilateral pallidal stimulation.

Adult↗
PubMed1999

Cognitive outcome after unilateral pallidal stimulation in Parkinson's disease.

OBJECTIVES: Chronic high frequency electrostimulation of the globus pallidus internus mimics pallidotomy and improves clinical symptoms in Parkinson's disease. The aim of this study was to investigate the cognitive consequences of unilateral deep brain stimulation. METHODS: Twenty non-demented patients with Parkinson's disease (age range 38-70 years) were neuropsychologically assessed 2 months before and 3 months after unilateral pallidal stimulation. The cognitive assessment included measures of memory, spatial behaviour, and executive and psychomotor function. In addition to group analysis of cognitive change, a cognitive impairment index (CII) was calculated for each individual patient representing the percentage of cognitive measures that fell more than 1 SD below the mean of a corresponding normative sample. RESULTS: Neurological assessment with the Hoehn and Yahr scale and the unified Parkinson's disease rating scale disclosed a significant postoperative reduction in average clinical Parkinson's disease symptomatology (p<0.001). Repeated measures multivariate analysis of variance (using right/left side of stimulation as a between subjects factor) showed no significant postoperative change in cognitive performance for the total patient group (main effect of operation). The side of stimulation did not show a significant differential effect on cognitive performance (main effect of lateralisation). There was no significant operation by lateralisation interaction effect. Although the patients experienced significant motor symptom relief after pallidal stimulation, they remained mildly depressed after surgery. Analysis of the individual CII changes showed a postoperative cognitive decline in 30% of the patients. These patients were significantly older and took higher preoperative doses of levodopa than patients showing no change or a postoperative cognitive improvement. CONCLUSIONS: Left or right pallidal stimulation for the relief of motor symptoms in Parkinson's disease seems relatively safe, although older patients and patients needing high preoperative doses of levodopa seem to be more vulnerable for cognitive decline after deep brain stimulation.

Adult↗
PubMed1988

Mitotic activity in cerebrospinal fluid cells.

Mitotic figures were observed in 38 cases of a series of 3200 CSF cytograms. Their relative incidence was the highest in cases of tumoural invasion of the CSF, but they also occurred in inflammatory and reactive fluids and did not necessarily indicate tumoural origin. In bacterial infections of the central nervous system they were mainly present during the repair phase of the disease. In haemorrhagic spinal fluid they were absent. These findings suggest that cell division in spinal fluid tends to develop in conditions in which the viability of the cells is not affected by introduction of foreign material such as blood and bacteria.

Adult↗