Pini as a mortality index in the hospitalized elderly patient.
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A group of 63 patients infected by HIV and presenting with CD8 hyperlymphocytosis (CD8+) has been studied. CD8 hyperlymphocytosis was defined by the presence, during at least three months, of at least 1,500 CD8 circulating lymphocytes. The CD8+ patients (n = 63) were identified and followed within the cohort (1,444 patients) of the "Groupe d'Epidémiologie Clinique du SIDA en Aquitaine " (GECSA). CD8+ patients were compared with a control group of 126 HIV infected patients without CD8 hyperlymphocytosis recruited within the GECSA cohort and followed in the same manner during two years. The occurrence of opportunistic infections was less frequent in CD8+ patients. The proportion of patients with a CD4 lymphocyte count below 200/mm3 was lower in the CD8+ group than in the CD8- group at inclusion and at the last check-up (P less than 0.01). A tendency for longer survival and delayed onset of AIDS was noted in CD8+ patients. Such a difference in prognosis might be due to a peculiar cytotoxic response against HIV among CD8+ patients. Further follow-up of a larger group of patients is needed to confirm this hypothesis.
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The wealth of information in vascular pathology merits close examination. The French Cardiology Society vascular group turned its attention to arteries, veins, hypertension and a more fundamental investigation to analyse the results from some illuminating studies which appeared in 2004, despite some pertinent therapeutic doubts. Examination of the trials discussed here shows the importance, as much in vascular pathology as elsewhere, of founding our practice on evidence based medicine.
Echo-duplex exploration of heart and inferior limbs arteries is performed in 76 patients less than 60 years old, with angiographically established coronary heart disease. Peripheral vascular lesions are found in 15 cases (20%), they are more frequent in patients with tritrunkular coronary disease (35%) than in those with one (16%) or two-vessel lesions (10%). Mean encephalic circulatory resistance index is higher in patients with tritrunkular lesions (p less than 0.03). Vascular echo-duplex should be performed in case of coronary disease in order to avoid catheterism complications and to purpose combined surgical procedure (coronary bypass and carotid endarterectomy).
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It is illusory to think that one year is long enough to establish all the truths that will guide our clinical practice in vascular medicine. On the contrary, one year was long enough to contradict what the preceding twelve months had set out to demonstrate. Consequently, promising trials in the treatment of abdominal aortic aneurysms by endoprostheses have been the object of contradictory debate with regards to the long-term benefits. In fundamental research, circulating progenitors of endothelial cells have been shown to be a marker of atherosclerosis, but is it a better marker than LDL-cholesterol values? The demonstration that these progenitors are of value in the treatment of essential ischaemia of the lower limbs is awaited. Finally, ximelagatran, a direct thrombin antagonist, seemed to have all the qualities of an ideal anticoagulant: easy to use, safe... until the report of raised hepatic enzymes, the clinical relevance of which remains to be determined. In the good news section: the Systolic Pressure Index, an unquestioned marker of arterial disease. Its reduction was known to be correlated with the prevalence of cardiovascular complications. However, it has now been shown that an increase in the index is also associated with cardiovascular complications, a real U-shaped curve. Renal arterial stenosis should be considered in patients with left ventricular failure presenting with flash pulmonary oedema. In the absence of cardiac pathology, BNP would seem to be a good biological marker of haemodynamically significant renal arterial stenosis. Finally, should superficial femoral artery stenosis be treated by an active stent. To date, there is no formal proof.
OBJECTIVE: To analyse the dietary habits of pregnant women in two base Health areas and to propose modifications in any damaging patterns found. DESIGN: A descriptive study of a crossover type using weekly dietary questionnaires on food consumption and a 24-hour record. SETTING: Almanjayar and Cartuja Health Centres in Granada. PARTICIPANTS: Pregnant women being monitored at the Health Centres who were chosen by randomized sampling (N = 52). MEASUREMENTS AND MAIN RESULTS: We studied the following variables: total energy consumption; intake of carbohydrates, lipides, proteins, fibre, Ca, Mg, Zn, Fe and hydrosoluble and liposoluble vitamins. Average energy consumption was 2516 Kcal per day, although 14.46% of the pregnant women consumed less than 2200 Kcal and in 9.6% average consumption was below 1800 Kcal per day. The energy percentages of total consumption are excessive in the case of proteins (21%), lightly increased in Carbohydrates (51.8%) and acceptable in Lipides (27.2%). In the following there were notable intake deficiencies: Ca (69%), Fe (38.4%), Mg (53.8%), Vit D (49.7%), Folic Acid (81%) and Fibre (33%). On the question of how often food was consumed, we should note the scant consumption of vegetables and alcohol and excessive consumption of refined Carbohydrates. CONCLUSIONS: There are no big nutritional imbalances. The following are necessary: to maintain energy intake between 2200 and 2600 Kcal per day; to find a new equilibrium between animal and vegetable protein consumption, to diminish the intake of complex and refined Carbohydrates and to increase the intake of Fe, Ca, Folic acid and Vitamin D.
Mycoplasma hominis, a mycoplasma potentially isolated from the genital tract of healthy women, seems to have some role in pelvic inflammatory diseases (PID). Three serologic techniques were developed to detect antibodies to M. hominis: ELISA (IgG, IgM), microimmunofluorescence (MIF) and Western blot. Rabbit and human control sera were used to establish the standard assay conditions. ELISA proved to be more sensitive but less specific than MIF. Cross-reactivity with antibodies to M. pneumoniae existed with ELISA but not with MIF. Twenty six and 60 kDa proteins were responsible for that cross-reactivity, as assessed by Western blot analysis. Among 33 patients with PID, 18 to 35 year old, 67% had antibodies to M. hominis by ELISA and 33% by MIF. Among 52 age comparable healthy women, 44 and 13% were positive for M. hominis by ELISA and MIF respectively. The Western blot analysis showed heterogeneity in the antibody response to M. hominis, but a 76 kDa protein reacted with half of the tested sera. Our study agrees with some role for M. hominis in PID. M. hominis was certainly the primary pathogen in one case, played a role that was probable in seven cases, and possible in three patients.
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Dehydration is frequently encountered in elderly patients and hypodermoclysis is an alternative method of parenteral rehydration. Hyaluronidase is classically added to the solution infused subcutaneously. The local effects of hypodermoclysis with or without hyaluronidase were investigated by using a randomized double-blind study in 12 dehydrated elderly patients. Five hundred millilitres of a 5% glucose saline solution was infused subcutaneously in 2 hours in each thigh, (A) with and (B) without 250 U of hyaluronidase. Circumference and temperature of each thigh were assessed before and after the infusion. Color was evaluated after the infusion. The gain in thigh circumference was less in the presence of hyaluronidase, but the other variables did not differ. The patients were thoroughly questioned about pain: no difference was noted between solutions A and B. We conclude that hyaluronidase adds no comfort that justifies its systematic use in the hypodermoclysis of glucose saline solutions.
Concentrated irradiation (two series of 1,800 rads in 2 sessions and 3 days) separated by a rest period of 3 to 4 weeks has been used to treat 214 adult patients with brain tumors between 1965 and 1972. These included 108 glioblastomas, 18 astrocytomas and 88 brain metastases from different origins. Early side effects are moderate or inexistent provided synthetic ACTH or corticoid steroids have been given several days before irradiation. Survival is related, at least, in the first 2 groups of primary tumor to local failure. For brain metastases, death could be related to others reasons. In spite of the fact that comparison is made with a previous series of 121 cases it seems that this type of irradiation gives the same survival rates. Moreover it has specific advantages as reducing duration of hospitalization and the number of treatment sessions.
Since 1965, 118 glioblastoma and 18 malignant astrocytomas of the adult have been treated by concentrated irradiation after a more or less complete surgical excision of the tumor. Three types of irradiation have been used; at present 3 600 rads whole brain irradiation are delivered in 2 series of 1 800 rads over 3 days 20 to 30 spaced a part. All patients receive ACTH and the tolerance has been excellent. The results of this rapid palliative therapy are quite comparable to those of more classical irradiation. Because of the very short survival of these patients, it would appear advantageous to treat them in as short a time interval as possible.
In order to assess the relationship between increase of gamma-glutamyl transferase and diabetes, we measured serum gamma-glutamyl transferase in 48 male and 43 female insulin-dependent diabetics aged 20-60 years, 49 male and 41 female non insulin dependent diabetics aged 30-60 years, and in 114 male and 124 female controls (blood donors) aged 20-60 years. A1C haemoglobin was assayed in 124 diabetics. There is no increase of serum gamma-glutamyl transferase activity in insulin dependent diabetics of both sexes when compared with the controls. There is an increase of serum gamma-glutamyl transferase activity in non insulin dependent diabetics when compared either with controls (men p less than 0.02, women p less than 0.02) or with insulin dependent diabetics (men p less than 0.05, women p less than 0.02). There is no correlation between serum gamma-glutamyl transferase activity and fasting blood sugar (148 diabetics). In non insulin dependent diabetics of both sexes there is no correlation between A1C haemoglobin and serum gamma-glutamyl transferase activity. These results suggest that the increase observed in diabetics is not caused by diabetes itself, ie, by hyperglycemia, but by diabetes associated pathologies.
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Red blood cell metabolism was studied in male patients with polycythemia rubra vera (Vaquez disease) and compared to a reference sample of 74 healthy adults. A total of seventeen enzyme activities and seventeen metabolite concentrations were determined. In addition to the modifications of the hematological parameters among the polycytemic patients significant variations were detected: a decreased content of hemoglobin in the cells; significantly decreased levels of ATP, ADP and AMP associated to an accelerated turn over of these metabolites; an acceleration of the glycolytic pathway associated with an increase of the energetic charge and levels of 2-3BPG and G1-6BP. In polycythemia rubra vera patients, the modifications of the hematological and biochemical parameters were compared to previous results obtained in high altitude residents (adaptative hypoxia) and in red cells belonging to new borns.
We report an observation where a patient suffering HIV related thrombocytopenia was followed up for 23 months. Introduction or reintroduction of azidothymidine obtained a raise of platelet rate. When azidothymidine was stopped, platelet rate climbed down. This observation is in agreement with recent data suggesting efficiency of azidothymidine on HIV related thrombocytopenia.