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1.
I. Gallais Sérézal S. Le Jeune X. Belenfant R. Bakir O. Fain A. Mekinian N. Gambier L. Mouthon O. Steichen P. Blanche J.-J. Mourad R. Dhôte 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2014
Purpose
Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up.Methods
We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy.Results
Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55 ± 13 years old. The mean creatinine clearance was 66 mL/min/1.73 m2 and the mean CRP was 45 ± 36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P = 0.023), diabetes (P = 0.007), and initial renal insufficiency (P = 0.05) were associated with a risk of chronic renal insufficiency.Conclusion
The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF. 相似文献2.
Background
The Mediterranean diet is one of the food models which showed its ability at the patient at high cardiovascular risk in numerous cohort studies and two major interventional studies: Lyon Heart Study in 1999 and PREDIMED in 2013.Aim of the study
Propose a practical assistance in the analysis of the dietary habits of the coronary patient with a simplified food frequency questionnaire.Patients and methods
Hundred coronary patients followed a program of cardiac rehabilitation and benefited from a nutritional education. The analysis of their dietary habits was made with the questionnaire of frequency of consumption of Rennes upon their arrival and 6 months later. We have coded again these data by means of a simplified questionnaire with 15 items and compared the results and their evolution in 6 months.Results
On studied 200 questionnaires, the score of Rennes was 10.6 ± 4.5 and the simplified score 8.2 ± 3.4 with a coefficient of correlation of Pearson r = 0.94 (0.91–0.95) at risk P < 0.0001. Initial scores were respectively 8.0 ± 4.4 and 6.3 ± 3.4 (r = 0.93) and the scores at 6 months 13.1 ± 2.9 and 10.1 ± 2.2 (r = 0.86). The evolution of the scores of 100 patients were respectively 14.2 ± 11.7% and 12.6 ± 11% (P < 0.26).Conclusion
The use of a simplified questionnaire allows to analyze the dietary habits of the coronary patient and to estimate their evolution during a therapeutic educational program. 相似文献3.
4.
P.-G. Reuter S. Kernéis C. Turbelin C. Souty C. Arena G. Gavazzi M. Sarazin T. Blanchon T. Hanslik 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2012
Purpose
In-patients characteristics generate cost differences between hospitals. In France, there are few data on the characteristics on the patients referred to hospitals by their general practitioners (GPs) and none on the predictors of referral to the public or for-profit hospitals. The aim of this study was to analyze those characteristics and the predictors of referral to the public or for-profit hospitals.Methods
We collected, prospectively, the request for hospitalizations made by the GPs of the Sentinelles network in France, from 2007 to 2009. Patients’ characteristics and also the reasons for that request were analyzed. A logistic regression was used to compare the population between local hospitals.Results
Ten thousand seven hundred and eighteen statements were collected. The median age was 73 years. Patients were women in 51% of the cases, and only 14% of the hospitalizations had been planned. Hospitalization in the public sector was preferred for young children and the elderly (P < 0.001). When compared to the patients referred to the private sector, patients addressed to the public sector were more often seen for emergencies (OR: 2.3 [2.0–2.8]), by a doctor different from their referring GP (OR: 1.7 [1.4–2.1]) and out of the GP's office. The reasons for hospital admission were different depending on the sector of hospitalization (P < 0.001), patients addressed to the public sector hospitals presented with greater comorbidity or more complex diagnosis (for example: feeling ill, fainting or syncope and fever) or a greater disability (for example: stroke, neurological and psychiatric diseases).Conclusion
This study suggests that GPs send their patients to the public or for-profit hospitals according to criteria of severity, comorbidity and disability. 相似文献5.
Introduction
Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization.Methods
To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4 years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain = diRect chain (Call the emergency number–specialist mobile emergency unit–Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain = Long chain.Results
On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26 hours (±3.12), 6.17 hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9 hours (P < 0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit.Conclusion
These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion. 相似文献6.
Objective
Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope.Method
Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews.Results
A head-up tilt test was realized in 77 patients (47.8 ± 20 years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32 ± 11 months (range 6–54 months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n = 5/48; 10%) or a negative head-up tilt test response (n = 2/19; 10%).Conclusion
The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope. 相似文献7.
A. Bachir Cherif M. Temmar C. Labat L. Atif A. Chibane S. Benkhedda A. Taleb N. Benfenatki A. Benetos M.T. Bouafia 《Annales de cardiologie et d'angeiologie》2014
Introduction
Arterial hypertension is a major public health problem not only internationally, but also in our country, and it is the major risk factor for cardiovascular diseases. In south Algeria, the black population is nearly half the population of the oases of the Algerian Sahara.The objectives of the study
The objectives of the study are to analyze the long-term fate of the black hypertensive subjects in Algerian oases in southern Algeria, in terms of morbidity and mortality, comparing the morphometric profile and cardiovascular complications with the white population of the same oases.Materials and methods
One thousand four hundred and twenty-five subjects of both sexes were included (811 blacks and 614 white subjects), aged 40 and older, living in the Algerian Sahara and were reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, target organ damage, the number of hospitalizations and mortality. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software.Results
Mean age for the black population and the white population was 60.3 ± 11.1 and 58.6 ± 10.6 years, respectively. The incidence of hypertension was 50 % among blacks. The main complications observed were: stroke in 3.8 %, heart failure in 3.1 %, myocardial infarction in 1.7 %, hospitalizations related to cardiovascular complications of the black population was around 4.4 %, mortality 5.4 %.Conclusion
These data on hypertension black subjects emphasize the importance of a policy of adequate local health issues raised, both in terms of the management of hypertension, as in investment in local medical research. 相似文献8.
Z. Amoura C. Deligny J.-L. Pennaforte M. Hamidou P. Blanco E. Hachulla J. Pourrat V. Queyrel A. Garofano F. Maurel L. Levy-Bachelot I. Boucot 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2014
Purpose
To evaluate in France the annual direct medical cost of adult patients with active systemic lupus erythematosus (SLE) on medication and estimate the cost of a flare.Methods
A two-year, observational, retrospective, multicenter study, carried out between December 2010 and February 2011. Patients’ characteristics, SLE disease activity and severity, rate of flares, healthcare consumption (medications, hospitalisations, etc.) were evaluated. Medical costs were assessed from the national Health Insurance perspective. Cost predictors were estimated using multivariate regression models.Results
Eight centres specialized in SLE management included 93 eligible patients (including 50.5% severe). The mean age was 39.9 (11.9) years and 93.5% were women. At baseline, the mean SLE duration was 9.8 (6.6) years. The mean scores of the SELENA-SLEDAI instrument and the SLICC/ACR index were higher in severe patients (9.8 vs 5.6, and 1.2 vs 0.4 respectively; P < 0.001). Over the study period, 51% of patients received the combination containing at least corticosteroids or immunosuppressants. The mean annual direct medical cost of severe patients was €4660 versus €3560 for non-severe patients (non-significant difference). The cost of medications (61.8% of the annual cost) was higher in severe patients (€3214 vs €1856; P < 0.05). Immunosuppressants and biologics represented 26.5% and 4.6% of the annual total cost respectively. Patients experienced on average 1.10 (0.59) flares/year, of which 0.50 were severe flare. The occurrence of a new severe flare incremented the annual cost of €1330 (P < 0.05).Conclusion
Medications represented the major component of the annual direct medical cost. Severe flares increase significantly the cost of SLE care management. 相似文献9.
10.
O. Debouverie P. Roblot F. Roy-Péaud C. Boinot F. Pierre O. Pourrat 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2012
Purpose
The aim of this study was to assess the platelet count outcome during a pregnancy occurring in a series of 62 women followed for a chronic idiopathic thrombocytopenia.Methods
We studied the medical files of women who had a previous history of chronic idiopathic thrombocytopenia persistently below 150 G/L for at least 1 year, and who became pregnant over a 14-year period.Results
Sixty-two pregnancies (including 41 in women suffering from an immune thrombocytopenic purpura according to updated definition criteria) which occurred in 50 women, were analysed. At the beginning of the pregnancy, platelet count was above 150 G/L in 16% of the cases and lower than 50 G/L in 8%. Platelets decreased by more than 25% for 55% of the pregnancies, remained stable during pregnancy in 33% and improved in 12%. Platelet count remained above 50 G/L in 70% of the pregnancies and higher than 100 G/L in 27%. Mean nadir was 84 G/L at 31 weeks of gestation. A treatment was started in 40% of pregnancies, among them 64% of the cases during the last month only in order to allow locoregional anaesthesia at delivery. Platelet count was below 150 G/L at delivery in 82% of the women (116 ± 56 G/L). No bleeding occurred in 83% of the pregnancies. Neonatal mean platelet count was 225 ± 87 G/L, thrombocytopenia occurred in 17% of the babies (platelet count below 150 G/L), without any serious bleeding.Conclusion
Pregnancy worsens chronic idiopathic thrombocytopenia outcome in half of the cases, most of the time without any haemorrhagic complications. 相似文献11.
Objective
To study medical practice in the management of hypertension as a factor in renal risk in general medical practice and primary prevention in children at school, and pregnant women under prenatal monitoring.Method
The longitudinal study, observational over a year, focused on medical practice in schools, maternal health and medical practice among 100 physicians (general practitioner and specialist practitioner) in Annaba (Algeria).Results
In children in schools, measurement of blood pressure is never done on the grounds because this gesture is considered unnecessary in 100% of cases. In pregnant women, the measurement of blood pressure is not performed in more than 26% of pregnant women because it is deemed unnecessary by the midwife in 89% of pregnant women and default material in 11% of they. In current medical practice, 69% of doctors routinely take blood pressure. For the rest, represented mainly by specialists, it is the patient who does not justify. Sixty-two percent of physicians, that is hypertension, above 140/90 mmHg, and 15% of physicians that is hypertension, above 145/95 mmHg. Among the physicians, 58.7% did not use urinary strip, either, because they think that this review should be done in a laboratory (64.8%), or because the urinary strip are not available at even consulting (35.2%).Conclusion
Inadequacies in the coverage (care) of the HTA are real. Their effects on the progress of prevalence of the renal insufficiency chronic terminal treated are possibly important. 相似文献12.
Salameh E Mallat S Hamdan R Azar H Azar R Kadri Z Kassab R Abou Jaude S Badaoui G 《Annales de cardiologie et d'angeiologie》2009,58(1):7-10
Background and aim
Decrease in heart rate variability (HRV) is a known risk factor for cardiovascular morbidity and mortality. The aim of our study is to evaluate HRV in chronic hemodialysis patients and to determine factors that might decrease or increase it.Methods
This is a retrospective study including 51 patients, 23 males and 28 females, with a mean of age of 64.5 years (23-84 years) on chronic hemodialysis for end stage renal disease due to various causes. Twenty-four-hour heart rate monitoring was recorded in all patients to evaluate HRV. HRV of hemodialysis patients was compared to normal patients (control). We also looked for correlation between HRV and a number of clinical and biological factors.Results
All HRV parameters were decreased in chronic hemodialysis patients compared to normal controls with a significant difference (p < 0.0005). HRV decreases with age (p = 0.012), and is lower in diabetic patients (p = 0.026). Interestingly, we found that chronic hemodialysis patients on beta-blockers had higher HRV with p = 0.011.Conclusion
HRV is reduced in chronic hemodialysis patients mainly in old and diabetic patients, but this decrease is less important in those receiving beta-blockers. 相似文献13.
Myopathies inflammatoires et anticorps anti-PM-Scl : à propos d’une série et revue de la littérature
I. Marie L. Lahaxe K. Tiev A.-B. Duval-Modeste O. Vittecoq H. Levesque F. Jouen 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2010
Purpose
The objectives of this study were to evaluate: (1) the prevalence of anti-PM-Scl antibodies within the framework of antinuclear antibodies detection; and (2) the clinical features and outcome of patients with isolated polymyositis/dermatomyositis.Methods
Nine thousand and sixty-four consecutive antinuclear testing data allowed us to evaluate anti-PM-Scl antibody prevalence. Second, we also assessed the characteristics of patients with isolated dermatomyositis/polymyositis and associated anti-PM-Scl antibody.Results
Over 9064 consecutive antinuclear samples tested for antinuclear antibodies, 3263 (36%) were positive; anti-PM-Scl antibody were positive in nine patients: 0.1% of all sera, 0.2% of sera positive for antinuclear antibodies, 1.2% of sera positive for anti-ENA antibodies. Four of the nine patients with anti-PM-Scl antibody had dermatomyositis (n = 3) and polymyositis (n = 1). Patients with dermatomyositis/polymyositis and anti-PM-Scl antibody exhibited severe complications, as follows: ventilatory insufficiency (n = 2) requiring mechanical ventilation in one case, esophageal involvement requiring enteral feeding (n = 1); also, two of these patients had cancer.Conclusion
Our case series suggests that the presence of anti-PM-Scl antibody is not a favorable prognostic factor in patients with dermatomyositis/polymyositis. This type of antibody appears to be associated with lung and esophageal involvement; in addition, anti-PM-Scl antibody may co-exist with malignancy in PM/DM patients. Taken together, we suggest that patients with dermatomyositis/polymyositis and anti-PM-Scl antibody require both initial evaluation for lung/digestive manifestations and cancer and close surveillance. 相似文献14.
15.
Cuneyt Tayman Ferhat Cekmez Ilker Mustafa Kafa Fuat Emre Canpolat Merih Cetinkaya Alparslan Tonbul Sema Uysal Turan Tunc S. Umit Sarici 《Archivos de bronconeumología》2013
Background
Oxygen-induced lung injury is believed to lead to the development of bronchopulmonary dysplasia in premature infants. We have evaluated the beneficial effects of Nigella sativa oil (NSO) on rats with hyperoxia-induced lung injury.Methods
Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups as hyperoxia (95% O2), hyperoxia + NSO and control (21% O2). Pups in the hyperoxia + NSO group were administered intraperitoneal NSO at a dose of 4 ml/kg daily during the study period. Histopathologic, immunochemical, and biochemical evaluations (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], malonaldehyde [MDA] and myeloperoxidase [MPO]) were performed.Results
In the histopathologic and immunochemical evaluation, severity of lung damage was significantly lower in the hyperoxia + NOS group (P < .05). Tissue GSH-Px and SOD levels were significantly preserved, and MDA, MPO levels were significantly lower in the hyperoxia + NSO group (P < .05).Conclusion
NSO significantly reduced the severity of lung damage due to hyperoxia. 相似文献16.
Christopher R. Gilbert Andrew Lerner Michael Baram Bharat K. Awsare 《Archivos de bronconeumología》2013
Introduction
Pulmonary infiltrates are common within the hematopoietic stem cell transplant (HSCT) population and unfortunately portend an increased mortality. Bronchoscopy is often utilized as an initial diagnostic tool, but the literature supporting its diagnostic utility and effect on clinical management varies significantly. The aim of this study was to investigate the diagnostic ability, complication rate, and clinical impact of flexible bronchoscopy (FB) in evaluating pulmonary infiltrates in a large HSCT population.Patients and method
Retrospective review of all patients undergoing FB after HSCT in the Bone Marrow Transplant Unit from 1996 to 2009.Results
FB was performed 162 times in 144 patients with pulmonary infiltrates yielding positive results in 52.5%. The most common positive results were bacterial pneumonia (31%), fungal pneumonia (15%), and alveolar hemorrhage (11%). Treatment changes occurred in 44% of patients after FB. Treatment changes included antibiotic modification (59%), addition of corticosteroids (21%), antifungal modification (12%), and antiviral modification (7%). The overall complication rate associated with FB was 30%, although 84% of these complications were considered minor.Conclusions
FB in patients with pulmonary infiltrates after HSCT should still be considered a valuable tool in the evaluation and management of pulmonary infiltrates in the HSCT population. Future prospective, multicenter randomized studies are needed to evaluate the overall clinical impact that bronchoscopic results and management changes have in this unique population. 相似文献17.
M. Lachamp V. Pauly R. Sambuc X. Thirion I. Potard C. Molines F. Retornaz 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2012
Purpose
Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.Methods
This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.Results
Our study showed a significant decrease in the number of drugs (mean ± standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.Conclusion
Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted. 相似文献18.
Introduction
Interventional cardiology procedures are regularly exposed to ischemic neurological complications. IV fibrinolysis is the only approved treatment in ischemic stroke but is very often contraindicated in these situations. Many techniques of interventional neuroradiology (mechanical thrombectomy) have been developed over the past years and are used to treat these patients.Observation
We report the case of two patients who were admitted in emergency for ischemic stroke with contraindication to IV fibrinolysis (cardioversion for atrial fibrillation under anticoagulation; 24 hours after carotid surgery). These patients were treated by endovascular thrombectomy procedure.Discussion
After validation of IV fibrinolysis within 4.5 hours after stroke onset, techniques of mechanical thrombectomy have gradually been developed, either as a complementary treatment or as an alternative in the case of CI to fibrinolysis. These endovascular thrombectomy devices currently allow recanalization of proximal cerebral occlusions, which correlates with a favorable clinical prognosis. A review of the literature is provided, along with a discussion about the techniques currently being improved, their advantages and disadvantages and the selection of patients that can benefit from endovascular procedures.Conclusion
In the case of a sudden occurrence of a neurological deficit during a cardiovascular procedure, a “thrombolysis alert” should be triggered. This will permit the rapid establishment of a clinico-radiological report for selecting stroke patients eligible for a procedure of recanalization by thrombolysis and/or mechanical thrombectomy. 相似文献19.
A. Hamzaoui R. KliiO. Harzallah C. AttigS. Mahjoub 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2012
Purpose
Behçet's disease (BD) is a multisystemic inflammatory disease characterized, on the one hand, by the frequency of benign mucocutaneous and articular manifestations, and on the other hand by the severity of ocular, neurological, vascular and digestive manifestations which may threaten functional or vital prognosis. The male BD predominance is obvious in many retrospective studies and a few studies only have focused on BD in women.Methods
In this study, we report the epidemiological, clinical, outcome and therapeutic data of a series of 71 female BD compared to a series of 111 male BD. This retrospective study was conducted in the internal medicine department of Monastir university hospital over a 19-year period (1990 to 2008), including all patients followed-up and treated for BD.Results
The comparison of clinical manifestations of BD between men and women showed the predominance of erythema nodosum (P = 0.016), necrotic pseudofolliculitis (P = 0.001), and joint involvement (P = 0.009) in women, while genital ulcers (P = 0.039), ocular involvement (P = 0.003) and vascular (P = 0.002) involvement were more common in men.Conclusion
Our results confirmed the results of previous studies regarding the benign nature of BD in women compared to men. 相似文献20.