B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 1996
Comparative Study[Evolution of blood glucose control and retinopathy during long-term treatment of insulin-dependent diabetes mellitus with intraperitoneal infusion of insulin].
To evaluate the efficacy on blood glucose control of long-term peritoneal insulin infusion and its consequences on the evolution of diabetic retinopathy, we analyzed retrospectively the values of glycosylated haemoglobin measured quarterly and the retinal angiograms obtained after 1, 5 and 9 years from seventeen insulin-dependent diabetic patients treated by this technique during 9.0 +/- 2.2 years. Blood glucose control was significantly improved from the first year of treatment (p < 0.01). Seventy-one per cent of patients had a level of glycosylated hemoglobin below one standard deviation of normal values after five years and ninety-two per cent of 12 patients treated up to nine years remained in the same near-normal range. ⋯ Nine patients with severe nonproliferative (level 50, n = 1) or proliferative (level 65, n = 8) retinopathy, all treated by panretinal photocoagulation before initiation of IP treatment, improved and one patient with severe nonproliferative retinopathy, incompletely treated by laser photocoagulation, remained stable, after 5 to 9 years. No macular edematous reaction or impairment of existing macular edema occurred after panretinal photocoagulation under IP treatment. These data indicate that a sustained near-normal blood glucose control can be achieved under long-term peritoneal insulin infusion, without significant impairment of diabetic retinopathy when an initial ophthalmological evaluation, and a specific treatment if necessary, are performed.
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Statistical surveys have established that, in France, hysterectomy was carried out too frequently: 50 to 70,000 hysterectomies (perhaps only 40,000) are carried out each year in our country. This fact, together with the deleterious psychological effects of this operation, have urged the authors to express some remarks on the current practice of hysterectomy in France. The currently approved indications are the following: invasive cancer, benign lesions with intractable disabling symptoms and technical requirements (e.g. cure of prolapse in the elderly). ⋯ The adverse psychological effects of hysterectomy are due to several factors: fear of the operation, pain, possible complications, breach of the femininity, alteration of the body image, fear of menopause and ageing. These effects could be reduced by an accurate information of the patient on the actual consequences of the operation, which are far from considerable, specially if the hormonal secretion is preserved. Also, a certain period of time between the decision and the operation might help to further reduce this psychological impact.
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B Acad Nat Med Paris · Oct 1995
Biography Historical Article[Eulogy of Jérôme Lejeune (1926-1994)].
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B Acad Nat Med Paris · Jun 1995
Review[Analgesic effect of morphine and its metabolites administered by an intracerebroventricular route].
Intraventricular morphine administration is indicated, in some selected cases, to alleviate intractable cancer pain. Our pharmacokinetics data in cerebro-spinal fluid allowed us to formulate the theory of "Front de Recrutement". Then we were able to determine in cisternal and ventricular cerebrospinal fluid the morphine 6-glucuronide concentrations. ⋯ By demonstrating the 6-monoacetyl morphine potency (analgesic metabolite of heroin that is 20 times more potent than morphine), we showed the involvement of the 6 position in the analgesic effect of these opioids. When we compared the morphine-6 concentrations in human cerebro-spinal fluid with the analgesic potency of this metabolite, the morphine-6 glucuronide was responsible of 33% to 67% of the supra-spinal analgesic effect. As heroin, morphine must be considered as a precursor whose metabolites have pharmacologic effects.
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B Acad Nat Med Paris · Jan 1995
Review[Controlled hypercapnia: a new strategy in the treatment of severe respiratory insufficiency].
Permissive hypercapnia (PHY) represents an interesting approach in critically ill ventilated patients, because it allows to ensure adequate gas exchange while avoiding the adverse effects related to excessive airway pressures. Its objective is to improve oxygenation while reducing the risk of barotrauma and circulatory impairment. ⋯ This good tolerance legitimizes two strategies: firstly to accept hypercapnia in conditions such as acute severe asthma for which enforced normalization of PaCO2 would imply potentially lethal complications, and secondly to deliberately induce respiratory acidosis while using very low airway pressures and alveolar ventilation to limit or prevent overdistension lung damage in injured as well as in normal areas. When the cerebral vasodilation induced by CO2 might aggravate a preexisting intracranial disorder, PHY is obviously contraindicated.