Long-term benefits of exercise maintenance after outpatient rehabilitation program in patients with chronic obstructive pulmonary disease

BACKGROUND

Optimal strategies to maintain short-term benefits of an initial rehabilitation program (RP) are not known. To assess the long-term effects of exercise maintenance (EM) after an initial outpatient RP, the authors conducted a prospective study.

PATIENTS AND METHODS

Fifty-eight patients with moderate to moderately severe chronic obstructive pulmonary disease who completed an initial 7-week outpatient RP were included. They were allocated into four groups according to the conditions of EM they self-selected: 15 patients received a structured EM session supervised by a physiotherapist twice a week (group A); 14 patients received a structured EM session supervised by a physiotherapist once a week (group B); 15 patients continued self EM daily at home (group C); and 14 patients did not continue EM (group D). Patients were evaluated before, immediately after, and 18 months after the initial outpatient RP. Measurements included exercise testing on a cycle ergometer and a visual analog scale to evaluate chronic dyspnea.

RESULTS

After RP, all patients exhibited improvements in maximal workload (P < 0.05) and in dyspnea (P < 0.05). Improvements in maximal workload were maintained at 18 months in patients in groups A, B, and C but these only reached significance in groups B and C (P < 0.05). On the other hand, maximal workload returned to baseline values in group D (P = 0.01) at 18 months.

CONCLUSION

Our results indicate definite benefits of EM after an initial outpatient RP compared with no EM. Daily EM at home appears to be as efficient as structured EM sessions supervised by a physiotherapist, once or twice a week, in moderate to moderately severe chronic obstructive pulmonary disease.

[Secondary prevention of coronary disease in France. Result of the EUROASPIRE study: the Lille register of ischemic cardiopathies]

The EUROASPIRE study was initiated to assess the impact of recommendations concerning secondary prevention of coronary artery disease in Europe published in 1994 by the European Societies of Cardiology, Hypertension and Atherosclerosis. France and eight other countries are involved in this project. The authors report the French data. A total of 546 men and women, aged less than 71, divided into 4 diagnostic groups (coronary bypass, angioplasty, myocardial infarction, acute ischaemia) were selected in different departments of cardiology. Data concerning their main risk factors and management were noted from the hospital files. At least 6 months after their hospital admission, 396 patients were systematically interrogated and examined. The availability of information on the risk factors in the hospital files varied according to the risk factor and diagnostic group from 61 to 97%. At the time of hospital admission, 42% of patients were considered to be smokers and 23% to be obese. Six months after hospital admission, 28% of patients were still smoking, 34% were obese, 49% had total cholesterol levels greater than 5.5 mmol/L (2.10 g/L) and 48% had blood pressure readings of over 140/90 mmHg. In France, as in other European countries, the prevalence of modulable risk factors of coronary artery disease is high at least 6 months after hospital admission. Systematic application of the recommendations of scientific societies should result in a significant decrease in recurrences and in mortality after an initial coronary event.

Evaluation of surgical gamma probes for radioguided sentinel node localisation

By using a surgical gamma probe after peritumoral injection of a radioactive tracer, the surgeon can identify the sentinel, or first, nodal site of regional metastasis in clinically node-negative patients. In the near future, the pathological status of this node will have an important impact on the treatment strategy in breast cancer and melanoma patients. This article reviews the necessary requirements for the instrument, such as: absolute sensitivity, spectral resolution, angular sensitivity and response ratio to the radioactive source at depth. In addition, ergonomic characteristics are important. The surgeon must consider the above characteristics, as they influence operational handling. Four commercially available surgical gamma probes were subjected to laboratory tests to appraise the extent to which they fulfilled these criteria. The results for each gamma probe are summarised and discussed.<

Incidence of inflammatory bowel disease in northern France (1988-1990)

There were no data concerning the incidence of inflammatory bowel disease (IBD) in France. The aim of this study was to investigate the incidence of Crohn's disease and ulcerative colitis in northern France. This prospective population based study was realised through the gastroenterologists of the region Nord-Pas de Calais and the Somme Department. Each gastroenterologist referred patients consulting for the first time with clinical symptoms compatible with IBD. Data were collected by an interviewer practitioner present at the gastroenterologist's consulting room. Two independent expert gastroenterologists assessed each case in a blind manner and made a final diagnosis of Crohn's disease, ulcerative colitis, ulcerative proctitis, or unclassifiable chronic colitis. From 1988 to 1990, 1291 cases of IBD were recorded: 674 (52%) Crohn's disease, 466 (36%) ulcerative colitis including 162 proctitis (35%), and 151 (12%) unclassifiable chronic colitis. The mean annual incidence was 4.9 per 100,000 for Crohn's disease and 3.2 for ulcerative colitis. The sex ratio F/M was 1.3 for Crohn's disease and 0.8 for ulcerative colitis. The highest age specific incidence rate for Crohn's disease was between 20 and 29 years: 13.1 for women and 9.8 for men. The highest age specific incidence rate for ulcerative colitis was between 20 and 39 years: 5.5 for women and 6.5 for men. This first French prospective study has shown an incidence rate for Crohn's disease comparable with that seen in north European studies but lower than that seen for ulcerative colitis. These results could be related to the different environmental factors or the genetic background of the population studied, or both.

[Treatment of severe rhesus isoimmunization by repeated transfusions in utero]

Repeated transfusions in utero by umbilical cord puncture enable the treatment of severe forms of rhesus incompatibility. The two cases reported, including one involving seven transfusions between twenty and thirty seven weeks since the LMP, form the basis of a review of the literature defining the advantages and results of this technique.

[Surgical treatment of vulvar stenosis. Technic description]

A surgical technique for the treatment of vulvar stenosis is described. The recto-vaginal space is approached by the cutaneous route, starting with incisions for resection of 2 skin triangles arranged as butterfly wings on either side of the midline. The sclerous cicatricial tissue between rectum and vagina is widely exposed and incised so that the lower part of the posterior vaginal surface can be dissected and mobilized without any risk of damaging the mucosa, since the tractions required for cleavage are exerted on the cutaneous side of the bridle. It is only at this stage that a median sagittal cutaneo-mucosal incision of the bridle is carried out, followed by a transverse suture without tension. This easily performed technique has been used in 11 cases without complication and with satisfactory long-term functional results.

[Placental villitis]

Placental villitis, which is defined by the presence of lymphocytic or macrophagic inflammatory cells within the villosities, constitutes a recently-described histopathological entity. This condition is the consequence of an immune response of the feto-placental unit towards a non-specific, multiple aggression and the incidence is very low. The extent of the inflammatory reaction may culminate in placentitis, resulting in miscarriage. Although a large number of infecting agents are known to be responsible for the pathogenesis of villitis, in most cases the etiology remains unknown. The hypothesis of a failure of the mechanisms of immunotolerance during pregnancy is suggested by many authors to explain their origin.

[Epithelialization of a new vagina after nymphoplasty and salpingoplasty]

The association of salpingoplasty to the previously described nymphoplasty improves the result of the vaginoplasty of the Rokitansky-Kuster-Hauser syndrome. The pediculate mucous flaps obtained by cleavage of the labium minus are linked with the vascularized tubal flaps from the lumbo-ovarian ligament. In the present observation, this dressing up technique of the new vagina has enabled a quick and complete epithelialization, avoiding a progressive obturation from inwards towards the surface, without the use of a mandrin in the long run.

[Retroplacental hematoma and factor XI deficiency]

The authors report a case of premature separation of a normally located placenta at 28 weeks, associated with factor XI deficiency. The deficiency became known 6 weeks before the acute episode. In this particular case the deficiency did not occur in the context of congenital abnormalities, hepatocellular insufficiency nor any autoimmune disease. This rare case raises the problem of the role of a coagulation disorder in the etiopathogenesis of retroplacental hematoma.

[Urinary tract infection in gynecology-obstetrics: resistance to beta-lactam antibiotics and previous antibiotic therapy]

From June 1988 to October 1989, 190 women from the department of Obstetrics-Gynecology with bacteriuria due to Gram-negative rods were studied. One hundred and three were investigated as ambulatory patients. Fifty three had received treatment with a bêta-lactam antibiotic during the past three months and 11 between three and six-months before sampling. The organisms causing bacteriuria were 163 E. coli, 12 P. mirabilis and 15 were due to other species. Thirty three E. coli and the 15 other species were resistant to amoxicillin and/or to cefalotin. When comparing previous treatment and resistance to amino-penicillins it appears that: of the women who had received a beta-lactam antibiotic within the three months before testing, 57% of the strains recovered were found resistant for amino-penicillins; of the women without treatment during the past six months, 89% of the strains recovered were sensitive and six per cent of E. coli plus five per cent of another Gram negative rod were resistant to amino-penicillins.

[Surgical treatment of genital prolapse by vesicovaginal interposition of the myometrium]

The authors propose a new technique for the surgical treatment of uterine prolapse. The technique consists of placing the myometrium between the bladder and the vagina after amputation of the cervix uteri and total excision of the endometrium. The bladder is then supported by a strong and well vascularized muscular tissue. Anterior transposition of the cervical pedicles and fixation of the myometrium to the anterior vagina ensure that the fitting is solid and in the correct direction. These modifications of the old technique of vesico-vaginal uterine interposition suppress the drawbacks which have gradually led to the rejection of the Wertheim-Schauta operation.

[Neonatal death following injuries in utero, in the absence of maternal lesions]

The authors report a case of neonatal death at 24 hours following maternal trauma during a traffic accident. The abdominal trauma did not result in any maternal injury. Caesarean delivery was justified by fetal rhythm disorders. A wide variety of fetal injuries, in the absence of maternal injuries, are reported in the literature. Some benefit from an early diagnosis, improving therefore the fetal prognosis.

[Phyllodes breast tumors]

Phyllodes tumors represent a particular class in breast pathology. They are defined as bi-tissue, fibro-epithelial tumors, similar to fibro-adenomas, but their connective tissue component is greatly predominant. They are infrequent as they represent only 3% of breast tumors. They mainly occur during the premenopausal period, since alteration of the hormonal balance may play a role. The authors feel that they represent only a type of the evolution of the fibroadenomas with a relationship, in time, following the sequence: fibroadenomaphyllodes tumor-sarcoma. The diagnosis is exclusively made by histology and there is no pathognomonic sign, whether it is clinical or mammographic. The course is essentially characterized by the possibility of local recurrences, sometimes numerous, and by the occurrence of metastases in case of malignant phyllodes tumor. These two possibilities are correlated with the histological stage of the tumor. The treatment is definitely surgical, possibly mastectomy in case of large or aggressively active tumor.

[Clinically localized cancers of the breast. Therapeutic consequences of the evaluation of extension]

The therapeutic modifications induced by pretreatment evaluation were studied in a consecutive series of 852 asymptomatic women with newly diagnosed primary breast cancer attending our center between 1980 and 1984. Staging tests included chest X-rays in 851 patients, bone X-rays in 831, alkaline phosphatase in 826, hepatic enzymes in 818, liver echography in 750 and bone scintigraphy in 504. The intended local treatment was changed for a systemic one in 8 patients due to suspicious abnormalities. The follow-up confirmed evidence of metastases in 6 out of 8 patients (bone: 4; liver: 1; lung: 1). Mastectomy, initially avoided in these 6 patients, was subsequently performed in 2 of them owing to slow progression of distant metastases. On the basis of the current study, pretreatment staging in asymptomatic primary breast cancer cannot be recommended due to the low prevalence of detectable metastases.

[Spontaneous abortion with an IUD and Candida chorioamnionitis]

Interruption and expulsion of a stillborn fetus in patients with an IUD Candida albicans chorioamniotic infection is a very rare obstetrical event. Generally, the diagnosis is established in retrospect by the routine histological examination of the products of expulsion and the demonstration of a specific chorioamniotic infection. This infection occurs by upward dissemination in a pregnancy where the amniotic membrane is unbroken, with the IUD being the facilitating factor of infection. Prevention appears to be the withdrawal of an IUD at the beginning of pregnancy.

Incidence of inflammatory bowel disease in northwestern France. Preliminary results in region Nord-Pas-de-Calais

A prospective study in the region Nord-Pas-de-Calais between 1 February and 15 November 1988 identified 166 cases of Crohn's disease, 116 of ulcerative colitis, and 31 of proctitis. The incidence of ulcerative colitis was 2.96 cases/10(5)/year and of Crohn's disease, 4.23/10(5)/year.

Management of vulvar condylomata acuminata with argon laser

One hundred and one female patients with vulvar condylomata acuminata were treated with the argon laser. Most were managed under regional or general anesthesia because of the large size and extent of the warts. Ten patients were lost to follow-up after the first session. Of 91 other patients, 78 (86%) were free of lesions on follow-up examinations after one or two treatments. The 13 other patients had recurrent lesions: seven patients underwent three laser sessions; four required four sessions, and 2 others required five and six sessions, respectively. These results were comparable with those achieved with the carbon dioxide laser.

Disseminated aspergillosis in a patient with bronchiectasis. A 15-month clinical and immunological follow-up

We report a case of disseminated aspergillosis involving both lung and brain in an adult female patient affected with bronchiectasis. Immunological follow-up was conducted before the clinical diagnosis and during the illness and revealed an excessively high helper-inducer/cytotoxic-suppressor (T4/T8) ratio. Peripheral granulocyte function was normal. A progressive reduction of lung and brain localizations was obtained with antifungal therapy and Imuthiol, an immunopotentiator which regulates the ratio of T-cell subsets. T4/T8 ratio returned to average values. The patient is alive 12 months after the diagnosis.

Value of the estimation of thyroglobulin levels in the surveillance of treated differentiated thyroid carcinoma

Thyroglobulin levels were measured, without interruption of hormone treatment, in 115 patients who had undergone thyroidectomy for differentiated carcinoma. Thyroglobulin levels were invariably high in patients with iodine fixing metastases. The estimation of thyroglobulin was found to be more sensitive than the detection of metastases by their uptake of 131 iodine. A new protocol is suggested for monitoring treated differentiated carcinoma.

Theoretical conformational analysis of phospholipids. I. Study of the interactions between phospholipid molecules by use of semi-empirical methods with the explicit introduction of polar headgroup interactions

We present a theoretical conformational analysis of a system composed of seven dipalmitoylphosphatidylethanolamine molecules in interaction. The combined use of classical semi-empirical methods for the polar headgroup region with mechanical statistical calculations for the aliphatic chains permits the evaluation of the free energy for a phospholipids molecule. The free energy variation in function of the mean intermolecular interchain distance gives information about the main lipid bilayer phase transition. It appears, however, necessary to take into account the hydration of the polar headgroups.