Improved Outcome Prediction Based on Csf Extrapolated Creatine Kinase Bb Isoenzyme Activity and Other Risk Factors in Severe Head Injury

in Journal of Neurosurgery (1989), 71(1), 54-8

The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk ... [more ▼]

The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk factors. The patients were classified into three groups according to their actual outcome after 6 months: death (22 patients); persistent vegetative state or severe disability (eight patients); and moderate disability or good recovery (13 patients). By applying stepwise logistic discriminant analysis to the patients' data, five significant risk factors were selected: degree of neurological damage assessed by cerebrospinal fluid (CSF) extrapolated creatine kinase BB isoenzyme activity, Glasgow-Liege Coma Scale score, age, incidence of thoracic injury, and intracranial pressure (ICP). Extrapolated creatine kinase BB activity had the highest prognostic ability (67%). Uncontrollable elevated ICP proved to be systematically associated with death, whereas its absence was not necessarily indicative of a favorable outcome. The combination of the five variables yielded a total prognostic efficiency of 91%. The percentages of correctly predicted patients for the three outcome groups were, respectively, 100%, 50%, and 100%. Thus, half of the persistently vegetative and severely disabled patients were identified by the selected factors. [less ▲]

Relationship between Whole Plasma Calcitonin Levels, Calcitonin Secretory Capacity, and Plasma Levels of Estrone in Healthy Women and Postmenopausal Osteoporotics

in Journal of Clinical Investigation (1989), 83(3), 1073-7

The exact role of calcitonin (CT) in the pathogenesis of postmenopausal osteoporosis remains unknown. Whole plasma calcitonin (iCT) basal levels, metabolic clearance rate (MCR), and production rate (PR ... [more ▼]

The exact role of calcitonin (CT) in the pathogenesis of postmenopausal osteoporosis remains unknown. Whole plasma calcitonin (iCT) basal levels, metabolic clearance rate (MCR), and production rate (PR) of CT were measured in 9 premenopausal and 16 postmenopausal women, including 11 osteoporotics (OP). Basal iCT levels were statistically lower in postmenopausal women than in the premenopausal group (P less than 0.01) and strongly correlated (r = 0.72; P less than 0.001) with estrone circulating levels (E1). MCR were similar in all groups. PR were similar in eugonadal women between 22 (mean +/- SD = 30.9 +/- 9.9 micrograms/d) and 37 yr (mean +/- SD = 25.5 +/- 11.1 micrograms/d) premenopausal women. In healthy postmenopausal women PR were reduced, but not significantly (mean +/- SD = 19.5 +/- 6.95 micrograms/d), whereas osteoporotic patients presented a highly significant reduction of CT PR (mean +/- SD = 9.8 +/- 4 micrograms/d) (P less than 0.01). Because there is a strong relationship between E1 and PR (r = 0.64; P less than 0.001), CT secretory capacity appears to be modulated by estrogen circulating levels. This modulation leads to a menopause-related decrease in iCT. In osteoporotics, an independent impairment of CT production drastically lowers PR and basal iCT levels. CT might be one of the determining factors in the pathogenesis of postmenopausal osteoporosis. [less ▲]

Relative prognostic value of clinical, biochemical, echocardiographic and haemodynamic variables in predicting in-hospital and one-year cardiac mortality after acute myocardial infarction.

in European Heart Journal (1989), 10(1), 24-31

This study examined the relative value of clinical, biochemical, echocardiographic and haemodynamic variables, obtained early after acute myocardial infarction in predicting in-hospital and one-year ... [more ▼]

This study examined the relative value of clinical, biochemical, echocardiographic and haemodynamic variables, obtained early after acute myocardial infarction in predicting in-hospital and one-year cardiac mortality in 66 consecutive patients. Clinical examination and cross-section echocardiography were obtained in all 66 patients. An echocardiographic score index was calculated by grading wall motion from 0 to 5 in each of 16 left ventricular segments. Right-sided cardiac catheterization was performed soon after admission in 51 patients. Cardiac enzymes were measured every fourth hour in all patients and peak levels were identified in 55. During the follow-up of one year, 14 patients died of cardiac causes, seven of them during hospital stay; three patients died of a non-cardiac cause and were excluded from analysis. The echocardiographic score index was the best predictor of cardiac death and survival (chi 2 = 35), followed by Killip class on admission (chi 2 = 22), stroke volume index (chi 2 = 17) and a biochemical risk index (chi 2 = 11). Stepwise logistic discriminant analysis performed in the patients in whom all variables were obtained resulted in three independent prognostic variables: the echocardiographic score index, systemic vascular resistance at the time of catheterization and the development of infarct expansion. High- and low-risk patients are well identified by echocardiography in the acute phase of myocardial infarction. [less ▲]

Multiple-group logistic regression diagnostics

in Journal of the Royal Statistical Society. Series C Applied Statistics (1989), 38(2), 425-440

Prediction of mortality after myocardial infarction by simple clinical variables recorded during hospitalization.

in Clinical Cardiology : International Journal for Cardiovascular Diseases (1989), 12(9), 500-4

Simple clinical variables obtainable in any coronary care unit and in any patient were recorded in 769 consecutive patients who were admitted with acute myocardial infarction (AMI) and who were discharged ... [more ▼]

Simple clinical variables obtainable in any coronary care unit and in any patient were recorded in 769 consecutive patients who were admitted with acute myocardial infarction (AMI) and who were discharged from the hospital and followed for up to 3 years. To identify the patients at highest and lowest risk of posthospital mortality, a prognostic index was established from a stepwise logistic discriminant analysis of variables obtained in a consecutive series of 418 patients discharged alive from one of two coronary care units admitting new patients on alternate days. This prognostic index was validated by applying it to a comparison group of 351 consecutive control patients discharged from the other coronary care unit. In the training group, 59 of the 418 patients (14%) died during the first year after hospital discharge and 34 (8%) died during the second or third year. The stepwise logistic discriminant analysis made it possible to distinguish between 1-year survivors and nonsurvivors, but not between the patients who died during the second and third years and the 3-year survivors. Four variables were selected for obtaining a 1-year prognostic index: the maximum grade of left ventricular function during hospitalization (0 to 4), history of previous AMI (1 or 0), predischarge cardiothoracic ratio (0 to 0.99), and complete bundle branch block (1 or 0). Prognostic index = 7.0196-0.6515 function - 1.6623 previous AMI - 0.0729 cardiothoracic ratio - 1.0813 bundle branch block. This index was validated in the comparison group.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

Test de normalite graphique en paleontologie humaine.

in Zeitschrift für Morphologie und Anthropologie (1989), 77(3), 259-71

In human palaeontology, samples are generally collections of objects gathered according to morphological criteria and their statistical analysis usually calls for caution because of the relatively small ... [more ▼]

In human palaeontology, samples are generally collections of objects gathered according to morphological criteria and their statistical analysis usually calls for caution because of the relatively small number of objects. Testing normality for such samples is a critical problem. The procedure suggested by Filliben, however, is particularly suitable for small to moderate sample sizes. Moreover, it provides a graphical presentation of the data that permits to locate each object within the distribution range. We briefly review the principle of the method and give a computer program to carry out the necessary computations and plot. Finally, we illustrate the method by studying the distribution of the maximum length and the maximum breadth for a sample of skulls of the Upper Palaeolithic. [less ▲]

Effects of pulsatile delivery of insulin and glucagon in humans.

in American Journal of Physiology (1989), 257(5 Pt 1), 686-96

The purpose of the present study was to investigate the respective effects of continuous intravenous delivery of both insulin and glucagon compared with those of pulsatile insulin (and continuous glucagon ... [more ▼]

The purpose of the present study was to investigate the respective effects of continuous intravenous delivery of both insulin and glucagon compared with those of pulsatile insulin (and continuous glucagon), pulsatile glucagon (and continuous insulin) and both hormones administered in a pulsatile manner (but out of phase) on various parameters of glucose turnover. The study was performed on six healthy male volunteers submitted to a 325-min glucose-controlled glucose intravenous infusion using the Biostator. The endogenous secretion of pancreatic hormones was inhibited by somatostatin (2 micrograms/min). Four combinations of continuous and pulsatile infusions of insulin and glucagon were performed on different days and in random order. The amounts of hormone infused were identical in all instances and were 0.2 mU.kg-1.min-1 (continuous insulin), 67 ng/min (continuous glucagon), 1.3 mU.kg-1.min-1 and 435 ng/min with a switching on-off length of 2-11 min (for intermittent insulin and glucagon delivery, respectively). In the case of pulsatile administration of both hormones, the pulses of insulin and glucagon were given out of phase with a 6-min interval. Blood glucose levels and glucose infusion rate were monitored continuously by the Biostator, and classic methodology using a D-[3-3H]glucose infusion allowed to study glucose turnover. When compared with pulsatile insulin and continuous glucagon, pulsatile glucagon and continuous insulin were characterized by a significantly higher endogenous (hepatic) glucose production. When both insulin and glucagon were delivered in a pulsatile manner, the effect of pulsatile glucagon was predominant, maintaining a high endogenous glucose production. Under no circumstance was an effect on glucose utilization or clearance detected. This study demonstrates that pulsatile delivery of insulin or glucagon in humans has greater effects in modulating endogenous glucose production than continuous infusion. Furthermore, when both insulin and glucagon are delivered intermittently and out of phase, the stimulatory effect of glucagon on endogenous glucose production prevails over the inhibitory effect of insulin. [less ▲]

Variation du taux sérique de ferritine glycosylée chez des patients présentant une pathologie hépatobiliaire

Poster (1989)

Comparison of the long-term predictive efficiency of two serum glycoproteins, alpha 1-acid glycoprotein and haptoglobin, in patients with myocardial infarction

Poster (1989)

Serum creatine kinase isoenzymes and isoenzymes and isoforms as indicators of coronary reperfusion in acute myocardial infarction

Conference (1988, September)