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Biomedical subjects

A Gilbert

Publications and source records attributed to A Gilbert.

At least 73 records · Page 4Linked to original sources
PubMed1993

Medication use and its correlates among the elderly.

Medication use and its correlates were examined in a randomly selected sample of 178 urban-dwelling elderly people: 89 per cent were currently using medication and 44 per cent were using four or more medications concurrently. Forty percent were using at least one nonprescription medication, usually in combination with prescription medication. The treatment of hypertension was the most commonly given reason for medication use. Respondents demonstrated good knowledge of their medication and how to take it, and good compliance with prescribing instructions. Multiple medication use was associated with advanced age, living in supervised accommodation, and a range of measures indicative of reduced wellbeing. There was no association between cognitive functioning and multiple medication use. These findings suggest that stereotypical images of older people as being poor compliers and having little knowledge about their medication should be treated with caution. However, the extensive use of medication and of multiple medications and concerns about the appropriateness of use of some classes of medication highlight the need for more detailed study of medication use among the elderly.

Aged↗
PubMed1993

Assay of brain natriuretic peptide (BNP) in human plasma: evidence for high molecular weight BNP as a major plasma component in heart failure.

A RIA for human brain natriuretic peptide (BNP) was developed. Both BNP and atrial natriuretic peptide (ANP) were extracted from human plasma with Vycor glass powder (71% recovery for BNP). The assay had a minimum detection limit of 0.45 fmol/tube and an IC50 of 9 fmol/tube. The within-assay coefficients of variation were 11.4% at 4 pmol/L and 3.2% at 22 pmol/L, and the between-assay coefficient of variation was 11% at 24 pmol/L. There was no significant loss of immunoreactive (IR)-BNP in plasma samples stored at -80 C for 4 weeks. Low rates of labeled BNP and IR-BNP degradation occurred in EDTA plasma incubated at 37 C. The mean venous plasma IR-BNP (6.3 +/- 0.3 pmol/L) in normal subjects (n = 48) was significantly lower than plasma ANP (8.4 +/- 0.6 pmol/L). In contrast to ANP, IR-BNP did not increase when normotensive or hypertensive subjects changed from erect to supine posture. Markedly elevated levels were found in patients with congestive heart failure (mean IR-BNP, 87 +/- 11 pmol/L; ANP, 87 +/- 12 pmol/L; n = 35), recent myocardial infarction (mean IR-BNP, 60 +/- 9 pmol/L; ANP, 33 +/- 6 pmol/L; n = 7), and chronic renal failure. High pressure liquid chromatography of plasma extracts from heart failure subjects revealed both high (mol wt, 10,000) and low (mol wt, 4,000) mol wt IR-BNP. High mol wt BNP was the major component (mean ratio, 1.9:1) and was linearly correlated with low mol wt BNP (r = 0.99). HPLC of plasma extracts from three normal subjects receiving constant infusions of human BNP (2 pmol/kg.min) showed a single major peak eluting in the position of hBNP-32, with no evidence of high mol wt material. These results show that whereas marked elevations in BNP occur in circulatory disorders, a major (> 50%) and consistent contribution to immunoreactivity is due to precursor forms. Further, compared to ANP, there is no IR-BNP response to supine posture in normal and hypertensive subjects.

Adult↗
PubMed1993

Endocytosis is inhibited in hepatocytes from diabetic rats.

The consequences of type I diabetes on cellular endocytosis were investigated by comparing [125I]insulin, [125I]alpha 2-macroglobulin, and Lucifer yellow uptake in hepatocytes freshly isolated from control and STZ-induced diabetic rats. In addition to the previously described reversible inhibition of ligand-induced internalization of the insulin receptor, we report a decrease in the constitutive receptor-mediated endocytosis of alpha 2-macroglobulin and a near abolition of fluid-phase endocytosis of Lucifer yellow in cells from diabetic animals. Despite decreased receptor autophosphorylation and internalization, the ligand-induced surface redistribution of the insulin receptor was normal in the diabetic cell population. By contrast, the insulin receptor association with clathrin-coated pits was impaired in diabetic cells as a result of a decreased concentration of these specialized invaginations on the nonvillous cell surface. The morphology and diameter of clathrin-coated pits were similar in both conditions under study. These results demonstrate a general impairment of endocytosis in hypoinsulinemic diabetes: receptor-mediated endocytosis was less affected than fluid-phase endocytosis. Impaired endocytosis of specific ligands or other macromolecules could be an important mechanism underlying the accumulation of extracellular matrix or even blood cholesterol removal in diabetes.

Animals↗
PubMed1993

[Free transfer of the vascularized fibula in pseudarthrosis and femoral bone loss].

The authors report their experience of femoral reconstruction by free fibular graft transfer. Twenty eight patients were operated on between 1977 and 1988. The average follow-up was 7 years and 3 months. The etiology of most of the cases was a post traumatic lesion (70 per cent). Loss of substance was found in 19 cases. 60 per cent of these were septic. The approach was usually posterior and vessels from the sciatic nerve were used. Union was obtained in 89 per cent of the cases. In 65 per cent of the cases union occurred in less than 1 year. In 1 out of 4 cases graft thickening was necessary and achieved by secondary bone grafts. The comparison of this technique with standard treatments evidenced a definite superiority of vascularized bone grafts in cases of septic pseudarthrosis and significant losses of bone.

Adolescent↗
PubMed1992

Results of the renewed extravesical reimplant for surgical correction of vesicoureteral reflux.

In 1987 Firlit et al described their results using Hodgson's technique of the modified extravesical Gregoir-Lich procedure. They coined the term detrusorrhaphy or extravesical ureteral advancement to describe this technique. During the last 4 years we performed this reimplantation on 211 ureters in 132 patients. Of the patients 79 had unilateral and 53 had bilateral procedures. Included were 6 megaureters requiring ureteral tailoring and 9 uncomplicated duplications. All but 1 patient were cured of reflux. No postoperative obstruction was encountered. Our results indicate that this is an excellent procedure to repair vesicoureteral reflux with minimal morbidity and short hospital stay.

Child↗
PubMed1992

Free bladder mucosal graft biology: unique engraftment characteristics in rabbits.

To study the biology of bladder mucosal grafts we developed an animal model using New Zealand white male rabbits. A 25 x 9 mm. segment of bladder mucosa was harvested and tubularized over an 8F catheter using 7-zero polyglactin sutures. An equivalent portion of rabbit urethra was then excised and the graft was anastomosed to this defect in an end-to-end fashion. A urethral catheter was left in place to provide bladder drainage and to stent the anastomosis. Animals were sacrificed on postoperative days 1 to 90. India ink was injected into the aorta at sacrifice to visualize the microvasculature. All 59 specimens were stained with hematoxylin and eosin, and studied using light microscopy. Our results demonstrated vascular ingrowth at 72 hours. Between postoperative days 8 and 10 healthy viable epithelium first bridged the entire urethral defect. By postoperative day 12 the epithelial lining was complete. A poor outcome was observed in all animals whose stents were removed early. We conclude that the biology of bladder mucosal grafts is unique in that the graft initially undergoes partial degeneration followed by regeneration. Of concern are the results of those animals whose stents were removed early. In all such cases a poor outcome was observed.

Animals↗
PubMed1992

A new flap based on the distal branches of the radial artery.

A flap based on the distal branches of the radial artery is raised on the dorso-lateral aspect of the distal third of the forearm. Thirty fresh cadaver dissections have established the anatomical rationale of the flap. The potential territory is supplied by a subaponeurotic plexus of vessels fed by lateral branches of the radial artery in the distal third of the forearm. This new knowledge of the anatomy has been applied to the performance of this flap in seven clinical cases. Various methods of application to hand and wrist reconstruction are described along with a discussion of the various advantages and disadvantages.

Adult↗
PubMed1992

The versatile metacarpal and reverse metacarpal artery flaps in hand surgery.

Vascular anatomy of dorsal metacarpal arteries was investigated in fresh cadaver dissections and by injection of methylene blue. Origin and termination of the vessels were studied, as well as their connection to the palmar vasculature. Vascular territories and elevation of flaps based on these vessels are also discussed. The second dorsal metacarpal artery was found to be the most consistent. This vessel has a large distal connection to the palmar vessels which allows both proximal and reverse elevation. Representative cases and surgical technique are described.

Adult↗
PubMed1992

Use of the appendix for urethral reconstruction in children with congenital anomalies of the bladder.

BACKGROUND: The presence of the cecal appendix offers a unique opportunity for the achievement of urinary continence and stable access to the reconstructed urinary bladder. METHODS: We have reviewed the cases of 17 children treated over a 56-month period whose urinary anomalies have required the construction of a neourethra. Fourteen of these patients underwent neourethral reconstruction by use of the appendix. RESULTS: All neourethras are easily catheterized, and all are continent. CONCLUSIONS: The ease of application of this reconstructive modality along with its high success rate makes incidental appendectomy contraindicated in children with congenital anomalies of the bladder.

Adolescent↗
PubMed1991

Obstetrical brachial plexus lesions.

The renewal of interest in brachial plexus surgery has been led by the success of microsurgical techniques in other peripheral nerve repairs. The results in adults remain poor, but in obstetrical palsy the regenerative capacity of babies allows for dramatic recovery after nerve repair or reconstruction. Obstetrical brachial plexus injuries represent a unique group with similar aetiology, age and prognosis.

Birth Injuries↗
PubMed1991

The superficial anastomosis on the palm of the hand between the ulnar and median nerves.

The communications between the median and ulnar innervated territories on the palm of the hand have been studied anatomically and microscopically. A communicating branch is well appreciated but its description has had little emphasis in anatomical or surgical literature. 50 cadaveric palms were dissected in both sexes and an anastomotic branch was found in 45 hands. In 43 of them it originated proximally from the ulnar nerve and proceeded distally to enter the third common digital nerve; in the other two hands it left the median nerve to reach the fourth common digital nerve. By microscopic dissection we have seen that the ulnar fibres of the anastomotic branch which join the median nerve may contribute to the sensory innervation of the radial half of the ring finger and ulnar side of the middle finger on its palmar surface. We have therefore described a cutaneous area on the palm where care must be taken to avoid surgical damage to this branch.

Aged↗
PubMed1991

[Training of microsurgery in the laboratory of the Hôpitaux de Paris].

The Microsurgical Laboratory of Paris Hospitals' Anatomy Amphitheater has been organizing an initiation into microsurgery since 1976 and the University Diploma of Microsurgical Techniques of Paris VI University since 1977. Since this time, 1,426 surgeons have been trained in the laboratory. The geographic origin of the students is worldwide, but predominantly European. The success rate at the final examinations is relatively constant and averages 60%. The results have been compared to the number of sessions in which the candidates had taken part, and a correlation between a number of sessions exceeding 30 and results above 90% at the examinations was established; A minimum number of sessions of vascular microsurgery was therefore laid down in order to ensure the serious training of the students.

General Surgery↗
PubMed1991

[Reconstruction of loss of bony substance in limbs by free vascularized fibula transplant].

The authors present their experience of bone-loss reconstruction by a free vasculized fibular transfer. 62 cases were operated, with an average follow-up of 6 years (between 24 to 13 years). Studied were 15 upper limbs (10 humerus, 3 ulna, 2 radius), 28 femurs and 19 tibias. We found a male predominance: 46 cases and the average age was 33 years old. The etiology was often due to trauma: serious road traffic accidents (37 cases). 44 cases were septic and the average bone-loss was of 10 cm (between 4 cm to 30). The most frequent complications were due to fractures of the graft (10 cases) and stiffness (15 cases). Consolidation rate was of 87%: 8 were failures (3 upper limbs: 20% at femur level, 10% at tibia level). The average consolidation rate of the septic cases was of 81%, and the non-septic cases over 97.5%. It seems to be a good technique and in particular for septic cases using a basic orthopedic technique and microsurgical suture.

Bone Transplantation↗
PubMed1991

Surgical treatment of brachial plexus birth palsy.

Brachial plexus birth palsy remains a challenging condition. In the 1000 infants followed from 1977 to 1988, functional results were much improved over those obtained by observation only, if surgical exploration and repair were performed when no clinical recuperation of biceps function occurred by three months of age. Recovery is slow, and comprehensive follow-up study of reconstructed and conservatively managed children is required to prevent joint contractures. Children who will benefit from palliative procedures such as tendon transfers must also be identified.

Brachial Plexus↗