Search PubMed⌕ Search

Biomedical subjects

A M Fournier

Publications and source records attributed to A M Fournier.

At least 37 records · Page 2Linked to original sources
PubMed1989

Preoperative screening for HIV infection. A balanced view for the practicing surgeon.

Routine preoperative screening for human immunodeficiency virus (HIV) infection is becoming increasingly prevalent. Reasons in favor of routine screening include the following: (1) Knowledge of HIV status may allow the surgeon to decrease risk of infection. (2) The patient may benefit, because HIV infection may alter the risk-benefit ratio of a procedure. (3) Knowledge of HIV status will not affect how the patient is treated. Arguments against routine screening include the following: (1) Since the risk during individual procedures is low, it is unlikely that knowledge of HIV status can actually reduce risk. (2) Patient care may be negatively affected. (3) There is a possibility of false-positive results. (4) The accepted ethical standards of autonomy, confidentiality, and informed consent are not always adhered to. We explore these issues in detail. Recent work has framed the risk of surgeons and defined the reliability of diagnostic screening tests. All of these factors must be weighed before a surgeon can decide for or against a policy of routine preoperative screening.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Tuberculosis and nontuberculous mycobacteriosis in patients with AIDS.

Thirty-six patients with AIDS and culture-proven nontuberculous mycobacteriosis were compared to 20 patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis with regard to clinical signs, symptoms, and diagnostic methods. Patients with nontuberculous mycobacteriosis were more often younger and homosexuals, while patients with tuberculosis were usually Haitian-American or users of intravenous drugs. A majority of patients with tuberculosis presented with fever and weight loss. These symptoms were seen in approximately 50 percent of the patients with nontuberculous mycobacteriosis. A distinct syndrome of dyspnea, chills, hemoptysis, and chest pain was seen in a significant minority of patients with nontuberculous mycobacteriosis. Lymphadenopathy was seen almost exclusively in patients with tuberculosis. Pulmonary sources (expectorated sputum or bronchoscopy specimens) were the most common source of diagnosis in both groups. Patients in both groups in whom the diagnosis was obtained from pulmonary sources frequently had negative chest x-ray films on presentation. Cavitary disease was absent from both groups.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Blood pressure, insulin, and glycemia in nondiabetic subjects.

The relation of blood pressure to fasting (basal) insulin and glycosylated hemoglobin (hemoglobin A1) was examined in 248 nondiabetic subjects (137 women and 111 men). None of the subjects was taking antihypertensive medication. There were statistically significant associations of systolic and diastolic blood pressure with insulin levels (r = 0.24, p less than 0.01; r = 0.30, p less than 0.01) and hemoglobin A1 levels (r = 0.28, p less than 0.001; r = 0.22, p less than 0.05) in women. These blood pressure indexes were also related to insulin levels in men (r = 0.23, p less than 0.05; r = 0.02, p less than 0.05). In a multiple regression analysis, the association between blood pressure and insulin level was diminished with an allowance for adiposity; however, it remained statistically significant. These data indicate that blood pressure is related to insulin levels in nondiabetic subjects and suggest that insulin may be a physiologic determinant of blood pressure.

Blood Glucose↗
PubMed1986

Body stature as a risk factor for diabetic sensory neuropathy.

Risk factors for vibratory perception threshold abnormalities were studied in 200 diabetic patients between the ages of 21 and 70 years and 62 control subjects of similar age. Vibratory perception (measured with the Biothesiometer) was absent over one or both halluces in 18 percent of the patients. In a stepwise multiple logistic regression analysis, height was the variable most strongly associated with absent vibratory perception (coefficient +/- SE, 0.501 +/- 0.097/inch; p less than 0.0001). Duration of diabetes (p less than 0.001), age (p less than 0.05), and ethanol use (p less than 0.05) were also associated. The prevalence of absent vibratory perception in the lower, middle, and upper thirds of the height distribution was 0.05, 0.08, and 0.40, respectively. Among the control subjects, there was no association of vibratory perception with either height or ethanol use. These data strongly suggest that body stature is a major risk factor for diabetic sensory neuropathy.

Body Height↗
PubMed1986

High-density lipoprotein and glycosylated hemoglobin in nondiabetic individuals.

We investigated associations of high-density-lipoprotein (HDL) cholesterol, apolipoprotein A-I, and triglyceride levels with hemoglobin A1 (HbA1) and insulin levels in nondiabetic subjects (137 women and 111 men). In women, HDL cholesterol, apolipoprotein A-I, and log-triglyceride values were significantly correlated with those of HbA1 and log-fasting insulin. These univariate associations persisted when age and Quetelet's index were included as covariates in multiple regression analyses. Conversely, univariate associations of HDL cholesterol and log-triglyceride levels with Quetelet's index were diminished by the addition of insulin values to multivariate models. Insulin levels and Quetelet's index were highly correlated. Although there were weaker associations in men, apolipoprotein A-I and HbA1 values were inversely related. These data suggest that HDL cholesterol and apolipoprotein A-I levels are closely linked to glucose metabolism in nondiabetic individuals.

Adult↗
PubMed1985

Systemic necrotizing vasculitis seen initially as hypertensive crisis.

Necrotizing vasculitis is not usually considered in the differential diagnosis of hypertensive crisis. Three cases are presented in which hypertensive crisis with encephalopathy was the principal initially seen manifestation of systemic necrotizing vasculitis. The correct diagnosis was suspected because of the patients' young age, elevated ESRs, and evidence of previous exposure to hepatitis B virus and was confirmed by renal angiography. All three patients had metabolic alkalosis, and two of the three patients had hyponatremia and hypokalemia. The literature presents a picture of hypertension in necrotizing vasculitis as insidious, relentless, and progressive. Our cases illustrate that it can be a dramatic, life-threatening initial manifestation. A renal angiogram can be justified in similar patients, since effective therapy for necrotizing vasculitis exists. In these patients control of BP ultimately depends on successful treatment of the underlying vasculitis.

Adult↗
PubMed1983

Opportunistic infections and Kaposi's sarcoma among Haitians: evidence of a new acquired immunodeficiency state.

Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.

Acquired Immunodeficiency Syndrome↗
PubMed1982

A description of a means of improving ambulatory care in a large municipal teaching hospital: a new role for nurse practitioners.

We describe a nurse practitioner program that has improved ambulatory care in a large municipal teaching hospital. The significant feature of this program is an expanded role for nurse practitioners in the follow-up of patients with complicated illnesses. Benefits of this program include improved continuity of care and an easing of the house staff's service burden. Similar use of nurse practitioners at other municipal teaching hospitals would be a useful approach to problems in quality of care and continuity of care.

Florida↗