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Biomedical subjects

C Francis

Publications and source records attributed to C Francis.

At least 37 records · Page 2Linked to original sources
PubMed1999

Tracheobronchial foreign bodies: presentation and management in children and adults.

STUDY OBJECTIVES: To compare the clinical and management aspects of tracheobronchial aspirated foreign body (AFB) removal in children and adults; to assess the influence of the operator's experience on the outcome of the procedure. DESIGN: A retrospective review of a 20-year experience (from 1976 to 1996). SETTING: A 900-bed university hospital. PATIENTS: Eighty-four children up to 8 years old (the child group) and 28 adult patients (the adult group). RESULTS: The peak incidence of foreign body aspiration occurred during the second year of life in the child group and during the sixth decade in the adult group. The symptoms at presentation were similar in both age groups, but the diagnosis was significantly delayed in the adults. The AFBs were lodged preferentially in the right bronchial tree only in the adults; a central location was predominant (but not at all exclusive) in the children. Atelectasis was more common in the adults, and air trapping was more common in the children. The most frequent procedure was rigid bronchoscopy; when a flexible bronchoscope was used, it was always in the adult patients. When the operator was less experienced, a failed first attempt at bronchoscopy and the need for a second procedure were significantly more frequent. CONCLUSIONS: At presentation, the symptoms seen with AFBs do not differ according to the age of the patient; however, the delay to diagnosis, the location of the AFBs, and the radiographic images differ between child and adult populations. The removal of AFBs in patients of all ages can be performed by the same operators. Because the outcome associated with these procedures improves when the operator is experienced, the removal of AFBs should be performed in medical centers that are capable of acquiring and maintaining the necessary expertise.

Adolescent↗
PubMed1999

Access to family planning clinics--a local experience.

Teenage pregnancy is unacceptably high in the UK. The family planning services in the London borough of Harrow dramatically increased access to teenagers during a period of financial constraints and difficult political and ideological changes in the 5 years from 1992/93 to 1996/97. This was carried out through reconfiguration of clinical services, retraining the multidisciplinary staff, development of clinical guidelines and proformas, outreach activities, reducing wastage, and income generation.

Adolescent↗
PubMed1998

Chlamydia trachomatis infection: is it relevant in irritable bowel syndrome?

BACKGROUND: Irritable bowel syndrome can present with gynaecological symptoms similar to those of chronic pelvic inflammatory disease, which is commonly caused by Chlamydia trachomatis. Infection with this organism might therefore lead to diagnostic and management difficulties in patients, not only as a result of symptom overlap between the two disorders but also because chlamydial infection might exacerbate the symptoms of irritable bowel syndrome. This study was designed to investigate any possible link between chlamydial infection and irritable bowel syndrome. PATIENTS/METHODS: The prevalence of antibodies to C. trachomatis and abdominal symptomatology was assessed in a group of 100 female patients with irritable bowel syndrome and 100 matched female controls. RESULTS: 25% of patients and 17% of controls were found to have evidence of previous chlamydial infection. This difference was not statistically significant. Within the patient group, no association was found between chlamydial infection and any particular pattern of symptomatology. CONCLUSIONS: The results of this study indicate that occult chlamydial infection is not a major problem in irritable bowel syndrome and that routine investigation for this organism is unnecessary. They also provide some reassurance that pelvic inflammatory disease and all its potentially serious consequences is not being significantly overlooked in gastroenterological practice.

Adult↗
PubMed1998

Abortion in Thailand: a feminist perspective.

With the passing of the Fourth World Conference on Women in Beijing, China, women's issues in Asia have moved increasingly to the forefront. One such issue, abortion, continues to generate controversy as many women argue for protection and/or recognition of their reproductive rights. The objectives of this paper are threefold: (1) To examine the abortion debate in Thailand, identifying issues raised by Thai feminist scholars about the status of women; (2) To overview some of the more prominent feminist arguments regarding abortion (particularly those written by Canadian and American scholars) as a tool for defining women's reproductive rights; (3) To focus on a study of attitudes toward abortion among health care personnel and post-induced abortion patients in Bangkok, Thailand in order to discern the degree of support (if any) for feminist abortion arguments.

Abortion, Induced↗
PubMed1997

Effect of alveolar volume on the interpretation of single breath DLCO.

Single-breath carbon monoxide diffusing capacity in the whole lung (DLCO) and per unit alveolar volume (DLCO/VA), as expressed in percentage of normal values, gave discordant results when VA of the patients was abnormal. It was hypothesized that normal reference values were inappropriate to interpret data collected in such patients. To substantiate this hypothesis, DLCO and DLCO/VA were measured in four groups: (1) normal volunteers in whom both indices were measured at five different VA; (2) patients with high VA; (3) emphysematous patients; and (4) patients with diffuse interstitial lung diseases (DILD). In normal subjects, DLCO increased and DLCO/VA decreased with VA. In patients with overinflated lungs, the percentage of DLCO was more increased than DLCO/VA. In the emphysematous patients, both indices were equally decreased. In patients with DILD, DLCO was significantly more decreased than DLCO/VA in those suffering from a restrictive pattern. Theoretical values were re-calculated taking into account their true VA and using the relationships observed between DLCO, DLCO/VA and VA. The divergences between DLCO and DLCO/VA were strongly minimized. Therefore, the authors suggest the need to correct theoretical formulas in the presence of a restrictive pattern.

Adult↗
PubMed1997

The application of meta-analysis in assessing racial differences in the effects of antihypertensive medication.

Meta-analysis is an important technique for synthesizing research findings. Although the statistical foundations of meta-analysis continue to be debated, few question its value as a rigorous framework for organizing literature reviews. In recent years, there has been increasing emphasis on the use of meta-analysis not only to summarize the central tendency of findings but also to explain variation between studies. This article reviews the major steps in a meta-analysis with an emphasis on comparative analysis of subgroups of studies. A meta-analysis of the antihypertensive efficacy of calcium channel blockers is used to illustrate how a comparative analysis can be applied to investigate racial variation in the effects of calcium channel blockers. A statistically significant trend is found between the proportion of African-American hypertensive subjects and the mean reduction in blood pressure. Meta-analytic techniques also are applied to explore possible confounders due to differences in research design and patient characteristics.

Age Factors↗
PubMed1996

Rapid single-step method for flow cytometric detection of surface and intracellular antigens using whole blood.

Fixation/permeabilization methods used for the detection of intracellular antigens by flow cytometry often result in the destruction of cellular morphology and surface immunoreactivity, properties useful in flow cytometry for the characterization of cells in heterogeneous populations. In addition, a majority of these methods are incompatible with whole blood and require that peripheral blood leukocytes (PBLs) be purified prior to fixation. This article describes a new technique for the rapid detection of both intracellular and cell surface antigens, while preserving cell morphology, through the use of a single-step fixation/permeabilization reagent, ORTHO PermeaFix (OPF). OPF is compatible with whole blood, allowing for the direct preparation of PBLs without prior cell separation. An additional red blood cell lysing reagent was not required because RBC lysis occurred upon resuspension of OPF-treated whole blood samples in isotonic solution. Discrimination of leukocyte populations by light scatter after OPF treatment was comparable to matched unfixed live cells. In addition, absolute lymphocyte and white blood cell (WBC) counts were not significantly affected when OPF-treated cells were compared with unfixed cells. Treatment of whole blood from 7 normal donors showed no significant difference in percentage of cells positive for CD2, CD3, CD4, CD8, CD16, or CD19 between fixed and unfixed samples when cells were stained before fixation, and no difference in CD3, CD4, CD8, CD16, or CD19 percentages when cells were stained following fixation. Monoclonal antibodies specific for intracellular antigens located at various sites within the cell were tested on fixed samples. OPF-treated peripheral blood lymphocytes showed greater than 95% reactivity for the inner mitochondrial membrane protein bcl-2, and the cytoskeletal cytoplasmic protein vimentin. TIA-1, a cytolytic granule-associated protein, showed differential reactivity within lymphocyte subsets, from a low of 8 +/- 2% in CD4+ cells to 89 +/- 6% in CD16+ cells, when whole blood from five normal donors was fixed and stained. Reh cells treated with OPF showed greater than 95% reactivity for the internuclear protein TdT. A comparison of OPF with two other fixation/permeabilization procedures, 1% paraformaldehyde followed by 45% ethanol and 0.25% paraformaldehyde followed by 0.2% Tween 20, showed that only OPF could be used both prior to or following cell surface staining with no effect on antigen detection while allowing optimal detection of all of the intracellular antigens tested.

Antigens↗
PubMed1996

Rationale and design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT Research Group.

Are newer types of antihypertensive agents, which are currently more costly to purchase on average, as good or better than diuretics in reducing coronary heart disease incidence and progression? Will lowering LDL cholesterol in moderately hypercholesterolemic older individuals reduce the incidence of cardiovascular disease and total mortality? These important medical practice and public health questions are to be addressed by the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind trial in 40,000 high-risk hypertensive patients. ALLHAT is designed to determine whether the combined incidence of fatal coronary heart disease (CHD) and nonfatal myocardial infarction differs between persons randomized to diuretic (chlorthalidone) treatment and each of three alternative treatments--a calcium antagonist (amlodipine), an angiotensin converting enzyme inhibitor (lisinopril), and an alpha-adrenergic blocker (doxazosin). ALLHAT also contains a randomized, open-label, lipid-lowering trial designed to determine whether lowering LDL cholesterol in 20,000 moderately hypercholesterolemic patients (a subset of the 40,000) with a 3-hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitor, pravastatin, will reduce all-cause mortality compared to a control group receiving "usual care." ALLHAT's main eligibility criteria are: 1) age 55 or older; 2) systolic or diastolic hypertension; and 3) one or more additional risk factors for heart attack (eg, evidence of atherosclerotic disease or type II diabetes). For the lipid-lowering trial, participants must have an LDL cholesterol of 120 to 189 mg/dL (100 to 129 mg/dL for those with known CHD) and a triglyceride level below 350 mg/dL. The mean duration of treatment and follow-up is planned to be 6 years. Further features of the rationale, design, objectives, treatment program, and study organization of ALLHAT are described in this article.

Antihypertensive Agents↗
PubMed1996

Respiratory failure due to tracheobronchomalacia.

A case is described of tracheobronchomegaly progressing to extensive tracheomalacia, complicated by episodic choking, recurrent pulmonary infections, and irreversible hypercapnic respiratory failure. A Y-shaped tracheobronchial stent was placed endoscopically to splint the trachea open, with excellent clinical and physiological improvement. New stent designs may provide long term palliation in selected cases of diffuse tracheal collapse or stenosis, and offer an alternative to surgical repair.

Airway Obstruction↗
PubMed1995

Relative reactivity of the V3 loop PND of HIV-1 subtypes A, B, C, D, and F with sera from selected Ugandan localities.

Synthetic peptides comprising the predicted principal neutralizing determinant (PND) in new African and North American HIV-1 clones were tested in ELISA for reactivity with ninety six serum samples from asymptomatic donors in six selected localities in Uganda. Irrespective of the geographical origin of the samples, the majority of the test sera cross-reacted at high intensities with the peptides derived from the North American clone, BRT3.6 (Group B), the Ugandan clone, CUG045, (Group C), and the Romanian clone, FRMA (Group F). The frequency of reactivity of the peptides from BRT3.6, CUG045, and FRMA were within the ranges of 57-100%, 50-100%, and 57-100%, respectively, for the sera collected from these disparate localities. In contrast to these findings, the V3 peptides derived from the other Ugandan isolates showed a more restricted pattern of reactivity with the same serum samples: AUG06c (1-63%), DUG23c (2%), and DUG044 (38-87%). The results from ELISA inhibition assay indicated that the V3 peptide from BRT 3.6, CUG045, and FRMA express closely related antigenic specificities quite distinct from those in AUG06c and DUG044. The residues comprising the PND in BRT 3.6, CUG045, and FRMA appear to be well conserved in the HIV-1 subtypes prevalent in the selected Ugandan locales.

Amino Acid Sequence↗
PubMed1995

Obesity: nutrition support practice and application to critical care.

Much controversy exists regarding the nutritional care of obese, hospitalized patients. There is no real agreement among health care professionals in the nutritional support of obese patients. A survey was designed to determine the methods used to provide for the nutritional needs of obese, hospitalized patients. The survey included questions on definition of obesity, equations used to calculate energy and protein needs, and body weight used for calculations. The information received from this survey describes the variability of nutritional care for obese, hospitalized patients. In addition, a review of the current literature is provided regarding the metabolic response of the obese.

Critical Care↗
PubMed1995

[Spontaneous pneumothorax. Results of pleural talc therapy using thoracoscopy].

The aim of this retrospective study is to evaluate the advantage of thoracoscopy and the efficacy of talcage in the treatment of spontaneous pneumothorax (SP). Two hundred cases have been analyzed with a follow-up of 1 to 8 years after the occurrence of the disorder. The ratio man/woman is 4/1. One hundred and forty two pneumothorax are considered as being of idiopathic origin and 58 are associated to bronchopneumopathy, with a mean age of 33 and 56 years, respectively. The percentage of smokers is 69.5% with a mean smoking of 14 packets/years. The endoscopic aspect of pleura is either normal (30%) or shows adhesions (23.5%), blebs (17%) or bullaes (29.5%). Thoracoscopy allowed talc poudrage in 191 patients and allowed to indicate the need for surgery in nine patients. The immediate success rate of talcage is 93.7%. In the group of immediate failure (6.3%), unexpected bullous structures (8/12) are found at tomodensitometry (TDM), as well as during surgery. Late recurrence is reported in 2 cases (1%) at 20 and 25 months. Radiological sequelaes are minimum (9%). Lung function testing in patients with idiopathic pneumothorax (n = 64) shows, before talc poudrage, signs of pulmonary hyperdistension (total lung capacity (TLC) at 116% of predicted values), reflecting the illness pathology, 3 months after talcage a discrete restrictive syndrome (TLC 93%) and one year after the partial recovery of the lost volume (TLC 105%). Tomodensitometry revealed to be complementary to thoracoscopy in secondary SP and very instructive in idiopathic SP after immediate failure of talc poudrage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cytokine dysregulation and the initiation of systemic autoimmunity.

Autoimmunity (AI) exemplifies the potent and destructive activity expressed by the immune system when normal constraints against self-reactivity are lost or compromised. We have previously described a dramatic and intrinsic defect in cytokine expression in macrophages (M phi) from young AI-prone mice [1-3]. There are two points in particular that we believe speak to the importance of this observation: (i) Cytokine dysregulation is distinguished from many of the aberrancies reported in AI-prone mouse strains in that, as an inherent trait, it cannot arise as a consequence of the disease process. (ii) This defect is a remarkably consistent characteristic of M phi from strains that develop manifestations of systemic AI, including MRL/+, NZB, NZB/W F1, BXSB, and NOD, and distinguishes these strains from mice whose disease is predicated on defects in apoptosis (e.g., the lpr and gld mutations). The multigenic basis for disease and renal pathology in the former strains more closely mirror human lupus than do the disease manifestations of lpr and gld mice. In light of clear evidence that cytokines are key mediators of lymphocyte growth and function, a defect in the cytokine network has the potential to disrupt the normal regulation of self-reactivity, leading to the initiation of systemic AI.

Animals↗
PubMed1994

Epikeratophakia for correction of complicated aphakia.

We reviewed the cases of 21 patients (22 eyes) who underwent epikeratophakia for aphakia with at least 4 months' follow-up. Thirteen had traumatic cataracts, six had relative contraindications for implantation of an intraocular lens (IOL), one had a dislocated IOL and one had bilateral congenital cataracts. The mean best corrected visual acuity was 20/32.0 (range 20/20 to 20/70) before surgery and 20/38.6 (range 20/20 to 20/70) after surgery. The uncorrected visual acuity improved in all eyes. Twenty eyes (91%) were within two lines of the preoperative best corrected acuity; all eyes were within four lines. Twenty eyes were within 3.0 dioptres of emmetropia postoperatively; all eyes were within 5.0 dioptres of emmetropia. No serious complications were encountered. We conclude that epikeratophakia is a good alternative for the correction of aphakia.

Adolescent↗
PubMed1993

Increased expression of Fc gamma RI on isolated PMN from individuals of African descent.

Fc gamma R plays an important role in host defense, triggering and/or facilitating many immunologic responses. Of the three defined Fc gamma Rs, Fc gamma RI (CD64) is not known to be constitutively expressed on normal PMN. We report here that there is markedly increased expression of Fc gamma RI on the PMN of normal, healthy blacks, detected by binding of monoclonal antibody to this receptor. This may have significant implications when multiracial data are pooled in studies of receptor expression as markers of response to various chemotherapeutic agents.

Africa↗
PubMed1993

Thoracoscopy in the diagnosis and management of chronic pleural effusions.

Thoracoscopy was performed in 76 patients with chronic pleural effusions in which thoracocentesis and blind needle biopsy failed to reach a precise diagnosis. Analysis of thoracoscopic biopsies provided a definitive diagnosis in 53 of the 76 subjects. The diagnoses included 35 malignant diseases in which the macroscopic appearance was diagnostic in only 27 patients. Among these 76 patients, a talc dusting was performed in the management of recurrent effusion in 33 patients. No recurrence of pleural effusion was observed after 1 month in 87% and after 6 months in 76% of patients with recurrent pleural effusion. We confirm that thoracoscopy is a safe and useful technique for the diagnosis of pleural effusion which substantially decreases the necessity for diagnostic thoracotomy and that talc dusting is effective to achieve pleurodesis.

Adolescent↗
PubMed1992

Thoracoscopic lung biopsy in interstitial lung disease.

Thoracoscopic lung biopsy has been proposed as an alternative to open lung biopsy for the diagnosis of interstitial lung disease. We performed thoracoscopic lung biopsy under local anesthesia and diathermic coagulation in 33 non-immunocompromised patients with interstitial lung disease. A diagnosis was obtained in all patients. No severe complication was observed. The average time of drainage was 4 days. We confirm that this technique has advantages compared to open lung biopsy.

Adult↗