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Biomedical subjects

C Girard

Publications and source records attributed to C Girard.

At least 145 records · Page 8Linked to original sources
PubMed1990

Physician adaptation to health maintenance organizations and implications for management.

The growth of health maintenance organizations (HMOs) and other forms of managed care presents a challenge to traditional patterns of private practice. In Dane County, Wisconsin (Madison Metropolitan Area), the proportion of the population enrolled in closed-panel HMOs increased dramatically, from 10 percent in 1983 to over 40 percent by 1986. This study surveyed 850 practicing physicians regarding their expectations before, and experiences after this rapid change to competitive HMOs. Although most physicians expected a loss of earnings and lower-quality care, the majority reported that neither declined. However, most physicians expected and reported a decline in their autonomy. Primary care physicians were most supportive of the change to HMOs. The implications of these findings for management practices are discussed.

Adaptation, Psychological↗
PubMed1989

Extensive colonization of the porcine colonic epithelium by a spirochete similar to Treponema innocens.

Specimens of colonic mucosa from two pigs with diarrhea were examined by light and electron microscopy. The epithelial surfaces of both pigs were extensively colonized by large spirochetes morphologically compatible with Treponema hyodysenteriae or Treponema innocens. The microorganisms were intimately attached end-on to the luminal cells. A weakly beta-hemolytic spirochete similar to T. innocens was isolated from the colon of one of the pigs.

Animals↗
PubMed1989

[The history of training at the Société psychoanalytique de Paris].

As from its creation in 1926, the Société psychanalytique de Paris took charge of organizing the transmission of psychoanalysis by founding a first Institut whose activities came to an end in 1940. As from the founding of a second Institut de Psychanalyse by S. Nacht in 1954, the training of psychoanalysts was to follow an orientation that was particular to the Société psychanalytique de Paris. Specific conflicts pertaining to the question of psychoanalytic training, the scisson of the Société psychanalytique de Paris and the evolution of the psychoanalytic movement in France were determining factors in the evolution of training at the Institut. The selection of candidates, didactic analysis, supervision, teaching and details concerning the training program are presented in their evolution.

Education↗
PubMed1989

[Clinical and metabolic evaluation of myocardial protection by oxygenated cardioplegia (Hamburg solution) in multiple coronary bypass surgery or polyvalvular replacement].

Myocardial protection by the Hamburg oxygenated crystalloid cardioplegic solution was evaluated. A prospective metabolic study was conducted by measuring the myocardial adenosine triphosphate (ATP) and creatine phosphate (CP) contents by enzymatic techniques in 30 coronary bypass patients with a mean of 3.5 (+/- 0.9) aorto-coronary bypass grafts. Mean aortic cross clamp time was 48.4 (+/- 9.8) min. Myocardial samples were obtained from the left anterolateral ventricular wall: 1 = before CPB, 2 = before aortic cross clamp removal, 3 = 10 min following reperfusion. During ischemia, there was no statistically significant decrease in myocardial ATP contents [3.26 (+/- 0.82) vs 3.01 (+/- 0.92) mumol/g of frozen weight]; in contrast myocardial CP contents decreased significantly [2.71 (+/- 1.44) vs 1.87 (+/- 1.19) mumol/g; p = 0.01]. Following 10 min of reperfusion, the mean ATP level [2.96 (+/- 0.84) mumol/g] was 90% of the preischemic value, and myocardial CP levels (2.32 (+/- 0.92) mumol/g] increased to 85% of preischemic levels. Spontaneous myocardial defibrillation was observed in 93.3% of cases. Early postischemic myocardial function was studied in 228 cardiac operations using the same myocardial protection. 48 patients underwent multiple valve replacement (MUVR), and 180 patients had 4 or more aorto-coronary bypass grafts (CABG). Spontaneous myocardial defibrillation was observed in 90.3% of all; cases; mean CPB time after aortic cross clamp removal was 10.3 (+/- 8) min. Cardiac index by Swan-Ganz thermodilution catheter were measured just before cardiopulmonary bypass and one and twelve hours later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1988

[Indications for inotropic agents in cardiac surgery].

Inotropic drugs are widely used before, during and after cardiac surgery. Besides the old well known inotropic drugs, new sympathomimetic drugs and phosphodiesterase inhibitors are available. They can be used alone or in combination. The choice of drug is difficult to make and depends, for one part, on the side-effects of each drug. Before surgery, they are required for patients who present with cardiogenic shock while waiting for emergency repair of their lesion. During surgery, inotropic drugs are used before, during and after using cardiopulmonary bypass. After surgery, they are used to treat low cardiac output states. A decision algorithm is suggested, but it is modified by personal clinical experience, aetiological patterns and pharmacological data. Therapeutic doses must be adjusted according to haemodynamic data. Physiological controls are required, such as venous return and heart rate. Mechanical assistance devices must not be forgotten, especially after myocardial reperfusion and weaning from extracorporeal circulation.

Algorithms↗
PubMed1986

Isolation and characterization of bacterial strains with inulinase activity.

Thirty-two bacterial strains growing on inulin as the sole carbon and energy source were isolated from soil samples by enrichment culture on a mineral medium. Twenty of the strains were identified as Flavobacterium multivorum. All the bacteria contained a beta-fructosidase that was active on both inulin and sucrose. The enzyme activity was cell bound and was produced at the end of the growth phase. These enzymes have potential uses in the preparation of fructose syrups from inulin and invert sugar from sucrose.

Journal Article↗
PubMed1985

[Cardiogenic shock].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1985

[Anesthetic induction with Althesin or diazepam in patients undergoing an aortocoronary bypass].

The haemodynamic effects of induction of anaesthesia with diazepam (group D) and Althesin (group A) were studied in 25 coronary patients under betablockers with good myocardial function. Haemodynamic variables monitored were vascular pressures, cardiac output and systolic time intervals. The effects of both drugs were observed when used alone (time I) and in combination with fentanyl, pancuronium and nitrous oxide (time II). The results seemed to show that Althesin (12.51% fall in SI and 10.79% increase in PEP/LVET) depressed myocardial function more than diazepam (no significant difference), but the introduction of fentanyl, pancuronium and nitrous oxide removed the differences between the drugs as to their effect on myocardial performance. These drugs added a depressant effect to diazepam (13.83% fall in SI and 15.77% increase in PEP/LVET) without increasing Althesin's negative inotropic effect. However, in group A at time II, the pulmonary arterial pressure, the wedge pressure and the pulmonary vascular resistance were significantly reduced, while they remained stable in the diazepam group.

Adrenergic beta-Antagonists↗
PubMed1985

[Associated coronary and carotid atheroma. Implications and current role of indications for double surgery].

Coronary insufficiency is responsible for part of the peri-operative mortality of carotid surgery and it is by far the principal long term cause of death. Conversely, cerebral vascular accidents due to extra-cranial carotid stenosis compromise the results of myocardial revascularisation operations less than coronary insufficiency itself. Patients who require double surgery can be recognised on the basis of the clinical findings. The essential indication for this surgery is double clinical instability. Apart from these patients, the group of patients at high risk still need to be defined. Strictly preventative coronary and carotid surgery seem to be less justified, particularly as the currently available prophylactic measures and medical treatments appear to achieve a relative improvement in the long term prognosis of these patients with multiple vessel disease.

Arteriosclerosis↗