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Biomedical subjects

C Lefebvre

Publications and source records attributed to C Lefebvre.

At least 55 records · Page 3Linked to original sources
PubMed1994

An investigation of the adequacy of MEDLINE searches for randomized controlled trials (RCTs) of the effects of mental health care.

Valid reviews of the effects of mental health care depend on identifying as high a proportion as possible of relevant randomized controlled trials (RCTs). To investigate the sensitivity and precision both of MEDLINE and of hand-searching for RCTs in mental health, 12 journals specializing in mental health and indexed by the National Library of Medicine (NLM) for MEDLINE were searched for the years 1971, 1976, 1981, 1986 and 1991. The sensitivity of the hand-search was 94% (95% Confidence Interval (CI) 93-95%), but it had a precision of only 7% (CI 6-8%). The optimal MEDLINE search had a sensitivity of only 52% (CI 48-56%) and a precision of 59% (CI 55-63%). Of the reports of RCTs identified by the hand-search, 9% (CI 7-11%) were not included in MEDLINE at all. Authors had included methodological descriptions in 84% (CI 80-88%) of RCTs found by the hand-search but missed by the MEDLINE search. Systematic reviews of mental health care which are based solely on MEDLINE searches of the literature will miss a large proportion of the relevant RCTs, and are thus liable to random error and bias. A register of mental health RCTs is urgently required.

Bias↗
PubMed1994

The Cochrane Collaboration: the role of the UK Cochrane Centre in identifying the evidence.

This paper attempts to explain why systematic reviews of randomized controlled trials, based on as high a proportion as possible of the relevant studies, are so important in generating reliable information for evidence-based decision making within health care. The preparation, maintenance and dissemination of such reviews is the challenge which has been taken up by the Cochrane Collaboration. The first phase of data collection is the identification of relevant studies. Currently, bibliographic databases are inadequate for this task. MEDLINE searches identify on average only about half of the relevant studies, and until 1994 there were no suitable indexing terms in EMBASE to identify randomized controlled trials. Co-operation between the Cochrane Collaboration and both the National Library of Medicine and Elsevier, however, is already transforming this situation. From January 1994 a new indexing term has been added to EMBASE to help identify randomized controlled trials. From January 1995 a new indexing term will be added to MEDLINE to help identify controlled trials where the method of allocation to treatment or control cannot be described with certainty as being randomized. Also from January 1995 an additional 20,000 reports will be identifiable as randomized controlled trials in MEDLINE. Progress during the first 2 years of the Cochrane Collaboration has been encouraging, but much remains to be done if users of health services are to benefit from the evidence-based health care which they deserve.

Abstracting and Indexing↗
PubMed1994

[Prenatal diagnosis of hepatic hemangioendothelioma. Apropos of a case].

An antenatal echography performed at 32 weeks of amenorrhoea revealed a formation in the liver. Other tests during the antenatal period were unable to provide an exact diagnosis which was only established after exploratory laparotomy after birth. A review of the literature showed that this hepatic tumour has been diagnosed in 3 reported cases antenatally. Haemangioendothelioma occurring during the antenatal period is difficult to diagnose and the severe forms discovered by echography have a poor prognosis.

Adult↗
PubMed1993

[Perverse effects of an apparently harmless habit...].

We report the case of a 47-year old woman with a long history of arterial hypertension. Because of a recent difficulty to control blood pressure values accompanied by hypokalaemia, a thorough investigation was performed, showing low renin and aldosterone blood levels and high urinary potassium levels. Repeated questioning revealed that the patient regularly consumed non-negligible quantities of liquorice-flavored chewing-gun. The physiopathogenic mechanisms of action of liquorice are reviewed.

Chewing Gum↗
PubMed1993

Acute cholestatic hepatitis with rash and hypereosinophilia associated with ranitidine treatment.

We report a case of acute cholestatic hepatitis associated with rash and hypereosinophilia, in which the absence of transfusion, intercurrent viral infection, alcohol consumption or other hepatotoxic drugs are suggestive of ranitidine-induced hepatotoxicity. The pathogenesis of the disorder is unknown, but the lack of a dose-effect relationship, the rarity and unpredictability of the reaction, as well as the clinical signs suggest that hypersensitivity is involved. Physicians should be aware of this rare and idiosyncratic side-effect of ranitidine.

Chemical and Drug Induced Liver Injury↗
PubMed1993

Haematological changes and infectious complications in anorexia nervosa: a case-control study.

To determine the prevalence of haematological abnormalities in patients with anorexia nervosa (AN), and assess the relationships between these changes, the severity of AN and the propensity to infections, we retrospectively studied 67 patients who met the DSM-III-R diagnostic criteria for AN. We recorded physical findings and routine haematological data on admission, and infectious events during hospitalization. The patients were compared with 67 normal controls matched for age and sex. Mean haemoglobin (Hb) was normal but lower in AN patients than in controls (131 +/- 19 vs. 137 +/- 11 g/l, p = 0.03) and the prevalence of anaemia (Hb < 120 g/l) was higher in the AN group (27% vs. 1.5%, p < 0.0001). Patients had a lower leucocyte count (4.94 +/- 1.9 vs. 6.78 +/- 2.4 x 10(9)/l, p < 0.0001), and increased prevalence of leucopenia (< 4 x 10(9) cells/l)(36% vs. 1.5%, p < 0.0001), neutropenia (< 1500 x 10(6) cells/l)(17% vs. 0%, p = 0.0015) and thrombocytopenia (< 150 x 10(9)/l) (10% vs. 0%, p = 0.03). Only 2 patients (3%) had pancytopenia, but 9/17 patients with anaemia (53%) also had leucopenia. There was a slight but significant correlation between body-mass index (BMI) and total leucocyte, neutrophil and red blood cell counts. Severe infectious complications occurred in 9% of AN patients vs. 0% in controls (p = 0.01); they were more frequent with neutropenia (relative risk, 15.1: 95% CI, 10-20.2) or low (< 12) BMI (relative risk, 11.6: 95% CI, 6.6-16.6) on admission. Compared with controls, AN patients thus had an increased prevalence of anaemia, leucopenia and thrombocytopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Colonic adenocarcinoma and scleroderma].

The association of cancer and connective tissue disease is well known, the most frequent being certainly with dermatomyositis. The association cancer and PSS is more controversial. The incidence of neoplasia in that group seems to be comparable with the general population but the proportion of certain types of cancer is different, and the temporal relationship with the apparition of symptoms of PSS is stunning. The hypothesis actually in favor is an imbalance of the immune system, which cause the diminution of the immune surveillance and the apparition of cancer and a concomitant dysregulation of the system, causing the fibrosis of the PSS. We describe a 75 year-old white female who developed a colic adenocarcinoma; she also had, concomitantly, a systemic scleroderma, with sclerodactyly and pulmonary fibrosis. The patient corresponded to the criteria of the American Rheumatism Association for progressive systemic scleroderma (PSS). The prognosis of patients with PSS depends on their systemic involvement but also, we believe, in the more aged group, on the apparition of a neoplasia.

Adenocarcinoma↗
PubMed1993

[Partial 12q trisomy and chylothorax].

The authors present a case of partial trisomy 12q associated with chylothorax, diagnosed at 30 weeks of pregnancy. Cordocentesis for the karyotype as well as thoracocentesis were carried out. In spite of the administration of tocolytic drugs the patient delivered a girl with multiple clinical abnormalities, who died at 7 days of age. From this case, the authors report 6 other cases of partial trisomy 12q in the literature, and, in the discussion they suggest the management after the diagnosis of hydrothorax has been made by ultrasound.

Abnormalities, Multiple↗
PubMed1992

Self-reported and measured weights and heights of participants in community-based weight loss programs.

Self-reported weights and heights of 82 adults were compared with measured weights and heights 1 to 3 years after participation in community weight loss programs. The mean self-reported weight was 2.3 +/- 1.9 kg lower than measured weight (P < .05). Differences in underreporting were not significant for gender or age group. Heavier individuals misreported their weight to a greater extent (P < .05) than lighter persons, and individuals who had not recently weighed themselves underreported their weight to a greater extent than those who had weighed recently (P < .05). On the average, height was overreported by a mean of 1.8 +/- 2.7 cm. Overreporting increased with increasing height, and men overestimated their height to a greater extent than women (P < .05). Younger subjects reported their height more accurately than those older than 60 years. Results of our study are similar to those of previous investigations that examined self-reporting bias in subjects enrolled in weight loss programs. The mean discrepancy in body weight, however, was greater than that reported in samples drawn from the general population. Our findings indicate that self-reported weight and height values in overweight populations should be interpreted with caution.

Adult↗
PubMed1991

The Pawtucket Heart Health Program. Influencing adolescent eating patterns.

The Pawtucket Heart Health Program, a research effort testing a process of community activation for cardiovascular risk factor behavior change, risk factor change, and coronary heart disease event rate change, utilizes risk factor behavior change programs for the entire population of a northeastern city. A diversity of nutrition programs designed to teach new skills and to alter the nutrition environment have been delivered. These include group programs, highlighting restaurant menus, labeling grocery shelf items, screening for blood cholesterol levels accompanied by nutritional counseling, and provision of programs in schools. In addition to standard curricula, the Heart Healthy Cook-Off for both junior high school and high school students has been developed. Students select recipes, make substitutions to lower fat, saturated fat, and cholesterol content, analyze original and substitution recipe nutrient content using a microcomputer and nutrient analysis software, and prepare the food. A panel of judges assesses presentation, taste, and health-promoting characteristics. In one junior high school class, cholesterol measure before and after the cook-off decreased by 10.7% among those with elevated cholesterol. The Heart Healthy Cook-Off is an education program that influences the culinary practices of children in an enjoyable, challenging format.

Adolescent↗
PubMed1990

Hereditary pyropoikilocytosis and elliptocytosis in a white French family with the spectrin alpha I/74 variant related to a CGT to CAT codon change (Arg to His) at position 22 of the spectrin alpha I domain.

We describe a white French family in which 12 subjects presented with hereditary elliptocytosis (HE) or hereditary pyropoikilocytosis (HPP). Eight of these subjects were shown to be heterozygous for a spectrin (Sp) alpha I/74 variant, as demonstrated by analysis of partial tryptic digestion fragments of spectrin. This abnormal peptide pattern was associated with a decreased ability of Sp dimers to self-associate. In this kindred, in which four generations were available for study, the clinical expression varied from mild HE to HPP with an intermediate status of hemolytic HE. The severity of the disease appeared to be correlated both with the estimated amount of variant Sp (42% to 65%) and the excess of Sp dimers found in the membrane (30% to 51%, with a normal value of 3.7% +/- 1.6%). Reassociation studies using isolated Sp alpha and beta chains from an affected patient and an unaffected control subject showed that the Sp alpha I/74 Kd abnormal tryptic peptide resulted from a defect in the Sp alpha chain. Partial amino acid sequencing showed that the Sp alpha I/74 Kd peptide resulted from cleavage at lysine residue 42 of the Sp alpha I/80 Kd domain. Knowledge of the exon/intron organization of the human alpha Sp gene allowed us to amplify by the polymerase chain reaction the second exon of the alpha Sp gene in total cellular DNA of the HPP proposita. The amplified fragment was subcloned and sequenced. We found a G to A base substitution in the 22nd codon (CAT for CGT), which changes the normal arginine to a histidine. Hybridization of amplified DNAs with allele-specific oligonucleotides corresponding to the normal and mutant sequences confirmed the presence of the mutation in six other HE and HPP members of the family. The identification of this mutation at the DNA level confirmed the transmission of the same molecular defect in Sp through four generations but with different patterns of clinical expression.

Adult↗
PubMed1990

Jaundice and intracardiac tumour.

We report the case of a type B lymphoma originating from the mediastinum, characterized principally by massive metastatic invasion of the right cardiac cavities in the form of a projecting mass well visualized at echography responsible of the presenting features of the illness. This lymphoma was, moreover, associated with an auto-immune haemolytic anaemia due to cold agglutinins.

Aged↗
PubMed1990

A new series of antiarrhythmic procainamide derivatives: toxicity and activity-simulated passive absorption relation.

Several compounds derived from benzamidines and nicotinic pyridinic amidines with a structure similar to that of procainamide, exhibit notable antiarrhythmic properties after injection into animals. The diffusion rate of these different compounds through a solid lipidic artificial membrane was studied with Dibbern's apparatus. A statistical relation was established between the diffusion rate and the principal pharmacological parameters obtained after intraperitoneal injection (toxicity and anthiarrhythmic activity). Essential structural elements seem to determine a better bioavailability than procainamide: character of the substitution (in para) of the benzenic cycle; length of the lateral chain.

Absorption↗