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Biomedical subjects

D Martin

Publications and source records attributed to D Martin.

At least 343 records · Page 19Linked to original sources
PubMed1997

Issues in the measurement of satisfaction with treatment.

Patients satisfaction with treatments is a growing area of research that has tremendous potential to provide outcome measures for clinical trials and disease management programs. It also has applications in marketing and product development, especially for the treatment of chronic diseases. The objective of this review is to demonstrate that treatment satisfaction is a distinct area of research that has produced some important initial results. We define treatment satisfaction and provide a conceptual framework that clarifies the role of treatment expectations, preferences, and satisfaction in the context of healthcare in general. Nineteen articles were selected from more than 1,400 abstracts and were reviewed for the following information: (1) topics covered; (2) method used to design the measure; (3) descriptive statistics; (4) assessment with respect to the attributes in the Instrument Review Criteria of the Medical Outcome Trust's Scientific Advisory Committee; and (5) covariates. We conclude that some important initial results about treatment satisfaction have been obtained, but that much work remains to be performed. We recommend that future research devote more attention to qualitative research with patients, assessment of the measures, and the covariates presented in the conceptual model. We also recommend that decision makers insist on measures that meet these criteria.

Chronic Disease↗
PubMed1997

[Lateral brachial flaps].

The "extreme" lateral arm flap is a new method for covering the distal upper limb. This flap is a modification of the classical lateral arm flap allowing his transfer as a pedicled flap to cover the forearm and the wrist. This technique is based on a new concept: "the reverse flow VY pedicle advancement". This requires an arterial bifurcation of the deep humeral artery: the medial collateral artery described in this study.

Aged↗
PubMed1997

[Submental island flaps. Surgical technique and possible variations in facial reconstruction].

The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial forehead region). Including the facial vessels in its pedicle allows a safe free transfer. A greater are of rotation is obtained transferring the flap on its distal pedicle. One can include in the flap a segment of internal basilar margin. The resulting scar is perfectly hidden under the mandible. The operative protocol is now well defined and makes the flap easy to use. 21 flaps have been transferred, resulting in a single partial necrosis of a flap extremity.

Face↗
PubMed1997

Reconstruction of the hand with forearm island flaps.

From all of the flaps reviewed, it is important to know how to select the most suitable choice in each case. Aside from the technical expertise of the surgeon, the indication depends on the size and the location of the substance loss. For large defects in any location, the radial forearm flap remains the most reliable and safest choice. For children and women, the authors prefer distant pedicled transfers or free flaps to minimize cosmetic donor site morbidity. For small or medium defects that cannot be managed by a local transposition flap, the indication is based on the location of the wound. Palmar defects, if proximal and ulnar, may be covered using the dorsal ulnar flap, with little morbidity in the donor area. The anterior interosseous flap seems a better choice whenever vascularized tendon, nerve, or bone are needed also. For the first web space and neighboring radial defects, the posterior interosseous flap provides a reasonable alternative. Dorsal defects of the hand can be reconstructed with a posterior interosseous flap, provided there is no suspicion of injury to the anastomotic dorsal system of the wrist. The anterior interosseous flap is a good choice for composite osteocutaneous transfers. For complex composite defects, the ulnar artery forearm flap distally based may be indicated for reconstructive problems requiring vascularized flexor tendons. The anterior interosseous flap is able to provide excellent quality vascularized bone. Indications depend above all on the surgeon's experience and on the different schools. As always, the better flap is that which is performed by the surgeon who has mastered the particular surgical technique. In conclusion, this article is devoted to an update on forearm flaps and illustrates the innovative strength of this specialty. It also points out that, through in depth knowledge of the anatomy, flaps may be raised from many anatomic regions of a limb without disturbing the main vascular axis of that extremity. Minimizing the donor site morbidity while maximizing the quality of the reconstruction is the primary concern when indications are established for reconstructive hand surgery, which is where one of the authors' main research efforts resides.

Forearm↗
PubMed1997

In vivo stable isotope studies in three patients affected with mitochondrial fatty acid oxidation disorders: limited diagnostic use of 1-13C fatty acid breath test using bolus technique.

The in vivo oxidation of fatty acids (FA) of different chain length was investigated in three patients with documented mitochondrial FA oxidation disorders: one patient with mild multiple acyl-CoA dehydrogenase deficiency (MADM), one with medium chain acyl-CoA dehydrogenase deficiency (MCAD), and one with carnitine palmitoyltransferase I deficiency (CPT I). Breath tests were performed after oral administration of 1-13C butyric. 1-13C octanoic, and 1-13C palmitic acids. 13C/12C ratio in the expired oxidative end product CO2 was measured. The cumulative 13C elimination was calculated and expressed as a percentage of the administered dose. In the MADM patient the influence of carnitine therapy (or deprivation) on the utilization of 1-13C palmitic acid was also examined. In the MCAD and CPT I patients, the 1-13C butyric, 1-13C octanoic and 1-13C palmitic acids in vivo oxidation were similar to five healthy controls. In the MADM patient, the oxidation of 1-13C butyric and 1-13C octanoic acids were normal, whereas the metabolism of 1-13C palmitic acid ranged from 33% of 66% of controls. In this patient the serum carnitine level decreased from 60 to 27 mumol/l without carnitine supplementation. Clinically there was mild hypotonia. 1-13C palmitic acid oxidation compared to controls was 50%. After 2 further weeks of carnitine deprivation the serum carnitine was 10-15 mumol/l. Clinically he was very hypotonic and had a large liver. 1-13C Palmitic acid oxidation was 33%. After 6 weeks of readministration of carnitine (L-carnitine 100 mg/kg/day p.o.) the serum carnitine was 60 mumol/l and the patient was in good clinical condition. 1-13C palmitic acid oxidation was 66% compared to controls. Our study implies that this simple fatty acid breath test is not of diagnostic use for detection of enzymatic defects in FA oxidation disorders. The carnitine dependent 1-13C palmitic acid oxidation indicates that this test might be of some value in cases with primary or secondary carnitine deficiencies.

Acyl-CoA Dehydrogenase↗
PubMed1997

[Agenesis of the corpus callosum: modes of manifestation in adults].

Agenesis of corpus callosum is an uncommon brain malformation that is usually detected in childhood. In adult, focal epileptic seizure is the most frequent manifestation. Otherwise, asymptomatic patients can be detected by cerebral imagery with specific criteria. Neither developmental disability nor interhemispheric transfer dysfunction are observed in those patients. Minor facial abnormalities can be found. Agenesis of corpus callosum in adult is usually paucisymptomatic. The prognosis depends on cerebral associated malformations which are involved in epilepsy and cognitive disturbances.

Adolescent↗
PubMed1997

From enumeration districts to output areas: experiments in the automated creation of a census output geography.

This article briefly reviews the advantages of using separate geographies for census enumeration and output, and explains how a geographical information system is being used for the planning of enumeration districts for the 1997 Census Test. Experimental work is described which offers the potential to automatically create a new output geography, formed from aggregations of unit postcodes, and which offers control over output area population and boundaries.

Censuses↗
PubMed1997

The neurological basis of attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a serious disability with long-term consequences. At present the disorder is considered organic in pathology, particularly in regard to central nervous system functioning. This paper reviews research on ADHD. The role of neurochemical stimulation is discussed, and the signs of neurological deficits are explored. Nearly 600,000 young people in the United States receive medication daily for ADHD, and these drugs mimic brain neurotransmitters. The chemical action of these drugs and the cognitive, affective, and behavioral effects are discussed. Side effects and dosage levels are also examined. Basic behavior modification with ADHD children and how these techniques can be combined with effective drug treatment are elaborated.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Identifying Ultrasound Markers for Down Syndrome.

Although the incidence of Down syndrome increases with advancing maternal age, the use of maternal age alone as a screening tool results in the identification of only about one third of the cases of fetal Down syndrome. Screening tools for Down syndrome (trisomy 21) have become more sensitive and specific during the last few years. The use of biochemical markers for the screening of patients with fetuses having chromosomal anomalies has become more widespread in the obstetric community. The triple-screen test uses maternal age plus serum alpha-fetoprotein, unconjugated estriol, and human chorionic gonadotropin levels to calculate a risk for fetal Down syndrome. Because as many as 11% to 35% of fetuses with chromosomal defects have anatomical characteristics that can be visualized on a detailed ultrasound evaluation, researchers are studying the usefulness of this imaging technique as a screening tool for Down syndrome. Ultrasound findings associated with trisomy 21 may be divided into 2 groups. The first group comprises the common major malformations associated with Down syndrome, such as duodenal atresia and cardiac disease. The second group comprises the ultrasound screening indicators, that is, anatomical malformations highly specific to Down syndrome. This group includes brachycephaly, mild ventriculomegaly, macroglossia, abnormal facies, nuchal edema, echogenic or hyperechoic bowel, pyelectasis, and shortening of the limbs. Although the diagnosis of chromosomal anomalies remains dependent on karyotyping, the use of ultrasound may limit the number of invasive procedures and allow for more accurate genetic counseling of the mother at risk for delivering an infant with Down syndrome.

Journal Article↗
PubMed1997

[Update mid-term review of the pedicular extension in reverse YV flow. Review of a 7-year experience].

Since 1990, the authors use a surgical procedure called reverse flow YV pedicle extension to transfer a flap distally to its donor site. Their clinical experience, based on of 8 different applications and more than 80 clinical cases, demonstrates the reliability of the procedure. Nevertheless, the latissimus dorsi transfer, based on scapular vessels, must be an exceptional indication due to the need to achieve a venous microanastomosis. Moreover, the "extreme lateral arm flap" is considered to require a precise preoperative anatomical assessment because of the variants of the pedicle bifurcation. The authors are convinced that further applications will extend their experience of this procedure.

Humans↗
PubMed1997

[Distal extensor digitorum brevis muscle flap. Report of 2 cases].

The authors describe an original technical modification of the extensor digitorum brevis muscle flap. As described, its use in a classical reverse flow manner allows the flap to reach only the metatarsophalangeal joints. The presence of the first dorsal interosseous pedicle offers the possibility to sacrifice the plantar anastomoses of the pedis pedicle and raise the flap on the vascular network of the first metatarsal space. The point of rotation is moved distally from the apex of the first metatarsal space to its base. The length of the vascular pedicle is substantially enhanced and enables the flap to cover all dorsal and palmar defects of the toes. Two clinical cases are showed. The advantages of this flap are discussed, particularly its indication in reconstructive surgery of the foot.

Adult↗
PubMed1996

Intranigral or intrastriatal injections of GDNF: effects on monoamine levels and behavior in rats.

The present studies were designed to determine whether administration of recombinant human glial cell line-derived neurotrophic factor (rhGDNF) into either the substantia nigra or striatum is capable of augmenting dopamine function of the nigrostriatal pathway in normal rats. Single bolus intracranial injections of rhGDNF at either site increased locomotor activity and decreased food and water consumption and body weight in a dose-dependent manner when compared to vehicle-treated animals. These behavioral responses returned to pre-control levels within 3 weeks post rhGDNF administration. Administration of rhGDNF intranigrally increased dopamine, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels of the ipsilateral substantia nigra at 2 and 6 weeks post injection but had no augmenting effects on dopamine or its metabolites in the striatum. Administration of rhGDNF intrastriatally increased DOPAC and HVA levels of the ipsilateral striatum, although striatal dopamine levels were unchanged. Ipsilateral nigral dopamine levels were increased after intrastriatal injection of rhGDNF. The effects of intracranial rhGDNF were not specific to the nigrostriatal dopamine system, since nigrostriatal serotonin, 5-hydroxyindoleacetic acid (5-HIAA), epinephrine and norepinephrine transmitter levels were altered depending on administration route for rhGDNF and dose. Taken together, these data demonstrate long-lasting neurochemical and behavioral changes which suggest that rhGDNF can augment function in adult rat dopamine neurons. Therefore, rhGDNF may have therapeutic potential for Parkinson's disease.

Animals↗
PubMed1996

NT-3 has a tropic effect on process outgrowth by postnatal auditory neurones in vitro.

CONFOCAL analysis of early postnatal auditory neurones in a bicompartmental culture system was used to test for chemoattractant properties of NGF, BDNF and NT-3 on neuronal process outgrowth. NT-3 exerted a strong tropic effect on neuritic outgrowth from auditory neurones in this system. BDNF and NGF did not have any tropic activity that directed processes outgrowth from auditory neurones. However, BDNF was important for the support of neuronal survival in NGF-treated cultures and for neuritogenesis in NT-3-treated cultures. Since NT-3 has been identified as both a survival factor and a chemotropic agent for auditory neurones, it is likely that this neurotrophin will be a useful therapeutic agent in the treatment of damaged cochleae for the recovery of hearing.

Animals↗
PubMed1996

GDNF enhances dopaminergic cell survival and fibre outgrowth in embryonic nigral grafts.

Two groups of rats with unilateral 6OHDA lesions received either intrastriatal suspension grafts of embryonic ventral mesencephalon or sham grafts. Three subgroups of each of these received intrastriatal infusions of 1000 ng or 500 ng glial cell-line derived trophic factor (GDNF) or vehicle alone for 10 consecutive days. There was a highly significant dose-dependent effect of GDNF both on the number of TH-positive cells surviving in the grafts and on the density of fibre outgrowth. All grafted rats showed rapid compensation of amphetamine-induced rotation compared with rats with sham grafts. GDNF may provide a powerful tool to enhance the survival and maturation of dopaminergic neurones within mesencephalic transplants.

Animals↗
PubMed1996

Inhibition of tumor necrosis factor-alpha reduces focal cerebral ischemic injury in the spontaneously hypertensive rat.

Tumor necrosis factor-alpha (TNF-alpha) is acutely expressed following focal cerebral ischemia, but its pathophysiological role remains to be extensively characterized. In this study we determined the effect of inhibiting TNF-alpha on the microvascular perfusion impairment and ischemic injury induced by permanent middle cerebral artery occlusion (MCAO). TNF-alpha activity was inhibited with recombinant type I soluble TNF receptor (TNFbp; 1 mg/kg i.v., 0.5 h pre- or post-MCAO). TNFbp significantly attenuated the microvessel perfusion impairment observed in vehicle treated rats, particularly in perifocal/penumbral regions of cortex, and significantly reduced (by 34-38%) the total volume of ischemic injury. These results demonstrate that TNF-alpha contributes to focal ischemic injury and that inhibition of TNF-alpha can confer dramatic neuroprotection. The association of the neuroprotective effect of TNFbp with improved microvascular perfusion suggests that inflammatory and vascular responses to TNF-alpha contribute to its pathological action.

Animals↗
PubMed1996

Alpha-MSH stimulates neurite outgrowth of neonatal rat corticospinal neurons in vitro.

Peptides related to melanocortin (alpha MSH) and corticotropin (ACTH), collectively termed melanocortins, exert trophic effects on the outgrowth of neurites from peripheral and central nervous system in vitro. Here we study the neurite outgrowth promoting effect of alpha-MSH on corticospinal (CS) neurons in vitro. Corticospinal neurons were identified in cell culture of neonatal rat cortex by immunostaining of cholera toxin subunit B (CTB), retrogradely transported from the cervical parts of the spinal cord. The CTB-immunoreactive neurons represent a small percentage (3-5%) of the total cell population after 72 h in vitro. The axons or dendrites of cortical and CTB-labelled layer V neurons were visualized using antibodies against axon- or dendrite-specific markers and measured using a semi-automatic quantification device. Here we report that alpha-MSH stimulates axonal as well as dendrite outgrowth from both total and CTB-labelled neurons with a bell-shape response curve. Axonal outgrowth of CTB-labelled neurons was dose-dependently stimulated with a maximal effect of 50% at 10(-10) M alpha-MSH. The maximal effect for stimulation of axon outgrowth for the total cortex population was observed at 10(-8) M alpha-MSH. In addition dendrite outgrowth of both total and CTB-labelled neurons is stimulated in a dose-dependent manner with maximal effects (varying between 46 and 48%) at 10(-8) M alpha-MSH. Explanations in the shift for the optimal alpha-MSH concentration for stimulation of axonal outgrowth of CTB-labelled layer V neurons as compared to total cortex neurons are discussed.

Animals↗