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Biomedical subjects

E Franssen

Publications and source records attributed to E Franssen.

68 records · Page 4Linked to original sources
PubMed1993

A clinical comparison of two triphasic oral contraceptives with levonorgestrel or norethindrone: a prospective, randomized, single-blind study.

Menstrual bleeding patterns were investigated in young women taking either a levonorgestrel triphasic, Triquilar, or a norethindrone triphasic, Ortho 7/7/7, two commonly prescribed low-dose oral contraceptives. The levonorgestrel triphasic contains ethinyl estradiol (EE) 30 micrograms + levonorgestrel (LNG) 50 micrograms for the first six days, EE 40 micrograms + LNG 75 micrograms for the following five days, and EE 30 micrograms + LNG 125 micrograms for the last ten days. The norethindrone triphasic contains EE 35 micrograms + norethindrone (NET) 0.5 mg for the first seven days, EE 35 micrograms + NET 0.75 mg for the following seven days and EE 35 micrograms + NET 1.0 mg for the last seven days. Three hundred women from 16 to 25 years of age were randomized to the levonorgestrel triphasic (n = 150) or the norethindrone triphasic (n = 150) groups. Assessments were made from daily diary cards and from bimonthly investigator interviews over 6 pill cycles. The results showed a higher incidence of intermenstrual bleeding (breakthrough bleeding and/or spotting) in the norethindrone triphasic group (NET group) than in the levonorgestrel triphasic group (LNG group): 44.9% of patients (66/147) randomized to the LNG group reported intermenstrual bleeding one or more times during the study compared with 61.9% (91/147) randomized to the NET group (p = 0.0036). Furthermore, in subjects who did not miss any pills, the proportion of patients with intermenstrual bleeding in each cycle was significantly greater (p < 0.02, cycles 1-4, 6; p > 0.05, cycle 5) and was experienced for more days per cycle (p < 0.05, cycle 1) and for more cycles per patient (p < 0.05, 5 cycles) in the NET group compared with the LNG group. Intermenstrual bleeding was also less frequently observed in the LNG group than in the NET group in patients who missed pills (p < 0.05, cycles 3, 5 and 6). In addition, early withdrawal bleeding occurred more often in the NET group than in the LNG group (p < 0.05, cycles 1, 3 and 4). The incidence of amenorrhea was similar in both groups. These results demonstrate a significantly lower incidence of intermenstrual bleeding and therefore better cycle control with the levonorgestrel triphasic Triquilar, compared with the norethindrone triphasic Ortho 7/7/7.

Adolescent↗
PubMed1993

Laboratory investigations in general practice.

Forty-eight family physicians completed a 10-item questionnaire about their use of laboratory investigations, and "ordered" tests for five clinical vignettes, estimating the cost of tests ordered. Physicians practising less than 10 years ordered more tests and overestimated the cost. Patients' expectations and risk of litigation affected test-ordering behaviour. Strategies to manage resources dedicated to laboratory investigations are explored.

Attitude of Health Personnel↗
PubMed1990

Application of Piagetian measures of cognition in severe Alzheimer's disease.

Conventional psychometric measures uniformly yield zero or near zero scores (i.e., "bottom-out") as patients with Alzheimer's disease (AD) progress to the more severe stages of the illness. Consequently, there are no psychometric measures which objectively assess the mental abilities of AD patients with very severe cognitive impairment. We explored the hypothesis that mental function in AD patients with very severe cognitive impairment can be effectively assessed using test measures developed to assess the earliest stage of cognitive development as proposed by Piaget. We also investigated the relationship between decline on these experimental cognitive measures and progressive functional disability in patients with severe cognitive impairment. The results indicate that modified instruments derived from measures developed to assess Piaget's sensorimotor stage of cognitive development provide useful information about the cognitive abilities of very severely impaired AD patients. These modified instruments provide a measure of cognition in these extremely impaired patients that has acceptable validity and demonstrable reliability.

Aged↗
PubMed1989

The stage specific temporal course of Alzheimer's disease: functional and behavioral concomitants based upon cross-sectional and longitudinal observation.

A series of studies published over the past 6 years now permit a relatively precise description of the temporal course of Alzheimer's disease (AD). Initially, 7 global stages of CNS aging and AD were described. Subsequently, data on the stage specific relationship between these stages and widely employed mental status, psychometric, and other assessment measures were collected. Longitudinal studies helped to clarify the borders between normal CNS aging and AD using these measures. Other studies described functioning and self-care correlates of the 7 global stages. These were ultimately divisible into 16 clearly defined, ordinal functional stages. Empirical longitudinal observations permitted the description of the mean temporal course of each of the 16 functional stages of aging and AD. The cross-sectional stage specific data on mental status and other measures can now be applied to the mean temporal course observations and the validity of the temporal estimates forwarded can be investigated in detail. Etiologic hypotheses based upon the observed phenomenologic and temporal course of AD are discussed.

Aging↗
PubMed1989

Clinical features of a neuropathologically verified familial Alzheimer's cohort with onset in the fourth decade: comparison with senile onset Alzheimer's disease and etiopathogenic implications.

Clinical and pathologic features of a family with early onset, autosomal dominant, familial Alzheimer's disease (AD) are compared and contrasted with senile onset dementia of the Alzheimer type. Late onset AD has previously been observed to have a characteristic progression and clinical course. A previously unreported pedigree, with two siblings and their father affected, of early clinical onset is presented. Molecular genetic study of this family using in situ chromosome hybridization showed an apparent marker on chromosome 9. This early onset form of AD is observed to be clinically consistent with the common late onset form of AD, but follows a more rapid course. An etiopathogenic model explaining the early onset, and other forms of AD is presented.

Adult↗
PubMed1988

Clinical stages of dementia and the dexamethasone suppression test.

1. This study was undertaken to evaluate the relationship between clinical aspects of primary degenerative dementia and suppression or non-suppression in the dexamethasone suppression test. 2. We studied 34 male patients with primary degenerative dementia (as diagnosed by DSM-III criteria). Dexamethasone 1 mg p.o. was administered at 11:00 PM and blood was drawn for cortisol determination at 4:00 PM the next day. 3. CLINICAL FACTORS INCLUDED: age, age at onset, duration of dementia, history of psychiatric illness, severity as measured by Global Deterioration Scale (GDS) score, and "malignancy" of dementia (rated by years of onset to institutionalization and as a ratio of Global Deterioration Scale to duration of primary degenerative dementia). 4. RESULTS: 56% of primary degenerative dementia patients failed to suppress. The highest degree of non-suppression was seen in Global Deterioration Scale 5 and 6 subjects (Table). 5. An unexpected finding was that a large number of Global Deterioration Scale 7 patients demonstrated normal post-dexamethasone suppression of the hypothalamic-pituitary-adrenal axis. 6. Some contradictions in previously reported studies may be explained by this pattern.

Aged↗
PubMed1987

Behavioral symptoms in Alzheimer's disease: phenomenology and treatment.

Limited information is available regarding the incidence, nature, and treatment of behavioral problems in Alzheimer's disease (AD). A chart review of 57 outpatients with a diagnosis of AD was conducted to examine these issues. Thirty-three (58%) patients had significant behavioral symptomatology (most commonly delusions, nonspecific agitation, and diurnal rhythm disturbances). Twenty-seven were treated with thioridazine (10-250 mg/day), 15 (55.6%) of whom were judged to have a positive response (mean maximum dose = 55 mg/day). Information regarding the characteristic phenomenology of the behavioral symptoms studied was used to design a clinical rating instrument for AD patients, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), which should be useful in prospective studies of behavioral symptoms as well as in pharmacologic trials.

Aged↗
PubMedDate not supplied

Postoperative borderline elevated CEA predicts for earlier relapse in patients with rectal cancer receiving adjuvant postoperative therapy.

PURPOSE: The purpose of this study was to determine the impact of a borderline elevated postoperative carcinoembryonic antigen (CEA) on the duration of disease-free survival in patients with rectal cancer treated with postoperative adjuvant radiotherapy and chemotherapy. PATIENTS AND METHODS: A retrospective review was undertaken of 145 patients undergoing curative surgery for rectal adenocarcinoma (American Joint Committee on Cancer stages II and III) and treated with postoperative radiotherapy and chemotherapy from January 1994 to February 1997. Patients with known metastatic disease, with gross residual disease after surgery, or without an available postoperative CEA level before adjuvant therapy were not included. All patients were monitored for a minimum of 1 year or until death. The rates of relapse, disease-free survival and overall survival were estimated according to the Kaplan-Meier method. Univariate analyses for the endpoint time to relapse was carried out for the following potential prognostic factors: age, gender, American Joint Committee on Cancer stage, number of lymph nodes, perineural invasion, capillary-like space invasion, margin status, and postoperative CEA level (< or = 4.0 microg/L vs > 4.0 microg/L). A mulitvariate regression analyses was conducted with the Cox proportional hazards model. RESULTS: With a median follow-up of 45 months, the disease-free and overall survival rates at 2 years were 78% and 90% respectively. Eight patients were identified who expressed an elevated postoperative CEA (4.1-10.2 microg/L). Two patients had T3N0 tumors; one tumor was T4N0, four tumors were T3N1, and one was T4N1. The median time to first relapse in these eight patients was 26 months, compared with 69 months for the 137 patients with a postoperative CEA in the normal range (0-4.0 microg/L), (log-rank Chi-squared test = 4.92). As determined by a proportional hazards model, an elevated CEA remained an independent predictor (along with number of positive nodes) for early relapse. DISCUSSION: Postoperative CEA in patients undergoing curative surgery for rectal cancer provides additional prognostic information in those patients embarking on adjuvant postoperative therapy. An elevated CEA predicts for early relapse and may help define a high-risk subset of patients in whom more aggressive adjuvant therapies should be considered.

Aged↗
PubMedDate not supplied

A process for evaluation of residency rotations.

An evaluation tool for measuring the experiences of family practice residents as they rotate through various services was developed and tested. The tool is described and the effect on the program is discussed. The ease of administration has led to acceptance in not only the family practice program but also in other departments.

Evaluation Studies as Topic↗