Biomedical subjects
Publications and source records attributed to G Robert.
We aimed to establish a 1996 baseline of new health care technologies that are predicted to have an impact on the United Kingdom's National Health Service in the next five years. One thousand and ninety-nine health care technologies were identified from a variety of sources. Further work will attempt to determine the most efficient method of identifying and monitoring new health care technologies.
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Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open access to a hospital-based physical therapist), and general practice fundholders are increasingly committing resources to ensure such services are available to their patients. This may lead to potential increases in costs as a larger total number of patients are treated owing to improved access and awareness of such services. A review of the available published literature found eight studies that compared two or more models of providing physical therapy services. Analysis of the studies revealed that there are several advantages for patients who are referred directly for physical therapy. The main advantages are significant reductions in waiting times, convenience, reduced costs for the patient and a lower cost per treated patient. There is also some evidence that the recovery time may be slightly better for patients who have direct access to a physical therapist.
This paper examines the detailed pattern of hormonal and affective response to natural variations in work demands, in relation to a taxonomy of adaptive response based on Frankenhaeuser's (1986) psychobiological analysis of coping modes and Hockey's (1993) regulatory control model. Two junior doctors were monitored every day over a 7-week period of work on a cardio-thoracic surgery ward. Measurements were made for each morning and afternoon work period of self-rated workload, effort and affective state, and the level of urinary catecholamines and cortisol. The de-trended data were analysed separately for the two individuals, using multivariate methods. Following reduction of work variables by principal components analysis, canonical correlation analyses were carried out for each individual. These revealed differences in the patterns of adaptation to two distinctive work contexts (enabling and demanding work) across the two doctors, as identified through loadings on two significant pairs of canonical variates. As expected, enabling work (high medical demands, with high personal resources) was associated with active coping in both subjects (low fatigue, high effort/adrenaline and low cortisol). However, demanding work (high general demands) was associated with marked differences between them in the pattern of loadings. One subject showed the strain pattern normally associated with effortful engagement in difficult tasks (high anxiety and fatigue, high effort/adrenaline), though without the anticipated reduction in cortisol. The response pattern of the other individual was indicative of passive coping (high anxiety and cortisol, with no effort/adrenaline component). The findings are interpreted in terms of the role of personal coping styles on the adaptive response to work demands. The use of canonical correlation methods with intra-individual data sets, although relatively unusual, appears to provide potentially valuable evidence on the nature of individual differences in the process of psychobiological response to stress underlying work-health relationships.
The Order of Malta established in Jerusalem in the 12th century retreated to Saint Jean of Acra then to Cyprus in 1291, to Rhodes on 1310 and to Malta in 1530 to remain there until 1798. In Rhodes it erected an hospital called the "Collachium". The "Grand Maître" had for assistant in charge of the health the Hospitalier a man who was always the chief of the French Knights. In Malta, in 1593, was founded a great hospital or Sacred Infirmary, at la Valette with a staff of three doctors and two assistants, eight surgeons and assistants and a apothicary with three apothicaries and five assistants. The Malta University, including a Faculty of Medicine was founded in 1769 where they taught anatomy, chemistry, physiology, pathology, semeiologie, hygiene and therapeutics.
The anterior approach to the cervical spine is currently a worldwide traditional surgical technique used by neurosurgeons or orthopedists in the treatment of traumatic, degenerative or tumoral cervical spinal lesions. Many original rules of these techniques were raised by pioneers as R. Cloward and H. Verbiest, and are still valid. Advances in the surgical armentarium and in bio-materials markedly improved the original technique and subsequently improved the clinical results. The present course was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was helded during the winter meeting in December 1995. The aim of this course is to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points are strengthened by the author's personal experience and comments. Part I presents the different anterior or antero-lateral approaches which any surgeon involved in cervical spine surgery actually needs to know. Secondly, the materials and technical basis needed to achieve an interbody graft or fusion or fixation are described. Lastly, some practical applications are detailed as a microdiscectomy, a medial or lateral cervical spine decompression, and the use of acrylic plastic or prothesis for a cervical vertebral replacement.
The present course on the anterior and antero-lateral surgical approach of the lower cervical spine was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was held during the winter meeting in December 1995. The aim of this course was to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points were strengthened by the author's personal experience and comments. In Part I, the technical bases of the different anterior or antero-lateral approaches were presented (1996, 42 : 105-122). In the present Part II, the main indications of the anterior surgical approach to the cervical disk or the vertebral body are detailed, and the requirement of a bone graft and/or an osteosynthesis are discussed with their consequences on the final results. Secondly, variants of the surgical technics in use in case of cervical spinal instability are commented. Then various approaches to the cervical spinal tumors and to the vertebral artery are detailed and commented. Lastly, general and specific complications of the anterior cervical approach are listed with their rate of occurrence, and their prevention and management are discussed.
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BACKGROUND: Vasoconstriction occurs after percutaneous transluminal coronary angioplasty (PTCA) along the dilated vessel. The vasomotor changes, initiated by the mechanical stretch of the stenotic region, are thought to be due to various mechanisms but whether the sympathetic nervous system plays a role in this phenomenon remains unknown. METHODS AND RESULTS: Quantitative angiography (ARTREK) was performed in 45 patients undergoing an epicardial vessel PTCA for a stenosis of 76 +/- 1% (1) in basal conditions, (2) after PTCA, and (3) 30 minutes after PTCA (vasoconstriction). In 14 control patients, the same measurements were obtained up to 60 minutes after PTCA. Coronary diameters were measured along the PTCA vessel at the narrowest stenosis level and at a level peripheral to stenosis. In 36 patients two diameters were also measured at a proximal segment and at a distal segment along a nonmanipulated vessel. Thirty minutes after PTCA the dilated segment underwent a -31 +/- 2% (mean +/- SEM, ANOVA, P < .05) reduction in diameter when compared with PTCA values, and the segment peripheral to stenosis showed a reduction of -17 +/- 2% (P < .05). In all patients a significant vasoconstriction also was observed along the control vessel (proximal segment, -14 +/- 3%; P < .05 versus basal; and distal segment, -17 +/- 2%). At the time of maximal vasoconstriction (30 minutes after PTCA), the patients (treatment groups) received (1) 18 micrograms/kg IC phentolamine (Phe, n = 7), (2) 14 micrograms/kg IC yohimbine (YO, n = 7), (3) 16 micrograms/kg IC propranolol (Pro) followed by 18 micrograms/kg IC phentolamine (Pro+Phe, n = 7), and (4) 0.2 mg/kg IC bretylium (Bre, n = 10). In 14 patients (control groups) an intracoronary injection of warm saline was given. After drug injections, angiograms were repeated at 5-minute intervals for 20 minutes and ended after a 300-micrograms intracoronary trinitroglycerin injection. At stenosis level, Phe and Bre counteracted vasoconstriction, inducing a dilatation of +19 +/- 3% and +22 +/- 6%, respectively, while Pro+Phe caused a dilatation of +16 +/- 9% above the PTCA values (P < .05 versus PTCA). YO only partially reversed vasoconstriction (from -33 +/- 4% to -12 +/- 4%, P = NS versus PTCA). At peripheral-to-stenosis level, vasoconstriction was abolished by Phe (+26 +/- 7%, P < .05 versus basal), while it was still present after Pro+Phe (-23 +/- 2%) and Bre (-18 +/- 4%). In addition, Phe and Bre dilated the control vessel at the proximal segment (+17 +/- 6% and +8 +/- 4%, respectively, P < .05 versus basal), while YO and Pro+Phe only counteracted vasoconstriction (from -15 +/- 3% to +7.6 +/- 1% and from -16 +/- 3% to +4 +/- 5%, respectively, P = NS versus basal). At the distal segment only Phe produced a vasodilatation of +23 +/- 1%; YO counteracted constriction (from -16 +/- 2% to +9 +/- 6%, P < .05 versus basal), whereas after Pro+Phe and Bre, the vasoconstriction persisted. CONCLUSIONS: The mechanical stretch and ischemia caused by balloon inflation induced vasoconstriction mediated by alpha-adrenergic receptors (mainly alpha 1), overcoming a beta-mediated dilatation. The use of different antiadrenergic drugs showed that Phe counteracts post-PTCA vasoconstriction, and the simultaneous use of alpha- and beta-receptor blocking agents (Pro+Phe and Bre) reveals the presence of a peripheral, predominant beta-mediated dilatation. The presence of vasoconstriction also along the control vessels not branching from the stretched ramus provides evidence for the existence of neural sympathetic vasoconstrictor reflexes.
INTRODUCTION AND OBJECTIVES: Intracoronary stenting has been proposed as an adjunct to balloon angioplasty in order to improve the immediate and long-term results. The purpose of this study was evaluate the short-term results, subacute closure rate and to try to identify angiographic predictors of subacute thrombotic after Palmaz-Schatz stent implantation. METHODS: Through a prospective registry, we have evaluated in 500 patients the safety and efficacy of Palmaz-Schatz stent implantation (580 in total) in coronary arteries and saphenous vein grafts. The identification of clinic and angiographic predictors of subacute closure have been evaluated with the assistance of a BMDP statistical software using an univariate and multivariate statistical analysis (logistic regression). The determination of diameter and stenosis has been achieved by electronic caliper. RESULTS: The stent was implanted successfully in 98.6% of the patients. There was no abrupt closure (< or = 1 day), however 36 patients (7.2%) developed subacute thrombotic closure (among 2nd-21st day after stenting). The major complications were: death 9 patients (1.8%), bypass surgery 7 patients (1.4%) and myocardial infarction 21 patients (4.2%). The predictors of subacute thrombotic closure through univariate statistical were: stenting for bail-out (S.T.: 27%; p < or = 0.0001), multiple stenting (S.T.: 24.1%; p < or = 0.0001), final diameter stent < or = 3.25 mm (S.T.: 12.6%; p < or = 0.013), and left ventricular ejection fraction < or = 45% (S.T.: 15.7%; p < or = 0.022). We showed with logistic regression that final diameter stent < or = 3.25 mm; p < or = 0.0030, left ventricular ejection fraction < or = 45%; p < or = 0.0012, stenting for bail-out; p < or = 0.0195 and multiple stenting; p < or = 0.0252, were predictors of subacute thrombotic closure. CONCLUSIONS: The Palmaz-Schatz coronary stenting will preferably realize in those arteries bigger than 3.25 mm and left ventricular ejection fraction > 45%, showing multiple stenting and stenting for bail-out greater subacute thrombotic closure rate.
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Parasite extracts of Plasmodium falciparum and P. chabaudi and three synthetic peptides from the P. falciparum MSA2 merozoite antigen were tested for suitability as antigens in an antibody detection ELISA using sera from malaria patients in Brisbane. The P. chabaudi extract was superior to P. falciparum extract for detecting P. vivax cases, while for P. falciparum cases the two parasite extracts were equivalent. Single peptide antigens were generally less sensitive than parasite extracts; however, peptides G3 and G7 were more sensitive than parasite extracts in detecting first attacks of P. vivax. Examination of isotype specific responses demonstrated that this may be explained by higher IgG responses to these peptides in first than in subsequent P. vivax attacks. Because of the differing antibody specificities in primary and secondary P. falciparum and P. vivax cases, the best sensitivity was achieved by using the combined results of assays with three antigens: P. chabaudi, peptide G3 and peptide G7. The combined sensitivity was 77.1% for P. falciparum and 88.6% for P. vivax acute cases with 91.1% specificity.
Direct coronary angioplasty as an emergency procedure in the first hours of myocardial infarction without prior thrombolytic therapy requires a heavy infrastructure. The different results reported in the literature show a recanalisation rate of 90% with an average hospital mortality of 7%, an acceptable risk given the inclusion of patients of over 75 years of age in these series and cases of cardiogenic shock. The reocclusion rate in the hospital phase is between 10 and 15%. At medium term, the survival rates of single vessel disease are excellent but the mortality is higher in multivessel disease (78% survival at 2 years). Angioplasty performed in the first three hours after the onset of symptoms is associated with an improvement in global an regional left ventricular function in patients with anterior infarction and altered initial left ventricular function. The preliminary results of a randomised multicenter trial comparing direct angioplasty with intravenous thrombolytic therapy with rt-PA (PAMI) seem to show in favour of angioplasty with a lower rate of complications in the hospital phase. The results of this multicenter trial should provide information as to the exact role of direct angioplasty in the initial phase of infarction, a procedure reserved for well-equipped cardiological centres with highly trained invasive cardiologists.
We evaluated renal function within 48 hours after extracorporeal shock-wave lithotripsy (ESWL) as well as 1 month and up to 6 months later employing technetium-99m dimercaptosuccinic acid and iodine-131-labelled ortho-iodohippurate. All 17 patients displayed abnormal renal function immediately after ESWL. The abnormalities identified included focal cortical lesions, diffuse reduction of renal function, increased kidney volume, and diffusely and focally increased parenchymal transit times. The follow-up scintigraphic studies indicated that the great majority of the lesions had been temporary.
Extracorporeal shock-wave lithotripsy is a procedure recently introduced to treat gallstone disease. According to the literature, 15% to 25% of symptomatic persons will be candidates for this procedure if it proves effective. Currently, sonography is one of the best methods for monitoring the performance of lithotripsy. The authors have confirmed this. They have designed an in-vitro model which allows comparison between what is actually happening during gallstone lithotripsy and what is being seen by real-time sonography. The sonographic characteristics of the different phases of gallstone lithotripsy are presented.
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