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Biomedical subjects

J French

Publications and source records attributed to J French.

At least 73 records · Page 4Linked to original sources
PubMed1996

Unrelated donor bone marrow transplantation to treat severe aplastic anaemia in children and young adults.

Alternative donor bone marrow transplantation (BMT) to treat severe aplastic anaemia (SAA) in children and young adults has been complicated by high rates of graft rejection and severe graft-versus-host disease (GVHD). We hypothesized that increased immunosuppression combined with T-cell depletion of the marrow graft would enable successful use of unrelated donor BMT in this disease. Preconditioning consisted of cytosine arabinoside, cyclophosphamide, and total body irradiation (TBI). T-cell depletion was with the anti-CD3 antibody T10B9. GVHD prophylaxis consisted of cyclosporine A. 28 previously transfused patients were transplanted. Nine donor/recipient pairs were HLA matched. As of 1 January 1996, 15/28 (54%) patients are alive, transfusion independent and well with a range of follow-up of 13 months to 8 years (median 2.75 years). Fatalities include all three patients with nonengraftment and all three patients with grade III/IV GVHD. Other fatalities were due to infections or therapy-related toxicity. The incidence >or= grade II acute GVHD was 28%. These data show that in children with SAA who have failed immunosuppression, unrelated donor BMT offers a reasonable hope of long-term survival.

Adolescent↗
PubMed1996

Trends in heterosexual tertiary students' knowledge of HIV and intentions to avoid people who might have HIV.

This study investigated trends in HIV knowledge and endorsement of social avoidance of people who might be infected with HIV. The respondents (n = 7387) were self-identified heterosexual students. Most of them (n = 6500) were first-year behavioural or biological sciences students from annual surveys (1988-1995) at Macquarie University. The others (n = 887) were from four biennial (1987-1993) random samples of all students below 30 years of age at the University of Sydney. Students at both campuses completed self-administered questionnaires. Nine items were used to compute Partner Distinction Scale scores which indicated whether students had accurate knowledge that HIV may be transmitted through specific sexual practices with either casual or regular partners. Eleven items contributed to a Social Avoidance Scale. At Macquarie, male students had more accurate knowledge than female students, [F(1, 6024) = 9.20, p < 0.003], but at Sydney there were no significant sex differences in knowledge. Male students endorsed greater social avoidance at both Macquarie, [F(1, 6421) = 195.57, p < 0.00005], and Sydney, [F(1, 881) = 32.41, p < 0.00005]. Multiple linear regression on social avoidance revealed a significant reduction in social avoidance over time, with more rapid decrease among male students. Whereas less social avoidance was partly attributable to better knowledge over time, it is concluded that the improved social climate towards those most affected by HIV is mainly due to a shift in cultural norms.

Adult↗
PubMed1996

Hemodynamic effects of amrinone in children after Fontan surgery.

After Fontan repair in children, we performed a prospective, open-label study to evaluate the effect of amrinone on pulmonary vascular resistance (PVRI). Eight patients who underwent the Fontan repair had baseline arterial pressure, left atrial pressure, central venous pressure, and cardiac output measured postoperatively. Hemodynamic measurements were repeated after amrinone 4.5 mg/kg. The PVRI tended to decrease, but the change was not statistically significant. Although the systemic vascular resistance decreased to 802 +/- 222 from 941 +/- 191 dynes.s.cm-5.m-2 (P < 0.05), mean arterial blood pressure was unchanged. Cardiac index (3.8 +/- 1.2 to 4.7 +/- 1.6 L.min-1.m-2) and stroke volume index (23.6 +/- 6.7 to 30.5 +/- 8.1 mL.beat-1.m-2) increased, and heart rate decreased (160 +/- 21 to 151 +/- 24 bpm) (P < 0.05). Colloid transfusion during amrinone bolus administration was 13.9 mL/kg. The mean serum amrinone concentration was 4.2 micrograms/mL at the end of bolus and clearance was 2.24 mL.kg-1.min-1. Arrhythmias and thrombocytopenia were not noted. We conclude that amrinone administration is effective in increasing cardiac output in children who have undergone a Fontan repair.

Amrinone↗
PubMed1996

Sexual practice and understandings of safe sex: assessing change among 18- to 19-year-old Australian tertiary students, 1988 to 1994.

From 1988 to 1994, first-year students in a large introductory class at Macquarie University completed a questionnaire regarding sexual practice, knowledge of transmission of human immunodeficiency virus (HIV) and understandings of safe sex. Data from 18- and 19-year-old students were analysed to examine changes over time among recent school leavers. Approximately 58 per cent were sexually experienced, young men were more experienced than young women, and both had more experience with regular than with casual partners. The number of partners did not vary over the years, most respondents having had one or two partners. Changes over time were found with respect to condom use, particularly with regular partners. The percentage using condoms "always' with casual partners was greater, having increased to around 60 per cent. Accuracy of knowledge relating to safety of sexual practices with casual and with regular partners increased over time, particularly with respect to regular partners. While both accuracy of knowledge and safety of practice increased with time, there was no relationship between these two variables in any one year. The findings suggest that there has been normative change with regard to condom use and that this has occurred within a reasonably static and unchanging set of sexual practices. Sex education appears to be one of the factors contributing to this change.

Adolescent↗
PubMed1996

Molecular pathology of the X-linked hyper-immunoglobulin M syndrome: detection of wild-type transcripts in a patient with a complex splicing defect of the CD40 ligand.

The X-linked hyper-immunoglobulin M syndrome (XHIM) is a primary immune deficiency disorder characterized by an inability to produce immunoglobulin isotypes other than immunoglobulin M (IgM) and IgD. Recently, a B-cell surface antigen (CD40) and its conjugate T-cell counterstructure (CD40 ligand) were shown to mediate immunoglobulin isotype switching in the presence of cytokines such as interleukin 4. Most patients with XHIM have been shown to have mutations of the extracellular domain of the CD40 ligand. Here we describe a novel point mutation of an intronic splice acceptor site which results in a complex splicing defect of the CD40 ligand in a patient with XHIM. In addition to two species of deleted transcripts, wild-type transcripts were also detected in this individual. The demonstration of wild-type CD40 ligand transcripts may be an explanation for previous observations suggesting that some XHIM patients are able to undergo immunoglobulin isotype switching in vivo.

Adolescent↗
PubMed1995

Pseudoseizures in the era of video-electroencephalogram monitoring.

Psychogenic seizures may be difficult to distinguish from epileptic seizures lacking electrographic correlate. The presence of concomitant epilepsy or Munchausen syndrome by proxy may increase diagnostic difficulty. Clinical seizure characteristic, suggestion, prolactin levels, and continued recording after medication withdrawal may be useful in reaching a diagnosis. Dissociative disorders may be very common in psychogenic seizure patients.

Adult↗
PubMed1995

Network integration: the impact of integrated delivery systems. Roundtable discussion.

One of the hottest, most competitive segments of the healthcare IS industry encompasses integration tools and systems for linking divergent, best-of-breed systems. As firms such as Healthcare Communications, HUBLink, Oacis, Software Technologies Corp., Century Analysis and Eagle Innovations vie for new contracts, CIOs and IS directors wonder about the strategic advantages of single-vendor solutions vs. the best-of-breed approach. This dynamic has driven system acquisitions for several years. More recently, 33 percent of respondents to the 1995 HIMSS/HP Survey cited integration across separate facilities as their No. 1 priority for the next two years. Clearly the emergence of integrated delivery systems and providers of continuums of care--where the cost to replace the information technologies of acquired or partnered entities remains prohibitive--will cause the market for interface engines and other integration tools to continue expanding. Following are the perceptions of a few experts on the topic. They were asked to answer two questions: 1) What are the toughest challenges faced when integrating an integrated delivery system? and 2) What are the current best practices to solving this challenge?

Comprehensive Health Care↗
PubMed1995

Circadian rhythm desynchronosis in military deployments: a review of current strategies.

The combined problems of changing work schedules and work places are not uncommon in military operations. For example, during the Persian Gulf War, many military units underwent short notice transmeridian deployment with immediate commencement of 24-h operations upon arrival. Some of these individuals likely suffered from circadian desynchronosis, blunting their effectiveness. The United States Air Force approved limited use of one short acting hypnotic medication to assist aircrew sleep disorders in the operational theater and, until recently, one stimulant medication to enhance alertness. Multiple theoretical strategies for circadian rhythm management are available. However, many U.S. Air Force flight surgeons are not trained on how best to use medications in combination with other circadian rhythm strategies. We present a condensed review of current human circadian rhythm coping strategies pertinent to military operations.

Aerospace Medicine↗
PubMed1995

Thermal study of anti-G ensembles aboard F-16 aircraft in hot weather.

Continuing advances in the performance of new fighter aircraft have engendered requirements for more sophisticated protective clothing and life support systems. A major goal is prevention of acceleration-induced loss of consciousness. The USAF's Advanced Technology Enhanced Design G-Ensemble (COMBAT EDGE) increases acceleration tolerance by providing positive pressure to the oxygen mask; the work of pressure breathing is reduced by adding a counter-pressure bladder over the chest. However, the addition of impermeable layers over the chest reduces the area available for evaporation of sweat. This study was designed to determine whether COMBAT EDGE (CE) was demonstrably hotter than standard summer flight clothing (ST) during F-16 sorties in hot weather. Eight male pilots served as volunteer subjects, each flying missions at 1430 and 1745 h on two consecutive days, one day with CE and the other with ST. Data were logged at 1-min intervals for rectal temperature (Tre), skin temperatures at the chest and thigh (Tch and Tth) and air temperatures outside the clothing at the same two sites (Tach and Tath). The weather was stable over the 4 d of data collection with highs of 34-36 degrees C and simultaneous dewpoints of 19-23 degrees C (relative humidity 35-45%). The mean Tach was stable at 28 degrees C in flight, while individual means for Tath ranged from 22 to 25 degrees C. The lower value and greater variability at the thigh reflect its proximity to the air conditioning vent. Despite the differences in air temperature, Tch and Tth remained in the range 34-36 degrees C throughout the flights.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The long-term therapeutic management of epilepsy.

OBJECTIVE: To provide a rational strategy for the evaluation and long-term management of epilepsy. DATA SOURCES: Articles written between 1964 and 1993, obtained from a MEDLINE search on epilepsy-related topics as well as from the author's personal files, major reference books on antiepileptic drugs, and references identified from these books. STUDY SELECTION: Articles were selected if they contained well-documented information comparing anti-epileptic drugs, represented controlled clinical trials, or were considered "key" articles of clinical relevance. DATA SYNTHESIS: Epilepsy is a chronic condition requiring careful long-term management. The treatment is complex, involving classification and diagnosis, selection and monitoring of the appropriate antiepileptic agent, and evaluation of the chosen drug's side effects and drug interactions. Because these side effects increase when drugs are combined, monotherapy is recommended. Long-term management issues and optimal drug selection differ from patient to patient. If seizures are not controlled by medication, the patient may have been misdiagnosed or misclassified. Noncompliance, a major cause of apparent unresponsiveness to treatment, should also be ruled out. Recognizing that current therapy is not ideal for many patients, new pharmacologic and surgical therapies are briefly discussed. CONCLUSIONS: Physicians can pursue a rational strategy for the management of epilepsy if they understand the risks and benefits of various pharmacologic and therapeutic options and if they maintain open lines of communication with the patient.

Anticonvulsants↗
PubMed1994

Relationship between plasma insulin and triglyceride concentrations in hypertriglyceridaemic donkeys.

Hyperinsulinaemia is a commonly-observed characteristic of insulin resistance, and a reduction in insulin sensitivity is thought to be either a causative and/or symptomatic feature of equine hyperlipaemia. A positive correlation (r = 0.545, P = 0.0015) existed between plasma insulin and triglyceride concentrations determined in 31 donkeys with naturally occurring hyperlipidaemia/hyperlipaemia. Greater insulin values tended to occur in the animals with an overweight body score. Inter-animal variation in insulin concentrations, however, prevented the identification of any differences either within hypertriglyceridaemic donkeys (when classified by clinical condition, date of arrival to a sanctuary and eventual outcome after treatment) or between groups of normotriglyceridaemic (n = 6) and experimentally fasted hypertriglyceridaemic (n = 5) donkeys. Determination of basal plasma insulin concentrations may not provide an accurate assessment of underlying insulin sensitivity. Alternatively, hyperinsulinaemia may be evident only in animals with established insulin resistance.

Animals↗
PubMed1994

Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age.

Early diagnosis of colorectal cancer may be delayed by the wide prevalence of gastrointestinal symptoms in the general population. This study assessed, with respect to age, the frequency of gastro-intestinal symptoms in patients with colorectal carcinoma in comparison with community controls and also compared the frequency of such symptoms between 'young' (under 70 years) and 'old' (70 year or over) subjects. Two hundred and seventy three consecutive unselected colorectal cancer patients and 273 age and sex matched community controls were interviewed in a structured manner. Among controls, the 'old' group compared with the 'young' reported abdominal pain (p < 0.05), mucous discharge (p < 0.01), faecal incontinence (p < 0.05), change in flatus production (p < 0.05) significantly more often. There were no significant differences in regularity and frequency of bowel habit by age group. All the symptoms considered were significantly more common in colorectal cancer cases than controls (except abdominal bloating), but the association was less strong in the 'old' group. This study confirms that symptoms attributable to the lower gastrointestinal tract are reported by a clinically important number of community subjects and by a significantly higher proportion of elderly people.

Abdominal Pain↗
PubMed1994

Subjective fatigue of C-141 aircrews during Operation Desert Storm.

Airlift crews were exposed to extended work periods, reduced sleep periods, night work, and circadian dysrhythmia caused by shift work and time-zone crossings during Operations Desert Shield and Desert Storm. This research reveals the extent to which severe subjective fatigue was experienced by the crews during Operation Desert Storm. In addition, through the evaluation of long-term and short-term work and sleep histories, this research shows that recent sleep and flight histories are correlated with high fatigue levels. Furthermore, we found a tendency for fatigue to correspond with pilot error. We recommend that the training of personnel involved in long-duration operations include fatigue management strategies and, further, that work policies and environments be designed to take into account the importance of regular and restorative sleep when unusual duty hours are required.

Adult↗
PubMed1994

Crew fatigue during simulated, long duration B-1B bomber missions.

Crew fatigue associated with successive and unaugmented 36 h missions was evaluated in B-1B simulators. Data were obtained from 32 operationally qualified crewmembers. All crew-members completed three consecutive, long duration missions, each preceded by 33 to 35 h of crew rest. Oral temperature, salivary melatonin and cortisol, as well as actigraph and subjective measures, were collected during all missions. Temperature and melatonin data indicate that crews maintained their local home base circadian cycles. Elevated cortisol and subjective fatigue during the first mission indicate that it was the most difficult of the three. Furthermore, quality and duration of sleep were lowest during the first mission. These findings emphasize the need for realistic training in long duration fatigue management to improve the safety and effectiveness of the first and subsequent missions.

Aerospace Medicine↗
PubMed1993

Third-trimester maternal psychosocial factors and infants' home stimulation. A prospective study.

OBJECTIVE: To examine prospectively the association between mothers' third trimester maternal social support, depression, and satisfaction with a male support figure and their infants' home stimulation 4 months after birth. DESIGN: Prospective cohort. SETTING: Prenatal clinics in three private obstetric offices and two public clinics in western Michigan, a postpartum ward in a community hospital, and subjects' homes at follow-up. PATIENTS OR OTHER PARTICIPANTS: Nulliparous mothers who made at least one visit to a participating prenatal clinic during the third trimester who experienced vaginal deliveries, and whose infants were discharged from normal newborn nurseries between July 1988 and September 1989. One hundred thirty-five mothers agreed to participate, and 101 were available for follow-up home visits. MAIN OUTCOME MEASURES: Home Observation for Measurement of the Environment, a measure of home stimulation. RESULTS: Mothers' third-trimester social support explained 20% of the variance (P = .0001) in infants' home stimulation scores at age 4 months. Third-trimester social support was a stronger predictor of postnatal home stimulation than socioeconomic status, race, depressive symptoms, and satisfaction with a male support figure. Third-trimester social support continued to explain a significant amount of variance in home stimulation scores (R2 = .06, P = .01) even after marital status was included in the model. CONCLUSIONS: Mothers who report higher levels of social support during the third trimester of pregnancy provide higher levels of home stimulation for their infants. These findings suggest that primary care health providers may facilitate early child development by encouraging pregnant mothers to identify and make use of their social resources.

Adult↗
PubMed1993

Dysphagia and expiratory air flow.

Expiratory air flow preserves the freedom of the upper airway from foodway contamination in patients with dysphagia. Valving the tracheostomy cannula, "quad coughing," the Heimlich maneuver, the "supraglottic swallow," and coupling to a ventilator each has a place among the measures used for treating aspiration.

Deglutition Disorders↗
PubMed1993

An additional marker for familial hypertrophic cardiomyopathy?

BACKGROUND: Family screening for hypertrophic cardiomyopathy using conventional techniques yields some equivocal cases. Although mutations in the beta-cardiac myosin heavy-chain gene (MYH7) have been demonstrated in some patients, additional diagnostic methods are desirable to clarify the equivocal cases until the full genetic spectrum is characterized. Because coronary flow reserve is reduced in patients with typical hypertrophic cardiomyopathy independent of the severity of left ventricular hypertrophy, this measurement may help to identify patients with equivocal features of the disease. METHODS: Coronary flow reserve was measured in two subjects: one with a MYH7 mutation but without typical diagnostic features of hypertrophic cardiomyopathy, and one with borderline left ventricular hypertrophy but no mutation in the MYH7 gene. Both subjects underwent screening for hypertrophic cardiomyopathy because of a family history of the disease. Positron-emission tomography was performed to measure myocardial blood flow (MBF) with oxygen-15 labeled water. MBF was measured at baseline and during coronary vasodilatation obtained by intravenous dipyridamole (0.56 mg/kg body weight infused over 4 minutes). Coronary flow reserve was expressed as the ratio MBF-dipyridamole/MBF-baseline. RESULTS: Coronary flow reserve was 1.69 and 1.12 in the two subjects. Both of these values are 2 SD below that (3.87 +/- 1.08) measured in 17 normal subjects using the same method. CONCLUSIONS: Noninvasive quantification of coronary flow reserve by positron-emission tomography may have a role in identifying patients with equivocal hypertrophic cardiomyopathy and should be further explored.

Adolescent↗