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Biomedical subjects

J Lambert

Publications and source records attributed to J Lambert.

At least 181 records · Page 10Linked to original sources
PubMed1994

Evaluation of cutaneous and proprioceptive sensation in children: a reliability study.

Forty-three healthy children aged between six and 12 years were tested to determine the intra-rater reliability of four clinical cutaneous and proprioceptive sensory assessment tools: touch pressure, vibration perception, thermal discrimination and kinaesthesis. The tests were carried out bilaterally on proximal and distal upper- and lower- extremity sites. The mean intraclass coefficients represented good to excellent reliability, which suggests that these assessment tools allow objective and reproducible measurements of cutaneous and proprioceptive sensation in children. The results were compared with existing data in the literature: in general, children and adults obtain similar sensory scores, and sex, age and laterality have no significant effect on the results for any test. However, the touch-pressure and vibration scores were significantly influenced by the site tested, the index fingerpad being the most sensitive area in both tests.

Child↗
PubMed1994

Controversies in maternity care: where do physicians, nurses, and midwives stand?

Through a mail survey in 1991, we compared the opinions of 597 physicians practicing obstetrics, 723 maternity care nurses, and 70 midwives from the province of Quebec, Canada, about selected maternity care issues, including the practice of midwifery. Results showed that divergent points of view existed between and within the three groups on many maternity care issues. Physicians were more divided over the routine use of obstetric intervention than the approach to care or their opinion about midwives. Midwives held more client-centered and less interventionist attitudes than nurses or physicians. Nurses were much more open to midwives than physicians, but 20 to 30 percent of physicians saw some advantages in legalizing the practice of midwifery. Physicians and nurses generally considered midwives as a greater professional threat to the other group than to themselves. The fact that many physicians were critical of current maternity care is difficult to reconcile with their general opposition to midwives. How and to what extent physicians will respond to women's desire for more humanized and less interventionist care remains an open question. Given the problems facing maternity care in North America, expanding midwifery services is an alternative to examine seriously.

Attitude of Health Personnel↗
PubMed1994

Ciprofloxacin and sparfloxacin penetration into human brain tissue and their activity as antagonists of GABAA receptor of rat vagus nerve.

Patients undergoing elective surgery for removal of brain tumors, aneurysms, or other vascular malformations were administered a single oral dose of sparfloxacin (400 mg; 16 patients) or ciprofloxacin (750 mg; 5 patients) either 3 to 5 h or 22 to 26 h before surgery. Serum samples were taken from all patients at 0, 1, 3 to 5, 7 to 9, and 22 to 26 h after dosing; an additional serum sample was obtained at 48 h from patients who received sparfloxacin. A single sample of brain tissue was taken from all patients; a sample of cerebrospinal fluid (CSF) uncontaminated with blood was obtained from five patients. Serum and brain tissue samples were assayed by high-pressure liquid chromatography. Drug concentrations in brain tissue exceeded those in CSF by 1.8- to 19.4-fold. Kinetic modeling suggested that peak sparfloxacin concentrations in brain tissue may have occurred later than 3 to 5 h and that actual peak concentrations may therefore have been higher (up to 10 micrograms/g of tissue). The activities of ciprofloxacin and sparfloxacin as antagonists of the gamma-aminobutyric acid antagonist (GABAA) receptor were measured with the rat vagus nerve preparation. The 50% inhibitory concentration (IC50) of ciprofloxacin was 250 microM (95.25 micrograms/ml), but in the presence of biphenyl acetic acid (BPAA), the IC50 of ciprofloxacin was only 0.6 microM (0.23 microgram/ml). In contrast, the IC50 of sparfloxacin alone or in the presence of BPAA was > 300 microM (> 100 micrograms/ml). We conclude that the concentrations of ciprofloxacin and sparfloxacin in brain tissue may exceed serum drug concentrations and cannot be predicted from the concentrations in CSF. Sparfloxacin does not have any activity as a GABA antagonist, either alone or in the presence of BPAA, at the concentrations which are likely to be reached in human brain tissue.

Animals↗
PubMed1994

Eosinophilic pustular folliculitis and B-cell chronic lymphatic leukaemia.

BACKGROUND: The major problem of eosinophilic pustular folliculitis (EPF) is its generally unknown aetiology. OBJECTIVE AND METHODS: The purpose of this case report is to advise a thorough medical investigation of all patients with EPF. RESULTS: The case of EPF presented seems to be associated with a chronic B-cell lymphatic leukaemia. CONCLUSION: Before regarding EPF as an idiopathic disease of unknown aetiology a thorough immunologic and haematologic investigation has to be advocated.

Eosinophilia↗
PubMed1994

Effect of timolol vs. acetazolamide on sodium hyaluronate-induced rise in intraocular pressure after cataract surgery.

This prospective study was done to compare the efficacy of timolol and acetazolamide in lowering the intraocular pressure (IOP) secondary to the use of sodium hyaluronate (Healon) in cataract surgery. Fifty patients undergoing extracapsular cataract extraction and implantation of a posterior chamber lens were randomly assigned to one of four treatment groups: no viscoelastic (10 patients), Healon with 0.5% timolol drops postoperatively (12 patients), Healon with acetazolamide postoperatively (16 patients), or Healon only (12 patients). The IOP was measured during the first 24 hours after surgery. Sodium hyaluronate caused a marked increase in IOP in the early (6 to 12 hours) postoperative period. Timolol proved to be more effective than acetazolamide in controlling this pressure increase.

Acetazolamide↗
PubMed1994

Comparative and combined effects of interleukin 6, interleukin 1 beta, and tumor necrosis factor alpha on proteoglycan metabolism of human articular chondrocytes cultured in agarose.

OBJECTIVE: To study the effects of recombinant tumor necrosis factor alpha (TNF-alpha), interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6) on proteoglycan metabolism of isolated chondrocytes. METHODS: Human articular cartilage cells were cultured in agarose gel. In these culture conditions, chondrocytes keep their phenotypic stability. They release cartilage specific proteoglycans into the surrounding artificial matrix. Proteoglycan synthesis was measured by the incorporation of 35sulfate (35S). RESULTS: TNF-alpha and IL-1 beta depressed proteoglycan synthesis and induced proteoglycan degradation. The effects of both cytokines were additive, when used in submaximal doses. No mutual induction of TNF-alpha and IL-1 beta was shown, but both cytokines stimulated the chondrocytes to release IL-6, up to 100,000 pg/ml. Equal amounts of human recombinant IL-6 did not affect proteoglycan synthesis. IL-6 did not alter proteoglycan quality, nor did it modulate the IL-1 beta activities on proteoglycan metabolism. CONCLUSION: These findings illustrate the role of IL-1 beta and TNF-alpha in cartilage degradation and suggest that the role of the large amounts of IL-6 released in response to IL-1 in chronic arthritis is not directly protective with regard to proteoglycan metabolism.

Arthritis↗
PubMed1993

Structure of the human apolipoprotein D gene promoter region.

A human genomic clone of 18.2 kbp encompassing the apolipoprotein D (apoD) exon-1 and 2 and 10 kbp of upstream sequence was isolated and characterized. DNA sequencing and primer extension analysis revealed a transcriptional initiation site located 27 bp downstream of a consensus TATA box sequence. The exon 1 was 66 bp long. Computer analysis of DNA sequence from positions -557 to +129 revealed some putative transcriptional regulatory elements including a stretch of (pyrimidine/purine)26 located from nucleotide -263 to nucleotide -212, which could potentially form Z-DNA. Steroid hormone regulatory elements were identified which may be related to the modulation of apoD gene expression by androgens and estrogens in vitro.

Apolipoproteins↗
PubMed1993

Characteristics and evolution of writing impairment in Alzheimer's disease.

Rapcsak et al. (Archs Neurol. 46, 65-67, 1989) proposed a hypothesis describing the evolution of agraphic impairments in dementia of the Alzheimer type (DAT): lexico-semantic disturbances at the beginning of the disease, impairments becoming more and more phonological as the dementia becomes more severe. Our study was conducted in an attempt to prove this hypothesis on the basis of an analysis of the changes observed in the agraphia impairment of patients with DAT. A writing test from dictation was proposed to 22 patients twice, with an interval of 9-12 months between the tests. The results show that within 1 year there was little change in the errors made by the patients in the writing test. The changes observed however were all found to develop within the same logical progression (as demonstrated by Correspondence Analysis). These findings made it possible to develop a general hypothesis indicating that the agraphic impairment evolves through three phases in patients with DAT. The first one is a phase of mild impairment (with a few possible phonologically plausible errors). In the second phase non-phonological spelling errors predominate, phonologically plausible errors are fewer and the errors mostly involve irregular words and non-words. The last phase involves more extreme disorders that affect all types of words. We observe many alterations due to impaired graphic motor capacity. This work would tend to confirm the hypothesis proposed by Rapcsak et al. concerning the development of agraphia, and would emphasize the importance of peripheral impairments, especially grapho-motor impairments which come in addition to the lexical and phonological impairments.

Agraphia↗
PubMed1993

Industrial disaster and mental health of children and their parents.

OBJECTIVE: We report the findings of research conducted a year after an industrial disaster (PCB fire), which occurred on Montreal's South Shore in 1988. A total of 1,663 families were evacuated for a period of 18 days. The study evaluated 174 children between the ages of three and eleven years: 87 in the exposed group and 87 in the control sample. METHOD: Structured questionnaires were administered to the children and their mothers and fathers during home visits. RESULTS: Based on the responses of the children and the mothers, children aged 6 to 11 years displayed more overall internalized and post-traumatic stress disorder (PTSD) symptoms than did those in the control group. CONCLUSIONS: The study demonstrates that the mental health of fathers as well as mothers correlates with children's symptoms and that parents are able to accurately observe their child's reaction to a disaster.

Adaptation, Psychological↗
PubMed1993

A task contingent model of medical practice organization.

The treatment of acute episodes of morbidities in hospitalized patients is a complex and uncertain task. To accomplish this task, physicians organize themselves into teams in an effort to overcome two constraints: the necessity to offer both complete care and continuous care. This study examines the extent to which the nature and size of medical teams is explained by task difficulty and task variability, which are two dimensions of task uncertainty. The results support globally the hypothesis that the organization of medical practice is contingent upon the nature of the task defined in terms of uncertainty. However, the results also suggest that the task contingent model should be adjusted to take into account the fact that formal organizational characteristics may have an a priori influence on team structure.

Analysis of Variance↗
PubMed1993

Medical team interdependence as a determinant of use of clinical resources.

OBJECTIVE: Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources. DATA SOURCES/STUDY SETTING: Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec. STUDY DESIGN: Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks. PRINCIPAL FINDINGS: Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork. CONCLUSIONS: Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked.

Dependency, Psychological↗
PubMed1993

Influence of interferon-gamma on isolated chondrocytes from human articular cartilage. Dose dependent inhibition of cell proliferation and proteoglycan synthesis.

The effect of human recombinant interferon-gamma (IFN-gamma) on cultured human cartilage cells was studied by 2 variables: cell proliferation and proteoglycan synthesis. Cell proliferation was determined from 3H-thymidine incorporation rates in monolayer cultured chondrocytes. Proteoglycan synthesis was determined from 35S incorporation rates in monolayers and in chondrocytes cultured in agarose gel. IFN-gamma concentrations used in these experiments ranged from 10(-6) micrograms/ml (0.025 U/ml) to 10(-2) micrograms/ml (250 U/ml). The lowest concentrations are comparable with the synovial fluid levels in inflamed joints of patients with rheumatoid arthritis. At these concentrations, IFN-gamma was found to induce a dose dependent decrease of cell proliferation and of proteoglycan synthesis in monolayer cultured human chondrocytes. The decrease of proteoglycan synthesis was ascribed both to an inhibition of the proteoglycan protein core production and to a downregulation of the glycosaminoglycan chain elongation.

Cartilage, Articular↗
PubMed1993

Effects of dexfenfluramine treatment on body weight and postprandial thermogenesis in obese subjects. A double-blind placebo-controlled study.

The purpose of this study was to determine the effects of dexfenfluramine on body weight and post-prandial thermogenesis in obese subjects. Thirty obese subjects, men and women, with an excess weight between 20 and 80% of the ideal weight and aged from 20 to 60 years, participated in this double-blind, placebo-controlled study. During the treatment period, the subjects were not submitted to caloric restriction. Basal metabolic rate and postprandial thermogenesis (following a 400 kcal test meal) measurements were made by indirect calorimetry. Metabolic parameters such as glucose, insulin, thyroid hormones, free fatty acids, beta-hydroxybutyrate, total cholesterol and triglycerides were also measured before the test meal. These measurements were done at baseline, after one week and after three months of treatment. Following the three month treatment period, the mean weight loss of the dexfenfluramine group was 4.6 +/- 1.6 kg (s.e.) (P < 0.01) whereas the placebo group maintained the initial weight. The mean weight loss in the dexfenfluramine group represented 15% of the initial overweight. There was no significant change in either group in basal metabolic rate and postprandial thermogenesis following one week and three months of treatment (P > 0.05). The caloric intake after the treatment period was significantly reduced in the dexfenfluramine group (from 1631 +/- 103 kcal (s.e.) to 1353 +/- 109 kcal (s.e.); P < 0.05); in the placebo group, the changes were not significant (P > 0.05). The plasma concentrations of tri-iodothyronine, total cholesterol and triglycerides were significantly reduced in the dexfenfluramine group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Effects of therapy with didanosine on hematologic parameters in patients with advanced human immunodeficiency virus disease.

Myelosuppression is associated with human immunodeficiency virus (HIV) infection and may also be produced by agents used for the treatment of the disease or the treatment of its complications. Didanosine (ddl; 2',3'-dideoxyinosine) is a newer purine nucleoside that has recently become available for therapy for HIV infection. The effects of didanosine on peripheral blood counts have been retrospectively evaluated in the first 170 patients treated with this new agent in four phase I trials. Patients treated with didanosine showed statistically significant improvements in hemoglobin levels, white cell counts, and granulocyte and platelet numbers as compared with baseline values. These changes were seen with or without prior therapy with zidovudine, were somewhat more pronounced at higher doses of didanosine, and persisted for up to 1 year. Reported adverse events included peripheral neuropathy, diarrhea, and most notably, pancreatitis. It is concluded that, while some toxic side effects occur, didanosine therapy in HIV infection is associated with an amelioration of HIV-induced myelosuppression.

AIDS-Related Complex↗
PubMed1992

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.

Adult↗
PubMed1992

Metabolism of androstenedione and 11-ketotestosterone in the kidney of the three-spined stickleback, Gasterosteus aculeatus.

Stickleback kidneys were incubated with tritiated androstenedione (A4) or 11-ketotestosterone (OT). After the A4 incubations the following steroids were found, testosterone (T), 5 beta-androstane-3,17-dione (5 beta Ad), etiocholanolone (Et), 5 beta-dihydrotestosterone (5 beta DHT), 5 beta-androstane-3 alpha,17 beta-diol (5 beta A3 alpha 17 beta diol), androsterone, 5 alpha-androstane-3,17-dione, 5 alpha-androstane-3 alpha,17 beta-diol (5 alpha A3 alpha 17 beta diol), as well as glucuronides of T, Et, 5 beta DHT, 5 beta A3 alpha 17 beta diol, and 5 alpha A3 alpha 17 beta diol. The metabolites found in the largest amounts were usually T, 5 beta Ad, Et, and the glucuronides of T, Et, and especially of 5 beta A3 alpha 17 beta diol. These results suggest the main pathway to be A4-5 beta Ad-Et-5 beta A3 alpha 17 beta diol-5 beta A3 alpha 17 beta diol-glucuronide or Et-Et-glucuronide-5 beta A3 alpha 17 beta diol-glucuronide. The formation of 5 beta-reduced compounds was larger in postbreeding males and females than in breeding males. The opposite was the case for 5 alpha-reduced compounds. The total formation of glucuronides was lower in the breeding males than in the other groups. After the OT incubations 11-ketoandrostenedione, 17 beta-hydroxy-5 beta-androstane-3,11-dione (tentatively identified), and OT-glucuronide were found. 17 beta-Hydroxy-5 alpha-androstane-3,11-dione was not present.

Androstane-3,17-diol↗