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Biomedical subjects

L Lambert

Publications and source records attributed to L Lambert.

69 records · Page 4Linked to original sources

Prognosis of patients after open mitral commissurotomy. Actuarial analysis of late results in 100 patients.

The continuing controversy between proponents of open and closed commissurotomy might be clarified by analysis of late follow-up with modern actuarial techniques that provide a true perspective of patient risk. We have used open mitral commissurotomy exclusively for 15 years in 100 patients. There was one operative death from pancreatitis and one late death from cancer; the actuarially projected survival rate (+/- the standard error) at 10 years is 97 per cent (+/- 2). Thirteen patients had preoperative emboli, 6 of whom were in sinus rhythm and 7 in atrial fibrillation. Two patients had postoperative emboli, both in sinus rhythm. The actuarial chance of remaining free of embolism at 10 years is 97 per cent (+/- 2). Sixteen patients required reoperation on the mitral valve for functional deterioration. The remaining survivors were in Class I or II when last seen. The actuarial chance of not requiring a reoperation after 5 years is 91 per cent (+/- 4) and at 10 years, 38 per cent(+/- 16). Results in different centers are difficult to compare for many reasons, but imprecise statistical methods further obscure such comparisons. The use of actuarial techniques may help to define the role of open mitral commissurotomy.

Adult↗

A case report including EM and DNA repair investigations in a dermatosis associated with multiple skin cancers: epidermodysplasia verruciformis.

This report describes the clinical, histological and electron microscopic observations in a 51-year-old male with epidermodysplasia veruciformis (EV). Cells with early signs of malignant transformation were found closely connected with virus infected epidermal regions. Skin cancers appeared initially on sun-exposed areas, such as the face and ear lobes. The UV-induced DNA repair synthesis was therefore studied, utilizing peripheral leukocytes. The patient had 40% lower UV-induced DNA repair synthesis than the mean of nine healthy subjects of the same age. These results suggest that a decrease in UV-induced DNA repair synthesis in combination with a possibly oncogenic viral infection may enhance the disposition for somatic mutations and malignant transformation in patients with EV.

DNA Repair↗

A complex control circuit. Regulation of immunity in temperate bacteriophages.

Temperate bacteriophages can display in a stable way two essentially different behaviours. In the immune state, a gene (cI) produces a repressor which prevents expression of all the other viral genes; in the non-immune state the typically viral functions are expressed. The choice between the two pathways and the establishment of one of them have much in common with cell determination and differentiation. This choice depends on a complex control system, in fact one of the most intricate nets of regulation known in some detail. Our paper provides a formal description and partial analysis of this regulatory net. It is shown that even for relatively simple known models, this kind of analysis uncovers predictions which had previously remained hidden. Some of these predictions were checked experimentally. The experimental part chiefly deals with the efficiency of lysogenization by thermoinducible lambda phage carrying mutations in one or more of the regulatory genes, N, cro and cII. Although N- mutations are widely known for preventing efficient integration, and both N- and cII mutations for preventing efficient establishment of immunity, it is shown that, as predicted by a simple model, both N- and cII- phage efficiently lysogenize at low temperature if they are in addition cro-. In contrast with lambda N- cro+, lambda N- cro- is not propagated as a plasmid at low temperature, precisely because it establishes immunity too efficiently. Genetic control circuits are described in terms of sets of logic equations, which relate the state of expression of genes or of chemical reactions (functions) to input (genetic and environmental) variables and to the presence of gene and reaction products (internal, or memorization varibles). From the set of equations, one derives a matrix which shows the stable stationary states (if any) of the system, and from which one can derive the pathways (temporal sequences of states) consistent with the model. This kind of analysis is complementary to the more widely used analysis based on differential equations; it allows one to analyze in less detail more complex systems. The language might be used as well, mutatis mutandis, in fields very different from genetics. The last part of the discussion deals with the role of positive feedback loops in our specific problem (establishment and maintenance of immunity in temperate bacteriophages) and in developmental genetics in general. As a generalization of an old idea, it is suggested that cell determination (for a given character) depends on a set of genes whose interaction constitutes a positive feedback loop. Such a system has two stable stationary states: which one is chosen will usually depend on additional controls grafted on the loop.

Bacteriophages↗

Mitral valve replacement: a 10-year follow-up of non-cloth-covered vs. cloth-covered caged-ball prostheses.

The timing of operation and the selection of prosthesis depend upon the evaluation of long-term results at 5 years and beyond. From 1965 to 1975, 290 patients had isolated mitral valve replacement with currently used prostheses, resulting in a 6.6% operative mortality and 64% relative survival at 10 years. In considering mortality, the results obtained with both series of valves were combined and a search made for significant differences in preoperative variables between the operative deaths and operative survivors. The significant variables for operative mortality were valve model, preoperative functional class, pump time, and the presence or absence of right ventricular hypertrophy on electrocardiography. There were significant differences in long-term survival only with regard to preoperative functional class, pulmonary vascular resistance, and pump time. Exponential curves were fitted to the event-free rates, and long-term results were then extrapolated. The 10-year projection of the percentage of patients alive and free of embolus (disregarding transient ischemic attacks) for the Model 6310-6320 (50%) was similar to that actually observed for the Model 6120 (46%). Although further experience may show one prosthesis more effective than the other, statistical extrapolations suggest continued comparable performance.

Female↗

[Gastrectomy].

Explore the source record for details and available documents.

Gastrectomy↗

Living in one-parent families: relationships and attitudes of 16-year-olds.

The proportions of 16-year-olds in the National Child Development Study who are not living with both their natural parents in 1974 are examined and compared with proportions in earlier follow-ups. The children who have ever lived in one-parent families are selected for more detailed examination, such as the reasons for their parental situation, the age their families broke up and the ratio of motherless to fatherless at each age. The children's view of their relationship with their parents or new parent figures and their attitudes towards their own future marriage and family are considered and compared with those of children still living with both their own parents. The overall conclusion is that the differences in these respects between children in one and two-parent families are very slight, suggesting that the attitudes of children in one-parent families towards their future family life have not been greatly affected by their own childhood experiences.

Adolescent↗

Health and lifestyle issues as risk factors for homelessness.

BACKGROUND: The objective of this study was to test the hypothesis that there are health and lifestyle issues among homeless persons that differentiate them from other segments of the population and that can be described as risk factors for homelessness. METHODS: This case-control study investigated health and lifestyle issues in a panel of patients visiting a health care clinic for homeless persons. The same information was collected from a panel of county indigent patients and an equal number of privately insured patients enrolled in a nearby academic family practice center. RESULTS: We found significant differences among these three groups. Differences in health problems were evident, as significantly more homeless persons reported mental health, drug and alcohol abuse, and smoking problems. There were no differences in the prevalence of other general medical conditions as listed by the patients. Homeless persons were younger than the control group respondents and more likely to be male, a member of a minority group, and unmarried. The childhood experiences of homeless persons were distinctive; they were more likely to have lived in a group home or some other nonfamily situation, considered themselves to have been delinquent, run away from home, been expelled from school, or been placed in reform school. The same held true for having been in jail as an adult. They had significantly less education, their job experiences were in manual and unskilled arenas, and they were more likely to have a gambling problem. A continuum of risk also appeared in that for the most part the characteristics and experiences of the indigent group members ranked in frequency between those of the homeless and insurance groups. CONCLUSIONS: Causes of homelessness appear to be multifactorial. Issues related to mental health, alcohol, nicotine, and other drug and substance abuse could be responsible for their medical problems, whereas other lifestyle issues might be regarded as risk factors for homelessness.

Adolescent↗