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Biomedical subjects

L Marchand

Publications and source records attributed to L Marchand.

At least 19 recordsLinked to original sources
PubMed2001

Factors influencing rural Wisconsin elders in completing advance directives.

PURPOSE: Advance directives can assist in end-of-life decision-making. This study explores the factors that influence completion of advance directives. METHODS: Qualitative study using in-depth interviews of 10 patients over age 60 in a rural office practice. RESULTS: Major themes: (1) patient autonomy: the patient and family role as decision maker, the physician as educator; (2) barriers that deter patients from completing advance directives include fear and confusion about these documents; and (3) quality of life is an important value in end-of-life decision-making. CONCLUSIONS: Decision making about advance directives is a personal and family issue, but physician efforts to initiate the process and educate patients are important, especially if done routinely in the office or preferably in community settings. The main difference between those who do and don't complete advance directives is an understanding of the documents and their purpose.

Advance Directives↗
PubMed2000

Bridging the gap between conventional and alternative medicine.

BACKGROUND: The use of various forms of complementary and alternative medicine (CAM) has become widespread. We investigated this use in Madison, Wisconsin. METHODS: We conducted semistructured indepth interviews focused on the knowledge, attitudes, and behaviors of a random sample of 17 patients who had used both CAM and conventional therapies during the past year. Participants were recruited using telephone listings. Twenty alternative practitioners were selected to represent the major modalities. The topics discussed included healing philosophy, choices of therapeutic methods, and ideas concerning concurrent use of differing therapeutic modalities. An 8-member multidisciplinary team analyzed the transcripts individually and in group meetings. RESULTS: Four major themes emerged from the interview data: (1) holism, (2) empowerment, (3) access, and (4) legitimization. Both patients and providers distinguished between the socially legitimized and widely accessible but disempowering and mechanistic attributes of conventional medicine and the holistic and empowering but relatively less accessible and less legitimate nature of alternative healing. There was a strong call for integrating the best aspects of both. CONCLUSIONS: Practitioners and users of alternative therapies in the Madison area confirmed both the alternative and complementary natures of unconventional health care, called for more integrated and accessible health care, and provided insights that could be useful in bridging the gap between conventional and alternative medicine.

Attitude of Health Personnel↗
PubMed1999

Serotonin innervation of Lurcher mutant mice: basic data and manipulation with a combination of amantadine, thiamine and L-tryptophan.

The Lurcher (Lc/+) mutant mouse is characterized by a considerable atrophy of the cerebellum due to a massive loss of cerebellar Purkinje and granule cells, as well as of neurons from the inferior olivary nucleus. In this study the effects of a therapeutic combination of amantadine, thiamine and L-tryptophan on the serotonin (5-HT) innervation was assessed in Lurcher mice by autoradiography, using [3H]citalopram to label 5-HT transporters. In wild type mice as well as in both saline-treated and drug-treated Lurcher mutants, [3H]citalopram binding remained unchanged in forebrain and brainstem regions. In the cerebellum, labelling of deep cerebellar nuclei (CBnuc) was about twofold higher than in the cortex (CBctx). In saline-treated Lurcher mutants compared to wild type mice, the densities of [3H]citalopram were 98% higher in CBctx, and 180% higher in CBnuc. In CBctx of drug-treated Lurcher mutants, transporter densities were 89% higher than in the wild type, but did not differ from the saline-treated Lurcher. In the CBnuc of the drug-treated Lurcher mutants, [3H]citalopram binding was 50% higher than in the saline-treated Lurcher group, and 320% higher than in wild type mice. The results show that 5-HT transporters, already upregulated in the CBnuc of Lurcher mutant mice, can be further increased by a pharmacological treatment, possibly altering the availability of 5-HT in some of its target areas.

5-Hydroxytryptophan↗
PubMed1999

What physicians can learn from consumers of dietary supplements.

BACKGROUND: Many Americans consume dietary supplements, including vitamins, minerals, herbs, and amino acids. Government regulation of dietary supplements is limited, and patients typically do not consult with their physicians regarding the use of supplements. METHODS: We conducted a qualitative study to describe patients' decisions about the use of dietary supplements and the communication they have with their physicians about such use. Four focus groups of customers from 3 local suburban health food stores were interviewed. RESULTS: The customers in the health food stores we investigated were motivated to pursue wellness and wanted to take responsibility for their health. They would welcome a partnership with their physicians, but generally believed that physicians are closed-minded and have little knowledge about dietary supplements. These consumers determined the effectiveness of dietary supplements through personal study and subjective experimentation. CONCLUSIONS: The health food store customers in our study were self-informed consumers who did not consult their physicians about their use of dietary supplements, because they did not believe that physicians were knowledgeable about or interested in supplements. An open-minded patient-centered approach would help physicians provide better care for patients who use dietary supplements.

Adolescent↗
PubMed1998

The treatment of spinocerebellar ataxias: facts and hypotheses.

Actual therapeutic assays in spinocerebellar ataxias, i.e. in Friedreich's ataxia (FA) and olivopontocerebellar atrophy (OPCA) are discussed in relation to (i) the serotoninergic theory; (ii) the excitotoxic action of glutamate; and (iii) cerebrospinal fluid thiamine deficiency in ataxic patients. Data from the literature show that neurochemical deficiencies arising from cerebellar damage in both FA and OPCA patients are multiple. Assays of replacement and neuroprotective therapeutics with a single drug have produced controversial data or mildly effective results. Consequently, it is hypothesized that a drug cocktail, i.e. L-5-hydroxytryptophan, thiamine and amantadine hydrochloride, would be more beneficial. This cocktail proved to be useful in open studies, improving respiratory disorders in FA patients. More powerful inhibitors of N-methyl-D aspartate receptor channels should be tried initially in animal experiments.

Animals↗
PubMed1994

Infant feeding practices: understanding the decision-making process.

BACKGROUND: Using qualitative methods, this case study of an inner-city family practice explores how a group of eight minority women and their families decided whether to breast-feed or bottle-feed their infants and how the office and hospital settings affected this decision-making process. METHODS: The methods included depth interviews, a focus group interview, and participant observation. RESULTS: Five key themes emerged from the data: 1) knowledge alone does not ensure any particular decision, 2) support is primarily from family networks in this group, with health care providers in a secondary role, 3) mothers and their families want to provide their infants with quantifiably sufficient nourishment, 4) physical and psychosocial satisfaction with the feeding method chosen is important, and 5) breast-feeding in public is not acceptable. CONCLUSION: If the nutritional and bonding advantages do not outweigh the social embarrassment, inconvenience, and insecurity of breast-feeding, then bottle-feeding is chosen as the preferred method of infant feeding in this case study. Timely interventions in the postpartum period by providers often play a critical role in the initial success of breast-feeding.

Adolescent↗
PubMed1994

The role of single photon emission computed tomography brain imaging with 99mTc-bicisate in the localization and definition of mechanism of ischemic stroke.

99mTc-bicisate (99mTc-ECD) is a new brain perfusion imaging agent formulated from a radiochemically stable kit (Neurolite). A multicenter trial was conducted to determine the sensitivity and specificity of single photon emission computed tomography (SPECT) imaging with 99mTc-bicisate in the localization of ischemic stroke; 170 subjects were enrolled, 128 patients with stroke and 42 controls. Imaging results from 148 subjects (107 stroke patients and 41 controls) were considered evaluable. In the evaluable subjects, SPECT brain imaging with 99mTc-bicisate (21.0 +/- 2.5 mCi) was interpreted without clinical information and was compared with a final assessment using all clinical, diagnostic, and laboratory procedures except the 99mTc-bicisate SPECT results. 99mTc-bicisate was safe and well-tolerated. SPECT imaging with 99mTc-bicisate demonstrated a specificity of 98% and a sensitivity of 86% for localization of strokes (kappa, 0.75; 95% confidence interval, 0.64-0.86). Results were unchanged over time and were similar for all stroke mechanisms except for lacunar disease (sensitivity, 58%). In a secondary analysis, a normal image or small, deep (e.g., subcortical) perfusion defect was highly predictive of a lacunar mechanism. Defects involving the cortical surface were strongly associated with nonlacunar mechanisms. SPECT imaging with 99mTc-bicisate is a sensitive marker in the localization of perfusion defects associated with ischemic stroke and may assist in the determination of the underlying mechanism of a stroke.

Adult↗
PubMed1993

Retrograde transneuronal transport of the fluorescent dye rhodamine beta-isothiocyanate from the primary and centrifugal visual systems in the pigeon.

The transneuronal labeling properties of the fluorescent dye Rhodamine beta-isothiocyanate (RITC) were investigated in the pigeon following the intraocular injection of the tracer either alone or in combination with kainic acid (RITC/KA). The RITC was transported bidirectionally from the eye producing both orthograde axonal and terminal labeling of the primary visual system (PVS) and retrograde labeling of the centrifugal visual system (CVS) comprising the n. isthmo-opticus (NIO) and associated ectopic neurons (EN) as well as the tractus isthmo-opticus (TIO). In addition, RITC-positive cell bodies were identified in layers 9/10 of the optic tectum, n. isthmi parvocellularis (Ipc) and the hyperstriatum accessorium (HA) subdivision of the telencephalic visual Wulst. In the RITC/KA experiments, the orthograde transport of the dye within the PVS was selectively suppressed and this coincided with the absence of somatic labeling in n. Ipc and HA. The results are explained in terms of transneuronal transport of RITC, involving the terminal uptake and subsequent retrograde axonal transport of the tracer within second-order neurons in n. Ipc and HA which project to the PVS and in tectal layers 9/10 projecting to the CVS. Moreover, the transneuronal transport of RITC, as demonstrated using the present experimental conditions, appears to be very specific and only labeled distant cell populations known to project to either the PVS or CVS.

Animals↗
PubMed1991

Mental dysfunction: a clinical pilot project in the elderly.

In recognizing that there will be an increase in the number of individuals with dementing illnesses well into the next century, the authors show how one institution is coping with this problem today. The authors outline an innovative approach to admission and discharge planning and monitoring of patients with irreversible dementias and behavioral problems. Nurses and other team members need a mechanism (ie, a flow chart) to monitor behavior and plot progress within an individualized program designed to meet the needs of dementia patients.

Aged↗
PubMed1991

Divergence and collateral axon branching in subsystems of visual cortical projections from the cat lateral posterior nucleus.

The projections from the lateral (LPl), intermediate (LPi) and medial (LPm) subdivisions of the cat lateral posterior nucleus (n. LP) to visual areas 17, the posteomedial (PMLS) and posterolateral (PLLS) lateral suprasylvian and anterior ectosylvian (AEV) were studied using the retrograde labeling technique following concomitant injections of fluorescent dyes (Fast blue, Nuclear yellow, Evans blue and Rhodamine beta-isothiocyanate) into the different cortical loci. The results showed a medial-lateral topographical reversal of the visual n. LP-cortical connections: The ventral portion of LPl projects to area 17 whereas more dorsolateral regions of LPl and lateral LPi provide input to PMLS. Cells in medial LPi project mainly to the PLLS cortex and AEV receives afferents from the LPm. Areas of overlap were identified within the ventral LPl which projects to both area 17 and PMLS and within the LPi/LPm border region at the origin of connections to both PLLS and AEV. Furthermore, some single neurons within the areas of overlap were found to be double-labeled indicating divergent projections to their respective cortical targets via collateral axon branching. The data show that divergence and axonal branching are common features of the different n.LP-visual cortical subsystems and support the notion of the existence of families of thalamo-cortical systems which are distinct in their connection patterns and underlying functional properties.

Animals↗
PubMed1990

Projections of the dorsolateral anterior complex and adjacent thalamic nuclei upon the visual Wulst in the pigeon.

The distinctive patterns of thalamic input to the rostral (R), intermediate (I) and caudal (C) divisions of the pigeon Wulst were determined using the retrograde multiple label technique following concomitant injections of various fluorescent tracers into different Wulst loci. The results showed topographical projections from components of the visual thalamic n. dorsolateralis anterior complex. Major ipsilateral and contralateral projections upon the R and I Wulst stem from the pars lateralis ventralis and dorsalis nuclei, respectively. The nuclei pars lateralis rostralis, pars magnocellularis and n. suprarotundus provide weak bilateral projections to all of the Wulst divisions sampled. Lastly, bilateral connections from the n. superficialis parvocellularis upon I and C, and from n. dorsolateralis posterior upon the posterior C Wulst were also demonstrated. Based upon their patterns of terminal distribution upon the Wulst, some of these thalamic nuclei are compared to specific components of the mammalian geniculate and extrageniculate visual systems.

Animals↗
PubMed1990

Fate of alpha-1,4-glucosidases and cathepsin D in the rat epididymis after vasectomy.

Short-term vasectomy was studied in adult male rats in order to ascertain whether cytosolic or lysosomal hydrolases were differently affected 100 days after vas ligation. The secretory form of alpha-1,4-glucosidase remained unchanged while the lysosomal form of the enzyme and also cathepsin D increased in the cytosol of both caput and cauda epididymis. This set of data demonstrates for the first time that a triggering mechanism which stimulates lysosomal activity is present all along the rat epididymis. Disposal of the continuous influx of spermatozoa from the testis could therefore require both an active and a passive process.

Animals↗
PubMed1990

Scintigraphic evaluation of renal function after extracorporeal shock-wave lithotripsy.

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.

Adult↗
PubMed1989

Acute effect of protein or carbohydrate breakfasts on human cerebrospinal fluid monoamine precursor and metabolite levels.

Patients with normal pressure hydrocephalus who had three lumbar punctures during 1 week ingested either water, a protein breakfast, or a carbohydrate breakfast 2.5 h before each of the lumbar punctures. The CSF was analyzed for biogenic amine precursors and metabolites. The protein meal raised CSF tyrosine levels, a finding consistent with animal data, but did not alter those of tryptophan or any of the biogenic amine metabolites. The carbohydrate meal increased CSF 3-methoxy-4-hydroxyphenylethylene glycol, an unexplained finding. The carbohydrate meal did not affect CSF tryptophan, tyrosine, 5-hydroxyindoleacetic acid, or homovanillic acid. Our results support the idea that in humans protein or carbohydrate meals do not alter plasma amino acid levels sufficiently to cause appreciable changes in CNS tryptophan levels or 5-hydroxytryptamine synthesis.

Dietary Carbohydrates↗