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Biomedical subjects

L Meyer

Publications and source records attributed to L Meyer.

246 records · Page 14Linked to original sources
PubMedDate not supplied

Lipodystrophy in 685 HIV-1-treated patients: influence of antiretroviral treatment and immunovirological response.

PURPOSE: To describe the clinical features in HIV-1-infected patients treated with protease inhibitors (PIs) or not, and to determine factors related to occurrence of lipodystrophy (LD). METHOD: We performed a cross-sectional analysis of 685 treated HIV-1-infected patients that were routinely followed in 6 Paris hospital centers between January and May 1999. Demographic data, familial and personal vascular risk factors, history of antiretroviral treatment, HIV plasma viral load, CD4 cell count, and metabolic data were collected. Clinical examination was based on an assessment of changes in abdominal, dorso-cervical, and breast girth and wasting of the limbs, face, and skin as quoted by the clinician. RESULTS: The mean age at inclusion in the study was 38 years; 29.5% were women. At study assessment, 77.5% of patients were PI-treated and 22.5% had never received a PI. LD was observed in 403 (58.8%) patients, of whom 340 were currently receiving a PI and 63 had never received a PI. More than half of the lipodystrophic patients had a mixed form (53.9%), while 25.3% were classified as exclusive lipoatrophic and 20.8% as exclusive hypertrophic. In multivariate analysis, older age, duration of antiretroviral treatment (ART), antiretroviral combinations including stavudine, antiretroviral combinations including a PI, AIDS status, and a low HIV RNA were independently associated with occurrence of LD. CONCLUSION: LD is frequently observed in PI-treated patients, but it is also observed in patients receiving an ART regimen without PIs. Our study suggests different underlying mechanisms, because immunovirological response to treatment as well as certain therapies were linked to the occurrence of LD. This hypothesis would be best clarified in a large prospective cohort of naive patients.

Adult↗
PubMedDate not supplied

Medicare HMO withdrawals: what happens to beneficiaries?

More than 400,000 Medicare beneficiaries had to seek other insurance arrangements when their health maintenance organization (HMO) withdrew from Medicare at the end of 1998. According to a new survey of 1,830 involuntarily disenrolled Medicare beneficiaries, two-thirds subsequently enrolled in another Medicare HMO; one-third experienced a decline in benefits, and 39 percent reported higher monthly premiums. One in seven lost prescription drug coverage; about one in five had to switch to a new primary care doctor or specialist. Those with traditional Medicare by itself or with Medigap, the disabled under age sixty-five, the oldest old, and the near-poor experienced the greatest hardship after their HMO withdrew.

Aged↗
PubMedDate not supplied

Implications of laparoscopic cholecystectomy for surgical residency training.

BACKGROUND: Widespread adoption of minimal access techniques forced a generation of abdominal surgeons to re-learn many standard abdominal procedures. This threatened to reduce the pool of suitable "training" operations for surgical residents. METHODS: Operator grade, duration of operation, acute/elective operation, conversion rate, complications, and postoperative stay were recorded prospectively on all laparoscopic cholecystectomies (LC) since 1992. This data was evaluated to determine how the introduction of LC affected residents' training. RESULTS: The percentage of LCs performed by residents increased progressively to reach 58%. Operating time was longer for trainee surgeons, particularly for acute cases (145+/-50 minutes vs 111+/-54 minutes, p<0.05); however, conversion rate, incidence of complications, and postoperative stay were no different. CONCLUSIONS: LC can be performed by surgical trainees with similar complication rates and outcomes as those of qualified surgeons. Once institutional experience has accumulated, this procedure can be integrated into residency training.

Adolescent↗
PubMedDate not supplied

Hypermedia-assisted instruction: authoring with learning guidelines.

The use of computers in nursing education has evolved from elementary drill and practice tutorials to challenging presentations. Hypermedia technology has emerged as a powerful method of instruction that allows the user to experience new concepts, gain cognitive skill, and encounter realistic clinical situations in a no-harm environment. Hypermedia incorporates sound, video, graphics, text, and interaction. This article describes the process used to develop a CD-ROM for adult cardiovascular nursing that can be used as an interactive instructional program. A description of the use of Gagne's instructional design theory is incorporated as a framework to guide the project. Educators possess knowledge expertise and must become involved in the design of new teaching methodologies. If instructional design principles are followed when using authoring software, learners are motivated with real, challenging, life-like, nonthreatening scenarios to expand their critical-thinking and decision-making skills.

Anatomy↗
PubMedDate not supplied

[Mycobacterium fortuitum infection after total hip prosthesis. A report of 3 cases (author's transl)].

The authors have observed three instances of sepsis due to Mycobacterium fortuitum complicating total hip replacement for osteoarthritis. The case histories are fully described. The requirements are given for recognition of the organism which grows on special culture media and which may be mistaken for Mycobacterium tuberculosis. This feature explains why, in some cases, the organism may not be discovered. Antibiotics were ineffective but the general condition of the patient was not greatly affected.

Aged↗
PubMedDate not supplied

Interaction of Mycobacterium leprae and mycobacteriophage D29.

This study of the interaction between Mycobacterium leprae and the mycobacteriophage D29 showed that the viruses caused a patchy damage of cell wall structure and the accumulation in the host of internal crystalline structures. Whether the observed ultrastructural alterations were caused by the replication of D29 was not clear. Mitomycin C also caused the accumulation of crystalline structures in M. leprae.

Cell Wall↗
PubMedDate not supplied

[Cofactors in the course of HIV infection].

Cohorts of patients infected with the human immunodeficiency virus (HIV), and followed-up since their infection, have identified risk factors of progression to acquired immunodeficiency syndrome (AIDS). The risk of progression increases with the subject's age at contamination by 40% for each decade. Other host factors such as certain HLA subtypes would be related to progression. Virus-related factors have also been described. Sexual or transfusional transmission from a highly immunodepressed subject increases the risk of progression in the infected subject. Progression is more rapid in male homosexuals than in heterosexuals, even after exclusion of Kaposi's syndrome. There has been little success in isolating co-infections which might explain this finding. The more rapid progression in homosexuals could be due to infection with particularly virulent strains or particular subtypes. Finally, progresion is more rapid when signs of primary infection are major or prolonged, an observation which probably results from a complex host-virus interaction. Behavioral factors occurring after contamination (pregnancy, continued intravenous drug abuse, tobacco, alcohol) have not been demonstrated until now to play a role in progression.

Acquired Immunodeficiency Syndrome↗