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Biomedical subjects

L Meyer

Publications and source records attributed to L Meyer.

At least 109 records · Page 6Linked to original sources
PubMed1998

Cloning and sequencing of the bovine STAT5A cDNA reveals significant sequence divergence with ovine.

The transcription factors STAT5 mediates prolactin signals in mammary epithelial cells. The cDNA of bovine STAT5A was cloned, sequenced and compared to other species. The encoded protein proves to be > 95% homologous to other mammals. We show that the STAT5A mRNA of the closely related ovine species contains an extended (by 130 nt) 5'-untranslated region, being encoded by an extra-exon, and accounts, possibly, for improved translation efficiency.

Amino Acid Sequence↗
PubMed1998

[Prevalence and incidence of cytomegalovirus infection in patients infected with HIV-1. SEROCO group].

OBJECTIVES: To study prevalence of the cytomegalovirus (CMV) infection as well as incidence of the CMV seroconversions in HIV-infected subjects enrolled in the French multicentric cohort SEROCO. METHOD: Prevalence of CMV infection at inclusion in the cohort was estimated from 1504 HIV-infected subjects. Incidence of the CMV seroconversion was estimated from 184 subjects CMV seronegative at inclusion. Cox model was used to identify independent factors related to CMV seroconversion. RESULTS: CMV prevalence was high (87.2%) mainly in homosexual men. The incidence of the CMV seroconversions was also high (9, 18/100 person-years), particularly in homosexual men, in subjects declaring sexual intercourse with occasional partner, and in those declaring a sexually transmitted disease during the follow-up. CONCLUSION: The risk to develop serious disease related to CMV in subjects with AIDS being particularly high when the CMV primary infection occurs during the course of the HIV infection, the prevention of CMV primary infections is thus a major element in the counselling of HIV-infected subjects.

AIDS-Related Opportunistic Infections↗
PubMed1998

Blood glucose control on Sunday in IDDM patients: intensified conventional insulin therapy versus continuous subcutaneous insulin infusion.

We have assessed the capacity of continuous subcutaneous insulin infusion (CSII) to maintain good blood glucose metabolic control on Sundays, when waking is delayed, with reference to intensified conventional insulin therapy by multiple daily injections (MDI). The study lasted 3 weeks, including 3 week-ends. A total of 20 IDDM patients were selected for metabolic control: ten were treated by CSII and ten by MDI. Blood glucose was determined at least three times a day (fasting on waking, pre-lunch and pre-dinner). The times of blood glucose determinations and their values were recorded in a memory reflectance meter. Waking, the first blood glucose measurement and the first insulin injection (MDI) or bolus (CSII) were about 1 h later on Sundays than on a weekday (44 +/- 4 min in MDI group, P < 0.04; and 59 +/- 7 min in CSII group, P < 0.02). The times of the pre-lunch and pre-dinner blood glucose determinations were not significantly different. The mean waking and pre-lunch blood glucose values of the MDI group were higher on Sundays (11.5 +/- 3.8 and 9.7 +/- 4.5 mmol/l) than on weekdays (8.7 +/- 2.3 and 7.1 +/- 2.5 mmol/1)(P < 0.01). The pre-prandial blood glucose levels of the CSII group on Sundays and weekdays were not statistically different at any time. Changes in the waking time and the subsequent delay in the first insulin bolus on Sunday may alter blood glucose control in patients on MDI, but CSII allows such changes without any glycemic side effects.

Adult↗
PubMed1998

A control programme for MRSA (methicillin-resistant Staphylococcus aureus) containment in a paediatric intensive care unit: evaluation and impact on infections caused by other micro-organisms.

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly reported as a hospital-acquired pathogen in intensive care units (ICUs). The inconsistent application of hygiene measures by healthcare workers accounts largely for the epidemic dissemination of such resistant strains. The efficacy of a control programme to prevent spread of MRSA was assessed in our paediatric ICU (PICU) from April 1992 to December 1995. Patients initially had weekly MRSA cultures taken from samples of anterior nares and perineum, but from January 1994, cultures were also obtained upon admission. Immediately after notification, all MRSA carriers were isolated. Education of hospital staff was an essential component of our programme. Nosocomial infection rates were recorded retrospectively in 1992 and 1993, and prospectively in 1994 and 1995. Incidence rates between 'pre-programme' and 'programme' periods were compared. The rate of MRSA infection decreased from 5.9-0.8/1000 Patient-Days (PD), (P < 10(-7). MRSA carriage also decreased from 34-2% (P < 10(-9) and the ratio of MRSA to all S. aureus fell from 71-11% (P < 10(-4). The decrease in the global incidence of infection from 20.1-13.9/1000 PD (P = 0.002) was due only to the decrease in MRSA infection. However, between 1994 and 1995, there was a significant increase in the number of transplant patients despite a constant patient/nurse ratio. The nosocomial infection rates caused by other micro-organisms decreased among the transplant patients from 64.8-33.2/1000 transplanted PD (P = 0.009) between 1994 and 1995. At the same time, we observed a slight increase of infections in non-transplanted patients, which may have been due to the effect of increased overall workload on those patients who were supposed to have fewer nosocomial risk factors. We conclude that implementation of infection control measures directed towards limiting person-to-person spread was effective in controlling high MRSA infection rates in a PICU, but it is important to allow enough time for staff to carry out hygiene practices thoroughly.

Child↗
PubMed1998

Psychological factors predicting nausea and vomiting in breast cancer patients on chemotherapy.

A series of 100 breast cancer patients were included in a study to test the hypothesis that incidence of anticipatory nausea and vomiting during chemotherapy and towards the end of a patient's course of treatment is influenced by patient expectation, anxiety level and coping response. The role of psychological factors in postinfusional nausea and vomiting was also examined. Incidence of postinfusional and anticipatory nausea was high overall, with vomiting less frequently reported; 43% of patients reported nausea or vomiting before treatment at some stage over their chemotherapy cycles and 77% reported post-treatment symptoms. Anticipatory nausea was described by 47% of those experiencing it as being of moderate or severe intensity at some point throughout chemotherapy. Postinfusional side-effects were more intense; 21 and 10 patients, respectively, described severe or very severe levels as occurring at some point during their treatment. The majority of patients experiencing postinfusional symptoms indicated that these persisted for more than 24 h and were worse a day or two after chemotherapy administration. Incidence of anticipatory nausea or vomiting was found to relate directly to experience of nausea or vomiting during preceding cycles. Psychological variables were associated with symptoms of anticipatory nausea mid-treatment, but not with postinfusional symptoms. In particular, trait anxiety and a baseline expectation that nausea would be experienced during treatment were predictive in a multivariate model. Despite this, the overwhelming factor influencing ANV and PNV both mid- and towards the end of treatment was that of previous experience of the symptoms at earlier courses.

Adult↗
PubMed1998

Surgical-site infection rates in patients who undergo elective surgery on the same day as their hospital admission.

OBJECTIVE: To follow over time surgical-site infection (SSI) rates in patients admitted to the hospital on the same day as their elective surgery (group I), and to compare these rates with those of other surgical patients who also required postoperative hospitalization but either were hospitalized for 1 or more days immediately prior to surgery or underwent surgery on a nonelective basis (group II). DESIGN: Observation of overall SSI rates over time for group I and II patients and study of risk factors associated with increased SSI rate among group I neurosurgical patients. SETTING: A 900-bed, tertiary-care community hospital with >10,000 surgical procedures performed each year on patients requiring postoperative hospital stay. PATIENTS: A total of 48,464 surgical procedures were performed on consecutive patients from 1990 to 1994, with 18,794 (39%) involving group I patients. In addition, 511 consecutive procedures performed on neurosurgical patients requiring postoperative hospitalization from July 1994 to May 1995 were analyzed. RESULTS: In 1990, the overall SSI rate of group I patients was significantly lower than that of group II patients (0.4% vs 1.3%, relative risk [RR], 3.6; 95% confidence interval [CI95], 2-6.4; P<.0001), but, by 1994, there was no longer any significant difference between the SSI rates of group I and II patients (1.8% and 1.6%, respectively; P=.38). In 1994, the SSI rate in group I neurosurgical patients was significantly greater than that of group II patients (3.4% vs 0.4%; RR, 8.3; CI95, 1.05-66; P=.02). During the period April through September 1994 (warm months), group I neurosurgical patients were associated with a significantly lower American Society of Anesthesiologists score and SSI risk index (based on National Nosocomial Infection Surveillance System data) and a higher likelihood of having "clean-class" wounds, but significantly greater-than-expected SSI rate when adjusted for patient risk index and type of procedure (4.7% vs 1.4%; RR, 3.3; CI95, 1.3-8.6; P=.02). During the same period, the observed and expected SSI rates were not significantly different for group II neurosurgical patients. CONCLUSIONS: As a whole, the SSI rates among patients undergoing elective surgery on the same day of their hospital admission is no longer significantly lower than that of other patients who also require postoperative hospitalization. For certain procedures, such as those commonly performed on the neurosurgical service, elimination of preoperative hospital stay may be associated with greater-than-expected risk of SSI.

Adult↗
PubMed1998

Predictive value of viral load and other markers for progression to clinical AIDS after CD4+ cell count falls below 200/microL. SEROCO & HEMOCO Study Group.

BACKGROUND: To assess the predictive value of biological and clinical events for progression to AIDS (1993 European classification) when the CD4+ cell count falls below 200/microL (CD4 threshold) in different exposure groups. To investigate whether such markers remain predictive independently of the serum HIV-1 RNA level at the CD4 threshold. METHODS: The predictive value of biological and clinical events occurring during the 24 months prior to the occurrence of CD4 threshold (n = 333) was quantified in a Cox model. Another Cox model was carried out in a subset of 77 patients in whom viral load from stored sera was available. Furthermore, changes in viral load during the 24 months preceding the CD4 threshold were assessed in a mixed model according to subsequent development of AIDS. RESULTS: Among the 333 patients, the slope of the CD4+ cell counts, the emergence of p24 antigen, persistent thrush, and age at the CD4 threshold were independent predictors of progression to clinical AIDS (44.7%). Among the subset of 77 patients, the HIV-1 RNA level at the CD4 threshold, persistent thrush and age remained independent predictors of progression to AIDS (45.5%). The increase of the HIV-1 RNA level was moderate, both in non-progressors (24.0% per year) and in those who subsequently developed AIDS (27.1% per year), (P = 0.93). Viral load was consistently higher in the latter group (P = 0.002). CONCLUSION: At a late stage of infection, age and persistent thrush remain predictive of progression to AIDS, independently of viral load.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Gender difference in persistent at-risk sexual behavior after a diagnosed sexually transmitted disease. ACSF-Investigators.

BACKGROUND AND OBJECTIVES: There are few data on sexual behavior after an episode of sexually transmitted disease (STD). GOALS: To examine association between a history of STD and subsequent at-risk sexual behavior in the general population. STUDY DESIGN: In the French National Survey of Sexual Behavior, current sexual behavior was compared between heterosexuals who reported an STD in the 4 years prior to the last year and those who reported no STD (n = 2517). RESULTS: Reporting of STD was associated with a high rate of past multiple partnership among both sexes, but was associated with current at-risk behavior in men only. Men with a previous history of STD were 2.8 times (95% confidence interval [CI]: 1.4-5.6) more likely to report high-risk unprotected sex as a current behavior. No such association was observed in women (adjusted odds ratio [OR]: 1.0; 95% CI: 0.5-2.0). Conversely, in women, a previous episode of STD was significantly associated with reporting of behavior changes (adjusted OR: 3.4; 95% CI: 1.6-7.1). CONCLUSION: A self-reported history of STD is a marker of current high-risk sexual behavior among heterosexual men that could be used to target prevention programs. In contrast, it may be associated in women with subsequent adoption of STD and HIV risk reduction strategies.

Adult↗
PubMed1998

Incidence and sexual risk factors of cytomegalovirus seroconversion in HIV-infected subjects. The SEROCO Study Group.

BACKGROUND: Data on incidence of cytomegalovirus (CMV) seroconversion in HIV-infected (HIV(+)) subjects was sparse. GOAL: To determine the incidence of CMV seroconversion in sexually active HIV(+) subjects and sexual factors associated with CMV seroconversion. STUDY DESIGN: One hundred eighty four persons not infected by CMV at enrollment in a cohort of HIV(+) persons were studied. A case-control study within the cohort was conducted to determine the effect of sexual behavior in the 6 months prior to CMV seroconversion. Thirty seven cases of CMV seroconversion were compared with 136 controls. RESULTS: The overall incidence of CMV seroconversion was 9.18 per 100 person-years (95% confidence interval (CI), 6.67-12.28) and was particularly high among homosexual men. After adjustment for age, socio-professional category, sexual orientation, and casual sex, the risk of CMV seroconversion was higher in subjects who never used condoms than in those who used them systematically (adjusted odds ratio (OR) 3.37;95% CI, 1.05-11.00). CONCLUSIONS: In addition to the need to protect their sexual partners from HIV infection, HIV(+) subjects free of CMV infection should use condoms to avoid CMV infection and its complications.

AIDS-Related Opportunistic Infections↗
PubMed1998

Improvement of HbA1c and blood glucose stability in IDDM patients treated with lispro insulin analog in external pumps.

OBJECTIVE: To compare the efficacy of the short-acting insulin analog lispro (LP) with that of regular insulin in IDDM patients treated with an external pump. RESEARCH DESIGN AND METHODS: Thirty-nine IDDM patients (age, 39.4 +/- 1.5 years; sex ratio, 22M/17W; BMI, 24.4 +/- 0.4 kg/m2; diabetes duration, 22.5 +/- 1.6 years) who were treated by external pump for 5.1 +/- 0.5 years were involved in an open-label, randomized, crossover multicenter study comparing two periods of 3 months of continuous subcutaneous insulin infusion with LP or with Actrapid HM, U-100 (ACT). Boluses were given 0-5 min (LP) or 20-30 min (ACT) before meals. Blood glucose (BG) was monitored before and after the three meals every day. RESULTS: The decrease in HbA1c was more pronounced with LP than with ACT (-0.62 +/- 0.13 vs. -0.09 +/- 0.15%, P = 0.01). BG levels were lower with LP (7.93 +/- 0.15 vs. 8.61 +/- 0.18 mmol/l, P < 0.0001), particularly postprandial BG levels (8.26 +/- 0.19 vs. 9.90 +/- 0.20 mmol/l, P < 0.0001). Standard deviations of all the BG values (3.44 +/- 0.10 vs. 3.80 +/- 0.10 mmol/l, P = 0.0001) and of postprandial BG values (3.58 +/- 0.10 vs. 3.84 +/- 0.10 mmol/l. P < 0.02) were lower with LP. The rate of hypoglycemic events defined by BG < 3.0 mmol/l did not significantly differ between LP and ACT (7.03 +/- 0.94 vs. 7.94 +/- 0.88 per month, respectively), but the rate of occurrences of very low BG, defined as BG < 2.0 mmol/l, were significantly reduced with LP (0.05 +/- 0.05 vs. 0.47 +/- 0.19 per month, P < 0.05). At the end of the study, all but two (95%) of the patients chose LP for the extension phase. CONCLUSIONS: When used in external pumps, LP provides better glycemic control and stability than regular insulin and does not increase the frequency of hypoglycemic episodes.

Adult↗
PubMed1998

[Risk reduction and intravenous drug use abstinence in patients with HIV infection. The SEROCO group].

BACKGROUND: Little is known about the complex stepwise process of giving up intravenous (i.v.) drugs. However, HIV risk reduction programs directed towards i.v. drug users have been accused by some opponents to encourage users to continue. In order to better assess the relationships between risk reduction and abstinence, we studied factors associated with abstinence in HIV-infected patients using i.v. drugs at enrollment in the SEROCO cohort (1988-1994). METHODS: 63 HIV-infected patients injecting i.v. drugs at enrollment were followed-up every 6 months with a clinical examination and a questionnaire concerning sexual and drugs practices since last consultation. Abstinence was defined as non injecting for at least 6 months. The 30 patients who became abstinent during a follow-up period of 3 years were compared to the 33 remaining. RESULTS: Abstinence during follow-up was not related to age at inclusion, duration of i.v. drug use, gender or marital status. However, patients who became abstinent were more likely to have a professional activity at inclusion than the remaining (70% vs 42%, p = 0.03). Before knowledge of HIV infection, frequency of injections, needle sharing and use of condoms did not differ between the 2 groups. During follow-up, behavioural changes occurred in the two groups, but were more marked in those who lately became abstinent. These latter were more likely to always inject with new needles/syringes (57% vs 18%, p = 0.003), and to use condoms with HIV-negative partners or of unknown status (73% vs 39%, p = 0.06). Professional activity and systematic use of new needles/syringes remained independently associated with abstinence in multivariate analysis. CONCLUSION: In this cohort, abstinence appeared as a stepwise process in which risk reduction preceded abstinence. This confirms that risk reduction programs do not work against those messages aimed at stopping i.v. drug use. Since this analysis selected particular subjects, enrolled in a cohort of HIV-infected patients, results should be confirmed in other samples of i.v. drugs users.

Adult↗
PubMed1998

[Laparoscopic cholecystectomy as routine intervention in acute cholecystitis].

The laparoscopic cholecystectomy has become the gold standard in the therapy of gall bladder stones in the last few years. The most contraindications of the first period of the laparoscopic era had been eliminated by the development of laparoscopic technique and growing experience. Since September 1995 the laparoscopic cholecystectomy has been established as routine procedure also for acute cholecystitis. From September 1995 to Dezember 1996 177 laparoscopic cholecystectomies were performed, 132 for symptomatic cholecystolithiasis and 45 for acute cholecystitis. Postoperative complications occurred in 8.3% in the elective group and in 8.8% in the acute cholecystitis group. There was no death in both groups. Patients left the hospital on day 3 (range 2-21) in the elective group, on day 4 (1-13) in the acute colecystitis group. There are no statistically significant differences. According to our results acute cholecystitis does not increase postoperative morbidity and mortality after laparoscopic cholecystectomy and has to be a contraindication for this method no longer.

Acute Disease↗
PubMed1998

[Value and sensitivity of abdominal ultrasound in preoperative histologic diagnosis before laparoscopic cholecystectomy].

In a retrospective study we compared the findings of our abdominal ultra-sound diagnostic of the gallbladder and the common bile duct with the results ot preoperative ERCP, intraoperative findings and the histological results. The test parameters were the size of the gallbladder, the number and the size of biliary calculi, the thickness and the constitution of the wall of the gallbladder and the consecutive grade of inflammation, the wideness of the common bile duct and the suspicion of a choledocholithiasis, respectively. In acute cholecystitis we performed laparoscopic cholecystectomy within 24 hours, in symtomatic cholecystolithiasis without cholecystitis an elective laparoscopic cholecystectomy. If there was suspicion of a choledocholithiasis we performed a preoperative ERCP. Altogether we had correct findings of the common bile duct in our ultrasound diagnostic in 133 of 136 cases (97.8%), only in 3 of 136 cases (2.2%) we had false negative ultrasound findings. With a generous indication to ERCP caused by anamnestic and/or laboratory findings the obstruction of the bile duct could be diagnosted and eliminated in 2 of these 3 cases preoperatively. In all cases of bile duct dilatation (7 mm and more) we found an obstruction of the common bile duct. Our results demonstrate that abdominal ultrasound is a high-efficiency method in the preoperative diagnostic of gallbladder and common bile duct stones.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

[Substance abuse and dependence in adolescents].

This manuscript reviews literature on the prevalence/frequency, risk factors, course and outcome of substance use disorders in adolescents. Recent epidemiological studies conducted in various parts of the world have indicated a high frequency of substance use disorders in adolescents, with values ranging from 5 to 8%; the rate for alcohol abuse and dependence range from 2 to 32%, and for drugs from 5 to 10%. Substance use disorders were significantly higher in males than in females, and that they increased with age. Other risk factors commonly reported for substance use disorders include biological, familial, and social factors. Several intervention and prevention programs are presented and discussed.

Adolescent Psychiatry↗
PubMed1998

Lipoatrophic diabetes mellitus treated by continuous subcutaneous insulin infusion.

This case report evaluated continuous subcutaneous insulin infusion (CSII) in a 50-year-old Caucasian woman who suffered from partial lipodystrophy and severely insulin-resistant diabetes mellitus. Intensive insulin therapy (three daily injections) failed to provide good metabolic control (HbA1c ranging from 10 to 12%). Even though the patient had very thin subcutaneous tissue, CSII was initiated and proved highly efficient, improving blood glucose control considerably (HbA1c ranging from 7.5 to 8.5%), but with no decrease in the daily insulin requirement (2 IU/kg/day). Plasma triglycerides were also greatly improved (from 16.5 to 3.7 mmol/l). Thus, this study indicates that CSII is suitable for patients with lipoatrophy and insulin-resistant diabetes mellitus.

Adolescent↗
PubMed1998

Protease inhibitors, diabetes mellitus and blood lipids.

We report the case of a patient with human immunodeficiency virus (HIV) and no familial or personal history of metabolic disease, who experienced two diabetes decompensations (severe hyperglycaemia without ketonuria) associated with severe hypertriglyceridaemia, after the introduction of protease inhibitors. Initial insulin therapy at high doses (2 IU/kg/day) was required, and metabolic control was restored within several weeks without treatment after withdrawal of protease inhibitors. This case confirms that due attention must be paid to both blood glucose and plasma triglyceride levels in HIV-infected patients treated with protease inhibitors.

Adult↗
PubMed1997

Instant power spectrum analysis of heart rate variability during orthostatic tilt using a time-/frequency-domain method.

BACKGROUND: Spectral analysis of heart rate (HR) variability (HRV) requires, as a rule, some level of stationarity and, as a result, is inadequate to quantify biological transients. A time-/frequency-domain method (TF) was developed to obtain an instant spectral power (SP) of HRV during tilt. METHODS AND RESULTS: HR was recorded by Holter monitoring in volunteers and analyzed with a TF, the smoothed pseudo-Wigner-Ville transformation (SPWVT), with the table inclination randomly set or continuously increased while the table rotated in head-up position. (1) The SPWVT assesses, beat by beat, the instant center frequency (ICF) of the SP. ICF correlates better with instant HR than the ratio of low- (LF) to high-frequency (HF) oscillations. The transient effect of tilt is better characterized as a shift of SP toward lower frequencies than by changes in amplitudes. (2) The method evidences variations of HR from one second to another. During the passage to head-up position, the vagal withdrawal and the sympathetic activation occur nearly simultaneously, as indicated by the instant changes in both LF and HF amplitudes and ICF. (3) The averaged results of the SPWVT give results similar to those previously obtained with autoregressive algorithms. CONCLUSIONS: The SPWVT is a new tool to explore HR transitions such as periods before episodes of arrhythmias on a time scale of one beat and allows quantification of an instant frequency index (ICF) that closely reflects the instantaneous relationship between sympathetic and vagal modulations.

Adult↗