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Biomedical subjects

M Germain

Publications and source records attributed to M Germain.

At least 73 records · Page 4Linked to original sources
PubMed1996

Absence of the posterior tibial artery: implications for free transplants of the fibula.

A well-documented case of absence of the posterior tibial a. is reported. We have studied 40 personal case-records of dissection of the arteries of the leg in fresh corpses. This study allowed classification of the origins of the leg arteries from the popliteal a. into 7 groups. Several findings emerged: 1) the peroneal a. is constant, for phylogenetic and embryologic reasons, 2) the posterior tibial a. is absent in 1 to 5% of cases [1, 2, 4, 6-8] (Fig. 4), in which case the vascularisation of the fibula remains as normal (the proximal epiphysis of the fibula is vascularised by the anterior tibial a., the diaphysis and the distal epiphysis by the peroneal a.). Other anatomic variations may be found: trifurcation of the popliteal a., origin of the anterior tibial a. from the peroneal a., absence of the anterior tibial a., aplasia of the terminal portions of both the anterior and posterior tibial aa. In practice, absence of the posterior tibial a. can be demonstrated by arteriography and doppler ultrasound. We are dubious about the indications for arteriography, which is not always a risk-free examination, and therefore prefer doppler examination with ultrasound, which supplies adequate information in the majority of cases.

Female↗
PubMed1996

Management of intermittent ovarian torsion by laparoscopic oophoropexy.

BACKGROUND: Ovarian torsion is a serious gynecologic condition that often results in adnexal removal. If recurrent, this can result in castration of young patients. Torsion in the pediatric population is rare, but it presents more management challenges for gynecologists. There are few reports of prophylactic oophoropexy in patients with intermittent torsion. CASE: A patient with a history of left adnexal torsion was treated with salpingo-oophorectomy at age 10. She subsequently presented at age 12 with right lower quadrant pain, and was found to have a 7 x 6 cm right adnexal mass on ultrasound examination. She was diagnosed with ovarian edema secondary to intermittent torsion. At laparoscopy, she was found to have a 3-cm utero-ovarian ligament. She was treated with laparoscopic shortening of the utero-ovarian ligament, and has remained symptom-free for 1 year. CONCLUSION: We believe that this is the first reported case of laparoscopic triplication of the utero-ovarian ligament to prevent recurrent torsion. In young patients, this treatment may be a reasonable alternative to oophoropexy as prophylaxis for ovarian torsion.

Child↗
PubMed1996

Positive intrasurgical suggestion fails to affect postsurgical pain.

The present study explored the effect of positive intrasurgical suggestion during the anesthetic state on postsurgical pain. One-half of the patients who were undergoing elective cholecystectomy or hysterectomy received strong positive intrasurgical suggestion directed specifically towards reducing pain. The control patients received information about pain without suggestion content. There was no effect on postsurgical pain measured by the McGill Pain Questionnaire and a visual analogue scale. The lack of effect on postsurgical pain indicates that intrasurgical suggestion does not provide a therapeutic method to achieve pain control.

Adult↗
PubMed1996

Ambivalence and dialysis discontinuation.

Although dialysis discontinuation is the second leading "cause" of death among individuals who are maintained with chronic dialysis, little attention is accorded in the literature to patient ambivalence with this crucial decision. Three cases are presented of clinical situations involving termination of dialysis and ambivalence. The ambivalence of the patients is mirrored by the literature's vacillation between viewing cessation of life-support as pathological, and perceiving it as rational. There is considerable variability in the presentation of these cases, and they require exquisite sensitivity and flexibility on the part of medical personnel. As patient-physician communication is encouraged, and staff attempt to honor requests for initiation and/or discontinuation of treatment, we will see increasing numbers of ambivalent patients.

Adult↗
PubMed1996

Does an abortion increase the risk of intrapartum infection in the following pregnancy?

Spontaneous and induced abortions have been suggested to increase the risk of intrapartum infection in the following pregnancy. We conducted a case-control study using data from the Washington State Birth Registry for the years 1989-1991. The study population comprised women delivering a singleton livebirth. A case was defined by the presence of intrapartum fever (N = 2,550). Controls (1:3) were selected from the remaining births (N = 7,326). We calculated Mantel-Haenszel summary odds ratios by stratified analysis. We evaluated the validity of intrapartum fever recorded on the birth certificate using data from an ongoing case-control study on clinical amnionitis in Washington State. We found intrapartum fever to be highly specific (0.98) and moderately sensitive (0.57) for a diagnosis of clinical amnionitis. We saw no increased risk of intrapartum fever after a fetal loss or termination when using women with no prior pregnancy as the reference group. On the other hand, we found a threefold elevated risk for both induced and spontaneous abortion when using women with a prior livebirth as the reference group. Our findings indicate that an abortion in a woman's first pregnancy does not have the same protective effect of lowering the risk for intrapartum infection in the following pregnancy as does a livebirth.

Abortion, Induced↗
PubMed1996

Bradykinin B2 receptor involvement in rabbit and murine models of septic shock.

The purpose of our work was to evaluate the role of bradykinin B2 receptors in the early phase (first 3 h) of bacterial lipopolysaccharide (LPS)-induced shock in anesthetized and mechanically ventilated rabbits and to determine if HOE 140, a specific, potent, and long-acting bradykinin B2-receptor antagonist, could improve survival in two murine models of septic shock. In rabbits, LPS injection induced rapid hypotension associated with metabolic acidosis. Three hours after the injection of LPS, we observed leukopenia, thrombocytopenia, and a moderate increase in arterial blood cyclic GMP. The injection-of HOE 140 [1.7-mumol/kg bolus intravenously (i.v.) 20 min before LPS] inhibited the decrease in blood pressure, but did not influence any of the other parameters studied. Mice were subjected to intraperitoneal (i.p.) injection of LPS, which induced almost 100% mortality in the 4 days after the injection. Pretreatment with HOE 140 (1 mg/kg i.p.) 30 min before the LPS injection and 4, 8, and 24 h afterward the injection did not improve survival at any given time during the 4 days of the study. Cecal ligation and puncture in mice induced a mortality rate > 90% in < or = 10 days. HOE 140 (1 mg/kg i.v.) given 30 min before cecal ligation did not significantly improve the survival rate. In contrast with previous reports, in the present study in a rabbit model of endotoxic shock (early phase) and in two murine models of septic shock, the involvement of bradykinin B2 receptors appeared to be minimal.

Adrenergic beta-Antagonists↗
PubMed1995

In vitro effects of HOE 140 in human bronchial and vascular tissue.

Bradykinin is a potent inflammatory mediator which may be involved in various airway diseases. A selective and potent antagonist of the bradykinin B2 receptor has recently been discovered (HOE 140: D-Arg-[Hyp3,Thi5,D-Tic7,Oic8]bradykinin). The purpose of this study was to evaluate the potency of this compound in isolated human tissue (bronchus, pulmonary artery endothelium, umbilical artery and vein smooth muscle). Bradykinin induced contractions of the isolated human bronchus and umbilical artery and vein (the umbilical vessels were pretreated with indomethacin and L-nitro-arginine to inhibit prostaglandin and nitric oxide synthesis). It provoked an endothelium-dependent relaxation in the human pulmonary artery. HOE 140 was a non-competitive antagonist in human bronchial tissue (pKB: 8.19 +/- 0.30) and a competitive one in vascular tissue (pA2: 7.97 +/- 0.12, 8.16 +/- 0.16 and 8.00 +/- 0.11 in human pulmonary artery, umbilical artery and vein respectively). The effect of HOE 140 was selective as it did not influence the umbilical vein contractile response to serotonin and histamine. HOE 140 up to 3 x 10(-6) M was devoid of residual agonistic activity in the various human preparations studied. Furthermore, although the effects of HOE 140 were fully reversible, in isolated bronchial airways and umbilical veins, HOE 140 (10(-6) M) still possessed activity 1 h after being washed out in both tissues. Our results indicate that HOE 140 is a potent and potentially long-acting antagonist of the human bradykinin B2 receptor.

Binding Sites↗
PubMed1995

Dialysis discontinuation. A 'good' death?

BACKGROUND: Approximately 10% of the deaths of patients receiving long-term dialysis for end-stage renal disease are preceded by discontinuation of dialysis. We prospectively studied the decision to discontinue dialysis and whether, as is often stated, these patients have a prompt, predictable, and comfortable death. METHODS: All patients receiving hemodialysis in a hospital-based and a freestanding unit whose long-term dialysis was discontinued in 1990 were included in the study. Patients, providers, and families of prospectively enrolled cases were interviewed to determine the reasons for discontinuation; the patients' terminal courses were reviewed daily to collect information describing their quality of death. Retrospectively enrolled cases were studied by chart review and interviews of providers. The reasons for discontinuation of dialysis and a rating of the quality of their deaths (for prospectively studied patients only) were determined by interdisciplinary team consensus. Quality of death was rated on scales of 1 (worst) to 5 (best) according to duration of dying, discomfort, and psychosocial circumstances. RESULTS: Eighteen patients discontinued dialysis after a mean duration of 43.6 months of hemodialysis, and they lived a mean of 9.6 days after termination. The quality of death of the 11 patients who were enrolled prospectively was subjectively assessed as "good" (> 10 of a possible 15 points) for seven patients and "poor" for four patients. A good quality of death was more likely if dialysis was discontinued because of medical deterioration from progressive chronic disease (P = .009); none of the three patients whose dialysis was discontinued for other reasons had a good death (P = .024). CONCLUSIONS: A majority of the prospective cohort of patients who discontinued dialysis experienced a good death by our largely subjective criteria. Improved palliative therapy for some of these dying patients, however, could have ameliorated prolonged suffering, delirium, and inadequately treated pain that led to a poor quality of death.

Aged↗
PubMed1995

A geriatric assessment and intervention team for hospital inpatients awaiting transfer to a geriatric unit: a randomized trial.

The objective of this study, designed as a randomized controlled trial, was to decrease the length-of-stay (LOS) of hospitalized patients on a waiting list for admission to an inpatient geriatric assessment unit (GAU), and to optimize use of the GAU and other hospital services. The participants included 108 elderly, functionally impaired inpatients referred for geriatric consultation, and appropriate for GAU admission, stratified into high and low ADL functioning groups. They were admitted to a 354-bed acute hospital, with a 31-bed long-stay ward and a 15-bed GAU; a 25-30 day delay occurred between screening and admission of inpatients to the GAU. Experimental subjects (N = 25) received the consultative services of a geriatric assessment and intervention team (GAIT) immediately after being qualified for GAU admission, in place of waiting for GAU services. Controls (N = 52) received usual hospital care until admitted to the GAU. While high-function patients randomized to the GAIT had significantly shorter hospital LOS than comparable controls (41.4 vs 56.5 days; p = 0.03), LOS reduction was even greater in the low-function stratum (44.5 vs 74.5 days; p = 0.001). Further, significantly more GAIT than control patients were discharged home (28% vs 11%; p = 0.044). A trend toward reduced mortality in the GAIT group was non-significant. We conclude that for Canadian hospitals in which extensive stays of frail elderly patients, "bed blockage", and thus access to unit-based geriatric services are common problems, the GAIT can efficiently decrease hospital LOS, increase home placement, and may improve outcomes.

Aged↗
PubMed1995

Reproductive history and the risk of neonatal sepsis.

It was recently suggested that a previous abortion increases the risk of intrapartum infection in a following pregnancy. The authors hypothesised that abortion also could be associated with a higher risk of neonatal sepsis. A case-control study of neonatal sepsis was conducted using the Washington State Birth Registry. Cases of sepsis were selected among singleton livebirths during the period 1984-90, and compared with a control group for the occurrence of spontaneous or induced abortion in previous pregnancies. The risk estimates were calculated using a stratified analysis. After exclusion of primigravidae, the age-adjusted odds ratio (OR) was 1.68, with a 95% confidence interval (CI) 1.33, 2.11 for previous spontaneous abortion, and 2.20 (95% CI 1.73, 2.79) for induced abortion, compared with previous livebirth. After exclusion of nulliparous women, the OR decreased to 1.19 (95% CI 0.90, 1.58) for spontaneous abortion and 1.45 (95% CI 1.03, 2.04) for induced abortion. After controlling for the effect of parity, induced abortion is associated with an increased risk of neonatal sepsis in a subsequent pregnancy, but the association between spontaneous abortion and sepsis is small and non-significant. The authors suggest that the procedures involved in a therapeutic abortion might produce a latent, sub-clinical infection that persists until the next pregnancy, and is then transmitted to the newborn.

Abortion, Induced↗
PubMed1995

Crescentic glomerulonephritis and eosinophilic interstitial infiltrates in a patient with hypereosinophilic syndrome.

Crescentic glomerulonephritis with immune complex deposition and acute eosinophilic interstitial nephritis developed in a patient with the hypereosinophilic syndrome. Acute renal failure ensued but was rapidly reversed by high-dose oral prednisone. Confounding factors and unusual findings are described with a review of recent literature. This mode of presentation has not previously been reported.

Acute Disease↗
PubMed1994

Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection.

Chronic mucocutaneous candidiasis (CMC) is usually characterized by onset in childhood and is almost never complicated by deep fungal infection. The authors report two cases of fatal candida meningitis in patients who suffered from mild, adult-onset CMC. The pedigrees suggest an autosomal recessive disorder. In the index cases and in a symptomatic sibling, the immunologic work-up showed a specific cellular deficit as opposed to Candida albicans, as is typical of other forms of CMC. Both families were of French Canadian descent and originated from eastern Quebec. Three other cases of primary candida meningitis in patients of the same ethnic origin are also reported and reviewed. It is suggested that these cases may represent a variant of familial adult-onset CMC, in which there is a striking predisposition to deep infection.

Adult↗
PubMed1994

Agonistic and antagonistic properties of the bradykinin B2 receptor antagonist, Hoe 140, in isolated blood vessels from different species.

1. Hoe 140, a recently described bradykinin B2 antagonist, and NPC 567 from an earlier generation of bradykinin B2 antagonists, were tested in rabbit and sheep isolated blood vessels. 2. In rabbit jugular vein, a bradykinin B2 preparation, NPC 567 was an antagonist (apparent pA2: 8.67 +/- 0.16) with marked residual agonistic activity (log[EC50]: -7.29 +/- 0.13). Hoe 140 was a potent non-competitive antagonist devoid of agonistic properties (slope of the Schild plot: 2.02; estimated pA2: 9.04). 3. In rabbit aorta, a bradykinin B1 preparation, NPC 567 was a competitive antagonist (pA2: 6.32 +/- 0.13) but Hoe 140 was ineffective. The two antagonists did not show any agonistic properties in this tissue. 4. In sheep femoral artery without endothelium, bradykinin and Hoe 140 induced contractions with identical efficacy and similar potency (log[EC50]: -8.05 +/- 0.12, -7.73 +/- 0.10; maximal contraction in % of KCl [60 mM]: 59.5 +/- 15.1, 62.0 +/- 13.1; for bradykinin and Hoe 140, respectively). In contrast NPC 567 was an extremely weak agonist. The contractile responses to bradykinin and Hoe 140 were inhibited by NPC 567 (apparent pKB: 6.89 +/- 0.22 and 6.58 +/- 0.08 versus bradykinin and Hoe 140, respectively) but not by a B1 bradykinin antagonist, suggesting that the receptor involved was a bradykinin B2 receptor. 5. In sheep femoral artery with endothelium, bradykinin induced a biphasic response: an endothelium-dependent relaxation and a contraction which were both inhibited by NPC 567 (apparent pKB: 7.10 +/- 0.15) and Hoe 140 (pA2: 8.38 +/- 0.12). As bradykinin B2 receptor antagonists, Hoe 140 and NPC 567 were less potent in the sheep femoral artery than in the rabbit jugular vein. Neither Hoe 140 nor NPC 567 were agonists for the endothelial receptor.6. This study demonstrates that Hoe 140, a new bradykinin B2 receptor antagonist, is more selective and more potent than NPC 567; however, it may possess, depending on the tissue studied, marked residual agonistic properties. Furthermore, bradykinin B2 receptors are subject to important species specificity. Finally, two different bradykinin B2 receptor subtypes may coexist in the sheep femoral artery with endothelium.

Amino Acid Sequence↗
PubMed1994

Genital flora in pregnancy and its association with intrauterine growth retardation.

A study of risk factors for intrauterine growth retardation (IUGR) was conducted among a cohort of 13,914 pregnant women enrolled in the multicenter Vaginal Infections and Prematurity Study. From 23 through 26 weeks of gestational age, cultures of specimens from the vagina and cervix were done for group B streptococci, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and anaerobic gram-negative rods belonging to the genera Bacteroides, Porphyromonas, and Prevotella. Newborns who were small for their gestational age were delivered by 1,251 women, and infants of the appropriate weight for their gestational age were delivered by 10,332 women. When controlling for ethnicity and smoking and excluding women treated with antibiotics, the Mantel-Haenszel adjusted relative risk of IUGR was 1.16 for Bacteroides, Prevotella, and Porphyromonas spp. (95% confidence interval [95% CI], 1.01 to 1.33), 1.16 for M. hominis (95% CI, 1.04 to 1.29), 1.20 for U. urealyticum (95% CI, 1.05 to 1.38), and 1.22 for T. vaginalis (95% CI, 1.05 to 1.42). There was also a strong and significant trend for an increasing risk of IUGR with the number of these four microbes recovered. Among women colonized with all four isolates, the adjusted odds ratio of IUGR was 1.79 (95% CI, 1.27 to 2.52) in comparison with women not colonized with any of these microorganisms. Group B streptococci, N. gonorrhoeae, C. trachomatis, and C. albicans were not significantly associated with IUGR. These results suggest that infection is associated with some cases of IUGR and that specific microorganisms, alone or in combination, are involved. Since genital isolates are highly correlated with each other, the relative contribution of each microbe is difficult to determine.

Bacteria↗
PubMed1994

A comparison of the three most common Papanicolaou smear collection techniques.

OBJECTIVE: To evaluate three common instruments for sampling the endocervical canal: the Q-tip applicator, the Cytobrush, and the Cervex brush. METHODS: Clinical, cytologic, and histologic data were collected from patients enrolled in the colposcopy clinic at the National Naval Medical Center. Subjects were assigned to one of three techniques: a combination of spatula and swab, a combination of spatula and Cytobrush, and the Cervex brush alone. RESULTS: There was no significant difference in the ease of use or the amount of patient discomfort among the three methods, although the Cytobrush caused an increase in mild cervical bleeding. The Cytobrush yielded the greatest number of endocervical cells. The swab produced the lowest number of endocervical cells and the greatest cellular distortion. The ability to identify patients with biopsy-proven dysplasia was comparable for each of the three methods. CONCLUSION: The Cytobrush was the best device for sampling the endocervical canal, but it was no more sensitive in detecting cervical dysplasia.

Adult↗
PubMed1993

Influence of training, sex, age and body mass on the energy cost of running.

To highlight the influences of age, sex, body mass (mb) and running training on the energy cost of running (Cr) young basketball players [38 boys (BB) and 14 girls (BG), aged 14.2 (SD 0.3) and 12.2 (SD 1.9) years, respectively] were selected to be compared to middle-distance runners [27 men (MR) and 14 women (FR) aged 23.7 (SD 3.4) and 23.9 (SD 4.1) years, respectively]. The Cr was measured during a maximal treadmill test. In each group Cr and body mass (mb) and body height were negatively and significantly correlated. A stepwise regression showed that among both the body dimensions measured, mb was the most important factor in determining the variations of Cr. For the whole group (n = 93) the correlation coefficient was 0.72 (P < 0.0001). For a given mb, there was no significant difference between the Cr of BG, BB and MR: this result would support the hypothesis that the differences in Cr currently attributed to age, running training or sex differences are mainly related to mb. On the other hand, for a given mb, FR showed a significantly lower Cr than the basketball players (P < 0.01 for BG and BB) and than MR (P < 0.05), thus suggesting that women decrease their Cr as a response to running training more efficiently than do men.

Adolescent↗
PubMed1993

Structure-activity relationships of ET-1 and selected analogues in the isolated guinea pig trachea: evidence for the existence of different ETB receptor subtypes.

We tested endothelin-1 (ET-1) derivatives on the guinea pig trachea (GPT) and compared their biologic activities to ET-1 in this tissue and to published reports using similar analogues in different assay systems, such as vascular smooth-muscle preparations. Six ET-1 analogues with no intramolecular disulfide bridges and/or with the substitution of one or more amino acids at position 7 and/or 21 were synthesized. Oxidation of the Met7 or formylation of the indole moeity of the Trp21 did not affect the biologic activity of ET-1 on the trachea. Acetamidomethylation of the Cys1-15 decreased the potency and intrinsic activity, but not as much as had been reported on vascular preparations. However, modifications involving one or both disulfide bridges, combined with formylation of the Trp21, yielded analogues with very weak contractile activity. These findings, when compared with the biologic activity of ET-1 analogues in other assay systems, suggest that a different population of receptors, probably non-ETA (i.e., an ETB subtype different from the one reported to be involved in ET-1-induced binding or activities in rabbit pulmonary artery or in rat cerebellum or vasculature) is present and responsible for ET-1-induced bronchoconstriction on the GPT.

Amino Acid Sequence↗