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Biomedical subjects

S Clement

Publications and source records attributed to S Clement.

At least 37 records · Page 2Linked to original sources
PubMed1997

Ross procedure in congenital patients: results and left ventricular function.

METHODS: From April 1990 to August 1995, 121 patients (median age 42 years) underwent aortic valve replacement with allografts (69 patients) or autografts (52 patients). In this latter group, 24 Ross procedures have been performed in congenital patients since November 1991 (median age 10 years, range five months to 27 years): aortic incompetence (n = 17), isolated aortic stenosis (n = 5), small stenotic prosthesis (n = 2). Transthoracic echocardiography was obtained preoperatively in all patients and serially after surgery with the aim of measuring aortic and pulmonary annuli and evaluate gradients and incompetence and to study the left ventricular function. Intraoperative transoesophageal echocardiography was routinely used. Complete root replacement was performed in all patients. RESULTS: One patient died in the early postoperative period (4%). There was no late death. All survivors remained in NYHA class I and were free of complications and medications. No gradient nor any significant aortic incompetence could be demonstrated. In 17 patients with predominant aortic incompetence before surgery, the left ventricular function was followed prospectively, end-diastolic left ventricular dimensions diminished drastically from 2 +/- 3.4 S.D. above normal to -0.63 +/- 2.4 S.D. at one week postoperatively (day 10) to reach a normal value one to three months after surgery. Left ventricular mass remained abnormal at day 10 (from 4.7 +/- 3.3 S.D. to 5.3 +/- 3.8 S.D.) and diminished more progressively to reach a normal value (0.14 +/- 1.4 S.D.) at three months. This resulted in a significant decrease of end-systolic wall stress (-3.6 +/- 2.1 S.D.) and in a hyperdynamic function in the immediate postoperative days except in two patients. These two patients were characterized preoperatively by more severely dilated left ventricle (end diastolic dimension 5.3 +/- 0.03 versus 1.6 +/- 3 S.D.) with decreased left ventricular wall thickness (1.19 +/- 0.7 versus 3.44 +/- 1.9 S.D.), decreased ratio between end diastolic wall thickness and end diastolic dimension (0.14 +/- 0.06 versus 0.2 +/- 0.06) and a decreased velocity of shortening. Unlike the other 15 patients, the left ventricular function did not recover completely at mid term follow-up in those two patients. CONCLUSION: The Ross operation is a safe procedure and allows us to suppress completely the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function in most patients.

Adolescent↗
PubMed1997

A transglutaminase-related antigen associates with keratin filaments in some mouse epidermal cells.

A mouse monoclonal IgG, G82, directed against guinea pig liver transglutaminase recognizes a transglutaminase-related antigen that is associated with the keratin intermediate filament network in some primary mouse keratinocytes. The association can be seen at the resolution of individual keratin tonofibrils following fixation and staining for double-label indirect immunofluorescence. Western blots indicate that G82 reacts with two proteins of 95 kDa and 280 kDa, respectively, in extracts of these cells. The 95-kDa band is also recognized by a polyclonal antibody against purified guinea pig liver transglutaminase, and the 280-kDa protein seems to correspond to a similar protein that was shown to be recognized by G92.1.2 in the intermediate filament fraction of primary mouse fibroblasts. The transglutaminase-related antigen was shown by confocal microscopy to co-localize only with nonbasal cell specific keratin intermediate filaments.

Animals↗
PubMed1996

A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project.

OBJECTIVE: To compare the clinical and psychological effectiveness of the traditional British antenatal visit schedule (traditional care) with a reduced schedule of visits (new style care) for low risk women, together with maternal and professional satisfaction with care. DESIGN: Randomised controlled trial. SETTING: Places in south east London providing antenatal care for women receiving shared care and planning to deliver in one of three hospitals or at home. SUBJECT: 2794 women at low risk fulfilling the trial's inclusion criteria between June 1993 and July 1994. MAIN OUTCOME MEASURES: Measures of fetal and maternal morbidity, health service use, psychosocial outcomes, and maternal and professional satisfaction. RESULTS: Pregnant women allocated to new style care had fewer day admissions (0.8 v 1.0; P=0.002) and ultrasound scans (1.6 v 1.7; P=0.003) and were less often suspected of carrying fetuses that were small for gestational age (odds ratio 0.73; 95% confidence interval 0.54 to 0.99). They also had some poorer psychosocial outcomes; for example, they were more worried about fetal wellbeing antenatally and coping with the baby postnatally, and they had more negative attitudes to their babies, both in pregnancy and postnatally. These women were also more dissatisfied with the number of visits they received (odds ratio 2.50; 2.00 to 3.11). CONCLUSIONS: Patterns of antenatal care involving fewer routine visits for women at low risk may lead to reduced psychosocial effectiveness and dissatisfaction with frequency of visits. The number of antenatal day admissions and ultrasound scans performed may also be reduced. For the variables reported, the visit schedules studied are similar in their clinical effectiveness. Uncertainty remains as to the clinical effectiveness of reduced visit schedules for rare pregnancy problems.

Anxiety↗
PubMed1996

Women's satisfaction with traditional and reduced antenatal visit schedules.

OBJECTIVE: to ascertain: (i) which demographic, obstetric, maternity care, practical and attitudinal variables, and which variables relating to social support and life problems predict satisfaction with traditional antenatal visit schedules; and (ii) which of these variables predict satisfaction with reduced antenatal visit schedules. DESIGN: a secondary analysis of data from the Antenatal Care Project (a randomised controlled trial comparing two schedules of routine antenatal visits). SETTING: three hospitals and their community sites in south-east London. PARTICIPANTS: 1882 pregnant women, that is all those who took part in the Antenatal Care Project, on whom maternity record data were available, and who returned their antenatal questionnaire. INTERVENTION: participants were randomly allocated to follow either the traditional schedule of 13 routine antenatal visits, or a reduced schedule of seven visits for nulliparous women and six visits for multiparous women. MEASUREMENTS: a questionnaire developed specifically for the Antenatal Care Project. Also some data extracted from women's maternity records. FINDINGS: women satisfied with reduced schedules were more likely to live in rented accommodation, and to have a caregiver who both listened and encourage them to ask questions than women not satisfied with reduced schedules. Women satisfied with the reduced schedules were less likely to be depressed in pregnancy than those not satisfied with reduced schedules. Women satisfied with the traditional schedule were more likely to have their general practitioner involved in their antenatal care, and to receive social support from relatives than those not satisfied with the traditional schedule. Initial preferences and expectations were also associated with satisfaction. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: (i) groups most likely to be satisfied with traditional or reduced antenatal visit schedules cannot be easily identified. It is therefore necessary to talk to women individually, and tailor care to their particular preferences; (ii) social support for depressed women needs to be safeguarded if reduced schedules are to be introduced; (iii) improving the psychosocial quality of antenatal care may be a good strategy for making reduced visit schedules more acceptable to pregnant women.

Adult↗
PubMed1995

Differential recognition of free and covalently bound polyamines by the monoclonal anti-spermine antibody SPM8-2.

The reactivity of an anti-spermine MAb (SPM8-2) toward polyamines either free or bound to a solid surface was investigated using equilibrium dialysis and ELISA methods. When polyamines were covalently linked to hydrophilized microtiter plates using carbodiimide, the MAb SPM8-2 reacted both with spermine and spermidine, with a higher affinity for the latter, but did not show any reactivity towards bound putrescine. In contrast, the MAb SPM8-2 reacted with all three polyamines bound to the microtiter plates with glutaraldehyde, with an affinity in the order: putrescine > spermidine > spermine. Equilibrium dialysis and competitive ELISA tests showed that the MAb SPM8-2 exhibited high affinity for free spermine and 50% and 5% cross-reactivity with free spermidine and putrescine respectively. The affinity of the MAb SPM8-2 for putrescine, spermidine and spermine appears to depend on whether the polyamine is free or bound. The antigenicity of the polyamines differs according to the nature of their link to the solid phase. These observations are discussed in the light of the structural modification produced by covalent binding of the polyamines. It is also concluded that when antibodies are used, due care has to be exercised in choosing the appropriate immunoassay for determining the specificity of antibodies directed against small haptens such as the polyamines.

Animals↗
PubMed1995

A survey of health professionals' views on possible changes in the provision and organisation of antenatal care.

OBJECTIVE: To ascertain the views of midwives, obstetricians and general practitioners (GPs) on possible changes in the provision of antenatal care, and to describe any differences in attitude between the three professional groups. DESIGN: survey using postal questionnaire. SETTING: Three hospitals in south-east London. PARTICIPANTS: The questionnaire was sent to 251 midwives, 50 obstetricians, and 438 GPs. The overall response rate was 70%. MEASUREMENTS: A questionnaire asking whether the health professionals would like to see, were undecided, or would not like to see, 12 possible changes in the provision of antenatal care. FINDINGS: The changes that most health professionals wanted to see were individualised visit schedules and an increase in continuity of care-giver. There were significant differences between the three professional groups for 11 of the 12 possible changes, with midwives being the group most keen, and GPs tending to be the least keen, to see change. KEY CONCLUSIONS: It is important to recognise and address the different views of midwives, obstetricians and general practitioners at this time when major changes in the organisation of antenatal care are being planned or implemented. IMPLICATIONS FOR PRACTICE: Differences in attitudes between health professionals need to be addressed when planning changes in the provision of antenatal care.

Attitude of Health Personnel↗
PubMed1995

'Listening visits' in pregnancy: a strategy for preventing postnatal depression?

OBJECTIVE: to examine existing research evidence to ascertain whether 'listening visits' in pregnancy, targeted at women with low emotional wellbeing, are likely to be effective in preventing postnatal depression and in improving other maternal psychological outcomes. FINDINGS: the evidence currently available suggests that postnatal listening visits are effective in preventing postnatal depression; that many women who are depressed after childbirth were also depressed in pregnancy; and that psychological interventions in pregnancy can have beneficial effects on postnatal emotional wellbeing. Existing research also suggests that the Edinburgh Postnatal Depression Scale may be an appropriate tool for selecting women for antenatal 'listening visits'; and that a formal approach is likely to prove more beneficial than ad hoc approaches. KEY CONCLUSIONS: it is concluded that 'listening visits' in pregnancy may well be a useful strategy for preventing postnatal depression. However, further research is necessary before antenatal 'listening visits' are introduced on a large scale. IMPLICATIONS FOR PRACTICE: midwives might usefully consider introducing antenatal 'listening visits', auditing this new practice and disseminating findings.

Communication↗
PubMed1992

Reactive hypoglycemic coma due to insulin autoimmune syndrome: case report and literature review.

Recurrent episodes of postprandial hypoglycemic symptoms culminated in hypoglycemic coma in a hypertensive but otherwise healthy man while he was taking hydralazine. The patient was found to have an extreme elevation in the immunoreactive insulin level, leading to the discovery of insulin antibodies in the absence of prior exposure to exogenous insulin. Negative results of an anatomic study of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast helped to exclude insulinoma. In contrast, symptomatic hypoglycemia developed in response to oral glucose loading and was associated with an elevation in total and free insulin as well as C-peptide levels. The patient was diagnosed with insulin autoimmune syndrome, which, although a common source of hypoglycemia in Japan, has been well documented in only 15 cases from other countries. HLA typing revealed the patient to be positive for groups Cw4 and DR4, a combination that has been preliminarily associated with insulin autoimmune syndrome in Japan. Unlike the majority of cases previously reported, this patient had no clinical or serologic evidence of an underlying autoimmune disorder and had not been exposed to drugs containing sulfhydryl groups. This case adds to the world literature on insulin autoimmune syndrome, lends support to a postulated HLA association, and documents the presence of insulin autoantibodies in the absence of another underlying autoimmune disorder.

Adult↗