PubMed Health⌕ Search

Biomedical subjects

A Ferrier

Publications and source records attributed to A Ferrier.

At least 19 recordsLinked to original sources
PubMed2006

[Cryptococcal meningitis disclosed by visual loss in HIV negative patient with ventriculo-atrial shunting].

INTRODUCTION: HIV infection is the main cause of cryptococcal neuromeningitis but other diseases may be associated with this infection. CASE REPORT: We report a case of cryptococcal neuromeningitis in a patient with sarcoidosis and ventriculoatrial shunting. The patient was successfully treated by effective therapy without device withdrawal. CONCLUSION: The relationship between cryptococcosis and sarcoïdosis has been already described and may be not fortuitous. However it remains a very rare complication of sarcoidosis. Because of its potential severity (mortality rate of 40%), the diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

Amphotericin B↗
PubMed2006

[Neurological aspects of Fabry's disease].

Fabry disease is a rare X-linked disorder caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. Progressive accumulation in lysosomes of the undegraded glycosphingolipids leads to a multi-system disease with dermatological, ocular, renal, cardiac, and neurological manifestations. Peripheral nerve involvement, neuropathic pain and chronic acroparesthesiae, are frequent and early-onset signs revealing the disease. They are due to the involvement of small nerve fiber, thus explaining the normality of electroneuromyography. Cochleo-vestibular and autonomic nervous system involvement is frequent. Besides rare aseptic meningitis, central nervous system involvement is essentially represented by cerebrovascular events (stroke, transient ischemic attack). Affecting essentially the posterior circulation, their etiologies have to be clarified: progressive stenosis of small vessels with globotriasocylceramide deposits, arterial remodeling, endothelial dysfunction, pro-thrombotic state, cerebral hypoperfusion consecutive to dysautonaumy, cardiac embolism. MRI shows numerous silent lesions, increasing with age, mainly in small perforant arteries (periventricular white matter, brainstem, cerebellum, basal ganglia). Pulvinar calcifications, due to an increase in cerebral hyperperfusion, could be specific of Fabry disease. Positon tomography analysis shows a reduced cerebral flow velocity and impaired cerebral autoregulation, secondary to the glycosphingolipid storage in vascular endothelial cells. Enzyme replacement therapy has to be carefully monitored.

Brain↗
PubMed2004

Rapid inactivation of vaccinia virus in suspension and dried on surfaces.

A bioterrorist attack with smallpox virus would be disastrous with a 30% disease fatality rate. Such an outbreak would require biomedical laboratories for diagnosis and analyses and extensive use of clinical care facilities for patient quarantine. Safe decontamination procedures will have to be in place in order to limit the spread of the disease. In order to fulfil this need, Sanytex, a new non-corrosive commercial solution containing quaternary ammonium, aldehydes, alcohol and detergent, was tested with a view to using it in decontamination procedures. Vaccinia virus was used in this investigation as a model for smallpox virus. We determined exposure time and the concentration of Sanytex required to inactivate the virus in suspension and dried on surfaces in the presence of protein (up to 70 mg/mL). After 3 min incubation, Sanytex at a concentration of 3% led to a complete inactivation (virus titre reduction >10(4)-fold of vaccinia virus in suspension containing protein up to 30 mg/mL. A virus suspension containing 70 mg protein/mL, simulating biological fluids, was decontaminated with 10% Sanytex after 3 min. After 10 min, Sanytex at a concentration of 30%, applied on to a dried vaccinia virus contaminated surface in the presence of protein (10 mg/mL before desiccation), led to complete decontamination of the surface. Thirty minutes exposure with 30% Sanytex was necessary for a virus titre reduction of >10(4)-fold on a surface contaminated with a dried suspension of vaccinia virus in the presence of protein at 70 mg/mL. Sanytex is not corrosive, not toxic to environment and stable for up to three months even diluted. Its virucidal effect was preserved when used under pressure in a fire-hose nozzle. These results support the use of Sanytex for decontamination of biological fluids and surfaces contaminated by the smallpox virus.

Alcohols↗
PubMed2001

Comparison of tissue injury between laparosonic coagulating shears and electrosurgical scissors in the sheep model.

STUDY OBJECTIVE: To compare laparosonic coagulating shears (LCS), which use ultrasonic energy, and unipolar diathermy scissors with respect to depth of tissue injury. DESIGN: Prospective observational study (Canadian Task Force classification I). SETTING: A reproduced surgical setting. SUBJECTS: An anesthetized sheep. INTERVENTION: We laparoscopically harvested uterine horn and bowel tissue. MEASUREMENTS AND MAIN RESULTS: Tissue was transected while hemostasis was maintained. Two pathologists examined tissue independently, and each was blinded as to the instrument used for harvesting. Clinical characteristics and tissue injury created by the instruments were compared. CONCLUSION: Subjectively, LCS appeared to produce less smoke plume than diathermy scissors. It also produced greater tissue damage than unipolar electrosurgery on settings of 35 W cut and 30 W coagulate.

Animals↗
PubMed1999

Emergency coronary artery bypass surgery following coronary angioplasty and stenting: results of a French multicenter registry.

This study investigates the influence of coronary stenting on the risk of emergency bypass surgery performed within 24 hr of percutaneous transluminal coronary angioplasty (PTCA) with particular concern for incidence and indication. Since 1995, coronary stenting has been increasingly performed in France during angioplasty procedures, altering significantly the role of emergency bypass surgery. The outcome of elective stenting and widespread use of coronary stenting and its influence on emergency surgery have not been evaluated so far. Through a retrospective (1995) and prospective (1996) registry, we analyzed the incidence, indication and results of emergency bypass surgery performed within 24 hr of PTCA in 68 and 57 centers, respectively, accounting for nearly half of all angioplasty procedures in France. Data were collected through questionnaires consisting of separate forms for every case report that were sent to every center. Over the two years, 26,885 and 27,497 procedures were investigated with a stenting rate of 46% and 64%, respectively. The observed need for emergency surgery was constantly low throughout this period (0.38% and 0.32%, respectively). Indications for surgery included complications directly due to stent in 37% of cases in the 2-year period. Outcome remained poor, with in-hospital mortality in 10% and 17% and myocardial infarction in 27% and 25% of cases, respectively. A comparison of the results in centers with and without surgical facilities showed no differences in outcome, despite a longer time to surgery (359 min +/- 406 min vs. 170 min +/- 205 min, P = 0.0001) and a lower incidence of emergency surgery (0.25% vs. 0.44%, P = 0.0001) in centers without on-site surgery backup. The French multicenter registry reveals an increase in the use of stents together with a dramatic decrease in the incidence of emergency bypass surgery (below 0.5%) following PTCA. There has been a significant evolution in the indication, and stent implantation now accounts for a third of the indications for emergency bypass surgery.

Angioplasty, Balloon, Coronary↗
PubMed1998

Emergency cervical suture: the obstetrician's dilemma.

We studied the perinatal mortality and morbidity associated with emergency cervical suture at Royal North Shore Hospital over 7 years. There were 23 patients who had an emergency cervical suture inserted and they were divided into 3 groups for analysis, Group 1: patients with cervical dilatation initially detected on routine 18-20 week ultrasonography and later confirmed on clinical examination, Group 2: cervical dilatation < or = 3 cm and Group 3: cervical dilatation >3 cm at presentation. The median delay in delivery in each group was 6, 5 and 3 weeks respectively. The perioperative membrane rupture rate for emergency suture insertion in this study was 13%. The perinatal mortality rate for each group was 0%, 33% and 43% respectively with an overall rate of 33%. Follow-up at 3-5 years of 9 babies with a birth-weight < or = 1,000 g, revealed that of 6 survivors, 1 had moderate disability and 2 had mild disability. No survivors had severe disability. From the results of our study, emergency cervical suture can prolong gestation and in the absence of prolapsed fetal membranes, the perioperative membrane rupture rate is low. However, it is important to consider that the time gained from emergency cervical suture insertion may convert a previable fetus into an extremely premature infant with the risk of long-term disability.

Emergencies↗
PubMed1996

Have the most recent Pap smear guidelines affected GP practices?

OBJECTIVE: To assess the attitudes and knowledge of a sample of NSW general practitioners on issues concerning Papanicolaou (Pap) smear tests after the 1991 National Guidelines were established. DESIGN: During January-March 1994, a sample of Sydney general practitioners obtained from a list from the Department of General Practice, Royal North Shore Hospital, were asked to complete a questionnaire based on Pap smear screening. Issues explored included the perceived value of Pap smears, views on recommended screening intervals and the type of patients believed to be at highest risk of developing cervical cancer. SETTING: Northern Sydney metropolitan area. RESULTS: Seventy of 104 general practitioners from the Department of General Practice, Royal North Shore Hospital, returned completed questionnaires. Ninety-five per cent of respondents rated the Pap-smear as an extremely valuable screening test for cervical cancer prevention. The majority of GPs surveyed tended to overscreen younger patients and underscreen both older women and those at highest risk of developing cervical cancer. Seventy-seven per cent of doctors indicated the use of a patient reminder system, in most cases provided by a pathology laboratory but 43% were unaware of the NSW Cancer Council's reminder service. CONCLUSION: Our study suggests that Pap smears are viewed as an important means of cervical cancer prevention. Unfortunately the majority of respondents did not adhere to the recommended guidelines of 2-yearly screening. Possible changes to the current system include improved awareness of the 1991 National Guidelines, greater public awareness of the NSW Cancer Council reminder service, and the establishment of a state cytology registry.

Adolescent↗
PubMed1995

The 33-kDa C-terminal domain of Raf-1 protein kinase exhibits a Ras-independent serum- and phorbol ester-induced shift in gel mobility.

Experiments were carried out to determine Raf-1 protein kinase domain fragments which exhibit a characteristic electrophoretic mobility shift noted with Raf-1 protein kinase in response to serum and phorbol ester (PMA) treatment of serum-deprived NIH 3T3 cells. Epsilon-epitope tagged 84 kDa Raf-1 holoenzyme (HR-epsilon), as well as the epsilon-epsilon pitope tagged 35 kDa N-terminal (RI-epsilon), 33 kDa mid-portion (RII-epsilon), and 33 kDa C-terminal (RIII-epsilon) fragments of Raf-1 were overexpressed in NIH 3T3 cells. The overexpressed HR-epsilon exhibited a serum- and PMA-induced shift in gel mobility similar to that noted with endogenous Raf-1. The C-terminal RIII-epsilon fragment exhibited a similar shift in gel mobility while the electrophoretic mobility of the N-terminal RI-epsilon fragment remained unchanged. These results suggest that modification(s) within the 33 kDa C-terminal portion of Raf-1 which occur independently of association with Ras may be responsible for the band shift observed with serum and PMA treatment of serum-deprived NIH 3T3 cells.

3T3 Cells↗
PubMed1990

Evaluation of leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins for in vitro fertilization or gamete intrafallopian transfer.

A prospective randomized trial was conducted to compare the efficiency of two ovarian stimulation protocols for in vitro fertilization-embryo transfer or gamete intrafallopian transfer. Protocol 1 consisted of clomiphene citrate and human menopausal gonadotropin (hMG) with 55 cycles of 42 patients being evaluated. Protocol 2 had 38 cycles of 34 patients receiving a gonadotropin-releasing hormone agonist (GnRH-a) and hMG. The incidence of a spontaneous luteinizing hormone surge was 38.2% in protocol 1 and 0% in protocol 2. Both protocols had a similar cancellation rate. The total clinical pregnancy rates per oocyte retrieval for patients receiving protocol 1 and protocol 2 were 19.5% and 10.3%, respectively. The difference was not statistically significant. Therefore, as first-line ovulation induction agents, it cannot be concluded that either protocol demonstrates a clear superiority over the other and further trials of the GnRH-a/hMG combination are indicated.

Adult↗
PubMed1988

[Diagnosis of acute aortic dissection by echocardiography].

Until recently, the diagnosis of aortic dissection rested on aortography. The purpose of this study was to evaluate the diagnostic value of echocardiography in that disease and its ability to inform on the extent of the dissection and on the presence of associated lesions. Twenty-six patients (mean age 64 +/- 10 years) admitted for suspected aortic dissection were explored by echocardiography and the results were compared with those of angiography and/or anatomical findings. Echocardiography provided the diagnosis in 14 of the 16 patients with aortic dissection and excluded it in the remaining 10 patients. The sensitivity and specificity of the method were 87.5 p. 100 and 100 p. 100 respectively. The type of dissection was correctly determined in 90 p. 100 of the patients whose aorta had been totally explored by echocardiography. Aortic regurgitation and pericardial effusion were detected in 81 p. 100 and 50 p. 100 respectively of patients with aortic dissection. These results confirm the diagnostic value of echocardiography in dissection of the aorta. The extent of the lesion can only be evaluated when the whole of the aorta is visualized. The echocardiographic diagnosis is easier when the ascending aorta is involved (type I), while in type III aortic dissection there is a risk of missing a retrograde lesion of the aorta and confusing this type with type I. In this study two kinds of intimal flap motion were observed: in the first one the motion was independent of that of the aorta, while the second one resembled a division of the aortic, wall the motion of which is parallel to that of the aorta.

Acute Disease↗
PubMed1986

Effects of full-dose heparin anticoagulation on the development of left ventricular thrombosis in acute transmural myocardial infarction.

The incidence of left ventricular thrombosis after acute transmural myocardial infarction has been evaluated with two-dimensional echocardiography. To assess the preventive action of early anticoagulation with full-dose heparin, 90 patients, admitted within 5.2 +/- 4.6 hours after the onset of symptoms of their first episode of acute myocardial infarction (46 anterior and 44 inferior), were prospectively studied. Patients were randomly assigned either to therapeutic anticoagulation with heparin or to no anticoagulant therapy. Serial two-dimensional echocardiograms were recorded on the day of admission, the next day, days 4 to 7 and days 20 to 50 to detect left ventricular thrombus and to assess global left ventricular performance. On the first echocardiogram (10.3 +/- 8.0 hours after the onset of symptoms) no thrombus was visualized. In 44 patients with inferior myocardial infarction (23 receiving heparin and 21 not receiving heparin) no further left ventricular thrombus developed. In 46 patients with anterior myocardial infarction, 21 additional thrombi developed (45.6%) within 4.3 +/- 3.0 days after the acute event. Thrombus developed in 8 (38%) of 21 patients receiving heparin, compared with 13 (52%) of 25 patients not receiving heparin. This difference in ventricular thrombosis was not statistically significant (chi-square with the Yates correction = 0.76; NS). No difference was found between the subgroups in terms of clinical variables, infarct size, hemodynamic impairment, intensity of the inflammatory process and quantitative two-dimensional echocardiographic and cineangiographic left ventricular function. It is concluded that early anticoagulation with heparin reduced by 27% the incidence of left ventricular thrombus formation in anterior acute transmural myocardial infarction, and this relative risk reduction was not statistically significant when compared with findings in the untreated group.

Dose-Response Relationship, Drug↗
PubMed1986

Disseminated intraperitoneal oxyuris granulomas.

The threadworm, enterobius (oxyuris) vermicularis, is an nematode which may inhabit the human terminal ileum, colon and appendix. Its presence in ectopic sites is uncommon. We describe a case of generalized intraperitoneal oxyuris granulomas detected as an incidental finding at laparotomy for tuboovarian abscess.

Abscess↗
PubMed1986

[Diagnosis of atrial septal defects by contrast echocardiography with sensitivity increased by coughing].

The aim of this study was to assess the sensitivity of contrast echocardiography in the diagnosis of permanent (atrial septal defects, ASD) and transient (patent foramen ovale, PFO) interatrial communications under basal conditions, after Valsalva manoeuvres and coughing. Sixty-four patients suspected of having defects of the interatrial septum were studied. The results of echocardiography were compared with those of cardiac catheterisation, the classical method of reference. The sensitivity of contrast echocardiography was significantly improved in the diagnosis of PFO by the cough test (100%) compared with contrast echocardiography during spontaneous respiration (55%). Similarly, the cough test increased the sensitivity of contrast echocardiography in the diagnosis of ASD (96% compared to 83%). The specificity was good in both cases, about 90%. The cough test was a better method (98%) than Valsalva manoeuvres (59%) for the potentiation of interatrial right-to-left shunts. The results of echocardiography and catheterisation explain the mechanism of the right-to-left shunt during spontaneous respiration, Valsalva manoeuvres and coughing. The passage of the microbubbles from the right to the left atrium occurs during early systole when the atrioventricular valves are closed. The right-to-left shunt is potentiated by provocative manoeuvres. The demonstration of a right-to-left shunt by contrast echocardiography therefore indicates the presence of an interatrial communication; our results show that this non-invasive technique is a reliable method of diagnosing ASD and PFO.

Adolescent↗
PubMed1986

[Two-dimensional echocardiography in a cardiac intensive care unit].

The increasing number of physicians competent to carry out emergency echocardiography, and the availability of high performance equipment, facilitated the development of this technique in the Coronary Care Unit (CCU). This paper reports our experience of 610 2D echocardiographic recordings performed on 319 patients admitted to the CCU. The quality of the recording was excellent or satisfactory in 67% of cases and mediocre in 30% of cases. In 11 patients (3%) the quality of the recording was too poor to obtain reliable data. In this group of patients, the apical 4-chamber and subcostal views seemed better than the apical 2-chamber and parasternal views. An echocardiographic diagnosis was made in 94% of cases. It contributed to the diagnostic process in 70% of cases. Of the patients studied, 54% were admitted for a recent myocardial infarction. Echocardiography was particularly useful in atypical forms or when the diagnosis was difficult. It was also helpful in detecting complications of recent myocardial infarction, the frequency of which was determined. With respect to other cardiovascular emergencies, echocardiography was determined. With respect to other cardiovascular emergencies, echocardiography was very useful in the diagnosis of dissection of the aorta, pericarditis and for assessing left ventricular function and the causal mechanism in cases of decompensated cardiac failure. The non invasive nature of the investigation allows repeated examination of the patient at the bedside and makes it a particularly valuable technique to monitor the evolution of acute cardiac conditions requiring admission to the Coronary Care Unit.

Aged↗
PubMed1985

Monitoring of postimplantation embryo viability following successful in vitro fertilization and embryo transfer by measurement of placental proteins.

Serum levels of pregnancy-associated plasma protein A (PAPP-A), human chorionic gonadotropin (hCG), and pregnancy-specific beta 1-glycoprotein (SP1) were measured in 21 women after successful in vitro fertilization and embryo transfer. Of the 21 pregnancies, 14, including 1 twin gestation, progressed successfully to term. The remaining seven, composed of tubal (n = 3), anembryonic (n = 1), and spontaneously aborted (n = 3) pregnancies, failed during the first half of pregnancy. Placental protein measurement was of no diagnostic value in the detection of anembryonic pregnancy. Similarly, measurement of hCG and SP1 could not readily distinguish tubal ectopic from normal intrauterine pregnancies. By contrast, the predictive value (38.9%) of a depressed PAPP-A level in conjunction with superior diagnostic sensitivity (70%) and relative risk factor (23.6) proved to be of greater diagnostic value in this potentially lethal condition. In the absence of ultrasonography, the biochemical diagnostic indices were comparable in the prediction of spontaneous abortion. However, in the presence of a live fetus, PAPP-A levels were consistently depressed (sensitivity, 91.7%) many weeks before pregnancy demise. The relative risk factor of depressed PAPP-A levels was 29 times greater than the risk associated with a depressed hCG level. These findings further demonstrate the potential diagnostic value of PAPP-A measurement for monitoring postimplantation embryo viability.

Abortion, Spontaneous↗
PubMed1985

Monitoring of postimplantation embryo viability by measurement of PAPP-A, SP1, and hCG.

After successful in vitro fertilization and embryo transfer, chorionic gonadotropin, pregnancy-specific beta 1-glycoprotein, and pregnancy-associated plasma protein-A were measured in serum samples collected serially from 21 patients. While 14 pregnancies, including one twin pregnancy, progressed successfully to term, the remaining seven pregnancies failed during the first half of gestation. This latter group consisted of three tubally implanted, one anembryonic, and three spontaneously aborted pregnancies. Circulating levels of hCG, SP1, and PAPP-A in the patient with an anembryonic pregnancy were within normal limits. Similarly, 90.5% of the serum samples obtained from women with tubal pregnancies showed hCG levels within normal limits. By contrast, only two of these samples had detectable PAPP-A, of which only one was within normal limits. Of the samples obtained from the patients who spontaneously aborted, including one patient with normal ultrasonic findings up to 48 hours prior to the event, 85.7% had PAPP-A concentration below the 10th percentile, whereas only 16.7% of these samples showed depressed hCG levels. These data suggest that PAPP-A measurement has great clinical potential in the management of compromised early pregnancies.

Abortion, Spontaneous↗