PubMed Health⌕ Search

Biomedical subjects

L Gerard

Publications and source records attributed to L Gerard.

13 recordsLinked to original sources
PubMed2000

Intensive chemotherapy (LNHIV-91 regimen) and G-CSF for HIV associated non-Hodgkin's lymphoma.

The purpose of the study was to evaluate the safety and long-term efficacy of an intensive chemotherapy regimen associated with G-CSF in HIV-associated non-Hodgkin's lymphoma (NHL). Fifty two consecutive patients with HIV infection, aggressive NHL and CD4+ cells > or = 100 x 10(6)/l were included. The median CD4 cell count was 276 x 10(6)/l. Nineteen tumors were of the Burkitt's type, 23 were large cells, 7 immunoblastic, and 3 anaplastic. Twenty-five patients had stage IV disease (bone marrow involvement in 7, and central nervous system in 9). Three cycles of ACVBP (doxorubicine, cyclophosphamide, vindesine, bleomycin, prednisolone) were given. A fourth cycle was delivered to patients in partial remission or with initial bulky disease. The induction was followed by three cycles of CVM (cyclophosphamide, etoposide, methotrexate). G-CSF 5 microg/kg was used at each cycle. Results showed that 37 patients (71%) achieved a complete remission. With a median follow-up of 74 months, 8 of them have relapsed. The median survival was 15 months and 34 patients have died (21 with NHL). The 4-year estimate survival was 33.9% (95% CI, 19.8%-47.4%). The Relative Dose-Intensity of the chemotherapy was 85% for doxorubicine and 87% for cyclophosphamide. In a multivariate analysis, homosexual men and patients with ECOG < 2 had a lower risk for death: RR = 0.32 (95% CI, 0.15-0.65) and RR = 0.36 (95% CI, 0.18-0.74), respectively. Achievement of complete remission was strongly associated with survival. In conclusion, it seems that in HIV-infected patients with NHL and a CD4 cell count above 100 x 10(6)/l, high complete remission rate and prolonged survival can be achieved with the intensive LNHIV-91 regimen.

Actuarial Analysis↗
PubMed1997

Group learning behavior modification and exercise for women with urinary incontinence.

INTRODUCTION: Can group learning be effective in reducing symptoms of urinary incontinence? Would women with stress incontinence respond more favorably than women with urge incontinence? Would age make a difference? Would women with various ethnic backgrounds attend the sessions? METHODS: Eighty-five women between the ages of 40 and 78 years attended a 2-hour class offered at two sites. The class covered anatomy and physiology, causes of incontinence, treatment/management alternative (including behavioral methods and dietary changes), and specific exercises to identify pelvic muscles. Women filled out a questionnaire before the training and 1 month after the training. Telephone interviews were conducted at 3 and 6 months after the training. RESULTS: Thirty-eight women (45%) completed the posttraining questionnaire. Some were lost to follow-up at 3 and 6 months. There was a significant reduction in the number of absorbency products used, especially during the day. Women with stress incontinence had a significant decrease in urine loss. Women with urge incontinence showed a significant decrease in urine loss, not to the same extent, but many did not have to hurry to the toilet. Younger women (59 years) reported reduced wetness at 1 and 3 months. Older women improved at 1 month, not at 3 months, and saw a trend toward improvement again at 6 months. Eighty-four percent of those attending the class were white. Others were Hispanic, Native American, Asian, and black. DISCUSSIONS: Although limitations to the study were identified, group training was seen as an effective means to educate women about incontinence management and to have them take an active role. Several recommendations followed the study: to increase the number of classes with an optional one-on-one follow-up appointment, to use biofeedback equipment for those patients who have difficulty identifying appropriate muscle groups, to develop an education program focusing on prevention of incontinence, and to develop a rehabilitation program for those patients who require surgery.

Adult↗
PubMed1996

The use of auxiliary events to improve the analysis of survival for HIV-infected patients: application to the French Prospective Multicenter Cohort (SEROCO).

SUMMARY: A multicenter prospective cohort study, including 512 patients for whom date of HIV infection was known, showed that the use of an appropriate auxiliary event can improve the analysis of survival data and lead to an earlier detection of risk factors for HIV patients. Age at seroconversion and primary symptomatic infection were used as risk factors. Two age groups were defined as age at seroconversion >30 years (n = 203) and < or = 30 years (n = 309). Patients with primary symptomatic infection PSI (n = 215) were compared with patients without any clinical manifestation during primary infection (n = 297). Death was considered as the endpoint of primary interest and occurred in 76 patients in the study. Classical non-parametric methods (Kaplan-Meier estimate and long-rank test) and parametric regression model (Weibull model) were used for a standard analysis of survival data. A parametric approach using auxiliary information was used to estimate the survival function and to test the effect of age at seroconversion and PSI. We also applied a recently proposed distribution-free method to produce a non-parametric estimate of the survival function and to test age at seroconversion and PSI with respect to survival estimates. Both methods are compared for two distinct auxiliary events (Karnofsky score below 75 and a first drop of CD4 lymphocyte counts below 200 cells/MM3). The use of CD4 lymphocyte counts below 200 cells/MM3 as an auxiliary event improved the analysis of survival data available in December 1994. For both methods incorporating CD4 counts below 200 cells/mm3 in addition to survival data, the effect of age at seroconversion on survival was significant in April 1992 whereas it was not significant with standard methods. For PSI exposure group, results shown in this work do not indicate any improvement in using auxiliary information. Conditions for using an appropriate auxiliary event as well as advantages and shortcomings of both methods are discussed. Methods used in this work, with appropriate auxiliary information, are promising either through a reduction in the time to follow-up to detect risk factors for cohort studies or the time needed for drug development in clinical trials.

Adult↗
PubMed1996

Life expectancy in hospitalized patients with AIDS: prognostic factors on admission.

In the course of the inevitable hospitalizations of AIDS patients, many difficult questions concerning curative and palliative approaches to care have to be answered. In order to guide these strategies, we conducted a prospective study to identify those variables which can be easily quantified on admission which might be predictive of patient outcomes. Between 1 June 1990 and 25 April 1991, 140 consecutive hospitalizations of 83 AIDS patients were recorded. Demographic, clinical, and biological data were collected within 48 hours of admission. Probable (p <0.10) or definite (p <0.05) factors contributing to a higher mortality included type of opportunistic infections, serum albumin level, total lymphocyte count, weight, CD4 cell count, and neurological manifestations. In the multivariate proportional hazards model, two factors were significantly and independently predictive of lower survival: body weight less than 90% of ideal body weight and neurologic manifestations. The probability of survival was significantly affected by the number of predictive factors present on admission, and patients were significantly more likely to die when these latter two factors were present concomitantly. These factors might be useful to define the optimal mode of care for hospitalized AIDS patients, considering both patients' wishes and an objective assessment of the prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Age deficits in retrieval: the fan effect.

The fan effect paradigm was used to investigate age-related changes in the effects of different levels of interference on retrieval. Younger and older adults learned a list of person-activity "facts" in which each person and each activity occurred in 1, 2, or 3 different facts (fan level). A subsequent speeded recognition test required the participants to distinguish the learned facts from foils constructed by recombining the same concepts. On this recognition test, both groups showed an increase in response time and errors as the fan level of the probe increased. For older adults these effects were larger, however, indicating an age-related increase in interference effects in retrieval. These results are consistent with a theoretical framework (Hasher & Zacks, 1988) which proposes an age-related decline in the ability to screen irrelevant information out of working memory. The findings also have implications for age differences in discourse processing and other cognitive tasks that crucially depend on the timely and accurate retrieval of stored information.

Adult↗
PubMed1984

Women and the economics of aging.

Economic and policy arrangements assure the maintenance of gender-based inequities throughout the life cycle. To understand the economics of aging requires consideration of the problems of women of all ages, commencing early in the adult life cycle when the different social roles and opportunity structures available to men and women take effect. Because the economic inequities suffered by women in old age derive principally from inequities suffered earlier as wives and workers, public policy focused on redressing income in old age does nothing to alter the structural basis of inequity. This article examines factors underlying the economics of aging for older women in the United States; delineates the relation between women's roles, social policy, and income; and raises salient policy questions for younger and older women.

Aged↗
PubMed1984

[Normovolemic hemodilution without previous blood collection].

Iso-volaemie hemodilution without preoperative blood letting was produced inpatients undergoing orthopedic surgery. Bleeding was compensated by a modified fluid gelatin-electrolyte solution until a predetermined volume was reached. Further blood-loss was compensated by blood transfusion. Clinical condition, hematocrit, coagulation and renal function were observed in the per- and post-operative period.

Adolescent↗
PubMed1976

Hypothesis of an ovular regulation of pregnancy weight-gain.

A retrospective study of 127 twin pregnancies has been carried out, considering the relation between maternal weight-gain and zygosity of the ovum. At 28 weeks of gestation, the maternal weight-gain distribution goes on according to a bimodal curve, the analysis of which shows that each pike corresponds to one twin-pregnancy variety. Whatever the considered term might be (28-32-36 weeks), the maternal weight-gain is higher in DZ than in MZ pregnancies, and it should be pointed out that toxemic pregnancies, in each group, have nothing to do with this difference. This maternal weight-gain difference may reflect the known quality difference between MZ and DZ ova. The data lead to set up the more general hypothesis of an ovular regulation factor of the maternal weight-gain, in addition to classic data such as the own fetal weight, its annexes, and maternal diet.

Body Weight↗
PubMedDate not supplied

[Splenic artero-venous fistula and portal hypertension. A case report with review of the literature].

Splenic artero-venous fistula (SAVF) is a rare but potentially curable cause of pre-hepatic portal hypertension. About 100 cases have been reported in the world medical literature. The Authors report a case of 46-year-old man with a splenic artery aneurysm and a large SAVF treated by surgical resection of splenic vessels and splenectomy. The literature about SAVF is reviewed to recognize etiology, anatomical location, main symptoms at presentation, diagnostic findings and management of this rare syndrome.

Arteriovenous Fistula↗