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Biomedical subjects

R Blais

Publications and source records attributed to R Blais.

At least 37 records · Page 2Linked to original sources
PubMed1989

Increased hematocrit with normal red blood cell mass in early borderline essential hypertension.

Hematocrit, red blood cell mass, plasma volume and plasma renin activity were evaluated in 33 (15 women) young patients with borderline hypertension and in 30 (15 women) age- and sex-matched normotensive control subjects. Mean hematocrit values were slightly but significantly higher (P less than 0.05) at this early stage of hypertension and it correlated with the elevation of arterial hypertension (r = 0.39, P less than 0.05). Red blood cell mass was normal indicating normal bone marrow production. Plasma volume was significantly contracted (p less than 0.05) and it can account in part for the increased hematocrit and plasma renin activity. These results indicate that the alterations in circulating fluid components and in hematocrit described in moderate to severe forms of hypertension are also present in early borderline hypertension.

Adult↗
PubMed1989

Morphologic prognostic factors of malignant mixed müllerian tumor of the uterus: a clinicopathologic study of 58 cases.

Sixty-one patients with malignant mixed müllerian tumor (MMMT) of the uterus were seen at L'Hôtel-Dieu de Québec between 1950 and 1986, and the histopathologic material was available for review in 58 cases. Of the morphologic parameters studied, the histologic grade of both epithelial and mesenchymal components correlated with the initial stage. Patients with stages I and II disease had a significantly better survival rate than those with stages III and IV (P less than 0.006). Twenty-five patients with a minimum follow-up of two years were initially stage I or II. All six patients of this subgroup with an epithelial component of serous carcinoma type were dead of their disease at 2 yr. Although not statistically significant, tumor necrosis, the mode of tumor invasive (pushing and infiltrative), and the ratio of epithelial to mesenchymal components tended to influence the outcome. The mitotic rate, the type of mesenchymal components, and vascular and myometrial invasion were of no prognostic significance. We conclude that the outcome of patients with uterine MMMT is mainly influenced by the initial stage and the type of epithelial component. The influence of tumor necrosis, the ratio of epithelial to mesenchymal component, and the mode of tumor invasion deserve further studies.

Adult↗
PubMed1984

Abnormal relation of extracellular fluid volume and exchangeable sodium with systemic arterial pressure in early borderline essential hypertension.

Interrelations between systemic arterial pressure, extracellular fluid (ECF) volume, exchangeable sodium (Na) and the renin-angiotensin-aldosterone system were studied in 38 young patients with borderline hypertension and in 37 age- and sex-matched control subjects. ECF volume and exchangeable Na were subnormal (not significant) in borderline hypertension. In normal subjects, volume data did not relate to arterial pressure; in contrast, negative correlations were observed between arterial pressure and ECF volume or exchangeable Na in patients with borderline hypertension (in hypertensive women, r greater than or equal to 0.7, p less than 0.01). Plasma renin activity was consistently elevated in borderline hypertension, mainly in the upright posture, and these values were inversely correlated with ECF volume and exchangeable Na. No correlation was observed between arterial pressure and plasma renin activity. These results show that slight elevation of arterial pressure in the early stage of hypertension induces a proportional decrease in ECF volume, suggesting that the phenomenon of pressure-natriuresis is operative in young borderline hypertensive persons. The renin-angiotensin system is activated in these patients, in part to preserve sodium homeostasis.

Adult↗
PubMed1983

Internal mammary lymphoscintigraphy in breast carcinoma--a surgeon's perspective.

Internal mammary lymphoscintigraphy (IML) should now be considered a standard staging procedure in the present state of the art of the management of the patient with breast carcinoma. It provides clues for assessing the extent of disease and helps one to select individualized therapy. The interpretation is reliable enough in expert hands, to rule out the necessity of internal mammary node histopathologic diagnosis. In view of the significance of nodal invasion in relation to distant spread of the disease, one would be entitled to use this test as an indication for complementary systemic therapy when positive. On the other hand, if systemic therapy is to be employed without selection according to the multitude of relevant criteria, there may be no need to carry out this staging procedure prior to a management decision. The authors have reviewed their experience with more than 1000 examinations and have shown some of the practical implications of IML as a staging procedure as well as a guide to therapy.

Breast Neoplasms↗
PubMed1981

Alteration of the volume-renin component in borderline essential hypertension.

Interrelations between blood pressure, circulatory volumes and the renin-angiotensin system were studied in 15 normal subjects and in 25 young patients with borderline hypertension after equilibration on controlled sodium intake. Total blood and plasma volumes were consistently lower and plasma renin activity higher in borderline hypertensive as compared to normotensive controls. The decreased volumes were inversely correlated with blood pressure and plasma renin activity, but no correlation was found between blood pressure and plasma renin activity or the product of circulating renin and volumes. The fact that blood pressure and plasma renin activity were independently correlated to circulating volumes but did not correlate between themselves would suggest a common causal factor for the three observed phenomena: elevated renin, decreased volume and borderline hypertension; these anomalies of the volume-renin axis might be mediated through the well documented hyperresponsiveness of the sympathetic nervous system in these patients.

Adolescent↗
PubMed1981

[Breast neoplasms: a 1980 dilemma].

For many reasons, breast cancer is still the most controversial topic in oncology. Questions raised many years ago in relation to diagnosis and treatment have not yet been answered. Clinical classification, such as the TNM system, is open to many pitfalls and the degree of error in axillary staging is still high, even in expert hands. The situation with regard to management is similar. The types of treatment are numerous and controversial, so that interpretations of results is unreliable. The fundamental questions will be answered only by clinical trials.

Breast Neoplasms↗
PubMedDate not supplied

Coping with regional variations: the case of surgery in Denmark.

This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.

Cholecystectomy↗
PubMedDate not supplied

What accounts for physician opinions about midwifery in Canada?

The objective of this study was to identify the characteristics of physicians practicing obstetrics in the province of Quebec, Canada and relate these to their opinions about midwifery practice. A self-administered questionnaire was sent to a systematic random sample of 844 physicians; 597 physicians answered (response rate = 71%). Results show that physicians who were more open to midwives had a more client-centered approach to maternity care. They had attended premed school outside Canada but received their specialty training in Canada. They also had often collaborated with midwives since they had begun practicing. Physicians who were more open to midwives were less demanding in terms of level of midwife training. They agreed that midwives should be self-regulating. It is concluded that greater knowledge of midwives' practice, gained through collaboration in the workplace and interdisciplinary education, could help physicians to better understand the significant contributions that midwives can make to the health care system.

Adult↗
PubMedDate not supplied

Comparing women's assessment of midwifery and medical care in Québec, Canada.

In 1990, the province of Québec, Canada, adopted a law that authorized the evaluation of the practice of midwifery through pilot projects before its legalization. A key objective of this evaluation, as defined by the law, was the documentation of women's assessment of maternity care, especially with regard to humanization and continuity of care. Two to 3 months after birth, 933 midwifery clients and 1,000 physicians' clients, matched on several characteristics, responded to a mailed questionnaire (response rates were 93% and 76%, respectively). Results showed that women from both groups were generally satisfied with the care they received, although women who received midwifery care were assessed as more positive on every issue surveyed. Objective measures supported impressions that were also confirmed through qualitative data analysis: midwifery clients had a greater number of and longer prenatal visits, their care was perceived to be more personalized, and a greater number of midwives' clients breastfed their infants. However, the interpretation of these results must take into account that the two groups had different personal expectations and values with regard to health and health care. These findings are enlightening in evaluating women's needs, expectations, and satisfaction with health care services and should be included in future development of maternity care, including idwifery services, in Québec and other locations.

Cohort Studies↗
PubMedDate not supplied

Evaluation of the midwifery pilot projects in Quebec: an overview. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birth centres outside hospitals, started operating in 1994. The objectives of the evaluation were 1) to compare midwives' services to current physician services with regard to maternal and neonatal mortality and morbidity, the use of obstetrical intervention, individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the health care system. A mixed evaluative design was used: a multiple case study with each pilot project representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were matched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were favourable to midwifery practice, while some were favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.

Birthing Centers↗