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Biomedical subjects

R Blanchard

Publications and source records attributed to R Blanchard.

At least 19 recordsLinked to original sources
PubMed1995

Regulation of the ferredoxin component of renal hydroxylases at transcriptional and postranslational levels and of the protein inhibitor of cyclic AMP-dependent kinase.

We have studied two proteins potentially involved in the regulation of the 25-OH-D-1-hydroxylase, which is located in the renal mitochondria and which is responsible for the production of the steroid hormone 1,25(OH)2D3. The endogenous inhibitor of cyclic AMP-dependent protein kinase, PKI, is down regulated by 1,25(OH)2D3. Having cloned and sequenced PKI cDNA, we studied its message levels and found them to be regulated by 1,25(OH)2D3 tissue specifically in the kidney and in kidney cell culture. In other experiments we over expressed the ferredoxin component of the 1-hydroxylase and found it to be physically and chemically indistinguishable from those of classic steroidogenic tissues. The mRNA encoding the ferredoxin component is up-regulated by chronic vitamin D deficiency, which at the same time leads to sustained elevation in 1-hydroxylase activity; no short term effect of 1,25(OH)2D3 on ferredoxin mRNA in kidney cell culture could be demonstrated. Finally, there was an association between decreased phosphorylation of ferredoxin and decreased 1-hydroxylase activity brought about by treatment of cultured kidney cells with TPA. Control of the renal signaling events involved in the production of 1,25(OH)2D3 remains a fruitful area of investigation in the field of the metabolism and actions of vitamin D and its metabolites.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗
PubMed1994

A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics.

Nonhomosexual male gender dysphorics often make their first requests for clinical assessment when they are in or approaching middle age. This study investigated how well patients' explanations for the timing of these requests fit the objective data. Subjects were 194 outpatients presenting for the first time at a gender identity clinic. Their common explanations for the timing of their requests were incorporated into a formal path model, which was tested using Bentler's structural equations program. The model provided an acceptable fit to the data. The more times a patient has been married and the more children he has fathered, the older he is likely to be when first presenting for clinical attention. This outcome is consistent with the claims of patients that they would have come to a gender clinic sooner if they had not been restrained by commitments to wives and children.

Adolescent↗
PubMed1994

Reanalysis of Bell, Weinberg, and Hammersmith's data on birth order, sibling sex ratio, and parental age in homosexual men.

The authors compared parental age, birth order, and sex ratio of siblings for 575 homosexual men and 284 heterosexual men, matched on age and education. They were originally part of Bell, Weinberg, and Hammersmith's large-scale study of male and female homosexuality. The results confirmed the previous findings that homosexual men have older fathers and later births than do heterosexual men but not the finding that homosexual men have larger proportions of brothers. The collective findings suggest that birth order is perhaps the single most reliable demographic difference between homosexual and heterosexual men.

Adult↗
PubMed1993

Treatment of advanced non-small cell lung cancer with very high-dose cisplatin combined with etoposide and mitomycin C.

BACKGROUND: Treatment options for advanced non-small-cell lung cancer are inadequate. There remains a critical need for more effective systemic therapies. METHODS: Forty-one patients with advanced non-small-cell lung cancer were treated on a 28-day cycle with a very high-dose, cisplatin-based three-drug regimen. A treatment cycle consisted of an intravenous (IV) injection of cisplatin 100 mg/m2 on days 1 and 8; etoposide 60 mg/m2 IV over 30 minutes on days 1, 2, 8, and 9 (cycles 1 and 3 only); and mitomycin C 8 mg/m2 IV bolus on day 1 (cycles 2 and 4 only) (PEM regimen). RESULTS: The median dose intensity of cisplatin delivered was 49 mg/m2/wk, or 98% of the planned dose. One patient achieved a complete response and 16 patients a partial response or regression, yielding an overall objective response rate of 41%. The median duration of response was 21 weeks. Median survival of all patients was 38 weeks. Neurologic toxicity was dose limiting. The frequency of peripheral neuropathy and ototoxicity was directly related to cumulative cisplatin dose. In five patients, a progressive peripheral neuropathy developed after discontinuation of cisplatin. Hematologic toxicity also was significant. CONCLUSIONS: This very high-dose, cisplatin-based chemotherapy regimen has appreciable activity in advanced non-small-cell lung cancer. In comparison with previous reports on the use of very high-dose cisplatin alone, however, this combination appears at best to be only marginally more active, to confer no additional survival advantage, and to be considerably more toxic.

Adult↗
PubMed1993

Partial versus complete autogynephilia and gender dysphoria.

Autogynephilia (sexual arousal in men produced by the thought or image of themselves as women) is often associated with gender dysphoria (the desire to belong to the opposite sex). Previous research has shown that autogynephiles who are principally aroused by images of themselves as nude women are more gender dysphoric than those principally aroused by images of themselves as partially or fully dressed women. This study tested the hypothesis that the feature of the nude self-image most responsible for its correlation with gender dysphoria is the imagined vulva. The subjects were 220 nonhomosexual male outpatients who reported sexual arousal while imagining themselves with one or more features of the female anatomy. Autogynephilia and gender dysphoria were assessed with questionnaires. The findings confirmed that men who are sexually aroused at the thought of having a vulva are more likely to want to be women.

Adolescent↗
PubMed1993

Men with sexual interest in transvestites, transsexuals, and she-males.

This study was a preliminary exploration of gynandromorphophilia, that is, sexual interest in cross-dressed or anatomically feminized men. Subjects were male subscribers to a voice mail system devoted to personal advertisements for sexual or romantic partners. These comprised 51 gynandromorphophiles who sought cross-dressers, transvestites, transsexuals, or she-males for such relationships, 37 gynandromorphophilic cross-dressers who identified themselves as cross-dressers and sought similar men, and 31 residual cross-dressers who sought masculine or unspecified male partners. Analysis of advertisement content suggested that gynandromorphophilia constitutes a distinct erotic interest.

Adult↗
PubMed1992

The cellular and molecular regulation of 1,25(OH)2D3 production.

The synthesis of 1,25(OH)2D3 is a critical control point in the regulation of calcium metabolism, and possibly in the growth and differentiation of a number of cell types. This paper reviews our current understanding of the regulation of this process at the cellular and molecular levels, with the emphasis on the mechanisms of feedback control 1,25(OH)2D3 itself, control of parathyroid hormone, the roles of cyclic AMP dependent protein kinase and protein kinase C, and the interaction between the various intracellular regulators of 1,25(OH)2D3 production.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗
PubMed1992

Nonmonotonic relation of autogynephilia and heterosexual attraction.

In this study I investigated the relation between normal heterosexual attraction and autogynephilia (a man's propensity to be sexually aroused by the thought or image of himself as a woman). The subjects were 427 adult male outpatients who reported histories of dressing in women's garments, of feeling like women, or both. The data were questionnaire measures of autogynephilia, heterosexual interest, and other psychosexual variables. As predicted, the highest levels of autogynephilia were observed at intermediate rather than high levels of heterosexual interest; that is, the function relating these variables took the form of an inverted U. This finding supports the hypothesis that autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it.

Adolescent↗
PubMed1992

Sibship size, sibling sex ratio, birth order, and parental age in homosexual and nonhomosexual gender dysphorics.

This study investigated whether demographic variables previously reported to differentiate ordinary homosexuals from heterosexuals also differentiate gender-dysphoric homosexuals from gender-dysphoric persons with other sexual orientations. Subjects were outpatients aged 16 and older who were referred by physicians to a specialty clinic for the assessment of gender identity disorders. The subjects were divided into three groups: 204 homosexual women, 193 homosexual men, and 273 nonhomosexual men; the last category included men sexually attracted to females, to both sexes, and to neither sex. Demographic data on patients' families of origin were extracted from their clinical charts and from structured interview protocols. A multiple-range test at the .05 level showed that the homosexual men had significantly more siblings than the homosexual women, who, in turn, had significantly more siblings than the nonhomosexual men. The sibling sex ratio of the homosexual men, 131 brothers per 100 sisters, was significantly higher than the sex ratio of live births for the population as a whole (106 men per 100 women; p = .01); the sibling sex ratios of the other groups did not differ from the expected value. The homosexual men had a significantly later birth order than the nonhomosexual men (p = .004); the homosexual women, who fell in between, did not differ significantly from either male group. There were no between-groups differences in paternal or maternal age at the time of the subject's birth. The results concerning sibling sex ratio and birth order are consistent with previous findings for homosexual men.

Birth Order↗
PubMed1992

Proportion of unmarried siblings of homosexual and non homosexual gender-dysphoric patients.

Among the siblings of homosexuals, a lack of sexual and romantic interest in women may be independent of erotic feelings for men. This study investigated the sexual histories of siblings of gender-dysphoric outpatients. The patients were classified into three groups: non homosexual males, homosexual males and homosexual females. Their siblings consisted of 301 brothers and 284 sisters over the age of 25. Logistic regression showed that the brothers of the homosexual male patients were significantly less likely to have been married, either legally or common-law, than the brothers of the other gender-dysphoric groups, even with age and relative birth order taken into account. This finding suggests that the low propensity for long term heterosexual relationships seen in homosexual male gender-dysphoric patients also tends to appear in their brothers.

Adult↗
PubMed1991

Interim report of the DSM-IV Subcommittee on Gender Identity Disorders.

This article summarizes the discussions and recommendations of the DSM-IV Subcommittee on Gender Identity Disorders, a subcommittee of the Child Psychiatry Work Group, regarding diagnostic issues. The issues reviewed include placement in the nomenclature, the concept of a spectrum of gender dysphoria rather than discrete levels of symptomatology, criticisms of current diagnostic criteria, subtyping by sexual orientation, and proposed changes in diagnostic criteria for the current DSM-III-R diagnoses of Gender Identity Disorder of Childhood, Transsexualism, and Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type.

Adolescent↗
PubMed1991

Clinical observations and systematic studies of autogynephilia.

The term autogynephilia denotes a male's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman. This term subsumes transvestism as well as erotic ideas or situations in which women's garments per se play a small role or none at all. This review article presents clinical examples of the lesser known types of autogynephilia (i.e., those in which the element of cross-dressing is secondary or entirely absent), sketches earlier attempts to label and conceptualize these phenomena, summarizes recent quantitative studies exploring the relationships between autogynephilia and other psychosexual variables (e.g., heterosexual attraction), and speculates on the etiology of autogynephilia and its relationship to transsexualism. It is concluded that the concept of autogynephilia is needed to fill a gap in our current battery of concepts and categories for thinking about gender identity disorders.

Adult↗
PubMed1991

Group therapy for gender-dysphoric heterosexual men.

The treatment and clinical management of gender dysphoric heterosexual men often poses a challenge to the clinician. Gender dysphoric patients pursuing various lifestyle options may seek psychotherapy to deal with some of their conflicts. This paper describes one form of counseling--group therapy--which has been helpful to gender dysphoric heterosexual men and outlines the group psychotherapy program at the Gender Clinic of the Clarke Institute of Psychiatry.

Adult↗
PubMed1991

Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia.

Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

Accidents↗
PubMed1990

Knowledge of hemodialysis and CAPD patients about their prescribed medicines.

A questionnaire was designed to determine and compare the extent of knowledge of 40 continuous ambulatory peritoneal dialysis (CAPD) and 40 hemodialysis (HD) patients about their medicines. It was administered orally to outpatients attending a clinic by an investigator unknown to the patients. Data were collected pertaining to the following target drugs: calcium supplements, phosphate binders, vitamins B and C and folic acid. HD and CAPD groups were closely matched for age and sex. Sixty percent of CAPD and 49% of HD patients were taking four or more medications. The dose of folic acid was accurately recalled by 91% and 71% of CAPD and HD patients. Indications for calcium supplements and phosphate binders were known by only 8% and 30% of CAPD patients compared to 72% and 73% of HD patients. More HD patients knew the indications for all target drugs (p less than 0.01). More CAPD than HD patients knew the expected duration of therapy (p less than 0.01). There was a trend between decreased knowledge of whether the medication was working with increasing age of CAPD patients. Most drug information was supplied by physicians, but many CAPD patients (21%) obtained information from lay sources. When given the opportunity to ask questions about their medicines, only 56% CAPD and 46% HD patients did so. The knowledge of CAPD and HD patients studied was grossly deficient in terms of indications, effectiveness, duration and action to be taken if doses were missed.

Adult↗
PubMed1989

The classification and labeling of nonhomosexual gender dysphorias.

This report suggests systematic strategies for the descriptive classification of nonhomosexual gender identity disorders, based on clinical observations and research findings. The classification of biological males is considered first. A review of cross-gender taxonomies shows that previous observers have identified and labeled a homosexual type far more consistently than any other category of male gender dysphoric. It is suggested that the apparent difficulty in differentiating reliably among the nonhomosexual types results from the sharing of many overlapping characteristics by the various groups. This is supported by a review of informal, mostly clinical, observations and by the findings of three studies designed to test the hypothesis that the nonhomosexual gender dysphorias, together with transvestism, constitute a family of related disorders in men. It is concluded that the main varieties of nonhomosexual gender dysphoria are more similar to each other than any of them is to the homosexual type. Two recommendations, based on the foregoing review, are offered for the classification of male gender dysphorics in research studies. When the number of subjects is small, they may be classified simply as homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases may be classified as heterosexual, bisexual, or analloerotic (unattracted to male or female partners, but not necessarily devoid of sexual drive or activities).

Female↗
PubMed1989

Phallometric diagnosis of pedophilia.

We investigated the sensitivity of our phallometric test for pedophilia (and hebephilia). An initial sample of subjects included 47 men accused of sexual offenses against minors and 26 control subjects-men accused of offenses against adult women (exhibitionism, rape, or sexually sadistic activity). A second sample included 107 offenders against minors and 30 control subjects. In both samples, the offenders against minors were further classified according to the targets of their sexual offenses (girls, boys, or both) and according to the extent to which they admitted an erotic preference for the immature physique. Computerized diagnostic rules were developed with the first sample and cross-validated with the second. The sensitivity of the test in detecting pedophilia or hebephilia in complete nonadmitters is probably greater than or equal to 55% but is certainly less than 100%. Its specificity appears to be over 95%.

Adolescent↗