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Dermer E, Spahr A, Tran LT, Mirchi A, Pelletier F, Guerrero K, Ahmed S, Brais B, Braverman N, Buhas D, Chandratre S, Chenier S, Chrestian N, Desmeules M, Dilenge ME, Laflamme J, Larbrisseau A, Legault G, Lim KY, Maftei C, Major P, Malvey-Dorn E, Marois P, Mitchell J, Nadeau A, Osterman B, Paradis I, Pohl D, Reggin J, Riou E, Roedde G, Rossignol E, Sébire G, Shevell M, Srour M, Sylvain M, Tarnopolsky M, Venkateswaran S, Sullivan M, Bernard G. Stress in Parents of Children With Genetically Determined Leukoencephalopathies: A Pilot Study. J Child Neurol 2020; 35:901-907. [PMID: 32720856 DOI: 10.1177/0883073820938645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genetically determined leukoencephalopathies comprise a group of rare inherited white matter disorders. The majority are progressive diseases resulting in early death. We performed a cross-sectional pilot study including 55 parents from 36 families to assess the level of stress experienced by parents of patients with genetically determined leukoencephalopathies, aged 1 month to 12 years. Thirty-four mothers and 21 fathers completed the Parenting Stress Index-4th Edition. One demographic questionnaire was completed per family. Detailed clinical data was gathered on all patients. Statistical analysis was performed with total stress percentile score as the primary outcome. Mothers and fathers had significantly higher stress levels compared with the normative sample; 20% of parents had high levels of stress whereas 11% had clinically significant levels of stress. Mothers and fathers had comparable total stress percentile scores. We identified pediatric behavioral difficulties and gross motor function to be factors influencing stress in mothers. Our study is the first to examine parental stress in this population and highlights the need for parental support early in the disease course. In this pilot study, we demonstrated that using the Parenting Stress Index-4th Edition to assess stress levels in parents of patients with genetically determined leukoencephalopathies is feasible, leads to valuable and actionable results, and should be used in larger, prospective studies.
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Affiliation(s)
- E Dermer
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada.,E. Dermer and A. Spahr are co-first authors of this article
| | - A Spahr
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada.,E. Dermer and A. Spahr are co-first authors of this article
| | - L T Tran
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - A Mirchi
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - F Pelletier
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - K Guerrero
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - S Ahmed
- 27364North Bay Regional Health Centre, North Bay, Ontario, Canada
| | - B Brais
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada
| | - N Braverman
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - D Buhas
- Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada
| | - S Chandratre
- Department of Pediatric Neurology, 6397Oxford University Hospitals, Oxford, United Kingdom
| | - S Chenier
- Department of Medical Genetics, 7321University of Sherbrooke, Sherbrooke, Québec, Canada
| | - N Chrestian
- Division of Pediatric Neurology, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada.,Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - M Desmeules
- Department of Pediatrics, Saguenay, Chicoutimi, Québec, Canada
| | - M E Dilenge
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada
| | - J Laflamme
- Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - A Larbrisseau
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada.,Department of Neurology, CHU Saint-Justine, Montréal, Québec, Canada
| | - G Legault
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada
| | - K Y Lim
- Department of Pediatric Neurology, Providence Pediatric Neurology-St. Vincent, Portland, OR, USA
| | - C Maftei
- Department of Pediatrics, Division of Medical Genetics, CHU Saint-Justine, Montreal University, Montréal, Québec, Canada
| | - P Major
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada
| | - E Malvey-Dorn
- Department of Pediatrics, All About Children Pediatrics Eden Prairie, St. Louis Park, MN, USA
| | - P Marois
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada
| | - J Mitchell
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - A Nadeau
- Department of Pediatric Neurology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - B Osterman
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada.,Department of Neurology, CHU Saint-Justine, Montréal, Québec, Canada
| | - I Paradis
- CIUSSS de l'Est-de-l'Île-de-Montréal, CLSC de Rivière-des-Prairies, Montréal, Québec, Canada
| | - D Pohl
- Division of Neurology, 274065Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - J Reggin
- Department of Pediatric Neurology, Providence Child Neurology, Spokane, Washington, United States
| | - E Riou
- Department of Pediatric Neurology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - G Roedde
- Latchford Medical Centre, Latchford, Ontario, Canada
| | - E Rossignol
- Brain and Child Development, CHU Saint-Justine Research Center, Montréal, Québec, Canada
| | - G Sébire
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Shevell
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Srour
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Sylvain
- Division of Pediatric Neurology, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada.,Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - M Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Venkateswaran
- Department of Pediatrics, CHEO Research Institute, Ottawa, Ontario, Canada
| | - M Sullivan
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - G Bernard
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
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Prince P, Boulay ME, Pagé N, Desmeules M, Boulet LP. Induced sputum markers of fibrosis and decline in pulmonary function in asbestosis and silicosis: a pilot study. Int J Tuberc Lung Dis 2008; 12:813-819. [PMID: 18544209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To evaluate the usefulness of fibrogenic cytokines and mediators in the analysis of induced sputum and determine if their levels correlated with previous decline in lung function in asbestosis and silicosis. DESIGN In a pilot study for the evaluation of 19 workers with asbestosis and 15 with silicosis, all workers had chart reviews and records of previous lung function tests. Fourteen healthy control subjects were also included in the study. All subjects attended the laboratory for a clinical evaluation, pulmonary function tests and induced sputum sampling. Differential cell counts were performed and the following mediators and cytokines were measured: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), fibronectin, interleukin 1 beta (IL-1beta), IL-6, IL-8, IL-12, transforming growth factor beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha). RESULTS Levels of IL-1beta were higher in the sputum of subjects with asbestosis and silicosis than in controls. Eosinophils, neutrophils and IL-1beta levels were significantly correlated with the rate of decline in pulmonary function. CONCLUSION The induced sputum levels of certain inflammatory cells and IL-1beta correlate with the decline in pulmonary function associated with asbestosis and silicosis. It remains to be established if these markers can help predict the clinical outcome of workers exposed to these mineral particles or fibers in a prospective study.
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Affiliation(s)
- P Prince
- Centre de Recherche de l'Hôpital Laval, Institut de Cardiologie et de Pneumologie de l'Université Laval, Québec, Canada
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Pan SY, Desmeules M, Jiang X. A Case-Control Study of Physical Activity, Obesity and Energy intake and the Risk of Kidney Cancer. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s111-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To examine national trends in mortality rates for injuries among Canadian children younger than 15 years in 1979-2002. METHODS Data on injury deaths were obtained from the Canadian Vital Statistics system at Statistics Canada. Injuries were classified using the codes for external cause of injury and poisoning (E-codes) by intent and by mechanism. Mortality rates were age adjusted to the 1990 world standard population. Negative binomial regression was used to estimate the secular trends. RESULTS Annual mortality rates for total and unintentional injuries declined substantially (from 23.8 and 21.7 in 1979 to 7.2 and 5.8 in 2002, respectively), whereas suicide deaths among children aged 10-14 showed an increasing trend. All Canadian provinces and territories showed a decreasing trend in mortality rates of total injuries. Motor vehicle related injuries were the most common cause of injury deaths (accounted for an average of 36.4% of total injury deaths), followed by suffocation (14.3%), drowning (13.5%), and burning (11.1%); however, suffocation was the leading cause for infants. The number of potential years of life lost due to injury before age 75 decreased from 89 343 in 1979 to 27 948 in 2002 for children aged 0-14 years. CONCLUSIONS During the period 1979-2002, there were dramatic decreases in childhood mortality for total injuries and unintentional injuries as well as various degrees of reduction for all causes of injury except suffocation in children aged 10-14 years and drowning in infants. The reason for the reduction in injury mortality might be multifactoral.
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Affiliation(s)
- S Y Pan
- Evidence and Risk Assessment Division, Centre of Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
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Heng D, Pong RW, Pitblado JR, Lagacé C, Desmeules M. Sources of data for rural health research: development of an inventory of Canadian databases. J Agric Saf Health 2005; 11:219-27. [PMID: 15931948 DOI: 10.13031/2013.18189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Secondary data sources can often be used to help address questions about the health status, health behavior, health resources allocation, and utilization of health services of rural Canadians. But the task of deciding which Canadian databases are amenable to rural health research remains a challenge. As part of a larger research project titled "Canada's Rural Communities: Understanding Rural Health and Its Determinants," an inventory of 51 Canadian databases that have the potential of being used for rural health research was compiled, and it continues to be maintained and updated. The websites maintained by two of Canada's leading statistical data centers were systematically searched, along with other published articles and national reports, to produce this inventory. The criteria used to determine which data sources to include in this inventory are: (1) databases containing data at the national level that can be accessed by researchers, (2) databases containing data that are relevant to a variety of rural health issues, and (3) databases containing data that could be partitioned into rural and non-rural geographies. Detailed information is available by searching the inventory of national rural health research-related databases through the internet (www.cranhr.ca) or by contacting the lead author of this article. This article examines some of the issues in developing this resource and demonstrates the usefulness of its contents to Canadian and other rural health researchers.
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Affiliation(s)
- D Heng
- Centre for Rural and Northern Health Research, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, Canada P3E 2C6.
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Lagacé C, Desmeules M, Wang F, Heng D, Pong R, Pitblado JR. 529: Chronic Diseases, Risk Factors, and Health Behaviours in Canadians: A Rural/Urban Comparison. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Lagacé
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - M Desmeules
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - F Wang
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - D Heng
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - R Pong
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - J R Pitblado
- Public Health Agency of Canada, Ottawa, ONT Canada
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Maltais F, Simon M, Jobin J, Desmeules M, Sullivan MJ, Bélanger M, Leblanc P. Effects of oxygen on lower limb blood flow and O2 uptake during exercise in COPD. Med Sci Sports Exerc 2001; 33:916-22. [PMID: 11404656 DOI: 10.1097/00005768-200106000-00010] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantify the effects of acute oxygen supplementation on lower limb blood flow (QLEG), O2 delivery (QO2LEG), and O2 uptake (VO2LEG) during exercise and to determine whether the metabolic capacity of the lower limb is exhausted at peak exercise during room air breathing in patients with COPD. METHODS Oxygen (FIO2 = 0.75) and air were randomly administered to 14 patients with COPD (FEV1: 35 +/- 2% pred, mean +/- SEM) during two symptom-limited incremental cycle exercise tests. Before exercise, a cannula was installed in a radial artery and a thermodilution catheter inserted in the right femoral vein. At each exercise step, five-breath averages of respiratory rate, tidal volume, and ventilation (VE), dyspnea and leg fatigue scores, arterial and venous blood gases, and QLEG were obtained. From these measurements, VO2LEG was calculated. RESULTS Peak exercise capacity increased from 46 +/- 3 W in room air to 59 +/- 5 W when supplemental oxygen was used (P < 0.001). QLEG, QO2LEG, and VO2LEG were greater at peak exercise with O2 than with air (P < 0.05). During submaximal exercise, dyspnea score and VE were significantly reduced with O2 (P < 0.05), whereas QLEG, VO2LEG, and leg fatigue were similar under both experimental conditions. The improvement in peak exercise work rate correlated with the increase in peak QO2LEG (r = 0.66, P < 0.01), peak VO2LEG (r = 0.53, P < 0.05), and reduction in dyspnea at iso-exercise intensity (r = 0.56, P < 0.05). CONCLUSION The improvement in peak exercise capacity with oxygen supplementation could be explained by the reduction in dyspnea at submaximal exercise and the increases in QO2LEG and VO2LEG, which enabled the exercising muscles to perform more external work. These data indicate that the metabolic capacity of the lower limb muscles was not exhausted at peak exercise during room air breathing in these patients with COPD.
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Affiliation(s)
- F Maltais
- Centre de recherche, Institut de Cardiologie et de Pneumologie de Québec, Département de Médecine, Université Laval, Québec, Canada.
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Simon M, LeBlanc P, Jobin J, Desmeules M, Sullivan MJ, Maltais F. Limitation of lower limb VO(2) during cycling exercise in COPD patients. J Appl Physiol (1985) 2001; 90:1013-9. [PMID: 11181613 DOI: 10.1152/jappl.2001.90.3.1013] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) usually stop exercise before reaching physiological limits in terms of O(2) delivery and extraction. A plateau in lower limb O(2) uptake (VO(2)) and blood flow occurs despite progression of the imposed workload during cycling in some patients with COPD, suggesting that maximal capacity to transport O(2) had been reached and that it had been extracted in the peripheral exercising muscles. This study addresses this observation. Symptom-limited incremental cycle exercise was performed by 14 men [62 +/- 11 (SD) yr] with severe COPD (forced expiratory volume in 1 s = 35 +/- 7% of predicted value). Leg blood flow was measured at each exercise step with a thermodilution catheter inserted in the femoral vein. This value was multiplied by two to account for both working legs (Q(LEGS)). Arterial and femoral venous blood was sampled at each exercise step to measure blood gases. Leg O(2) consumption (VO(2LEGS)) was calculated according to the Fick equation. Total body VO(2) (VO(2TOT)) was measured from expired gas analysis, and tidal volume (VT) and minute ventilation (VE) were derived from the flow signal. In eight patients, VO(2LEGS) kept increasing in parallel with VO(2TOT) as external work rate was increasing. In six subjects, a plateau in VO(2LEGS) and Q(LEGS) occurred during exercise (increment of <3% between 2 consecutive increasing workloads) despite the increase in workload and VO(2TOT) [corresponding mean was 110 +/- 38 ml (11 +/- 4%)]. These six patients also exhibited a plateau in O(2) extraction during exercise. Peak exercise work rate was higher in the eight patients without a plateau than in the six with a plateau (51 +/- 10 vs. 40 +/- 13 W, P = 0.043). VT, VE, and dyspnea were significantly greater at submaximal exercise in patients of the plateau group compared with those of the nonplateau group. These results show that, in some patients with COPD, blood flow directed to peripheral muscles and O(2) extraction during exercise may be limited. We speculate that redistribution of cardiac output and O(2) from the lower limb exercising muscles to the ventilatory muscles is a possible mechanism.
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Affiliation(s)
- M Simon
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec, Canada G1V 4G5
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Nixon Speechley K, Maunsell E, Desmeules M, Schanzer D, Landgraf JM, Feeny DH, Barrera ME. Mutual concurrent validity of the child health questionnaire and the health utilities index: an exploratory analysis using survivors of childhood cancer. Int J Cancer Suppl 2000; 12:95-105. [PMID: 10679879 DOI: 10.1002/(sici)1097-0215(1999)83:12+<95::aid-ijc18>3.0.co;2-h] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mutual concurrent validity of 2 generic measures of health-related quality of life (HRQL), the Child Health Questionnaire (CHQ) and the Health Utilities Index Mark 2 (HUI2) and HUI3, was assessed. Data were from 3 centers participating in a Canadian multi-center retrospective cohort study currently in progress to assess psycho-social and physical late effects in children surviving >/=5 years after cancer diagnosis between 1981 and 1990. Exploratory results are from 244 parent reports on HRQL in children <16 years old when studied. Spearman rank-order correlations between sub-scale scores for the CHQ and single-attribute utility scores for the corresponding attribute from the HUI2 and HUI3 were used. As predicted, the correlation between CHQ bodily pain and HUI2 and HUI3 pain was strong, 0.58 and 0.60, respectively, while correlations between CHQ physical functioning and HUI2 mobility and HUI3 ambulation were moderate, both 0.45. Correlations between CHQ mental health and HUI2 and HUI3 emotion were strong, 0.64 and 0.54, respectively, rather than moderate, as predicted. Both the CHQ general health scale and the general health single item were moderately correlated with the HUI2 and HUI3 global utility scores rather than weakly, as predicted (CHQ general health scale and HUI2 and HUI3 global utility were 0.43 and 0.44, respectively; CHQ general health single item and HUI2 and HUI3 global utility were 0. 38 and 0.42, respectively). The CHQ and HUI, which are based on different methodologies (summative Likert scaling and utility analysis, respectively), appear to capture similar constructs in childhood cancer survivors.
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Affiliation(s)
- K Nixon Speechley
- Departments of Pediatrics and of Epidemiology and Biostatistics, University of Western Ontario and the Child Health Research Institute, London, Canada
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Schaubel DE, Morrison HI, Desmeules M, Parsons DA, Fenton SS. End-stage renal disease in Canada: prevalence projections to 2005. CMAJ 1999; 160:1557-63. [PMID: 10373996 PMCID: PMC1230359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The incidence and prevalence of end-stage renal disease (ESRD) have increased greatly in Canada over the last 2 decades. Because of the high cost of therapy, predicting numbers of patients who will require dialysis and transplantation is necessary for nephrologists and health care planners. METHODS The authors projected ESRD incidence rates and therapy-specific prevalence by province to the year 2005 using 1981-1996 data obtained from the Canadian Organ Replacement Register. The model incorporated Poisson regression to project incidence rates, and a Markov model for patient follow-up. RESULTS Continued large increases in ESRD incidence and prevalence were projected, particularly among people with diabetes mellitus. As of Dec. 31, 1996, there were 17,807 patients receiving renal replacement therapy in Canada. This number was projected to climb to 32,952 by the end of 2005, for a relative increase of 85% and a mean annual increase of 5.8%. The increased prevalence was projected to be greatest for peritoneal dialysis (6.0% annually), followed by hemodialysis (5.9%) and functioning kidney transplant (5.7%). The projected annual increases in prevalence by province ranged from 4.4%, in Saskatchewan, to 7.5%, in Alberta. INTERPRETATION The projected increases are plausible when one considers that the incidence of ESRD per million population in the United States and other countries far exceeds that in Canada. The authors predict a continued and increasing short-fall in resources to accommodate the expected increased in ESRD prevalence.
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Affiliation(s)
- D E Schaubel
- Laboratory Centre for Disease Control, Health Canada, Ottawa, Ont
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11
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Martin RR, Ghezzo H, Amyot R, Bégin R, Desmeules M, Gauthier JJ, Malo JL, Ostiguy G. [Quebec spirometry reference values]. Rev Mal Respir 1998; 15:781-8. [PMID: 9923033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Lung volumes forced expiratory flow rates and carbon monoxide diffusing capacity (apnea) were measured in 397 non-smoking, nonatopic, asymptomatic subjects (219 women, 178 men). The equipments and methods for measurements met the ATS criteria. The linear regression of the different variables according to age and height allowed the elaboration of a new set of predictive equations (Quebec). When comparing the different reference values used in North America and Europe, it is found that those of Miller and associates as well as those recommended by the CECA provide the best description of the Quebec situation. However, we would eventually prefer the reference values of Miller and associates over those of the CECA, because they better fit the current ATS criteria and also provide references for smokers. Lung volumes and forced expiratory flow rates of 97 non-smoking, nonatopic, asymptomatic manual workers were measured in the same conditions and submitted to the same comparisons. Quebec predictive values as well as those of Miller and associates isolated the same individuals in the so called abnormal zone. We therefore conclude that Quebec's standards should be preferred in the Province of Quebec pulmonary function laboratories.
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Affiliation(s)
- R R Martin
- Hôpital du Sacré-Caeur de Montréal, Québec
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12
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Maltais F, Jobin J, Sullivan MJ, Bernard S, Whittom F, Killian KJ, Desmeules M, Bélanger M, LeBlanc P. Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD. J Appl Physiol (1985) 1998; 84:1573-80. [PMID: 9572801 DOI: 10.1152/jappl.1998.84.5.1573] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Premature lactic acidosis during exercise in patients with chronic obstructive pulmonary disease (COPD) may play a role in exercise intolerance. In this study, we evaluated whether the early exercise-induced lactic acidosis in these individuals can be explained by changes in peripheral O2 delivery (O2). Measurements of leg blood flow by thermodilution and of arterial and femoral venous blood gases, pH, and lactate were obtained during a standard incremental exercise test to capacity in eight patients with severe COPD and in eight age-matched controls. No significant difference was found between the two groups in leg blood flow at rest or during exercise at the same power outputs. Blood lactate concentrations and lactate release from the lower limb were greater in COPD patients at all submaximal exercise levels (all P < 0.05). Leg D02 at a given power output was not significantly different between the two groups, and no significant correlation was found between this parameter and blood lactate concentrations. COPD patients had lower arterial and venous pH at submaximal exercise, and there was a significant positive correlation between venous pH at 40 W and the peak O2 uptake (r = 0.91, P < 0.0001). The correlation between venous pH and peak O2 uptake suggests that early muscle acidosis may be involved in early exercise termination in COPD patients. The early lactate release from the lower limb during exercise could not be accounted for by changes in peripheral O2. The present results point to skeletal muscle dysfunction as being responsible for the early onset of lactic acidosis in COPD.
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Affiliation(s)
- F Maltais
- Unité de Recherche en Pneumologie, Centre de Pneumologie de l'Hôpital Laval, Quebec, Canada
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13
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Schaubel DE, Morrison HI, Desmeules M, Parsons D, Fenton SS. End-stage renal disease projections for Canada to 2005 using Poisson and Markov models. Int J Epidemiol 1998; 27:274-81. [PMID: 9602410 DOI: 10.1093/ije/27.2.274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) incidence and prevalence are increasing in many countries worldwide. Due to the high cost of therapy, predicting future numbers of patients requiring dialysis and transplantation is necessary for health care planners. Projecting therapy-specific chronic disease prevalence is inherently problematic, and examples of suitable models and their application are sparse. When applied, rarely was the adequacy of such models evaluated. METHODS We describe and illustrate a method for projecting therapy-specific ESRD prevalence in Canada for 1995-2005 using data obtained from the Canadian Organ Replacement Register. The projections combine the Poisson model for incidence rates and a Markov model for patient follow-up. Model adequacy is empirically validated by data-splitting. RESULTS Large increases in ESRD prevalence are expected in Canada, with an average annual increase of 6.9% projected for 1995-2005. Upon validation, the projection model based on 1981-1987 data was able to predict 1994 prevalence within 1%, while projected therapy-specific prevalences closely approximated those observed. CONCLUSIONS Therapy-specific ESRD prevalence was successfully projected using Poisson and Markov models. Where multistate prevalence forecasts are required, the method could be augmented for application to various other chronic diseases.
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Affiliation(s)
- D E Schaubel
- Laboratory Centre for Disease Control, Health Canada Ottawa, ON, Canada
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14
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Fenton SS, Schaubel DE, Desmeules M, Morrison HI, Mao Y, Copleston P, Jeffery JR, Kjellstrand CM. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 1997; 30:334-42. [PMID: 9292560 DOI: 10.1016/s0272-6386(97)90276-6] [Citation(s) in RCA: 396] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although kidney transplantation is the preferred treatment method for patients with ESRD, most patients are placed on dialysis either while awaiting transplantation or as their only therapy. The question of which dialytic method provides the best patient survival remains unresolved. Survival analyses comparing hemodialysis and continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis (CAPD/CCPD), a newer and less costly dialytic modality, have yielded conflicting results. Using data obtained from the Canadian Organ Replacement Register, we compared mortality rates between hemodialysis and CAPD/CCPD among 11,970 ESRD patients who initiated treatment between 1990 and 1994 and were followed-up for a maximum of 5 years. Factors controlled for include age, primary renal diagnosis, center size, and predialysis comorbid conditions. The mortality rate ratio (RR) for CAPD/CCPD relative to hemodialysis, as estimated by Poisson regression, was 0.73 (95% confidence interval: 0.68 to 0.78). No such relationship was found when an intent-to-treat Cox regression model was fit. Decreased covariable-adjusted mortality for CAPD/CCPD held within all subgroups defined by age and diabetes status, although the RRs increased with age and diabetes prevalence. The increased mortality on hemodialysis compared with CAPD/CCPD was concentrated in the first 2 years of follow-up. Although continuous peritoneal dialysis was associated with significantly lower mortality rates relative to hemodialysis after adjusting for known prognostic factors, the potential impact of unmeasured patient characteristics must be considered. Notwithstanding, we present evidence that CAPD/CCPD, a newer and less costly method of renal replacement therapy, is not associated with increased mortality rates relative to hemodialysis.
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Affiliation(s)
- S S Fenton
- Division of Nephrology, The Toronto Hospital, Canada
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15
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Cormier Y, Israël-Assayag E, Desmeules M, Lesur O. Effect of contact avoidance or treatment with oral prednisolone on bronchoalveolar lavage surfactant protein A levels in subjects with farmer's lung. Thorax 1996; 51:1210-5. [PMID: 8994517 PMCID: PMC472765 DOI: 10.1136/thx.51.12.1210] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surfactant protein A (SP-A) acts as an immune system modulator in the lungs and may therefore be involved in the pathogenesis of hypersensitivity pneumonitis. METHODS The levels of SP-A in bronchoalveolar lavage (BAL) fluid were measured in 20 subjects with acute farmer's lung, 16 asymptomatic dairy farmers, and 14 normal controls. Eight patients had a second evaluation after one month of treatment by either contact avoidance (n = 3) or oral prednisolone (20 or 25 mg/day, n = 5). Chest radiographs and lung function measurements were also obtained in all farmers, twice in those re-evaluated after treatment. RESULTS Patients with acute farmer's lung had significantly higher levels of SP-A than asymptomatic farmers and normal controls (p = 0.005) with mean (SE) values of 1.43 (0.29) micrograms/ml, 0.62 (0.09) microgram/ml, and 0.68 (0.11) microgram/ml, respectively. In eight subjects tested after one month of treatment the level of SP-A was unchanged although all were clinically improved. No correlations were seen between levels of SP-A in BAL fluid and numbers of BAL cells, lung function measurements, or chest radiographic scores. CONCLUSION Although the level of SP-A is increased in the BAL fluid of patients with acute farmer's lung, it is not correlated with clinical abnormalities of this disease.
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Affiliation(s)
- Y Cormier
- Unité de Recherche, Hôpital and Université Laval, Chemin Ste-Foy, Québec, Canada
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16
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Abstract
OBJECTIVE To assess the relationship between serum folate level and the risk of fatal coronary heart disease (CHD) among men and women. DESIGN Retrospective cohort study with serum folate levels measured from September 1970 to December 1972, with follow-up through 1985. SETTING Participants in the Nutrition Canada Survey. PARTICIPANTS A total of 5056 Canadian men and women aged 35 to 79 years with no history of self-reported CHD. MAIN OUTCOME MEASURE Fifteen-year CHD mortality. RESULTS A total of 165 CHD deaths were observed. We found a statistically significant association between serum folate level and risk of fatal CHD, with rate ratios for individuals in the lowest serum folate level category (<6.8 nmol/L [3 ng/mL]) compared with the highest category (>13.6 nmol/L [6 ng/mL]) of 1.69 (95% confidence interval, 1.10-2.61). CONCLUSIONS These data indicate that low serum folate levels are associated with an increased risk of fatal CHD.
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Abstract
Childhood asthma usually begins early in life. Neonatal characteristics are reportedly predictive of symptom onset. This investigation utilized data from a provincial health organization to evaluate the effect of several birth characteristics on asthma incidence and hospitalization for asthma during age 0-4. Using logistic regression, the odds ratios (OR) for the following variables indicate a significant (p < 0.05) association with physician-diagnosed preschool asthma: male gender (OR = 1.72), birthweight < 1500 g (OR = 2.11), prematurity (OR = 1.34), respiratory distress syndrome (RDS) in the presence (OR = 2.95) or absence (OR = 1.61) of bronchopulmonary dysplasia (BPD), and transient tachypnea of the newborn (TTN; OR = 1.36). Male gender (OR = 1.91), birthweight < 1500 g (OR = 2.56), RDS with and without BPD (OR = 3.35 and 2.50, respectively), TTN (OR = 2.08), and severe birth asphyxia (OR = 1.94) showed an important association with hospitalization due to asthma. Neonatal characteristics are important determinants for the risk of preschool asthma, even after mutual adjustment.
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Affiliation(s)
- D Schaubel
- Bureau of Chronic Disease Epidemiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada
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18
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Schaubel D, Desmeules M, Mao Y, Jeffery J, Fenton S. Survival experience among elderly end-stage renal disease patients. A controlled comparison of transplantation and dialysis. Transplantation 1995; 60:1389-94. [PMID: 8545862 DOI: 10.1097/00007890-199560120-00003] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Renal transplantation is a relatively recent treatment option among the elderly with end-stage renal disease (ESRD). Since little is known regarding the clinical benefits of transplantation relative to dialysis in this age group, this study compares transplantation and dialysis among the elderly with respect to patient survival. Data utilized in this investigation were obtained from the Canadian Organ Replacement Register (CORR). The study population consisted of the 6400 patients aged 60 and over at registration, diagnosed between 1987 and 1993, for whom data on comorbid conditions were available. Survival probability, death rates, age-standardized mortality ratios (SMRs) and Cox regression analysis were employed to evaluate the survival experience among the transplant and dialysis groups. Transplant recipients were matched (by age, underlying diagnosis leading to ESRD, and number of comorbid conditions) to 2 randomly selected patients who did not undergo transplantation. Using Cox regression, the time-dependent hazard ratio for transplantation versus dialysis patients was estimated at 0.47 (P < 0.0001), indicating that even after adjusting for other known prognostic factors, elderly patients who received a transplant experienced significantly greater survival probability than those who remained on dialysis. When transplant patients were matched to randomly selected dialysis patients with the constraint that the corresponding dialysis patient have at least as much follow-up time as the transplant patient had waiting time, five-year survival rates were 81% and 51% for the transplant and dialysis groups, respectively (P < 0.0001). These results support the potential advantage of transplantation among the elderly, and may have important implications for renal care in this age group.
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Affiliation(s)
- D Schaubel
- Bureau of Chronic Disease Epidemiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada
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19
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Abstract
Relatively little is known of the chronic effects attributable to the ingestion of inorganic components such as uranium and silicon. Although ingestion of large amounts of U can cause acute renal damage through a chemical effect, studies on humans have typically considered inhalation the route of exposure. We investigated the association between drinking water concentration levels of U and Si, and microalbuminuria, a sensitive biological indicator of renal dysfunction. Linear regression analysis revealed a statistically significant association between U cumulative exposure index and albumin per mmol creatinine (P = 0.03). No such significant relationship appeared for Si, although a positive trend was witnessed. Since normal but increasing levels of microalbuminuria were observed at U concentration levels below the Canadian Maximum Allowable Concentration (MAC), it is suggested that further study be undertaken.
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Affiliation(s)
- Y Mao
- Cancer Bureau, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada
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20
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Desmeules M, Schaubel D, Fenton SS, Mao Y. New and prevalent patients with end-stage renal disease in Canada. A portrait of the year 2000. ASAIO J 1995; 41:230-3. [PMID: 7640434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The number of patients initiating treatment for end-stage renal disease (ESRD) has increased dramatically in Canada and other countries. To assist healthcare planners, the prevalence of ESRD in Canada has been projected to the year 2000 using a Markov modelling technique. Significant increases in ESRD are expected in Canada during the next decade, particularly among the elderly and diabetic populations: estimated increases in prevalence rates of ESRD between 1992 and the year 2000 were 78% and 154% for non diabetic and diabetic populations respectively. These expected increases did not differ significantly between the treatment groups, except among patients with diabetes, in whom projected increases in the prevalence of functioning transplant was smaller than for hemodialysis or peritoneal dialysis. Because the current Canadian prevalence rates are lower than those of some other countries, such as the United States and Japan, these expected trends in prevalence appear reasonable, and illustrate the growing healthcare needs of the ESRD population in Canada during the next decade.
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Affiliation(s)
- M Desmeules
- Bureau of Chronic Disease Epidemiology, Health Canada, Ottawa, Ontario
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21
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Fenton S, Desmeules M, Copleston P, Arbus G, Froment D, Jeffery J, Kjellstrand C. Renal replacement therapy in Canada: a report from the Canadian Organ Replacement Register. Am J Kidney Dis 1995; 25:134-50. [PMID: 7810519 DOI: 10.1016/0272-6386(95)90639-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report here the demography and results of renal replacement therapy in Canada from 1981 to 1992. The new case rate for patients entering renal replacement therapy programs in Canada has increased dramatically over the last 12 years, from 49.9 per million to 98.4 per million of the population. The largest increases have been among the elderly, from 146.2 per million in 1981 to 381.9 per million in 1992 for those aged 65 to 74 years. There has been an even more dramatic increase for those over 75 years, from 83.6 per million in 1981 to 261.6 per million in 1992. There has been a similar increase in the prevalence rate, with an increase from 229.1 per million in 1981 to 518.5 per million in 1992. The hemodialysis rate for 1992 was 172.2 per million and that for peritoneal dialysis was 103.1 per million of the population. The renal transplantation rate also increased from 20 per million in 1981 to 34.8 per million in 1988, but unfortunately has decreased to 27.5 per million in 1992. Diabetes is now the most common primary renal diagnosis, having increased from 15% in 1981 to 24% in 1992. The 5-year survival rate of all patients on renal replacement therapy was 55%. For nondiabetic patients, the 5-year survival rate ranged from 85% for the those aged 15 to 44 years to 20% for those over 65 years. Among diabetic patients, the 5-year survival rate declined from 58% for the 15 to 44 year age group to 10% for those over 65 years.
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Affiliation(s)
- S Fenton
- Canadian Organ Replacement Register, Canadian Institute for Health Information, Ontario
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22
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Abstract
Renal function recovery (RFR) is a rare event in patients with end-stage renal disease (ESRD). Although some predictive factors have been described, there are still unresolved questions. We have analyzed the Canadian Organ Replacement Register data for the 1981 to 1989 period to assess the incidence and factors predictive of RFR in a large ESRD population as well as the outcome after recovery. Renal function recovery was defined as the interruption of renal replacement therapy (RRT) for more than 3 months. Patients on RRT for < or = 45 days were excluded. Of 14,318 registered ESRD patients, 342 (2.4%) experienced RFR after 8.9 +/- 0.5 months of RRT (mean +/- SEM); 52.3% of the recoveries occurred within 6 months of initiating RRT, while 23.7% were only observed after 12 months or more. By Cox regression, patients within the following diagnostic groups had a significantly higher rate of RFR than those with primary glomerulonephritis, who are considered to comprise the reference group: myeloma (relative rate [RR] = 6.00; P < 0.001), drug-induced disease (RR = 4.21; P < 0.001), vascular/hypertensive disease (RR = 2.60; P < 0.001), and systemic disease (RR = 2.58; P < 0.001). Inversely, patients with polycystic kidneys (RR = 0.06; P = 0.004) and diabetic patients (RR = 0.56; P = 0.024) had a lower rate of RFR than those with glomerulonephritis. Men younger than 45 years had a lower rate of RFR than older men and women of all ages (P < or = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V Pichette
- Service de Néphrologie, Hôtel-Dieu de Montréal, Quebec, Canada
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23
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Mao Y, Desmeules M. Re: "Increased mortality from brain tumors: a combined outcome of diagnostic technology and change of attitude toward the elderly". Am J Epidemiol 1993; 137:1035-7. [PMID: 8317449 DOI: 10.1093/oxfordjournals.aje.a116761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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24
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Sériès F, Cormier Y, La Forge J, Desmeules M. Mechanisms of the effectiveness of continuous positive airway pressure in obstructive sleep apnea. Sleep 1992; 15:S47-9. [PMID: 1470809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nasal continuous positive airway pressure (NCPAP) is considered the most effective treatment of obstructive sleep apnea. Its beneficial effects are related to the normalization of breathing during sleep and to the prevention of nocturnal desaturations. NCPAP interacts with the pathophysiologic mechanisms of sleep apnea onset and with the consequences of these apneas. Upper airway patency is maintained with NCPAP by a pneumatic splinting effect while changes in lung volume and pre-apnea SaO2 level may be implicated in the improvement of apnea-related desaturations. An improvement in central chemosensitivity could account for the improvement in diurnal oxygenation observed with long term NCPAP therapy.
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Affiliation(s)
- F Sériès
- Unité de Recherche, Centre de Pneumologie de l'hôpital Laval, Université Laval, Québec, Canada
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25
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Desmeules M, Huang J, Lindsay J. Changing patterns of mortality and hospital morbidity among Canadians aged 85 and over. Can J Public Health 1992; 83:315-7. [PMID: 1423117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Desmeules
- Bureau of Chronic Disease Epidemiology, LCDC, Ottawa, Ontario
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Abstract
BACKGROUND The incidence of brain cancer has increased dramatically over the last decades in most developed countries. Whether these trends can be attributed to improved diagnosis is not clear. PURPOSE To determine the effect of new imaging technology on increased rates of brain cancer, we assessed the level of detection for neurological disorders when computed tomography (CT) and magnetic resonance imaging (MRI) results were not available. METHODS A neurologist performed a blind review of hospital charts from 356 randomly selected patients, hospitalized between 1985 and 1989 for neurological disorders, including brain cancer. All prediagnosis information except CT and MRI results was used as a basis for diagnostic re-evaluation. Also, a random sample of 151 brain cancer patients diagnosed between 1960 and 1965 was selected for a description of diagnostic methods used during that period. RESULTS A comparison between the original diagnoses and the re-evaluations for patients in the 1985-1989 sample indicated that there was, among the diseases selected, a 24% misclassification when CT scans and MRI were not available. In particular, 20% of brain tumors were undetected (95% confidence interval = 15%-25%), and 10% of non-tumor disorders were inaccurately labeled as brain tumors in the absence of these tests. The repeatability of the re-evaluations was 86%. CONCLUSIONS Among elderly North Americans, at least twofold increases in brain cancer incidence were observed over the last two decades. Since our findings show that CT scans and MRI are responsible for the detection of about 20% of brain tumors, we conclude that other factors also are responsible for the observed trends.
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Affiliation(s)
- M Desmeules
- Bureau of Chronic Disease Epidemiology, Laboratory Center for Disease Control, Health and Welfare, Ottawa, Ont., Canada
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27
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Abstract
Prior surveys of malignant mesothelioma in Québec have noted that almost all the excess in occupational exposure related mesothelioma was in the manufacture and industrial application of asbestos rather than in the mining and milling operations. To evaluate the current status of malignant pleural mesothelioma in the Québec workforce, we reviewed all cases of pleural mesothelioma seen and accepted by the Québec Workman's Compensation Board (CSST) for work related compensation of industrial disease. We identified 120 cases, 7 of whom were females. They were of an average age of 59 +/- 8.5 yrs (sd) (range 42-84); they were exposed to asbestos dust in the workplace for an average of 26 +/- 14.3 yrs (range 0.5-50). The cases were subdivided into 3 groups according to workplace asbestos exposures. There were 49 cases originating in the mines and mills of the Québec Eastern Township region (primary industry, group 1), 50 cases from the manufacture and industrial application sector (secondary industry, group 2), and 21 cases from industries where asbestos was not a major work material, often an "incidental" material (tertiary industry, group 3). Group 1 was of an average age of 62 +/- 8 years, exposed to asbestos dust 31 +/- 14 years and the distribution of exposure time was as follows: 15% cases with < or = 10 year-exposure and 77% > or = 25 year-exposure. In group 2, the age was significantly lower at 57 +/- 9 years; the exposure time was also significantly lower at 22 +/- 14 years, and the distribution of exposure time differed from the above (29% cases with < or = 10 year-exposure and 48% > or = 25 year-exposure). In group 3, the average age was 58 +/- 7 years, the exposure time was also significantly lower at 28 +/- 12 years and the distribution of exposure time differed from the above (33% cases with < or = 10 year-exposure and 62% > or = 25 year-exposure). Analyses of the yearly incidence of new cases in each group documented the general incremental trend in all groups, with the sharpest rises in group 3. In the mining towns of Thetford and Asbestos, the incidence of mesothelioma was proportional to the workforce, thus suggesting that the tremolite air contamination, which is 7.5 x higher in Thetford, may not be a significant determinant of the disease in these workers.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- R Bégin
- Commission de Santé et Sécurité au Travail du Québec, Canada
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28
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Mao Y, Desmeules M, Semenciw RM, Hill G, Gaudette L, Wigle DT. Increasing brain cancer rates in Canada. CMAJ 1991; 145:1583-91. [PMID: 1742695 PMCID: PMC1336078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyse brain cancer patterns in Canada, particularly according to age and sex distributions, temporal patterns and regional variations. Changes in diagnostic techniques, survival rates and trends by tumour type were also examined. DESIGN Descriptive epidemiologic study based on Canada-wide population data for 1959-88. OUTCOME MEASURES Rates of death, incidence and admission to hospital because of brain cancer, as well as survival time and methods of diagnosis. SUBJECTS Incidence and death rates and time trends were examined for Canada as a whole, by province and by census division. RESULTS The rates of death from brain cancer increased rapidly among Canadians aged 55 years or more from 1959 to 1988. In particular, age-adjusted death rates increased by 117%, 797% and 118% among men 65 to 74 years, 75 to 84 and 85 or more respectively. The corresponding increases among women were 138%, 535% and 400%. The incidence rates also increased substantially. The trends in incidence rates by tumour type indicated that the increase was more pronounced for glioblastomas. The incidence rates of cases detected histologically, radiologically and clinically all increased. CONCLUSIONS Because glioblastomas are generally easier to diagnose than astrocytomas and because the incidence rates of glioblastomas were found to increase substantially, the increased brain cancer rates among elderly people may not be entirely attributable to improved diagnostic techniques. However, analytic investigations of the impact of changes in diagnostic procedures on brain cancer trends are needed to clarify this issue.
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Affiliation(s)
- Y Mao
- Surveillance and Risk Assessment Division, Department of National Health and Welfare, Ottawa, Ont
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Desmeules M, Semenciw R. The impact of medical care on mortality in Canada, 1959-1988. Can J Public Health 1991; 82:209-11. [PMID: 1884318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Desmeules
- Surveillance and Risk Assessment Division, Bureau of Chronic Disease Epidemiology, National Health and Welfare, Canada, Ottawa, Ontario
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Sériès F, Cormier FY, Desmeules M. Alcohol and the response of upper airway resistance to a changing respiratory drive in normal man. Respir Physiol 1990; 81:153-63. [PMID: 2263781 DOI: 10.1016/0034-5687(90)90042-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied the effects of alcohol ingestion on the response of upper airway resistance (UAR) to changing respiratory motor output in 9 normal subjects. Nasal and pharyngeal pressures were measured with two low bias flow catheters placed at the tip of the epiglottis and in the posterior nasopharynx. Respiratory flow was measured with a Fleisch no. 3 pneumotachograph connected to a tightly fitting mask. Breath-by-breath inspiratory upper airway resistances were calculated at isoflow during 1) a CO2 rebreathing (increase in drive), 2) 2 min following five slow vital capacities of 100% O2 (decrease in drive) (Post-O2 period), and 3) 1 min before each procedure (baseline measurements). The respiratory motor output was estimated by the pressure developed 0.1 sec after the onset of inspiration (P0.1) during rebreathing and by the mean inspiratory flow (VT/TI) during the post-O2 period. Measurements were performed before and after the ingestion of 1.5 ml/kg of 40% alcohol. Blood alcohol level rose from 0 to 14.9 +/- 1.8 mmol.L-1 (Mean +/- SD) and total supralaryngeal resistance increased from 2.8 +/- 1.8 cm H2O.L-1.sec to 4.2 +/- 1.8 cm H2O.L-1.sec (P less than 0.001, Student's paired t-test). During CO2 rebreathing UAR decreased exponentially as P0.1 increased both before and after alcohol intake. The slope of the plot Log (pharyngeal resistance) against P0.1 decreased from -17.0 x 10(-3) +/- 9.3 x 10(-3) before alcohol to -11.0 x 10(-3) +/- 6.6 x 10(-3) after alcohol intake (P = 0.03). The slope of the decrease in nasal resistance remained unchanged. A decrease in VT/TI occurred during the Post-O2 period and was accompanied by an exponential increase in UAR at each experiment. The slope of Log (pharyngeal resistance) over VT/TI was significantly higher after (-27.0 x 10(-3) +/- 7.1 x 10(-3)) than before alcohol (-12.0 x 10(-3) +/- 4.2 x 10(-3), P less than 0.001). The slope of the increase in nasal resistance with decreasing VT/TI rose from -8.4 x 10(-3) +/- 6.5 x 10(-3) to -13.0 x 10(-3) +/- 7.4 x 10(-3) after alcohol ingestion (P = 0.06). We conclude that alcohol ingestion depresses the pharyngeal responses to changing central drive in normal subjects.
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Affiliation(s)
- F Sériès
- Unité de recherche, Hôpital Laval, Sainte-Foy, Québec, Canada
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Abstract
The total upper airway resistances are modified during active changes in lung volume. We studied nine normal subjects to assess the influence of passive thoracopulmonary inflation and deflation on nasal and pharyngeal resistances. With the subjects lying in an iron lung, lung volumes were changed by application of an extrathoracic pressure (Pet) from 0 to 20 (+Pet) or -20 cmH2O (-Pet) in 5-cmH2O steps. Upper airway pressures were measured with two low-bias flow catheters, one at the tip of the epiglottis and the other in the posterior nasopharynx. Breath-by-breath resistance measurements were made at an inspiratory flow rate of 300 ml/s at each Pet step. Total upper airway, nasal, and pharyngeal resistances increased with +Pet [i.e., nasal resistance = 139.6 +/- 14.4% (SE) of base-line and pharyngeal resistances = 189.7 +/- 21.1% at 10 cmH2O of +Pet]. During -Pet there were no significant changes in nasal resistance, whereas pharyngeal resistance decreased significantly (pharyngeal resistance = 73.4 +/- 7.4% at -10 cmH2O). We conclude that upper airway resistance, particularly the pharyngeal resistance, is influenced by passive changes in lung volumes, especially pulmonary deflation.
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Affiliation(s)
- F Sériès
- Unité de Recherche, Centre de Pneumologie, Hôpital Laval, Ste-Foy, Quebec, Canada
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32
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Abstract
The influence of pulmonary inflation and positive airway pressure on nasal and pharyngeal resistance were studied in 10 normal subjects lying in an iron lung. Upper airway pressures were measured with two low-bias flow catheters while the subjects breathed by the nose through a Fleish no. 3 pneumotachograph into a spirometer. Resistances were calculated at isoflow rates in four different conditions: exclusive pulmonary inflation, achieved by applying a negative extra-thoracic pressure (NEP); expiratory positive airway pressure (EPAP), which was created by immersion of the expiratory line; continuous positive airway pressure (CPAP), realized by loading the bell of the spirometer; and CPAP without pulmonary inflation by simultaneously applying the same positive extrathoracic pressure (CPAP + PEP). Resistance measurements were obtained at 5- and 10-cmH2O pressure levels. Pharyngeal resistance (Rph) significantly decreased during each measurement; the decreases in nasal resistance were only significant with CPAP and CPAP + PEP; the deepest fall in Rph occurred with CPAP. It reached 70.8 +/- 5.5 and 54.8 +/- 6.5% (SE) of base-line values at 5 and 10 cmH2O, respectively. The changes in lung volume recorded with CPAP + PEP ranged from -180 to 120 ml at 5 cmH2O and from -240 to 120 ml at 10 cmH2O. Resistances tended to increase with CPAP + PEP compared with CPAP values, but these changes were not significant (Rph = 75.9 +/- 6.1 and 59.9 +/- 6.6% at 5 and 10 cmH2O of CPAP + PEP). We conclude that 1) the upper airway patency increases during pulmonary inflation, 2) the main effect of CPAP is related to pneumatic splinting, and 3) pulmonary inflation contributes little to the decrease in upper airways resistance observed with CPAP.
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Affiliation(s)
- F Sériès
- Unité de Recherche, Hôpital Laval, Québec, Canada
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33
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Abstract
We compared the changes in nasal and pharyngeal resistance induced by modifications in the central respiratory drive in 8 patients with sleep apnea syndrome (SAS) with the results of 10 normal men. Upper airway pressures were measured with two low-bias flow catheters; one was placed at the tip of the epiglottis and the other above the uvula. Nasal and pharyngeal resistances were calculated at isoflow. During CO2 rebreathing and during the 2 min after maximal voluntary hyperventilation, we continuously recorded upper airway pressures, airflow, end-tidal CO2, and the mean inspiratory flow (VT/TI); inspiratory pressure generated at 0.1 s after the onset of inspiration (P0.1) was measured every 15-20 s. In both groups upper airway resistance decreased as P0.1 increased during CO2 rebreathing. When P0.1 increased by 500%, pharyngeal resistance decreased to 17.8 +/- 3.1% of base-line values in SAS patients and to 34.9 +/- 3.4% in normal subjects (mean +/- SE). During the posthyperventilation period the VT/TI fell below the base-line level in seven SAS patients and in seven normal subjects. The decrease in VT/TI was accompanied by an increase in upper airway resistance. When the VT/TI decreased by 30% of its base-line level, pharyngeal resistance increased to 319.1 +/- 50.9% in SAS and 138.5 +/- 4.7% in normal subjects (P less than 0.05). We conclude that 1) in SAS patients, as in normal subjects, the activation of upper airway dilators is reflected by indexes that quantify the central inspiratory drive and 2) the pharyngeal patency is more sensitive to the decrease of the central respiratory drive in SAS patients than in normal subjects.
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Affiliation(s)
- F Sériès
- Centre de Pneumologie, Hôpital Laval, Sainte-Foy, Quebec, Canada
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34
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Abstract
The variations in nasal and pharyngeal resistance induced by changes in the central inspiratory drive were studied in 10 normal men. To calculate resistances we measured upper airway pressures with two low-bias flow catheters; one was placed at the tip of the epiglottis and the other in the posterior nasopharynx, and we measured flow with a Fleisch no. 3 pneumotachograph connected to a tightly fitting mask. Both resistances were obtained continuously during CO2 rebreathing (Read's method) and during the 2 min after a 1-min voluntary maximal hyperventilation. The inspiratory drive was estimated by measurements of inspiratory pressure generated at 0.1 s after the onset of inspiration (P0.1) and by the mean inspiratory flow (VT/TI). In each subject both resistances decreased during CO2 rebreathing; these decreases were correlated with the increase in P0.1. During the posthyperventilation period, ventilation fell below base line in seven subjects; this was accompanied by an increase in both nasal and pharyngeal resistances. These resistances increased exponentially as VT/TI decreased. Parallel changes in nasal and pharyngeal resistances were seen during CO2 stimulus and during the period after the hyperventilation. We conclude that 1) the indexes quantifying the inspiratory drive reflect the activation of nasopharyngeal dilator muscles (as assessed by the changes in upper airway resistance) and 2) both nasal and pharyngeal resistances are similarly influenced by changes in the respiratory drive.
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Affiliation(s)
- F Sériès
- Centre de Pneumologie, Hôpital Laval, Sainte-Foy, Québec, Canada
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Leblanc P, Desmeules M. [Malignant pleural mesothelioma: clinical aspects and results of treatment]. Union Med Can 1984; 113:968-72. [PMID: 6516054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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36
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Laberge F, Desmeules M, Bergeron D, La Forge J, Cormier Y. [Value of polychemotherapy for bronchogenic carcinoma other than undifferentiated small cell carcinoma]. Union Med Can 1984; 113:222-224. [PMID: 6730096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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37
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Abstract
The benefits of polychemotherapy in advanced (Stage III) non-small-cell bronchogenic carcinoma remain uncertain. In attempt to answer the important question whether treatment improves well-being and survival in these patients, we did a prospective, randomized, single-blind study to compare polychemotherapy to a placebo. Thirty-nine consecutive patients were enrolled. Twenty received a drug combination consisting of: methotrexate, doxorubicine hydrochloride (Adriamycin), cyclophosphamide, and lomustine (CCNU) (MACC). The other group (19 subjects) received a placebo physically comparable to MACC. The two groups were initially comparable in terms of age, sex, clinical status, and tumor burden. In the treated group, seven patients had a radiologic response (more than 50% reduction in the tumor size), and the tumor stabilized in an additional five subjects. There were no responders in the placebo group. Median survival was 30.5 weeks for the MACC group compared to 8.5 weeks in the placebo group (P less than 0.0005, Gehan-Wilcoxon). We conclude that polychemotherapy (in this case MACC) significantly benefits patients with advanced non-small-cell lung cancer.
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38
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Abstract
In the 16-year period 1962 to 1978, 409 transaxillary apical pleurectomies were carried out for definitive treatment of spontaneous pneumothorax in 362 patients. Surgical indications included recurrence (336), bilaterality of the disease (23), persistent air leak (22), and nonexpansion of the lung (10). There was 1 operative death (unsuspected brain tumor), and 3 patients required reexploration for clot removal. The average postoperative period of hospitalization was 6 days. Three hundred ten patients (86% of all patients) were contacted for follow-up 1 to 16 years after operation (average, 4.5 years). There were two documented episodes of recurrent ipsilateral pneumothorax (0.6%). Postoperative pulmonary function studies were done in 40 patients (unilateral, 29; bilateral, 11) 2 to 5 years after operation. The results indicate that there are no significant abnormalities compared with predicted values.
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Abstract
Tracheobronchopathia osteochondroplastica is a rare disorder characterized by the projection of ossified formations into the trachea and bronchi. Unlike most cases, which are reported because of incidential postmortem findings, our patient presented with a slowly resolving pneumonia. The diagnosis was suspected by radiographic evaluation and bronchoscopic findings, then confirmed by histopathologic studis of a tracheal biopsy specimen. Pulmonary function studies were normal, except for flow-volume loops, which provided information for diagnosis and follow-up.
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Zidulka A, Desmeules M, Harvey J, Anthonisen NR. The effect of lobar obstruction on regional perfusion in the intact dog. Can J Physiol Pharmacol 1975; 53:954-7. [PMID: 1201501 DOI: 10.1139/y75-130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effect of acute obstruction of the right lower lobes (RLL) on the relative perfusion of different lung regions was studied using Xenon-133 in anesthetized artificially ventilated supine dogs. When the RLL were obstructed at functional residual capacity (FRC) and the rest of the lung was inflated to a transpulmonary pressure of 10 or 20 cm H2O (1 cm H2O = 94.1 N/m2), relative perfusion increased within 10 s to the obstructed lobes by 59 and 92%, respectively. The increase was less marked but still present (17 and 42%, respectively) when obstruction was maintained for 15 min, at a time when arterial hypoxemia had occurred. Hence, there was increased perfusion to an obstructed hypoxic region. The perfusion distribution correlated with the difference in alveolar pressure between the obstructed lobes and the unobstructed lobes such that relative perfusion was always increased to the low alveolar pressure region.
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Desmeules M, Pirollet H, Saraiva C, Sadoul P. [Action of disodium chromoglycolate on the airway resistance increase induced by allergens in asthmatic patients]. J Fr Med Chir Thorac 1971; 25:715-20. [PMID: 5000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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42
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Desmeules M, Peslin R, Saraiva C, Uffholtz H, Sadoul P. [Pulmonary static and dynamic properties in chronic bronchitis and emphysema]. Bull Physiopathol Respir (Nancy) 1971; 7:395-411. [PMID: 5112102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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43
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Desmeules M, St-Hilaire JM, Gascon J. [Corticotherapy in polymyositis]. Union Med Can 1969; 98:2099-103. [PMID: 5400438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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44
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Gosselin L, Daris R, Lalancette B, Desmeules M. [The Achilles tendon reflexogram: a valuable parameter of thyroid function]. Union Med Can 1968; 97:727-9. [PMID: 5758616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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