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Biomedical subjects

B A Mueller

Publications and source records attributed to B A Mueller.

At least 91 records · Page 5Linked to original sources
PubMed1995

Epidemiology of eclampsia.

The purpose of this study was to examine the risk of eclampsia in relation to several maternal characteristics and exposures, including demographic characteristics, reproductive history, and tobacco use during pregnancy. A case control study was conducted using data for all singleton births from the Washington State birth certificates for 1984-1990. In the check box feature employed by these certificates, eclampsia is listed under maternal conditions. Risk estimates, adjusted for various confounders, were calculated comparing eclampsia among exposed versus unexposed women. The risk of eclampsia was elevated in women without prenatal care, those with weight gain of more than thirty pounds during pregnancy, nulliparous women, and those with chronic hypertension. The association with tobacco smoking were inverse and dose related. Women's race, urban or rural place of residence, history of pre-term births, and anemia were not associated with eclampsia. Our data reaffirm the importance of prenatal care, and provide further evidence of an inverse relationship with prenatal smoking. As eclampsia and pre-eclampsia are important pregnancy complications, further research is needed to explore their possible causes.

Adolescent↗
PubMed1995

Mucositis management practices for hospitalized patients: national survey results.

The optimal management strategies for cancer chemotherapy and radiotherapy-induced mucositis have not been identified. In 1989, the National Institutes of Health (NIH) published a consensus statement outlining a standardized approach for the prevention and treatment of oral complications. The purpose of this survey was to identify the national treatment practices for oral mucositis, mucocutaneous Herpes simplex virus infections, and oral candidiasis, and to compare them to the NIH guidelines. Surveys were mailed to clinical pharmacists at 200 hospitals throughout the United States. Sixty-two of the 200 questionnaires were completed and returned. Institutions used a diversity of agents, generating substantial variability in mucositis prophylaxis and treatment protocols. Many of these therapies included products or combinations of ingredients that lack proven clinical efficacy. Mucositis management strategies for hospitalized patients vary widely at US hospitals. Coordinated, controlled studies are needed to identify optimal therapies for these patients.

Antineoplastic Agents↗
PubMed1995

Childhood cancer occurrence in relation to power line configurations: a study of potential selection bias in case-control studies.

Several case-control studies have reported positive associations between childhood cancer and proximity to high-current residential power lines as defined by the Wertheimer-Leeper code. We conducted a study to evaluate whether or not differential nonparticipation of controls as a function of socioeconomic status is likely to account for the observed associations. We assessed the relation of annual family income to the Wertheimer-Leeper code in a sample of 392 households in western Washington state, and we evaluated the magnitude of bias that could occur from differential participation of low- and high-income eligible controls. Very-high-current configurations were most frequently located among households with self-reported family income of less than +15,000 per year, and very-low-current configurations were most frequently located among those with self-reported family income of more than +45,000 per year. In a hypothetical case-control study in which: (1) it was assumed that there is no true etiologic relation between power line configurations and cancer occurrence, and (2) controls with very low income were less likely to participate than others, observed (biased) odds ratios ranged from 1.03 to 1.24. If these results are applicable to other areas where case-control studies of cancer in relation to power lines have been conducted, they suggest that relatively lower participation among exposed controls (as a function of very low income) is not likely to account for the elevated risks of 1.5- to 3-fold that have been observed in these previous studies.

Adult↗
PubMed1995

Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies.

To study the relation of maternal periconceptional vitamin use to the risk of a congenital urinary tract anomaly (CUTA), we conducted a case-control study using the Washington State Birth Defect Registry. We identified CUTA cases with no known chromosomal abnormality in seven counties in western Washington State occurring between January 1, 1990, and December 31, 1991. We randomly selected a sample, as controls, of all infants delivered in five large hospitals in King County who did not have a birth defect and who were born in the same year as the cases. About 55% of all infants in King County and a smaller proportion of infants in the other six counties are delivered in these five hospitals. We interviewed mothers of 118 cases and 369 controls to obtain information about their vitamin use during the pregnancy and during the year before the conception. After adjustment for maternal race, family income, county of maternal residence, and birth year, we found that women who used multivitamins during the first trimester had only 15% the risk of bearing a child with a CUTA compared with women who did not take vitamins [odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.05-0.43]. The reduction was smaller for use restricted to the second or third trimesters (OR = 0.31; 95% CI = 0.09-1.02). Among women who used vitamins during the first trimester, vitamin use before conception was not associated with any further reduction in the risk, nor did there appear to be an association with the amount or brand of vitamin used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Electric blanket use during pregnancy in relation to the risk of congenital urinary tract anomalies among women with a history of subfertility.

To study the potential effect of prenatal exposure to electromagnetic fields on the occurrence of cogenital urinary tract anomalies (CUTAs) in offspring, we conducted a case-control study in western Washington State. CUTA cases without known chromosomal abnormalities were identified from the Washington Birth Defects Registry. Controls without birth defects were randomly selected from among infants born in five large hospitals in King County, WA. Mothers of cases and controls were interviewed to obtain information on prenatal use of electric blankets, electrically heated water beds, and video display terminals. After adjustment for potential confounders, the risk of CUTAs was found not to be materially associated with these prenatal exposures among all subjects. Among women with a history of subfertility, however, prenatal use of electric blankets was associated with a more than four-fold increase in the risk of CUTAs [adjusted odds ratio (OR) = 4.4; 95% confidence interval (CI) = 0.9-22.7]. The risk was greater if the exposure occurred during the first trimester (adjusted OR = 10.0; 95% CI = 1.2-85.5). The risk also appeared to increase with increasing duration of electric blanket use. Despite small numbers and the potential for recall bias, our study indicates that identifying a susceptible population may be required for detecting adverse reproductive effects of electromagnetic fields.

Abnormalities, Radiation-Induced↗
PubMed1995

The role of previous birthweight on risk for macrosomia in a subsequent birth.

Macrosomia (birthweight > or = 4,500 gm) is associated with increased perinatal morbidity and mortality. Although past studies have evaluated risk factors for macrosomia, little is known about the effect of a prior macrosomic birth on the risk for a macrosomic infant in a subsequent birth. To assess the risk for delivery of a macrosomic infant subsequent to a previous macrosomic infant, we performed a population-based cohort study utilizing the Washington State linked infant birth file for 1984-1990. We identified 1,793 infants with birthweight > or = 4,500 gm who were linked to a subsequent birth and 3,596 randomly selected infants with birthweight of < 4,500 gm also linked to a subsequent livebirth. We then compared the risks for subsequent macrosomic births between the two groups. Infants with birthweights > or = 4,500 gm were 7.0 times more likely (95% confidence interval = 5.4-9.1) to have a subsequent macrosomic sibling than were infants with smaller birthweights, after controlling for pregnancy smoking status, parity, and gestational age. Race, maternal age or marital status, and diabetes mellitus did not materially affect this relation. The overall prevalence of macrosomic infants subsequent to a previous macrosomic birth was 22%, a proportion that did not vary notably with parity, or when paternity changed between successive births. Mothers with one macrosomic infant are at markedly increased risk for repeat macrosomic births.

Adult↗
PubMed1995

Methodological challenges in injury epidemiology and injury prevention research.

In the past decade there has been increasing attention to the public health importance of injuries. Public health agencies seeking to reduce injuries need methods for counting injuries, calculating injury rates, identifying the causes of injuries, and measuring outcomes of interventions. All of these areas present problems for injury epidemiologists and injury prevention programs. This paper provides a framework for classifying these problems into five categories: (a) numerator problems; (b) denominator problems; (c) causation; (d) exposure measurement problems; and (e) multiplicity. For most problems, we identify proven or potential solutions, using examples from the literature of injury epidemiology.

Causality↗
PubMed1994

Infant injury death in Washington State, 1981 through 1990.

OBJECTIVE: To measure annual rates of infant injury death in Washington State and identify potential risk factors for infant injury death. METHODS: A population-based case-control study using a linked file of birth and death certificates for the years 1981 through 1990. RESULTS: The leading causes of infant injury death, per 100,000 live births, were intentional injury (9.1); suffocation, choking, or hanging (6.9); motor vehicle crashes (4.4); and drowning (3.2). Unintentional injury death rates fell steeply during the 1970s but remained steady during the 1980s. Infanticide rates rose during the 1980s. Young maternal age (odds ratio, 9.0; 95% confidence interval, 4.5 to 17.9, for age < 20 years vs age > 30 years) and higher parity (odds ratio, 5.0; 95% confidence interval, 3.1 to 8.3, for parity of two or more vs parity of zero) were associated with infant injury death. There was a twofold increase in the risk of infant injury death if the mother smoked, was black, or lived in a rural area. Male sex of the infant, late prenatal care, and low income were associated only with intentional deaths, while higher parity was more strongly associated with unintentional injury deaths. CONCLUSIONS: During 1981 through 1990, infant mortality caused by injuries increased in Washington State. Young maternal age and higher parity were strongly associated with infant injury death.

Accidents↗
PubMed1994

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin.

The relative oral bioavailabilities of ciprofloxacin and ofloxacin when they were coadministered with water or an enteral feeding product (Ensure) were assessed in 13 healthy volunteers. The area under the concentration time curve from time zero to infinity and the maximum concentration of drug in serum for both drugs were reduced by Ensure in comparison with those by water (P < 0.01). However, Ensure reduced the percent relative bioavailability of ciprofloxacin (72% +/- 14%; range, 52 to 96%) significantly more than ofloxacin (90% +/- 8.3%; range, 74 to 105%) (P < 0.005). Coadministration of Ensure significantly diminished ciprofloxacin and ofloxacin absorption, but ciprofloxacin absorption was reduced significantly more than ofloxacin absorption.

Administration, Oral↗
PubMed1994

A comparison of metabolic control by continuous and intermittent therapies in acute renal failure.

Azotemia control provided by blood pump-assisted continuous hemofiltration has not been rigorously compared with that provided by intermittent hemodialysis (IHD) for critically ill patients with acute renal failure (ARF). The metabolic control achieved by continuous venovenous hemofiltration (CVVH) and IHD was compared. In ARF patients treated with CVVH (N = 11), the normalized daily dose of therapy was 0.59 +/- 0.23 (mean +/- SD) and the normalized protein catabolic rate was 1.82 +/- 0.95 g/kg per day. The serum urea nitrogen concentration (SUN) declined with CVVH from an initial value of 114 +/- 32 to 79 +/- 17 mg/dL at steady state (SUNs). The initial analysis was a theoretical comparison between CVVH azotemia control and the control that would have been provided by IHD. Simulated IHD data were generated by conventional urea kinetic methods. The peak concentration hypothesis was invoked to compare CVVH SUNs and the peak IHD SUN (SUNp). A simulated IHD frequency of five times or more weekly was required to achieve a SUNp that did not differ from the CVVH SUNs. A similar comparison between the CVVH group and a separate group of ARF patients (N = 11) who received IHD was also performed. In the latter group, the normalized protein catabolic rate and the normalized daily dose of therapy were similar to those of the CVVH group. The SUNp (101 +/- 12 mg/dL) in the IHD group was significantly higher than the mean CVVH SUNs (P < 0.05). These data suggest that intensive hemodialysis is required to provide azotemia control similar to that provided by CVVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1993

Comparison of O6-methylguanine-DNA methyltransferase activity in brain tumors and adjacent normal brain.

We assayed the activity of the DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) in 60 human brain tumors to assess the effects of tumorigenesis in brain on DNA repair capability. Activity was not detectable (< 0.5 fmol/10(6) cells, i.e., < 300 molecules/cells) in 27% of the tumors. Measurable MGMT varied by more than 2 orders of magnitude, 0.5-104.1 fmol/10(6) cells. Mean tumor MGMT levels did not differ between the sexes but did vary widely between diagnostic groups. A significant inverse correlation was observed between tumor MGMT activity and patient age. We also assayed MGMT activity in overlying, histologically tumor-free brain resected with 25 tumors. Of these samples, 52% had no detectable MGMT activity, and the remainder had activity comparable to that in tumors ranging from 0.7-21.8 fmol/10(6) cells. MGMT activity in normal brain was also inversely correlated with patient age. For 15 of 25 (60%) paired samples, tumor activity was 2 to > 38-fold greater than that of normal brain; for 4 pairs (16%) tumor activity was 2.5 to > 17-fold lower than that of normal brain; the remaining 6 (24%) had no detectable activity in both tumor and normal tissue. These differences in the magnitudes and distributions of activities for tumor versus normal brain tissue were significant (P = 0.02), demonstrating that tumorigenesis in brain is often accompanied by marked elevation of MGMT.

Adolescent↗
PubMed1993

The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma.

OBJECTIVE: To determine the effect of acute alcohol intoxication and chronic alcohol abuse on morbidity and mortality from trauma. DESIGN: Prospective cohort study. PATIENTS: Blunt or penetrating trauma patients at least 18 years of age admitted to one trauma center or dying at the injury scene. MAIN OUTCOME MEASURES: Mortality, complications (infection, pneumonia, respiratory failure, or multiple organ failure), and length of hospital stay. RESULTS: Acute intoxication had no effect on risk of dying--at the injury scene, within the first 24 hours of hospitalization, after the first 24 hours, or overall. Acute intoxication also did not increase the risk of complications and was associated with shorter lengths of stay. Patients with both biochemical and behavioral evidence of chronic alcohol abuse had a twofold increased risk of complications, particularly pneumonia and any infection, compared with those with no evidence of chronic alcohol abuse. CONCLUSIONS: Chronic, but not acute, alcohol abuse adversely affects outcome from trauma. Attention to the problem of chronic alcohol abuse in trauma patients is necessary, and screening trauma patients for chronic alcohol abuse appears to be warranted.

Adult↗
PubMed1993

Comparison of imipenem pharmacokinetics in patients with acute or chronic renal failure treated with continuous hemofiltration.

The total clearance of imipenem, a carbapenem antibiotic, is reduced from approximately 230 mL/min in patients with normal renal function to approximately 50 mL/min in patients with chronic renal failure. This decline in clearance results not only from the loss of renal clearance, but also from a reduction in the nonrenal clearance from 130 to 50 mL/min. Current dosing recommendations for the administration of imipenem to patients with acute or chronic renal failure are based on this reduced clearance rate. We investigated the pharmacokinetics of imipenem in critically ill patients with acute or chronic renal failure to determine whether published dosing guidelines were applicable to both patient populations. Imipenem pharmacokinetic parameters were determined in 10 anuric patients with renal failure managed by continuous venovenous hemofiltration (CVVH). Seven patients had acute renal failure, while the other three had preexisting chronic renal failure. Imipenem serum concentration data were incorporated into a first-order, single-compartment pharmacokinetic model. Determinations of the area under the serum concentration-time curve were made by the trapezoidal rule. Dosing regimens were calculated from clearance data to achieve a mid-dose imipenem serum concentration of 12 mg/L. The total clearance of imipenem in patients with acute renal failure (108.3 +/- 13.8 mL/min; mean +/- SD) was significantly greater than the total clearance measured in patients with chronic renal failure (64.4 +/- 10.5 mL/min; P < 0.02). This increased clearance resulted from a greater nonrenal clearance of the drug in patients with acute renal failure (95.0 +/- 13.8 v 51.1 +/- 10.5 mL/min; P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1993

Detection of Chlamydia trachomatis deoxyribonucleic acid in women with tubal infertility.

OBJECTIVE: To determine the presence of Chlamydia trachomatis by in situ hybridization in fallopian tube tissues of women with distal tubal occlusion. PATIENTS: Subjects were selected from a Seattle-based study of infertility in women with distally occluded fallopian tubes undergoing reconstructive surgery. For comparison, six specimens were obtained from women undergoing surgery for noninfertility-related conditions who had normal appearing tubes. METHODS: Tissue specimens from 16 of these patients were selected for analysis by in situ hybridization and immunoperoxidase (IP) staining. RESULTS: C. trachomatis was detected in 9 of 16 women by either in situ hybridization or IP. Six of the nine were seropositive with titers ranging from 1:16 to 1:64. Tissue from 6 women with normal appearing fallopian tubes were negative by in situ hybridization. CONCLUSIONS: The demonstration of C. trachomatis deoxyribonucleic acid and/or antigens in fallopian tube tissue from infertile women with distal tubal disease suggests that C. trachomatis can persist in these tissues in an uncultivable state.

Biopsy↗
PubMed1993

Urokinase plasminogen activator is elevated in human astrocytic gliomas relative to normal adjacent brain.

We assayed urokinase plasminogen activator (uPA), tissue type plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) in 43 human brain tumors (predominantly astrocytic gliomas) and in histologically disease-free brain tissue resected with 21 of the tumors. Levels of uPA, tPA, and PAI-1, measured by enzyme-linked immunosorbent assay, varied widely among individuals in neoplastic and in normal tissue but did not correlate with age or sex. Pairwise comparison of neoplastic and normal tissue from 21 individuals revealed that mean tumor uPA level was elevated 6-fold (P < 0.001). Mean tumor tPA and PAI-1 were 2.5-fold greater than those of normal brain, but these differences were not statistically significant. Tumor uPA was elevated 2- to 30-fold in 16/21 paired samples (76%). In contrast, tumor tPA was elevated 2- to 22-fold in 7/21 (33%) of pairs, whereas tumor PAI-1 was 2- to 13-fold greater in 10/21 (48%) of pairs. Our results demonstrate that elevation of uPA content is frequent in astroglial tumors, as is the case in other major human cancers.

Adolescent↗
PubMed1992

The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury.

The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. Serum alcohol levels were measured from blood drawn in the emergency room, and the subjects were stratified into two groups: intoxicated (> or = 100 mg/dL, n = 191) and nonintoxicated (< 100 mg/dL, n = 329). Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.

Adolescent↗
PubMed1992

Lovastatin-induced rhabdomyolysis in the absence of concomitant drugs.

OBJECTIVE: Presentation of a case of lovastatin-induced rhabdomyolysis in the absence of other medications known to potentiate this adverse effect. METHODOLOGY: Case report. RESULTS: A 60-year-old black man developed rhabdomyolysis after receiving lovastatin for 14 months. Rhabdomyolysis developed in the absence of other medications previously reported to cause this adverse effect when administered concomitantly with lovastatin. Adverse drug reaction causality algorithms categorized this reaction as either possible or probable. CONCLUSIONS: Rhabdomyolysis is an uncommon adverse effect associated with lovastatin therapy. Although reported cases of lovastatin-induced rhabdomyolysis were associated with the coadministration of cyclosporine, erythromycin, gemfibrozil, or nicotinic acid, this adverse effect may occur in the absence of these agents.

Humans↗