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Biomedical subjects

B A Mueller

Publications and source records attributed to B A Mueller.

At least 109 records · Page 6Linked to original sources
PubMed1992

First-year mortality among infants with facial clefts.

Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a child's risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.

Abnormalities, Multiple↗
PubMed1992

Maternal smoking and the risk of polyhydramnios.

BACKGROUND: Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios. METHODS: All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios. RESULTS: Women who reportedly smoked prenatally were found to be at increased risk for polyhydramnios (relative risk [RR] = 1.7, 95% confidence interval [CI] = 1.5-2.1, adjusted for marital status, maternal age, and parity). When women with conditions known to be associated with polyhydramnios were excluded, the risk for those who smoked prenatally remained elevated (RR = 1.8, 95% CI = 1.1-2.3). CONCLUSION: Overdistention of the uterus from polyhydramnios may cause a variety of pregnancy complications. The observed association of smoking with polyhydramnios may be a further indication for public health interventions aimed at preventing smoking during pregnancy.

Adult↗
PubMed1992

Epidemiology of pediatric brain tumors.

Brain tumor research is unlike some other areas of cancer research, in which definite causes have been identified and prevention and treatment strategies may be developed. Primary brain tumors are heterogeneous with respect to several characteristics, and brain tumor research is hampered by this fact, as well as by the small numbers of cases, by the lack of a clearly established and consistently applied histopathologic classification scheme, and by geographical variations in diagnostic capabilities and mechanisms for case reporting. The current movement toward molecular epidemiology has resulted in several changes in the ways we will be able to investigate cancer etiologies in the future, and promises to be especially fruitful in the area of brain tumor research. The search is under way for biologic markers of risk exposures for various cancers, and for laboratory methods to identify those individuals who, because of their genetic qualities, are most likely to have brain tumors. There are probably multiple causes for brain tumors, incorporating both genetic and environmental pathways. Prior research has consistently identified few risk factors for brain tumors, such as ionizing radiation. Thus, collaborative efforts among clinicians, laboratory scientists, and epidemiologists, which make use of molecular epidemiologic methods, are perhaps of greater importance in this field than for cancers arising at other sites.

Brain↗
PubMed1992

A pharmacokinetic and endoscopic comparison of an oral and an experimental buccal piroxicam formulation.

We compared the endoscopic effects and pharmacokinetic profiles of an experimental buccal formulation of piroxicam to oral capsules in an attempt to determine whether nonsteroidal antiinflammatory drug-induced gastropathy is due to a local or systemic effect. Ten healthy subjects received 20 mg piroxicam daily in a double-blind, randomized, crossover, placebo-controlled study. Upper endoscopies were performed at the baseline and at the end of each 2-week dosing arm of the study. Pharmacokinetic data obtained included serum and gastric piroxicam concentrations and serum 5'-hydroxypiroxicam metabolite concentrations after the first dose and 2 weeks of dosing. No differences in endoscopy scores or patient symptom scores were noted between the two dosage forms after 2 weeks of dosing. Pharmacokinetic data of piroxicam and the metabolite revealed that the buccal formulation may not have been absorbed exclusively from the buccal mucosa.

Administration, Buccal↗
PubMed1991

The bleeding time effects of a single dose of aspirin in subjects receiving omega-3 fatty acid dietary supplementation.

Dietary supplementation with omega-3 fatty acids reduces platelet aggregation in subjects who usually eat a diet low in these fatty acids. Aspirin also has an antiplatelet effect. The clinical effects of the concomitant administration of these agents were examined in this double-blind controlled crossover trial. Twelve healthy adults were randomized to supplement their diet for 21 days with 8 g of omega-3 fatty acids or identical-looking olive oil capsules. At the end of each treatment period, bleeding times were obtained before and after the administration of one 325-mg aspirin tablet. Overall, percent change in bleeding time after omega-3 fatty acid supplementation was significantly prolonged compared with olive oil supplementation before aspirin administration but not after. Bleeding times were influenced significantly by the order of randomization in the two treatment groups. Changes in post-aspirin bleeding time varied in subjects after they received olive oil. Post-aspirin bleeding times after omega-3 fatty acid supplementation were prolonged compared with baseline values but not significantly prolonged when compared with those after olive oil administration. The authors concluded that the concomitant administration of a single dose of aspirin does not prolong bleeding time in subjects who eat a diet enriched by omega-3 fatty acids versus a diet enriched by olive oil.

Aspirin↗
PubMed1991

Continuous venovenous hemofiltration: an alternative to continuous arteriovenous hemofiltration and hemodiafiltration in acute renal failure.

Continuous venovenous hemofiltration (CVVH) has been used as an alternative to continuous arteriovenous hemofiltration (CAVH) and hemodiafiltration (CAVHD) in the management of critically ill patients with acute renal failure. This report describes our experience with the first 25 patients treated with CVVH at our institution. Vascular access was obtained through a single dual-lumen venous catheter. A blood pump was used to provide ultrafiltration pressure. An ultrafiltrate pump was incorporated to ensure predictable ultrafiltrate production rates. Safety features in the extracorporeal circuit included a venous drip chamber with bubble detector and an in-line pressure monitor. CVVH was initiated by a nephrologist and dialysis nurse and was maintained by the intensive care unit (ICU) nursing staff. Fifteen females and 10 males received CVVH therapy for a total of 193.5 days (average, 7.7 +/- 10.3 days; range, 0.5 to 48 days). Four of the 25 patients (16%) survived and were discharged from the hospital. Four additional patients (16%) survived the acute phase of their illness, but died from complications of their primary disease before discharge from the hospital. The mean weight change during CVVH was -7.9 +/- 7.0 kg (range, -26.5 to +2.9 kg). Metabolic waste products and electrolytes were adequately controlled by CVVH in all but one hypercatabolic patient. The mean heparin dose required was 6.5 +/- 4.2 U/kg/h and was adjusted to prevent filter clotting rather than to achieve a predetermined activated partial thromboplastin time (PTT). The median PTT was 35.8 seconds (range, 22.0 to 100; control, 19.5 to 29.5 seconds). Four episodes of volume-responsive hypotension occurred during the 193.5 treatment days. Only one patient experienced a hemorrhagic complication during CVVH. No patient experienced a complication related to vascular access. Twelve of 111 total hemofilters were changed because of clot formation. CVVH was well tolerated by patients and managed efficiently by the ICU nursing staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1991

Vancomycin pharmacokinetics in acute renal failure: preservation of nonrenal clearance.

INTRODUCTION: The normal nonrenal clearance of vancomycin is reduced in patients with chronic renal failure (40 versus 6 ml/min). The nonrenal clearance of vancomycin in patients with acute renal failure has not been characterized extensively. PURPOSE: To prospectively determine the pharmacokinetic profile of vancomycin in anuric patients with acute renal failure who are receiving continuous venovenous hemofiltration. METHODS: Vancomycin serum samples were obtained in 10 patients immediately before and 1 and 12 hours after a 1-hour infusion. Thirteen sets of data were obtained. Vancomycin concentration data were incorporated into a first-order, single-compartment model. Determinations for the area under the serum concentration-time curve were made by the trapezoidal rule. RESULTS: Total vancomycin clearance was 28.5 +/- 6.4 ml/min (range, 17.1 to 36.6 ml/min. Hemofilter clearance was either 6.7 or 13.3 ml/min, depending on ultrafiltrate production rate (assuming a sieving coefficient of 0.8). Nonrenal clearance, calculated as total clearance minus hemofilter clearance was 16.2 +/- 7.0 ml/min (range, 3.8 to 23.3 ml/min). Total clearance did not correlate with hemofilter clearance (r = 0.1; p greater than 0.25) but correlated strongly with nonrenal clearance (r = 0.94; p less than 0.0005). Nonrenal clearance decreased significantly as the days on continuous venovenous hemofiltration increased (range, 2 to 14 days; r = 0.68; p less than 0.025). CONCLUSION: Early in the course of acute renal failure there is a substantial preservation of the normal nonrenal clearance of vancomycin. This nonrenal clearance appears to decrease with the duration of renal failure, eventually approaching the clearance observed in patients with chronic failure.

Acute Kidney Injury↗
PubMed1990

Environmental factors and the risk for childhood pedestrian-motor vehicle collision occurrence.

In King County, Washington, during 1985-1986, 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions resulting in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner's Office. Two age- and sex-matched controls were selected for each case, one through random digit dialing and the other from children undergoing appendectomy. Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects. Children living in multifamily dwellings had a risk for injury that was 5.5 times greater than children living in single family homes (95% confidence interval 2.5-12.3). In general, areas with busier streets (greater posted vehicle speeds and/or greater traffic volumes) were associated with increased risk for pedestrian injuries. The lack of pedestrian crossing devices, crosswalks, or sidewalks, however, was not associated with an increased risk. When the analysis was restricted to the 23 cases injured in front of their homes and their controls, risks were not elevated for any of the street or traffic characteristics. The small size of the study and the lack of relevant information for many subjects limited our ability to adjust for the likely confounding influence of other household/environmental factors. Thus, these results should be viewed as suggestions for future investigations of the causes of childhood pedestrian injuries.

Accidents, Traffic↗
PubMed1990

Recreational drug use and the risk of primary infertility.

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.0 to 3.0). The risk was greatest among women who had used marijuana within one year of trying to become pregnant (RR = 2.1, 95% CI = 1.1 to 4.0). No consistent frequency or duration of use effects could be demonstrated, and the risk was confined to low-frequency users. Risks associated with the use of other drugs were not elevated. The risk of infertility from a tubal abnormality associated with cocaine use was greatly increased (RR = 11.1, 95% CI = 1.7 to 70.8). Our results are consistent with animal studies suggesting that smoking marijuana may cause a transient disruption of ovulatory function. The possibility that cocaine exposure influences the development of tubal infertility needs further investigation.

Adult↗
PubMed1990

Impact of college of pharmacy-based educational services within the hospital.

Using a pharmacy intervention form, we measured the influence that university-based pharmacy educational personnel had on the pharmacy department's drug costs and on patient charges over a three-month period. A total of 278 interventions were made; 88.8 percent were implemented. Implemented interventions decreased drug costs by $1661.99 and decreased patient charges by $5938.37. The average implemented intervention decreased drug cost by $6.73 and patient cost by $24.04. Regardless of economic benefits, 218 of the 247 implemented interventions were considered to have positive clinical effects on patient care. Educational personnel were responsible for generating $6028.27 of fee revenues to the pharmacy department through generation of pharmacokinetic drug dosing consults. We conclude that the educational programs provided by the pharmacy department through affiliation with a college of pharmacy directly contributed $7690.26 to the pharmacy department in the form of cost-avoided dollars and revenue generation over a three-month period. The provision of educational services by a hospital pharmacy department results in financial rewards as well as other benefits that have been previously described.

Budgets↗
PubMed1990

Soft tissue calcification in renal failure.

Disorders of phosphorus, calcium, and vitamin D are common in patients with renal failure. Medical management, including dietary phosphorus restriction, administration of phosphate binding agents, and calcium and vitamin D sterol supplementation, must be instituted to control serum concentrations of these substances because of the loss of normal homeostatic mechanisms. If these measures are not employed, soft tissue calcification and hyperparathyroidism may result. We report the case of a 22-year-old woman with endstage renal disease treated with continuous ambulatory peritoneal dialysis who developed secondary hyperparathyroidism and tumorous calcinosis as a result of noncompliance with dietary phosphorus restriction and phosphate-binding agent therapy. The etiology and treatment of soft tissue calcification in patients with renal disease are discussed. Compliance with dietary restrictions and phosphate binding agents is frequently problematic in this population. Pharmacists should play an active role in educating patients with renal disease on the consequences of noncompliance with dietary and drug therapy.

Adult↗
PubMed1989

Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities.

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable. The one preventable death occurred in the emergency department, while the possibly preventable deaths more commonly occurred after 48 hours and were due to central nervous system injury, sepsis, and multiple organ failure. Prolonged prehospital and emergency department time and failure to establish an airway were the most common problems identified as contributing to fatal outcome. The use of explicit criteria was demonstrated to be an effective addition to the analysis of trauma care systems.

Accidents, Traffic↗
PubMed1989

Drug use in trauma victims.

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured. Tests were positive for at least one drug in 40.3% of the ER and 18.7% of the MEO samples. Marijuana was the most commonly detected drug in both groups. Specimens were more likely to be positive in younger persons and in males, and in victims of assaults and traffic accidents. Alcohol was present in the blood in more than one third of ER and MEO samples. Only 39.8% of ER samples and 52.3% of MEO samples were negative for both alcohol and drugs.

Adolescent↗
PubMed1988

Urban-rural location and the risk of dying in a pedestrian-vehicle collision.

Statewide data from two sources were used to compare the pedestrian-vehicle collision injury and fatality rates for urban and rural areas of Washington State from 1981 through 1983. Although the rates of pedestrian injuries are higher in urban areas, the pedestrian fatality rate in rural areas is higher for nearly all age groups, and at all posted speeds. Multiple logistic regression was carried out to measure the risk of dying once involved in a pedestrian-vehicle collision in rural areas compared to the risk for urban areas. This relative risk was seen to be elevated (RR = 2.3; 95% CI = 2.0-2.6) even after controlling for the effects of age and sex of the pedestrian, and posted speed of the vehicle. When explored further it was seen that a larger proportion of fatalities died out of the hospital and within the first hour after injury in rural areas than in urban areas. It is possible that Emergency Medical Services care is less rapidly available and that accessibility to trauma centers is more limited in rural areas.

Accidents, Traffic↗