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Biomedical subjects

B A Mueller

Publications and source records attributed to B A Mueller.

At least 127 records · Page 7Linked to original sources
PubMed1988

Fatal pedestrian injuries to young children: a different pattern of injury.

All pedestrian vehicle collision fatalities to children less than five years of age in Washington State were evaluated for a five-year period using State death certificates, coroners' reports, and police records. Although the majority of pedestrian fatalities to older children have been shown to be due to "dart-outs" into traffic with the child being struck by an oncoming car, pedestrian fatality incident for children less than five tended to occur when the child was backed over in the home driveway by the family van or light truck driven by a parent. Prevention of pedestrian injuries in this age group requires strategies aimed at safeguarding the driveway and reassessing the safety of light trucks and vans as family vehicles.

Accidents, Traffic↗
PubMed1988

Biological mechanisms and cardiovascular effects of omega-3 fatty acids.

The mechanisms and cardiovascular effects of omega-3 fatty acids are reviewed. Omega-3 polyunsaturated fatty acids are the major ingredient found in commercially available fish oil products. The incidence of many diseases, including coronary heart disease, diabetes mellitus, and psoriasis, is lower in Eskimos, who ingest diets rich in omega-3 fatty acids, compared with European controls. Potential mechanisms by which these fatty acids cause their many physiologic effects include competing with omega-6 fatty acids for prostaglandin and leukotriene pathways and enhancing cell membrane fluidity by virtue of the high degree of unsaturation. Numerous studies have documented longer bleeding times and decreased platelet aggregation in subjects ingesting omega-3 fatty acids. Omega-3 fatty acids may reduce serum cholesterol concentrations by decreasing the synthesis of very low density lipoprotein and, therefore, low-density lipoprotein. Blood viscosity is significantly and uniformly lower in subjects receiving omega-3 fatty acids compared with controls. Potential risks of supplementation with fish oils include hypervitaminosis A and D, vitamin E deficiency, increased bleeding times, decreased platelets, and ingestion of contaminated fish. Supplementation with moderate amounts of omega-3 fatty acids appears to be relatively safe. Possible adverse effects include nausea, diarrhea, and a "fishy" taste. Properly controlled, long-term clinical trials are needed to determine whether supplementation with omega-3 fatty acids would be therapeutically beneficial in various patient populations and disease states.

Fatty Acids, Unsaturated↗
PubMed1988

Lack of endogenous crossreactivity with three digitoxin radioimmunoassays in adults with renal insufficiency.

The possibility of interference by apparent digitoxin-like immunoreactive substance (DTLIS) with three radioimmunoassays was studied in patients with renal insufficiency. From each of 25 adult patients with renal insufficiency and 25 age-matched and sex-matched control subjects with normal renal function, a single serum sample was obtained and assayed for digitoxin content by three commercially available radioimmunoassays (GammaCoat, Coat-A-Count, and the Wien assay). Although two of the three assays found measurable concentrations, the difference in apparent digitoxin concentrations between the control subjects and those with renal insufficiency was not significant. Assay interference could not be explained on the basis of differences in age, serum creatinine concentration, or weight. The magnitude of DTLIS interference in relation to the digitoxin therapeutic range appears to be small with the radioimmunoassays used in this study.

Acute Kidney Injury↗
PubMed1987

Tubal pregnancy and the risk of subsequent infertility.

One hundred forty-one women with tubal infertility, all of whom had been pregnant at least once before, were interviewed concerning their reproductive, contraceptive, medical, and sexual histories. Their responses were compared with those of a control group of 467 fertile women. A higher percentage of cases (13%) than controls (1%) had had a tubal pregnancy. From these percentages, we estimate that 92% of tubal infertility in women who have had a tubal pregnancy results from tubal pregnancy itself or factors that predisposed to its occurrence. We also estimate that approximately one-fifth of women who suffer a tubal pregnancy will subsequently be infertile because of a tubal abnormality. After controlling for the joint effects of several known risk factors for tubal pregnancy that independently predispose to infertility (eg, a history of pelvic inflammatory disease), the relative risk of tubal infertility associated with tubal pregnancy was 15.0 (95% confidence interval 5.2-43.6). However, because we had no sensitive indicator of antecedent tubal disease, we were extremely limited in our attempt to determine the extent to which this association was actually due to the consequences of the tubal pregnancy itself.

Adolescent↗
PubMed1987

Factors affecting individual injury experience among petroleum drilling workers.

To identify factors affecting the number of injuries experienced by petroleum drilling workers, we carried out a 44-month incidence density study on a cohort employed in January 1979 on mobile drilling units in the Gulf of Mexico. To control for job-related hazards, we computed a standardized ratio of observed to expected injuries for each worker based on his job history. The effect of personal and work history factors was then examined using analysis of variance. Age, rate of job changes, and rate of rig transfers had independent effects on injury rates. Length of service had little effect when age was controlled. The findings suggest that younger workers under stress such as job change may be more susceptible to injury than older workers, regardless of job. If so, targeted changes in procedures and environment which protect workers of all ages are important alternatives to reliance on supervision and experience in injury reduction.

Accidents, Occupational↗
PubMed1987

Factors associated with pedestrian-vehicle collision injuries and fatalities.

Data from Washington State police records of pedestrian-vehicle collisions were used to tabulate injury and fatality rates for 1981 to 1983 and to investigate event characteristics associated with the occurrence of fatalities. Case-fatality rates are seen to be relatively higher when there is decreased visibility due to fog, lack of lighting or dark color of pedestrian clothing. Fatality rates from death certificate data for the same time period were compared with the police-reported rates. For children younger than 5 years, fewer cases of pedestrian death are reported by police than by death certificate, because a large proportion of fatal injuries (27%) is not traffic related or occurs at home (46%) in the garage or driveway.

Accidents, Traffic↗
PubMed1986

Appendectomy and the risk of tubal infertility.

We studied the importance of a history of appendectomy for appendicitis in 279 women with laparoscopically or surgically diagnosed tubal infertility and a control group of 957 fertile women. After controlling for the effects of age, use of an intrauterine device for contraception, a history of pelvic inflammatory disease, and other potential confounding variables, we found that no excess risk of tubal infertility was associated with a simple appendectomy without rupture. However, when the operation was reportedly for a ruptured appendix, the relative risk of tubal infertility was 4.8 (95 percent confidence interval, 1.5 to 14.9) for women who had never been pregnant and 3.2 (95 percent confidence interval, 1.1 to 9.6) for women with one or more previous pregnancies. We conclude that the early diagnosis and treatment of suspected appendicitis in girls and women of reproductive age may reduce the incidence of tubal infertility resulting from the sequelae of a ruptured appendix.

Adult↗
PubMed1986

Level of response in epidemiologic studies using the card-back system to contact subjects.

Response levels obtained from two methods of patient contact to obtain subject consent for participation in epidemiologic studies were compared. When a signed, return card was required prior to further contact, 70 to 83 per cent of patients consented to participate, compared with consistently higher levels (89 to 93 per cent) obtained with telephone contact. These data suggest that the likelihood of obtaining the high response level required in epidemiologic studies is increased by methods that do not rely on a return card.

Adolescent↗
PubMed1986

Extremity injuries in children: predictive value of clinical findings.

This study sought to identify clinical predictors of extremity fracture in children with trauma. There were 189 children 1 to 15 years of age with 209 extremity injuries seen during a 9-month period. Gross deformity and point tenderness were the best predictors of upper extremity fracture; these two findings correctly identified 81% of children with fractures and 82% of these without fractures. Gross deformity and pain on motion best predicted lower extremity fracture, with 97% of children with fractures correctly identified. The study showed that physical examination is predictive of fractures in extremity injuries of children, regardless of age. In the absence of the specific physical findings identified by the study, the probability of diagnosing a fracture by roentgenographic findings is low.

Adolescent↗
PubMed1986

Changing spectrum of serious child abuse.

To determine whether the spectrum of serious child abuse has changed over the past decade, hospital and medical examiner records in the Seattle area were reviewed for the years 1971 to 1973 and 1981 to 1983. Although the incidence of hospitalized cases was similar in the two time periods (81 v 93), the proportion of severe injuries that occurred increased significantly (from 32% to 54%). The large number of cases in which the perpetrator was unknown makes generalization difficult. However, changes in the sex distribution for known perpetrators suggest that child abuse, especially serious and fatal cases, may be occurring more frequently at the hands of men.

Child↗
PubMedDate not supplied

Adverse birth outcomes among Mexican-Americans: are US-born women at greater risk than Mexico-born women?

OBJECTIVE: We examined adverse birth outcomes among Mexican-Americans to determine the effect of country of maternal birth, a measure of acculturation. DESIGN: We conducted a retrospective cohort analysis of birth outcomes among 4800 Mexico-born and 4800 US-born Mexican-American women using Washington State birth certificate data from 1989 to 1994. Length of residence at current address was used to help refine our measure of acculturation. RESULTS: US-born women had a slightly increased risk of preterm birth relative to Mexico-born women [relative risk (RR) 1.18, 95% confidence interval (CI) 1.04-1.33]. Among Mexico-born women, the risk of preterm birth increased with greater duration of current residence. CONCLUSIONS: US-born Mexican-American women had a slightly increased risk of preterm birth despite having more adequate prenatal care, more education, and higher socioeconomic indicators. This may be due to acculturation factors, such as earlier pregnancy, loss of social support systems, and increased smoking or alcohol use. Reducing this risk depends on recognition among health care workers and policy-makers of the potential influence of acculturation on health in this population.

Acculturation↗
PubMedDate not supplied

Urea kinetics during continuous hemofiltration.

Urea kinetic analysis allows for the calculation of the urea distribution volume and urea generation rate. This method was employed in patients with acute renal failure managed by continuous venovenous hemofiltration (CVVH). Based on serial serum urea nitrogen concentration measurements, each patient's treatment course consisted of both steady state and non-steady state periods. Thirteen data sets were obtained from 11 critically ill patients treated with CVVH. The duration of therapy was 9.5 +/- 7.5 days (mean +/- SD). Serum urea nitrogen concentration fell from 114 +/- 32 mg/dl to a steady state value of 79 +/- 17 mg/dl (p < 0.0005). The urea distribution volume was 0.55 +/- 0.11 L/kg (range 0.29-0.73), and the urea generation rate 11.7 +/- 3.1 mg urea N/min (range 7.1-17.3). The steady state serum urea nitrogen concentration had a linear relationship to the rate of urea generation (r = 0.92). Urea kinetic analysis permitted the simultaneous determination of the urea generation rate and distribution volume, on an individualized basis, in patients with acute renal failure treated with CVVH.

Acute Kidney Injury↗
PubMedDate not supplied

Use of an in-house-built ribavirin aerosol evacuation system to control incidental employee exposure to ribavirin aerosol.

Ongoing controversy regarding the hazards of exposure of healthcare workers to ribavirin aerosol led to the design and evaluation of a ribavirin aerosol evacuation system that scavenges the excess ribavirin. An oxyhood was placed within a croupette oxygen and cool mist tent. The tent was placed under negative pressure, using the hospital wall suction. Air samples were taken to determine ambient air concentrations and patient exposure concentrations and were compared to airborne ribavirin concentrations that occurred during administration of ribavirin without an evacuation system. The ribavirin evacuation system reduced ribavirin ambient air concentrations from 54 ug/m3 (mean) to 11 ug/m3 (mean) without reducing patient exposure concentrations. The results suggest that the system evaluated is an efficient and inexpensive means of reducing incidental employee exposure to ribavirin aerosol.

Aerosols↗
PubMedDate not supplied

Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease.

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained. Logistic regression was used to compute the relative risks for silent and overt PID-related tubal dysfunction associated with various lifestyle and contraceptive habits in an effort to identify practices that potentially affect these outcomes. In general, practices associated with an increased risk of overt tubal disease, such as use of Dalkon Shield and other types of intrauterine devices, were also associated with an increased risk of silent tubal disease, but to a lesser extent. Women who used oral contraceptives for longer than three years had a decreased risk for silent disease (relative risk = 0.5, 95% confidence interval = 0.3-0.8), but their risk for overt disease did not decrease to the same extent (relative risk = 0.9, 95% confidence interval = 0.3-2.5). These results suggest that silent and overt tubal disease share many common lifestyle risk factors.

Adult↗
PubMedDate not supplied

Impact of the nutritional regimen on protein catabolism and nitrogen balance in patients with acute renal failure.

BACKGROUND: Patients with acute renal failure are in substantial negative nitrogen balance as a result of their extremely high protein catabolic rates. We prospectively evaluated a series of patients with acute renal failure managed with continuous venovenous hemofiltration to determine which nutritional and nonnutritional variables might influence protein catabolism and nitrogen balance. METHODS: Forty consecutive patients (aged 52 +/- 20 years; mean +/- SD) were monitored for 357 treatment days (average treatment duration 8.9 +/- 8.6 days). All data (including nutritional regimen, laboratory values, APACHE II score, administered blood products, hemofiltration parameters, and medications) were collected daily. RESULTS: For all patients, the mean normalized protein catabolic rate was 1.4 +/- 0.5 g/kg per day. The rate did not differ between those who received nutrition support and those who did not. The net nitrogen deficit was less in those patients receiving nutrition support (-6.0 +/- 5.2 vs -14.0 +/- 5.6 g N/d; p = .02). Using regression techniques (adjusted for the within-person correlation and the previous day's normalized protein catabolic rate), the level of protein and energy provision and the interaction between protein and energy provision were predictive of the normalized protein catabolic rate. Predicted values, using this equation, suggest that at low protein administration rates (< 1 g/kg per day), increasing energy provision may reduce the protein catabolism. However, at this level of protein provision, patients remain in negative nitrogen balance. At protein administration rates necessary to achieve nitrogen balance (approximately 1.5 to 1.8 g/kg per day), protein catabolism may increase. Providing relatively low levels of energy may diminish the magnitude of this increase. CONCLUSION: These results suggest that the optimal nutritional regimen for patients with acute renal failure may require a high-protein (approximately 1.5 to 1.8 g/kg per day) and a relatively low-energy (approximately 25 to 35 kcal/kg per day) content.

Acute Kidney Injury↗
PubMedDate not supplied

Ciprofloxacin penetration into human breast milk: a case report.

The concentration of ciprofloxacin achieved in human breast milk following oral administration of a single 500-mg dose was investigated. A 24-year-old white woman, 17 days postpartum, was being treated for resolving acute renal failure. Oral ciprofloxacin was prescribed for a suspected urinary tract infection. Due to suspected pediatric toxicity and a lack of published information describing ciprofloxacin excretion in breast milk, the antibiotic was discontinued after one 500-mg dose. All breast milk was collected at four-hour intervals and was tested for the presence of ciprofloxacin by bioassay. Ciprofloxacin breast milk concentrations were 9.1, 9.1, 9.1, and 6.0 mumol/L at 4, 8, 12, and 16 hours postdose, respectively. These ciprofloxacin concentrations were similar to other published body fluid concentrations following a single oral 500-mg dose.

Acute Kidney Injury↗
PubMedDate not supplied

Small and middle molecular weight solute clearance in nocturnal intermittent peritoneal dialysis.

OBJECTIVES: To determine the dialysate-to-plasma (D/P) concentration ratios and peritoneal dialytic clearance (CI(D)) of substances with a wide range of molecular weights in subjects receiving a simulated nocturnal intermittent peritoneal dialysis (NIPD) session. DESIGN: Open-label single-dose study. SUBJECTS: Six end-stage renal disease patients undergoing peritoneal dialysis (PD). SETTING: Clinical research center of a university-affiliated hospital. INTERVENTIONS: Subjects received intravenous gentamicin and vancomycin on the first day of the study. Subjects received no PD until their return on the following day, when subjects underwent a simulated NIPD session utilizing four 2- to 2.5-L peritoneal dialysate dwells of 2 hours. Blood and dialysate samples were collected immediately before the session and after each dialysate dwell for determination of urea, creatinine, gentamicin, vancomycin, and beta2-microglobulin (beta2M) concentrations. Each solute's D/P concentration ratio and peritoneal CI(D) were calculated. MEASUREMENTS AND MAIN RESULTS: The (mean +/- SD) 2-hour D/P concentration ratios were 0.78 +/- 0.05 (urea), 0.49 +/- 0.11 (creatinine), 0.38 +/- 0.08 (gentamicin), 0.11 +/- 0.06 (vancomycin), and 0.07 +/- 0.03 (beta2M). Peritoneal CI(D) values (mL/min of dialysis) were 19.0 +/- 2.8 (urea), 12.1 +/- 3.5 (creatinine), 8.4 +/- 2.8 (gentamicin), 2.7 +/- 1.5 (vancomycin), and 1.7 +/- 0.8 (beta2M). The D/P concentration ratios and peritoneal CI(D) values for urea, creatinine, and gentamicin were significantly different from vancomycin and beta2M (repeated measures ANOVA, p < 0.05). Beta2-microglobulin peritoneal CI(D) was strongly related to gentamicin peritoneal CI(D) (r = 0.96, p < 0.05). CONCLUSION: Small molecular weight solutes have significantly greater D/P and peritoneal CI(D) than middle molecular weight solutes in NIPD. In NIPD, daily peritoneal CI(D) of beta2M is lower than that reported in continuous ambulatory PD. NIPD also results in lower drug CI(D) than that reported in continuous ambulatory PD studies.

Adult↗