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Biomedical subjects

D C Martin

Publications and source records attributed to D C Martin.

At least 145 records · Page 8Linked to original sources
PubMed1987

A controlled study of survival with dementia.

Widely conflicting data exist regarding the relationship of dementia to mortality and the relative risk of senile dementia of the Alzheimer type vs multi-infarct dementia with respect to mortality. In a historic prospective study, 202 patients with dementia were matched by age and sex with 202 nondemented controls attending the same geriatric assessment clinic and receiving comparable medical and psychiatric care. The three-year survival rate was 70% for patients with dementia and 84% for controls. Patients with multi-infarct dementia survived more poorly than patients with senile dementia of the Alzheimer type, but the difference did not reach statistical significance. The relative risk associated with dementia in the context of a multivariate analysis was 1.92 (95% confidence [1.25, 2.97]). We conclude that dementia carries a significantly increased risk of mortality but that the survival of patients with dementia may be better than previous reports would suggest.

Aged↗
PubMed1987

Facial effects of fetal alcohol exposure: assessment by photographs and morphometric analysis.

This study was designed to assess the limits of alcohol-related facial dysmorphogenesis. Standard full face and lateral facial photographs were obtained on 21 7-year-old children who had been exposed gestationally to known, heavy quantities of ethanol. Only two of these children had been previously considered to have definite fetal alcohol syndrome (FAS). Similar photographs of 21 other 7-year-old children with negligible gestational ethanol exposure were obtained for control purposes. Copies of the 42 photographs were given to each of seven expert clinicians who were asked to select any child with an FAS-related facial appearance. Six of seven judges were accurate in identifying children with high levels of alcohol exposure as having a fetal alcohol-affected face. A set of homologous points on the photographs were then digitized and analyzed by newly developed morphometric methods to determine the facial shape characteristics that distinguish the selected photographs of highly exposed children. The analysis confirmed that the judges specifically identified children with facial changes consistent with those previously published as defining the face of the FAS: short palpebral fissures, a relatively long and flat midface, and a retrusive mandible. This methodology may be useful in more accurately delineating the facial phenotype in other conditions diagnosed primarily on the basis of subjective clinical criteria.

Anthropometry↗
PubMed1987

Two-dimensional immunoelectrophoretic analysis of urinary ultraconcentrates: antigenic differences between bladder cancer positive patients, normal individuals, and patients with urinary tract infections.

Urine ultraconcentrates (100-fold) from bladder cancer patients, patients suffering from urinary tract infection, and normal individuals were analyzed using polyacrylamide gel electrophoresis (PAGE) and two-dimensional immunoelectrophoresis. A combined sample of normal urine was resolved into 1 to 3 protein bands by PAGE, whereas a single concentrated bladder cancer urine was resolved into 10-12 protein bands. Yet, this same concentrated urine sample was resolved into 17-20 antigen peaks by two-dimensional immunoelectrophoresis (2DIEP) against antihuman serum. A significant (P less than 0.05) increase was observed in the relative antigen concentration when comparing 2DIEP profiles of bladder cancer urines to normal controls. A significant increase in the relative antigen concentration and the number of antigen peaks was also found when comparing immunoelectrophoretic patterns obtained from ultraconcentrated urine specimens of bladder cancer positive urine and normal controls using a rabbit antibladder cancer urine antisera (P less than 0.002 and P less than 0.02, respectively). In addition, significant (P less than 0.02) antigenic differences were found when comparing concentrated urine samples from bladder cancer positive individuals to those with urinary tract infection. The bladder cancer group demonstrated 8/9 positive results for relative antigen concentrations greater than 3.0. Fifteen of 16 normal or urinary tract infected individuals combined had relative antigen concentrations less than 3.0. These differences were highly significant (P less than 0.001). No differences were found between concentrated bladder cancer and normal urine specimens tested against rabbit antinormal urine antisera.

Antigens↗
PubMed1987

Laparoscopic assessment of ovarian healing following CO2 laser microsurgery: Vicryl vs. Surgilon.

A prospective multicenter study was undertaken by the Intraabdominal Laser Study Group to assess the type and extent of ovarian adhesions formed following incisional ovarian surgery performed as part of a fertility-promoting procedure with the aid of the carbon dioxide laser. Ovarian healing with subsequent adhesion formation was evaluated by early second-look laparoscopy. Two suture closing materials were used--Surgilon (siliconized braided nylon, David and Geck, Wayne, NJ) and Vicryl (polyglactin 910, Ethicon, Somerville, NJ). Sixty-five ovaries were evaluated in 37 patients with subsequent adhesions found in 37% (18/49) of the Surgilon-closed ovaries and in 94% (15/16) of the Vicryl-closed ovaries. The adhesions were filmy in 83% (15/18) of the Surgilon group and 47% (7/15) of the Vicryl group. Dense/vascular adhesions were found in 17% (3/18) of the Surgilon group and 53% (8/15) of the Vicryl group. The subsequent conception rates were 68% (17/25) in the Surgilon group and 33% (4/12) in the Vicryl group, although the small number of patients and multitude of infertility factors made pregnancy rate comparisons difficult. One of the authors noted lack of tensile strength in the Vicryl-closed ovaries within 12 weeks postlaser laparotomy, which led to incisional dehiscence during laparoscopic lysis of ovarian adhesions. From this preliminary study, it is concluded that additional data are needed to more fully resolve the debate on whether absorbable or nonabsorbable suture is preferred for ovarian infertility surgery.

Female↗
PubMed1987

Aspirin and acetaminophen use by pregnant women and subsequent child IQ and attention decrements.

In a longitudinal prospective study of 1,529 women pregnant in 1974-1975, aspirin and acetaminophen were the two medications most frequently taken during the first half of pregnancy (46 and 41%, respectively). In a selected cohort of 421 offspring of these women, examined at 4 years of age, maternal aspirin use during the first half of pregnancy was significantly related to IQ and attention decrements in the exposed children. Multiple regression analyses were used to statistically adjust for a variety of potentially confounding factors including demographic characteristics, child characteristics, other exposures, and lifestyle/environmental variables. Continuous dose-response and step-function parameterizations of aspirin exposure were both statistically significant and not clearly distinguishable from each other. The estimated aspirin effect is significantly greater for girls than boys. Aspirin effects on offspring function were found in the absence of effects on physical size both at birth and at 4 years. Maternal acetaminophen use was not significantly related to child IQ or attention. As this exploratory research originated from observations of a data set gathered for other purposes, it would be desirable to have these findings replicated in other studies. Further follow-up of the children at a later age is planned.

Acetaminophen↗
PubMed1987

Hypomagnesemia and renal magnesium wasting in renal transplant recipients receiving cyclosporine.

Following the adoption and use of cyclosporine as the drug of choice in the management of renal allograft recipients, several cases of symptomatic hypomagnesemia were noted. These observations prompted the current prospective study of serum concentration and urinary excretion of magnesium in 27 renal transplant recipients treated with cyclosporine and prednisone. Relevant laboratory measurements were obtained shortly before and regularly after transplantation. The results were compared with those obtained in a group of 17 allograft recipients treated with azathioprine and prednisone. The cyclosporine-treated patients showed a significant reduction in the serum magnesium concentration and an inappropriately increased urinary excretion and fractional excretion of magnesium, suggesting renal magnesium wasting. The observed hypomagnesemia required magnesium supplementation in nearly all cyclosporine-treated patients. In contrast, azathioprine-treated patients showed normal serum magnesium concentrations and required no magnesium supplementation. In conclusion, administration of cyclosporine in renal allograft recipients appears to be commonly associated with renal magnesium wasting and hypomagnesemia. Therefore, it is recommended that serum levels of magnesium be monitored regularly in renal allograft recipients receiving cyclosporine and that magnesium supplementation be employed as needed to avoid magnesium depletion.

Adult↗
PubMed1987

Growth and activity but not maturation are affected by perinatal diet.

Growth, maturation and activity in Sprague-Dawley rat offspring were studied as a function of two diets which were offered both pre- and postnatally. Day 1 gravid rats were placed ad lib on either Purina chow or Ensure, a total liquid diet. Half of each group was switched to the other diet on day 21 of gestation and maintained on it through weaning. Offspring remained on the same diet until sacrificed on postnatal day 60. Seven developmental measures were assessed daily until all of the animals reached criterion. The type of diet significantly affected maternal weight gain during the second third of gestation, and neonatal weight gain as measured on days 7, 14, 21, 28 and 45. Females were affected more than were male littermates. Males were significantly heavier than female littermates at all postnatal weighings. Diet had little or no effect on the developmental measures. Male/female differences were found for voluntary activity in the wheel which was measured on day 45. The use of liquid diets in behavioral teratology studies and the wisdom of using pellet diets as a control are discussed. The possibility of substituting careful measures of growth as an alternative to developmental testing is discussed.

Animal Nutritional Physiological Phenomena↗
PubMed1987

Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery.

At second-look laparoscopy, 82 of 161 women (51%) were noted to have adhesions at at least one new location. Such adhesions occurred at 31% of available sites. Among 121 women with adhesions at the initial operative procedure, the rate and type of recurrence assessed on the ovaries, fimbriae, and other sites were independent of the initial type. Additionally, neither the rate nor the type of adhesion recurrence observed at the time of second-look laparotomy was determined by the variable amount of time between the initial and second-look operative procedures. We conclude that reproductive pelvic surgical procedures are frequently complicated not only by adhesion reformation but by de novo adhesion formation as well.

Female↗
PubMed1987

Treatment of endometriosis-associated infertility with CO2 laser laparoscopy: the use of one- and two-parameter exponential models.

Laparoscopic vaporization with the carbon dioxide laser has become a popular treatment modality for endometriosis-associated infertility, yet little data exist regarding the efficacy of such an approach. The authors have applied sophisticated modeling techniques to pregnancy rates in 129 endometriosis patients following laser laparoscopy. Patients were identified for stage of disease, danazol usage before and after surgery, and identifiable infertility factors. Fertility rates were analyzed with monthly fecundity rates and a two-parameter exponential model. Results indicate monthly fecundity rates comparable to other forms of therapy for stage I and stage II endometriosis, but substantially higher than more traditional modalities for stage III disease. The two-parameter model revealed "cure" rates comparable or lower than with major conservative surgery or danazol therapy, but a "monthly" probability of pregnancy" substantially higher than with other treatments. These results indicate that, in experienced hands, laser laparoscopic vaporization of endometriosis is as efficacious as other published forms of therapy, including use in moderate and severe disease. In addition, these results suggest an immediate, transient effect upon the patient with endometriosis-associated infertility.

Actuarial Analysis↗
PubMed1987

Excisional techniques for endometriosis with the CO2 laser laparoscope.

Laparoscopic excisional techniques, used for endometriosis on 319 of 495 patients during the years 1982-1986 at Baptist Memorial Hospital, Memphis, significantly increased the percentage of confirmation per patient. That percentage for all patients rose from 8 in 1982 to 97 in 1986. A significant increase occurred also in confirmation for patients with specimens submitted--from 62% in 1982 to 97% in 1986. At the same time, tissue confirmation also increased the documentation of the appearance of endometriosis. Pink, red, white, black and clear lesions were proven to be endometriosis. In addition, psammoma bodies, hemangiomas, old suture material, hemorrhages around old suture material, carcinoma and ectopic pregnancy, all of which had some characteristics of endometriosis, were shown not to be that disease. There were no complications related to the excisional techniques.

Endometriosis↗
PubMed1987

Extensive prolongation of rat renal allograft survival following donor or nonspecific transfusions and concomitant immunosuppressant.

We report here a marked beneficial effect upon rat renal allograft survival transplanted across a strong histocompatibility barrier (BN----LEW) by pretransplant concomitant donor-strain blood transfusion (DST) and CsA treatment. Comparisons between recipient groups treated with pretransplant nonspecific blood (NST) and concomitant cyclosporine (CsA) or azathioprine (Aza) administration were also made. LEW recipients receiving only a BN renal allograft survived for a geometric average time of 8.9 days. Recipients receiving 1 ml of donor blood at weekly intervals, each week for three weeks prior to transplantation, demonstrated a geometric mean survival time (GMST) of 40.5 days. Recipients receiving this same regimen and concurrent CsA cover (5 mg/kg/day) starting 7 days prior to the first transfusion with discontinuation 5 days prior to transplantation showed extensive prolongation (greater than 100 days). Recipients treated with only CsA cover survived for a GMST of 34.4 days. LEW recipients receiving 1 ml of nonspecific blood at weekly intervals (DA, BUF, WKY, respectively) each week for 3 weeks prior to transplantation were prolonged to 27.7 days. Recipients treated with this same regimen while under CsA cover also demonstrated extended prolongation (greater than 100 days). Recipients receiving multiple donor blood transfusions under Aza (2 mg/kg/day) cover demonstrated lesser prolongation (22.8 days). Recipients receiving the multiple nonspecific blood protocol under Aza cover showed similar prolongation (38.6 days). Recipients treated only with Aza did not show prolonged survival (9.3 days). These differences in survival were considered significant among the 9 transplant groups as determined by ANOVA (P less than 0.001). The majority of recipient groups showed relatively poor renal function over their life spans, independent of whether prolongation occurred. Yet, renal function in the NST or particularly the DST groups covered by pretransplant CsA, demonstrated the best renal function in our laboratory over many years of investigations using the BN----LEW combination. In conclusion, there was a dramatic synergistic beneficial effect of prior multiple DST or NST specific to CsA, as opposed to another immunopharmacologic agent, Aza.

Animals↗
PubMed1987

Clinical prediction rules for computed tomographic scanning in senile dementia.

The role of computed tomography (CT) of the head in evaluating patients with dementing illnesses remains a controversial issue. Several prediction rules to guide the selective application of CT in the evaluation of dementia have recently been proposed in the medical literature. The present authors examine the value of four such rules through a validation study performed in an outpatient geriatric assessment unit. The rules were assessed in terms of their diagnostic sensitivities, specificities, misclassification rates, and information contents. Prediction rule sensitivities ranged from 12.5% to 87.5%, specificities from 37.2% to 77.9%, and misclassification rates from 23.5% to 60.8%. Of the four prediction rules examined, one emerged as significantly more sensitive than the others, and also served to reduce diagnostic uncertainty a full order of magnitude more than the others, as determined by an information content analysis. Disadvantages to this rule, however, were found in its more complex nature and the assessment of a very high rate of misclassification. Through a critique of existing strategies, this study purports to determine the potential for establishing a useful clinical prediction rule to guide selective CT scanning in the diagnostic evaluation of dementia.

Aged↗
PubMed1986

Use of bupivacaine as block to relieve postoperative pain in pediatric orchiopexy and hernia repair.

Bupivacaine was utilized for postoperative analgesia in patients undergoing orchiopexy and hernia repair. In a study of 75 pediatric patients, ranging in ages from twelve months to twelve years, who had undergone orchiopexy and hernia repair during a three-year period, 42 received bupivacaine hydrochloride as a local infiltration block anesthesia to relieve postoperative pain; 33 patients did not receive bupivacaine. Patients receiving bupivacaine had less postoperative pain and were more comfortable when leaving the hospital within a few hours after surgery.

Bupivacaine↗