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Biomedical subjects

D O Hodge

Publications and source records attributed to D O Hodge.

At least 73 records · Page 4Linked to original sources
PubMed1998

Effect of intraocular lens design on neodymium:YAG laser capsulotomy rates.

PURPOSE: To compare the effect of 2 poly(methyl methacrylate) (PMMA), 1-piece biconvex intraocular lens (IOL) designs on the cumulative frequency of neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthamology, Mayo Clinic, Rochester, Minnesota, USA. METHODS: This retrospective study evaluated 369 eyes that had phacoemulsification with continuous curvilinear capsulorhexis (CCC) and IOL implantation in the capsular bag. Patients were placed in 1 of 2 groups based on the 1-piece, biconvex PMMA IOL design: large IOL, with a lens diameter of 13.50 to 13.75 mm, optic size of 6.5 mm, and 10 degree haptic angulation; small capsular IOL, with a lens diameter of 12.0 to 12.5 mm, optic size of 5.5 mm, and 2 degree haptic angulation. RESULTS: Using Kaplan-Meier analysis, the frequency of Nd:YAG laser posterior capsulotomy 1, 2, and 3 years after cataract surgery was 1.6, 12.3, and 26.5%, respectively, in the large IOL group and 3.4, 9.5, and 23.5%, respectively, in the small capsular IOL group. The cumulative frequency of Nd:YAG laser capsulotomy was not statistically different between the 2 groups. CONCLUSION: After phacoemulsification and CCC, there was no significant difference in the Nd:YAG laser capsulotomy rate in eyes with a small, capsular design, 1-piece, biconvex PMMA IOL and those with a larger, angulated, 1-piece, biconvex PMMA IOL.

Adolescent↗
PubMed1998

Intravenous adenosine and lidocaine in patients with acute myocardial infarction.

OBJECTIVES: A pilot study was designed to assess the safety of combined intravenous adenosine and lidocaine in patients with acute myocardial infarction and to estimate the likelihood of a beneficial effect on final infarct size. BACKGROUND: Adenosine plus lidocaine reduces infarct size in animals, but the safety and efficacy in human beings is unknown. METHODS AND RESULTS: Adenosine (70 microg/kg per minute intravenous infusion) plus lidocaine (1 mg/kg intravenous bolus injection and 2 mg/kg per minute infusion) was given to 45 patients with acute myocardial infarction. Patients underwent immediate balloon angioplasty without preceding thrombolytic therapy. Myocardial perfusion defects were measured with serial technetium 99m sestamibi studies. One patient developed persisting hypotension in conjunction with a large inferolateral myocardial infarction. Transient hypotension in three other patients resolved with a reduction in adenosine. Advanced atrioventricular block was never observed. Other adverse events (including atrial fibrillation, ventricular tachyarrhythmia, bradycardia, and respiratory distress) occurred at low frequencies, as expected for patients with acute myocardial infarction. An initial median perfusion defect of 45% of the left ventricle (60% for anterior infarction, 17% for nonanterior infarction) was observed. At hospital discharge (mean +/- SD = 4.3 +/- 2.1 days) the median value was 12%, and at 8 +/- 4 weeks it was 3% (7% for anterior infarction, 0% for nonanterior infarction); 14 patients had no measurable follow-up. Compared with historical control patients, prehospital discharge measurements were not different but late perfusion defects were improved. CONCLUSIONS: Treatment with intravenous adenosine and lidocaine during acute myocardial infarction has sufficient safety and potential for improved myocardial salvage. Randomized studies are justified.

Adenosine↗
PubMed1998

Effect of dorzolamide on corneal endothelial function in normal human eyes.

PURPOSE: To assess the effects of dorzolamide hydrochloride, a topical carbonic anhydrase inhibitor, on corneal endothelial function. METHODS: The authors measured the rate of corneal deswelling and the endothelial permeability to fluorescein after 2 hours of hypoxic contact lens wear in 19 normal human subjects. The study was double-masked; one eye of each subject was randomly assigned to receive 2% dorzolamide drops, and the other eye received placebo drops every 8 hours for 24 hours before the study day and twice during the study day. RESULTS: Dorzolamide-treated eyes were not significantly different from placebo-treated eyes in corneal deswelling rate, expressed as the percent recovery per hour (55.7% +/- 13.6% versus 59.6% +/- 14.5%; P > or = 0.10), open eye steady state thickness, swelling induced by hypoxia, and corneal autofluorescence. Endothelial permeability to fluorescein was increased in the dorzolamide eyes (4.40 +/- 0.84 x 10(-4) cm/minute versus 4.10 +/- 0.80 x 10(-4) cm/minute; P = 0.01). As expected, the intraocular pressure and aqueous humor flow rate were decreased in the dorzolamide eyes. CONCLUSIONS: Dorzolamide hydrochloride, when topically administered to normal human eyes for 24 hours, had no significant effect on the corneal deswelling rate after hypoxic stress. The corneal endothelial permeability to fluorescein, however, was increased by the drug, although this did not result in increased corneal thickness.

Adult↗
PubMed1997

Predictive value of electrophoretically detected lipoprotein(a) for coronary heart disease and cerebrovascular disease in a community-based cohort of 9936 men and women.

BACKGROUND: Elevated lipoprotein(a) [Lp(a)] levels have been associated with the presence of atherosclerotic disease. However, the results of prospective studies of Lp(a) and cardiovascular disease have been contradictory. METHODS AND RESULTS: From 1968 through 1982, lipoprotein analysis was performed in 11,335 Olmsted County residents. Quantitative cholesterol and triglycerides were obtained along with semiquantitative Lp(a) levels based on electrophoretic pattern. Lp(a) bands were scored from 0 (absent) to 3 (increased). A cohort of 4967 men and 4968 women with no prior history of atherosclerotic disease who had baseline Lp(a) determinations were followed up for 14 years for development of coronary artery disease (CAD) and cerebrovascular disease (CVD). During 131,330 person-years of follow-up, there were 1848 CAD events and 841 CVD events. Age, diabetes, hypertension, cholesterol, and triglycerides were significantly and independently associated with an increased risk of CAD and CVD in men and women. There was a significant increase in the adjusted hazards ratio for CAD with increasing Lp(a) levels for men and women. For Lp(a) level 3, the hazard ratio was 1.9 (range, 1.3 to 2.9) in women and 1.6 (range, 1.0 to 2.5) in men. The adjusted hazard ratio for CVD showed an irregular association with Lp(a) levels in men and no association in women. CONCLUSIONS: In this cohort of 9936 men and women initially free of cardiovascular disease who were followed up for 14 years, Lp(a) was a significant predictor of risk of future CAD. Lp(a) was a weak risk factor for CVD in men and was not a significant predictor of CVD risk in women.

Adult↗
PubMed1997

Concordance of Medicare data and population-based clinical data on cataract surgery utilization in Olmsted County, Minnesota.

The authors assessed concordance of local Medicare health care utilization data on cataract surgery and estimates generated using the databases of the Rochester Epidemiology Project, which capture virtually all medical care received by residents of Olmsted County, Minnesota. The Rochester Project databases identified 1,353 primary cataract extractions performed in Olmsted County between October 1989 and December 1993 among county residents aged > or = 65 years. Medicare data identified 1,148 claims-84.8% of the number of procedures identified by the Rochester Project. Ratios of numbers of encounters (Medicare/Rochester Project) were 189/350 (0.540) for 1992 versus 959/1,003 (0.956) for the other years combined. Changes in Medicare data file transfer procedures may have produced the 1992 data shortfall. Medicare data should periodically be compared with source data to assess concordance.

Aged↗
PubMed1997

Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators.

BACKGROUND: Aortic valve replacement for aortic stenosis (AS) carries an increased risk in the presence of left ventricular (LV) systolic dysfunction. Few data are available on the outcome of such patients. METHODS AND RESULTS: Between 1985 and 1992, 154 consecutive patients (107 men and 47 women) with LV systolic dysfunction (ejection fraction [EF] < or = 35%) underwent aortic valve replacement for AS. The mean preoperative characteristics included EF, 27 +/- 6%; aortic valve mean gradient, 44 +/- 18 mm Hg; aortic valve area, 0.6 +/- 0.2 cm2; and cardiac output, 4.1 +/- 1.5 L/min. Simultaneous coronary artery bypass graft surgery was performed in 78 patients (51%). Perioperative (30-day) mortality was 9% (14 of 154 patients). Fifty patients died during follow-up. Coronary artery disease (P = .002) and a reduced preoperative cardiac output (P = .03) were significantly related to reduced overall survival rate by multivariate analysis. Postoperative improvement occurred in most patients; 88% were New York Heart Association class III or IV before surgery versus 7% after surgery. Postoperative EF was assessed in 76% of survivors; 76% of these demonstrated improvement. By multivariate analysis, change in EF was inversely related to coronary disease (P = .002) and preoperative aortic valve area (P = .03). CONCLUSIONS: Despite LV dysfunction, the risk of aortic valve replacement for AS was acceptable and related to coronary artery disease and mean aortic gradient, and long-term survival was related to coronary disease and cardiac output. Improvement in symptoms and EF occurred in most patients.

Adult↗
PubMed1997

The contralateral corneal endothelium in the iridocorneal endothelial syndrome.

OBJECTIVE: To evaluate the corneal endothelial morphometric measures of the contralateral, clinically uninvolved eye of patients with the iridocorneal endothelial (ICE) syndrome. DESIGN: A retrospective review of the specular microscopic photographs of the contralateral corneal endothelium of all patients with ICE syndrome seen at Mayo Clinic, Rochester, Minn. SETTING: Ophthalmology department, Mayo Clinic. PARTICIPANTS: Twenty-eight patients with unilateral ICE syndrome who had bilateral endothelial photographs (ICE group) and 28 normal, age-matched control subjects (control group). MAIN OUTCOME MEASURES: Percentage of hexagonal cells, coefficient of variation of cell area, and endothelial cell density. METHODS: For each patient and control, 100 endothelial cells were digitized from projected endothelial photomicrographs of the central corneas in the uninvolved eyes. RESULTS: A statistically significant decrease was noted in the mean percentage of hexagonal cells (ICE, 62%; control, 69%; P = .002), and an increase was noted in the mean coefficient of variation of cell area (ICE, 0.28; control, 0.25; P = .02) in the patients with ICE syndrome compared with normal, age-matched controls. The mean endothelial cell density did not differ significantly between the 2 groups (ICE, 2588; control, 2759; P = .10). CONCLUSION: Our data suggest that the clinically uninvolved, contralateral eyes in patients with ICE syndrome have subclinical endothelial abnormalities as evidenced by a relatively low percentage of hexagonal cells and a relatively high coefficient of variation of cell area.

Adult↗
PubMed1997

The incidence of primary angle-closure glaucoma in Olmsted County, Minnesota.

OBJECTIVES: To determine the incidence of primary angle-closure glaucoma (PACG) and to assess the visual outcomes of patients treated for PACG. DESIGN: Population-based retrospective incidence study. SETTING AND PATIENTS: Residents of Olmsted County, Minnesota, aged 40 years and older and diagnosed with PACG in the 13-year period between January 1, 1980, and December 31, 1992. MAIN OUTCOME MEASURE: Incident cases of PACG identified through the Medical Diagnostic Index of Mayo Clinic, Rochester, Minn, and the Rochester Epidemiology Project. RESULTS: Thirty-six incident cases were identified. The mean annual age-and sex-adjusted incidence per 100000 people aged 40 years and older was 8.3 (95% confidence interval, 5.6-11.0). The probability of monocular blindness associated with PACG at the time of diagnosis was 14%. Among patients not monocularly blind at diagnosis, the 5-year probability of developing monocular blindness associated with PACG was 4%. CONCLUSIONS: Primary angle-closure glaucoma is an uncommon disease in our community. Most of the patients blinded by PACG were blind at the time the condition was diagnosed.

Acute Disease↗
PubMed1997

Cataract extraction rates in Olmsted County, Minnesota, 1980 through 1994.

OBJECTIVE: To analyze population-based trends in cataract extraction. DESIGN: Rochester Epidemiology Project databases; which capture virtually all health care services provided to residents of Olmsted County, Minnesota, were used to perform retrospective cohort analyses of rates of primary cataract extractions performed between 1980 and 1994. PARTICIPANTS: The population of Olmsted County, Minnesota. MAIN OUTCOME MEASURES: Incidence rates adjusted to the age and sex distribution of the 1990 US white population were analyzed using Poisson regression. RESULTS: The 4257 procedures performed on 3176 patients of all ages represented overall annual age-adjusted rates of 404 procedures per 100,000 females and 320 per 100,000 males. Annual age- and sex-adjusted rates for both sexes combined rose from 133 procedures per 100,000 in 1980 to a peak of 507 per 100,000 in 1992. The rates fell to 470 per 100,000 in 1994. Manual review of a random sample of records estimated case overascertainment at 0.9%. CONCLUSIONS: With the exception of 1988 and 1989, rates of cataract surgery in this geographically circumscribed population increased every year between 1980 and 1992. Data from 1993-1994 indicate that rates may have plateaued and possibly declined slightly. If sustained, these patterns could have major implications for future utilization of ophthalmologic resources.

Age Distribution↗
PubMed1997

Incidence of nonarteritic anterior ischemic optic neuropathy.

PURPOSE: Nonarteritic anterior ischemic optic neuropathy is the most common acute optic nerve disease of adults over age 50 years. This study determined the incidence of acute nonarteritic anterior ischemic optic neuropathy in the circumscribed population of Olmsted County, Minnesota. METHODS: This was a retrospective study of the incidence of acute nonarteritic anterior ischemic optic neuropathy between 1981 and 1990. The Rochester Epidemiology Project medical records linkage system facilitates identification of the medical records of virtually all Olmsted County residents with a given diagnosis. All cases of acute nonarteritic anterior ischemic optic neuropathy that fulfilled certain inclusion and exclusion criteria were identified. RESULTS: Twenty-two cases in 21 patients (11 men and 10 women) were recorded. The crude annual incidence rate was 10.3 per 100,000 individuals (95% confidence interval [CI] = 5.1 to 18.4). When adjusted to the age and sex distribution of the 1990 United States white population, the incidence rate was 10.2 per 100,000 (95% CI = 6.5 to 15.6). At diagnosis, the median age was 72 years, mean visual acuity was 20/200 in the affected eye, and the most common visual field defect was an altitudinal deficit (10 cases). CONCLUSIONS: Although results of this small study should be interpreted cautiously, extrapolation of our findings to the United States white population indicates that nearly 5,700 new cases of acute nonarteritic anterior ischemic optic neuropathy may be expected to occur each year in this group.

Aged↗
PubMed1997

Pacing mode and long-term survival in elderly patients with congestive heart failure: 1980-1985.

Dual-chamber pacing may improve short-term hemodynamics and functional class in some patients with congestive heart failure, even in the absence of conventional indications for pacemaker implantation. However, the impact of different pacing modes on survival of patients with congestive heart failure is controversial. In this retrospective study we analyzed survival data from 546 elderly patients, aged 70 years and older, who underwent implantation of a permanent dual-chamber (DDD, n = 62, DVI, n = 102) or single-chamber (VVI) pacemaker (n = 382) between 1980 and 1985. Survival was further analyzed according to the presence of absence of congestive heart failure, and pacemaker mode (DDD vs. DVI vs. VVI). Overall, dual-chamber pacing (DDD and DVI) was associated with a more favorable long-term outcome when compared with single-chamber ventricular pacing, although differences were only significant for DDD pacing (P = 0.002). When patients with and without preexisting congestive heart failure were analyzed separately, survival following dual-chamber pacing (DDD and DVI) was significantly better than survival following single-chamber pacing in patients without congestive heart failure (P = 0.03), but not in patients with preexisting heart failure (P = 0.139). When patients were analyzed according to the electrophysiological indication for pacemaker implantation, overall survival of patients with AV block (P = 0.0025) but not sinus node dysfunction (P = 0.346) was improved with dual-chamber pacing. This survival advantage in patients with AV block following dual-chamber pacing was lost in the presence of heart failure (P = 0.11). These findings suggest that dual-chamber pacing, in particular DDD pacing, improves the survival in elderly patients without preexisting congestive heart failure. In contrast to the short-term hemodynamic improvement observed in selected patients with congestive heart failure, dual-chamber pacing in elderly patients with congestive heart failure, paced for conventional indications, is not associated with improved survival when compared with single-chamber ventricular pacing.

Aged↗
PubMed1997

Variability in anticoagulation control predicts thromboembolism after mechanical cardiac valve replacement: a 23-year population-based study.

OBJECTIVE: To assess optimal control of blood anticoagulation to maximize antithrombotic protection after mechanical cardiac valve replacement. DESIGN: A population-based study of 96 patients with a mean follow-up of 7.7 years (range, 1 month to 23 years) was performed in Olmsted County, Minnesota, and 10,301 prothrombin time (PT) ratios were determined after mechanical heart valve replacement. MATERIAL AND METHODS: PT ratios were analyzed in a new time-dependent Cox proportional-hazards model by defining an algorithm for comparing variability in PT ratios at each month of follow-up and relating these to thromboembolic events. The new method was compared with several conventional time-independent definitions. RESULTS: During 740 person-years of follow-up, 19 of 96 patients (20%) had 27 thromboembolic events. Of these 19 patients, 8 (42%) had events within 3 months after valve replacement. Freedom from any thromboembolic event was 72% at 15 years. The event rate was high (7.5% per year) during high variability and low (0.9% per year) during low variability in the PT ratio. This relationship was lost when time dependence was removed. More PT ratios were less than 1.5 during high (27%) than during low (19%) variability. Several conventional definitions of adequacy of anticoagulation that averaged PT ratios before a thromboembolic event or throughout follow-up or that compared the proportion of PT ratios above or below a fixed ratio did not define or only partially defined different thromboembolic risks. CONCLUSION: Periods of high and low variability of PT ratios define high and low risk of thromboembolism, respectively.

Adult↗
PubMed1997

Central corneal endothelial cell changes over a ten-year period.

PURPOSE: To obtain longitudinal data to estimate long-term morphometric changes in normal human corneal endothelia. METHODS: Ten years after an initial study, the authors rephotographed the central corneal endothelium of 52 normal subjects with the same contact specular microscope. The findings for the 10 subjects younger than 18 years of age at the initial examination were considered separately. For the remaining 42 adult subjects, the time between examinations averaged 10.6 +/- 0.2 years (range, 10.1 to 11 years). At the recent examination, these subjects' ages averaged 59.5 +/- 16.8 years (range, 30 to 84 years). Outlines of 100 cells for each cornea were digitized. RESULTS: For the 42 adult subjects, the mean endothelial cell density decreased during the 10.6-year interval from 2715 +/- 301 cells/mm2 to 2539 +/- 284 cells/mm2 (P < 0.001). The calculated exponential cell loss rate over this interval was 0.6% +/- 0.5% per year. There was no statistically significant correlation between cell loss rate and age. During the 10.6-year interval, the coefficient of variation of cell area increased from 0.26 +/- 0.05 to 0.29 +/- 0.06 (P < 0.001), and the percentage of hexagonal cells decreased from 67% +/- 8% to 64% +/- 6% (P = 0.003). For the 10 subjects 5 to 15 years of age at the initial examination, the exponential cell loss rate was 1.1% +/- 0.8% per year. CONCLUSIONS: Human central endothelial cell density decreases at an average rate of approximately 0.6% per year in normal corneas throughout adult life, with gradual increases in polymegethism and pleomorphism.

Adult↗
PubMed1997

Lysosomal enzymes in corneal storage media and corneal graft outcome.

PURPOSE: The purpose of this study was to relate lysosomal enzyme activities in corneal storage media to the outcome of the transplanted corneas. METHODS: Corneal storage media from 358 transplanted corneas were frozen at -70 degrees C and kept for enzyme analysis. Corneas were stored in K-Sol (28), CSM (35), Dexsol (80), Index medium (five), Optisol (158), and Optisol GS (52). Activities of alpha-D-mannosidase, beta-glucuronidase, alpha-glucosidase, and N-acetyl-beta-glucosaminidase were assayed fluorometrically. Mayo Clinic records were examined for donor information, including cause of death and 2-month graft follow-up data. RESULTS: For all corneas, there was a low but significant correlation between activities of each enzyme and storage time (rs = 0.13-0.35; p = 0.02-0.0001), and donor age (rs = -0.14 to -0.23; p = 0.009-0.0001). There was no significant correlation of enzyme activity with 2-month endothelial cell density, structure, cell loss, or corneal thickness. Enzyme activities for four primary donor failures and six grafts with > 65% 2-month endothelial cell loss were not significantly different from those for the rest of the transplanted corneas. Enzyme activities were higher for corneas from donors with renal failure but not from those with diabetes mellitus. There was no significant difference in graft outcome for different cause-of-death groups. CONCLUSIONS: The activities of lysosomal enzymes released into corneal storage media are not useful as predictors of graft outcome.

Acetylglucosaminidase↗
PubMed1996

Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis.

OBJECTIVES: This study was designed to determine the clinical value of a Doppler-derived index of combined systolic and diastolic myocardial performance in the assessment of cardiac amyloidosis. BACKGROUND: Cardiac amyloidosis is an infiltrative disease with diastolic and systolic dysfunction. Therefore, the index of myocardial performance combining systolic and diastolic time intervals could be a useful predictor of clinical outcome in cardiac amyloidosis. METHODS: The study included 45 patients with biopsy-proved amyloidosis and 45 age-matched normal subjects. All patients had typical echocardiographic features of amyloid cardiac involvement. A Doppler-derived index, defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time, was measured from left ventricular outflow and mitral inflow Doppler velocity profiles recorded during routine echocardiography. The index as well as conventional systolic or diastolic echocardiographic/Doppler variables were related to subsequent outcome. RESULTS: The isovolumetric contraction and relaxation times were prolonged and ejection time was shortened (p < 0.001) in patients with amyloidosis compared with that in normal subjects, resulting in a marked increase of the index from normal values (p < 0.001). In the amyloid group the index was highest in patients with a low stroke index or with both shortened mitral deceleration time and lower ejection fraction. By univariate analysis, New York Heart Association functional class, the index, ejection fraction and mitral deceleration time were significant predictors of outcome. However, by multivariate stepwise regression analysis, functional class and the index were the only independent predictors of survival. CONCLUSIONS: The Doppler-derived index of combined systolic and diastolic myocardial performance correlates with global cardiac dysfunction and is a useful predictor of clinical outcome in patients with cardiac amyloidosis.

Adult↗
PubMed1996

Spontaneous recovery rate in traumatic sixth-nerve palsy.

PURPOSE: To estimate the spontaneous recovery rate of isolated traumatic sixth-nerve palsy. METHOD: A retrospective chart review over a 24-year period at a single institution, excluding patients who were first seen more than 6 weeks after injury, to reduce bias toward nonrecovery. RESULTS: The Kaplan-Meier survival estimate of spontaneous recovery at 6 months was 27% (95% confidence interval [CI], 5% to 44%) in unilateral traumatic sixth-nerve palsy and 12% (95% CI, 0% to 33%) in bilateral traumatic sixth-nerve palsy. CONCLUSION: Spontaneous recovery from isolated traumatic sixth-nerve palsy may be lower than previously reported. A prospective study is needed to provide a more accurate estimate of recovery rate.

Abducens Nerve Injury↗