Biomedical subjects

J C Aldag

Publications and source records attributed to J C Aldag.

At least 37 records · Page 2Linked to original sources

PubMed1995

Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication.

BACKGROUND: The rates of seizure activity associated with surgical treatment of chronic subdural hematoma (CSH) reported in the literature has varied greatly. The efficacy of prophylactic anticonvulsive medication (ACM) has been debated and its use been erratic. With improved diagnosis, reduction of associated morbidity impacts greatly on the mortality rate, and so the use of ACM may be important to the patient with CSH. METHODS: We conducted a retrospective analysis of the records of patients treated surgically for CSH and examined the prevalence of seizure activity, morbidity, and mortality and the effects of anticonvulsant medication. RESULTS: Ninety-eight patients (65 = male) were identified with a mean age of 72 years and a range of 4 to 97 years. Six patients had a preexisting seizure disorder; despite therapeutic serum levels of ACM, 3 of these 6 patients experienced seizures without mortality. Seizures occurred in 20/98 (20.4%) patients during hospitalization or follow-up. Of the 92 patients without a preexisting seizure disorder, 42 (46%) received prophylactic phenytoin with therapeutic serum levels. One patient among the 42 (2.4%) who received prophylactic ACM experienced seizure activity in comparison to 16 of 50 (32%) patients who did not receive adequate prophylactic ACM (P = < 0.001). Six of 11 deaths within one month of discharge occurred in patients with a new onset of seizures (P = < 0.005). Age, sex, history of trauma, Markwalder scores on admission, location of hematoma, or type of surgery were unrelated to the occurrence of seizures or mortality. Following hospital discharge, patients were continued on ACM for a mean duration of 8 months without seizures. CONCLUSIONS: The onset of new seizures was found in 17 (18.5%) of 92 patients and was associated with increases in morbidity and mortality. Patients who received prophylactic ACM demonstrated a significant decrease in the occurrence of seizures, and we therefore recommend the use of phenytoin prophylaxis in patients treated surgically for chronic subdural hematoma.

Adolescent↗

PubMed1994

Platelet ultrastructure of high-risk premature infants.

Hemorrhagic and thrombotic complications are common in the term and preterm infant. Limited information is currently available about neonatal platelet structure and function, and how these may predispose infants to bleeding problems. This study comparing platelet ultrastructure of 71 different term and preterm infants with that of 15 adult control subjects revealed certain platelet morphological differences. Specifically, the adult platelets had more pseudopods, larger glycogen deposits, more visible microtubular structure, markedly fewer alpha granules, and smaller areas/perimeters than the infant platelets. Also, in infants greater than 31 weeks gestation, the platelets of vaginally-delivered infants were larger than those of both infants delivered by C-section and normal adults. These differences in platelet size and morphology may be related to developmental differences and/or the stress of delivery. These findings provide a framework for further exploration of neonatal platelet structure and function.

Adult↗

PubMed1993

A 10-year experience with postpump chorea.

Postpump chorea (PPC) is the development of choreoathetoid movements within 2 weeks following cardiopulmonary bypass. Over a 10-year period, 668 children underwent open cardiac surgery, of whom 8 (1.2%) developed PPC. Age at surgery ranged from 8 to 34 months. The onset of chorea was 3 to 12 days following surgery. Computed tomography and magnetic resonance imaging showed atrophy but no focal lesions. Cerebral positron emission tomography using [18F]fluorodeoxyglucose in a patient following 12 months of chorea showed patchy areas of decreased glucose metabolism. None of the patients were developmentally normal 22 to 130 months following surgery. Three patients have had transient and 5 have persistent chorea. Neurological deficits ranged from a mild learning disability to progressive hypotonia and obtundation ending in death. One of 4 patients who received haloperidol had a decrease in the severity of chorea. We compared PPC patients with 39 randomly selected controls. During surgery, affected patients spent significantly more time on pump and at temperatures under 36 degrees C, were cooled to lower temperatures than controls, and were more likely to have had a circulatory arrest. One patient developed chorea without a history of circulatory arrest. We conclude that (1) there is a strong association between PPC, deep hypothermia, and circulatory arrest, (2) absence of characteristic macroscopic changes suggests a biochemical or microembolic etiology in some cases, (3) chorea is frequently associated with developmental delay, and (4) the prognosis for complete resolution of chorea is guarded.

Brain↗

PubMed1993

Insufficient milk supply among black and white breast-feeding mothers.

The purpose of this study was to investigate whether ethnicity is associated with insufficient milk supply (IMS) among breast-feeding mothers. A major reason reported by mothers for early termination or introduction of formula and/or solids is insufficient milk. A retrospective survey was conducted among 42 black and 148 white breast-feeding mothers participating in the WIC program in a midwestern state. The results suggested that: (1) the incidence of IMS was similar for black and white mothers; (2) controlling for education, black mothers initiated breast-feeding later and stopped sooner; IMS mothers fed less frequently and for shorter periods; and (3) controlling for education, there were no ethnic differences in the determinants or indicators of IMS.

Adult↗

PubMed1993

Antinuclear antibodies and connective tissue disease features in fibromyalgia syndrome: a controlled study.

OBJECTIVE: The objective was to investigate the prevalence of antinuclear antibodies (ANA) and of connective tissue disease (CTD) features in patients with fibromyalgia syndrome (FS) compared with healthy, pain-free controls. METHODS: One hundred ninety-two patients with FS and 80 pain-free healthy controls were studied by a protocol that included features of FS and those of a CTD, e.g., Raynaud's phenomenon (RP) and dry mouth. ANA was tested by indirect immunofluorescence assay with mouse kidney substrate. Patients with an initial positive ANA were followed after a mean period of 3.3 years. RESULTS: ANA was positive in 11.5% of all patients, 11.3% of 160 female patients and 10.0% of 80 female controls, with no significant differences between the groups. Among the women, RP was present in 8.8% of patients and 2.5% of controls (p < 0.07), whereas subjective dry mouth without an obvious cause occurred in 12% of patients and none of the controls (p < 0.005). The frequency of other CTD features was similar in both groups. Diagnosis of a CTD was not made in any patient initially or in those seen on followup. CONCLUSIONS: Prevalence of ANA and of CTD features was similar in patients with FS and healthy controls, with the exception of subjective dry mouth, the frequency of which was significantly greater among the patients.

Adult↗

PubMed1992

A multidisciplinary approach to information management and critical appraisal instruction: a controlled study.

A study of the effectiveness of a collaborative course in teaching library and critical appraisal skills was conducted at the University of Illinois College of Medicine. A critical appraisal and library skills course was taught at the Peoria site during the third-year medical clerkship. The performance of Peoria students on a twenty-item multiple choice posttest was compared to that of third-year students in Rockford, who received no library or critical appraisal instruction during their medicine clerkship. The two groups were similar in self-perceived library skills, critical appraisal skills, and other demographic values. Peoria students scored significantly higher on library, critical appraisal, and total posttest questions. An improving trend during the year was not observed at either site, implying that students were not acquiring these skills in day-to-day clerkship activities. Results suggest that this multidisciplinary course is effective in teaching library and critical appraisal skills.

Curriculum↗

PubMed1992

Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study.

To test the hypothesis that plasma tryptophan and/or its transport ratio is decreased in primary fibromyalgia (PF), we measured plasma tryptophan and its transport ratio in 29 patients with PF and 30 healthy controls without significant pain, in a blinded manner. Twenty-one other amino acids were also similarly analyzed among these study subjects. Transport ratio of tryptophan was found to be significantly (p less than 0.01) decreased in PF compared with the control group (0.09 +/- 0.02 vs 0.10 +/- 0.02). Plasma tryptophan level was lower in PF (45 +/- 10 nmol/ml) than in healthy controls (51 +/- 15 nmol/ml), showing a trend towards significance (p less than 0.09). Additionally, plasma histidine and serine levels were found to be significantly (p less than 0.01) lower in patients with PF than in controls. Our results suggest that a decreased brain serotonin level, as possibly reflected by a decreased transport ratio of plasma tryptophan, may play a pathophysiologic role in PF.

Amino Acids↗

PubMed1992

Plasma and urinary catecholamines in primary fibromyalgia: a controlled study.

Plasma and urinary catecholamines were measured in a blinded manner among 30 patients with primary fibromyalgia (PF) and 30 healthy controls without significant pain to determine possible elevations of catecholamines in PF, as well as their correlations with psychological and clinical variables in this syndrome. Results showed no significant differences between fibromyalgia and control groups in any of the catecholamines measured, nor was there a correlation between catecholamine levels and any of the clinical features or psychologic measures.

Adult↗

PubMed1991

Relationship of clinical features with psychological status in primary fibromyalgia.

Clinical features and psychological status determined by the Minnesota Multiphasic Personality Inventory (MMPI) in 103 patients with primary fibromyalgia syndrome (PFS) were analyzed by univariate and multivariate techniques to determine if clinical features were related to psychological status or were intrinsic to PFS per se. The central features of PFS, e.g., number of pain sites, number of tender points, fatigue, and poor sleep, were independent of psychological status. However, discriminant analysis identified 4 variables--patient-reported depression, anxiety, stress, and pain severity--which together predicted 3 MMPI subgroups with an accuracy of 55% (P less than 0.001); the only musculoskeletal feature--pain severity--alone provided an accuracy of only 34% (P greater than 0.05). These data suggest a new concept, that the central features of fibromyalgia are independent of the psychological status and are more likely related to the PFS itself. However, pain severity may be influenced by psychological factors.

Adult↗

PubMed1990

A randomized study of cancer screening in a family practice setting using a recall model.

A randomized controlled study that evaluated a recall system and patient education material by mail in 178 asymptomatic female family practice patients aged 50 to 69 years showed no effect on the proportion of patients who had cancer screening tests (P = .20) and a significant adverse effect on the mean number of tests performed (P = .05) after 4 months. In a subgroup of previous compliers (those who had one or more tests 12 months before the study), however, there was a lower proportion of patients receiving one or more tests (P = .019) with a lower mean number of tests (P = .007) than previous compliers in the control group. Recall strategies for cancer screening tests need to be more extensively studied in the United States before they are routinely adopted in family practice.

Aged↗

PubMed1989

Accuracy of interpretations of emergency department radiographs: effect of confidence levels.

We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.

Emergency Medicine↗

PubMed1989

Short term effects of ibuprofen in primary fibromyalgia syndrome: a double blind, placebo controlled trial.

Therapeutic effects of ibuprofen were evaluated in 46 patients with primary fibromyalgia syndrome in a double blind, placebo controlled study for 3 weeks and in an open trial for another 3 weeks. Several features of primary fibromyalgia syndrome, including number of pain sites, fatigue, swelling feeling, and tender points significantly improved over time in both groups. However, no significant differences were found between the ibuprofen and placebo groups. Improvements in fibromyalgia features might have occurred as a result of physician or study interactions (i.e., an intervention effect). An important observation in our blinded study was that tender point sites among patients with fibromyalgia were significantly (p less than 0.001) consistent at 3 as well as 6 weeks when compared with the baseline.

Adult↗

PubMed1989

A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes.

One hundred and thirteen patients with primary fibromyalgia syndrome, 77 with rheumatoid arthritis (RA) and 67 healthy controls without significant aches or pains were studied by protocol to determine clinical features of primary fibromyalgia syndrome and to assess the possible association of primary fibromyalgia syndrome with common functional disorders compared with the control groups. Previously reported common features of primary fibromyalgia syndrome are confirmed in this controlled study. In addition the extent of cutaneous hyperemia on palpation was found to be greater in patients with primary fibromyalgia syndrome than in normal controls. All the 3 functional syndromes evaluated, e.g., irritable bowel, chronic functional headache and primary dysmenorrhea, were significantly (p less than 0.005) more common in primary fibromyalgia syndrome, compared with RA and normal control groups. These data suggest that primary fibromyalgia syndrome is a characteristic clinical condition that overlaps with other well recognized functional syndromes.

Arthritis, Rheumatoid↗

PubMed1989

Electron microscopic studies of muscle biopsy in primary fibromyalgia syndrome: a controlled and blinded study.

Trapezius muscle biopsy was carried out in 21 patients with primary fibromyalgia syndrome (PFS) and 11 healthy controls, and assessed blindly by electron microscopy. Common findings in both the PFS and control groups were mild myofibrillar separation, papillary projections and subsarcolemmal accumulation of glycogen. However, the differences between the 2 groups were not statistically significant in any of the findings.

Adolescent↗

PubMed1988

A comparison of epinephrine and methoxamine for resuscitation from electromechanical dissociation in human beings.

Electromechanical dissociation (EMD) is an organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output. Patients in EMD have a poor prognosis for resuscitation and long-term survival. The beneficial effect in resuscitation of epinephrine, the adrenergic agent currently recommended, has been shown to depend on stimulation of alpha-adrenergic vasoconstriction. The beta-adrenergic inotropic and chronotropic effects of epinephrine are theoretically detrimental by increasing myocardial oxygen consumption and subendocardial ischemia. The purpose of our study was to determine whether the pure alpha agonist methoxamine was superior to epinephrine in human beings in EMD as determined by survival at one hour. These two agents were compared in a prospective, randomized, and double-blinded study involving 80 patients with EMD of various causes seen in the emergency department and internal medicine inpatient service. The advanced cardiac life support (ACLS) algorithm (current at the time of our study) for resuscitation from EMD was used, with the blinded study drug (epinephrine 1 mg or methoxamine 10 mg) administered where the algorithm calls for epinephrine. Calcium and isoproterenol also were used in the majority of cases according to ACLS standards but never prior to the use of methoxamine or epinephrine. Survival data are summarized as: survival less than one hour, 22 patients receiving methoxamine, 22 receiving epinephrine; one to six hours, 15 patients receiving methoxamine, 13 patients receiving epinephrine; six to 12 hours, one patient receiving epinephrine; more than 24 hours but not surviving to discharge, three patients receiving methoxamine, two patients receiving epinephrine; and survival to discharge, one patient receiving epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Fibromyalgia syndrome among the elderly. Comparison with younger patients.

Thirty-one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self-assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P less than .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.

Age Factors↗

PubMed1988

The single-patient clinical trial.

A single-patient clinical trial is useful in helping the physician decide whether a specific treatment is helpful or harmful in a specific case. The patient's problem must be chronic and stable, and there must be a clearly measurable end point. The close cooperation of the patient, the nurse and the pharmacist is required. In a situation that meets these prerequisites, a properly performed and analyzed single-patient study may be of great benefit.

Clinical Trials as Topic↗

PubMed1975

Physical therapist assistant selection and academic success.

Assessment of a standardized test as one criterion for student admission to a physical therapist assistant program is made. Comparisons are made of ACT scores between the physical therapist assistant and associate degree nurse, and the physical therapist assistant and the practical nurse. A correlation matrix was used to analyze data with differences among the three groups determined by t test computation. This sample supports a positive correlation of ACT test scores with graduation grade point average. The means show no significant difference between the two associate degree programs and a significant difference between the associate degree programs and the practical nurse program.

Achievement↗