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Biomedical subjects

J Owen

Publications and source records attributed to J Owen.

At least 91 records · Page 5Linked to original sources
PubMed1996

Complications of midtrimester pregnancy termination: the effect of prior cesarean delivery.

OBJECTIVE: Our purpose was to determine whether a prior cesarean delivery affects the incidence of complications in women having an indicated midtrimester medical pregnancy termination. STUDY DESIGN: A retrospective review of women who underwent a midtrimester medical termination of pregnancy from January 1980 to July 1995 ascertained obstetric history, uterotonic agent(s), and the occurrence of uterine rupture, blood transfusion, or curettage. The frequencies of maternal complications were compared in women with and without a prior cesarean section. RESULTS: Our study population included 606 women with a mean gestational age of 21.1 +/- 3.1 weeks and a mean maternal age of 26.3 +/- 7 years. Seventy-nine (13%) had undergone a prior cesarean section. There was no significant difference in the need for curettage between women with and without a prior cesarean section. However, there was an increased need for blood transfusions in women with a prior cesarean delivery (11.4% vs 5.3%, odds ratio 2.3, 95% confidence interval 1.1 to 5.0, p = 0.04). The incidence of uterine rupture was significantly higher among women with a prior cesarean (3.8% vs 0.2%, odds ratio 20.8, 95% confidence interval 14.1 to 104, p = 0.008). CONCLUSION: Our data suggest that a prior cesarean section is a risk factor for uterine rupture and blood transfusion in women having a midtrimester pregnancy termination.

Abortion, Induced↗
PubMed1996

Effect of parity correction on Down syndrome detection by the multiple-marker screening test.

OBJECTIVE: Our purpose was to determine whether maternal parity affects analyte levels in the multiple-marker screening test for Down syndrome and to derive a correction factor and determine its effect on Down syndrome detection and screen-positive rates. STUDY DESIGN: Our database consisted of 3039 multiple-marker screening test results and corresponding fetal karyotypes (2983 euploid and 56 Down syndrome). Cases were grouped by maternal parity as follows: 0 (n = 848), 1 (n = 1140), or > or = 2 (n = 1051). The mean multiple of the median of maternal serum alpha-fetoprotein, estriol, and human chorionic gonadotropin was determined for each group. A correction factor was derived for each parity group and applied to the database. Parity-corrected Down syndrome detection rates and screen-positive rates were determined. RESULTS: Parity significantly affected the mean multiple of the median of human chorionic gonadotropin levels (p = 0.0001) but did not affect the values for estriol or maternal serum alpha-fetoprotein. Application of a parity correction factor for human chorionic gonadotropin increased the Down syndrome detection rate in women who had two or more pregnancies from 71% to 82% without increasing the overall screen-positive rate. CONCLUSION: Human chorionic gonadotropin levels are significantly lower in multiparous women. Correcting human chorionic gonadotropin for maternal parity increases Down syndrome detection for women who had two or more pregnancies without affecting the overall screen-positive rate.

Adult↗
PubMed1996

Second-trimester cystic hygroma: prognosis of septated and nonseptated lesions.

OBJECTIVE: To compare karyotypic, ultrasonographic, and prognostic features of septated cystic hygromas and nonseptated cystic hygromas in second-trimester fetuses. METHODS: A computerized ultrasound data base was used to identify fetuses diagnosed with cystic hygromas at 14-22 weeks' gestation. Photographs from the initial ultrasound were reviewed retrospectively for hygroma type (septated or nonseptated) and any abnormal structural findings. Fetal karyotypes were obtained from amniotic fluid, aspiration of hygroma pouches, or fetal tissue culture. Pregnancy outcome information was obtained from hospital charts and physician office records. Ultrasound findings were then compared with fetal karyotype results and pregnancy outcome data. RESULTS: From 1990 to 1995, 61 fetuses with cystic hygromas were identified. Karyotypes were obtained in 55 fetuses, and pregnancy outcome was available for 59. Abnormal karyotype was present in 42 of 55 fetuses (76%). The most common chromosomal abnormality in septated hygromas was the 45,X karyotype. Trisomy 21 was the most common chromosomal abnormality in nonseptated hygromas. Compared with fetuses with nonseptated cystic hygromas, those with septated cystic hygromas were more likely to be aneuploid (33 of 39 [85%] versus nine of 16 [56%]; P = .03), more likely to develop hydrops (27 of 45 [60%] versus three of 16 [19%]; P = .005), and less likely to be live-born (one of 44 [2%] versus four of 15 [27%]; P = .01). CONCLUSIONS: Fetuses with septated cystic hygromas are more likely to be aneuploid and to develop hydrops, and thus are less likely to be survive than fetuses with nonseptated hygromas.

Adult↗
PubMed1996

The significance of non-visualization of the fetal bladder during an ultrasound examination to evaluate second-trimester oligohydramnios.

Our objective was to determine the pregnancy outcome after targeted sonography performed for the evaluation of second-trimester oligohydramnios fails to visualize the fetal bladder. A retrospective review identified patients in 1990-94 who were referred for targeted sonography from 16 to 24 weeks to evaluate oligohydramnios. The ultrasound records and photographs from the initial examination were reviewed and compared to later pregnancy outcome data obtained by reviewing delivery and neonatal records, neonatal renal ultrasound reports or autopsy information. Complete outcome data were available in 98 patients. The fetal bladder was not visualized in 29 patients (30%). Post-delivery analysis of the fetal urinary tract was performed in 25 patients either by autopsy or by neonatal renal ultrasound scanning. A severe anatomic malformation of the urinary system was present and had been detected by targeted sonography in 23 of 25 cases (92%). The remaining two fetuses were found to have anatomically normal urinary tracts at autopsy, but other pathological findings suggested that a functional derangement of the urinary system had led to non-visualization of the bladder at ultrasound examination. Non-visualization of the fetal bladder during targeted sonography to evaluate oligohydramnios indicates a severe anatomic or functional problem of the fetal urinary tract. In our study, this ultrasound finding was associated with universal fetal or neonatal death.

Female↗
PubMed1996

The synergistic relationship between ethics and quality improvement: thriving in managed care.

Financial issues are encroaching upon health care decisions at a rapid pace in today's managed care arena. An examination of the parallel historical perspectives of bioethics, health care reimbursement, and quality improvement reveals that, by integrating an ethical framework with the quality improvement process, health care professionals can preserve patient-centered care. The article demonstrates the strength of this combined approach using restraints as an example.

Delivery of Health Care↗
PubMed1996

Low vision and surfing.

Low vision rehabilitation often concentrates on vocational and living skills training. Nonetheless, the motivation for improving reading or travel skills may be to pursue some enjoyable recreational activity. A case report of a telescopic aid for surfing is presented, emphasizing the importance of recreation in low vision rehabilitation.

Adult↗
PubMed1996

Rhabdomyolysis and hemolysis associated with sickle cell trait and glucose-6-phosphate dehydrogenase deficiency.

We report a case of severe oxidative hemolysis and rhabdomyolysis in a patient with sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient was a 34-year-old black man admitted 24 hours after vigorous exercise with myalgias, malaise, myoglobinuria, anemia, low haptoglobin, and a peripheral blood smear with bite cells consistent with oxidative hemolysis. He had two similar episodes within 21 months of the initial admission. Subsequent evaluation resulted in the diagnosis of sickle cell trait and G6PD deficiency; muscle enzyme levels were normal. G6PD deficiency and sickle cell trait can be expected to occur simultaneously in up to 1% of black males. A second red blood cell defect should be considered when severe hemolysis is seen in a person with sickle cell trait.

Adult↗
PubMed1996

Preterm delivery after indomethacin. A risk factor for neonatal complications?

OBJECTIVE: To determine if tocolytic therapy with indomethacin is associated with an increased risk of neonatal complications in infants born prior to 32 weeks' gestation. STUDY DESIGN: We performed a retrospective matched cohort study of infants born between 24 and 31(6)/7 weeks' gestation. The 62 cases (indomethacin treatment) and the 62 controls were matched by week of gestation, prenatal betamethasone exposure and multifetal gestation. RESULTS: The mean gestational age of the two groups was 28.5 +/- SD weeks. The median total dose of indomethacin was 425 mg, the median treatment duration was three days, and the median interval from the last dose of indomethacin until delivery was one day. There was no significant difference between the groups in the incidence of necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosis, sepsis or neonatal death. CONCLUSION: The use of indomethacin for tocolysis was not associated with an increased risk of neonatal complications in infants born between 24 and 31(6)/7 weeks' gestation.

Cohort Studies↗
PubMed1995

The ACC1 gene, encoding acetyl-CoA carboxylase, is essential for growth in Ustilago maydis.

Acetyl-CoA carboxylase [ACCase; acetyl-CoA:carbon dioxide ligase (ADP forming), EC 6.4.1.2] catalyses the ATP-dependent carboxylation of acetyl-CoA to form malonyl-CoA. We have amplified a fragment of the biotin carboxylase (BC) domain of the Ustilago maydis acetyl-CoA carboxylase (ACC1) gene from genomic DNA and used this amplified DNA fragment as a probe to recover the complete gene from a lambda EMBL3 genomic library. The ACC1 gene has a reading frame of 6555 nucleotides, which is interrupted by a single intron of 80 bp in length. The gene encodes a protein containing 2185 amino acids, with a calculated M(r) of 242,530; this is in good agreement with the size of ACCases from other sources. Further identification was based on the position of putative binding sites for acetyl-CoA, ATP, biotin and carboxybiotin found in other ACCases. A single ACC1 allele was disrupted in a diploid wild-type strain. After sporulation of diploid disruptants, no haploid progeny containing a disrupted acc1 allele were recovered, even though an exogenous source of fatty acids was provided. The data indicate that, in U. maydis, ACCase is required for essential cellular processes other than de novo fatty acid biosynthesis.

Acetyl-CoA Carboxylase↗
PubMed1995

Patterns of care survey results: treatment planning for carcinoma of the prostate.

PURPOSE: Treatment planning has been defined differently at various institutions to encompass tasks ranging from the initial evaluation of the patient to the delivery of the treatment as well as a more narrow view, focused primarily on isodose computation. To evaluate the impact of much of the new treatment-planning technology that has become available, it is necessary to define and develop recommended guidelines for the treatment-planning process. METHODS AND MATERIALS: The 1989 Patterns of Care Study (PCS) included questionnaires to access treatment planning practices currently in use for the entire census of oncology facilities in the United States. These questionnaires were developed by a consensus committee consisting of both physicists and radiation oncologists whose charge was to formulate a description of current treatment-planning practices. The description was based on the committee's experience and knowledge of the treatment-planning process considered to be widely available and in general use, as well as a review of the literature. From the description of the treatment-planning process, a set of guidelines for treatment planning was developed for prostate as well as each of the other disease sites included in the PCS. Data from the study defined the general structure, methodology, process, and tools used by each institution involved in the Patterns of Care Survey Study. National averages for all of the variables were calculated with weighted averages, with the weights reflecting the sample design and number of patients in the different types of facilities. The data were stratified according to academic, hospital, or free-standing facility and were compared with the Consensus Guidelines for Treatment Planning of the Prostate. DISCUSSION: Based on the consensus statement, the treatment-planning process was separated into the following categories: (a) Treatment-Planning Workup, (b) Treatment Plan Implementation, (c) Treatment Delivery, (d) Treatment Verification, and (e) Quality Assurance. The results from the survey were summarized for each category and compared with the consensus statement. CONCLUSIONS: Although there is an increasing trend toward using computed tomography (CT) information to acquire individualized patient data, volume definition and localization are often completed in the simulator without the direct use of CT information (47%). As more sophisticated beam arrangements and blocking are used, one needs to look at the full three-dimensional (3D) volume to ensure that there are no marginal misses due to blocking and beam arrangement. Improved and more widespread use of immobilization devices is also required with conformal treatments and reduced margins. The results of the survey helped to identify and establish the standard of practice for treatment planning of the prostate as well as to provide documentation for better defining a complete description of the treatment planning process. Well-documented guidelines will provide more consistent treatment of patients, which should have an impact on outcome.

Clinical Protocols↗
PubMed1995

Zidovudine for the prevention of vertical HIV transmission: a decision analytic approach.

The purpose of this study was to quantify the benefits of maternal-neonatal zidovudine (ZDV) administration for the prevention of vertical human immunodeficiency virus (HIV) transmission against the potential risks of drug-induced complications in uninfected children. A decision analysis model was created with use of a Markov cohort simulation, for evaluating both survival and quality of life for two hypothetical cohorts of HIV-exposed neonates: one with in utero and neonatal exposure to preventive ZDV therapy and the other not exposed. The model included the probability of congenital HIV infection with and without ZDV treatment (estimates derived from AIDS Clinical Trials Group study 076), the yearly probability of death with and without congenital HIV infection, a range of probabilities of adverse effects from ZDV use, and a range of ages in life when any adverse effect would manifest. In a series of scenarios, the impact of different estimates for the quality-of-life decrement from any adverse ZDV effect in HIV-uninfected children was assessed, and threshold values for this estimate were established, i.e., critical values below which withholding ZDV would be the preferred choice. Across a wide range of estimates for multiple contingencies, ZDV use was associated with a greater number of quality-adjusted life years than was non-use. Only in implausible, pessimistic scenarios (i.e., a high incidence of profound adverse effects beginning early in life) would withholding ZDV be the rational choice for an asymptomatic HIV-infected pregnant woman.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Support Techniques↗
PubMed1995

The influence of flavor and color on drink identification by children and adults.

This study investigated how color and flavor influences drink identification by children and adults. The children ranged in age from 2 to 18 years of age. Each subject tasted four drinks that differed in color and flavor. Each drink had an atypical color-flavor pairing (e.g., brown-pineapple) or a typical pairing (e.g., brown-chocolate). After tasting each drink, the subject chose which of four flavor names identified the drink. For the atypical drinks, the selection of color-associated names (e.g., chocolate for a brown drink) decreased, and the selection of flavor-associated names increased with age from the preschoolers to the adults. For the typical drinks, the selection of the correct name was greater than 80% for all ages. These results suggest that drink identification becomes more influenced by flavor as children get older because of an increase in the ability of children to focus on flavor as their perceptual-attentional skills mature.

Adolescent↗
PubMed1995

Gestational diabetes survey.

OBJECTIVE: Our purpose was to determine how residents in obstetrics and gynecology and fellows in maternal-fetal medicine are currently being trained to diagnose and manage gestational diabetes mellitus. STUDY DESIGN: Questionnaires were mailed to 202 obstetrics and gynecology residency program directors and 78 maternal-fetal medicine fellowship directors. RESULTS: Sixty-four (82%) of the maternal-fetal medicine directors versus 142 (70%) of the residency directors responded. Universal screening, use of a 50 gm glucose challenge with a 1-hour-postingestion sample, no requirements for fasting before the screening test, use of two abnormal values on the 3-hour glucose tolerance test to define gestational diabetes mellitus, and initiation of insulin for elevated fasting glucose levels in spite of diet therapy were each recommended by > 90% of the respondents. CONCLUSION: Although the optimal management of gestational diabetes mellitus remains controversial, program directors are in general agreement with many aspects of the diagnosis and management.

Data Collection↗
PubMed1995

Determinants of the optimal time in gestation to initiate antenatal fetal testing: a decision-analytic approach.

To identify the most important determinants of the optimal timing for the initiation of antenatal fetal testing in a high-risk pregnancy (such as insulin-dependent diabetes mellitus), we performed a decision analysis based on a Markov model. The model incorporated several components: test sensitivity and specificity and week-specific probability estimates for fetal death, delivery, and neonatal morbidity and mortality. The analysis demonstrated that the optimal time in gestation to begin testing (from the combined standpoint of both maximizing neonatal survival and minimizing fetal death) was highly dependent on test specificity, the cumulative risk of fetal death (and its distribution throughout gestation), and the week-specific probabilities of neonatal death. For example, even with the increased risk of fetal death associated with insulin-dependent diabetes, very high test specificity (> 99%) is required to recommend testing before 30 weeks. If tests of lower specificity (higher false-positive rates) are used, neonatal deaths will increase and will not be offset by a corresponding decrease in fetal deaths. By performing sensitivity analyses, we demonstrated the effect and relative importance of the model components for determining the optimal gestational age to initiate fetal testing.

Decision Support Techniques↗
PubMed1995

Does magnesium sulfate affect the length of labor induction in women with pregnancy-associated hypertension?

OBJECTIVE: Our purpose was to determine whether seizure prophylaxis with magnesium sulfate prolongs induction of labor in women with pregnancy-associated hypertension. STUDY DESIGN: Women with a singleton pregnancy in vertex presentation between 32 and 42 weeks' gestation who required induction of labor for either preeclampsia, preeclampsia superimposed on chronic hypertension, or transient hypertension were randomized to receive either magnesium sulfate or phenytoin (Dilantin) for seizure prophylaxis. Women with rupture of the membranes, spontaneous contractions resulting in cervical change, or an initial cervical examination showing > 2 cm dilatation and 50% effacement were excluded. RESULTS: Fifty-four women were randomized to receive either magnesium sulfate (n = 28) or phenytoin (n = 26). The two groups were similar for selected maternal antepartum, intrapartum, and postpartum characteristics that have been associated with a prolongation or failure of labor induction. The two groups were also similar for the interval from the start of induction to (1) the first examination > or = 5 cm cervical dilatation and (2) delivery and in the frequency of women requiring cesarean delivery. CONCLUSION: Compared with phenytoin, magnesium sulfate seizure prophylaxis in women with pregnancy-associated hypertension does not prolong the induction of labor nor does it result in an increase in cesarean deliveries.

Adolescent↗
PubMed1995

Comparison of multiple-marker screening with amniocentesis for the detection of fetal aneuploidy in women > or = 35 years old.

OBJECTIVE: Our purpose was to compare the multiple-marker screening test with elective amniocentesis for the detection of fetal Down syndrome and other aneuploidies in women aged > or = 35. STUDY DESIGN: Our database included the multiple-marker screening test (maternal serum alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and maternal age) and genetic amniocentesis results from 1942 women aged > or = 35. A Down syndrome risk > or = 1:190 was considered screen positive. An algorithm to detect trisomy 18 was also used. RESULTS: The multiple-marker screening test Down syndrome screen-positive rate was 26.1% (507/1942). The Down syndrome detection rate was 75% (33/44); the trisomy 18 detection rate was 75% (3/4). However, the multiple-marker screening test detection rate for all aneuploidies was only 61%. Missed aneuploidies included trisomy 21, sex chromosome abnormalities, trisomy 13, trisomy 22, and trisomy 18. CONCLUSIONS: The multiple-marker screening test fails to detect approximately 39% of all fetal aneuploidies in women aged > or = 35. These data should be provided to women considering prenatal diagnosis so that they can make an informed decision regarding the multiple-marker screening test versus amniocentesis for advanced maternal age.

Adult↗
PubMed1995

The influence of maternal weight on human chorionic gonadotropin in the multiple-marker screening test for fetal Down syndrome.

OBJECTIVE: Our purpose was to determine the effect of maternal weight on human chorionic gonadotropin concentration in the multiple-marker screening test for fetal Down syndrome. STUDY DESIGN: Two genetics databases were used: database I contained the results of 8297 multiple-marker screening tests and database II contained the results of 1936 multiple-marker screening tests and fetal karyotypes. RESULTS: The overall screen-positive rate in database I was 7.1%; it was 7.5% in patients weighing < 180 pounds and 5.1% in patients weighing > or = 180 pounds (p = 0.001). Weight significantly affected the screen-positive rate only in women > or = 30 years old (p = 0.003 for 30 to 34 years, p = 0.00004 for > or = 35 years). A weight correction formula was derived; when applied to database II it eliminated individual weight-related differences but had no effect on the overall screen-positive rate or Down syndrome detection rate. CONCLUSIONS: Human chorionic gonadotropin concentration is affected by maternal weight. A weight correction formula eliminates individual weight-related differences in the screen-positive rate but has no discernible effect on the overall screen-positive or Down syndrome detection rates.

Adult↗