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Biomedical subjects

P C O'Brien

Publications and source records attributed to P C O'Brien.

At least 289 records · Page 16Linked to original sources
PubMed1983

Oligohydramnios: ultrasonically detected incidence and subsequent fetal outcome.

Oligohydramnios is a hallmark for intrauterine growth retardation (IUGR) and has been evaluated in populations suspected of having IUGR. We chose to evaluate its incidence in a routine obstetric population. During a 16-month period, ultrasound scans were performed on 1,408 patients. Severe oligohydramnios was identified in six patients (0.43%); Two infants had congenital malformations, and four had severe IUGR. A subset of 317 patients scanned within 2 weeks of delivery was reviewed. Although none of the patients fulfilled our original criterion of oligohydramnios (absence of a pocket of amniotic fluid 1 cm or more in broadest diameter), three of six small-for-gestational age infants had a subjective decrease in amniotic fluid volume for their stated gestational age. By changing the criterion of oligohydramnios to a subjective decrease in amniotic fluid volume, the sensitivity of this ultrasonic marker was increased to 50% and the specificity to 100%. We believe that the semiquantitative assessment of amniotic fluid volume can effectively screen for IUGR and thereby delineate a population, regardless of gestational age, that is at risk for perinatal morbidity and mortality.

Adult↗
PubMed1983

Maturation of vaginal and cervical epithelium in women exposed in utero to diethylstilbestrol (DESAD Project).

A total of 452 women with documented exposure in utero to diethylstilbestrol (DES) with epithelial findings present at the time of their initial examination have been evaluated prospectively to determine whether these findings changed over a period of 3 years. The examinations were all performed according to a strict protocol. Findings present at the time of the third annual examination were verified at a fourth examination. A verified decrease in the extent of epithelial findings occurred in 29.2% of these women and a verified increase in 6.6%; 53.1% had no change in the extent of epithelial findings, and 11.1% had a change that could not be verified at the time of the fourth visit. Analysis of many variables failed to identify a strong association between any variable and a decrease in the extent of the findings. It appears that the most important factor in the occurrence of changes in DES-associated findings is the passage of time.

Adolescent↗
PubMed1983

Effects of size, time of day and sequence of meal ingestion on carbohydrate tolerance in normal subjects.

The effects of size, time of day and sequence of meal ingestion were determined in healthy subjects using a Latin square design. Plasma glucose, insulin and gastric inhibitory polypeptide, but not glucagon, were correlated with meal size. Plasma glucose, but not insulin, gastric inhibitory polypeptide or glucagon, were greater later in the day. The progressive decline in carbohydrate tolerance from 08.00 to 18.00 h was associated with impaired insulin secretion estimated by C-peptide, and with impaired insulin action.

Adult↗
PubMed1983

Melanoma of the vulva: an update.

During the time interval 1950 through 1980, 48 patients having a mean age of 60.2 years were treated primarily for melanoma of the vulva. In all but one patient, a surgical therapeutic approach was selected, including 40 modified Basset procedures and 23 pelvic lymphadenectomies. The 5-year survival rate of the eligible population was 54%. Although surgical staging according to the classification established by the International Federation of Gynecology and Obstetrics (FIGO) was of minimal value, microstaging, using Clark's and Breslow's stratifications for assessing dermal penetration, was of prognostic significance. Ten-year survival rates associated with Clark's level II, III, IV, and V tumors were 100, 83, 65, and 23%, respectively. Histologic growth patterns (5-year survival rates of 71 and 38% for superficial spreading and nodular melanomas, respectively) and groin nodal metastasis were cogent prognostic factors and indirectly were related to depth of local tumor invasion. Likewise, assessment of treatment failures demonstrated a positive correlation between recurrences (specifically at distant sites) and Clark's level of melanocytic penetration. Because of the unacceptably high (32%) local treatment failure rate despite radical vulvar resection, treatment modifications for vulvar melanoma are imperative.

Adult↗
PubMed1983

Response of patients with irritable bowel syndrome and lactase deficiency using unfermented acidophilus milk.

Acidophilus milk has been reported to help patients with irritable bowel syndrome by correcting the "imbalance of flora" and to be tolerated better by lactase-deficient subjects by providing bacterial lactase in the small intestine. In a double-blind randomized study, 61 lactase-sufficient patients with irritable bowel syndrome each ingested 240 ml of milk three times a day for 2 wk and the same amount of acidophilus milk for an additional 2 wk. The degree of symptoms during the two milk-drinking periods was the same as during the control periods. Also, 18 lactase-deficient patients ingested unaltered milk for 1 wk and acidophilus milk for 1 additional wk. There was no difference in the degree of tolerance to the two varieties of milk. In summary, patients with irritable bowel syndrome were not helped by the ingestion of acidophilus milk, and lactase-deficient patients were as intolerant to acidophilus milk as to unaltered milk.

Adolescent↗
PubMed1983

Prandial insulin requirements in insulin-dependent diabetics: effects of size, time of day, and sequence of meals.

To assess the effects of size, time of day, and sequence of meals on insulin requirements determined by an artificial endocrine pancreas, eight insulin-dependent diabetics ate meals of 12.5%, 25%, and 50% of total calories (30 Kcal/kg) at 0800, 1300, and 1800 on each of 3 separate days in a randomized order in one of two sequences in a three by three Latin square design. Plasma glucose and free insulin concentrations and amounts of insulin infused by the artificial endocrine pancreas were associated with meal size (P less than 0.001) but not with time of day of meal ingestion (analysis of variance). The sequence of meal ingestion did not alter integrated plasma glucose responses, but did influence the meal-related amounts of insulin infused. Thus, consideration should be given to meal size and sequence of meal ingestion but not time of day of meal ingestion when determining prandial iv insulin requirements.

Adult↗
PubMed1983

Neurogenic arthropathy and recurring fractures with subclinical inherited neuropathy.

Some patients with radiologic findings of neurogenic arthropathy or multiple fractures do not exhibit overt neurologic signs. Results of nerve conduction velocity, computer-assisted sensory examination, periosteal nociception, and morphometric and graded teased-fiber evaluation of cutaneous nerves allowed us to recognize a mild neuropathic abnormality. Neurogenic arthropathy and subclinical neuropathy were also found in relatives. In three kinships, the underlying disorder was probably hereditary sensory neuropathy type 1 and in several others, it was recessively inherited sensory neuropathy. These arthropathies were often painful, and overt loss of superficial and deep pain sensation was not a prominent or necessary condition. An interplay of multiple factors including insensitivity, trauma, obesity, activity, abuse, personality, mental subnormality, and metabolic joint and bone disease are probably involved in the development of the bony lesions and thus provide further evidence that environmental factors affect expression of human mutant genes for inherited neuropathy.

Adolescent↗
PubMed1983

Effect of blood glucose control on peripheral nerve function in diabetic patients.

A prospective, stratified, randomized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years. The goals for conventional glucose control were the mean of fasting and 80-minute postprandial plasma glucose of 150 mg/dl for non-insulin-dependent diabetes and 200 mg/dl for insulin-dependent diabetes. The goal of rigorous glucose control was an approximation of nondiabetic glucose control. No significant difference in glucose control or peripheral nerve function was observed between the rigorously and the conventionally controlled groups. Eight patients in the conventional-control group spontaneously achieved glucose control in the range that was the objective for the rigorous-control group, and five patients in the rigorous-control group never achieved the desired glucose control. In the remaining 20 patients, with similar baseline glucose control and peripheral nerve function characteristics, observed over a median of 2 years, improved blood glucose control (P less than 0.01) was not associated with any significant improvement in peripheral nerve function. Nevertheless, a significant (P less than 0.05) correlation was found between the degree of abnormal nerve function at entry into the study and change in nerve function during the study. If control of hyperglycemia benefits peripheral nerve function of diabetic patients, its demonstration may require a closer approximation of normoglycemia, a larger difference in glucose control between the two study groups, a longer duration of treatment, and the use of patients with more advanced peripheral nerve function abnormalities than those in this study.

Adult↗
PubMed1983

Grade 3 placentation: incidence and neonatal outcome.

Although ultrasonically detectable placental changes have been correlated with fetal maturity, the relative incidence of each placental grade at various gestational ages has not been known. During a one-year study period, placental grading was evaluated in 1709 scans performed at 27 weeks' gestation or after. At 40 weeks' gestation or beyond, only about 20% of placentas had extensive calcification (Grannum grade 3). Significant placental calcification was rarely seen before 37 weeks' gestation. Placental grading could not be used to predict postmaturity. The incidence of fetal distress in labor was found to be increased with postmaturity as well as with other pregnancy complications that give rise to premature placental senescence, rather than with grade 3 placentas per se.

Apgar Score↗
PubMed1983

Minimal pathologic expression of a mutant gene for hereditary motor and sensory neuropathy.

Transverse sections of the sural nerve of a 46-year-old woman without neuropathic symptoms or abnormalities on nerve conduction, electromyography, or computer-assisted sensory examination contained minute regions with large onion bulbs intermingled with normal-appearing myelinated fibers and surrounded by fields of normal myelinated fibers. This woman's 19-year-old daughter had long-standing hypertrophic neuropathy with diffusely distributed large onion bulbs. Computer-imaging reconstruction of myelinated fibers and teased myelinated fiber studies of fascicles containing focal regions with onion bulbs of the mother's nerve provided evidence that onion bulbs surrounded atrophic axons with short internodes and demyelination. This is the least expression for inherited neuropathy which has been reported. These findings therefore suggest that an inherited neuropathy may be minimally expressed by a pathologic alteration of only selected neurons (axons).

Adult↗
PubMed1982

Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment.

Of 40 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 28 completed a controlled three-month trial of prednisone. Prednisone was shown to cause a small but significant improvement over no treatment in scored neurological disability, some measures of computer-assisted sensory detection threshold, graded muscle strength, and some attributes of nerve conduction. No subset of patients was more likely than another to be responsive to prednisone; those with a progressive course were as likely to be responsive as recurrent cases. This finding provides further justification for classifying progressive with recurrent cases as CIDP and demonstrates that prednisone treatment should not be withheld from patients with progressive disease.

Adolescent↗