Search PubMed⌕ Search

Biomedical subjects

R B Stewart

Publications and source records attributed to R B Stewart.

At least 55 records · Page 3Linked to original sources

Absorption characteristics at 1.9 microns: effect on vascular welding.

A 1.9 microns laser was used to investigate the acute weld strengths for anastomoses of rat and rabbit aortas and femoral arteries. The wall thicknesses for these vessels approximately matched the optical absorption depth of 125 microns for 1.9 microns radiation in vascular tissues. A low power (150 mW) 1.9 microns laser was used. Laser power was delivered through silica fiber optics for manual control. The fiber tip was held approximately 1 mm from the target resulting in a laser spot size of 0.7 mm at the tissue. The linear delivery rate was approximately 0.3 mm/sec. Acute burst pressures of the welds showed a linear correlation with the reciprocal of the vessel radius. These results suggest that the product of the weld strength times the optical absorption depth is constant over the range of vessel sizes studied. A weld strength for a weld thickness equal to the optical absorption depth was determined to be 4 x 10(6) dynes/cm2, which is comparable to the strength of sutured anastomoses. These acute studies suggest that a laser wavelength with absorption depth in tissue matched to the vessel wall thickness should yield optimum welds. Therefore, a laser operating near 1.9 microns is suitable for small vessel welding.

Anastomosis, Surgical↗

Advances in pharmacotherapy: depression in the elderly--issues and advances in treatment.

Depression continues to be major cause of morbidity and mortality in the elderly. It is estimated that 1-5% of elderly persons who live in the community and 5-43% of nursing-home patients have major depression. Symptoms of depression in the elderly do not differ substantially from younger patients. Tricyclic antidepressants continue to be the drugs of choice in the elderly because of their long record of use with proven efficacy, known adverse effect profile and availability of less expensive generic formulations. The newer second-generation antidepressants, including serotonin reuptake inhibitors, appear to offer a major advantage of fewer serious adverse effects in the elderly. This review will highlight recent developments regarding the prevalence and treatment of depression in the elderly.

Aged↗

Full-arch implant framework casting accuracy: preliminary in vitro observation for in vivo testing.

PURPOSE: Conventional techniques for implant metal framework fabrication produce error of a magnitude that is inconsistent with the passive-fit requirement for osseointegrated implants. To understand the correlation between prosthesis fit and the implant-tissue response, evaluation of the interface tissue reactions to customary levels of fit is required. The purpose of this study is to determine the accuracy of torch casting full arch frameworks using a high palladium alloy and a ringless phosphate-bonded investment technique. MATERIALS AND METHODS: Three different variables were considered relative to casting accuracy effect. The first variable, completeness of mold-fill, compared cast specimens where the entire sprue system was filled as part of the casting and cast specimens without the sprue system filled. The second variable, phosphate-bonded investment special liquid concentrations, compared groups of castings produced from 0%, 12%, 25%, and 50% special liquid. The third variable, investment mold shape, compared casting produced from a conventional ringless mold shape with a modified ringless mold shape where the investment in the same horizontal plane as the pattern was equal in thickness at the internal and external surfaces. Horizontal and vertical distances on the wax pattern and resulting framework were measured using a machinists microscope to determine casting error. Combined vertical and horizontal error was used for comparison between groups (one-way analysis of variance). RESULTS: No significant differences existed among the three groups compared (P > 0.05). The mean error comparison between the complete and incomplete mold-fill groups showed no statistical difference, while the incomplete fill group was found to be more porous. The mean error of all groups (0.130 mm) exceeded the recommended level of fit needed to satisfy the passive fit requirement by more than 10-fold. CONCLUSIONS: These results verify clinical observation and suggest that the use of conventional lost wax casting technique to cast one-piece full arch implant frameworks is both imprecise and inaccurate as judged against the passive fit requirement. The consequences of screw-fastening misfitting prostheses to osseointegrated implants is currently under investigation.

Analysis of Variance↗

Differences in the hypothermic response to ethanol in rats selectively bred for oral ethanol preference and nonpreference.

The duration of retention of tolerance to ethanol was tested in the alcohol-preferring (P) and alcohol-nonpreferring (NP) rats lines, using ethanol-induced hypothermia as a measure of tolerance. Rats received two injections of ethanol (3.5 g/kg) body wt, IP) and the time between the injections was 1, 2, or 3 days. When one day separated the two injections, tolerance to the hypothermic effect of a second "test" injection was found in both lines. When 2 or 3 days separated the two injections, the P line showed a loss of tolerance and the NP line showed sensitization to ethanol. Sensitization in the NP line grew stronger when the interval between injections was increased from 2 to 3 days. The duration of retention of tolerance to ethanol-induced hypothermia in the P line was shorter than has previously been reported for motor impairment in this line. It appears that the duration of tolerance retention in the P line depends on the test used to measure tolerance. Sensitization to ethanol in the NP line may be associated with low oral ethanol intake.

Alcohol Drinking↗

Fatigue strength of cantilevered metal frameworks for tissue-integrated prostheses.

The design of the metal alloy framework in cantilevered sections of fixed tissue-integrated prostheses, is critical. Several cross-sectional designs have been advocated, including the popular L-shaped beam, which permits the economical use of space for tooth placement. The fatigue strengths of 15 L-shaped cantilevered framework sections of the same metal alloy were tested. The castings were divided into three groups of five according to vertical wall heights of 4, 5, and 6 mm. Fatigue durability of each sample was determined by counting the number of cycles of vertical forces required to induce catastrophic failure. Statistical analysis revealed significant differences between all three groups in the cycles counted at failure (p less than 0.0019). Fatigue strengths improved significantly with increasing vertical wall height of the L-shaped cantilevered frameworks. In addition, beam flexure was shown to be indirectly proportional to fatigue strength. Theoretical beam deflection was calculated and shown to correlate with the actual beam deflection during the testing. Theoretical calculations in static bending specific for a cross-sectional design may aid in the predictability of fatigue strength.

Dental Alloys↗

Arterial laser welding with a 1.9 micrometer Raman-shifted laser.

A new 1.9 micron Raman-shifted neodymium:yttrium aluminum garnet (Nd:YAG) laser was used for small vessel welding. Bursting pressures and stresses of sutured and laser-welded arteriotomies created in the rat femoral artery and aorta were measured. Sutured arteriotomies had a significantly higher burst stress than laser-welded arteriotomies. Although there were no significant differences in burst stress at the various laser powers tested, an optimal power was identified. The laser was also used to weld transected rat aortas. The average power delivered was 200 mW for 30 seconds per anastomosis. The average time for completing an anastomosis was 6 minutes compared with 18 minutes when sutures were used. In relation to proximal aortic diameter, there was a 7.9% decrease at the anastomosis immediately (n = 4), and a 6.6% and 4.9% increase occurred at 24 hours (n = 4) and 10 weeks (n = 5), respectively. Acute anastomotic compliance, and compliance at 24 hours and 10 weeks were decreased by 47.2%, 39.5%, and 47.8%, respectively, and were similar to sutured anastomoses. Histology showed little thermal denaturation of the aorta within 0.6 mm of the anastomosis, approximately 1 mm of medial cell death, and nearly normal elastic fiber alignment. One focal false aneurysm was noted at 10 weeks. Although the sutured and laser-welded anastomoses share similar compliance changes, the laser-welded anastomoses are more isodiametric. This preliminary experience with the 1.9 micron laser shows the distinct advantages of a handheld fiber, no requirement for cooling irrigation, speed, and no difference in compliance from sutured anastomoses.

Analysis of Variance↗

Nocturia: a risk factor for falls in the elderly.

OBJECTIVE: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons. DESIGN: Cross-sectional study comparing falls in men and women with and without nocturia. SETTING: Longitudinal health screening program of ambulatory elderly participants. PARTICIPANTS: Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program. MAIN OUTCOME MEASURES: Reported falls in the past year and reported bone fractures in the past 5 years. RESULTS: Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05-3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04-4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360). CONCLUSIONS: Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events.

Accidental Falls↗

Acute confusional states in older adults and the role of polypharmacy.

Cognitive impairment resulting from drug therapy in older persons has been well documented for numerous classes of drugs. Unfortunately, the problem of ACS caused by polypharmacy is rarely reported in the medical literature, although we believe that it occurs frequently. Health professionals need more education concerning the risks of drug therapy in older persons and methods of reducing the use of multiple drug therapy. Finally, more research is needed to identify patient and drug factors that lead to drug-induced ACS and cognitive decline in the elderly.

Aged↗

Lack of association of nonsteroidal anti-inflammatory drug use and cognitive decline in the elderly.

Folstein Mini-Mental State Examination (MMSE) scores obtained in an ambulatory elderly population were used to examine the effect of nonsteroidal anti-inflammatory drug (NSAID) use on cognitive performance. There were 1,310 participants who met the inclusion criteria for the study, of whom 873 (66.6%) were women and 437 (33.3%) were men. There were no differences in mean MMSE scores or in the five dimensions of cognitive function measured by the MMSE for subjects reporting NSAIDs or aspirin use.

Aged↗

Polypharmacy in psychiatry: three case studies and methods for prevention.

OBJECTIVE: To illustrate problems of overprescribing in the elderly and to make practical suggestions for prevention of polypharmacy. DESIGN: Three cases of polypharmacy in psychiatric patients admitted to the hospital between January and March 1990 are described. Intervention to correct drug-related problems in these patients is described and methods of preventing polypharmacy are discussed. SETTING: Inpatient psychiatry service in a tertiary-care center. PATIENTS: Elderly psychiatry patients (n = 3) taking an excessive number of medications. This polypharmacy was believed to contribute to decreased cognitive and/or physical function. INTERVENTIONS: Medication regimens were reviewed by the physician and pharmacist. Those considered unnecessary or believed to be adversely affecting the patient were discontinued. RESULTS: All patients were discharged on a reduced number of medications, with improvement in cognitive and/or physical function. CONCLUSIONS: Polypharmacy contributes to an increased incidence of adverse reactions in the elderly. Implementation of practical methods for reducing polypharmacy can lead to a reduction in the number of drug-related adverse effects and improved care of the elderly patient.

Aged↗

Correlates of constipation in an ambulatory elderly population.

Constipation is a common and often perplexing problem for elderly people. The prevalence of self-reported constipation and factors associated with constipation were investigated in 3,166 people over age 65. Twenty-six percent of women and 15.8% of men reported recurrent constipation (p less than 0.0001). There was a significant increase in reported constipation with increasing age (p less than 0.0001). Multiple factors were found to correlate with self-reported constipation. A logistic regression model revealed 13 factors of significance in predicting constipation. The most important factors were age, sex, total number of drugs taken, pain in the abdomen, and hemorrhoids (p less than 0.0001). Specific drugs do not appear to be important factors in constipation in the elderly. Elderly people who report the use of multiple drugs, pain in the abdomen, and hemorrhoids are at increased risk for constipation.

Age Factors↗

Narrow QRS ventricular tachycardia.

OBJECTIVE: To determine the frequency and clinical characteristics of narrow QRS ventricular tachycardia (QRS duration less than or equal to 0.11 seconds). DESIGN: Consecutive survey of patients with ventricular tachycardia. SETTING: Tertiary, referral-based arrhythmia service at a university medical center. PATIENTS: Sequential sample of patients with inducible ventricular tachycardia who had a 12-lead electrocardiogram of the tachycardia available for review. MEASUREMENTS AND MAIN RESULTS: Of 106 patients with ventricular tachycardia, 5 (4.7%; 95% CI, 2.1% to 10.6%) had ventricular tachycardia with a QRS duration less than or equal to 0.11 seconds. Three of the five patients were previously incorrectly diagnosed as having supraventricular tachycardia. All five patients had at least two electrocardiographic findings other than QRS duration to suggest ventricular tachycardia. CONCLUSIONS: Narrow QRS ventricular tachycardia should be considered in the differential diagnosis of narrow QRS tachycardias. Electrocardiographic findings other than QRS duration are usually present to suggest the diagnosis.

Diagnosis, Differential↗

Effect of psyllium hydrophilic mucilloid on serum cholesterol in the elderly.

The effect of psyllium hydrophilic mucilloid (PHM) when used as a laxative and/or stool softener on serum cholesterol concentrations was examined in 176 ambulatory elderly participants attending a health screening program. The change in one-year serum cholesterol concentration in subjects using PHM was compared with the change in cholesterol in 741 participants who did not report the use of PHM. Serum cholesterol concentration decreased by 0.073 mmol/liter (2.82 mg/dl) in the treatment group compared with a decrease of 0.036 mmol/liter (1.39 mg/dl) in the control group. After adjusting for confounding factors, excluding psyllium dose, by using a multiple regression model there was no significant difference in the change in serum cholesterol concentration (P = 0.935). PHM dosage information was available for 158 participants. After adjusting for baseline serum cholesterol and confounding factors using multiple regression analysis, it was found that the dose of PHM administered was significantly correlated with the change in serum cholesterol (P = 0.0120). For every 1-g increase in daily PHM dose there was a 0.022 mmol/liter (0.84 mg/dl) decrease in serum cholesterol concentration.

Aged↗

Chronic alcohol consumption in alcohol-preferring P rats attenuates subsequent conditioned taste aversion produced by ethanol injections.

Rats of the P line were tested for the development of tolerance to the aversive effects of ethanol during 33 days of continuous availability of food, water and a 10% (v/v) ethanol solution. Beginning on the day following the removal of ethanol, five daily conditioned taste aversion (CTA) trials were administered to the ethanol-drinking P rats and an ethanol-naive control group. The CTA trials consisted of a 20-min access to a Polycose solution, followed by IP injection of saline, 0.5, 1.0, or 1.5 g ethanol/kg. The ethanol-drinking rats developed a preference for the Polycose solution when it was paired with 0.5 g ethanol injections, but the control rats did not. Both control and ethanol groups had similar CTAs at the 1.5 g dose. However, at the 1.0 g dose, the ethanol group had an attenuated CTA compared with the water control group. The results suggest that P rats develop tolerance to aversive effects of ethanol during chronic drinking. This tolerance could contribute to the high ethanol intake in these selectively-bred rats.

Alcohol Drinking↗

A longitudinal evaluation of drug use in an ambulatory elderly population.

Participants in a geriatric health screening program were studied longitudinally to determine the patterns of drug use over a 10 year period. There were 314 (34.0%) men and 610 (66.0%) women who completed 10 yearly health screening evaluations. The mean number of prescribed and non-prescribed drugs used per participant increased from 2.90 in 1978-79 to 4.08 in 1987-88 (p less than 0.0001). There was no significant difference between men and women in the rate of increased drug use. There was no significant increase in the mean number of drug ingredients per participant used over the 10 year period. The most frequently reported therapeutic categories for 1978-79 were antihypertensives, analgesic-antipyretics, antirheumatics, multiple vitamins, cathartics and vitamin E, which represented 10.2, 7.2, 6.5, 4.9, 4.8 and 3.8% of all categories used. There was a decline in all of these categories between interval 1 and 10. Increased use of drugs, particularly prescribed medications, by the elderly population may present problems of adverse drug reactions, drug interactions and medication compliance in the future. Changing patterns of drug use may have resulted, in part, from introduction of new therapeutic classes and from new treatment concepts over the 10 year study period.

Aged↗

Regulation of alcohol consumption by the renin-angiotensin system: a review of recent findings and a possible mechanism of action.

The renin-angiotensin system has traditionally been associated with the regulation of fluid and electrolyte balance. In this review we summarize the data which ascribes a completely new function to this system, i.e., the regulation of alcohol consumption. In addition, we suggest a possible mechanism for this effect based on the concept of a satiety or stop process. The approach taken was to examine the effect on alcohol intake of a wide variety of drug, genetic, dietary, surgical and neurosurgical manipulations, each of which has a range of biological effects characteristic of that manipulation, but all of which share the common property of altering activity in the renin-angiotensin system. The effect of these manipulations on alcohol intake was most parsimoniously explained by reference to their ability to raise or lower activity in the renin-angiotensin system. Any intervention which modulates activity in this system, either directly or indirectly, is likely to have consequences for alcohol consumption.

Alcohol Drinking↗

Changing patterns of therapeutic agents in the elderly: a ten-year overview.

Drug use patterns in a large ambulatory elderly population were studied cross-sectionally over a 10-year period. There were 24192 drug histories obtained on 4509 individuals during the period from 1 August 1978 to 31 July 1988. The average number of drugs used per person increased from 3.22 in 1978-9 to 3.94 in 1987-8. Prescribed drug use increased by 0.52 per person compared with an increase of 0.21 for nonprescribed medication. Analysis of two mutually exclusive groups of participants from 1978-9 and 1987-8 revealed a significant (p less than 0.0001) increase in the use of nonprescribed medication but no significant increase in the use of prescribed medication after adjusting for age and sex effects. The four most frequently used therapeutic classes of drugs in 1978-9 as a percentage of all drugs used were antihypertensives (10.8%), analgesic-antipyretics (6.4%), antirheumatic (6.4%), and cathartics (5.4%) compared with the antihypertensives (9.5%), analgesic-antipyretics (5.9%), anticoagulants (5.5%), and antirheumatic (4.6%) for the 1987-8 period.

Age Factors↗