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Biomedical subjects

R Vander Zwaag

Publications and source records attributed to R Vander Zwaag.

At least 37 records · Page 2Linked to original sources
PubMed1989

Laparoscopic appearances of peritoneal endometriosis.

This article studies endometriosis diagnosed in patients undergoing laparoscopy for infertility and/or pain from 1982 to 1988. The diagnosis of endometriosis at laparoscopy increased from 42% in 1982 to 72% in 1988. The greatest change is in "subtle" lesions, which increased from 15% in 1986 to 65% in 1988. An increased awareness and histologic confirmation of the protean presentation of endometriosis is associated with a significant increase in the diagnosis of endometriosis at laparoscopy.

Cicatrix↗
PubMed1989

Microbial associations of 167 patients with psoriasis.

Microbial findings were analyzed from a group of 167 patients with psoriasis in an attempt to discover specific associations. Positive findings include associations between Malassezia ovalis and scalp/ear/face psoriasis and between bacteria and bodyfold, nailfold, and gluteal/rectal psoriasis.

Anti-Bacterial Agents↗
PubMed1988

The effect of cigarette smoking on the pattern of coronary atherosclerosis. A case-control study.

Cigarette smoking is a risk factor for development of coronary atherosclerosis. We examined the relationship between smoking and the anatomic location of coronary artery stenosis in 8,705 patients undergoing cardiac catheterization for suspected coronary artery disease (CAD). The smoking history of patients with CAD (greater than or equal to 70 percent stenosis) was compared with that of control subjects (0 percent stenosis) for each of nine anatomic locations (proximal, middle, and distal segments of right [RCA], anterior descending [LAD], and circumflex arteries [LCX]), using a case-control method. The odds ratio (OR) estimate of relative risk of CAD for smokers relative to nonsmokers was 2.8, with a 95 percent confidence interval (CI) of 2.5 to 3.1. Relative risk was greater for RCA stenosis (OR = 5.8; CI = 4.6-7.2) than for LCX (OR = 3.5; CI = 2.7-4.5) or LAD (OR = 2.1; CI = 1.8-2.4) lesions when comparing smokers with nonsmokers. After control for age, gender, history of diabetes mellitus, and serum cholesterol level, the adjusted relative risk for an RCA lesion (Mantel-Haenszel odds ratio [MOR] = 4.9) was significantly elevated (p less than 0.05) compared with the LAD (MOR = 1.9) but not with the LCX (MOR = 3.1). The relative risks of CAD were the same (p greater than 0.05) for the proximal, middle, and distal coronary segments. Thus, smoking increased the risk of all coronary lesions but did so more for the RCA than for other vessels, suggesting a spatial pattern to the increased risk produced by smoking.

Adult↗
PubMed1988

Postmenopausal estrogen use and coronary atherosclerosis.

STUDY OBJECTIVE: To determine whether estrogen replacement therapy affects the prevalence of severely obstructive coronary arterial lesions defined by selective coronary arteriography. DESIGN: Case-control study. SETTING: Large, urban, university-affiliated referral hospital. PATIENTS: From a consecutive sample of 6452 women having coronary arteriography between 1972 and 1984, 2188 patients were eligible for study; others were excluded because they were nonmenopausal, had congenital heart defects, valvular heart disorders, primary myocardial disease, or no more than mild to moderate coronary artery disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hospital nurses routinely obtained medication histories. Staff invasive cardiologists interpreted coronary arteriograms. Clinical, laboratory, and angiographic data were abstracted from the cardiac catheterization reports and entered into a computerized registry. Postmenopausal estrogen use for 1444 cases of coronary artery disease (70% stenosis) was compared to that 744 controls (0% stenosis). The odds ratio estimate of the risk of coronary artery disease for estrogen users relative to the risk of coronary artery disease for nonusers was 0.44 (95% confidence interval, 0.29 to 0.67) after adjustment for age, cigarette smoking, diabetes, cholesterol, and hypertension. Postmenopausal estrogen replacement was a significant independent protective factor for coronary artery disease in a multivariate logistic regression model (P = 0.037). CONCLUSION: The data suggest that postmenopausal estrogen treatment reduces the risk for angiographically significant coronary artery disease.

Age Factors↗
PubMed1987

Association between the severity of diabetes mellitus and coronary arterial atherosclerosis.

The relation between the severity of diabetes mellitus (DM) and the risk of significant coronary artery lesions were studied in 7,655 patients undergoing coronary arteriography for suspected coronary artery disease (CAD) between 1972 and 1982. The principal treatment regimen for DM was used to estimate the severity of DM. DM treated with insulin was defined as the most severe (n = 244), followed by DM treated with oral agents (n = 344) and with diet only (n = 380); 6,687 patients did not have DM. Severity of DM in patients with CAD (70% or greater diameter stenosis) was compared with that in control subjects without CAD (0% stenosis) for each of 9 anatomic locations (proximal, middle and distal portions of right, anterior descending and circumflex coronary arteries) using a retrospective case-control approach. The risk of CAD was highest in patients with DM treated with insulin (odds ratio estimate of the relative risk [OR = 3.0]), followed by patients with DM treated with oral agents (OR = 1.8) and lastly in those treated with diet alone (OR = 1.4). Severity of DM was a significant (p less than 0.05) independent predictor of CAD in a multivariate logistic regression model, whereas age at onset and duration of DM were not. The relative risk of CAD was the same (p greater than 0.05) for each of the 9 coronary segments. The data suggest that the risk of CAD increases with the severity of DM, which was a stronger predictor of CAD than duration of DM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The limitation of liver function tests in metastatic carcinoid tumors.

To evaluate the utility of liver function tests (LFT) as indicators of metastatic carcinoid tumors, a retrospective study was performed. The LFT results of 17 patients with carcinoid tumors metastatic to the liver were compared with 17 patients with other malignant tumors. In the noncarcinoid group, 82.4% of the patients had elevated alkaline phosphatase (AP) or gamma glutamyl transpeptidase (GGTP), whereas only 28.6% of carcinoid patients had abnormal enzymes. The medians of all LFT values were significantly higher in noncarcinoid patients than in the carcinoid group, except for glutamic pyruvic transaminase (SGPT). Our data indicate that LFT are helpful in screening for liver metastases in patients with noncarcinoid tumors, but are unreliable in carcinoid tumors. Imaging tests should be used to rule out liver metastases in carcinoid tumors, irrespective of LFT results.

Carcinoid Tumor↗
PubMed1987

Prognostic value of the pressure-volume ratio in patients with coronary artery disease.

To determine if the peak-systolic pressure/end-systolic volume ratio [PSP/ESV], a load-insensitive index of left ventricular function, predicted perioperative mortality and long-term survival after coronary artery bypass surgery or medical treatment, 4,829 patients with coronary artery disease were studied retrospectively. Cardiac volumes, ejection fraction, and PSP/ESV ratio were computed using standard methods, and follow-up was performed using annual questionnaires. PSP/ESV ratio values were not significantly different (p = .09) between those who died during hospitalization (n = 101) after coronary surgery and those who were discharged. Long-term follow-up in surgically treated patients demonstrated a 97% 3-year and 93% 5-year survival for those with PSP/ESV over 2.292. These were significantly greater (p = .0026) in value in patients with PSP/ESV less than 1.237 (3-year and 5-year survival of 92 and 79.2%, respectively). In the medical group, survival rate for those with PSP/ESV over 2.292 at 5 years was 89.3%, while for those with PSP/ESV less than 1.237 it was 52.5% (p less than .001). Multivariate analysis, however, showed ejection fraction to be a more significant predictor of survival in both the groups compared with PSP/ESV ratio. Thus, PSP/ESV ratio does predict long-term survival in coronary disease patients treated either surgically or medically. Ejection fraction was nevertheless a more powerful predictor of outcome.

Adult↗
PubMed1987

Diagnosis of diseases of the lumbar spine: correlation of computerized tomography with myelography and clinical findings.

Data from 339 patients referred for evaluation of suspected lumbar disease were studied retrospectively to correlate findings in the routine clinical evaluation with results of computed tomography and myelography. Clinical features from the patients' history that correlated with an abnormal CT and myelogram included age greater than or equal to 40, a history of previous surgery, and absence of a history of injury. Signs from the physical examination that correlated included reduced lumbar motion, a motor or sensory deficit, abnormal reflexes, and reduced capacity for straight leg-raising or walking. Using a clinical score incorporating these variables, we suggest a diagnostic strategy to promote more efficient and selective use of CT scans and myelograms. We project that the use of this diagnostic approach can reduce the number of myelograms ordered in a similar population by more than 50%.

Adult↗
PubMed1984

Acute myocardial infarction in elderly patients.

We conducted a retrospective chart review on 50 patients under age 65 (average age 52.9 years) and 55 patients over 65 (average age 75.6 years). The older patients were much more likely to have atypical pain or no pain (38% vs 4%, P less than .0001). They were less likely to have electrocardiographic QRS changes (47% vs 72%), but more likely to have congestive heart failure (44% vs 16%, P less than .01). In 25% of the older patients, no diagnosis was made in the first 24 hours, as compared to 8% of the younger group. The increased mortality in the older group (16% vs 4%) approached statistical significance (P = .08). We conclude that the manifestations of acute myocardial infarction are more subtle in the elderly, with a higher proportion of atypical chest pain and nondiagnostic electrocardiograms, but the elderly are more likely to have congestive heart failure.

Adult↗
PubMed1983

A geriatric rehabilitation and assessment unit in a community hospital.

This report describes functional status at admission, discharge, and six months later for 100 elderly persons treated at a community hospital assessment and rehabilitation unit. The goal of the unit is to prevent institutionalization of frail elderly persons considered at risk for nursing home placement. Characteristics of the first 100 admissions include the following: average age, 79 years; female, 77 per cent; length of stay, 23 days; average number of admitting diagnoses, 3.4. Ninety-one new diagnoses of treatable conditions were made. On admission, 81 per cent of patients were confined to bed or chair or needed assistance with ambulation, compared with 27 per cent at discharge and 22 per cent at six months. Activities showing significant improvement include dressing, housekeeping, use of toilet, and ambulation. At six months, 15 per cent had died, 67 per cent were living in the community, and 19 per cent were institutionalized. It is concluded that care at the geriatric unit probably resulted in improved function and decreased nursing home placement.

Activities of Daily Living↗
PubMed1982

Control of systolic blood pressure in elderly black patients.

To study what effect the level of control of systolic blood pressure (SBP) has in elderly persons with systolic-diastolic hypertension, 503 elderly black hypertensive patients were followed up for as long as nine years. The combined rate of hospitalizations and mortality for hypertension-related disorders was significantly (P less than 0.01) higher for the group with inadequate control of SPB (mean, 183.6 mm Hg) than for the group with partial (mean, 151.2 mm Hg) or complete (mean, 131.5 mm Hg) control. The group with complete control of SBP had a significantly (P less than 0.005) higher combined rate of hospitalizations and mortality for hypertension-related disorders than did the group with partial control. This suggests that a target goal for control of systolic as well as diastolic blood pressure should be set for elderly black hypertensive patients. However, the control of SBP should not be to rigorous.

Aged↗
PubMed1980

Why people are hospitalized. A description of preventable factors leading to admission for medical illness.

We evaluated factors leading to the admission of 136 patients to the general medical services of two large metropolitan hospitals. We developed explicit criteria for the contribution of various specific factors to illness prevention and control in these patients. According to these criteria, the illness was found to be preventable in 44 per cent and the illness could have been controlled without admission in 31 per cent if a standard medical regimen had been followed. Social circumstances of individual patients influenced the admission decision in 21 per cent. Lack of medical or community resources or failure to make use of them contributed to 21 per cent of admissions. Alcohol abuse and smoking were factors in 17 per cent and 15 per cent respectively. Compliance played a role in 21 per cent. In 29 per cent of admissions more than one preventable factor was identified. Personal habits and lifestyle, less-than-optimal management or prior illness, social considerations or lack of community resources were factors in 78 per cent of the admissions.

Alcoholism↗
PubMed1978

Relation between component parts of fibrocystic disease complex and breast cancer.

Specimens of benign breast disease obtained from biopsies performed at Vanderbilt Hospital (Nashville, Tenn.) between 1952 and 1959 were histologically reviewed and characterized as to individual component types of fibrocystic disease. Follow-up for information regarding breast cancer development was 94% successful. Carcinoma developed more often when epithelial proliferative lesions were present. Atypical lobular hyperplasia had a greater predictive value than other epithelial lesions and was associated with an elevated risk six times that expected prior to the age of 45 years and a tripling of risk after the age of 45 years. Various ductal hyperplastic lesions are associated with approximately a doubly increased risk that is present only if the lesions are identified at biopsy after the age of 45 years. Women with cysts, sclerosing adenosis, fibrosis, and other nonhyperplastic changes were at no greater risk for subsequent carcinoma than women in the general population.

Adenofibroma↗
PubMedDate not supplied

Acquisition of group A streptococcal M protein antibodies.

Seventy-five children who acquired positive throat cultures for Group A streptococci among 250 cultured weekly were studied during the school years 1972-1973 and 1973-1974 in order to investigate streptococcal M protein antibodies. Eleven (14.7%) of the children had strain-specific serum M protein antibodies at the time a positive throat culture was first detected or 6 weeks previously. Eight of 64 (12.5%) children acquired strain specific serum M protein antibodies within 6 weeks and another 6 of 46 (13%) did so within 1 year of infection. The presence of strain-specific serum M protein antibodies did not appear to be protective. One-third of the 75 children who acquired positive throat cultures had a significant rise in anti-streptolysin O or anti-hyaluronidase antibody titers. Among those who acquired Group A streptococci, 25 children had positive cultures on 7 or more culture dates.

Antibodies, Bacterial↗
PubMedDate not supplied

A cohort study of mortality in two clinic populations of patients with diabetes mellitus.

Mortality rates of two cohorts of patients with diabetes mellitus are estimated and compared. The Atlanta cohort is defined as all black patients receiving care at the diabetes clinic of Grady Memorial Hospital for the first time during calendar year 1971. The Memphis cohort is defined as all black patients referred from the City of Memphis Hospital outpatient clinic to a decentralized neighborhood clinic operated by the Memphis and Shelby County Health Department during September 1969 through August 1970. The Atlanta program discontinued all prescriptions of oral hypoglycemic drugs and emphasized instead an aggressive diet therapy. The Memphis program has used diet therapy but also insulin and/or oral hypoglycemic agents according to current guidelines. The ratios of observed to expected deaths (standardized mortality ratios) were remarkably similar for the two cohorts. In both cohorts the standardized mortality ratios were greatest for the youngest patients and for those patients whose duration of illness was longest. Nine-year survival rates, estimated by the life-table method and adjusted for differences in frequency distributions of entry age and duration of diabetes, were also similar for the two cohorts.

Actuarial Analysis↗