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Biomedical subjects

T E Nolan

Publications and source records attributed to T E Nolan.

At least 37 records · Page 2Linked to original sources
PubMed1995

Outcomes of ultrasound diagnosis of ectopic pregnancy. Dependence on observer experience.

BACKGROUND: The effect of examiner experience on the detection of ultrasound findings in ectopic pregnancy was assessed in a retrospective study. METHODS: Records and examinations of 267 consecutive patients with surgically proven ectopic pregnancy were reviewed. Patients were divided into two groups: (1) those who were examined by faculty during the day (182 examinations) and (2) those who were examined by resident physicians at night (85 examinations). RESULTS: A statistical difference was found in the incidence of adnexal mass, free fluid, sac within the mass, and corpus luteum cyst. CONCLUSION: Examiner experience has a strong effect on the diagnostic accuracy of ultrasound examination. Adnexal abnormalities may be difficult to identify because of confusion with loops of bowel or other pelvic structures. Faculty follow-up and review are important in patient management.

Faculty, Medical↗
PubMed1995

Prospective survey of continuous versus single-injection spinal anesthesia in obstetrics.

Prior to the removal of spinal microcatheters from the market in 1992, these catheters were used extensively in the Obstetric Anesthesia Service at the Medical Center of Louisiana. We report on a prospective survey of the clinical application of single-injection versus continuous-catheter spinal anesthesia. Two hundred sixteen patients had single-injection anesthesia, and 218 had continuous-catheter anesthesia. No neurologic complications other than postdural puncture headache (PDPH) were encountered in either group. Five patients had PDPH after single-injection technique, and 8 patients had PDPH from continuous spinal anesthesia. Patients with diabetes were at higher risk for PDPH, and blacks were at lower risk (relative risks 4.35 and 0.31, respectively). Additionally, PDPH was associated with lower intraoperative urine output. No increased risk of complications was found after continuous spinal anesthesia with microcatheters.

Adult↗
PubMed1995

A vaccine-elicited, single viral epitope-specific cytotoxic T lymphocyte response does not protect against intravenous, cell-free simian immunodeficiency virus challenge.

Protection against simian immunodeficiency virus (SIV) challenge was assessed in rhesus monkeys with a vaccine-elicited, single SIV epitope-specific cytotoxic T-lymphocyte (CTL) response in the absence of SIV-specific antibody. Strategies were first explored for eliciting an optimal SIV Gag epitope-specific CTL response. These studies were performed in rhesus monkeys expressing the major histocompatibility complex (MHC) class I gene Mamu-A*01, a haplotype associated with a predominant SIV CTL epitope mapped to residues 182 to 190 of the Gag protein (p11C). We demonstrated that a combined modality immunization strategy using a recombinant Mycobacterium bovis BCG-SIV Gag construct for priming, and peptide formulated in liposome for boosting, elicited a greater p11C-specific CTL response than did a single immunization with peptide-liposome alone. Vaccinated and control monkeys were then challenged with cell-free SIVmne by an intravenous route of inoculation. Despite a vigorous p11C-specific CTL response at the time of virus inoculation, all monkeys became infected with SIV. gag gene sequencing of the virus isolated from these monkeys demonstrated that the established viruses had no mutations in the p11C-coding region. Thus, the preexisting CTL response did not select for a viral variant that might escape T-cell immune recognition. These studies demonstrate that a potent SIV-specific CTL response can be elicited by combining live vector and peptide vaccine modalities. However, a single SIV Gag epitope-specific CTL response in the absence of SIV-specific antibody did not provide protection against a cell-free, intravenous SIV challenge.

Animals↗
PubMed1995

Acute pulmonary dysfunction and distress.

Acute pulmonary dysfunction and distress is not uncommon in the obstetric patient. In these situations, however, a quick assessment and intervention is necessary in many cases. This article familiarizes the practicing obstetrician with the physiology and therapy to evaluate and effectively treat these patients.

Asthma↗
PubMed1994

Comparative efficacy of two sonographic measurements for the detection of aberrations in the amniotic fluid volume and the effect of amniotic fluid volume on pregnancy outcome.

OBJECTIVE: To determine in pregnant women with preterm labor the relative efficacy of the amniotic fluid index (AFI) and the two-diameter pocket to detect abnormalities in amniotic fluid volume (AFV), and to relate these findings to pregnancy outcome. METHODS: Fifty-seven healthy women with preterm labor underwent amniocentesis in the third trimester to detect subclinical chorioamnionitis and assess fetal lung maturity. The AFV was estimated by the AFI and two-diameter-pocket methods, then confirmed by a dye (aminohippurate sodium)-dilution technique. Each labor was evaluated for severe variable decelerations requiring amnioinfusion, fetal distress resulting in cesarean delivery, and a 5-minute Apgar score below 7. RESULTS: Using fluid volume confirmed by dye dilution, the AFI correctly diagnosed AFV as low (less than 500 mL) in only two of 23 (8.7%) patients, compared to 14 of 23 (61%) for the two-diameter pocket (P < .001). Fetal distress requiring cesarean delivery occurred significantly more often in the hydramnios group (three of six) compared to those with normal AFV (one of 23) (P < .03), and approached significance in the oligohydramnios group (two of 21) (P = .056). There were no significant differences among the three patient groups regarding the need for amnioinfusion for severe variable decelerations or the occurrence of 5-minute Apgar scores below 7. CONCLUSIONS: Compared to the AFI, the two-diameter pocket is a superior sonographic measurement for the detection of oligohydramnios. In an otherwise low-risk pregnancy with preterm labor, oligohydramnios is associated with no greater risk for an adverse outcome than is a normal AFV.

Adult↗
PubMed1994

Ruptured pelvic appendix diagnosed by transvaginal sonography.

BACKGROUND: Appendicitis in a pelvic appendix can be difficult to diagnose. Transvaginal sonography may help to visualize an inflamed pelvic appendix. CASE: A 31-year-old woman presented to the hospital with symptoms suggestive of pelvic inflammatory disease. Transabdominal ultrasound, useful in the diagnosis of appendicitis, showed a mass between the uterus and the right ovary. Transvaginal ultrasound clarified the finding as a bulbous fluid-filled structure extending into the cul-de-sac. The structure was diagnosed as an inflamed appendix. Laparoscopic appendectomy was performed, and the patient had an uneventful recovery. CONCLUSION: To our knowledge, this is the first case of appendicitis diagnosed with transvaginal sonography. Transvaginal sonography can delineate the features of an inflamed pelvic appendix and help to narrow the diagnostic possibilities in symptomatic women of childbearing age.

Adult↗
PubMed1993

The gynecologist and multiple organ failure syndrome (MOFS).

Multiple organ failure syndrome (MOFS) has been alluded to since the early 1940s. It was recognized as a progressive failure to organs in the mid 1970s. Mortality from this syndrome increases proportionally, as the number of failed organs increases. Therapies to prevent MOFS and current concepts about treating failures of individual organs will be presented. Data sources were retrieved from critical care and surgical literature using MEDLINE from 1966 to the present. Searches were confined to English. Several promoters of MOFS are related to the care of gynecologic patients, especially sepsis and hemorrhage. Treatment strategies, especially those related to pulmonary, gastrointestinal, renal, cardiovascular, and nutritional aspects are discussed. Outcome and prognosis may be affected if recognition and therapeutic intervention are initiated early in the clinical course. The ability to prognosticate outcome is related to the number of organs involved. Gynecologists should have clear knowledge of the prognosis of progressive organ failure in order to appropriately counsel the patient and her family.

Acute Kidney Injury↗
PubMed1993

A rapid test for abruptio placentae: evaluation of a D-dimer latex agglutination slide test.

OBJECTIVE: Our purpose was to evaluate a rapid latex agglutination slide test for D-dimer, a byproduct of clot lysis, in the prediction of abruptio placentae. STUDY DESIGN: Four groups were studied: (1) 15 patients with normal pregnancies at 40 weeks' gestation, (2) 17 participants with preeclamptic pregnancies, (3) 14 patients with preterm labor, and (4) 15 patients with confirmed abruptio placentae. The latex agglutination slide test was performed with positive and negative reference solutions and plasma dilutions of 1:1, 1:2, 1:4, and 1:8. A test was considered positive if, at 2 minutes, agglutination was present at dilutions of > or = 1:2 (> or = 1.0 micrograms/ml fibrin equivalent units). Test results were compared in patient groups with and without abruptio placentae by means of the chi 2 test. RESULTS: The likelihood of a positive D-dimer test result was not significantly different among patients in the non-abruptio placentae groups (p = 0.454). Patients in the abruptio placentae group were significantly more likely to have a positive D-dimer slide test result than those in the non-abruptio placentae groups (p = 0.0001). The D-dimer test conferred sensitivity, specificity, positive predictive value, and negative predictive value of 67%, 93%, 91%, and 48%, respectively. In contrast, other laboratory measures of coagulation (e.g., platelet count, prothrombin time, partial thromboplastin time, and fibrinogen levels) yielded no better than a 20% sensitivity for abruptio placentae. CONCLUSIONS: The D-dimer slide test may be a superior rapid method to improve early diagnosis of abruptio placentae.

Abruptio Placentae↗
PubMed1993

Necrotizing surgical infection and necrotizing fasciitis in obstetric and gynecologic patients.

Necrotizing fasciitis (NF) is a rapidly progressive disease characterized by extensive necrosis of the skin, fascia, and subcutaneous tissue, with sparing of the underlying muscle. Diabetes mellitus, Bartholin's gland abscess, and recent surgical procedures (including episiotomy) are factors often found in obstetric and gynecologic patients. Mortality in this group of patients is higher than in the general surgical population. Death is usually due to overwhelming sepsis, renal and respiratory failure, and multiple organ failure. The infections are usually polymicrobial, with alpha-hemolytic streptococci, gram-negative coliforms, and anaerobic bacteria. Lower survival has been reported in large series when the groin is involved or when the general nutritional state is poor. From October 1988 to August 1990, we treated five patients with necrotizing fasciitis. Certain important characteristics of such patients have not been discussed in the obstetric and gynecologic literature. Nutritional status, with special emphasis on total protein, albumin, and the effects of alcoholism, has a significant impact on mortality. Nutritional support of these patients may improve survival. To limit the impact of secondary infections, surgical approaches should be modified by the anatomic location of the initial lesions. More frequent debriding in the operating room and early fecal diversion are recommended.

Adult↗
PubMed1993

Chronic pelvic pain. Differentiating anatomic from functional causes.

Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are often reluctant to discuss intimate details of a patient's sex life even though they may provide important information. In addition, sleep disorders are very prevalent. Use of vaginal-probe ultrasound may decrease the need for diagnostic laparoscopy, especially in patients without pelvic disease. In most cases, ovarian cysts in ovulating patients do not represent an abnormality. Laparoscopy and major pelvic surgery should be limited to patients with a high probability of anatomic abnormalities or persistent symptoms.

Adolescent↗
PubMed1993

Maternal plasma D-dimer levels in normal and complicated pregnancies.

OBJECTIVE: To evaluate D-dimer as a marker for fibrinolysis in normal and complicated pregnancies using an enzyme-linked immunosorbent assay (ELISA) technique. METHODS: Four groups of pregnant women were enrolled: 17 normal women followed longitudinally from 28-40 weeks' gestation, 14 patients with preterm labor at 28-34 weeks, 17 patients with preeclampsia at term (37-40 weeks), and 14 patients with abruptio placentae (32-40 weeks). We assayed peripheral venous blood samples from each patient for D-dimer levels using a commercial ELISA kit. D-dimer values were calculated by regression analysis using internal standards and controls for each assay. Data were compared using Student t test or analysis of variance with repeated measures. RESULTS: D-dimer values increased slightly with increasing gestational age. Patients with preterm labor, preeclampsia, and abruptio placentae had mean D-dimer values significantly greater than those of controls (P < .003). D-dimer values of the abruption group were approximately twice those of the control group (3393 +/- 2086 versus 1750 +/- 839 ng/dL). CONCLUSION: An increase in fibrinolysis may be associated with the pregnancy complications studied, as reflected by alterations in maternal plasma D-dimer levels.

Abruptio Placentae↗
PubMed1992

Surgery in the elderly. Lowering risks by understanding special needs.

Elderly patients should be evaluated closely before surgery. Problems commonly found in these patients (ie, hypertension, diabetes, and cardiac and pulmonary disease) should be sought with special care and treated before surgery is undertaken. Also, wound healing may be compromised, drug clearance and metabolism impaired, and nutritional status abnormal. However, if these and other age-related problems are anticipated, surgery is usually successful and recovery uneventful.

Adrenal Cortex Hormones↗
PubMed1992

Measurement of amniotic fluid volume: accuracy of ultrasonography techniques.

OBJECTIVE: Our purpose was to determine amniotic fluid volume by the dye-dilution technique and compare it with the amniotic fluid index, largest vertical pocket, and two-diameter pocket (defined as vertical x horizontal of the largest vertical pocket). STUDY DESIGN: This prospective study involved 40 women undergoing amniocentesis in late pregnancy to detect fetal lung maturity or evidence of chorioamnionitis. The amniotic fluid volume was quantified ultrasonographically by means of the amniotic fluid index, largest vertical pocket, and two-diameter pocket. During amniocentesis the fluid volume was calculated by the dye-dilution technique of Charles and Jacoby. RESULTS: Ultrasonographic measurements by amniotic fluid index, largest vertical pocket, and two-diameter pocket correctly predicted normal amniotic fluid and hydramnios (74%). A new measurement, two-diameter pocket, gave a significantly more accurate estimate of oligohydramnios than did amniotic fluid index (p < 0.002) or largest vertical pocket (p < 0.0003). CONCLUSION: All three indices are moderately accurate in identifying normal amniotic fluid volume and hydramnios. Two-diameter pocket is the most accurate test to predict oligohydramnios.

Adolescent↗
PubMed1992

A prospective evaluation of an endometrial suction curette.

The object of this study was to assess the reliability of a technique using an endometrial suction curette to obtain tissue for diagnosis. A prospective study was performed. One hundred sequential outpatient biopsies using the Z-Sampler were studied. All samples were reviewed a second time by a single pathologist for adequacy. In 75% of samples, a histologic diagnosis could be determined. The remaining 25% were inadequate for diagnosis--4 identified at the time of sampling and completed with a Novak curette and 21 in which the sample would not support the histologic diagnosis. Analysis of the inadequate samples found that 12 of the 25 (48%) inadequate samples came from patients with the clinical diagnosis of postmenopausal or climacteric bleeding. This diagnosis was represented in only 18 of the 75 successful biopsies (24%, p less than 0.001). The findings suggest that endometrial sampling using disposable endometrial curettes provides adequate tissue for histologic interpretation in most patients. Although patients with postmenopausal or climacteric bleeding made up one half of all patients with an inadequate sample, 60% of these patients did have interpretable tissue obtained. In these patients, use of other or adjunctive sampling methods should be entertained based on clinical or other considerations.

Adult↗
PubMed1992

Unrecognized association of sleep disorders and depression with chronic pelvic pain.

Assessment of cases of chronic pelvic pain presents a challenging problem, and many physicians overlook the association of sleep disorders and depression with such pain. We examined these linkages in our chronic pelvic pain clinic, using a questionnaire that assists in diagnosis and management of these cases. To date, the cases of 72 patients (both physician- and self-referred) with pelvic pain have been evaluated. Of these patients, 51 of 71 (72%) reported sleep disorders, and 37 of 72 (51%) had clinical depression, as determined by the Beck Depression Inventory. After adjustment for a sleep-related item on the Beck scale, these two measures showed a positive correlation of .355 (P < .01). The scores of pain patients differed significantly from those of a control group of asymptomatic patients on the depression and sleep disorder measures. By being aware and using a simple questionnaire, the clinician may readily identify overlooked factors, such as sleep disorders and depression, when assessing cases of chronic pelvic pain.

Adult↗
PubMed1992

Maternal coagulation inhibitors and the effects of cesarean delivery.

Maternal hypercoagulability in normal pregnancy results from significant increases in blood factors that promote thrombosis or decreases in factors that inhibit thrombosis, such as antithrombin III (AT-III) and proteins C and S. The precise role of these factors in puerperal hemostasis is not clear. In 10 normal, pregnant women at term undergoing scheduled repeat cesarean section, the percent activities of AT-III, proteins C and S, and C4b-binding protein were determined in peripheral venous blood preoperatively and in samples of uterine venous blood before the uterine incision was made and 5 and 15 minutes after placental delivery using the Laurell Rocket electroimmunodiffusion technique. The mean percent activities of AT-III (73%), protein S (81%) and C4b-binding protein (85%) were lower than those in nonpregnant controls, were similar in peripheral and uterine venous blood and were unchanged after placental delivery. These data suggest that such factors may not play an important role in acute uteroplacental hemostasis during normal pregnancy.

Antithrombin III↗
PubMed1992

Antepartum assessment of the maternal peripheral venous system with light reflection rheology.

The noninvasive detection of deep venous thrombosis (DVT) in pregnancy is a significant problem. The Hemodynamics AV-1000 uses light reflection rheology in superficial capillaries to detect DVT but has not been evaluated adequately in pregnancy. Four hundred one pregnant women in the second and third trimesters were studied with the AV-1000; none had symptoms of DVT or thrombophlebitis, and all had uncomplicated pregnancy outcomes. AV-1000 reflection curves were related to maternal age, gestational age, weight gain, Quetelet index and device sensitivity settings. No statistically significant differences in test outcomes were found for any variable. The high incidence of abnormal (25%) and inadequate (19%) tracings, coupled with an overall specificity of 45%, suggests that the system would not be useful in distinguishing patients with DVT from normal ones and could lead to excessive follow-up testing.

Academic Medical Centers↗