Search PubMed⌕ Search

Biomedical subjects

W D Hager

Publications and source records attributed to W D Hager.

At least 55 records · Page 3Linked to original sources
PubMed1983

Effects of antibiotic prophylaxis on women undergoing nonelective cesarean section in a community hospital.

A randomized, double-blind, placebo-controlled study was done of a short course of cefamandole administered intravenously after cord clamping as prophylaxis in women undergoing primary nonelective cesarean section in a community hospital. Duration of labor equal to or more than 14 hours was the only significant risk factor between patients who had postoperative infectious morbidity and those who had none. Four of 43 patients (9.3%) who received cefamandole, as opposed to 13 of 47 (27.7%) who received the placebo, developed infections (p less than 0.05). This difference was reflected totally in the difference in endomyometritis development between the groups. The use of intraoperative culturing predicted infection in 4 of 13 patients in the placebo group who developed infections postoperatively. No adverse side effects were noted, and there were no cases of delayed serious infection.

Adult↗
PubMed1983

Follow-up of patients with tubo-ovarian abscess(es) in association with salpingitis.

The medical records of 143 patients hospitalized with a diagnosis of salpingitis over a five-year period were reviewed. Ninety-three patients had salpingitis without clinical evidence of a tubo-ovarian abscess. Seven (7.5%) of these women had surgical treatment; five of the seven were found to have tubo-ovarian abscesses which had not been detected clinically. Eighty-six of 93 (92.5%) patients with a clinical diagnosis of salpingitis and no abscess responded to medical management alone. Fifty patients had salpingitis and clinical evidence of a tubo-ovarian abscess(es); five of these patients had medical management only, 27 had medical treatment followed by surgery, and 18 had surgery initially before receiving antibiotics. There was a significant difference in age but not in parity between patients with evidence of a tubo-ovarian abscess that was managed medically and those who had surgery. There was no significant difference in surgical procedure performed, chronic symptoms, subsequent gynecologic surgery, or subsequent pregnancy among the groups with an abscess. There was a trend toward more surgical complications among women who had delayed surgical intervention for an abscess. Among women with a unilateral tubo-ovarian abscess, those who had a unilateral salpingo-oophorectomy had a higher pregnancy rate than those who received antibiotics alone. In this study, women with a tubo-ovarian abscess in association with salpingitis did not respond well to antibiotic treatment alone. This may be the most reliable way of distinguishing these patients from women with salpingitis alone or salpingitis in association with a tubo-ovarian inflammatory complex, who, as a group, did respond well to medical management alone.

Abscess↗
PubMed1982

Digoxin-quinidine interaction in patients with chronic renal failure.

We evaluated the effect of quinidine on digoxin pharmacokinetic in six patients with severe renal failure. Quinidine reduced the total body clearance of digoxin from 1.87 to 1.06 l/hour (p less than 0.001), and prolonged the digoxin half-life of elimination from 5.20 to 9.61 days (p less than 0.01). The digoxin volume of distribution was unchanged. Renal clearance of digoxin was negligible; thus, the decrease in total body clearance was due to a decrease in the nonrenal clearance of digoxin. The mean trough serum concentrations of quinidine ranged from 1.0 to 3.0 micrograms/ml. We conclude that in patients with chronic renal failure, the dose of digoxin should be decreased by 50% if quinidine therapy is initiated.

Adult↗
PubMed1981

Assessment of beta blockade with propranolol.

Each of seven subjects received on a weekly basis placebo or 10, 20, 40, 80, or 160 mg propranolol orally four times daily. The effect of propranolol on the resting heart rate and the heart rate responses to the Valsalva maneuver, tilt, isoproterenol, and maximal exercise were measured. Coefficients of determination were calculated from the individual dose-response curves. The results indicate that the resting heart rate and the tachycardiac response to the Valsalva maneuver and tilt cannot be used to estimate beta blockade. Propranolol concentrations correlated well (mean r2 = 0.80) with the isoproterenol dose ration minus one, but isoproterenon challenges appear clinically inapplicable. Reduction in maximal exercise tachycardia correlated best with propranolol concentrations (mean r2 = 0.89) but, to the extent that exercise could not be performed, there was no reliable way of clinically documenting beta blockade and only the serum concentration of propranolol was available as an indicator of appropriate therapy.

Administration, Oral↗
PubMed1981

Digoxin bioavailability during quinidine administration.

Digoxin serum concentration rises in the presence of quinidine. To determine whether quinidine alters digoxin bioavailability, six subjects received 1.0 mg of digoxin intravenously alone and by mouth on alternate weeks during steady-state oral quinidine administration. The area under the digoxin concentration:time curves (AUC) and the amount of digoxin excreted in the urine (Xxu) were determined for the 96 hr after each of the four experiments. Values for digoxin bioavailability relative to the corresponding intravenous study in the absence and presence of quinidine were (+/- S.D.) 73.5 +/- 8.6% and 79.5 +/- 22.6% (P greater than 0.05) for serum and 69.8 +/- 6.8% and 70.2 +/- 10.5% (P greater than 0.05) for urine. There was no difference in the steady-state quinidine serum concentration during the 4 days after intravenous and oral digoxin. We conclude that quinidine does not alter digoxin bioavailability and therefore that altered absorption does not explain the rise in digoxin serum concentration in the presence of quinidine.

Adult↗
PubMed1980

Metronidazole for vaginal trichomoniasis. Seven-day vs single-dose regimens.

This randomized, double-blind evaluation of metronidazole therapy for trichomonal vaginitis compared the efficacy and side effects of a single 2-g dose and the standard seven-day regimen (250 mg three thimes daily). Eighty (86%) of the 93 women examined seven to 21 days after therapy with the 2-g regimen, and 76 (91.6%) of 83 examined after the seven-day regimen, were cured. These cure rates were not significantly different. In addition, symptom duration and the occurrence of side effects and yeast infection were not significantly different for the two treatment groups. Because the efficacy and side effects of the two regimens are comparable and the 2-g dose is easier to administer and less expensive, we recommend the 2-g dose as standard treatment for trichomoniasis.

Clinical Trials as Topic↗
PubMed1980

The microbiology and therapy of acute pelvic inflammatory disease in hospitalized patients.

We examined microbial isolates from the endocervical and peritoneal cavity of 30 women hospitalized with acute PID. Patients were randomly assigned to one of two antibiotic regimens: amoxicillin, 6 gm by mouth every 24 hours, or aqueous penicillin G, 30 million units and gentamicin, 180 to 240 mg intravenously every 24 hours. We measured response by quantifying physical examination findings. Neisseria gonorrhoeae was isolated from the cervix of 24 patients (80%) and from the peritoneal cavity of 10 (33%). Other peritoneal isolates included Enterobacteriaceae in five patients, Ureaplasma urealyticum in five, Mycoplasma hominis in six, and Chlamydia trachomatis in three. Bacteroides melaninogenicus, the most frequent anaerobe, was isolated in 11 cases. Bacteroides fragillis was not isolated from any specimen. The cure rates were the same for both regimens: three patients failed on each. Four women required total abdominal hysterectomy and unilateral or bilateral salpingo-oophorectomy.

Adolescent↗
PubMed1980

Response of atrial fibrillation to therapy: role of etiology and left atrial diameter.

Left atrial diameter was measured by echocardiography in 107 patients in atrial fibrillation. The etiology of atrial fibrillation was rheumatic heart disease with predominant mitral valve involvement (RHD) in 51 patients and idiopathic atrial fibrillation (IAF) in 56. The left atrial diameter was correlated to the patient's response to therapy. The mean left atrial diameter was 3.4 cm in patients with paroxysmal atrial fibrillation, 3.8 cm in those requiring direct current (DC) cardioversion, and 4.4 cm in patients with persistent atrial fibrillation. However, in each of these therapeutic response groups, the left atrial diameter was signficantly smaller in patients with idiopathic atrial fibrillation. In the group with paroxysmal atrial fibrillation, the mean left atrial diameter was 4.3 +/- .7 cm in patients with RHD, compared to 3.1 +/- .6 cm in those with IAF (p less than .001). In the group requiring DC cardioversion, the left atrial diameter was 4.7 +/- .8 cm in patients with RHD compared to 3.6 +/- .5 cm in those with IAF (p less than .01). In patients with persistent atrial fibrillation, the left atrial diameter was 5.2 +/- .9 cm in patients with RHD and 4.0 +/- 1.0 cm in IAF (p less than .001). Left atrial diameter as well as the etiology of the heart disease are important in determining the response of atrial fibrillation to therapy.

Adult↗
PubMed1980

Effect of quinine on digoxin kinetics.

Six subjects were evaluated for the effect of quinine, the l-isomer of quinidine, on digoxin pharmokinetics. A 1.0-mg intravenous digoxin dose was given before and during quinine administration, followed by the measurement of digoxin serum and urine concentrations for 96 hr after each dose. Quinine reduced digoxin total body clearance by 26% from 2.98 to 2.22 ml/min/kg (p < 0.03). Digoxin elimination half-life (t 1/2) was lengthened from 34.2 to 51.8 hr, reflecting a 32% decrease in digoxin elimination rate constant (p < 0.003). Quinine did not reduce digoxin renal clearance or any volumes of distribution. The amount of digoxin excreted into the urine increased from x = 628. 29 micrograms to x = 772.52 micrograms (p < 0.02). Digoxin nonrenal clearance decreased an average of 55% from 1.2 to 0.55 ml/min/kg (p < 0.05). These results suggest that quinine alters digoxin metabolism or biliary secretion, reducing digoxin total body clearance by a mechanism that is qualitatively similar, but quamtitatively different, from quinidine.

Adult↗
PubMed1980

Digitoxin-quinidine interaction: pharmacokinetic evaluation.

The effect of quinidine on digitoxin single-dose pharmacokinetics was evaluated in five healthy adults. Blood was collected for 3 weeks, and a complete urine collection was obtained for 4 days, after a single intravenous dose of digitoxin. The protocol was conducted once while each subject was taking oral quinidine, for 3 weeks, and then repeated 10 days after discontinuing quinidine treatment. Quinidine induced the following changes in digitoxin pharmacokinetics: Elimination half-life was prolonged from 174 +/- 25 to 261 +/- 58 hours (p less than 0.02); total body clearance decreased from 1.54 +/- 0.40 to 1.09 +/- 0.31 mL/h . kg (p less than 0.05); renal clearance decreased from 0.65 +/- 0.07 to 0.46 +/- 0.17 mL/h . kg (p less than 0.05). Digitoxin volume of distribution and protein binding were unaltered by quinidine. Quinidine caused a rise in serum digitoxin levels. Digitoxin total body clearance was decreased by quinidine to an extent comparable to that reported for digoxin; however, the mechanism of the interaction with the two digitalis glycosides may, in part, be different.

Adult↗
PubMed1979

Pelvic colonization with Actinomyces in women using intrauterine contraceptive devices.

Recent reports suggest a relationship between intrauterine contraceptive device (IUD) use and colonization or infection of the genital tract with Actinomyces species. This prospective, case-controlled study was designed to determine the incidence of colonization or infection with Actinomyces in IUD users. None of 50 control patients and four of 50 study patients (8%) had Actinomyces identified. None of the patients with positive results had symptomatic pelvic infection. Cervical cytology was effective in detecting each of the four study patients with positive results. It appears that the presence of any type of IUD is a major predisposing factor to colonization with Actinomyces.

Actinomycosis↗
PubMed1979

Digoxin-quinidine interaction Pharmacokinetic evaluation.

Several recent reports have shown that plasma concentrations of digoxin increase when quinidine is administered along with digoxin; the present study was designed to explore the pharmacokinetics of this digoxin-quinidine interaction in six subjects. The elimination half-life of digoxin, although variable, did not change appreciably (42 vs. 44 hours) when quinidine was administered. Other pharmacokinetic values were substantially reduced in the presence of quinidine: total body clearance (from 3.08 to 1.96 ml per minute per kilogram), renal clearance (from 1.64 to 1.09 ml per minute per kilogram) and volume of distribution (from 10.87 to 7.35 liters per kilogram). The results may be explained by the displacement of digoxin from binding sites in tissue by quinidine, causing a rise in the plasma concentration of digoxin. The reduction in renal clearance of digoxin may result also from inhibition of renal secretion of digoxin by quinidine.

Digoxin↗
PubMed1979

Pelvic actinomycosis in women using intrauterine contraceptive devices.

Several recent reports have indicated the possible association between pelvic infection caused by Actinomyces and the use of intrauterine contraceptive devices. Seven cases of infection or colonization of the female genital tract have been detected among women using intrauterine contraceptive devices (IUD's) at Grady Memorial Hospital, Atlanta, Georgia, from March, 1975, until May, 1977. No single IUD type has been incriminated. The shortest duration of consecutive IUD use before the diagnosis was two and a half years. Six of these cases were detected incidentally at the time of endometrial or endocervical biopsy. The diagnosis in each case was made histologically. One patient presented with severe pelvic inflammatory disease and had Actinomyces identified. This is the first reported death associated with pelvic actinomycosis in a woman using an IUD. This organism must be considered as a possible pathogen whenever a patient with an IUD develops pelvic inflammatory disease.

Actinomycosis↗