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Biomedical subjects

W Rogers

Publications and source records attributed to W Rogers.

At least 73 records · Page 4Linked to original sources
PubMed1989

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study.

We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.

Adult↗
PubMed1989

The functioning and well-being of depressed patients. Results from the Medical Outcomes Study.

We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.

Adult↗
PubMed1989

The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP.

There is marked debate by physicians and policymakers regarding the creation of regionalized acquired immunodeficiency syndrome (AIDS) centers. A central issue is whether outcomes of care, particularly mortality, differ as a function of hospital experience with patients with AIDS. We evaluated the experience of 257 patients with AIDS and Pneumocystis carinii pneumonia treated at 15 California hospitals between October 1986 and October 1987. An overall 15.2% in-hospital mortality rate was observed. However, a markedly lower in-hospital mortality rate was observed in the group of patients treated at hospitals that had a high level of experience with patients with AIDS (greater than or equal to 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges) relative to the group treated at hospitals with less experience (less than 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges): 12% vs 33%. Other factors significantly associated with in-hospital mortality included intensive care unit use, admission from an emergency department or through an interhospital transfer, and a history of hospitalizations. A logistic regression model indicated that, after controlling for severity indicators, AIDS experience remained significantly related to mortality. Our findings suggest that policymakers should consider three options: creating regional AIDS centers, implementing policies that promote a rapid but carefully monitored increase in experience of low-volume hospitals with human immunodeficiency virus-infected individuals, or providing highly focused educational efforts at low-AIDS-experience facilities. Without such policy initiatives, differences in mortality rates like those we have found might persist as cases of AIDS begin to occur in every area of the country.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Angioplasty and stenting of completely occluded iliac arteries.

Percutaneous angioplasty and placement of balloon-expandable intraluminal stents were performed in 12 iliac occlusions in 12 patients. Indications were limb salvage in seven and claudication in five. After successful stenting, ankle-brachial indexes improved by 0.15 or more in 11 of 12 patients (mean increase, 0.40), transstenotic pressure gradients decreased to less than 5 mm Hg (mean, 0.58 mm Hg) in all patients, and improvement in clinical grade was seen in all patients. At follow-up at 1-14 months (median, 6 months), ankle-brachial indexes were stable (mean, 0.95), and clinical grades were unchanged in all patients. Complications occurred in two patients; both experienced distal embolization, and one, who was receiving corticosteroid therapy, also suffered stent thrombosis. Local surgical embolectomy was successful in both patients, and the thrombosed stent was recanalized with urokinase. This early experience suggests that stenting may play an important role in the management of iliac occlusions, especially in poor surgical candidates.

Adult↗
PubMed1988

Cranial nerve injuries after carotid artery endarterectomy.

We present a seven-year experience with cranial nerve injuries due to carotid artery endarterectomy. A total of 433 carotid endarterectomies were done on 355 patients by senior surgical residents, with a staff surgeon assisting. Thirteen cranial nerve injuries were identified, five of which were permanent. Knowledge of the anatomic features of the cranial nerves and their branches in the operative field, as well as technical maneuvers during surgery, can reduce such injuries to a minimum.

Carotid Arteries↗
PubMed1987

The Thrombolysis in Myocardial Infarction (TIMI) phase II pilot study: tissue plasminogen activator followed by percutaneous transluminal coronary angioplasty.

The Thrombolysis in Myocardial Infarction (TIMI) Study Group is investigating whether percutaneous transluminal coronary angioplasty or intravenous beta-receptor blockers, or both, are useful adjuncts to recombinant tissue-type plasminogen activator (rt-PA) in the treatment of patients with acute myocardial infarction (TIMI II study). A total of 317 patients with acute myocardial infarction were treated an average of 2.7 hours after the onset of chest pain during the course of a nonrandomized pilot investigation with 150 mg of rt-PA given over 6 hours. This dose of rt-PA resulted in a high rate of infarct-related coronary artery patency (82 and 87% of patients catheterized an average of either 1 or 32 hours after entry, respectively) and a low 21 day mortality rate of 4.4%. Coronary angioplasty was performed successfully in greater than 90% of patients with appropriate anatomy and in greater than 50% of those treated with rt-PA. In 75 patients treated within 2 hours of the onset of chest pain only 2 (2.7%) were dead by 6 weeks. However, five cases of intracranial hemorrhage were noted, and the rt-PA dose was subsequently reduced to 100 mg given over 6 hours. The TIMI II design and the results of the TIMI II pilot study are discussed.

Adrenergic beta-Antagonists↗
PubMed1986

Gastric absorption of D-xylose in the rat: its influence on the D-xylose absorption test.

Relatively high incidences of false-positive results of D-xylose absorption tests have been reported. Delayed gastric emptying is invariably listed as one important cause for such tests. However, this conclusion assumes that gastric absorption from the relatively concentrated D-xylose solutions used clinically is negligible. In our study, D-xylose was injected (0.5 gm/kg) into either the stomach or duodenum of rats that had undergone pyloric ligation. Blood xylose levels 30 minutes later were almost as high after intragastric administration (0.61 +/- 0.22 mmol/L) as they were after intraduodenal injection (0.65 +/- 0.16 mmol/L). A chymotrypsin-labile peptide (N-benzoyl-L-tyrosyl-p-aminobenzoate), given at the same time, was poorly absorbed from the stomach, as shown by the low plasma p-aminobenzoic acid levels (14 +/- 2 mumol/L vs. 158 +/- 22 mumol/L after intraduodenal injection). Intragastric absorption of xylose, therefore, did not appear to result from the surgical trauma of pyloric ligation. In rats given doses orally of the D-xylose, the peptide, and a nonabsorbable marker (phenol red), epinephrine and atropine both showed gastric emptying without any surgical trauma, decreased digestion and absorption of the peptide as expected, but did not significantly decrease xylose absorption. These results indicate that, at least in rats, D-xylose is absorbed from relatively concentrated solutions within the stomach. Consequently, circumstances that delay gastric emptying should not markedly decrease xylose absorption. Bacterial overgrowth and altered blood flow seem more likely causes for false-positive D-xylose absorption test results.

4-Aminobenzoic Acid↗
PubMed1985

Management of blunt and penetrating external esophageal trauma.

The records of 26 patients with external blunt or penetrating esophageal trauma were reviewed to determine clinical features and results of therapy. Twenty-one injuries (four blunt, 17 penetrating) were to the cervical esophagus, and five to the thoracic esophagus. Major physical signs included subcutaneous air, neck hematoma, and blood in the nasogastric tube. Helpful roentgenographic findings were cervical and/or mediastinal air, mediastinal widening, pleural effusion, and pneumothorax (15%). Nine of 12 (75%) contrast studies and five of six (83%) esophagoscopies were positive. Twenty-four patients had associated injuries, the most common of which was tracheal (14 patients) (64%). All patients were managed by prompt surgical exploration, primary closure, and drainage. There were three early deaths. Thirteen patients had postoperative complications, four of which were esophageal leaks. Two of the leaks caused mediastinitis, pleural sepsis, and led to death. They were not treated by early esophageal exclusion or excision. There were no significant strictures or esophageal sequelae in the other patients. It is concluded that early primary closure and drainage results in a relatively high incidence of survival. If a thoracic esophageal leak occurs, aggressive management of prompt esophageal exclusion or excision is necessary to control sepsis and improve survival.

Adolescent↗
PubMed1985

Health status, sociodemographic factors, and the use of prescribed psychotropic drugs.

The relations among sociodemographic factors, health status, and use of prescribed sleeping pills and tranquilizers are examined. The data are from the Rand Health Insurance Experiment, which has a random sample of the nonaged, noninstitutionalized, civilian population in six U.S. sites. Information on sociodemographic factors, health status, and the use of prescribed psychotropic drugs during the previous 3 months was obtained from self-report questionnaires collected at enrollment. Mental and physical health status have large independent and significant effects on the probability of use of both prescribed tranquilizers (P less than 0.0001) and sleeping pills (P less than 0.0001), whether or not we remove the effects of sociodemographic factors. For the probability of tranquilizer use, there is no significant interaction between gender and mental health or between mental health and physical health. Age and gender have large and significant effects on the use of prescribed psychotropic drugs even after controlling for differences in health status and other demographic factors. The effects of site and socioeconomic status are modest compared with the effects of health, age, and gender.

Adult↗
PubMed1984

Tumor growth rate varies with age in lethargic mutant BALB/cGnDu mice.

BALB/cGnDu lethargic mutant mice suffer from an age-related temporary defect in their cell-mediated immune response which is "spontaneously" corrected in animals 7 weeks of age or older. Thus, mutants of different ages (3 to 4 weeks old and 7 to 9 weeks old) were used to compare tumor incidence, tumor growth rate, and host survival time of Harding-Passey (HP) melanoma, mKSA, and GI110(BK)B6D2Tu tumors. Normal littermates were used as controls. Only the HP tumor was successfully transplanted in all recipients. In the 3- to 4-week-old lethargic mutants, the HP tumor had an increased growth rate and decreased the mean lifespan of the mice, when compared to normal littermates, but only one mKSA and no GI110(BK)B6D2Tu tumors proved transplantable. In contrast, lethargic mutants 7 to 9 weeks old injected with the HP tumor survived longer than their normal littermates, and they did not accept either of the other tumors tested. These results corroborate the notion that lethargic mutant mice have a partially impaired anti-tumor cell-mediated immune response at 3 to 4 weeks of age, but that their anti-tumor response is enhanced at the time of their "spontaneous" correction of the immune deficiency. The need for future studies on the possible use of this model to study various human immunological and adrenal disorders is discussed.

Age Factors↗
PubMed1984

Inhibition of angiotensin-converting enzyme by dipeptide analogs.

Several dipeptide analogs containing an acyclic teritary amide group are effective angiotensin-converting enzyme (ACE) inhibitors with I50 values comparable to those of the best natural dipeptide inhibitors (e.g. Val-Trp). The most potent inhibitors studied feature a p-tolyl or norbornyl substituent on the amide nitrogen atom and a methyl or butylamino substituent on the carbon atom alpha to the amide group. REV 5277-R, alanyl-N-exo-norbornyl-glycine, is a competitive inhibitor of rabbit lung ACE with a Ki value of 9 microM.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1982

Susceptibility of BALB/cGnDu mice to transplantable tumors, in vitro transformed cells, BK and SV40 viruses, and chemical carcinogens.

Various oncogenic agents were employed in tumor susceptibility studies of an inbred subline of BALB/cGn mice, BALB/cGnDu, which carries a mutant gene that results in spontaneous thymic involution in homozygous recessive individuals. Of 18 transplantable tumors, 3 in vitro transformed cell lines, 2 oncogenic papovaviruses and 3 chemical carcinogens evaluated, only the Harding-Passey amelanotic melanoma produced tumors in 100% of the normal adult mice injected. The S180 pleomorphic sarcoma produced tumors in 56% of normal adult mice. Although not tumorigenic in adults, the mKSA, Morris (rat) hepatoma No. 7777, and a human papovavirus - transformed human cell induced mouse tumor line [GI110(BK) B6D2 Tu] formed tumors in 100, 62 and 70%, respectively, of recipients inoculated as neonates. SV40 and human papovavirus BK virions, as well as sV40, BK, and spontaneous in vitro transformed BALB/cGnDu cells were not tumorigenic. Although the histocompatibility antigens of these animals have not been studied, no correlations could be made between the tumor susceptibility of these animals with regard to the commonly employed inbred line BALB/c nor with regard to the range of host susceptibility of the transplantable tumors. This inbred subline represents a new strain of mice whose genetic defect makes it useful for transplantation immunology and physiological genetics.

Animals↗
PubMed1982

Epidemiologic study of candidates for coronary artery bypass surgery.

Simplified estimates of the potential patients eligible for coronary artery bypass surgery are presented. Various means of identification are discussed, as well as effects of two levels of stenosis. Although ultimate operability is not directly considered, the results demonstrate a substantial and growing pool of eligible patients. Data from the National Center for Health Statistics characterizes the trend toward more arteriograms and bypass procedures and more procedures being performed in smaller hospitals. Unexplained patterns exist with regard to racial and geographic differences. Factors that contribute to the increase of bypass procedures include more catheterizations being performed, declining mortality, the aging of the U.S. population, less reluctance to perform surgery, repeat operations, and increased availability of surgical teams and facilities. Factors discouraging an increase in the number of procedures include cost, equivocal results relative to increased survival in certain stages of disease, and improved alternative therapies.

Angina Pectoris↗
PubMed1981

Atypical hypoadrenocorticism in three dogs.

Three dogs with hypoadrenocorticism did not have characteristically abnormal serum concentrations of sodium, potassium, and chloride and had not been treated with glucocorticoids. Diagnosis was based on lack of adrenocortical response to exogenous adrenocorticotropic hormone. Clinical signs included lethargy, weakness, anorexia, vomiting, and weight loss. The case demonstrated that the diagnosis of canine hypoadrenocorticism should not be excluded on the basis of normal serum electrolyte values.

Adrenal Cortex Function Tests↗
PubMed1981

Morbidity and mortality of carotid endarterectomy: rates of occurrence in asymptomatic and symptomatic patients.

During a six-year period ending December 1979, a retrospective study of 252 carotid endarterectomies in 211 patients was undertaken to review morbidity and mortality, and factors related to them. For purposes of the study, patients were categorized into asymptomatic and symptomatic groups. Indications for operation were internal carotid artery stenosis that occluded 50% or more of the vessel, an ulcerated plaque proved by angiography, or both. There were no postoperative deaths or neurological complications in the asymptomatic group. In the symptomatic group, there was an overall postoperative mortality of 2% and a stroke rate of 2%. All postoperative CNS deaths and strokes occurred in patients in whom there was difficulty in controlling blood pressure postoperatively. We conclude that with regard to carotid endarterectomy for treatment of extracranial occlusive disease (1) there is an acceptable morbidity and mortality in the symptomatic patient, (2) in the asymptomatic patient the procedure is associated with minimal complications, and (3) strict control of blood pressure in the immediate postoperative period is a critical factor in preventing neurological morbidity and mortality.

Carotid Artery Diseases↗