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PubMed1999

In situ (mesocosm) assessment of immunotoxicity risks to small mammals inhabiting petrochemical waste sites.

Oil refineries inadvertently deposit a variety of complex mixtures of organic hydrocarbons and heavy metals in the soil, many of which are thought to be potent immunotoxicants. Terrestrial ecosystems such as this have not been adequately investigated with respect to wild rodent populations. The primary objective of this study was to use mesocosms to assess the immunotoxicity risks to feral small mammal populations associated with soils contaminated with petroleum refinery wastes. A series of 4-week and 8-week exposure trials using laboratory raised cotton rats (Sigmodon hispidus) were conducted in situ on three contaminated and three reference sites on the Oklahoma Refining Company Superfund Waste Site, Cyril, Oklahoma. Cotton rats exposed to these soils showed significant alterations in selected morphological traits, in vivo humoral immune responses, complement activity, and macrophage activity. However, immune alterations were not great, suggesting that resident small mammals may be a better biomonitoring choice than using mesocosms.

Animals↗
PubMed1998

Positive prostate biopsy rate consistently increases with age at the same prostate-specific antigen level in patients with normal digital rectal examination.

OBJECTIVES: To examine the relationship between positive prostate biopsy rates and age over the range of serum prostate-specific antigen (PSA) concentrations of 4 to 10 ng/mL. METHODS: The rates for adenocarcinoma were calculated for prostate biopsy specimens received at UroCor Inc., Oklahoma City, Oklahoma between April 1995 and June 1997. The selection criteria were as follows: men between 50 and 79 years of age, normal digital rectal examination (DRE), prebiopsy PSA level between 4.01 and 10.0 ng/mL obtained within a 4-month period prior to receipt of biopsy, and no previous prostate biopsy. Five thousand six cases were selected out of 81,545 prostate biopsy specimens submitted by office-based urologists. The rates of positive prostate biopsies were stratified by age in decade increments and by PSA in increments of 1 ng/mL. The P values were calculated by the chi-square test. RESULTS: The patient mean age was 65.8 years. An overall increase in the positive prostate biopsy rate for men between 50 and 79 years of age as serum PSA increases from 4.01 to 10.0 ng/mL (P = 0.047) was found; however, this increase was less significant than the increase found in positive biopsy rates caused by age alone (P <0.0001). CONCLUSIONS: Undetected prostate cancer appears to be a major cause of the increasing serum PSA seen with advancing age.

Adenocarcinoma↗
PubMed2002

Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system.

PURPOSE: This study analyzed the accuracy of the Inoveon Diabetic Retinopathy (DR-3DT) system (Inoveon Corp., Oklahoma City, OK), a scalable evaluation method for the management of diabetic retinopathy using high-quality digital retinal imaging. DESIGN: An independent, masked, cross-sectional, clinical validation study. PARTICIPANTS: Two hundred ninety adult patients with diabetes from the Chickasaw Nation's Carl Albert Indian Health Facility in Ada, Oklahoma. METHODS: All participants underwent DRS7 imaging using a Zeiss FF450 fundus camera with images recorded on 35-mm film and a Kodak DCS520 digital camera back. Masked double grading with independent third reader adjudication yielded an Early Treatment Diabetic Retinopathy Study (ETDRS) Final Retinopathy Severity Scale Level (ETDRS Level) and macular edema stage for each eye. The presence of greater-than-or-equal ETDRS Level 53, questionable or definite clinically significant macular edema in either eye, or ungradeable images was defined as a threshold event requiring referral. MAIN OUTCOME MEASURES: Accuracy (sensitivity, specificity, predictive values) of the digital system relative to the film "gold standard" on the threshold referral criteria per patient. RESULTS: All patients with gradeable 35-mm slides from at least one eye were included in this per patient analysis (n = 290). The prevalence of threshold events was 19.3%. The sensitivity of the digital system in detecting threshold events was 98.2% (95% confidence interval [CI], 90.5%-100.0%) and specificity 89.7% (95% CI, 85.1%-93.3%). The positive predictive value was 69.5% and negative predictive value 99.5% for this sample. CONCLUSIONS: When compared with the "gold standard," Inoveon's DR-3DT system provides highly accurate diabetic retinopathy referral decisions. Given their inherent advantages, high-quality digital imaging systems could replace the film "gold standard" as the basis for scalable, accessible, diabetic retinopathy evaluation.

Adult↗
PubMed1997

Characterization of a new isolate of Ehrlichia platys (Order Rickettsiales) using electron microscopy and polymerase chain reaction.

A mixed-breed pup approximately 3 months old obtained in north central Oklahoma by the Laboratory Animal Resources Unit of Oklahoma State University presented with platelet inclusions. The dog developed severe thrombocytopenia (< 10,000 microliters-1) following the appearance of inclusions. Blood films were monitored daily and when about 75% of platelets had inclusions, samples were collected in EDTA and processed for electron microscopic (EM) studies and polymerase chain reaction (PCR). EM studies on glutaraldehyde-fixed buffy coat revealed rickettsia-like inclusions in numerous platelets. Serologic examination, using Ehrlichia platys antigen, showed high titre suggestive of E. platys infection. PCR primers derived from a highly variable region of the 16S rRNA gene sequence of E. platys were used to specifically amplify that region of the parasite's DNA. Sequencing of the PCR product obtained by general Ehrlichia primers showed one nucleotide difference from the published sequence for E. platys which suggests possible strain variation of this intracellular parasite. Our results indicate that PCR may be a useful tool in the diagnosis of E. platys infection and that, like other Ehrlichia spp., E. platys isolates may vary.

Animals↗
PubMed1998

Greenbug (Homoptera: Aphididae) biotypes characterized using random amplified polymorphic DNA.

Genomic DNA was extracted from seven greenbug, Schizaphis graminum, biotypes (B, C, E, F, G, H and I) obtained from laboratory colonies maintained by USDA-ARS, Stillwater, Oklahoma. DNA was amplified using single 10-base primers. Of 100 primers tested, four were found which either alone, or in combination, distinguished all biotypes by distinct size differences in amplified fragments. Results were repeatable using aphids obtained from the same colonies 2 years later. These diagnostic primers produced unvarying banding patterns for all biotype E greenbugs collected in the field in Nebraska, Kansas, Oklahoma, and Texas.

Animals↗
PubMed2003

Environmental fate of roxarsone in poultry litter. Part II. Mobility of arsenic in soils amended with poultry litter.

Poultry litter often contains arsenic as a result of organo-arsenical feed additives. When the poultry litter is applied to agricultural fields, the arsenic is released to the environment and may result in increased arsenic in surface and groundwater and increased uptake by plants. The release of arsenic from poultry litter, litter-amended soils, and soils without litter amendment was examined by extraction with water and strong acids (HCI and HNO3). The extracts were analyzed for As, C, P, Cu, Zn, and Fe. Copper, zinc, and iron are also poultry feed additives. Soils with a known history of litter application and controlled application rate of arsenic-containing poultry litter were obtained from the University of Maryland Agricultural Experiment Station. Soils from fields with long-term application of poultry litter were obtained from a tilled field on the Delmarva Peninsula (MD) and an untilled Oklahoma pasture. Samples from an adjacent forest or nearby pasture that had no history of litter application were used as controls. Depth profiles were sampled for the Oklahoma pasture soils. Analysis of the poultry litter showed that 75% of the arsenic was readily soluble in water. Extraction of soils shows that weakly bound arsenic mobilized by water correlates positively with C, P, Cu, and Zn in amended fields and appears to come primarily from the litter. Strongly bound arsenic correlates positively with Fe in amended fields and suggests sorption or coprecipitation of As and Fe in the soil column.

Absorption↗
PubMed1997

Role of appendectomy and tonsillectomy in pathogenesis of ulcerative colitis.

We wished to determine the effect of appendectomy and tonsillectomy on the subsequent risk for development of ulcerative colitis (UC). We conducted a case-control study at the University of Oklahoma Hospital and VA Medical Center gastroenterology clinics, as well as at the offices of private physicians. Subjects being followed for UC formed the study group. Patients being followed at Internal Medicine Associates of the University of Oklahoma clinics formed the controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. The study group consisted of 193 patients, and there were 394 controls. The prevalence of appendectomy was lower (17.8% vs 5.2%) among patients with UC (P < 0.01). The prevalence of tonsillectomy was similar in the two groups (20.6% vs 18.1%; P = NS). We conclude that appendectomy is associated with a decreased risk for subsequent development of ulcerative colitis.

Adult↗
PubMed2005

The effects of universal pre-K on cognitive development.

In this study of Oklahoma's universal pre-K program, the authors relied on a strict birthday eligibility criterion to compare "young" kindergarten children who just completed pre-K to "old" pre-K children just beginning pre-K. This regression-discontinuity design reduces the threat of selection bias. Their sample consisted of 1,567 pre-K children and 1,461 kindergarten children who had just completed pre-K. The authors estimated the impact of the pre-K treatment on Woodcock-Johnson Achievement test scores. The authors found test impacts of 3.00 points (0.79 of the standard deviation for the control group) for the Letter-Word Identification score, 1.86 points (0.64 of the standard deviation of the control group) for the Spelling score, and 1.94 points (0.38 of the standard deviation of the control group) for the Applied Problems score. Hispanic, Black, White, and Native American children all benefit from the program, as do children in diverse income brackets, as measured by school lunch eligibility status. The authors conclude that Oklahoma's universal pre-K program has succeeded in enhancing the school readiness of a diverse group of children.

Aptitude Tests↗
PubMed2003

Treatment of lentigo maligna with topical imiquimod.

A published case report and anecdotal experience suggested that topical imiquimod is an effective treatment for stage 0 melanoma (lentigo maligna). To gauge the efficacy of this therapy, we undertook a trial of topical imiquimod in 30 subjects with histologically confirmed lentigo maligna. Thirty subjects with lentigo maligna were recruited for an open-labelled efficacy trial with daily topical application of imiquimod 5% cream for 3 months. Study subjects were enrolled from the Dermatology service of the University of Oklahoma, the Oklahoma City Veteran's Administration Hospital Dermatology service and from referrals for the study from other practitioners. In order to determine an initial response rate, a four-quadrant biopsy was carried out on all patients 1 month after cessation of treatment, targeting the most clinically and dermatoscopically suspicious areas. Of 28 evaluable subjects who have completed the 3-month treatment phase, 26 (93%) were complete responders and two were treatment failures at the time of the 4-quadrant biopsy. Over 80% of the 28 subjects that completed treatment have been followed for more than 1 year with no relapses. The results of this study demonstrate that topical imiquimod produces a high complete response rate in lentigo maligna when applied daily for 3 months.

Adjuvants, Immunologic↗
PubMed2003

Fire ants represent an important risk for anaphylaxis among residents of an endemic region.

BACKGROUND: Imported fire ants (IFA) represent a potential anaphylactic risk to IFA-sensitized individuals. OBJECTIVE: We examined the prevalence of allergic sensitization to IFA, yellow jacket venom (YJV), and peanut in an adult population from an IFA-infested region, Augusta, Georgia. METHODS: Specific IgE to IFA, YJV, and peanut were determined by using the Pharmacia UniCAP assay in 200 random blood donors from an Augusta blood bank. These results were compared with specific IgE to identical allergens in a random sample of blood donors from Oklahoma City, Oklahoma (OKC), a nonendemic region for IFA. RESULTS: Prevalence of IFA-specific IgE (17%) in the Augusta population was significantly higher than to YJV (10%, P =.04) or peanut (7.5%, P =.004). The majority of individuals who had significant IgE to IFA (> or =0.35 kIU/L) did not have IgE to YJV (24/34 = 71%). YJV caused significantly more inhibition of IgE binding to a YJV solid phase than to an IFA solid phase when the 10 dual-positive sera were analyzed (58% vs 11%, P =.005). The prevalence of IFA-specific IgE in adults from Augusta was higher than in OKC (17% vs 2%, P =.0002). YJV-specific IgE was also more prevalent in Augusta compared with OKC (10% vs 6.0%, P =.04), whereas no difference was demonstrated for peanut-specific IgE (7.5% vs 6.5%, P =.6). CONCLUSIONS: Allergic specific IgE to IFA is 1.7 times more common in adults living in an endemic area than specific IgE for other allergens associated with potentially fatal anaphylaxis. This suggests that IFA may pose the greatest risk of anaphylaxis for adults residing in IFA-endemic regions.

Adolescent↗
PubMed2001

Aspartame effect in sickle cell anemia.

OBJECTIVE: To examine the in vitro and in vivo attributes of aspartame and to determine its efficacy for treating sickle cell anemia. RATIONALE: Aspartame (l-aspartyl-l-phenylalanine methyl ester) binds with 2 human Bence Jones proteins. The proteins (Mcg and Sea) showed phenylalanine penetrating into hydrophobic binding sites. This aspartame property suggested a potential to interfere with sickle hemoglobin fibril formation. METHODS: For the in vitro studies, blood from 20 subjects monitored for sickle cell anemia was collected in heparinized tubes. Specimens were divided in thirds and aspartame was added to 2 tubes to yield a 1 mg/mL or 2 mg/mL concentration. Sickled cells that were present after a drop from each aliquot was added to a fresh 2% metabisulfite solution were counted 3 times. For the in vivo studies, 23 subjects from the Sickle Cell Clinic (University of Oklahoma Health Sciences Center, Oklahoma City, Okla) consented to participate in a randomized single-dose administration of 1.5, 3.0, or 6 mg/kg aspartame. Heparinized blood was obtained at 0, 30, 60, 120, 240, 480, and 1440 minutes after aspartame administration. Specimens were counted in a blinded manner by means of the technique used for the in vitro method, but a photomicrograph of 1 field from each triplicate count was made. The pictures were marked and were computer counted. RESULTS: For the in vitro studies, sickled cells decreased from 28% to < 14% when 1 mg/mL aspartame was added and decreased further with 2 mg/mL. For the in vivo studies, a decreased number of sickled cells in homozygous blood (HbSS) were observed after oral administration of aspartame. Sickling was inhibited by 6 mg/kg aspartame for at least 6 hours in 15 subjects with HbSS anemia. CONCLUSIONS: Further evaluations of the efficacy of aspartame for sickle crisis and crisis prevention appears to be warranted.

Administration, Oral↗
PubMed2006

2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database.

BACKGROUND: The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org ) maintains the national database of information logged by the country's 61 Poison Control Centers (PCCs). Case records in this database are from self-reported calls: they reflect only information provided when the public or healthcare professionals report an actual or potential exposure to a substance (e.g., an ingestion, inhalation, or topical exposure.), or request information/educational materials. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to PCCs, and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s). U.S. Poison Centers make possible the compilation and reporting of this report through their staffs' meticulous documentation of each case using standardized definitions and compatible computer systems. The 61 participating poison centers in 2005 are: Regional Poison Control Center, Birmingham, AL; Alabama Poison Center, Tuscaloosa, AL; Arizona Poison and Drug Information Center, Tucson, AZ; Banner Poison Control Center, Phoenix, AZ; Arkansas Poison and Drug Information Center, Little Rock, AK; California Poison Control System-Fresno/Madera Division, CA; California Poison Control System-Sacramento Division, CA; California Poison Control System-San Diego Division, CA; California Poison Control System-San Francisco Division, CA; Rocky Mountain Poison and Drug Center, Denver, CO; Connecticut Poison Control Center, Farmington, CT; National Capital Poison Center, Washington, DC; Florida Poison Information Center, Tampa, FL; Florida Poison Information Center, Jacksonville, FL; Florida Poison Information Center, Miami, FL; Georgia Poison Center, Atlanta, GA; Illinois Poison Center, Chicago, IL; Indiana Poison Center, Indianapolis, IN; Iowa Statewide Poison Control Center, Sioux City, IA; Mid-America Poison Control Center, Kansas City, KA; Kentucky Regional Poison Center, Louisville, KY; Louisiana Drug and Poison Information Center, Monroe, LA; Northern New England Poison Center, Portland, ME; Maryland Poison Center, Baltimore, MD; Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA; Children's Hospital of Michigan Regional Poison Control Center, Detroit, MI; DeVos Children's Hospital Regional Poison Center, Grand Rapids, MI; Hennepin Regional Poison Center, Minneapolis, MN; Mississippi Regional Poison Control Center, Jackson, MS; Missouri Regional Poison Center, St Louis, MO; Nebraska Regional Poison Center, Omaha, NE; New Jersey Poison Information and Education System, Newark, NJ; New Mexico Poison and Drug Information Center, Albuquerque, NM; New York City Poison Control Center, New York, NY; Long Island Regional Poison and Drug Information Center, Mineola, NY; Ruth A. Lawrence Poison and Drug Information Center, Rochester, NY; Upstate (formerly Central) New York Poison Center, Syracuse, NY; Western New York Poison Center, Buffalo, NY; Carolinas Poison Center, Charlotte, NC; Cincinnati Drug and Poison Information Center, Cincinnati, OH; Central Ohio Poison Center, Columbus, OH; Greater Cleveland Poison Control Center, Cleveland, OH; Oklahoma Poison Control Center, Oklahoma City, OK; Oregon Poison Center, Portland, OR; Pittsburgh Poison Center, Pittsburgh, PA; The Poison Control Center, Philadelphia, PA; Puerto Rico Poison Center, San Juan, PR; Palmetto Poison Center, Columbia, SC; Tennessee Poison Center, Nashville, TN; Central Texas Poison Center, Temple, TX; North Texas Poison Center, Dallas, TX; Southeast Texas Poison Center, Galveston, TX; Texas Panhandle Poison Center, Amarillo, TX; West Texas Regional Poison Center, El Paso, TX; South Texas Poison Center, San Antonio, TX; Utah Poison Control Center, Salt Lake City, UT; Virginia Poison Center, Richmond, VA; Blue Ridge Poison Center, Charlottesville, VA; Washington Poison Center, Seattle, WA; West Virginia Poison Center, Charleston, WV; Wisconsin Poison Center, Milwaukee, WI.

Databases, Factual↗
PubMed2005

Genetic variation in Echinacea angustifolia along a climatic gradient.

BACKGROUNDS AND AIMS: Echinacea angustifolia is a widespread species distributed throughout the Great Plains region of North America. Genetic differentiation among populations was investigated along a 1500 km north-south climatic gradient in North America, a region with no major geographical barriers. The objective of the study was to determine if genetic differentiation of populations could be explained by an isolation-by-distance model or by associations with climatic parameters known to affect plant growth and survival. METHODS: Historical climatic data were used to define the nature of the climatic gradient and AFLP markers were used to establish patterns of population genetic differentiation among ten Echinacea populations collected from North Dakota to Oklahoma. A total of 1290 fragments were scored using six EcoRI/MseI and three PstI/MseI primer combinations. Assessment of the correlation between climatic, genetic and geographic distances was assessed by Mantel and partial Mantel tests. KEY RESULTS: PstI/MseI combinations produced significantly fewer fragments, but a larger percentage was unique compared with EcoRI/MseI markers. Using estimates of F(ST), populations in Oklahoma and southern Kansas were identified as the most divergent from the other populations. Both the neighbour-joining tree and principal co-ordinate analysis clustered the populations in a north-south spatial orientation. About 60% of the genetic variation was found within populations, 20% among populations and the remaining 20% was partitioned among groups that were defined by the topology of the neighbour-joining tree. Significant support was found for the isolation-by-distance model independent of the effects of annual mean precipitation, but not from annual mean temperature and freeze-free days. CONCLUSIONS: Echinacea angustifolia populations exhibit genetic divergence along a north-south climatic gradient. The data support an isolation-by-distance restriction in gene flow that is independent of annual mean precipitation.

Adaptation, Physiological↗
PubMed1991

Serologic diagnosis of human ehrlichiosis using two Ehrlichia canis isolates.

Ehrlichia canis or a closely related rickettsial organism has been implicated serologically and morphologically as the causative agent of human ehrlichiosis in the United States. Although E. canis has been serially propagated in primary canine monocytes, only a limited quantity of antigen is obtained by this method. A continuous canine macrophage cell line, DH82, supports the growth of a new isolate of E. canis established from the whole blood of a carrier dog in Oklahoma. Serologic comparison of the Oklahoma isolate in the continuous canine cell line with a Florida isolate in commercial antigen slides revealed 100% specificity and 87.5% sensitivity.

Animals↗
PubMed2002

Storage stability of simulator ethanol solutions for vapor-alcohol control tests in breath-alcohol analysis.

We conducted a one-year stability study on aqueous alcohol simulator solution, stored in sealed polyethylene bottles at 4 degrees C and at room temperature. Thirty-nine aliquots of simulator solution with a VAC target value of 0.079 +/- 0.010 g/210 L were stored and analyzed independently monthly at two locations: The University of Oklahoma HSC Toxicology Laboratories (OUHSC) and Oklahoma Department of Public Safety Alcohol and Drugs Countermeasures Unit (DPS/ADCU). Paired Intoxilyzer 5000 Evidential Breath-Alcohol Analyzers + Guth Breath Test Simulators were used to measure 20 consecutive VACs generated at 34 degrees C with individual simulator solution aliquots, followed by VAC control tests in triplicate. Control tests at OUHSC were carried out with a NIST-traceable compressed ethanol/nitrogen gas mixture with a validated label ethanol concentration of 0.085 g/210 L +/- 2% at 760 torr. Control tests at DPS/ADCU were carried out with simulator-generated vapor-alcohol samples with a validated VAC of 0.10 +/- 0.01 g/210 L. The measurement results were analyzed by standard statistical methods with a STATGRAPHICS Plus for Windows Version 6.0 microcomputer statistics program. No significant changes occurred during the one-year study period in the concentration of the aqueous simulator alcohol solution, as reflected by close agreement of the mean results of each set of 20 consecutive VAC analyses. The summary descriptive statistics for the VAC measurements were OUHSC (4 degrees C) mean +/- SD = 0.077 +/- 0.0004 g/210 L, median = 0.077, mode = 0.077, span = 0.075-0.079; DPS/ADCU (4 degrees C) mean +/- SD = 0.079 +/- 0.0013 g/210 L, median 0.079, mode = 0.078, span = 0.077-0.081; DPS/ADCU (Room Temp.) mean +/- SD = 0.078 +/- 0.0011 g/210 L, median = 0.078, mode = 0.078, span = 0.076-0.080. All OUHSC and DPS/ADCU VAC control tests were within acceptable target value ranges. The least squares linear regression model equations for y (= VAC, g/210) upon x (= time in months) were OUHSC (4 degrees C) y = 0.077 - 0.000021x; DPS/ADCU (4 degrees C) y = 0.079 + 0.000032x; and DPS/ADCU (Room Temp.) y = 0.078 + 0.000038x. The essentially zero slopes for all 3 models signify that no significant change occurred in the alcohol concentrations of all 39 simulator solutions aliquots measured over the 1-year study period, for either 4 degrees C or room temperature storage. The Pearson correlation coefficients for the above three regression models were R = -0.20, 0.10, and 0.13, respectively; each value is close to zero, confirming the absence of significant statistical relationship between VACs and passage of time. The coefficients of determination for the above three regression models were 4.3%, 1.0%, and 1.7%, respectively. These statistics indicate that the fitted models explain only 1 to 4% of the small total variability in the VAC as a function of time. ANOVA statistics for each of the three sets of VAC test results yield a P-value greater than 0.10, indicating that there is not a statistically significant relationship between VAC and the passage of time, at a 90% or higher confidence level. We conclude that the ethanol concentration of simulator alcohol solutions stored in sealed polyethylene bottles, at either 4 degrees C or normal room temperature, does not change significantly for at least one year after preparation, and that a correct initial VAC target value will remain valid during that time period.

Breath Tests↗
PubMed1995

Coronary heart disease prevalence and its relation to risk factors in American Indians. The Strong Heart Study.

Although coronary heart disease (CHD) is currently the leading cause of death among American Indians, information on the prevalence of CHD and its association with known cardiovascular risk factors is limited. The Strong Heart Study was initiated in 1988 to quantify cardiovascular disease and its risk factors among three geographically diverse groups of American Indians. Members of 13 Indian communities in Arizona, Oklahoma, and South and North Dakota between 45 and 74 years of age underwent a physical examination that included medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, hemoglobin A1c, and urinary albumin. Prevalence rates of definite myocardial infarction and definite CHD were higher in men than in women at all three centers (p < 0.0001) and higher in those with diabetes mellitus (p = 0.002 in men and p = 0.0003 in women). Diabetes was associated with relatively higher prevalence rates of myocardial infarction (diabetic:nondiabetic prevalence ratio = 3.8 vs. 1.9) and CHD (prevalence ratio = 4.6 vs. 1.8) in women than in men. Prevalence rates of heart disease were lowest in the communities in Arizona; prevalence rates were similar in Oklahoma and South Dakota/North Dakota and were two- to threefold higher than those in Arizona. By logistic regression, prevalent CHD among American Indians was significantly and independently related to age, diabetes, hypertension, albuminuria, percentage of body fat, smoking, high concentrations of plasma insulin, and low concentrations of high density lipoprotein cholesterol. In contrast to reports from other non-Indian populations, diabetes was the strongest risk factor. The lower prevalence of CHD among Indians in Arizona is distinctive in view of their higher rates of diabetes, obesity, hypertension, and albuminuria, but it may be partly related to their low frequency of smoking and their low concentrations of total and low density lipoprotein cholesterol. These findings from the initial Strong Heart Study examination emphasize the importance of diabetes and its associated variables as risk factors for CHD in Native American populations.

Aged↗
PubMed1997

Congenital aortic valve disease. Improved survival and quality of life.

OBJECTIVE: The purpose of the study was to assess the effect of recent trends in surgical management, including use of the Ross Operation, on improved survival and quality of life in patients treated surgically for aortic valve (AV) disease at Oklahoma Children's Hospital. BACKGROUND: Surgical treatment of congenital AV disease has proved to be palliative, but newer procedures may be improving outcomes. METHODS: A retrospective review of 301 patients, age 1 day to 26 years (median, 5 years), having a surgical AV procedure or aortic balloon valvuloplasty at Children's Hospital of Oklahoma between 1960 and February 1996, was conducted. Information was collected on all prior and subsequent operations, and follow-up within 1 year was 96% complete. RESULTS: Survival for all patients was 90% +/- 2% at age 10 years and 73% +/- 8% at age 25. By age 5, 52% +/- 4% had required an AV procedure, 89% +/- 3% by age 15. Patient survival was affected adversely by the diagnosis of valvar aortic stenosis, 79% +/- 6% at age 25 compared to 95% +/- 4% for subvalvar aortic stenosis or aortic insufficiency (p = 0.01). The AV morphology did not affect survival, but patients with a bicuspid or unicuspid valve required operative intervention at an earlier age. Survival after autograft replacement of the AV (Ross Operation) was significantly better than for other types of valve replacement (p = 0.0043). Quality of life as assessed by need for reoperation favors the use of the Ross Operation, with freedom from reoperation at 9 years of 87% +/- 7% compared to 55% +/- 5% in all patients after first AV surgery (p = 0.003). CONCLUSIONS: The Ross Operation appears to have a significant advantage in survival and quality of life in children requiring a valve replacement as a first operation or after a prior AV procedure.

Adolescent↗
PubMed1997

Is a history of tonsillectomy associated with a decreased risk of Helicobacter pylori infection?

To determine the relation between a history of tonsillectomy and the prevalence of colonization by Helicobacter pylori (HP), we conducted an observational, cohort study at the University of Oklahoma Hospital over a 13-month period. Subjects under-going upper endoscopic evaluation and antral biopsies for HP at the University of Oklahoma Hospital formed the database. The indication of the endoscopy and biopsies was determined by the endoscopist. The antral biopsy specimens were tested for HP using a rapid urease test. We recorded the patient's name, age, gender, race, history of smoking, and history of appendectomy or tonsillectomy. One hundred nine subjects constituted our database. There was no difference in age, gender, or smoking between the HP+ (n = 37) and HP- (n = 72) groups. The ability to pay for healthcare through a third-payor party also was similar. The prevalence of prior tonsillectomy was 30.6% in HP- group versus 5.4% in HP+ group (p < 0.01). In contrast, the prevalence of prior appendectomy was 21.6% in HP+ group versus 23.6% in HP- group (p = not significant). Multiple regression was carried out to account for confounding variables. The model showed that only white race and tonsillectomy were significantly related to the presence of HP colonization. Both appendectomy and health insurance, which were the surrogate markers for access to healthcare and socioeconomic status, were insignificant. We conclude that a history of tonsillectomy is associated with decreased prevalence of HP colonization.

Appendectomy↗