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Biomedical subjects

D M Montgomery

Publications and source records attributed to D M Montgomery.

At least 19 recordsLinked to original sources
PubMed1998

Associations between passive immunity and morbidity and mortality in dairy heifers in Florida, USA.

A prospective cohort study was undertaken to determine calf-level factors that affected calf health status between birth and 6 months of age. A convenience sample of approximately 3300 female Holstein calves born in 1991 on two large Florida dairy farms was used for the study. Data collected on each calf at birth included farm of origin, weight, height at the pelvis, birth date, and serum total protein (a measure of colostral immunoglobulin absorption). Birth season was dichotomized into summer and winter using meteorological data collected by University of Florida Agricultural Research Stations. Health data including date of initial treatment and number of treatments were collected for the diseases diarrhea, omphalitis, septicemia and pneumonia. All calves were followed for 6 months. Cumulative incidences of mortality and occurrence of diarrhea, omphalitis, septicemia and pneumonia were 0.12, 0.35, 0.11, 0.24 and 0.21, respectively. Serum total protein (TP) was a significant risk factor for mortality. The association of TP and mortality was quadratic and showed a dramatic decrease in mortality as TP increased from 4.0 to 5.0 g/dl, a small improvement from 5.0 to 6.0 g/dl and virtually no improvement in mortality rates as TP increased over 6.0 g/dl. The hazard mortality ratio was constant from birth to six months, indicating that the increased risk of mortality associated with low levels of TP was evident through six months of age. No interactions between TP, farm, season, or birth weight were found in these analyses. Serum total protein concentration was a significant risk factor for the occurrences, age of onset and severity of septicemia and pneumonia. The association between TP and septicemia was linear and an interaction with birth season was found. The association between TP and pneumonia was quadratic, and in contrast to the TP-and-septicemia relationship, the morbidity hazard ratio for pneumonia was not constant over the time measured; that is, colostral immunity protected the calf from developing pneumonia early in life, but this effect disappeared as the calf got older. Total protein was not a significant risk factor for diarrhea or omphalitis.

Animals↗
PubMed1998

Calf and disease factors affecting growth in female Holstein calves in Florida, USA.

A prospective cohort study was undertaken to determine calf-level factors that affect performance (growth) between birth and 14 months of age in a convenience sample of approximately 3300 female Holstein calves born in 1991 on two large Florida dairy farms. Data collected on each calf at birth included farm of origin, birth date, weight, height at the pelvis, and serum total protein (a measure of colostral immunoglobulin absorption). Birth season was dichotomized into summer and winter using meteorological data collected by University of Florida Agricultural Research Stations. Data collected at approximately 6 and 14 months of age included age, weight, height at the pelvis, and height at the withers. Growth in weight and stature (height) was calculated for each growth period; growth period 1 (GP1) = birth to 6 months, and growth period 2 (GP2) = 6 to 14 months. Health data collected included data of initial treatment and number of treatments for the diseases diarrhea, omphalitis, septicemia, pneumonia and keratoconjunctivitis. After adjusting for disease occurrence, passive transfer of colostral immunoglobulins had no significant effect on body weight gain or pelvic height growth. Season of birth and occurrence of diarrhea, septicemia and respiratory disease were significant variables decreasing heifer growth (height and weight) in GP1. These variables plus farm, birth weight and exact age when '6 month' data were collected explained 20% and 31% of the variation in body weight gain and pelvic height growth, respectively, in GP1. The number of days treated for pneumonia before 6 months of age significantly decreased average daily weight gain in GP2 (P < 0.025), but did not affect stature growth. Treatment for pneumonia after 6 months of age did not significantly affect weight or height gain after age 6 months. Neither omphalitis nor keratoconjunctivitis explained variability in growth in either of the growth periods.

Animals↗
PubMed1997

1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation.

STUDY DESIGN: This prospective study analyzed the influence of transpedicular instrumented on the operative treatment of patients with degenerative spondylolisthesis and spinal stenosis. OBJECTIVES: To determine whether the addition of transpedicular instrumented improves the clinical outcome and fusion rate of patients undergoing posterolateral fusion after decompression for spinal stenosis with concomitant degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: Decompression is often necessary in the treatment of symptomatic patients who have degenerative spondylolisthesis and spinal stenosis. Results of recent studies demonstrated that outcomes are significantly improved if posterolateral arthrodesis is performed at the listhesed level. A meta-analysis of the literature concluded that adjunctive spinal instrumentation for this procedure can enhance the fusion rate, although the effect on clinical outcome remains uncertain. METHODS: Seventy-six patients who had symptomatic spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied. All patients underwent posterior decompression with concomitant posterolateral intertransverse process arthrodesis. The patients were randomized to a segmental transpedicular instrumented or noninstrumented group. RESULTS: Sixty-seven patients were available for a 2-year follow-up. Clinical outcome was excellent or good in 76% of the patients in whom instrumentation was placed and in 85% of those in whom no instrumentation was placed (P = 0.45). Successful arthrodesis occurred in 82% of the instrumented cases versus 45% of the noninstrumented cases (P = 0.0015). Overall, successful fusion did not influence patient outcome (P = 0.435). CONCLUSIONS: In patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws may lead to a higher fusion rate, but clinical outcome shows no improvement in pain in the back and lower limbs.

Aged↗
PubMed1996

Objective detection of hemifield and quadrantic field defects by visual evoked cortical potentials.

AIMS/BACKGROUND: An objective method for detecting hemifield and quadrantic visual field defects has been developed using steady state visual evoked cortical potentials (VECPs), an adaptive noise canceller (ANC), and Hotelling's t2 statistic. The purpose of this study was to determine the sensitivity and specificity of the technique. METHODS: Nine subjects (mean age 44 years) were investigated with field loss due to a variety of causes including both anterior and posterior visual pathway lesions. Dynamic perimetry was performed by means of a Goldmann or Tübingen perimeter. VECP recordings were made from each visual field quadrant (23 degrees X 23 degrees) by means of a steady state reversing checkerboard (7.7 rev/s). The central 5 degrees of the visual field and the vertical and horizontal meridians were masked during these measurements. Recordings were made from three electrode sites, positioned over the visual cortex, relative to a mid frontal electrode. Each recording lasted 2 minutes, during which time fixation was monitored. The data from each recording were divided into 4 second segments, and the amplitude and phase of the VECP signal measured using the ANC. Hotelling's t2 statistic was applied to determine the probability of signal detection. Receiver operating characteristic curves were used to find the optimum signal detection threshold for identification of the visual field defects. RESULTS: The results of the study confirmed patterns of subjective visual field loss. The technique had a sensitivity and a specificity of 81% and 85%, respectively, for detecting 'non-seeing' areas in the inferior visual field, and 82% and 89%, respectively, for detecting 'non-seeing' areas in the superior visual field. CONCLUSION: These results demonstrate that the technique is of potential clinical value to ophthalmologists and neurologists when subjective perimetry is not possible.

Adolescent↗
PubMed1996

Efficacy of closed wound suction drainage after single-level lumbar laminectomy.

The use of closed suction drainage after spinal surgery remains controversial. The purpose of this study was to determine the indications for closed suction drainage after single-level lumbar surgery. Two hundred patients who were scheduled to undergo single-level lumbar surgery without fusion were prospectively randomized into two groups. One group had a closed wound suction drain placed deep to the lumbodorsal fascia before routine closure, whereas the second group had no drain placed. Hemostasis was achieved in all patients before the surgeon had knowledge of the randomization outcome. All drains were removed on the 2nd postoperative day, and the amount of drainage was recorded. After surgery, the patients were evaluated for signs and symptoms of continued wound drainage, hematoma/seroma formation, and/or infection as well as evidence of an acquired neurologic deficit. One hundred three patients had a drain placed before closure and two patients developed postoperative wound infection, both of which were successfully treated with orally administered antibiotics. Of the 97 patients who had no drain placed after the surgical procedure, one patient developed a postoperative wound infection that was treated with surgical incision and drainage, as well as intravenously administered antibiotics. Statistical analysis revealed that the presence or absence of a drain did not affect the postoperative infection rate. No new neurologic deficits occurred in any postoperative patient. The use of drains in single-level lumbar laminectomy without fusion did not affect patient outcome. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit.

Adult↗
PubMed1995

Determination of the neuroretinal rim area using the horizontal and vertical disc and cup diameters.

BACKGROUND: This study evaluated whether the neuroretinal rim area can be calculated on the basis of the horizontal and vertical diameters of the optic disc and cup applying the formula of an ellipse. METHODS: Color stereo optic disc photographs of 587 normal subjects and 1193 patients with glaucoma were morphometrically examined. In a first method, the areas of the optic disc and cup were planimetrically measured and the area of the neuroretinal rim was determined as optic disc area minus cup area. In a second method, the optic disc and cup were assumed to have an elliptical shape. Their areas were calculated by applying the formula of an ellipse, taking into account their horizontal and vertical diameters. As in the first method, the rim area was then determined as disc area minus cup area. RESULTS: The values of the neuroretinal rim area as measured using the first method differed by 0.05 +/- 0.05 mm2 from the values as calculated by the second method. The average error was 2.8 +/- 2.9% for the normal group and 8.2 +/- 20.8% for the glaucoma patients. It increased with decreasing neuroretinal rim area and increasing mean visual field defect. CONCLUSIONS: For clinical purposes, the neuroretinal rim area can be determined on the basis of the horizontal and vertical diameters of the optic disc and cup. The horizontal and vertical disc and cup diameters being determinable upon ophthalmoscopy, this finding is important for the direct measurement of optic disc morphology during any ophthalmoscopic examination.

Adolescent↗
PubMed1995

Quantitative assessment of the blue-light hazard during indirect ophthalmoscopy and the increase in the "safe" operating period achieved using a yellow lens.

PURPOSE: The indirect ophthalmoscope presents a blue-light hazard with the potential for causing photochemical injury to the retina. In this study, this hazard was assessed with respect to the threshold limit values (TLVs) recently adopted by the American Conference of Governmental Industrial Hygienists. METHOD: Spectral radiometric measurements were made from a standard indirect ophthalmoscope headset used in conjunction with either a clear or a yellow lens. The results were weighted spectrally with the published blue-light hazard function. RESULTS: When the clear lens was used, the TLV was exceeded after approximately 2.5 minutes. The yellow lens filtered out the more hazardous blue wavelengths of light and this increased the "safe" operating period by a factor of approximately 20. CONCLUSION: In clinical practice, with a clear lens, the TLV could be exceeded easily if the patient is subjected to prolonged or repeated examination because the blue-light hazard is additive in a linear manner for periods as long as 3 hours with a potential for a cumulative effect over longer periods. Furthermore, some ophthalmic patients, such as those with aphakia, are less tolerant of blue-light than healthy subjects. In the interests of patient safety, it is recommended that yellow lenses are considered for use for routine indirect ophthalmoscopy.

Equipment Safety↗
PubMed1995

Phosphatase production and activity in Citrobacter freundii and a naturally occurring, heavy-metal-accumulating Citrobacter sp.

The ability of a naturally occurring Citrobacter sp. to accumulate cadmium has been attributed to cellular precipitation of CdHPO4, utilizing HPO4(2-) liberated via the activity of an overproduced, Cd-resistant acid-type phosphatase. Phosphatase production and heavy metal accumulation by batch cultures of this strain (N14) and a phosphatase-deficient mutant were compared with two reference strains of Citrobacter freundii. Only strain N14 expressed a high level of acid phosphatase and accumulated lanthanum and uranyl ion enzymically. Acid phosphatase is regulated via carbon-starvation; although the C. freundii strains overexpressed phosphatase activity in carbon-limiting continuous culture, this was approximately 20-fold less than the activity of strain N14 grown similarly. Citrobacter strain N14 was originally isolated from a metal-contaminated soil environment; phosphatase overproduction and metal accumulation were postulated as a detoxification mechanism. However, application of Cd-stress, and enrichment for Cd-resistant C. freundii ('training'), reduced the phosphatase activity of this organism by about 50% as compared to Cd-unstressed cultures. The acid phosphatase of C. freundii and Citrobacter N14 had a similar pattern of resistance to some diagnostic reagents. The enzyme of the latter is similar to the PhoN acid phosphatase of Salmonella typhimurium described by other workers; the results are discussed with respect to the known phosphatases of the enterobacteria.

Acid Phosphatase↗
PubMed1994

A personal computer-based visual evoked potential stimulus and recording system.

A system for recording electroretinograms and visual evoked cortical potentials has been constructed with the use of a personal computer and a digital signal processing card. The system is based on widely available commercial hardware. It has been designed to be capable of performing routine visual electrophysiology as well as allowing the development of novel visual stimuli and signal detection techniques. The system enables both transient and steady-state stimulation rates. Pattern stimuli can be presented in pattern-reversal, pattern-onset, pattern-offset or motion-onset modes. In addition to conventional signal averaging, the digital signal processing card can also provide on-line Fourier analysis and is facilitating the development of adaptive filtering techniques for the detection of steady-state visual evoked cortical potentials. This versatile system is in regular clinical use for the measurement of electroretinograms and visual evoked cortical potentials.

Electrophysiology↗
PubMed1994

Passive reduction of spondylolisthesis on the operating room table: a prospective study.

Translational motion of low-grade spondylolisthesis is traditionally assessed with lateral flexion and extension radiographs. Maximum motion in an unanesthetized patient may be limited by patient cooperation, pain, or muscle spasm. Twenty-four patients with degenerative or isthmic spondylolisthesis were assessed with preoperative lateral flexion and extension radiographs. A lateral radiograph was obtained on the operating room table after administering an anesthetic, exposing the spine, and performing a laminectomy. The percentage slip decreased from 24 to 15 to 6% on flexion, extension, and intraoperative lateral radiographs, respectively (p < 0.001). The amount of reduction did not correlate with disc height, slip angle, slip level, or type of spondylolisthesis. Many low-grade spondylolisthesis deformities reduce almost completely on the operating table. Translational motion of spondylolisthesis is greater than preoperative flexion and extension radiographs indicate.

Aged↗
PubMed1993

Clinical disc biometry in early glaucoma.

PURPOSE: To assess the potential of a clinical method of optic disc measurement in the detection of early neuroretinal rim loss in glaucoma. METHODS: A method of disc biometry based on indirect ophthalmoscopy was used to estimate disc and neuroretinal rim areas in 81 ocular hypertensive eyes of 43 patients and in 28 fellow eyes with normal visual fields of patients with unilateral visual field loss from primary open-angle glaucoma. The results were compared with those from age-matched visually normal patients. RESULTS: Neuroretinal rim area was significantly smaller in both hypertensive and fellow eye groups compared with controls (P < 0.0001; P = 0.0009). Disc area also was smaller in both groups (P = 0.0034; P = 0.046); however, this was inadequate to explain the differences in rim area, which, when corrected for disc size, were still highly significant (P < 0.0001; P = 0.0001). CONCLUSION: The differences in neuroretinal rim area observed are likely to indicate that a proportion of the eyes studied had suffered a reduction of neuroretinal rim area, which was measurable by this method at a stage before the development of demonstrable visual field loss.

Glaucoma, Open-Angle↗
PubMed1993

Inter-observer variation in clinical optic disc biometry.

This study investigated the inter-observer reproducibility of measurements of the optic nerve head as carried out with a clinical optic disc biometer. This instrument employs a modification of indirect ophthalmoscopy to enable measurement of fundus structures. Measurements were made independently by two observers on 84 eyes of 47 patients. The median inter-observer differences for each measurement were as follows: maximum disc diameter, 0.085 mm; minimum disc diameter, 0.080 mm; maximum cup diameter, 0.098 mm; minimum cup diameter, 0.078 mm; disc area, 0.225 mm2; neuroretinal rim area, 0.215 mm2. Utilising the above measurements, the instrument automatically calculates a 'rim index' to take account of variations in disc size. It then interprets the disc as normal, suspicious or glaucomatous. The optic disc biometer produced seriously conflicting interpretations in 8 discs, 7 of which had been judged by both observers to have indistinct boundaries of the disc or cup.

Biometry↗
PubMed1993

Optic disc interpretation in glaucoma: is confidence misplaced?

A photographic questionnaire has been used to investigate whether or not clinicians have realistic expectations of their ability to distinguish optic discs associated with glaucomatous visual field loss from discs of healthy eyes. The questionnaire consisting of 30 non-stereoscopic fundus photographs from 15 patients was administered to 40 ophthalmologists of varying experience and 10 optometrists. Each group displayed large discrepancies between their expected and achieved scores suggesting that clinicians may overestimate their ability to recognize the glaucomatous optic disc. This could lead to diagnostic errors especially in cases where tonometric and visual field parameters are considered equivocal. An over-reliance on the cup/disc ratio appeared to be the most likely cause of error.

Adult↗
PubMed1993

Diagnosis and treatment of discogenic low back pain.

Low back pain (LBP) is very prevalent in the general population. Treatment of nonradicular back pain, in the absence of deformity, continues to be controversial. Recently, anatomic dissections, magnetic resonance imaging studies, and the use of provocative discograms (pain-related response during the injection similar to the typical pattern of pain reported prior to the procedure) have contributed to our understanding of the etiology of discogenic back pain. Various techniques of spine fusion, with and without instrumentation, have altered the natural history of LBP unresponsive to conservative treatment. This review discusses the etiology and diagnosis of discogenic back pain and the treatment options available to the spine surgeon.

Diagnosis, Differential↗
PubMed1992

Cervical spondylotic myelopathy. Clinical syndrome and natural history.

A wide-based spastic gait is the classical presentation of the patient with cervical spondylotic myelopathy. A complete neurologic evaluation is needed to determine the degree of involvement and to classify the clinical syndrome. The natural history seems to be one of static neurologic deficit or episodic progression.

Cervical Vertebrae↗
PubMed1991

Rate of recurrence of preterm premature rupture of membranes in consecutive pregnancies.

The reported incidence of preterm premature rupture of membranes ranges between 1% and 2% of all pregnancies. The rate of recurrence is poorly defined. The goal of this study was to establish the frequency of recurrence in a high-risk referral practice. Over a 5-year period we identified 121 patients with preterm premature rupture of membranes who had a minimum of two consecutive pregnancies under our care, resulting in a total of 255 pregnancies for analysis. Recurrent preterm premature rupture of membranes occurred in 39 of 121 patients, for a rate of 32.2% (95% confidence interval, 23.9 +/- 40.5). We were unable to demonstrate an association between the estimated gestational age at the time of rupture in the index pregnancy, latency period, interval between pregnancies, and the probability of repeat preterm premature rupture of membranes in the next pregnancy. We conclude that patients with preterm premature rupture of membranes should be counseled regarding the significant risk of recurrence and need to have close follow-up in their subsequent pregnancies.

Adult↗