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Biomedical subjects

E F Meydrech

Publications and source records attributed to E F Meydrech.

At least 37 records · Page 2Linked to original sources
PubMed1994

Determination of fetal acidemia at birth from a remote umbilical arterial blood gas analysis.

OBJECTIVE: Sampling of the umbilical artery for determination of acid-base status is performed within 60 minutes of birth, but is not feasible in all hospitals on a 24-hour basis. A desirable alternative would be to perform the arterial cord blood gas analysis hours after the sample was obtained at delivery with reliable identification of whether the newborn was acidotic. STUDY DESIGN: After 19 deliveries multiple umbilical arterial blood samples were withdrawn into five preheparinized syringes, and these were analyzed at 0.5, 15, 30, 45, and 60 hours after delivery. On the basis of observed changes in pH and base deficit over 60 hours, two separate regression equations were generated. These two equations permit calculation of the original pH and base deficit if the following are known: (1) the time interval from delivery to blood gas analysis and (2) the values of the remote pH and remote base deficit. The regression models were validated among 23 subsequent deliveries to assess how accurately they identified newborn acid-base status at birth. RESULTS: The original pH and base deficit can be calculated with two separate equations from linear regression models if two variables are known: the results of the remote umbilical arterial blood gas analysis and time intervals from delivery to analysis. Of 23 newborns during the validation phase of the study, 16 were not acidotic, one had respiratory acidosis, and six had metabolic acidosis. The second umbilical arterial blood gas analysis was performed at a mean (+/- SD) interval of 53.8 +/- 41.5 hours (range 7.5 to 138 hours). The remote gas analysis inaccurately identified 68.7% (11/16) of nonacidotic newborns as being acidotic at birth. However, insertion of these data into these equations produced results with none of the newborns predicted to have normal acid-base when they were acidotic at birth or predicted to be acidotic when the cord pH was normal. CONCLUSIONS: Use of these mathematic models allows the clinician to perform an umbilical arterial blood pH analysis < or = 60 hours after delivery yet with accurate estimation of true acid-base status at birth.

Acidosis↗
PubMed1993

Open hand fractures: an analysis of the recovery of active motion and of complications.

Seventy-five of 104 patients who underwent operative fixation of open hand fractures were reviewed between 6 months and 7 years after injury (average, 17 months). There were 140 fractures involving 125 fingers. Results, evaluated on the basis of total active range of digital motion achieved at final follow-up, correlated highly with severity of soft tissue injury. When open fractures of comparable severity were contrasted between groups that did and did not require additional extension by incision to achieve acceptable reduction and stabilization, there was some additional loss of active range of motion in the surgically treated group. Metacarpal fractures had significantly better outcomes than phalangeal fractures. Fractures involving the proximal phalanx or the proximal interphalangeal joint had the poorest prognosis, especially when they were associated with tendon injury. There were significant complications in 13 fingers. Infection and late amputation were related to wound severity.

Adolescent↗
PubMed1993

Clinical estimate of birth-weight in labour: factors influencing its accuracy.

Clinical assessments of birth-weight were made among 88 parturients at term, to determine what maternal and neonatal factors influence the accuracy of predicting neonatal weight. An estimate within +/- 10% of actual weight was considered accurate, while a prediction off by more than 10% was classified as inaccurate. Seventy-one per cent (63 of 88) of the estimates were considered accurate and 28% (25 of 88) inaccurate. Among these 2 groups of patients, univariate analysis did not identify maternal age, gravidity, parity, gestational age, maternal height, prepregnancy weight and maternal body mass index, maternal weight and maternal body mass index at the time of delivery, change in body mass index during pregnancy, intrapartum amniotic fluid index, newborn's weight, length, and ponderal index as being significant correlates of an accurate clinical estimate of the birth-weight. Over 2 years, as the provider gained experience in predicting the neonatal weight, the accuracy of the clinical estimate of birth-weight did not improve.

Adult↗
PubMed1993

Immediate postpartum curettage: accelerated recovery from severe preeclampsia.

OBJECTIVE: To investigate the ability of immediate postpartum curettage to accelerate maternal recovery from severe preeclampsia. METHODS: Thirty-two parturients with severe preeclampsia were randomly assigned to either undergo ultrasound-directed curettage following delivery or to have no curettage. RESULTS: Subjects who underwent immediate postpartum curettage had a significantly decreased mean arterial pressure at each 2-hour point for the first 24 hours compared with those who were not curetted (P < .0002). The mean urine output after uterine curettage was significantly greater during each 4-hour interval of the first 24 hours postpartum compared with controls (P < .0002). The platelet count increased in the curettage group from 12 to 24 hours following curettage, whereas controls exhibited a decrease in the platelet count from 12 to 24 hours (P < .0003). CONCLUSION: Immediate puerperal uterine curettage of the parturient with severe preeclampsia appears to accelerate disease recovery with no apparent adverse sequelae.

Adolescent↗
PubMed1992

Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors.

BACKGROUND: The long-term survival of cadaveric renal allografts is lower in black recipients than in white recipients, although the one-year graft survival is similar in these racial groups. We sought to determine what factors account for this disparity. METHODS: We studied 100 consecutive recipients of primary cadaveric renal allografts (57 were black and 43 white) at least 1 year after transplantation (mean, 40 months); all had received identical immunosuppressive therapy. We evaluated differences in the cause and duration of end-stage renal disease, the number of pretransplantation transfusions, age, matching for HLA-A, B, and DR antigens, race of the donor, insurance coverage, and compliance to assess their effect on graft survival in both groups. RESULTS: Allograft survival after one year was significantly lower in black than in white patients (P = 0.025). According to univariate analysis, only the recipient's age at transplantation, the number of mismatches for HLA antigens, the type of insurance coverage, the source of referral for transplantation, and the degree of compliance correlated significantly with the rate of graft survival. The frequency of all variables that reduced graft survival was higher among the blacks. According to proportional-hazards analysis, the only factors contributing to a lower rate of graft survival were age of less than 30 years at transplantation (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.6), mismatches for all six HLA antigens as compared with three or fewer mismatches (relative risk, 5.6; 95 percent confidence interval, 3.3 to 9.6), and coverage by Medicaid or Medicare (relative risk, 2.2; 95 percent confidence interval, 1.5 to 3.2). Race had no additional effect. Noncompliance was more frequent among blacks (16 percent vs. 2 percent) and could substitute for insurance status in the model. CONCLUSIONS: When immunosuppression is equivalent in black and white transplant recipients, apparently race-related differences in the long-term survival of renal cadaveric allografts appear to be related to other factors that affect graft survival unfavorably, notably poor HLA matching and unfavorable socioeconomic factors.

Adult↗
PubMed1992

Vaginal birth after cesarean delivery: are there useful and valid predictors of success or failure?

OBJECTIVE: Before parturition are there useful and valid predictors of successful or unsuccessful vaginal birth after previous cesarean birth that could be used to enhance the obstetric care of a patient and her pregnancy? STUDY DESIGN: The clinical course and outcome of all patients who attempted vaginal birth after cesarean delivery at one level III center during 1989 were evaluated to identify factors prognostic of a successful or unsuccessful patient group; use of this information in stepwise logistic regression and cluster analysis was disappointing. RESULTS: No single criterion or optimal clusters of factors were found and no equation achieved greater than 75% predictability of outcome with acceptable sensitivity and specificity. CONCLUSIONS: Before parturition prediction of outcome of vaginal birth after cesarean delivery is tenuous regardless of past obstetric history or recent clinical parameters. Thus it seems appropriate to encourage a trial of labor in almost all patients with a prior low-segment uterine incision (transverse or vertical) unless there is a strong physician or patient-derived contraindication to such an undertaking.

Body Weight↗
PubMed1992

Relationship between peer status and health behaviors.

Over the past decade, univariate studies have identified peer-rated popularity/sociability as a correlate of individual health practices (e.g., alcohol and drug use, exercise habits). Yet, the relationship between multiple health habits and broader social competencies rarely has been systematically examined. Accordingly, using a multivariate approach, the present study investigated the relative influence of background characteristics (i.e., age, gender, race, family type, and socioeconomic status) and peer status on health-related behaviors (i.e., physical activity, eating habits, smoking, alcohol use, and stress-related behaviors) in 589 junior high school students (ages 11-13). In this sample, peer popularity provided no significant increment in the prediction of health habits over and above the effects explained by demographics. These results are consistent with current perspectives on health and interpersonal behaviors, and have important practical implications for the initiation and maintenance of healthful and risky practices in the natural environment.

Adolescent↗
PubMed1992

Unscheduled hospital admission following ambulatory gynecologic surgery.

OBJECTIVE: To identify causes of unscheduled admission following ambulatory gynecologic surgery. METHODS: We compared each patient admitted on an unscheduled basis with two patients who did not require admission. Thirty demographic and clinical factors were evaluated by univariate analysis. Significant factors (P less than .05) were then analyzed using multivariate stepwise logistic regression. RESULTS: During a 4-year period, 90 patients required unscheduled admission. This represented 3.64% of 2470 patients who underwent ambulatory gynecologic surgery. Factors associated with admission by multivariate analysis included: 1) previous abdominal surgery, 2) significant medical illnesses, 3) preoperative hemoglobin concentration, 4) general anesthesia, 5) procedure length, and 6) blood loss. Sensitivity was 60.0%, specificity was 90.6%, and the overall correct rate of prediction was 80.4%. Postoperative emesis, the most common reason for unscheduled admissions, occurred in 23.4% of patients. CONCLUSIONS: Previous abdominal surgery and significant medical illnesses are factors that cannot be altered preoperatively. The need for general anesthesia, procedure length, and blood loss are functions of the procedure and cannot be easily modified. Postoperative emesis may warrant further investigation. Successful antiemetic therapy may reduce unscheduled admissions.

Ambulatory Surgical Procedures↗
PubMed1990

Relationships among children's health-related behaviors: a multivariate, developmental perspective.

Considerable evidence documents the aggregation of cardiovascular risk factors in children; yet, very little is known about the covariation of children's health practices. Accordingly, using a multivariate and developmental perspective, the present research examines the interrelationships among multiple health behaviors (i.e., physical activity, eating habits, smoking, alcohol use, and stress-related behaviors) in 1,092 predominantly low-socioeconomic status, rural schoolchildren (ages 11-18, grades 6-12). Our data provide support for a multidimensional view of children's health habits and suggest that patterns of interrelationships may vary at different developmental levels. Implications of these results are discussed and directions for future research are highlighted.

Adolescent↗
PubMed1990

Effect of back support and stethoscope head on seated blood pressure determinations.

Seated BP measurements were taken in 48 men with a history of essential hypertension: in a chair with back support v on an examining table with no back support, and with bell v diaphragm stethoscope head in each condition. There were no significant differences between bell and diaphragm in SBP or DBP determinations. SBP was not significantly different between table and chair, but table DBP was 6.5 mm Hg higher (P less than .0001) than chair DBP. We conclude that back support, but not bell v diaphragm stethoscope head, affects seated BP determinations.

Back↗
PubMed1990

A simplified hypoplasia index.

A simplified hypoplasia index for deciduous teeth has been developed. The index utilizes a two-digit system to signify the type and severity of the hypoplastic lesion. The types of lesions recorded are primary canine hypoplasia (PCH) and linear enamel hypoplasia (LEH). The severity ranges from minimal to severe and accounts for the presence of dental caries, dental restorations, and recurrent caries. To determine the reliability of the index, two tests were conducted. The first measure was a repeat reliability coefficient (test-retest) to calculate the stability of the instrument. This measure was calculated for two populations by two examiners under the same examination conditions and exams were conducted seven weeks apart. The second measure calculated the interrater reliability (standardization). Test results were analyzed by employing the Pearson product moment correlation. The repeat reliability coefficients were .75 (P less than or equal to .0001) and .74 (P less than or equal to .0001). The interrater reliability coefficient was .87 (P less than or equal to .0001). These data seem to indicate that the index is reliable over time and between examiners.

Dental Caries↗
PubMed1990

Major hepatic resections: a 10-year experience with emphasis on special problems.

From 1976-1985, 32 patients underwent major hepatic resection at the University of Mississippi Medical Center. This experience was reviewed to determine the relationship of blood loss, postoperative hyperbilirubinemia, and the performance of concomitant surgical procedures to operative mortality, local tumor recurrence, and long-term survival. There were no deaths among 16 elective resections. Of 16 patients undergoing emergency resections, seven died (43.8%). The mortality rate correlated strongly with intraoperative transfusion of more than 10 units of blood and with postoperative hyperbilirubinemia. Performance of additional procedures increased mortality significantly after emergency, but not elective, hepatic resection. Median survival was 53.4 months in patients resected for hepatoma and 33.5 months in those patients resected for metastatic colon lesions. Local recurrence in a patient with hepatoma was managed by resection at 13 months, with no evidence of further recurrence at 69 months.

Adolescent↗
PubMed1989

Primary canine hypoplasia in Head Start children.

Primary canine hypoplasia is an incomplete or defective development of the enamel matrix. The lesion is located on the labial surface and is seen more frequently on mandibular teeth. The purpose of this preliminary study was to determine the prevalence of this lesion among Head Start children. During a dental needs assessment of Mississippi Head Start children, 371 children from 11 centers were examined for this lesion. Of the centers, four were located in optimally fluoridated communities, and six were located in fluoride-deficient communities. Ages ranged from three to five years. There were 206 males and 165 females, 334 black and 37 white children. At ten centers all children were black, while all children at one center were white. Results indicated no significant differences in the black population between fluoridated (38.2%) and fluoride-deficient (36.3%) communities (P = .729) or between males (36.8%) and females (37.6%) (P = .877). When data were collapsed on sex and fluoridation status, the racial differences were highly significant (P = .001). The prevalence rate of dental caries associated with primary canine hypoplasia was 26.0 percent. These preliminary data indicate that the presence of primary canine hypoplasia may result in an increased potential for the tooth becoming carious.

Black People↗
PubMed1989

Dental caries assessment of Mississippi Head Start children.

This study assessed the dental caries status and treatment needs of Mississippi Head Start children during the 1987-88 school year. The 2,393 children examined, representing a 10 percent random sample of all Mississippi Head Start children, were three to six years old with a majority being four to five years old. The mean deft ranged from 1.34 for three-year-olds to 4.32 for six-year-olds; the mean defs ranged from 2.33 to 9.99. More than 50 percent of primary teeth of three-year-olds with dental caries experience required treatment, whereas less than one-quarter of similarly affected teeth of six-year-olds were in need of treatment.

Age Factors↗
PubMed1989

Protection of hepatotoxic and lethal effects of CCl4 by partial hepatectomy.

CCl4 is a hepatotoxic haloalkane, capable of producing hepatocellular fatty degeneration and centrilobular necrosis. Previous reports indicate induction of liver regeneration after 36-48 hr of CCl4 treatment, which is considered as a secondary effect. The present investigation was undertaken to evaluate the primary effects of CCl4 on hepatic DNA synthesis and to correlate liver regeneration with CCl4 toxicity. These studies were conducted in normal and actively regenerating livers using male Sprague-Dawley rats undergoing sham operation (SH), or partial (70%) hepatectomy (PH). Incorporation of 3H-thymidine (3H-T) in hepatocellular nuclear DNA and autoradiographic analyses of liver sections served as indices for hepatocellular regeneration. Initial experiments established that peak regeneration occurs at 2 days post-PH (PH2) and liver regeneration phases out by 7 days post-PH (PH7). SH and PH rats were challenged with a single ip dose of either corn oil vehicle or CCl4 at either 0.1 ml/kg (to represent subtoxic dose) or 2.5 ml/kg (to represent toxic dose). The low dose of CCl4 was not toxic and did not alter 3H-T incorporation and percentage labelled cells at 6 or 24 hours after administration to SH, PH2 or PH7 groups, indicating that there was no interference with PH-stimulated hepatocellular regeneration. The high dose of CCl4 was significantly hepatotoxic and lethal in SH rats, while in PH2 rats both hepatotoxic and lethal effects were significantly decreased. 3H-T incorporation as well as percentage labelled cells, highly stimulated by PH, were significantly decreased by high dose of CCl4. However, hepatocellular regeneration in PH2 rats treated with high dose of CCl4 was still significantly higher than SH or PH7 groups by virtue of the stronger stimulatory effect of PH. In PH7 rats, where hepatocellular regeneration had returned to the SH level, the hepatotoxic and lethal effects of the large dose of CCl4 were also restored. These findings show that the progressive phase of a single high dose of CCl4 injury which normally culminates in hepatotoxic and lethal effects is significantly mitigated by previously stimulated hepatocellular regeneration. High dose of CCl4 suppresses hepatocellular regeneration at early time points after administration in contrast to the smaller subtoxic dose of CCl4. By virtue of the much stronger stimulatory effect, PH results in the protection against the hepatotoxic and lethal effects of CCl4 despite the obtunding effects of the high dose on hepatocellular regeneration.

Alanine Transaminase↗
PubMed1989

Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones.

Pearl millet [Pennisetum millet (L.) leeke] is the main source of food energy for the rural poor in many areas of the semiarid tropics. Epidemiological evidence suggests that millet may play a role in the genesis of endemic goiter in these areas, and sparse experimental data in rats support this suspicion. This study was undertaken to determine in vivo in rats and in vitro using porcine thyroid slices and a thyroid peroxidase (TPO) assay the goitrogenic and antithyroid effects of millet diets, extracts of millet, and certain pure compounds contained therein. For use in these studies, whole grain millet was progressively dehulled to yield successively four bran and four flour fractions in which direct analyses revealed progressively lower concentrations of C-glycosylflavones. In vivo feeding of bran fraction 1, that richest in C-glycosylflavones, led to a significant increase in thyroid weight and antithyroid effects. Feeding of bran fraction 2, the next richest in C-glycosylflavones, produced similar, but less marked, changes. In vitro studies of 125I metabolism using porcine thyroid slices indicated that extracts of bran fractions 1 and 2 were most potent, producing changes similar to those produced by methimazole (MMI). At a concentration of 60 mumol/L, glucosylvitexin, the major C-glycosylflavone present in millet, had effects comparable to those of 1 mumol/L MMI. Similarly, in studies of porcine TPO, extracts of bran fraction 1 caused pronounced (85%) inhibition of enzyme activity, and progressively less inhibition was induced by extracts of bran fractions 2, 3, and 4. Overall, the TPO-inhibiting activities of the various millet fractions closely correlated with their C-glycosylflavone concentrations. Three C-glycosylflavones present concentrations. Three C-glycosylflavones present in millet, glucosylvitexin, glycosylorientin, and vitexin, also inhibited TPO activity. Thus, in vivo and in vitro studies revealed that millet diets rich in C-glycosylflavones produce goitrogenic and antithyroid effects similar to those of certain other antithyroid agents and small doses of MMI. We conclude that in areas of iodine deficiency in which millet is a major component of the diet, its ingestion may contribute to the genesis of endemic goiter.

Animals↗
PubMed1989

Thyroid function in neonates from goitrous and nongoitrous iodine-sufficient areas.

We compared thyroid function between newborns from goitrous and nongoitrous localities in which iodine intake has been supplemented since 1955. Cord serum samples were analyzed in 185 infants born during a 9-month period (1986-1987) in 2 goitrous and 1 nongoitrous localities of western Colombia. Urinary iodine was determined in all mothers before delivery. No significant differences were found among neonates of the 3 localities (Kruskal-Wallis test) for the various thyroid hormone values, and all values were within the normal range, although there was a trend in distribution of TSH to higher values in both goiter areas. Thyroid autoantibodies (antithyroglobulin and antithyroid microsomal) were negative in all neonates, and iodine intake, as indicated by urinary iodine, was adequate and similar among the mothers of the 3 groups. Those newborn infants with serum TSH values higher than 20 mU/L were reexamined 5-7 months later. At this time, all infants had lower serum TSH values and their serum free T4 index and T3 values were normal. Gestational age, weight, and height at birth were normal and also equal among the neonates in the 3 localities. These results indicate that neonates from goitrous iodine-sufficient areas have thyroid function similar to that of infants born in nongoitrous areas equally supplemented with iodine, and therefore, they are not more at risk to develop congenital hypothyroidism.

Colombia↗