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Biomedical subjects

E L Peterson

Publications and source records attributed to E L Peterson.

At least 19 recordsLinked to original sources

Static and fatigue failure properties of thoracic and lumbar vertebral bodies and their relation to regional density.

This study investigated (1) whether a characterization of the macroscopic architecture within the vertebral centrum would improve predictions of vertebral strength, (2) if regions in the centrum where least bone loss with age occurs are more predictive of vertebral strength, and (3) whether different patterns of the macroscopic architecture are predictive of static as compared to fatigue strength. To characterize the vertebral macroscopic architecture, a regional bone mineral density (rBMD) technique was used that estimated the cancellous density distribution (in 18 specific regions of the vertebral centrum) for vertebrae T7-L4, from spines of 20 female cadavers. Static and fatigue failure properties of whole vertebrae were obtained, and predictive models of static and fatigue failure properties of whole vertebrae were examined. We found that (1) vertebral failure properties were better predicted by combinations of vertebral regional cancellous density (multiple linear regressions) rather than by any individual region of cancellous density alone (simple linear regressions); (2) models using regions of density that demonstrated minimum decline with age [from the data of Flynn and Cody (Calcif. Tissue Int. 53, S170-S175 (1993))] resulted in better correlations with ex vivo vertebral static failure properties than models using density regions that showed maximum decline with age, and (3) static and fatigue characteristics required different density regions to reach significance. (A comparison of models predictive of static and fatigue failure properties revealed that anterior density regions were most often included in predictive models of the static properties while posterior regions were more predictive of the fatigue properties).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Proportionate mortality study of Vietnam-era veterans of Michigan.

This study examines the proportion of deaths from major diseases among Michigan Vietnam veterans. The distribution of deaths among Michigan Vietnam veterans was compared to deaths among veterans serving elsewhere for 1974-1989 to generate a proportionate mortality ratio (PMR). PMRs were estimated overall and for Black versus non-Black veterans. Overall, Vietnam veterans had significantly elevated PMRs for infectious and parasitic diseases and endocrine disease and lower PMRs for all malignant neoplasms combined. Vietnam veterans overall and non-Black specifically had elevated PMRs for non-Hodgkin's lymphoma. Black Vietnam veterans had elevated PMRs for cancer of the digestive organs, peritoneum, and pancreas. The elevated PMR for non-Hodgkin's lymphoma is consistent with results of individuals exposed to phenoxy herbicides. Results suggest that future studies should examine risks among racial groups separately.

Adult

A gradient relationship between low birth weight and IQ at age 6 years.

OBJECTIVE: To test for a suspected adverse effect of low birth weight (< or = 2500 g) on IQ at age 6 years in two socioeconomically disparate populations. DESIGN: Nonconcurrent prospective study. SETTING: An urban, predominantly disadvantaged population and a suburban middle-class population in southeastern Michigan. PARTICIPANTS: Low-birth-weight (N = 473) and normal-birth-weight (N = 350) subjects, randomly selected from the 1983 through the 1985 newborn lists of two major hospitals, one serving an urban and the other a suburban population. MAIN OUTCOME MEASURES: The Wechsler Intelligence Scale for Children-Revised to measure IQ. RESULTS: The mean full-scale IQ of low-birth-weight children was 4.9 points lower than that of normal-birth-weight children, controlling for population site, maternal IQ, maternal education, and race (95% confidence interval [CI], 3.0 to 6.8). There was no evidence of low-birth-weight interaction with population site, and the same IQ difference was detected in both populations. In the urban population, low birth weight was associated with an increased risk for IQ below 85 (odds ratio, 2.2; 95% CI, 1.3 to 3.7). In the suburban population, low birth weight was associated with an increased risk for IQ below 100 (odds ratio, 2.0; 95% CI, 1.2 to 3.4). A gradient relationship with full-scale IQ was observed, with the largest deficit in those born weighing 1500 g or less, an intermediate deficit in those born weighing 1501 through 2000 g, and the least pronounced deficit in those born weighing 2001 through 2500 g. CONCLUSIONS: The overall effect of low birth weight represents an increase of approximately 10% of low-birth-weight children with an IQ of more than 1 SD below the population's mean. Children born weighing 2000 g or less bore the major burden of the IQ deficits.

Child

Reversal of vertebral deformities in osteoporosis: measurement error or "rebound"?

Digitized morphometry of vertebral bodies on lateral spine films is used to identify and quantify vertebral deformities or fractures. One problem associated with this method is the phenomenon of "disappearing fractures," which results from the apparent increase in vertebral body heights of previously deformed vertebrae on subsequent radiographs. These have been considered biologically implausible and therefore a result of measurement error. Measurement error is unlikely to be unidirectional, so that a proportion of fractures identified by morphometry is also the result of measurement error. Since some vertebral deformities are real events, some disappearances of deformities detected by morphometry may be real events. In this report, we examine the data from our clinical trial of sodium fluoride in spinal osteoporosis to assess critically the plausibility of two hypotheses: (1) The "rebound" phenomenon results from measurement error. If this is the case, then some fractures of the same magnitude as the rebound must also represent measurement error. (2) Some deformed vertebrae in fact rebound toward their original shape and size, displaying an elastic response to deformation. If this occurs, then some vertebral deformities are transient events, not true fractures. We conclude that the variability inherent in morphometric data obtained from serial spine x-rays results in both disappearing fractures and a high false positive fracture rate. The use of more stringent criteria for defining significant deformities, or true fractures, will minimize these problems. We cannot exclude the second hypothesis, that some vertebral deformities may be transient events, but this needs further study.

Aged

Reference data for bone mass, calciotropic hormones, and biochemical markers of bone remodeling in older (55-75) postmenopausal white and black women.

From a random sample of our institution's health maintenance organization (HMO), we recruited 250 white women and 112 black women, aged 55-75, all of whom were 10 or more years postmenospause with minimal estrogen exposure and free of osteoporosis, other metabolic bone disease, and medical, surgical, or therapeutic situations that may influence bone loss. Bone mass was measured in the radius, spine, and femur by DXA and in L1 by QCT. Serum samples were analyzed for parathyroid hormone, calcidiol, calcitriol, osteocalcin, and bone alkaline phosphatase and urine samples analyzed for creatinine, calcium, and hydroxyproline. Mean Z score, based on published reference data for forearm and femoral neck BMD in the white women, was not significantly different from zero, but mean Z score at the lumbar spine was 0.6 (p < 0.001), 17.2% of the individual values being > 2.0. In normal white women (BMI < 27.3, n = 143), Z score was still > 2.0 in 10.3%, suggesting that the upper bound of the published reference interval may be too low. After adjustment for body mass index, BMD was greater in the forearm (9.8%), spine (8.7%), and femoral neck (14.7%) in black women (p < 0.001 at all sites). At L1, adjusted BMC in the black women was 37.4% greater than in the white women (p < 0.001). Serum calcidiol was significantly lower and serum PTH and calcitriol significantly higher in the black women. Despite this, biochemical markers of bone resorption and formation were significantly lower in the black women. We conclude that skeletally healthy older black women have a greater bone mass and lower rates of bone remodeling than a comparable group of white women. These data can serve as reference intervals for the variables measured.

Aged

Comparison of radiographic absorptiometry with dual-energy x-ray absorptiometry and quantitative computed tomography in normal older white and black women.

Bone mineral density (BMD) of the phalanges of the hand was measured by the technique of radiographic absorptiometry (RA) in 199 older postmenopausal women previously determined to have normal BMD by dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT). The average age of the women was 66.8 +/- 4.9 years, and they were 19.9 +/- 6.7 years postmenopause. In the 54 black women, phalangeal BMD was 11.7% greater than in the 145 white women, a difference comparable to that found using DXA at the radial midshaft, the lumbar spine, and femoral neck. A correlation matrix comparing BMD measured by RA to BMD measured by DXA and QCT indicates that, in general, RA was related to the various DXA and QCT measurement sites as well as these sites were related to each other. When results for RA, DXA, and QCT obtained in our cohort of older women were compared to available reference data for peak adult bone mass, the average difference (SD units) from peak value was greatest for RA (-1.77 radius, -1.24 spine, -2.13 femoral neck, -2.34 QCT spine, and -2.71 phalanges). We conclude that RA is an acceptable measure of phalangeal BMD and that the data in our cohort can serve as reference data for older white and black women aged 55-75 years. Once the ability of RA to predict future fracture occurrence has been demonstrated, it could be rapidly deployed as a low-cost, widely available bone mass measurement technique.

Absorptiometry, Photon

Estimation of total body and extracellular water using single- and multiple-frequency bioimpedance.

OBJECTIVE: To determine the precision and bias of single- and multiple-frequency bioimpedance estimates of total body water (TBW) and extracellular water (ECW) volumes in comparison with the true values for these volumes established by gold standard dilution techniques. DESIGN: Controlled, prospective, open-label investigation. SETTING: Private, not-for-profit university-affiliated, acute care hospital. PARTICIPANTS: Normal, healthy men (n = 8) and women (n = 6) volunteers, 25-46 years of age. INTERVENTIONS: A single oral dose of a mixture of deuterium oxide 10 g and bromine 30 mmol; bioimpedance analysis pre- and three hours postmixture administration. MAIN OUTCOME PARAMETERS: TBW and ECW volumes established by deuterium oxide and bromine dilutional spaces (gold standards), respectively, and single- and multiple-frequency bioimpedance estimates of those same volumes. RESULTS: The mean multiple-frequency bioimpedance (MFB) and single frequency bioimpedance (SFB) estimates of TBW, 41.2 and 42.1 L, respectively, were not statistically different (NS) from the 41.2 L deuterium oxide value. Although the two methods had similar precision (NS), MFB was less biased. For ECW, the mean MFB and SFB values of 19.5 and 24.8 L, respectively, were significantly different from the bromine value of 18.8 L (p = 0.013 and p = 0.001, respectively). MFB was the more precise and less biased predictor of ECW. CONCLUSIONS: Compared with SFB, the MFB approach is a more precise and less biased predictor of TBW and ECW volumes in young, healthy adults, and may offer more accurate assessment in subjects with aberrant physiology.

Adult

Body composition and gonadal steroids in older white and black women.

Obesity offers protection against osteoporosis in older women. The mechanisms are not well understood, but relate in part to increased aromatization of adrenal androgens to estrone in peripheral fat and muscle tissue. Two hundred and one white and 77 black women previously reported to be free of skeletal disease and to have normal bone mass had measurements of total body bone mineral (TBBM), fat mass (TBFM), and lean mass (TBLM) performed by dual energy x-ray absorptiometry. Serum estrone, androstenedione, and dihydroepiandrostenedione sulfate were measured on the same day. Body weight, body mass index, TBFM, and TBLM were all significantly higher in the black women. However, proportionately, there were no differences in body composition between the two groups. This suggests that the black women were not more obese despite their greater body mass index, and that future studies on the health impact of obesity in older black women should take this into consideration. Despite the greater TBFM and TBLM in the black women and no difference in serum androstenedione levels, the serum estrone level was not higher in the black women, and the higher bone mass in blacks was not related to serum estrone. In both ethnic groups, TBBM was significantly related to body weight (white, r = 0.80; black, r = 0.85; P < 0.001 for both). Both TBFM and TBLM were significantly related to TBBM in both ethnic groups. Serum estrone was significantly related to all measures of body mass in the white women, but to no measures of body mass in the black women, indicating apparent differences in the metabolism of estrone between older white and black women.

Adipose Tissue

Determination of gentamicin pharmacokinetics by bioelectrical impedance in critically ill adults.

This investigation compares the accuracy of calculating gentamicin pharmacokinetic parameters by a noninvasive body composition technique (bioelectrical impedance analysis; BIA) with an empiric method, against the two-point method as the criterion standard. A prospective concurrent open label design was used. The 32 medical and surgical intensive care unit beds at Henry Ford Hospital, a not-for-profit, university-affiliated teaching hospital, served as the setting. Twenty critical ill adults, Therapeutic Index Scoring System (TISS) = 4, who required gentamicin as part of their normal course of therapy for gram-negative bacillary infections, were evaluated. Gentamicin Vd and k were calculated by three methods. After measurement of body composition parameters by BIA, previously derived gentamicin dosing equations were used to predict gentamicin volume of distribution (Vd) and elimination rate constant (k) (BIA method). Empiric estimates of these parameters (Vd = 0.3L/kg and k derived from creatinine clearance) were compared with the BIA parameters against a criterion standard Vd and k determined from a two-point sampling of gentamicin serum concentrations. Measurements of BIA parameters and gentamicin serum concentrations were made in duplicate with coefficients of variation, < or = 2% and < or = 3%, respectively. The BIA and empiric methods produced resultant pharmacokinetic parameters (Vd and k) not different than those measured by the two-point method. There were no statistically significant differences in mean error (bias), or mean squared error (precision) for both Vd and k assessed by the empiric or BIA methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Early smoking initiation and nicotine dependence in a cohort of young adults.

We examined the extent to which nicotine dependence and daily smoking might vary by age at first cigarette. The potential confounding effects of sex, race and history of childhood behaviour problems were examined as well. A sample of 1200 was randomly selected from the subset of 21-30-year-old members of a large HMO in the Detroit SMSA; 1007 (84%) agreed to participate. Personal interviews were conducted in respondents' homes, using the NIMH-DIS to elicit information on DSM-III-R diagnoses, including nicotine dependence. Controlling for sex and race, persons who smoked their first cigarette at 14 to 16 years of age were 1.6 times more likely to become dependent than those who initiated smoking at an older age (P = 0.03). The association was unchanged when history of childhood behaviour problems was also controlled. Smoking initiation before age 14 was not associated with increased probability of dependence. Persons who initiated smoking before age 14 had a longer lag time to daily smoking and a lower likelihood of progressing to daily smoking, compared to persons who initiated smoking later on. The findings suggest that, among persons who have ever smoked, there might be two distinct groups in whom the chances of developing dependence are considerably reduced. The first comprises persons who delayed first use until age 17. The second comprises persons who smoked their first cigarette before age 14, a group in whom the progression to daily smoking might be markedly slower than in persons who initiated smoking when they were older.

Adolescent

Predictability of creatinine clearance estimates in critically ill patients.

OBJECTIVES: a) To evaluate the predictive ability of different creatinine clearance methods as compared with the criterion standard, inulin clearance; and b) to determine which of the predictive methods yields the most accurate estimation of creatinine clearance. DESIGN: Prospective study. SETTING: Medical intensive care unit (ICU) of a university-affiliated tertiary care hospital. INTERVENTIONS: Glomerular filtration rate was measured by the criterion standard, inulin clearance. PATIENTS: Twenty mechanically ventilated adults. MEASUREMENTS: Renal function was assessed by the following procedures: inulin clearance using a standard protocol, 30-min creatinine clearance, 24-hr creatinine clearance, and creatinine clearance estimates by the Cockcroft-Gault equation. Ideal body weight, total body weight or lean body mass with actual serum creatinine or serum creatinine concentration corrected to 1 mg/dL (85 mumol/L) in cachectic patients were sequentially incorporated into the Cockcroft-Gault equation. RESULTS: The Cockcroft-Gault equation, using ideal body weight and the corrected serum creatinine concentration, was the best predictor of inulin clearance with the smallest bias (9.7 +/- 8.6, 95% confidence interval 5.7 to 13.8). The bias encountered with the 30-min creatinine clearance was not different from that value with the 24-hr creatinine clearance (21.6 +/- 33.0, 95% confidence interval 6.2 to 37.1 vs. 25.4 +/- 28.3, 95% confidence interval 11.8 to 42.9). Good correlations existed between inulin clearance and the Cockcroft-Gault equation, using ideal body weight and the corrected serum creatinine concentration (r2 = .81; p = .0001), as well as between inulin clearance and the Cockcroft-Gault equation, using the lower of ideal or total body weight and the higher of the actual serum creatinine concentration or corrected serum creatinine (r2 = .75; p = .0001). The 30-min creatinine clearance and the 24-hr creatinine clearance had poorer agreement with inulin clearance. The incorporation of a corrected serum creatinine value into the Cockcroft-Gault equation consistently led to better predictions and higher correlation coefficients. CONCLUSIONS: The utilization of the Cockcroft-Gault equation as used clinically (the lower of ideal or total body weight and the higher of actual serum creatinine or corrected serum creatinine concentration to 1 mg/dL [85 mumol/L]) results in more accurate predictions of glomerular filtration rate in the medical, critically ill patient than urine creatinine clearance measures. If creatinine clearance measures are used, the 30-min collection provided results not different from those results obtained with 24-hr urinary collections.

Adult

Outcome variables in osteoporosis trials.

The conduct of controlled clinical trials examining the anti-fracture efficacy of potential therapies for osteoporosis is a relatively new and developing science. We have reviewed several aspects of data acquisition, emphasizing that bone mass measurement and, similarly, back pain can only be regarded as ancillary outcome variables. Serial measurement of stature when performed in a precise manner may be an inexpensive, quick, and convenient surrogate outcome variable, most applicable to large multi-center studies. The only true end-point of such trials is the radiographic documentation of new vertebral fracture occurrence. Techniques for obtaining serial radiographs and assessing vertebral morphometry with good quality control have been described. Important questions still need to be resolved concerning the most appropriate criteria for defining incident fractures and for calculating fracture frequency. Implications regarding trial sample size requirements are discussed.

Body Height

Prediction of glomerular filtration rate using aminoglycoside clearance in critically ill medical patients.

OBJECTIVE: The aim of this preliminary investigation was to evaluate the use of aminoglycoside serum concentrations as a surrogate measure of the glomerular filtration rate (GFR) in comparison with other measured and empiric methods against inulin, the criterion standard measure of GFR. DESIGN: A consecutive sample of all eligible patients. SETTING: An eight-bed medical intensive care unit in a university-affiliated tertiary-care teaching hospital. PATIENTS: Ten critically ill medical patients receiving gentamicin or tobramycin for presumed or documented gram-negative bacillary infection were enrolled in the study. The patients were mechanically ventilated and had underlying organ system dysfunction. All ten patients completed the study. INTERVENTION: Patients underwent renal functional assessment by measured inulin (Cl(in)) and 24-hour urinary creatinine clearance (Clcr). Aminoglycoside serum concentrations were used to estimate GFR and were compared with the two measured methods and a creatinine clearance calculated with the Cockcroft-Gault method (ClCG). All evaluations were performed the same day. RESULTS: Cl(in) averaged 51.6 +/- 35.0 mL/min and serum creatinine ranged from 0.3 to 5.4 mg/dL (26.5 to 477.3 mumol/L). Steady-state peak and trough aminoglycoside concentrations were 6.1 +/- 1.4 and 1.3 +/- 0.9 micrograms/mL, respectively. There were no statistically significant differences between the various methods, although the aminoglycoside-calculated GFR (Cl(amg)) 95 percent confidence intervals were smaller than Clcr and ClCG compared with Cl(in). Mean absolute errors were smaller with Cl(amg) than with Clcr and ClCG. Regression results indicated that only Cl(amg) and ClCG demonstrated agreement with Cl(in) (lines not different from y = x). However, the Cl(amg) showed closer agreement, with a mean square error almost half that of ClCG (9.6 vs. 18.1). CONCLUSIONS: Cl(amg) can be used routinely as an estimate of GFR in critically ill patients, with less error than empiric methods.

Adult

A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis.

The anti-fracture efficacy of sodium fluoride (NaF) was evaluated in 84 postmenopausal white women with spinal osteoporosis. The dose of NaF used was 75 mg/day and all patients in this prospective, randomized, double-blind, placebo-controlled clinical trial received calcium supplements (carbonate salt) 1500 mg/day in addition to participating in a structured physical therapy program. For each of the outcome measures (change in stature, change in cortical bone mass in the forearm and development of new vertebral fractures determined by change in vertebral morphometry and by scintigraphy) there was no significant difference between the fluoride or placebo treated groups. Side effects, predominantly gastrointestinal symptoms and the development of the painful lower extremity syndrome, occurred significantly more frequently in the fluoride group (P less than 0.05). Peripheral fractures were not more frequent in the fluoride group. We conclude that, in the dose and manner used in this study, NaF is no more effective than placebo in retarding the progression of spinal osteoporosis. There is no role for NaF in the treatment of osteoporosis outside the confines of clinical research.

Aged

Maternal smoking does not influence cord serum IgE or IgD concentrations.

Increased cord blood IgE concentrations have been related to atopic risk in children, and a previous study reported increased cord blood IgE concentrations in smoking mothers. These associations suggest a relationship between maternal smoking during pregnancy and atopic risk. To evaluate this question, we prospectively studied parental smoking and cord blood IgE and IgD concentrations in a geographically defined group of women belonging to a health maintenance organization. Cord blood samples were obtained from 847 infants born to these women. Cotinine concentrations were measured in 114 cord blood samples to evaluate the veracity of the maternal smoking histories. Smoking during the prenatal period was reported by 144 mothers (17%) and 204 fathers (25%). Decreased birth weight and length were associated with maternal smoking (p less than 0.001 for both), confirming previous studies. Neither maternal nor paternal smoking was found to be associated with IgE level in univariate or multivariate analyses. Maternal and paternal smoking was associated with IgD (p = 0.03 and p = 0.06, respectively) in univariate analysis. In multiple regression analysis controlling for potentially confounding variables, the association between paternal, but not maternal, smoking and IgD was sustained (p = 0.05 and p greater than 0.20, respectively). Our data do not demonstrate that maternal or paternal smoking increases cord blood IgE.

Adult

Perilymphatic fistula: analysis of free amino acids in middle ear microaspirates.

High-performance liquid chromatography was used to determine 19 free amino acid concentrations in perilymph, serum/plasma, and red blood cell intracellular fluid. Significant differences were found between perilymph and these fluids. Free amino acid analysis was then used to quantitatively analyze middle ear microaspirates in order to test the hypothesis that perilymph is a potential source of clear fluid in perilymphatic fistulas (PLF). Fourteen unknown samples from patients with visually identified PLF, including patients with no identifiable otic capsule defect, were studied. Six samples on amino acid pattern analysis were correlated most similarly with perilymph (rrho greater than 0.95). Four of these six samples were scored on the basis of quantitative amino acid values as similar to perilymph. However, three samples of clear fluid were more similar to serum/plasma than to perilymph on both amino acid pattern and quantitative amino acid score analysis. These results objectively suggest perilymph as a potential source of clear fluid in some patients with a diagnosis of PLF. Not all clear fluid observed in the middle ear, however, is potentially perilymph.

Alanine

Body composition analysis by bioelectrical impedance: the effects of time of day and body side on estimated gentamicin pharmacokinetics.

To assess if repetitive measures are useful in a clinical setting, the effects of time of day and body side on bioelectrical impedance (BI) measurements were evaluated. Fifteen healthy, male volunteers underwent serial BI measurements at 0, 3, 6, 9, 24, and 48 hours on both sides of the body using a four-electrode plethysmograph. Analysis of variance for repeated measures indicated that the mean resistance (R) value of the right side was statistically lower from that of the left side (447 +/- 27.9 vs 457 +/- 29.1 ohms; p = 0.006). Both R and reactance (Xc) varied significantly over time. For R, the mean response at 0, 6, 9, and 48 hours was different from the overall mean of the remaining time points (p less than 0.007). Only times 6 and 24 hours were significantly different for Xc (p less than 0.006). No relevant time and side effects were noted in calculated gentamicin pharmacokinetic parameters on incorporation of BI measurements into impedance-derived predictive equations for clearance, volume of distribution, and elimination constant. Correlation coefficients of reliability were high within 1 day and across days (R greater than or equal to 0.8407). These data suggest that under normal conditions, BI analysis provides reliable results, and that time and side standardizations in its measurements are not necessary.

Adult