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Biomedical subjects

G D Davis

Publications and source records attributed to G D Davis.

At least 19 recordsLinked to original sources
PubMed2000

The relationship of the in-situ advancing vaginal wall sling to vaginal epithelial inclusion cyst.

Epithelial inclusion cyst is an under recognized complication of the in-situ advancing vaginal wall sling. A 63-year-old woman with stage I pelvic organ prolapse and mixed incontinence underwent in-situ sling placement in November 1997. In February 1998 she presented with a painful recurrent inflammatory anterior vaginal wall mass. The mass was cystic and drained spontaneously four times over the period of conservative management. The patient underwent resection of a clinical and pathological vaginal epithelial inclusion cyst in September 1998. At 6-month follow-up the patient remains continent and the cyst has not reformed. The vaginal surgeon should be aware of the potential for epithelial inclusion cyst formation after in-situ sling placement, and actively search for them at postoperative examination.

Cysts↗
PubMed2000

The relation between stress fractures and bone mineral density: evidence from active-duty Army women.

OBJECTIVE: To determine if bone mineral density (BMD) is associated with the probability of stress fractures in premenopausal women. DESIGN: Case-control study. SETTING: Large Army post, Fort Lewis, WA. PARTICIPANTS: Twenty-seven active duty Army women with documented stress fractures within the last 2 years and 158 female controls. METHODS AND MAIN RESULTS: All subjects were examined and interviewed. BMD of the femoral neck and posteroanterior lumbar spine (L2-L4) was measured using dual energy X-ray absorptiometry. Univariate comparisons revealed no significant differences in BMD of the femoral neck or lumbar spine between groups. Women with stress fractures had a significantly higher exercise intensity (428 vs 292 minutes per week, p<.05) and were more likely to be entry-level enlisted soldiers (63% vs. 44%, p<.05) than those without stress fractures. Multivariate analyses revealed a strong negative association between femoral neck BMD and the probability of stress fractures (lower BMD, higher risk). Exercise intensity and body mass index had a significant positive effect on BMD of the femoral neck and lumbar spine, yet both were associated with an increased probability of stress fractures. CONCLUSIONS: Femoral neck BMD was significantly associated with the probability of stress fractures. Optimal training programs should balance the beneficial indirect effect of increased exercise (through increased BMD) with its detrimental direct effect on stress fractures.

Adult↗
PubMed2000

Credentialing residents for intraoperative cystoscopy.

OBJECTIVE: To determine whether incorporation of routine intraoperative cystoscopy for evaluation of potential urinary tract injury into gynecologic residency training provides sufficient experience to justify hospital credentials after graduation. METHODS: We developed a curriculum to train residents in intraoperative cystoscopic evaluation of potential lower urinary tract injury. Cystoscopy was performed when indicated with hysterectomy and routinely in conjunction with pelvic reconstruction. Faculty members evaluated conceptual and technical proficiency by oral examination and direct observation in the operating room. Once the resident demonstrated a thorough understanding and proficiency in performing intraoperative cystoscopy, a competency certification document was issued by the Program Director. This certification was transmitted to the postresidency hospital credentials committee to justify granting privileges. RESULTS: Since 1994 over 400 transurethral cystoscopic evaluations have been done in conjunction with major gynecologic abdominal and vaginal surgeries, and since 1997 an additional 50 transvesical microcystoscopies have been done in selected abdominal cases. Twenty-five residency graduates have been certified as fully trained in intraoperative diagnostic cystoscopy. All these graduates have been granted intraoperative cystoscopy privileges at their subsequent hospital practice. CONCLUSION: Incorporation of cystoscopic urinary tract evaluation into routine gynecologic surgical training is good medical practice and provided a mechanism whereby obstetrics and gynecology residents could obtain intraoperative cystoscopy hospital privileges after graduation. (Obstet Gynecol 2000;96:1014-7.)

Credentialing↗
PubMed1999

New fusion protein systems designed to give soluble expression in Escherichia coli.

Three native E. coli proteins-NusA, GrpE, and bacterioferritin (BFR)-were studied in fusion proteins expressed in E. coli for their ability to confer solubility on a target insoluble protein at the C-terminus of the fusion protein. These three proteins were chosen based on their favorable cytoplasmic solubility characteristics as predicted by a statistical solubility model for recombinant proteins in E. coli. Modeling predicted the probability of soluble fusion protein expression for the target insoluble protein human interleukin-3 (hIL-3) in the following order: NusA (most soluble), GrpE, BFR, and thioredoxin (least soluble). Expression experiments at 37 degrees C showed that the NusA/hIL-3 fusion protein was expressed almost completely in the soluble fraction, while GrpE/hIL-3 and BFR/hIL-3 exhibited partial solubility at 37 degrees C. Thioredoxin/hIL-3 was expressed almost completely in the insoluble fraction. Fusion proteins consisting of NusA and either bovine growth hormone or human interferon-gamma were also expressed in E. coli at 37 degrees C and again showed that the fusion protein was almost completely soluble. Starting with the NusA/hIL-3 fusion protein with an N-terminal histidine tag, purified hIL-3 with full biological activity was obtained using immobilized metal affinity chromatography, factor Xa protease cleavage, and anion exchange chromatography.

Animals↗
PubMed1999

Clinical management of vulvodynia.

Vulvodynia represents a group of vulvar disorders that can be clinically perplexing. Unfortunately, there are no simple tests for its diagnosis. Patients often are reluctant to report vulvar pain. Some are embarrassed to reveal their perceived "sexual dysfunction" caused by dyspareunia. Others have been told in the past "It's all in you head," or "It's just a yeast infection." Most patients with vulvodynia are seen by multiple practitioners and are placed on a variety of treatments before a correct diagnosis is made. All too often, these treatments are not only ineffective but also damaging. Careful clinical investigation is required for the correct diagnosis and treatment of vulvodynia (Figure 2).

Dermatitis↗
PubMed1999

Abnormal eating behaviors in military women.

PURPOSE: The purpose of this study was to evaluate the prevalence of abnormal eating behaviors in women on active duty in the Army. METHODS: A total of 423 female soldiers from the general population on active duty volunteered to participate in this study. They completed the Eating Disorder Inventory (EDI) questionnaire. Each questionnaire was screened and any woman on active duty practicing abnormal eating behaviors (criteria set up by the authors) underwent an interview. A diagnosis, using DSM IV criteria, of one of the following was determined from the interview: 1) No eating disorder, (2) Anorexia nervosa, 3) Bulimia nervosa, 4) binge eating disorder, 5a) Eating disorder NOS, and 5b) Situational eating disorder. A situational eating disorder was defined as any abnormal eating behaviors consistent with an eating disorder NOS that was practiced intermittently and in response to external pressures associated with significant distress, such as military weigh-ins or army physical fitness testing (APFT). RESULTS: Of the 423 women on active duty who participated, 33.6% (N = 142) met the questionnaire screening criteria for being "at risk" for abnormal eating behaviors and underwent an interview. Of the 142 women interviewed, 33 (8%) women were diagnosed with an eating disorder. The women with eating disorders exercised, felt dissatisfied with their weight, and felt significantly more pressure about their weight than the women without eating disorders. In addition, they also had significantly greater scores on the Drive for Thinness (DT), Bulemia (B), and Body Dissatisfaction (BD) subscales, and the total EDI scores for both the 8 and 11 subscales. CONCLUSION: In the women on active duty in the Army studied, there was an 8% prevalence of eating disorders.

Adolescent↗
PubMed1999

Decline in bone mineral density with stress fractures in a woman on depot medroxyprogesterone acetate. A case report.

BACKGROUND: Depot medroxyprogesterone acetate is a popular contraceptive among young, physically active women. However, its administration has been linked to a relative decrease in estrogen levels. Since bone resorption is accelerated during hypoestrogenic states, there has been growing concern about the potential development of osteoporosis and fractures with the use of this contraceptive method. CASE: A physically active, 33-year-old woman demonstrated a 12.4% drop in femoral neck bone mineral density (BMD), 6.4% drop in lumbar BMD and 0.8% drop in total BMD with the subsequent development of a tibial stress fracture while on depot medroxyprogesterone acetate. Bone mineralization rapidly improved, and the stress fracture resolved with discontinuation of the medication. CONCLUSION: The long-term effects of depot medroxyprogesterone acetate on bone mineralization in physically active women should be evaluated more thoroughly.

Adult↗
PubMed1999

Enhancing advanced surgical laparoscopy. Combined, routine use of microlaparoscopes and macrolaparoscopes.

OBJECTIVE: To describe a variety of techniques for using the microlaparoscope in conjunction with a standard-sized laparoscope for simplifying and enhancing advanced laparoscopic surgery. STUDY DESIGN: Descriptive study of microlaparoscopic techniques for enhancing macrolaparoscopic procedures. RESULTS: The microlaparoscope facilitates macrolaparoscopy by permitting: (1) specimen removal and use of 10-mm instruments without secondary, large ports; (2) performance of laparoscopic vaginal hysterectomy with the endoscopic stapler using only one 12-mm port; (3) lysis of difficult pelvic and periumbilical adhesions; (4) enhancement of visual access to difficult operative sites; (5) closure of large umbilical and secondary port sites under direct monitoring; (6) visualization from the left upper quadrant when umbilical adhesions are suspected; and (7) use as the initial entry laparoscope when extensive surgery is not anticipated. CONCLUSION: The routine, combined use of the microlaparoscope and 10-mm laparoscope significantly expands the capabilities of the advanced laparoscopic surgeon. Procedures are simplified, facilitated and made less invasive.

Endoscopes↗
PubMed1998

Recombinant production and purification of novel antisense antimicrobial peptide in Escherichia coli.

A fusion protein was genetically engineered that contains an antimicrobial peptide, designated P2, at its carboxy terminus and bovine prochymosin at its amino terminus. Bovine prochymosin was chosen as the fusion partner because of its complete insolubility in Escherichia coli, a property utilized to protect the cells from the toxic effects of the antimicrobial peptide. This fusion protein was purified by centrifugation as an insoluble inclusion body. A methionine linker between prochymosin and the P2 peptide enabled P2 to be released by digestion with cyanogen bromide. Cation exchange HPLC followed by reversed-phase HPLC were used to purify the P2 peptide. The recombinant P2 peptide's molecular mass was confirmed by mass spectrometry to within 0.1% of the theoretical value (2480.9 Da), and the antimicrobial activity of the purified recombinant P2 against E. coli D31 was determined to be identical to that of the chemically synthesized peptide (minimal inhibitory concentration of 5 mg/mL). Although the yield of the fusion protein after expression by the cells was high (16% of the total cell protein), the percentage recovery of the P2 peptide in the inclusion bodies was relatively low, which appears to be due to losses in the cyanogen bromide digestion step.

Amino Acid Sequence↗
PubMed1997

A microlaparoscopic technique for Pomeroy tubal ligation.

OBJECTIVE: To evaluate the efficacy of performing Pomeroy tubal ligation using microlaparoscopic techniques. METHODS: Thirty-eight consecutive women desiring permanent sterilization underwent laparoscopic Pomeroy tubal ligation using small (2 or 5 mm) transumbilical laparoscopes and secondary midline sites (5 mm and 14 gauge). The procedures were performed under general anesthesia (n = 28) or local anesthesia with conscious sedation (n = 10). RESULTS: The mean operative time +/- standard deviation (SD) in minutes was 33.0 +/- 10.3. The mean recovery time +/- SD in minutes was 104.3 +/- 41.6. There were no operative complications, and no cases required conversion from the microlaparoscopic technique to a traditional method. CONCLUSION: The results of this study indicate that the Pomeroy tubal ligation may be performed using microlaparoscopic techniques. Furthermore, in selected cases, this technique can be performed under local anesthesia in an outpatient setting.

Adult↗
PubMed1997

Long-term results of laparoscopic Burch urethropexy.

STUDY OBJECTIVE: To evaluate the long-term efficacy of laparoscopic Burch urethropexy. DESIGN: Pilot study. SETTING: Private practice. PATIENTS: Thirty-five consecutive women (average age 45.5 yrs, average parity 2.3, average weight 67.7 kg) treated for genuine stress incontinence between May 1992 and July 1994. INTERVENTIONS: Urethropexy was performed with curved needle suturing in 7 women, straight needle suturing in 5, and Stamey needle suturing in 23. Twenty-five (71.4%) patients had concomitant pelvic surgery. MEASUREMENTS AND MAIN RESULTS: Wilcoxon two-sample, chi2, and Fisher's exact tests were performed to determine which variables were significantly associated with surgical success. Average operating time was 190 minutes, hospitalization 24 hours, and catheterization 5 days. The cure rate of stress incontinence was 89% 3 months and 86% 1 year after surgery. At average follow-up of 34 months, only 68.6% of patients reported complete or almost complete cure, 11.4% were improved, and 20% were complete failures. The only operative variable approaching statistical significance for predicting surgical success was type of suture needle (p = 0.07), with the Stamey needle group having the highest cure rate. Women who were cured or almost cured had a significantly shorter follow-up than those who were improved or failures (p = 0.001). CONCLUSION: The success rate of laparoscopic Burch urethropexy compares with that of open Burch procedure at 1 year, but drops considerably thereafter.

Case-Control Studies↗
PubMed1997

Behavioral treatment of exercise-induced urinary incontinence among female soldiers.

One-third of 450 female soldiers surveyed indicated that they experienced problematic urinary incontinence during exercise and field training activities. The other crucial finding of this survey was probably that 13.3% of the respondents restricted fluids significantly while participating in field exercises. Although only 5.3% of respondents felt that their urine leakage had a significant impact on their regular duties, it is obvious that many more are sufficiently worried about leakage to put themselves at significant risk for dehydration-related injuries. This study tested whether behavioral interventions effective among older people could help younger soldiers. Thirty-nine female soldiers reporting exercise-induced urinary incontinence underwent urodynamic assessments of bladder capacity, urethral closure pressure, and detrusor contraction pressures as well as a symptom questionnaire before and after therapy. They were stratified by diagnosis of physical stress incontinence or mixed urge/stress incontinence and randomized into two groups. Twenty-three participants performed pelvic muscle exercises with urethral biofeedback for 8 weeks, and 16 participants performed pelvic muscle exercises alone. Patient reports as well as the post-treatment examinations indicated that all subjects improved significantly. Only five subjects in the biofeedback/exercise and three in the exercise-only group desired further treatment. All subjects initially diagnosed with detrusor dysfunction had normal readings at the end of the study. Thus, behavioral treatments can be effective against exercise-induced urinary incontinence among most female soldiers.

Adult↗
PubMed1996

Purification of (+)-delta-cadinene synthase, a sesquiterpene cyclase from bacteria-inoculated cotton foliar tissue.

A sesquiterpene cyclase whose activity is induced in a glandless, bacterial blight-resistant line of cotton (Gossypium hirsutum L.) catalyses the conversion of (E,E)-farnesyl diphosphate to (+)-delta-cadinene. This enzyme was purified by a combination of salt-induced phase separation, hydroxylapatite fractionation, hydrophobic interaction and strong anion-exchange chromatography, and denaturing polyacrylamide gel electrophoresis, followed by renaturation with Tween 80. The purified enzyme has a molecular weight of 64-65 kDa, and exhibited a single silver-staining band following electrophoresis in analytical denaturing polyacrylamide gels. Amino acid sequences of three tryptic peptides from the enzyme have been determined and are similar to known sequences in other terpene cyclases from plants.

Amino Acid Sequence↗
PubMed1996

Uterine prolapse after laparoscopic uterosacral transection in nulliparous airborne trainees. A report of three cases.

BACKGROUND: Laparoscopic uterine nerve ablation (LUNA) has become a common alternative therapy for refractory dysmenorrhea. Few long-term complications have been reported. CASES: Severe uterine prolapse was diagnosed in three young female soldiers during or after the rigors of airborne training. All three had previously undergone LUNA procedures. No other risk factors for uterine prolapse could be identified in these cases. CONCLUSION: The etiology of uterine prolapse is complex, and although no conclusions as to cause and effect can be made, these cases suggest that LUNA should be performed with caution on women whose occupation or life-style is associated with heavy physical labor or exercises producing marked increases in intraabdominal pressure.

Adult↗
PubMed1994

Lactation from axillary breast tissue in the absence of a supernumerary nipple. A case report.

A case of lactation apparently from axillary supernumerary breast tissue was observed in a lactating woman. The tissue showed histologic features typical of both normal glands of lactation and apocrine sweat glands, and the fluid showed evidence of milk production. The supernumerary breast tissue was not associated with a nipple. Renal and skeletal anomalies were also noted.

Abnormalities, Multiple↗
PubMed1993

Clinical characteristics of adolescent endometriosis.

Our study objective was to describe the appearance, stage, and treatment of endometriosis in adolescents undergoing laparoscopic treatment of severe dysmenorrhea and endometriosis. We designed a retrospective analysis of adolescents with endometriosis whose primary symptom was severe dysmenorrhea. We studied patients in a private practice associated with a residency program. Forty-nine adolescents with histologically confirmed endometriosis underwent laparoscopy. Thirty-six of these patients (mean age, 16.6 +/- 1.4 years; range, 13-20 years) presented with severe dysmenorrhea in a non-emergency state and were refractory to prior therapy. All patients underwent laparoscopic surgery. We classified endometriosis implants as typical implants, red lesions, and occult lesions in thirty-six adolescents. We excised infiltrating lesions (defined as implants penetrating greater than 3-5 mm) and vaporized or coagulated superficial lesions (defined as surface implants or those penetrating < 3 mm). All adolescents underwent postsurgical ovulation suppression with a daily birth control pill. The need for reoperation at any time or the use of GnRH analogs, Danazol, or large doses of progestins served to indicate treatment failure. The presence or absence of red lesions was recorded in this group and compared to the presence or absence of such lesions in an older population of patients undergoing definitive therapy for endometriosis during the same time period. Our results showed that red lesions are the predominant implant type in adolescents. Adolescents with cyclic pain and those who complain of abdominal pain, nausea, constipation, and diarrhea, during menses had the largest proportion of red lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Colposcopic examination of the vagina.

Examination of the vagina must include assessment of the minor vestibular glands and urethral meatus. Vaginal mucosal lesions related to papillomavirus infection and neoplasia are best discovered by the use of acetic acid wash followed by the application of Monsel's solution.

Adult↗