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Biomedical subjects

G M Weiner

Publications and source records attributed to G M Weiner.

18 recordsLinked to original sources
PubMed1999

The assessment of lamotrigine, an antiepileptic drug, in the treatment of tinnitus.

OBJECTIVE: Tinnitus is an extremely prevalent condition that currently has no satisfactory clinical treatment. Development of therapy has been hampered by the diversity of underlying conditions that give rise to the symptom of tinnitus. A drug that has multiple actions may have an improved chance of being effective. One such drug is lamotrigine, a recently developed antiepileptic agent that has both glutamate release inhibition and sodium channel antagonist activity. STUDY DESIGN: Lamotrigine was evaluated in a double-blind, placebo-controlled, crossover clinical trial. Patients initially were tested with an intravenous infusion of lidocaine (10 mg/mL) to a maximum of 100 mg or until a reduction in tinnitus. Lamotrigine or placebo tablets were taken once daily (25 mg) for 2 weeks, 50 mg for 2 weeks, and 100 mg for 4 weeks. SETTING: Patients were chosen from among volunteers from the tinnitus clinic in the local hospital without reference to underlying pathology. PATIENTS: Those patients whose tinnitus had been present for less than 6 months or whose tinnitus was likely to vary spontaneously were excluded. INTERVENTIONS: Perceived intensity and intrusiveness of tinnitus was assessed before entry onto the trial and at 4-week intervals throughout the trial. MAIN OUTCOME MEASURES: Assessment comprised questionnaires, visual analog scales, and a battery of audiologic measurements. RESULTS: There was no correlation between the response to lidocaine and the response to lamotrigine. There was good agreement between the questionnaires and visual analog scales in the reporting of perceived changes; however, this was not reflected as changes in the audiologic tests. CONCLUSIONS: Of the 31 participants who completed the trial, questionnaires indicated that lamotrigine was effective in a very few of these persons.

Anticonvulsants↗
PubMed1998

Successful treatment of neonatal arterial thromboses with recombinant tissue plasminogen activator.

Seven newborns were treated with recombinant tissue plasminogen activator for arterial thromboses. Complete lysis occurred in four of seven and partial in two of seven patients. Serious bleeding complications were observed in two of seven patients. This and published experience suggest that successful lysis with recombinant tissue plasminogen activator occurs in most patients and that hemorrhagic complications are unusual but are not.

Arteries↗
PubMed1998

Ureaplasma urealyticum and chronic lung disease in very low birth weight infants during the exogenous surfactant era.

BACKGROUND: An association between recovery of Ureaplasma urealyticum from the respiratory tract of very low birth weight (VLBW) infants (< or =1500 g) and later chronic lung disease (CLD) was reported by several authors before the routine use of exogenous surfactant (SURF). We sought to assess whether this relation persists in the era of routine SURF. METHODS: We prospectively studied a cohort of 105 VLBW infants who required mechanical ventilation at < 12 h of age. Tracheal aspirates for U. urealyticum culture were obtained before administration of SURF or antibiotics. Clinicians were unaware of U. urealyticum status. Chest radiographs at 28 days were reviewed by a single pediatric radiologist, blinded to U. urealyticum status. Sample size was predetermined to detect a 30% increase in CLD among those with U. urealyticum recovery from tracheal culture (U. urealyticum-positive) with alpha <0.05 and beta <0.20. RESULTS: Of the study infants 22 were U. urealyticum-positive and 83 were U. urealyticum-negative. No differences were found between the groups for birth weight, gestational age, gender, inborn, antenatal or postnatal steroid use, SURF therapy, non-U. urealyticum infection, necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage or cystic periventricular leukomalacia. At 28 days U. urealyticum-positive patients were significantly more likely to have CLD than U. urealyticum-negative [15 of 22 (68%) vs. 30 of 83 (36%); P < 0.02]. The U. urealyticum-positive patients also required significantly longer courses of supplemental oxygen and mechanical ventilation. No significant differences were found for CLD at 36 weeks postconception or duration of hospitalization, although type II error could not be excluded for these secondary endpoints. CONCLUSIONS: Respiratory U. urealyticum at or shortly after birth remains associated with CLD at 28 days despite routine use of SURF. Controlled trials of anti-Ureaplasma therapy in U. urealyticum-positive VLBWs as soon after birth as possible may determine whether CLD, duration of respiratory support and attendant costs can be decreased.

Chronic Disease↗
PubMed1997

The role of surgery in tuberculous mastoiditis: appropriate chemotherapy is not always enough.

We present a case of tuberculous otitis media in which a facial palsy occurred after the start of appropriate chemotherapy. To our knowledge this circumstance has not been described previously. It has been argued that radical surgery is completely unnecessary if chemotherapy is commenced early in the disease. We would suggest that this is not always the case, and would advocate a more measured approach.

Adult↗
PubMed1996

Should nasopharyngeal biopsy be mandatory in adult unilateral glue ear?

Unilateral secretory otitis media is a recognized presenting feature of nasopharyngeal neoplasia. In the two cases presented, biopsy from the nasopharynx revealed an unsuspected underlying adenocarcinoma. The need to biopsy the normal looking post-nasal space is highlighted.

Adenocarcinoma↗
PubMed1996

Tuberculous parotitis: limiting the role of surgery.

The diagnosis of parotid gland involvement with tuberculosis has traditionally been made after superficial parotidectomy. We present four cases that suggest that fine needle aspiration cytology followed by antituberculous therapy can avoid the need for surgery in this uncommon condition.

Biopsy, Needle↗
PubMed1995

Deep lobe parotid lipoma: a case report.

We present a patient with a lipoma of the deep lobe of the parotid gland. Despite the common occurrence of this tumour in other regions of the body, we believe that this is only the second report in the literature of a lipoma in this location. We believe that these tumours are easily dealt with by simple enucleation, and that superficial parotidectomy should be reserved for tumours deep to the facial nerve.

Humans↗
PubMed1995

Dysphonia as an atypical presentation of gastro-oesophageal reflux.

We present three cases of dysphonia in which gastro-oesophageal reflux (GOR) appeared to be a precipitating factor. In all cases reflux was clinically occult. We discuss the theory and implications of GOR presenting atypically with laryngeal symptoms, and outline our current approach to laryngeal symptoms of clinically evident or occult GOR.

Adult↗
PubMed1990

Effects of abrasion therapy on tears in the avascular region of sheep menisci.

This study was designed to test the hypothesis that abrasion of the parameniscal synovium aids healing of a stable tear in the avascular region of the meniscus in a sheep model. In six sheep, a 5-7-mm longitudinal full-thickness tear was made in the avascular inner half of the anterior part of the lateral meniscus. The parameniscal synovium was abraded superiorly and inferiorly from the meniscus periphery to the lesion. Three animals in a control group received identical meniscal tears but no abrasion treatment. A harness prevented weight bearing and maintained the knee fully flexed after surgery. Twelve weeks after the operation, no healing was seen in any tears. Histologic examination revealed in both groups increased numbers of dividing chondrocytes on either side of the tear. In the test group, several layers of fibroblasts, which appeared in two menisci to derive from the upper meniscal surface, were seen covering both cut surfaces of the tear. It is concluded that the distance from the periphery to the defect is too far for abrasion therapy to stimulate sufficient cellular ingrowth to facilitate repair of tears in the avascular region of the meniscus.

Animals↗
PubMedDate not supplied

Improving the timing of antibiotic administration to high-risk newborns.

OBJECTIVES: To describe the timing of initiation of administration of parenteral antibiotics to infants with suspected sepsis at birth, identify barriers to prompt administration, and assess the effectiveness of subsequent interventions designed to minimize these barriers. The goals were to administer antibiotics within 1 hour of the physician order and within 2 hours of birth with more than 80% compliance for both goals. STUDY DESIGN: Retrospective chart review and prospective interventions involved 488 infants born at the University of Michigan Medical Center with indications for antibiotic therapy at birth. After an initial audit of the charts of 56 infants and the identification of poor compliance with the goals, unit policies and educational programs were developed to facilitate timely antibiotic administration. After a second audit demonstrated improvement but failure to attain the target compliance rates, review of individual cases with the responsible physician and nurse was initiated. Time intervals between birth, writing the order for antibiotics, noting the order by the nurse, and administration of antibiotics were tracked for an additional 20 months after these interventions. RESULTS: Before the interventions, antibiotics were administered to 28% of infants within 1 hour of the physician order (mean +/- SEM 1.58 +/- 0.11 hours) and to 19% within 2 hours of birth (3.12 +/- 0.16 hr). By the conclusion of the study, antibiotics were administered to 87% (p < 0.0001) of infants within 1 hour of the physician order (0.79 +/- 0.04 hour; p < 0.001) and to 92% (p < 0.0001) within 2 hours of birth (1.26 +/- 0.06 hours; p < 0.001). CONCLUSIONS: Administration of the first dose of parenteral antibiotics to newborns with suspected sepsis at birth frequently takes more than 1 hour after the order is written and more than 2 hours after birth. Efforts to identify and minimize common barriers significantly improved the timing of antibiotic administration. Additional improvement was attained by means of continued surveillance and individual feedback to caregivers of infants when timing objectives were not fulfilled.

Anti-Bacterial Agents↗