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Biomedical subjects

H Sullivan

Publications and source records attributed to H Sullivan.

At least 19 recordsLinked to original sources
PubMed2001

Dose finding in a low-dose 21-day combined oral contraceptive containing gestodene.

An open label, non-comparative study was carried out in 22 women over a total of five cycles. After an untreated cycle, oral administration of 20 microg ethinyl estradiol (EE) with 50 microg gestodene (GST) (tablets taken daily for 21 days with a break of 7 days) was commenced, and three treatment cycles were followed by an untreated follow-up control cycle. The ability of this formulation to inhibit ovulation and suppress ovarian activity was assessed by using hormonal parameters and ultrasound. One ovulation occurred during treatment. Luteinized unruptured follicles were observed in three cases in the second treatment cycle and in one case during the third treatment cycle. Follicle-like structures larger than 13 mm associated with a serum estradiol level of more than 30 pg/mL were noted in 19% of the women in the first treatment cycle. The rate of active follicle-like structures was 43% in the second treatment cycle and 28% in the third treatment cycle. The results were compared with previously reported findings of a preparation containing 20 microg EE and 75 microg GST. With regard to ovarian grading and endogenous hormone secretion, considerably more residual ovarian activity, with all parameters examined, was found in the 20 microg EE and 50 microg GST preparation compared to the 20 microg EE and 75 microg GST preparation. It was concluded that the 20 microg EE and 50 microg GST preparation administered for 21 days does not meet the requirements of a combined oral contraceptive with respect to ovulation inhibition.

Adult↗
PubMed1999

Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity.

OBJECTIVE: To compare ovulation inhibition and ovarian activity with 21-day and 24-day regimens of a low-dose combined oral contraceptive (COC) containing 60 microg of gestodene and 15 microg of ethinyl estradiol. DESIGN: Interventional observational study. SETTING: Reproductive medicine unit. PATIENT(S): Fifty-eight healthy volunteers aged 18-35 years. INTERVENTION(S): Ovarian activity was monitored every other day with the use of ultrasound to measure the diameters of follicle-like structures and blood samples to measure serum concentrations of 17beta-E2 and progesterone. Subjects were observed for five cycles: pretreatment and posttreatment control cycles and three cycles in which the COC was administered for either 21 or 24 days of each cycle. MAIN OUTCOME MEASURE(S): Occurrence of ovulation and evidence of ovarian activity. RESULT(S): The study was completed by 27 (90%) of the 30 subjects who received the 24-day regimen and by 24 (79%) of the 28 subjects who received the 21-day regimen. Ovulation was inhibited in all cycles in the 24-day group and in 74 of 75 cycles in the 21-day group. Luteinized unruptured follicles were seen in no cycles with the 24-day regimen and in 6 (8%) of 75 cycles with the 21-day regimen. Mean ovarian follicular development and serum 17beta-E2 and progesterone levels were lower in the 24-day group. CONCLUSION(S): The 24-day regimen is an innovative strategy for maintaining effective ovulation inhibition at ultra-low doses of contraceptive steroids.

Adolescent↗
PubMed1998

An in-house coordinator program to increase organ donation in public teaching hospitals.

The organ donor referral rates at Ben Taub General Hospital, a level 1 county trauma facility in Houston, Tex, were in the high 90s from 1993 through 1996. However, organs were procured from only 25% of those potential donors who were medically suitable. LifeGift Organ Donation Center identified two issues concerning the hospital's organ donor referrals: early medical management problems and a low consent rate. The hospital and LifeGift developed an in-house coordinator program along with specific protocols that have markedly increased the quantity of organ donors. In fiscal year 1994, 15 organ donors were recovered; in fiscal year 1995, following the implementation of the program, 25 organ donors were recovered. In fiscal year 1996, 39 organ donors were recovered. The in-house coordinators' consent rate was 72% of medically suitable potential donors. Early referrals for evaluation contributed to these successes.

Clinical Protocols↗
PubMed1998

An in-house coordinator program to increase organ donation in public trauma hospitals.

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increase 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

Hospitals, Public↗
PubMed1998

Designing an automated services tracking system for a caregiver support program.

This article describes the process of developing an automated services tracking system for California's 11 regional Caregiver Resource Centers. The system was designed over a 3-year period for use by social workers, administrative personnel, and managers and has implications for both internal services monitoring and state reporting functions. The system development included input from clinical staff to be user-friendly to nontechnical staff. The article recounts technical and conceptual obstacles overcome and the evaluation of a relatively modest idea into a sophisticated, custom-made computer program. Issues of start-up, implementation, expansion, and report design are discussed. Lessons learned and other insights have practice and policy implications for documenting and reporting service usage at case management and other social services agencies. Lastly, an overview of the system's features and highlights of automated reports are provided.

California↗
PubMed1996

Shorter pill-free interval in combined oral contraceptives decreases follicular development.

The objective of the study was to determine the suppressive effect on ovarian activity of 20 micrograms ethinylestradiol plus 75 micrograms gestodene administered for 21 or 23 days. The study was designed as a double-blind, randomized, multicenter trial in 60 women. A pre-treatment cycle, three treatment cycles and a post-treatment period were monitored by ovarian ultrasound and by LH, FSH, 17 beta-estradiol and progesterone measurements every other day. No ovulation and no luteinized, unruptured follicle were observed. Suppression of ovarian activity was more pronounced by the 23-day regimen. 17 beta-Estradiol serum levels during the last six days of a cycle and during the first six days of the next cycle were significantly less (p < 0.05) in the 23-day regimen. The superiority of the 23-day regimen in comparison to the 21-day regimen with regard to the suppression of ovarian activity was shown in this study. The observed differences in the 17 beta-estradiol levels and follicular development between a 21-day and 23-day preparation combine to suggest that shortening the pill-free interval in combined oral contraceptives may increase the contraceptive safety margin in women on low-dose formulations.

Adult↗
PubMed1996

Natural history of allograft coronary arteriopathy: a retrospective study of 54 patients over a 8 1/2-year period.

A total of 288 patients underwent heart transplantation at Loyola University Medical Center over a 8 1/2-year period starting in March, 1984. Of these patients, 54 were identified as having allograft coronary arteriopathy. Diagnosis was made on the basis of abnormal findings on coronary angiography in 44 patients; either an autopsy or explanted heart revealed the diagnosis in the remainder. A total of 279 abnormal lesions were identified by coronary angiography, and over 70% of these stenoses were discrete and located in large epicardial vessels. The left ventricular ed-diastolic pressure demonstrated a steady rise over time (2.5 mmHg/year), and also correlated with the degree of allograft coronary arteriopathy stenosis. The rate of stenosis progression was 33% per year from the time of initial allograft coronary arteriopathy development. Actuarial survival rate was lower than that of patients with arteriopathy. In conclusion, first, the majority of allograft coronary arteriopathy stenoses detected on coronary angiography are discrete, involve large epicardial vessels, and progress rapidly over time. Second, left ventricular end-diastolic pressure seems to reflect the degree of allograft coronary arteriopathy stenosis, and may prove to be a useful indicator of left ventricular dysfunction related to allograft coronary arteriopathy. Third, patients with allograft coronary arteriopathy show a decreased actuarial survival rate.

Actuarial Analysis↗
PubMed1994

Survival and functional outcome after single and bilateral lung transplantation. Loyola Lung Transplant Team.

BACKGROUND: The experience at Loyola University Chicago was retrospectively reviewed to evaluate survival and functional outcome after single lung transplantation (SLT) and bilateral lung transplantation (BLT). METHODS: Ninety patients underwent lung transplantation at Loyola University Chicago between April 1990 and December 1993. Mean age was 45 years (range, 13 to 66 years). Fifty percent were male. Pre-lung transplant pulmonary diseases were as follows: emphysema and/or chronic obstructive pulmonary disease in 43 patients, pulmonary fibrosis in 13, cystic fibrosis in 14, pulmonary hypertension in eight, repeated transplantation for obliterative bronchiolitis in four, bronchiectasis in two, bronchoalveolar cell carcinoma in two, sarcoidosis in one, primary obliterative bronchiolitis in one, histiocytosis X in one, and lymphangiomyomatosis in one. Fifty-seven patients underwent SLT, and 33 had BLT. Maintenance immunosuppression medications consisted of cyclosporine, azathioprine, and prednisone. RESULTS: Perioperative complications were as follows: seven of 33 patients bled after BLT, and two of 57 bled after SLT. Bronchial complications were found in six of 66 (9%) BLT anastomoses and eight of 57 (14%) SLT anastomoses. Nine operative deaths occurred in SLT patients: six from allograft failure, one from infection, one from intrapulmonary hemorrhage, and one from bronchial dehiscence. Only two patients died in the perioperative period after BLT and that was of infection. Three late deaths occurred after BLT, all as a result of infection; 13 recipients died late after SLT: five of infection, four patients from lymphoma, two of pancreatitis, one of tension pneumothorax, and one of pulmonary embolism. For the entire patient population the actuarial 1- and 2-year survival rates were 72% and 68%, respectively. One-year survival rates were significantly better for patients undergoing lung transplantation for obstructive and nonrestrictive lung diseases than those of patients undergoing lung transplantation for vascular or restrictive pulmonary disease. Recipients of BLT had a trend toward better survival than recipients of SLT. Lung function 6 months after transplantation measured by forced expiratory volume in 1 second was significantly better in BLT than SLT, 71% of predicted versus 54%. CONCLUSIONS: Patients who undergo BLT have significantly better postoperative pulmonary function than those who undergo SLT. On the basis of the study there was a trend toward better survival with BLT.

Adolescent↗
PubMed1992

Maternal and environmental factors associated with infections and undernutrition in young Australian aboriginal children.

Forty-eight Aboriginal infants in remote communities in north-west Australia were studied monthly from birth to 2 years. Birthweight and growth were positively associated with maternal health during pregnancy, regular antenatal supervision and lack of drinking alcohol or smoking tobacco as well as with personal and family hygiene. Impaired growth was associated with families which had more expensive consumer goods such as televisions, air conditioners, video cassette recorders and cassette tape players. Most children had impaired growth or frank failure to thrive which was associated with high rates of infections, particularly of the respiratory and gastro-intestinal tracts, and high rates of hospitalization.

Adult↗
PubMed1992

Myocardial metabolism and adaptation during extreme hemodilution in humans after coronary revascularization.

OBJECTIVE: This study was designed to evaluate the oxygen transport adjustments and myocardial metabolic adaptation that occurs with different levels of hemodilution during normothermia after cardiopulmonary bypass. DESIGN: Prospective, nonrandomized study. SETTING: Operating room in a university hospital. PATIENTS: Eight patients with ejection fractions (> 40%) undergoing elective coronary artery bypass grafting. METHODS: Before the institution of cardiopulmonary bypass, blood was withdrawn from patients to a target hematocrit of 15%. After coronary artery bypass grafting, a catheter was inserted directly into the coronary sinus. After the patients were rewarmed to 37 degrees C, they were weaned from cardiopulmonary bypass. Hemodynamic indices were measured, as well as measurements of myocardial oxygen consumption (VO2) and myocardial metabolism (lactate extraction and coronary sinus hypoxanthine). Measurements were made at three different hematocrit values: 15%, 20%, and 25%. Hematocrit was increased by autologous blood transfusion. MEASUREMENTS AND MAIN RESULTS: The three levels of hemodilution (hematocrit: 17.4 +/- 3.4%; 23.0 +/- 3.7%; 27.8 +/- 4.8%) were significantly different from baseline (hematocrit 37 +/- 2.6%; p < .05). Oxygen delivery, which increased with autologous transfusion, exceeded 350 mL/min/m2 at each level of dilution. The myocardial VO2 increased significantly after autologous transfusion compared with the most dilute condition (7.0 +/- 3.7 mL/min at hematocrit 17.4% vs. 11.2 +/- 4.8 mL/min at hematocrit 23.0% and 12.4 +/- 4.0 mL/min at hematocrit 27.8%). This transfusion-induced increase was also true of myocardial oxygen extraction. Lactate extraction and hypoxanthine release were normal and unchanged at each level of hemodilution. Systemic oxygen extraction ratio increased with hemodilution and decreased with autologous transfusion. CONCLUSIONS: Hemodilution to a hematocrit of approximately 15% is tolerated in anesthetized humans after coronary artery bypass surgery. There was no evidence of myocardial ischemia, as demonstrated by absence of S-T depression on the electrocardiogram, lactate extraction, or hypoxanthine release. In selected patients, postoperative transfusion may be based on systemic physiologic end-points, such as oxygen extraction ratio, rather than set hematocrit values.

Blood Transfusion, Autologous↗
PubMed1991

The resazurin reduction test provides an assessment of sperm activity.

OBJECTIVE: The objective of the study was to determine if reduction of the dye resazurin by semen could be correlated with the concentration of motile sperm. DESIGN: After assessment of sperm count and motility, specimens were incubated for 1 hour with resazurin (25 micrograms/mL of semen) and visual color changes indicative of dye reduction noted. SETTING: Specimens were obtained from men seeking care for infertility at one of four sites: (1) University of California, San Francisco (UCSF) In Vitro Fertilization Program; (2) UCSF Andrology Laboratory; (3) a gynecological practice in Maine; and (4) a private andrology laboratory in Southern California. PATIENTS: Individuals were self-selected by their desire to have a semen analysis in conjunction with the diagnosis or treatment of infertility. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The reduction of the dye resazurin and its correlation with motile sperm density. RESULTS: When the motile sperm concentration was greater than or equal to 20 X 10(6)/mL, 86% of specimens produced a positive color change. Conversely, 86% of specimens with a motile sperm concentration of less than 20 X 10(6)/mL either did not change color or changed only over a narrow range. CONCLUSION: Reduction of resazurin offers an assessment of the active sperm in a specimen without the need to do a sperm count or evaluation of motility.

Humans↗
PubMed1989

Kindling in spontaneous hypertensive rats.

Vasopressin is a neurohormone and neuromodulator with many effects on behavior. Rats lacking vasopressin have been found to develop kindled seizures more slowly with amygdala stimulation. In the present study the spontaneous hypertensive (SH) rat and rats from the parent strain, the Wistar-Kyoto (WKY) rat received amygdala and pyriform kindling. The SH rat has been reported to have increased plasma vasopressin and increased brain vasopressin release. Plasma vasopressin, osmolality and hematocrit were also measured in blood samples obtained through chronic, indwelling catheters implanted in SH, WKY normal and Sprague-Dawley rats. SH rats were found to kindle with fewer afterdischarges than WKY normal rats with both amygdala and pyriform cortex stimulation. The total afterdischarge duration required to reach each kindling stage was significantly shorter in the SH rat. Plasma osmolality and vasopressin were significantly higher in the SH rats compared to WKY normal rats and Sprague-Dawley rats. These findings provide additional evidence that vasopressin may influence the establishment of enduring behaviors such as kindled seizures.

Animals↗
PubMed1988

Doppler color-flow imaging assessment of shunt size in atrial septal defect.

Two-dimensional echocardiography and pulsed-Doppler studies have not proved to be reliable methods of assessing left-to-right shunt size in atrial septal defect. Doppler color-flow imaging displays the transatrial jet, providing a new dimension with the potential capability of quantifying left-to-right shunt size. Twenty-three patients with atrial septal defect were studied by color-flow imaging and cardiac catheterization. The defect size measured by two-dimensional echocardiography, the maximal color-flow jet width in the atrial septum, and the maximal color-flow jet area in the right atrium were correlated with cardiac catheterization-derived left-to-right shunt size. Correlation coefficients were 0.57 (p less than 0.01), 0.67 (p less than 0.001), and 0.65 (p less than 0.01), respectively. Atrial septal color-flow jet width distinguished patients with less than a 2:1 left-to-right shunt size ratio (eight patients, jet width less than 15 mm in in all) from patients with greater than a 2:1 left-to-right shunt size ratio (15 patients, jet width greater than 15 mm in all). These results indicate that Doppler color-flow imaging can distinguish left-to-right shunt size in atrial septal defect accurately enough to influence decisions with regard to subsequent patient management.

Adult↗
PubMed1988

Early management of acute myocardial infarction.

Management of acute myocardial infarction (AMI) has changed dramatically since 1962, when the world's first operating coronary care unit opened in our hospital. Recently, thrombolytic agents, aspirin and beta-blockers have been shown to reduce the mortality of patients with AMI if given early. This article reviews management strategies and therapeutic options currently available during the first 24 hours of the hospital phase of AMI.

Humans↗