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Biomedical subjects

J Gutmann

Publications and source records attributed to J Gutmann.

At least 19 recordsLinked to original sources

Inhibin-B as a test of ovarian reserve for infertile women.

The objective of the study was to compare a standard clomiphene citrate challenge test with inhibin-B serum concentrations also obtained on cycle days 3 and 10 as a negative predictor of pregnancy in a group of 106 women at risk for compromised ovarian function. Mean duration of follow-up was 8.25 months in 95 patients with 30 pregnancies recorded (plus one biochemical). Inhibin-B concentrations on cycle days 3 and 10 were correlated only with each other and not with serum oestradiol, follicle stimulating hormone (FSH) and/or pregnancy rates. Pregnancy occurred in 34.5% (10/29) of all patients with inhibin-B values >/=45 pg/ml on cycle day 3 and in 31.8% (21/66) of those with values <45 pg/ml. For FSH >11 mIU/ml on either day, pregnancy rate was 13.6% versus 38.4% for FSH of </=9 mIU/ml (P = 0.03). This study reconfirmed the usefulness of a clomiphene citrate challenge test as an indication of ovarian reserve but failed to find clinical value for inhibin-B testing.

Adult↗

Microleakage of Diaket and amalgam in root-end cavities prepared using MicroMega sonic retro-prep tips.

The in vitro sealing ability of the root-canal sealer Diaket when used as a root-end filling material was compared with that of amalgam using linear micro-leakage of Indian ink. Eight groups of 20 extracted teeth each were formed, plus 12 control teeth as follows: 1) root-end resection of 45 degrees bevel, root-end cavity preparation with an 008 round bur, amalgam root-end filling; 2) 45 degrees bevel, bur, Diaket; 3) 45 degrees bevel, using a sonic retro-prep tip, amalgam; 4) 45 degrees bevel, sonic, Diaket; 5) no bevel, bur, amalgam; 6) no bevel, bur, Diaket; 7) no bevel, sonic, amalgam; 8) no bevel, sonic, Diaket. Root-end cavity depths of 3 mm were prepared. Specimens were immersed in Indian ink for 2 weeks. The teeth were demineralized, rendered transparent and linear dye penetration recorded. Results showed that Diaket provided a superior seal to amalgam irrespective of the root-end preparation. The degree of bevel of the resected root-end did not influence leakage. Sonic instrumentation resulted in a larger root-end cavity than with burs.

Apicoectomy↗

Randomized controlled trial of a drug regimen that includes ciprofloxacin for the treatment of pulmonary tuberculosis.

The fluoroquinolones are promising new antituberculous agents. A randomized controlled trial of 200 adult patients with sputum smear-positive pulmonary tuberculosis was conducted in Tanzania. Patients received either a trial regimen (HRC) consisting of isoniazid (300 mg), rifampin (600 mg), and ciprofloxacin (750 mg) or a control regimen (HRZE) consisting of isoniazid (300 mg), rifampin (600 mg), pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg). The 168 evaluable patients all had negative smears and cultures by month 6, but the time to conversion to negativity was longer for the HRC group than for the HRZE group because of the poor response of patients infected with human immunodeficiency virus (HIV) to the HRC regimen. Relapse was more frequent in the HRC group. The sterilizing activity of ciprofloxacin does not appear to be equal to that of the combination of pyrazinamide and ethambutol, but the difference in outcome was significant only among HIV-infected patients.

AIDS-Related Opportunistic Infections↗

Efficacy of ketorolac in the management of pain associated with root canal treatment.

Patients requiring root canal treatment were randomly assigned to one of three groups. The first group received Ketorolac oral 10 mg at six hour intervals for 24 hours, the second group received Ketorolac (Toradol) injectable 10 mg at the height/depth of the buccal vestibule of the tooth to be treated, and the third group received no assigned medication. Significantly better pain relief was achieved when Ketorolac injectable or oral was used then when no drug was administered. Some of the patients in the Ketorolac injectable group felt that an additional dose of medication would have been helpful at the six- to eight-hour postoperative period. However, there was no significant difference in pain relief between the two groups treated with different drug regimens.

Administration, Oral↗

Unusual appearances of primary central nervous system non-Hodgkin's lymphoma.

There is an increasing incidence of primary central nervous system (CNS) non-Hodgkin's lymphoma (NHL) in immunocompromised and immunocompetent patients. The lymphoma commonly abuts a ventricular or meningeal surface and enhances homogeneously after injection of intravenous contrast medium. The radiological features of 39 patients with cerebral lymphoma were reviewed and five patients with less commonly observed manifestations of this disorder are presented. A differential diagnosis of lateral and third ventricular masses is given.

Aged↗

Oral contraceptive risk assessment: a survey of 247 educated women.

OBJECTIVE: To determine womens' beliefs regarding the risks and health benefits of oral contraceptives (OCs). METHODS: Between April 26 and June 7, 1991, 247 women completed a self-administered questionnaire at the Yale University Health Services evaluating their perceptions of the risks and benefits of OC agents. RESULTS: The mean age of the study population was 30.2 years (range 16-68), and more than 90% of the study group had at least 1 year of college education. Forty-nine percent of the study group believed there are substantial risks to OC use. Between 80-95% of women were unaware of the following health benefits of OCs: decreased risks of endometrial cancer, ovarian cancer, pelvic inflammatory disease, ectopic pregnancy, anemia, and benign breast disease. CONCLUSIONS: Perceptions of the risks of OCs are exaggerated and there is a clear knowledge deficit with regard to their health benefits. Increased educational efforts by health care providers should emphasize the health benefits of OCs and attempt to dispel the common misconceptions.

Adolescent↗

Circulating tumor markers in the monitoring of gynecologic malignancies.

Plasma from 262 patients with gynecologic malignancies was assayed for levels of circulating tumor markers (CA 125, LSA [lipid associated sialic acid in plasma, LASA-P (Dianon Systems, Inc., Stratford, CT )], Ca 19-9, and carcinoembryonic antigen [CEA]) and correlated with the patients' clinical status. In the patients with ovarian cancer the sensitivities of LSA and CA 125 for patients with clinical evidence of disease were 71% and 76% respectively; the specificities for patients with no clinical evidence of disease were 90% and 86% respectively. Using both tumor markers, a sensitivity of 84% and specificity of 85% was obtained. Additionally, CA 125 was elevated in 59% of patients with clinically advanced or recurrent endometrial cancer, and LSA was elevated in 63% of patients with clinical evidence of cervical cancer. Neither CEA nor CA 19-9 levels correlated with clinical status in patients with ovarian or cervical cancer. The values of Ca 125 and LSA were examined in relation to the findings at second-look surgery in patients with ovarian cancer. Absence of elevated tumor markers does not obviate the need for second-look surgery; the false negative rate for CA 125 was 40% (6/15). However, the finding of two elevated plasma markers 1 month or more apart, in ovarian cancer patients who were clinically free of disease, was strongly suggestive of recurrent cancer; 13 of 14 such patients showed this association. This latter finding may help to identify a group of patients in whom early surgical intervention is indicated.

Antibodies, Monoclonal↗

Hepatic haemobilia: non-operative management in eight cases.

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.

Acute Disease↗