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Biomedical subjects

L C Fish

Publications and source records attributed to L C Fish.

At least 19 recordsLinked to original sources
PubMed2000

Two-year follow-up of distraction osteogenesis: its effect on mandibular ramus height in hemifacial microsomia.

Distraction osteogenesis has been used to lengthen the mandible in patients with hemifacial microsomia. Questions regarding soft tissue and skeletal growth after distraction osteogenesis have not been clearly elucidated in the literature. In this case report, a 2-year follow-up of distraction osteogenesis in a 7 year old boy is documented with lateral and posterior/anterior cephalometric analysis. The analysis was performed preoperatively and at specific postsurgical periods to evaluate the facial soft tissue and skeletal growth patterns. Objective analysis of this growing patient after distraction osteogenesis clearly demonstrates that the anteroposterior elongation of the mandible is relatively stable, whereas the vertical lengthening and soft tissue effects are minimal. Critical evaluation of other patients who have undergone distraction osteogenesis is needed to determine if this was an isolated incident or the expected result in similar patients.

Abnormalities, Multiple↗
PubMed1999

Atrial natriuretic peptide and the development of congestive heart failure in the oldest old: a seven-year prospective study.

BACKGROUND: Atrial natriuretic peptide (ANP) levels are elevated in symptomatic heart failure and correlate with invasively measured left heart pressures. OBJECTIVE: To examine the association between plasma ANP level and the subsequent development of congestive heart failure (CHF) in older subjects with no history of CHF. DESIGN: A 7-year, prospective, blinded, cohort study. SETTING: A life care facility in Boston, Massachusetts. PARTICIPANTS: Two hundred fifty-six frail older subjects (mean age 88 +/- 7) with no history of CHF at study entry. MAIN OUTCOME MEASURE: Clinical episodes of CHF with confirmatory chest roentgenogram findings. Cox proportional hazard analyses were performed to examine the relationship between ANP levels and the development of CHF while controlling for 19 clinical, physical, and laboratory parameters. A Kaplan-Meier estimator (log-rank test) was used to determine if the development of CHF differed by tertile of ANP. RESULTS: During the follow-up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L +/- 11 pmol/L versus 60 pmol/L +/- 5 pmol/L in the no CHF group (two tailed t test P = .005). On multivariate analysis, a high ANP level was found to be associated significantly (P = .01) with the development of CHF. CONCLUSIONS: There is a statistically significant association between ANP level and the subsequent development of CHF in frail older individuals with no history of CHF.

Aged↗
PubMed1998

Atrial natriuretic peptide level contributes to a model of future mortality in the oldest old.

OBJECTIVES: To determine if atrial natriuretic peptide (ANP) level is associated with mortality in the oldest old and to develop a comprehensive model of mortality in the oldest old using clinical and laboratory parameters. DESIGN: Prospective cohort study with 7 years of follow-up. SETTING: A 725-bed life care facility. PARTICIPANTS: 282 frail older individuals (mean age 88, range 70-102). MEASUREMENTS: Variables measured included age, gender, Charlson Comorbidity Index, functional measurements, weight, blood pressure, and multiple laboratory variables, including ANP. Main outcome measurement was death. RESULTS: Eighty-four percent (237/282) of subjects died during the 7-year follow-up period. On univariate analysis, the risk ratio (RR) for ANP tertile was 1.28. On bivariate analysis, adjusting for the development of congestive heart failure, the RR was 1.22. On multivariate analysis, the following variables were associated with mortality: ANP tertile (RR 1.24), age (RR 1.04), female gender (RR 0.43), Charlson Comorbidity Index score (RR 1.13), mentation score (RR 1.27), BUN/Cr ratio (RR 1.04), albumin level (RR 0.63), and hemoglobin level (RR 0.84). CONCLUSIONS: ANP level and other variables are independent risk factors for mortality in frail individuals. ANP level may indicate homeostatic failure to adapt to fluid volume changes or may reflect subclinical heart disease. ANP level contributes to a multivariate model of mortality in frail older individuals.

Aged↗
PubMed1997

Effects of hypertonicity on water intake in the elderly: an age-related failure.

Dehydration is a common clinical syndrome associated with many illnesses and treatments in the elderly. Prior studies have shown diminished sensation of thirst during water deprivation. It is currently unclear whether age-related decreases in thirst perception impair the defense against a hyperosmolar challenge. To examine the impact of water ingestion during hyperosmolality, young and old subjects were allowed free access to water during and after an intravenous infusion of 5% hypertonic saline. Cumulative water intake and serum osmolality were compared between seven healthy young (20-28 yrs) and seven healthy old (72-89 yrs) volunteers during and following a two hour hypertonic saline infusion at a rate of 0.06 mlxkg(-1) min(-1). Serum osmolality and water intake were markedly different between the two groups. In the old group, serum osmolality increased by 17 mosmol/kg above baseline despite free access to water. In contrast, serum osmolality increased to only 7 mosmol/kg above baseline in the young group and did not rise further. By ingesting water, the young were able to defend against an additional increase in serum osmolality. The young drank approximately twice that of the old during the infusion period. Healthy older individuals drink less than young despite a significantly increased serum osmolality. This hypodipsia in old individuals increases their susceptibility to hypertonicity.

Adult↗
PubMed1996

Atrial natriuretic peptide levels in the elderly: differentiating normal aging changes from disease.

BACKGROUND: Atrial natriuretic peptide (ANP) levels increase with advancing age and in patients with cardiac dysfunction. Previous studies have failed to differentiate the elevated ANP levels of normal aging from those of cardiac disease. METHODS: To differentiate the increased ANP levels seen in normal aging from that of disease, fasting supine ANP was measured in healthy young (n = 24), healthy old (n = 90), and clinically stable but cardiovascularly diseased old (n = 269) residents of a life care facility. ANP levels were correlated with physical exam findings, blood chemistries, measures of physical and cognitive function, and medications. RESULTS: ANP levels were almost fourfold higher in the healthy elderly than in the young (11.4 +/- 1.1 (SEM) vs 3 +/- 0.3 pmol/L, p < .01), and two-and-one-half times higher in the cardiovascular-diseased elderly than the healthy elderly (29 +/- 1.9 vs 11.4 +/- 1.1 pmol/L, p < .01). An ANP value of 21 pmol/L has a sensitivity of 83% and specificity of 52% in distinguishing those elders classified as healthy from those classified as having chronic cardiovascular disease. ANP levels had positive univariate correlation with age (even from 70 to 102 years) and systolic blood pressure. ANP rose progressively with increasing numbers of markers of cardiovascular comorbidity. ANP was higher in subjects with jugular venous pressure > 10 cm, presence of a third heart sound, peripheral edema, artificial cardiac pacemaker, atrial arrhythmias, and in those taking digoxin, diuretics, or nitrates. On multivariate analysis independent predictors of ANP levels were, in descending order, nitrates, age, diuretics, and atrial arrhythmias. CONCLUSION: These data suggest that ANP levels greater than 21 pmol/L are associated with cardiovascular comorbidity in a clinically stable elderly cohort.

Adult↗
PubMed1996

Peer review by nursing research committees in hospitals.

With the increasing amount of nursing research conducted in clinical settings, the value of peer review by nursing research committees (NRCs) in hospitals has come under greater scrutiny. Research facilitation has been the prevailing paradigm of NRCs for several decades. Reports of activities by NRCs in the literature appear to indicate a shift in that paradigm. The presence of clinical nurses with expert knowledge and advanced academic degrees who are serving as intra- and interdisciplinary scientific reviewers are leading a shift in the paradigm of NRCs toward activities that strengthen nursing science and nurse scientists. Eight strategies to support NRCs as review bodies for scientific merit are recommended.

Education, Nursing, Graduate↗
PubMed1993

Orthognathic surgery: the correction of dentofacial deformities.

The field of orthognathic surgery offers ever-improving technology to better rehabilitate patients with dentofacial deformities. Hospital stays have been reduced due to improved surgery and anesthesia. Rigid internal fixation has increased comfort for many patients by eliminating the inconvenience of having the jaws wired together. Most important has been the realization that teamwork between the general dentist and the various specialty disciplines is indispensable for good patient care and the attainment of the very best results.

Adolescent↗
PubMed1992

Atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly.

OBJECTIVE: To develop a noninvasive clinical predictive model for acute congestive heart failure (CHF) in a frail elderly cohort using bedside clinical assessment (medical history and physical examination) and venous atrial natriuretic peptide (ANP) levels. DESIGN: One-year prospective blinded cohort study. SETTING: Life care facility. PARTICIPANTS: Three hundred thirty-one frail, elderly volunteers free of acute illness at study entry (mean +/- SD age, 88 +/- 7 years; 23% male, 77% female). MAIN OUTCOME MEASURE: Clinical episodes of CHF with confirmation of acute pulmonary edema by chest roentgenogram. RESULTS: Fifteen percent of the elderly cohort developed at least one episode of CHF during the 1-year follow-up period. Those developing CHF had significantly higher mean +/- SE ANP values at study entry: 493 +/- 55 vs 207 +/- 15 pmol/L. The risk for development of CHF rose progressively with increasing ANP levels at study entry. In multivariate analysis, only two independent variables significantly predicted CHF: ANP value greater than 200 pmol/L (adjusted odds ratio [OR], 7.9; 95% confidence interval [CI], 3.2 to 19.2) and history of CHF in the previous year (adjusted OR, 7.0; 95% CI, 2.9 to 17). Stratifying the cohort by these two variables results in three CHF risk groups: 55% of the population at 3% annual risk of CHF, 37% of the population at 20% to 24% annual risk of CHF, and 8% of the population at 66% annual risk of CHF. CONCLUSIONS: This simple clinical prediction model identifies elderly subjects at risk for CHF and allows appropriate focusing of medical resources for prevention, early detection, and treatment of this highly morbid clinical syndrome.

Acute Disease↗
PubMed1983

The surgical-orthodontic correction of mandibular deficiency. Part II.

As discussed in Part I of this study, persons with mandibular deficiency and Class II malocclusions exhibit a wide spectrum of esthetic, cephalometric, and occlusal characteristics. In many such patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such patients a critical evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. Our method of making these two basic decisions was presented in Part I. In this article the indications for mandibular advancement with or without genioplasty, total subapical mandibular advancement, superior repositioning of the maxilla, and inferior repositioning of the maxilla are discussed in detail. These alternatives are illustrated with representative cases, and the results are discussed. The intention of these two presentations is to illustrate an orthodontic-surgical approach to the correction of mandibular deficiency and Class II malocclusion that is predicated on a systematic evaluation of the individual patient rather than a standard approach.

Adolescent↗
PubMed1983

The surgical-orthodontic correction of mandibular deficiency. Part I.

Persons with mandibular deficiency and Class II malocclusions have a spectrum of esthetic, skeletal, and occlusal characteristics. In many of these patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such cases a critical patient evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. In Part I of this article our method of making these two basic decisions is presented, the decisions being predicated upon achieving optimal esthetic, functional, and stable results. In addition, two of the possible orthodontic-surgical approaches--the augmentation genioplasty and the anterior maxillary ostectomy are discussed in detail. These approaches are illustrated with representative cases. In Part II of the article additional options for combined orthodontic surgical-management of this patient population will be discussed.

Adolescent↗
PubMed1982

Surgical-orthodontic treatment planning for simultaneous mobilization of the maxilla and mandible in the correction of dentofacial deformities.

Simultaneous mobilization of the maxilla and mandible is indicated for the optimal correction of specific dentofacial deformities, as discussed in the preceding publication. Because of the added complexity of this type of surgical-orthodontic treatment, it is important to determine the absolute need for surgery and to construct a detailed blueprint of the specific changes to take place at the time of surgical intervention as well as those to be made by the orthodontist prior to initiation of any treatment. The intent of this article is to describe a technique of treatment planning which includes cephalometric prediction tracings, model surgery, determination of orthodontic-surgical sequencing, splint construction, and specific sequencing of surgery. When followed, these guidelines will enable the surgeon and the orthodontist to accurately determine the need for simultaneous mobilization of both the maxilla and the mandible and provide more predictable and stable results when it is performed.

Cephalometry↗
PubMed1982

Indications for simultaneous mobilization of the maxilla and mandible for the correction of dentofacial deformities.

As improvements in diagnosis, treatment planning, and surgical techniques have evolved it has become increasingly more common to consider simultaneous mobilization of the maxilla and mandible in order to achieve optimal correction of selected dentofacial deformities. In the experiences of the authors, there are patients with specific deformities of the Class III, Class II, Class I, and asymmetry types who can benefit from simultaneous mobilization of both jaws. It is the purpose of this article, the first in a series of three, to detail those specific conditions which warrant consideration for simultaneous mobilization of the maxilla and mandible. In the second article the details of treatment planning for simultaneous mobilization of the maxilla and the mandible will be presented, and in the third article the results of treatment in 100 consecutive cases will be evaluated.

Cephalometry↗