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Biomedical subjects

M G Wilson

Publications and source records attributed to M G Wilson.

At least 19 recordsLinked to original sources
PubMed1995

Long-term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group.

BACKGROUND: A large collaborative 8-week study has shown fluoxetine to be effective and safe in treating patients with bulimia nervosa. The present study evaluated fluoxetine over 16 weeks. METHOD: Fifteen US out-patient psychiatry clinics conducted a double-blind parallel study in men and women with DSM-III-R bulimia nervosa (483 patients entered, 398 randomised [3:1 ratio, fluoxetine 60 mg/day or placebo], 225 completed). Outcome measures included change in vomiting and binge-eating episodes per week. Eating Disorder Inventory, Clinical Global Impressions and Patient's Global Impression. RESULTS: Compared with placebo, fluoxetine treatment resulted in significantly greater reductions in vomiting (F[1,360] = 14.73, P < 0.0001) and binge-eating (F[1,360] = 14.39, P = 0.0002) episodes per week at endpoint and improvement in other outcome measures. Adverse event, vital sign and laboratory analyses indicated that fluoxetine was safe. CONCLUSION: Fluoxetine appeared to be safe and effective in patients with bulimia nervosa for up to 16 weeks.

Adolescent↗
PubMed1994

Fixed low-dose versus adjusted higher-dose warfarin following orthopedic surgery. A randomized prospective trial.

Orthopedic patients are at a high risk for developing venous thromboembolism, yet only a fraction of eligible patients receive anticoagulation prophylaxis after hospital discharge. This pilot study compared the efficacy of a fixed 2 mg/d dose of warfarin versus an adjusted higher dose of warfarin for 1 month after discharge to prevent the development of proximal leg deep venous thrombosis among recently discharged orthopedic patients. After standard inhospital treatment with adjusted higher-dose warfarin and a predischarge leg ultrasound to exclude deep venous thrombosis, 96 orthopedic patients were randomized just prior to discharge to either fixed low-dose (n = 49) or adjusted higher-dose warfarin (n = 47). At the 6-week follow-up evaluation, ultrasonographically confirmed, asymptomatic, proximal leg deep venous thrombosis occurred in two patients (4%). Both patients were randomized to the fixed low-dose group, although one remained on adjusted higher-dose warfarin throughout the trial. No patient in either group developed major bleeding complications. Further studies should be undertaken to further test fixed low-dose warfarin for venous thromboembolic prevention in high-risk orthopedic patients.

Female↗
PubMed1994

Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans.

The purpose of this study was to determine differences in the use of total knee arthroplasty for osteoarthritis among black and white older Americans and to determine whether clinical and economic factors contribute to these differences. Data on black and white Americans aged 65 years and older were gleaned from national Medicare hospitalization records for 1980 through 1988 and the Medicare enrollment file for 1987, the First National Health and Nutrition Examination Survey of 1971 through 1975, the National Hospital Discharge Survey of 1979 through 1988, the 1980 through 1988 US census counts and estimates, and 1980 census economic data. Information gathered includes prevalence of osteoarthritis of the knee among blacks and whites; rate of total knee arthroplasty use in the United States by race, sex, and age of subjects at the time of operations; use of competing procedures; and economic factors. Results showed that blacks were less often treated with total knee arthroplasty than were whites (white-to-black rate ratios = 3.0 to 5.1 for men and 1.5 to 2.0 for women) but had nonsignificantly higher rates of clinical osteoarthritis of the knee (white-to-black rate ratios = 0.39 for men and 0.78 for women). This racial difference in total knee arthroplasty rates was consistent across income levels and was unexplained by black patients' having operations at earlier ages or using competing procedures. Furthermore, the discrepancy occurred even among Medicaid-eligible Medicare recipients, who had no direct economic disincentive for surgery. These findings suggest that even though elderly blacks have higher rates of knee osteoarthritis, they do not receive total knee arthroplasty as often as do elderly whites. This discrepancy does not appear to have an economic explanation. Even if a comprehensive care system were in place to remove economic barriers, inequality in the use of this procedure would likely persist. Future studies should assess the nonclinical and noneconomic causes of these differences.

Black or African American↗
PubMed1993

Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia. Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures.

We compared the diagnostic value of quantitative cultures of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples in 40 patients with moderately severe community-acquired pneumonia (CAP). None had received antibiotics previously. BAL quantitative cultures were performed in 13 control patients without pneumonia. In 28 (70 percent) patients, TPC cultures yielded > or = 10(3) cfu/ml of a pathogenic bacterium in pure culture. In 27 of these cases and in four additional cases, BAL cultures yielded > or = 10(3) cfu/ml. BAL cultures from the control group were sterile in seven cases, yielded normal flora in three cases, and yielded microorganisms thought to be not significant in two cases. Microbiologic agreement was reached by both TPC and BAL for 32 (84 percent) of 38 microorganisms recovered. Quantitative cultures from both techniques correlated very well (r = 0.71, p < 0.0001). We conclude that both TPC and BAL have similar accuracy to determine etiologic diagnosis of CAP. There was good qualitative and quantitative agreement between both techniques.

Adolescent↗
PubMed1992

Birth prevalence of Down syndrome in a predominantly Latino population: a 15-year study.

The birth prevalence of Down syndrome (DS), although decreasing in parts of the world, is not known in many specific subpopulations. The rate of DS for live births was determined for a 15-year period (1974-1988) at the Los Angeles County-University of Southern California Medical Center, which is a large public hospital serving a predominantly Latino population. DS was ascertained primarily by clinical monitoring of newborn infants. The overall rate of DS was 1.60/1,000 live births and had minimal fluctuation throughout the 15 years. The rate of DS for Latino births was 1.69/1,000 live births, 1.67 when adjusted for maternal age, and 1.75 when corrected for prenatal diagnosis. The high rate of DS in the Latino population was associated with advanced maternal ages and increased maternal-age specific rates for DS, especially in the age ranges of 30 to 34 and 40 to 44 years, when compared with other studies.

Adolescent↗
PubMed1992

Cost effectiveness of work-site cholesterol screening and intervention programs.

A study was conducted to evaluate the costs and cost effectiveness of behavioral interventions designed to reduce high serum cholesterol levels in a manufacturing population. A sample of 3202 employees participating in a screening was separated into four intervention groups and a control group. All four intervention groups received an educational program of varying length (1 or 3 months). Two of these groups also received incentives. A second screening was conducted after the interventions to determine effectiveness. The 1-month educational intervention with incentive and the 3-month educational intervention had the lowest costs per participant ($46.28 and $53.09, respectively) and costs per borderline high or high risk participant reducing cholesterol greater than 10% ($285.89 and $351.56) and the greatest effectiveness per dollar spent (0.60 and 0.62). The cost-effectiveness analyses were affected by the impact of the intervention and participation rate. Sensitivity analyses showed that increasing participation had a greater impact on the less cost-effective interventions.

Adult↗
PubMed1991

Cholesterol reduction in the workplace and in community settings.

Recent emphasis has been placed on the role of serum cholesterol in the development of cardiovascular disease and on reducing high serum cholesterol levels through a screening followed by a behavioral intervention. However, evidence about the effectiveness of this technique in reducing cholesterol has yet to be evaluated. A review of the biomedical and allied health literature was conducted to determine the effectiveness of reducing serum cholesterol levels in the general population through the use of a screening to identify those at risk followed by a behavioral intervention. Only worksite and community based studies published from 1980-89 were reviewed. Seven worksite and four community studies were identified. All studies used total serum cholesterol as the dependent variable while some included other physiological measures. The majority of studies used a multicomponent intervention involving dietary education, exercise, smoking cessation, or weight reduction components. The interventions tested lasted from 14 weeks to five years and varied from low intensity to high intensity. The methods of intervention ranged from face-to-face interaction to mail and telephone counseling. Although many of the studies reviewed contain methodological flaws, certain findings are evident. The studies show that cholesterol can be reduced through a screening followed by a behavioral intervention, the multicomponent program is the most effective intervention, and low intensive interventions are as equally effective as high intensive interventions. Program implications and future research directions are discussed.

Cholesterol↗
PubMed1991

Total knee arthroplasty: a population-based study.

Total knee arthroplasty (TKA) is being used increasingly for the management of chronic arthritis of the knee. In this report, we review the frequency of application of TKA in the population of Olmsted County, Minnesota, from 1971 through 1986. The utilization rate of TKA increased from 20.5 per 100,000 person-years for 1971 through 1974 to 60.8 per 100,000 for 1983 through 1986. Although rates were higher in women, they increased with advancing age in both sexes. Rates between the urban and rural populations of Olmsted County did not differ. The two most common underlying diseases that necessitated TKA were osteoarthritis and rheumatoid arthritis; they were the cause of more than 90% of all operations. By extrapolating the rates of TKA in Olmsted County to the total 1986 US population, we estimate a need for at least 143,000 TKAs annually at a direct cost of more than $2.3 billion each year.

Adult↗
PubMed1991

Program for the prevention of venous thromboembolism in high-risk orthopaedic patients.

Postoperative orthopaedic patients remain at risk for venous thromboembolism (VTE) after hospital discharge. Therefore, the authors designed and implemented a program for prevention of VTE that included outpatient adjusted-dose warfarin using twice-weekly prothrombin time (PT) determinations, a dedicated telephone line for PT results, and vigilant nurse-physician supervision to administer prophylaxis to 125 postoperative orthopaedic patients against VTE for an average of 31.4 days after discharge. PT was maintained between 13.2 and 18.3 seconds (1.1-1.5 x control) in the average patient. There was a failure rate of 3.2% and 0.8% for clinically suspected and radiologically confirmed deep venous thrombosis (DVT) and pulmonary embolism (PE), respectively. The rate of bleeding complications was 3.2%, but none of these patients required transfusion or hospital readmission for hemorrhage. The authors conclude that the described program for VTE prevention is a safe, effective, and practical program to administer prophylaxis to postoperative orthopaedic patients against clinically evident VTE for the first month after hospital discharge.

Adult↗
PubMed1991

Capsular impingement as a source of pain following bipolar hip arthroplasty.

Concerns regarding the extent and predictability of pain relief with bipolar hemiarthroplasty have been raised. Inconsistent clinical results have been reported, with persistent postoperative groin pain noted in some patients. A diverse number of bipolar operative techniques have been reported, but discussion of the surgical treatment of capsular tissue has usually been omitted. Although the source of postoperative pain is difficult to determine, the authors report the relief of groin pain after a capsulectomy in a patient with a preexisting bipolar hemiarthroplasty, thus offering one possible etiology.

Adult↗
PubMed1990

Growth retardation in Wolf-Hirschhorn syndrome.

Postnatal growth records of 13 patients with Wolf-Hirschhorn syndrome indicate that the syndrome is associated with continuing severe growth retardation and marked microcephaly. In spite of severe retardation, these patients (with one exception) survived beyond infancy.

Abnormalities, Multiple↗
PubMed1990

Idiopathic symptomatic osteoarthritis of the hip and knee: a population-based incidence study.

We identified all residents of Rochester, Minnesota, who sought medical assistance for the first time in 1985 because of symptomatic osteoarthritis of the hip or knee that was unrelated to a specific disease. Of these residents, 98 (59 women and 39 men) had 122 symptomatic joints (95 knees and 27 hips), for age- and sex-adjusted incidence rates of 205 new patients and 255 newly affected joints per 100,000 person-years. The incidence of osteoarthritis of the hip was greater in women than in men, whereas the sex ratio for occurrence of osteoarthritis of the knee approached unity. Rates at both sites increased steadily with aging in men but plateaued after the menopause in women; similar patterns were seen whether or not grade 1 disease was included. Projected nationally, these first population-based data indicate that as many as approximately half a million new symptomatic cases of idiopathic osteoarthritis of the knee and hip may arise annually in the white population of the United States. With increasing longevity, osteoarthritis may exact an even greater toll in the future.

Adult↗
PubMed1990

Lack of specificity of DA/DAPI fluorescence.

Cytogenetic studies showed 47,XY, + mar in a developmentally retarded child with some features of Prader-Willi syndrome, and 46,XX in his mother. The marker chromosome showed a single subterminal primary constriction, bisatellites, and two C-bands. DA/DAPI staining showed two intense bands in the marker chromosome, which most likely was derived from chromosome 15. Intense DA/DAPI fluorescence was also found in one chromosome 13 in the child, and one 13 and one 10 in his mother. The present results confirm the reports of DA/DAPI heteromorphism in acrocentric chromosomes other than the 15, and demonstrate a pericentric DA/DAPI heteromorphism in chromosome 10.

Adult↗
PubMed1990

Depression of force by phosphate in skinned skeletal muscle fibers of the frog.

The relation between isometric force and phosphate concentration in skinned skeletal muscle fibers of the frog is found to depend on fiber size. Force decreased with increasing phosphate concentration, but depression of force in thick fibers was smaller than in thin segments. When the external phosphate concentration was abruptly altered during a sustained contracture, force changed. The half-time of the force change was proportional to the cross-sectional area of the preparation. From this relation, a value for the diffusion constant of phosphate in skinned fibers of 0.9 x 10(-10) m2/s was derived. The rate of phosphate production was determined photometrically via the enzymatic coupling of the resynthesis of ATP to the oxidation of nicotinamide adenine dinucleotide. The average value (+/- SE) of the rate of ATP hydrolysis (at 4 degrees C) was 2.7 +/- 0.3 mumol.s-1.g dry wt-1, which corresponds to 0.34 mmol.l-1.s-1. From a calculation based on the diffusion constant and the rate of phosphate production determined, it follows that the dependency of the force-phosphate relation on fiber diameter is due to phosphate accumulation inside the fiber.

Adenosine Triphosphatases↗
PubMed1990

Suspected ciprofloxacin-induced interstitial nephritis.

Interstitial nephritis is a rare but serious adverse effect of many drugs and usually is diagnosed by clinical signs and symptoms of hematuria, proteinuria, eosinophilia, fever, azotemia, and rash. Ciprofloxacin is one drug that has been reported to cause interstitial nephritis. Renal toxicities have been reported in less than one percent of the patients receiving ciprofloxacin therapy. Limited documentation of this adverse effect exists in the literature. This article describes a patient with suspected ciprofloxacin-induced interstitial nephritis.

Aged↗
PubMed1990

Reconstruction of the deficient acetabulum using the bipolar socket.

Although originally conceived as part of a two-stage procedure for the reconstruction of the deficient acetabulum, the use of a bipolar/grafting technique in selected patients can provide acceptable results as a definitive procedure. Critical technical considerations include proper preparation and grafting of the acetabular bed and careful sizing of the outer bipolar shell. Acceptable levels of pain relief and functional gain were obtained in 47 cases, with a follow-up mean Harris hip score of 86. Despite some initial socket migration in all hips, roentgenographic stability was gained after the first year. One acetabular failure was related to graft placement in the superolateral position. Bipolar reconstruction is indicated for contained acetabular defects only. In addition, the surgeon must have access to a complete inventory of socket sizes to ensure a proper fit and a bone bank to obtain adequate amounts of allogeneic bone.

Acetabulum↗
PubMed1990

Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases.

Of 4171 total knee arthroplasties that were performed at our institution from 1973 to 1987, sixty-seven were followed by infection. The risk of infection was significantly increased in patients, particularly men, who had rheumatoid arthritis; in patients who had ulcers of the skin; and in patients who had had a previous operation on the knee. Infection was also associated with obesity, recurrent urinary-tract infection, and oral use of steroids, although the correlation was not statistically significant. Of the various treatment options that were studied, removal and delayed replacement of the knee prosthesis resulted in the best functional results.

Aged↗