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Biomedical subjects

M L Wagner

Publications and source records attributed to M L Wagner.

At least 55 records · Page 3Linked to original sources
PubMed1993

Effect of felbamate on carbamazepine and its major metabolites.

Felbamate is a novel antiepileptic drug that is now available in the United States. During a previous double-blind, crossover, placebo-controlled safety and efficacy study, concomitant phenytoin concentrations increased, whereas carbamazepine concentrations decreased. We evaluated the effect of felbamate on the concentrations of carbamazepine and of its major metabolites, carbamazepine-10,11-epoxide (epoxide) and carbamazepine-trans-10,11-diol (diol) in 26 patients. After the addition of felbamate, mean epoxide concentrations increased from 1.8 micrograms/ml during placebo or baseline periods to 2.4 micrograms/ml during felbamate treatment (p < 0.05); there was no significant change in diol concentrations. Mean carbamazepine concentrations decreased from 7.5 micrograms/ml during placebo treatment to 6.1 micrograms/ml during felbamate treatment (p < 0.05). Mechanisms that could account for the increase in steady-state epoxide concentrations are induction of carbamazepine metabolism to epoxide, inhibition of the conversion of epoxide to diol, or both.

Adolescent↗
PubMed1993

Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo.

In a double-blind randomized crossover trial, oxycodone or placebo was given in divided night-time doses to 11 patients with idiopathic restless legs syndrome (RLS) for 2 weeks prior to appropriate polysomnographic studies. Under double-blinded conditions, patients were asked to do daily ratings of their leg sensations, motor restlessness and daytime alertness on a 1-4 scale for the 2 weeks prior to the polysomnographic studies and for the nights of the polysomnographic studies as well. Leg sensations (p < 0.009), motor restlessness (p < 0.006) and daytime alertness (p < 0.03) were significantly improved on oxycodone as compared to baseline or placebo. Patients were studied polysomnographically under double-blinded conditions for 2 nights in each phase of the protocol. On an average dose of 15.9 mg oxycodone (equivalent to approximately three 5-mg tablets of commercial preparation), there was a statistically significant reduction in the number of periodic limb movements in sleep [(PLMS)/hour sleep (p < 0.004)] and in the number of arousals/hour sleep (p < 0.009) on drugs as compared to baseline or placebo. A statistically significant improvement was also noted in sleep efficiency (p < 0.006) and 10 of the 11 patients preferred oxycodone over placebo. We conclude that oxycodone is an effective treatment for RLS and PLMS.

Adult↗
PubMed1992

A familial lymphoproliferative disorder presenting with primary pulmonary manifestations.

A familial lymphoproliferative disorder presented in three male siblings with primary pulmonary involvement manifested as either lymphoid interstitial pneumonia or an angiodestructive polymorphous infiltrate morphologically resembling lymphomatoid granulomatosis. The polymorphous infiltrate consisted chiefly of mature T-cells with a few B-cells and plasma cells, and gene rearrangement studies failed to show clonality. Epstein-Barr virus, frequently associated with proliferative lesions in males in the X-linked lymphoproliferative syndrome, was not demonstrated in any of the pulmonary lesions. An HLA haplotype shared among the affected siblings was A1, B8, DR4. The unusual clinical presentation plus the lack of involvement by EBV in the pulmonary lesions suggests that this is a previously undescribed familial lymphoproliferative disorder.

Adolescent↗
PubMed1992

Is combination sulfonylurea and insulin therapy useful in NIDDM patients? A metaanalysis.

OBJECTIVE: To assess the efficacy of combination therapy with insulin and sulfonylurea in the treatment of NIDDM. RESEARCH DESIGN AND METHODS: Studies published between January 1966 and January 1991 were identified through a computerized Medline search and by hand searching the bibliographies of identified articles. We identified 17 eligible randomized, controlled trials of combination therapy in NIDDM. These trials had a minimum duration of 8 wk and at least one of three outcome measures (fasting glucose, HbA1, or C-peptide) with SD or SE of the mean reported to do metaanalysis. With standardized forms, three independent reviews abstracted measures of study quality and specific descriptive information about population, intervention, and outcome measurements. RESULTS: We calculated effect size and weighted mean changes of the three outcome measures for control and treatment groups. In the treatment group, the fasting plasma glucose decreased from a mean of 11.4 mM (206 mg/dl) at baseline to a mean of 9.16 mM (165 mg/dl) posttreatment, whereas the control group decreased from (11.3 to 10.8 mM) (204 to 194 mg/dl) (effect size 0.39, P less than 0.0001). For HbA1, the treatment group decreased from a baseline of 11.0 to 10.2% compared to 11.0 and 11.2% in the control group (effect size 0.43, P less than 0.0001). For fasting C-peptide, the treatment group increased from 0.49 to 0.58 nM (1.45 to 1.75 ng/ml) compared with 0.47 and 0.43 (1.42 and 1.30) for the control group (effect size 0.26, P less than 0.017). CONCLUSION: Combined insulin-sulfonylurea therapy leads to modest improvement in glycemic control compared with insulin therapy alone. With combined therapy, lower insulin doses may be used to achieve similar control. Obese patients with higher fasting C-peptides may be more likely to respond than others.

Blood Glucose↗
PubMed1992

Effects of eimerian (Apicomplexa: Eimeriidae) infections on nutrient assimilation in the Wyoming ground squirrel.

Effects of infection with mixed species of Eimeria (E. callospermophili, E. morainensis, and E. beecheyi) on the digestive physiology of Wyoming ground squirrels (Spermophilus elegans) are described. Infected and uninfected squirrels were administered arginine and methionine in saturated glucose solution. Blood was drawn at time 0 and 30 min postadministration. Significant differences were not found between infected and uninfected squirrels in plasma glucose, arginine, or methionine assimilation. In a second experiment, infected and uninfected squirrels were fed a food slurry of known caloric value. All feces were collected for 24 hr postfeeding. Differences were not detected in fecal caloric content or digestive efficiency. These results in conjunction with results reported in the literature suggest a reassessment of the "parasitic" nature of these squirrel symbionts. We propose that associations of some Eimeria species and hosts that evolve under natural conditions are examples of parasite-host interactions that often evolve toward commensalism.

Amino Acids↗
PubMed1991

Osteomyelitis of the talus: an unusual cause of limping in childhood.

Hematogenous osteomyelitis of the talus is a rare and infrequently considered cause of limping in children. We describe five children younger than 2 years of age with osteomyelitis of the talus who had a limp and a paucity of constitutional symptoms. Conventional radiography and scintigraphy were the imaging techniques used. The usual radiologic features include soft-tissue swelling and an osteolytic defect in the talus without sequestrum formation of periosteal reaction. Bone scans were positive in all cases and led to the localization of the lesion in two patients. Definitive diagnosis was made in all cases only after needle aspiration or open biopsy and curettage. Increased awareness of this unusual lesion and its subtle early radiologic manifestations will allow prompt diagnosis and treatment.

Gait↗
PubMed1990

Typhlitis. An 18-year experience and postmortem review.

A review of pediatric autopsy results at the Texas Children's Hospital, Baylor College of Medicine from 1970 through 1987 was conducted. Thirty-three cases of typhlitis were identified in patients with acute leukemia and two cases each in patients with lymphoblastic lymphoma and aplastic anemia. Patients ranged in age from 10 months to 17 years. Fifty-seven percent were male and 43% were female. All were myelosuppressed. A postmortem incidence rate of 24% was determined for patients with acute leukemia. Common symptoms included abdominal pain and distention in 78% of patients and acute lower gastrointestinal bleeding in 35%. Abdominal radiographs varied in spectrum from a nonspecific bowel gas pattern to frank right colonic pneumatosis intestinalis. Thirty-three patients received chemotherapy within 30 days before onset of abdominal symptoms. All patients were febrile (greater than 38.5 degrees C), and 33 received broad-spectrum antibiotics. Three patients received amphotericin B. Premortem, 84% of organisms cultured from blood were bacterial whereas 16% were fungal. Fungal pathogens accounted for 53% of new microorganisms seen at autopsy. Postmortem examination showed typhlitis in the following anatomic distributions: (1) confined to the cecum; (2) involving the cecum and ileum; (3) involving the cecum, ileum, and ascending colon; or (4) involving the cecum, with sporadic ulcers throughout the intestine. This review includes clinical and postmortem features of typhlitis and current strategies for diagnosis and management.

Adolescent↗
PubMed1989

Gastric leiomyoblastoma (epithelioid leiomyoma) occurring in a child: a case report.

Leiomyoblastomas are rare smooth muscle tumors occurring most commonly in the gastrointestinal tract of adults. We report the unusual occurrence of a gastric leiomyoblastoma in a child who presented with refractory iron deficiency anemia. The tumor had a superficial erosion which was apparently the source of intermittent hemorrhage resulting in anemia. Epithelioid cells, spindled cells, and cells arranged in a perithelial pattern were seen by microscopy, characteristic of a leiomyoblastoma. Immunohistochemical staining demonstrated muscle actin, vimentin, desmin, and alpha-1-antichymotrypsin, and electron microscopy showed focal densities alternating with thin filaments. All of these features help to differentiate the tumor from an inflammatory pseudotumor. Leiomyoblastomas are associated with paragangliomas and pulmonary chondromas in children, but these were not present in this child. The prognosis of leiomyoblastomas may be related to tumor size, mitotic rate, and cellular characteristics.

Child↗
PubMed1988

Mediastinal lipomatosis: a complication of high dose steroid therapy in children.

Mediastinal lipomatosis has been described in adults and is a well recognized cause of mediastinal enlargement. Fatty accumulation in the mediastinum has been observed following extended usage of large doses of steroids, generally greater than 60 mg daily. Little documentation of this entity exists in pediatric patients. A 9-year-old male who received large doses of steroids for graft-versus-host disease following bone marrow transplantation for acute myelogenous leukemia developed mediastinal lipomatosis. Early qualification of this diagnosis is especially important in this group of patients, who are also at risk for a second neoplasm.

Child↗
PubMed1988

Review of bronchopulmonary foregut malformations.

The term bronchopulmonary foregut malformation (BFM) describes rare cases of pulmonary sequestrations that communicate with the upper gastrointestinal tract. An unusual type of BFM is described; it consisted of esophageal atresia, proximal and distal tracheoesophageal fistulae, and bilateral extralobar pulmonary sequestrations communicating with a common bronchial structure that replaced the distal esophagus. This case is related to other reported cases in the literature, and serves as the basis for a proposed theory of the embryonic development of BFM.

Bronchopulmonary Sequestration↗
PubMed1988

Cholinergic muscarinic receptor blockade suppresses arginine- and exercise-induced growth hormone secretion in type I diabetic subjects.

Stimulatory cholinergic pathways participate in the regulation of GH release, and cholinergic receptor antagonists inhibit GH secretion in normal man. Whether similar mechanisms are active in subjects with insulin-dependent diabetes is not known, yet this is of potential importance since GH hypersecretion has been implicated in both the acute and chronic complications of diabetes mellitus. To address this question we studied the effects of cholinergic receptor blockade on stimulated GH release in 18 type I diabetic men. Paired tests were performed using 1 of 2 different stimuli (30 g arginine, iv, or physical exercise for 30 min) with or without prior administration of the selective cholinergic muscarinic receptor antagonist pirenzepine (30 mg, iv). Arginine elicited a mean peak serum GH level of 9.0 +/- 1.9 (+/- SEM) micrograms/L, which was completely suppressed by pirenzepine (1.5 +/- 0.4 micrograms/L; n = 8; P less than 0.01). Blood glucose rose after arginine infusion and was not affected by pirenzepine. Serum GH levels rose during physical exercise to a mean peak of 7.3 +/- 1.6 micrograms/L, which was abolished by pirenzepine (1.2 +/- 0.3 micrograms/L; n = 10; P less than 0.01). Blood glucose was not influenced by pirenzepine. Two subjects had no serum GH response to exercise. We conclude that GH secretion in subjects with insulin-dependent diabetes, as in normal subjects, is modulated by cholinergic pathways and is responsive to pharmacological suppression by muscarinic receptor blockade. This may have implications for therapeutic trials designed to lower elevated GH levels in subjects with diabetes mellitus.

Adult↗
PubMed1986

Chronic pulmonary embolism in children.

Chronic pulmonary embolism with pulmonary hypertension in children is rarely diagnosed clinically; literature review yielded only 17 recorded cases. To demonstrate the radiographic features as well as to encourage the diagnostic consideration of chronic pulmonary embolism in children, this report focuses on three additional children with chronic pulmonary embolism. Of these 20 total cases, only two were not catheter-related; 17 patients had emboli as a complication of ventriculoatrial shunting, and one had emboli secondary to indwelling venous hyperalimentation. Analysis of the information available on the 20 cases revealed the following radiographic features: cardiomegaly (19 cases), large central pulmonary arteries with rapid distal tapering (15 cases), oligemia (five cases), "infiltrate" (three cases), and effusion (two cases). With increasing use of central catheterization as treatment for children with chronic illness, the incidence of chronic pulmonary embolism will likely increase; therefore, clinical diagnosis should reflect this increase. The radiologist in particular should be aware of the clinical and radiologic features of chronic pulmonary embolism in children.

Adolescent↗
PubMed1985

The use of digital subtraction angiography in evaluating pulmonary abnormalities in children.

In nine cases of pulmonary lesions in children, the diagnostic procedure of digital subtraction angiography was used with minimal invasiveness. Vascular anatomy was additionally confirmed by angiocardiography in four cases. One patient had a thoracotomy with removal of a nonvascular mass, whereas the other four patients, based on information provided by the digital subtraction angiogram, continued to be followed clinically. Using a peripheral vein for injection, intravenous subtraction angiography proved to be a satisfactory method of evaluating pulmonary vascular lesions and provided considerable information. Although other imaging modalities, including angiocardiography, computerized axial tomography scanning, or radionuclide studies, may be necessary for confirmation of the diagnosis, digital subtraction angiography should be considered in the work-up of pulmonary abnormalities in the pediatric patient. Five of the nine case studies are presented as appropriate examples.

Journal Article↗
PubMed1983

Digital subtraction angiography in children.

Preliminary results with digital subtraction angiography in infants and children have shown this to be an excellent screening procedure and often diagnostic. The examination can be performed satisfactorily on outpatients. Sixty patients have undergone this examination for evaluation of suspected abnormalities of the aortic arch and its branches, intracranial arteries, pulmonary arteries, abdominal aorta and its branches, and peripheral vessels. Adequate sedation is mandatory to prevent motion artifacts. While the literature reports increasing use of central venous catheters for delivery of contrast material, the use of short catheters placed in an antecubital vein is satisfactory for the pediatric patient. Techniques of the procedures are described along with seven appropriate case examples.

Angiography↗
PubMed1982

Complications of gastroesophageal reflux in patients with cystic fibrosis.

Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.

Adolescent↗