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Biomedical subjects

P D Connor

Publications and source records attributed to P D Connor.

At least 19 recordsLinked to original sources
PubMed2001

Geometric morphometrics of corpus callosum and subcortical structures in the fetal-alcohol-affected brain.

BACKGROUND: Although experienced clinicians have been diagnosing fetal alcohol syndrome (FAS) for nearly 30 years, the rest of the spectrum of fetal alcohol damage is not being classified effectively. This article describes a quantification of neuroanatomical structure that may supply a useful discriminator of prenatal brain damage from alcohol. It is demonstrated in a data set of adults of both sexes. METHODS: Ninety adults (45 males) were examined by magnetic resonance imaging (MRI). These subjects were group-matched for age and ethnicity across three diagnoses: FAS, fetal alcohol effects (FAE), and normals. All FAS and FAE were heavily alcohol-exposed in utero; normals were not. From T(1)-weighted MR brain images, we extracted 3D morphometric representations of shape for 33-landmark point configurations and 40-point outlines of the corpus callosum along its midline (a slightly nonplanar structure). RESULTS: There are striking differences between exposed and unexposed in the statistical distributions of these two shapes. The differences are better characterized by excess variance in the exposed group than by any change in average landmark or outline shape. For each sex, combining the callosal outline data with the landmark data leads to a powerful quadratic discriminator of exposed from unexposed. The discriminating features include the relationship of brain stem to diencephalon, and localized variabilities of callosal outline shape, but not diagnosis (FAS vs. FAE). CONCLUSIONS: Statistical analysis of brain shape is a powerful new source of information relevant to fetal alcohol spectrum nosology and etiology. Patients with FAS and FAE do not differ in these brain shape features, but both differ from the unexposed. The aspects of brain shape that are especially variable may be entailed in the underlying neuroteratogenetic mechanisms.

Adolescent↗
PubMed2000

Meckel's diverticulum.

Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain completely asymptomatic, or it may mimic such disorders as Crohn's disease, appendicitis and peptic ulcer disease. Ectopic tissue, found in approximately 50 percent of cases, consists of gastric tissue in 60 to 85 percent of cases and pancreatic tissue in 5 to 16 percent. The diagnosis of Meckel's diverticulum should be considered in patients with unexplained abdominal pain, nausea and vomiting, or intestinal bleeding. Major complications include bleeding, obstruction, intussusception, diverticulitis and perforation. The most useful method of diagnosis is with a technetium-99m pertechnetate scan, which is dependent on uptake of the isotope in heterotopic tissue. Management is by surgical resection.

Female↗
PubMed2000

Direct and indirect effects of prenatal alcohol damage on executive function.

Patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) often have difficulty functioning appropriately in everyday life and seem to employ poor problem-solving strategies. Tests of executive function are relevant for quantifying the functional deficits and underlying real-life problems associated with prenatal alcohol exposure. This study considers two pathways for the effects of prenatal alcohol on executive function: a direct effect and an indirect effect through prenatal alcohol's effect on IQ. We compared 30 men who had been diagnosed with FAS or FAE with young adults participating in a longitudinal prospective study (n = 419) and 15 control participants that comprised a comparison group. This study is unique in its analysis of the same battery of assessments of executive function in both a large low dose longitudinal study sample and a clinically diagnosed group. Participants were evaluated on 9 tests (including 58 scores) of executive function. For some but not all of the tests in this executive function battery, the decrement in the alcohol exposure group is greater than would be predicted from their IQ scores. We found that 3 of 6 Stroop scores, 2 of 4 Trails scores, 9 of 16 Wisconsin Card Sorting scores, 1 of 2 Ruff's Figural Fluency scores, and 2 of 4 Consonant Trigrams scores appear to be particularly sensitive to the direct effects of prenatal alcohol damage for patients with FAS and FAE. The findings suggest that these executive function tests would be particularly useful in clinical evaluations of persons suspected of fetal alcohol damage because they would not simply reflect deficits in IQ or facial stigmata.

Adult↗
PubMed2000

Unilateral mandible fracture with bilateral TMJ dislocation.

Temporomandibular joint (TMJ) dislocation occurs when the condylar head slips forward causing the posterior articulating surface of the condyle to advance ahead of the articular eminence, possibly becoming entrapped. Following dislocation, the ligaments around the joint often stretch, causing severe muscle spasms and joint pain. There is no standard evaluation and treatment method for acute TMJ dislocation, but the most effective course is immediate reduction. This paper presents a 42-year-old woman who sustained a unilateral mandible fracture with bilateral TMJ dislocation in an automobile crash. Although the fracture was apparent on plane film and panorex, the dislocation was not found until six weeks later, when the jaw was unwired. At that time, the dislocation was suspected because of decreased range of motion, but was not verified until an MRI was performed. The result was long-term therapy, eventual bilateral TMJ surgery, and chronic TMJ pain for the patient.

Accidents, Traffic↗
PubMed1999

Individual differences in auditory and visual attention among fetal alcohol-affected adults.

BACKGROUND: Deficits in attention are commonly identified among patients who have been prenatally exposed to alcohol, and they often affect the ability of the patients to function appropriately in society. METHODS: Eleven adult patients with fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE) were compared with nine adult subjects with no history of prenatal alcohol exposure, using four tests of visually and auditorially mediated attention. RESULTS: In relation to the comparison group, patients with FAS/FAE exhibited substantial deficits in both auditory and visual attention; the auditory deficits were greater. We observed two predominant patterns of deficits among patients with FAS/FAE, one involving both auditory and visual attention problems and the other involving less severe auditory problems and even fewer visual problems. Most subjects with FAS or FAE had some manifestations of attention problems in at least one of the tests of attention used in this study. We present a new graphical representation of individual auditory Continuous Performance Test data across a 6-min period, which, compared with conventional scores, more clearly reveals the markedly disrupted and variable attention patterns displayed by some individuals with FAS or FAE. CONCLUSIONS: These findings suggest that detailed analysis of the pattern of individual performance for each subject is an important aspect of Continuous Performance Test assessment. Our findings further suggest that intellectual performance (intelligence quotient score) alone is not sufficient to account for the patterns of disrupted attention for individuals with FAS/FAE. Assessment of individuals with FAS or FAE should include measurement of attentional functioning in both the visual and auditory modalities.

Adult↗
PubMed1998

Cancer screening guideline preference surveys: physicians' perceptions of the American Cancer Society.

OBJECTIVE: The primary objective of this study was to assess cancer screening guideline preference by Tennessee internists and family physicians. DESIGN: A one-page, 14-item survey was mailed to 580 internists and family physicians followed by a reminder postcard and a second survey within six weeks of the original mailing. The survey addressed physician practice characteristics, specific preferred cancer screening guidelines used, and self-evaluation of cancer screening and detection practices compared with the practice of coronary artery disease risk and prevention, depression, and obesity/adult-onset diabetes mellitus. SETTING: Internal medicine and family physicians in Tennessee. RESULTS: The overall survey response rate was 57% (N = 300). Of respondents, 83.4% were male and 16.6% were female. Eighty-three percent were board-certified, 30% had subspecialty training, and 62% practiced in a solo practice or a single-specialty group. There were few differences in guideline preference between generalists and subspecialists. Approximately 52% of respondents cited American Cancer Society (ACS) guidelines, 1.7% used US Preventive Services Task Force (USPSTF) guidelines, 34% cited a compilation of various guidelines, and 10% used no guidelines. More physicians rated their treatment of depression (22.9%) or obesity/diabetes mellitus (22.0%) as poor or needing improvement than rated their screening of cancer (16.3%) and coronary artery disease (12.5%) as poor or needing improvement. Survey respondents suggested that the ACS could be most effective in lobbying against tobacco and in providing patient education pamphlets. CONCLUSIONS: Most physicians report using ACS screening guidelines, rate their cancer screening practices as good or very good, and recommend that the ACS lobby against tobacco and provide patient pamphlets. This study reflects physician preference of various cancer screening guidelines. Further research is needed to determine factors influencing physician preferred guideline use as well as actual practices.

American Cancer Society↗
PubMed1995

Prevalence of and risk factors for Chlamydia in a rural pregnant population.

BACKGROUND: Chlamydia trachomatis infection is the most common sexually transmitted bacterial disease in the United States. Perinatal infection with C trachomatis has been associated with preterm labor, preterm rupture of membranes, stillbirth, and both conjunctivitis and pneumonia in newborns. Little is known about the prevalence of C trachomatis infection in rural pregnant women. METHODS: We completed a retrospective chart analysis of 347 obstetric patients in a rural family practice residency training program to determine the prevalence, associated risk factors, and screening criteria for cervical C trachomatis infection. RESULTS: The prevalence of C trachomatis infection in our study was 9.0%. Factors predictive of a positive test for C trachomatis infection included single marital status, African-American race, history of sexually transmitted diseases, presence of gonorrhea during the current pregnancy, age less than 20 years, and late onset of prenatal care. CONCLUSIONS: The prevalence of C trachomatis in this rural obstetric population emphasizes the importance of laboratory screening of rural pregnant women for this disease.

Adolescent↗
PubMed1995

A comparison of manual and ultrasound measurements of fundal height.

BACKGROUND: Uterine fundal height has long been used to assess fetal growth. The common prediction rule states that the distance in centimeters between the pubic symphysis and the top of the fundus equals the gestational age in weeks. The correlation holds best between weeks 18 and 32. This study compares manual and ultrasound measurements of fundal height. METHODS: We compared palpated and ultrasound symphysis-fundal height. We then compared both measurements with gestational age as determined by usual ultrasound measurements. Patients were statistically separated by weight into two groups: normal and obese. We hypothesized that manual measurements of fundal height would be affected by obesity and race. RESULTS: Ultrasound fundal height and manual fundal height were equivalent (P < or = .01, R2 = .92). Regression analysis in normal weight and obese patients showed that both methods have the same predictive power in determining fetal age. CONCLUSION: Manual measurements are still a reliable and inexpensive means of evaluating the course of pregnancy. Ultrasound is needed when there is a size-vs-date discrepancy. Ultrasound is also useful for teaching the measurement of fundal height.

Anthropometry↗
PubMed1994

Antidepressant augmentation with lithium.

Depression is one of the most prevalent disorders seen in primary care. About 50% of depression is treated in general medical settings. Although depression is highly treatable, incomplete response to a single antidepressant is common. We describe two clinical cases in which antidepressant augmentation was a therapeutic option and lithium carbonate was an appropriate choice. A brief review of the practical aspects of the clinical pharmacology of lithium is included. Lithium is a well-tolerated, safe, and effective medication for antidepressant augmentation.

Adult↗
PubMed1992

Diagnostic and therapeutic tools for the family physician's office of the 21st century.

Several new technologies are available to family physicians; however, numerous factors influence a physician's decision to adopt them. This study sought to determine interests and problems related to adopting new technology. The survey population was a group of family physicians who visited our scientific exhibit at the 1990 meeting of the American Academy of Family Physicians (AAFP). A 13-item questionnaire collected information on their use of and/or interest in technological procedures and equipment. Respondents were interested in a variety of new technological procedures. The most important criteria when considering new technology were training, costs, and office scheduling. The emphasis on outpatient care makes it increasingly important for family physicians to use modern technology in their offices and for departments of family medicine to offer training in these procedures. Our study provides a springboard for a broader discussion of the problems involved in selecting and implementing new technology in family practice.

Diagnostic Tests, Routine↗
PubMedDate not supplied

The bipolar spectrum: a review of current concepts and implications for the management of depression in primary care.

Family physicians inevitably encounter patients with bipolar disorders, often when the patient is depressed. For most of these patients, the attendant elevations in mood fall short of mania. Such milder periods of expansive mood, hypomanias, may go unrecognized unless the physician specifically queries the patient to uncover them. In addition, patients with bipolar disorders often manifest other distinctive characteristics. An understanding of these hints of bipolarity is helpful to clinicians treating depressive illness. Patients with bipolar disorders are at risk for treatment complications caused by the administration of antidepressants without the concurrent use of mood stabilizers, such as lithium carbonate, valproate sodium, and carbamazepine. Such complications include exacerbation of hypomania or mania, induction of refractory states, and, perhaps, rapid cycling or mixed states. We review current issues in classification of bipolar disorders and emphasize the importance of identifying hypomania. An introduction to the concept of affective temperaments and a brief review of treatment strategies and treatment complications are included.

Bipolar Disorder↗
PubMedDate not supplied

On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally.

Much of the scientific literature on affective states in primary care settings is derived from instrument-based diagnoses, typically without the benefit of clinical in-depth examination. In a naturalistic family practice setting, we prospectively evaluated 108 consecutive anxious and/or depressed patients. All diagnoses derived from semistructured interviews conducted by a family physician with enhanced training in mood disorders. Nonbipolar depressions were found in 60 of 108 patients (55.6%), nearly half of whom were in the depression not otherwise specified (DNOS) category; yet on careful history, all but two of 28 DNOS cases had major depressive episodes in the past. Twenty-eight patients (25.9%) were diagnosed with bipolar I, II, or III disorder or cyclothymia. Panic disorder was found in 9%, and obsessive-compulsive disorder and active chemical dependency were each diagnosed in 3%. Bipolar spectrum disorders were common (one in three within the depressive group) and at times were not recognized until several weeks or months into the treatment phase of the depressed or anxious state. Although the largest percentage of patients had DNOS at the index episode, bipolar illness (usually bipolar II) was also common. Our findings contrast with the nearly total unipolarity reported in the instrument-based (nonclinician) literature. If generalizable, our observations have significant implications for physician education and practice, since bipolar depressions require different interventions. Further investigation to explore interview approaches and/or instruments sensitive for hypomania and other "soft" bipolar features seems warranted.

Adolescent↗
PubMedDate not supplied

Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy.

BACKGROUND: Obstetric sonography is a valuable diagnostic procedure for family physicians who provide obstetrics; however, physicians tend to use technology that was effectively modeled during residency. The purpose of this study was to learn how many family medicine residency program directors had an interest in and a need for training in obstetric sonography, as well as whether they were willing to commit faculty and finances for adding the technology to their programs. METHODS: All program directors listed in the 1989 American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs (n = 379) received a five-item questionnaire about obstetric services and use of sonograms in their programs and their desire for training in obstetric sonography. RESULTS: More than 81 percent of respondents said their programs provided obstetrics. Sixty-eight percent of these respondents used sonograms, and 53 percent indicated a need for training in obstetric sonography. Forty-five percent of all respondents, regardless of whether their programs offered obstetrics, indicated a desire for training. CONCLUSIONS: The high level of interest in obstetric sonography can be explained, in part, by the 81 percent of respondents whose programs provided obstetrics. These figures suggest a need to establish a training curriculum in obstetric sonography for family medicine residency programs. Our training program, designed to reach faculty, residents, and practicing physicians, is described.

Education, Medical, Graduate↗
PubMedDate not supplied

Correlation of emergency department radiographs: results of a quality assurance review in an urban community hospital setting.

BACKGROUND: The study objective was to compare the accuracy of radiograph interpretation by emergency and family physicians with radiologists' overreadings. METHODS: We undertook a historical chart review of patients seen consecutively during a 1-year period at an inner-city emergency department of a medium-volume community hospital. The participants were a racially mixed group of 22,141 patients for whom 12,083 radiographs had been ordered. We compared interpretations by emergency and family physicians with those of radiologists who performed overreadings within 24 hours. This intervention was performed retrospectively. Measurements consisted of descriptive statistics, such as percentages and chi-square analysis. RESULTS: The main result was an overall discrepancy rate (ODR) of 1.1 percent. This figure is significantly different (P < 0.0001) from the lowest reported overall discrepancy rate to date (2.8 percent). CONCLUSIONS: Consistently low overall discrepancy rates have specific implications for the medical practice and reimbursement of primary care physicians for radiograph interpretation.

Clinical Competence↗