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Biomedical subjects

T M Maxwell

Publications and source records attributed to T M Maxwell.

12 recordsLinked to original sources
PubMed1992

Dyslipidemias among normoglycemic members of familial NIDDM pedigrees.

OBJECTIVE: To examine the hypothesis that hyperinsulinemia among relatives of NIDDM probands will increase the prevalence of DLPs, we measured insulin levels and examined the frequency of DLPs among NIDDM pedigree members. RESEARCH DESIGN AND METHODS: We performed 2-h 75-g OGTTs and measured lipid and insulin levels of 287 family members and 86 spouses from 16 large Utah pedigrees ascertained for greater than or equal to 2 siblings with NIDDM. RESULTS: One-hour insulin levels were higher among 206 family members with NGT than among 65 NGT spouses (483.3 vs. 361.7 pM, P = 0.05). Among the NGT family members, 32% had cholesterol levels at or above the age- and sex-specific 90th percentile level defined by the LRC studies, 33% had HDL levels less than or equal to 10th percentile, and 20% had triglyceride levels greater than or equal to 90th percentile. DLP (any of the three abnormalities) was found among 58% of NGT family members, which was significantly higher than the expected 27% (P less than 0.00001) and the prevalence among spouses of 45% (P less than 0.05). By NCEP criteria for hyperlipidemia, 40% of family members met criteria for diet and/or pharmacological therapy. CONCLUSIONS: Normoglycemic members of NIDDM pedigrees have a high prevalence of DLPs, which approaches the prevalence in patients with NIDDM. Our data suggest that members of NIDDM pedigrees should be screened carefully for lipid abnormalities.

Adult↗
PubMed1991

Insulin and glucose levels and prevalence of glucose intolerance in pedigrees with multiple diabetic siblings.

Hyperinsulinemia may be an early inherited marker for a defect in insulin action that subsequently results in glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM). To examine the role of hyperinsulinemia in individuals at high genetic risk for NIDDM and determine the prevalence of impaired glucose tolerance (IGT) and newly diagnosed diabetes in members of NIDDM pedigrees, we studied 310 members of 16 pedigrees ascertained for greater than or equal to 2 NIDDM siblings. Nondiabetic members of all pedigrees were examined by 75-g oral glucose tolerance test with fasting and 1-h insulin levels. Participants had height and weight recorded. Spouses of pedigree members (n = 88) served as control subjects. The spouse control subjects were older and slightly more obese than the undiagnosed pedigree members. The prevalence of IGT was 14.8% in spouses and 7.7% in pedigree members, and NIDDM was present in 11.3% of spouses and 2.3% of previously undiagnosed pedigree members. However, neither spouses nor pedigree members differed significantly from published age-specific prevalence rates for IGT or newly diagnosed NIDDM. Insulin and glucose levels were examined in pedigree members with normal glucose tolerance (NGT). Fasting insulin levels were not significantly different between spouses and NGT pedigree members. However, after adjustment for age, weight (body mass index), and sex, NGT pedigree members had higher 1-h insulin levels and higher fasting and 1-h glucose levels than spouses. These differences were also evident when pedigree members with at least 1 affected (NIDDM or IGT) parent were compared with spouses with no family history of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Color flow duplex screening of infrainguinal grafts combining low- and high-velocity criteria.

The aim of this prospective study was to evaluate the ability of duplex ultrasonography to identify infrainguinal grafts at high risk for failure. The criteria used identified low flow by low peak systolic velocity (less than 45 cm/s) and stenosis by high velocity (greater than 300 cm/s) or by velocity at the stenosis three times the velocity in the adjacent normal graft. A total of 114 patent grafts were scanned and compared with concurrent angiograms. Duplex scanning correctly identified 18 high-risk grafts by low-flow criteria and an additional 21 by stenosis criteria. There was one false-negative finding (sensitivity 98 percent). The velocity ratio of the stenosis to the adjacent graft was useful in estimating the degree of stenosis. Color flow duplex imaging reduced examination time through visual feedback by highlighting the graft and areas of high velocity. These results indicate that color flow duplex scanning, combining low- and high-peak systolic criteria, is a very sensitive screening test in the early detection of failing grafts.

Blood Vessel Prosthesis↗
PubMed1988

Reoperation within 2 years of aortofemoral bypass.

The authors analysed 267 consecutive primary aortofemoral grafts to identify the reasons for reoperation within the first 2 years postoperatively. Forty-one (8%) of the 521 limbs required a second operation. Precursors to reoperation were: occlusion of a superficial femoral artery (12%), gangrene (27%) and severe acute ischemia (35%). The rationale for reoperation was classified as technical 11, questionable selection (candidates for percutaneous transluminal angioplasty or inappropriate operation) 9, disease progress 11, residual symptoms 9, contralateral symptoms 1. The commonest technical problem was blind endarterectomy which preceded seven reoperations, five for thrombosis of the graft or a superficial femoral artery which was patent initially. Although 218 limbs had an occluded or severely stenosed superficial femoral artery, only 26 (12%) required reoperation within the first 2 years. The authors believe that the incidence of reoperation after aortofemoral bypass can be reduced by identifying the limbs at risk, by appropriate selection for percutaneous transluminal angioplasty, avoiding blind outflow endarterectomy and considering concomitant femoropopliteal bypass when gangrene is present.

Adult↗
PubMed1978

Rectal injuries.

Injuries to the rectum have always been associated with a high mortality. This was reduced when exteriorization was introduced, particularly when it was combined with prompt and effective resuscitative measures. Experience gained during the Vietnam war demonstrated the considerable benefit of washout of the distal rectal segment. The author describes the course of management he advises. After initial resuscitation, roentgenography of the pelvis and abdomen is necessary. Antibiotics should be administered preoperatively. Through a midline incision the rectal wounds are repaired and a proximal diverting colostomy is performed. The nonfunctioning bowel segment should then be thoroughly washed out. Careful search must be made for associated injuries that require attention.

Colostomy↗
PubMed1975

Noninvasive study of extremity perfusion by potassium 43 scanning.

In nine patients with lower extremity symptoms of arterial insufficiency, potassium chloride K 43 was injected intravenously during rest, reactive hyperemia, or exercise. Decreased radioactivity in muscle tissue was observed to correspond with symptoms, physical findings, Doppler ultrasound pressures, and angiographic findings in all six who had the procedure. Studies following surgical endarteractomies in two, a bypass procedure in one, and exploration without attempted reconstruction in one showed good correlation with postoperative symptoms, physical findings, and pressure measurements using Doppler ultrasound in three of four patients. The fourth patient showed no change on the postoperative study despite clinical imporvement. These findings suggest that intravenously administered radioactive potassium provides a noninvasive means for demonstrating the perfused muscle mass of the extremities with delieation of ischemic areas. The risk of arterial puncture is eliminated, and the ability to visualize perfusion patterns during exercise is unique to this method.

Adult↗