PubMed Health⌕ Search

Biomedical subjects

W K Vaughn

Publications and source records attributed to W K Vaughn.

At least 91 records · Page 5Linked to original sources
PubMed1986

Antiestrogenic effect of clomiphene citrate in a multiple follicular stimulation protocol.

End-organ antiestrogenic effects of clomiphene citrate (CC) have been demonstrated in the female reproductive tract at the levels of the ovary, cervix, and endometrium. However, it has not been established whether this effect is manifested during concomitant human menopausal gonadotropin (hMG) administration, as occurs in hMG/CC stimulations of multiple follicular development. To assess this question a review was made of serum estradiol (E2) and cervical mucus in 47 hMG and 56 hMG/CC stimulations on days -2, -1, 0, and +1 relative to the day of hCG administration. E2 levels (pg/ml) were significantly lower in the hMG as compared to the hMG/CC group. However, comparing the hMG and hMG/CC groups, cervical mucus scores were significantly higher in the former. Furthermore, an analysis of covariance demonstrated that the cervical mucus scores on each day were significantly lower in the hMG/CC group (P less than 0.001). Thus, in hMG/CC stimulations for in vitro fertilization (IVF), despite the concomitant administration of pharmacologic doses of hMG, CC exerts an antiestrogenic effect on at least one end organ, cervical mucus production. Potentially, this antiestrogenic effect in IVF stimulations would be exerted at other female reproductive tract sites including the endometrium; however, its clinical significance, if any, is unclear.

Cervix Mucus↗
PubMed1986

Electrocardiographic markers of cardiac metastasis.

Cardiac metastases are often clinically inapparent but have important prognostic significance. A total of 1046 consecutive autopsies performed between 1981 and 1983 were reviewed, and 210 patients with both premortem and autopsy diagnoses of cancer were found, in whom a recent (less than 3 months before death) ECG was available. Of these patients, 47 had cardiac metastases (group I) and 163 did not (group II). In group I, 19 patients had new ECG changes suggestive of myocardial ischemia or injury, including either diffuse T wave inversion (10%), segmental (ECG pattern suggestive of a specific coronary distribution) T wave inversion (80%), or ST elevation (10%). None of these patients had symptoms suggestive of myocardial ischemia. In group II, six patients had ECG changes suggestive of myocardial ischemia or injury: four patients with preterminal sepsis, one with myocardial infarction, and one with aspergillus nodules within the myocardium. New atrial arrhythmias (seven patients) and low voltage (10 patients) were found with greater frequency in group I patients (p less than 0.0005 and p less than 0.00001, respectively, vs group II). Patients with normal ECGs were unlikely to have cardiac metastases; however, the finding of nonspecific ST-T wave changes was not helpful in differentiating the two groups. In clinically stable patients with cancer and no cardiac symptoms suggestive of ischemia, any new ECG change should raise the suspicion of cardiac metastases. The ECG finding of myocardial ischemia or injury has high specificity (96%, p less than 0.000001) for cardiac metastases.

Adolescent↗
PubMed1986

The indirectly obtained fetal heart rate: comparison of first- and second-generation electronic fetal monitors.

Fetal heart rate variability has become an essential component in evaluation of the fetus during continuous electronic fetal monitoring. Because of technical deficiencies of monitoring equipment, fetal heart rate variability may not always be available, such as during indirect monitoring of the fetus. In lieu of integration, a mathematical procedure called autocorrelation has, with the use of microprocessors, been incorporated into the fetal monitor, creating the "second generation" of electronic fetal monitoring. This study examined the accuracy of the first- and second-generation monitors by comparing simultaneously obtained indirect and direct real-time fetal heart rate data. The second-generation monitor produced an indirectly obtained fetal heart rate that was more accurate when compared with the directly obtained data than that with the first-generation fetal monitor. In addition, the variation in data from the first-generation monitor was substantially higher than that with the second-generation monitor. It is concluded that the fetal heart rate tracing from the second-generation monitor is more accurate when compared with the fetal electrocardiogram and may facilitate a truer interpretation of fetal heart rate variability than that obtained with the first-generation monitor.

Electrocardiography↗
PubMed1986

Increased risk of endometritis and wound infection after cesarean section in insulin-dependent diabetic women.

To determine if diabetic women have an increased risk for post-cesarean section endometritis and/or wound infection, all insulin-requiring diabetic women who were delivered by cesarean section between 1977 and 1981 were compared with a group of nondiabetic patients delivered by cesarean section. Patients were divided into low-risk or high-risk groups on the basis of labor and ruptured membranes. Compared with control subjects, diabetic patients were at significantly greater risk for postoperative infectious morbidity. Among diabetic patients, risk for postoperative infections was independent of White's classification of diabetes and gestational age at delivery. The increased rate of infection among the diabetic patients suggests that prophylactic antibiotics might be efficacious for insulin-requiring diabetic patients undergoing cesarean section.

Cesarean Section↗
PubMed1986

Clinical results of terminal salpingostomy with the use of the CO2 laser: report of the Intraabdominal Laser Study Group.

Forty-eight women underwent terminal salpingostomies with a standard operative procedure with the use of the CO2 laser and microsurgical techniques at five centers. Early second-look laparoscopy was performed in all patients 1 to 12 weeks after the laparotomy. The tubal patency rate at the second look was 92% for these 48 patients, with a minimum of 6 months' follow-up study in all patients. Of these patients, ten became pregnant (21%), one with an ectopic pregnancy (10%). All pregnancies occurred within 12 months of the second-look procedure. It is preliminarily concluded from this series that use of the CO2 laser for neosalpingostomy at laparotomy with early second-look laparoscopy provides a term pregnancy rate similar to that previously achieved by nonlaser microsurgical techniques and shortens the time period between the surgical procedure and when conception would be expected to occur.

Adult↗
PubMed1986

Comparison of human menopausal gonadotropin, clomiphene citrate, and combined human menopausal gonadotropin-clomiphene citrate stimulation protocols for in vitro fertilization.

Human menopausal gonadotropins (hMG) and clomiphene citrate (CC), either alone or in combination, are frequently used for in vitro fertilization (IVF) in an attempt to maximize the number of oocytes recovered and the number of embryos transferred. However, direct comparison of the relative efficacy of these protocols in the same institution has been limited. To evaluate this question, the authors examined the outcome of 304 consecutive women attempting IVF. One hundred eighty-one women received hMG, 42 received CC, and 81 received combination hMG/CC. The percentages of women undergoing laparoscopy were not different among the groups (69%, 71%, and 74%, respectively), nor were the rates of oocyte recovery (94%, 100%, and 100%). However, the percentage of women achieving oocyte fertilization (77%, 83%, and 93%) and embryo transfer (73%, 83%, and 90%) were significantly greater among those who had received hMG/CC stimulation. A comparison of hMG/CC with hMG and CC cycles revealed a statistically significant increase in the total number of developing follicles (4.5 +/- 0.3, 3.3 +/- 0.2, and 3.1 +/- 0.3, respectively; P = 0.0137), total oocytes recovered (4.1 +/- 0.3, 3.2 +/- 0.2, and 2.5 +/- 0.2; P = 0.0011), and embryos transferred (2.2 +/- 0.2, 1.4 +/- 0.2, and 1.4 +/- 0.2; P = 0.0013). However, there was no significant difference in the occurrence of ongoing pregnancies. Thus, in terms of the per-patient number of follicles, oocytes, and embryo transfers, combined hMG/CC stimulation appears to be superior to either hMG or CC alone. However, to date the combined regimen has not improved pregnancy rates.

Clomiphene↗
PubMed1986

Determinants of left ventricular aneurysm formation after anterior myocardial infarction: a clinical and angiographic study.

To determine factors involved in left ventricular aneurysm formation after transmural anterior myocardial infarction, 79 patients with a first myocardial infarction who underwent cardiac catheterization within 6 months of infarction were evaluated. Patients who had received thrombolytic therapy were excluded. Patients were divided into four groups depending on the status of the left anterior descending artery and the presence or absence of a left ventricular aneurysm: Group I (n = 25): aneurysm with occluded left anterior descending artery; Group II (n = 27): no aneurysm and occluded left anterior descending artery; Group III (n = 23): no aneurysm and patent left anterior descending artery; and Group IV (n = 4): aneurysm with patent left anterior descending artery. Single vessel disease was more common in Group I (aneurysm) compared with Groups II and III (no aneurysm) (chi 2(4) = 12.8; probability value equal to 0.012). Collateral blood supply in the presence of an occluded left anterior descending artery was significantly less in Group I (aneurysm) compared with Group II (no aneurysm) (0.9 versus 2.4, p less than 0.001). The extent of coronary artery disease and collateral blood supply in Groups I and II were directly related (p = 0.012). Neither age, sex nor risk factors for coronary disease correlated with aneurysm formation. At a mean follow-up of 48 months, no differences were observed in the incidence of recurrent angina, new myocardial infarction, embolic events or sudden death. More patients in Group II underwent coronary artery bypass surgery. Total occlusion of the left anterior descending artery in association with inherent poor collateral blood supply is a significant determinant of aneurysm formation after anterior myocardial infarction. Multivessel disease with either good collateral circulation or a patent left anterior descending artery is uncommonly associated with the development of left ventricular aneurysm.

Angiography↗
PubMed1986

An outbreak of staphylococcal skin infections among river rafting guides.

Outbreaks of staphylococcal skin infections among healthy adults are most unusual. The authors report an epidemic of skin infections due to Staphylococcus aureus that involved river rafting guides in Tennessee, South Carolina, and North Carolina in summer 1982. Infections occurred only among employees of the rafting companies that provided communal, on-site housing; carriage rates of S. aureus were as high as 89% at those companies. A case-control study found that having had an infected roommate was significantly associated with infection, as was working at the livery with the most crowded housing. This outbreak appeared to be due to two factors: frequent minor skin wounds acquired while rafting, and prolonged close contact among the persons with wounds. It is likely that crowding and exposure to infected wounds led to elevated S. aureus carriage rates, which in turn increased the probability that wounds would become infected. Repeated immersion in water likely enhanced the development of infections.

Adolescent↗
PubMed1986

Correlation of the one-minute Apgar score and umbilical cord acid-base status.

The one-minute Apgar score has proven useful by ensuring rapid assessment of the neonate, but is often poorly correlated with other indicators of intrauterine well-being. Since fetal asphyxia is directly associated with neonatal acidosis, a low Apgar score in the face of normal pH and base deficit does not indicate an asphyxiated infant. In a study to ascertain the feasibility of combining umbilical artery pH with the one-minute Apgar score for neonatal assessment, umbilical artery pH and Apgar scores were obtained on 212 singleton pregnancies. When the Apgar score was less than 7, more than half (60%) of the neonates had a normal umbilical artery pH. Fifty-one percent of this group had had intubation and nasopharyngeal suctioning, procedures known to be associated with lowered Apgar scores. When reviewing the umbilical artery gas values and base deficit in those neonates with a pH less than 7.20, we found that of the eight patients with an Apgar score of 7 or greater, seven (87.5%) were classified as having metabolic acidosis, with only one having respiratory acidosis. In the neonates with Apgar scores of less than 7, approximately two thirds had blood gas values compatible with metabolic acidosis, while the others displayed respiratory acidosis. We recommend, therefore, that neonates with a one-minute Apgar score less than 7 have umbilical artery pH determinations to confirm the presence or absence of acidosis. We also recommend that when the pH is less than 7.20, a complete set of gas values be evaluated with that specimen. This information offers more precise confirmation of the diagnosis of fetal distress and neonatal asphyxia, both for treatment and more reliable follow-up data, as well as for medicolegal purposes.

Acid-Base Equilibrium↗
PubMed1986

Multivariate analysis of risk factors in cadaver donor kidney transplantation.

Data collected prospectively on 3811 kidney transplants performed between June 1977 and July 1982 with follow-up to July 1984 by the 42 member institutions of the South-Eastern Organ Procurement foundation were analyzed to identify factors associated with graft and patient outcome in patients not receiving cyclosporine. Multivariate Cox regression analysis was used to examine the association and relative risk of 24 variables with three actuarial outcomes: overall graft failure, irreversible rejection, and patient death. Factors having no suggested association with any outcome included: recipient sex, history of pregnancy, blood group, and time on dialysis; organ preservation method, time and source; donor race; crossmatch test sensitivity; and annual center transplant rate. In decreasing order of relative risk, the factors most significantly associated with irreversible rejection were: loss of two or more prior grafts, low HLA-A,B match, lack of pretransplant blood transfusion, high (greater than 60%) pretransplant sensitization to leukocyte (HLA) antigens, and delayed graft function. Splenectomy, insulin-dependent diabetes, and antilymphocyte serum therapy provided the greatest risk of patient death. Factors such as recipient age, race, and native nephrectomy had suggested associations with outcome. By adding each center as a separate covariate in the analysis, other center-dependent factors were quantitated and found in some cases to have a highly significant association with graft and patient outcome. These results provide a basis for evaluating the potential risk of graft loss or patient death for those prospective cadaver kidney transplant recipients not being considered for cyclosporine therapy.

Cadaver↗
PubMed1986

Dexamethasone suppression testing in chronic renal failure: pharmacokinetics of dexamethasone and demonstration of a normal hypothalamic-pituitary-adrenal axis.

The status of the hypothalamic-pituitary-adrenal axis in chronic renal failure (CRF) was examined by dexamethasone suppression testing (DST) using oral overnight, oral and iv 8-h daytime, and standard 48-h oral dosage protocols. Based on data obtained after iv administration of dexamethasone, the daytime study was used to calculate pharmacokinetic parameters for dexamethasone (clearance, volume of distribution at steady state, and terminal t1/2). None of a group of seven uremic patients had suppressed plasma cortisol concentrations after administration of 1 mg dexamethasone, orally, the night before. Six normal subjects and six patients with CRF participated in the pharmacokinetic study. There was no significant difference between the groups with respect to clearance, volume of distribution at steady state, or t1/2 of dexamethasone, indicating that patients with CRF metabolize dexamethasone in a fashion similar to that of normal subjects. Daily patterns of plasma cortisol determined between 0800-1600 h on a day when dexamethasone was not administered were similar in normal subjects and CRF patients. However, the degree of suppression of plasma cortisol after dexamethasone was significantly greater in the normal subjects (P less than 0.01), possibly due to a prolonged cortisol t1/2 in CRF. Nevertheless, the CRF patients did have decreased plasma cortisol levels from 4-8 h after iv and from 4-7 h after oral dexamethasone. The bioavailability of dexamethasone was not significantly different between the groups. When 48-h oral DSTs were performed in the CRF group, four of five patients had normal responses. The one patient who did not suppress had low levels of plasma dexamethasone, presumably due to decreased gastrointestinal absorption of dexamethasone. These results indicate that the metabolism of dexamethasone is similar in CRF patients and normal subjects, that normal suppression of plasma cortisol can be achieved in uremia if the duration of dexamethasone administration is prolonged sufficiently to compensate for the prolongation of cortisol t1/2 in CRF, and that it is essential to measure plasma dexamethasone as well as cortisol levels to interpret the results of a DST in CRF patients.

Administration, Oral↗
PubMed1986

Advanced poorly differentiated carcinoma of unknown primary site: recognition of a treatable syndrome.

We describe the clinical characteristics and prognostic features of 71 patients with advanced poorly differentiated carcinoma of unknown primary site. These patients had at least one component of the extragonadal germ cell cancer syndrome that we have previously described. Of 68 patients who received therapy, 62 were given intensive cisplatin-based combination chemotherapy that is used for treatment of germinal neoplasms. Fifteen patients (22%) had complete responses, and 9 patients (13%) have remained free of tumor after a minimum follow-up of 36 months (range, 36 to 67 months). Tumor in the mediastinum, retroperitoneum, and lymph nodes was associated with a favorable outcome of treatment when compared with tumor in other locations (p = 0.0016, Cox regression analysis). Although the histogenesis of tumors in many of these patients remains unclear, we believe the tumors most likely originate from germ cells. Patients with advanced poorly differentiated carcinoma should be considered for treatment with cisplatin-based combination chemotherapy, particularly if tumors occur predominantly in the mediastinum, retroperitoneum, or lymph nodes.

Actuarial Analysis↗
PubMed1986

HLA matching for cadaver renal transplantation in SEOPF: the impact of cyclosporine. Southeastern Organ Procurement Foundation.

Since the introduction of CsA in 1983, several changes in SEOPF activity have been observed: 1. Organ recovery has increased at a rate slower than candidate registration, whereas the utilization rate has increased substantially. 2. Overall organ sharing has decreased for both CsA and non-CsA-treated patients. 3. The percentage of poor HLA-A,B matched recipients has increased for both CsA- and non-CsA-treated patients. 4. The use of cold storage preservation has increased for both CsA- and non-CsA-treated patients. 5. The use of ALS has decreased, predominantly in CsA-treated patients. 6. A majority of diabetics are being treated with CsA. 7. There is substantial individual variation in SEOPF center preferences for CsA use, HLA matching, and use of shared kidneys. In terms of graft outcome, the following associations have been observed: 1. The incidence of delayed graft function has increased with shared kidneys only, suggesting sharing of poorer quality as well as fewer kidneys. 2. First transplant recipients receiving CsA tend to have lower delayed graft function rates, possibly as a result of treatment selection. However, the risk of graft failure associated with delayed function is greater in patients receiving CsA. 3. By univariate analysis, there is an additive benefit of HLA-A,B matching and CsA use in patients receiving local kidneys with immediate function. 4. By multivariate analysis, there is a significant relative risk of graft rejection associated with poor HLA-A,B matching in patients receiving CsA. 5. By multivariate analysis, there is an apparent risk of graft loss associated with shared organs, but only in patients receiving CsA. One possible explanation is that poorer quality kidneys are being accepted for patients treated with CsA. 6. By multivariate subset analysis, there is a significant benefit of CsA use in patients whose HLA is poorly matched, but no observed benefit in well-matched patients. 7. Definitive evaluation of the relative effects of CsA and HLA matching on cadaver renal allograft survival must await long-term follow-up data on survival and function, and the ability to control for center bias in sharing, HLA matching, and CsA use.

Cyclosporins↗
PubMed1986

Improved outcome of twice weekly nonstress testing.

The nonstress test is a commonly used tool for fetal well-being assessment. The antenatal death rate using the nonstress test as a primary modality is significantly higher than that with the use of the contraction stress test. The nonstress test is commonly performed on a once-a-week basis. The rate of stillbirths with reactive nonstress tests, performed once a week, was 6.1 per 1000 in the author's previously published report. Nonstress tests were performed on a twice-a-week basis beginning January 1981, and results are reported on 913 such patients. The rate of stillbirths with reactive nonstress tests was reduced to 1.9 per 1000 in this second group. It is suggested that the patients who are at risk for fetal stress should be evaluated on a twice-a-week basis when the nonstress test is used as the primary test.

Female↗
PubMed1985

Antepartum fetal monitoring in insulin-dependent diabetic pregnancies.

In order to minimize unexplained stillbirths in insulin-dependent diabetic pregnancies, fetal well-being was assessed by antepartum monitoring while development of pulmonary maturity was awaited. Antepartum monitoring consisted of outpatient nonstress tests beginning at 32 weeks' gestation. Fetuses with nonreactive nonstress tests were further evaluated by contraction stress tests and were delivered if tests were positive. With use of this system there were no unexplained stillbirths during management of 119 insulin-dependent diabetic pregnancies. Of 14 infants delivered because of positive contraction stress tests, six were found to have major disorders; the other eight had no major residual neonatal morbidity. Thus this system of antepartum fetal surveillance: eliminated unexplained stillbirths, identified a subgroup of insulin-dependent diabetic pregnancies with a high rate of major fetal abnormalities, and allowed for identification and subsequent timely delivery of the other distressed fetuses that were at a high risk of neonatal morbidity and/or mortality, such that potential long-term adverse outcomes were avoided.

Adult↗
PubMed1985

Selection of superior stimulation protocols for follicular development in a program for in vitro fertilization.

Classification of stimulated controlled follicular development cycles in programs for in vitro fertilization by the likelihood of culminating in a pregnancy would allow for increased efficacy in patient management and the distribution of care provider services. Analysis of human menopausal gonadotropin stimulations by the estradiol (E2) patterns identified trends suggesting superiority of one pattern, but no statistically significant difference was identified. Similarly, trends were identified in the Norfolk data for the height and pattern of E2 response, but no statistical significance was identified. While these observations may become significant with larger numbers, until that time, criteria for altering patient management based on the rise of follicular phase E2 levels should be reconsidered.

Chorionic Gonadotropin↗
PubMed1985

Outcome of successive cycles of ovulation induction in the same individual.

Because of the failure to conceive after the first cycle of in vitro fertilization (IVF), many couples often undergo repeated attempts. However, choosing the best stimulation protocol in successive cycles of IVF in the same individual is hindered by the lack of information regarding outcome in successive cycles following utilization of the same or different stimulation protocols. Examination of repeated cycles of the same stimulation protocol in 33 women demonstrated that comparing women with an initial "A" estradiol (E2) pattern (daily E2 levels that continued to rise throughout the stimulation) and those with non-A E2 patterns (failure to have continually rising E2 levels throughout the stimulation), the former were significantly less likely to have a subsequent passed cycle (P = 0.007) and tended to be more likely to have a subsequent A cycle (P = 0.079). Changing the stimulation protocol resulted in a different E2 pattern in 15 of 20 subsequent cycles. Thus, it is suggested that after a cycle with an acceptable E2 pattern, successive cycles be performed with the same stimulation protocol. However, after an initial unacceptable E2 pattern, it may be more efficacious to utilize an alternate stimulation protocol.

Chorionic Gonadotropin↗