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Biomedical subjects

C Duncan

Publications and source records attributed to C Duncan.

At least 73 records · Page 4Linked to original sources
PubMed1991

Effect of inadequate antivenin stores on the medical treatment of crotalid envenomation.

The case of a 27-y-old male with a serious Crotalus atrox envenomation is presented. His medical care was compromised by the lack of readily available polyvalent Crotalidae antivenin. An investigation of antivenin stocking by health care facilities in Arizona was undertaken. Failure to stock sufficient quantities of antivenin to initiate treatment of a single patient with a severe envenomation was found in 43.5% of urban hospitals, 41.2% of rural hospitals within 25 miles of another hospital, 52.9% of rural hospitals greater than 25 miles from another hospital, and 41.7% of Indian Health Service hospitals. Current antivenin stocking was related to antivenin use during the previous year. Reliance on recent antivenin use to guide current antivenin stocking leaves many hospitals with insufficient antivenin stores and may seriously compromise the medical care of patients suffering from rattlesnake envenomations.

Adult↗
PubMed1990

Evaluation of primary lung cancer with indium 111 anti-carcinoembryonic antigen (type ZCE-025) monoclonal antibody scintigraphy.

A study was undertaken to test whether indium 111 (111In)-labeled anti-carcinoembryonic antigen (CEA) (type ZCE 025) monoclonal intact antibody (MoAb) would concentrate in primary lung cancer enabling its detection and localization by scintigraphy. The scintigraphic results were correlated with chest radiograph, computed tomograph (CT), bronchoscopy, surgical resection, and tumor CEA analysis. Twenty adult male patients with clinical suspicion of primary lung cancer were studied. Each subject was infused with 4 to 5 mCi of 111In anti-CEA ZCE 025 MoAb, and planar and tomographic scintiphotos were obtained on days 3 and 6 or 7 postinfusion. The scintigraphy was true-positive in 12 of 16 patients with primary lung cancer, eight of nine patients with squamous cell carcinoma, and four of seven with adenocarcinoma; it was true-negative in three of four patients with benign lung disease with an overall accuracy of 75%. In seven patients with confirmed primary lung cancer, but with negative bronchoscopic findings, the scintigraphy was true-positive in four. In 11 patients with definitely positive or suspicious malignancy by bronchoscopy the monoclonal scintigraphy was positive in eight. In true-positive cases, the location and size of the lesion by 111In anti-CEA ZCE 025 MoAb imaging correlated well with CT findings and also tumor mass at surgery. Only one of 12 tumors stained positive for CEA had serum CEA levels greater than 10 ng/ml, indicating nonleakage of the tumor antigen into general circulation in early lung cancer. It is concluded that 111In anti-CEA ZCE 025 MoAb planar and tomographic imaging shows potential to serve as a noninvasive diagnostic test in the evaluation of primary lung cancer. The lung lesion is likely to be malignant if it concentrates 111In anti-CEA ZCE 025 MoAb and benign if it does not. Further studies in large number of patients with suspected primary lung cancer are needed to define the ultimate role for MoAb scintigraphy.

Adenocarcinoma↗
PubMed1990

Evaluation of a Fife 'Novopen' clinic held within a diabetes patient education centre.

In common with other hospitals throughout the United Kingdom, a diabetic patient education centre has been established at the Victoria Hospital, Kirkcaldy. Many activities now take place within the centre including a 'Novopen' Clinic at which insulin requiring diabetic patients are converted to a multiple injection method of delivering soluble human insulin. An evaluation of the Novopen Clinic, including the first 60 patients attending, has demonstrated a statistically significant fall in random blood sugar estimations (mean fall 2.0 m.moles 1(-1), 95 per cent confidence intervals 1.5 m.moles 1(-1) to 2.5 m.moles) since conversion at the Novopen Clinic. Changes in mean daily insulin intake (mean increase of 1.6 units per day) and glycosylated haemoglobin (mean fall of 0.88 per cent) were not significant. One hundred per cent of patients surveyed described the Novopen Clinic as 'helpful' or very 'helpful'. Staff see the clinic offering significant opportunities for patient education. The estimated cost of the clinic per new patient was 147 pounds.

Diabetes Mellitus↗
PubMed1989

Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program.

STUDY OBJECTIVE: To test whether physicians who receive a continuing education program ("Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke. DESIGN: Randomized trial with blinded assessment of principal outcomes. SETTING: Four health maintenance organization medical centers in northern California. SUBJECTS: Eighty-one internists assigned by blinded randomization to receive training (40) or serve as controls (41). Consecutive samples of smokers visiting each physician (mean, 25.6 patients per experimental and 25.2 per control physician). INTERVENTIONS: Internists received 3 hours of training about how to help smokers quit. Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting. MEASUREMENTS AND MAIN RESULTS: On the basis of telephone interviews with patients after visiting the physician, we determined that internists who attended the Quit for Life program discussed smoking with more patients who smoked, spent more time counseling them about smoking, helped more patients set dates to quit smoking, gave out more self-help booklets, and made more follow-up appointments to discuss smoking than did internists in the control group. One year later, the rate of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking was 1% higher among all patients of trained internists than among patients of controls (95% CI, -0.1% to +2.3%), and 2.2% (+0.2% to +4.3%) higher among the patients who most wanted to quit smoking. CONCLUSIONS: This continuing education program substantially changed the way physicians counseled smokers. As a result, a few more patients who wanted to quit smoking achieved long-term abstinence.

Attitude of Health Personnel↗
PubMed1989

Standard and double dose ipratropium bromide and combined ipratropium bromide and inhaled metaproterenol in COPD.

Inhaled ipratropium bromide (IPR) is effective in the management of COPD. The purpose of this study was to determine if doubling the standard dose of IPR resulted in greater bronchodilation and if the addition of an inhaled beta-agonist was superior to standard dose IPR alone. Twelve male patients with stable COPD completed a double blind, randomized trial. On each of three consecutive days, following baseline spirometry, all patients inhaled two puffs of IPR. This was followed by either two additional puffs of IPR, two puffs of metaproterenol (META), or two puffs of placebo. All inhalants were delivered by an InspirEase spacer. Spirometry was repeated at 30, 60, 120, and 180 minutes. The group mean percentage increases in the FEV1 and FVC from baseline were similar at all times tested for the three protocols. In conclusion, for the group, there was no objective benefit to doubling the standard dose of IPR or combining IPR with META. Two of 12 patients benefited from combining the two bronchodilators. A potential sequence for bronchodilator testing is suggested.

Administration, Inhalation↗
PubMed1988

School health education to prevent the spread of AIDS: overview of a national programme.

The ultimate goal of CDC's School Health Education to Prevent the Spread of AIDS programme is to reduce the incidence of HIV infection among school-aged youth. Working objectives that integrate programme research and development activities are listed in the opposite Table. In 1982 it was estimated that of the 4.6 billion people in the world, about one billion were school-aged, and about 870 million of these youth were enrolled in schools. WHO, UNESCO, and the International Union for Health Education have recognized that schools could provide a critical means for ensuring that young people throughout the world understand the global AIDS pandemic they face, and what they can do to protect themselves, the families for which they will become responsible, and the communities in which they will reside. But if schools are to provide effective AIDS education, they will require the commitment and active collaboration of education and health leaders in local, national, and international agencies.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Persistent pulmonary hypertension: assessment of perinatal risk factors.

Persistent pulmonary hypertension of the neonate, a disease of unknown etiology, is associated with a mortality rate as high as 50%. We conducted a retrospective study (1979-1983) to identify antenatal events that may be associated with this disease. Thirty-seven mothers of neonates with this disorder were compared with 150 randomly selected control patients. Logistic regression analysis revealed that meconium, maternal fever (caused by urinary tract infection, upper respiratory infection, chorioamnionitis, and unknown causes), maternal anemia (caused by abruptio placentae, placenta previa, and unknown causes), and maternal pulmonary disease (caused by asthma and/or pneumonia) were associated with persistent pulmonary hypertension of the neonate. The computed odds ratios for the variables associated with this disease were increased significantly above the controls. In addition, cesarean section, nonvertex presentation, fetal distress, and vaginal bleeding were found to be significant on univariate analyses. The cesarean section rate in the study group was 59%, with the primary indications of fetal distress and/or third-trimester bleeding in 77.3% of instances. These data suggest that antenatal risk factors and the computed odds ratio may help identify pregnancies likely to produce infants at high risk for persistent pulmonary hypertension of the neonate.

Asphyxia Neonatorum↗
PubMed1985

Adjuvant chemotherapy for medulloblastoma.

The use of adjuvant chemotherapy for cerebellar medulloblastoma is controversial. Twenty-one children and adolescents were treated with adjuvant low-dose cyclophosphamide and vincristine following surgery and radiotherapy. With a mean observation period of 6 years, the disease-free survival is 81%.

Adolescent↗
PubMed1985

Congenital cerebellar medulloblastoma.

Congenital cerebellar medulloblastoma is extremely rare. Reported here is a female infant who presented her first abnormal clinical manifestations on the sixth day of life and who was subsequently found to have medulloblastoma at operation. Electron microscopy revealed glial filaments and short cytoplasmic projections in some neoplastic cells and the presence of junctional complexes between neoplastic cells with and without glial filaments, which suggests the astrocytic differentiation of the tumor. Including our own case, there have been only 21 reported cases of congenital cerebellar medulloblastoma. A strong female preponderance and some familial occurrence are noted in congenital cerebellar medulloblastoma.

Cerebellar Neoplasms↗
PubMed1984

A fundamental temperature-dependent difference between beta-adrenoceptor agonists and antagonists.

Positive inotropic and chronotropic responses of guinea-pig isolated left and right atria to sympathomimetic amines were examined at bath temperatures of 38, 30 or 25 degrees C. The concentration-response curves to isoproterenol and orciprenaline were displaced to the left by cooling, indicating hypothermia-induced supersensitivity. The affinities of isoproterenol and orciprenaline were determined as their dissociation constants (pKA) from antagonism of their responses by either the functional antagonist carbachol or Ro 03-7894 which is reported to be an irreversible beta-adrenoceptor antagonist. By both methods of calculation, the affinities of isoproterenol and orciprenaline for the beta-adrenoceptors mediating inotropic and chronotropic responses were increased by lowering the temperature. In contrast, the affinity of practolol, measured as the pA2 for competitive antagonism of the isoproterenol- and orciprenaline-induced inotropic and chronotropic responses, did not increase with cooling. Thus hypothermia-induced supersensitivity is associated with an increase in agonist affinity only, which indicates a fundamental temperature-dependent difference between agonist and antagonist interactions with the beta-adrenoceptor.

Animals↗
PubMed1984

Outcome of fetal ventriculomegaly.

Ventriculomegaly was diagnosed in 50 fetuses in the perinatal ultrasound unit of Yale-New Haven Medical Center. The outcomes were elective abortion, 13 (26%); antepartum death, 0 (0%); intrapartum death, 7 (14%); neonatal death within 24 h, 11 (22%); neonatal death after 24 h and within 28 days, 3 (6%); death after 28 days, 2 (4%); survival, 14 (28%). 70% of the deaths were associated with severe congenital anomalies or intrapartum cephalocentesis. Of the 14 survivors, 6 (43%) had Bayley mental or Stanford-Binet scores of over 80, 2 (14%) had scores from 65 to 80, and 6 (43%) had scores of less than 65. The differences in outcome between this antenatal population and previously described neonatal populations with ventriculomegaly may result from the high rate (84%) of abnormalities in association with ventriculomegaly in this study and selection biases in neonatal studies.

Abnormalities, Multiple↗
PubMed1984

Folic acid therapy in the fragile X syndrome.

Two brothers with fra(X) positive X-linked mental retardation (XLMR) were treated with folic acid. Initially a double blind cross-over design was employed followed by a long-term high dose trial. A decrease in the frequency of fra(X) positive cells was observed when low folic acid culture medium was used but not when an FUdR induction system was employed. Selected behavioral characteristics improved in both while receiving folic acid. Decreased hyperactivity, greater attention span, increased motor coordination, increased quantity and quality of speech were noted. Improvement in Leiter mental age and regression after cessation of treatment was seen in one subject but not in the other. Further controlled trials with larger numbers of subjects using high doses of folic acid over longer periods of time are needed to assess the possible benefits of this experimental form of treatment.

Adolescent↗
PubMed1984

Paradoxical lipodystrophic changes due to conventional bovine and highly purified porcine/bovine insulins.

A 78-year-old woman developed marked insulin lipoatrophy due to conventional bovine insulin injected into the upper limbs. Changing to a combination of highly purified porcine/bovine insulins injected into the lower limbs resulted in the opposite effect, namely insulin-induced lipohypertrophy. Use was then made of this effect by injecting the highly purified insulins into the atrophied upper limb injection sites with resultant improvement in these wasted areas over the next 10 months.

Aged↗
PubMed1984

Perinatal management of meningomyelocele.

During a 24-month period, nine neonates with a meningomyelocele were delivered. Of these, four meningomyeloceles were detected antenatally with ultrasound during the third trimester. Sonographic diagnosis was based upon a discontinuity in the fetal spine and the presence of a protruding sac. Obstetric management included serial sonography until fetal pulmonic maturity was established, and subsequent low transverse cesarean section. A method of atraumatic abdominal delivery is described. Neonatal management consisted of early closure of the spinal defect and appropriate shunting of hydrocephalus. A team approach to the perinatal management of meningomyelocele is recommended for optimal outcome.

Cesarean Section↗
PubMed1983

The diagnosis of fetal hydrocephalus.

Thirty cases of fetal hydrocephalus were diagnosed at the perinatal ultrasound unit of Yale-New Haven Medical Center during a 41 month period. Prenatal ultrasound was found to be highly valuable in the detection of fetal hydrocephalus. However, the antenatal detection of associated anomalies was not as uniformly successful. The importance of a complete sonographic evaluation of intracranial and extracranial anatomy is stressed, as 10 patients with documented hydrocephalus (37%) had associated intracranial anomalies and 17 patients (63%) had associated extracranial anomalies. In this series, isolated hydrocephalus without associated anomalies occurred in only four patients (15%).

Female↗
PubMed1983

Positional variability in redundant lumbar nerve-root syndrome.

A case of redundant lumbar nerve roots associated with lumbar canal stenosis is described. At myelography, the redundant nerve roots proximal to a site of blockage were noted to disappear on flexion and extension while similar redundancy developed distally. The etiology of this condition is discussed along with the differential diagnosis.

Female↗