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Biomedical subjects

D H Scott

Publications and source records attributed to D H Scott.

At least 37 records · Page 2Linked to original sources
PubMed1993

The effect of transfusions on renal allograft survival in the cyclosporine era: a single center report.

The potential efficacy of prior transplant transfusions on graft survival in the cyclosporine era has been reported from several centers which are reconsidering their transfusion policy. The purpose of this study has been to evaluate the results obtained in a large series of first kidney transplant patients (N=284) treated with cyclosporine. Our past experience showed a beneficial effect of blood transfusions in cadaveric renal transplants on conventional immunosuppression. Forty-eight patients never received blood transfusions, 85 patients received 1-2 transfusions, 72 patients received 3-5 transfusions and 79 patients received more than 5 transfusions in their pre-transplant periods. We did not show an obvious beneficial effect of prior blood transfusions in improving 1- and 2-year patient and graft survival. In fact, no statistically significant differences were found among any of the groups depending upon the transfusion status. In the transfused group, graft survival rates were 81.4% (1 year) and 77.8% (2 years) while in the non-transfused group they were 81.2% (1 year) and 78.4% (2 years)(p=n.s.). The patients who rejected had a significantly lower graft survival in the transfused group as compared to the non-transfused group. On the other hand, the transfused patients without rejection episodes experienced the best graft survival, suggesting a beneficial transfusion effect. We conclude that since it is impossible to determine which patients will not reject, pre-transplant transfusions under certain circumstances might be harmful, or at least not beneficial. We would recommend restricting transfusions in cyclosporine-tested patients only in cases of therapeutic necessity.

Adolescent↗
PubMed1991

The isolated bowel segment (Iowa Model II): absorption studies for glucose and leucine.

A model of the isolated bowel segment (IBS, Iowa Model II) was successfully created in experimental animals using a new surgical technique we developed. The IBS is completely free of its mesenteric attachment, yet its viability is preserved. The technique consists of two staged procedures: (1) initial enteropexy between the anterior margin of the liver and the antimesenteric border of the IBS with its ends forming cutaneous stomas; and (2) division of the IBS mesentery 5 weeks later. The IBS is nourished by vascular collaterals that form at the hepatoenteropexy during the interval between these two procedures. Our previous studies demonstrated preserved viability and motility in the IBS. This study was undertaken to test absorption in the IBS. In 25 rats (experimental group), the IBS (Iowa Model II) was created using an 8-cm-long isolated segment of jejunum. In 15 rats (control group), an 8-cm-long segment of jejunum was arranged to form a Thiry-Vella loop. Five weeks later, the IBS mesentery was divided in the experimental group, and sham laparotomy was performed in the control group animals. Absorption of glucose and leucine was studied in 13 rats of the experimental group and 6 of the control group using a constant single perfusion technique at 3, 8, and 11 weeks after the initial operation. The results were compared between the two groups. There was a 25% to 35% reduction in absorption of glucose and leucine in both groups with the advance of time, but no significant difference was observed between the groups except in leucine absorption at 11 weeks after the initial operation. This study concludes that absorption of glucose and leucine is preserved in the IBS after its mesentery is divided, suggesting that the IBS can be used as a functioning bowel for bowel reconstruction.

Animals↗
PubMed1991

Reoperation for failed gastric bypass procedures for obesity.

Reoperation is worthwhile when there is an obvious defect in the gastric reduction operation that has failed to control weight. Reoperation occasionally is necessary to correct a complication of gastric bypass. Vertical banded gastroplasty is the operation of choice for reoperations, as it provides weight control while eliminating the problems of bypass. Conversion of a horizontal to a vertical pouch is safe but requires careful attention to the technique to avoid injury to the other organs in the area and preservation of blood supply to the stomach. The gastrogastrostomy across the old horizontal staple line in the vertical pouch can be constructed in a way that will minimize the risk of obstruction. Vertical banded gastroplasty is now the only operation in use at UIHC for the treatment of obesity and is used not only as the primary operation but in all reoperations. Bypass of the stomach and duodenum is not necessary for weight control and adds some risk of malabsorption and duodenal and stomal ulcer plus a lifetime of inaccessibility of the excluded areas for diagnostic and therapeutic measures.

Animals↗
PubMed1990

A disposable blood pressure cuff. An assessment of its accuracy.

An empty 500-ml infusion bag was used as the cuff for a Lifestat 100 oscillotonometer. The systolic and mean blood pressures obtained in 40 subjects were not significantly different from those measured with a standard cuff. The diastolic pressure was unrelated between the two cuffs. The empty bag is a cheap and hygienic option in patients who present a high infection risk.

Blood Pressure↗
PubMed1988

Squamous cell carcinoma of the anus: a twenty-five year retrospective.

Squamous cell carcinoma of the anus (SCCA), an aggressive and often fatal malignancy, has traditionally been treated with surgery. In recent years, however, nonoperative therapy has emerged as an alternative to operation. Twenty five years of experience with SCCA at this institution were reviewed to examine the presentation and outcome of a population treated primarily with surgery. Forty two patients, including 26 women and 16 men, had a mean age of 56 years. SCCA was usually heralded by a mass, bleeding, or pain and was associated with chronic perianal disease in 25.8%. Symptoms were present for an average of 11 months. Among the patients in this review, 92.3 per cent underwent radical surgery, while 11.9 per cent had radiation as their primary therapy following palliative surgery or local excisions for biopsy. Actuarial 5-year-survival for the entire group was 45.5 percent; all patients with nodal or disseminated disease at diagnosis have died. Patients with perianal lesions fared no better than those with anal tumors, probably due to the unusually large perianal tumors in this series. To diagnose SCCA at its earliest stage, a high index of suspicion must be maintained when dealing with anal and perianal lesions, especially if the abnormality is chronic. When compared with reported advances in combined therapy, it is likely that in most cases surgery alone no longer offers optimal treatment for SCCA.

Actuarial Analysis↗
PubMed1987

Role of an emergency helicopter transport service in rural trauma.

The records of 916 trauma victims transported by an emergency helicopter service were reviewed to evaluate its impact on patient outcome. According to strict criteria, the service was classified as essential, helpful, or "not a factor" in the preservation of life and/or limb in each case. The helicopter service was essential in 14.0%, helpful in 12.9%, and "not a factor" in 56.6% of patients. A fourth category included patients who, despite the delivery of maximal emergency medical care, died as a result of their injuries (16.5%). With the available initial information, it was impossible to determine prospectively which patients would benefit from air transport. We believe that the rapid evaluation of potentially serious injuries and the number of patients for whom the service proved beneficial justify its use, particularly in rural areas.

Adolescent↗
PubMed1987

Super obesity and gastric reduction procedures.

Identification and designation of those patients whose estimated ideal weight exceeds 225 per cent as super obese has improved our evaluation of operations designed for treatment of obesity. It has also allowed a more realistic prediction of results, and provided a basis for further study of both the need for, and effectiveness of, further modification of operative treatment of these extremely heavy people. The super obese patient provides a severe test for operative weight control. Much has been accomplished with purely restrictive operations in the super obese group and it is possible that the 50 per cent reduction of excess weight achieved by VBG among these patients is sufficient to prevent the more serious medical complications from extreme obesity.

Adolescent↗
PubMed1987

The utility of MMPI subtypes for the prediction of weight loss after bariatric surgery. Minnesota Multiphasic Personality Inventory.

In this paper we report a study designed to improve the ability to predict postoperative weight loss employing methods dictated by the premise that substantial psychological homogeneity is necessary within subsets of patients before similar weight losses can be observed within those subsets. Subjects were 138 women who completed the MMPI prior to undergoing vertical banded gastroplasty. Cluster analysis of the MMPI profiles identified 10 predictive MMPI types. Fifty-six percent of the patients were classified into the 10 types, the remainder were grouped into a residual category. Analysis of covariance revealed that MMPI type accounted for 50 percent of the variance in 12-month weight loss after covarying for initial weight and pre-operative percentage of ideal weight. Variables that added significantly to the prediction of weight loss were age and MMPI scale Pd. In general, the prototypic profiles indicative of the greatest disturbance predicted poor weight loss. In contrast to the 10 MMPI types described in this study, an alternative clustering of patients into fewer groups with much less psychological homogeneity was not predictive of outcome.

Adult↗
PubMed1984

Evaluation of an emergency air transport service as a component of a rural EMS system.

The authors reviewed the records of 569 patients transported by an emergency helicopter service to evaluate its impact on the outcome of patients with multisystemic injuries. A Total Trauma Score for each patient was computed. A number of other factors were also considered, including the nature of the injury, number of systems injured, origin and duration of flight, resuscitative maneuvers, number of blood transfusions given and the timing of operations required to treat the injury. The service was then rated utilizing strict specific guidelines as either essential, helpful or not a factor, in the preservation of life and/or limb in each case. A fourth group was comprised of patients who expired as a result of their injuries. The air transport service was essential to 16.5% and helpful to 10.9% of patients. In spite of rapid evaluation and maximal intervention, 102 (17.9%) of the patients died. The group for which air transport was judged "not a factor" (54.7%) consisted of patients whose injuries would not have proven fatal had their transportation to the tertiary care center been delayed. Retrospective analysis of the data available to the tertiary care center at the time of the decision to transfer the patients by air revealed that it was not possible to differentiate those patients who did not benefit from the service from those for whom the service was judged essential or helpful. Even though 17.9% of the helicopter transported patients died at some time during their period of hospitalization, they did receive the benefit of prompt sophisticated evaluation and management of their injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗