Biomedical subjects
J C Scott
Publications and source records attributed to J C Scott.
Effects of dietary fat on cholesterol metabolism in the diabetic rat.
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Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.
CONTEXT: Alendronate sodium reduces fracture risk in postmenopausal women who have vertebral fractures, but its effects on fracture risk have not been studied for women without vertebral fractures. OBJECTIVE: To test the hypothesis that 4 years of alendronate would decrease the risk of clinical and vertebral fractures in women who have low bone mineral density (BMD) but no vertebral fractures. DESIGN: Randomized, blinded, placebo-controlled trial. SETTING: Eleven community-based clinical research centers. SUBJECTS: Women aged 54 to 81 years with a femoral neck BMD of 0.68 g/cm2 or less (Hologic Inc, Waltham, Mass) but no vertebral fracture; 4432 were randomized to alendronate or placebo and 4272 (96%) completed outcome measurements at the final visit (an average of 4.2 years later). INTERVENTION: All participants reporting calcium intakes of 1000 mg/d or less received a supplement containing 500 mg of calcium and 250 IU of cholecalciferol. Subjects were randomly assigned to either placebo or 5 mg/d of alendronate sodium for 2 years followed by 10 mg/d for the remainder of the trial. MAIN OUTCOME MEASURES: Clinical fractures confirmed by x-ray reports, new vertebral deformities detected by morphometric measurements on radiographs, and BMD measured by dual x-ray absorptiometry. RESULTS: Alendronate increased BMD at all sites studied (P<.001) and reduced clinical fractures from 312 in the placebo group to 272 in the intervention group, but not significantly so (14% reduction; relative hazard [RH], 0.86; 95% confidence interval [CI], 0.73-1.01). Alendronate reduced clinical fractures by 36% in women with baseline osteoporosis at the femoral neck (>2.5 SDs below the normal young adult mean; RH, 0.64; 95% CI, 0.50-0.82; treatment-control difference, 6.5%; number needed to treat [NNT], 15), but there was no significant reduction among those with higher BMD (RH, 1.08; 95% CI, 0.87-1.35). Alendronate decreased the risk of radiographic vertebral fractures by 44% overall (relative risk, 0.56; 95% CI, 0.39-0.80; treatment-control difference, 1.7%; NNT, 60). Alendronate did not increase the risk of gastrointestinal or other adverse effects. CONCLUSIONS: In women with low BMD but without vertebral fractures, 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity. Alendronate significantly reduced the risk of clinical fractures among women with osteoporosis but not among women with higher BMD.
Evaluation of the effect of food on the absorption of sustained-release theophylline and comparison of two methods for serum theophylline analysis.
Fifteen healthy volunteers took part in a study to investigate the effect of food on the bioavailability of a slow-release formulation of theophylline. Serum theophylline levels were measured every two hours for ten hours after a single oral dose of 500 mg of theophylline. Serum levels were significantly higher after the dose was taken on an empty stomach; however, serum levels were significantly higher 10 hours later when the dose was taken after a standard meal. Despite these differences, eating had no overall effect on theophylline bioavailability. Two analytic methods for measuring serum levels of theophylline were compared, and it was found that fluorometry could measure lower levels and was therefore more precise than an enzyme immunoassay method, which is probably due to the complete automation and reduced interference of bilirubin and hemoglobin.
Retreatment of recurrent pelvic tumors with iodine-125.
We describe our experience with successful retreatment of common pelvic tumors including recurrent cervical and endometrial cancer, colorectal cancer, and soft tissue sarcomas. Two different permanent interstitial 125iodine (125I) endocurietherapy (ECT) techniques were employed. The first technique, percutaneous transperineal template 125I ECT, was used in the retreatment of recurrent tumors located within the true pelvis. The second technique, implantation of 125I in Vicryl carrier following celiotomy, was used for retreatment of recurrent tumors located outside the true pelvis within the false pelvis.
Choice of afterloading endocurietherapy techniques for vaginal carcinoma.
Vaginal cancer is highly curable in all stages by combining the proper interstitial or intracavitary endocurietherapy (ECT) techniques and external beam radiation therapy (EXRT). Each case must be individualized following careful evaluation of stage and local extent of disease. We describe three afterloading ECT techniques used for treatment of various presentations of vaginal cancer: 1) 137cesium vaginal obturator used for superficial lesions; 2) afterloading 192iridium tube and button technique used for localized lesions of the lower one-third of the vagina which do not involve more than one-half of the circumference; and 3) afterloading transperineal interstitial 192iridium template technique used for thick invasive lesions of the upper two-thirds of the vagina. Our technique for EXRT is also described.
Low morbidity following 9,000-rad intracavitary endocurietherapy (ECT) using the Kumar Cervical Applicator and external-beam radiotherapy (EXRT) in the management of carcinoma of the uterine cervix.
The Kumar Cervical Applicator minimizes patient discomfort and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. Patients with previously untreated invasive carcinoma of the uterine cervix, F.I.G.O. stages IB-IVA, were treated with two Kumar intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point "A," and 4,000 rad external-beam radiotherapy (EXRT) to midplane, for a total dose of 9,000 rad. The major complication rate was 2.7%, and the local control rate was 85% (22/26 patients) for stage I and II, and 91% (10/11 patients) for stage III and IVA.
TAH and BSO with adjuvant pelvic EXRT and vaginal Cs-137 boost in the management of carcinoma of the endometrium.
Combined surgery and radiation has become standard therapy for operable endometrial cancer patients with stage IA (grade 2-3 or deep muscle invasion), stage IB, stage II, and selected stage III disease. We discuss the rationale for whole pelvic external-beam radiation therapy (EXRT) followed by vaginal endocurietherapy (ECT) boost, and present the outcome of 43 patients with endometrial cancer treated by combined surgery and radiation.
Techniques for management of vulvar cancer by irradiation alone.
Vulvar cancer has traditionally been managed surgically, rather than by means of irradiation, because of the poor tolerance of the vulvar skin and mucous membranes to X-ray treatment. The use of moderate dose (4,000 rad) external-beam radiotherapy (EXRT) combined with two interstitial 192iridium endocurietherapy (ECT) applications of 2,500 rad to 3,000 rad allows delivery of an adequate tumoricidal dose (9,000 rad to 10,000 rad total dose) without producing radiation vulvitis. Irradiation is an effective alternate means of treatment in elderly patients who are medically unfit for radical vulvectomy and lymphadenectomy. It also provides an alternative to surgery for those patients who desire preservation of the genitourinary anatomy.