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Biomedical subjects

J S Scott

Publications and source records attributed to J S Scott.

At least 91 records · Page 5Linked to original sources
PubMed1994

Establishment of a cell line from a hepatocellular carcinoma from a patient with hemochromatosis.

We describe the establishment and characterization of a novel hepatoma cell line. This cell line, designated RBHF-1, was established from a hepatocellular carcinoma of a 67-yr-old man with a history of genetic hemochromatosis. At this writing, the cells have been maintained in RPMI-1640 tissue-culture medium and fetal calf serum without any additional supplements for 30 mo. The cells form colonies on soft agar and are not tumorigenic in nude mice. The cell line is polymorphic and displays characteristics of mature hepatocytes by synthesizing albumin, alpha 2-macroglobulin, fibronectin and alpha-fetoprotein. Cytogenetic analysis shows multiple chromosomal aberrations, with a consistent deletion in the long arm and deletions or rearrangements in the short arm of chromosome 1. There is no evidence for hepatitis B or hepatitis C virus infection of the cell line. The cells contain no detectable intracellular iron after staining with Perls' stain. Unlike other hepatoma cell lines, there is no detectable binding of epidermal growth factor to RBHF-1 cells. This is the first cell line to be established from a patient with hemochromatosis, and it provides a potentially important model for the study of hepatocyte transformation in association with iron overload.

Aged↗
PubMed1993

Autoreactivity in patients with Behçet's disease.

Behçet's disease (BD) has features consistent with an immunopathogenic mechanism. We tested 23 patients with BD and 139 normal controls for autoantibodies to nuclear, cardiolipin and smooth muscle antigens using indirect immunofluorescence, immunodiffusion, Western blots and an enzyme immunosorbent assay. Serum immunoglobulin G, M and A levels were measured by standard radial immunodiffusion techniques. The prevalence of the following autoantibodies was raised in patients with BD compared with the control group: ANA on rodent (P < 0.05) and human (P < 0.01) substrates and smooth muscle antibody (P < 0.001). Anticardiolipin antibody was detected in one patient (GPL 23.1 U). Antibodies to the ribonucleoproteins Ro, La, Sm and RNP were not found. Levels of serum immunoglobulins G, M and A were elevated in BD compared with the controls and this was significant for immunoglobulin M (P < 0.05) and A (P < 0.001). These findings support the concept of a polyclonal B cell activation in BD.

Adult↗
PubMed1993

Early discharge following vaginal hysterectomy.

OBJECTIVE: To assess the feasibility of discharging selected patients home within 72 h of vaginal hysterectomy. DESIGN: Women for whom vaginal hysterectomy was planned and who were invited to take part. Those who accepted were visited at home by a staff nurse experienced in gynaecology to assess home conditions and family support. If these were suitable, the general practitioner was informed and invited to comment. If the operation was uneventful women were discharged on the third post operative day and visited at home by the nurse until the seventh day. SETTING: Leeds Western Health Authority. MAIN OUTCOME MEASURES: The number of minor complications requiring treatment by the general practitioner, the readmission rate and the acceptability to the woman and her family. RESULTS: For 11 out of 61, home conditions proved unsuitable for early discharge. In six of the remaining 50, abdominal hysterectomy proved preferable to vaginal. Thirty women were discharged home on the third day after vaginal hysterectomy, five on the fourth and seven on the fifth. Two developed urinary tract infections, treated by their general practitioners. Two required readmission to hospital. Twenty-eight of 30 discharged on the third post operative day and nine of 12 discharged on the fourth or fifth post operative day were enthusiastic about the scheme. CONCLUSIONS: Early discharge following uncomplicated vaginal hysterectomy in selected patients appears to be a safe procedure, appreciated by the majority of women. Its adoption as a routine procedure would enable the surgical throughput in a unit to be maintained on a smaller bed complement.

England↗
PubMed1993

Washington mulls over managed-care reform options.

April 24, 1994, 10:35 a.m., EST ... the fateful moment when healthcare spending in America is predicted to reach the unbelievable $1 trillion mark. Managed care--or some version of the much-touted managed-competition proposal--is likely to be a part of cost-saving plans now spinning out of the beltway. Open systems governed by standards are the technological bywords of the future.

Competitive Medical Plans↗
PubMed1993

Community health MIS: "They who have the data make the rules".

Community Health Management Information Systems could be a blessing or a curse, depending on your point of view. But make no mistake, these reform-mandated systems are coming. Will they signal an end to personal privacy as "Big Brother" peeks into everyone's health background, or a new era in information-rich medical care?

Community Health Services↗
PubMed1992

Resident education in surgical endoscopy.

Under the auspices of the Resident Education Committee of the Society of American Gastrointestinal Endoscopic Surgeons, 158 of 298 (53%) of surgical training program directors responded to a survey on the current status of endoscopy in residency programs. Although 100 per cent claim that gastrointestinal endoscopy is provided by their program, only 76 per cent have formal endoscopy training, usually centered around the PGY 3 level, with only 23 per cent having didactic lectures in endoscopy. Directors claim to have trained nearly all of their residents by the completion of residency, averaging 44 esophagogastroscopies, 37 colonoscopies, and 46 flexible sigmoidoscopies per resident. However, they feel only 71 per cent of trainees are able to perform esophagogastroscopies and 67 per cent to perform colonoscopies in clinical practice. Ninety-seven per cent of directors feel endoscopy is important to surgical residency training, and 87 per cent have full-time faculty doing endoscopy. Only 44 per cent have a director of endoscopy; endoscopy is supervised by surgeons exclusively in only 48 per cent. Only 35 per cent have ongoing endoscopy research. When surgeons are not performing endoscopy, 66 per cent feel that the gastrointestinal (GI) service provides adequate service or training. Gastroenterology has a monopoly in endoscopy at 28 per cent of institutions, and 67 per cent of program directors feel there would be resistance to the formation of a separate surgical endoscopy service. Surgeons work in their own surgical endoscopy suite in only 15 per cent of institutions; in a GI suite in 13 per cent; and in a combined suite in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1991

Laparoscopic approach to gallstones in the morbidly obese patient.

Obesity has been suggested to be a contraindication to laparoscopic cholecystectomy (LC). In our center, in which all patients presenting with symptomatic gallstones are considered to be candidates for LC, 24 of the first 325 LC candidates were retrospectively found to be morbidly obese. In all, 20 were women and 4 were men. The average age was 51 years (range 32 to 83 years); the average height and weight amounted to 72 inches and 298 pounds, respectively, for men; and 63.5 inches and 258 pounds, respectively, for women. One-third of these patients suffered from acute cholecystitis, and more than 50% had undergone prior abdominal surgery. The average duration of LC in these subjects was 114 min., which was 25% longer than that in nonobese patients. The average length of the hospital stay was 1.6 days, with patients returning to normal activities within an average of 6.5 days. There was no major morbidity and no mortality. Since obese patients tolerated LC as easily as did normal patients, we concluded that obesity is an indication rather than a contraindication to LC.

Adult↗
PubMed1991

Thought police. Healthcare executives must carefully guard intellectual property developed in their facilities.

Healthcare executives should have a working knowledge of intellectual property law--the legal principle that, for a limited period, treats intangible ideas and concepts as if they were products or property. Not only should administrators be aware of how to protect their facilities' patents, trademarks, copyrights, and trade secrets, but they must also be sure that employees in their own facilities do not infringe on the intellectual property of others. A patent is granted when an inventor proposes a useful new process, machine, "article of manufacture," or composition of matter, including any new and useful improvement on existing items in these same categories. A trademark is a name, symbol, device, or combination thereof adopted and used by an institution to identify its goods or services and to distinguish them from its competitors' goods or services. Expressions of ideas and thoughts set forth in words, sentences, paragraphs, sketches, pictures, graphs, or any other means of conveying ideas or concepts commonly understood to be works of authorship--both published and unpublished--may be protected by a copyright. Trade secret law applies to those who might misappropriate information that has been given to them because of their special relationship with the holder of the trade secret (i.e., through employment, contract, or other fiduciary or trust relationship).

Confidentiality↗
PubMed1991

Beta-adrenergic receptor activity in ponies with recurrent obstructive pulmonary disease.

Pulmonary function measurements were made in control ponies and in ponies with recurrent obstructive pulmonary disease (principals) during clinical remission and during an attack of acute airway obstruction. The ponies were given beta-adrenergic antagonists and agonists to determine the role of beta receptors in recurrent obstructive pulmonary disease, and to determine the subtypes of beta receptors mediating bronchodilation in ponies. Aerosol administration of the beta antagonists, propranolol (beta 1 and beta 2), atenolol (beta 1), and butoxamine (beta 2) decreased dynamic compliance (Cdyn) and increased pulmonary resistance (RL) in the principal ponies during airway obstruction, but were without effect when the ponies were in clinical remission. Intravenous administration of atropine reversed the effect of atenolol on Cdyn and RL, but was without effect on the decrease in Cdyn and increase in RL observed after butoxamine administration. The beta antagonists did not affect airway function in the control ponies. The effect of beta blockade on Cdyn and RL suggests beta-adrenergic activation in the central and peripheral airways of principal ponies, mediated through both beta 2- and beta 1-adrenergic receptors. The aerosol beta agonists, isoproterenol (beta 1 and beta 2), and clenbuterol (beta 2) attenuated histamine-induced airway obstruction to a similar extent in control ponies that were given histamine IV. In addition, the beta 1 antagonist, atenolol, did not attenuate the bronchodilation observed with isoproterenol. We concluded that, although beta 1- and beta 2-adrenergic receptors exist in pony airways and are activated during acute airway obstruction, bronchodilation in response to beta agonists in ponies seems to be mediated primarily by beta 2-adrenergic receptors.

Aerosols↗
PubMed1991

Laparoscopic treatment of acute cholecystitis.

Retrospective review of the first 210 patients treated by laparoscopic cholecystectomy revealed 55 patients (26%) with acute cholecystitis diagnosed preoperatively or intraoperatively. Average age was 52 years amongst 38 women and 17 men. Cardiac history was present in 4%, pulmonary disease was noted in 9%, and other significant medical history was found in 10%. Abnormal preoperative laboratory values (white blood cell count, liver function) were seen in 80%. Operations averaged 104 minutes. Dissection was performed with the potassium titanyl phosphate (KTP) laser in 9%, neodymium-doped yttrium aluminum garnet (Nd Yag) laser in 20%, and electrocautery alone in 71%. Average body habitus was 5 ft 9 in, 178 lb for men and 5 ft 5 in, 155 lb for women. Average length of stay was 2.6 days. Thirty-eight patients (69%) left the hospital in < 2 days. Postoperative complications included one case each of urinary retention, pneumonia, myocardial infarction, and three cases of postoperative fever. Drains were placed in 10 patients (18%). There was no mortality. Suggestions are made for technical considerations that make laparoscopic cholecystectomy a safe and efficient approach to acute cholecystitis.

Acute Disease↗
PubMed1991

Comparison of operative versus percutaneous endoscopic gastrostomy tube placement in the elderly.

To compare techniques of gastrostomy in elderly patients, the records of 100 patients age 70 and older who underwent gastrostomy tube placement as a primary procedure were reviewed. Two separate unmatched groups of 50 patients each were identified: those that underwent operative gastrostomy tube (OGT) placement and those that underwent percutaneous endoscopic gastrostomy tube (PEG) placement. The groups were studied for demographic similarities and for differences in morbidity, mortality, and ease of feeding. Comparison showed that PEGs had a lower mortality (0%) and morbidity (10%) than did OGTs where mortality was 4 per cent and morbidity was 22 per cent. PEGs began feeding sooner (1.0 day vs. 2.8 days) than OGTs. In addition, almost 60 per cent of the PEG patients underwent complete upper endoscopy at the time of the PEG, which revealed pathology that either altered the type of tube placed or the eventual medical management. PEG offers a less morbid, safer, and easier to use method of gastrostomy tube placement than OGT in the majority of elderly patients.

Aged↗
PubMed1991

Tracheostomy. A new indication for percutaneous endoscopic gastrostomy tube placement.

A review of patients undergoing elective tracheostomy (TRACH) and percutaneous endoscopic gastrostomy (PEG) was undertaken to decide whether addition of PEG to a planned tracheostomy was safe and indicated by conditions mandating the tracheostomy. Charts were reviewed for demographic data, details of operation, outcome, and disposition. Sixteen patients with an average age of 61 years were studied. Primary diagnosis included CNS disease (7), trauma (6), and multisystem failure (3). These patients had 35 associated diseases. Indications for tracheostomy were respiratory failure (9) and prolonged intubation (7). The average time from admission to procedure was 23.7 days. Average operative time was 50 minutes. There were three postoperative complications. Ten patients were discharged (5 home, 5 skilled facility) and six expired. All patients had functioning tracheostomies and PEGs at the time of disposition. Percutaneous endoscopic gastrostomy is a logical adjunct to planned tracheostomy, adding little morbidity but with potential benefit to long-term management in this special group of chronic care patients.

Adult↗
PubMed1991

Percutaneous endoscopic jejunostomy in a patient with previous esophagectomy.

Establishment of a percutaneous endoscopic jejunostomy via direct jejunal puncture was accomplished in a 45-year-old woman five years after a partial esophagectomy with cervical esophagogastrostomy for adenocarcinoma of the esophagus. The patient had recurrence of the cancer at the anastomotic site with subsequent inability to eat, necessitating a feeding tube for prolonged enteral nutrition. Although percutaneous puncture of the jejunum has been previously described, it has been limited to patients who had undergone partial or complete gastrectomies with Bilroth II anastomoses. This case report of direct endoscopic jejunal tube placement in a patient after esophagectomy further establishes this procedure as a viable alternative to surgically placed feeding tubes in patients with altered gastric anatomy.

Anastomosis, Surgical↗
PubMed1990

Meakin adjuvant regimen in premenopausal patients with breast cancer.

A 10-year experience using ovarian ablation and prednisolone as adjuvant therapy for premenopausal patients with breast carcinoma, emphasizing tolerability and morbidity is reported. Thirty patients (15 aged less than 45 years, 15 aged greater than or equal to 45 years; range 28-54 years) underwent mastectomy/lumpectomy with axillary clearance (with or without local irradiation) followed by ovarian irradiation and prednisolone therapy (2.5 mg three times daily for 5 years). Patients were reviewed every 3 months for the first 3 years and every 6 months thereafter. Follow-up was between 1.5 and 10 years (median 5 years). Twenty-four patients are still alive. Three patients stopped therapy because of side-effects. There was a mean(s.e.m.) weight gain of 8.46(1.69) per cent on therapy. Nineteen patients have been weaned off prednisolone over a period of 0.5-7.5 months (median 2 months) and the median length of time off steroids is now 3 years (range 0.5-5 years). This regimen appears to be associated with an acceptable level of patient tolerability and a low chronic morbidity rate and should be considered as an alternative to adjuvant systemic cytotoxic therapy.

Adult↗
PubMed1990

The absence of hepatitis B virus DNA in hepatitis B e antigen positive sera from chronic hepatitis B surface antigen carriers in China.

Sera from 20 Chinese patients with chronic hepatitis B were examined for hepatitis B e antigen and hepatitis B virus (HBV) DNA. There was considerable discordance with HBV DNA not being detectable in 10 out of 13 (77%) patients who were hepatitis B e antigen positive. Further testing for anti-HBe and HBV-DNA polymerase activity confirmed the results. Possible reasons for this discordance are discussed but neither hepatitis D (delta) infection nor the acquired immunodeficiency syndrome (AIDS) could be implicated.

Adult↗
PubMed1990

Discordance of hepatitis B e antigen and hepatitis B viral deoxyribonucleic acid.

Sera from 899 hepatitis B surface antigen (HBsAg) carriers from four separate ethnic groups (Caucasian, Australian Aboriginal, Melanesian, and Asian) were studied for their correlation for hepatitis B virus deoxyribonucleic acid (HBV DNA) and hepatitis B e antigen (HBeAg). Discordance, as signified by the absence of HBV DNA despite the presence of HBeAg, was unusual in Caucasians but frequently occurred in the other three ethnic groups (11-25%). Analysis by age showed that it occurred occasionally during childhood and, in this age group, may simply be part of the process of seroconversion with impending loss of HBeAg, whereas its greater prevalence in patients with liver disease may have a different mechanism. In sera obtained from Melanesians with hepatocellular carcinoma and Asians with chronic hepatitis, discordance was a common feature with HBV DNA being undetectable in those with HBeAg in 87% and 72%, respectively. A number of important implications flow from these observations pertinent to the use of HBeAg to detect replicating virus and the prognostic significance of HBeAg in HBsAg carriers when HBV DNA is undetectable.

Child↗