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Biomedical subjects

J S Scott

Publications and source records attributed to J S Scott.

At least 109 records · Page 6Linked to original sources
PubMed1990

Plasma theophylline concentration and lung function in ponies with recurrent obstructive lung disease.

Six ponies with recurrent obstructive lung disease were studied during two separate 60 min periods while receiving constant equal volume infusions of either aminophylline or sterile water. Dynamic lung compliance, pulmonary resistance, respiratory rate, tidal volume, blood gas tensions and heart rate were measured. Plasma samples were obtained for determination of theophylline concentrations before, and at 10 min intervals during, the infusion period. Excitability was assessed subjectively at these same time periods. The plasma theophylline concentrations in ponies were well predicted by a previously published model of theophylline pharmacokinetics in the horse. Sterile water had no effect on lung function. Aminophylline produced significant changes in lung function compared to baseline values, including a decrease in resistance at 30 min when the mean plasma theophylline concentration was 59 +/- 14 mumol/litre and an increase in compliance at 60 mins at a mean plasma theophylline concentration of 102 +/- 23 mumol/litre. Excitement was noted between 40 and 50 mins in all ponies (mean plasma theophylline concentration 74 +/- 20 and 84 +/- 24 mumol/litre, respectively). Heart rate increased at 50 mins. The therapeutic range for intravenous (iv) theophylline concentration in 'heavey' ponies therefore appears to be between 59 and 84 mumol/litre when aminophylline is administered iv. Below 59 mumol/litre there was no consistent bronchodilator activity and above 84 mumol/litre excitement and tachycardia limited the usefulness of the drug.

Airway Resistance↗
PubMed1990

Physician payment reform--implementing resource-based relative value scales.

In this article, the author summarizes recently enacted legislation that will result in a phaseout of the traditional usual and customary fee reimbursement system for physicians under Medicare, explains how a system of relative value scales will be implemented, and offers some suggestions for physicians concerned about their economic futures.

Fee Schedules↗
PubMed1990

Total body irradiation as an alternative to systemic chemotherapy in small-cell anaplastic lung cancer.

The effectiveness of total body irradiation (TBI) plus local radiotherapy in the treatment of small-cell lung cancer was studied in 13 patients, using 4,000 cGy in 15 fractions over three weeks to the local site and 150 cGy in ten fractions over two weeks to the whole body. The mean survival for 12 patients was 31 weeks, with a median survival of 32 weeks. One patient received six courses of combination chemotherapy for recurrent disease four months after TBI without marrow depression and survived 72 weeks, the longest survivor in this series. Brain metastases occurred in only one patient, the most common site of metastases being the liver. All patients tolerated TBI well without nausea, vomiting or hair loss. When bone marrow suppression occurred it was asymptomatic, requiring no treatment and resolving within eight weeks.

Aged↗
PubMed1990

Single session panendoscopy. Indications and expectations for yield.

To assess the indications and yield of single session panendoscopy (SSPE), patients who underwent colonoscopy and esophagogastroduodenoscopy (EGD) at the same time were retrospectively reviewed. Endoscopy records and patient charts of 101 patients who underwent SSPE during a 45-month period were analyzed for demography, indication, and results. Average age was 72.9 years. Common indications were positive occult blood tests (74%), anemia (28%), altered bowel habits (15%), and iron deficiency (13%). Most frequent findings at colonoscopy included diverticulosis (47%), polyps (37%), hemorrhoids (28%), and arteriovenous (AV) malformations (13%). Nine cases of cancer were found, seven of which were right-sided. Colonoscopy was normal in 12 per cent. EGD findings include esophagitis (55%), hiatal hernia (47%), and gastritis (33%). Eleven per cent were normal. Occult blood loss is not predictive of either a positive or negative study. SSPE is a safe and specific approach; however, based on this study, colonoscopy is recommended as the initial study for occult blood loss with plans to proceed to EGD when the lower endoscopy is normal. Even when the colonoscopy suggests the etiology for occult blood loss, EGD will yield a significant number of treatable and unsuspected lesions.

Adult↗
PubMed1989

Efficacy and long term effects of antenatal prophylaxis with anti-D immunoglobulin.

OBJECTIVE: To measure the safety and efficacy of antenatal treatment with anti-D immunoglobulin. DESIGN: Open study with historical controls. SETTING: Multicentre study in 17 hospitals in West Yorkshire. PATIENTS: 1238 Rh negative women who delivered Rh positive infants after 34 weeks in their first pregnancy in 1980-1 (group 1) and 2000 similar primigravidas from 1978-9 (group 2). Obstetric data were collected for 616 women in group 1 who had a subsequent pregnancy, 536 similar women in group 2, and 410 Rh positive but otherwise similar primigravidas who delivered in the same hospitals in 1978-81 (group C). INTERVENTIONS: Anti-D immunoglobulin 100 micrograms intramuscularly was given at 28 and 34 weeks to the mothers in their first pregnancy who delivered in 1980-1. END POINTS: Detection of anti-D antibody in the first or any subsequent pregnancy in groups 1 and 2. For all three groups having subsequent pregnancies gestation at delivery, birth weight, fetal survival at one month, pre-eclampsia defined as blood pressure greater than 140/90 on two occasions more than 12 hours apart, and proteinuria greater than 0.25 milligram. MEASUREMENTS AND MAIN RESULTS: Antenatal immunisation to Rh(D) occurred in six mothers in group 1 and 32 group 2. Most immunisations occurred in the first or second pregnancy. The rates of abortion, gestation at delivery, birth weight, and fetal survival were not significantly different among the three groups. The incidence of pre-eclampsia was lower in mothers given antenatal anti-D immunoglobulin, but the difference was not significant. CONCLUSIONS: Antenatal prophylaxis with anti-D immunoglobulin is effective, and the effect of giving it in the first pregnancy persists into at least the second pregnancy. It seems to be safe for the fetus in the index and subsequent pregnancies.

Birth Weight↗
PubMed1989

Presence of autoantibodies in women with unexplained infertility.

Serum samples from 41 patients suffering from unexplained infertility and 351 normal pregnant women were assayed for a range of autoantibodies by means of immunofluorescence, counterimmunoelectrophoresis, double immunodiffusion, Western blots, and enzyme-linked immunosorbent assays. The prevalence of autoantibodies to smooth muscle, phospholipid, and nuclear antigens, the latter when detected by immunofluorescence, was elevated in women with infertility compared with normal pregnant women (p less than 0.001, less than 0.001, and less than 0.05, respectively). Antiviral antibodies were not detected. The reason for the high level of autoreactivity in infertile women is unclear, but smooth muscle and antiphospholipid antibodies may actively interfere with the reproductive process.

Antibodies, Antinuclear↗
PubMed1989

From mobsters to managers. RIC0 (Racketeer Influenced and Corrupt Organizations Act) extends its reach beyond the underworld.

The federal Racketeer influenced and Corrupt Organizations Act (RICO) was enacted in 1970 to combat the infiltration of organized crime into legitimate businesses operating in interstate commerce. During the first 10 years of its existence, the statute was applied almost exclusively in charges requiring criminal penalties. Section 1964 of RICO, however, allows civil remedies for injuries resulting from certain defined criminal activities. These civil remedies authorize treble damages and a reasonable attorney's fee. The Supreme Court has upheld the extension of this law to apply to general business activities, including hospitals. Hospitals risk involvement in civil RICO litigation as they become increasingly active in alternative healthcare businesses--medical supply operations real estate ventures, etc.--that involve public participation and the sale of securities, partnership units, and other equity interests. A disgruntled investor in a failed venture may initiate litigation. Other areas where hospitals are vulnerable to RICO claims include medical staff grievances, involvement in health maintenance organizations, and profile protest activities. The RICO civil provisions contain five basic elements: injury, person, enterprise, pattern of racketeering activity, and interstate or foreign commerce. Basically, this means that any person injured by the unlawful conduct of a person who is employed by or associated with any enterprise that engages in a pattern of activity which affects interstate commerce is entitled to civil RICO damages.

Abortion, Legal↗
PubMed1989

The use and misuse of relative value scales under Medicare.

Phoenix-like, the concept of using a relative value scale as a primary mechanism for Medicare reimbursement has risen from the ashes of past rejection. Medicare has already initiated a modified RVS program for anesthesia services; RVS programs for radiology and pathology services may be established within the year. In this article, the author predicts that a modified "resource based" RVS will be adopted for all Medicare physician services over the next several years.

Anesthesiology↗
PubMed1989

Percutaneous endoscopic gastrostomy. A mandate for complete diagnostic upper endoscopy.

One hundred patients underwent upper endoscopy for the placement of percutaneous endoscopic gastrostomies (PEGS) during a four year period from 1984 to 1988. These cases were retrospectively reviewed to document the need for total endoscopy during PEG. Ninety-seven per cent of the procedures were successful. In 89 per cent, a complete exam of the esophagus, stomach, and duodenum was performed, revealing pathologic findings in 59 per cent. The most common abnormalities were in the esophagus (23%) and the stomach (27%); however, a portion of the findings were also present in the duodenum (12%) and the pylorus (11%). Additional findings present in the complete esophagogastroduodenoscopy (EGD) done at the time of PEG included a five per cent incidence of gastric outlet obstruction and antral ulcers or polyps in six per cent. The breakdown of findings in the duodenum included eight per cent incidence of duodenal ulcers and four per cent incidence of duodenitis. A total of 22 per cent of the patients had some evidence of peptic ulcer disease. Many of the cases in which pathology was found required a change in medications and, when postoperative bleeding occurred after PEG, the other pathologic entity was much more likely to be the cause of the complication than the PEG. A careful and complete EGD is mandated every time a patient is scheduled for PEG.

Adult↗
PubMed1988

Steroid metabolism in testes of patients with incomplete masculinization due to androgen insensitivity or 17 beta-hydroxysteroid dehydrogenase deficiency and normally differentiated males.

For purposes of establishing suitable controls in studies of patients with a suspected enzyme deficiency, activities of enzymes involved in the biosynthesis of testosterone were compared in testes of patients with androgen insensitivity syndrome (AIS) and normally differentiated males with carcinoma of the prostate (Ca prostate) or testis (Ca testis). Activities of 17,20-desmolase and of 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) were higher in the testes of pre-, peri- or postpubertal patients with AIS than in elderly men (58-80 yr) with Ca prostate. Activities of 17 beta-HSD (reductive direction) and 3 beta-HSD tended to be higher in peri- or postpubertal than in prepubertal patients with AIS. Activity of 3 beta-HSD was low in the patient with Ca testis. In a peripubertal (12 yr) patient with incomplete masculinization due to a severe deficiency of 17 beta-HSD, reductive activity of 17 beta-HSD was very low compared with that of patients with Ca prostate, Ca testis or AIS. In contrast, in testes from the younger sibling (4 yr), in whom the deficiency of 17 beta-HSD was less severe, 17 beta-HSD reduction of dehydroepiandrosterone was as high as that of men with Ca prostate, yet deficient in comparison with that of more closely age-matched patients with AIS. This emphasizes the desirability of using age-matched tissue for control purposes in enzyme studies.

17-Hydroxysteroid Dehydrogenases↗
PubMed1988

The use of warfarin in pregnancy complicated by circulating lupus anticoagulant; a technique for monitoring.

A case is described in which a pregnancy, preceded by two mid-trimester fetal losses, was complicated by deep-vein thrombosis due to the presence of circulating lupus anticoagulant. Warfarin was used as anticoagulant therapy concurrently with high-dose prednisolone. It is suggested that warfarin may have advantages over heparin in managing pregnancies in women with circulating lupus anticoagulant. A technique is described which allowed the monitoring of levels of lupus anticoagulant in the circulation while warfarin is being administered.h3.

Adult↗
PubMed1988

Autoantibodies to soluble cellular antigens in unexplained recurrent abortion and infertility.

In 36 women with unexplained primary recurrent abortion, 13 with secondary unexpained recurrent abortion, 25 with primary unexplained infertility, 7 with secondary unexplained infertility and two groups of control women, autoantibodies to soluble cellular antigens were measured by Western blotting to a disaggregated HeLa cell antigen preparation, by counter immunoelectrophoresis and by indirect immunofluorescence. Using Western blotting the women with primary infertility and those with secondary recurrent abortion had a significantly higher prevalence of autoantibodies (P less than 0.01 in each case). This was not shown using the other methods. It is possible that these antibodies could be causally related to the pathology of the conditions studied.

Abortion, Habitual↗
PubMed1988

Prevalence of maternal Ro (SS-A) and La (SS-B) autoantibodies in relation to congenital heart block.

The prevalence of autoantibodies to ribonucleoprotein antigens in cases of congenital heart block was established using immunofluorescence, counterimmunoelectrophoresis, double immunodiffusion and Western blots. All of 35 mothers of babies with congenital heart block, none of five mothers of babies with other types of heart block, 10 of 29 women with connective tissue disease but no babies with heart block, four of 445 normal pregnant women and two of 109 healthy nonpregnant women had either Ro (SS-A) or La (SS-B) antibodies. Of 15 babies with congenital heart block, 10 of 10 who were less than 3 months old possessed antibody. Antibody titres in affected but not in normal infants were lower compared with their mothers' titres, suggesting deposition of antibodies in the baby's tissues. The findings indicate that placental transfer of anti-Ro (SS-A) or anti-La (SS-B) is essential for development of congenital complete heart block.

Antibodies, Antinuclear↗
PubMed1988

In-vivo and in-vitro endocrine investigation of pure gonadal dysgenesis.

Diagnosis of XY pure gonadal dysgenesis was established in a patient of female phenotype, with female internal genitalia, but with a chromosomal constitution of 46 XY. Streak gonads had undergone neoplastic transformation--gonadoblastoma and dysgerminoma. Before operation the concentrations of gonadotrophins in plasma were high and of oestradiol was low. Administration of oestradiol benzoate initially suppressed and then stimulated an increase in the plasma concentration of LH. These changes were not accompanied by changes in blood levels of endogenous sex steroids. A single injection of hCG failed to stimulate steroid secretion. The activities in vitro of steroid-metabolizing enzymes in the dysgenetic gonadal tissue more closely resembled those of ovarian tissue from a premenopausal and from a postmenopausal women than those in testes from two androgen-insensitive patients. However, aromatase activity was higher in the dysgenetic gonads than in the pre or post-menopausal ovaries. Examination of enzymes in genital skin fibroblasts demonstrated normal activities of 3 alpha/beta-beta-hydroxysteroid dehydrogenase and 17 beta-hydroxysteroid dehydrogenase (oxidative and reductive directions). However, 5 alpha-reductase activity was low in minces and fibroblasts of genital skin from the patient. Androgen binding was within the range for male controls.

Adolescent↗