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Biomedical subjects

R A Stevens

Publications and source records attributed to R A Stevens.

At least 55 records · Page 3Linked to original sources
PubMed1987

Nerve fibre layer loss in diseases of the outer retinal layer.

We present examples of nerve fibre layer changes in diseases thought to affect primarily the outer retinal layers. These disease processes include cone-rod dystrophies, rod-cone dystrophies, juvenile macular degeneration (Stargardt's disease) and fundus flavimaculatis, vitelliform macular dystrophy, and Leber's congenital amaurosis. All were associated with alterations in the retinal nerve fibre layer, either diffuse or focal. The presence of these nerve fibre layer changes raises the question of transsynaptic degeneration and of possible primary or associated disease of other retinal cells than the receptors-namely, bipolar, amacrine, Mueller, or ganglion cells--in these disease of the outer retinal layer. Involvement of the nerve fibre layer also indicates the need to examine patients with defects in the nerve fibre layer by electroretinograms and other tests for outer retinal layer disease when no obvious optic nerve disease is present.

Adult↗
PubMed1986

Assay performance and tracer properties for two analog-based assays of free triiodothyronine.

We determined binding characteristics of the triiodothyronine (T3) analog tracer used in the Amerlex and Amerlex-M FT3 radioimmunoassay for the three endogenous binding proteins in serum: thyroxin-binding globulin (TBG), thyroxin binding prealbumin (PA), and albumin. Both T3 and its analog bind to the same sites on TBG and PA. However, the analog has significantly lower association constants (1.0% and 3.8%, respectively, of T3 binding affinity) and it binds to different sites on albumin. Analog binding is characterized by two (weak) specific binding sites [K = 0.46 (SD 0.03) X 10(5) L/mol]; T3 is bound at about 28 very weak, nonspecific sites [K = 0.41 (SD 0.03) X 10(4) L/mol]. Sera from healthy subjects with a wide range of concentrations of binding proteins showed no interference from analog binding in the FT3 assay. In contrast, in vitro studies of albumin binding revealed a weak dependence of both assays on albumin concentration (0.05 pmol of FT3 per gram of albumin per liter), an interference probably unimportant for most laboratory samples. Nonesterified fatty acids (NEFA) and the T3 analog apparently bind to different sites on albumin; thus the Amerlex FT3 assay is insensitive to moderately increased concentrations of NEFA in serum.

Binding Sites↗
PubMed1985

Voluntary and governmental activity.

Voluntary institutions, previously a hallmark of the American medical care system, are rapidly creating their own demise. No longer a middle ground between government-provided health care service and profit-making ventures, voluntary institutions are becoming profit-motivated. This has served to extinguish the traditional ideologies that have surrounded their history. However, this same history dictates the necessity of their survival and the worth of preserving them.

Forecasting↗
PubMed1983

Equity: the issue.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1981

Abnormal visual-evoked potentials from eyes with optic nerve head drusen.

We evaluated 38 eyes (29 patients) with unilateral or bilateral optic nerve head drusen by means of visual field testing (static, tangent screen, and Goldmann perimetry), nerve fiber layer characterization (using red-free fundus photography), and flash visual-evoked potential testing. We found that 27 of 36 (75%) of the eyes with drusen had abnormal visual fields, 36 of 38 (94.7%) had abnormal nerve fiber layers, and 35 of 36 (97.2%) had abnormal visual-evoked potentials. The degree of abnormality on any one test did not reliably predict the results of either of the other two tests; however, there appeared to be an association between the visual-evoked potential aberrations and the retinal nerve layer deficits.

Adolescent↗
PubMed1977

Purification and characteristics of an alginase from Alginovibrio aquatilis.

An exocellular inducible alginase from a strain of Alginovibrio aquatilis was purified 61-fold by ammonium sulfate precipitation and column chromatography on Sephadex G-150 and diethylaminoethyl-cellulose. The purified enzyme was more resistant than the crude enzyme to elevated temperatures. The monovalent cations Cs+, Rb+, K+, Na+, and Li+, in order of decreasing enzyme activation, were required for activity. The pH optimum of the purified alginase was 8.0 and its molecular weight from exclusion chromatography on Sephadex G-150 was 110,000.

Alginates↗
PubMed1976

Studies on ligand binding to bovine liver uridine diphosphate glucose pyrophosphorylase.

A procedure for the preparation of crystalline UDP-glucose pyrophosphorylase is described. K(s) values for UDP-glucose and UTP were determined as 7 and 20 muM respectively, the latter being confirmed by three methods. By assuming an octameric structure, 1 mol of enzyme subunit bound 1 mol of substrate. The metal-ion activator, Mg2+, did not affect the equilibrium between nucleotide and enzyme. A substrate analogue, alphabeta-methylene-UTP, was synthesized and had the same K(s) value as UTP. In its presence, the K(s) for glucose 1-phosphate decreased by two orders of magnitude, thus confirming a compulsory binding order and excluding an uridylated enzyme intermediate. The results are discussed with respect to their implications in vivo.

Animals↗
PubMed1976

United States foreign medical graduates in Connecticut: how they compare with foreign medical graduates.

This study contrasts the graduate training and subsequent careers of a cohort of United States-born foreign medical graduates (USFMGs) and foreign medical graduates (FMGs) who were in training positions in Connecticut in 1964 and who were located in 1971. The data suggest that although USFMGs were foreign-educated, they had certain advantages--both cultural and administrative--in hospital training positions which helped them to pursue different career alternatives than FMGs. However, the data further suggest that they retained characteristics of their foreign training which continued to differentiate them from United States medical graduates (USMGs).

Age Factors↗
PubMed1976

Viscometric assay of bacterial alginase.

Equations defining the reaction of microbial alginase on commercial sodium alginate are presented with respect to the viscometric assay of enzyme activity. The negative log of K was found to be linearly related to the concentration of algin, where K is defined as the change in the reciprocal of relative viscosity with time. The negative log of K was also found to be linearly related to the amount of enzyme in reaction mixtures when the substrate concentration was held constant.

Alginates↗
PubMedDate not supplied

Sympathetic block during spinal anesthesia in volunteers using lidocaine, tetracaine, and bupivacaine.

BACKGROUND AND OBJECTIVES: Spinal anesthesia to high thoracic dermatomes is alleged to result in almost complete block of all sympathetic efferent nerves. To examine the degree of sympathectomy during spinal anesthesia, the sympathetic response to a cold pressor test (CPT) applied to unblocked dermatomes before and during spinal anesthesia was measured with use of three different local anesthetics. METHODS: Twelve healthy volunteers were studied in a randomized and double-blind fashion on three separate occasions. In random order, each volunteer received approximately equipotent spinal doses of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg in hyperbaric solutions. Prior to and 30 minutes after spinal injection of local anesthetic, a CPT was applied for 2 minutes, and changes from baseline resting conditions in five physiologic variables were measured. RESULTS: The CPT 1 given before anesthetic administration resulted in an increase in heart rate, mean arterial pressure, cardiac index, and plasma concentrations of norepinephrine and epinephrine. Spinal anesthesia to a median level of T3 resulted in a decrease in mean arterial pressure by 10-12% but did not significantly decrease the other variables. Spinal anesthesia did not change the increase in heart rate or cardiac index in response to the second CPT, but the increase in mean arterial pressure was attenuated compared to the CPT before anesthesia. No increase in norepinephrine or epinephrine concentration was observed during the CPT given during spinal anesthesia. There was no significant relationship between level of analgesia and sympathetic response to stress. CONCLUSIONS: Spinal anesthesia with hyperbaric solutions of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg attenuated sympathetic function but did not produce complete sympathectomy. The effects were independent of the local anesthetic used.

Adult↗
PubMedDate not supplied

The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand.

BACKGROUND AND OBJECTIVES: Although an increase in skin temperature of the hand implies sympathetic block after stellate ganglion block (SGB), it does not indicate complete sympathetic block unless accompanied by an absence of sweating because skin temperature may increase even with a partial sympathetic block. This study examined the efficacy of the SGB to block sweating in the hand and to determine if the magnitude of temperature change in the hand is predictive of a negative sweat test. METHODS: Fifty-nine SGBs were performed in 30 patients (15 women and 15 men) for diagnostic or therapeutic indications. Stellate ganglion block was performed via an anterior paratracheal approach at C6 using 15 mL 0.25% bupivacaine. Skin temperature was measured bilaterally on the index finger. A cobalt blue sweat test was performed bilaterally pre- and post-SGB on the middle finger. Successful sympathetic block after SGB was considered present when: (a) (change in ipsilateral temperature (postblock-preblock)] (Di)-[change in contralateral temperature] (Dc) > or = 1.5 degrees C; (b) Horner's syndrome present; and (c) sweat test changed from positive to negative. Logistical regression was applied to determine what value of Di - Dc could be used to predict a negative sweat test. RESULTS: Thirty-six percent (21/59) of blocks met all three criteria. Of the blocks where Di - Dc > or = 1.5 degrees C, 72% (21/29) had a negative sweat test post-SGB. Of the blocks where Di - Dc < 1.5 degrees C, 37% (11/30) had a negative sweat test postblock. If Di - Dc > or = 2.0 degrees C, a negative sweat test could be predicted with 69 +/- 12% sensitivity and 85 +/- 10% specificity. CONCLUSIONS: Stellate ganglion block often fails to increase skin temperature in the ipsilateral more than the contralateral hand. A value of Di - Dc > or = 2.0 degrees C was a good predictor of a sympathetic block, but was not sufficient to guarantee a complete sympathetic block of the hand after SGB in all cases. An apparently successful SGB as measured by "usual" clinical criteria may not result in a complete sympathectomy of the hand as is often assumed. Therefore, if obtaining a sympathectomy is important for diagnostic or therapeutic purposes, performing a sweat test provides important confirmatory evidence of the genuine success of the sympathetic block.

Adolescent↗