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Biomedical subjects

A G Scottolini

Publications and source records attributed to A G Scottolini.

At least 19 recordsLinked to original sources
PubMed1995

Problems in determining levels of free digoxin in patients treated with digoxin immune FAb.

Determination of free digoxin levels in patients treated with digoxin immune FAb has long been a problematic area in clinical laboratory testing. The older radioimmunoassays resulted in inaccurate and variable results due to the competition of the administered drug with the radioactively labelled forms. The 1995 Physicians' Desk Reference continues to state that digoxin immune FAb will interfere with digitalis immunoassay measurements. This statement, however, is based primarily on the RIA methods. We evaluated the Stratus digoxin assay and the TDX digoxin II assay. Increasing amounts of immune FAb were added in a stepwise fashion to 12 patient samples containing high normal to elevated digoxin levels. Results showed a progressive decrease in digoxin levels when assayed with the Stratus kit. However, five patient samples tested with the TDX kit resulted in constant digoxin values despite the presence of increasing digibind levels. These results suggest that the Stratus method measures free digoxin, whereas the TDX method measures the total digoxin. Measurement of digoxin by the Stratus method is simple and quick. The Stratus digoxin assay may be an accurate and objective way of measuring free digoxin levels in patients on digoxin immune FAb.

Digoxin↗
PubMed1994

A point mutation in the human serum albumin gene results in familial dysalbuminaemic hyperthyroxinaemia.

Using DNA samples obtained from two unrelated patients, diagnosed as having familial dysalbuminaemic hyperthyroxinaemia (FDH), exons 1-14 which span the entire coding region of the human serum albumin (HSA) gene were amplified by the polymerase chain reaction. The sequence of each of the 14 DNA fragments was then determined. In each case a point mutation was identified at nucleotide 653 which causes an Arg to His substitution at amino acid position 218. The substitution was confirmed by amino acid sequencing of a mutant peptide resulting from tryptic digestion of the protein. Abnormal affinity of FDH HSA for a thyroxine (T4) analogue was verified by an adaptation of the procedure used in routine free T4 measurement. The location of the mutation is discussed in relation to other studies on the binding properties of HSA.

Amino Acid Sequence↗
PubMed1990

L-tryptophan-related eosinophilia-myalgia syndrome: a case report.

Eosinophilia-myalgia syndrome (EMS) is characterized by intense eosinophilia and, very often, debilitating generalized myalgia in the absence of infectious or neoplastic causation. The Centers for Disease Control have established that the latter two features, along with an eosinophil count greater than 1000 cells per cu mm, are criteria for the syndrome. EMS has been reported in epidemic proportions over the last several months. Early data strongly suggested that in at least a small percentage of patients the syndrome leads to death. Epidemiological work in New Mexico, Minnesota, and Oregon has linked EMS most impressively to L-tryptophan-containing products (LTCPS).

Aged↗
PubMed1990

Rhabdomyolysis secondary to lovastatin therapy.

We report a case of lovastatin-induced rhabdomyolysis and resulting life-threatening renal failure. Lovastatin, a hypocholesterolemic agent, decreases endogenous cholesterol synthesis by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase (EC 1.1.1.88). This agent has been implicated in causing rare serious side effects in various clinical settings; however, the mechanism of these adverse reactions is not understood. The clinical course of our patient was characterized by profound muscle weakness with marked increases in serum creatine kinase and myoglobin. Light- and electron-microscopic studies of skeletal muscle of our patient demonstrated a noninflammatory myopathy suggestive of ongoing rhabdomyolysis with vacuolization and focal degeneration of myocytes. The patient's symptoms and the laboratory values referable to rhabdomyolysis resolved after discontinuation of the drug. We speculate that the rhabdomyolysis was due to mitochondrial damage secondary to inadequate synthesis of coenzyme Q and heme A, members of the electron-transport system of the inner mitochondrial membrane.

Acute Kidney Injury↗
PubMed1987

Double IgA bands in serum from a patient with lymphoplasmacytoid leukemia with hairy-cell morphology.

We present a case of plasmacytoid lymphocytic leukemia with hairy-cell-like cytoplasmic projections and separate monomeric and polymeric IgA(lambda) serum bands confirmed by immunofixation. After a prolonged initial good response to chemotherapy, the patient had recurrent disease with increased plasmacytoid blastic feature and died. The relationship of this case to B-cell proliferative disorders is discussed.

Humans↗
PubMed1986

Performance of a urine-screening protocol.

The performance of a urinalysis protocol using screening Chemstrip-9 dipstick analysis with selective sediment microscopy and culture is reviewed. Sediment microscopy performed on urine samples positive for leukocyte esterase, nitrite, protein, or blood, or when specifically ordered (15% of urinalyses) was reduced by 57.1%. Protocol urine culture performed when more than 5 WBC/high-powered field (HPF), more than 10 bacteria/HPF, or yeasts were found on sediment microscopy or with a positive nitrite test was done for 9.8%. Urine culture was specifically ordered for another 13.6%. Percent significant bacteriuria (greater than or equal to 10(5) colony-forming units/mL) was higher for protocol-generated cultures (37.1%) versus ordered cultures (17.2%). For urinalyses with ordered cultures, the protocol would have detected 89.8% of cases with significant bacteriuria. The protocol has facilitated detection of significant bacteriuria with good acceptance by clinicians. Cost savings achieved by reduction of sediment microscopy was partly off-set by some increase in urine cultures performed.

Bacteriuria↗
PubMed1985

Ataxia telangiectasia with hepatocellular carcinoma in a 15-year-old girl and studies of her kindred.

We studied a case of familial ataxia-telangiectasia in a 15-year-old girl who had a clinical history of cerebellar ataxia and recurrent pulmonary infections. She was found at autopsy to have a hepatocellular carcinoma, which has been described twice previously in the literature as occurring with this disorder. Family studies on the majority of her seven siblings (the product of one father and two mothers who were identical twins) showed one brother to have classic features of cerebellar ataxia, IgA deficiency, markedly elevated alpha-fetoprotein levels, and characteristic chromosomal abnormalities. This boy also died later of hepatocellular carcinoma in 1984. An affected sister had previously died of a respiratory tract infection.

Adolescent↗
PubMed1984

Urine screening strategy employing dipstick analysis and selective culture: an evaluation.

A cost-effective urinalysis test strategy, employing screening dipstick analysis with sediment microscopy performed on urines positive for leukocyte esterase, nitrite, protein, or blood, is evaluated. Screening urine culture is done when greater than or equal to 5 WBC/HPF, greater than 10 bacteria/HPF, or yeasts are found on sediment microscopy. Predictive value, sensitivity, and specificity of the test strategy in predicting significant bacteriuria is compared with sediment microscopy, Gram staining of uncentrifuged urine and leukocyte chamber counting. Employment of the test protocol for routine urine specimens would decrease sediment microscopy by 49%, while effectively screening for significant bacteriuria with a sensitivity of 88.9% and predictive value of a negative result of 98.8%.

Bacteriological Techniques↗
PubMed1984

Presumptive identification of Staphylococcus saprophyticus from urine specimens by colony appearance and coagulase testing: an evaluation.

Two hundred one urine specimens with pure or nearly pure cultures (greater than 5 X 10(4) CFU/mL) of coagulase-negative staphylococcus were identified in reviewing all significant urine isolates over a ten-month period. The majority of these were from young female adult outpatients with Staphylococcus saprophyticus constituting 88.9% of isolates determined with the API Staph-Ident System. For urine specimens, particularly for outpatients, coagulase-negative, nonhemolytic staphylococcal colonies with yellow pigmentation could be identified presumptively as S. saprophyticus with a sensitivity of 97.8% and a specificity of 98.3%, compared with novobiocin susceptibility testing with a sensitivity of 100% and a specificity of 96.9%.

Adolescent↗
PubMed1984

Familial dysalbuminemic hyperthyroxinemia: a study of four probands and the kindred of three.

We investigated four probands, and the kindred of three, with familial dysalbuminemic hyperthyroxinemia, using the one- and two-step tests for free thyroxin and other thyroid-function tests. The results indicate that this is an autosomal dominant trait. The discovery of eight cases in our patient population, which represents about 4% of our hyperthyroxinemic patients (8/320), during eight months indicates that this aberration is more common than suspected. Its importance lies in the misinterpretation of test results and the consequent inappropriate treatment for thyrotoxicosis.

False Positive Reactions↗
PubMed1984

Biclonal IgA and IgM gammopathy in lymphocytic lymphoma.

We report the case of a 76-year-old white man with a diffuse, well-differentiated lymphocytic lymphoma at the base of his tongue. Although serum electrophoresis, immunoelectrophoresis, and immunofixation showed he had a biclonal IgA kappa and IgM kappa gammopathy, biopsy of the tumor showed a positive immunoperoxidase response only for IgM kappa. The biclonal pattern persisted after chemotherapy, despite shrinkage of the tumor mass. The association of IgA and IgM appears to be the least frequent combination of separate biclonal immunoglobulins, the clinical course of such patients being more often that of lymphoma or macroglobulinemia than of myeloma. However, the symptomatology can be highly variable, as our case uniquely demonstrates.

Aged↗
PubMed1983

The autopsy in clinical quality control.

The postmortem examination, despite declining rates, remains the final word in diagnostic quality control and a major tool in research and education. In 100 autopsies studied at our institution, it was found that 13% of major clinical diagnoses were not confirmed, and in 24% the cause of death was not in the clinical diagnoses. These figures demonstrate a higher clinical diagnostic accuracy rate than in previous studies, and the possible reasons for this are discussed. The length of hospital stay is not found to have any bearing on diagnostic accuracy.

Adult↗
PubMed1982

A sixth lactate dehydrogenase isoenzyme (LD6) and its significance.

We have seen 11 patients who had a sixth cathodic band on routine lactate dehydrogenase (LD) electrophoresis of their serum specimens. This isoenzyme is heat stable and does not cross-react with any of the immunoglobulins; hence, it is not an immunoglobulin complex. An electrophoretic pattern of a liver extract obtained at the time of autopsy of one of these patients disclosed the LD6 band, thus verifying its origin or clearance in the liver. It was not seen in the heart extract of the same patient. Although no specific disease entity could be etiologically related to its presence, we noted that seven of the 11 patients had known arteriosclerotic cardiovascular disease, eight had had cardiogenic, septic, or hemorrhagic shock during their hospitalization, all had mildly to notably elevated levels of LD5 (implying at least acute hepatic congestion), and seven died during their hospitalization or shortly after discharge. The remaining four patients were still living one to two years later. However, we concluded that the presence of LD6 signifies a poor prognosis for the patient.

Adult↗