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Biomedical subjects

C Sutton

Publications and source records attributed to C Sutton.

At least 55 records · Page 3Linked to original sources
PubMed1994

Primary central nervous system lymphoma. Results at the University of California at Los Angeles and review of the literature.

The authors report 24 patients with primary central nervous system lymphoma (PCNSL) treated from 1977 to 1992. There were 13 females and 11 males. Median age was 57 (range: 17-84). Patients were symptomatic for a median of 3 months. Headache was the most common complaint. Median Karnofsky performance score was 70. There were 19 patients with solitary PCNSL, and 5 had multiple deposits. Disease was confined to the supratentorium in 23 patients. Cerebrospinal fluid cytology was positive in 5 of 22 patients examined. All patients received whole-brain irradiation with or without supplemental tumor boost. Tumor doses ranged from 10 to 60 Gy. Intrathecal chemotherapy was administered to 16 patients and 7 received systemic agents. After follow-up ranging from 1 to 66 months, median survival and progression-free survival were each 8 months. One- and 3-year actuarial survival rates were 50% and 36%, respectively. One- and 3-year actuarial progression-free rates were 41% and 15%, respectively. Relapse occurred in 18 patients, and in 17 there was a component of local progression. Lesions recurred in the spinal meninges in 1 patients and in the vitreous in 1. Patients with Karnofsky performance status > or = 70 demonstrated median progression-free survival of 27 months, compared to 4 months for patients < 70 (p = .024). No other significant patient or treatment-related prognostic factors were identified. Clinical dementia occurred in 2 of 11 patients surviving at least 1 year. Review of the literature indicates PCNSL demonstrates relative radioresistance. The most immediate improvement in prognosis for patients with PCNSL can be achieved by properly sequencing systemic and intrathecal chemotherapy with radiation therapy.

Actuarial Analysis↗
PubMed1993

Effects of stent design and serum cholesterol level on the restenosis rate in atherosclerotic rabbits.

We investigated the effect of serum cholesterol level and stent design on the restenosis rate within the stent after balloon angioplasty and stent implantation using atherosclerotic rabbits. Two types of nickel/titanium stents with gaps (open stent) and without gaps (closed stent) between the wire coils were implanted into the aorta of the rabbits 10 weeks after atherosclerosis had been induced using a standard high cholesterol diet and balloon abrasion. Each rabbit had an open stent and a closed stent implanted into the infrarenal abdominal aorta. Between these two stents a control segment of the aorta was treated with angioplasty alone. The animals were divided into two groups according to the diet protocol as follows: in group I (n = 9) a high cholesterol diet was stopped after stent implantation; in group II (n = 10) a high cholesterol diet was maintained after stent implantation. Digital subtraction angiograms were obtained every 4 weeks for up to 24 weeks and the narrowest diameter of the arterial segments within each stent and in the segment between stents was measured. The diameter narrowing within the closed stent was greater in the high cholesterol group compared with the low cholesterol group: 12 weeks (2.57 +/- 0.09 mm in group I vs 2.14 +/- 0.15 mm in group II, mean +/- S.E., p < 0.05); 16 weeks (2.55 +/- 0.09 mm vs 2.14 +/- 0.12 mm, p < 0.05); 20 weeks (2.59 +/- 0.06 mm vs 1.98 +/- 0.12 mm, p < 0.01); and 24 weeks (2.45 +/- 0.11 mm vs 2.01 +/- 0.11 mm, p < 0.05). No significant differences in the narrowest diameter of the arterial segments were observed between high and low cholesterol groups in the angioplasty alone areas or within the open stents. There was a significant difference in the narrowest diameter between stents with versus those without gaps (at 12, 16, and 20 weeks poststenting in group I and at 4, 8, 12, 16, 20, and 24 weeks in group II). Thus the stent with the least metal is correlated with less stenosis and intimal hyperplasia. From these data we conclude that both stent design and serum cholesterol are important factors for restenosis after stent implantation.

Angioplasty, Balloon, Coronary↗
PubMed1993

A psychological profile of endometriosis patients in comparison to patients with pelvic pain of other origins.

In order to investigate the possibility of a specific psychological profile associated with endometriosis, 81 women with pelvic pain were studied, of whom 40 were diagnosed as having endometriosis and 41 other gynaecological problems. Each patient completed six standardized psychometric tests to assess personality, psychopathology, marital state and pain. Endometriosis patients obtained higher psychoticism, introversion and anxiety scores in comparison to the other pain patients, although the two groups did not differ on pain ratings. Both groups obtained neuroticism, anxiety and psychiatric morbidity scores which were elevated relative to normative data. The possibility that there are certain psychological characteristics which make some women vulnerable to endometriosis is discussed.

Adult↗
PubMed1993

Lasers in infertility.

Lasers have been used in fertility surgery for the past two decades. This article reviews the development of different wavelength lasers, the different tissue effects and their applications in infertility surgery. The CO2 laser remains the most precise laser, especially in the ultrapulse mode, for the division of adhesions and the accurate and safe vaporization of deposits of endometriosis. The neodymium:YAG laser, because of its greater depth of penetration, is more suited to hysteroscopic surgery, and attempts to focus the energy by sapphire tips and sculpted quartz fibres merely enable tissue to be incised by a thermal effect. Carbon dioxide laser energy is strongly absorbed by the water molecule and is rendered ineffective in the presence of blood so the visible light lasers, argon and potassium titanyl phosphate (KTP/532) lasers, are more suitable for the treatment of ovarian endometriomas and ectopic pregnancies. Techniques and results of laser surgery in endometriosis, tubal surgery, ectopic pregnancy and polycystic ovarian syndrome are reviewed. The main advantage of the various lasers is that they allow fertility surgeons to perform operative surgery by the minimally invasive approach of laparoscopy rather than laparotomy.

Endometriosis↗
PubMed1992

Effects of design geometry of intravascular endoprostheses on stenosis rate in normal rabbits.

To investigate the effects of gaps between the individual wire coils of a shape memory Nitinol alloy intravascular endoprosthesis, 20 stents with and without gaps were implanted transluminally into the infrarenal abdominal aortas of 10 normal rabbits after balloon angioplasty. Digital subtraction angiography (DSA) was done at 4, 12, 16, 20, and 24 weeks after stent implantation to examine the stenosis rate and major side branch patency. Stenosis rate within stents with gaps were significantly lower than those without gaps: 8.1 +/- 5.0% versus 15.0 +/- 6.8% at 12 weeks, 13.6 +/- 6.0% versus 26.0 +/- 9.4% at 24 weeks by DSA, p greater than 0.005 and p less than 0.01 respectively. The maximum and mean neointimal thickness measured histologically at the time of animal death correlated significantly to the narrowest diameter obtained from the DSA studies, (r = 0.84 and r = 0.79, respectively, p less than 0.01). Greater hyperplasia of the neointima was evident in the stented arterial segments with stents without gaps compared with those with gaps (83 +/- 22 versus 187 +/- 46 microns mean thickness, p less than 0.001). The patency rate of the side branches in the stented arterial segment was significantly (p less than 0.05) higher in stents having gaps. These results suggest that the placement of gaps between wire pitches reduced the neointimal thickness within stents and prevented the obstruction of arterial side branches.

Angioplasty, Balloon↗
PubMed1992

Forecasting the extent of the HIV/AIDS epidemic.

This paper has a dual objective: (1) to describe the current status of the structure of a newly developed model system to generate a wide span of U.S. HIV/AIDS estimates; and (2) to implement that system through the development of a dataset of HIV/AIDS incidence and prevalence, by stage, in the U.S. for a range of past and future years. There are many uncertainties regarding the anticipated effects of HIV/AIDS; examination of many of these effects indicates multiple societal difficulties. The characteristic of AIDS-growth is that of a long-delayed but inexorable disabling morbidity "taking off" in 1991-1992 from an HIV population widely thought to be 1.0-1.5 million spread throughout the Nation. Although widely dispersed, its impact, even at this early stage of growth, is to endanger the health and social support systems of our urban centers. The spread of AIDS cases into the smaller cities and rural counties indicates that those problems will not be limited to our major cities. This paper provides new and purposely pessimistic estimates of the levels of prevalence and incidence of HIV/AIDS for future years, based on U.S. AIDS cases reported. Although these numbers are essentially upper bounds, their values are consistent with the upper sides of some recent broad band projections released in early Summer 1989 by the U.S. Government Accounting Office (GAO). However, our estimation has generated data within a more proscribed range. A first set of forecasts has been provided to the State of Virginia's Department of Health for their use in statewide resource planning. The United States and the world face a severe HIV pandemic in the coming decade. The certainty of the threat is acknowledged by all of the major private and public medical authorities and institutions. Yet, to date, no official projection of the emergence, the level, and the sweep of the epidemic has been accepted by the medical community. And, there is certainly little agreement on the impact on the delivery of health care services in the United States and Canada, as well as throughout the world. On 26 June 1989, the U.S. GAO released a report that concluded, in part, that the Federal government's official data [e.g. from the Centers for Disease Control's (CDC) Morbidity and Mortality Weekly Report (MMWR) of 12 May 1989] were greatly understating the epidemic's extent. Specifically, the CDC's estimate of 185,000-320,000 (cumulative) cases of AIDS expected to be reported by the end of 1991 contrasted with GAO's estimate of 300,000-480,000.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1992

The aftermath of youth suicide--providing postvention services for the school and community.

Suicide is one of the leading causes of death in adolescence. Due to the risk of contagion and maladaptive coping responses in the aftermath of suicide, clinicians have responded by developing postvention services. Based on a considerable amount of experience in this field, target groups of individuals have been identified to receive such assistance. These groups include school administrators, staff, students, families, and community members at large. In addition, it has become clear that the local media response to suicide is of critical importance, and that school administrators and local mental health officials should work effectively with reporters so that news stories do not contribute to suicide contagion.

Adaptation, Psychological↗
PubMed1992

Operative laparoscopy.

Minimally invasive surgery is going through a rapid phase of evolution and over a relatively short time we have witnessed progress from simple ablative procedures such as the division of adhesions and destruction of endometriosis to far more complex operations such as laparoscopic myomectomy, hysterectomy, and, perhaps the hardest of all, cul-de-sac dissection and resection of bowel involved in dense fibrotic endometriosis. Some of these newer procedures reach the very limits of technical virtuosity and are extremely time consuming and will need careful appraisal before their true place in clinical gynecology is established.

Endometriosis↗
PubMed1991

Purification of recombinant human prostromelysin. Studies on heat activation to give high-Mr and low-Mr active forms, and a comparison of recombinant with natural stromelysin activities.

Recombinant human prostromelysin was purified in a single step using Procion Red-Sepharose chromatography. The purified prostromelysin was self-activated to high-Mr (45,000) and low-Mr (28,000) forms by incubation at 55 degrees C without the addition of extraneous activators. The two forms of stromelysin were subsequently separated, again using Procion Red-Sepharose. Both of the heat-activated recombinant forms demonstrated similar specific activities (for the macromolecular substrates casein, gelatin, elastin, proteoglycan and type IV collagen) when compared with either heat- or trypsin-activated natural stromelysin. The heat-activated recombinant stromelysins both showed similar abilities to potentiate activation of human procollagenase when compared with trypsin-activated natural stromelysin.

Amino Acid Sequence↗
PubMed1991

Purification and characterization of Ku-2, an octamer-binding protein related to the autoantigen Ku.

The octamer motif (ATTTGCAT) is an important regulatory element in eukaryotic gene expression. A previously unidentified protein that recognizes this motif has been isolated from the human B cell line, Daudi. The protein, which we term Ku-2, bears a close resemblance to the DNA-binding autoantigen Ku. Like Ku, it is a heterodimer with subunits of 83 and 72 kDa; antisera raised against either subunit of Ku cross-react with Ku-2. Two peptides have been sequenced and show a strong similarity to regions in the corresponding subunits of Ku. The sequences are not identical, however, suggesting that Ku-2 may be a B cell homologue of Ku. Both Ku and Ku-2 bind to the termini of DNA duplexes, but Ku-2 also binds to an internal octamer motif. It is not known whether Ku shares the latter property or whether the octamer binding is a consequence of sequence differences between the two proteins. Ku-2 does not react with antisera against the POU domain of the octamer-binding protein Oct-2, indicating that the DNA binding domains of the two proteins are dissimilar despite the ability of both to bind to the octamer motif. We discuss the evidence for the existence of a family of octamer-binding proteins related to Ku.

Amino Acid Sequence↗
PubMed1991

The V3 loops of the HIV-1 and HIV-2 surface glycoproteins contain proteolytic cleavage sites: a possible function in viral fusion?

Located close to the crown of the V3 type-specific neutralization loop of the human immunodeficiency virus type 1 (HIV-1) (IIIB) SU glycoprotein gp120, are several potential sites that should be susceptible to proteolytic cleavage by enzymes of trypsinlike or chymotrypsinlike specificity, or by aspartic proteinases. The linkages potentially sensitive to chymotryptic/aspartic proteinase cleavage are retained also within the equivalent domain of HIV-2 (ROD) gp105. We show that thrombin and tryptase cleave HIV-1 gp120 specifically at the tryptic site (GPGR decreases AFVT), and that cathepsin E, an endosomal aspartic proteinase, cleaves at the chymotrypsinlike site (GPGRAF decreases VT). HIV-2 gp105 is also cut by cathepsin E at a site (QIML decreases MSGH) in its V3 loop. Cleavage of HIV-1 gp120 by thrombin is enhanced by sCD4 binding, but is prevented by transient exposure of gp120 to nonionic detergent. Thrombin treatment of HIV-1 gp120 destroys the binding sites for some neutralizing monoclonal antibodies (MAbs) on the V3 loop, but does not affect the affinity of gp120 for sCD4. Conversely, binding of neutralizing MAbs to the HIV-1 V3 loop prior to addition of thrombin or cathepsin E blocks the cleavage reactions, and the binding of some HIV-positive sera to gp120 blocks thrombin cleavage. Analysis of published sequences suggests that all HIV-1, HIV-2, and simian immunovirus (SIV) isolates contain potential proteolytic cleavage sites at similar positions in their V3 loops or equivalent domains. We suggest that cleavage of the V3 loop by a cell surface or endosomal proteinase occurs during the HIV-cell fusion reaction, and that neutralizing antibodies directed against the V3 loop might act by inhibition of this reaction.

Amino Acid Sequence↗
PubMed1990

Laser laparoscopic adhesiolysis.

Carbon dioxide laser laparoscopy offers a safe, effective, and relatively easy means of performing intraabdominal adhesiolysis. Sixty-five patients suffering from chronic lower abdominal pain have undergone laser laparoscopic adhesiolysis during the past 6 years. Fifty-three patients (84%) experienced symptomatic relief. The controversial association between abdominal pain and intraabdominal adhesions can be resolved only by performing a controlled prospective laser laparoscopic adhesiolysis study.

Abdominal Pain↗
PubMed1990

Mutilating palmoplantar keratoderma with periorificial keratotic plaques (Olmsted's syndrome).

We report the case of a boy, now aged 4 years, with a progressive, painful and disabling palmoplantar keratoderma, associated with well-defined hyperkeratotic plaques around the mouth and nostrils. His mother has an identical palmoplantar keratoderma. The palmoplantar keratoderma failed to improve with etretinate, but considerable benefit resulted from full-thickness excision of the skin of both palms, followed by skin grafting. We believe that he has a distinctive but extremely rare form of hereditary palmoplantar keratoderma, first described by Olmsted.

Child, Preschool↗
PubMed1990

Laser laparoscopy in the treatment of endometriosis. A 5-year study.

The carbon-dioxide laser used laparoscopically provides a precise and virtually bloodless technique for the vaporization of endometriotic implants in the pelvis. The technique has been used at St Luke's Hospital, Guildford, for the past 6 years and this report presents 228 consecutive patients with endometriosis treated during the 5 years between 1982 and 1987 and followed up for between 1 and 6 years. Pain was improved in 70% and 80% of the 56 infertile patients with endometriosis as the only identifiable abnormality conceived. Of the 54 pregnancies, only 37 (69%) had a successful outcome, reflecting the high pregnancy failure rate found in women with endometriosis. Hospital stay was relatively short and complications were few and usually minor and there was no injury or morbidity caused by laser energy. The main advantage of laser laparoscopy in endometriosis is that patients may be treated at the time of diagnosis with less need for medication and no delay before conception is attempted.

Adolescent↗