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Biomedical subjects

D A Shaw

Publications and source records attributed to D A Shaw.

13 recordsLinked to original sources
PubMed1992

Twin cities health care mergers, acquisitions, and affiliations. Implications for independent physician practices.

"The health care system in Minnesota, especially in the Twin Cities area, is currently undergoing change that can best be characterized as a consolidation of providers into larger and larger groups (multispecialty clinics, hospital/physician mergers, and expanded HMOs and PPOs). These changes are intended to produce economies of scale, less duplication of services, and better control of costs and quality of health care. Where does this leave the more traditional, smaller multispecialty or single-specialty practices often referred to as 'independents'?... How can independent groups respond to these trends in order to survive in the new health care marketplace?"

Health Facility Merger↗
PubMed1991

Haemodynamic considerations in the management of patients with subarachnoid haemorrhage.

Cerebral vasospasm occurs, following subarachnoid haemorrhage, in the majority of patients and is accompanied by cerebral ischaemia in 30%. The objectives of this article are to review (1) the effects of subarachnoid haemorrhage and vasospasm on cerebral blood flow (CBF); (2) the effects of induced hypotension and hypocapnia on CBF in these patients; (3) current therapy for cerebral ischaemia from vasospasm. The medical literature was searched using Index Medicus; for the period 1983-90 this search was done on a computer with the CD-ROM version of Index Medicus, Silver Platter. Papers were selected on the basis of validity and applicability to clinical practice; animal studies are included when human data is lacking. Cerebral vasospasm may decrease cerebral blood flow, disturb autoregulation and place the patient at risk for delayed cerebral ischaemia. Intraoperative induced hypotension and hypocapnia can decrease CBF further, although effects of either on outcome have not been evaluated. Calcium antagonists are effective for both the prevention and the treatment of delayed cerebral ischaemia. Of the mechanical treatments, systemic-arterial hypertension has the firmest scientific foundation, although this is frequently combined with haemodilution and blood volume expansion. There is a need for randomized clinical trials to assess the efficacy of these latter treatments.

Brain Ischemia↗
PubMed1990

Relation between apocrine differentiation and receptor status, prognosis and hormonal response in breast cancer.

The release of a gross cystic disease fluid protein (GCDFP 15) by tumour explants grown in tissue culture was used to measure apocrine differentiation in 117 women with breast carcinoma. GCDFP 15 was detected by radioimmunoassay in the media from 90% of tumours (range 2-2100 ng/ml, mean 41). Tumour secretion of GCDFP 15 was higher in oestrogen receptor rich (over 20 fmol/mg) tumours (P less than 0.05) but did not correlate with any other prognostic factors or with survival. Response to hormonal therapy was assessable by UICC criteria in 33 women (6 partial responses, 8 stable disease, 19 progression). Responders had significantly higher tumour oestrogen receptor levels (P less than 0.005) but a lower GCDFP 15 secretion than non-responders (P less than 0.02). Apocrine differentiation in breast cancer may be a marker for oestrogen receptor positive tumours that do not respond to hormonal therapy.

Adult↗
PubMed1990

Red blood cell and adipose tissue fatty acids in mild inactive multiple sclerosis.

The fatty acid profiles of phosphatidyl ethanolamine (PE) and phosphatidyl choline (PC) of the red blood cells of 30 patients with mild inactive multiple sclerosis (MS) and 30 healthy controls were studied by gas chromatography. The groups were well matched for factors likely to influence tissue lipid levels, including diet. The MS patients showed a significant reduction in PE eicosapentaenoic acid (p = 0.009) especially in women, and an increase in both PE dihomo-gamma-linolenic acid (p = 0.004) and PC stearic acid (p = 0.04). No reduction in linoleic acid was observed in either the PC or PE fractions of the MS subjects. A similar study of the fatty acid profile in adipose tissue in 26 MS and 35 healthy controls found no detectable eicosapentaenoic acid in either group. However, whereas docosahexaenoic acid was not detectable in any MS patient, 40% of the controls had measurable levels varying from to 0.1 to 0.3% of total estimated fatty acid (p = 0.0003). No reduction in linoleic acid in MS subjects was observed. Supplementation with oral fish body oil demonstrated that n-3 fatty acids were incorporated into red blood cells over 5 weeks and this occurred equally in MS and controls. The effects of oral supplementation on adipose tissue were studied after 1 and 2 years. Whereas many fatty acids such as linoleic acid were raised at 1 year, but did not rise subsequently, eicosapentaenoic acid and docosahexaenoic acid continued to rise through the 2-year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1978

Polyunsaturated fatty acids in treatment of acute remitting multiple sclerosis.

One hundred and sixteen patients with acute remitting multiple sclerosis (MS) took part in a double-blind controlled trial of treatment with polyunsaturated fatty acids and were randomly allocated to one of four groups. Two groups received linoleic acid, one alone as a spread and one with gamma-linolenic acid in capsules (Naudicelle); and two control groups received oleic acid, one as a spread and one in capsules. Rates of clinical deterioration and frequencies of attacks were not significantly different between treated and control groups. Exacerbations were shorter and less severe in patients receiving a high dose of linoleic acid than in controls, but those receiving a lower dose--that is, Naudicelle--showed no such difference. Thus supplementing the diet with 20 g linoleic acid marginally affected the duration and severity of relapses of MS but had no effect on overall disability. The dose of Naudicelle used provided insufficient supplementation.

Adult↗
PubMed1978

Hypothyroidism with true myotonia.

A patient with subclinical hypothyroidism who presented with true myotonia is described. There was no evidence that either he or members of his family had dystrophia myotonica or myotonia congenita. Treatment with thyroxine resolved his symptoms completely.

Adult↗
PubMed1977

A prospective study of nontraumatic coma: methods and results in 310 patients.

Neurological signs and outcome are compared in the first 310 patients from a continuing prospective study of coma not caused by trauma or drugs. Sixteen percent of the patients achieved an independent existence within a month; severe disability or the vegetative state developed in 25% of patients comatose for six hours and in 79% of those still in coma after a week. The chance of regaining an independent existence was greater in patients who, by one day, obeyed commands or moved the limbs appropriately in response to noxious stimuli or who had attained any of the following: orienting eye movements, normal responses to oculocephalic or oculovestibular stimulation, or normal muscle tone. Conversely, the chance of regaining an independent existence fell in patients who, after one day, had either extensor responses of the limbs or failed to move them in response to noxious stimuli or who lacked eye opening, pupillary reactions, corneal responses, or any eye movement in response to oculovestibular or oculocephalic stimulation. Beyond these general guidelines, numbers of patients with particular signs are presently too small for confident prediction of outcome.

Adolescent↗
PubMed1976

Rapid regular respiration in unconscious patients.

Respiratory frequency has been studied by strain gauge and impedance pneumography in a group of unconscious patients suffering from a variety of medical conditions, and has been compared with breathing in control subjects during wakefulness and sleep. Seventeen of 25 comatose patients had breathing patterns amenable to computerized statistical analysis of respiratory rate which demonstrated abnormalities in all patients studied. Unconscious patients breathed more rapidly and regularly than controls. Rapidity of respiration was not consistently associated with any specific central nervous system lesion, and was usually accompanied by coexistent pulmonary disease. Increasing regularity of respiration correlated well with deepening of coma and accurately reflected ultimate outcome even when other clinical signs were unchanging.

Adolescent↗
PubMed1976

Cervical myelopathy in rheumatoid arthritis.

Preliminary analysis of a follow-up study of one hundred patient with rheumatoid arthritis has lead to the following tentative conclusions: AAS is a common complication of rheumatoid arthritis. The incidence of AAS correlates with the duration of the disease. AAS is not necessarily associated with progressive myelopathy. AAS does not significantly affect survival in rheumatoid arthritis. AAS alone is not an indication for surgical operation, but this should be considered when there is intractable pain or progressive myelopathy.

Arthritis, Rheumatoid↗
PubMed1975

Cryptococcal meningoencephalitis.

A patient was admitted to hospital with an apparent psychiatric disturbance. When she became stuporous the cerebrospinal fluid was cultured but proved sterile. The latex test showed that serum was positive for cryptococcal antigens, and cryptococcal meningoencephalitis was diagnosed. Amphotericin B was given but when she developed a toxic reaction it was replaced by flucytosine. She responded well to flucytosine alone and no side effects appeared on continued treatment. Cryptococcal meningitis may present as a psychiatric disturbance, and serological tests are invaluable aids to diagnosis.

Adult↗