PubMed Health⌕ Search

Biomedical subjects

D A Stone

Publications and source records attributed to D A Stone.

14 recordsLinked to original sources
PubMed1992

Phase I study of taxol and granulocyte colony-stimulating factor in patients with refractory ovarian cancer.

PURPOSE: To increase the taxol dose beyond the current standard dose intensity of 175 mg/m2 per 21 days in patients with refractory ovarian cancer. PATIENTS AND METHODS: Fifteen patients who had platinum-refractory or recurrent advanced-stage ovarian cancer were treated with taxol in a phase I trial and were given granulocyte-colony stimulating factor (G-CSF). Taxol was administered at doses of 170, 200, 250, and 300 mg/m2 every 3 weeks. G-CSF was given as a daily subcutaneous injection that started 24 hours after the completion of the taxol infusion. RESULTS: Four patients required either taxol dose reduction or delay. The dose-limiting toxicity (DLT) was peripheral neuropathy, and it occurred at 300 mg/m2. This toxicity was manifested clinically as a stocking-and-glove sensory disturbance that primarily affected proprioception, and was associated with objective changes on nerve conduction studies in affected individuals. Mucositis was rarely observed. Substantial myelosuppression was observed, but was not dose-limiting. Five of 14 assessable patients experienced an objective response to therapy, with another five individuals who experienced a 30% to 45% reduction in tumor mass. CONCLUSION: Taxol can be safely administered in doses up to 250 mg/m2 with G-CSF support, which may make it possible to study taxol dose intensification.

Adult↗
PubMed1991

Handcuff neuropathies.

Compressive neuropathy due to tight application of handcuffs occurred in 5 patients. The superficial radial nerve was affected in 8 hands and the median nerve in two. Neurologic deficits persisted as long as 3 years after handcuffing. Nerve conduction studies helped to exclude malingering and other diagnoses. All patients had been intoxicated when handcuffed or had been arrested with force. The handcuff mechanism, which allows accidental overtightening after application, is an unrecognized factor in these neuropathies.

Adult↗
PubMed1989

Atmospheric chemistry of propellant vapors.

Hydrazine fuels are used as examples of the relatively rapid chemical processes which may occur when propellants are released into the atmosphere from normal handling or during accidents. The experimental procedures used to study these processes are reviewed along with postulated chemical reaction mechanisms and measured reaction rates and products. Results show that chemical processes which occur on a time scale comparable with meteorological processes must be considered in the development of dispersion models. These models must also account for the potential formation of toxic reaction products.

Air Pollutants↗
PubMed1987

Hearing loss screening in the neonatal intensive care unit: auditory brain stem response versus Crib-O-Gram; a cost-effectiveness analysis.

We used cost-effectiveness analysis to compare two strategies for screening for severe hearing loss in the neonatal intensive care unit (NICU): the auditory brain stem response (ABR) and the Crib-O-Gram (COG). We studied hypothetical cohorts of infants using data derived from the literature on screening test characteristics. We included the costs of initial screening and those of further diagnostic testing for infants who fail the screening test. The ABR cost more per test administered than COG, but had higher sensitivity and specificity to detect hearing loss. We found the ABR, therefore, to be more cost effective than the COG. Using best-estimate assumptions, ABR cost $10,610 for each correctly detected case of hearing loss; COG cost $14,310 for each correctly detected case; among every 1,000 NICU infants screened, furthermore, ABR detected all cases of hearing loss, whereas COG failed to detect five hearing-impaired infants. We conclude that cost-effectiveness analysis justifies using ABR as a screening tool.

Audiometry↗
PubMed1986

MMPI measures of psychological disturbance in adolescent and adult victims of father-daughter incest.

The MMPI was used to study psychological disturbance in two different age groups of victims of father-daughter incest. The profiles of a group of 27 adolescent victims and 31 adult victims were compared and analyzed. All subjects had a history of being molested when they were children by their fathers or stepfathers, and all were in psychotherapy at the time of testing. In order to establish clear age differentiation between the two groups, no adolescent was over the age of 19 and no subject in the adult group was under age 30 when they were tested. The results indicated that the overall profiles were more elevated for the adult victims than for the adolescent victims. Both groups were elevated (T greater than 70) on Scale 8 (Sc), and the adults also were elevated on Scale 4 (PD), while the adolescents were high (T = 69) on Scale 9 (MA). The results are discussed in terms of core personality disturbance shared by the two groups and the probable influence of time or age on how the psychopathology is expressed.

Adolescent↗
PubMed1986

Olfactory bulbectomy prevents anti-gonadal effect of exogenous melatonin in male hamsters.

When male Golden hamsters are maintained on short days (less than 12.5 h of light/day) the testes gradually regress. This testicular regression is due to an inhibitory effect of pineal gland melatonin on gonadotropin secretion. A previous report from the author's laboratory has indicated that olfactory bulbectomy (BX) will prevent the testicular regression associated with short photoperiod. The present study examined whether BX would also prevent the testicular regression associated with exogenous melatonin (MEL) injections. Male Golden hamsters were BX or sham (SH) BX at 23-28 days of age and were maintained on 14:10 light-dark cycle. Six weeks following surgery, one half of each surgical group began receiving injections of melatonin (15 micrograms sc), whereas the other half was injected with vehicle at 1600 daily. The testes size of the SH group injected with MEL progressively decreased, whereas the testes of all other groups remained large. These results indicate that BX prevents the testicular regression associated with short photoperiod by interfering with the antigonadotropic effect of melatonin.

Animals↗
PubMed1986

The resistible rise of preventive medicine.

The politics of preventive health care have changed dramatically in the last fifteen years. In the late 1960s and early 1970s, prevention was the motherhood issue of health care reform. With only the slightest glimmer of controversy, vaccination, promotion of lifestyle changes, mass screening, and safety regulation all became widely accepted strategies for improving health and reducing medical expenditures. By the mid-1980s, the dark side of each strategy became visible. Vaccinations can cause serious and permanent injuries; lifestyle factors are being used to raise insurance premiums, to deny eligibility for disability insurance benefits, and to deny employment. Screening is similarly used to deny employment, and new technologies for prenatal screening have raised fears of stigma and selective abortion among racial, handicapped, and antiabortion groups. Occupational safety regulation is increasingly focused on excluding the "high-risk" individual from jobs. In the absence of social protections from these economic and social harms, citizens have used tort and civil rights litigation to resist preventive health measures.

Health Promotion↗
PubMed1979

Health care cost containment in West Germany.

The West German health care system has experienced a serious escalation of expenditures since about 1970. For a variety of reasons, many features of the national health insurance program that might have provided restraints on costs were gradually eliminated. Most notably, some restrictions on the supply of physicians and hospital facilities were ended, as was an earlier system of fixed budgeting for ambulatory care services. In addition, legislative and judicial decisions have continually expanded both the benefits and the standard of care that must be provided to publicly insured patients. In 1977, the government passed a Health Care Containment Act which ordered several measures to curb costs: prospectively negotiated ceilings on expenditures for physicians' services, dentists' services and prescription drugs; strengthening of utilization review; composition of a unified fee schedule; small increases in cost sharing and limitations on insurance benefits; and some changes in financing. The reform efforts seem to have had a significant effect, though it is still too early to tell exactly what caused the declining growth rate of health expenditures, and whether the new trend will persist.

Cost Control↗
PubMed1979

Diagnosis and the dole: the function of illness in American distributive politics.

This article argues that the concept of illness has certain properties that make it a convenient administrative device for managing a need-based redistributive system in a society whose primary distributive system is based on work. These properties--cultural acceptance of illness as a legitimate excuse for not working, objective standards for identifying illness, and restrictiveness--have led to the widespread use of illness as an eligibility criterion for many social benefits, including cash transfers, services, privileges and exemptions. Paradoxically, the traditional rationales for using illness as one of the keystones of categorical welfare policy are eroding, yet welfare programs based on illness certification are growing rapidly. To explain this anomaly, the author suggests that medical certification as a distributive mechanisms serves certain latent political functions, such as allowing welfare programs to be responsive to political unrest, siphoning off opposition to controversial policies by the granting of medical exemptions to intense opponents, are reducing political conflict by using physicians as arbiters.

Attitude to Health↗