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Biomedical subjects

J A Butler

Publications and source records attributed to J A Butler.

At least 91 records · Page 5Linked to original sources
PubMed1987

Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors.

To identify factors modifying the outcome of reoperation for intra-abdominal infection, we analyzed the management of 47 patients who underwent repeated laparotomy from July 1980 through July 1985. Overall mortality was 30% (14/47). Factors predictive of death were as follows: age greater than 60 years (86% mortality vs 21% mortality), preoperative vs no organ failure (57% vs 6%), multiple vs single abscess (53% vs 16%), and exploratory vs directed operative approach (39% vs 17%). Although the interval between the primary surgery and reoperation was similar between survivors (13 days) and nonsurvivors (14 days), five (36%) of 14 nonsurvivors were in septic shock and eight (57%) of 15 survivors showed evidence of organ failure prior to reoperation. The median survival period following reoperation in this group was only four days. Computed tomography (CT) and/or ultrasonography were performed to localize a source of infection in 24 patients. In nine (82%) of 11 patients, CT identified the abscess, while ultrasonography was positive in 15 (72%) of 21 patients. Neither the interval to operation nor the mortality was significantly different in patients diagnosed with CT and ultrasonography when compared with those who underwent exploration on the basis of clinical findings. To lower the mortality and to shorten the interval to reoperation in these high-risk patients, noninvasive diagnostic testing and confirmation by percutaneous sampling must be sought before the onset of clinical sepsis and organ failure.

Abdomen↗
PubMed1987

Estrogen receptor protein of breast cancer in patients with positive nodes. High recurrence rates in the postmenopausal estrogen receptor-negative group.

In 448 patients with positive axillary lymph nodes who were treated with mastectomy at Memorial Sloan-Kettering Cancer Center, New York, from 1973 to 1978, estrogen receptor (ER) status was associated with survival. With a median follow-up of 75 months, significant differences were noted in the 288 postmenopausal patients; ER-positive patients had better six-year disease-free survival than ER-negative patients (60% vs 45%), as well as better overall survival. These differences were true in subgroups with one to three and four or more involved nodes. The addition of adjuvant systemic therapy had no significant effect on either ER-positive or ER-negative patients. The need for new imaginative systemic programs in the subgroup of ER-negative postmenopausal patients with breast cancer with positive nodes is apparent.

Axilla↗
PubMed1987

Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis.

A new 99mTc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with 99mTc by inducing phagocytosis of 99mTc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (greater than 75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5-90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% (10/12) and a specificity of 100% (26/26) the 99mTc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams.

Acute Disease↗
PubMed1987

Early identification of children's special needs: a study in five metropolitan communities.

In a study of special education programs in five urban school systems, parent interview data for 1726 children revealed how early the children's problems were identified and how the medical system was involved in the diagnosis. Problems included speech impairment, learning disabilities, emotional disturbance, mental retardation, sensory disorders, and physical and health disabilities. Overall, 4.5% of the children's problems were identified at birth, and only 28.7% before the age of 5 years. Variation in age at identification depended on the condition: 1 year for Down syndrome and cerebral palsy versus a 6-year range for mental retardation. Although physicians were most likely to identify the less common, more severe handicaps, they also identified from 15% to 25% of learning disabilities, speech impairments, emotional disorders, hyperactivity, and "other" development problems. The type, severity, and complexity of the condition were significant predictors of physician identification. No racial, socioeconomic, or site biases were associated with whether a physician was first to identify. Age at identification was predicted by the complexity of the problem, the association with other health and developmental concerns, socioeconomic indicators, and whether a physician was involved in the diagnosis. In the absence of clear assumption of responsibility for early identification, much terrain remains uncharted by medical practitioners and the schools. A better systematic sharing of responsibility for the early identification of developmentally disabling conditions is needed.

Affective Symptoms↗
PubMed1987

Effects of dietary selenite, selenocystine and selenomethionine on selenocysteine lyase and glutathione peroxidase activities and on selenium levels in rat tissues.

Weanling male rats were fed a basal selenium (Se)-deficient diet or this diet plus 2 ppm Se as either selenite, selenocystine (SeCys) or selenomethionine (SeMet) for 9 wk. The rats were killed by decapitation while anesthetized with ether, and tissues were assayed for glutathione peroxidase (GPx) and selenocysteine lyase activities, and for Se content. Dietary Se had no effect upon the activity of tissue selenocysteine lyase. This activity was highest in the liver, followed by kidney, muscle and testis in decreasing order. Although the GPx activity was lower in tissues of the Se-deficient rats, there were no significant differences in its activity between animals given the different chemical forms of dietary Se. Except for the kidney, the tissue Se concentrations were similar in rats fed selenite or SeCys, but the Se content in testis, muscle, pancreas, heart, spleen, whole blood, erythrocytes and plasma was significantly higher in rats fed SeMet than in those fed either selenite or SeCys. The greatest increase due to SeMet compared with the selenite and SeCys treatments was about 10-fold in the muscle compared with 1.3- to 3.6-fold for the other tissues.

Animals↗
PubMed1987

Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas.

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Child↗
PubMed1986

Health care access and use among handicapped students in five public school systems.

The authors studied the health care access and utilization patterns for a stratified random sample of 1,726 special education students in five large metropolitan school systems. Overall, 7% of the special education students had no regular source of care, 26% had no regular physician, and 38% had not visited a physician in the previous year; 13% had no health insurance. Each of these measures was worse for nonwhite and poorer children as well as for those whose mothers who had less formal education. Insurance coverage was associated with physician visits, with 45% of the uninsured children visiting a physician compared with 63% of those with public insurance and 66% of those with private insurance. Odds ratios for all health care access and use measures showed striking geographic variations. Thus, even for children identified as handicapped by their communities, barriers to health care are evident and are significantly greater for groups traditionally at risk.

Child↗
PubMed1985

Estrogen receptor protein of breast cancer as a predictor of recurrence.

To assess the value of estrogen receptor protein (ERP) as a predictor of tumor recurrence, 556 patients treated by mastectomy between 1973 and 1978 for primary operable breast cancer had ERP determination of their tumors. All patients had histologically negative nodes. Two hundred fifty-six patients were ERP-positive, 233 were ERP-negative, and 67 were ERP-borderline. ERP-borderline patients showed recurrence and survival figures similar to ERP-negative patients and were grouped with them in the analysis. With a median follow-up of 75 months, overall survival for the entire group at 72 months was 93% with a disease-free survival of 85%. No difference in either overall survival or DFS was noted between the ERP-positive (94% and 83%, respectively) and ERP-negative (91% and 86%, respectively) groups. The incidence of recurrence in premenopausal women was 12% (14/115) in the ERP-negative patients versus 17% (9/48) among the ERP-positive patients. This contradicts the current impression that ERP-negative, premenopausal patients have a poorer prognosis than ERP-positive patients. Postmenopausal patients had a 16% recurrence in both ERP-negative (27/171) and ERP-positive (31/202) categories. On the basis of 6-year median follow-up, it was concluded that ERP status is not an indicator of recurrence. In particular, patients with negative nodes should not be considered for adjuvant chemotherapy on the basis of negative estrogen receptor status of their primary tumors.

Actuarial Analysis↗
PubMed1985

Medical care use and expenditure among children and youth in the United States: analysis of a national probability sample.

Good access to health care for all US children and youth remains an important social policy goal. Recent patterns of access as reflected in the presence of regular care sources, health care use, health insurance coverage, and expenditures for medical care are described and analyzed using the subsample of all children 0 to 18 years of age from the 1980 National Medical Care Utilization and Expenditure Survey. Data from the survey indicate that in 1980, 92% of US children and youth had a regular care source and the same percentage were covered for the full year or part of the year by some form of public or private health insurance. However, use rates and patterns of expenditure continued to differ dramatically according to family background factors, particularly race, ethnicity, poverty status, and location of residence. These differences are analyzed and comparative data are presented for groups of children from various sociodemographic groups. Minority-group and near-poor children were found to be at highest risk for limited utilization of services and inadequate insurance coverage.

Adolescent↗
PubMed1984

Metabolism of [75Se]selenite by rhesus monkeys.

The metabolism of [75Se]selenite was studied in rhesus monkeys. In blood samples taken various times after injection, Sephadex G-150 gel filtration revealed that the majority of the 75Se was associated with hemoglobin and low-molecular-weight compounds in erythrocytes up to 24 hours after selenium injection. Subsequently a gradual increase of 75Se occurred in glutathione peroxidase (GSH-Px) with a concurrent decrease of label with hemoglobin. In contrast to the erythrocytes, over 80% of the labeled selenium in plasma was associated with one peak 3 hours and later after injection. This major protein eluted at a position similar to GSH-Px on gel filtration, but subsequent chromatography on diethylaminoethyl (DEAE)-Sephacel separated the radiolabeled protein from GSH-Px. Gel filtration of heart, muscle, brain and pancreas cytosol revealed two major selenium-containing proteins, whereas one was predominant in liver and kidney. The major selenium peak was associated with GSH-Px in liver but not in the kidney. GSH-Px activity with either organic or inorganic peroxides as substrates and glutathione transferase activity were higher in liver than kidney.

Animals↗
PubMed1983

Reducing childhood disability in the 80s.

Childhood disability is now known to be a major public health problem throughout the world. It is estimated that in 1975 about 10 percent of the world's 1.4 billion children suffered from one or more disabilities. The authors discuss the patterns and causes of childhood disability from an international perspective and outline a number of factors that will continue to influence the incidence of disability in the 1980s. They conclude by suggesting several strategies for change, both national and international in nature, to help prevent disability and to care for disabled children.

Accidents↗
PubMed1983

Auxiliary canine hepatic transplantation without portal blood flow.

Auxiliary liver transplantation for acute reversible hepatic failure has been suggested as a way to provide temporary hepatic support. The major technical difficulty in such an operation is providing portal blood flow, although it is unclear if this is necessary for short-term function of such a graft. Three groups of five dogs each underwent common duct ligation and cholecystectomy. One week later all animals underwent an end-to-side portocaval shunt. In Group I dogs only a "sham" transplant was done while those in Group II also received an auxiliary hepatic graft without portal blood flow which had been perfused with iced Collins solution and immediately grafted. Group III received similar auxiliary hepatic grafts with 22 hours of cold ischemia time. Reductions in mean total serum bilirubin values to near normal, usually lasting for one week (Group I, 12.02 mg% +/- 1.23 SEM vs. Group II, 3.58 mg% +/- 0.52 SEM, p = 0.01) were observed. Although several livers stored for 22 hours demonstrated function, there was considerable evidence of ischemic injury.

Acute Disease↗
PubMed1982

Blood selenium and glutathione peroxidase activity in pregnant women: comparative assays in primates and other animals.

The influence of pregnancy on blood selenium levels and glutathione peroxidase (GSH-Px) activity was studied in women. Whole blood and plasma selenium levels decreased whereas erythrocyte and plasma GSH-Px activities increased with the progress of pregnancy. The ratio of erythrocyte GSH-Px activity to whole blood selenium levels was 4- to 5-fold higher in rats and sheep than in primates (humans and monkeys), suggesting that more selenium is associated with GSH-Px in erythrocytes from rats and sheep than from primates. In assays of blood with low GSH-Px activity such as that from humans or selenium-deficient animals, a component of the erythrocyte other than GSH-Px was found to contribute more to the peroxidase activity. Evidence was obtained to indicate that t-butyl hydroperoxide is a better substrate than hydrogen peroxide for the assay of low GSH-Px erythrocyte activity. The length of time that the blood was stored before assay was found to have an effect on erythrocyte GSH-Px activity, and the storage patterns may be dependent on the species of animal from which the blood is drawn.

Adult↗
PubMed1981

Electroconvulsive shock and reserpine: effects on beta-adrenergic receptors in rat brain.

Electroconvulsive shock (ECS) administered once daily for up to 14 days decreases beta-adrenergic receptor binding in the cortex and hippocampus in a time-dependent manner. The decrease in binding in the cortex lasts at least 1 week after the last shock. In the striatum, hypothalamus, or cerebellum, 14 days of ECS did not produce significant changes in beta-adrenergic receptor binding. The brain regional pattern of beta-adrenergic receptor changes suggests that repeated ECS affects beta 1-adrenergic receptors in brain regions that receive a noradrenergic innervation activated by ECS. The effects of ECS on neurotransmitter receptor binding appear to be highly selective. Of five receptors in the cortex and three receptors in the hippocampus measured, only beta-adrenergic receptor binding is decreased. Chronic footshock stress does not alter beta-adrenergic receptor binding sites in the cortex, indicating that the effects of ECS are not due to stress alone. The effects of ECS on reserpine-induced alterations in beta-adrenergic receptor binding sites were also examined. Ten days of ECS following chronic reserpine injections reverses the increased binding of beta-adrenergic receptors.

Animals↗