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Biomedical subjects

R J Moss

Publications and source records attributed to R J Moss.

10 recordsLinked to original sources
PubMed1992

Ovulation induction with a single-blind treatment regimen comparing naltrexone, placebo and clomiphene citrate in women with secondary amenorrhea.

Secondary amenorrhea is often associated with emotional stress, weight loss, eating disorders or polycystic ovary-like disease. Involvement of the endogenous opioids in the pathophysiology of hypothalamic amenorrhea, by inhibition of hypothalamic GnRH secretion, has been demonstrated in some cases. Chronic blockade of the endogenous opioids with the long-acting opioid antagonist naltrexone could result in increased gonadotropin secretion and ovulation induction in these cases. A single-blind ovulation induction protocol comparing naltrexone, placebo and clomiphene citrate was evaluated in eight patients with secondary amenorrhea. Naltrexone proved not to be more effective than placebo in our study. Only one patient ovulated on naltrexone, one on placebo and four on clomiphene citrate. The latter therapy caused a better endocrine response. In conclusion, although ovulation could be incidentally induced by naltrexone, this drug did not appear to be more successful than placebo and clomiphene citrate for ovulation induction in this population of patients.

Amenorrhea↗
PubMed1991

The ethics of pressure sore prevention and treatment in the elderly: a practical approach.

The management of pressure sores in elderly patients raises a number of ethical dilemmas for health care professionals. Aggressive treatment of advanced pressure sores is often inconsistent with the overall goals of therapy. Private and public funding for effective prevention and early treatment are restricted and constrained. Little information is available that proves treatment efficacy. Health care professionals and their institutions are often stigmatized by the occurrence of a pressure sore even though accountabilities may lie in the natural history of the disease. We use case analysis to identify ethical dilemmas in pressure sore prevention and management and suggest a framework for ethical decisionmaking so that health care professionals and public policy analysts can make informed judgments about patients and standards of quality care.

Aged↗
PubMed1988

Synthesis, intramolecular hydrogen bonding, and biochemical studies of clitocine, a naturally occurring exocyclic amino nucleoside.

The total synthesis of clitocine [6-amino-5-nitro-4-(beta-D-ribofuranosylamino)pyrimidine] (1), a nucleoside recently isolated from the mushroom Clitocybe inversa, has been accomplished. Glycosylation of 4,6-diamino-5-nitropyrimidine (4) with 1-O-acetyl-2,3,5-tri-O-benzoyl-D-ribofuranose afforded the protected nucleoside 6-amino-5-nitro-4-[(2,3,5-tri-O-benzoyl-beta-D-ribofuranosyl) amino]pyrimidine (5) in good yield exclusively as the beta-anomer. Deprotection of 5 with NaOMe/MeOH gave 1 as an 11.5:1 mixture of the beta- and alpha-anomers, respectively. Recrystallization from MeOH, followed by chromatography, afforded 1 containing less than 1% of its alpha-anomer. X-ray crystal data revealed a planar aglycon moiety in clitocine with each oxygen atom of the nitro group intramolecularly hydrogen bonded to the hydrogen atoms of the two adjacent amino functions. Clitocine inhibited L1210 cells in vitro with an ID50 of 3 X 10(-8) M. Clitocine was also found to be a substrate and inhibitor of adenosine kinase with a Ki value of 3 X 10(-6) M.

Adenosine Kinase↗
PubMed1988

The coexistence and differentiation of late onset Huntington's disease and Alzheimer's disease. A case report and review of the literature.

The case report presented is clinically compatible with late onset HD. The diagnosis was initially obscured by a lack of family history due to the early death of both parents and siblings. The presence of symptoms at the age of 59 in one offspring is consistent with the intrafamilial transmission of late onset HD disease. The early neuropsychometric data were consistent with the cognitive changes of HD, particularly with the loss of higher cognitive functions, memory and the relative decline in the performance IQ with the preservation of language skills. The psychiatric symptoms of emotional lability and apathy were also congruent with the diagnosis of HD. The atypical features of this patient's course, including progressively severe dementia, seizures and rigidity, may have provided clinical clues to the coexistence of both AD and HD. The absence of caudate atrophy on serial CT scans in this patient, although inconsistent with the gross findings reported on postmortem exam, perhaps could be explained by the 3 1/2-year interval between the last CT scan and death. Further, it has been noted previously that pathological changes tend to lag behind the clinical manifestations of the disease. The pathologic findings on autopsy were confirmatory for the presence of both AD and HD in this patient. Genetic counseling for this family is now most appropriate.

Age Factors↗
PubMed1988

AIDS dementia.

For the geriatrician who commonly evaluates cognitive and psychiatric disorders in the elderly, the neurologic consequences of infection with the human immunodeficiency virus (HIV) are of particular importance. The most frequent neurologic disease is the AIDS dementia complex characterized by cognitive, behavioral, and motor changes, occurring in two-thirds of AIDS patients. The pathophysiology of central nervous system HIV infection has been advanced with important implications for both the diagnosis and the potential treatment of this devastating disease.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Evaluating life-sustaining treatments for demented persons.

Decisions to employ, withhold, or withdraw life-sustaining treatments from demented individuals should be centered on the patients' personal needs rather than on physiological abnormalities. To accomplish this, physicians and families need a trusting communication and flexible, comprehensive, and positive approaches to treatment goals and technologies. This article critiques and proposes approaches to such treatment planning.

Aged↗
PubMed1987

AIDS and the geriatrician.

Ten percent of acquired immune deficiency syndrome (AIDS) cases are in persons over 50 years of age with 25% of these cases in persons over 60, and 4% in persons over 70 years of age. If the present age distribution holds, there will be 27,000 AIDS cases in persons over 50, and 1100 cases in persons over 70 years of age, by 1991. Older persons are more likely to acquire AIDS through blood transfusions than to homosexual exposure or drug abuse. Changes in the management of blood products will benefit older persons. The nearly 1 million elderly homosexual men, who have been sheltered from the virus by their pattern of sexual activity, will face greater risks as the prevalence of the virus and the age of the carriers increases. The underappreciated neurological consequences of human T-cell lymphotrophic virus type III (HTLV-III) infection, subacute encephalitis, vacuolar myelopathy, and psychiatric disorders will be of particular interest to geriatricians who are often consulted to evaluate neurological dysfunction. Geriatricians will need to become familiar with the spectrum of HTLV-III infection and prepared to counsel patients and extended-care facilities.

Acquired Immunodeficiency Syndrome↗
PubMed1986

A luminescent label for the immunoassay of oxytocin.

Chemiluminescent labels have been shown to be interesting alternatives to radioisotope labels. Disadvantages of the latter are preparation of e.g. labelled protein/peptides every four to six weeks, and problems with storage and disposal. Amino-Butyl-Ethyl-Isoluminol(ABEI) was attached to the alpha-amino function of the N-terminal amino acid residue of oxytocin; this complex was used in immunoassays for oxytocin. This non-isotopic label did not require heating at 60 degrees C for optimal light-signal development, a procedure usually required for chemiluminescent labels. Standard curves were set up employing the ABEI-label on the one hand and 125I-label on the other. Under identical conditions of final antibody concentration and amount of label, a comparison was made between the performance of the luminescent immunoassay (LIA) and that of the radioimmunoassay (RIA). We conclude that the LIA systems resulted in standard curves of high precision; in comparison with RIA, the sensitivity of the LIA curves is not yet sufficient for the determination of oxytocin concentrations in e.g. human biological fluids. Further improvements in sensitivity of the LIA systems are to be expected by selection of other luminescent labels or by the use of a more sensitive measuring device.

Immunoassay↗