Search PubMed⌕ Search

Biomedical subjects

L Gallagher

Publications and source records attributed to L Gallagher.

15 recordsLinked to original sources
PubMed1999

A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration.

OBJECTIVE: To compare the efficacy, safety, and cost of fixed-dose low-molecular-weight heparin (dalteparin) with adjusted-dose unfractionated heparin as anticoagulant for continuous hemofiltration. DESIGN: Prospective, randomized, controlled clinical trial. SETTING: University-affiliated adult intensive care unit PATIENTS: All patients requiring continuous hemofiltration for acute renal failure or systemic inflammatory response syndrome (SIRS) were eligible. Fifty-seven patients were enrolled. Eleven were excluded, seven because of major protocol violations and four died before hemofiltration. INTERVENTIONS: Patients received continuous venovenous hemodialysis with filtration with prefilter replacement at 500 mL/hr and countercurrent dialysate at 1000 mL/hr. Filters were primed with normal saline containing anticoagulant. Dalteparin-treated patients received a commencement bolus of 20 units/kg and a maintenance infusion at 10 units/kg/hr. Heparin-treated patients received a commencement bolus of 2000-5000 units and a maintenance infusion at 10 units/kg/hr, titrated to achieve an activated partial thromboplastin time in the patient of 70-80 secs. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure--time to failure of the hemofilter--was compared using survival analysis. Twenty-two patients (13 with acute renal failure and nine with SIRS; total, 41 filters) were randomized to heparin. Twenty-five patients (16 with acute renal failure and nine with SIRS; total, 41 filters) were randomized to dalteparin. Mean (SE) activated partial thromboplastin time in the heparin group was 79 (4.3) secs. Mean (SE) anti-factor-Xa activity in the six patients given dalteparin who were assayed was 0.49 (0.07). Mean (SE) prehemofiltration platelet count was 225 (35.5) x 10(9) for heparin and 178 (18.1) x 10(9) for dalteparin (p = .24, unpaired Student's t-test). Mean (SE) prehemofiltration hemoglobin was 11.4 (0.61) g/dL for heparin and 10.6 (0.38) g/dL for dalteparin (p = .31, unpaired Student's t-test). PRIMARY OUTCOME: There was no significant difference in the time to failure between the two groups (p = .75, log rank test). For dalteparin, Kaplan-Meier (K-M) mean (SE) time to failure of the hemofilter was 46.8 (5.03) hrs. For heparin, K-M mean (SE) time to failure was 51.7 (7.51) hrs. The 95% CI for difference in mean time to failure was -13 to 23 hrs. The power of this study to detect a 50% change in filter life was >90%. SECONDARY OUTCOMES: Mean (SE) reduction in platelet count during hemofiltration was 63 (25.8) x 10(9) for heparin and 41.8 (26.6) x 10(9) for dalteparin (p = .57, unpaired Student's t-test). Eight patients given dalteparin and four patients given heparin had screening for heparin-induced thrombocytopenia; three of the dalteparin patients and one of the heparin patients were positive (p = 1.0, Fisher's exact test). There were three episodes of trivial bleeding and two episodes of significant bleeding for dalteparin, and there were three episodes of trivial bleeding and four episodes of significant bleeding for heparin (p = .53, chi-square test). The mean (SE) decrease in hemoglobin concentration during hemofiltration was 0.51 (0.54) g/dL for heparin and 0.28 (0.49) g/dL for dalteparin (p = .75, unpaired Student's t-test). The mean (SE) packed-cell transfusion volume during hemofiltration was 309 (128) mL for heparin and 290 (87) mL for dalteparin (p = .90, unpaired Student's t-test). Daily costs, including coagulation assays, of hemofiltration were approximately 10% higher using dalteparin than with heparin. CONCLUSIONS: Fixed-dose dalteparin provided identical filter life, comparable safety, but increased total daily cost compared with adjusted-dose heparin. Unfractionated heparin remains our anticoagulant of choice for continuous hemofiltration in intensive care.

Acute Kidney Injury↗
PubMed1997

Analysis of cDNA clones encoding sucrose-phosphate synthase in relation to sugar interconversions associated with dehydration in the resurrection plant Craterostigma plantagineum Hochst.

Sucrose-phosphate synthase (SPS) is a key enzyme in the regulation of sucrose metabolism, being responsible for the synthesis of sucrose 6-phosphate from fructose 6-phosphate and uridine 5'-diphosphate-glucose. We report on the isolation and characterization of cDNA clones encoding SPS from Craterostigma plantagineum Hochst., a resurrection plant in which the accumulation of sucrose is considered to play an important role in tolerance to severe protoplastic dehydration. Two distinct classes of cDNAs encoding SPS were isolated from C. plantagineum, and are represented by the clones Cpsps1 and Cpsps2. The transcripts corresponding to both cDNAs decrease to very low levels in dehydrating leaves of C. plantagineum. Only the Cpsps1 transcript occurs in the roots, where it is present at a higher level than in leaves and increases upon dehydration of the plant. Higher enzymatic activities have been determined in protein extracts of dehydrated tissues compared with untreated tissues, which correlates with an increase in protein levels. It is suggested that the overall regulation of SPS is strongly influenced by the changing composition of the cytoplasm in C. plantagineum leaves during the dehydration-rehydration cycle.

Amino Acid Sequence↗
PubMed1995

Malnutrition in hospitalized pediatric patients. Current prevalence.

OBJECTIVE: To document the current prevalence of protein-energy malnutrition compared with that reported from the same institution in 1976. DESIGN: All inpatients of this tertiary-care facility were assessed by anthropometric, laboratory, and clinical nutrition assessment methods in a 1-day cross-sectional survey. The comparison study from 1976 was also a 1-day cross-sectional survey. SETTING: A tertiary-care facility in Boston, Mass. PATIENTS: The entire inpatient population was assessed on a single weekday in September 1992. MAIN OUTCOME MEASURES: Prevalence of acute and chronic malnutrition as judged by anthropometric and laboratory data. Data on demographics, admission classification, underlying disease, route of nutrition, and global nutritional status were also assessed. RESULTS: The prevalence of acute protein-energy malnutrition (weight for height) based on the Waterlow criteria was as follows: severe, 1.3%; moderate, 5.8%; mild, 17.4%; and none, 75.5%. The prevalence of chronic protein-energy malnutrition (height for age) was as follows: severe, 5.1%; moderate, 7.7%; mild, 14.5%; and none, 72.8%. Although the prevalence of acute and chronic protein-energy malnutrition was significantly less in 1992 than in 1976 (P = .03 and P < .001, respectively), the numbers are still alarmingly high. Children younger than 2 years and older than 18 years and those with chronic medical conditions had a higher prevalence of protein-energy malnutrition. Twenty-four percent of patients had a serum albumin level less than 30 g/L, 34.8% had a total lymphocyte count less than 1.5 x 10(9)/L, and 24.9% had a hemoglobin concentration less than 105 g/L. One fourth of all patients were obese (> 120% weight for height), with the greatest prevalence in children aged 2 to 18 years. CONCLUSIONS: Acute and chronic protein-energy malnutrition remains common in hospitalized pediatric patients in the United States. Important risk factors may be underlying chronic disease, periods of normally rapid growth, and recognized need for nutrition intervention.

Acute Disease↗
PubMed1995

Hypertensive and normal pregnancy: a longitudinal study of blood pressure, distensibility of dorsal hand veins and the ratio of the stable metabolites of thromboxane A2 and prostacyclin in plasma.

OBJECTIVE: By combining serial measurements of the circulating concentrations of thromboxane A2 and prostacyclin with measurements of venous distensibility (taken during the pregnancies of both normal women and those with pregnancy induced hypertension or pre-eclampsia), to test the following hypotheses: 1. that changes in the venous plasma ratio of thromboxane (TXB2) and 6-keto-PGF1 alpha would correlate with changes in the blood pressure of women developing and recovering from pregnancy induced hypertension or pre-eclampsia and 2. that changes in venous distensibility would correlate with changes in arterial blood pressure in pregnancy induced hypertension or pre-eclampsia. DESIGN: Prospective, longitudinal cohort study. SETTING: John Hunter Hospital clinic, Newcastle, Australia. SUBJECTS: One hundred and sixty primiparous women, recruited when presenting for their first routine antenatal visit, were investigated at, or close to, 19, 28 and 37 weeks of gestation; a subgroup was also studied in the postnatal period. The measurements of the patients who developed pregnancy induced hypertension or pre-eclampsia were compared with those of controls selected from the cohort. MAIN OUTCOME MEASURES: Serial measurements of the circulating concentrations of the stable metabolites of thromboxane A2 and prostacyclin (TXB2 and 6-keto-PGF1 alpha, respectively), venous distensibility and immediate (no rest) and resting (for at least 30 min) blood pressures. RESULTS: There was no significant difference between the subject and control groups at any time during or after the pregnancy in the concentrations of prostaglandin metabolites, their ratio or venous distensibility. In contrast, there was a significant difference between the groups at 19 weeks for immediate and resting readings of diastolic pressure (6 mmHg (95% CI 1.5 to 10.5) and 4 mmHg (95% CI 0.1 to 7.9), respectively). These differences increased through the pregnancy but mean postnatal readings for the groups were almost identical suggesting that the subjects were not intrinsically hypertensive compared with controls. Blood pressures for the subject group, both immediate and resting, were significantly different from the 19 week readings at 28 weeks (diastolic) and at 37 weeks (systolic and diastolic). The only significant change from first readings among controls was in postnatal systolic pressure which was significantly higher than 19 week values, probably reflecting the vasodilatation, with accompanying hypotension, of early, normal pregnancy. This difference was not observed in those who subsequently developed pregnancy induced hypertension or pre-eclampsia. CONCLUSIONS: Our study was unable to demonstrate differences in circulating metabolites or venous distensibility between normotensive women and those with pregnancy induced hypertension or pre-eclampsia. If pregnancy induced hypertension or pre-eclampsia in humans represents not so much the presence of abnormal constrictor influences as a process initiated by failure of normal vasodilatation in early pregnancy, studies carried out later may detect mainly adaptive and secondary changes.

6-Ketoprostaglandin F1 alpha↗
PubMed1992

Hepatitis B.

Explore the source record for details and available documents.

Dental Staff↗
PubMed1991

Urothelial leiomyomatous hamartoma of the kidney.

A 34-year-old woman presented with a renal pelvic mass. A nephroureterectomy including a cuff of bladder, was performed and pathologic examination revealed a hamartoma involving the renal parenchyma and pelvis. The pelvic portion of the tumor was composed of papillae lined by urothelium; the parenchymal portion of the tumor was composed of tubules within a fibromuscular stroma. The authors propose that this is a distinct entity not previously described in the literature.

Adult↗
PubMed1991

Quantitative electroencephalography in dogs anesthetized with 2.0% end-tidal concentration of isoflurane anesthesia.

Quantitative electroencephalography was assessed in dogs under controlled, 2% end-tidal isoflurane anesthetic conditions, and each variable at each electrode site was tested for normal distribution. With the quantitative electroencephalographic system used, 16 values for each of 21 electrode sites were evaluated. Absolute power ratios also were evaluated. The methods for quantitative electroencephalographic recording and analysis appear to be readily adaptable to the dog. Most of the data do not conform to a normal distribution. Therefore, distribution-free nonparametric statistics should be used when looking for differences under experimental or clinical conditions. Quantitative electroencephalography appears to be a sensitive noninvasive method that could be used to evaluate brain function under anesthetic, clinical, and experimental settings.

Acid-Base Equilibrium↗
PubMed1987

Limb body wall complex: I. Pathogenesis.

Twenty-five fetuses with limb body wall complex (LBW complex) were evaluated. The diagnosis was based on two out of three of the following: exencephaly/encephalocele with facial clefts; thoraco- and/or abdominoschisis; and limb defect. Ninety-five percent (24/25) of the fetuses had associated internal structural defects. In 72% (18/25) the internal defects have been recognized as being secondary to vascular disruption. Concordance was not found between the side and location of the body wall defect versus the limb, internal, and cranial defects. In 85% there was evidence for persistence of the extraembryonic coelom by examination of the placenta. In this same group (85%) there was persistence of the ectodermal-amnion margin, with the amnion being continuous with the skin of the body wall defect. In 40% (10/25) there were tags and amniotic adhesions at other sites. There was no difference in the types or incidence of internal defects between those with and those without amniotic bands. The abnormalities in this collection and experimental animal models support vascular disruption during 4-6 weeks' gestation as an etiology for LBW complex. There is disruption and loss of existing tissues, persistence of embryonic structures, and secondary malformations. Persistence of the extraembryonic coelom may lead to the typical amniotic tags, ring constrictions, and adhesions seen in some specimens.

Abdominal Muscles↗
PubMed1987

Limb-body wall complex: II. Limb and spine defects.

Limb defects from 25 fetuses with limb-body wall (LBW) complex were evaluated to determine the mechanism of limb damage. The limb defects could be divided into 3 pathogenetic groups: (1) secondary to disruption of embryonic vessels and surrounding tissue (84%), (2) secondary to amniotic bands or adhesions (16%), and (3) deformation versus hemorrhage (44% with club feet), with some fetuses having more than one pathogenetic mechanism causing limb defects. The hypothesis that the majority of limb defects resulted from disruption of embryonic vessels was supported by the following findings: 96% of the LBW complex fetuses had limb defects; the lower limbs were at greater risk of damage than the upper limbs (28% rt arm, 52% lt arm, 60% rt leg, 72% lt leg); there was a distal to proximal progression of limb damage in 92% of the fetuses; statistical analysis of comparing the location of the most severe limb defect and the body wall defect did not find concordance between the side (p = 1.0) and the region (p = 0.18) of the body wall defect; and limb defects found in the human specimens were similar to those produced in experimental animals following disruption of embryonic vessels at a corresponding gestation. In the specimens with amniotic band related limb defects (16%), the most likely pathogenesis is mechanical rupture through the amnion in the presence of a persistent extraembryonic coelom or from adhesion of the amnion to necrotic embryonic tissue after the initial disruptive event. Club feet were present in 44% and may be due either to disruption of embryonic vessels or to deformation. Further studies are needed to resolve this question.

Abdominal Muscles↗
PubMed1986

National nutrition month: promoting the diversified role of dietitians as health care professionals.

In summary, the planning and directing of NNM activities for a large metropolitan hospital required extensive public relations efforts to assure the success of each event. NNM provided a unique opportunity for health care professionals to interact with the business community, therefore promoting a positive image of dietitians as professionals. The events, successful in promoting nutrition education, identified dietitians as nutrition experts.

Dietetics↗
PubMed1984

Primary choriocarcinoma of the urinary bladder in association with undifferentiated carcinoma.

A carcinoma of the urinary bladder with a distinct choriocarcinomatous component that developed in a postmenopausal woman was associated with high titers of circulating chorionic gonadotropin. The diagnosis was supported by histochemical demonstration of human chorionic gonadotropin in syncytial tumor giant cells and electron microscopic features consistent with syncytiotrophoblastic cell differentiation.

Carcinoma↗
PubMed1981

Effect of histamine and prostaglandin E2 on gastric blood flow in swine.

Gastric blood flow was measured by the radioactive microspheres entrapment technique following the IV infusions of saline solution, histamine, or prostaglandin E2 and histamine to young pigs. Pigs treated with histamine (2 micrograms/kg/minute for 60 minutes) had significantly higher blood flow to the gastric mucosa (P less than 0.025), particularly to the region of the proper gastric (fundic) glands (P less than 0.01), than did the saline-treated pigs. When prostaglandin E2 (1 microgram/kg/minute for 60 minutes) was infused simultaneously with histamine, there was a slight, but not significant, decrease (P less than 0.10) in mucosal blood flow to the region of the proper gastric glands. Analysis of the percentage distribution of blood flow indicated that the increase in blood flow to the region of the proper gastric glands after histamine infusion may be due to a redistribution of blood flow from the cardiac gland region.

Animals↗
PubMedDate not supplied

Management of intractable pleural effusion in a dog with pleuroperitoneal shunt.

Persistent nonchylous pleural effusion followed thoracic duct ligation for chylothorax in a dog. Attempts at tetracycline pleurodesis twice failed to reduce the quantity of pleural effusion. Repeated thoracentesis caused malnutrition and hypoproteinemia. A modified Denver peritoneal-venous shunt was implanted to internally drain the pleural fluid into the peritoneal cavity. Normal body weight and plasma protein concentration were regained in 40 days. Digital compression of the pump chamber alleviated the signs of respiratory compromise, without complication. At 50 weeks post-installation, a proteinaceous clot obstructed the original efferent pump valve, necessitating shunt replacement. Eight weeks after replacement, the dog was asymptomatic.

Animals↗