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L Jennings

Publications and source records attributed to L Jennings.

28 records · Page 2Linked to original sources
PubMed1993

The impact of operative bleeding on outcome in transplantation of the liver.

Excessive operative blood transfusion has been correlated with an increased rate of infectious complications and lower survival rate after transplantation of the liver. Two hundred and five consecutive transplants of the liver, performed between January 1988 and December 1989, were studied retrospectively to determine preoperative risk factors associated with an increased operative blood loss and to evaluate the impact of operative transfusion on the outcome of transplantation. Preoperative clinical and laboratory parameters in patients who required 10 units or more of banked erythrocytes were compared with those in patients who received less than ten units of erythrocytes. In evaluating the outcome, the two groups were compared for infection, rejection and graft and patient survival rates. The median operative blood loss for 205 patients was 5 units of banked erythrocytes (range of zero to 52, mean of 6.9 units). Only 41 patients (20 percent) required 10 units or more of erythrocytes. The significant factors on univariate analysis that were associated with an increased operative blood loss were hospitalized patients (United Network for Organ Sharing Status > or = 3), fulminant hepatic failure, previous portosystemic shunt and complete ABO mismatch. Patients who required more blood had higher incidence of coagulation abnormalities, renal dysfunction and high bilirubin levels. A stepwise logistic regression analysis model using all these parameters identified an elevated serum creatinine, decreased platelets and a prolonged partial thromboplastin time as being the strongest risk factors. Using these variables, operative bleeding of more than 10 units could be predicted accurately only 60 percent of the time (sensitivity 60.0 percent with a specificity of 69.1 percent). Septic episodes occurred more frequently in patients with an excessive operative blood loss (p < 0.05), and these patients also tended to have a higher rate of severe cytomegalovirus infections and a lower incidence of acute rejection. Patients who required more blood also had significantly prolonged stays in the intensive care units postoperatively (18.3 versus 6.3 days, p < 0.002) and lower graft and patient survival rates (p < 0.001 and p < 0.05, respectively). We conclude that intraoperative bleeding has remained a significant problem affecting the immediate outcome after transplantation of the liver. Preoperative parameters cannot predict operative bleeding accurately and the mainstay to prevent bleeding is a meticulous surgical technique during the hepatectomy and correction of coagulation abnormalities throughout the procedure.

Adult↗
PubMed1990

Hypofrontality and cognitive impairment in schizophrenia: dynamic single-photon tomography and neuropsychological assessment of schizophrenic brain function.

Regional cerebral blood flow (rCBF) was assessed in 40 chronic male schizophrenic patients (20 medicated, 20 unmedicated) and 31 matched normal controls with Dynamic Single-photon Emission Computed Tomography (D-SPECT). Blind analyses of normalized color-coded tomograms revealed significant bifrontal and bitemporal rCBF deficits in the patient group. Frontal flow deficits were most prominent in paranoid patients (n = 21) and right temporal deficits were most prominent in nonparanoid patients (n = 19). These relative regional declines were observed within the context of significantly elevated hemispheric blood flow in schizophrenics compared with controls. Reduced left frontal rCBF was associated with neuropsychological impairment on the Wisconsin Card Sorting Test and Luria-Nebraska Battery. Increased hemispheric CBF was correlated with the presence of positive schizophrenic symptoms. Medication status was unrelated to rCBF. These findings demonstrate that hypofrontality has important implications for cognitive function in some schizophrenic individuals.

Adult↗
PubMed1988

Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids.

To determine the safety and benefit of n-3 fatty acid therapy in the prevention of early restenosis after coronary angioplasty, we conducted a randomized, unblinded study comparing a conventional antiplatelet regimen (325 mg of aspirin and 225 mg of dipyridamole per day; control group) with a similar regimen supplemented with 3.2 g of eicosapentaenoic acid per day (treatment group). Treatment began seven days before angioplasty and continued for six months afterward. All angiographic analyses were blinded and performed by a method that was validated by comparison with quantitative coronary angiography. In 82 male patients, 103 coronary lesions were dilated. Both groups had similar base-line clinical and angiographic characteristics. The incidence of early vessel restenosis, as determined on a second angiogram three to four months after angioplasty, was 36 percent in the control group and 16 percent in the treatment group (P = 0.026). The incidence of restenosis per patient was also significantly lower in the treatment group (46 vs. 19 percent). Both multiple logistic regression and Mantel-Haenszel statistical analyses demonstrated a significant independent benefit of treatment with n-3 fatty acids. No important bleeding complications developed in the treated patients. These results, in a male population at relatively high risk for restenosis, suggest that a dietary supplement of n-3 fatty acids, administered for one week before and for six months after coronary angioplasty, is safe and reduces the occurrence of early restenosis after that procedure. Whether this beneficial effect also applies to other populations is unknown.

Angioplasty, Balloon↗
PubMed1988

Painful heel syndrome: radiographic and treatment assessment.

From July 1980 to January 1986, 170 patients who had unilateral heel pain were examined, x-ray filmed, and treated in a similar fashion. Radiographs of painful and nonpainful heels were measured. There was a statistically significant increased thickness of the heel fat pad and subfascial area compared with that of the control subject (the nonpainful side). A tightness of the Achilles tendon and a new sign, which the authors are designating as the "saddle" sign, were other prominent features. A treatment program of stretching exercises and walking seemed to be effective in relief of symptoms.

Heel↗
PubMed1981

Experimental anti-alveolar basement membrane antibody-mediated pneumonitis. I. The role of increased permeability of the alveolar capillary wall induced by oxygen.

Attempts to produce in animals lung lesions mediated by anti-alveolar basement membrane (ABM) antibodies have thus far been inconclusive. The aim of the present study was to test the hypothesis that increased permeability of the endothelial cell lining is needed before circulating antibodies can gain access and bind to ABM. A goat antiserum was prepared against purified rabbit ABM. After i.v. injection of the gamma-globulin fraction into rabbits, goat IgG was detected in glomerular basement membrane but not in ABM. However, 17 of 19 rabbits injected with anti-ABM antibody after exposure for 62 to 66 hr to 100% oxygen had a diffuse linear binding of goat IgG in ABM and died with pulmonary edema and hemorrhagic pneumonitis. By the paired label isotope technique, uptake of anti-ABM antibodies in lung far exceeded that in kidney. Semiquantitative histologic studies indicated that the lesions in the lung of these rabbits were more severe then those found in rabbits exposed to 100% oxygen and injected with normal goat serum gamma-globulin. None of the latter animals died with pulmonary edema; none was found to have binding of goat IgG in the lung. The results indicate that under normal physiologic conditions the endothelium is a barrier that prevents binding of IgG antibodies to ABM. The increased permeability induced by oxygen in the alveolar capillary wall is a nonimmunologic factor allowing the development of a reproducible model of severe anti-ABM antibody-mediated pneumonitis.

Animals↗
PubMed1978

Evaluation of an office method of detecting bacteriuria.

Although catheter-associated UTI continues to be the leading cause of nosocomial infection, epidemiological investigation of catheter use in many hospitals may be precluded by the reluctance of the laboratory to process the large number of urine cultures. We have evaluated the use by Nurse Epidemiologists of Bacturcult tubes for such purposes. The urine of 111 catheterized patients was cultured daily using both the Bacturcult and streak plate method until significant bacteriuria developed (greater than 10(5) colonies/ml). Bacturcult proved as accurate as the conventional technique in detecting bacteriuria. In contrast to previous studies, the daily incidence of infection rose with increasing duration of catheterization. Concomitant antibiotic usage reduced the risk of infection but selected out multi-drug resistant organisms. Older age and procedural errors also increased the risk of infection. The study took 150 hours to complete and cost about $250. It is concluded that Bacturcult is an accurate, simple and relatively inexpensive method of detecting bacteriuria and could be useful for investigating the epidemiology of catheter-associated infections in community hospitals.

Adult↗
PubMedDate not supplied

Using the absolute neutrophil count as a stand-alone test in a hematology/oncology clinic: an abbreviated test can be preferable.

More is not always better. We hypothesized that clinicians prefer an abbreviated but focused test to one that provides more--but not totally essential--information. We performed a retrospective analysis of physicians' ordering practices after introducing the absolute neutrophil count (ANC) as a stand-alone test in a hematology/oncology clinic. Previous studies have demonstrated a strong correlation between the ANC, as determined by the Coulter STKS instrument, and the manual neutrophil count. In contrast to the more extensive five-part differential the ANC is a one-part differential that focuses exclusively on the neutrophil count and provides abbreviated information. The hematology laboratory's records from 2 months before and 4 months after introducing this new test were analyzed. Total numbers of ANCs, automated complete differentials, and manual complete differentials performed were tabulated. After its introduction, the ANC comprised more than 75% of differentials performed in this clinic. Manual complete differentials dropped from 69.4% to 18.8%. The turnaround time (TAT) for all differentials taken together dropped by 75% (p = 0.042). We conclude that the ANC can be used widely in the hematology/oncology clinic as a separate, stand-alone test. For clinicians, its popularity over the five-part differential may be based on the fact that the ANC is a focused test with a relatively short TAT. Our experience suggests that it is the test result's relevance and not the volume of information provided that determines clinicians' use.

Boston↗