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Biomedical subjects

R Jenkins

Publications and source records attributed to R Jenkins.

At least 163 records · Page 9Linked to original sources
PubMed1990

Nosocomial infection rates during a one-year period in a nursing home care unit of a Veterans Administration hospital.

Infections in long-term care institutions are a constant source of morbidity in residents in these facilities. We report our experience with infection rates during a 1-year surveillance period in a 120-bed nursing home care unit of a Veterans Administration hospital. Our purpose was (1) to establish our own infection rate and (2) to ascertain the relationships (a) between infection rate and level of required nursing care and (b) between infection rate and staffing adequacy. Our overall nosocomial infection rate for 1987 was 4.6 infections/1000 patient days. The majority of infections were urinary tract infections, with the predominant pathogen Proteus mirabilis. One ward in the nursing home care unit had a significantly higher infection rate compared with that of the other wards (p less than 0.05), and there was a significantly higher infection rate in residents who required total nursing care versus less dependent residents (p less than 0.05). We were unable to find a direct relationship between the degree of staff shortages and infection rate. This prolonged infection control surveillance indicated our nosocomial infection rates were similar to those in previously published reports. We also identified problem infections in certain areas, which led us to develop staff in-service programs to address these problems. In summary, we believe this information is useful not only for us but for others involved in the care of residents in long-term care facilities inasmuch as there are little published data on yearly infection rates per patient days.

Cross Infection↗
PubMed1990

A materials-management quality assurance program.

Because the quality of a hospital depends on more than just the quality of its clinical departments, shouldn't the QA efforts required of clinical departments be duplicated throughout the institution? With the sensible insistence that quality should be a hospital-wide phenomenon, one materials manager explains how his hospital developed and implemented a materials QA plan.

Central Supply, Hospital↗
PubMed1990

Towards a system of outcome indicators for mental health care.

A system of outcome indicators for mental health care is urgently needed in order to ensure that clinicians, district health authorities, and directors of public health can monitor and evaluate mental health care. Theoretical aspects of health care indicators and the various classes of outcome measures available can be used to draw up a preliminary system of indicators of health care input, process and outcome for the major categories of mental illness, including schizophrenia, affective psychosis, neurosis, dementia, mental handicap, child psychiatry, forensic psychiatry, alcohol and drugs. Such a system is not intended to be definitive or exhaustive but rather to form a basis for development by clinicians, researchers and planners for their own requirements.

Adult↗
PubMed1990

Mechanisms of inhibition of mononuclear cell activation by the iron-chelating agent desferrioxamine.

Iron-withholding by the chelating agent desferrioxamine abrogates the proliferative response of human peripheral blood mononuclear cells (PBMC) to phytohaemagglutinin (PHA). The present study investigated whether desferrioxamine operates late in the activation process or, as recently suggested, at an early stage, by inhibiting the appearance of the interleukin-2 (IL-2) receptor. Human PBMC were stimulated with PHA (10 micrograms/ml) and [3H]thymidine ([3H]TdR) incorporation determined after 66 hr of culture. Greater than 90% inhibition was achieved by concentrations of desferrioxamine as low as 5 mumol/l present throughout culture, while IL-2 receptor expression (anti-Tac), analysed by FACS, was maintained at up to 75% of control levels. 300 mumol/l desferrioxamine present throughout culture abrogated [3H]TdR incorporation and additionally suppressed IL-2 receptor to 10-15% of control levels. In contrast, the same high dose of desferrioxamine when added for 2 hr to cells previously cultured for 66 hr produced 80% inhibition of [3H]TdR incorporation but failed to inhibit expression of the IL-2 receptor. Desferrioxamine rapidly achieved equilibrium across the cell membrane (within 60 min) and chelated 59Fe delivered to activated cells by the transferrin endocytic cycle. These results indicate that desferrioxamine can inhibit T-cell activation either early or late in the process by chelating iron and independently of an effect on the IL-2 receptor. In support of a dual effect of the drug is the finding that at 50 mumol/l, desferrioxamine-enhanced expression of the transferrin receptor occurred, an adaptive response made to intracellular iron depletion, while IL-2 receptor expression was inhibited.

Cell Division↗
PubMed1990

Serous carcinoma in endometrial polyps.

Sixteen patients who had serous carcinoma involving endometrial polyps and who demonstrated rare or absent myometrial or lymphovascular invasion are reported. Six of these patients had clinical manifestations of extrauterine disease at presentation. Of the ten patients who presented with clinical stage I disease, six eventually developed extrauterine recurrence, and four of these six were dead of disease within 19 mo of recurrence. Similarities between the patients who presented with extrauterine disease and the patients who presented with clinical stage I disease, including high percentages of patients with hyperplasia of ovarian epithelium surface and of fallopian tube epithelium, suggest that serous carcinoma involving endometrial polyps may represent one aspect of a multicentric disease. In such multicentricity, the entire female genital tract and the abdominal peritoneal surfaces would be at high risk for concurrent or subsequent involvement by serous carcinoma even in the absence of myometrial or lymphovascular invasion.

Carcinoma↗
PubMed1989

Third-party-mediated graft rejection and graft-versus-host disease after T-cell-depleted bone marrow transplantation, as demonstrated by hypervariable DNA probes and HLA-DR polymorphism.

Graft rejection after marrow transplantation is generally thought to be mediated by alloreactive immune effector cells of host origin. Transfused blood products also contain immune cells capable of alloreactivity against both donor graft and host. To reduce the risk of transfusion-associated graft-versus-host disease (GVHD) and graft rejection, standard procedure is to irradiate all blood products with at least 1,500 rad before transfusion. We report a patient with chronic myelogenous leukemia who developed graft rejection and GVHD after receiving a T-cell-depleted transplant from a serologically HLA-A, B, DR/DQ matched and mixed lymphocyte culture (MLC) nonreactive unrelated donor. Cytogenetic analysis of marrow cells collected at the time of graft rejection revealed a PH1-negative female karyotype that was not consistent with donor cells. Use of specific minisatellite DNA probes (YNH 24, H-RAS, and 3' HVR) revealed the exclusive presence of third-party (neither donor nor recipient) restriction-fragment-length polymorphisms (RFLP) in both peripheral blood and marrow. Repeat RFLP analysis 3 days later showed persistence of this unique third-party banding pattern. DNA-based HLA-typing, using polymerase chain reaction (PCR) and oligonucleotide probe hybridization, also showed these cells to be derived from an individual whose HLA-DR type was distinct from donor and recipient. Together, these findings suggested the presence of a proliferating population of transfused cells possessing alloreactivity against both donor graft and host, despite prior irradiation of all blood products with 2,000 rad. Limiting dilution analysis to assess the frequency of irradiated lymphocytes able to respond to mitogen revealed an approximate 5- to 6-log reduction at 1,500 to 2,000 rad as compared with unirradiated controls. These data indicate that a small percentage of lymphocytes can survive irradiation at these doses and suggest that existing blood-product irradiation guidelines may require reassessment, especially in T-cell-depleted transplant recipients.

Bone Marrow Transplantation↗
PubMed1989

Intraoperative radiation therapy for biliary tract carcinoma: results of a 5-year experience.

The results of a 5-year experience with use of intraoperative radiation therapy (IORT) in the management of locally advanced bile duct carcinoma are presented. Fifteen patients received IORT doses between 5 and 20 Gy for localized disease, which was either primary and resected with microscopic residual (2 patients), primary and unresected (10 patients), or recurrent (3 patients). Thirteen patients also received postoperative radiation therapy. The median survival of the 12 patients with primary disease was 14 months, with disease controlled in the porta hepatis in 5 of 10 evaluable patients. The three patients with recurrent disease survived 2, 9, and 11 months. There were two operative deaths, for an operative mortality of 13%. Acute and chronic complications are reviewed. Cholangitis is the most frequent in both categories. This aggressive approach in the therapy for advanced disease has an acceptable level of morbidity and may warrant the use of IORT as part of the management of biliary tract cancer.

Acute Disease↗
PubMed1989

The bcr gene in Philadelphia chromosome positive acute lymphoblastic leukemia.

In chronic myelogenous leukemia (CML) and in a percentage of childhood and adult acute lymphoblastic leukemia (ALL) the Philadelphia (Ph') chromosome is present in the leukemic cells of patients. This chromosome is the result of a reciprocal translocation between chromosomes 9 and 22. In CML the break on chromosome 22 occurs within the major breakpoint cluster region (Mbcr) of the bcr gene. In this study, we report on the examination of DNAs from nine Ph'-chromosome positive ALL patients for rearrangements within the bcr gene using Southern blot analysis. Of nine patients having a karyotypically identifiable Ph'-chromosome, only five exhibited rearrangements of the bcr gene. This could indicate that in ALL, chromosome 22 sequences other than the bcr gene are involved in the Ph'-translocation. Within the group of Ph'-positive ALL patients having a bcr gene breakpoint, a correlation appears to exist between the age of the patient and the location of the breakpoint within the gene: all or the vast majority of pediatric patients analyzed to date do not have a Mbcr breakpoint as found in CML and in adult ALL.

Adolescent↗
PubMed1988

Classification of mental disorder in primary care.

This monograph describes a study designed to test how far the two major international systems of disease classification, International Classification of Diseases (ICD) and International Classification of Health Problems in Primary Care (ICHPPC), can be consistently applied by General Practitioners (GPs) to mental disorder presenting in primary care, and to identify sources of observer variation occurring at different stages of clinical judgement. A group of 27 senior GPs was exposed to a series of real life general practice consultations, either in the form of videotape or written case-vignette material, chosen to reflect a wide range of minor psychiatric problems, differing not only in respect of phenomenology but also of their associations with social stresses and supports, physical illness and personality features. The findings clearly indicate that neither ICD nor ICHPPC can be applied consistently by GPs. However, while the overall diagnostic concordance using ICD and ICHPPC proved to be disappointingly low, agreement on individual observations relating to psychological, physical, personality and social features was moderately good. It was also noted that participants, when given the opportunity, tended to incorporate several domains into their diagnostic conclusions, aiming for a multidimensional formulation, to which neither ICD nor ICHPPC lend themselves. It is, therefore, not surprising that if the principal diagnostic schemata are neither adequate in themselves nor readily applicable to primary care, then GPs are more likely to resort to symptomatic treatment and evade diagnosis when confronted with minor psychiatric morbidity. The consequence of this approach for National Morbidity Surveys and drug trials are discussed. The historical development of multiaxial schemata of classification is briefly traced, the problems associated with DSM-III are discussed, and a comprehensive model of classification is proposed which incorporates the notions of severity and duration as well as of category on the four dimensions of psychological illness, social stresses and supports, personality and physical illness.

Adjustment Disorders↗
PubMed1987

Perforation of the terminal ileum with cytomegalovirus vasculitis and Kaposi's sarcoma in a patient with acquired immunodeficiency syndrome.

This case report documents a perforation of the terminal ileum in a 40-year-old white male homosexual with the acquired immunodeficiency syndrome. The perforation occurred at a site that had severe cytomegalovirus infection and was in close proximity to multiple nodules of Kaposi's sarcoma. The ileum showed multiple deep ulcers with large numbers of cytomegalovirus inclusions and vasculitis with infected endothelial cells, small-vessel thrombosis, focal disruption, and hemorrhage. We review the evidence that cytomegalovirus infection--and not Kaposi's sarcoma--was responsible for this perforation and, in light of the new medical therapy for such infections, should be regarded as an important cause of gastrointestinal perforation in patients with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Severe hepatotoxicity from Escherichia coli L-asparaginase.

A 51-year-old black woman with diabetes mellitus developed severe hepatotoxicity after receiving high-dose L-asparaginase (Elspar) for acute lymphatic leukemia. Patients with diabetes should be given this drug cautiously. Glutaminase-free L-asparaginase from Vibrio succinogenes has been reported to be less hepatotoxic in mice; it might be a safer product for this group of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Demonstration of glutamate dehydrogenase isozymes in beef heart mitochondria.

Glutamate dehydrogenase (GDH) has been purified from beef heart mitochondria and compared with crystalline beef liver GDH. The specific activity of heart GDH was 127 units and of liver GDH 80 units. Heart GDH subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis had a protein corresponding to liver GDH and a smaller molecular weight protein. On agarose gel electrophoresis heart GDH activity was resolved into two fractions (with or without protease inhibitors) while liver had only one fraction. One of the heart fractions moved with liver GDH on electrophoresis. Thermal stability studies showed heart and liver GDH activity differed. Mouse antibodies to liver GDH precipitated both liver and heart GDH on double immunodiffusion. Mouse antibodies to liver GDH identified on nitrocellulose paper the polypeptide band of liver and heart GDH that were the same molecular weight but did not cross-react with the smaller molecular weight polypeptide present in heart GDH. Trypsin digestion of the two major protein bands on sodium dodecyl sulfate-polyacrylamide gel electrophoresis of purified GDH from beef heart mitochondria did not show any overlapping peptides. We conclude beef heart GDH activity is composed of two isozymes. One is the same as beef liver GDH, and the other is a smaller molecular weight protein. We propose the terms GDH-LM for the liver GDH isozyme and GDH-HM for the smaller molecular weight isozyme present in heart mitochondria but not liver.

Animals↗
PubMed1986

Personality and psychosis: use of the Standardized Assessment of Personality.

The Standardized Assessment of Personality, a semistructured interview for use with an informant, was used with a relative or a close friend to determine the premorbid personality of 100 consecutive patients admitted with major psychiatric disorders - major affective disorders (18 manics, 35 depressives), schizophrenia (28) and other functional psychoses (19). Forty-four per cent of the entire sample had an abnormal personality as defined by the presence of one of 10 prominent traits to a marked degree. A further 6% had the same traits to a lesser degree. The proportion of patients with an abnormal personality (all types) was comparable across the four diagnostic groups (manics 39%, depressives 54%, schizophrenics 39%, other functional psychotics 37%). However, if one included all traits (marked and mild), patients with an affective disorder had more between them than did the non-affective groups. This difference was largely accounted for by cyclothymic, anxious and obsessional traits. The schizophrenics and other functional psychotics had surprisingly few prominent traits and, in particular, a schizoid personality rarely preceded a schizophrenic illness.

Adult↗