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Biomedical subjects

R L Jenkins

Publications and source records attributed to R L Jenkins.

At least 91 records · Page 5Linked to original sources
PubMed1991

Liver transplantation: MR angiography with surgical validation.

Thirty patients (mean age, 45 years) were evaluated with magnetic resonance (MR) angiography before liver transplantation to assess the accuracy of MR angiography. A series of breath-hold, two-dimensional images were acquired and subsequently processed to form three-dimensional projection angiograms. Graphic information on blood flow in the portal vein was acquired by using presaturation bolus tracking. Correlative duplex ultrasound (US) was performed in 28 patients, and surgical or autopsy correlation was available in all cases. MR angiography demonstrated patency of the portal vein in 26 (96%) of 27 patients, made possible the diagnosis of portal venous occlusion in three of three patients, depicted reversed portal flow in one patient, and provided clear delineation of the extent of varices and specific portosystemic collateral vessels. When duplex US was successful, there was full agreement with MR angiographic results in assessing portal vein patency and flow direction. All of the MR findings were corroborated at surgical exploration or autopsy. The authors conclude that MR angiography is very accurate in the portal system and is valuable in preoperative assessment for liver transplantation.

Abdomen↗
PubMed1990

Surgical therapy for recurrent liver metastases from colorectal cancer.

Forty percent of patients whose disease recurs after hepatic resection for liver metastases from colorectal cancer initially will have liver-only metastases. We have retrospectively reviewed our experience with repeated surgical treatment for liver-only recurrence after previous hepatic resection for colorectal metastases. Repeated hepatic procedures were performed with no mortality in 10 patients. Intraoperative ultrasound allowed identification of three unsuspected metastases and determination of unresectability of two metastases during 11 procedures. Three patients were free of disease at 31, 41, and 48 months from the first hepatic procedure and at 15, 31, and 43 months from the second procedure. Five patients have remained free of hepatic disease. Patients whose initial metastases were less than 6 cm in diameter and had single liver recurrences after hepatic resection appeared to be the best candidates for further surgical therapy. These data and a review of the literature suggest that surgical treatment of recurrent liver metastases from colorectal cancer can be performed safely, and it is associated with long-term disease-free survival in up to 38% of highly selected patients.

Aged↗
PubMed1990

A randomized clinical trial of prophylactic OKT3 monoclonal antibody in liver allograft recipients.

Seventy-nine hepatic allograft recipients were randomized to receive either conventional immunosuppression, including cyclosporine, azathioprine, and steroids (41 patients), or investigational therapy in which OKT3 replaced cyclosporine during the first postoperative week (38 patients). Early rejection occurred in 29 patients (71%) in the conventional group and 15 patients (39%) in the OKT3 group. Posttransplantation renal dysfunction occurred in 12 patients (29%) in the conventional group and 6 patients (16%) in the OKT3 group. Mean initial hospital stay was 34.1 +/- 18.8 days in the conventional group compared with 29.1 +/- 16.8 days in the OKT3 group. Cumulative patient survival (mean follow-up, 17.8 +/- 7.1 months) was 73.2% (30/41) for the conventional group and 84.2% (32/38) for the OKT3 group. Prophylactic OKT3 is indicated especially for liver allograft recipients with other complicating conditions that make management of early rejection unusually difficult.

Adult↗
PubMed1990

Surgical aspects of sclerosing cholangitis. Results in 178 patients.

Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.

Adolescent↗
PubMed1989

Experience with transplantation in the treatment of liver cancer.

Thirteen patients with hepatic tumors, from the Boston Center for Liver Transplantation, have been transplanted among a total of 169 recipients. Ten were transplanted primarily for tumor, while three other patients harbored incidental tumors. Two perioperative deaths occurred (15%). Eight patients had hepatocellular carcinoma, one hepatoblastoma and four bile duct (Klatskin) tumors. Two of the bile duct cancers recurred with patient deaths at 9 and 10 months. The remaining nine patients are alive from between 1 month and 36 months postoperatively. A selected review of the literature allowed analysis of follow-up on 185 patients transplanted for tumor. Overall, the proportion of patients transplanted for tumor was 16%. Fifty-two percent of patients had hepatocellular carcinomas (HCC), 24% cholangiocarcinomas, 10% other primary liver tumors, and 14% metastatic hepatic tumors. Median survival for HCC was 1 year; 90-day mortality was 30%. Actuarial survival for 1, 2 and 3 years was 49%, 37% and 30% respectively. Fibrolamellar HCC and incidental HCC had significantly better results than other HCC. Tumor recurrence was present in 72% of autopsies after 90 days. Transplantation for HCC has satisfactory results in selected patients and may be improved by adjuvant chemotherapy. The median survival with cholangiocarcinomas was 8 months; 90-day mortality was 40%. Actuarial survival for 1 year was 36%. Recurrence was present in 100% of autopsies after 90 days. Survival after transplantation for this tumor was similar to that observed in patients not undergoing surgical treatment. Median survival for 18 other primary hepatic tumors was 16 months. Transplantation in carefully selected patients with these other primary tumors appears warranted. Although experience overall with transplantation for metastatic disease has been relatively unfavorable, each histological type must be considered independently.

Adult↗
PubMed1989

The role of transplantation in liver disease.

Liver transplantation is rapidly emerging as the most effective treatment pathway for a growing number of acute and chronic liver disease states. Indications and contraindications to transplant are undergoing continuous revision and clarification as experience is accrued in the expanding number of treatment centers. For some disorders such as primary biliary cirrhosis, sclerosing cholangitis, and chronic active hepatitis with cirrhosis, the role of transplantation in patient management is obvious. For other hepatic diseases such as primary hepatic neoplasm, clear definition of the role of transplantation is likely to await development of improved early diagnostic techniques and more effective chemotherapy regimens. Standardization of the technical aspects of liver transplant and recent advances in graft preservation have led to reduction in the logistical problems that previously plagued this complex therapy. Refinements in immunosuppression with the introduction of cyclosporine and monoclonal antibody therapy have extended chances for survival and contributed to considerable improvement in quality of life following transplant. Further extension of transplantation as a treatment option to individuals with liver disease will require the concerned effort of the primary care or referral physician in the early recognition and management of patients with liver disease.

Adult↗
PubMed1989

Blood carnitine status after orthotopic liver transplantation in patients with end-stage liver disease.

We determined the effects of orthotopic liver transplantation on plasma and red cell carnitine concentrations in patients with end-stage liver disease. Before transplantation, plasma and red cell carnitine were significantly elevated above normal. The partitioning factor (ratio of red cell carnitine to plasma carnitine) was four times greater than that observed in our reference population. After hepatic replacement, plasma and red cell carnitine approached normal levels within 6 mo. The partitioning factor, however, remained elevated at that time. These results indicate that 1) there is no evidence for carnitine deficiency in severe liver disease on the basis of carnitine concentrations in the plasma and red compartments and 2) altered partitioning of carnitine between plasma and red cells persists for greater than or equal to 6 mo after hepatic replacement.

Carnitine↗
PubMed1989

Hemispheric asymmetry in processing visual half-field pattern-reversal stimuli assessed by reaction time and evoked potentials.

Reversing checkerboard patterns, like those used to elicit clinical visual evoked potentials (VEPs), were adapted to the study of cerebral lateralization of visual processing in a divided visual field experiment. Seventeen right-handed subjects (9 male, 8 female) provided left- and right-handed responses to pattern-reversal stimuli presented in left, right and both visual half-fields in pseudorandom order. Simple unwarned RTs were shorter for left- compared with right-field stimuli under left-hand response conditions. Parietal VEPs obtained from 9 of the subjects showed larger amplitudes for left compared with right field stimuli at the right hemisphere. The results were consistent with an efficiency model of cerebral dominance incorporating both interhemispheric transfer time and a reduced efficiency for left hemisphere processing of our patterned visual stimuli.

Adult↗
PubMed1989

Hemispheric asymmetry in the processing of tactual-spatial material of low verbal codability in normal subjects.

Two experiments were carried out using a modified Tactual Performance Test (TPT) to investigate patterns of tactual-spatial performance and memory in normal individuals. Right-handed mates were tested using either a right-left-both hands or left-right-both hands order. The left-hand-first group had better tactual-spatial memory than the right-hand-first group. In a second experiment, right-handed males performed the TPT with either the left hand or the right hand on all trials while simultaneously palpating a non-task-related nonsense figure with the opposite hand. The left-hand group had better time scores and memory for TPT figures than did the right hand group. The findings, consistent with previous studies, indicate a saliency of the right hemisphere in tactual-spatial performance and memory and suggest that dichhaptic stimulation may be the preferred method for revealing hemispheric asymmetries in tactual-spatial functioning.

Journal Article↗