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Biomedical subjects

R L Jenkins

Publications and source records attributed to R L Jenkins.

At least 127 records · Page 7Linked to original sources
PubMed1987

Effectiveness of orthotopic liver transplantation on the restoration of cholesterol metabolism in patients with end-stage liver disease.

The effects of end-stage liver disease and orthotopic liver transplantation on components that modulate cholesterol esterification in plasma were assessed. In comparison with healthy controls, patients with end-stage liver disease had significantly decreased concentrations of lecithin-cholesterol acyltransferase mass, apolipoprotein A-1, total phospholipids, and both total and esterified cholesterol. Elevated phosphatidylcholine and reduced lysophosphatidylcholine fractions indicated impairment of cholesterol esterification by lecithin-cholesterol acyltransferase. Constituent fatty acids of the patients' phospholipids and cholesterol esters manifested increased saturation and a concomitant reduction of polyunsaturated fatty acids, indicative of impaired hepatic elongation and desaturation of essential fatty acids. By the third month after hepatic replacement, the plasma concentrations of total cholesterol, phospholipids, lecithin-cholesterol acyltransferase, and apolipoprotein A-1 were comparable to those of the healthy subjects. Despite the improvement in cholesterol esterification and the rapid normalization of the enzyme and cofactor involved in this process, the percentage of phosphatidylcholine remained significantly higher and the percentages of lysophosphatidylcholine and esterified cholesterol remained significantly lower than in the healthy subjects at 6 mo. Phospholipid and cholesterol ester fatty acid patterns attained normalcy by the sixth month after transplant. We conclude that hepatic transplantation effectively restores cholesterol and essential fatty acid metabolism in patients with end-stage liver disease.

Adult↗
PubMed1987

Whole body leucine, phenylalanine, and tyrosine kinetics in end-stage liver disease before and after hepatic transplantation.

The kinetics of leucine, phenylalanine, and tyrosine metabolism following orthotopic human liver transplantation in end-stage liver disease in hospitalized patients were evaluated and compared to controls. The investigation was carried out by protein turnover studies using 13C leucine, D5-phenylalanine, and [U-14C] tyrosine by continuous infusion and employing a stochastic model in 32 patients with end-stage liver disease, 17 of whom went on to receive an hepatic allograft, and 7 controls without significant liver disease who underwent elective abdominal surgery. Mean tyrosine flux in the liver disease group was 3,242 +/- 811 (n = 32) v 2,899 +/- 688 mumol/h in controls (n = 7) (P less than .001), while the tyrosine oxidation was 328 +/- 179 v 422 +/- 185 mumol/h (P less than .001). Tyrosine clearance in pretransplant patients was 719 +/- 345 (n = 17) v 1,193 +/- 568 mL/min (P less than .005) in posttransplant patients (n = 17) with virtually no overlap. There was a significant correlation between serum albumin levels and the tyrosine clearance (r = .60, P less than .05), but correlations with other conventional liver function tests were of a low order. Leucine and phenylalanine kinetics in liver disease patients did not show any significant differences from controls. Leucine and tyrosine fluxes in controls did exhibit a significant correlation (r = .70, P less than .05), but no correlation was observed in patients with liver disease. These findings indicate that the kinetics of the amino acid tyrosine are substantially altered by end-stage liver disease, with the most profound effect on tyrosine clearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbon Isotopes↗
PubMed1987

A prospective, randomized trial of abdominal wound drainage in gastric bypass surgery.

A prospective, randomized trial was conducted in 194 morbidly obese patients who had gastric bypass to determine the effect of subcutaneous closed suction drainage on wound infection rates. There was no difference in the incidence of postoperative wound infection with the use of drains compared with simple abdominal closure. Organisms isolated from infected wounds were predominantly skin flora and did not differ between the two groups. Patients with wound infections had significantly prolonged hospitalizations compared with those without infections, but in the subgroup with wound infections there was no difference in hospitalization time between the drainage or control groups.

Abdomen↗
PubMed1987

Development of metabolic alkalosis after massive transfusion during orthotopic liver transplantation.

Five patients undergoing orthotopic liver transplantation were investigated for changes in acid-base homeostasis secondary to large volume transfusions. All patients developed a transient acidemia during the operative period, followed by alkalemia which persisted into the early postoperative period. The patients received an estimated mean of 750 mEq of citrate, which appeared to cause metabolic alkalosis. The biochemical basis underlying the regulation of citrate metabolism that may have led to the timing, extent, and duration of the subsequent metabolic alkalosis is presented. Finally, the time course for the development of metabolic alkalosis may be a potentially sensitive indicator of early allograft function.

Acid-Base Imbalance↗
PubMed1987

A randomized clinical trial comparing OKT3 and steroids for treatment of hepatic allograft rejection.

A multiinstitutional randomized trial was undertaken comparing OKT3 with steroids for treatment of hepatic allograft rejection. All patients received baseline immunosuppression with Cyclosporine (CsA) and steroids. At the time of biopsy-confirmed rejection, up to 2 intravenous boluses (250-1000 mg) of methylprednisolone were initially administered. Twenty-eight patients who failed to respond were then randomly assigned to OKT3 or continued steroid therapy. Rescue therapy with the opposite treatment arm was added after 6 days if the primarily allocated protocol failed. Three of 13 patients assigned to the steroid group responded promptly, and continue with good function 7-12 months later. OKT3 rescue was required in 10 patients who failed to improve despite receiving up to 6 g of methylprednisolone (mean: 3.3 g/patient). One patient died of sepsis and hepatic failure. Rejection was reversed in 9 OKT3-rescue patients, 7 of whom are well 1-17 months later. In the OKT3 group, improved allograft function was observed within 72 hr in 11 of 15 patients. Two patients with inadequate response were successfully rescued with steroids; 1 patient underwent retransplantation; and 1 patient developed a biliary fistula that eventually resulted in sepsis and death. In summary, 23 of 28 hepatic recipients (82%) are alive with the original allograft 1-17 (mean 7.8) months after treatment for acute rejection. Another patient is alive 14 months following retransplantation. Eighteen (78%) of the survivors required OKT3 as initial (11) or rescue (7) therapy, whereas only 5 were successfully managed with steroids. OKT3 is superior to steroids for reversing liver allograft rejection and has greatly reduced the need for retransplantation even in recipients selected on the basis of having failed initial steroid therapy.

Antibodies, Monoclonal↗
PubMed1987

Avoidance of transhepatic drainage prior to hepaticojejunostomy for obstruction of the biliary tract.

We retrospectively reviewed the course of 14 consecutive patients with symptomatic hepatic duct bifurcation obstruction of the biliary tract because of unresectable non-Klatskin malignant disease to clarify issues of diagnostic and therapeutic strategy. All patients were symptomatic with pruritus and were expected to survive three months or more. Ten patients underwent percutaneous transhepatic cholangiography preoperatively. In no instance did the study influence operative decision making, and complications included septic shock in two patients. Decompression of the biliary tract in one patient made the duct technically inadequate for internal drainage. The remaining 13 patients underwent surgical drainage of the biliary tree. Ten had peripheral hepaticojejunostomies, which offers the best palliation of symptomatic obstruction of the biliary tract due to unresectable malignant disease at the hepatic duct bifurcation. Percutaneous transhepatic cholangiographic drainage should not be used for diagnostic studies prior to hepaticojejunostomy for malignant obstruction as it interferes with surgical drainage.

Aged↗
PubMed1987

Increased protein catabolism without hypermetabolism after human orthotopic liver transplantation.

To evaluate the surgical stress of transplantation, resting energy expenditure (REE) and 24-hour urinary urea nitrogen (UUN) were measured in 11 patients with end-stage liver disease (ELD) before and after liver transplantation. Predicted mean basal energy expenditure as determined by the Harris-Benedict equation was 860 +/- 110 kcal/m2/day. Pretransplant mean REE was 930 +/- 130 kcal/m2/day versus 920 +/- 190 kcal/m2/day in the posttransplant period (p = NS). Pretransplant mean UUN was 7.7 +/- 3.5 gm/day versus 12.9 +/- 4.4 gm/day in the posttransplant period (p less than 0.05). It is concluded that the patients in the early period after liver transplantation are hypercatabolic (increased tissue breakdown) but not hypermetabolic (increased REE) when compared with their stable state before transplantation.

Energy Metabolism↗
PubMed1986

The Boston Center for Liver Transplantation (BCLT). Initial experience of a new surgical consortium.

Improved survival following liver transplantation has led to a rapid increase in the number of centers providing this expensive and demanding therapy. In January 1984, four Boston hospitals launched a cooperative program known as the Boston Center for Liver Transplantation (BCLT). From January 1984 through July 1985, 47 liver transplantations were performed in 41 patients ranging in age from 8 months to 60 years. Donor organs were retrieved from 22 states within a 2,500-mile radius. Thirty-five of the 47 procedures were performed by teams consisting of surgeons from at least two BCLT member hospitals. Twelve-month actuarial survival was 54.1% without significant institutional variability. The BCLT has developed into a unique transplant consortium capable of sharing manpower, equipment, and organs without sacrificing quality of care of disrupting preexisting medical services.

Adolescent↗