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Biomedical subjects

R L Jensen

Publications and source records attributed to R L Jensen.

At least 37 records · Page 2Linked to original sources

Arterial blood gas reference values for sea level and an altitude of 1,400 meters.

Blood gas measurements were collected on healthy lifetime nonsmokers at sea level (n = 96) and at an altitude of 1,400 meters (n = 243) to establish reference equations. At each study site, arterial blood samples were analyzed in duplicate on two separate blood gas analyzers and CO-oximeters. Arterial blood gas variables included Pa(O(2)), Pa(CO(2)), pH, and calculated alveolar-arterial PO(2) difference (AaPO(2)). CO-oximeter variables were Hb, COHb, MetHb, and Sa(O(2)). Subjects were 18 to 81 yr of age with 166 male and 173 female. Outlier data were excluded from multiple regression analysis, and reference equations were fitted to the data in two ways: (1) best fit using linear, squared, and cross-product terms; (2) simple equations, including only the variables that explained at least 3% of the variance. Two sets of equations were created: (1) using only the sea level data and (2) using the combined data with barometric pressure as an independent variable. Comparisons with earlier studies revealed small but significant differences; the decline in Pa(O(2)) with age at each altitude was consistent with most previous studies. At sea level, the equation that included barometric pressure predicted Pa(O(2)) slightly better than the sea level specific equation. The inclusion of barometric pressure in the equations allows better prediction of blood gas reference values at sea level and at altitudes as high as 1,400 meters.

Adolescent↗

Differences in spirometry reference values: a statistical comparison of a Mongolian and a Caucasian study.

New reference value studies for spirometry are commonly compared to existing reference value studies using average data derived from existing reference equations. Such comparisons are inherently flawed because they do not account for differences in distributions of the independent and dependent variables and they do not have identical methodologies. This study was undertaken 1) to derive reference equations for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) for natives of Mongolia and 2) to compare the Mongolian data with data from a 1981 reference study of Caucasians in Salt Lake City, UT, USA. Spirometry was performed on 344 (176 male, 168 female) healthy, nonsmoking urban natives of Mongolia to generate reference equations for FVC, FEV1, and FEV1/FVC. These data were compared with data from a 1981 reference study of Caucasians in Salt Lake City, using both an analysis of covariance of the raw data and parametric and nonparametric comparisons of a matched pair subset. Average measured forced vital capacity and forced expiratory volume in one second in native Mongolians were within 1-2% of the Caucasian predicted values. These small differences are not statistically significant in any of the multiple methods of comparisons. Power analysis suggests that, if real differences exist, the differences in forced vital capacity are <155 mL for males, <105 mL for females, and the differences in forced expiratory volume in one second are <107 mL for males and <76 mL for females.

Adolescent↗

Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation.

OBJECT: Recurrent laryngeal nerve (RLN) injury occurs after anterior cervical spine procedures. In this study the authors used intraoperative electromyographic (EMG) monitoring of the posterior pharynx as a surrogate for RLN function and monitored endotracheal tube (ET) cuff pressure to determine if there was an association between these variables and clinical outcome. METHODS: Sixty patients in whom anterior cervical spine procedures were to be performed comprised the study population. After intubation, the ET cuff was adjusted to a just-seal volume and attached to a pressure monitor. A laryngeal surface electrode was placed in the posterior pharynx, and spontaneous EMG activity was monitored throughout the procedure. Cuff pressures and EMG activity were recorded during neck retraction and when EMG activity increased 20% above baseline. Patients were divided into two groups: those with sore throat/dysphonia and those without symptoms. Cuff pressures and EMG values were compared between groups, and the differences were correlated with clinical outcome. CONCLUSIONS: Hoarseness immediately after surgery was reported in 38% of patients whereas 15% exhibited severe symptoms. In symptomatic patients the period of intubation had been longer, and the ET cuff pressures had been elevated. In most patients EMG activity increased during insertion of the retractor and decreased after its removal. In these patients a greater number of episodes of elevated EMG activity during surgery were also noted. Two patients experienced prolonged hoarseness, and one required teflon injections of the vocal fold. This patient's EMG activity increased (15-18 times baseline) during surgery. In the few patients who were symptomatic with increased EMG activity, neither the timing nor direction of change could be associated with symptoms. Intubation time and elevated ET cuff pressure were the most important contributors to dysphonia and sore throat after anterior cervical spine surgery.

Analysis of Variance↗

[Primary pyogenic liver abscess in a child].

A case report describing a child with a primary pyogenic liver abscess is presented. Primary pyogenic liver abscess is a rare disease at this age. Furthermore the clinical picture only rarely reveals indications of liver disease. To establish the correct diagnosis within the proper time, one must remember this diagnostic possibility. The recommended treatment is shortly discussed.

Anti-Bacterial Agents↗

Growth factor-mediated angiogenesis in the malignant progression of glial tumors: a review.

BACKGROUND: We review the role of peptide growth factors in angiogenesis and progression of low grade glial tumors to higher grade glioblastoma multiforme (GBM). METHODS: Vascular pathology is a key feature of glioblastoma multiforme characterized by hypervascularity, vascular permeability, and hypercoagulability. RESULTS: Vascular endothelial growth factor (VEGF) can mediate all of these effects, but by itself does not promote malignant growth. Epidermal growth factor (EGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and transforming growth factor beta (TGF-beta) are implicated in the angiogenesis of a number of tumors including those of glial origin. CONCLUSIONS: These growth factors are suggested to play a role in autocrine and/or paracrine mediated tumorogenesis of astrocytic tumors. VEGF secretion might be the product of induction by physiologic concentrations of other growth factors with VEGF being the common pathway of neovascularization and progression to GBM.

Animals↗

Matrigel augments xenograft transplantation of meningioma cells into athymic mice.

OBJECTIVE: We investigated the use of Matrigel to enhance the growth of human meningiomas in athymic (nude) mice. Tumor take and growth of xenograft meningioma cells in an in vivo model have previously been only partially successful. METHODS: The use of Matrigel has been reported to enhance tumorigenicity in a variety of solid tumors. This substance is derived from a mouse sarcoma and is a mixture of basement membrane proteins and growth factors. Meningioma cells obtained from human patients were placed in culture for 1 to 2 passages and then harvested and mixed with Matrigel and the mixture injected into the subcutaneous space in the flank of nude mice. Tumor volumes over time were measured at least three times a week and then harvested at 100 days postimplantation. Tumors were formalin-fixed, and histological examinations were performed. Immunohistochemistry was performed for human and mouse laminin, fibronectin, collagen Type IV, and epithelial membrane antigen. RESULTS: Tumors developed in all 40 mice studied. Growth of meningioma tumors was dependent on total number of cells injected and independent of the total volume of tumor cells and Matrigel matrix. Histologically and immunohistochemically, the xenograft tumors were very similar to the original human tumors. CONCLUSION: Matrigel is relatively easy to use and has a high rate of histologically confirmed meningioma tumor formation in an athymic mouse model. We plan to use this model for studying the growth of meningiomas in vivo.

Animals↗

Risk factors of intracranial pressure monitoring in children with fiberoptic devices: a critical review.

BACKGROUND: Intracranial pressure (ICP) monitoring has become standard in the management of severe head injuries. A variety of monitoring techniques and devices are available, each with advantages and disadvantages; however there have been few studies in the pediatric population. METHODS: To study the risk factors, efficacy, and complication rate of fiberoptic ICP monitoring we studied 98 consecutive children with severe head injuries over a 2-year period. The average patient age was 9 years and most had an initial Childrens Coma Score (CCS) of 8 or less. The monitoring devices were placed in frontal parenchyma of all children and no prophylactic antibiotics were used. All fiberoptic catheter tips were cultured upon removal. RESULTS: The average duration of ICP monitoring was 7 days; the usual range was 3-15 days, with the exception of one patient who underwent monitoring for 40 days. No complications occurred during insertion of the ICP monitors. Catheter tip cultures were positive for Staphylococcus epidermidis in 7% of the children, but none developed clinical features of CNS infection. The hospital location of placement or duration of ICP monitoring did not affect the rate of catheter tips with positive cultures. There was a 13% mechanical failure rate of the fiberoptic device. CONCLUSIONS: We conclude that fiberoptic ICP monitoring is safe and effective; however, there is a relatively low mechanical failure rate. Infection in uncommon despite prolonged use and there is little risk of complications associated with placement of this monitor.

Adolescent↗

Benjamin Winslow Dudley and early American trephination for posttraumatic epilepsy.

Benjamin Winslow Dudley (1785-1870) was a Kentucky frontier surgeon who received basic medical education in the United States and extensive surgical training in Europe. He returned to Lexington to become a dominant figure and the most prominent surgical teacher in the Mississippi Valley. Written evidence of Dudley's operative accomplishments are sparse, but he seems to have combined the finest French (Dominique Jean Larrey, Guillaume Dupuytren) and British (Henry Cline, John Abernethy, Astley Cooper) surgical training with conservative and thoughtful patient selection. His operative endeavors in the preantiseptic era included trephination for posttraumatic epilepsy in six patients (1819-1832). This was the largest recorded series of such cases, and it stimulated other American surgeons to trephine for relief of posttraumatic seizures. Trephination for decompression and debridement was undertaken at the site of original injury to remove the cause of "cerebral excitement" and restore "corporeal and intellectual function." Dudley considered this a safe operation in "cautious, firm, and intelligent hands." He thought crowded urban hospitals were unsafe and attributed his better surgical results to the clean, rural Kentucky air. Dudley's achievement is contrasted with other Early American preantiseptic trephinations for posttraumatic epilepsy.

Epilepsy, Post-Traumatic↗

The prediction of power and efficiency during near-maximal rowing.

The relationship between power and gross efficiency during near-maximal rowing, and physiological measures of strength, power, aerobic and anaerobic capacities and United State Rowing Association (USRA) performance tests (independent variables) was investigated among collegiate male rowers. Criterion measures of rowing power and gross efficiency were measured in a moving-water rowing tank, using an oar instrumented with strain gauges to assess force and a potentiometer to assess oar position. Bivariate correlation analysis (n = 28) indicated no relationship between the independent variables and rowing gross efficiency (P > 0.05). Rowing power [mean (SD) 483.4 (34.75) W] was significantly related to inboard leg extension strength (IL strength, r = 0.63), outboard leg extension strength (r = 0.45), combined leg extension strength (r = 0.45), and time to complete the USRA 2000-m simulated rowing race (r = -0.52; P <0.05). Stepwise regression using resampling cross-validation of 15 random samples (21 subjects per sample selected from a total group of 28 intercollegiate oarsmen) indicated that predictors of rowing power were IL strength and blood lactate following a peak oxygen uptake rowing test with significant multiple correlations of R 0.61 to 0.86 (P <0.05). The standard error of estimate (SEM) ranged from 18.1 to 29.9 W, or 5.3 (0.77) percent of the criterion value. Cross-validation with a hold-out group (seven subjects per sample) was performed for each equation and correlations ranged from R = 0.14 to 0.97 (SEM = 8.0 to 38.9 W). In conclusion, data from the present study suggest that to increase rowing power, training should emphasize leg strength and anaerobic training to decrease the level of lactate accumulated during rowing.

Adult↗

Introduction of the human Horsley-Clarke stereotactic frame.

It is well known that the Horsley-Clarke frame was developed and first used by Robert Henry Clarke and the pioneer neurosurgeon Victor Horsley in 1906 for making lesions in the central nervous system of animals. The Horsley-Clarke frame was extensively used throughout the next 4 decades for excitation and lesion production in animals. Aubrey Mussen, a student of Clarke, designed a stereotactic apparatus for use in humans, but no procedures were actually performed with the instrument. It is less appreciated that a Horsley-Clarke frame was also constructed for human use and first applied for depth electroencephalography by Robert Hayne and Frederic Gibbs in 1947. The assumed relationship between external landmarks and intracranial structures provided initial target localization, and pneumoencephalography confirmed depth electrode position. In many ways, the work of Hayne and Gibbs paralleled the simultaneous efforts of Ernest A. Spiegel and Henry T. Wycis. Events leading to the development of stereotactic frames and their subsequent use in humans for the treatment of epilepsy, movement disorders, and psychosurgery are reviewed.

Animals↗

Effect of altitude on hand-held peak flowmeters.

OBJECTIVE: To quantify the effect of altitude on the operational characteristics of hand-held peak flowmeters. DESIGN: Altitude simulation within a hypobaric chamber combined with five constant simulated peak flows delivered from a computerized pump were used to test commercially available peak flowmeters. SETTING: F.G. Hall Hyperbaric/Hypobaric facilities located at Duke University School of Medicine. MEASUREMENTS: Two each of nine models of commercially available hand-held peak flowmeters and a volume spirometer were tested at six simulated altitudes (100, 500, 1,000, 1,500, 2,000, and 3,000 m) using five target peak flows. Each peak flow was injected into each meter twice. Forward stepwise regression was used to check for nonlinear relationships between altitude and peak expiratory flowmeter readings. Linear regression equations were fit to the data at each target flow across altitude. Effect of absolute peak flow was tested by analysis of covariance. RESULTS: For these altitudes, linear relationships were found between altitude and measured peak flow. For all meters tested, the average decrease in peak flow ranged from -8.7% at the lowest target flow (123 L/min) to -6.5% at the highest target flow (702 L/min) for each 100 mm Hg decrease in barometric pressure (PB). Individual meters ranged from -12.3% at the lowest target flow to -4.4% at the highest target flow for 100 mm Hg decrease in PB. The spirometer had no significant changes associated with changes in PB. In all cases, the magnitude of the altitude effect, measured by percent change, decreased with increasing peak flow. CONCLUSIONS: Peak expiratory flowmeters underread PEF as a function of both increasing altitude and increasing target peak flow.

Altitude↗

Effects of PNF stretching phases on acute arterial blood pressure.

This study examined acute systolic (SBP) and diastolic (DBP) blood pressure responses within passive and modified proprioceptive neuromuscular facilitation (PNF) stretching techniques. Nonhypertensives (N = 60) were assigned to one of three treatment groups. Group 1 employed an antagonist passive stretch (APS), 6-sec maximal voluntary isometric contraction (MVIC) of the antagonist, and subsequent APS. Group 2 employed an APS, a 6-sec MVIC of the antagonist, submaximal concentric contraction of the agonist, and APS. Group 3 was similar to Group 2, with the deletion of an MVIC prior to the concentric contraction. Blood pressures were obtained during rest, baseline following passive stretch, and at the end of the three phases of the PNF technique. Range of motion (ROM) data were collected for baseline and treatment in terminal hip flexion for each group. All PNF treatments were effective for increasing ROM. One or two trials of PNF improve ROM and avoid increasing SBP, while a third trial increases SBP.

Adult↗

Use of the Horsley-Clarke stereotactic frame in humans.

It is well known that the Horsley-Clarke frame (HCF) was developed and engineered by the British physicians Robert Henry Clarke and Victor Horsley in 1906 for use in animals. It is less appreciated that the HCF was also used by the Frederic Gibbs group in 1947 for studies of human epileptics. Subcortical depth electrodes were placed using the relationship between external landmarks and intracranial structures and confirmed by pneumoencephalography. Events leading to the development of the HCF and its subsequent use in humans for depth recordings, and lesion production in the treatment of epilepsy, movement disorders, and psychosurgery are discussed.

Animals↗

In vitro growth inhibition of growth factor-stimulated meningioma cells by calcium channel antagonists.

Studies have shown that a majority of meningiomas contain receptors for platelet-derived growth factor and epidermal growth factor and that these growth factors promote the proliferation of meningioma cells in culture. Although the mechanism of action has not been elucidated, intracellular calcium appears to be part of the signal transduction mechanism. Because alterations in intracellular calcium could interrupt this pathway and decrease cellular proliferation, we investigated the effects of calcium channel-blocking agents on the growth of meningioma cells in vitro. Primary meningioma cell cultures were established, and the cells were characterized by light and electron microscopy and by immunohistochemical studies. Then, the cultures were given growth factors and/or various calcium channel antagonists, and growth rates were measured. A dose-response decrease in cell growth was seen when verapamil, nifedipine, or diltiazem (voltage-dependent calcium channel-blocking agents) was added to serum-containing media. Also, these drugs blocked the growth stimulation of epidermal growth factor and platelet-derived growth factor in a similar fashion. Dantrolene, which inhibits the release of sequestered intracellular calcium, was also an effective blocker of the mitogenic stimulation of these growth factors.

Adult↗

Inhibition of in vitro meningioma proliferation after growth factor stimulation by calcium channel antagonists: Part II--Additional growth factors, growth factor receptor immunohistochemistry, and intracellular calcium measurements.

We have previously reported that calcium channel antagonists can block both the growth of meningiomas in culture and the potent growth stimulation of meningioma cells by epidermal growth factor (EGF) and platelet-derived growth factor (PDGF). This study further defines the nature of this growth inhibition. Primary meningioma cultures were established, and cells were characterized. Fibroblast growth factor or insulin-like growth factor-I growth stimulation in the presence of calcium channel antagonists was examined. In addition, the effects of ethylene glycol-bis-(aminoethylether) N,N,N',N"-tetraacetic acid and Bay K 8644, a calcium channel agonist, on the growth factors were analyzed. Growth factor receptor immunohistochemistry was performed on the original tumors and the in vitro meningioma cells. Twelve of 17 (71%) meningiomas in this study were positive for the EGF receptor, and 14 of 17 (82%) were positive for the PDGF receptor. Five of six (83%) of the culture cells were positive for the EGF receptor, and four of five (80%) were positive for the PDGF receptor. Intracellular calcium changes were quantified using the intracellular calcium-chelating, fluorescent dye, Fura-2. The growth stimulation of fibroblast growth factor and insulin-like growth factor-I on meningioma cells in culture was decreased in a dose-dependent manner by calcium channel antagonists. The growth stimulation of fibroblast growth factor and insulin-like growth factor-I was not affected by a reduction of extracellular calcium, whereas the growth stimulation of EGF and PDGF was. Interestingly, intracellular calcium was not increased after exposure to growth factors but was increased after serum stimulation. This increase could be blocked by preincubation with verapamil. Calcium channel antagonists can inhibit proliferation of meningioma cells in culture after stimulation with a number of growth factors. These drugs might disrupt intracellular calcium homeostasis or interfere with key elements of the growth factor signal transduction pathways. These mechanisms as well as the potential clinical relevance of these findings are discussed.

Adult↗

Intraindividual peak flow variability.

OBJECTIVES: To quantify intraindividual variability in peak expiratory flow (PEF) measured with peak flow-meters and to define factors affecting PEF variability. METHODS: Three hundred one healthy subjects (aged 4 to 84 years) were recruited from sites at sea level (n = 220) and at 1,400 m altitude (n = 81). All testing was done with the same model peak flowmeter. Each subject was actively coached through five to eight successive PEF maneuvers. Three meters of the same model were tested using a mechanical waveform simulator at three different flows at both testing altitudes (sea level and at 1,400 m). RESULTS: Excluding outliers, the mean PEF was 523 L/min, mean standard deviation (SD) was 22 L/min, and mean coefficient of variation (CV) was 4.6%. The upper 95th percentile for CV was 8% for adults and 10% for youths. Analyzing only the three highest peak flows for each subject, the mean PEF was 539 L/min, mean SD was 12 L/min, and mean CV was 2.4%. The upper 95th percentile for CV was 6% for adults and 9% for youths. Linear regression analysis revealed a small but statistically significant correlation (p < 0.01) between mean peak flow and CV. In adults, SD correlated with sex (p < 0.01) but neither CV nor SD was correlated with age, height, weight, or altitude. Meter variability defined with the mechanical waveform simulator was small. Standard deviation varied from 1.5 to 4.2 L/min and CV from 0.4 to 1.6%. When the three largest peak flows for each subject were used, 5.5% of intraindividual variance was explained by meter variance. CONCLUSIONS: These estimates of intraindividual variability in healthy subjects are generally lower than those previously reported. Meter variability accounts for only a small part of total intraindividual variability. The 95th percentile data suggest that a fall in PEF of 6 to 8% in adults and 9 to 10% in youths would be statistically significant.

Adolescent↗

Physician-guided treatment compared with a heparin protocol for deep vein thrombosis.

BACKGROUND: Effective heparin therapy, defined by therapeutic prolongation of the activated partial thromboplastin time (APTT), decreases the risk of recurrent venous thromboembolism. Achieving therapeutic prolongation of the APTT within 24 hours of the start of heparin therapy has proved difficult. We hypothesized that a protocol that delivered high initial heparin infusions to patients without identifiable risk for bleeding complications would decrease the time to achieve a therapeutic anticoagulant effect without increasing the incidence of major bleeding complications. METHODS: To test this hypothesis, we studied concurrent patient cohorts. We defined a therapeutic anticoagulant effect (APTT > 55 seconds) to be an APTT more than 1.5 times the upper limit of normal. Twenty patients with acute symptomatic deep vein thrombosis received a 5000-U heparin bolus, followed by 1680 U/h (low risk to bleed) or 1240 U/h (high risk to bleed), adjusted by protocol-directed response to APTT results. Forty-eight patients with deep vein thrombosis were treated by their physicians. The Kaplan-Meier method was used to examine the proportion of patients who achieved an APTT greater than 55 seconds as a function of time. RESULTS: The two study cohorts did not differ with respect to age, weight, or risk factors for venous thromboembolism. Analysis of Kaplan-Meier curves showed that the heparin protocol decreased the time to achieve a therapeutic anticoagulant effect (P = .025). Ten (91%) of 11 patients (95% confidence interval, 59% to 100%) without risks to bleed who were treated by the heparin protocol and 29 (60%) of 48 patients (95% confidence interval, 45% to 74%) not treated by the protocol had an initial therapeutic APTT (P = .006). CONCLUSION: A protocol that delivers higher initial heparin infusions to patients without identifiable risks for bleeding decreases the time needed to achieve therapeutic prolongation of APTT, when compared with nonprotocol physician management.

Aged↗