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Biomedical subjects

R S Markin

Publications and source records attributed to R S Markin.

114 records · Page 7Linked to original sources
PubMedDate not supplied

Orthotopic liver transplantation for type I Crigler-Najjar syndrome.

A neurologically normal 3-year-old girl with Type I Crigler-Najjar syndrome was successfully treated with orthotopic liver transplantation. Preoperative serum bilirubin concentrations as high as 31 mg per dl were not diminished with phenobarbital or phototherapy. Bilirubin fractionation of duodenal bile prior to transplantation revealed 87.1% unconjugated bilirubin and 12.9% monoconjugates as determined by alkaline methanolysis-high-performance liquid chromatography. Postoperatively, the serum bilirubin concentration quickly fell to normal. Uridine diphosphate glucuronyl transferase activity in the recipient liver was not detectable. The gallbladder bile bilirubin concentration of 23.9 mg per dl was less than 15% of previously reported normal values. Since devastating kernicteric brain injury is the invariable outcome of Type I Crigler-Najjar syndrome, liver transplantation should be performed when phototherapy cannot maintain the serum bilirubin concentration at an unequivocally safe level.

Bilirubin↗
PubMedDate not supplied

Challenging the future. Clinical laboratory automation: a paradigm shift.

Compared to other industries, implementation of automation in the health-care arena has been delayed. Changes in reimbursement methods are forcing hospitals and other health-care providers to provide more cost-effective services. Clinical laboratory services are essential to the support of newer medical technologies and therapies such as organ transplantation and chemotherapy. The current paradigm for clinical laboratory operations is based on a mix of batch and random access testing and is dependent on personnel. In this article, a new paradigm based on a factory automation model is described. Mechanisms to support the paradigm shift--including a proposal for the creation of a consortium to jointly fund a development operation--are also explored. A clinical laboratory platform prototype currently under development at the University of Nebraska Medical Center is also described.

Academic Medical Centers↗
PubMedDate not supplied

Recent trends in clinical laboratory automation.

A convergence of concepts has allowed clinical laboratory automation to proceed in a greater number of laboratories: developing automation control interfaces, direct track sampling, and adopting a universal interface. The laboratory automation system (LAS) must interface to the laboratory information system (LIS), which provides the information necessary for routing and scheduling and for future rules-based processing, an important component of the LAS. The automation system also must operate in a real-time or near real-time environment and use the single tube per carrier paradigm. LAS capabilities should span the clinical laboratory and run parallel to the LIS with respect to information flow. The laboratory automation software will control the automated technology and the transportation system that binds clinical laboratory instruments together. It must be able to both drive the hardware components and interface with patient information sources, and it should further the goals of the health-care delivery system by supporting outcomes optimization and utilization management of laboratory resources. The development of workcells based on disciplines such as chemistry or hematology is having and will continue to have a significant effect on the acceptance of clinical laboratory automation technologies.

Autoanalysis↗
PubMedDate not supplied

Bronchoalveolar lavage in liver transplant patients.

Because immunosuppression is required to control rejection, liver allograft recipients are susceptible to a variety of opportunistic pathogens. A total of 191 bronchoalveolar lavage (BAL) specimens from 89 patients (53 adults and 36 children) who underwent orthotopic liver transplantation was reviewed. One case each of cytomegalovirus (CMV), staphylococcal and Enterobacter pneumonia was diagnosed with the aid of pretransplant BAL. The pretransplant BAL in 62 patients showed rare yeasts in 24.2%; these probably represent oropharyngeal contaminants since the patients involved had no symptoms of Candida pneumonia. Among 54 patients who developed respiratory symptoms and underwent posttransplant BAL, 23 (42.6%) were infected with opportunistic pathogens, including Pneumocystis carinii (22.2%), CMV (22.2%) and herpes simplex virus (HSV) (7.4%). Frequently, infection with multiple organisms was present. Adults constituted 100% of the HSV-infected group, 69.2% of the CMV-infected group and 16.6% of the group infected with P carinii. The diagnosis of these infections was aided by a combination of cytology, microbial culture and in situ hybridization techniques. Although BAL permitted the diagnosis and treatment of opportunistic infections, high mortality (62.5%) occurred with CMV and HSV pneumonia. Further studies into methods that permit earlier diagnoses of these infections are necessary.

Adult↗
PubMedDate not supplied

Hepatic ultrastructural changes induced by the toxin microcystin-LR (MCLR) in mice.

Microcystin-LR (MCLR) is a cyclic heptapeptide produced by the blue-green algae Microcystis aeruginosa. It is highly toxic and causes death in rodents due to hypovolemic shock with associated intrahepatic hemorrhage. The molecular mechanism of toxicity is unknown. In order to provide additional information regarding the toxicity of MCLR, the ultrastructural changes present in livers of mice following the administration of 100 micrograms MCLR/kg intraperitoneally, (i.p.) were examined. Time-dependent changes were observed. Disruption of cell to cell contact occurred with infiltration of erythrocytes 60 min after MCLR treatment. Hepatocyte distortion, mitochondrial aggregation, and the prominent accumulation of large areas of endoplasmic reticulum were observed. No detectable hepatic changes in sinusoidal endothelial cells were present. The results suggest that MCLR preferentially affects hepatocytes, although the observations do not preclude the involvement of hepatic vasculature in the toxicity of MCLR.

Animals↗