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Biomedical subjects

L Jenkins

Publications and source records attributed to L Jenkins.

12 recordsLinked to original sources

Field loss after pan retinal photocoagulation with diode and argon lasers.

Argon and diode laser pan retinal photocoagulation are used in diabetic proliferative retinopathy. This is a prospective study of the effects of each laser type on peripheral field loss. It shows that diabetics have significantly reduced peripheral field prior to laser compared to normals (p = 0.006). With identical pan retinal photocoagulation with either argon or diode laser there is no difference in field loss.

Diabetic Retinopathy

Fields, DVLC and panretinal photocoagulation.

Laser panretinal photocoagulation (PRP) reduces visual loss in proliferative diabetic retinopathy but decreases peripheral retinal function. The Driver and Vehicle Licensing Centre (DVLC) states that when a patient volunteers that he or she has had photocoagulation, a questionnaire will then be sent to the patient's diabetic physician who can refer the patient for formal field testing. Of 30 patients who had PRP, 15 failed DVLC visual field regulations using the Esterman binocular field test on the Humphrey field analyser. The failures were more likely to have had treatment with a xenon laser, but there was no difference between the groups as regards age, number of burns or whether an argon or diode laser was used. The patients who failed were more likely to be hypertensive (p = 0.04). Two patients with unilateral PRP could not meet the driving regulations because of other field defects. Diabetes itself causes field defects, and therefore even with small amounts of laser, formal field testing may be necessary.

Adult

The influence of an attachable subcutaneous cuff for preventing triple lumen catheter infections in critically ill surgical and trauma patients.

One hundred and ninety-one triple lumen central venous catheters were placed into 107 sites in 81 surgical and trauma patients who were prospectively studied to determine the rate of catheter related infection using a subcutaneous cuff of biodegradable collagen containing bactericidal silver and a guide wire exchange protocol. Thirty-seven sites in 36 nonseptic patients (group 1) were compared with 70 sites in 45 septic patients (group 2). The data were also compared with data consecutively collected one year earlier, using the same exchange protocol without the cuff. Fourteen of 70 sites in group 2 had catheter related infections, with seven causing bloodstream infection. Five of 14 were the result of fungus, with three causing fungemia. Two of 37 sites in group 1 had catheter related infections (p = 0.044), with no associated bacteremia. The number of triple lumen catheter related infections and associated bacteremia or fungemia are higher in septic patients compared with nonseptic critically ill surgical and trauma patients. The cuff significantly prolongs time of catheter site use in patients who are nonseptic, but may be of no benefit in reducing infection rates or prolonging site use time in patients who are septic and may predispose to fungal colonization.

Adolescent

Development of a school building model for educating students with handicaps and at-risk students in general education classrooms.

This study, conducted in the context of a 4-year project to redesign special and remedial services in an elementary school, examined the effects of cooperative learning, cross-age tutoring, and in-class services for students with handicaps and remedial students. All students (524) in Grades 1 through 6 in two medium-sized elementary schools took part in the study. All three treatments were introduced into one of the schools, with the second school serving as a control. The cooperative learning treatment was delivered to all sixth-grade students, cross-age tutoring to special and remedial students in Grades 1 through 3, and the in-class services to all grade levels. Results indicated that, although the character of the instructional services changed markedly, none of the three treatments had much impact on achievement. Reasons for the findings are explored.

Achievement

The value of hospital-based treatment for the homeless mentally ill.

The access of the homeless mentally ill to the benefits of psychiatric hospitalization has been excessively limited by deinstitutionalization, the devaluation of the benefits of inpatient evaluation and treatment, a shortage of public-sector psychiatric beds, and a tendency to regard the homeless mentally ill as untreatable. A pilot program was devised to increase the access of the homeless mentally ill to short-term hospital-based treatment within a public mental health system in which beds are in short supply. The program's usefulness demonstrates the value of hospital-based treatment for this population and suggests that hospital-based treatment is currently underutilized.

Aftercare

Expression in COS cells of a mouse-human chimaeric B72.3 antibody.

B72.3 is a mouse hybridoma cell-line secreting an IgG1 antibody which recognises an epitope on a tumour-associated antigen, TAG-72. This high molecular weight mucin-like molecule is found on a variety of human neoplasms, including colon, breast and ovarian carcinomas. Chimaeric immunoglobulin genes with the B72.3 specificity have been constructed by joining the mouse variable regions from cDNA clones to human genomic constant regions using recombinant DNA techniques. The chimaeric heavy and light chain immunoglobulin genes were placed under the control of a strong viral promoter, and co-transfected into COS-1 cells. SDS-PAGE analysis of the 35S-labelled products demonstrated that the transiently expressed antibodies were correctly synthesised and assembled. The specific binding characteristics of the parent B72.3 antibody were retained by the chimaeric antibody in an antigen-based ELISA. This system gave sufficiently high transient expression of the chimaeric antibody molecules to allow rapid physical and immunological characterisation of the engineered gene products.

Amino Acid Sequence

Prognostic significance of ventricular CSF lactic acidosis in severe head injury.

Brain-tissue acidosis inferred by cerebrospinal fluid (CSF) lactic acidosis is considered to play an important role in the clinical course of severe head injury. Ventricular CSF lactate concentration was studied in 19 patients during the first 5 days after severe head injury. All patients were intubated, paralyzed, and artificially ventilated so that PaCO2 was kept at 33.2 +/- 5.0 mm Hg and PaO2 at 122 +/- 18 mm Hg (mean +/- standard deviation). The mean Glasgow Coma Scale score on admission was 5.73 +/- 2.42. The first CSF sample was drawn within 18 hours after head injury. Over the first 4 days postinjury, patients with a poor outcome had significantly higher ventricular CSF lactate levels than did those with moderate disabilities or a good outcome. Patients showing favorable outcome had a significant decrease in ventricular CSF lactate levels 48 hours after injury. This decrease was not observed in patients with a poor outcome. Increased ventricular CSF lactate concentration was also reliably associated with increased intracranial pressure (ICP). Ventricular CSF lactate levels did not correlate with the magnitude of intraventricular bleeding. Arterial and jugular venous blood lactate levels, although high after head injury, were usually lower than the levels in the ventricular CSF and reached a normal range by the 3rd day following head trauma. At that time, the ventricular CSF lactate concentration was still above normal in patients with a poor outcome but had decreased to normal in patients with moderate disabilities or a good outcome. Ventricular CSF pH did not generally correlate with the ventricular CSF lactate concentration in patients under controlled ventilation; however, in a few patients close to death or with ventricular infection, a correlation was noted. Ventricular CSF lactate levels were not related to cerebral blood flow. In this study, profiles of ventricular CSF lactate concentration are defined in relation to the patients' clinical course and outcome. High ventricular CSF lactate concentration is present within 18 hours after severe head injury. Its decrease to normal in the following 48 hours is a reliable sign of clinical improvement; however, ventricular CSF lactate levels that are persistently high or that increase over time indicate the patient's deterioration. Serial assessment of ventricular CSF for acid-base status and metabolites in head-injured patients with a ventricular catheter already placed for ICP monitoring is useful in the evaluation of prognosis and clinical course.

Acidosis, Lactic