PubMed Health⌕ Search

Biomedical subjects

P Linton

Publications and source records attributed to P Linton.

9 recordsLinked to original sources

T cell senescence.

The aging of the immune system, referred to as immunosenescence, is associated with a dramatic reduction in responsiveness as well as functional dysregulation. This deterioration of immune function with advancing age contributes to the increased incidence among the elderly of morbidity and mortality from infectious disease, and possibly autoimmunity and cancer. In mammals, the defense for fighting infectious agents is composed of the innate and adaptive immune systems. Macrophages, granulocytes, and natural killer cells are the major components of the innate system whereas T and B lymphocytes comprise the adaptive system. Although both compartments are affected, adaptive immunity is most susceptible to the deleterious effects of aging. Innate immunity functions immediately after birth and manifests little change throughout life. In contrast, adaptive immunity is immature at birth, peaks at puberty and progressively declines thereafter. Though marginal alterations in B lymphocytes are apparent, the dramatic decline in humoral and cell-mediated responses is predominantly the consequence of senescent T cells. The following review focuses on the aging effect on T cells as reflected in altered function, subset representation, development, lifespan and activation. Age-associated alterations in antigen presenting cells are also discussed since these cells are required for T cell activation and may impact T cell function.

Aging↗

Blind orotracheal intubation with the intubating laryngeal mask versus fibreoptic guided orotracheal intubation with the Ovassapian airway. A pilot study of awake patients.

In a randomized, prospective pilot study, we compared awake blind orotracheal intubation using the intubating laryngeal mask airway (blind-ILM) with awake fibreoptic-guided orotracheal intubation using an Ovassapian airway (FOS-OA). Fifty-four patients (ASA 1 to 3, aged 18 to 85 years) requiring awake intubation for elective surgery were randomly allocated by coin toss into two groups: 31 patients were intubated blindly through the ILM (blind-ILM) and 23 were intubated using fibreoptic guidance through the Ovassapian airway (FOS-OA). Sedation to a target clinical end-point (spontaneous eye-closing, but responsive to verbal command) was obtained with fentanyl/midazolam and a cricothyroid puncture was performed with 3 ml lignocaine 4%. The oropharynx was then topicalized until tolerance of a Guedel airway was achieved. The number of failed attempts (maximum of three allowed), overall success rates, the time from insertion of the airway to capnographic (blind-ILM) or fibreoptic (FOS-OA) confirmation of intubation or until three failed attempts, and cardiovascular responses before and during intubation, were recorded. The first time (blind-ILM, 25/31 [81%]; FOS-OA, 20/23 [87%], P = 0.6) and overall (blind-ILM, 26/31 [84%]; FOS-OA, 22/23 [96%], P = 0.2) intubation success rates were similar. The mean +/- SD time to intubation was shorter for the blind-ILM group (104 +/- 65 vs 158 +/- 115 sec, P = 0.05). There were no clinically significant differences in blood pressure or heart rate between groups. Compared with baseline values, there was no cardiovascular response to intubation in either group. We conclude that the blind-ILM and FOS-OA techniques have similar success rates and cardiovascular responses, but intubation is slightly quicker with the blind-ILM technique.

Adult↗

Cervical dural puncture and lumbar extradural blood patch.

The authors report the successful treatment of post-dural puncture headache, consequent to a cervical dural puncture, with a lumbar extradural blood patch. The increase in intracranial pressure generated by the injection of autologous blood in the extradural space seems to be the likely mechanism for the prompt relief of post-dural puncture headache. We conclude that extradural injection of autologous blood at the same level of the dural puncture may not be necessary.

Adult↗

Benign schwannoma of the liver.

We report a case of benign schwannoma presenting as a rapidly enlarging liver mass in a 67-year-old man and review the literature on nerve sheath tumors of the hepatobiliary system. Such tumors, which may occur in patients with and without neurofibromatosis, are very uncommon in the liver. The case reported herein, to our knowledge, is the first well-documented benign schwannoma of the liver occurring in a patient without neurofibromatosis.

Aged↗

Aggressive early medical management by a specialist in physical medicine and rehabilitation: effect on lost time due to injuries in hospital employees.

Musculoskeletal injuries to hospital workers are both common and costly. Little advice has been written on how to decrease losses after injury. In a tertiary care hospital with 2700 employees a specialist in physical medicine and rehabilitation evaluated injured employees who were out of work for more than 2 days. Physician management emphasized increasing patient investment in the problem, early assessment of delayed recovery, and effective communication with the employer. There were 61 injuries averaging 6.7 days off per injury. In a previous year, 52 injuries averaged 11.8 days. Employees out for more than 2 days with back pain and seen by the physiatrist (52%) averaged 11 days off per injury whereas others averaged 14.9 days. In this hospital, early management by a specialist resulted in a substantial decrease in time off because of injury.

Absenteeism↗

Chronic use of triazolam: the effects on the sleep patterns of insomniacs.

The present study was designed to evaluate the effects of triazolam 0.5 mg on the sleep of insomniac patients when given for 3 weeks. The results showed that both acute and chronic triazolam administration are effective in decreasing sleep latency, increasing sleep duration, increasing sleep efficiency and decreasing total wake time without producing major effects on sleep staging. Sleep Stages 1 and 2 were significantly altered by drug treatment but in a positive direction. This change is primarily attributable to the significant decrease in sleep onset. Deep sleep and REM were not significantly changed during triazolam treatment nor was there any evidence of REM rebound after discontinuation of the medication. It was noted that some of the sleep parameters measured shifted toward baseline measures in the first night after triazolam treatment was terminated. However, the total recovery period recorded (7 days) showed the quality and quantity of sleep obtained to be improved over baseline measures. The recovery data compared favourably with those improvements noted during chronic administration of triazolam. It was also found that 3 weeks of triazolam 0.5 mg usage did not result in tolerance to its hypnotic properties. Thus, triazolam maintains its hypnotic effectiveness throughout 3 weeks of administration.

Adolescent↗

21st Century innovators. Interview by Joe Flower.

Last spring, The Healthcare Forum and 3M together announced the 21st Century Innovator Awards. They hoped to spotlight examples of the most forward-thinking organizations in American healthcare--organizations that could demonstrate readiness for the next century through the process of rebuilding their systems and structures. THF and 3M were looking for models for success with: (1) an organizational vision for the future, (2) an integrated planning process which reflected that vision, and (3) a measurable future benefit to the communities they served. The call elicited responses from more than 40 organizations across the country. THF and 3M were overwhelmed by both their range and quality. Choosing was difficult. But last September two winners were unveiled at the THF-3M Visionary Leadership conference in Hilton Head, South Carolina. Memorial Hospital and Health System of South Bend, Indiana, took the large, urban, regional, and national award for its progress in the long, tough process of revisioning itself according to a strategic concept CEO Phil Newbold calls "Quality Through People." The small, rural, and suburban prize went to Yavapai Regional Medical Center in Prescott, Arizona, where CEO Pat Linton is attempting to shape a "Total Healing Environment." We asked Joe Flower to visit both sites and send back an eyewitness report on what makes these two progressive organizations models for healthcare in the '90s and beyond.

Arizona↗