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Biomedical subjects

S Kendall

Publications and source records attributed to S Kendall.

16 recordsLinked to original sources

A peripherally implanted permanent central venous access device.

Totally implanted central venous access devices provide reliable delivery of repetitive chemotherapy courses. However, placement of these ports requires special expertise and facilities, and is not without risk of major complications. This paper reports the technique of placing a new peripherally accessed, totally implantable, central venous port in 22 patients for the repeated administration of systemic chemotherapy. All ports were successfully placed under local anesthesia, with catheter tip location determined by an electronic sensor wand. The ports have been in use for a total of 387 patient-weeks. One port required removal secondary to an infection at the port site. Twenty-one ports have remained functional for infusion and blood sampling through 99 courses of chemotherapy. Acceptance by patients, nurses, and physicians has been excellent.

Antineoplastic Agents

Helping people to stop smoking: a study of the nurse's role.

Sixteen trained nurses from various clinical backgrounds participated in a project designed to describe the process and assess the outcome of their attempts to help a range of patients and clients to stop smoking. A case-study approach was employed and the nurses initiated 68 health education interventions related to smoking cessation. All interventions were tape-recorded and data on patients' and clients' characteristics, smoking history, health beliefs and motivation to give up smoking were also collected. Forty-two patients were followed up 1 year post-intervention. Data collected at this time revealed that 17% had successfully given up smoking, while a further 12% had substantially reduced their cigarette consumption. These findings compare very favourably with those of previous studies in which general practitioners have attempted to help patients stop smoking. The results of the research reported here therefore suggest that nurses have enormous potential for fulfilling a highly effective health education function.

Attitude to Health

Longitudinal study of proteins in plasma and dialysate during continuous ambulatory peritoneal dialysis (CAPD).

The aim was to evaluate plasma proteins during continuous ambulatory peritoneal dialysis (CAPD) in relation to dialysis losses, membrane permeability, renal insufficiency, and time on CAPD. Ten male patients, established on CAPD for at least 14 months, were studied every 8 weeks for 56 weeks. Blood and dialysate from the morning exchange were analysed for urea, creatinine, and 7 proteins, and used to calculate dialysate to plasma concentration ratios (D/P). These ratios were not significantly changed suggesting that permeability remained constant. However, there was a trend for beta 2-microglobulin, creatinine, and urea to increase progressively. After 56 weeks, beta 2-microglobulin had increased from 27.9 to 31.3 mg/L (p less than 0.05) and creatinine 1006 to 1099 mumoL/L (p less than 0.05) and both correlated with time on CAPD (p less than 0.001). Plasma alpha 1-acid glycoprotein, albumin, transferrin, IgG, IgA, and complement C3 were not significantly changed, although IgA and complement C3 were each negatively correlated with time on CAPD (r = -0.70 and -0.67, respectively), creatinine (r = 0.51 and -0.54), and urea (r = -0.61 and -0.61) (p less than 0.001 for all). It is concluded that increases in beta 2-microglobulin, creatinine, and urea are not due to loss of membrane permeability but reflect a slight increase in uraemia. Long-term decreases in immunological proteins may be caused by uraemia or progressive depletion.

Adult

A longitudinal study of the effects of amino acid-based CAPD fluid on amino acid retention and protein losses.

During the evaluation of 1% amino acid solution as an alternative osmotic agent to glucose, we measured amino acids and proteins in dialysate, urine and plasma to evaluate the uptake of amino acids and their effects on membrane permeability. Eight patients (plasma albumin less than 35 g/l) were on 21 exchanges of glucose fluid for 4 weeks before and after 12 weeks, during which a solution of 15 amino acids (Baxter '151') was used for the morning exchange. The absorption of amino acids from the single daily '151' exchange increased during the study: 16.4 g at 4 weeks and 17.1 g after 12 weeks (P less than 0.01) with increases in eight amino acids. Amino acid uptake was related to the permeability characteristics of the patients. Following each '151' exchange, 1% of the amino acids absorbed were dialysed into subsequent glucose exchanges. Consequently the net daily gain was 15.0 g increasing to 15.6 g, whereas daily depletion during glucose exchanges was 1.8 g both before and after '151'. Clearance of five proteins increased both at the start and after 12 weeks of '151'. Total protein and prealbumin loss into dialysate increased by about 20%, and when glucose was restored loss of transferrin, albumin and immunoglobulin G decreased. Urinary concentrations were similar throughout. Amino acid uptake from '151' greatly exceeded all losses although our results suggest small reversible increases in macromolecular permeability of the peritoneum.

Absorption

Structure of proteoheparan sulfates from fibroblasts. Confluent and proliferating fibroblasts produce at least three types of proteoheparan sulfates with functionally different core proteins.

[3H]Leucine- and [35S]sulfate-labeled proteoheparan sulfates were isolated from postconfluent or proliferating cultures of human skin fibroblasts. Cell layers were solubilized by Triton X-100, and transferrin-binding macromolecules were isolated by affinity chromatography. Proteoglycans with no affinity for transferrin were purified by using ion-exchange and gel permeation chromatography. Postconfluent cells synthesize a proteoheparan sulfate of Mr 350,000 (as determined by gel permeation chromatography) which has affinity for transferrin as well as for octyl-Sepharose. Its core protein (Mr 180,000) consists of two disulfide-bonded polypeptides of Mr 90,000. This species was not detected in cultures of proliferating cells. Proliferating and confluent cells also synthesize other forms of proteoheparan sulfates (Mr 200,000-400,000) which have no affinity for transferrin. However, most of them have affinity for octyl-Sepharose. The core protein of proteoheparan sulfates made by proliferating cells has Mr 50,000. A smaller form (Mr 250,000) of this proteoglycan was solubilized by Triton X-100, whereas a larger form (Mr 400,000) remained associated with the pericellular matrix. A third type of proteoheparan sulfate (Mr 200,000) without affinity for transferrin nor octyl-Sepharose was associated with postconfluent cell layers but not with proliferating ones. Its core protein has Mr 35,000. Heparan sulfate oligosaccharides (Mr 6,000 or higher) were found in proliferating cells but not in postconfluent ones.

Cell Division

Allergens of mammalian origin. IV. Evidence for common allergens in cat and dog serum.

IgE antibodies present in serum from 3 patients clinically sensitive to cat and dog were shown to combine with whole cat and dog sera linked to cellulose particles. Employing a modified radioallergosorbent technique (RAST), it was shown that cat and dog sera inhibited the binding of IgE antibodies to insolubilized cat serum and to insolubilized dog serum. These findings suggest that cat and dog sera have common allergens. Other mammalian sera were also tested and found to have little inhibitory activity. Cat and dog sera did not inhibit the binding of IgE antiragweed antibodies to an insolubilized ragweed fraction. Following separation of cat serum by gel filtration on Sephadex G-200 or electrophoresis in acrylamide gel, several fractions were found to inhibit the binding of IgE antibodies to insolubilized cat and dog sera. Whether the heterogeneity observed reflects the presence of single allergens with diverse size and charge properties or multiple allergens remains to be determined.

Allergens

Allergens of mammalian origin V. Properties of extracts derived from the domestic cat.

Eight commercial cat dander extracts and two pelt extracts derived from mongrel and Siamese cats were compared. Cat allergn 1 and cat albumin were measured by radial immunodiffusion. Allergenic activity was evaluated by prick test and a modified radioallergosorbent test. In the latter, the dilution of each extract that produced 50% inhibition of binding of IgE antibodies to insolubilized cat allergen 1 (RAST 1) and insolubilized cat serum (RAST 2) was determind. The total non-dialysable solid content of the extracts did not correlate with any other parameter. Cat allergen 1 content determined by radial immunodiffusion correlated with average prick test results in ten cat-sensitive subjects and with RAST 1 activity. Cat albumin content correlated weakly with RAST 2 activity but not with any other measure of allergenic activity. Absorption of each extract with the gamma-globulin fraction of rabbit antiserum to cat allergen 1 significantly reduced prick test reactivity and RAST 1 activity, but not RAST 2 activity. These results indicate that cat allergen 1 is an important allergen in cat dander extracts and its measurement may be used to standardize the allergenic activity of such extracts.

Albumins

The symptomatic status of patients one year following revascularization by either coronary surgery or angioplasty.

This study consisted of a one year clinical follow-up of 81 patients who had coronary revascularization. In 32 patients, this was accomplished by bypass surgery and in 49, by percutaneous angioplasty. Prior to the procedure the two groups of patients were similar with regard to age, sex, antianginal medication and angina severity with 75% of the surgical patients and 65% of the angioplasty patients in CCS Angina Class III or IV. Although most of the surgical patients had multivessel disease and most of the angioplasty patients had single vessel disease, all had complete revascularization. At one year, 78% of the surgical patients and 84% of the angioplasty patients did not have angina and few patients in either group were taking medication. However, in the intervening year 39% of the angioplasty patients had had a second revascularization procedure, whereas, only 3% of the surgical patients required a second procedure. Extracardiac sequelae were more frequent in the surgical cohort. Therefore, at one year following complete revascularization, bypass surgery and angioplasty result in comparable symptomatic and functional improvement.

Adult