Transplantation and reanimation of hearts removed from donors 30 minutes after warm, asystolic 'death'

OBJECTIVE

To test whether hearts from "dead," pulseless, asystolic donors could be transplanted and reanimated successfully using reperfusion manipulations.

DESIGN AND INTERVENTIONS

Ten infant lambs (mean [+/- SD] weight, 4 +/- 1 kg) were anesthetized and pretreated with 50% dextrose, methylprednisolone, prostaglandin E1, and sublingual nifedipine. Five of these lambs were paralyzed; hypoxic asystolic arrest occurred 10 +/- 2 minutes later. Thirty minutes following asystole (mean, 40 +/- 2 minutes after paralysis) sternotomy was performed and the hearts were excised. Aortic blood gases were as follows: pH, 6.6 +/- 0.1; PCO2, 180 +/- 20 mm Hg; and PO2, 8 +/- 2 mm Hg. Donor hearts were given 30 mL/kg of Cardiosol (Water's Instrument Co, Danburg, Conn), a new cardioplegic agent, at 4 degrees C, and explanted into iced saline. The remaining five lambs then underwent cardiopulmonary bypass, were cooled to 20 degrees C, and hypothermic arrest was instituted. After excision of the recipient's heart, the donor heart was implanted in an orthotopic position. Total cold ischemic time was 1 hour 40 minutes +/- 10 minutes. The donor heart was retroperfused for 10 minutes with low-hematocrit, low-calcium blood via a coronary sinus catheter, then normal aortic inflow reperfusion was continued for 50 minutes.

MAIN OUTCOME MEASURES

Removal of the cardiopulmonary bypass and measurement of hemodynamic parameters.

RESULTS

One half hour after the bypass, mean systolic aortic pressure was 71 +/- 6 mm Hg; mean right atrial pressure was 6 +/- 2 mm Hg; mean left atrial pressure was 7 +/- 2 mm Hg; and mean pulmonary arterial pressure was 20 +/- 8 mm Hg. No inotropic drugs were given for postbypass blood pressure support.

CONCLUSION

It is possible to transplant and reanimate hearts that have been dead for 30 minutes. When further developed, the use of donors who were not brain dead but allowed to die naturally could greatly increase the donor pool.

[Pathogenic factors of postischemic ventricular dysfunction and effects of magnesium]

To investigate the mechanism of myocardial; tunning, a Langendorff model of rat hearts (n = 18) underwent 15 min ischemia with coronary flow at 0.2 ml/min and 10 min reperfusion with Ringer's solution of 1.06 mmol/L Mg2+. Histological exam revealed no myocardial necrosis. However, the recovery of pressure product (RPP) was only 77% compared with control period. The myocardial Ca2+ content and water content were significantly increased (P < 0.01, vs control hearts). Pretreatment with high concentration of Mg2+ (2.4 mmol/L) improved the recovery of postischemic ventricular function, attenuated the Ca2+ overload and myocardial edema. The results indicated that a brief period of low-flow ischemia could produce a postischemic ventricular dysfunction-the myocardial stunning. Calcium overload and myocardial edema might be two pathogenic factors. An increased Mg2+ had a protective effects on postischemic ventricular dysfunction, which may involve the following mechanisms: reduced Ca2+ overload and attenuated myocardial edema.

[Capillary blood viscosimeter of the microcomputer]

On the basis of specific property of non-Newtonian fluid (blood) we have worked out the formula of capillary blood viscosimeter:sheat stress tau alpha = alpha rho gh/2L shear rate f (tau alpha) = 1/pi alpha 3 [3q + h(dq/dh)] and designed and produced the prototype. Repetition experiments have indicated that the property of the instrument is stable, and a comparison of the prototype with the cone and plate viscosimeter has demonstrated the reliability of the measurements.

Characterization of absorption and scattering properties of small-volume biological samples using time-resolved spectroscopy

With time-resolved spectroscopy, we develop an experimental approach by sample substitution to measure the absorption (mu a) and reduced scattering (mu's) coefficients of small-volume biological samples. To investigate the method, small-volume control samples are substituted into a large-size host medium during increases in the absorber (or scatterer) concentration of the host. By characterizing the deviation of the spectra taken with and without the sample, we determine the matching points where the sample and surrounding medium are optically identical. We show that this method can result in correct values of the mu a and mu's for the sample within 6% error if the matching conditions for both the mu a and mu's are fully realized. The results also indicate that this method can give approximate values of the mu a and mu's in a reasonable range if either the mu a or the mu's matching between the two media is realized. This method has been applied to the studies of absorption properties of a human finger and of scattering properties of yeast.

Characterization of absorption and scattering properties for various yeast strains by time-resolved spectroscopy

An understanding of the optical properties of biological media and cells is essential to the development of noninvasive optical studies of tissues. Unicellular organisms offer a unique opportunity to investigate the factors affecting light propagation, since they can be manipulated in ways impossible for more complex biological samples. In this study, we examined optical absorption and scattering properties of strongly multiple scattering yeast suspensions by means of near-infrared (NIR) time-resolved spectroscopy (TRS) and a sample substitution method. We determined the critical parameters for photon migration by varying the cell organelle content, the cell ploidy, the cell size, and the concentration of suspended cells. The results indicate that the photon absorption is insensitive to cell differentiation and that the cell volume is the primary factor determining light-scattering property.

[Phospholipid components in BALFS from bleomycin induced pulmonary fibrosis in rats]

Qualitative and quantitative analysis was performed on 5 components of phospholipids (PL) isolated from bronchoalveolar lavage fluid (BALF) during the development of bleomycin induced pulmonary fibrosis in rats with high-performance liquid chromatography (HPLC). The measurement of cells and protein in BALF, the pathologic and morphometric observation with light and electronic microscope were also done. Results indicated that the changes both in BALF cells and in lung histopathology were similar, the amount of protein in BALF increased, the total amount of PL in BALF increased more than 1.8-fold over control animals at days 28 after administration of Bleomycin, phosphatidylglycerol (PG) decreased with time, phosphatidylinositol (PI) and phosphatidylethanolamine (PE) increased, PG/PI ratio decreased, the PG/PI ratio could be used as a marker for pulmonary fibrosis.

Health indicators of substance abuse problems in Baltimore

Selected health indicators were examined for which Baltimore-specific data were available, including substance abuse treatment admissions, AIDS (acquired immunodeficiency syndrome) case reports, and drug-related emergency room visits and deaths. All indicators reflected high levels and increasing rates of substance abuse problems in Baltimore. Drugs of choice most likely to result in adverse effects were heroin, cocaine, and alcohol--often in combination. The African-American population in Baltimore is disproportionately affected by substance abuse. Emerging drug use patterns are examined, and health service and policy issues are discussed.

Determination of total and free carbamazepine and the principal metabolites in serum by high-performance liquid chromatography with photodiode-array detection

A precise and accurate high-performance liquid chromatography (HPLC) method has been established for the simultaneous analysis of carbamazepine (CBZ), carbamazepine-10,11-epoxide (CBZ-E), and trans-10,11-dihydroxy-10,11-dihydro-CBZ (CBZ-H) in serum samples and their ultrafiltrates. CBZ and its metabolites are eluted in a 3-microM ODS-Hypersil column (250 x 2 mm) at a column temperature of 40 degrees C. The mobile phase is a mixture containing potassium phosphate buffer-acetonitrile-methanol (110:50:30, vol/vol/vol) at a flow rate of 0.2 ml/min. Signals are monitored by a photodiodearray detector with a main sample wavelength of 215 nm and a bandwidth of 10 nm. Coefficients of variation (CVs) for within- and between-day are within 5%, with the recovery rates ranging from 98.16 to 104.64%. This method has the necessary sensitivity and linearity for routine therapeutic monitoring of both total and free CBZ and its principal metabolites. Total serum concentrations of CBZ, CBZ-E, and CBZ-H obtained from 55 epileptic children were 12.58 +/- 4.42, 2.45 +/- 1.22, and 5.83 +/- 3.17 (mean +/- SD, micrograms/ml), respectively. Levels of free CBZ, CBZ-E, and CBZ-H were 2.59 +/- 0.93, 1.05 +/- 0.57 and 3.73 +/- 1.87, respectively. Free fractions of CBZ, CBZ-E, and CBZ-H were 20.98 +/- 4.34, 42.63 +/- 8.21, and 65.41 +/- 7.80%, respectively. CBZ-H and CBZ-E had larger CVs than did CBZ (54.34 and 49.75 vs 35.15%, respectively, for total levels, and 50.31 and 54.46 vs 36.22%, respectively, for free levels), as well as higher free fractions. Determination of both total and free concentrations and free fractions of CBZ and its metabolites, as well as their ratios, should provide additional needed information for therapeutic drug monitoring of CBZ.

Four years' experience with the treatment of all-trans retinoic acid in acute promyelocytic leukemia

A retrospective analysis was done on 43 patients with acute promyelocytic leukemia (APL) at our hospital from June 1987 to August 1992. All-trans retinoic acid was used to induce these patients to differentiation. In the early period of induction there were risks of severe hemorrhage, which was the main cause of early death. Treatments combined with platelets and heparin or aminomethylbenzoic (PAMBA) were given to patients with abnormal coagulation. As a result only 4 out of 43 patients died of intracranial bleeding at 4-12 days when their white blood cell (WBC) counts peaked. The combination of retinoic acid (RA) and HA chemotherapy could reduce hyperleukocytosis during the RA induction course. None of 7 patients died at early stage with this treatment combination. Our studies showed that it could predict the onset of remission at early stage through observations on the successive changes of karyotypes and morphology of the bone marrow and peripheral blood cells. Our studies also showed that the growth of CFU-F could be inhibited by RA. We think that it may play a role in the RA-induced differentiation. In 4 years of follow-up the overall leukemia-free survival (LFS) was 80% with a relapse rate of 45%. Thirty-five patients out of 43 cases were still alive in remission, and one was alive in relapse. All 11 out of 43 patients relapsed within 3 years, but the relapses occurred later, after 3 years duration of remission (P < .01). Retinoic acid failed to induce 5 patients who relapsed with the continuation treatment of RA and chemotherapy alternatively. In order to overcome the resistance to RA, the continuation treatment of simple chemotherapy had been administered following CR. Two cases achieved remission in this way. The difference of resistant events to RA reached significance between these 2 groups of different continuation treatment.

Simultaneous determination of carbamazepine, phenytoin, phenobarbital, primidone and their principal metabolites by high-performance liquid chromatography with photodiode-array detection

We have established a precise and accurate high-performance liquid chromatographic method for the simultaneous assay of carbamazepine, phenytoin, phenobarbital, primidone and their principal metabolites. This method has been used for the analysis of these drugs and the metabolites in serum, saliva and urine samples. Acetonitrile is used for the deproteinization of serum and saliva samples while solid-phase extraction is utilized for urine sample pretreatment. Samples of 2 microliters are injected onto a 3-microns ODS-Hypersil column (250 mm x 2 mm I.D.) with a column temperature of 40 degrees C. The drugs and metabolites are eluted with a mobile phase containing potassium phosphate buffer-acetonitrile-methanol (110:50:30, v/v/v) at a flow-rate of 0.2 ml/min. Signals are monitored by a photodiode-array detector at a sample wavelength of 200 nm with a bandwidth of 10 nm. These four commonly used antiepileptic drugs and their six metabolites are well separated from one another within 15 min. Within-day coefficients of variation (C.V.) are within 5% in most cases and between-day C.V. are from 2.32 to 4.75%. The recovery rates range from 95.12 to 104.42%. This method has the necessary sensitivity and linearity for routine therapeutic monitoring of both total and free drug levels and may be employed for pharmacokinetics studies of drug interactions and metabolism as well.

[Morphometric evaluation on the pathologic changes in ovariectomized endometria influenced by estrogen use]

Thirty SD female rats were divided into the following groups: (1) sham operation; (2) bilateral ovariectomized (OVX); (3) OVX and estrogen-treated (E). Computerized Image Analyser was used to evaluate the pathologic changes of endometria in these animals. The results showed the endometria of OVX group was in the state of atrophia, while the endometria of E group was in the state of early proliferative stage. The heights of endometria, endometrial epithelia cells and gland epithelia cells, the volume fraction and numerical density of endometrial glands, and the cavity diameter of the glands could effectively express the proliferative changes of the endometria. It is suggested that this method be used to study the pathology of the different endometric diseases.

Activation of serotonin1A receptors inhibits midbrain periaqueductal gray neurons of the rat

The midbrain periaqueductal gray (PAG) is involved in a variety of functions including pain modulation, vocalization, autonomic control, fear and anxiety. This area contains serotonin receptors, particularly 5-HT1A that are known to play a role in the above functions. The goals of this study were to characterize the effects of 8-OH-DPAT, a selective 5-HT1A agonist, on the firing characteristics and membrane properties of PAG neurons. Both in vivo and in vitro preparations were used. The effects of 8-OH-DPAT on baseline activity of 91 neurons were tested in the in vivo preparation. In 50/91 cells, 8-OH-DPAT produced a decrease in the firing rate that ranged between 21 and 98% (mean +/- S.E.M. decrease of 49 +/- 1.9%). This inhibitory effect was dose dependent and could be blocked by spiperone. In 10/91 cells, 8-OH-DPAT produced an increase in the firing rate that ranged between 13 and 290%, with mean increase of 83 +/- 7.4%. The baseline firing rate of the remaining 31 cells was not affected by 8-OH-DPAT. In the PAG slice preparation, the effects of 8-OH-DPAT on synaptic and membrane properties of 17 PAG neurons were tested using whole-cell voltage clamp-recording procedures. In 14 cells, application of 8-OH-DPAT produced hyperpolarization that ranged between 6 and 21 mV, with mean of 8.4 +/- 2.0 mV. This hyperpolarization was associated with a decrease in membrane impedance that ranged between 8 and 45%, with mean decrease of 21.6 +/- 4.5%. The remaining three neurons did not respond to 8-OH-DPAT.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationships in the Drosophila obscura species group, inferred from mitochondrial cytochrome oxidase II sequences

We compare the sequences for the mitochondrial cytochrome oxidase II gene of 13 species of the Drosophila obscura group. The survey includes six members of the D. affinis subgroup, four of the D. pseudoobscura subgroup, and three of the D. obscura subgroup. In all species, the gene is 688 nucleotides in length, encoding a protein of 229 amino acids plus the first position T of the stop codon. The sequences show the typical high-transition bias for closely related species, but that bias is essentially eliminated for species pairs of > 5% sequence divergence. The phylogenetic relationships in the species group are inferred using both neighbor-joining and maximum parsimony. The two procedures give comparable results, showing that the D. affinis and D. pseudoobscura subgroups are monophyletic groupings that appear to have closer affinities to one another than either has to the D. obscura subgroup. We use transversion distances to estimate times of divergence, on the basis of three different estimates of the time of separation of the D. obscura species group from the D. melanogaster group. If that event occurred 35 Mya, then we can estimate the origin of the nearctic forms at approximately 22 Mya and the separation of the D. affinis and D. pseudoobscura subgroups at approximately 17 Mya.

GABAergic regulation of noradrenergic spinal projection neurons of the A5 cell group in the rat: an electron microscopic analysis

Recent studies have demonstrated an important contribution of the A5 noradrenergic cell group of the rostral medulla in the regulation of nociceptive messages at the level of the spinal cord. These noradrenergic controls parallel those arising from the serotonin-containing neurons of the nucleus raphe magnus. In the present study, we used postembedding immunogold staining to identify GABA-immunoreactive terminals that synapse upon identified spinally projecting noradrenergic neurons of the A5 cell group in the rat. A5 projection neurons were identified by Fluoro-Gold transport from the spinal cord; sections containing retrogradely labelled cells were then immunoreacted for tyrosine hydroxylase (TH) to identify the catecholamine-containing, presumed noradrenergic, neurons. Double-labelled A5 cells were intracellularly filled with Lucifer Yellow (LY) and then the LY was photo-oxidized to an electron-dense product. Seven intracellularly filled TH-immunoreactive projection neurons were studied with postembedding immunocytochemistry. Each A5 neuron received a significant GABA-immunoreactive terminal input. Out of a pooled total of 151 terminal profiles found in apposition to intracellularly labelled somatic and dendritic profiles, 31 (20.5%) were GABA-immunoreactive. The proportion of GABA-immunoreactive terminals that contacted somatic profiles (12/72; 17%) was similar to the proportion that contacted TH-labelled dendritic profiles (19/79; 24%). There was a discernible synaptic specialization in about 50% of the labelled terminals that contacted the TH projection neuron. Both symmetric and asymmetric synaptic specializations were found. Labelled terminals contained round or pleiomorphic vesicles, but not flat vesicles; many also contained dense-core vesicles. Our results indicate that noradrenergic neurons of the A5 cell group, which contribute to both antinociceptive and cardiovascular controls through their projection to the spinal cord, are regulated by local GABAergic, presumably inhibitory, mechanisms. Whether the initiation of A5 neuron activity results from a lifting of tonic GABAergic inhibitory control, as has been proposed for the neurons of the nucleus raphe magnus, remains to be determined.

[Nilestriol prevents osteoporosis in ovariectomized rats]

In order to determine the effects and mechanism of Nilestriol upon bone metabolism, 4-month aged female SD rats were divided randomly into three groups: The OVX group subjected to bilateral ovariectomy, the SHAM group to sham operation, the Nilestriol (CEE3) group to bilateral ovariectomy and treated with CEE3 0.15 mg/100 g BW once a week for 10 weeks. The CEE3 was introduced directly into the stomach from the first day after operation. All rats were killed 10 weeks after operation and their right proximal tibiae were processed undercalcified for quantitative bone histomorphometry. The weights of bone and inorganic matter (ash content) and content of calcium, phosphorus of right humeral were measured. The results showed that in the OVX group the trabecular bone volume, the trabecular thickness, the content of calcium bone, and the ratios of bone weight and ash weight to body weight were all significantly reduced. The bone loss was associated with an increase in bone remodeling; the bone resorption appeared much more marked than the bone formation. In contrast, the ovariectomized animals treated with CEE3 had normalization of bone mass and a declined index of bone resorption and formation which recovered the balance of bone remodeling. It suggested that CEE3 is successful in prevention of bone loss in OVX rats. It is convinced of using Nilestriol to prevent postmenopausal osteoporosis.

Temporal sequence of plaque formation in the cerebral cortex of non-demented individuals

One of the hallmarks of Alzheimer's disease is the presence of argyrophilic plaques (arg-P) accompanying dementia and other forms of cognitive alterations. In the present investigation 195 non-demented, cognitively normal patients were grouped according to the presence or absence of critical coronary artery disease (cCAD), defined as a 75% or greater stenosis of one of the epicardial arteries. None of the subjects had significant cerebral vascular disease. The parahippocampal gyrus (PHG) and frontal pole were analyzed for the presence of arg-P, A4 deposition, ALZ-50 immunoreactive (IR) neurons and neuropil threads (NT). Individuals with cCAD have a significantly greater incidence of plaques than non-heart disease (non-HD) subjects. Every cCAD subject had ALZ-50 IR neurons in the PHG and a greater incidence of NT as compared to the non-HD subjects. Every subject with plaques also had IR neurons and NT in the PHG. Based on the presumption that early neurodegeneration labeled by ALZ-50 antibody and amyloid deposition are in some way linked, then the sequence of plaque formation is initiated by the presence of ALZ-50 IR neurons followed in order by NT, A4 deposition and diffuse form arg-P.

Thymic carcinoid tumor--a report of 7 cases

The thymic carcinoid tumor is a rare neoplasm which is often clinically misdiagnosed as thymoma. But the two differ in origin, biological behavior, accompanying syndromes, pathological features, and prognosis. The characteristics of the thymic carcinoid tumor are: difficulty in diagnosis, high malignancy, frequent recurrence and extrathoracic metastasis over a prolonged period postoperatively. Complete surgical resection of original and recurrent tumors is the important treatment. Microscopic, electron microscopic and immunohistochemical examinations may be required in making an accurate pathological diagnosis. This paper reports 7 cases of thymic carcinoid tumor.