Intraoperative hemostasis and wound healing in intestinal anastomoses using the ILA stapling device

Intraoperative hemostasis and wound healing of 24 side-to-side intestinal anastomoses constructed with the ILA stapling device were studied in 12 dogs by comparing the ILA-32 and ILA-52 staple cartridges. Hemostasis was evaluated by intraoperative measurement of blood loss and bleeding time at the staple line. There was no statistically significant difference in mean blood loss (p greater than 0.05) or mean bleeding time (p greater than 0.10) between the two cartridges. Wound healing was studied using bursting strength measurements and silicone rubber casting of the microvasculature at the staple line. At 3 days, 1 week, and 2 weeks postoperatively, there was no significant difference between bursting strength values achieved with the two cartridges. Microscopic examination revealed that wound healing in the ILA-52 anastomoses lagged behind healing in the ILA-32 anastomoses at each postoperative time period studied. The silicone rubber casting study showed a paucity of microvasculature at the healing staple line with the ILA-52 cartridge as compared with the ILA-32 cartridge. Our findings suggest that the ILA-52 cartridge does not offer significantly improved intraoperative hemostasis over the ILA-32 cartridge and may affect the microvasculature at the staple line in a way that delays wound healing.

Laser angioplasty

Clinical trials for Argon Laser angioplasty of patients with severe ischemia of the lower extremities are presented. All instances were limited to those in whom no conventional reconstructive operation was ideal. Laser angioplasty proved to be beneficial when used in conjunction with standard vascular surgical procedures under appropriate conditions. The short term evaluation was favorable; however, a long term study must be followed and completed prior to routine use of laser angioplasty.

Involvement of a nucleolar component, perichromonucleolin, in the condensation and decondensation of chromosomes

A component of the nucleolar material, perichromonucleolin (PCN), was identified by a specific antiserum against nucleoli obtained from a scleroderma patient. The distribution and changes of PCN during the mitotic cycle were followed using this antiserum and indirect immunofluorescence microscopy. Based upon the behavior of PCN during mitosis, it could be differentiated into chromosomal and nonchromosomal portions. During prophase the former gradually associates with the surface of the condensing chromosomes and forms the coat or pellicle around the metaphase and anaphase chromosomes. This pellicle PCN is carried by the anaphase chromosomes to the daughter nuclei. During the time from telophase to interphase, the pellicle PCN dissociates from the decondensing chromosomes and is incorporated into the new nucleoli. The nonchromosomal PCN, after the breakdown of the nuclear membrane, distributes in the cytoplasmic region around the condensed chromosomes and diffuses into the cytoplasm during anaphase. Preliminary biochemical analysis by immunoblotting showed that the PCN consists of two main proteins with molecular masses of 36 kDa and 30 kDa.

Direct vision valvulotomy in in situ venous bypass

The autogenous saphenous venous bypass is accepted as an optimal procedure for distal arterial reconstruction. However, serious complications, including incomplete valvulotomy, laceration of the venous wall and persistent arteriovenous communications, are found in in situ bypasses. To avoid these complications, a new and simple technique using an angioscope in the in situ venous bypass has been developed. Angioscopy prevents tearing of the vein wall and avoids inaccurate incision of the valves.

Direct vision valvulotomy for nonreversed vein graft

A new and easy technique using an angioscope in a nonreversed, isolated vein bypass is suggested herein. Direct vision valvulotomy with an angioscope in nonreversed vein graft saves operating time, prevents tearing of the vein wall and inaccurate incision of the valves.

Phospholipid methylation in canine myocardium: kinetic characteristics and the effect of endotoxin administration

The kinetic characteristics and the effect of endotoxin administration on the enzymatic methylation of phospholipids in dog heart microsomes were studied using S-adenosyl-L-[methyl-3H]methionine as a methyl donor. Kinetic studies in control dogs reveal that the stepwise methylation of phosphatidylethanolamine to phosphatidylcholine was catalyzed by three different enzymes. Methyltransferase I catalyzed the methylation of phosphatidylethanolamine to phosphatidyl-N-monomethylethanolamine, had a very low Km (approximately 1.5 microM) for S-adenosylmethionine, and a pH optimum of 6.5, and it was stimulated by Mg2+ and Ca2+. Methyltransferase II catalyzed the methylation of phosphatidyl-N-monomethylethanolamine to phosphatidyl-N,N-dimethylethanolamine, had a low Km (8-12 microM) for S-adenosylmethionine, and a pH optimum of 8.5, and it was stimulated by low concentrations (less than 1 mM) of Ca2+ but was unaffected by Mg2+. Methyltransferase III catalyzed the formation of phosphatidylcholine from phosphatidyl-N,N-dimethylethanolamine, had a high Km (approximately 33 microM) for S-adenosylmethionine, and a pH optimum of 9.5, and it was unaffected by Mg2+ or Ca2+. Experiments with trypsin digestion indicate that methyltransferases I and III were partially embedded while methyltransferase II was completely exposed to the surface of the membrane. Endotoxin administration (2 and 4 hr) decreased the Km and Vmax by 30 to 36% and 24 to 37.7%, respectively, for S-adenosylmethionine. Since the enzymatic methylation of phospholipids has been implicated to play an important role in the regulation of membrane structure and function, the endotoxin-induced decreases in the Km and Vmax of phospholipid-methylating enzymes in dog heart microsomes may contribute to the development of myocardial dysfunction in endotoxin shock.

Thermolabile proton translocating ATPase and pump activities in a clathrin-coated vesicle fraction from an acidification defective Chinese hamster cell line

We have recently described a mutant of Chinese hamster ovary cells, termed G.7.1, that contains a temperature-sensitive, conditionally lethal mutation resulting in defective vacuolar acidification (Marnell, M. H., Mathis, L. S., Stookey, M., Shia, S.-P., Stone, D.K., and Draper, R. K. (1984) J. Cell Biol. 99, 1907-1916). To further characterize the lesion, clathrin-coated vesicles were partially purified from wild type and G.7.1 cells, and the thermolabilities of vanadate and oligomycin-insensitive, N-ethylmaleimide-sensitive, H+-ATPase activity, 32Pi-ATPase exchange activity, and proton pumping were compared. All three parameters of H+ pump activity were markedly diminished by preincubation at 44 degrees C for vesicles harvested from the G.7.1 cells, but not for those from wild type cells. Phosphatidylserine did not protect against heat inactivation in vesicle fractions prepared from G.7.1 cells. The results suggest that the mutation responsible for defective acidification in G.7.1 cells is expressed at the level of the proton pump of organelles present in our clathrin-coated vesicle-enriched preparation.

Argon laser angioplasty with a laser probe

A preliminary basic study of argon laser angioplasty with the use of a specially designed probe is presented. Arterial specimens were harvested from 10 amputated lower extremities. The studies included the evaluation of coaxial laser angioplasty in 10 partially or totally occluded arteries; the observation of the effect of perpendicularly applied laser energy on 35 thrombi, 54 soft and 10 hard atherosclerotic, and 51 normal arterial walls; the comparison of laser energy requirements for coaxial vessel lumen enlargement or recanalization vs. perpendicular penetration in 10 occluded, hard atherosclerotic arteries; and the spectrographic analysis of calcium density gradient in two specimens. The results showed that the power required for vessel lumen enlargement was 10 +/- 6 J/mm of atherosclerotic vessel (mean +/- standard deviation). The probe followed the original arterial lumen, did not perforate the vessel wall, and created a smooth, enlarged path. The power required to penetrate perpendicularly to a similar depth for thrombi, soft and hard atherosclerotic plaques, and normal arterial walls was 15 +/- 4, 30 +/- 15, 65 +/- 32, and 246 +/- 123 J/mm, respectively. In the hard calcified specimens, laser energy required for coaxial lumen enlargement or recanalization was significantly less than that for perpendicular penetration (p less than 0.05), which correlated with the calcium density map indicating an increase from inside to outside.

Intimal response of saphenous vein to intraluminal trauma by stimulated angioscopic insertion

Endothelial damage after simulated angioscopic insertion was evaluated in 22 dogs by radioimmunoassay of endogenous 6-keto-prostaglandin F1 alpha (stable product of prostacyclin produced by the endothelium) by means of a closed perfusion system and scanning electron microscopy. In 20 dogs, a 1.7 mm diameter polyethylene tube similar in size and physical characteristics to a commercially available angioscope was passed once into the distal venotomy site and out of the proximal venotomy site for a total distance of 15 cm in the left saphenous vein (group A) and 10 times in both directions in the right saphenous vein, destroying all valves (group B). The vein segments were examined immediately after simulated angioscopic insertion and at intervals of 2, 3, and 4 weeks. The remaining two dogs were used as control animals to establish baseline prostacyclin production. All veins were patent when harvested. Scanning electron microscopy revealed globular and contracted endothelial cells in some areas of group A veins, whereas partial longitudinal absence of endothelial cells was noted in group B veins. Intimal coverage was complete by 2 weeks in group A veins and between 3 and 4 weeks in group B veins. Prostacyclin synthesis of group B veins was significantly less than that of group A at day 1 and at 2 weeks after operation (p less than 0.05), reaching that of control vein synthesis by 4 weeks. This study suggests that simulated angioscopic trauma of the luminal surface of the canine saphenous vein had no negative effect on early patency.

Role of enteric plexuses in the competency of telescoped intestinal valves

The mechanism of preventing intestinal regurgitation by means of a telescoped intestinal valve has been investigated in this study. Ten telescoped intestinal valves were uniformly created in dogs. A tolerance test to barium reflux was performed before the animals were sacrificed 16 weeks postoperatively, which yielded various barium tolerance values. Statistical analysis revealed that the differences in barium tolerance values in the uniformly constructed valves were closely related to the proportion of the enteric plexuses which contained ganglion cells with normal shapes (r = 0.97, p less than 0.001) and their intestinal segment coverage (r = 0.94, p less than 0.001), but no correlation was found between barium tolerance and the thickness of the valvular musculature (r = 0.04) or the length of the artificial valve (r = 0.39). The results in this study suggest that the intact enteric plexuses play an important role in modulating the competency of the telescoped intestinal valve.

Use of intragastric balloons for weight reduction. An experimental study

The effect of intragastric balloons as a noninvasive method for weight reduction was observed in nine castrated Yorkshire pigs. None of the animals lost weight. The appetites of the experimental animals were inhibited for only a short period of time. A significant dilatation of the stomach after balloon insertion was noted which resulted from increased food intake and obliterated the effect of the intragastric balloons. A long-standing lower blood glucose level played an important role in the increments in food intake and dilatation of the stomach. At the same time, ulceration was seen in 83.3 percent of the animals that received balloons. We conclude that intragastric balloon therapy may not be an effective approach for managing morbid obesity in human subjects.

Relationships between ionizing radiation, bone marrow transplantation and leukemogenesis

Studies of the relationships between ionizing radiation, bone marrow transplantation and leukemogenesis were carried out in 343 LACA mice. The recipients (female) were given whole-body irradiation with 7 or 8 Gy of Co-60 gamma-rays, while the donors (male) were given whole-body irradiation with 3, 1.5, 0.5, 0.1, 0.05 and 0 Gy of Co-60 gamma-rays. Each recipient was intravenously infused with 1-3 X 10(7) of the mixed marrow cells of donors. In the result, the average incidence of surviving over 1 month was 86% in the recipients. Myelocytic leukemia developed in all the transplanted groups, the average incidence being 88.5%. Leukemia was observed in 1.5-2.5 months after transplantation in the recipients receiving marrow cells from donors exposed to 3 Gy, but in 5-8 months in other groups. It was demonstrated by the analysis of Y-chromosome that the leukemic cells were derived from the donor's marrow cells. The results suggest that marrow transplantation for the mice irradiated by Co-60 gamma-rays of lethal dose can protect them from death, but promote the development of leukemia. Radiation can induce production of factors which lead to leukemic transformation of engrafted normal marrow cells in the irradiated mice; the direct damage of DNA caused by radiation is not the unique factor that gives rise to leukemia.

Patterns of pannus growth of the expanded polytetrafluoroethylene vascular graft with special attention to the intimal hyperplasia formation

Serial histologic observations of the healing process of expanded polytetrafluoroethylene (PTFE) vascular grafts in dogs were performed. The common iliac arteries of 12 mongrel dogs were replaced with a 2-cm segment of 6 mm PTFE graft, bilaterally. The grafts were studied microscopically after the animals were killed at 4, 8, 12, 16, 20, and 24 weeks. All the grafts remained patent up to 24 weeks. Special attention was paid to the histological characteristics of pannus growth, which were divided into two types: smooth appearing and irregular. The former type was characterized by smooth, thinner connective tissue growth along the graft, and the latter was defined as irregular-shaped pannus containing large and small thrombi. Only pannus of the smooth type showed similar growth patterns and growth rates. These findings suggest essentially that pannus develops smoothly from both ends of the graft; however, thrombi disturbed this growth pattern. In 24 grafts, eight nodular lesions of the pannus (greater than 500 mu in height) were found: five distally and three proximally. All eight lesions were found within 3 mm of the anastomoses. Among these eight lesions, five were on the completely healed pannus, and the remainings were all on the irregular pannus. This suggests that thrombi organization followed by nodular lesions are major offending factors that lead to the formation of intimal hyperplasia.

The competence and bacteriologic effect of the telescoped intestinal valve after small bowel resection

In 20 dogs the distal one-third of the small intestine and the proximal 10 cm of the ascending colon were resected. Bowel continuity was established by the telescoping technique to create an intestinal valve in ten dogs (group A) and by conventional end-to-end anastomosis in ten dogs (group B). Diarrhea and weight loss were similar in both groups. The ileal bacterial growth was significantly higher than the jejunum in group A (P less than 0.001) but not in group B. The jejunal bacterial growth in group B was significantly higher than that in group A (P less than 0.01). Intestinal transit times were 212 +/- 16.0, 219 +/- 152.4, and 163 +/- 85.8 minutes for normal dogs, groups A and B respectively. The competence of the normal ileocecal valve, the telescoped valve, and conventional anastomosis were 56 +/- 1.7, 49.9 +/- 17.4 and 13.2 +/- 7.8 cm of barium, respectively. Artificial intestinal valve formed by the telescoping technique is safe, simple, and effective in reducing bacterial overgrowth in the jejunum and appears to prolong intestinal transit time.

The healing and tensile strength of the gastroplasty staple line. An experimental study

Inverted and everted staple lines, with and without division of the anterior gastric wall, were performed in 15 mongrel dogs to simulate reduction gastroplasty staple line. There were no significant differences in tensile strength and healing between staple lines at different postoperative periods. The tensile strength of the inverted staple line seemed to be stronger due to breakage of the adjacent gastric tissue. However, the tensile strength of the everted stapling without division of the gastric wall, which is used clinically, was almost equal to that of normal gastric tissue. In addition, there was satisfactory healing 4 weeks postoperatively in the everted stapling without dividing the gastric wall. These results suggest that the everted staple line without division of stomach is not inherently weaker to any significant extent than if the gastric wall was divided or inverted. The reported failure rate of this procedure may be due to other factors.

Intestinal valve formation with a simple invagination technique

In 17 fully conditioned mongrel dogs, the small intestine approximately 50 cm proximal to the ileocecal valve was divided. Three centimeters of the proximal bowel was then inserted into the distal bowel and anastomosis was performed using interrupted 3-0 Dexon sutures in the seromuscular layer of the proximal end and through the entire thickness of the distal end. Two to four dogs were then sacrificed 2, 4, 6, 8, and 10 weeks postoperatively. Two dogs died 3 and 4 weeks postoperatively due to mechanical obstruction just proximal to the anastomosis by hair bezoar, and 15 survived without complications. Retrograde contrast radiologic examination of all segments showed no reflux. Microscopically, the serosal surface of the invaginated segment was found to be gradually covered with mucosa, and the whole segment formed a valvelike structure within 10 weeks time.

Electron microscopy of bacteriophage phi 6 nucleocapsid: three-dimensional image analysis

Electron micrographs of bacteriophage phi 6 nucleocapsids, negatively stained by neutralized phosphotungstate and tilted in a goniometer specimen cartridge, proved that the three distinct morphologies seen in the electron microscope are merely three different aspects of a single nucleocapsid structure and strongly suggested that this structure is dodecahedral.

Complement activation by heat-killed human kidney cells: formation, activity, and stabilization of cell-bound C3 convertases

Heat-killed kidney cells (HKKC) incubated with serum or purified C3 and factors B and D stain intensely for C3 by immunofluorescence. Binding of complement (C) did not occur if ethylenediaminetetraacetic acid (EDTA) was added to the C source or if factor B or D was omitted from the mixture of alternative pathway components. When the C-treated cells were washed, then incubated in purified C3 containing 10 mM EDTA, C3 conversion ensued, confirming the presence of a cell-bound C3 convertase. C3-reactive cells were not generated if EDTA was present during formation of the convertase. The addition of C3 nephritic factor (C3NeF) during formation of the C3 convertase from alternative pathway components greatly enhanced subsequent C3 cleavage, presumably by stabilizing labile C3bBb sites; however, binding of C3NeF did not appear to extend the half-life of the convertase, which was 35 min at 37 degrees C in each case. In contrast, little or no effect on C3 conversion could be detected after the addition of equivalent C3NeF to serum and HKKC. Thus, C activation by HKKC involves formation and activity of a cell-bound C3 convertase, which under certain circumstances can be stabilized by C3NeF.

Complement activation by heat-killed human kidney cells: formation, activity, and stabilization of cell-bound C3 convertases

Heat-killed kidney cells (HKKC) incubated with serum or purified C3 and factors B and D stain intensely for C3 by immunofluorescence. Binding of complement (C) did not occur if ethylenediaminetetraacetic acid (EDTA) was added to the C source or if factor B or D was omitted from the mixture of alternative pathway components. When the C-treated cells were washed, then incubated in purified C3 containing 10 mM EDTA, C3 conversion ensued, confirming the presence of a cell-bound C3 convertase. C3-reactive cells were not generated if EDTA was present during formation of the convertase. The addition of C3 nephritic factor (C3NeF) during formation of the C3 convertase from alternative pathway components greatly enhanced subsequent C3 cleavage, presumably by stabilizing labile C3bBb sites; however, binding of C3NeF did not appear to extend the half-life of the convertase, which was 35 min at 37 degrees C in each case. In contrast, little or no effect on C3 conversion could be detected after the addition of equivalent C3NeF to serum and HKKC. Thus, C activation by HKKC involves formation and activity of a cell-bound C3 convertase, which under certain circumstances can be stabilized by C3NeF.

Experimental study of singly placed staples for an everted intestinal anastomosis

This study was undertaken to confirm the technical feasibility and efficacy of an intestinal anastomosis created with singly placed staples in dogs. In 12 fully conditioned dogs, two end-to-end small bowel anastomoses were performed in an everted manner. In each dog, one anastomosis was performed with singly placed staples utilizing the Auto Suture 4.8 mm disposable skin stapler, and the other anastomosis was performed with a manual technique using 3-0 Dexon interrupted suture. Operation time was measured for each anastomosis. Dogs were sacrificed 2, 4, and 8 weeks postoperatively. Each anastomosis was examined grossly and microscopically, and its tensile strength was measured. All dogs survived without complications. Gross and microscopic examinations showed satisfactory healing of both types of anastomoses at different postoperative intervals. The stapled anastomosis required significantly shorter time (p less than 0.01), and had significantly greater tensile strength (p less than 0.05) when compared with manual anastomosis.

Change in membrane lipid fluidity induced by phospholipase A activation: a mechanism of endotoxic shock

The effects of endotoxin administration on the fluidity of dog liver plasma membranes and their relationship with changes in phospholipase A2 activity were studied. Endotoxin administration decreased the fluidity of liver plasma membranes and this decrease was reversible by phosphatidylcholine. The endotoxin-induced decrease in membrane fluidity could be mimicked by digesting control liver membranes with exogenous phospholipase A2. Endotoxin administration also increased the endogenous phospholipase A2 activity. Endotoxin in vitro had no phospholipase A2-like activity but it activated the hydrolytic activity of exogenous phospholipase A2. Based on these data, it is concluded that endotoxin administration decreased the fluidity of canine liver plasma membranes by acting through activation of phospholipase A2. The decrease in membrane lipid fluidity induced by endotoxin administration may play a significant role in the development of the pathophysiology of endotoxic shock at the cellular level.

Incoherent method for rotation-invariant recognition

An optodigital hybrid system using an incoherent circular correlator that has features suitable for space and industrial applications is introduced. The incoherent circular correlator uses a fiber-optics sampler and carries out the correlations in white light. The trade offs involved for efficient detection of objects are discussed. The system has been built, and experimental results on a real air photograph are presented.

Digital multiple correlation for pattern recognition

A method of digital multiple correlation for rotation-invariant recognition has been developed. It is also a computer simulation of an incoherent optodigital hybrid system previously introduced. Speed and flexibility of the digital system are investigated.

Hydrolysis of 4-methylumbelliferyl N-acetyl-chitooligosaccharides catalyzed by human lysozyme

Binding of N-acetyl-chitotetraose, 4-methylumbelliferyl chitotrioside ((GlcNAc)3-MeU), and 4-methylumbelliferyl chitotetraoside ((GlcNAc)4-MeU) to human lysozyme [EC 3.2.1.17] was studied by fluorescence measurement. Hydrolysis of (GlcNAc)3-MeU and (GlcNAc)4-MeU catalyzed by human lysozyme was studied by measuring the release of 4-methylumbelliferone fluorimetrically and the kinetic constants were determined in the pH range of 2 to 8 at 0.1 ionic strength and 42 degrees C. On the basis of binding and kinetic data, it was shown that (GlcNAc)3-MeU binds mainly to subsites A to D with the terminal MeU group bound to subsite D (nonproductive binding) and that (GlcNAc)4-MeU binds to subsites A to E (productive binding) and subsites A to D with the nonreducing sugar residue extending beyond subsite A (nonproductive binding). The pH dependences of the kinetic constants for hydrolysis of (GlcNAc)3-MeU and (GlcNAc)4-MeU were analyzed assuming that nonproductive binding occurs competitively, that an ionizable group in addition to the catalytic groups (Asp 52 and Glu 35) participates in the catalysis, and that the molecular species with ionized Asp 52 and protonated Glu 35 is active. Analyses of the kinetic constants for (GlcNAc)3-MeU and (GlcNAc)4-MeU both gave the same pK values of the catalytic groups (pK52 = 3.6(3) and pK35 = 6.6(8) at 0.1 ionic strength and 42 degrees C). These pK values were very close to the values determined previously by spectroscopic methods in our laboratory (Kuramitsu et al. (1974) J. Biochem. 76, 671-683; (1978) ibid. 83, 159-170; (1980) ibid. 87, 771-778).

Hydrolysis of 4-methylumbelliferyl N-acetyl-chitotetraoside catalyzed by hen lysozyme

Binding of 4-methylumbelliferyl chitotetraoside ((GlcNAc)4-MeU) to hen lysozyme [EC 3.2.1.17] was studied by measuring changes in fluorescence at 375 nm. Hydrolysis of (GlcNAc)4-MeU catalyzed by lysozyme was studied by measuring the release of 4-methylumbelliferone from (GlcNAc)4-MeU fluorimetrically, and the kinetic constants were determined in the pH range of 2 to 8 at 0.1 ionic strength and 42 degrees C. The binding and kinetic data showed that (GlcNAc)4-MeU binds to subsites A to E (productive binding) and subsites A to D with the nonreducing sugar residue extending beyond subsite A (nonproductive binding). The fraction of the productive complex was 0.77 at pH 8.5. The pH dependence of the kinetic constants was analyzed assuming that the molecular species with ionized Asp 52 and protonated Glu 35 is active and Asp 101 participates in the binding (Phillips (1966) Sci. Am. 215, 78-90; Blake et al. (1967) Proc. Roy. Soc. B167, 378-388), and the pK values of these groups were determined. The pK values of Asp 52, Glu 35, and Asp 101 were 3.60, 6.20, and 4.20, respectively, for free lysozyme, 3.40, 6.55, and 3.40, respectively, for the productive complex, and 3.95, 6.55, and 3.30, respectively, for the nonproductive complex. The pK values for free lysozyme were in excellent agreement with those obtained by analysis of the kinetic constants for (GlcNAc)3-MeU (Yang & Hamaguchi (1980) J. Biochem. 87, 1003-1014). The free energy of activation was 24 kcal mol-1 at pH 5.2. Comparison with the corresponding value obtained for hydrolysis of (GlcNAc)6 (Banerjee et all (1975) J. Biol. Chem. 250, 4355-4367) suggests that the interactions of GlcNAc residues with subsites E and F in the transition state are important in lysozyme catalysis. Hydrolysis of (GlcNAc)2-MeU catalyzed by lysozyme was also studied, and the Kcat/Km values for (GlcNAc)2-MeU, (GlcNAc)3-MeU, and (GlcNAc)4-MeU were compared.