1
|
Brinton EA, Triscari J, Brudi P, Chen E, Johnson-Levonas AO, Sisk CM, Ruck RA, MacLean AA, Maccubbin D, Mitchel YB. Effects of extended-release niacin/laropiprant on correlations between apolipoprotein B, LDL-cholesterol and non-HDL-cholesterol in patients with type 2 diabetes. Lipids Health Dis 2016; 15:116. [PMID: 27405296 PMCID: PMC4942972 DOI: 10.1186/s12944-016-0282-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/23/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) and/or high TG. These levels are lowered by extended-release niacin (ERN), and changes in the ratios of these levels may affect ASCVD risk. This analysis examined the effects of extended-release niacin/laropiprant (ERN/LRPT) on the relationships between apoB:LDL-C and apoB:non-HDL-C in patients with T2DM. METHODS T2DM patients (n = 796) had LDL-C ≥1.55 and <2.97 mmol/L and TG <5.65 mmol/L following a 4-week, lipid-modifying run-in (~78 % taking statins). ApoB:LDL-C and apoB:non-HDL-C correlations were assessed after randomized (4:3), double-blind ERN/LRPT or placebo for 12 weeks. Pearson correlation coefficients between apoB:LDL-C and apoB:non-HDL-C were computed and simple linear regression models were fitted for apoB:LDL-C and apoB:non-HDL-C at baseline and Week 12, and the correlations between measured apoB and measured vs predicted values of LDL-C and non-HDL-C were studied. RESULTS LDL-C and especially non-HDL-C were well correlated with apoB at baseline, and treatment with ERN/LRPT increased these correlations, especially between LDL-C and apoB. Despite the tighter correlations, many patients who achieved non-HDL-C goal, and especially LDL-C goal, remained above apoB goal. There was a trend towards greater increases in these correlations in the higher TG subgroup, non-significant possibly due to the small number of subjects. CONCLUSIONS ERN/LRPT treatment increased association of apoB with LDL-C and non-HDL-C in patients with T2DM. Lowering LDL-C, non-HDL-C and apoB with niacin has the potential to reduce coronary risk in patients with T2DM.
Collapse
Affiliation(s)
- Eliot A Brinton
- Division of Atherometabolic Research, Utah Foundation for Biomedical Research, 420 Chipeta Way, Room 1160, Salt Lake City, UT, 84108, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Bays HE, Brinton EA, Triscari J, Chen E, Maccubbin D, MacLean AA, Gibson KL, Ruck RA, Johnson-Levonas AO, O'Neill EA, Mitchel YB. Extended-release niacin/laropiprant significantly improves lipid levels in type 2 diabetes mellitus irrespective of baseline glycemic control. Vasc Health Risk Manag 2015; 11:165-72. [PMID: 25750540 PMCID: PMC4348131 DOI: 10.2147/vhrm.s70907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The degree of glycemic control in patients with type 2 diabetes mellitus (T2DM) may alter lipid levels and may alter the efficacy of lipid-modifying agents. Objective Evaluate the lipid-modifying efficacy of extended-release niacin/laropiprant (ERN/LRPT) in subgroups of patients with T2DM with better or poorer glycemic control. Methods Post hoc analysis of clinical trial data from patients with T2DM who were randomized 4:3 to double-blind ERN/LRPT or placebo (n=796), examining the lipid-modifying effects of ERN/LRPT in patients with glycosylated hemoglobin or fasting plasma glucose levels above and below median baseline levels. Results At Week 12 of treatment, ERN/LRPT significantly improved low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol, triglycerides, and lipoprotein (a), compared with placebo, with equal efficacy in patients above or below median baseline glycemic control. Compared with placebo, over 36 weeks of treatment more patients treated with ERN/LRPT had worsening of their diabetes and required intensification of antihyperglycemic medication, irrespective of baseline glycemic control. Incidences of other adverse experiences were generally low in all treatment groups. Conclusion The lipid-modifying effects of ERN/LRPT are independent of the degree of baseline glycemic control in patients with T2DM (NCT00485758).
Collapse
Affiliation(s)
- Harold E Bays
- Louisville Metabolic & Atherosclerosis Research Center (L-MARC), Louisville, KY, USA
| | - Eliot A Brinton
- Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
| | | | - Erluo Chen
- Merck & Co, Inc., Whitehouse Station, NJ, USA
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Miller G, MacLean AA, Hiotis K. Surgical images: soft tissue. Necrotizing fasciitis of the abdominal wall. Can J Surg 2008; 51:56. [PMID: 18257161 PMCID: PMC2386313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- George Miller
- Trauma Service, Bellevue Hospital Center, New York, NY, USA
| | | | | |
Collapse
|
4
|
|
5
|
MacLean AA, Katzen BT. Endovascular Aneurysm Repair. Interv Cardiol 2007. [DOI: 10.15420/icr.2007.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Abstract
The endovascular procedure for repair of abdominal aortic aneurysms has had an enormous impact on the treatment of this challenging disease. Complications, however, do occur and it is important to have a thorough understanding of the array of complications and appropriate management strategies. In this review of endovascular complications, we describe early and late complications paying particular attention to preventive, treatment and surveillance strategies.
Collapse
Affiliation(s)
- Barry T Katzen
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, Baptist Health Systems, Miami, Florida, USA.
| | | |
Collapse
|
7
|
Thompson BE, Thompson BT, Munera F, Cohn SM, MacLean AA, Cameron J, Rivas L, Bajayo D. Novel computed tomography scan scoring system predicts the need for intervention after splenic injury. ACTA ACUST UNITED AC 2006; 60:1083-6. [PMID: 16688074 DOI: 10.1097/01.ta.0000218251.67141.ef] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to develop a computed tomography (CT) scan screening test to predict the need for intervention in patients with splenic injury. METHODS CT scans of 20 patients with blunt injury to the spleen were reviewed to identify findings that correlated with the need for intervention (surgery or embolization). A screening test was created and then validated in CT scans from 56 consecutive patients. RESULTS Three findings correlated with the need for intervention: 1) devascularization or laceration involving 50% or more of the splenic parenchyma, 2) contrast blush greater than one centimeter in diameter (from active extravasation of intravenous contrast material or pseudoaneurysm formation), and 3) a large hemoperitoneum. The sensitivity of the screening test was 100%, specificity was 88%, and overall accuracy was 93%. CONCLUSIONS These CT scan grading criteria appears to reliably predict the need for invasive management in patients with blunt injury to the spleen.
Collapse
Affiliation(s)
- Burke E Thompson
- Department of Central Carolina Surgery, Moses Cone Health System, Greensboro, North Carolina, USA
| | | | | | | | | | | | | | | |
Collapse
|
8
|
MacLean AA, Durso A, Cohn SM, Cameron J, Munera F. A clinically relevant liver injury grading system by CT, preliminary report. Emerg Radiol 2005; 12:34-7. [PMID: 16317571 DOI: 10.1007/s10140-005-0441-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 07/26/2005] [Indexed: 11/30/2022]
Abstract
Current computed tomography (CT) grading scales are anatomic and do not reliably identify those liver injuries requiring intervention (surgery or angioembolization). We propose a clinically relevant CT grading system that could predict need for intervention. CT scans of 11 patients with hepatic injury were reviewed to establish criteria that correspond with intervention. Five features were identified that were associated with intervention: laceration in greater than or equal to three segments, laceration extending into the hilum, hemoperitoneum, active extravasation, and sentinel clot. Radiologists then evaluated the predictability of these criteria by analyzing 24 CT scans. Inter-observer agreement of the American Association for the Surgery of Trauma (AAST) grading system was compared to this new system. In the analysis of 24 CT scans, active extravasation and sentinel clot demonstrated the highest specificity for intervention. This new grading system had superior inter-observer agreement (k=0.56) as compared to the AAST grading system (k=0.47). Active extravasation and the presence of sentinel clot should form the foundation of a new liver grading system.
Collapse
Affiliation(s)
- Alexandra A MacLean
- Department of Surgery, Ryder Trauma Center, University of Miami, Miami, FL 33101, USA
| | | | | | | | | |
Collapse
|
9
|
Katzen BT, MacLean AA, Katzman HE. Retrograde migration of an abdominal aortic aneurysm endograft leading to postoperative renal failure. J Vasc Surg 2005; 42:784-7. [PMID: 16242569 DOI: 10.1016/j.jvs.2005.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022]
Abstract
The phenomenon of antegrade (distal) endograft migration is an extensively documented complication after endovascular abdominal aortic aneurysm repair. This case report describes the finding of postoperative abdominal aortic aneurysm endograft retrograde (proximal) migration occluding bilateral renal arteries and leading to dialysis-dependent renal failure.
Collapse
Affiliation(s)
- Barry T Katzen
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, Baptist Health Systems, Miami, Fla, USA.
| | | | | |
Collapse
|
10
|
|
11
|
Katzen BT, Ardid MI, MacLean AA, Kovacs MF, Zemel G, Benenati JF, Powell A, Samuels S. Bivalirudin as an Anticoagulation Agent: Safety and Efficacy in Peripheral Interventions. J Vasc Interv Radiol 2005; 16:1183-7; quiz 1187. [PMID: 16151058 DOI: 10.1097/01.rvi.0000171694.01237.26] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Traditionally, unfractionated heparin is used to prevent thrombotic complications in peripheral interventions. The purpose of this study is to evaluate the use of bivalirudin as the anticoagulant agent for peripheral interventions. MATERIALS AND METHODS A retrospective analysis of 108 patients who underwent 110 peripheral interventions between January 2002 and January 2004 and received bivalirudin as the sole anticoagulation agent was conducted at Baptist Cardiac and Vascular Institute. Interventions were performed in the following areas: iliac, femoropopliteal, and distal (n = 55), carotid (n = 31), vertebral (n = 1), renal (n = 14), aorta (n = 7), and subclavian (n = 2). The following procedural and clinical endpoints were examined: death, requirement of urgent surgery or surgery during the same admission, urgent percutaneous revascularization in the same treated vessel, thrombotic or embolic events, bleeding events, and groin complications. RESULTS A total of 266 lesions were dilated in 185 arteries. There were no procedural mortalities, procedural success was 99.1%, and the complication rate was 3.6%. There was one embolic stroke (0.9%), one thrombosis (0.9%), and two groin hematomas (1.8%). No patient required urgent surgery or reintervention in the same treated vessel. No complications were noted at 7 days after the procedure. There were two interventions by postprocedure day 30: toe amputation and groin debridement. CONCLUSION Bivalirudin is a safe alternative to unfractionated heparin as the anticoagulation agent in peripheral interventions. This study shows that the complication profile is comparable to other bivalirudin studies. Bivalirudin is effective, easy to use, and is associated with few bleeding complications.
Collapse
Affiliation(s)
- Barry T Katzen
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida 33176, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
MacLean AA, Almeida Z, Lopez P. Complications of acute fatty liver of pregnancy treated with activated protein C. Arch Gynecol Obstet 2005; 273:119-21. [PMID: 16091940 DOI: 10.1007/s00404-004-0716-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 11/26/2004] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute fatty liver (AFL) of pregnancy is a difficult and challenging diagnosis. The treatment plan is usually supportive. CASE REPORT We present a case of a patient with AFL of pregnancy and Gram-negative endomyometritis and sepsis. Our treatment plan included the use of activated protein C (APC). CONCLUSION This is the first case report of the use of APC in a post-partum patient with AFL and sepsis.
Collapse
Affiliation(s)
- Alexandra A MacLean
- Division of Trauma and Critical Care, DeWitt Department of Surgery, University of Miami, PO Box 016960 (D-40), Miami, FL 33101, USA
| | | | | |
Collapse
|
13
|
Abstract
Since the original descriptions of endovascular grafts for treatment of aneurysms, a number of devices and approaches have been developed. The following is a discussion summarizing the number of devices which have been developed and used in patients, as well as chosen the directions of this technology. The diversity of approach from an engineering and materials point of view speaks of the fact that opportunity exists for continued development in the future.
Collapse
Affiliation(s)
- Barry T Katzen
- Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA.
| | | |
Collapse
|
14
|
MacLean AA, Miller G, Bamboat ZM, Hiotis K. Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series. Am Surg 2004; 70:827-31. [PMID: 15481304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.
Collapse
Affiliation(s)
- Alexandra A MacLean
- Trauma Service, Bellevue Hospital Center, New York University School of Medicine, New York, New York, USA
| | | | | | | |
Collapse
|
15
|
Fischer S, De Perrot M, Liu M, MacLean AA, Cardella JA, Imai Y, Suga M, Keshavjee S. Interleukin 10 gene transfection of donor lungs ameliorates posttransplant cell death by a switch from cellular necrosis to apoptosis. J Thorac Cardiovasc Surg 2003; 126:1174-80. [PMID: 14566265 DOI: 10.1016/s0022-5223(03)00114-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We have previously shown that cell death is a pathophysiologic consequence of ischemia-reperfusion and that interleukin-10 gene therapy improves the function of transplanted lungs. Interleukin-10 downregulates the inflammatory response and can inhibit apoptosis. The objective was to determine whether donor lung transfection with the interleukin-10 gene ameliorates lung dysfunction by decreasing cell death after transplantation. METHODS Single lung transplants were performed in 3 groups of rats (n = 5 each): AdhIL-10, transtracheal administration of Ad5E1RSVhIL-10 (5 x 10(9) pfu); EV, empty vector; and VD, vector diluent (3% sucrose). After in vivo transfection, donor lungs were excised, stored at 4 degrees C for 24 hours, and then transplanted. After 2 hours of reperfusion, lungs were flushed with trypan blue and fixed. TUNEL staining was used for the detection of apoptosis. This combined staining technique allows one to determine the mode of cell death by distinguishing apoptotic dead cells from necrotic dead cells. RESULTS Lung function was superior in the interleukin-10 group (P =.0001) vs the EV and VD group (Pao(2): 240 +/- 31 mm Hg vs 98 +/- 17 mm Hg vs 129 +/- 11 mm Hg, respectively). Although the total number of dead cells (as percent of total cells) was similar in all groups (32.7% +/- 3.2%, 30.2% +/- 2.5%, and 30.3% +/- 3.8%), interestingly, apoptosis was highest in interleukin-10 lungs (9.7 +/- 1.9 vs 2 +/- 1.9 and 1.8 +/- 2, P =.0001), and necrosis was lowest in the interleukin-10 group (20.6 +/- 5.7 vs 28.3 +/- 3.1 and 30.3 +/- 4.2, P =.01). CONCLUSIONS AdhIL-10 gene transfection improves function of transplanted lungs. Although the total number of cells dying as a result of the transplant process did not change, the mode of cell death appears to have been modified. It is possible that AdhIL-10, by decreasing proinflammatory cytokine production, ameliorates the overall injury and preserves the ability of damaged cells to undergo a more quiescent and less tissue-damaging mode of cell death-apoptosis, rather than necrosis.
Collapse
Affiliation(s)
- Stefan Fischer
- Thoracic Surgery Research Laboratory, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Fischer S, Liu M, MacLean AA, de Perrot M, Ho M, Cardella JA, Zhang XM, Bai XH, Suga M, Imai Y, Keshavjee S. In vivo transtracheal adenovirus-mediated transfer of human interleukin-10 gene to donor lungs ameliorates ischemia-reperfusion injury and improves early posttransplant graft function in the rat. Hum Gene Ther 2001; 12:1513-26. [PMID: 11506694 DOI: 10.1089/10430340152480249] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the effect of adenovirus-mediated transtracheal transfer of the human interleukin 10 (hIL-10) gene on lung ischemia-reperfusion (IR) injury, which is the insult due to hypothermic preservation plus graft reperfusion, and posttransplant lung function in Lewis rat lungs. Thirty rats were divided into 6 groups (n = 5). Groups 1 and 4 received 5 x 10(9) PFU of Ad5E1RSVhIL-10, groups 2 and 5 received 5 x 10(9) PFU of Ad5BGL2 ("empty" vector), and groups 3 and 6 received 3% sucrose (diluent). After 24 hr of in vivo transfection, lungs were stored at 4 degrees C (cold ischemic time, CIT) for 6 hr (groups 1-3) or 24 hr (groups 4-6) before transplantation. After 2 hr of reperfusion, lung function was assessed by oxygenation (FIO2, 1.0), airway pressure (AwP), and wet-to-dry (W/D) weight ratios. Rat tumor necrosis factor alpha (rTNF-alpha), interferon gamma (IFN-gamma), IL-10, and hIL-10 were measured in graft tissue and recipient plasma by ELISA and detected by immunohistochemistry (IHC). Partial pressure of oxygen (PaO2) levels in the hIL-10 group (6 hr of CIT) were higher than in empty vector and diluent groups (PaO2, 530 +/- 23 vs. 387 +/- 31 and 439 +/- 27 mmHg, respectively, p < 0.05). IL-10 rats after 24 hr of CIT showed higher PaO2 levels (260 +/- 29 mmHg) than empty vector (96 +/- 24 mmHg) or diluent (133 +/- 10 mmHg) lungs (p < 0.05). AwP and W/D ratios were reduced in hIL10 lungs (p < 0.05) compared with the other groups. rTNF-alpha and INF-gamma were reduced in tissue and plasma in groups 1 and 4 (p < 0.05). rIL-10 was reduced in the tissue of hIL-10 lungs (p < 0.05). IHC showed equal distribution of cytokines in tissue and abundant transgene expression in large and small airway epithelium in hIL-10 lungs.
Collapse
Affiliation(s)
- S Fischer
- Thoracic Surgery Research Laboratory, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada M5G 2C4
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Fischer S, Hopkinson D, Liu M, MacLean AA, Edwards V, Cutz E, Keshavjee S. Raffinose improves 24-hour lung preservation in low potassium dextran glucose solution: a histologic and ultrastructural analysis. Ann Thorac Surg 2001; 71:1140-5. [PMID: 11308150 DOI: 10.1016/s0003-4975(01)02426-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We have previously shown that the addition of raffinose to low potassium dextran (LPD) preservation solution improves transplanted rat lung function after 24 hours of storage. The mechanisms by which raffinose acts are unclear. The aim of this study was to examine the histologic and ultrastructural correlates of this enhanced pulmonary function after preservation with raffinose. METHODS In a randomized, blinded study, rat lungs were flushed with LPD, or LPD containing 30 mmol/L of raffinose, and stored for 24 hours at 4 degrees C. Control lungs were flushed with LPD but not stored (n = 5 each group). Changes in postpreservation edema were determined. In addition, lungs were flushed with a trypan blue solution to quantify cell death, and examined using both light and electron microscopy. RESULTS The LPD lungs gained significantly more weight (25.5%+/-5.5%) compared with raffinose-LPD lungs (5.2%+/-5.3%; p < 0.0001). There were higher percentages of dead cells in the LPD lungs (29%+/-0.3% of total cells) compared with raffinose-LPD lungs (14%+/-1.4%; p < 0.001) and control lungs (0.2%+/-5%; p < 0.001). Control lungs maintained normal ultrastructure, whereas LPD lungs showed a decreased number of intact type II pneumocytes and significant cellular necrosis. Interstitial and alveolar edema with interstitial macrophage infiltration was also observed. Alveolar capillaries were collapsed. In contrast, raffinose-LPD lungs showed only mild alterations such as minimal interstitial edematous expansion, fewer damaged cells, and minimal capillary injury. CONCLUSIONS Raffinose exerts a cytoprotective effect on pulmonary grafts during preservation, which explains the previously documented improved function. This simple modification of LPD with raffinose may provide clinical benefit in extended pulmonary preservation.
Collapse
Affiliation(s)
- S Fischer
- Department of Pathology, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
18
|
Fischer S, Troidl H, MacLean AA, Koehler L, Paul A. Prospective double-blind randomised study of a new regimen of pre-emptive analgesia for inguinal hernia repair: evaluation of postoperative pain course. Eur J Surg 2000; 166:545-51. [PMID: 10965833 DOI: 10.1080/110241500750008619] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a new regimen of pre-emptive analgesia on the development of postoperative pain after inguinal hernia repair. DESIGN Prospective, double-blind, randomised study. SETTING University Hospital, Germany. SUBJECTS 70 consecutive patients who had primary unilateral inguinal hernia repairs. INTERVENTIONS A new regimen of pre-emptive analgesia with bupivacaine that was infiltrated preoperatively, intraoperatively, and postoperatively was tested. The control group were given saline infiltrations at the same times. Pain was measured up to postoperative day 30 using the visual analogue scale (VAS), the verbal rating scale (VRS), and by recording patient-controlled use of ibuprofen suppositories. RESULTS Pain was significantly less in the pre-emptive analgesia group than in the control group during the first 10 days postoperatively as assessed by VAS and VRS (p < 0.05). Analgesic consumption was also significantly reduced in the pre-emptive analgesia group (p < 0.05). Multivariate analysis showed that bupivacaine infiltration (pre-emptive analgesia) was associated with significantly less postoperative pain (p < 0.0001). CONCLUSION This regimen of pre-emptive analgesia is an effective and safe method of reducing postoperative pain and analgesic consumption after inguinal hernia repair.
Collapse
Affiliation(s)
- S Fischer
- Second Department of Surgery, University of Cologne, Germany
| | | | | | | | | |
Collapse
|
19
|
Fulton IC, MacLean AA, O'Rielly JL, Church S. Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in thoroughbred and standardbred horses. Aust Vet J 1994; 71:233-5. [PMID: 7986183 DOI: 10.1111/j.1751-0813.1994.tb03417.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Bilateral superior check ligament desmotomy was performed on 31 Thoroughbred and 17 Standardbred horses as the sole method of treatment for superficial digital flexor tendonitis. Horses resumed racing between 6 and 19 months after surgery. Horses that were able to compete in 5 or more races without injury to the tendon again were considered to have had a successful return to racing. Twenty-five Thoroughbreds were suitable for later study and 13 of these (52%) raced on 5 or more occasions. Fifteen Standardbreds were suitable for later study and 10 of these (66%) raced on 5 or more occasions. Within the racing industry it is generally thought that about 20 to 30% of horses with superficial digital flexor tendonitis can return to racing after a prolonged rest. The results of this study suggest that bilateral superior check ligament desmotomy may improve the prognosis for a horse returning to racing after injury to the superficial digital flexor tendon.
Collapse
|
20
|
Affiliation(s)
- R F Slocombe
- Veterinary Clinical Centre, University of Melbourne, Princes Highway, Werribee, Victoria, Australia
| | | | | |
Collapse
|
21
|
Hyland JH, MacLean AA, Robertson-Smith GR, Jeffcott LB, Stewart GA. Attempted conversion of twin to singleton pregnancy in two mares with associated changes in plasma oestrone sulphate concentrations. Aust Vet J 1985; 62:406-9. [PMID: 3008692 DOI: 10.1111/j.1751-0813.1985.tb14121.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The removal of one of twin embryos was attempted by infusion of 24% (w/v) saline into the gestation sac in 2 mares by laparotomy. The treatment was successful in one mare (Case 1) and the untreated embryo remained viable. However, neither foetus survived in the second mare (Case 2). Plasma oestrone sulphate (E1S) concentrations fell immediately after treatment in both mares but recovered to approximately 50% of pretreatment levels in Case 1. In Case 2 plasma E1S concentrations declined steadily and were less than 1 ng/ml within 6 days of treatment. These preliminary results suggest that the method may be useful for selective removal of one of twin embryos in mares. Furthermore, plasma E1S concentrations may be a useful indicator of embryonic viability.
Collapse
|
22
|
Abstract
The upper respiratory tract of a pony mare with marked exercise intolerance and respiratory stridor was examined with a flexible fibreoptoscope. Both arytenoids were adducted and distorted. A diagnosis of bilateral chondritis of the arytenoids was made and confirmed at autopsy after surgery to enlarge the rima glottidis was unsuccessful. Other space occupying lesions of the rima glottidis are discussed and theories on the aetiology are postulated.
Collapse
|