Gasous hole closing in a polymer Langmuir monolayer

The hole-closing phenomenon is studied in a polymer Langmuir film with coexisting gaseous and liquid phases both as a test of hydrodynamic theories of a two-dimensional fluid embedded in a three-dimensional one and as a means to accurately determine line tension, an important parameter determining size, shape, and dynamics within these and other membrane model systems. The hole-closing curve consists of both a universal linear regime and a history-dependent nonlinear one. Improved experimental technique allows us to explore the origin of the nonlinear regime. The linear regime confirms previous theoretical work and yields a value lambda = (0.69 +/- 0.02) pN for the line tension of the boundary between the gaseous and liquid phases. The observed hole closing also demonstrates that the two-dimensional polymer gas must be taken as having a small, probably negligible elasticity, so that line-tension measurements assuming that both phases are incompressible should be re-evaluated.

Triglyceride synthesis in epididymal adipose tissue: contribution of glucose and non-glucose carbon sources

The obesity epidemic has generated interest in determining the contribution of various pathways to triglyceride synthesis, including an elucidation of the origin of triglyceride fatty acids and triglyceride glycerol. We hypothesized that a dietary intervention would demonstrate the importance of using glucose versus non-glucose carbon sources to synthesize triglycerides in white adipose tissue. C57BL/6J mice were fed either a low fat, high carbohydrate (HC) diet or a high fat, carbohydrate-free (CF) diet and maintained on 2H2O (to determine total triglyceride dynamics) or infused with [6,6-(2)H]glucose (to quantify the contribution of glucose to triglyceride glycerol). The 2H2O labeling data demonstrate that although de novo lipogenesis contributed approximately 80% versus approximately 5% to the pool of triglyceride palmitate in HC- versus CF-fed mice, the epididymal adipose tissue synthesized approximately 1.5-fold more triglyceride in CF- versus HC-fed mice, i.e. 37+/-5 versus 25+/-3 micromolxday(-1). The [6,6-(2)H]glucose labeling data demonstrate that approximately 69 and approximately 28% of triglyceride glycerol is synthesized from glucose in HC- versus CF-fed mice, respectively. Although these data are consistent with the notion that non-glucose carbon sources (e.g. glyceroneogenesis) can make substantial contributions to the synthesis of triglyceride glycerol (i.e. the absolute synthesis of triglyceride glycerol from non-glucose substrates increased from approximately 8 to approximately 26 micromolxday(-1) in HC- versus CF-fed mice), these observations suggest (i) the importance of nutritional status in affecting flux rates and (ii) the operation of a glycerol-glucose cycle.

Chronic ethanol and triglyceride turnover in white adipose tissue in rats: inhibition of the anti-lipolytic action of insulin after chronic ethanol contributes to increased triglyceride degradation

Chronic ethanol consumption disrupts whole-body lipid metabolism. Here we tested the hypothesis that regulation of triglyceride homeostasis in adipose tissue is vulnerable to long-term ethanol exposure. After chronic ethanol feeding, total body fat content as well as the quantity of epididymal adipose tissue of male Wistar rats was decreased compared with pair-fed controls. Integrated rates of in vivo triglyceride turnover in epididymal adipose tissue were measured using (2)H(2)O as a tracer. Triglyceride turnover in adipose tissue was increased due to a 2.3-fold increase in triglyceride degradation in ethanol-fed rats compared with pair-fed controls with no effect of ethanol on triglyceride synthesis. Because increased lipolysis accompanied by the release of free fatty acids into the circulation is associated with insulin resistance and liver injury, we focused on determining the mechanisms for increased lipolysis in adipose tissue after chronic ethanol feeding. Chronic ethanol feeding suppressed beta-adrenergic receptor-stimulated lipolysis in both in vivo and ex vivo assays; thus, enhanced triglyceride degradation during ethanol feeding was not due to increased beta-adrenergic-mediated lipolysis. Instead, chronic ethanol feeding markedly impaired insulin-mediated suppression of lipolysis in conscious rats during a hyperinsulinemic-euglycemic clamp as well as in adipocytes isolated from epididymal and subcutaneous adipose tissue. These data demonstrate for the first time that chronic ethanol feeding increased the rate of triglyceride degradation in adipose tissue. Furthermore, this enhanced rate of lipolysis was due to a suppression of the anti-lipolytic effects of insulin in adipocytes after chronic ethanol feeding.

Determination of interphase line tension in Langmuir films

A Langmuir film is a molecularly thin film on the surface of a fluid; we study the evolution of a Langmuir film with two coexisting fluid phases driven by an interphase line tension and damped by the viscous drag of the underlying subfluid. Experimentally, we study a 4{'} -8-alkyl[1, 1{'} -biphenyl]-4-carbonitrile (8CB) Langmuir film via digitally imaged Brewster angle microscopy in a four-roll mill setup which applies a transient strain and images the response. When a compact domain is stretched by the imposed strain, it first assumes a bola shape with two tear-drop shaped reservoirs connected by a thin tether which then slowly relaxes to a circular domain which minimizes the interfacial energy of the system. We process the digital images of the experiment to extract the domain shapes. We then use one of these shapes as an initial condition for the numerical solution of a boundary-integral model of the underlying hydrodynamics and compare the subsequent images of the experiment to the numerical simulation. The numerical evolutions first verify that our hydrodynamical model can reproduce the observed dynamics. They also allow us to deduce the magnitude of the line tension in the system, often to within 1%. We find line tensions in the range of 200-600pN; we hypothesize that this variation is due to differences in the layer depths of the 8CB fluid phases.

Novel application of the "doubly labeled" water method: measuring CO2 production and the tissue-specific dynamics of lipid and protein in vivo

The partitioning of whole body carbon flux between fat and lean compartments affects body composition. We hypothesized that it is possible to simultaneously determine whole body carbon (energy) balance and the dynamics of lipids and proteins in specific tissues in vivo. Growing C57BL/6J mice fed a high-fat low-carbohydrate diet were injected with a bolus of "doubly labeled" water (i.e., (2)H2O and H2(18)O). The rate of CO2 production was determined from the difference between the elimination rates of 2H and 18O from body water. The rates of synthesis and degradation of triglycerides extracted from epididymal fat pads and of proteins extracted from heart muscle were determined by mathematically modeling the 2H labeling of triglyceride-bound glycerol and protein-bound alanine, respectively. We found that mice were in positive carbon balance (approximately 20% retention per day) and accumulated lipid in epididymal fat pads (approximately 9 micromol triglyceride accumulated per day). This is consistent with the fact that mice were studied during a period of growth. Modeling the 2H labeling of triglycerides revealed a substantial rate of lipid breakdown during this anabolic state (equivalent to approximately 25% of the newly synthesized triglyceride). We found equal rates of protein synthesis and breakdown in heart muscle (approximately 10% of the pool per day), consistent with the fact that the heart muscle mass did not change. In total, these findings demonstrate a novel application of the doubly labeled water method. Utilization of this approach, especially in unique rodent models, should facilitate studies aimed at quantifying the efficacy of interventions that modulate whole body carbon balance and lipid flux while in parallel determining their impact on (cardiac) muscle protein turnover. Last, the simplicity of administering doubly labeled water and collecting samples allows this method to be used in virtually any laboratory setting.

Quantifying rates of protein synthesis in humans by use of 2H2O: application to patients with end-stage renal disease

A method is introduced for quantitating protein synthetic rates in humans by use of (2)H(2)O. Its validity was tested in subjects with end-stage renal disease. Six clinically stable subjects, hemodialyzed three times weekly, ingested (2)H(2)O to a body water (2)H enrichment of approximately 0.4%. On dialysis, body water enrichment declined to approximately 0.1%. Enrichment of the alpha-hydrogen of plasma free alanine was also approximately 0.4% before and approximately 0.1% after dialysis. Beta-hydrogen enrichment was approximately 80-100% of alpha-hydrogen enrichment. (2)H(2)O was ingested to replace (2)H(2)O removed after each dialysis for 15-51 days, returning enrichment to approximately 0.4%. Enrichment of alanine from plasma albumin gradually increased, with again approximately 80-100% as much (2)H in beta- as in alpha-hydrogens. With continued dialyses, without (2)H(2)O replacement, alanine from albumin enrichment gradually declined, whereas free alanine and water enrichments were negligible. The fractional albumin synthesis rate, calculated from the increase in enrichment in alanine from albumin, was 4.0 +/- 0.5%/day, and from the decrease, 4.6 +/- 0.2%/day. Thus body water enrichment in a subject given (2)H(2)O can be maintained constant long term. A rapid exchange, essentially complete, occurs between the hydrogens of alanine and body water. An integrated measure over a long period of albumin's synthetic rate can be estimated from both the rise in enrichment of alanine from the protein during (2)H(2)O ingestion and fall on (2)H(2)O withdrawal, while the subject's living routine is uninterrupted. Estimates are in subjects with renal disease, but the method should be applicable to estimates of protein synthetic rates in normal subjects and in other pathological states.

Influence of diet on the modeling of adipose tissue triglycerides during growth

We have studied the accretion of lipids in growing mice. We measured the rates of synthesis and degradation of triglycerides in epididymal fat pads of mice maintained for 44 days on a low-fat, high-carbohydrate diet (I) or a high-fat, low-carbohydrate diet (II). 2H2O was added to the drinking water for 14 days. Rates of incorporation/washout of 2H to/from C1 of triglyceride-glycerol showed that triglyceride synthesis was greater than triglyceride degradation (net triglyceride balance was approximately 2.5 times greater in II than in I). The data also show that the contribution of de novo lipogenesis to triglyceride-bound palmitate was approximately 3 times greater in I than in II. This was consistent with a greater relative intake of carbohydrate in I vs. II. The rates of incorporation and washout of newly synthesized (2H-labeled) palmitate into and from triglycerides were also measured. Those data suggested a remodeling of triglyceride-bound fatty acids. On measuring the profile of triglyceride-bound fatty acids, we observed a decrease in the relative abundance of triglyceride-bound palmitate and stearate and an increase in triglyceride-bound oleate and linoleate. This was observed in I and II. In summary, diet substantially affects the deposition and modeling of triglycerides in adipose tissue during growth. 2H2O can be used to examine the mechanisms responsible for the accumulation of triglycerides, e.g., factors that affect 1) triglyceride synthesis and degradation and 2) the source of fatty acids that are used in esterification.

Oral glycoprotein IIb/IIIa inhibition with orbofiban in patients with unstable coronary syndromes (OPUS-TIMI 16) trial

BACKGROUND

Although intravenous glycoprotein IIb/IIIa inhibitors are beneficial in patients with acute coronary syndromes, prolonged oral IIb/IIIa inhibition might provide an additional reduction in recurrent events.

METHODS AND RESULTS

Investigators at 888 hospitals in 29 countries enrolled 10 288 patients with acute coronary syndromes, which was defined as ischemic pain at rest within 72 hours of randomization, associated with positive cardiac markers, electrocardiographic changes, or prior cardiovascular disease. Patients received aspirin and were randomized to receive, for the duration of the trial, (1) 50 mg of orbofiban twice daily (50/50 group), (2) 50 mg of orbofiban twice daily for 30 days followed by 30 mg of orbofiban twice daily (50/30 group), or (3) a placebo. The primary composite end point was death, myocardial infarction, recurrent ischemia requiring rehospitalization, urgent revascularization, or stroke. The trial was terminated prematurely because of an unexpected increase in 30-day mortality in the 50/30 orbofiban group. Mortality through 10 months was 3.7% for the placebo group versus 5.1% in the 50/30 group (P=0.008) and 4.5% in the 50/50 group (P=0.11). There were no differences in the primary end point (22.9%, 23.1%, and 22.8%, for the placebo, 50/30, and 50/50 groups, respectively). Major or severe bleeding (but not intracranial hemorrhage) was higher with orbofiban; it occurred in 2. 0%, 3.7% (P=0.0004), and 4.5% (P<0.0001) of patients, respectively. Exploratory subgroup analyses found that patients who underwent percutaneous coronary intervention had a lower mortality and a significant reduction in the composite end point (P=0.001) with orbofiban.

CONCLUSIONS

-Fixed-dose orbofiban failed to reduce major cardiovascular events and was associated with increased mortality in this broad population of patients with acute coronary syndromes; however, a benefit was observed among patients who underwent percutaneous coronary intervention.

Method for creation of the aortotomy site for saphenous vein grafts

Saphenous vein coronary artery bypass grafting requires a proximal anastomosis of the vein to the aorta. A variety of techniques have been described to create the aortotomy. We have developed a four-sided knife (Xcision Scalpel; patent pending, Research Medical, Inc, Midvale, UT) that facilitates the creation of a more uniform circular aortotomy. The purpose of this communication is to describe the knife and the technique for its use.

False aneurysm of the right internal mammary artery. Late rupture after sternotomy

This report describes a late, near-fatal rupture of a false aneurysm of the right internal mammary artery subsequent to coronary artery bypass grafting. The patient presented to us in shock due to hemorrhaging, 8 weeks after bypass surgery that had been complicated by sternal fracture, dehiscence, and infection. Emergent thoracotomy and suture ligation controlled the hemorrhage. To the best of our knowledge, this is the 1st reported case of late massive hemorrhage caused by injury to an internal mammary artery after sternotomy. The literature is reviewed and discussed.

Hemodynamic stabilization of acute prosthetic valve thrombosis using percutaneous catheter manipulation

Thrombosis of a tilting-disk prosthetic heart valve can be an acute and potentially life-threatening problem. Surgical thrombectomy, valve replacement, or systemic thrombolytic agents have been successfully employed in the management of such cases. Some patients, however, may not survive the acute episode long enough to receive definitive surgical therapy. For such patients, temporary hemodynamic stabilization might be achieved by re-establishing partial valve disk mobility. This report describes a technique for re-establishing valve disk mobility in an acutely compromised patient by using a percutaneously introduced "rigid" catheter to manipulate an entrapped tilting-disk valve in the aortic position.

Modulation of alloreactivity in transplant recipients by phenotypic manipulation of donor endothelium

Phenotypic manipulation of allograft endothelium to reduce immunogenicity would have a significant impact on transplantation. In this study we have demonstrated that random seeding of a heart allograft with endothelium, of host origin, not only promotes long-term survival, but reduces the requirement for pharmacologic immunosuppression. We propose that this simple technology could easily be extrapolated to the clinical arena where hypothermia and preservation solutions have allowed allografts to remain ex vivo for extended periods.

The relationship between hospital charges and a modified Parsonnet risk score

Health care now consumes approximately 14 percent of the U.S. Gross National Product (GNP). The amount of money spent on health care in America per capita and as a percentage of GNP far exceeds that of any other industrialized country. Currently, the financial burden of health care is being shouldered by government and business. The expenditure of billions of dollars of corporate profits on health care progressively undermines the global competitiveness of American business. These economic realities have emerged as the dominant driving force in health care reform. Cost control efforts to date have focused on strategies to limit inpatient hospital expenditures. The DRG prospective payment system is designed to reimburse a fixed sum based on the diagnostic category of the patient. The DRG payment is essentially independent of underlying patient characteristics that can potentially drive up expenditures. The work reported in this article was done to develop a descriptive formula that could be used to predict resource consumption in the care of patients. The financial viability of a hospital depends on its ability to predict expenditures, allocate resources, and choose its service areas correctly. Errors in financial forecasting in the era of prospective payment will result in financial failures of entire institutions.

The haemostatic effectiveness of autologous platelet rich plasma sequestered after heparin administration and institution of cardiopulmonary bypass

Preoperative harvesting and postoperative reinfusion of autologous platelet rich plasma (PRP) has been reported to decrease blood loss as well as the requirement for homologous blood transfusion following cardiopulmonary bypass (CPB). We have developed a technique of intraoperative PRP sequestration which occurs during the initial period of CPB after the patient's circulation is supported and heparin has been given (PRP+). This process does not require any additional hardware, personnel or expense and it is performed without difficulty or complication. To evaluate the effect of PRP+ sequestration and reinfusion on blood loss and homologous blood requirement after CPB, we randomly assigned 126 consecutive patients undergoing elective open heart surgery into the experimental group 1 (PRP+) (n = 64) or the control (no platelet pheresis) group 2 (n = 52). A third group (n = 10) were not included in the randomization. Patients in group 3 had PRP prepared by conventional techniques (PRPc) prior to heparin administration and given to the patient after protamine infusion. Aggregation and activation studies were performed on the PRP+, PRPc, and blood bank platelets (BBP). Per cent aggregation of PRP in response to ADP was superior to that of BBP. There were no significant differences in ADP induced aggregation between PRP+ and PEPc. There was no significant difference in platelet activation (CD62) or number between the three groups. Patients infused with PRP+ showed significantly increased aggregation to ADP when compared with untreated patients 120 minutes after return to the ICW. Furthermore, more homologous haemostatic components (platelets/fresh frozen plasma) were required in the control group. We have demonstrated that collection of autologous PRP+ after administration of heparin does not interfere with its haemostatic effectiveness compared with PRPc prepared before the initiation of bypass. Moreover, this can be performed universally in haemodynamically unstable patients without any additional costs.

Cardiopulmonary bypass with adequate flow and perfusion pressures prevents endotoxaemia and pathologic cytokine production

Endotoxin and cytokine inflammatory mediators comprise the afferent and efferent limbs of the 'acute phase response'. During cardiopulmonary bypass (CPB) there may be gut translocation of endotoxin and contact activation of lymphocytes. It has been hypothesized that the haemodynamic instability encountered following CPB is caused by the 'acute phase response'. In this study we attempted to quantify the acute phase response in patients undergoing open-heart surgery and determine the influence of these cytokines on perioperative morbidity. Four perioperative blood samples were drawn from 20 consecutive patients undergoing coronary artery bypass grafting (CABG). These samples were assayed for endotoxin and four cytokines. In all cases the cardiac index was maintained > 2.4 l/min/m2 during nonpulsatile normothermic bypass (37 degrees C) and > 1.8 l/min/m2 during nonpulsatile hypothermic bypass (28 degrees C), and the perfusion pressure > 60 mmHg. Endotoxin was not detected in any of the test samples despite positive nonpatient controls. Interleukin 6 (IL-6) and tumour necrosis factor (TNF) were not detected despite an assay sensitivity of 80 and 10 pg/ml, respectively. TNF was detectable with an assay sensitivity of 0.5 pg/ml although there were no significant differences within the group. Interleukin 1 (IL-1) was detected (range = 0.98 - 9.09 ng/ml) in patients and again there were no trends within the group. The platelet activating factor (PAF) values peaked at crossclamp release (1.3 ng/ml versus a baseline of 0.2 ng/ml); however, there was no significant difference within the study.

Management of massive pulmonary thromboembolism complicating diabetic ketoacidosis

Intravascular volume depletion secondary to diabetic ketoacidosis may result in thrombosis of major blood vessels. Without anticoagulation these thrombi can embolize to the lungs and compromise cardiopulmonary function. When this occurs early surgical pulmonary embolectomy is indicated to salvage a failing right heart.

Intraoperative procurement of autologous fibrin glue

A method of intraoperative procurement of autologous fibrin glue is described. The relative efficacy of our autologous preparation is compared with that of fibrin glue made with homologous cryoprecipitate. Experimentally, the fibrinogen content and the strength are less than those found in cryoprecipitate and appear related to the fibrinogen content of the autologous plasma used as substrate in the fibrin glue reaction. Clinically, no significant differences are noted in the performance of autologous fibrin glue. We believe the absence of the risk of blood-borne infection with the autologous product is a major advantage.

On the dynamics of bursting systems

The dynamics of three-variable models of bursting are studied. It is shown that under certain conditions, the dynamics on the attractor can be essentially reduced to two dimensions. The salient dynamics on the attractor can thus be completely described by the return map of a section which is a logistic interval map. Two specific bursting models from the literature are shown to fit in the general framework which is developed. Bifurcation of the full system for one case in investigated and the dynamical behavior on the attractor is shown to depend on the position of a certain nullcline.

Right lower lobectomy for pulmonary infarction before orthotopic heart transplantation

A 39-year-old potential heart transplant recipient had a right lower lobe infiltrate and on pulmonary angiography was found to have an embolous to the common basilar artery. This was successfully managed by a right lower lobectomy, after aggressive medical management failed. The patient was treated postoperatively with antibiotics and subsequently underwent orthotopic heart transplantation. At 1 year after transplant the patient has no evidence of cardiac or pulmonary insufficiency.

Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients

We simultaneously evaluated platelet and fibrinolytic parameters to assess their individual and combined contributions to postoperative blood loss in cardiopulmonary (CP) bypass patients. Platelet count, platelet aggregability, hematocrit, plasminogen (PLG) concentration, alpha 2-antiplasmin (AP) concentration, free protease activity (fPA), and antithrombin-III (AT-III) were measured in nine patients undergoing surgery using cardiopulmonary bypass. Chest tube drainage was used as the measure of postoperative blood loss. Hematocrit, platelet count, PLG, AP, and AT-III all decreased during CP bypass, with PLG and AT-III decreasing much more than dilution. During CP bypass, platelet aggregability to ADP did not change significantly from pre-bypass, but aggregability to arachidonic acid (AA) decreased significantly. Following protamine administration there was a large increase (83%) in fPA, the platelet count showed a further drop (from 61% to 50% of pre-bypass levels), and platelet aggregability decreased significantly (from 95% to 34% of pre-bypass levels for ADP, and from 55% to 11.9% for AA). Chest tube drainage during the first four postoperative hours correlated positively (p less than 0.05) with the combination of increase in free protease activity and decrease in platelet count. The total chest tube drainage correlated significantly with the combination of decrease in platelet count and the decrease in platelet aggregability. These combinations of changes correlated significantly with postoperative blood loss whereas the individual changes did not.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological observations from feeding heated corn oil and heated peanut oil to rats

Five groups of male weanling rats were provided purified diets containing 15% by weight of either fresh or laboratory-heated corn oil (FCO, HCO) or fresh, laboratory-heated, or commercial pressure deep-fry peanut oil (FPO, HPO, PPO). Total weight gain, feed consumption, and feed efficiency were consistently greater for the FCO, FPO, and PPO groups. Although relative heart weights were unaffected, the HCO and HPO produced elevated liver and kidney weights. The dietary fats had no effect on the hematological status of the animals or the proportions of cells comprising the total leukocytes of the blood. Physical, chemical, and microscopic evaluation of the urine detected no pathologic conditions. Rats fed diets containing HCO or HPO demonstrated toxicity of thermally oxidized fats by the appearance of diarrhea, dermatitis, seborrhea, and hair loss. Histological examinations revealed injury of the thymus by all fat samples except the FCO; the liver was damaged by the HCO, HPO, and PPO, and the testes and epididymides by HPO and PPO. In the latter case there was complete cessation of spermatogenesis.

Calcium-accentuated ischemic damage during reperfusion: the time course of the reperfusion injury in the isolated working rat heart model

The purpose of this study was to determine the time course of calcium-induced postischemic reperfusion injury to the myocardium, using an initial short-term calcium-enriched reperfusion solution. The isolated rat heart model was subjected to 30 min of normothermic potassium cardioplegia-induced ischemic arrest. Control hearts received normal calcium Krebs-Henseliet buffer (KHB) reperfusion. Experimental hearts were challenged with 10 min of calcium-enriched (KHB) reperfusion starting at 0, 1, 2, 5, 15, and 30 min after the beginning of reperfusion. Aortic flow recovery 60 min after reperfusion was used to determine functional recovery. Control hearts recovered 82 +/- 3% of preischemic aortic flow. Hearts which received calcium challenge at 0 and 1 min after the start of reperfusion recovered 43 +/- 4 and 69 +/- 3% of preischemic aortic flow, respectively (P less than 0.01 and P less than 0.05, respectively). Hearts which received calcium challenge 2, 5, 15, and 30 min after reperfusion recovered 75 +/- 2, 80 +/- 2, 85 +/- 2, and 83 +/- 2% of preischemic aortic flow, respectively. Our results indicate that the postischemic myocardium is very susceptible to calcium-accentuated ischemic damage during the initial period of reperfusion. The postischemic heart, however, quickly recovers its ability to withstand a calcium challenge. Five minutes after the start of reperfusion the heart is not influenced by calcium challenge.

Spontaneous oscillations in two 2-component cells coupled by diffusion

Mathematical examples are presented of oscillators with two variables which do not oscillate in isolation, but which do oscillate stably when coupled with a twin via diffusion. Two examples are presented, the Lefever-Prigogine Brusselator and a system used to model glycolytic oscillations. The mathematical method is not the usual bifurcation theory, but rather a type of singular perturbation theory combined with bifurcation theory. For both examples, it is shown that all stationary solutions are unstable for appropriate parameter settings. In the case of the Brusselator, it is further shown that there exist limit cycles; i.e. stable oscillations, in this parameter range. A numerical example is presented.

Terminal magnesium cardioplegia: protective effect in the isolated rat heart model using calcium accentuated ischemic damage

We have developed a modified isolated working rat heart model to study the effect of potassium and magnesium cardioplegia given just prior to reperfusion, "terminal cardioplegia," on preservation of aortic flow following a standard ischemic insult. The model incorporates a short-term calcium challenge at the beginning of reperfusion to accentuate ischemic injury. All hearts were given initial potassium cardioplegia and subjected to 30 min of normothermic ischemia. Terminal cardioplegia was given for the 2 min prior to reperfusion. Calcium-challenged hearts were reperfused initially with calcium-enriched reperfusate and then switched to standard reperfusate. Aortic flow prior to and 60 min after ischemia was used to determine functional protection. Hearts recovered 82 +/- 3% of preischemic aortic flow when reperfused with normocalcemic reperfusate. When the initial reperfusate was enriched with calcium, aortic flow was only 43 +/- 4% of control. Hearts given terminal magnesium cardioplegia and then challenged with calcium-enriched reperfusate recovered 79 +/- 4% of control aortic flow. Hearts given terminal potassium cardioplegia recovered only 53 +/- 5% of control aortic flow when challenged with calcium-enriched initial reperfusate. Our results indicate that the recovery of aortic flow is significantly reduced by short-term postischemic calcium challenge. This damage is blocked by terminal magnesium cardioplegia, but not by terminal potassium cardioplegia.

Chylothorax review

Chylous leakage from the thoracic duct into the pleural space may occur after any type of thoracic surgery; however, there are few reports of this condition after coronary artery bypass grafting. A case of chylothorax after combined coronary bypass and mitral valve replacement is reported to illustrate a discussion of its pathologic basis, diagnosis and management.

Long-term experience with nadolol in treatment of hypertension and angina pectoris

Two-hundred ninety-one patients with hypertension and 313 patients with angina pectoris were enrolled and treated with nadolol for up to 2 years. The efficacy of nadolol in hypertension and angina was maintained over the 2-year period. Discontinuation because of an adverse reaction occurred with 8.3% of the hypertensive patients and 8.6% of the angina patients. The observed reactions were typical of those which occur with beta-blocking drugs. Serum creatinine levels fell significantly (p less than 0.05) after 12 months of treatment for both the angina and hypertensive patients. After 24 months of treatment the serum creatinine levels had decreased 20% from baseline (p less than 0.001). Blood urea nitrogen levels fell in the angina patients after 12 months of treatment but not in the hypertensive patients. Nadolol is safe and effective for the long-term treatment of both hypertension and angina. Renal function, as measured by serum creatinine levels, improved with long-term treatment.

Inhibition of chemiluminescence in human neutrophils by dapsone

Dapsone at doses of 0.5 to 5.0 micrograms/ml was found to produce a dose-dependent inhibition of opsonized zymosan-induced human polymorphonuclear leukocyte (PMN) chemiluminescence (CL) in vitro. Simultaneous exposure of PMN to dapsone and zymosan was as effective in reducing CL as preincubation of PMN with dapsone. Preincubation of PMN with dapsone followed by washing, resulted in the loss of dapsone-mediated CL inhibition, indicating that dapsone did not permanently alter the CL-generating mechanism and that the drug had to be present to inhibit CL. Dapsone did not absorb light at the wavelength of CL and was not toxic to PMN at concentrations tested. Sodium azide, an inhibitor of myeloperoxidase-mediated CL inhibited PMN CL to the same degree as dapsone. When incubated together with PMN, dapsone and azide did not produce an additive inhibition of CL. These data suggest that inhibition of myeloperoxidase may be the mechanism by which dapsone inhibits PMN CL.

Captopril in the treatment of scleroderma renal crisis

Scleroderma is a disease of unknown cause characterized by interstitial fibrosis and vascular lesions in many organ systems. Renal failure, often associated with malignant hypertension, may ensue as a life-threatening component of this disorder. Activation of the renin-angiotensin-aldosterone system has been hypothesized as a cause of this complication. Captopril has been used in 23 patients with this condition. Of this group, 20 (87%) responded favorably with a decrease of the supine diastolic BP to less than 90 mm Hg and a reduction in the serum creatinine level in 14 patients. During long-term therapy (median, 29 months), 11 of the 23 patients continued to have a good clinical response while receiving captopril. Six patients died and six patients were alive after captopril therapy was discontinued. These data suggest that captopril is beneficial in the treatment of scleroderma renal crisis.

Stapled esophagogastric anastomosis

In a consecutive, nonrandomized series of 92 patients, esophagogastric anastomosis was performed with a suture technique in 32 patients and with a stapler in 60 patients. Only one anastomotic leak occurred in each group. Stricture later formed in three sutured anastomoses and in eight of the stapled anastomoses. A review of published reports shows anastomotic leak in 3.5 percent of the patients with stapled anastomoses. In patients with sutured anastomoses, leak occurred in approximately 10 percent. The improved results with the stapler do not alter the necessity for meticulous attention to technical detail.

Enzymatic hydrolysis in vitro of thermally oxidized sunflower oil

The hydrolysis of thermally oxidized sunflower oil by pancreatic lipase was studied in relation to chemical changes in the acylglycerols. Four classes of compounds (monomers, dimers, trimers and polymers) formed from the acylglycerols were separated from the heated oils by column chromatography on silica gel, and further verified by thin layer chromatography. Each fraction, after analyses for generaly properties, was subjected to a time course study of hydrolysis by pancreatic lipase over a 30-min period. After 70 hr of heating, the amount of hydrolysis for the acylglycerol dimers was only about half that of the monomers, and that for the trimers was, in turn, about one-third that of the monomers. The polymers were the least hydrolyzed and showed no further reaction after 5 min. The reduction in enzymatic hydrolysis of isolated fractions from the thermally oxidized oils indicates structural differences, related to formation of polar compounds and polymerization products. Adverse effects on animals from feeding these materials can be attributed partly to inhibition of hydrolysis resulting in less available energy.

Enzymatic hydrolysis of fractionated products from oils thermally oxidized in the laboratory

Enzymatic hydrolysis of the acylglycerol products obtained from thermally oxidized vegetable oils was studied. Corn, sunflower and soybean oils were heated in the laboratory at 180 C for 50, 70 and 100 hr with aeration and directly fractionated by silicic acid column chromatography. By successive elution with 20%, then 60% isopropyl ether in n-hexane, and diethyl ether, the thermally oxidized oils were separated into three fractions: the nonpolar fraction (monomeric compounds), slightly polar fraction (dimeric compounds), and polar fraction comprising oligomeric compounds. Enzymatic hydrolysis with pancreatic lipase showed that the monomers were hydrolyzed as rapidly as the corresponding unheated oils, the dimers much more slowly, and the oligomeric compounds barely at all. Overall, the hydrolysis of the dimers was less than 23% of that for the monomers, with small differences among the oils. Longer heating periods resulted in greater reductions in hydrolysis of the dimeric compounds. These results suggest that the degree of enzymatic hydrolysis of the fractionated acylglycerol compounds is related to differences in the thermal oxidative deterioration, and amounts of polar compounds in the products.

Dysrhythmias caused by histamine release in guinea pig and human hearts

Histamine is released into the systemic circulation during anaphylaxis, by drugs and by surgical procedures. Studies in animal models have conclusively demonstrated that released cardiac histamine is a major mediator of arrhythmias that occur during anaphylaxis and following the administration of histamine-releasing drugs. Several lines of evidence suggest a similar arrhythmogenic role for cardiac histamine in humans: (1) The human heart is rich in histamine; (2) cardiac histamine can be readily released from human heart in vitro by therapeutic concentrations of drugs; (3) histamine has potent arrhythmogenic effects on the human heart in vitro. Arrhythmogenic effects of histamine include enhancement of normal automaticity, induction of abnormal automaticity, induction of triggered tachyarrhythmias, depression of atrioventricular conduction, and increase in the vulnerability of the ventricles to fibrillation. A combination of H1 and H2 antihistamines is needed to block the arrhythmogenic effects of histamine. Certain arrhythmogenic effects of histamine (e.g. induction of slow responses and delayed afterdepolarizations) can also be blocked by drugs which inhibit the influx of cations through slow channels. In contrast, the commonly-used drug digitalis potentiates the arrhythmogenic effects of histamine. We propose that histamine release produced by drugs and surgical procedures may be an overlooked factor in fatal cardiac arrhythmias. Experimental studies suggest that selective pharmacological methods can be developed to block the arrhythmogenic effects of histamine.

Influence of dose level and methionine intake on the effects of linamarin administration to rats

Rats were fed a semipurified diet providing 10% casein supplemented with methionine for 2 wk, at which time some animals received the same diet without the methionine for 4 d. Animals that received linamarin were given a single oral dose containing 500 or 250 mg per kilogram of body weight. At the higher linamarin dose all animals died within 5 h after dosing. Biochemical and physiological changes observed in these rats included severe metabolic acidosis, decreased cytochrome oxidase activities, atrial fibrillation, and decreased respiratory rates. In general, the cardiac adenosinetriphosphatase enzymes were inhibited by linamarin. None of these changes were moderated by dietary methionine supplementation. At the lower linamarin dose dietary supplementation with methionine appeared to reduce incidences of clinical toxicity signs and fatalities. No methionine effect was observed in the other biochemical and physiological measurements in rats given this amount of linamarin. The results suggest that dietary supplementation with methionine provided some protection against the toxicity of the lower level of linamarin administered.

Cytotoxicity of thermally oxidized fats

The effects of oxidized fat components (free fatty acids from the distillable nonurea adductable fraction) isolated from heated corn oil or heated olive oil on the morphology and growth of heart cells in primary culture were investigated. The free fatty acid fractions isolated from the fresh fats served as controls. Different concentrations of the fat fractions (20, 60, and 100 micrograms/ml) were added to the medium in the form of an emulsion with bovine serum albumin (Fraction V, poor in unesterified fatty acids). In the cell cultures treated with heated fats, intracellular lipid accumulation, increased cytoplasmic vacuolization, mitotic aberrations, pyknotic cells, and decreased mitosis were observed and were more pronounced in the case of the heated olive oil. These cytotoxic effects increased with higher concentrations of heated fats in the medium. The fresh fats also produced intracellular lipid accumulation, reductions in mitosis, and changes in the nucleus and cytoplasm, at the higher levels. These effects were greater in fresh olive oil-treated cultures. These observations indicate that oxidized fat components interfere physically or biochemically with normal cell functions resulting in pathological changes.

Chemical and biological properties related to toxicity of heated fats

Heating of fats brings about measurable changes in their chemical and physical characteristics. Heat is applied in processing for food manufacture, such as during hydrogenation of oils with a catalyst, and in frying for meal preparation. Partially hydrogenated products generally contain substantial quantities of geometric and positional isomers of the original unsaturated fatty acids. During deep-fat frying, when the fat is used repeatedly, oxidative and thermal effects result in the formation of many volatile and nonvolatile products, some of which are potentially toxic, depending on the level of intake. Because of concern about the types of changes that take place in fats during oxidative and thermal deterioration and the effects the derivatives could have on the consumer, many chemical and biological studies have been carried out. Experimental findings indicate that any potential danger to the consumer is relative to the severity of the overall treatment of the fat. In some studies we evaluated biological effects on rats of trans fatty acid in the diet and of concentrates of fatty acid derivatives produced in thermally oxidized fats. trans-Octadecenoic acid changed the concentrations of the phospholipid classes in the liver lipids, and interfered with conversion of the essential n - 6 series of fatty acids to higher members. Compared to oleic acid, elaidic acid was preferentially incorporated into the phospholipids instead of the triacylglycerols and was also concentrated in the lipoprotein fractions. Administration of non-urea-adductable concentrates from thermally oxidized fats produced cellular damage in hearts, livers, and kidneys of the animals. Since even practical processing and frying conditions can produce some nutritionally undesirable products, a concerted effort should be made to minimize substantial accumulation of these in our dietary fats.

Effects of vitamin E and ascorbyl palmitate on cultured myocardial cells exposed to oxidized fats

Primary cultures of rat heart cells were used as a model system to study the influence of two antioxidants, vitamin E and ascorbyl palmitate, on biological effects of thermally oxidized fat. The free fatty acid fraction of the distillable non-urea-adductable fraction of heated corn oil (HCO) was used as the test lipid; the free fatty acid fraction of fresh corn oil was the control. HCO (100 microgram/ml medium) depressed the mitotic index, induced excessive lipid accumulation, and increased the number of pyknotic nuclei in the cells. Addition of extra vitamin E (10 microgram/ml medium) reduced the toxicity of HCO by counteracting these changes. In comparison, ascorbyl palmitate (10 microgram/ml medium) in the presence of HCO was beneficial in that it produced only a slight increase in the mitotic index. HCO treatment also resulted in reduced levels of linoleic and arachidonic acids in the phospholipid fractions of the cells, and addition of vitamin E or ascorbyl palmitate increased the level of arachidonic acid. The triacylglycerol fraction of HCO-treated cells showed markedly reduced linoleic acid and increased arachidonic acid. These changes were unaffected by the antioxidant treatments. Vitamin E counteracted the adverse effects of HCO treatment on the rat heart cells. Ascorbyl palmitate only was as efficient as vitamin E in elevating the concentration of arachidonic acid at the membrane level in the presence of HCO.

Lung abscess and empyema of the thorax

Empyema is best managed by the physician familiar with the indications and principals of the various procedures used in the treatment of empyema of the thorax. The objective of each modality used to treat empyema is to drain the pleura cavity and to allow full expansion of the lung. If the infected material can be removed and the visceral and parietal pleural approximated, the body will heal the pleural infection. The procedure chosen to treat empyema greatly depends upon the phase of maturation of the empyema when treatment is begun.