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Biomedical subjects

A Slivka

Publications and source records attributed to A Slivka.

At least 55 records · Page 3Linked to original sources
PubMed1996

Biological chemistry of thiols in the vasculature and in vascular-related disease.

For all their similarities in structure and common chemistry, the functions of the amino thiols in vascular biology are remarkably different. This review details the basic chemistry of sulfhydryls that dictates their functions in health and disease. In addition, the biochemistry and metabolism of each thiol are outlined, in an effort to highlight its specific contributions to the normal biology and physiology of blood vessels and to the pathogenesis of vascular-related disease.

Animals↗
PubMed1995

Clinical and angiographic features of thunderclap headache.

Thunderclap headache is an acute high intensity headache similar to that seen in the setting of ruptured saccular aneurysm. We report four patients without subarachnoid hemorrhage who presented with thunderclap headache. Three patients had transient neurologic signs or symptoms. Cerebral angiography revealed diffuse segmental intracerebral arterial vasoconstriction which was reversible in the one patient in whom angiography was repeated. The headaches resolved spontaneously in all cases and after 1 week did not recur. These cases highlight the specific clinical and angiographic features and the self-limited course of patients with thunderclap headache and suggest that thunderclap headache may represent a unique headache category. On the basis of these cases and others reported in the literature, we propose diagnostic criteria for thunderclap headache.

Adult↗
PubMed1995

Cerebral edema after temporary and permanent middle cerebral artery occlusion in the rat.

BACKGROUND AND PURPOSE: The potential of thrombolytic agents to improve outcome after ischemic stroke could be negated if recanalization of an occluded artery exacerbates cerebral edema. We examined whether infarctions associated with reperfusion have more edema than those without reperfusion and whether the time course for the development of cerebral edema varied with and without reperfusion. METHODS: Infarct volumes were measured 24 hours after permanent and 1, 2, and 3 hours of temporary right middle cerebral artery (MCA) occlusion in spontaneously hypertensive rats. Hemispheric volume, water, sodium, and potassium were measured 3, 6, 12, 24, 36, and 48 hours after permanent and 3 hours of temporary MCA occlusion and also determined 24 hours after permanent and 2 and 3 hours of temporary MCA occlusion. RESULTS: Minimal tissue damage occurred after 1 hour of temporary ischemia. Infarct sizes were similar after permanent and 3 hours of temporary MCA occlusion and significantly greater than after 2 hours of temporary ischemia. Hemispheric volume, water, and sodium from the infarcted right hemisphere were significantly greater than those from the left hemisphere beginning 6 hours after MCA occlusion and continuing for 48 hours, with a peak at 24 hours. Right hemispheric water measured 24 hours after 2 hours of temporary ischemia was significantly less than after permanent or 3 hours of temporary ischemia. CONCLUSIONS: This study demonstrates that cerebral edema after focal stroke is related to infarct size and is independent of reperfusion status. The results suggest that exacerbation of cerebral edema will not occur after thrombolytic treatment or spontaneous recanalization of occluded cerebral vessels.

Analysis of Variance↗
PubMed1995

Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough.

OBJECTIVES: Bile leaks are a well documented complication of biliary surgery, occurring more frequently with laparoscopic procedures. Endoscopic therapy with a long biliary endoprosthesis traversing the site of the leak is effective. We have evaluated the hypothesis that equalizing biliary and duodenal pressures with a short transpapillary stent is an equally effective therapy for bile leaks. METHODS: Thirty one consecutive patients presenting over a 52-month period with postsurgical bile leaks were evaluated. Patients had been treated with long endoprostheses (stents or nasobiliary tubes), sphincterotomy, or short transpapillary stents. The success, complication rate, need for additional therapy, and hospitalization time of each therapeutic approach were determined. RESULTS: Endoscopic therapy was successful in all 25 patients in whom a bile leak could be documented. The clinical success, need for radiological drainage, length of hospitalization, and incidence of pancreatitis were similar for all methods of treatment. CONCLUSIONS: These results confirm that endoscopic therapy is highly successful in the treatment of postoperative bile leaks and suggest that the mechanism of healing is the equalization of bile duct and duodenal pressures, allowing flow of bile into the duodenum. The endoscopic placement of short transpapillary stents without sphincterotomy is a temporary, effective, and technically simple method of pressure equalization. This should be considered as the primary therapy for most postoperative bile leaks.

Adult↗
PubMed1994

Nitric oxide decreases oxidant-mediated hepatocyte injury.

Nitric oxide (NO) is a readily diffusible, short-lived free radical with a multitude of organ-specific regulatory functions. Within the hepatocyte, NO production is associated with inhibition of mitochondrial electron transport enzyme activity, activation of soluble guanylyl cyclase, and inhibition of glyceraldehyde-3-phosphate dehydrogenase. However, while NO can regulate a number of hepatocyte functions, it is unknown whether NO production is hepatoprotective or hepatotoxic. Using isolated rat hepatocytes in primary short-term culture, we investigated the role of cytokine-mediated NO production in toxin-induced hepatocyte injury. In a model of acetaminophen (AM) hepatotoxicity, inhibition of cytokine-mediated NO production potentiated AM injury. In the presence of an inhibitor of NO synthesis, NG-monomethyl-L-arginine (L-NMMA), hepatocyte release of aspartate aminotransferase was increased twofold in the presence of 4.0 and 8.0 mM AM (P < 0.01). In addition, in the presence of AM, cytokine-mediated NO production was increased by 75% over baseline (P < 0.01). Maximum NO synthesis occurred at an AM concentration of 2 mM. A potential mechanism for the hepatoprotective effect of NO centers on its role in glutathione (GSH) homeostasis. In the presence of increasing concentrations of AM, hepatocyte GSH stores decreased in parallel in both control and cytokine-stimulated hepatocytes (ANOVA, P < 0.01). When cytokine-stimulated hepatocytes were exposed to 50 microM L-NMMA, NO release was ablated, while glutathione levels decreased by threefold in comparison to controls (P < 0.01). In the presence of increasing concentrations of AM, cytokine-treated cells exposed to 50 microM L-NMMA exhibited significant decremental decreases in GSH levels (P < 0.05). These data suggest that inhibition of cytokine-mediated NO production potentiates AM hepatoxicity by modulation of hepatocyte glutathione stores.

Acetaminophen↗
PubMed1994

In vivo transfer of nitric oxide between a plasma protein-bound reservoir and low molecular weight thiols.

Plasma albumin reacts with nitric oxide (NO) to form the bioactive adduct, S-nitroso-albumin (S-NO-albumin). The limited intracellular access of S-NO-albumin suggests the need for a vascular transfer mechanism of NO from a large plasma S-NO-albumin pool to effect biologic function. To study the role of low molecular weight (LMW) thiols in NO transfer in vivo, we administered intravenous S-NO-albumin (1-300 nmol/kg) to rabbits before and after an intravenous infusion of L-cysteine or N-acetyl-L-cysteine. S-NO-albumin produced dose-dependent hypotension that was significantly augmented by prior infusion of either LMW thiol. LMW thiol infusion significantly accelerated the rate of onset and reduced the duration of action of the hypotension induced by S-NO-albumin. The hemodynamic effects of S-NO-albumin after pretreatment with LMW thiols were mimicked by administration of the corresponding LMW S-nitrosothiol. The transfer of NO from albumin to L-cysteine was directly measured in rabbit plasma using a novel technique that couples high performance liquid chromatography to electrochemical detection. These data demonstrate that NO exchange between plasma protein thiol-bound NO and available LMW thiol pools (transnitrosation) occurs in vivo.

Acetylcysteine↗
PubMed1994

Inhibition of sphincter of Oddi function by the nitric oxide carrier S-nitroso-N-acetylcysteine in rabbits and humans.

Nitric oxide (NO) is an inhibitor of gastrointestinal smooth muscle. Model systems of the gut predict the NO will complex with biological thiol (SH) groups, yielding S-nitrosothiols (RS-NO), which may limit the propensity to form mutagenic nitrosamines. The inhibitory effects of NO and its biologically relevant adducts on sphincter of Oddi (SO) motility have been inferred from animal studies; however, their importance in regulating human SO is not known. The objectives of this study were to (a) provide histologic confirmation of nitric oxide synthase (NOS) in human SO; (b) characterize the pharmacology of S-nitroso-N-acetylcysteine (SNAC), an exemplary S-nitrosothiol, on SO motility in a rabbit model; and (c) study the effects of topical SNAC on SO motility in humans. Immunocytochemical and histochemical identification of NOS was performed in human SO. The pharmacologic response of SNAC was defined in isolated rabbit SO using a standard bioassay. Topical SNAC was then applied to the duodenal papilla in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and biliary manometry. NOS was localized to nerve fibers and bundles of the SO in rabbits and humans. SNAC inhibited spontaneous motility (frequency and amplitude) as well as acetylcholine-induced elevations in SO basal pressure in the rabbit model. In patients undergoing ERCP and biliary manometry, topical SNAC inhibited SO contraction freqency, basal pressure, and duodenal motility. NOS is localized to neural elements in human SO, implicating a role for NO in regulating SO function. Supporting this concept, SNAC is an inhibitor of SO and duodenal motility when applied topically to humans during ERCP. Our data suggest a novel clinical approach using local NO donors to control gastrointestinal motility and regulate sphincteric function.

Acetylcysteine↗
PubMed1994

Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized.

OBJECTIVE: The objective of this report was to determine the clinical outcome of intervention among patients with a pancreatic pseudocyst associated with sterile pancreatic necrosis. METHODS: We reviewed records of all patients with sterile pancreatic necrosis who required intervention during the past 10 yr. RESULTS: A total of 17 patients required intervention. Twelve with sterile necrosis unassociated with a pancreatic pseudocyst underwent surgical debridement. An additional five patients with sterile necrosis associated with a pancreatic pseudocyst underwent drainage of the pseudocyst (two by pigtail catheter drainage, one by endoscopic cyst gastrostomy, and two by surgical cyst gastrostomy). After drainage, four of these five patients developed pancreatic infection that required surgical debridement. Pancreatic infection occurred because the drainage procedures in these four patients failed to remove the underlying necrotic material. CONCLUSIONS: When a pancreatic pseudocyst occurs in association with pancreatic necrosis, radiological and endoscopic decompression should not be attempted.

Adult↗
PubMed1993

Brain ischemia markedly elevates levels of the neurotoxic amino acid, cysteine.

The mechanisms underlying cell damage in stroke or during experimental brain ischemia are not fully understood. L-Cysteine, an excitotoxic amino acid that could contribute to tissue damage, is normally found in relatively low levels in brain (ca. 0.05 mumol/g), compared to the cysteine-containing tripeptide, glutathione (GSH, ca. 1.5 mumol/g). We have observed that during brain ischemia in gerbils, levels of cysteine rise 10-13-fold over an 8 h period to 0.66 and 0.62 mumol/g, respectively, in the ischemic hippocampus and striatum. At the same time, levels of GSH fall by 0.84 and 0.94 mumol/g, respectively. The elevated free cysteine may be derived largely from GSH. The levels of cysteine found in ischemic brain are similar to those reported after parenteral administration of neurotoxic doses of L-cysteine to perinatal rats. The remarkable increase in cysteine during brain ischemia, coupled to its neurotoxic properties, may play a role in aspects of brain damage during or following brain ischemia.

Animals↗
PubMed1993

Pneumocystis carinii pneumonia during steroid taper in patients with primary brain tumors.

Pneumocystis carinii causes life-threatening pneumonitis (PCP) in immunocompromised individuals. In the non-AIDS (acquired immunodeficiency syndrome) population, PCP is frequently associated with corticosteroid therapy, and the rodent model uses corticosteroid-induced immunosuppression to provoke PCP. Although patients with intracranial tumors are frequently treated with long courses of corticosteroids, there have been very few descriptions of PCP in this population. We report the diagnosis and treatment of PCP in four patients over a 12-month period with intracranial neoplasms who developed symptoms during corticosteroid taper. Effective prophylaxis against PCP exists and should be considered for patients with intracranial neoplasms receiving long-term steroids.

Aged↗
PubMed1993

Age as a modifying factor on the effect of antihypertensive therapy in focal stroke in rats.

BACKGROUND AND PURPOSE: Antihypertensive treatment with hydralazine for 10 weeks but not 6 weeks reduces infarct size in 13-week-old spontaneously hypertensive rats subjected to focal cerebral ischemia. This study was designed to examine whether the duration of treatment needed to reduce infarct size depends on how long hypertension is present before the initiation of antihypertensive therapy. METHODS: Six-week-old spontaneously hypertensive rats were treated for 6 weeks and 10-month-old spontaneously hypertensive rats for 10 weeks with 20 mg/kg hydralazine added daily to the drinking water. The animals were then subjected to focal cerebral ischemia by tandem permanent common carotid and middle cerebral artery occlusion. RESULTS: Blood pressure in the treated groups was lower than that in the untreated groups for the entire treatment period in both experiments. Infarct volume in 10-month-old spontaneously hypertensive rats treated for 10 weeks, but not in 6-week-old spontaneously hypertensive rats treated for 6 weeks, was significantly less than in untreated controls (p = 0.02). CONCLUSIONS: This study emphasizes the importance of duration of antihypertensive treatment in reducing infarct volume in spontaneously hypertensive rats after focal cerebral ischemia and demonstrates that the effect appears to be independent of the duration of hypertension before the initiation of treatment.

Age Factors↗
PubMed1992

The effect of the NMDA receptor antagonist MK-801 on cerebral blood flow and infarct volume in experimental focal stroke.

The non-competitive N-methyl-D-aspartate receptor/channel antagonist dizocilipine maleate (MK-801) has been reported to reduce infarct volume in a variety of focal stroke models. We examined the effect of MK-801 on infarct volume and cerebral blood flow in temporary and permanent focal ischemia in rats. In Wistar rats exposed to permanent right common carotid artery and 2 h of transient right middle cerebral and left common carotid artery occlusion followed by 22 h of reperfusion, MK-801 reduced infarct volume by 73% (P less than 0.05) and significantly increased cerebral blood flow to the ischemic core throughout the 2-h period of ischemia. In spontaneously hypertensive rats (SHRs) exposed to permanent right common carotid artery occlusion and 2 h of transient right middle cerebral artery occlusion followed by 22 h of reperfusion, MK-801 decreased infarct volume by 13% (P greater than 0.05) and increased cerebral blood flow to the penumbral region. In SHRs subjected to permanent right common carotid and middle cerebral artery occlusion MK-801 reduced infarct volume by 18% at 3 h (P greater than 0.05), by 25% at 6 h (P less than 0.01) and by 18% at 24 h (P less than 0.05). MK-801-treated SHRs had no difference in cerebral blood flow to the ischemic core, but increased cerebral blood flow to penumbral zones as compared with untreated SHRs. These results suggest that the protective effect of MK-801, at least in part, relates to improved cerebral blood flow.

Animals↗
PubMed1992

A new model of temporary focal neocortical ischemia in the rat.

BACKGROUND AND PURPOSE: We describe a new rat model of temporary focal ischemia that produces neocortical ischemia without the need for prolonged anesthesia. METHODS: Temporary focal cerebral ischemia was initiated during halothane anesthesia, maintained for varying periods without anesthesia, and reversed by clip removal requiring brief anesthesia. Tandem carotid and middle cerebral artery occlusion for 1-4 hours and permanent occlusion were used to determine the duration and extent of ischemia necessary to produce predictable volumes of neocortical infarction in Wistar and spontaneously hypertensive rats. RESULTS: In Wistar rats, occlusion of the right middle cerebral and both common carotid arteries resulted in cerebral blood flow reductions to approximately 8% of baseline. One hour of transient ischemia with 23 hours of reperfusion did not result in infarction. Three hours of ischemia followed by 21 hours of reperfusion resulted in infarction comparable to that caused by 24 hours of permanent ischemia. In spontaneously hypertensive rats, unilateral right middle cerebral and common carotid artery occlusion reduced cerebral blood flow to approximately 11% of baseline. Minimal damage was seen with 1 hour of reversible ischemia, but intervals of 2 and subsequently 3 hours followed by 22-21 hours of reperfusion produced progressively larger infarcts. Damage indistinguishable from that seen with 24 hours of permanent ischemia was seen with 3 or 4 hours of transient ischemia followed by 21 or 20 hours of reperfusion. CONCLUSIONS: For unanesthetized normothermic rats, cerebral blood flow reductions to 10-20% of baseline resulted in maximal infarction once ischemic durations exceeded 2-3 hours. To be effective, experimental therapies aimed at lessening infarct size or restoring blood flow must be initiated within this critical time interval.

Animals↗
PubMed1992

Tirilazad reduces cortical infarction after transient but not permanent focal cerebral ischemia in rats.

BACKGROUND AND PURPOSE: We examined the cytoprotective effect of the lipid peroxidation inhibitor tirilazad mesylate (U74006F) in rodent models of neocortical infarction induced by transient and permanent focal cerebral ischemia. METHODS: Wistar rats (experiment 1) and spontaneously hypertensive rats (experiment 2) were subjected to 2 hours of transient middle cerebral artery occlusion followed by 22 hours of reperfusion and pretreated with 10 mg/kg i.p. tirilazad, vehicle, or saline. Repeat doses were given at 4 and 10 hours after reperfusion. Spontaneously hypertensive rats were also subjected to permanent middle cerebral artery occlusion and either pretreated with tirilazad, vehicle, or saline intraperitoneally (experiment 3) or treated with either tirilazad or vehicle intravenously after ischemia (experiment 4). Cortical infarct volumes were measured 24 hours after the onset of either transient or permanent ischemia, and changes in core regional cerebral blood flow were monitored with laser Doppler flowmetry. RESULTS: Tirilazad reduced infarct volume after transient ischemia by 40% in Wistar rats (p = 0.08) (experiment 1) and 23% in spontaneously hypertensive rats (p less than 0.05) (experiment 2) but did not reduce infarction after permanent ischemia whether it was given intraperitoneally (experiment 3) or intravenously (experiment 4). Ischemic core blood flows were not affected during ischemia, nor were they affected during reperfusion after transient ischemia. CONCLUSIONS: Tirilazad reduces cortical infarction in transient but not permanent ischemia, an effect not related to improvement in regional cerebral blood flow. Tirilazad might prove to be useful as an adjuvant therapy after successful thrombolysis in acute stroke patients.

Animals↗
PubMed1991

Effect of antihypertensive therapy on focal stroke in spontaneously hypertensive rats.

Spontaneously hypertensive rats subjected to focal cerebral ischemia develop larger infarcts than normotensive rat strains. To determine whether antihypertensive therapy decreases infarct volume in hypertensive rats, 60 13-week-old animals were treated with 20 mg/kg hydralazine added daily to the drinking water for 1.5, 6, 10, or 16 weeks and then subjected to focal cerebral ischemia by tandem right common carotid artery and middle cerebral artery occlusion. Blood pressure in the treated groups was substantially lower than that in untreated groups after 1 week of hydralazine therapy and remained lower for the entire treatment period in all four experiments. Mean infarct volume in spontaneously hypertensive rats treated for 10 (p = 0.02) or 16 (p = 0.005) weeks, but not 1.5 or 6 weeks, was significantly less than that in the untreated controls. The percentage reduction of infarct volume in animals treated for 10 and 16 weeks was similar. This study demonstrates that antihypertensive therapy decreases infarct volume in hypertensive rats subjected to focal cerebral ischemia. This treatment effect appears to be dependent on the duration of therapy, and the magnitude of the treatment effect seems to plateau by 10 weeks of therapy.

Animals↗
PubMed1990

Natural history of progressive ischemic stroke in a population treated with heparin.

Data on the acute natural history of progressive stroke with or without heparin treatment are limited. To define the acute course of patients treated with heparin for progressive stroke, we examined the charts of 69 such patients identified through the Cornell Neurology Database from October 1979 to June 1985. Analysis included determining whether further clinical deterioration or hemorrhagic complications were associated with readily identifiable clinical or laboratory variables. Twenty-five patients (36%) continued to deteriorate while receiving heparin, another two (3%) worsened due to intracerebral hemorrhage, and a total of 10 patients (14%) had bleeding complications. No clinical features or heparin dosing regimens distinguished the patients likely to benefit from heparin. Clinical progression or hemorrhage did not correlate with the level of anticoagulation as measured by the average heparin dose per day or the mean partial thromboplastin time. Without unequivocal evidence demonstrating heparin's ineffectiveness for progressive stroke, many clinicians managing such patients will continue to use heparin. Our results suggest that this decision should not be governed by such clinical features as a patient's age or sex or by the vascular distribution of the stroke. Furthermore, frequent measurement of and overzealous efforts to adjust the partial thromboplastin time may be unnecessary since it does not correlate with outcome.

Adult↗
PubMed1990

Carnitine treatment for stroke in rats.

Changes in the concentrations of carnitine, long-chain acylcoenzyme A, and long-chain acylcarnitine in ischemic myocardium parallel those in ischemic brain. Since carnitine treatment reverses these changes and improves function in ischemic hearts, we examined whether carnitine given to rats before focal cerebral ischemia (produced by tandem right common carotid artery and middle cerebral artery occlusion) alters infarct volume in four separate experiments. Mannitol was used to control for the osmotic effect of carnitine on brain edema in one experiment. While carnitine was found to significantly decrease infarct volume compared with saline in one experiment (p less than 0.05, Student's t test), this result could not be replicated in the subsequent three experiments. Because the positive treatment effect was not reproducible despite similar experimental conditions, the result of the first experiment was attributed to a type I error. Mannitol also showed no significant effect on infarct volume. This study emphasizes the need for concurrent controls with each group of treated animals and the need for replicating the results of a single experiment when testing for drug efficacy in animal models of focal cerebral ischemia.

Animals↗