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Biomedical subjects

J A Mannick

Publications and source records attributed to J A Mannick.

At least 199 records · Page 11Linked to original sources
PubMed1977

Improved results with femoropopliteal vein grafts for limb salvage.

Over a ten-year period from 1966 to 1975, 154 femoropopliteal vein grafts were performed for limb salvage in 139 patients, including 42 diabetics. The average patient age was 70 years. The one-month operative mortality was 2.9% (four patients). Average preoperative Doppler ankle pressure was 46 mm Hg, with an average ankle-arm systolic blood pressure index (ASPI) of 0.33. The average postoperative Doppler ankle pressure was 96 mm Hg, with an ASPI of 0.76. Five-year vein graft patency was 72%. Poor quality of vein was a statistically significant cause of graft failure (P less than .015). Small saphenous veins of good quality and arm veins gave satisfactory results. Diabetics had a lower, but not statistically significantly decreased, five-year patency. Because of this high success rate and low operative mortality, we recommend an attempt at limb salvage by femoropopliteal vein grafting in patients threatened with limb loss because of atherosclerotic occlusive disease of the femoropopliteal segment.

Aged↗
PubMed1977

Assessment of myocardial performance and optimal volume loading during elective abdominal aortic aneurysm resection.

Myocardial depression has been suggested as a cause of declamping hypotension. To investigate and manage this problem, thermal dilution catheters were placed in 22 elderly, high-risk patients (mean age 71 years) who underwent elective abdominal aortic aneurysm resection. There were no deaths. Myocardial performance curves (MPC) were determined preoperatively, following induction of anesthesia, during aortic clamping, following declamping, and 12 to 48 hours postoperatively. The slope of this curve was taken as an index of myocardial performance. Preoperative cardiac index at a pulmonary artery wedge pressure of 10 mm Hg (CI10) decreased significantly following induction of anesthesia (P less than .002) and persisted during aortic cross-clamping. Following declamping, CI10 rose to preoperative levels. The slope of the MPC followed this same pattern. There was no significant change in blood pressure with the aorta clamped or following declamping. Myocardial performance is depressed following induction of anesthesia but declamping hypotension can be minimized or prevented by optimum volume loading as guided by Starling's myocardial performance curves.

Aged↗
PubMed1977

Association of a circulating immunosuppressive polypeptide with operative and accidental trauma.

The serum from 109 traumatized patients was examined for immunosuppressive activity which might explain diminished host immune responsiveness following operative or accidental injury. Twenty-eight fo 31 (90%) severely tralmatized patients, 25 of 60 (42%) moderately traumatized patients, and 0 of 18 minimally traumatized patients developed serum which suppressed the response of normal human lymphocytes to phytohemagglutinin. The degree and duration of serum immunosuppressive activity paralleled the severity of the clinical course but did not correlate with serum cortisol or barbiturate levels. Suppressive sera were not cytotoxic. The immunosuppressive factor(s) was contained in a low molecular weight (less than 10,000 daltons) peptide fraction and was present in 5--10 times the amount recoverable from normal serum. By size and activity the trauma serum factor resembled immunoregulatory alpha globulin, a naturally-occurring serum inhibitor of T-lymphocyte reactions. Thus, depressed immunoreactivity following trauma may be due in part to high concentrations of an endogenous immunosuppressive polypeptide.

Adolescent↗
PubMed1977

Is axillo-bilateral femoral graft an effective substitute for aortic-bilateral iliac/femoral graft?: an analysis of ten years experience.

During the past ten years, 88 aorto-bilateral iliac/femoral grafts and 56 axillo-bilateral femoral grafts were electively performed for occlusive disease of the abdominal aorta or iliac vessels. The results of this retrospective study indicate that the axillo-bilateral femoral graft, although performed in an older population and more frequently for limb salvage, has a lower operative mortality than does conventional aortic bypass surgery with similar patency (76%) and survival (67%) at five years. However, axillo femoral grafting requires more frequent remedial surgery to obtain long term patency.

Amputation, Surgical↗
PubMed1977

Anti-immunoglobulin as an adjunct in producing long-term antigen-specific allograft survival. Organ localization of immune complexes.

Heterologous anti-immunoglobulin is a potent immunosuppressive agent that prolongs H-2- and H-3-incompatible skin graft survival. In conjunction with antithymocyte serum, anti-immunoglobulin promotes greater graft life than either antiserum used alone, without evidence of toxicity to recipient animals. Combination treatment with anti-immunoglobulin, antithymocyte serum, and donor spleen cells produces long-term allograft survival to the lifetime of the host and can result in antigen-specific immune unresponsiveness of sufficient strength to permit acceptance of a second-set graft. Anti-immunoglobulin complexes formed in treated mice appear to be localized primarily in the lymphatic reticuloendothelial system.

Animals↗
PubMed1977

A comparison of the late patency rates of axillobilateral femoral and axillounilateral femoral grafts.

A total of 130 axillofemoral grafts were peformed in 120 patients from 1966 to present; 66 were axillobilateral femoral moral and 64 were axillounilateral femoral grafts. The average patient age was 66 years. The indications for operation were occlusive disease with rest pain or gangrene in 102 patients, severe claudication four, and bypass of a thoracic aneurysm in one. The one month operative mortality rate was 8 percent (ten patients). Four deaths occurred in elderly patients operated upon as emergencies with acute aortic occlusion. In the 126 elective cases, there were six postoperative deaths (4.7 percent). Twenty thrombectomies were performed in 15 axillobilateral femoral grafts of which 15 (75 percent) were successful. In the unilateral grafts there were 25 thrombectomies in 22 grafts, of which only eight (32 percent) were successful. The 5 year patency rate by the life-table method was 74 percent for axillobilateral femoral grafts and 37 percent for axillounilateral femoral grafts. This difference in patency rates is statistically significant (p < 0.01). Average flow measured by electromagnetic flow meter in six axillobilateral femoral grafts was 621 c.c. per minute and in 11 unilateral femoral grafts was 273 c.c. per minute. We attribute the higher patency rate in axillobilateral femoral grafts to this increased flow. These data indicate that axillobilateral femoral grafts may be performed with anticipation of a 5 year patency rate comparable to that with conventional aortoiliac reconstruction and that axillobilateral femoral grafts should be performed in preference to axillounilateral femoral grafts in poor-risk patients requiring extra-anatomic bypass for aortoiliac occlusive disease.

Aged↗
PubMed1977

Immunosuppressive activity of IRA on the plaque-forming response to SRBC in vitro: reversal with educated cells.

The alpha-globulin-rich fraction of Cohn Fraction IV, designated IRA, suppresses the in vitro antibody response to sheep red blood cells (SRBC) without cytotoxicity. IRA was effective if added before or up to 24 hr after antigen exposure. The suppression could be reversed after 24-hr treatment by washing the cells two to three times; after 48 hr of IRA treatment, however, suppression could only be partially reversed. The addition of a population of thymus-derived cells educated to the antigen SRBC could effectively reverse the IRA-induced inhibition of antibody production, whereas BSA-educated T cells could not.

Alpha-Globulins↗
PubMed1977

Suppression of tumor-specific cell-mediated cytotoxicity by immunoregulatory alpha-globulin and by immunoregulatory alpha-globulin-like peptides from cancer patients.

The suppression of tumor-specific cell-mediated cytotoxicity by human immunoregulatory alpha-globulin (IRA), by a peptide fraction derived from IRA, and by IRA-like peptides from the serum of cancer patients was studied in a syngeneic murine tumor-host system. Splenic lymphocytes from tumor-immunized mice were cytotoxic specific tumor cells in vitro as measured by the [125]-iododeoxyuridine release microcytotoxicity assay. However, this effect was significantly depressed if 1.25 to 5 mg of IRA per ml were added to the cultures. Pooled lyophilized normal human serum protein was inactive. IRA peptide and IRA-like peptide fractions from cancer patients were also highly suppressive of cell-mediated cytotoxicity at much lower concentrations (0.05 to 0.5 mg/ml). Control human serum peptide, which failed to inhibit the induction of hemolytic plaque-forming cells in sheep erythrocyte-injected mice, had no effect on cell-mediated cytotoxicity. IRA and IRA-like peptide fractions were not cytotoxic to the effector lymphocytes or to the target cells at the concentrations used.

Alpha-Globulins↗
PubMed1976

The specificity of concomitant tumor immunity at large tumor volumes.

Two antigenically distinct fibrosarcomas, designated BP-8 and BP-9, induced in syngeneic C3H/HeN mice by 3,4-benzo(a)pyrene were used to study tumor-specific immunity, concomitant tumor immunity and the effect of large tumor volumes on the loss of immunological reactivity. Two groups of mice were immunized to the BP-8 tumor by amputation of growing BP-8 isografts. One group was rechallenged with the BP-8 cells, and tumor growth was not noted. Both groups of mice then received an inoculum of BP-9 cells that grew to palpable tumors to the same extent as in control mice. BP-8-immunized mice bearing progressively larger PB-9 tumors were sacrified at varying intervals after the BP-9 isograft. Tumor weight was recorded as a percentage of total body weight and viable spleen cells from these animals were tested in vitro for cytotoxicity against BP-8 and BP-9 cells in the [125I]iododeoxyuridine microcytotoxicity assay. Spleen cells from untreated mice were used as controls. The mice with growing BP-9 tumors developed an immune reaction against the tumor antigens which increased with time from initial tumor isograft and with increasing tumor size up to a definite but variable limit. Cytotoxicity to BP-9 cells rose from 18% when the BP-9 tumor was not palpable to a maximum of 77% when the tumor represented 5 to 10% of the total body weight. Cytotoxicity to BP-9 fell progressively as tumor size exceeded 15% of the total body weight and approached the 10% background cytotoxicity of control lymphocytes to BP-9 cells, when the tumor weight achieved 25% of the animal's weight. Conversely, cytotoxicity of lymphocytes against the BP-8 tumor did not vary significantly and remained about 41 to 44% over the same interval even while specific reactivity to BP-9 cells significantly decreased. In addition, with time, lymphocyte-mediated cytotoxicity to the BP-8 tumor increased from 41 to 70% if the BP-8-immunized mice had been rechallenged with antigenically identical BP-8 cells prior to the BP-9 isograft. These data suggest that loss of immunoreactivity at large tumor volumes is tumor and, presumably, antigen specific. No evidence of a generalized immune paralysis was demonstrated, since the mice always maintained immunity to the BP-8 tumor despite progressive and lethal growth of the antigenically distinct BP-9 tumor.

Animals↗
PubMed1975

Bypass vein grafts in patients with distal popliteal artery occlusion.

The results obtained by placing reversed autogenous saphenous vein bypass grafts in either isolated popliteal artery segments or tibial vessels distal to the popliteal artery segments or tibial vessels distal to the popliteal artery are compared. Fifty-five patients with arteriosclerotic peripheral vascular disease who were threatened with limb loss were followed up from six months to nine years prior to this report. The success rate at one year was 94 per cent for the isolated popliteal segment grafts and 73 per cent for the tibial vessel grafts. The success rate after four years was 70 per cent for the isolated popliteal segment grafts and 63 per cent for the tibial vessel grafts. The clinical factors associated with the success of isolated popliteal segment bypass grafts and the factors apparently associated with failure of vein grafts in both of these groups with very poor distal arterial outflow are discussed. Our results suggest that either an isolated popliteal artery segment graft or a tibial vessel graft is a satisfactory means of treating these patients; however, a graft to an isolated popliteal segment is probably preferable to a graft to a tibial artery.

Aged↗