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J A Mannick

Publications and source records attributed to J A Mannick.

At least 163 records · Page 9Linked to original sources
PubMed1981

Femorotibial and femoroperoneal bypass vein grafts. A 15-year experience.

Results with 111 femoral-infrapopliteal vein grafts in 105 patients were subjected to life-table analysis. The overall five-year cumulative graft patency rate of 46% was associated with a 60% limb salvage rate. In cases in which the infrapopliteal graft represented the initial operative procedure, the five-year limb salvage and patency rates (69% and 56%, respectively) were significantly higher (P less than .05) than those achieved with secondary grafts (38% and 22%, respectively). Most limbs (79%) with failed intrapopliteal grafts, without further attempts at reconstruction, required major amputation within six months. The site of the distal anastomosis (anterior tibial, posterior tibial, or peroneal arteries) proved not to be a significant factor in determining long-term limb salvage or graft patency rates. Furthermore, the differences between five-year salvage and patency rates in diabetics (45% and 32%, respectively) and nondiabetics (65% and 53%, respectively) approached but did not reach statistical significance. It is believed these observations support the established but controversial role of infrapopliteal bypass in advanced peripheral occlusive diseases.

Actuarial Analysis↗
PubMed1981

Immunogenicity and cross-protection among B16 melanoma variants with differing proclivities to metastasize.

We report here the lack of any relationship between immunogenicity and the potential to metastasize among four B16 melanoma variants. Groups of C57BL/6J mice were immunized with one of four B16 variant lines (maintained by serial IM passage) that were shown in separate experiments to produce the following incidences of pulmonary metastases four to six weeks after isograft excision: M1, 10%-15%; M2 10%-20%; M3, 75%-80%; and M4, 75%-90%. After immunization, mice were challenged with one of the four variant lines in a crisscross fashion. Two challenge doses for each line were chosen on the basis of earlier experiments showing 100% and 50% challenge tumor take in nonimmunized animals. Despite earlier work published from this laboratory showing that splenocytes harvested from immunized mice could distinguish antigenic differences among the B16 variants, we could find no significant difference in immunogenicity or cross-protection among the lines regardless of their metastatic potential. We conclude that no correlation exists between the antigenic differences shown by in vitro splenocyte-mediated cytotoxicity assays among the B16 variants and in vivo immunogenicity or cross-protection experiments. Futhermore, the relationship (if any) between immunogenicity and the ability to metastasize among these B16 variants is not straightforward.

Animals↗
PubMed1981

Independence of renin production and hypertension in abdominal aortic aneurysmectomy.

Seventeen patients undergoing elective repair of abdominal aortic aneurysm were examined to determine the causal mechanism for postoperative hypertension. In nine patients who had elevated systemic pressure after surgery, there were no correlations between mean arterial pressure and values of peripheral renin activity or angiotensin II. Further, no relation was demonstrated between systemic pressure and the volumes of crystalloid, colloid infused or milliequivalents of sodium administered pre- and intraoperatively. Postoperative arterial pressure correlated best with the preoperative value.

Aged↗
PubMed1981

In vivo and in vitro effects of xenogeneic immune ribonucleic acid in patients with advanced renal cell carcinoma: a phase I study.

Based upon demonstration in our laboratory of repeated prevention of pulmonary metastases by adjuvant immune ribonucleic acid in animal preparations, xenogeneic immune ribonucleic acid was given in a phase I study to patients with advanced renal cell carcinoma. Six patients were treated with intravenous infusions of autologous lymphocytes incubated in vitro with immune ribonucleic acid extracted from splenocytes of guinea pigs immunized with the patient's own tumor. Serial peripheral blood lymphocytes were obtained during and after each treatment with immune ribonucleic acid for in vitro evaluation of cell-mediated cytolysis by 51chromium release assay and 125iodine iododeoxyuridine assay against allogeneic renal cell carcinoma targets and melanoma targets. Neither toxicity nor enhancement of tumor growth was observed. All patients demonstrated significantly increased cell-mediated cytolysis against allogeneic renal cell carcinoma targets but no change against melanoma targets. Increased cell-mediated cytolysis could be demonstrated in individual blood samples after incubation with immune ribonucleic acid. Further, progressive in vivo effect was demonstrated in in vitro assay of serial peripheral blood lymphocytes before each successive exposure to immune ribonucleic acid. Increased cell-mediated cytolysis persisted in peripheral blood lymphocytes up to 9 months after therapy. Although without controls 1 patient had complete response and 2 patients had partial responses (8 to 18 months). Two patients had stabilization of the disease for 3 to 4 months and 1 patient had progression of cerebral metastases. One patient is alive 24 months after therapy. These results would favor the institution of a randomized prospective trial in patients with advanced renal cell carcinoma or lesser tumor burdens.

Adenocarcinoma↗
PubMed1981

Secondary femoropopliteal reconstruction.

Retrospective analysis of the authors' experience with 109 primary femoropopliteal bypass vein grafts that failed allows description of three distinct modes of failure. Within 30 days of surgery, failure resulted primarily from technical or judgmental errors. The development of stenotic lesions within the vein graft caused a second group of failures during the first year after bypass. The third group most commonly failed due to progression of peripheral atherosclerosis a year or more following original bypass. No correlation was found, however, between the mode of failure and results of secondary femoropopliteal-tibial reconstruction, which yielded an overall 50% five-year cumulative limb salvage rate. The results indicate that this salvage rate can be anticipated regardless of the number of secondary operations required. The highest long-term patency rate was achieved when frequent postoperative follow-up examinations allowed recognition of graft failure prior to total occlusion. Under such circumstances a simple vein patch of stenotic lesions yielded an 85% five-year graft patency. Following actual thrombosis, however, the highest five-year patency rate was achieved when reconstruction was performed using a new vein graft; saphenous vein and arm vein were equally effective. When prosthetic material was used, no secondary graft remained patent beyond three years. Finally, when a proximal or distal portion of the original vein graft proved adequate in caliber following thrombectomy, it could be successfully incorporated in a secondary reconstruction with the expectation of a 50% five-year limb salvage rate. No statistically significant difference was found in salvage rates among each of the patient groups representing the three common modes of graft failure. This finding, coupled with an acceptable 2.5% operative mortality rate, provides justification for an aggressive approach toward secondary femoropopliteal reconstruction.

Arteriosclerosis↗
PubMed1981

Maintenance of cardiodynamics with aspirin during abdominal aortic aneurysmectomy (AAA).

The importance of prostacyclin (PGI2) and thromboxane (Tx) medication of depressed cardiac performance during abdominal aortic aneurysm operative surgery was studied by contrasting the effects of 650 mg aspirin administered 12 hours before operation to that of a placebo. In 11 patients who received a placebo, the stable metabolite of PGI2, 6-keto-PGF1 alpha rose from 0.050 +/- 0.032 eta grams/ml to 0.419 +/- 0.257 eta grams/ml (p less than 0.01) 30 minutes after the skin incision. The stable metabolite of TxA2, TxB2 did not increase until the aorta was clamped when TxB2 rose from 0.089 +/- 0.054 eta grams/ml to 0.193 +/- 0.138 eta grams/ml (p less than 0.05); this was prior to blood transfusion. During aortic clamping cardiac output decreased 27% (p less than 0.001). In vitro testing of patient plasma showed: 1) depressed developed tension (Tpd) of a rat papillary muscle by 16% (p less than 0.05); 3) reduction of Ca++-ATPase and Mg++-ATPase activity in a rat myocardial subfraction of sarcoplasmic reticulum (p less than 0.05); 3) reduction of Ca++-ATPase in a rat myocardial subfraction of myofibrils (p less than 0.01). Aspirin administered to 11 patients produced no measurable changes in blood loss or fluid requirements. Aspirin lowered preoperative 6-keto-PGF1 alpha and TxB2 levels (p less than 0.01) and prevented an increase of either agent during operation. The low Tx levels were associated with a stable cardiac output during aortic clamping. Further, plasma obtained from aspirin-treated patients did not depress papillary muscle contractility nor decrease ATPase activity of either myocardial subfraction. The observation that TxB2 when added to a papillary muscle or myocardial subfractions, did not decrease Tpd or ATPase suggests that TxB2 plays an indirect role in altering cardiac muscle activity. The results indicate that Txs modulate cardiac depression, which can be prevented with 650 mg aspirin before operation.

6-Ketoprostaglandin F1 alpha↗
PubMed1981

Cardiopulmonary function following transfusion of three red blood cell products in elective abdominal aortic aneurysmectomy.

In order to evaluate the importance of red cell O(2) affinity of transfused blood on cardiac performance and adverse effects of transfusion on lung function, a prospective double-blind protocol was used in 27 patients undergoing abdominal aortic aneurysmectomy. Three types of blood were administered: packed red cells (PC), washed red cells (WC) and high 2,3 DPG red cells (2,3 DPG). An average of 4.5 units of blood was used per patient. Transfusion of 2,3 DPG blood resulted in maintenance of in vivo P(50) during surgery and an increase to 31.2 torr after operation (p < 0.001). An intraoperative fall in in vivo P(50) to 23.2 +/- 2.0 torr was observed in patients who were transfused with PC (p < 0.001) and to 25.1 +/- 2.6 torr with WC (p < 0.005). A fall in body temperature averaging 2.2 C intraoperatively was noticed in all three groups. After operation, in vitro P(50) decreased in patients transfused with PC (p < 0.005) and WC (p < 0.005) while it remained unchanged in the high 2,3 DPG group. This was consistent with the decrease of red cell 2,3 DPG in the PC (p < 0.001) and WC groups (p < 0.01) and maintenance in the 2,3 DPG group. Left ventricular stroke work and volume loading Starling type myocardial performance curves were similar for the three groups. Microaggregates measured by Coulter counting and screen filtration pressure were the same for all three products in samples drawn on both sides of the 40 microm transfusion filter. There was no relationship of transfusion volumes or type of blood product to changes in lung function (physiologic shunting, dynamic compliance and pulmonary arterial pressure) in the three groups of patients. The false negative, beta, error of missing a true 25% difference was less than 10%. It is concluded that 2,3 DPG enriched red cells improved oxygen availability, but that a 4.5 unit transfusion of any of the three blood products did not influence lung function or myocardial performance following aneurysmectomy.

2,3-Diphosphoglycerate↗
PubMed1981

Suppressive serum, suppressor lymphocytes, and death from burns.

Both suppressor lymphocytes and serum immunosuppressive factors have been found in patients who have had major thermal burns, and may inhibit host resistance to the bacteria invariably present in burn wounds. However, the relationship and clinical importance of these two manifestations of impaired immune reactivity are poorly understood. Eighteen patients (aged 20-84 years) with full thickness burns of varying severity have been studied, and the clinical course related to the presence of nonspecific immunosuppressive serum and circulating suppressor lymphocytes. Serum factors capable of suppressing the phytohemagglutinin (PHA) response of normal lymphocytes usually appeared early and were detected in 15 of the 18 patients at some time during the illness. Thirteen of these patients developed systemic infection. Depression of the PHA response of peripheral blood lymphocytes was much less common and was associated with this finding died. No patients who did not have severe depression of the lymphocyte response to PHA died. Nonadherent leukocyte (NA leukocyte) populations exhibiting a depressed PHA response were capable of suppressing the PHA response of normal human lymphocytes and, therefore, contained suppressor cells.

Adult↗
PubMed1981

Suppressive effects of cyclosporin A on the induction of alloreactivity in vitro and in vivo.

The purpose of the present study was the investigation of the effect of cyclosporin A (CsA) on the induction of alloreactivity in vitro and in vivo. Addition of CsA to mouse mixed lymphocyte cultures (MLC) not only inhibited lymphocyte proliferation but also prevented the generation of alloreactive cytolytic lymphocytes (CL). It was necessary to add CsA within the first 3 days of a 5-day MLC in order to achieve a significant suppressive effect. Lymphocytes, after being cultured in MLC with CsA for 4 days or longer, were incapable of being activated upon re-exposure to the same alloantigens although their responses to unrelated antigens remained intact, indicating antigen specificity of the suppression induced by CsA and its long-lasting effect. Furthermore, lymphocytes from mice treated with CsA after allosensitization failed to manifest primary cytotoxicity and could not be reactivated in a secondary MLC. Finally, CsA had no effect on those CL already generated, suggesting that CsA acts upon the induction of CL rather than the effector phase.

Animals↗
PubMed1981

The ischemic leg.

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Angioplasty, Balloon↗
PubMed1980

Femoropopliteal bypass grafting for intermittent claudication: is pessimism warranted?

From 1965 to 1979, 43 consecutive patients underwent 51 femoropopliteal reconstructions to relieve disabling claudication. This represented 17% of 298 femoropopliteal and femorotibial reconstructions performed by the same surgical team during this period of time. All patients operated on for claudication experienced relief of symptoms after surgery. There was no operative mortality and there was only one case of immediate graft failure. Cumulative graft patency was 93% at two years and 88% at five years by life table analysis. One patient who underwent below-knee amputation 12 years after his initial femoropopliteal graft was the only patient who lost a limb at any time during the follow-up period. On the basis of this experience, we now offer femoropopliteal grafting to any active individual who is disabled by intermittent claudication on the basis of superficial femoral artery occlusive disease.

Adult↗
PubMed1980

Volume loading and vasodilators in abdominal aortic aneurysmectomy.

Preoperative infusion of volume to increase the wedge pressure will maintain stable flow and arterial pressure at the time of aortic declamping. Usually 1,500 ml of balanced salt solution given with 75 g of albumin is sufficient to accomplish this purpose. Pressor or inotropic agents are not required. In our experience 14 percent of patients will have a down-slope in the preoperative myocardial performance curves. In these persons, volume infusions should be adjusted to keep the pulmonary arterial wedge pressure on the ascending portion of the curve. The use of vasodilator agents in normotensive patients has a deleterious effect on cardiac performance.

Aged↗
PubMed1980

Aortic aneurysm repair. Reduced operative mortality associated with maintenance of optimal cardiac performance.

Recent advances in the operative management of aortic aneurysms have resulted in a decreased rate of morbidity and mortality. In 1972, we hypothesized that a further reduction in operative mortality might be obtained with controlled perioperative fluid management based on data provided by the thermistor-tipped pulmonary artery balloon catheter. From 1972 to 1979 a flow directed pulmonary artery catheter was inserted in each of 110 consecutive patients prior to elective or urgent repair of nonruptured infrarenal aortic aneurysms. The slope of the left ventricular performance curve was determined preoperatively by incremental infusions of salt-poor albumin and Ringer's lactate solution. With each increase in the pulmonary arterial wedge pressure (PAWP), the cardiac index (CI) was measured. The PAWP was then maintained intra- and postoperatively at levels providing optimal left ventricular performance for the individual patient. There were no 30-day operative deaths among the patients in this series and only one in-hospital mortality (0.9%), four months following surgery. The five-year cumulative survival rate for patients in the present series was 84%, a rate which does not differ significantly from that expected for a normal age-corrected population. Since the patient population was unselected and there were no substantial alterations in operative technique during the present period, these improved results support the hypothesis that operative mortality attending the elective or urgent repair of abdominal aortic aneurysm can be minimized by maintenance of optimal cardiac performance with careful attention to fluid therapy during the perioperative period.

Adult↗
PubMed1980

Generation of suppressor cells in mice after surgical trauma.

Immunoincompetency is often seen in patients after various types of trauma and is associated with increased morbidity and mortality from infectious complications. To understand better the immunologic impairment associated with trauma, we have studied this phenomenon in an animal model. Splenocytes from mice traumatized by amputation of their right hind limbs were consistently shown to have a diminished capacity to proliferate in response to alloantigens and to form alloreactive cytolytic cells in mixed lymphocyte cultures. Anesthesia itself had no effect in this system. The immunoincompetency was detected from 2 h to 6 d after surgical trauma and was completely reversed by removing adherent and phagocytic cells from the splenocytes. Furthermore, addition of splenocytes from traumatized mice to mixed lymphocyte cultures from normal mice prevented normal lymphocytes from responding to alloantigens, suggesting the existence of suppressor cells. The suppressor cells were found to adhere to glass and to nylon wool columns, and were contained within an esterase-positive cell population. They were insensitive to treatment with anti-Thy 1.2 and anti-Ig sera in the presence of complement. Therefore, the present results suggest that a Thy 1.2-negative, Ig-negative, esterase-positive cell population capable of adhering to glass and nylon wool, presumably macrophages, was responsible for the inhibition of the responsiveness of lymphocytes to alloantigens in traumatized animals.

Animals↗