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Biomedical subjects

J A Sullivan

Publications and source records attributed to J A Sullivan.

At least 55 records · Page 3Linked to original sources

Different sensitivities of neutrophil responses to a selective protein kinase C inhibitor Ro 31-8425; redundancy in signal transduction.

Previous studies implicating a role for protein kinase C (PKC) in mediating stimulation of cellular responses by physiological agonists have relied on use of non-specific inhibitors or direct stimulation of PKC by phorbol esters. However, much of this evidence is questionable. Here, we have investigated the effects of a potent and selective PKC inhibitor, Ro 31-8425, on three different responses of human neutrophils stimulated by either a physiological agonist, C5a, or a phorbol ester, PMA. The responses studied were superoxide generation, collagenase secretion and adhesion to endothelial cells. In each case, the PMA-stimulated response was more sensitive to inhibition than the C5a-stimulated response. Even the PMA-stimulated responses differed in their sensitivity to inhibition, with superoxide production being the most sensitive and adhesion at least sensitive. The different sensitivities of the PMA stimulated responses suggest that, although activation of PKC stimulates the responses, either different degrees of activation or different isozymes are required for the different responses. The lower sensitivity of the C5a-stimulated responses in each case suggests that PKC activation, if needed at all, is not rate limiting in these signal transduction pathways. These results emphasize the redundancy in intracellular signal transduction.

Collagenases↗

Magnesium in cardioplegia: is it necessary?

OBJECTIVE: To study the effectiveness of magnesium in cardioplegic solution in preventing postoperative arrhythmias and perioperative ischemia. DESIGN: Randomized, control study. SETTING: The cardiovascular surgery division of a major referral centre for the maritime provinces of Canada. PATIENTS: Fifty patients scheduled to undergo coronary artery bypass who had a normal ejection fraction, normal preoperative serum magnesium level and no history of atrial or ventricular arrhythmia were randomized into two groups of 25 patients. One group received magnesium sulfate (15 mmol/L) in the cardioplegic solution (group 1), the other (control) group did not receive magnesium sulfate in the cardioplegic solution (group 2). INTERVENTION: Coronary artery bypass grafting during which myocardial protection was provided by intermittent cold blood cardioplegia. OUTCOME MEASURES: Postoperative serum magnesium levels, cardiac-related death, infarction and arrhythmias. RESULTS: All group 2 patients had a lower postoperative serum magnesium level than group 1 patients. There were no cardiac-related deaths in either group. More group 2 patients had ischemic electrocardiographic changes than group 1 patients (p < 0.03). Non-Q wave myocardial infarction occurred in two patients (one in each group). Eight patients in group 2 had atrial fibrillation compared with five patients in group 1. Ventricular ectopia occurred significantly (p < 0.01) more frequently in group 2 than in group 1. CONCLUSION: The addition of magnesium to the cardioplegic solution is beneficial in reducing the incidence of perioperative ischemia and ventricular arrhythmia in patients who undergo coronary bypass grafting.

Aged↗

Adolescent femoral shaft fractures: rigid versus flexible nails.

Twenty-one skeletally immature patients between 11 and 16 years of age were treated operatively for a unilateral femoral shaft fracture. Eleven patients underwent fixation with flexible nails and 10 with rigid nails. The patients were studied retrospectively to determine the similarity of the groups. Each method of fixation was then compared to determine the technical ease and final outcome. Both methods gave excellent final radiographic alignment with minimal complications. Flexible nailing required much less operative time and less fluoroscopy time. Estimated cost of using Ender nails is much less than using Russell-Taylor interlocking nails.

Adolescent↗

Evidence of type 2 herpes simplex infection in human coronary arteries at the time of coronary artery bypass surgery.

OBJECTIVE: To examine histologically biopsies from the coronary arteries of patients undergoing coronary artery bypass grafting (CABG) for evidence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) antigen and to correlate the incidence with pathological and clinical data. DESIGN: Sequential patients undergoing CABG in whom adequate tissue could be obtained for histology. SETTING: University teaching hospital. PATIENTS: Forty-six patients were enrolled. Thirty-one provided sufficient tissue and clinical information for the analysis. METHODS: Biopsy material was collected in the operating room and prepared immediately for histology and electron microscopy. Slides were prepared by staining with hematoxylin and eosin, Masson trichrome, avidin biotin complex immunoperoxidase for HSV-1 and HSV-2 protein and specific DNA probes for HSV-1 and HSV-2 by hybridization. Clinical data were obtained in structured interviews. RESULTS: Sixty-one per cent of biopsies demonstrated evidence of inflammation, 45% were positive for antigen to HSV-2 and only one to HSV-1. Significant positive correlations were detected between inflammatory cells in the biopsy and a recent history of cold sores and between the presence of the infiltrate and positivity to HSV-2 antigen. CONCLUSION: A correlation exists between HSV-2 infection and the inflammatory response associated with atherosclerosis.

Adult↗

Effect of a selective protein kinase C inhibitor, Ro 31-8425, on Mac-1 expression and adhesion of human neutrophils.

The role of protein kinase C (PKC) in mediating up-regulation of macrophage 1 adhesion protein (Mac-1) and adhesion of neutrophils in response to physiological agonists is not clear. Previous studies have relied on use of phorbol esters to activate PKC directly or on results obtained with non-selective inhibitors of protein kinases. 3-[8-(Aminomethyl)-6,7,8,9-tetrahydropyridol[1,2-a]-indol-10-yl]-4 -(1- methyl-3-indolyl)-1H-pyrrole-2,5-dione hydrochloride (Ro 31-8425) is a potent and highly selective inhibitor of PKC (Bit et al. J. Med. Chem. 1993. 36: 21). In these studies Ro 31-8425 has been used to define, more definitively, the role of PKC in mediating complement fragment C5a (C5a)-stimulated up-regulation of Mac-1 and adhesion of neutrophils to endothelial cells and to bovine serum albumin (BSA)-coated plastic. Phorbol 12, 13 dibutyrate (PBu2) increased surface expression of Mac-1 and stimulated adhesion of neutrophils to endothelial cells and to BSA-coated plastic. This confirms previous reports that activation of PKC can stimulate these responses. The PKC inhibitor, Ro 31-8425, inhibited the PBu2-stimulated responses, which confirms that Ro 31-8425 was effective in inhibiting PKC in these neutrophils. A more physiological agonist, C5a, also increased surface expression of Mac-1 and adhesion of neutrophils to endothelial cells and BSA-coated plastic. However, the responses to C5a were unaffected by Ro 31-8425. These results suggest that, although activation of PKC can promote up-regulation of Mac-1 and adhesion of neutrophils, this does not appear to be the physiological pathway. A non-selective protein kinase inhibitor, staurosporine, inhibited both PBu2 and C5a-stimulated adhesion. This suggests that a protein kinase other than PKC, possibly a tyrosine protein kinase, is likely to be involved in mediating C5a-stimulated Mac-1 up-regulation and adhesion. These results emphasise the need for caution in interpreting experiments and assuming a role for PKC. Use of a potent and selective inhibitor of PKC, Ro 31-8425, provides more definitive information.

Alkaloids↗

Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise.

A large set of sentence materials, chosen for their uniformity in length and representation of natural speech, has been developed for the measurement of sentence speech reception thresholds (sSRTs). The mean-squared level of each digitally recorded sentence was adjusted to equate intelligibility when presented in spectrally matched noise to normal-hearing listeners. These materials were cast into 25 phonemically balanced lists of ten sentences for adaptive measurement of sentence sSRTs. The 95% confidence interval for these measurements is +/- 2.98 dB for sSRTs in quiet and +/- 2.41 dB for sSRTs in noise, as defined by the variability of repeated measures with different lists. Average sSRTs in quiet were 23.91 dB(A). Average sSRTs in 72 dB(A) noise were 69.08 dB(A), or -2.92 dB signal/noise ratio. Low-pass filtering increased sSRTs slightly in quiet and noise as the 4- and 8-kHz octave bands were eliminated. Much larger increases in SRT occurred when the 2-kHz octave band was eliminated, and bandwidth dropped below 2.5 kHz. Reliability was not degraded substantially until bandwidth dropped below 2.5 kHz. The statistical reliability and efficiency of the test suit it to practical applications in which measures of speech intelligibility are required.

Acoustic Stimulation↗

Does hypothermia or hyperventilation affect enflurane MAC reduction following partial cardiopulmonary bypass in dogs?

This study in dogs determined the effect of systemic cooling and arterial hypocarbia during cardiopulmonary bypass (CPB) on the requirements for enflurane anaesthesia (MAC) before and after CPB. Twelve mongrel dogs were each anaesthetized with enflurane in oxygen on two separate occasions. End-tidal enflurane concentration was measured with a Puritan-Bennett Anaesthesia Agent Monitor. Using the tail-clamp method, MAC was determined twice with a one-hour interval between measurements (MAC 1 and MAC 2). Partial CPB was then initiated using femoral arterio-venous cannulation and maintained for one hour. Following separation from CPB, MAC was again determined twice with a one hour interval between measurements (MAC 3 and MAC 4). Dogs were randomly assigned according to PaCO2 management during CPB (low, 17.6 +/- 8.6 mmHg vs high, 38.9 +/- 11.5 mmHg), and then subjected to two experimental conditions. The first experiment on each dog was undertaken using normothermia during CPB (warm, 35-37 degrees C) while the second experiment (at least two weeks later) was conducted using hypothermia during CPB (cold, 30 degrees C). Analysis of the data, using ANOVA for repeated measures, revealed MAC 3 (1.95 +/- 0.33%, post-CPB) to be reduced when compared with MAC 1 (2.18 +/- 0.28%, P < 0.01) or MAC 2 (2.10 +/- 0.22%, P < 0.01), determined before CPB. Multivariate repeated measures analysis revealed no independent effects of hypothermia or arterial hypocarbia during CPB, on MAC reduction. By the time of the second experiment in each dog (two weeks later), MAC had returned to baseline levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

Capitellocondylar total elbow replacement in rheumatoid arthritis. Long-term results.

We evaluated the long-term results of 202 capitellocondylar total elbow replacements that had been performed, from July 1974 through June 1987, in 172 patients. The duration of follow-up averaged sixty-nine months (range, twenty-four to 178 months). At the most recent follow-up examination, use of a 100-point rating score demonstrated an improvement from an average preoperative score of 26 points (range, 2 to 50 points) to an average postoperative score of 91 points (range, 45 to 100 points). The most improvement occurred in the categories of relief of pain, functional status, and range of motion in all planes except extension. The improvements in these categories and in the roentgenographic appearance that were seen in the early postoperative period did not deteriorate with time. The average preoperative arc of motion at the elbow ranged from -37 degrees of extension to 118 degrees of flexion. The average postoperative arc of motion at the elbow ranged from -30 degrees of extension to 135 degrees of flexion. Supination improved from 45 degrees preoperatively to 64 degrees postoperatively; pronation improved from 56 degrees preoperatively to 72 degrees postoperatively. The roentgenograms showed a radiolucent line adjacent to eight humeral and nineteen ulnar components; most of the lines were incomplete and one millimeter wide or less. Revision of the prosthesis was necessary in three elbows (1.5 per cent) because of loosening without infection, and in three additional elbows because of dislocation of the prosthesis. Complications included deep infection in three elbows (1.5 per cent); problems related to the wound in fifteen (7 per cent); permanent, partial sensory ulnar-nerve palsy in five (2.5 per cent); permanent, partial motor ulnar-nerve palsy in one (0.5 per cent); and dislocation in seven (3.5 per cent).

Adult↗

Is pinning in situ a safe procedure for slipped capital femoral epiphysis?

This report reviews the results of 37 patients with 46 involved hips treated with pinning for slipped capital femoral epiphysis. Particular attention was given to incidence of complications, including avascular necrosis, chondrolysis, and penetration of the joint. Of 46 hips with 1-year follow-up, there were no cases of chondrolysis. Of 23 hips with 2-year follow-up, there was only 1 case of avascular necrosis. Pin penetration, recognized at the time of surgery, produced no significant sequelae. Pinning can produce satisfactory results without a significant incidence of major complication.

Adolescent↗

Amplification for listeners with steeply sloping, high-frequency hearing loss.

Two experiments were conducted to determine the effects of various upper cutoff frequencies on performance of listeners with steeply sloping, high-frequency hearing loss. The upper cutoff frequency of individually prescribed responses was systematically adjusted to 0.71, 1.79, and 6.0 kHz. Measures of nonsense syllable recognition and subjective ratings of speech intelligibility and speech quality were obtained at three overall gain settings for each frequency response. Experiment 1 assessed performance on tests in quiet and Experiment 2 assessed performance on tests in noise. Nonsense syllable recognition improved as the upper cutoff frequency increased, particularly for tests in noise. In contrast, the subjects gave significantly poorer quality ratings for the shaped response with the highest cutoff frequency (6.0 kHz). Few significant effects of cutoff frequency were found for ratings of intelligibility in either quiet or noise.

Aged↗

Hip stabilization in severely involved cerebral palsy patients.

Thirty-two patients (48 hips) with total body involved cerebral palsy (CP) underwent medial release and proximal femoral osteotomy for hip subluxation or dislocation. Twenty-eight hips were rated good, 15 were rated fair, and five were rated poor at follow-up. The better located the hip preoperatively and the better the reduction obtained at operation, the better the final result. The major factor that correlated with a good result was early operation, performed before significant deformity had occurred.

Adolescent↗

The accuracy of tibial intramedullary alignment devices in total knee arthroplasty.

The accuracy of a tibial medullary alignment device is assessed radiographically in 30 varus and 30 valgus knees undergoing total knee arthroplasty. The results suggest that although the device is reliable and accurate for varus knees, it may lead to malalignment of up to 5 degrees in valgus knees. Overall neutral alignment was achieved in 83% of the varus knees and 37% of the valgus knees. Tibial bowing was the main source of error and was present in 66% of the valgus knees, with mean of 3 degrees. Preoperative long films or cross-checking with external alignment devices is recommended to assure neutral alignment in genu valgus deformity.

Congenital Abnormalities↗

Does cardiopulmonary bypass alter enflurane requirements for anesthesia?

This study on dogs determined whether the requirement for enflurane anesthesia was different pre- versus postcardiopulmonary bypass (CPB). Male mongrel dogs (n = 16) were anesthetized with enflurane in oxygen. Tracheal intubation was performed, monitors placed, and end-tidal enflurane concentration measured via a Puritan-Bennett Anesthesia Agent Monitor. MAC was determined by the tail-clamp method. CPB was then initiated using aortoatrial (n = 6, group 1) or femoral artery-vein (n = 4, group 2) cannulation or none (n = 6, group 3, control). CPB was maintained for 1 h using a bubble oxygenator, a crystalloid prime, and flows of approximately 70-80 ml/kg with a mean systemic pressure maintained between 50-70 mmHg. Following separation from CPB, MAC was again determined. The reduction in enflurane MAC following CPB was 30.1 +/- 21.5% (mean +/- SD; P less than 0.05 vs. pre-CPB) in group 1 but there was a wide range of reduction produced (3.8-58.8%). The degree of MAC reduction (19.8 +/- 8.6%; P less than 0.05 vs. pre-CPB) produced by CPB in group 2 was much less variable in degree (range 13.0-32.4%) but did not differ from group 1. Although pre- versus post-CPB mean systemic pressure fell from 83 +/- 13 to 69 +/- 15 mmHg (P less than 0.05), this is above the level likely to produce a reduction in MAC. No other significant hemodynamic changes were observed. Temperature pre- versus post-CPB was not different. The degree of hemodilution and acid-base disturbances are unlikely to be the explanation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

Ligamentous injuries of the knee in children.

Ligamentous injuries, although uncommon in the skeletally immature patient, can be found in isolation or associated with physeal injury or long-bone fracture. Four new cases of ligamentous injury in the child show that recognition and management of these injuries are important to achieve good recovery. In addition to history and physical examination, standard and stress roentgenographs, examination under anesthesia, and arthroscopy are important for early diagnosis.

Adolescent↗

Both recombinant interleukin-1 (beta) and purified human monocyte interleukin-1 prime human neutrophils for increased oxidative activity and promote neutrophil spreading.

Both purified human monocyte interleukin-1 and recombinant interleukin-1 (beta) primed neutrophils for increased superoxide production and chemiluminescence in response to f-met-leu-phe. In addition, purified human monocyte interleukin-1 and recombinant interleukin-1 (beta) altered neutrophil shape. Recombinant interleukin-1 (alpha) used at the same concentration of interleukin-1 (beta) did not prime neutrophils for increased superoxide production after stimulation with f-met-leu-phe. Interleukin-1 expressed by monocytes in response to endotoxin stimulation could act as a modulator of neutrophil function.

Humans↗

Giant cell reaction in a phalangeal bone.

A case of the rare and non-neoplastic lesion, giant cell reaction of bone, is described. The pathological and radiological features of this lesion are reviewed and an aetiological mechanism is proposed to account for its unique histopathological features. Recognition of this lesion and its non-neoplastic nature are important so as to avoid surgical ablation of the affected bone.

Adult↗