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Biomedical subjects

J B Adams

Publications and source records attributed to J B Adams.

At least 37 records · Page 2Linked to original sources

Complications of extraperitoneal balloon dilation.

The success of balloon dissection techniques has given laparoscopic surgeons the option of a direct extraperitoneal approach to urologic disease. Unfortunately, these techniques are not without risks. We report on four cases of complications secondary to balloon dilation. In two instances, balloon misplacement caused dissection between muscle layers. This resulted in conversion to an open procedure in one instance and to a postoperative flank hernia in another. Balloon rupture with loose fragments occurred in two patients. In one of these cases, the peritoneum was lacerated, with balloon fragments displaced within the peritoneal cavity.

Adult↗

High-intensity focused ultrasound ablation of rabbit kidney tumors.

High-intensity focused ultrasound (HIFU) is a noninvasive surgical technique in which ultrasound energy is delivered transcutaneously to a discrete area within the body. This energy can result in a well-defined zone of cellular death within the targeted tissue. We used HIFU in an effort to ablate rabbit VX-2 kidney tumors. A tumor cell suspension was injected into a renal segmental artery (Phase 1, nine rabbits) or directly into the lower pole parenchyma (Phase 2, nine rabbits). After a 2-week incubation period, open direct contact (Phase 1) or transcutaneous ablation (Phase 2) was performed. In Phase 1, after sonablation, there was pathologic evidence of tissue destruction in nine animals, and seven had both gross and histologic evidence of tumor ablation. There was sharp demarcation between viable and ablated tissue. In Phase 2, pathologic evidence of kidney ablation was seen in seven of nine animals. However, only two rabbits showed the well-demarcated effects of ablation in the tumor. High-intensity focused ultrasound can be effective at causing cell death in renal tumors and surrounding renal tissue. However, with the present ultrasound technology, imaging of renal lesions in the rabbit model is not adequate to consistently localize and completely ablate tumor.

Animals↗

Venous dissection injuries during laparoscopic urological surgery.

PURPOSE: The incidence of major venous dissection injuries during laparoscopic procedures is assessed and recommendations are made for management. MATERIALS AND METHODS: We evaluated our experience with all major intra-abdominal injuries occurring during 274 consecutive laparoscopic procedures performed within a 4-year period. Five patients (1.7%) had a total of 6 major vascular injuries, including gonadal vein avulsion in 1 case, lumbar vein avulsion in 1 and a tear in the inferior vena cava in 4. Two patients sustained inferior vena caval injuries during nephrectomy because of adhesions from previous surgery and 1 of them had 2 venacavotomies. RESULTS: All vascular injuries were venous and 5 of the 6 major vessel injuries were treated successfully endoscopically via intracorporeal suturing techniques. The injury requiring open repair was a gonadal vessel avulsion that occurred during retroperitoneal lymph node dissection early in our laparoscopic experience. Major vessel injuries were more likely to occur during complex laparoscopic procedures in patients who had undergone previous ipsilateral retroperitoneal surgery. CONCLUSIONS: In select situations new techniques can allow for safe endoscopic control and repair of venous injuries during laparoscopic surgery.

Adult↗

New laparoscopic suturing device: initial clinical experience.

OBJECTIVES: New instrumentation and techniques have enabled laparoscopic surgeons to perform complicated reconstructive procedures. Few centers have attempted these procedures because of the excessive time involved with laparoscopic suturing. The Endo stitch suture device was developed to facilitate suture placement. We clinically compared conventional intracorporeal suturing and Endo Stitch suturing for laparoscopic suture placement and knot tying. METHODS: Intracorporeal suturing was used to complete laparoscopic dismembered pyeloplasties and bladder neck suspensions. Sutures were placed with either needle holders and graspers or the automatic suture device. A total of 85 maneuvers were assessed. Operative videotapes were reviewed to assess accuracy of suture placement, knot tying, and time to place suture and tie knots. All suturing was performed by an experienced laparoscopist. RESULTS: Accuracy of stitch placement and knot tying were equivalent. The average time for stitch placement with the Endo Stitch was 43 +/- 27 seconds (n = 41). This was significantly less than the average stitch placement time for conventional suturing, which was 151 +/- 24 seconds (n = 14). The Endo Stitch knot tying was completed in an average of 74 +/- 50 seconds (n = 17), whereas knot tying with the conventional technique took 197 +/- 70 seconds (n = 13). The needle is automatically loaded in the Endo Stitch after each suture and is immediately ready. CONCLUSIONS: The Endo Stitch device reduced the amount of time needed for placement of stitches and knot tying. Reconstructive laparoscopic procedures requiring multiple suture placement may be completed in a shorter time period using this instrument.

Equipment Design↗

Adhesion formation after transperitoneal nephrectomy: laparoscopic v open approach.

The risk of postoperative adhesion formation is a significant concern with transperitoneal laparoscopic surgery. To evaluate the incidence of adhesions after major interventional urologic laparoscopy, 16 pigs underwent either laparoscopic (N = 8) or transperitoneal open (N = 8) nephrectomy. Adhesions occurred at 12.5% of the operative sites in the laparoscopic group compared with 75% of the operative sites of the open group. Adhesions were present along the incision site in all the pigs in the open group compared with 5 of 40 (12.5%) trocar sites in the laparoscopic group. Adhesion number, grade, and extent were significantly greater in the open group than the laparoscopic group for both nephrectomy and access (incision/trocar) sites (p < 0.05). Transperitoneal laparoscopic urologic surgery in the porcine model results in a marked decrease in adhesion formation compared with incisional transabdominal surgery.

Abdominal Muscles↗

A double-blind, placebo-controlled study of a CCK-B receptor antagonist, CI-988, in patients with generalized anxiety disorder.

This multicenter, double-blind, placebo-controlled, parallel-group, randomized study assessed the efficacy, safety, and tolerability of a novel CCK-B antagonist CI-988 in the treatment of generalized anxiety disorder (GAD). Patients received placebo or CI-988 (300 mg/day, thrice daily) for 4 weeks. Patients with a primary diagnosis of GAD according to DSM-III-R criteria were randomized. The study design included a 1- to 2-week single-blind placebo baseline phase, followed by a 4-week double-blind treatment phase. Efficacy was measured weekly by Hamilton Rating Scale for Anxiety (HAM-A), Clinical Global Impressions of Severity and Change, UCLA-Multi Dimensional Anxiety Scale, and Hamilton Rating Scale for Depression. Patients were also evaluated to determine whether they met criteria for irritable bowel syndrome (IBS) at screening and were evaluated with a gastrointestinal visual analog scale at each visit. Eighty-eight patients were randomized to CI-988 (N = 45) and placebo (N = 43) at three centers. CI-988 did not demonstrate an anxiolytic effect superior to placebo in this clinical trial. There was no significant difference in mean change in HAM-A total between placebo (-7.73) and CI-988 (-8.64). However, a significant treatment-by-center interaction and a highly variable placebo response rate among the three centers limit the interpretation of the results. CI-988 did not have an effect on symptoms of IBS other than diarrhea, which worsened in patients with IBS. Other than a higher incidence of some gastrointestinal symptoms (diarrhea, dyspepsia, flatulence, and nausea), CI-988 was well tolerated. Results suggest that testing higher oral doses of CI-988 may be warranted.

Adult↗

Comparison of robotic versus human laparoscopic camera control .

PURPOSE: We investigated the accuracy and use of a robotic surgical arm compared to a human surgical assistant during urological laparoscopic surgery. MATERIALS AND METHODS: A total of 11 patients undergoing pelvic laparoscopic procedures that required identical bilateral surgical manipulations was evaluated. On 1 side a robotic surgical arm was used to manipulate the laparoscopic camera, while on the contralateral side the camera was positioned by a human surgical assistant. The side (left versus right) on which the robot was used was alternated with each case. Parameters assessed included operative time, erroneous camera motions, complications and outcome. RESULTS: All procedures were successfully completed without complications. Laparoscopic camera positioning was significantly steadier with less inadvertent movements when under robotic control (p < 0.0005). Operative times during dissections using the robot or human assistant were not statistically different. CONCLUSIONS: A robotic device can more effectively manipulate and accurately control the video endoscope than a human assistant during laparoscopic procedures.

Female↗

Complete robot-assisted laparoscopic urologic surgery: a preliminary report.

BACKGROUND: The feasibility and applicability of using surgeon-controlled robotic arms as a substitute for surgical assistants during urologic laparoscopic surgery was assessed. STUDY DESIGN: Seventeen laparoscopic procedures (nephrectomy, n = 4; retroperitoneal lymph node sampling, n = 2; varix ligation, n = 2; pyeloplasty, n = 3; Burch bladder suspension, n = 2; pelvic lymph node dissection, n = 1; orchiopexy, n = 1; ureterolysis, n = 1; and nephropexy, n = 1) were performed by a single laparoscopic surgeon assisted by one or two robotic arms directly controlled by the operating surgeon. One robotic arm controlled the laparoscope and was maneuvered by a foot pedal. The second robotic arm served as a retractor and was manipulated by a hand control. Assessment of robotic positioning, laparoscopic instrument port placement, time for setup and breakdown of the operative field, operative time, outcome, and operative complications were made for each procedure and compared with historical human-assisted laparoscopic procedures. RESULTS: Standard laparoscopic port placement was adequate for use of the robotic arms. All procedures were successfully completed with three minor surgical complications not related to the use of the robotic arm. Robotic arm positioning on the operating room table differed for each type of procedure, yet placement of the robotic arm controlling the laparoscope on the surgeon's side provided optimal surgical views. In three cases, intraoperative bleeding required human assistance for camera control. There was no increase in operating time when the robotic arms were used. There was no difference between the setup and breakdown time for this series of complete robot-assisted procedures when compared with either a nonrobot-assisted series (p > 0.05) or another robotic series completed prior to initiation of this study when no focus was made on setup and breakdown times and in which the robotic arm and human surgical assistant were compared (p < 0.05). CONCLUSIONS: We found that simultaneous use of remote controlled robotic arms as surgical assistants is feasible in genitourinary laparoscopic surgery. The potential long-term cost effectiveness of using robotic surgical assistants in laparoscopic surgery highlights the economic impact of this research and warrants further investigation.

Adult↗

Results of drug screening from a producer's view.

The dairy industry is faced with increasing governmental and public concern about the safety of the nation's milk supply. New regulations under the Grade A Pasteurized Milk Ordinance require that prescription drugs be properly labeled and that all tanker loads of milk be tested for beta-lactam antimicrobial residues. Concern over the use of animal drugs in an extralabel manner has prompted the National Milk Producers Federation and the American Veterinary Medical Association to develop a quality assurance program for on-farm residue prevention known as the Dairy Quality Assurance 10-Point Milk and Dairy Beef Residue Prevention Protocol. The program promotes the concept of Hazard Analysis Critical Control Points, applied to a pre-harvest farm environment. Screening limitations at point of milk receipt necessitates widespread adoption of the Dairy Quality Assurance protocol to address controlled use of all animal medications under a valid relationship among veterinarian, client, and animals, thus minimizing the potential for violative residues in the milk and meat supply.

Animals↗

Pigmenting agents in Martian soils: inferences from spectral, Mossbauer, and magnetic properties of nanophase and other iron oxides in Hawaiian palagonitic soil PN-9.

We have examined a Hawaiian palagonitic tephra sample (PN-9) that has spectroscopic similarities to Martian bright regions using a number of analytical techniques, including Mossbauer and reflectance spectroscopy, X-ray diffraction, instrumental neutron activation analysis, electron probe microanalysis, transmission electron microscopy, and dithionite-citrate-bicarbonate extraction. Chemically, PN-9 has a Hawaiitic composition with alkali (and presumably silica) loss resulting from leaching by meteoric water during palagonitization; no Ce anomaly is present in the REE pattern. Mineralogically, our results show that nanophase ferric oxide (np-Ox) particles (either nanophase hematite (np-Hm) or a mixture of ferrihydrite and np-Hm) are responsible for the distinctive ferric doublet and visible-wavelength ferric absorption edge observed in Mossbauer and reflectivity spectra, respectively, for this and other spectrally similar palagonitic samples. The np-Ox particles appear to be imbedded in a hydrated aluminosilicate matrix material; no evidence was found for phyllosilicates. Other iron-bearing phases observed are titanomagnetite, which accounts for the magnetic nature of the sample; olivine; pyroxene; and glass. By analogy, np-Ox is likely the primary pigmenting agent of the bright soils and dust of Mars.

Evolution, Planetary↗

Human breast cancer: concerted role of diet, prolactin and adrenal C19-delta 5-steroids in tumorigenesis.

The low incidence of breast cancer in Japan disappears within 2 generations in migrant Japanese in the USA. This is of fundamental importance if we are to understand, and perhaps reverse, the high rate seen in Western countries. Diet is the most likely factor involved, and a review of the topic of diet, body mass index, and gain in adult body mass, supports a relationship between these factors and breast-cancer risk in post-menopausal, but not pre-menopausal, women. A direct link between nutritional factors and secretion of the hormones prolactin and dehydroepiandrosterone sulfate is proposed. An estrogen 5-androstene-3 beta, 17 beta-diol is formed peripherally from the latter steroid, and in Western women attains a blood concentration at which it is biologically active. Thus diet/fat provides factors, viz., fatty acids, prolactin and estrogen, which in concerted fashion provide a milieu conducive to mammary tumorigenesis.

Adrenal Glands↗

Regulation of estrogen sulfotransferase by estrogen in MCF-7 human mammary cancer cells.

The importance of the steroid hormone microenvironment within cells is now recognised in studies on endocrine-related neoplasms such as breast cancer. This focuses attention on enzymes which control the intracellular levels of estradiol-17 beta (E2). One such enzyme, estrogen sulfotransferase, which converts E2 to inactive E2-3 sulfate, has now been shown to be regulated by estrogen in MCF-7 human mammary cancer cells. Hydroxysteroid sulfotransferase, which sulfurylates the adrenal-derived estrogen 5-androstene-3 beta,17 beta-diol, is also under estrogen control. Evidence is provided which shows that one function of these enzymes may involve elimination of estrogen from the cell following processing of the ligand-charged estrogen receptor (ER).

Breast Neoplasms↗

Enzymatic regulation of estradiol-17 beta concentrations in human breast cancer cells.

Estradiol-17 beta is known to be involved in both the etiology and maintenance of growth of breast cancer. However, blood levels of the hormone do not reflect those found within the cells due to a number of transformations catalysed by enzymes which may be under metabolite and/or hormonal regulation. Recognition of the importance of the hormone microenvironment within the cell focuses attention on these enzymes and provides the subject for this review. An interplay between the sex hormones, estrogen and progestin, can control estradiol-17 beta concentrations in breast cancer cells at the level of key transforming enzymes. In addition, some enzymes catalyse production of biologically inert derivatives which are rapidly eliminated from the cell. Other enzymes catalyse the formation of derivatives which are exclusively intracellular and can act as reserve forms of the hormone. Yet others lead to estradiol-17 beta metabolites which are cytotoxic. An improved understanding of the enzymes and the role of the related metabolites can provide the opportunity for the development of new therapeutic agents.

Breast Neoplasms↗

Estrogen receptor and C19-5-ene-steroid concentrations in the nuclear fraction from human breast carcinoma tissue.

The adrenal-derived estrogen 5-androstene-3 beta,17 beta-diol (ADIOL) is estrogenic at the concentrations found in the blood of Western women. We have now measured the concentrations of both ADIOL and the estrogen receptor (ER) in the nuclear fraction (800 g pellet) of 89 primary human mammary tumors. No difference was found in nuclear ADIOL concentrations in tumors from 45 pre- and 44 postmenopausal women. Significantly higher nuclear ADIOL concentrations were found in 49 ER negative tumors compared to 40 ER positive tumors (P < 0.005). A similar relationship applied in the postmenopausal group (P = 0.01) and the premenopausal group, but in this latter instance failed to reach significance (P = 0.1). In ER positive tumors there was no correlation between ADIOL and ER nuclear levels. ADIOL was present in the total particulate fraction (100,000 g pellet) at twice the concentration found in the nuclear 800 g pellet and again no difference was found in its concentration in tumors from 20 pre- compared to 34 postmenopausal women. Dehydroepiandrosterone was also measured in the 800 g fraction of 45 tumors and its concentration, which was some 10-fold higher than ADIOL and significantly correlated with that steroid, was again independent of menopausal status. The higher concentration of C19-5-ene-steroids in ER negative cellular fractions could be due to differences in their metabolism; ER negative tumors either lack, or possess very low levels of, hydroxysteroid sulfotransferase which catalyzes formation of sulfate esters of C19-5-ene-steroids previously observed to be major metabolites produced by ER positive cells. Higher concentrations of free steroids in ER negative cells would then be available for combination with membranes and non-specific binding sites throughout the cell.

Androstenediol↗

Enzymic synthesis of steroid sulphates. XVII. On the structure of bovine estrogen sulphotransferase.

Estrogen sulphotransferase plays a major role in controlling intracellular levels of 17 beta-estradiol in human mammary cancer cells and human endometrium. Bovine estrogen sulphotransferase c-DNA has recently been cloned; the encoded protein having a maximum Mr of 35,000 (Nash, A.R. et al. (1988) Aust. J. Biol. Sci. 41, 507-516). Enzyme of Mr 35,000 by SDS-PAGE has now been isolated and cyanogen bromide-cleaved peptides sequenced. The latter were identified in the c-DNA-predicted amino acid sequence which confirms that the active enzyme (Mr approximately 70,000) exists as a dimer of identical subunits. Sequence data on similar peptides isolated from an enzyme preparation containing a protein of Mr 74,000 as the major species on SDS-PAGE, which was previously thought to represent the enzyme, suggested that this protein was transferrin. This was confirmed by PAGE, SDS-PAGE, susceptibility to neuraminidase and reaction with bovine transferrin antibody. Isoelectric focusing experiments show that active enzyme exists in two or three polymorphic forms (pI values 5.3, 5.7 and possibly 5.9) having similar physicochemical properties of polymorphic forms of transferrin so that they overlap on ion-exchange chromatography and PAGE. The enzyme shows some homology to the amino acid sequence close to the Fe-binding site in lactoferrin and the question is raised as to the possible presence of a tightly bound metal in estrogen sulphotransferase involved in the binding of adenosine 3'-phosphate 5'-phosphosulphate.

Amino Acid Sequence↗

Metabolism of lipoidal derivatives of estradiol-17-beta in human mammary cancer tissue and cell lines.

Estradiol-17 beta (E2) is converted exclusively to intracellular metabolites, termed lipoidal estrogens [long chain fatty acid 17 beta-esters (E2-L)], by human mammary cancer tissue and cell lines. In order to further evaluate the biological role of lipoidal estrogens, rates of saturation of the estrogen receptor (ER) along with formation of [3H]E2-L have been measured in human mammary cancer cells exposed to 5 nM [3H]E2. Extensive specific binding of E2 to ER in MCF-7 cells (approximately 37%) and ZR-75-1 cells (approximately 62%) occurred before appreciable synthesis of E2-L was evident and the maximum level of E2-L attained was only 3-9% of the E2 specifically bound to ER. In these ER positive cell lines, and in the ER negative cell line MDA-MB-231, an initial rise in the rate of E2-L formation was followed by a decrease at approximately 6 min and re-establishment of a new rate, indicating turnover of the E2-L fraction by esterification-de-esterification reactions. This data does not support the concept that E2-L acts in the transport of E2 to nuclear receptors, but rather than liberation of E2 from E2-L could serve to maintain occupancy of ER necessary for initiation of DNA synthesis. The esterase, as studied in pooled human mammary cancer tissue, was found to hydrolyse E2-17 beta-long chain fatty acid esters at different rates--the enzyme being less active towards E2-17 beta-stearate compared to E2-17 beta-oleate, -linoleate and -linolenate. Esterase activity was significantly higher in MDA-MB-231 cells compared to MCF-7 cells. Treatment of MCF-7 cells with E2 did not alter the specific activity of the esterase towards E2-17 beta-oleate as substrate. Similarly, addition of dibutyryl c-AMP to ZR-75-1 cell cultures was without effect on E2-L, both during the time when E2-L was accumulating, or during a subsequent phase when E2-L was decreasing following transfer to medium lacking E2. Calcitonin, which increases endogenous c-AMP in MCF-7 cells, had no effect on E2-L in this latter phase using this cell line. Thus, no evidence could be provided that the esterase was under E2 control, or control by polypeptide hormones which utilize c-AMP as a second messenger.

Breast Neoplasms↗

Properties of estrogen and hydroxysteroid sulphotransferases in human mammary cancer.

Partial purification (approximately x 140-fold) of estrogen sulphotransferase (EC 2.8.2.4) in human mammary estrogen receptor positive cancer tissue was achieved by affinity chromatography on adenosine-3',5'-diphosphate-agarose. It had a Mr of approximately 70,000 by gel filtration and upon electrophoresis on concave gradient polyacrylamide gels, showed a major (Mr 70,000) and a minor (Mr 200,000) peak of activity. Kinetics of this preparation (estradiol-17 beta and estrone as substrates), and also that of hydroxysteroid sulphotransferase (EC 2.8.2.2) contained in the cytosol of human mammary cancer MCF-7 cells (5-androstene-3 beta,17 beta-diol and dehydroepiandrosterone as substrates), were compared. The enzymes showed very similar behaviour, characterized by high affinity for their steroid substrates (low nM range) and co-operativity in their binding. For hydroxysteroid sulphotransferase, the adrenal-derived estrogen 5-androstene-3 beta,17 beta-diol was the preferred substrate compared to dehydro-epiandrosterone in the 0-40 nM concentration range. Such properties of the enzymes might be designed to limit the exposure of nuclear receptor to free ligand. Alternatively, a defined subcellular location would perhaps involve the enzymes in the elimination of estrogen after processing of the ligand-bound receptor.

Breast Neoplasms↗