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Biomedical subjects

J G Turcotte

Publications and source records attributed to J G Turcotte.

At least 91 records · Page 5Linked to original sources

Biophysical properties of cytidine diphosphate diacylglycerol in solution.

The physical properties of CDP diacylglycerol derived from egg phosphatidylcholine are very different from those of the common glycerophospholipids, such as phosphatidylcholine. Gently dispersed in buffer (5 mM phosphate, 0.15 M NaCl, pH 7.4), the liponucleotide initially forms an opalescent suspension of spherical vesicles, up to 50 micron in diameter, which appear to be unilamellar. These large vesicles are unstable and, independently of initial concentration, unstirred suspensions are no longer turbid after being incubated for about 1 h at room temperature. The passage of samples through Sepharose and Sephadex at increasing time intervals after the first hour reveals a continuing but slow diminution in size until, at about two days, a final peak is obtained which remains invariant for longer times. Chromatography of these ultimate stable micelles on Sephadex G-200 gives a Stokes radius of 4.2 nm. Their sedimentation coefficient extrapolated to zero concentration is 6.1 S. These numbers, combined with a partial specific volume of 0.835 ml X g-1, give an anhydrous mass of 155 000 Da and an aggregation number of 158. Although the data suggest the particles to be spherical, other compact forms cannot be excluded. Proton NMR at 220 MHz shows time-dependent spectral changes which are consistent with the slow structural transformation observed by gel-filtration chromatography, and indicate that the sugar and cytosine groups in the ultimate micelles apparently are motionally restricted. The critical micelle concentration is near 6 microM, but micelle-free molecule equilibration requires at least 7 days at a total concentration of 89 microM. Sonication considerably decreases the time required for the vesicle-micelle transformation and the micelle-free molecule equilibration. Some implications for enzymology are discussed.

Biophysical Phenomena↗

Association of inclusion of the donor spleen in pancreaticoduodenal transplantation with rejection.

Clinical pancreas transplantation (txp) using a pancreaticoduodenal allograft (pda) and the donor spleen has been applied as treatment for insulin-dependent diabetes mellitus. Inclusion of the spleen in the pda is purported to protect against thrombosis and may be of possible immunological benefit. In pancreatectomized pigs, we compared the results of pda txp with (n = 8) and without (n = 10) the donor spleen. Animals were maintained on cyclosporine (6 mg/kg/day i.v.) and prednisolone (1.5 mg/kg/day i.v. tapered over 7 days to a maintenance dose of 0.5 mg/kg/day i.v.). Pancreatic exocrine enzyme replacement was administered daily. In 10 recipients of the technically successful pda without the spleen, rejection (blood glucose greater than 150 mg/dl) was not seen in the 28 days after txp. Mean daily blood glucose was 95 +/- 8 mg/dl during this period. In contrast, 5 of 8 recipients of the technically successful pda with the donor spleen rejected their grafts an average of 13 days (range 7-16) after txp (P less than 0.01). Mean daily blood glucose was 88 +/- 21 mg/dl prior to the declaration of rejection and increased to 275 +/- 59 mg/dl after rejection (P less than 0.0001). Rejection was histologically confirmed in all cases. None of the recipients of the pda with the donor spleen developed signs of graft-versus-host disease. Glucose tolerance testing carried out 28 days after transplantation in normoglycemic pigs from both experimental groups demonstrated no difference between the groups. In the porcine pda model used in this study, the inclusion of the spleen in the pda was associated with rejection of the transplant.

Animals↗

Oral examinations: actual and perceived contributions to surgery clerkship performance.

Controversy persists regarding the validity, utility, and practicality of oral examinations. This study of a recent 3-year experience at the University of Michigan Medical School was undertaken to determine the value of the oral examination in the required junior year surgery clerkship. Multiple regression analysis of the relationship between the oral examination and ward grades, written examination grades, and the final grades for the clerkship years 1980 to 1981 (n = 198), 1981 to 1982 (n = 234), and 1982 to 1983 (n = 215) (classes of 1982, 1983, and 1984) revealed significant correlation between the oral examination and other evaluation parameters. Stepwise regression analysis revealed that the oral examination contributed unique information to final grade determination. Two surveys identified faculty and student opinion regarding the oral examination. The results were consistent during the 3-year period of study. Faculty and student opinion regarding the examination as an evaluation process and motivational device were positive, as was opinion regarding the breadth and depth of knowledge tested and the examination as a learning experience and an accurate reflection of students' performance. Both faculty and students agreed that the examination was worth the time and effort invested by faculty, was an appropriate evaluation process, and was a source of worthwhile faculty and student interaction.

Attitude of Health Personnel↗

Pancreatic polypeptide-producing tumors. Silent lesions of the pancreas?

Eight patients with pancreatic polypeptide (PP)-producing islet cell tumors and one patient with pseudo-PP-producing tumors were examined. Their age range was 20 to 74 years. Clinical features included abdominal pain in four patients, weight loss in four patients, diarrhea in two patients, gastrointestinal bleeding in two patients, and jaundice in one patient. The range of the basal serum level of PP was 394 to 35,100 pg/mL. In two patients the PP-producing tumors were associated with multiple endocrine neoplasia. Two patients had diffuse hepatic metastases at the time of diagnosis and four patients had disease limited to the pancreas. Pancreaticoduodenectomy and 80% pancreatectomy were performed in four and two patients, respectively. Immunohistochemical staining was positive for PP and neuron-specific enolase in all cases and was negative for other peptides except in one specimen with microadenomatosis. Patients who underwent curative resection are asymptomatic with normal serum levels of PP.

Abdomen↗

Breast feeding and maternal-donor renal allografts. Possibly the original donor-specific transfusion.

Large numbers of maternal lymphocytes are present in breast milk. We asked whether exposure of an infant to maternal lymphocytes during the process of breast feeding would have an effect on the subsequent reactivity of a patient to a maternal-donor related renal transplant. We studied the posttransplant course of 55 patients who had received a primary maternal-donor transplant. Twenty-seven recipients had been breast-fed during infancy and 28 recipients had not been breast-fed. A history of breast feeding was associated with a more favorable posttransplant course as measured by the percentage of patients who had no rejection episodes during the first posttransplant year (P less than or equal to .006). The one-year graft function rate for breast-fed recipients was 82%; this was statistically significantly better than the 57% measured for non-breast-fed recipients (P less than or equal to .05). Statistical significance of differences between groups was not attained when results were evaluated over a five-year interval. A difference between breast-fed and non-breast-fed recipients was not apparent when we evaluated a somewhat smaller group of patients who had received a paternal donor transplant. From these observations we conclude that the process of breast feeding during infancy may result in a measurable immunologic benefit to the recipient of a subsequent maternal-donor related renal transplant.

Breast Feeding↗

Near-total pancreatectomy for chronic pancreatitis.

Eighty-seven patients underwent distal subtotal or near-total (80% to 95%) pancreatectomy (NTP) during a 25-year period for management of intractable pain resulting from chronic pancreatitis. Alcoholism affected the majority of patients and 20% of cases were idiopathic in origin. Ten patients (12%) exhibited insulin-requiring diabetes before operation. The perioperative mortality rate was 3.4%. Significant improvement or complete pain relief was achieved in 75% of patients while 14% remained narcotic dependent. Forty-four patients (51%) required insulin postoperatively, with an average insulin requirement of 35 U per day. Thirty late deaths occurred 2 to 15 years after operation, 12 (40%) of which were related to complications of pancreatic insufficiency or persistent alcoholism. Five patients (8.5%) required completion pancreatectomy 6 months to 4 years after NTP for complications relating to persistent pancreatitis. NTP provides effective pain relief in the majority of patients with chronic pancreatitis. While this procedure can be performed with a low operative mortality rate, the high incidence of endocrine and exocrine insufficiency after operation may contribute to late deaths. Consequently, this procedure should be performed only when the underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief.

Adolescent↗

Effect of eicosatetraenyl (3-aminopropyl) phosphonate (URI-73A) on platelet aggregation and arachidonic acid metabolism.

Eicosatetraenyl (3-aminopropyl) phosphonate (URI-73A), an experimental anti-hypertensive drug, when tested in vitro, inhibits platelet aggregation especially that induced by arachidonic acid (AA) and to a lesser degree by epinephrine. Preincubation of human platelets with this compound in the majority of individuals resulted in a dose-dependent inhibition of the platelet response to AA, mostly in the form of a delay and a reduction of maximal aggregation. Platelets from two smaller groups of donors either exhibited full aggregation or no aggregation. Both the prelabel and pulse label techniques used to study arachidonic acid metabolism yielded complementary results. Production of thromboxane and hydroxy fatty acids was reduced in thrombin-aggregated washed platelets preincubated with URI-73A. In addition, the release of AA from phospholipids was inhibited. Its complex effects on human platelets suggest that URI-73A may, as an AA analog, depress cyclooxygenase and lipoxygenase, and as a phospholipid analog inhibit phospholipase activity.

Adenosine Diphosphate↗

Noncirrhotic portal hypertension: differing patterns of disease in children and adults.

Of 440 patients who underwent operative portal decompression to control variceal hemorrhage, 25 (6%) had histologically verified noncirrhotic portal hypertension (NCPH). A review of these patients identified two distinct patterns of disease. Fourteen children with an average age of 8.5 years were treated with no deaths at operation. Occlusion of the portal vein (PV) was demonstrated preoperatively or intraoperatively in 10 children (71%). Follow-up for 12 to 207 months showed that no children died of a liver-related illness and only one child (7%) developed portal-systemic encephalopathy (PSE). In contrast, 11 adults with an average age of 56 years were treated with an operative mortality rate of 18%. Occlusion of the PV was demonstrated angiographically in four adults (35%). Of nine surviving adults who were followed for 12 to 164 months, five adults (56%) manifested PSE. Intraoperative liver biopsy specimens were analyzed by light microscopy in all cases. With the possible exception of sinusoidal fibrosis and dilatation of intrahepatic portal venous radicles, no histologic discriminators of adult forms versus childhood forms were identified regardless of the status of the PV. We conclude that age stratification in patients with NCPH may provide important prognostic data regarding survival rates and the incidence of PSE after portal-systemic shunting.

Adolescent↗

Physical properties of arabinofuranosylcytosine diphosphate diacylglycerol, an antitumor liponucleotide.

Dispersed from a dry film into buffer (5 mM phosphate, 0.15 M NaCl, pH 7.4), the liponucleotide 1-beta-D-arabinofuranosylcytosine 5'-diphosphate L-1,2-diacylglycerol (ara-CDPdiacylglycerol) spontaneously forms vesicles which are several microns in diameter and probably unilamellar. Their average size immediately begins to decrease, and after 2 h none can be seen in the light microscope. During 1-2 days in unstirred solutions at 25 degrees C, the vesicles are transformed to spherical or nearly spherical micelles having an apparent partial specific volume of 0.835 ml . g-1, a maximum possible aggregation number of about 150, and an anhydrous radius of about 37 A. The critical micelle concentration (CMC) is about 10 microM in buffer and 20 microM in distilled water, but micelle-monomer equilibration requires at least 1 week at a total concentration of 66 microM. This exceedingly slow equilibration is unique among reported detergents. The standard enthalpy and entropy of micellization are - 13 kJ . mol-1 and 87 J . mol-1 . K-1, respectively. These values are within the range reported for other detergents. Sonication accelerates the vesicle-micelle transformation to 30 min.

Chemical Phenomena↗

Etiology and management of early and late peritransplant infections.

Subfascial peritransplant infection is a life-threatening complication of renal transplantation with multiple etiologies, early onset, and subtle or catastrophic presentation. Thirteen such deep space infections were encountered in 160 consecutive transplants followed for up to 4 years. Difficult management decisions were required frequently. Three patients presented with acute peritonitis. In each instance the source of infection was obscure until abdominal exploration revealed transperitoneal rupture of an infected peritransplant fluid collection. Gray scale ultrasonography and ultrasound guided needle aspiration of fluid collections proved valuable in the clarification of often confusing clinical situations. The transplant was left in situ, with good function and complete wound healing in 5 cases. Transplant nephrectomy was required in 8 patients. Three patients died despite transplant nephrectomy and discontinuation of immunosuppression.

Bacterial Infections↗

Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment.

Fifty-one patients underwent operation for adenocarcinoma of the ampulla of Vater. Seven patients underwent palliative bypass, with an operative mortality of 28.6%; 44 additional patients underwent potentially curative pancreaticoduodenal resection (PDR), with an operative mortality of 15.9%. Postoperative complications occurred in 63% of patients. Postoperative gastrointestinal bleeding was observed in 11 of 44 patients who underwent PDR (25%). Although anastomotic ulcers (AU) were directly implicated in five cases (45%), the 12% incidence of AU-related bleeding among 33 patients who underwent PDR without truncal vagotomy (TV) was not significantly different from the 9% incidence observed in 11 patients who underwent PDR plus TV. However, performance of TV appeared to result in a higher incidence of postoperative pulmonary complications. Five patients who underwent curative resection survived for five years (11%). Only one of seven patients who underwent palliative bypass survived three years (14%), and none survived to five years. Acceptable survival rates following resectional therapy warrant an aggressive approach to this tumor. Further, our experience suggests that TV may increase postoperative patient morbidity without actually providing any protection from anastomotic ulceration.

Adenocarcinoma↗

Bizarre complications of peritoneovenous shunts.

Implantable peritoneovenous shunts have facilitated the management of patients with medically intractable ascites. The more commonly reported complications occur with an incidence of 20-50%. Rare and problematic complications are becoming increasingly frequent. Two unusual complications, 1) progressive respiratory insufficiency and death secondary to pulmonary embolization of ascites fluid containing cholesterol crystals, and 2) shunt malfunction caused by the formation of a fibrous envelope around the venous catheter are presented. Pathogenesis, diagnosis and therapy of each of these unusual complications is discussed.

Ascites↗

Significance of corrected sinusoidal pressure (CSP) in patients with cirrhosis and portal hypertension.

The relationship between the degree of portal hypertension measured by the corrected sinusoidal pressure (CSP), the size of varices graded endoscopically, the risk of variceal hemorrhage and the prognosis following portal decompression were studied in 32 patients with cirrhosis demonstrated by examination of a biopsy specimen. The CSP was no different in patients with large-sized versus small or moderate-sized varices. CSP was of no discriminant value in patients with bleeding versus nonbleeding varices and, furthermore, was of no prognostic value in patients requiring operative portal decompression. The risk of variceal bleeding was highest in patients with large-sized varices. We conclude, therefore, that CSP measurements have little if any therapeutic or prognostic importance in cirrhotic patients with portal hypertension or gastrointestinal bleeding. CSP may, however, be useful in establishing extrahepatic or presinusoidal causes of portal hypertension.

Adult↗