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Biomedical subjects

J T Davis

Publications and source records attributed to J T Davis.

At least 73 records · Page 4Linked to original sources

Vocal cord paralysis in premature infants undergoing ductal closure.

A series of 106 consecutive ductal closures in premature infants was reviewed to assess the incidence of left vocal cord paralysis. To our knowledge, this syndrome is described for the first time in premature infants. In our experience, it is a relatively benign complication that completely resolves clinically in several weeks. This complication occurred in 5.2% of patients closed by suture ligature and in none of those closed by a surgical clip. Although the series is too small for this difference to be statistically significant, we believe it strongly favors the use of the clip, with less dissection.

Ductus Arteriosus, Patent↗

Biosynthetic thiolase from zoogloea ramigera. I. Preliminary characterization and analysis of proton transfer reaction.

The biosynthetic thiolase, from Zoogloea ramigera, involved in generation of acetoacetyl-CoA for poly-beta-hydroxybutyrate synthesis, has been prepared pure in quantity for initial structural characterization of this homotetrameric enzyme. Edman degradation provided the sequence of the NH2 terminal 25 residues and an active site cysteine-containing nonapeptide labeled on stoichiometric inactivation by iodoacetamide. Both sequences were used to align the encoding DNA sequence of the cloned gene as described in an accompanying paper. Synthetic analogs of acetoacetyl-S-CoA, modified in the CoA moiety, were prepared and tested, and acetoacetyl-S-pantetheine 11-pivalate 1 was shown to have a kcat/Km of 6.4 X 10(6) M-1 s-1, comparable to the kcat/Km of 2 X 10(7) M-1 s-1 for acetoacetyl-S-CoA. The pantetheine pivalate group facilitates nonaqueous synthetic manipulations and may be generally useful as a CoA replacement. We have also prepared the carba analog of 1, with CH2 replacing S, to yield a beta-diketone analog 10 of acetoacetyl-S-CoA and the corresponding methyl ketone analog 9 of acetyl-S-CoA. These analogs have been used to prove the ability of Z. ramigera thiolase to catalyze proton abstraction from the C-2 methyl group of the acetyl portion of substrate in a transition state separate from C-C bond formation. NMR studies in D2O show exchange only when condensation is possible. Further studies with [2-3H]acetyl-CoA show there is neither pre-equilibrium washout nor detectable kH/kT expressed in turnover and provide no evidence for a discrete acetyl-CoA C-2 carbanion or a nonconcerted reaction.

Acetyl Coenzyme A↗

Biosynthetic thiolase from Zoogloea ramigera. II. Inactivation with haloacetyl CoA analogs.

The thiolase involved in biosynthesis of poly-beta-hydroxybutyrate in Zoogloea ramigera generates an acetyl-enzyme species during catalysis. Up to 0.86 [14C] acetyl eq/subunit of this homotetrameric enzyme is accumulated by acid precipitation in the presence of [14C]acetyl-CoA. Gel filtration of the same solutions produced only 7% acetyl-enzyme suggesting hydrolytic lability of the acetyl-enzyme during the 10-min isolation at 4 degrees C. In an effort to identify active site residues which may function as basic groups to deprotonate at C-2 of acetyl-CoA to generate the required nucleophilic equivalent in carbon-carbon bond formation, we have prepared and tested haloacetyl-thioesters, oxoesters, and amides in the panthetheine pivalate series (Davis, J. T., Moore, R. N., Imperiali, B., Pratt, A. J., Kobayashi, K., Masamune, S., Sinskey, A. J., and Walsh, C. T. (1987) J. Biol. Chem. 262, 82-89). The [14C]bromoacetyl-oxoester alkylatively inactivates thiolase irreversibly with stoichiometric incorporation of four labels/tetramer. Determination of amino acid composition of the radiolabeled tryptic peptide indicated trapping of Cys-89 (Peoples, O. P., Masamune, S., Walsh, C. T., and Sinskey, A. J. (1987) J. Biol. Chem. 262, 97-102), the same residue modified by iodoacetamide. When the bromoacetyl-thioester was used, inactivation was pH-dependent. The data are consistent with the competition of two processes, acylation, and alkylation. Direct (rather than secondary) alkylation of thiolase by the inactivator accounts for the significant 14C incorporation into thiolase with the thioester labeled with [14C] in the pantetheine pivalate moiety. It appears likely that the haloacetyl analogs described herein should be generally useful for affinity labeling other enzymes using acetyl-CoA as a substrate.

Acetyl Coenzyme A↗

An unusual position of a Swan-Ganz catheter.

Placement of a Swan-Ganz catheter can cause many complications. This case report presents a new complication of Swan-Ganz catheter insertion--placement of the Swan-Ganz catheter tip in the coronary sinus.

Aged↗

Echocardiographic estimate of left atrial pressure in children.

Echocardiographic estimates of left atrial pressure using the Q-MVC/AVC-E ratio were obtained from 21 patients in the early postoperative period and compared to simultaneously recorded mean left atrial pressure. A good correlation was obtained between mean left atrial pressure and the Q-MVC/AVC-E ratio (r = 0.81, p less than 0.001) with a regression equation of: left atrial pressure = 11.09 (Q-MVC/AVC-E) + 0.84. The present data compared to those of previous investigators reveal that, although there are quantitative differences between each of the studies, the correlation coefficient of each study is good. Echocardiography provides a useful noninvasive estimate the left atrial pressure; however, each laboratory must establish its own normals.

Blood Pressure↗

Heyde's syndrome: failure of a mechanical prosthesis and the possibility of a coagulation defect.

Recent data indicate that the gastrointestinal bleeding due to angiodysplasia associated with aortic stenosis (Heyde's syndrome) can be alleviated by aortic valve replacement with a bioprosthesis. This report details a situation in which valve replacement with a mechanical prosthesis and the subsequent anticoagulation promoted gastrointestinal bleeding from angiodysplastic lesions. Only when the mechanical prosthesis was replaced with a porcine prosthesis and the anticoagulation discontinued did the gastrointestinal bleeding stop.

Anticoagulants↗

Long-term follow-up of cardiac rhythm in repaired total anomalous pulmonary venous drainage.

Seven consecutive patients with total anomalous pulmonary venous drainage were operated at the Medical College of Ohio at Toledo and long-term follow-up is reported on their rhythm status. The patients were generally under 3 months of age at operation. All patients are alive at the present time. The median length of follow-up is 4 years. Five of the 7 patients demonstrated ectopic pacemaker activity and 2 exhibited episodes of nodal rhythm as well. In general, these were not apparent on standard screening electrocardiography. There was no correlation between the presence or absence of this arrhythmia and the type of repair. It is concluded that arrhythmias may be present in these patients, but that they are unrelated to the type of surgery performed. The ectopic atrial focus may be of no clinical significance but there is more cause for concern in those patients with nodal rhythm.

Arrhythmias, Cardiac↗

Scanning and transmission electron microscopic study of recovered porcine aortic valved conduits.

Four explanted porcine aortic valved conduits were examined using scanning and transmission electron microscopy. Sources of obstruction such as neointima or "peel" and calcification were observed. In one sample the neointima was found to possess an unusually large expanse of squamous cells partially lining the luminal surface. This lining much resembled a normal endothelium, which is not an expected feature of neointima. Cells, presumably of host origin, were noted upon the leaflet surfaces. They did not seem as well organized as those found on the neointima. Calcification did not seem greatly advanced but was clearly apparent. Certain treatments proposed by others to curtail calcification are discussed and amended herein. SEM examination of three of these conduits provided good evidence of lining cells on only the inflow surface of the leaflet. The fourth conduit, however, showed cells on both inflow and outflow surfaces. These cells possessed certain characteristics of cells from leaflets of the other three conduits, but questions remain as to the precise identification of all of these lining cells. TEM examination provided cytological evidence of macrophage-like cells lining the inflow surface of a leaflet.

Adolescent↗

Truncus arteriosus with interrupted aortic arch: report of a successful surgical repair.

The association of truncus arteriosus with interrupted aortic arch represents a formidable surgical challenge. Two successful repairs have been reported, but none for the past ten years. This report presents a third successful repair using a technique that allows the widely patent ductus arteriosus to maintain continuity between the truncus (with pulmonary arteries detached) and the descending aorta. Right ventricle-pulmonary artery continuity is established in the usual way with a porcine-valved conduit. While long-term potential difficulties with this approach are recognized, it appears to give satisfactory initial palliation and to be an acceptable method of treatment for this combination of defects. The embryology and the anatomy of the lesion are briefly discussed.

Aorta, Thoracic↗

Current status of valve prostheses.

The deterioration in cardiac function caused by a valvular lesion frequently can be halted or reversed by timely surgery. This article discusses the principles used to decide when surgery is beneficial and briefly reviews current indications for operation in the more common acquired and congenital valve lesions. The factors influencing the choice of a valve prosthesis are also discussed.

Age Factors↗

Measurements of combustion product emission factors of unvented kerosene heaters.

Emissions of combustion products from unvented kerosene heaters were measured in an exhaust system used to ventilate the units. Measurements of carbon monoxide, nitrogen dioxide, sulfur dioxide, formaldehyde and particulates are reported and compared with the results of several other studies. Dilution ventilation requirements to maintain occupational and air quality standards are presented.

Air Pollutants↗

Treatment of nonocclusive mesenteric infarction after cardiopulmonary resuscitation.

Nonocclusive mesenteric infarction is a potentially lethal complication that may follow successful resuscitation of cardiopulmonary arrest. This case demonstrates that the manifestations may be delayed and that urgent surgical intervention may be lifesaving despite the precarious status of these patients. Vigilance for several days is mandatory.

Critical Care↗

Noninvasive techniques in the assessment of lower-extremity arterial occlusive disease. The advantages of proximal and distal thigh cuffs.

We studied 209 limbs angiographically and noninvasively to determine whether measurements of upper-thigh (UT) and lower-thigh (LT) segmental pressures (four-cuff technique), combined with segmental pulse-volume recordings (PVRs), offered any advantage over the standard single-thigh cuff (three-cuff technique) and PVR in the diagnosis of aortoiliac (AI) and superficial femoral artery (SFA) occlusive disease. Angiographic stenosis of 50% or greater and occlusions were considered to be hemodynamically significant lesions in this study. In the absence of SFA disease, sensitivity to AI disease was high (96%) and not significantly different using three- or four-cuff measurements. However, in the presence of SFA-segment disease, four-cuff measurements, both with and without PVR, were significantly more sensitive to AI disease (100%) and more specific for a normal AI segment (76%) than the three-cuff, PVR technique. Plethysmography alone was most sensitive to SFA disease (90%), even in the presence of AI disease, and sensitivity was not improved by additional segmental pressure measurements. The four-cuff system enhances the physician's ability to diagnose AI disease in the presence of SFA lesions, while PVR is most useful in detecting SFA lesions in the presence of AI disease.

Angiography↗

Primary myelolipoma of mediastinum.

Myelolipoma is a benign nonepithelial neoplasm composed of mature marrow elements and fat cells. This rare neoplasm is usually discovered by pathologists incidentally at autopsy, and, with rare exceptions, usually occurs in the adrenal glands. One of these exceptional anatomic sites is the mediastinum, and only three cases of primary mediastinal myelolipomas have been documented in the English-language literature (1-3). We are presenting a primary myelolipoma involving the posterior mediastinum that was discovered on routine chest radiographs and successfully resected. Computed tomography (CT) scan findings of this rare mediastinal tumor are also presented. This is the first case report in the English language of primary myelolipoma in the mediastinum that was detected clinically and resected successfully.

Humans↗