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Biomedical subjects

K M Taylor

Publications and source records attributed to K M Taylor.

At least 145 records · Page 8Linked to original sources
PubMed1996

Tricuspid valve replacement subsequent to previous open heart surgery.

BACKGROUND AND AIMS OF THE STUDY: Earlier surgical intervention to the mitral and/or aortic valve means that it will be uncommon to replace the tricuspid valve (TVR) in a patient who has not had prior open heart surgery. METHODS: We report the short and medium term results of a consecutive series of 14 patients who underwent bioprosthetic TVR between December 1985 and February 1993 at the Hammersmith Hospital, UK. All patients had undergone previous open heart surgery on at least one occasion. Mean patient age was 59 years (range: 45-77 years), 11 were female and three were male. Ten patients (72%) were in New York Heart Association class III or IV preoperatively, eight patients were first time reoperations and six patients were second time reoperations. RESULTS: Hospital mortality was 50% (7/14). Of these seven patients, six were in NYHA class III or IV preoperatively, and three were second time reoperations. There were no 'on-the-table deaths' and no patients required reoperation for bleeding or permanent pacing. For the patients discharged from hospital, the mean follow up was 46 months (range 9-84 months) and it was 100% complete. There was no significant difference in the preoperative assessment data between the hospital mortality group and the patients who left hospital (p > 0.05). Of the patients discharged, four (57% of this group, 28.5% of all patients) showed an improvement in NYHA classification and all patients reported a reduction in peripheral edema. Amongst the survivors there was 100% freedom from valve related complications. Within this group there have been three deaths since discharge, all due to biventricular failure. CONCLUSIONS: From this study we conclude that TVR in patients who have had prior cardiac surgery is a high risk procedure. Nonetheless, amongst survivors, benefit may be gained by either a reduction in peripheral edema and/or an improvement in NYHA class.

Aged↗
PubMed1996

The therapeutic significance of pulse reverse osmosis.

Pulse reverse osmosis (1) is a new theory of fluid balance and exchange which suggests that the mean blood pressure and osmotic gradient control fluid balance and that the pulse controls fluid exchange. In vitro testing has confirmed some of the physico chemical principles underlying the theory (2). The hypothesis suggests a relationship between mean capillary blood pressure and osmotic gradient. Imbalance in this relationship can be related to the development of hypertension, hypotension, oedema and shock. In an attempt to test this concept mean blood pressures and colloid osmotic pressures were measured and compared in a group of 50 healthy human volunteers. The results suggest a curvilinear correlation between the mean blood pressure and the COP.

Blood Pressure↗
PubMed1995

Effect of cholesterol, fatty acyl chain composition, and bilayer curvature on the interaction of cytochrome b5 with liposomes of phosphatidylcholines.

To determine the effect of cholesterol and lipid packing on the solubility of membrane proteins in bilayers, cytochrome b5 incorporation into phosphatidylcholine (PC) liposomes was determined as a function of bilayer curvature (SUVs versus LUVs), fatty acyl chain composition, and cholesterol content. The equilibrium affinity constant for the formation of a 1:1 b5/PC complex, Kp, and the number of PC's per "site" at saturation, n, were determined from binding isotherms, which were obtained by measuring the increase in intrinsic tryptophan fluorescence. With LUVs, n was also determined directly by gel filtration. The following results were obtained: (1) Both Kp and the saturating level of b5 binding, s (n-1), are significantly greater for SUVs than for LUVs. In LUVs, a binding site must consist of several surrounding lipid layers. (2) Cholesterol reduces Kp and s by factors that range from 1 to > 100. Binding inhibition is highly sensitive to the liposome size and to the fatty acyl composition of the PC; the latter correlates with the condensing effects on PC: C1satC2mono > C1satC2di approximately natural mixtures > C1unsat-C2unsat. (3) With POPC LUVs, the binding inhibition was 3.6-, 1.4- and 17-fold within the ranges of 0-20, 20-33, and 33-50 mole percent cholesterol, respectively. (4) The equilibrium binding constant to SUVs is greater for liposomes that are prepared from natural PC mixtures than for vesicles of a single synthetic phospholipid. The reductions in b5 binding correlate with reductions in bilayer free volume, which were calculated from monolayer studies of the lipid mixtures. The sensitivity of liposome saturability to bilayer curvature, fatty acyl chain composition, and cholesterol content may account for the disparate results among previous studies of cholesterol-protein interactions. A more significant implication is that in biological membranes with high levels of cholesterol, subtle variations in the fatty acyl chain composition could substantially affect the solubility and physical states of integral membrane proteins.

Cholesterol↗
PubMed1995

Characterization of the role of the stimulatory magnesium of Escherichia coli porphobilinogen synthase.

The synthesis of tetrapyrroles is essential to all phyla. Porphobilinogen synthase (PBGS) is a zinc metalloenzyme that catalyzes the formation of porphobilinogen, the monopyrrole precursor of all biological tetrapyrroles. The enzyme from various organisms shows considerable sequence conservation, suggesting a common fold, quaternary structure, and catalytic mechanism. Escherichia coli and plant PBGS are activated by magnesium, a property that is absent from mammalian PBGS. This stimulatory Mg(II) is called Mgc. Mgc is not required for activity and is distinct from the two zinc ions (ZnA and ZnB) common to mammalian and E. coli PBGS (PBGSE.coli). For PBGSE.coli, both the Km for the substrate 5-aminolevulinic acid (ALA) and the Vmax are altered by the presence of Mgc; Mg(II) causes the Km to drop from approximately 3 to 0.30 mM and the maximum specific activity to increase from 23 to 50 mumol h-1 mg-1. Mgc also causes the saturating concentration of the required Zn(II) to decrease from 0.1 mM to 10 microM. Maximal activation by Mg(II) occurs at 0.5 mM; thus, in E. coli the Mgc site is probably saturated under physiological conditions. Mn(II) is a good substitute for Mgc, giving a comparable increase in catalytic activity. Consequently, Mn(II) has been used as an EPR active probe of the Mgc binding site. Mn(II) binds at a stoichiometry of eight ions per enzyme octamer. The X- and Q-band EPR spectra reflect a single type of binding site with rhombic symmetry and are consistent with oxygen and/or nitrogen ligands. The addition of unlabeled or 1-13C-labeled ALA does not significantly affect the Mn(II) EPR spectra.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1995

Assessment of the value of the immediate postoperative chest radiograph after cardiac operation.

The value of the immediate postoperative chest radiograph upon a patient's return to the intensive care unit after a cardiac surgical procedure is uncertain. This study represents a prospective analysis of the immediate postoperative radiograph in 100 consecutive adult patients undergoing cardiac operations. In 11 patients it was found that the routine postoperative radiograph was of value when it was necessary either to clarify or confirm clinical findings or to check the position of an intraaortic balloon catheter. For those chest radiographs that were deemed unnecessary, only one of 89 were found to be of clinical value. Furthermore, in those situations in which an emergency radiograph was obtained, the routine radiograph was not found to be contributory to patient management. We conclude that the policy of obtaining routine, immediate postoperative chest radiographs in the absence of a specific clinical indication provides virtually no additional clinical yield. Residents should therefore request radiographs only to check the position of an intraaortic balloon catheter, and to clarify or confirm a clinical diagnosis.

Adult↗
PubMed1995

Nebulization of fluids of different physicochemical properties with air-jet and ultrasonic nebulizers.

PURPOSE: Empirical formulae relate the mean size of primary droplets from jet and ultrasonic nebulizers to a fluid's physicochemical properties. Although the size selective "filtering" effects of baffling and evaporation may modify the secondary aerosol produced, this research sought to evaluate whether viscosity and surface tension of nebulized fluids influenced the aerosol's size and output characteristics. METHODS: Fluid systems of different surface tension and viscosity (glycerol and propylene glycol solutions [10-50% (v/v)] and a range of silicone fluids [200/0.65 cs-100cs]) were nebulized in three jet and two ultrasonic nebulizers. Secondary aerosol characteristics were measured with a Malvern 2600C laser diffraction sizer and the nebulization times, residual volumes and percentage outputs were determined. RESULTS: While the droplet size appeared to be inversely proportional to viscosity for jet nebulizers, it was directly proportional to viscosity for ultrasonic nebulizers. Although fluid systems with lower surface tensions generally produced slightly smaller MMDs, the relationship between surface tension and droplet size was complex. The more viscous fluids required longer nebulization times and were associated with increased residual amounts (lower outputs). The ultrasonic nebulizers did not effectively, and were on occasion unable to, nebulize the more viscous fluids. CONCLUSIONS: It follows that there are cut-off values for viscosity and/or surface tension above or below which ultrasonic devices fail to operate. Moreover, jet nebulizers generated an aerosol with an optimum respirable output from median-viscosity fluids.

Aerosols↗
PubMed1995

Pericardial trauma and adhesions in relation to reoperative cardiac surgery.

In an attempt to appreciate the changes that favour adhesion formation we compared the morphological and fibrinolytic changes that occur in human primary and reoperative pericardium. Ten patients undergoing primary elective open heart surgery and ten undergoing first time reoperative open heart surgery were studied. Pericardial samples were taken at four time points. At 0 (time A) and 30 (time B) minutes from the time of pericardiotomy (before the commencement of CPB), 30-50 minutes (time C) after the commencement of CPB, and then finally 10 minutes (time D) after the patient had been rewarmed. The fibrinolytic activity, as measured by the plasminogen activating activity (PAA), in the pericardial samples of the ten primary cases was compared with that in 5 of the reoperative cases. For the primary group, the PAA after 30 minutes of exposure (median 6.65 IU/cm2, range 3.85-11.89 IU/cm2, p = 0.14, n = 10) was not significantly reduced when compared to the initial activity (median 8.74 IU/cm2, range 2.22-17.68 IU/cm2, n = 10). After 30-50 minutes CPB the PAA was significantly reduced (median 3.93 IU/cm2, range 1.5-13.24 IU/cm2, p = 0.028, n = 10) and still reduced after rewarming for 10 minutes (median 3.12 IU/cm2, range 0.88-19.93 IU/cm2, p = 0.047, n = 10). The simultaneous plasma tissue-type plasminogen activator activity showed a significant (p < 0.05) increase after 30-50 minutes bypass with a later decline. The changes in the reoperative pericardial PAA were similar. In addition, the degree of PAA in reoperative pericardium was consistently lower than that observed in primary tissue. The extent of primary pericardial mesothelial damage at times B, C, and D compared with that at time A showed a significant (p < 0.01 for times B, C, and D) increase. Similarly there was a significant worsening of the degree of inflammation. Compared with primary pericardium, the reoperative samples showed a significant (p < 0.01 for times A, B, and C) preponderance of damaged mesothelium at the earlier stages of the operation. It appears that, following the initial bypass surgery, the processes that cause pericardial and mesothelial healing with recovery of PAA compete with those leading to pericardial adhesions and fibrosis. The histological and biochemical outcome seen in reoperative pericardium is the result of these competitive actions.

Adult↗
PubMed1995

Endotoxaemia detected during cardiopulmonary bypass with a modified Limulus amoebocyte lysate assay.

Cardiopulmonary bypass (CPB) is associated with blood heparin level fluctuations and a reduction in haematocrit due to crystalloid haemodilution. The effect of these changes on the reliability of the Limulus amoebocyte lysate (LAL) chromogenic microassay for the measurement of plasma endotoxin was assessed in vitro. It was shown that the assay could be significantly compromised by twofold haemodilution which can occur during CPB. The interference effect on the assay caused by CPB-associated heparin was not significant if a comparatively large amount of heparin (25 IU/ml) was added to the blood at the time of sampling. The effect of haemodilution was counteracted by prediluting plasma samples with crystalloid by a factor dependent on the sample haematocrit (to ensure that the proportion of plasma was similar in all samples). A correction was then required to determine the endotoxin level in the original sample. The modified assay was used to determine sequential plasma endotoxin levels in 14 patients undergoing hypothermic nonpulsatile CPB. Endotoxaemia occurred at the time of aortic cross-clamp release and reached a peak of 48.9 +/- 12.9 ng/l shortly before the end of CPB, which was significantly higher than baseline values pre-CPB (p < 0.05). Thereafter, there was a decline in endotoxin levels to 28.9 +/- 13.6 ng/l 24 hours later which was still significantly higher than baseline levels (p < 0.05). Peak endotoxaemia was a predictor of protracted hospital stay when compared with haemodynamic and tissue perfusion parameters.

Cardiopulmonary Bypass↗
PubMed1995

The haemodynamic effects of the thromboxane A2 receptor antagonist GR32191B during cardiopulmonary bypass in the dog.

This study examined whether treatment with the specific thromboxane (TX) A2 receptor antagonist GR32191B would result in an improvement in peripheral haemodynamics during and after cardiopulmonary bypass (CPB) in anaesthetized dogs compared with animals given either saline (control) or aspirin. Following thoracotomy, heparinization and aortic cannulation, and 35 minutes before CPB, dogs received intravenously either GR32191B (15 micrograms/kg/min), saline (50 ml bolus) or aspirin (225 mg bolus) (n = 6 per group). Cardiac output (dye dilution), femoral artery blood flow (electromagnetic flowmeter), gastrocnemius muscle tissue perfusion (133Xe clearance), retinal blood flow (fluorescein angiography), and thromboxane biosynthesis (urinary excretion rates of TXB2 and the metabolite 2,3-dinor-TXB2) were measured before, during and after a standard 90 minute period of CPB at 2.4 l/min/m2 and 28 degrees C. The aspirin-treated group manifested an eightfold reduction in TXB2 excretion compared with controls, indicating a decrease in TXA2 biosynthesis. There were few haemodynamic differences between the groups, though the aspirin-treated group had better maintained muscle tissue perfusion post-CPB and significantly fewer retinal microcirculatory occlusions than GR32191B-treated animals. We conclude that specific TXA2 receptor antagonism provides no significant improvement in peripheral haemodynamics; rather aspirin provides a modest haemodynamic benefit.

Animals↗
PubMed1995

Effect of calcium ions on the surface charge and aggregation of phosphatidylcholine liposomes.

The aggregation behaviour of multilamellar liposomes composed of egg phosphatidylcholine (EPC) and dipalmitoylphosphatidylcholine (DPPC) in the presence of varying concentrations of calcium ions has been studied by measuring changes in the particle size of liposome suspensions. Reversible aggregation occurred with both liposome preparations, showing a maximum rate at approximately 0.9 to 1.8 mM calcium chloride. At higher or lower concentrations aggregation was inhibited in the case of EPC suspensions or, for DPPC systems, occurred only slowly. Furthermore, the EPC systems showed more marked increases in size when aggregation occurred. The zeta potentials of both systems were negative in water, becoming positive on increasing the concentration of calcium ions. A reasonable correlation was found between calcium concentration corresponding to the minimum in initial zeta potential and that producing the greatest aggregation rate.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1995

Cytogenetic response to alpha-interferon is predicted in early chronic phase chronic myeloid leukemia by M-bcr breakpoint location.

Alpha-interferon (alpha-IFN) therapy is an effective agent in early chronic phase (ECP) chronic myeloid leukemia (CML), achieving hematologic control in the majority and major cytogenetic response (MCR) (reduction in Ph' +ve metaphases to < 35%) in a substantial minority. Currently no pretreatment markers exist to ascertain likelihood of meaningful response. The site of breakpoint in M-bcr and relationship to prognosis is controversial. Studies have been hampered by variation in definition of breakpoint and difference in treatment protocols. In this study of ECP CML patients, Southern analysis and reverse transcription polymerase chain reaction (RT-PCR) were used to determine breakpoint location. Patients received alpha-IFN (9 x 10(6) units/day) and dose-adjusted hydroxyurea (HU) to maintain granulocyte count between 1.0-2.0 x 10(9)/l for 6 months or more. Twelve of 31 patients entered on the study achieved a MCR. The Sokal index did not predict for cytogenetic response to alpha-IFN. Eight of 11 patients with 5' breakpoint achieved MCR compared to only four of 20 patients with 3' breakpoint (P = 0.007). These results suggest site of M-bcr rearrangement may be predictive of response to alpha-IFN therapy. If verified by further study, this may allow more appropriate use of alpha-IFN with respect to other modalities such as allogeneic transplant.

Base Sequence↗