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PubMed2001

Morphological changes of the anterior spinal artery during aortic cross-clamping and effect of prostaglandin E1 with perfusion.

This investigation was designed to evaluate the morphological changes of anterior spinal artery (ASA) and its reaction to prostaglandinE1 (PGE1) during aortic cross-clamping. ASA during 30 min cross-clamping was observed with charge-coupled device (CCD) and ASA diameter (ASAD) was measured. Group A: Infrarenal aorta was cross-clamped. Group B: Infrarenal aorta was cross-clamped and aorta above the bifurcation was snared. The aortic segment between clamp and snare was perfused with blood. Group C: PGE1 of 100 ng/kg/min was added to perfusate of Group B. The aortic segmental pressures in group B and C were about 30% of the proximal systolic arterial pressure and were significantly higher than distal pressure of group A. After cross-clamping, ASAD decreased about 80% of before cross-clamping in group A. By segmental perfusion of which pressure was about 30% of proximal systolic arterial pressure, ASAD remained almost 90% in group B. By administration of PGE1, ASAD was significantly increased in group C. The changes of ASAD were significantly different between group A and C, and between group B and C.

Alprostadil↗
PubMed1994

Protecting the ischemic spinal cord during aortic clamping: the influence of selective hypothermia and spinal cord perfusion pressure.

PURPOSE: We verified the hypothesis that selective deep hypothermia of the spinal cord during double thoracic aortic clamping can prevent postoperative paraplegia in dogs. METHODS: Normal saline solution was circulated from the cisterna magna through an extracorporeal perfusion system consisting of a reservoir, a pump, and a heat exchanger, back into the subarachnoid space at the level of the medullary cone at a rate of 25 ml/min, starting 30 minutes before clamping, and ending after removal of the clamps. The thoracic aorta was cross-clamped below the left subclavian artery and above the diaphragm for a period of 45 minutes. Cerebrospinal fluid, intracranial, and central venous pressure and aortic pressure proximal, between, and distal to the clamps were continuously recorded. In five dogs, temperature of the circulating normal saline solution at the inflow level was maintained at 2 degrees +/- 1.5 degrees C (group 1), in five controls at 37 degrees +/- 0.8 degrees C (group 2). Five dogs underwent continuous cerebrospinal fluid drainage starting before clamping until sacrifice (group 3). Dogs were observed for up to 4 days, and neurologic function was graded by an independent observer with the Tarlov scale. Animals were then killed, and their spinal cords were prepared for microscopic examination. RESULTS: Hemodynamic parameters were not significantly different between groups. All dogs in groups 2 and 3 were paraplegic with histologic evidence of spinal cord infarction. All animals in group 1 were neurologically normal without microscopic evidence of infarction (p < 0.005). CONCLUSIONS: Selective deep hypothermia of the spinal cord prevents paraplegia after 45 minutes of double aortic clamping in dogs. Cerebrospinal fluid drainage was not effective in preventing paraplegia in this model.

Animals↗
PubMed1986

[Hemodynamic effect of the clamping of the carotid in the surgically treated coronary patient].

To determine both the incidence of myocardial ischaemia and haemodynamic response to carotid cross-clamping in coronary artery disease, 30 patients undergoing carotid endarterectomy were studied with a clear history of effort related disabling angina pectoris. Myocardial ischaemia was detected by a recording of lead CM5 of the electrocardiogram. A radial arterial and a thermodilution pulmonary catheter were inserted to obtain haemodynamic measurements before and after carotid cross-clamping and unclamping. Anaesthesia was induced with increments of thiopental, fentanyl 6 micrograms X kg-1 and pancuronium. Additional fentanyl (2 micrograms X kg-1) was injected before skin incision and before carotid cross-clamping. Carotid cross-clamping results in a significant increase in both mean arterial blood pressure and capillary wedge pressure. Two patients experienced myocardial ischaemia with ST segment depression during carotid cross-clamping. Nitroglycerin infusion led to the improvement of ST segment depression. When halothane was additionally administered to patients who developed hypertension in response to carotid cross-clamping, arterial blood pressure returned to normal value. These results indicate that carotid cross-clamping increases determinants of myocardial oxygen demand and may cause myocardial ischaemia in patients suffering from angina pectoris.

Aged↗
PubMed1995

Alterations in intracranial volume following cross-clamping of the descending thoracic aorta in pigs--an experimental study using MRI.

OBJECTIVES: To determine whether alterations in intracranial volume occurred following cross-clamping of the descending thoracic aorta in pigs. DESIGN AND SETTING: Laboratory animal study. MATERIALS: Eight pigs undergoing cross-clamping of the descending thoracic aorta for 30 min. CHIEF OUTCOME MEASURES: A Philips Gyroscan T5-II Release 3 (0.5 T) was used to obtain intracranial images before cross-clamping, during cross-clamping and after declamping. The ventricular volume was measured on Spin Echo T1-weighted images. The signal intensity of the cerebral tissue was measured on Spin Echo T2-weighted images. Increased signal intensity of the cerebral tissue relative to an external reference was used as an indicator of cerebral oedema. MAIN RESULTS: The ventricular volume decreased to 89% (p < 0.01) of the baseline value after 5 min of cross-clamping. At 5 min after declamping the ventricular volume decreased further to 71% (p < 0.01). At 25 min after declamping the ventricular volume had returned to the baseline value. The signal intensity of the cerebral tissue did not differ from baseline values following aortic cross-clamping. CONCLUSIONS: In this study, ventricular volume decreased following cross-clamping of the descending thoracic aorta. Since no cerebral oedema was observed, the decrease of ventricular volume was most likely due to increased intracranial blood volume.

Animals↗
PubMed2003

Combined triplex/duplex invasion of double-stranded DNA by "tail-clamp" peptide nucleic acid.

"Tail-clamp" PNAs composed of a short (hexamer) homopyrimidine triplex forming domain and a (decamer) mixed sequence duplex forming extension have been designed. Tail-clamp PNAs display significantly increased binding to single-stranded DNA compared with PNAs lacking a duplex-forming extension as determined by T(m) measurements. Binding to double-stranded (ds) DNA occurred by combined triplex and duplex invasion as analyzed by permanganate probing. Furthermore, C(50) measurements revealed that tail-clamp PNAs consistently bound the dsDNA target more efficiently, and kinetics experiments revealed that this was due to a dramatically reduced dissociation rate of such complexes. Increasing the PNA net charge also increased binding efficiency, but unexpectedly, this increase was much more pronounced for tailless-clamp PNAs than for tail-clamp PNAs. Finally, shortening the tail-clamp PNA triplex invasion moiety to five residues was feasible, but four bases were not sufficient to yield detectable dsDNA binding. The results validate the tail-clamp PNA concept and expand the applications of the P-loop technology.

Base Pair Mismatch↗
PubMed2006

Adhesive pi-clamping within synthetic multifunctional pores.

We report the design, synthesis, and evaluation of synthetic multifunctional pores with adhesive, that is, electron-deficient naphthalenediimide (NDI) pi-clamps at their inner surface. We find that, in lipid bilayer membranes, comparable synthetic pores with and without pi-clamps have similar, nanomolar activity. Functional relevance of adhesive pi-clamping within synthetic pores is demonstrated by means of an innovative in situ blocker screening method. The obtained line of experimental evidence includes (a) different blockage efficiency with and without pi-clamps (quantified as clamping factors), (b) increasing clamping factors with increasing blocker charge (supportive ion pairing), and, most importantly, (c) increasing clamping factors with increasing aromatic electron donor-acceptor interactions. The availability of advanced synthetic multifunctional pores with refined active sites is important for practical applications in domains such as drug discovery (enzyme inhibitor screening) and diagnostics (multianalyte sensing).

Journal Article↗
PubMed2000

Supraceliac aortic cross-clamping and declamping. Effects of dopexamine and dopamine on systemic and mesenteric hemodynamics, metabolism and intestinal tonometry in a rat model.

BACKGROUND: The effects of dopexamine and dopamine on mesenteric ischemia during reperfusion following aortic cross-clamping are not known. We determined intramucosal tonometric PCO2 and PCO2 gap using a rat model of supraceliac aortic cross-clamping and declamping. METHODS: Under pentobarbital and fentanyl anesthesia, 24 rats were surgically instrumented with arterial, right atrial, and portal venous catheters, ultrasonic flowprobes for measurements of abdominal aortic, superior mesenteric and carotid artery blood flow, and a pediatric tonometer for intestinal mucosal PCO2 measurements. Rats were randomized to receive a continuous infusion of dopexamine (10 x microg(-1) x kg(-1) x min(-1), n=8), dopamine (10 microg x kg(-1) x min(-1), n=8 ), or physiologic saline (control, n= 8), infused at a rate of 4 ml x kg(-1) x h(-1), administered throughout the experimental protocol. After 30 min of drug infusion, the aorta was cross-clamped at the supraceliac level for 30 min. Reperfusion following declamping was observed for 180 min. RESULTS: Intestinal tonometric PCO2 remained unchanged during drug treatment before aortic cross-clamping, increased similarly in all groups following declamping during early reperfusion, and recovered to baseline within 30 min of reperfusion. Dopexamine treatment was associated with higher lactate levels and increased heart rate (P<0.05) during aortic cross-clamping. CONCLUSIONS: 1) Mesenteric ischemia, determined by intestinal tonometric PCO2 and PCO2 gap, recovers within 30 min of reperfusion following 30 min of aortic cross-clamping irrespective of drug treatment and, 2) dopexamine induced higher lactate levels and increased heart rate during aortic cross-clamping and should be carefully analyzed for potentially adverse effects on cardiac function.

Animals↗
PubMed2001

Monitoring of end-tidal carbon dioxide partial pressure changes during infrarenal aortic cross-clamping: a non-invasive method to predict unclamping hypotension.

BACKGROUND: To assess the variations in end-tidal CO2 in response to aortic cross-clamping and the relationship with systolic arterial pressure (SAP) changes induced by unclamping. METHODS: Thirty-three patients undergoing infrarenal aortic abdominal aneurysm repair by aorto-aortic prothetic bypass were prospectively studied. All patients were anesthetized with i.v. midazolam (0.05 mg x kg(-1)), thiopentone (3-5 mg x kg(-1)), fentanyl (5 microg x kg(-1)), pancuronium (0.1 mg x kg(-1)) and the maintainance of anesthesia used was 1-1.5% end-tidal isoflurane and i.v. fentanyl. The perioperative management was standardized. End-tidal CO2 and SAP were measured 5 min before (Pre-XAA), 15 min after infrarenal aortic cross-clamping (XAA), 5 min before (Pre-UXAA) and immediately after unclamping (UXAA). RESULTS: A total of 16 (48.5%) from 33 patients presented decrease in SAP following aortic unclamping, and 13 out of these patients had arterial hypotension defined as SAP<90 mmHg. End-tidal CO2 variation (PreXAA-PreUXAA) induced by aortic clamping was correlated with SAP variation (PreUXAA-UXAA) induced by unclamping (r=0.763; P=0.0001). An end-tidal CO2 reduction above 15% after aortic cross-clamping was found to have a 100% sensitivity to detect a SAP decrease greater than 20% after unclamping, with a 100% specificity and a negative predictive value of 1.0. Complete aortic occlusion duration was not correlated to SAP unclamping variation (deltaSAP). Intraoperative characteristics (fluid loading, hematocrits, urinary output) were comparable, although blood loss was higher in patients experiencing deltaSAP>20%. CONCLUSIONS: End-tidal CO2 variation monitoring during aortic cross-clamping may provide a reliable and non-invasive method to predict unclamping hypotension. When the aortic clamp was released, systolic hypotension (>20%) occurred in those subjects who had a decrease in end-tidal CO2 greater than 15% during aortic cross-clamping.

Aged↗
PubMed1984

A cold-clamping technique for the rapid sampling of rat liver for studies on enzymes in separate cell fractions. Suitability for the study of enzymes regulated by reversible phosphorylation-dephosphorylation.

A technique for the rapid sampling, cooling and homogenization of rat liver is described. Its effectiveness in preserving the activity status of pyruvate kinase (soluble) and 3-hydroxy-3-methylglutaryl-CoA reductase (HMG-CoA reductase) (microsomal) during sampling is assessed in comparison with that of the freeze-clamping technique and of simple excision and mincing of liver tissue before homogenization. The results suggest that cold-clamping is equally effective as freeze-clamping in preserving the activity status of pyruvate kinase in liver samples obtained in situ, but in addition allows the subsequent separation of subcellular fractions, notably microsomes (microsomal fractions) and mitochondria. It is suggested that this property makes the technique useful in studying the activity status of enzymes (e.g. HMG-CoA reductase) the assay of which is subject to interference from the activity of other enzymes which are released from damaged organelles in crude homogenates of freeze-clamped liver samples. This suggestion was tested directly; the cold-clamping technique was found to preserve a substantially higher initial/total HMG-CoA reductase activity ratio [Easom & Zammit (1984) Biochem. J. 220, 739-745] in subsequently isolated microsomes compared with that obtained in microsomes prepared from liver samples processed in the conventional manner. The integrity of mitochondria isolated from homogenates of cold-clamped liver samples was preserved, as judged by the latency of intramitochondrial enzymes and by good respiratory control of the mitochondria. Possible further areas of metabolic studies to which the cold-clamping technique could be applied are suggested.

Animals↗
PubMed2000

Continuous fiberoptic PCO2 monitoring indicates poorer gastric perfusion during supraceliac aortic clamping than conventional gastric tonometry in humans: a pilot study.

OBJECTIVE: To compare two monitors of gastric perfusion intraoperatively--continuous fiberoptic carbon dioxide partial pressure (PCO2) sensor and conventional gastric tonometer. DESIGN: Prospective, unblinded study. SETTING: University teaching hospital. PARTICIPANTS: Adult patients undergoing major abdominal surgery. INTERVENTIONS: A fiberoptic probe (Biomedical Sensors, Pfizer, High Wycombe, England) capable of continuous PCO2 measurement and adapted to fit into the saline-filled balloon of a tonometric orogastric tube (Tonometrics, Instrumentarium Corp, Helsinki, Finland) was placed in the patients. The fiberoptic probe was attached to a Paratrend 7 machine (Biomedical Sensors, Pfizer) providing continuous intragastric PCO2 data. A second tonometric orogastric tube was passed and used according to the manufacturer's instructions, yielding intermittent PCO2 values. MEASUREMENTS AND MAIN RESULTS: Twelve patients provided 79 data pairs: 33 without aortic clamp, 23 infraceliac aortic clamp, and 23 supraceliac aortic clamp. Data are presented as mean +/- SD, and analysis of variance was used for comparison (p < 0.01); bias and precision were also calculated. Intramusosal PCO2 and PCO2 gradient were significantly higher, and intramucosal pH was significantly lower from continuous fiberoptic measurement in the supraceliac clamp group. In the no-clamp and infraceliac clamp groups, the differences between the 2 methods of measurement were not significant. CONCLUSION: Conventional gastric tonometry overestimated perfusion during conditions of compromised gastric blood flow (supraceliac aortic clamp).

Adult↗
PubMed2000

Evaluation of low-pressure arterial and venous clamps: electron microscopic study and possible clinical applications.

These authors report on validating their choice of disposable clamps in arterial and venous microsurgery in a comparative and experimental study using the scanning electron microscope. This appears to be the first evaluation of venous endothelial clamping lesions. Early intimal clamping lesions were studied using three different clamps and two protocols in 18 femoral arteries and veins in rabbits. Results were evaluated using a new classification that can be applied to both arterial and venous lesions: Grade I: cellular disorientation and disorganization; endothelial lamination; and absent or very few platelet deposits; Grade II: alterations of the cytoplasmic membranes in fusiform cells; presence of at least one breach of endothelial continuity; and moderate number of platelet deposits; Grade III: presence of endothelial detachment; and large numbers of platelet deposits. They showed that in arteries, all the clamps tested caused only low-grade lesions. In contrast, in veins, they demonstrated both the very fragile nature of the endothelium, and also the comparative safety of the low-pressure venous clamp. Their choice of specific clamps for venous anastomoses was validated.

Animals↗
PubMed2003

Protective effect of prostaglandin E1 against ischemia of spinal cord during aortic cross clamping.

PURPOSE: The purpose of this study was to investigate whether or not 5-minute segmental intraaortic perfusion of prostaglandin E1 (PGE1) in the preischemic period has a protective effect against spinal cord ischemia during aortic cross clamping. METHODS: The rabbits were divided into two groups. In group A (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. In group B (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution containing PGE1 of 100 ng/kg/min at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. After the aorta was declamped, the experimental animals recovered from the anesthesia. Twenty-four and 48 hours after the operation, the hind limb function was estimated with Tarlov's grade. Then, the animals were killed for pathologic study. RESULTS: The systolic arterial pressures measured at the left common carotid artery through the experiment were not significantly different between the two groups. The perfusion of the aortic segment between the proximal and distal clamp was nonpulsatile. The perfusion pressures of the aortic segments at 5 minutes after aortic cross clamping were 29 +/- 6 mm Hg and 33 +/- 6 mm Hg in groups A and B, respectively. No significant differences were seen between the two groups. In group A, the hind limb functions evaluated with Tarlov's grade after 24 hours and 48 hours were 0 to 3 (1.5 +/- 1.4) and 0 to 3 (1.3 +/- 1.4), respectively. In group B, these were 3 to 4 (3.5 +/- 0.5) and 3 to 4 (3.7 +/- 0.5), respectively. A significant difference was seen between the two groups (P <.05). In the ventral horn of the L5, L6, and L7 segments, large motor neurons that seemed viable were more preserved in group B than in group A. CONCLUSION: Segmental intraaortic perfusion of PGE1 in the preischemic period reduced neurologic damage of spinal cord ischemia.

Alprostadil↗
PubMed1998

Devoted to the lagging strand-the subunit of DNA polymerase III holoenzyme contacts SSB to promote processive elongation and sliding clamp assembly.

Escherichia coli DNA polymerase III holoenzyme contains 10 different subunits which assort into three functional components: a core catalytic unit containing DNA polymerase activity, the beta sliding clamp that encircles DNA for processive replication, and a multisubunit clamp loader apparatus called gamma complex that uses ATP to assemble the beta clamp onto DNA. We examine here the function of the psi subunit of the gamma complex clamp loader. Omission of psi from the holoenzyme prevents contact with single-stranded DNA-binding protein (SSB) and lowers the efficiency of clamp loading and chain elongation under conditions of elevated salt. We also show that the product of a classic point mutant of SSB, SSB-113, lacks strong affinity for psi and is defective in promoting clamp loading and processive replication at elevated ionic strength. SSB-113 carries a single amino acid replacement at the penultimate residue of the C-terminus, indicating the C-terminus as a site of interaction with psi. Indeed, a peptide of the 15 C-terminal residues of SSB is sufficient to bind to psi. These results establish a role for the psi subunit in contacting SSB, thus enhancing the clamp loading and processivity of synthesis of the holoenzyme, presumably by helping to localize the holoenzyme to sites of SSB-coated ssDNA.

Binding Sites↗
PubMed2001

Psoralen-modified clamp-forming antisense oligonucleotides reduce cellular c-Myc protein expression and B16-F0 proliferation.

The c-myc protooncogene plays an important role in the abnormal growth pattern of melanoma cells. In an attempt to inhibit c-Myc expression and the growth of an established murine melanoma cell line, we targeted homopurine sequences within the mouse myc mRNA with modified antisense oligonucleotides (AS ODNs). Psoralen was conjugated to the 5'-end of these clamp-forming oligonucleotides (clamp ODNs). Gel mobility shift analysis demonstrated a sequence-specific interaction between the active clamp ODNs (Myc-E2C and Myc-E3C) and the 1.4 kb c-myc mRNA, but no interaction with the control clamp ODN (SCR**). This association was further confirmed by thermal denaturation studies. In vitro translation assays demonstrated that both Myc-E2C and Myc-E3C at 5 microM inhibited c-Myc expression >99% after UV activation at 366 nm. Immunostaining of B16-F0 cells with a c-Myc monoclonal antibody revealed a significant reduction in c-Myc after clamp ODN treatment compared with the untreated or SCR** control-treated cells. This result was corroborated by western blot analysis. Utilizing the MTT assay to determine the effects of ODN-mediated c-Myc reduction on B16-F0 growth, we observed 60 and 64% reductions in growth after treatment with 5 microM Myc-E3C and Myc-E2C, respectively. We attribute the enhanced effectiveness of the clamp ODNs to psoralen activation. Our preliminary data suggest that inhibiting c-Myc overexpression results in a significant reduction in abnormal proliferation of B16-F0 melanoma cells and that the increased efficiency of clamp ODNs may provide an important advantage for their use in antisense therapies.

Animals↗
PubMed2003

Evolutionary clues to DNA polymerase III beta clamp structural mechanisms.

The prokaryotic DNA polymerase III beta homodimeric clamp links the replication complex to DNA during polynucleotide synthesis. This clamp is loaded onto DNA and unloaded by the clamp loader complex, the delta subunit of which by itself can bind to and open the clamp. beta Clamps from diverse bacteria were examined using contrast hierarchical alignment and interaction network (CHAIN) analysis, a statistical approach that categorizes and measures the evolutionary constraints imposed on protein sequences by natural selection. Some constraints are subtle inasmuch as they are unique to certain bacteria. Examination of corresponding molecular interactions within structures of the Escherichia coli beta dimeric and delta-beta complexes reveals that N320, Y323 and R176, which are subject to very strong constraints, form a substructure that may serve as a platform for leveraging and directing delta-induced conformational changes. N320 may play a prominent role, as it is strategically situated between this substructure and regions linked to delta binding and opening of beta's dimeric interface. R176 appears to act as a relay between the delta binding site and the clamp's central hole. Other residues subject to strong constraints are likewise associated with structurally important features. For example, two pairs of interacting residues, R269/E304 and K74/E300, form salt bridges at the dimeric interface, while the C-terminal residues M362, P363, M364 and R365 appear to play key roles in delta binding. Q149 and K198 appear to sense DNA within the clamp's central hole while other residues may relay this information to the delta binding site. Mutagenesis experiments designed to explore possible mechanisms are proposed.

Amino Acid Sequence↗
PubMed1998

Does the duration of cardiopulmonary bypass or aortic cross-clamp, in the absence of blood and/or blood product administration, influence the IL-6 response to cardiac surgery?

UNLABELLED: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response characterized by release of proinflammatory cytokines, including interleukin 6 (IL-6). Recent reports suggest that plasma IL-6 is increased after CPB. Previous studies evaluating the influence of duration of CPB and/or aortic cross-clamp time on the release of IL-6 are conflicting. Infusion of blood and blood products during these studies may have influenced plasma concentrations of proinflammatory cytokines by inducing host cell (monocyte) activation and IL-6 release. The purpose of our investigation was to determine, in an environment free from blood and/or blood product administration, the influence of duration of CPB and/or aortic cross-clamp on the magnitude of the IL-6 response in patients undergoing cardiac surgery. We prospectively evaluated plasma IL-6 levels preinduction (T0) and at sternal closure in 16 patients undergoing CPB (coronary artery bypass grafting, n = 9; valvular cardiac surgery, n = 7) to determine whether there is a correlation between the absolute increase in IL-6 and the duration of CPB or aortic cross-clamp time. None of the patients received blood and/or blood products during the study to control for the introduction of additional activated cells and soluble mediators, including IL-6. The results demonstrate that the magnitude of the IL-6 response to CPB is positively correlated with the duration of CPB but not with duration of aortic cross-clamp. It seems that induction of IL-6 release is part of a normal response to CPB and does not depend on activation of host cells during prolonged aortic cross-clamp. The activation or presence of inflammatory cytokines associated with administration of blood and/or blood products could have influenced previously published investigations relating the influence of duration of CPB and/or aortic cross-clamp time to the magnitude of the IL-6 response. IMPLICATIONS: This study found a positive correlation between the magnitude of the interleukin 6 response to cardiopulmonary bypass and duration of cardiopulmonary bypass (but not duration of aortic cross-clamp) when measurements were made in the absence of blood/blood product transfusion. Future studies evaluating strategies to reduce cytokine responses to cardiopulmonary bypass should therefore control for cardiopulmonary bypass duration.

Adult↗
PubMed1996

Is clamp and sew still viable for thoracic aortic resection?

OBJECTIVE: The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. BACKGROUND: Paraplegia remains a devastating complication after thoracoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clamp and sew has been the preferred technique at the University of Virginia for the thoracoabdominal aortic resection when proximal control is possible. METHODS: Between 1987 and 1994, the authors reviewed 91 consecutive patients who underwent thoracic aortic resection using clamp-and-sew techniques without any additional adjuncts for spinal cord protection. RESULTS: The average age of patients was 60.8 years; 57.1% were male. No intraoperative deaths occurred. In-hospital mortality was 13% (12/91), with an overall incidence of postoperative spinal cord injury manifested as paraparesis or paraplegia of 9.9% (9/91). Eighty-nine percent (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minutes or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits. CONCLUSIONS: The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearly all resections can be completed within 40 minutes of aortic occlusion. However, the "safe" duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times. Reproducible, safe, and technically simple means of spinal cord protection must be developed.

Adolescent↗
PubMed1995

Effectiveness of chest tube clamping in massive hemothorax.

OBJECTIVE: To test the effectiveness of chest tube clamping in massive hemothorax. DESIGN, MATERIALS AND METHODS: This was assessed in 32 spontaneously breathing Yorkshire piglets with 2.5 mm (groups A and B) or 4.0 mm (groups C and D) lacerations of the thoracic aorta. MEASUREMENTS: Hemodynamics, blood loss, length of survival, and arterial blood gases (on 100% oxygen) were monitored. The four groups of eight animals all had chest tubes but groups A and C had these tubes clamped. Measurements were made at baseline, immediately after aortic injury, and every 15 minutes until death. RESULTS: Groups C and D survived 39 +/- 4 and 38 +/- 5 minutes respectively compared to 68 +/- 6 and 70 +/- 4 minutes in groups A and B. Total blood loss was not statistically significantly different among the four groups (1225 +/- 72, 1312 +/- 84, 1020 +/- 90, and 1110 +/- 84 mL for groups A, B, C, and D respectively). The rate of blood loss was greater in groups C and D (29.4 +/- 0.2 mL and 30.1 +/- 0.3 mL/min) compared with 14.7 +/- 0.5 mL and 16.0 +/- 0.9 mL/min respectively in groups A and B. Blood loss rate was similar with clamped or unclamped chest tubes. All groups had similar baseline cardiac output (3.5 to 3.8 L/min) and arterial blood pressures (110 to 114 mm Hg) with a greater decrease in these parameters following the larger lacerations and no difference with chest tube clamping. Arterial PO2 decreased from approximately 400 to 50 mm Hg with clamping but only decreased to approximately 350 mm Hg without clamping. The hypoxia was associated with significant hypercapnea (PCO2 of 78 mm Hg). CONCLUSIONS: Chest tube clamping did not decrease hemorrhage or mortality but worsened gas exchange without improving hypotension and is therefore not recommended in the treatment of massive hemothorax.

Animals↗