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1.
J Pediatr ; 137(6): 785-93, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11113834

ABSTRACT

OBJECTIVE: To determine whether premature infants who have necrotizing enterocolitis (NEC) have deficiencies in glutamine (GLN) and arginine (ARG), which are essential to intestinal integrity. STUDY DESIGN: A 4-month prospective cohort study of serum amino acid and urea levels in premature infants was done. Serum amino acid and urea levels were measured by high-pressure liquid chromatography and enzymatic methods, respectively, on samples obtained on days of life 3, 7, 14, and 21. RESULTS: Infants in the control (n = 32) and NEC groups (n = 13) were comparable for birth weight, gestational age, and Apgar scores. NEC began on mean day of life 14.5 (95% CI, day of life 11 to 18). Median values of GLN were 37% to 57% lower in the NEC group on days 7, 14, and 21 compared with those in the control group (P <.05). On days 7 and 14, median values of ARG, GLN, alanine, lysine, ornithine, and threonine were decreased 36% to 67% (P <.05) in the NEC group. Total nonessential amino and total essential amino acids were 35% to 50% lower in the NEC group on days 7 and 14 (P <.05). Infants in the NEC group had significant reductions in GLN and ARG 7 days before the onset of NEC. CONCLUSIONS: Infants who have NEC have selective amino acid deficiencies including reduced levels of GLN and ARG that may predispose to the illness.


Subject(s)
Arginine/blood , Enterocolitis, Necrotizing/blood , Glutamine/blood , Infant, Premature, Diseases/blood , Age Factors , Chromatography, High Pressure Liquid , Cohort Studies , Gestational Age , Humans , Infant Food , Infant, Newborn , Infant, Premature , Milk, Human , Prospective Studies , Reference Values , Urea/blood
2.
Ann Thorac Surg ; 67(1): 194-9; discussion 199-200, 1999 Jan.
Article in English | MEDLINE | ID: mdl-10086548

ABSTRACT

BACKGROUND: The perfusion of rat lungs retrieved from cadavers with a solution containing isoproterenol has been shown to ameliorate the ischemia-reperfusion injury seen in lungs retrieved after death, and this protective effect parallels increases in tissue cyclic adenosine monophosphate levels. In this study, we investigated the effect of rolipram, a phosphodiesterase inhibitor, on capillary permeability and lung cyclic adenosine monophosphate levels in lungs retrieved from circulation-arrested rats. METHODS: Using an isolated perfused lung circuit, we retrieved lungs from circulation-arrested donor rats either ventilated with 100% oxygen or not ventilated for varying postmortem times. The lungs were reperfused with or without rolipram (2 micromol/L). The capillary filtration coefficient and wet to dry weight ratio, indicators of pulmonary vascular integrity, were determined, and tissue levels of adenine nucleotides and cyclic adenosine monophosphate were measured by high-performance liquid chromatography. RESULTS: The capillary filtration coefficient was significantly reduced in nonventilated cadaver lungs reperfused with rolipram 120 minutes after death (p<0.05). Oxygen ventilation or reperfusion with rolipram had a similar effect on the capillary filtration coefficient. Cyclic adenosine monophosphate levels were significantly higher in rolipram-reperfused lungs retrieved 120 minutes after death in both oxygen-ventilated (p<0.01) and nonventilated (p<0.01) lungs. CONCLUSIONS: In lungs from nonventilated, circulation-arrested donors, reperfusion with rolipram reduces the ischemia-reperfusion injury that may be due to intracellular cyclic adenosine monophosphate. Alteration of perfusate may have an impact on capillary leak caused by antecedent ischemia. Thus, rolipram may be a useful adjunct in the preservation of donor lungs retrieved after death.


Subject(s)
Phosphodiesterase Inhibitors/pharmacology , Pyrrolidinones/pharmacology , Reperfusion Injury/prevention & control , Adenine Nucleotides/metabolism , Animals , Capillary Permeability/drug effects , Chromatography, High Pressure Liquid , Cyclic AMP/metabolism , Disease Models, Animal , Heart Arrest, Induced , In Vitro Techniques , Lung/chemistry , Lung Transplantation , Male , Rats , Rats, Sprague-Dawley , Rolipram
3.
Genomics ; 54(1): 70-8, 1998 Nov 15.
Article in English | MEDLINE | ID: mdl-9806831

ABSTRACT

In this report, we have identified, sequenced, and characterized the expression pattern of a novel human gene, mammaglobin B. Mammaglobin B (MGB2) is highly homologous to mammaglobin (MGB1), a previously characterized human gene whose expression is limited to the mammary epithelium and frequently up-regulated in human breast cancer cells. Based upon amino acid sequence similarities, both mammaglobin and mammaglobin B may be considered members of a larger, mammalian multigene family that includes rabbit uteroglobin, human Clara Cell 10-kDa protein (CC10), and the multimeric rat prostatein protein. Together with the human CC10 gene, mammaglobin and mammaglobin B are closely linked on human chromosome 11q13. However, despite their primary sequence similarity and close chromosomal proximity, the expression of mammaglobin and mammaglobin B is nonconcordant in both nonmalignant and neoplastic tissue.


Subject(s)
Neoplasm Proteins/genetics , Uteroglobin/genetics , Amino Acid Sequence , Animals , Base Sequence , Blotting, Northern , Breast/metabolism , Breast Neoplasms/metabolism , Chromosomes, Human, Pair 11/genetics , Female , Humans , In Situ Hybridization, Fluorescence , Mammaglobin A , Mammaglobin B , Molecular Sequence Data , Myelin Proteins , Neoplasm Proteins/chemistry , Neoplasm Proteins/metabolism , Polymerase Chain Reaction , Proteins/genetics , Proteolipids , RNA, Messenger/genetics , RNA, Messenger/metabolism , Salivary Glands/metabolism , Secretoglobins , Uterine Neoplasms/metabolism , Uteroglobin/chemistry , Uteroglobin/metabolism , Uterus/metabolism
4.
J Appl Physiol (1985) ; 83(1): 247-52, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9216970

ABSTRACT

Lungs harvested from cadaveric circulation-arrested donors may increase the donor pool for lung transplantation. To determine the degree and time course of ischemia-reperfusion injury, we evaluated the effect of O2 ventilation on capillary permeability [capillary filtration coefficient (Kfc)], cell viability, and total adenine nucleotide (TAN) levels in in situ circulation-arrested rat lungs. Kfc increased with increasing postmortem ischemic time (r = 0.88). Lungs ventilated with O2 1 h postmortem had similar Kfc and wet-to-dry ratios as controls. Nonventilated lungs had threefold (P < 0.05) and sevenfold (P < 0.0001) increases in Kfc at 30 and 60 min postmortem compared with controls. Cell viability decreased in all groups except for 30-min postmortem O2-ventilated lungs. TAN levels decreased with increasing ischemic time, particularly in nonventilated lungs. Loss of adenine nucleotides correlated with increasing Kfc values (r = 0.76). This study indicates that lungs retrieved 1 h postmortem may have normal Kfc with preharvest O2 ventilation. The relationship between Kfc and TAN suggests that vascular permeability may be related to lung TAN levels.


Subject(s)
Adenine Nucleotides/metabolism , Death , Heart Arrest/metabolism , Heart Arrest/physiopathology , Lung/metabolism , Lung/physiopathology , Animals , Cell Survival/physiology , Heart Arrest/pathology , Hemodynamics/physiology , In Vitro Techniques , Lung/pathology , Male , Organ Size/physiology , Oxygen Consumption/physiology , Postmortem Changes , Pulmonary Circulation/physiology , Pulmonary Wedge Pressure/physiology , Rats , Rats, Sprague-Dawley , Reperfusion Injury/metabolism , Reperfusion Injury/physiopathology
8.
Minn Med ; 74(2): 21-4, 1991 Feb.
Article in English | MEDLINE | ID: mdl-2017120

ABSTRACT

We reviewed the records of all 66 cases of tuberculosis in St. Paul between 1986 and 1989. Two-thirds of the patients were foreign born. Some of these patients experienced problems in adherence to therapy because of cultural barriers. Resistance of the organism to antituberculosis medications was also a significant problem.


Subject(s)
Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Aged , Child , Cross-Sectional Studies , Female , Humans , Incidence , Male , Middle Aged , Minnesota/epidemiology
9.
Ann Thorac Surg ; 36(4): 453-8, 1983 Oct.
Article in English | MEDLINE | ID: mdl-6625739

ABSTRACT

A survey of members of The Society of Thoracic Surgeons was undertaken to obtain information on experiences with cardiac operations in pregnant women. The experiences reported were highly successful, with only 1 maternal death in 68 procedures utilizing cardiopulmonary bypass and more than 80% survival of fetuses. Cardiac operations in pregnant patients probably can be made safer by avoidance of perfusion hypothermia and by use of fetal heart and uterine monitoring. When valve replacement is necessary, use of biological valves is recommended to avoid the necessity for anticoagulation.


Subject(s)
Cardiac Surgical Procedures , Pregnancy , Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass , Female , Heart Failure/surgery , Heart Valves/surgery , Humans , Mitral Valve/surgery , Pregnancy Complications/etiology
12.
Chest ; 81(3): 378-80, 1982 Mar.
Article in English | MEDLINE | ID: mdl-6976884

ABSTRACT

A 65-year-old patient sustained massive air embolism after the needle used for left atrial pressure line insertion punctured the posterior wall of the superior pulmonary vein, entering the middle lobe bronchus and causing a pulmonary venous-bronchus fistula. This is an apparently heretofore unrecognized potential cause of massive air embolism following cardiac surgery.


Subject(s)
Bronchial Fistula/etiology , Embolism, Air/etiology , Fistula/etiology , Pulmonary Veins/injuries , Punctures/adverse effects , Aged , Catheterization/adverse effects , Coronary Artery Bypass , Female , Humans , Postoperative Complications , Pressure
14.
Chest ; 80(3): 331-3, 1981 Sep.
Article in English | MEDLINE | ID: mdl-7273885

ABSTRACT

A 72-year-old woman presented 12 months postaortic valve replacement with a false aneurysm near the aortic cannulation site. The diagnosis was suspected from clinical findings and confirmed by a nuclear flow study. The patient refused surgery and died shortly afterward. At autopsy, a smooth-walled 1 cm defect adjacent to the cannulation site (presumably related to injury from a partial occlusion clamp) was found; this would have been easily reparable with surgery.


Subject(s)
Aorta/injuries , Aortic Aneurysm/etiology , Cardiopulmonary Bypass/adverse effects , Aged , Aorta/diagnostic imaging , Aorta/pathology , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/pathology , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Constriction , Female , Heart Valve Prosthesis , Humans , Intraoperative Complications/etiology , Radionuclide Imaging , Technetium
15.
Ann Thorac Surg ; 32(2): 120-6, 1981 Aug.
Article in English | MEDLINE | ID: mdl-7259353

ABSTRACT

Utilizing a questionnaire specifically designed to uncover potential thromboembolic episodes, we personally interviewed 97 patients who underwent valve replacement with the Ionescu-Shiley valve between January, 1977, and June, 1980. In both the aortic and mitral positions, the attrition rate after the first year was low; cumulative survival at 3 to 4 years was 78% (aortic) and 61% (mitral). None of the deaths were attributed to primary valve failure. Patients with aortic prostheses, none of whom were anticoagulated, had a cumulative thromboembolism-free rate of 94% at 3 to 4 years. Patients with mitral prostheses had a thromboembolism-free rate of 71% at 3 to 4 years with 80% of the episodes occurring in patients in atrial fibrillation. Most emboli produced only transient symptoms, and only 1 patient has residual impairment. The Ionescu-Shiley valve performs well in the early years after valve replacement. Anticoagulation should be strongly considered for patients with mitral prostheses who are in atrial fibrillation.


Subject(s)
Aortic Valve/surgery , Bioprosthesis , Heart Valve Prosthesis , Mitral Valve/surgery , Adult , Aged , Anticoagulants/therapeutic use , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/mortality , Surveys and Questionnaires , Thromboembolism/mortality , Thromboembolism/prevention & control
16.
Can Anaesth Soc J ; 28(4): 334-8, 1981 Jul.
Article in English | MEDLINE | ID: mdl-7260711

ABSTRACT

The hormonal responses to anaesthesia and cardiac surgery were studied in patients undergoing valve or coronary bypass surgery. Marked increases in antidiuretic hormone levels as a result of surgical stress were seen, and were of approximately equal magnitude in both groups. Although both groups also showed marked increases in plasma cortisol levels in response to operations, this response appeared to be relatively blunted in valve surgery patients, especially at the end of operation and in the intensive care unit. This blunted cortisol response may be a manifestation of exhaustion of adrenocortical reserves in valvular surgical patients whose sympathoadrenal system has already been chronically stimulated by a low output state. The important role of the neuroendocrine system in maintaining homeostasis postoperatively has long been recognized; this relative cortisol deficiency may be aetiologically related to poor postoperative recovery in critically ill valvular surgery patients.


Subject(s)
Coronary Disease/surgery , Heart Valve Diseases/surgery , Hydrocortisone/blood , Stress, Physiological/blood , Vasopressins/blood , Coronary Disease/blood , Coronary Disease/physiopathology , Heart Valve Diseases/blood , Heart Valve Diseases/physiopathology , Hemodynamics , Humans , Middle Aged , Stress, Physiological/physiopathology
18.
J Thorac Cardiovasc Surg ; 80(4): 613-20, 1980 Oct.
Article in English | MEDLINE | ID: mdl-7421295

ABSTRACT

The hemodynamic performance of the Ionescu-Shiley bovine heterograft valve has been evaluated by intraoperative measurement of transvalvular gradients and cardiac outputs. Effective orifice areas (EOAs) were calculated and the data compared to those obtained by other investigators for other prostheses. In the aortic position, each valve, from 19 to 31 mm external diameter, produced a pressure gradient; mean EOA increased with increasing valve size, so that small (19 to 23 mm) valves were moderately stenotic and larger valves were only mildly stenotic. The presence of a mitral prosthesis produced larger transaortic valve gradients, probably as a result of aortic outflow obstruction by the mitral prosthesis. The Ionescu valve appears to be hemodynamically superior to other biological valves in the aortic position and comparable to most mechanical prostheses, although the data for comparison are scant. Each mitral valve produced a pressure gradient and, on the average, larger (29 mm) valves performed no better than smaller (25 mm). Mean EOAs for each valve size (25 to 29 mm) were adequate to provide satisfactory hemodynamics comparable to other available prosthetic valves. Mild obstruction of the left ventricular outflow by the prosthetic struts was seen to be related to the distance between ventricular septum and the struts. Most currently available prostheses seem to provide similar hemodynamics in the mitral position, and considerations such as thrombogenicity and durability may be relatively more important in the choice of a mitral valve substitute than in the choice of an aortic valve substitute.


Subject(s)
Bioprosthesis , Cardiac Output , Heart Valve Prosthesis , Heart Valves/physiology , Aortic Valve/physiology , Aortic Valve/surgery , Heart Valves/surgery , Humans , Mitral Valve/physiology , Mitral Valve/surgery
19.
Circulation ; 62(2 Pt 2): I19-25, 1980 Aug.
Article in English | MEDLINE | ID: mdl-6994924

ABSTRACT

In a randomized trial of pulsatile vs nonpulsatile cardiopulmonary bypass for coronary artery surgery, we studied hemodynamic and hormonal responses. Anesthesia did not produce a response but, from the time of the incision, cortisol and antidiuretic hormone levels and plasma renin activity all increased. Cortisol levels continued to rise after surgery, whereas the other began to fall. Systemic vascular resistance fell dramatically during cardiopulmonary bypass but rapidly rose after bypass with a reciprocal change in cardiac index. We did not see the changes ascribed to nonpulsatile bypass by others. There ws no difference between our pulsatile and nonpulsatile cases. High-flow cardiopulmonary bypass, vasodilating inhalation anesthesia and continuation of Inderal therapy may account for our results.


Subject(s)
Cardiopulmonary Bypass , Hemodynamics , Hydrocortisone/blood , Vasopressins/blood , Body Temperature , Body Weight , Humans , Hydrogen-Ion Concentration , Middle Aged , Osmolar Concentration , Potassium/blood , Renin/blood , Sodium/blood , Urine
20.
Am J Cardiol ; 46(1): 95-105, 1980 Jul.
Article in English | MEDLINE | ID: mdl-7386399

ABSTRACT

Transesophageal M mode echocardiography was used for continuous monitoring of left ventricular dimensions in 21 patients (11 with valvular and 10 with coronary heart disease) undergoing open heart surgery. Echocardiograms were recorded in six stages of the procedure and simultaneous measurements of cardiac output (with dye dilution) and atrial pressures were made. Measurements of left ventricular diameters with the transesophageal technique correlated excellently with the corresponding measurements obtained with the standard parasternal method. In patients with volume overload, surgical correction was accompanied by a decrease in diastolic dimension, velocity of circumferential fiber shortening, mid wall stress and end-diastolic stiffness, and an increase in cardiac output. Pericardial and chest wall closures generally caused a significant decrease in cardiac output, and correlated with a decrease in diastolic diameter and an increase in the stiffness constant of the left ventricle. Thus, the decrease in cardiac output may have been due to decreased distensibility of the ventricular cavity secondary to mechanical restriction by the pericardium and chest wall. Pericardial opening caused a significant delay in septal motion that was reversed by closing the pericardium. This study confirms the validity of transesophageal echocardiography and its usefulness in monitoring changes in ventricular function during cardiac surgery.


Subject(s)
Cardiac Surgical Procedures , Echocardiography , Esophagus , Adult , Aged , Cardiac Output , Coronary Disease/physiopathology , Diastole , Female , Heart Septal Defects, Ventricular/physiopathology , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Time Factors
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