A comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating clips versus standard sutures.

PURPOSE: Anastomotic compliance is an important predictive factor for long-term patency of small diameter vascular reconstruction. In this experimental study we compare the compliance of continuous and interrupted sutured vascular anastomoses with those using nonpenetrating clips. METHODS: Both common carotid arteries in nine goats (average weight, 57 +/- 5.7 kg) were transected, and end-to-end anastomoses were constructed with nonpenetrating clips or polypropylene sutures. The latter were applied with both interrupted and continuous techniques. Intraluminal pressure was measured with a Millar Mikro-tip transducer, and vessel wall motion was determined with duplex ultrasound equipped with an echo-locked wall-tracking system. Diametrical compliance was determined. Environmental scanning electron microscopy was performed on explanted anastomoses. RESULTS: There was a reduction in anastomotic compliance and associated proximal and distal para-anastomotic hypercompliant zones with the use of all techniques. However, compliance loss was significantly less in those anastomoses with clips and interrupted sutures when compared with continuous suture (P <.001). Furthermore, the total compliance mismatch across anastomoses with continuous sutures was significantly greater than those with clips or interrupted sutures (P <.05). The mean time for constructing clipped anastomoses was 5.7 +/- 1.4 minutes, which was significantly less than either continuous (P <.0001) or interrupted sutures (P <.0001). Furthermore, environmental scanning electron microscopy demonstrated minimal intimal damage with good intimal apposition in the clip group. CONCLUSION: Anastomoses performed with nonpenetrating clips resulted in improved para-anastomotic compliance profiles and reduced intimal damage when compared with those with polypropylene sutures. These benefits may enhance long-term graft patency by reducing the risk of anastomotic intimal hyperplasia.

The mechanical behavior of vascular grafts: a review.

The development of intimal hyperplasia (IH) near the anastomosis of a vascular graft to artery is directly related to changes in the wall shear rate distribution. Mismatch in compliance and diameter at the end-to-end anastomosis of a compliant artery and rigid graft cause shear rate disturbances that may induce intimal hyperplasia and ultimately graft failure. The principal strategy being developed to prevent IH is based on the design and fabrication of compliant synthetic or innovative tissue-engineered grafts with viscoelastic properties that mirror those of the human artery. The goal of this review is to discuss how mechanical properties including compliance mismatch, diameter mismatch, Young's modulus and impedance phase angle affect graft failure due to intimal hyperplasia.

Comparison of the antimicrobial capability of an abrasive paste and chemical-soak denture cleaners.

The objective of this research was to compare the ability of the two most popular methods for denture cleaning to remove plaque microorganisms from dentures. Dentu-Creme abrasive denture paste and Efferdent alkaline peroxide denture-cleanser soak were selected for study. Two trials were completed in which these materials were used alone and in combination along with a no-treatment control to determine the level of recoverable plaque bacteria from removable dentures. Plaque was allowed to accumulate for 48 or 72 hours in individuals with healthy oral mucosa during which time they refrained from all denture hygiene procedures. The results of two studies following similar double-blind cross-over designs were consistent in that soaking with the denture cleanser caused a significantly greater reduction of microorganisms than did brushing with the denture paste. Further, combining brushing with the soak did not reduce the level of recoverable microorganisms significantly more than soaking alone. Overall, brushing alone did not consistently remove more microorganisms than were observed in the no-treatment group. The denture-cleanser soak displayed broad antimicrobial activity against gram-negative anaerobic rods (Fusobacterium sp.), gram-positive facultative cocci (streptococci), and gram-negative anaerobic cocci (Veillonella sp.), as well as total recoverable microorganisms, which were all equally reduced by the denture-cleanser treatment. These results support the need for use of a denture cleanser in addition to brushing with a denture paste for proper denture hygiene.

Enterotoxin synthesis by nonsporulating cultures of Clostridium perfringens.

Chemostat-cultured Clostridium perfringens ATCC 3624 and NCTC 10240, and a nonsporulating mutant strain, 8-5, produced enterotoxin in the absence of sporulation when cultured in a chemically defined medium at a 0.084-h-1 dilution rate at 37 degrees C. The enterotoxin was detected by serological and biological assays. Examination of the chemostat cultures by electron microscopy did not reveal sporulation at any stage. The culture maintained enterotoxigenicity throughout cultivation in a continuous system. The enterotoxin was detected in batch cultures of each strain cultivated in fluid thioglycolate medium and a chemically defined medium. No heat-resistant or light-refractile spores were detected in batch cultures during the exponential growth.

Development of a minimal medium for Clostridium perfringens by using an anaerobic chemostat.

A minimal medium was developed for the cultivation of Clostridium perfringens in an anaerobic chemostat. Cultures of C. perfringens ATCC 3624 and NCTC 10240 were grown at 46 and 43 degrees C, respectively, in a glucose-limited, chemically defined medium at pH 7.2. The concentrations of amino acids, minerals, nucleotides, and vitamins, initially present in excess, were varied independently. The minimum concentration of each nutrient which would support 3 X 10(8) CFU/ml with a generation time of less than 40 min was determined and used to develop a reformulated defined medium. Atomic absorption spectroscopy and amino acid analyses of the reformulated medium indicated additional adjustments in nutrient content which led to the development of a minimal medium for each strain. The nutritional profile for each strain was similar. A decrease in the concentration of arginine, histidine, and tyrosine for strain 3624 and of arginine, histidine, and isoleucine for strain 10240 resulted in an increase in the optical density of each culture.

Respiratory modulation of barareceptor and chemoreceptor reflexes affecting heart rate and cardiac vagal efferent nerve activity.

1. Brief stimuli were delivered to the carotid chemoreceptors or baroreceptors in dogs anaesthetized with chloralose. Chemoreceptor stimulation was achieved by rapid retrograde injection of 0.2-0.5 ml. CO2 equilibrated saline through a cannula in the external carotid artery. Baroreceptor stimulation was achieved by forceful retrograde injection of 2-5 ml. air-equilibrated saline into the external carotid artery after first clamping the common carotid artery. 2. prompt decreases in heart rate were elicited by brief sudden chemoreceptor or baroreceptor stimuli when these were delivered during the expiratory phase of respiration. The stimuli did not modify the control heart rate pattern when delivered in the inspiratory phase of respiration. This respiratory modulation of reflex effectiveness persisted when the animals were completely paralysed and the phase of the respiratory cycle was monitored through a phrenic electroneurogram. 3. single cardiac vagal efferent nerve fibres were dissected from the cut central end of the right cervical vagus nerve. They were classified as cardiac efferents by their cardiac and respiratory rhythmicity, and by their increased activity in response to stimulation of a carotid sinus nerve or to mechanical elevation of the systemic arterial pressure. These efferent fibres increased their activity in response to brief chemoreceptor or baroreceptor stimuli delivered in expiration, but did not respond to stimuli delivered in inspiration. This respiratory modulation of both reflexes persisted after bilateral cervical vagotomy.

Effect of graded reductions in regional coronary perfusion on regional and total cardiac function.

This study examines the effects of graded reduction in regional coronary perfusion and changes in arterial oxygen concentration upon regional myocardial function and left ventricular function. In 14 open chest dogs, the distal left anterior descending coronary artery was cannulated and perfused at different pressures with blood equilibrated with either 21 or 95 percent oxygen, and regional function in the perfused myocardial segment was determined by use of the pressure-length loop. The mass of perfused left ventricular myocardium was determined by injection of sodium fluorescein at a constant pressure of 100 mm Hg. Regional function decreased minimally as coronary perfusion pressure and flow were reduced to 50 to 65 mm Hg and 25 to 55 ml/min per 100 g, respectively. When pressure and flow were reduced below these critical ranges, regional function decreased sharply. Changes in left ventricular function were comparable but of lesser magnitude. The relations between regional function or left ventricular function and coronary perfusion were not affected by changing arterial oxygen concentration, except at the low range of coronary perfusion pressures (22 plus or minus 6 mm Hg), at which pressure regional function was significantly lower (P less than 0.025) in the experiments with 95 percent oxygen. Thus, the sensitivity of myocardial performance to a decrease in effective coronary perfusion pressure and flow is remarkably dependent upon whether pressure and flow are above a critical level.