Negative impact of cardiac evaluation before vascular surgery.

The optimal preoperative evaluation of cardiac risk in patients with peripheral vascular disease is controversial. In developing a paradigm for preoperative cardiac workup, potential adverse effects of evaluation and cardiac intervention must be considered. This study analyzed the deleterious outcomes of extensive, comprehensive cardiac evaluation and intervention before planned vascular surgery in patients treated at the Denver Department of Veterans Affairs Medical Center. Over a 12-month period between 1994 and 1995, 161 patients were scheduled to undergo major vascular operations; 153 patients came to operation. The decision to pursue a cardiac evaluation was variously made by a combination of surgeons, cardiologists, and anesthesiologists. No defined protocol was followed. Cardiac history, chest X-rays and ECGs were obtained for all patients. Extended cardiac evaluation included these studies plus special tests, including echocardiography (echo), radionuclide ventriculography (RNVG), dipyridamole thallium scintigraphy (DTS), and cardiac catheterization (CC). Extended cardiac evaluations were undertaken in 42 patients. Complications related to percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) were also recorded. Cardiac mortality and morbidity after vascular interventions were itemized in all 153 patients. Forty-two male patients, aged 68 +/- 9 years, underwent extended cardiac evaluations before planned vascular operations. The median elapsed time for cardiac workup was 14 days (mean 30 +/- 59 days). The median and mean times from cardiac workup to vascular surgery were 25 days and 76 +/- 142 days, respectively. Eighteen (43%) patients had echo or RNVG; 22 (52%) patients had DTS; 27 (64%) had CC; 9 (21%) had PTCA; 7 (17%) had CABG. Sixteen (38%) patients had untoward events related to cardiac evaluation. Eight patients (19%: one with cerebrovascular disease, and seven with aortic aneurysms) refused vascular surgery after extended cardiac workup. Complications attributable to CC, PTCA, and CABG included prosthetic graft infection, pseudoaneurysms (two), sternal wound infections (two), renal failure and brain anoxia. Two patients with severe limb ischemia who were candidates for revascularization ultimately required amputations because of delay due to cardiac evaluations. Extensive cardiac evaluation prior to vascular operations can result in morbidity, delays, and refusal to undergo vascular surgery. The underlying indication for vascular operations and the local iatrogenic cardiac complication rates must be considered before ordering special studies.

Sonochemistry of quinones in argon-saturated aqueous solutions: enhanced cytochrome c reduction.

Sonolysis of argon-saturated aqueous quinone solutions resulted in an enhancement in ferricytochrome c (Cyt c) reduction. Upon addition of superoxide dismutase, Cyt c reduction was partially inhibited, thus implying a role of superoxide ion in this reduction process. Neither quinone hydrophobicity nor reduction potential exclusively controls the Cyt c reduction enhancement, although a preference for hydrophobicity versus reduction potential is noted.

Electrokinetic isolation of vesicles and ribosomes derived from Serratia marcescens.

Ribosomes and vesicles derived from the bacterium Serratia marcescens were separated from each other and from solubles using density gradient electrophoresis. Transport relationships were used to determine the electrophoretic mobilities of the particles. The effects of convection, sedimentation and diffusion were found to be negligible. The electrophoretic mobility obtained for the ribosome peak is -7 x 10(-5) cm2/(V.s). Under appropriate conditions, two vesicles peaks were obtained, the first with a mobility of -4 x 10(-5) cm2/(V.s) and the second with -9 x 10(-6) cm2/(V.s). This information can be used to predict the resolution of the separands in large-scale electrophoretic separations.

Dosimetric intercomparison in the British Institute of Radiology fractionation study of 3F/week versus 5F/week in radiotherapy of laryngo-pharynx cancer.

A dose intercomparison was carried out by the National Physical Laboratory between the seven radiotherapy centres which contributed the largest number of patients to the British Institute of Radiology fractionation study of three fractions per week versus five fractions per week in clinical cancer treatment. Six of the centres showed remarkable agreement within the acceptable limits of error of the measurements. In one centre there appeared to be a physical dose discrepancy of 2.8% which was materially less than could be detected clinically.

Stoichiometry of lac repressor binding to nonspecific DNA: three different complexes form.

The stoichiometry of lac repressor binding to nonspecific DNA was investigated by three different techniques. Four molecules of the fluorescent probe 5,5'-bis(8-anilino-1-naphthalenesulfonate) [bis(ANS)] bind to each repressor subunit with an average dissociation constant of 20 microM. Nonspecific DNA displaces most of this bound bis(ANS), reducing the fluorescence. Titrations of repressor with nonspecific DNA monitored with high [bis(ANS)] (5-15 microM) had end points at 8 base pairs per repressor. Lower [bis(ANS)] (0.1-1 microM) resulted in end points at either 15 or 26 base pairs per repressor, depending on the ionic strength. These end points correspond to complexes containing approximately one, two, or four repressors per 28 base pairs. Boundary sedimentation velocity experiments with saturating amounts of repressor revealed that five repressors can bind to 28 base pairs. By monitoring the circular dichroism as DNA was added to repressor, the sequential appearance of complexes containing approximately four, two, and one repressors per 28 base pairs was observed. The inability of repressor cores or iodinated repressor to bind to complexes containing one or two repressors per 28 base pairs implies that all of the repressors directly contact the DNA in the complex containing four repressors per 28 base pairs. It is proposed that while two subunits of each repressor contact the DNA in complexes containing one or two repressors per 28 base pairs, only one subunit of each repressor contacts the DNA in the complex with four repressors per 28 base pairs. These results suggest a novel mechanism for the one-dimensional diffusion of repressor along DNA.

Thin-layer fluorescence cell for ligand binding studies.

A high precision method for measuring the binding of gaseous ligands to proteins is presented. Front face fluorescence techniques are utilized with a special thin-layer cell in order to monitor the change in fluorescence intensity caused by changing the ligand partial pressure. The method is illustrated by examining the binding of carbon monoxide to hemocyanin from the lobster Homarus americanus.

Binding of recrystallized and chromatographically purified 8-anilino-1-naphthalenesulfonate to Escherichia coli lac repressor.

8-Anilion-1-naphthalenesulfonate (Ans), recrystallized from water as the magnesium salt, contains a fluorescent impurity representing 0.3% of the absorbance at 351 nm. This impurity can be removed by Sephadex LH-20 chromatography. The chromatographic and spectral properties of this impurity suggest that it is bis(Ans), a dimer of Ans. This bis(Ans) impurity makes a significant contribution to the fluorescence increment observed when lac repressor is added to recrystallized Ans. This occurs because bis(Ans) binds much more tightly to this protein than does Ans. The dissociation constant divided by the number of binding sites per subunit is 3.1 X 10(-6) M for bis(Ans); the corresponding value for Ans is greater than 1 X 10(-4) M. Because of their differing absorption spectra, the impact of this bis(Ans) impurity is especially large with excitation wavelengths above 400 nm. Users of recrystallized Ans should consider the potential consequences of this impurity whenever working with a protein to which Ans binds weakly.

The response of the ferrous sulphate dosemeter to neutrons.

A semi-empirical method of calculating G-values for the ferrous sulphate dosemeter irradiated by neutrons up to 18 MeV has been developed. It utilizes published charged particle G-values along with particle spectra calculated for mono-energetic neutron interactions with the dosemeter medium. All available G-value measurements with neutrons have been evaluated and compared with values predicted by this method. The agreement was excellent for DT generator and cyclotron neutron beams in which the neutron spectra had been accurately determined. However, the predictions could not be completely confirmed for lower energy neutrons becuase of the large experimental uncertainties in the measured G-values and the lack of detailed information on the neutron spectra.

A novel fast neutron dosemeter based on fission chambers. Part I: Principles of operation and theoretical response in neutron therapy radiation fields.

A novel method is proposed of accurately measuring fast neutron doses of interest in radiotherapy. The technique, which utilizes calculated neutron fluence-to-kerma conversion factors, is based upon the combination of measurements with calibrated neptunium-237 and uranium-238 pulse fission chambers to obtain a response which matches the variation of kerma with neutron energy. The theoretical performance of a practical instrument has been assessed for a variety of neutron spectra to evaluate the spectrum dependence of the dosemeter. The overall systematic uncertainty using this absolute method of determining the neutron dose under charged particle equilibrium conditions is comparable to that encountered with ionization chamber techniques.

Interaction of gamma-ray and neutron effects on the proliferative capacity of Chinese hamster cells.

The loss of reproductive capacity of Chinese hamster cells has been studied using 60Co gamma-rays and DT neutrons singly or combined in fixed proportions. Surviving fractions were measured down to 2 times 10-4. Interaction between the effects produced by neutrons and gamma-rays in the mixed irradiations has been demonstrated. The results are compared with those predicted by the cellular inactivation model developed by Katz and co-workers from their delta-ray theory of track structure.