Lessons learned from the DIASTAT vascular access graft.

BACKGROUND: The vascular community continues to search for the ideal vascular access graft that will allow early cannulation and avoid temporary central venous catheters. METHODS: This is a review of the Cranley Surgical Associates' experience with the use of the Gore-Tex DIASTAT (W.L. Gore & Associates, Inc., Flagstaff, Arizona) vascular access graft in 20 patients compared with 20 control patients matched for age, sex and risk factors. RESULTS: Although the DIASTAT graft is touted for early accessibility and decreased need for central venous access, that was not found to be the case as 14 patients in the DIASTAT group received temporary access catheters. There was significantly more edema in the DIASTAT patients (P = 0.0048). Comparing the time to the first thrombosis or to revision revealed an average of 18 weeks for the DIASTAT group and 56 weeks for the control group. The length of time to thrombosis or revision was significantly longer in the control group (P = 0.0058). Comparison of the number of weeks of function and serviceability of the grafts revealed the average DIASTAT graft functioned for 34 weeks and that of the control group for an average of 70 weeks (P = 0.0131). Comparison of the two groups showed a significant increase in early thrombotic events (< 90 days) in the DIASTAT grafts (P = 0.0013). CONCLUSIONS: The DIASTAT vascular access graft does not appear to be the ideal hemodialysis access graft.

Investigations of gas-phase lithium-peptide adducts: Tandem. mass spectrometry and semiempirical studies.

Tandem mass spectrometry using a hybrid mass spectrometer of BEqQ geometry was used to investigate the gas-phase formation of the [An (+) Li - H)(+) ion from lithium-peptide adducts. High resolution mass measurements as well as precursor and product ion scans of five peptides indicate that one source of [An (+) Li - H) arises from [An (+) Li](+). Semiempirical calculations (MNOO) and metastable ion decomposition studies of the peptide Gly-Gly-Gly show that the lithium ion prefers to coordinate to the three internal carbonyls of the neutral molecule to give a species that is energetically more stable than the lithiated zwitterion by 305 kJ/mol. Theoretical and experimental evidence suggest that the monolithiated precursor ion population may be a distribution of structural isomers. (J Am Soc Mass Spectrom 1990, 1, 473-480).