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B Sumpio

Publications and source records attributed to B Sumpio.

14 recordsLinked to original sources
PubMed2001

Basic science curriculum in vascular surgery residency.

Recognizing the importance of basic science teaching in surgical education, the leadership of the Association of Program Directors in Vascular Surgery (APDVS) appointed a panel to gather information and to present its findings at the 1999 annual fall meeting of the Apdvs. A questionnaire was distributed to the program directors present. In addition, information was gathered from the American Board of Surgery regarding the basic science content in the vascular surgery item pool on the vascular surgery qualifying examination (VQE). The vascular surgery unit of the surgical resident curriculum was also analyzed. Fifty-three program directors (64%) completed the questionnaire. Although only two program directors felt that their residents were better prepared to answer basic science questions, the results of the Vqe showed that the examinees do not, as a group, perform differently on basic science items than on clinical management questions. In addition, only a minority of program directors (15%) use a specific method to monitor the learning process of their residents. The majority of the program directors responding (75%) felt that they were capable of teaching basic science to residents. Interestingly, almost half the 53 respondents (47%) said that a basic science curriculum should be comprehensive, not exclusively relevant to the clinical setting. Vqe content outline and the vascular surgery unit of the surgical resident curriculum revealed great emphasis on clinically relevant basic science information. The Apdvs panel recommends that a basic science curriculum should be comprehensive, yet clinically pertinent, and completely integrated with the clinical curriculum. In terms of how to teach basic science in vascular residencies, the panel supports teaching conferences that are problem-based with a faculty member acting as the "resource person" and with specific goals set for the conferences. The panel also suggested establishing a Web site that provides a series of questions, the answers of which could be readily available to trainees and program directors. such immediate feedback could be of great help to program directors to focus the learning process of their residents and monitor its progress.

Curriculum↗
PubMed2000

Gender does not impact infrainguinal vein bypass graft outcome.

BACKGROUND: The percentage of women requiring infrainguinal bypass graft operations continues to increase, whereas the effect of gender on postoperative outcome remains unclear. The purpose of this study was to assess the influence of gender on patient selection and outcome in patients requiring infrainguinal vein bypass grafting procedures. METHODS: This retrospective study reviewed 217 infrainguinal vein bypass grafts performed over an 8-year period. Medical records and patient interviews were used to determine study measures and outcomes. Gender and multiple covariables affecting patient survival were analyzed; postoperative complications and graft patencies were examined. Bivariate and life-table analyses were conducted, followed by multivariate analysis with the Cox proportional hazards model. RESULTS: No statistical differences existed between men and women for age, diabetes, cardiac disease, tobacco use, hypertension, stroke, renal disease, or prior contralateral bypass or major amputation. Women were more likely to be black (P =.014) and have a spliced vein graft (P =.035). No differences were noted between the 2 groups for 30-day morbidity rates-except women had more incisional complications (P =.01)-or for survival (P =.45), primary-patency (P =.57), secondary-patency (P =. 79), or limb-salvage rates (P =.40). Multivariate analysis showed that gender had no role in affecting survival rates. CONCLUSIONS: Gender does not affect graft patency, limb salvage, or survival rates. There should be no introduction of a gender bias into management of infrainguinal occlusive disease.

Adult↗
PubMed2000

Functional parathyroid hormone receptors are present in an umbilical vein endothelial cell line.

Acute parathyroid hormone exposure induces vascular smooth muscle relaxation. In contrast, continuous infusion of parathyroid hormone leads to vasoconstriction and an elevation of blood pressure. Despite the known effects of parathyroid hormone on vascular smooth muscle, possible direct effects on the vascular endothelium have not previously been investigated. Using a human umbilical vein endothelial cell line, we found that parathyroid hormone increased both intracellular calcium and cellular cAMP content in these endothelial cells. Furthermore, exposure of these cells to increasing concentrations of parathyroid hormone stimulated both [(3)H]thymidine incorporation and endothelin-1 secretion. Parathyroid hormone/parathyroid hormone-related peptide receptor mRNA could be detected at low levels in these cells. In summary, these data demonstrate that endothelium-derived cells contain functional parathyroid hormone receptors. The potential physiological role of these receptors remains to be determined.

Calcium↗
PubMed1999

Localization of atherosclerosis: role of hemodynamics.

Atherosclerosis is a chronic disease attributed to risk factors that are systemic in nature. Yet the lesions involved do not occur in random fashion. The coronary arteries, the major branches of the aortic arch, and the abdominal aorta and its visceral and major lower extremity branches are particularly susceptible sites. Hemodynamic forces interacting with an active vascular endothelium are responsible for localizing lesions in a nonrandom pattern of distribution. Shear stress and cyclic circumferential strain are the predominant forces that have been characterized. The modification of endothelial cell structure and function by these mechanical forces sheds insight into the vasculature's propensity for atherogenesis.

Adolescent↗
PubMed1999

Recurrent Celiac Artery Compression Syndrome.

The celiac artery compression syndrome (CACS) is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. We present a patient with CACS who suffered a recurrence of her original abdominal complaints.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p150.html

Journal Article↗
PubMed1999

Clinical and biological relevance of vein cuff anastomosis.

Since a significant number of patients do not have suitable autologous saphenous vein for femorodistal bypass, the search for alternative graft material continues. The most commonly used prosthetic material is Polytetrafluoroethylene, however because of the poor patency of these grafts in the below knee position, a variety of techniques have been tried to improve their patency. A series of studies utilizing venous cuffs at the distal anastomosis have showed improved patency of PTFE grafts. We have reviewed the biological basis for graft failure and the literature for possible mechanical explanations.

Anastomosis, Surgical↗
PubMed1996

Quantitative blood flow measurements with cine phase-contrast MR imaging of subjects at rest and after exercise to assess peripheral vascular disease.

OBJECTIVE: The purpose of this study was to determine whether cine phase-contrast MR volume flow measurements can identify patients with peripheral vascular disease. SUBJECTS AND METHODS: We performed MR measurements of volume blood flow in the popliteal artery of subjects at rest and after 5 min of plantar flexion exercise in 10 volunteers (mean age, 28 years old), in five patients suspected of having peripheral vascular disease (mean age, 58 years old), and in five other volunteers of a similar age (mean age, 57 years old). RESULTS: Volume blood flow at rest was similar in volunteers and in patients. Four patients who had abnormal ankle-brachial indexes had lower flow increases after exercise (2.6-fold) compared with the five older normal volunteers (4.8-fold; p < .03, t test). These flow increases correlated well with ankle-brachial indexes: r = .97. The four patients with abnormal ankle-brachial indexes had monophasic resting waveforms, whereas all other subjects had triphasic waveforms. CONCLUSION: MR volume blood flow measurement may aid in evaluating peripheral vascular disease. Studies of larger patient groups will be necessary.

Adult↗
PubMed1993

Common pathway of endothelial-leukocyte interaction in shock, ischemia, and reperfusion.

Impaired blood flow in shock and ischemia results in significant organ dysfunction and failure of critical cellular functions. Although some cellular function can proceed via anaerobic mechanisms, a point is reached at which restoration of blood flow and oxygen delivery does not result in restoration of function ("refractory shock" or the "no-reflow phenomenon"). But even if blood flow is restored after shock or ischemia, a second mechanism of cellular injury is initiated: monocytes and neutrophils are activated, resulting in an inflammatory response. Current evidence suggests that the activation of inflammatory cells is triggered by substances from ischemic or injured vascular endothelium that cause leukocyte adherence, activation, and further injury. This review summarizes the current literature on endothelial cell, monocyte, and neutrophil interactions in reperfusion injury after shock or ischemia and suggests how a recently described peptide from the vascular endothelium may play an important role in the cascade.

Animals↗
PubMed1993

Captopril renal scintigraphy: a new standard for predicting outcome after renal revascularization.

PURPOSE: Captopril renal scintigraphy (CRS) is a nuclear medicine technique for evaluating each kidney independently for changes in glomerular filtration rate and perfusion induced by captopril-associated alterations in vascular tone. This study was undertaken to determine the role of CRS in predicting the response to renal revascularization. METHODS: The study group consisted of all patients who underwent preintervention CRS and arteriography, followed by renal revascularization performed between December 1987 and February 1992. After cessation of administration of angiotensin-converting enzyme inhibitors for 48 hours, a standard renogram was obtained, a 50 mg dose of captopril was given, and a second renogram was obtained. A captopril-induced change in the renogram was present when a normal pre-captopril renogram became abnormal after captopril administration. An abnormal baseline scan by definition cannot have a captopril-induced change. Blood pressure before revascularization was compared with blood pressure at 3 to 6 months after the procedure according to American Heart Association criteria for hypertension response. RESULTS: Fifty patients received renal revascularization by operation (28 patients) or balloon angioplasty (22 patients). Preoperative captopril-induced changes were present in 29 of the 50 patients. Among the 29 patients with captopril-induced changes, hypertension was cured or improved in 26. When captopril-induced changes were not present, only one of 21 patients improved (p < 0.00001). CONCLUSION: On the basis of these data, CRS appears to reliably predict hypertension response to revascularization in patients with renovascular disease.

Adult↗
PubMed1990

Mechanosensitive adenylate cyclase activity in coronary vascular smooth muscle cells.

The purpose of the present study was to test the hypothesis that adenylate cyclase activity of porcine coronary artery smooth muscle cells is sensitive to mechanical stretch. Cultured vascular smooth muscle cells were stretched at 24% maximal strain at 60 cycles/min for 30 minutes. Both basal and maximal catalytic activity of adenylate cyclase (as assessed by stimulation by 100 microM forskolin with 5 mM manganese chloride) were reduced by 30% (P less than 0.05) in membranes obtained from stretch versus unstretched cells. The magnitude of the stretch-induced reduction in Gpp(NH)p was identical over the entire time course studied (5-30 minutes). Furthermore, basal adenylate cyclase activity was inversely related to the magnitude of stretch. Thus, cyclic stretch can influence adenylate cyclase activity in coronary vascular smooth muscle cells. These data provide important information concerning potential biochemical mechanisms involved in the myogenic response of vascular smooth muscle and also suggest a potential mechanism by which the coronary circulation may adapt to chronically reduced perfusion pressure.

Adenylyl Cyclases↗
PubMed1990

Captopril renal scintigraphy--an advance in the detection and treatment of renovascular hypertension.

Despite the risks associated with renovascular hypertension and the durable benefits of revascularization, the detection of patients with renovascular hypertension and the selection of those who will benefit from interventional therapy remains a challenge. We have previously documented the reliability of captopril renal scintigraphy in predicting angiographically significant renal artery stenosis in patients suspected of having renovascular hypertension. In the present study we report our recent experience with this noninvasive technique in predicting outcome after revascularization. Captopril renal scintigraphy involves the administration of 50 mg of captopril 3 hours after a baseline technitium-99m diethylenetriaminepentaacetic acid renal scan and 1 hour before a repeat captopril renal scintigraphy scan. Nineteen of the last 70 patients with clinically suspected renovascular hypertension undergoing captopril renal scintigraphy had abnormal renal scan outcomes, and 17 had a decrease in flow or function after captopril (positive captopril renal scintigraphy). Eight of these 17 with abnormal findings on captopril renal scintigraphy underwent revascularization, and the hypertension was cured or improved in six of the eight: two of three after surgical bypass grafting and four of five after angioplasty. In the seven surviving patients with abnormal renal scan results but no change with captopril (negative captopril renal scintigraphy), improvement in hypertension after treatment occurred in only one: one of two after nephrectomy, zero of three after bypass surgery, and zero of two after angioplasty (p less than 0.05). We conclude that captopril renal scintigraphy is an accurate predictor of hypertension response to revascularization. Further evaluation of this new noninvasive technique for assessing patients with suspected renovascular hypertension appears warranted.

Aged↗
PubMed1987

Treatment with verapamil and adenosine triphosphate-MgCl2 reduces cyclosporine nephrotoxicity.

Nephrotoxicity is a serious side effect that limits the use of cyclosporine (CyA) as an immunosuppressive agent. The purpose of this study was to develop a model of CyA nephrotoxicity in the isolated perfused rat kidney and to evaluate the effects of adenosine triphosphate (ATP)-MgCl2 and verapamil treatment on this model. Kidneys were perfused for 90 minutes in a 7.5% albumin-Krebs-HCO3 solution containing 3H-inulin (glomerular marker) and 5.0 micrograms/ml 14C-cytochrome C (cyt) (marker of tubular protein absorption). After 10-minute equilibration, perfusate and urine samples were collected with 10-minute clearance periods. After two control clearance periods, 500 ng/ml CyA was added to the perfusate. In some experiments, 1 micrograms/ml of verapamil was added 10 minutes before CyA and in others 2 mmol/l ATP-MgCl2 was added with CyA. Cyt and inulin radioactivity, [Na+] and [K+], were measured in perfusate and urine. Tissue ATP levels were also determined. The results demonstrate that CyA treatment leads to a marked depression of glomerular filtration rate (GFR), tubular absorption of protein, urine output, and renal flow. ATP-MgCl2 cotreatment improved GFR, tubular absorption, and renal perfusate flow but the increase in urine output was not dramatic. Verapamil pretreatment markedly improved GFR and urine and renal perfusate flow but not tubular function. The combination of verapamil and ATP-MgCl2 treatment with CyA returned GFR to control values, significantly improved tubular absorption, urine and renal perfusate flow, and enhanced renal tissue ATP of isolated kidneys to levels seen in vivo. These data lead us to conclude that ATP-MgCl2 cotreatment with CyA after verapamil pretreatment greatly reduces the nephrotoxic potential of this immunosuppressive agent.

Animals↗