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Biomedical subjects

D L Larson

Publications and source records attributed to D L Larson.

At least 19 recordsLinked to original sources

Opioid agonist and antagonist activities of morphindoles related to naltrindole.

A series of naltrindole-related ligands (4-10) with an N-methyl,N-phenethyl,N-cinnamyl, or an unsubstituted basic nitrogen were synthesized and tested for opioid agonist and antagonist activity in smooth muscle preparations and in mice. The nor compounds (4 and 6) and the phenethyl derivatives (5 and 8) displayed full agonist activity (IC50 = 85-179 nM) in the mouse vas deferens preparation (MVD) while the other members of the series exhibited partial agonist or weak antagonist activity. In the guinea pig ileum preparation (GPI), all compounds except 8 were partial agonists. The ligands that were evaluated in mice were found to produce antinociception that was not selectively mediated via delta opioid receptors. However, two of these ligands (4 and 5) appeared to be delta-selective opioid receptor antagonists at subthreshold doses for antinociception. The finding that all of the compounds bind selectively to delta opioid receptors in guinea pig brain membranes together with the in vitro pharmacology and in vivo antagonist studies suggests that the lack of delta agonist selectivity in vivo may be due to a number of factors, including a basic difference between the delta receptor system in the MVD and in the mouse brain. Further, it is suggested that the constellation of message and address components in the morphindole nucleus may tend to stabilize delta receptors in the brain in antagonist state.

Analgesia

Toxic shock syndrome following latissimus dorsi musculocutaneous flap breast reconstruction.

Acute toxic shock syndrome (TSS) not related to menstruation has comprised an increasing proportion of cases reported to the Center for Disease Control in recent years. We report a patient with TSS resulting from a postoperative donor site infection after bilateral breast reconstruction with latissimus dorsi musculocutaneous flaps. The diagnosis, management, and outcome of TSS are reviewed. The plastic surgeon should be aware of TSS as a potential postoperative complication of routine procedures in plastic surgery.

Adult

Elimination of the vertical scar in reduction mammaplasty.

We describe a technique to eliminate the vertical portion of the inverted-T incision in patients who have combined enlargement of the breasts and moderate to severe ptosis. Initial preoperative markings are made, placing the new nipple site at the level of the transposed inframammary crease. The nipple-areola complex is then retained on a vascularized pedicle, with major reduction of the breast tissue being done in the medial and lateral quadrants. The nipple and breast tissue are then tucked underneath the superior skin segment and placed in this new position as one would do with the umbilicus in an abdominoplasty. Excess vertical skin is removed, and horizontal excess is collected at the midline as a small dog-ear. We have found that this dog-ear reduces markedly with time, rounding out the inferior portion of the breasts. The remaining small amount of excess skin can then be removed under local anesthetic at a later date. We have performed this procedure on 20 patients, with follow-up from 6 to 24 months.

Adolescent

Persistent binding of fatty acyl derivatives of naltrexamine to opioid receptors.

A series of fatty acid derivatives of naltrexamine and naltrexhydrazine were synthesized and evaluated for their persistent binding to opioid receptors. Members of this series were found to require greater than five washes for removal from mouse brain membranes when the fatty acyl chain was saturated. The presence of unsaturation in the fatty acyl groups enhanced the persistent binding. In this regard the persistent binding increased as a function of the number of double bonds, with the unsaturated congeners requiring greater than 10 washes for removal of the ligand from the membranes. The results of this study are consistent with the apparently important role of polyunsaturated fatty acids in the binding of ligands to opioid receptors.

Animals

Hyperbaric oxygen therapy in plastic surgery: a review article.

The most important effects of hyperbaric oxygen (HBO), for the surgeon, are the stimulation of leukocyte microbial killing, the enhancement of fibroblast replication, and increased collagen formation and neovascularization of ischemic tissue. Preoperative hyperbaric oxygen induces neovascularization in tissue with radionecrosis. Refractory osteomyelitis and necrotizing fasciitis appear to respond to adjunctive hyperbaric oxygen. Crush injury and compartment syndrome appear to benefit through preservation of ATP in cell membranes, which limits edema. Hyperbaric oxygen in burn injury permits shorter hospital stays, a reduced number of surgeries, and less fluid replacement. Skin grafts and flaps are reported to take more completely and more rapidly. The same mechanisms may apply in ischemic problem wounds such as infected diabetic extremities. Contraindications and side effects are described. Hyperbaric oxygen will not heal normal wounds more rapidly but may, under certain circumstances, induce problem wounds to heal more like normal ones.

Burns

Long-acting agonist and antagonist activities of naltrexamine bivalent ligands in mice.

A series of naltrexamine bivalent ligands, compounds with two naltrexamine pharmacophores separated by a spacer which contains a variable number of glycyl units flanking a succinyl group, were synthesized and evaluated in vivo in mice. These compounds possessed long-acting agonist and especially antagonist activities. The bivalent ligands, 2 and 3 displayed antinociceptive activity that lasted greater than 4 h. Compound 1, a bivalent ligand and 4, the monomer, antagonized the antinociceptive effect of morphine for a week after a single injection i.c.v. The long duration of action may be due to entrapment of these ligands in the central nervous system. These compounds may give future insights into the design of long-acting agonists and antagonists.

Analgesics

Chloroxymorphamine, and opioid receptor site-directed alkylating agent having narcotic agonist activity.

Chloroxymorphamine, the 6beta-N,N-bis(2-chloroethyl) derivative of oxymorphone, is a potent nonequilibrium narcotic agonist in the longitudinal muscle preparation of guinea pig ileum. The corresponding naltrexone analog,chlornaltrexamine, is a potent nonequilibrium antagonist of morphine. These receptor sitedirected alkylating agents possess considerable potenial as pharmacologic and biochemical probes of apoid receptors.

Alkylating Agents

Synthesis and pharmacologic characterization of an alkylating analogue (chlornaltrexamine) of naltrexone with ultralong-lasting narcotic antagonist properties.

Chlornaltrexamine (CNA) produces ultralong-lasting (3--6 days) narcotic antagonism in mice and persistent stereospecific binding to rat-brain homogenate. Protection studies in mice suggest that CNA mediates its narcotic antagonist effects by interacting with the same receptors that are occupied by naloxone. A single icv dose of CNA also has been found to inhibit the development of physical dependence in mice for at least 3 days. These studies suggest that CNA exerts its sustained effects by selective covalent association with opioid receptors.

Alkylating Agents

Effect of thymosin on T-lymphocyte functions in patients with acute thermal burns.

Patients with severe thermal burns demonstrate a decreased cellular immunity. The purpose of this study was to ascertain whether thymosin enhances in vitro T-lymphocyte functions in such patients. Peripheral blood lymphocytes were obtained serially from 22 burned patients and 35 health adults. In vitro lymphocyte functions were evaluated by E-rosette formation, lymphocyte culture responses to PHA, Con A, PWM, PPD, SK-SD, mumps antigen, and tetanus toxoid, and mixed lymphocyte culture reactions. These tests were performed with and without in vitro addition of thymosin. Most of the parameters examined were significantly decreased in patients during the first 2 weeks postburn. The in vitro addition of thymosin significantly restored impaired lymphocyte responses, except in mixed lymphocyte culture reactions. These results demonstrate that thymosin enhances certain in vitro T-lymphocyte functions in burned patients. They further suggest that the administration of thymosin may restore decreased cell-mediated immunity in severely burned patients.

Adult

Proteoglycans and collagenase in hypertrophic scar formation.

The collagen fibers of the nodules and whorl-like figures in hypertrophic scars are "coated" with proteoglycans, mainly chondroitin-4-sulfate. The latter was shown to prevent collagenase from breaking down collagen. This suggests that the presence of great amounts of chondroitin-4-sulfate in hypertrophic scars may contribute to the overabundance of collagen deposition which is characteristic of this abnormal healing process.

Child

En bloc ethmoidectomy and medial maxillectomy.

A method is described which enables the surgeon to gain necessary visual access for en bloc removal of certain tumors of the nasoethmoid area. A "medial maxillectomy" has been performed on ten patients, three of whom underwent combined craniofacial surgery for extensive neoplasms. The procedure is especially suitable for those tumors in which piecemeal or "shelling out" techniques are not desirable, and in which one desires to preserve the eye, palate, and facial appearance.

Adenocarcinoma

Management of burns.

An overview of the management of the acutely burned patient has been described. Adherence to the sound principles of early resuscitation, appropriate nutrition, wound management, and rehabilitation can provide hope for many of the victims of this tragic injury. Complications encountered throughout the burn illness present unique and perplexing problems for the physician, who must utilize all the clinical wisdom and facility available in the management of such complex problems.

Anesthesia