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Biomedical subjects

J A Mannick

Publications and source records attributed to J A Mannick.

At least 19 recordsLinked to original sources
PubMed1979

Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma.

In order to clarify the relationship between anergy and immunosuppressive activity in the serum, we studied 46 previously well patients before and at three, five, seven and 28 days after surgery. Delayed hypersensitivity was measured by skin testing with four common recall antigens, and serum immunosuppressive activity was determined by the ability of the patient's serum in 10% concentration to suppress by 50% or more the phytohemagglutinin (PHA) stimulation of normal human lymphocytes as compared to pooled normal serum. Prior to surgery, all patients manifested delayed hypersensitivity to one or more antigens, and no patient had immunosuppressive serum. Fifteen patients underwent minor surgery under general anesthesia and did not develop anergy or immunosuppressive serum. Thirty-one patients underwent major cardiovascular surgery. Thirteen of these patients became anergic by day 3 after operation, and 11 of the 13 developed immunosuppressive serum. Eighteen patients maintained delayed hypersensitivity after major surgery, and only three developed immunosuppressive serum. The correlation between anergy and immunosuppressive serum was highly significant (p < 0.001). There was a significant difference in the degree of suppressive activity in the serum of the anergic and reactive patient groups for each postoperative day studied until day 28, when there was recovery of delayed hypersensitivity and lack of immunosuppressive serum. The occurrence of postoperative anergy and immunosuppressive serum was not related to the patient's age, sex, number of perioperative blood transfusions or duration of anesthesia but was associated with an increase in postoperative infectious complications (p < 0.05) and in postoperative days in the hospital (p < 0.01). Pooled immunosuppressive serum from anergic patients was fractionated by ion exchange chromatography, gel filtration and preparative high voltage electrophoresis. The majority of the immunosuppressive activity could be accounted for by an electrophoretically homogenous polypeptide-containing fraction not identified in the serum of patients undergoing minor surgery or in normal individuals. We conclude that anergy occurring after major operative trauma is associated with the appearance of a circulating immunosuppressive molecular species and that these events are in turn associated with increased patient morbidity and increased length of hospitalization.

Adult↗
PubMed1979

Intrapulmonary clotting and fibrinolysis during abdominal aortic aneurysm surgery.

Intravascular clotting and fibrinolysis (C and F) are events which often accompany major surgical trauma. Their role in inducing cardiopulmonary failure is debated and prompted this study of 13 patients undergoing elective AAA. Following intubation, anesthesia and pressure breathing fibrinolytic activity (FA) in arterial blood exceeded that in mixed venous blood (p < 0.001) indicating pulmonary secretion of proteolytic activity. Fibrinogen, plasminogen and fibrin degradation products (FDPs) were normal. During surgery, fibrinogen and plasminogen fell (p < 0.001) while nonplasmin mediated FA and FDPs rose (p < .001). Despite heparinization (5000 U IV) aortic clamping (avg 56 min) led to evidence of C and F within the lungs. Arterial fibrinogen was 33.2 mg/ml lower than mixed venous blood (p < 0.01) and plasminogen was 0.47 Sherry units lower (p < 0.001). Soluble fibrin monomer appeared in arterial blood (p < 0.01). At the same time nonplasmin mediated FA was consumed within the lungs (p < 0.01) and FDPs were produced (44.6 microg/ml higher in arterial blood, p < 0.001). Similar changes were noted after aortic declamping. The transient 5.3 ml/cm H(2)0 fall in dynamic compliance was unrelated to C and F. Pulmonary vascular resistance and arterial pressure were unchanged. During wound closure intrapulmonary C and F ceased. Postoperatively (6 h), the physiologic shunt of 15.1% was similar to tbe preoperative value of 13.3%. All C and F factors returned to normal except FDPs which remained elevated. An average of 0.2 U blood was given prior to aortic clamping and 3.1 U during clamping. Neither the volume nor the type of blood (7 patients received washed RBCs) influenced pulmonary C and F. The results show that pressure breathing will alter pulmonary metabolism from clearance to secretion of fibrinolytic activity. Surgery leads to systemic C and F while intrapulmonary C and F is triggered by aortic clamping despite IV heparin. Delayed functional consequences of C and F are possible. Immediate postoperative effects are not apparent.

Aorta, Abdominal↗
PubMed1979

Immunotherapy with RNA in cancer.

The effect of I-RNA therapy was studied in a B16 melanoma-C57BL/6J mouse system. After having primary B16 isografts excised, mice receiving syngeneic lymphocytes incubated in vitro with specific guinea pig B16 I-RNA showed significantly improved survival as compared to control mice receiving untreated lymphocytes. This therapeutic effect was tumor specific and RNase sensitive. Significant cytotoxicity against B16 cells in vitro was consistently observed with lymphocytes prepared from B16 I-RNA treated animals, whereas lymphocytes from control animals or those treated with RNase-degraded B16 I-RNA or 3LL I-RNA had no effect. Results suggest that the combination of surgery and immunotherapy with I-RNA may be useful in preventing tumor recurrence in certain patients with cancer.

Animals↗
PubMed1978

Prevention of death from metastases by immune RNA therapy.

The effect of immune RNA treatment on the incidence of death from pulmonary metastases was studied in C57BL/6J mice after excision of a B16 murine melanoma. Immune RNA was extracted from the lymphoid tissues of guinea pigs immunized with B16 tumor and then incubated in vitro with normal C57BL/6J mouse splenocytes. Mice receiving intraperitoneal injections of these RNA-treated syngeneic splenocytes after the primary B16 isograft was resectioned showed significantly improved long-term survival (42 to 67 percent in three successive experiments) as compared to control mice (0 to 20 percent survival) receiving untreated splenocytes. The effect of RNA treatment was tumor-specific and ribonuclease sensitive. The results suggest that immunotherapy with immune RNA may be of benefit to certain patients after surgery for cancer.

Animals↗
PubMed1978

Effect of arterial reconstruction on limb salvage: a ten-year appraisal.

Two hundred forty-four consecutive patients were reviewed who presented themselves over a ten-year period (1967 to 1977) with threatened limb loss secondary to arteriosclerosis involving the arteries supplying the lower extremities. Patients with claudication as the presenting complaint were not included. Primary amputation was performed in 14 patients (6%), with an operative mortality of 21%, whereas arterial reconstructive surgery was carried out in 230 patients (94%) with an operative mortality of 2.7% One hundred eleven femoral-popliteal vein grafts in 101 patients showed a cumulative five-year graft patency of 78% with a limb salvage rate of 73%. Twenty-eight femoral-femoral grafts and 21 axillary-bilateral femoral grafts yielded five-year graft patency rates of 91% and 77%, respectively: the limb salvage rates were 91% and 86%. Inclusive of the 14 patients undergoing primary amputation, the overall five-year cumulative limb salvage in the entire group was 76%.

Adult↗
PubMed1978

Femorofemoral grafting: indications and late results.

Experience with fifty-three femorofemoral grafts performed as the initial operation for iliac occlusive disease over a ten year period is reviewed. There was one operative death (2 per cent). There were two early and three late graft failures, for a five year cumulative graft patency rate of 80 per cent. Of the twenty-eight patients in whom the femorofemoral graft was performed for limb salvage, the five year cumulative limb salvage rate was 91 per cent. During the follow-up period, two grafts were converted to axillobilateral femoral grafts because of recurrent symptoms of claudication caused by progression of disease in the iliac system from which the femorofemoral graft originated. All other patients with patent grafts have had satisfactory relief of symptoms throughout the follow-up period.

Aged↗