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J B Dunne

Publications and source records attributed to J B Dunne.

12 recordsLinked to original sources
PubMed2004

Development and transferability of a cost-effective laparoscopic camera navigation simulator.

BACKGROUND: Laparoscopic camera navigation (LCN) is vital for the successful performance of laparoscopic operations, yet little time is spent on training. This study aimed to develop an inexpensive LCN simulator, to design a structured curriculum, and to determine the transferability of skills acquired. METHODS: In this study, 0 degrees and 30 degrees LCN simulators were developed for use on a videotrainer platform. Transferability was tested by enrolling 20 medical students in an institutional review board-approved, randomized, controlled, blinded protocol. Subjects viewed a video tutorial and were pretested in LCN on a porcine Nissen model. Procedures were videotaped and the LCN performance was scored by a blinded rater according to the number of standardized verbal cues required and the percentage of time an optimal surgical view (%OSV) was obtained. Procedure time also was recorded. Subjects were stratified and randomized. The trained group practiced on the LCN simulator until competency was demonstrated. The control group received no training. Both groups were posttested on the porcine Nissen model. RESULTS: The constructed simulators required 35 man hours for development, cost $25 per board for materials, and proved to be durable. The trained group demonstrated significant improvement in verbal cues (p = 0.001), %OSV (p < 0.001), and procedure time (p = 0.001), whereas the control group showed improvement only in verbal cues (p < 0.02). At posttesting, the training group demonstrated significantly better scores for verbal cues (2.1 vs 8.0; p = 0.02) and %OSV (64% vs 45% p = 0.01) than the control group. CONCLUSION: These data suggest that the LCN simulator is cost effective and provides trainees with skills that translate to the operating room.

Adult↗
PubMed2004

Incidental paraduodenal hernia found during laparoscopic colectomy.

This paper describes a rare right paraduodenal hernia discovered during an elective laparoscopic colon resection. Our patient was a 60-year-old Asian man with a history of multiple bouts of diverticulitis and a lifelong history of mild constipation and postprandial abdominal pain. Prior CT scans and preoperative barium enema confirmed the diagnosis of diverticular disease, and no other abnormalities were appreciated. At laparoscopic exploration, a right paraduodenal hernia was found with complete herniation of the small intestine under the ascending colon and hepatic flexure. The unclear anatomy prompted conversion to an open laparotomy. This allowed safe reduction of the hernia and sac excision. Adhesions were lysed to relieve a partial duodenal obstruction, and a Ladd's procedure was performed to correct the incomplete rotation. Additionally, a sigmoid colectomy was performed. After prolonged ileus, the patient was discharged on postoperative day 14. At 6-month follow-up, the patient was asymptomatic and doing well.

Colectomy↗
PubMed1998

Evidence that S-adenosyl-L-methionine diastereoisomers may reduce ischaemia-reperfusion injury by interacting with purinoceptors in isolated rat liver.

1. Mechanisms underlying the haemodynamic activity of diastereoisomers of S-adenosyl-L-methionine (SAM) were investigated using inhibitors of purinoceptors and nitric oxide (NO) synthase in perfused rat livers damaged by sequential 24 h cold and 20 min rewarming ischaemia + reperfusion. 2. Stored livers were flushed with 10 ml saline alone (control) or with added (R,S) or (S,S) SAM (100 microM) and reperfused in the absence (control) or presence of 10 microM 8-phenyltheophylline (8-PT) or 100 microM L-N-monomethylarginine (L-NMMA). 3. Both SAM diastereoisomers rapidly increased blood flow and bile production versus controls (P<0.001) but the (R,S) isomer induced greater increases in blood flow and the (S,S) isomer greater increases in bile production: 625 versus 596 versus 518 ml blood flow and 100 versus 119 versus 56 mg bile production per g liver over 3 h in (R,S), (S,S) and control, respectively. 4. 8-PT prevented the enhancement of blood flow by (S,S) SAM (529 versus 596 ml g(-1) liver over 3 h for (S,S) SAM alone, P<0.001), but was without effect in control livers. 8-PT also reduced SAM-enhanced bile production: 51 versus 119 mg g(-1) liver over 3 h, P<0.001. L-NMMA reduced blood flow and bile production similarly in the absence or presence of (S,S) SAM. 5. Thus, SAM may improve liver perfusion after ischaemia-reperfusion injury via stimulation of P, (A2) purinoceptors at which SAM shows activity. The choleretic activity of (S,S) SAM is disproportionately greater than enhanced blood flow and may occur independently of a NO-dependent component of bile production.

Animals↗
PubMed1997

Treatment of experimental ischemia/reperfusion injury with S-adenyosylmethionine: evidence that donor pretreatment complements other regimens.

Triple therapy with S-adenosylmethionine (SAM) (given to the donor animal, included in University of Wisconsin solution [UW], and added to the reperfusing medium) has been shown to reduce the sequential cold and warm ischemia/reperfusion injuries characteristic of the liver transplantation procedure. To clarify the actions of SAM during different stages of ischemia/ reperfusion, we have compared its benefit in five dosage regimens, using perfused rat livers after sequential periods of 24 hr cold and 20 min rewarming ischemia. When added only to UW, the presence of SAM throughout ischemia improved hepatic blood flow by 26% after 15 min of reperfusion versus no treatment (2.32+/-0.18 vs. 1.84+/-0.11 ml/min/g liver, P<0.05). SAM also improved blood flow by 23% during the 3-hr perfusion overall (P<0.05). Oxygen consumption and the release of purine nucleoside phosphorylase (PNP) were decreased (both P<0.05). When added to both UW and the perfusate, SAM additionally increased bile production at 15 min (7.14+/-1.21 vs. 2.31+/-0.74 mg/h/g liver, P<0.01). By pretreating the liver donor with SAM in vivo, and including it in the preservation and reperfusing media, it was possible to prolong and amplify the benefits on blood flow (P<0.001) and bile production (P<0.05) and to sustain glucose uptake (P<0.01). An acute exposure to SAM, when used in saline to flush UW from the graft before reperfusion, increased blood flow at 15 min (by 68%) and over a 3-hr period (both P<0.001), but no indices of metabolic activity were improved. Oxygen consumption and PNP release were both decreased (P<0.05). When added to the perfusate (present throughout reperfusion), SAM increased blood flow at 15 min (58%) and over a 3-hr period (P<0.01 in both cases). Net glucose uptake was increased (P<0.05), whereas oxygen consumption (P<0.001) and PNP release fell (P<0.05). Actions of SAM achieved acutely and over the intermediate- and long-term all seem to underlie its benefits in reducing ischemia/reperfusion injuries.

Adenosine↗
PubMed1996

Catalytic metal ions and the loss of reduced glutathione from University of Wisconsin preservation solution.

The University of Wisconsin solution is widely used for organ preservation. We show that this fluid is often contaminated by traces of iron catalytic for free radical reactions, as demonstrated by the bleomycin assay and the ability of the iron to stimulate lipid peroxidation. Reduced glutathione (GSH) added to University of Wisconsin solution during its commercial preparation had oxidized to the disulfide in all samples examined. Addition of GSH to UW solution showed its half-life to be about one day. The metal ion chelators desferrioxamine and phenanthroline did not substantially delay the loss of GSH, although desferrioxamine was able to suppress iron-mediated lipid peroxidation induced by the contaminant iron in the preservation solution. Additional iron was released from rat liver after a period of cold storage/rewarming.

Adenosine↗
PubMed1996

Peripheral blood and intrahepatic subsets of T lymphocyte activation and function in liver allograft rejection and drug-induced tolerance in rats.

T lymphocyte kinetics in liver allograft rejection were studied by measuring levels of activated (CD25+ and class II MHC+) T lymphocytes (CD5+) and T cell subsets (CD4 and CD8) in peripheral blood and the livers of allogeneic DA (RT1b) to LEW (RT1') and syngeneic LEW to LEW orthotopic rat liver transplants. Median survival was 10 days in untreated allogeneic rats (n = 17). Mean (+/- SEM) T lymphocyte class II MHC expression increased from 3.4 +/- 0.44% (day 2/3) to 4.9 +/- 1.1% (day 7) (p = 0.01). Complete sequential data were available for nine animals over the period of rejection confirming the increase in class II MHC expression (p = 0.05) and showing a decrease in CD25 expression (p = 0.05). There was a significant fall in CD4:CD8 ratio from day 2/3 to day 7 (p = 0.002). CD25 and class II MHC molecule expression and the CD4:CD8 ratio remained unchanged over the comparable period in the syngeneic LEW to LEW control model (n = 5, p > 0.3 for all comparisons). Cyclosporin A (5 mg/kg/day) was given orally for 17 days and then withdrawn to induce allograft tolerance in a further nine DA to LEW rats (median survival > 100 days). Samples taken at 2/3, 7, 17, 30, 40 and 100 days showed that T cell activation marker expression remained low during cyclosporin treatment (e.g. class II MHC expression 2.32 +/- 0.35%; CD25 expression 3.53 +/- 0.44% on day 7) but increased thereafter (e.g. class II MHC expression 8.19 +/- 0.65%. CD25 13.25 +/- 0.95% on day 100). There was a fall in CD4:CD8 ratio throughout (p < 0.001). Intrahepatic mononuclear cells were harvested from six normal livers, four allogeneic livers (at 10 days), five syngeneic livers (at 10 days) and five tolerant allografts (at 100 days). Rejecting grafts showed the highest proportion of T lymphocytes (66.8 +/- 4.0% vs 18.5 +/- 3.6% in controls, p = 0.01). T cell activation was higher in both rejecting and tolerant grafts versus normal control livers (p = 0.05 for CD25 and p < 0.01 for class II MHC expression). CD8+ lymphocytes predominated in the hepatic infiltrate in all models, although the majority of these cells were both CD5 and alpha beta T cell receptor negative. There was a higher proportion of T cells in tolerant allografts (44.5 +/- 5.2%, p < 0.01) compared with control animals. Serial changes in peripheral T lymphocyte subsets may be useful in monitoring experimental acute rejection. In peripheral blood, the increase in T cell activation and loss of CD4+ lymphocytes, along with evidence of increased intragraft infiltration by this subset implies that it has a primary role in the development of tolerance in this nodel.

Animals↗
PubMed1995

Relationship between early liver graft viability and enzyme activities in effluent preservation solution.

Determination of cellular enzyme activities in washout preservation solution used in hypothermic liver graft storage may allow development of an index that could be clinically valuable in prediction of early post-transplant graft function. In the present study, we collected washed out preservation fluid at the time of graft rinsing from 53 liver recipients. Aspartate aminotransferase and, to a lesser extent, lactate dehydrogenase levels correlated with early postoperative graft viability as assessed by 1-month graft survival and standard biochemical indices of liver function. Those patients with the highest aspartate aminotransferase activity in the washout preservation solution experienced the highest levels of this enzyme postoperatively (area-under-the-curve day 1-3; 1340 vs. 788 IU/L), total bilirubin (area-under-the-curve day 1-5; 901 vs. 538 mumol/L), and rejection frequency (67% vs. 31%) (all P < 0.05), with a significantly lower 1-month graft survival rate compared with patients with low effluent levels (62% vs. 92%, P < 0.05). Two markers of endothelial cell damage, purine nucleoside phosphorylase and a creatine kinase isoenzyme, measured in the fluid did not correlate with early graft viability. It is suggested that assay of aspartate aminotransferase activities in preservation fluid washout samples is a clinically useful indicator of graft viability.

Adult↗
PubMed1995

Amlodipine improves hepatic hemodynamic and metabolic function in the isolated perfused rat liver after sequential cold and warm ischemia.

Amlodipine, a long acting calcium antagonist, was used to reduce the adverse effects of ischemic/reperfusion injury studied in isolated perfused rat livers. Amlodipine (10 mumol/L) was added to University of Wisconsin (UW) solution in which the liver was stored for 24 hr at 4 degrees C and incorporated in the saline flush used to displace the UW solution before 20 min of warm ischemia (at 37 degrees C) and reperfusion. Initial median blood flow at 15 min was significantly higher after amlodipine treatment (2.78 vs. 1.41 ml/min/g of liver without amlodipine treatment, P = 0.013) as was the area under the curve of blood flow for the entire 3-hr perfusion (472 vs. 316 ml/g of liver, P = 0.003). Amlodipine treatment induced corresponding increases in oxygen delivery (1302 vs. 896 mumol of O2/g of liver over 3 hr of perfusion, P = 0.003) and oxygen consumption (279 vs. 242 mumol of O2/g of liver over 3 hr, P = 0.06). Initial bile flow at 15 min was increased 4-fold by amlodipine treatment (17.27 vs. 4.59 mg/hr/g of liver for sequential cold and warm ischemia, P = 0.013), and the median area under the curve of bile flow for the entire perfusion increased to 92.2 vs. 53.9 mg/g of liver (P = 0.0006). Amlodipine treatment also reduced glucose release into the perfusate (116 vs. 149 mmol/L/g of liver min over 3 hr, P = 0.03) and prevented hepatocyte injury by reducing alanine aminotransferase release both initially (0.43 vs. 0.96 IU/L/g of liver, P = 0.055) and overall (343 vs. 797 IU/L/g of liver min, P = 0.048). When amlodipine was added only to the UW solution, blood flow increased by 66% initially (P = 0.02) and 32% overall (P = 0.013), but there was no corresponding improvement in hepatic function. Amlodipine may reduce hepatic ischemic/reperfusion injury by cytoprotective effects on parenchymal and non-parenchymal hepatocytes during both preservation and reperfusion leading to an improvement in liver microcirculation and an inhibition of the release of toxic mediators.

Amlodipine↗
PubMed1994

Evidence that S-adenosylmethionine and N-acetylcysteine reduce injury from sequential cold and warm ischemia in the isolated perfused rat liver.

S-Adenosylmethionine (SAMe) and N-acetylcysteine (NAC), two agents with known benefit for reducing hepatic injury, were used to treat ischemic injury in a rat liver perfusion model. We compared cold ischemic injury with sequential periods of cold and warm ischemia that equate to episodes during the storage and implantation of liver grafts. The additional period of 20 min warm ischemia after 24 hr cold ischemia profoundly impaired initial (15 min) mean blood flow (1.8 +/- 0.1 vs. 2.7 +/- 0.4 ml/min/g liver for cold ischemia, P < 0.001) and bile flow (2.31 +/- 0.74 vs. 10.6 +/- 3.96 mg/hr/g liver for cold ischemia, P < 0.001) and increased the oxygen extraction ratio (OER) (0.53 +/- 0.03 vs. 0.29 +/- 0.08 for cold ischemia, P < 0.01) and acid release from glycolysis (0.18 +/- 0.02 vs. 0.11 +/- 0.02 mmol/g liver for cold ischemia, P < 0.05). Impairment of blood flow, bile flow, and OER was sustained throughout the 3-hr perfusion. In the same model, SAMe restored hepatic blood flow to control values when administered to the donor, included in the UW, and added as a bolus to the perfusate on reperfusion. SAMe also improved OER (P < 0.001 vs. sequential cold and warm ischemia) and initial bile flow (9.63 +/- 2.01 mg/hr/g liver, P < 0.01), returning values to control levels by 3 hr. SAMe reduced the initial release of glucose upon reperfusion (P < 0.01) and improved subsequent glucose uptake, but corresponding benefits on enzyme release from damaged hepatocytes (AST) or endothelial cells (purine nucleoside phosphorylase) were not observed. Equimolar concentrations of NAC induced transitory improvements in blood and bile flow but these were not sustained beyond 30 min of reperfusion.

Acetylcysteine↗
PubMed1993

Analysis of peripheral blood mononuclear cells in rodents by three-colour flow cytometry using a small-volume lysed whole blood technique.

Techniques were adapted to permit phenotypic analysis of peripheral blood leucocytes in rats and mice using small volumes of lysed whole blood and single, dual- or triple-colour immunofluorescence staining with flow cytometry. Red cell lysis using proprietary lysing solutions provides populations of lymphocytes, monocytes and granulocytes clearly differentiable by their light scatter properties. In the present study, measurement of functional and activation T lymphocyte subsets was performed by single- and dual-colour flow cytometry in both species and in excess of 5000 lymphocytes could be counted using as little as 10 microliters of whole blood. Triple-colour fluorescence, using antibodies labelled with fluorescein, phycoerythrin and biotin permitted simultaneous detection of three phenotypic markers. This novel technique has two major advantages, maximising the phenotypic information which may be obtained and using volumes of blood which are sufficiently small that they can be drawn regularly from the same animal.

Animals↗