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Biomedical subjects

J E Connolly

Publications and source records attributed to J E Connolly.

At least 19 recordsLinked to original sources
PubMed1991

Cytologic assessment of tumor cell kinetics: applications of monoclonal antibody Ki-67 to fine-needle aspiration smears.

Rates of tumor-cell proliferation often provide prognostic information about a given neoplasm. Previously available methods for accessing cell kinetics are time consuming and expensive, and often require special equipment or radioactive reagents. Monoclonal antibody Ki-67 binds a nuclear antigen expressed in proliferating but not in resting cells. We studied Ki-67 immunostaining of fine-needle aspiration smears from 40 benign and malignant masses. Labeling indices ranged from 0 (thyroid follicular adenoma) to 75 percent (pulmonary oat-cell carcinoma). Frozen section immunostaining (11 cases) and flow cytometric assessment of cell proliferation (8 cases) were in good agreement with Ki-67 labeling indices on smear material. We suggest that this method provides a rapid, inexpensive, and dependable means of assessing tumor-cell kinetics in cytologic preparations.

Antibodies, Monoclonal↗
PubMed1989

Laser-assisted thermal angioplasty in human peripheral artery occlusions: mechanism of recanalization.

Recanalization of completely occluded superficial femoral or popliteal arteries was attempted in 18 patients with use of an Argon laser-mediated thermal probe. The length of the occluded segments varied between 0.5 and 26.0 cm, but 67% of the occlusions were greater than 9 cm long. The initial success rate was 67%. Arterial perforation occurred in six patients but was not associated with major complications. To study the mechanism of the laser-mediated thermal probe, thermal recanalization was performed on 11 human arterial segments in vitro obtained after amputation, and mechanical recanalization was performed in vitro in 10 human peripheral arteries with use of a guide wire and catheter technique. An additional four arteries were studied with the laser probe as a non-heated mechanical device. Both the mechanical and thermal devices appear to follow a similar pathway through a complete obstruction. These studies suggest that the thermal probe burns through soft fibrous tissue but is mechanically deflected away from hard fibrocalcific plaque. The probe then advances along the plane between the intimal plaque and the media for a variable length before perforating through the adventitia. These observations suggest that the major mechanism of thermal probe recanalization may be a mechanical process. It appears that thermal probe devices do not inherently seek the true lumen of an occluded artery and that better guidance systems need to be developed.

Aged↗
PubMed1989

Tourette syndrome and otolaryngology.

Tourette syndrome (TS) is the most complex tic disorder and presents primarily in the pediatric population between the ages of two and 15. The otolaryngologist may be consulted to see such a patient because of head and neck or facial tics or more often because of phonic or vocal tics such as throat-clearing, sniffing, coughing or abnormal noises. As this disorder has not appeared in the otolaryngologic literature we undertook a retrospective chart review (N = 72) and follow-up questionnaire related to the otolaryngologic aspects of this disorder.

Child↗
PubMed1989

The current status of surgery for bullous emphysema.

The great majority of cases of emphysema are generalized with diffuse involvement of all portions of the lung: Clearly, surgery has little to offer in such cases. In contrast, there is an uncommon variant involving primarily the upper lobes and the superior portions of the lingula and lower lobes, which spares the relatively normally functioning lower lobes. A number of diagnostic tests are available to identify compression of uninvolved lower lobe tissue, the most reliable of which identify pulmonary vasculature that is crowded together. We suggest that whole lung tomograms or pulmonary angiograms provide the most convincing evidence of compression of normal tissue. In properly selected patients with compression or displacement of normal lung, thoracotomy with simple excision of the bullae is tolerated by even the most ill patients if care is taken to carefully support the patient postoperatively with assisted ventilation and prolonged chest tube suction. There were no deaths in 19 patients and the results were rewarding, often spectacular, and surprisingly enduring. It is likely that some patients with operable bullous emphysema are not being studied or offered operation because of a lack of knowledge about the benefits possible with bullectomy.

Adult↗
PubMed1987

In situ saphenous vein bypass: 1962 to 1987.

The historical development of in situ saphenous vein bypass has been traced over the past quarter century. The principal advantage of the in situ vein graft over the conventional reversed vein graft is the increase in flow that occurs in a tapered channel. Both the advantages of this hemodynamic observation in the in situ graft and its disadvantages in the reversed graft are accentuated in longer bypasses as the discrepancy in proximal and distal vein diameter increases. Furthermore, there is new evidence that unusual shear and stress tend to occur at sites of severe vein-artery discrepancy, such as seen in reversed vein grafts but less so in the in situ graft. Experience with the in situ graft has shown that another important advantage is that there is less chance of trauma to the vein from overdistention and rotation, which is inherent in the operation since the vein is not removed from its bed. On the other hand, the overly traumatic disruption of venous valves required in the in situ operation can cause subendothelial damage with resultant fibrosis of the vein. Although it has been demonstrated that equally good results with reversed as with in situ grafts can be obtained by careful attention to detail, this is true only for grafts carried to the popliteal level. The advantages of increased flow and less shear damage because of tapering, physiologic distention under arterial pressure, and finally, decreased handling and manipulation of the vein have become increasingly important as bypass is carried distal to the knee. I believe that the evidence to date indicates that the in situ operation has strong superiority over the conventional reversed graft for reconstructive operations on the lower extremity extending below the knee.

Femoral Artery↗
PubMed1985

The structure of human platelet thrombospondin.

Two distinct murine monoclonal antibodies, designated MA-I and MA-II, and limited proteolysis with thrombin and trypsin have been used to probe the structure of human platelet thrombospondin. The results indicate that each of the constituent chains of thrombospondin comprise four distinct polypeptide segments. The production of these segments is influenced by the presence of calcium, the enzyme employed, the temperature of digestion, and the enzyme-to-substrate ratio. Thrombin digestion in the presence of calcium results in the release of a 30,000-dalton fragment, designated segment I, which contains the epitope for MA-II and the heparin-binding site. Prior EDTA treatment results in the concomitant cleavage of a 25,000-dalton fragment, designated segment IV, from the other terminus. Limited tryptic digestion in the absence of calcium produces a 47,000-dalton fragment (segment III) which is adjacent to segment IV. Segment III contains the epitope for MA-I. Segment II is an 85,000-dalton fragment which contains the interchain disulfide bonds. Calcium inhibits proteolysis at cleavage sites between segments II and III and between segments III and IV. In the presence of calcium, an 85,000-dalton fragment is produced, which is derived from portions of segments II, III, and possibly IV. Electron microscopy of platinum replicas produced by low angle rotary shadowing reveals that thrombospondin is composed of four well-defined globular regions connected by thin flexible regions. Three of the globular regions, designated globular region C, appear to be at the ends of the three thin connecting regions. The fourth globular region, designated globular region N, appears to be close to the site where the chains are cross-linked. Globular region N can be resolved into three separate smaller globular structures which are 70 +/- 7.1 A in diameter. This region is selectively removed by thrombin digestion in the presence of calcium and binds a monoclonal antibody directed against the heparin-binding peptides. These data indicate that globular region N comprises the three NH2-terminal portions (segment I) from each of the three chains of thrombospondin. Globular region C is located at the ends of each of the three thin connecting regions which are each approximately 291 +/- 46 A long. The removal of calcium results in a decrease in the size of globular region C from 118 +/- 18.6 A to 80 +/- 7.4 A and an increase in the length of the adjacent thin connecting region to 383 +/- 30 A.(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies, Monoclonal↗
PubMed1985

Accuracy and indications of diagnostic studies for extracranial carotid disease.

We reviewed extracranial carotid studies in two groups of patients. The first group consisted of 200 patients who had been evaluated by both duplex scanning (DS) and direct arch-selective carotid arteriography (SCA). The second group consisted of 100 patients who had been evaluated by both intravenous digital subtraction angiography (IDSA) and conventional SCA. In 200 patients DS disclosed a 92% accuracy in delineating stenotic internal carotid disease and was accurate in recognizing ulcerative disease in 76% of patients. A review of the 100 patients studied by both IDSA and SCA showed that in 40% IDSA gave excellent correlation with SCA; in 35%, good correlation; and in 25%, poor correlation. In 10% DS was more accurate in delineating ulcerative disease than was IDSA, and on occasion DS was even more diagnostic than SCA. The relative accuracy, cost, risk, and clinical usefulness of each carotid diagnostic modality are discussed.

Arteriosclerosis↗
PubMed1985

Carotid endarterectomy in the awake patient.

The advantages of performing carotid endarterectomy in the awake patient have been presented based on a 13 year experience. Anesthesia consisted of either local infiltration of local lidocaine or regional neck block supplemented by intravenous sedation. The principal advantages of the technique are that it is the only exact method of assessing the need for an intraluminal shunt by neurologic assessment of the awake patient during trial carotid cross-clamping, and the elimination of general anesthesia allows carotid endarterectomy to be safely performed on patients with advanced inoperable coronary artery disease and in those with chronic obstructive pulmonary disease. One hundred consecutive carotid endarterectomies have been reported with one late death and one mild, permanent neurologic deficit. These results support the belief that carotid endarterectomy can be performed with very low morbidity and mortality rates by operating on the awake patient.

Adult↗
PubMed1979

Management of lymph fistula in the groin after arterial reconstruction.

Leakage of lymph from the inguinal incision is a rare but disturbing complication of arterial surgery. This article describes our experience in the management of 12 patients in whom lymphorrhea developed following arterial reconstruction. Seven patients were treated with pressure dressings, antibiotics, and immobilization. In this group, fistula healing was delayed up to four weeks, and wound infection occurred in three of seven patients. One patient eventually required removal of the prosthetic graft and below-knee amputation. Early groin reexploration and direct ligature of ruptured lymphatics was performed in the remaining five patients. Hospitalization was shortened and wound infection prevented in all patients in this group. We recommend prompt operative closure as the preferred approach in the management of lymph fistula following vascular reconstruction, especially when synthetic graft material is present.

Adult↗
PubMed1979

Doppler assessment of the inferior epigastric artery flow patterns as a screening test for aortoiliac obstruction.

A simplified technic utilizing the ultrasonic directional flowmeter for the detection of hemodynamically significant aortoiliac obstruction is described. The method is based upon the presence of a reversed flow pattern along the inferior epigastric artery in patients with aortoiliac obstruction. Correlation with angiographic findings was made in the twenty patients reported on in this study. In twelve patients with severe or complete iliac artery obstruction, reverse epigastric flow was present, whereas in the remaining eight without significant obstruction to arterial flow, the inferior epigastric arterial flow direction remained normal.

Aged↗
PubMed1979

Experimental evaluation of myocardial preservation techniques: IV. Potassium cardioplegia.

To investigate whether potassium per se plays a significant role in cold potassium cardioplegia, isolated blood-perfused rabbit papillary muscle preparations were used to determine the recovery of myocardial contractility after normothermic anoxia. Cardioplegia was induced by infusing an isotonic electrolyte solution containing either 5 or 40 mEq/liter of potassium chloride. Anoxic periods of 30 minutes (9 experiments each) 45 minutes (10 experiments each), and 60 minutes (1 experiment each) were compared. Hearts stopped contracting in 45 seconds with infusion of a 40mEq/liter of potassium chloride solution compared to 5 minutes with a 5 mEq/liter solution. After 30 minutes of anoxia, myocardial recovery was 65.39 +/- 24.48 per cent with 5 mEq/liter of potassium chloride and 90.05 +/- 6.40 per cent with 40mEq/liter of potassium chloride. The difference was highly significant (p less than 0.01). After 45 minutes of anoxia the same trend as just described was noted, but the difference was statistically insignificant. After 60 minutes of anoxia, recovery was extremely poor regardless of the potassium concentration of the cardioplegic solution. Our conclusion was that a high potassium solution will arrest the heart rapidly and provide protection against anoxic injury of the myocardium. Its protective effect becomes less significant, however, as the anoxic time is prolonged.

Animals↗
PubMed1979

Prophylactic revascularization of the gut.

Reconstitution of the mesenteric vascular circulation, in our experience, is advisable when advanced occlusive disease is noted on the preoperative arteriogram of patients selected for aortoiliofemoral, renal artery, or aortic aneurysm surgery. A lateral aortogram is mandatory, and the presence of an anastomotic meandering mesenteric artery on frontal arteriogram is especially valuable in signaling significant disease. This is the first report of prophylactic concomitant revascularization of compromised mesenteric vessels during aortic reconstructive procedures on selected patients. It is our opinion that such an approach can be a significant deterrent to subsequent catastrophic bowel infarction from mesenteric arterial occlusive disease.

Celiac Artery↗
PubMed1979

Successful management of early stroke after carotid endarterectomy.

This paper concerns the management of stroke coming on in the early postoperative period after successful carotid endarterectomy. Our experience in effectively reversing hemiplegia in three such consecutive patients forms the basis of this report. The value of instant reoperation is emphasized, and several factors that facilitate urgent reoperation have been identified. These include omission of preoperative angiography, immediate reexploration under local anesthesia, and rapid restoration of cerebral flow by insertion of a shunt. Our experience would indicate that reversal of neurological deficit in such patients can be accomplished if reoperation is carried out within one hour of onset of stroke. All three patients managed by these criteria recovered and were neurologically intact eight to twelve months later. These results are in contrast to the failure to reverse stroke noted by us and others when the above measures were not followed.

Aged↗
PubMed1979

Experimental evaluation of hypothermic intermittent coronary perfusion.

The recovery of the myocardial contractility of blood-perfused papillary muscle from the rabbit hearts was used to determine if hypothermia would minimize the myocardial injury associated with intermittent aortic cross-clamping (IACC). Continuous normothermic coronary perfusion for 2 hours with either cross circulation or a membrane oxygenator had only minimal adverse effects on contractility. None of the hearts tolerated normothermic IACC (45 minutes of anoxia and 10 minutes of reperfusion, repeated twice), When the myocardial temperature was reduced to 32 degrees C., the recovery following IACC was 41.25 +/- 11.21 percent (n=8). With hypothermia of 28 degrees C., it was 70.43 +/- 13.03 percent (cross circulation group, n=7) or 68.36 +/- 13.11 percent (membrane oxygenator group, n=7). If the hearts were cooled to 24 degrees C., the recovery of the myocardial contractility following IACC was 90.95 +/- 5.42 percent (n=11). The improvement of the degree of recovery by hypothermia was statistically highly significant (p less than 0.005). Creatine phosphokinase (CPK) and isoenzymes (CPK-MB) were also measured in some groups, but the results warrrant further studies before they can be correlated with the myocardial function.

Animals↗