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J G Jacobson

Publications and source records attributed to J G Jacobson.

34 records · Page 2Linked to original sources
PubMed1985

Biochemical characterization of VLA-1 and VLA-2. Cell surface heterodimers on activated T cells.

The very late antigen complexes VLA-1 and VLA-2 which appear on long-term activated human T cells have been characterized with respect to 1) subunit arrangement, 2) location of monoclonal antibody (MAb) binding sites, 3) carbohydrate content, and 4) protein homology. Cross-linking experiments showed that the VLA-1 complex is a heterodimer composed of an Mr 210,000 subunit (alpha 1) in acid-labile association with an Mr 130,000 subunit (beta). The VLA-2 complex is a heterodimer with an Mr 165,000 subunit (alpha 2) in base-labile association with the Mr 130,000 beta subunit. The subunits of VLA-1 (alpha 1 beta) and VLA-2 (alpha 2 beta) each appear to be arranged with 1:1 stoichiometry. The MAb A-1A5 has been shown to bind to an epitope on the common beta subunit, consistent with its recognition of both the VLA-1 and VLA-2 heterodimers. On the other hand, MAb TS2/7 bound to an epitope of the alpha 1 subunit, thus explaining the specific recognition of the VLA-1 heterodimer by TS2/7. Digestion of the alpha 1, alpha 2, and beta subunits with neuraminidase and with endoglycosidase F revealed that each subunit contains substantial sialic acid and N-linked carbohydrate. By one-dimensional peptide mapping, the alpha 1, alpha 2, and beta subunits were shown to be highly nonhomologous with respect to each other, although each subunit from different T cell sources appeared highly homologous if not identical.

Antibodies, Monoclonal↗
PubMed1985

VLA-1: a T cell surface antigen which defines a novel late stage of human T cell activation.

The VLA-1 protein complex defines a previously undescribed very late stage of activated T cell differentiation, following either alloantigen or mitogen activation. This protein appears after 2-3 weeks of activation, considerably later than the early T cell activation antigens such as the interleukin 2 (IL 2) receptor, transferrin receptor, 4F2 antigen, T10 and HLA-DR, and has therefore been termed very late antigen-1 (VLA-1). Unlike the IL 2 receptor, VLA-1 expression does not require restimulation with antigen, and in fact, VLA-1 expression was high on T cells that had lost their IL 2 receptors. Expression of VLA-1 was found on all or nearly all long-term-activated T cells including T4+ and T8+ clones, bulk cultures, long-term T cells from adults and newborns and long-term T cells maintained in pure or crude IL 2 preparations. VLA-1 was also found on HTLV-1 infected T cell populations. Immunoprecipitation experiments confirmed that the VLA-1 protein complex (210 000/130 000 Mr) can be co-expressed with another protein complex called VLA-2 (165 000/130 000 Mr) on the same T cell clones. However, co-expression was not obligatory because in some long-term cultures little or no VLA-2 was present relative to VLA-1. Because VLA-1 defines a novel late stage of T cell activation, being present on all or most all types of long-term activated T cells, and not on any other cell types in peripheral blood, it has unique potential as a marker for activated T cells in vivo and may provide a clue towards elucidating novel long-term T cell functions or growth requirements of this late stage of T cell differentiation.

Antibodies, Monoclonal↗
PubMed1984

Thoracic aortic injury. A ten-year experience.

Between 1974 and 1983, 41 patients arrived alive at Loma Linda (Calif) University Medical Center after sustaining a traumatic disruption of the thoracic aorta. Four patients died during the resuscitation attempts and the 37 patients who survived underwent thoracotomy for attempted definitive repair. There were six hospital deaths (16.22%) among those who underwent definitive repair; associated injuries (mostly orthopedic and neurologic) were contributing factors. Four patients were discharged with spinal cord injuries, two were paraplegic on arrival at the hospital, and two became paraplegic postoperatively (surgical spinal cord injury, 5.41%). Most injuries were distal to the left subclavian artery (97.56%). Cardiopulmonary (left heart) bypass was gradually abandoned in favor of more simple techniques, including ventriculoaortic and aorto-aortic heparinized shunts or a "clamp and sew" method. Experience has demonstrated that most traumatic aortic disruptions can be repaired safely by direct suture technique (without graft interposition) if accomplished during the acute episode.

Adolescent↗
PubMed1983

Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa.

We present the apparently unique M-mode and two-dimensional echocardiographic features of a surgically confirmed pseudoaneurysm of the left ventricular outflow tract, which probably developed as a result of perforation of the mitral-aortic intervalvular fibrosa. Echocardiographic studies revealed an aneurysmal sac situated between the aortic root and the left atrium. The aneurysm expanded in systole and collapsed or emptied in diastole, suggesting direct communication with the left ventricle. Such an aneurysm must be differentiated from various pathologic findings of the aortic root. The location and characteristic motion during the cardiac cycle should alert the clinician to the correct diagnosis of such an aneurysm.

Adolescent↗
PubMed1983

The structural theory and the representational world.

I have attempted to articulate a means of incorporating representational world concepts firmly within the structural theory, while still maintaining their clarity, a view which I believe can be useful both clinically and theoretically. It can facilitate an analyst's working with complex clinical material that reflects conflicts at multiple developmental levels, without forcing a premature commitment to restrictive conceptualizations which could impede his listening to the full richness of the material. In addition, I have argued that the perpetual resurgences of representational world psychologies may be understood as an indication of the need for the inclusion of those phenomena in our theory in a clear and integrated way. Finally, I have presented some basis for suggesting that the drive-defense and the representational world models represent coordinate aspects of the structural theory, each with its vantage points for highlighting and clarifying certain phenomena, but best used complementarily in our observations of psychopathology at all levels of development. I do not believe this represents a totally new view or departure within psychoanalytic thinking. On the contrary, I have assembled, organized, and attempted to make explicit certain understandings which I believe we often apply naturally through the use of empathy and intuitive gifts. In an analysis which is going well, an analyst operating within a drive-defense framework is almost certainly finding some natural way of dealing with self and object issues, even if he does not formulate them explicitly to himself. To set down and make explicit, however, the functions we may much of the time perform without awareness is worthwhile preparation against times of difficulty in understanding a particular case. At those times we need at our disposal as specific, as inclusive, and as illuminating a theory as we can find to assist us. It is that clinical need which has guided me in these attempts at theoretical clarification.

Adult↗
PubMed1983

The structural theory and the representational world: developmental and biological considerations.

Although the intriguing question of whether the division into two viewpoints within the structural theory is a theoretical convenience or whether it mirrors fundamental psychobiological truths is not capable of full resolution at the moment, fortunately that resolution is not required for our usual clinical purposes. I believe that analytic work presents us with data readily conceptualized now from one, now from the other, viewpoint, so that analytic understanding benefits from the analyst's shifting his frame of reference from moment to moment in listening and associating to the patient's material. I believe that in every event within the analytic situation or in a person's life, our understanding is deepened and made more complete by approaching the phenomena from both vantage points, bearing in mind that the same ego we conceptualize as testing, assessing, and evaluating emergent drives is also assessing the congruence or discrepancy between the wished-for and perceived states of the representational world. These processes are occurring both in the analysand and in the analyst who is attempting to resonate with and understand the intrapsychic functioning of his patient. They constitute two observational vantage points within the structural theory, organizations of motives (Friedman, 1980) either of which may offer the most immediate access to understanding a particular segment of clinical material. I believe our understanding is most often deepened, however, by subsequent scrutiny in the light of the other model. I have tried here to supplement my previous exposition of a representational world point of view (J.G. Jacobson, 1983) by providing some of its developmental, ethological, and psychophysiological landmarks and underpinnings.

Animals↗
PubMed1982

Mustard operation in the 1st month of life.

Since April 1976, nine infants less than 1 month of age underwent a Mustard intraatrial baffle procedure. All had transposition of the great arteries and were persistently symptomatic or hypoxic after the Rashkind balloon atrioseptostomy. Two had an associated large ventricular septal defect patched at the time of physiologic correction. The average age of the infants was 11.6 days (range 36 hours to 28 days). Weight averaged 3.4 kg (range 2.5 to 4.2). In all the Mustard procedure was performed using deep hypothermic circulatory arrest, averaging 71 minutes (range 48 to 88) at a mean core temperature of 13 degrees C. An average of 2.8 days of postoperative ventilatory assistance was required. One death occurred in a 28 day old male infant with an associated ventricular septal defect who, the morning after operation, had a sudden unresponsive cardiac standstill. The postoperative hospitalization period averaged 15 days (range 10 to 23). Follow-up evaluation has extended from 4 to 63 months (average 31). Six patients were restudied 2 to 21 months postoperatively. One had obstruction of the superior limb of the baffle, which had separated from the right atrial wall permitting a modest right to left shunt. She has had uneventful repair employing a unique modification of Senning's operation. Another child has asymptomatic partial obstruction of the superior limb of the baffle demonstrated angiographically. None has pulmonary venous obstruction and all have prevailing normal sinus rhythm. Significant right ventricular dysfunction has been demonstrated in one. Early correction in these persistently symptomatic or hypoxic neonates with transposition of the great arteries with or without a ventricular septal defect has obviated the need for palliative operations and produced gratifying early and late results.

Child, Preschool↗
PubMed1981

Pericardial closure and paradoxic septal motion after surgery.

We tested the role of the pericardium in the development of paradoxic septal motion in 29 patients by analyzing M-mode echocardiograms made before and after cardiac surgery. Surgical technic was the same for all patients, but the pericardium was closed by random selection in 12 (40%). Paradoxic septal motion developed in five of the 12 patients (42%) with a sutured pericardium and in 11 of 17 (65%) whose pericardium was not closed (chi-square not significant). Septal motion measured 7.3 +/- 3.3 mm before and -0.6 +/- 4.6 mm after surgery (P less than .001), with a similar degree of impairment for both groups. An echographically derived ejection fraction changed from 71 +/- 9% before to 60 +/- 13% after surgery (P less than .001). We conclude that leaving the pericardium open has no particular role in the development of paradoxic septal motion. Septal motion diminished in all. Changed in the echo ejection fraction could represent an impairment in ventricular function.

Adult↗
PubMed1981

Biologic reconstruction of the right ventricular outflow tract. Preliminary experimental analysis and clinical application in a neonate with type I truncus arteriosus.

A unique concept of right ventricular outflow tract reconstruction is presented. Applications of this concept, employing a glutaraldehyde-preserved heterograft mitral valve leaflet mounted directly to the right ventricle, was studied in six immature goat models. Interval evaluation of these models demonstrated no significant outflow tract obstruction or aneurysm. Only one animal had significant pulmonary outflow regurgitation angiographically at the time of sacrifice. All heterograft valve leaflets showed a degree of calcification and/or retraction directly related to the time interval between implant and sacrifice. Encouraging early results were obtained with this method of pulmonary outflow tract reconstruction in a 2,400 gram neonate with type I truncus arteriosus.

Animals↗
PubMed1981

Anatomic correction of interrupted aortic arch complex in neonates.

Anatomic correction of interrupted aortic arch complex by direct aortic anastomosis was accomplished in five neonates ranging in age from 2 to 19 days. Three had type B and two had type A interruption of the aortic arch. All operations were performed through a transverse bilateral thoracotomy by use of hypothermic circulatory arrest. The descending thoracic aorta is widely mobilized to the level of the diaphragm. The ductus arteriosus is completely excised and the descending aortic segment is anastomosed end to side to the ascending aorta. The large ventricular septal defect is patched with Dacron velour, and atrial communications are closed with running suture. Three of the babies survived surgery and are making satisfactory clinical progress. All three have been restudied on a routine basis. They were found to have excellent anatomic repairs with no residual intracardiac shunts. There was a peak systolic gradient of 8 mm Hg at the aortic anastomosis in the second survivor; however, she does not have ascending aortic hypertension. The first and last survivors have no aortic gradients. It is recommended that a newborn with interrupted aortic arch complex be subjected to corrective surgery as the procedure of choice. Excellent results may be expected when surgery is done prior to irreversible metabolic decompensation of the patient.

Aorta, Thoracic↗
PubMed1979

Repair of interrupted aortic arch and aortopulmonary window in an infant.

The diagnosis and repair in infancy of interrupted aortic arch and aortopulmonary window is described. Using deep hypothermia and circulatory arrest, aortic continuity was established with a prosthetic graft, which was anastomosed to the aortic orifice of the aortopulmonary window. The pulmonary artery side of the aortopulmonary window was closed directly. Postoperative cardiac catheterization demonstrated a good reconstruction. Previous experience with this rare variety of interrupted aortic arch complex is reviewed.

Aorta, Thoracic↗
PubMed1978

Interrupted aortic arch complex: successful total correction in the neonate.

Two neonates subjected to definitive repair of interrupted aortic arch complex during the first week of life are presented. Results correlated well with preoperative status. Our definition of complete correction, including direct aortic anastomosis, is discussed along with the surgical strategy employed for successful repair of this otherwise dismal anomaly.

Aorta, Thoracic↗
PubMed1976

Correlation of neurologic complications and pressure measurements during carotid endarterectomy.

There was no significant difference between the mean occluded internal carotid artery pressure in asymptomatic, transient ischemic attack or prior stroke patients. The stump pressure was not consistently elevated at the second operation in those having undergone bilateral procedures. Estimate of back bleeding from the internal carotid artery operation did not necessarily correlate with the stump pressure. Adequate back bleeding was recorded in patients with a low stump pressure, and reduced bleeding was noted in individuals with a high stump pressure. The pressure gradient across the stenosis of the bifurcation of the carotid artery was helpful in assessing the degree of stenosis present. The occluded internal carotid artery pressure seemed to be a helpful aid in indicating those patients with poor collateral flow and, therefore, at high risk of ischemic brain damage. The use of an inlying shunt in those individuals having a low stump pressure may be expected to reduce the over-all neurologic complication rate in patients undergoing carotid endarterectomy.

Blood Gas Analysis↗