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Biomedical subjects

J J Ferrara

Publications and source records attributed to J J Ferrara.

104 records · Page 6Linked to original sources
PubMedDate not supplied

Gender and cancer support group participation.

PURPOSE: Although support groups are offered to many patients who have received a diagnosis of cancer, a majority of patients choose not to participate. This article reports the results of a study comparing the behavior of men diagnosed with prostate cancer and women diagnosed with breast cancer in their responses to invitations to participate in support groups. DESCRIPTION OF STUDY: One hundred thirty women with breast cancer and 87 men with prostate cancer completed a structured telephone interview. The interview included questions about the patients' choices about support group participation. RESULTS: Interview findings showed that men are less likely to join a support group, but those men who do join attend meetings for about 1 year, as do the women who join. Men and women cite essentially the same reasons for participation: to learn more about their diagnosis, to share their, concerns to compare their physical and emotional progress with other individuals. CLINICAL IMPLICATIONS: These results indicate the need for further exploration of effective interventions for men and women who have been diagnosed with prostate and breast cancer, respectively, in an effort to offer support for the difficult psychological and emotional issues associated with their diagnoses. Although more women than men join support groups, the majority of both populations (67% for women, 87% for men) do not attend any support group meetings. Innovative approaches are needed to encourage participation in existing support groups or to design alternative interventions.

Aged↗
PubMedDate not supplied

The suppressive effect of subeschar tissue fluid upon in vitro cell-mediated immunologic function.

UNLABELLED: Fluid administered during resuscitation translocates beneath the burn wound and is considered inert "third space" loss. This study was done to determine whether subeschar tissue fluid (STF) functions as an immunobiologic reservoir. Seven patients with a mean BSA burn of 55% underwent isotonic volume resuscitation and burn treatment with low penetration topical agents. STF was collected at the time of fascial excision. Chemical analysis of STF was similar to serum; bacterial cultures grew no organisms. Ten percent dilutions of STF and burn serum significantly blunted mitogen-induced blastogenic response compared to control serum. STF was significantly more suppressive than burn serum (P less than .03). CONCLUSIONS: 1. STF may act as both an immunologic barrier to microbial clearance in otherwise viable subcutaneous tissue and a reservoir for systemically reabsorbed immunosuppressive factors. 2. In addition to removing dead tissue, fascial excision may prove beneficial because it removes large amounts of immunosuppressive STF.

Adult↗
PubMedDate not supplied

Inhibition of lymphocyte blastogenesis caused by suppression of interleukin-2 receptor sites after thermal injury.

Burn patients often exhibit prolonged cell-mediated immune suppression. Of the mechanisms proposed to account for this, one invokes an inability on the part of T lymphocytes to undergo blastogenesis, clonal expansion, and differentiation--a process partially mediated by interleukin-2. Triplicate samples of 10% dilutions of burn serum from nine burn patients (three with greater than 60% burn) were analyzed for their ability to suppress mitogen-induced lymphocyte blastogenesis. A separate aliquot of stimulated cultured lymphocytes was tagged with a monoclonal antibody to interleukin-2 receptors. The serum of patients with greater than 60% burn was significantly more suppressive (as measured by depressed tritiated thymidine incorporation by cultured lymphocytes) than that taken from patients with smaller burns. In addition, serum from those with larger burns caused a marked reduction in the interleukin-2 receptor-labeling index, suggesting that it possesses factor(s) that directly or indirectly block T lymphocyte interleukin-2 receptor expression.

Adult↗
PubMedDate not supplied

Transportation of immunosuppressive substances produced at the site of burn injury into the systemic circulation: the role of lymphatics.

Serum of patients with severe burns has the ability to suppress mitogen-induced lymphocyte proliferation. Edema fluid collected from the site of injury during resuscitation and at the time of fascial excision has also been shown to suppress this response. An animal model was designed to identify the onset time of the formation of suppressive factors, their potential site(s) of origin, and their route of entry into the systemic circulation. Femoral artery, saphenous vein, and lateral saphenous lymphatic vessels were cannulated in an anesthetized dog. Baseline samples were collected, the hind paw was subjected to scald injury, and samples were collected serially for up to 6 hours after burn injury. Tissue fluid beneath the scald injury was harvested at the end of the experiments. In the absence of significant serologic evidence for inhibition, lymph and tissue fluid exhibited early and prolonged suppression of mitogen-induced lymphocyte proliferation. We concluded that edema fluid capable of cell-mediated immune suppression forms early after thermal injury and that lymph generated from the site of burn injury is immunosuppressive.

Animals↗
PubMedDate not supplied

Lymph isolated from a regional scald injury produces a negative inotropic effect in dogs.

Large surface-area burns in patients have been associated with a severe impairment in cardiac performance, as evidenced by a decline in cardiac output. The mechanisms responsible for this profound myocardial dysfunction are largely unknown. We investigated the effects of lymph isolated from the scalded hind limb of dogs on regional myocardial blood flow, coronary vascular reactivity, and contractile performance. Dogs were instrumented with ultrasonic dimension crystals in the myocardium supplied by the left anterior descending (LAD) and by the left circumflex (LCx) coronary arteries. After cannulating a hind limb lymphatic, lymph was infused directly into the LAD before and after a 10-second 100 degrees C hind limb scald. Scalding alone did not alter myocardial contractile performance in the LAD or LCx regions, coronary artery blood flow, or systemic hemodynamics. Interestingly, postburn lymph infused into the LAD resulted in a 38% decline in LAD zone segment shortening (p < 0.01 vs baseline) that lasted throughout the 5-hour observation period. In contrast, segment shortening in the (control) LCx region was unaffected by postburn lymph injections into the LAD. Regional myocardial blood flow (radiolabeled microspheres) in the LAD and LCx regions was unchanged after scald injury or intracoronary injection of postburn lymph. In addition, LAD coronary artery vascular reactivity to acetylcholine and nitroglycerin was also unaffected by the regional thermal injury or by injection of lymph into the LAD. These data suggest that a regional scald injury results in the production and release of a potent myocardial depressant factor(s) that produces a direct negative inotropic effect on the canine myocardium.

Animals↗
PubMedDate not supplied

Postburn vitamin C infusions do not alter early postburn edema formation.

To determine whether vitamin C would alter burn induced edema accumulation, hind paw venous pressure, lymph flow (QL), and lymph-to-plasma protein ratio (CL/CP) were monitored in groups of 5 dogs before and 4 hours after 1) a 5 sec 100 degrees C or 90 degrees C foot paw scald; 2) intravenous vitamin C given 30 min before or after a 100 degrees C scald; and 3) vitamin C given 30 min after a 90 degrees C scald. Throughout the experiments, hind paw venous pressure was elevated and maintained by outflow restriction until steady state QL and (CL/CP)min were reached. Changes in protein permeability (CL/CP), fluid conductance properties (Kf) of the capillary membrane, and paw weight gain were determined. Compared with preburn values, scald uniformly produced significant (P < .05, ANOVA) increases in QL, CL/CP and Kf. Although preburn infusion of vitamin C significantly (P < .01) attenuated burn-induced increases in paw weight gain (36 +/- 3% vs 19 +/- 4%), neither of the groups that received vitamin C postburn experienced significant modulations in paw weight gain (28 +/- 4% vs 36 +/- 3% in 100 degrees C burn only; 23 +/- 4% vs 28 +/- 3% in 90 degrees C burn only) or in any of the variables used to monitor capillary membrane integrity. Vitamin C infusions initiated after graded scald produced no changes in the burn-induced increases in microvascular permeability or in edema formation measured at the injury site.

Animals↗
PubMedDate not supplied

Modulation of microvascular permeability by 21-aminosteroids after burn injuries.

Burn injuries initiate lipid peroxidation in capillary endothelial cells and cause alterations in microvascular permeability, with subsequent leakage of fluid and protein from the plasma into the interstitium. We evaluated the effects of two lazaroid compounds (U74389F and U75412E) on alterations in microvascular permeability that resulted from burn injuries. A canine model was used for the evaluation of microvascular permeability at the site of the burn injury with the use of a measure of the reflection coefficient (sigma(d)). Hindpaw lymph flow, lymph and plasma total protein concentrations, and arterial, venous, and capillary pressures were measured before burn injuries and for 6 hours in 6 different groups. Footpaw weight gain was then calculated as the percentage of increase of experimental hindpaw relative to the contralateral paw. The damage was attenuated by 20 mg/kg of lazaroid U75412E given before the injuries, but a lower dose was not effective. This agent was also effective in limiting edema formation, as evidenced by changes in footpaw weight gain. However, the administration of either lazaroid compound produced no significant effect on the burn-induced changes in capillary permeability. We conclude that these lazaroids do not prevent burn-induced changes in permeability at the site of injury when administered after an injury. U75412E administered before the injury was effective in limiting the alterations in microvascular permeability.

Animals↗
PubMedDate not supplied

Development of a protocol to provide prolonged general anesthesia to pregnant sows.

This study was designed to determine whether a pregnant sow could be maintained under conditions of prolonged general anesthesia in order to provide access to prematurely delivered piglets for purposes of acute experimentation. Fifteen time-dated pregnant (90% of gestation) sows were preanesthetized with intramuscular xylazine (Rompun Mobay Pharmaceutical, Shawnee, KS)/ketamine (Aveco Pharmaceutical, Fort Dodge, IA). After anesthesia was induced with intravenous sodium thiopental, the animals underwent tracheotomy and mechanical ventilation. The electrocardiogram was monitored externally; systemic arterial pressure was supervised by the insertion of a brachial artery cannula; and urine output was determined by inserting a cystostomy tube. A surgical plane of anesthesia was achieved by the "balanced" technique: an inhalant, isoflurane, supplemented by intravenous doses of sufentanil citrate, propofol (Stuart Pharmaceuticals, Wilmington, DE), and vecuronium. Sows were maintained under general anesthesia for an average of 12 h; piglets were delivered, one or two at a time, by a modified cesarean section technique. No sows or piglets were lost to anesthetic complications. It is concluded that, with appropriate precautions, pregnant sows can be anesthetized for a prolonged period of time, and provide viable premature neonates for acute experimentation.

Anesthesia, General↗
PubMedDate not supplied

Effects of anti-inflammatory agents on hydrochloric acid-induced pulmonary injury.

To determine the effects of anti-inflammatory agents on hydrochloric acid lung injury, the heart and lungs were harvested from rats, placed in a lung chamber, constant flow perfused with whole blood, and ventilated. The following experiments were conducted: observation alone; intratracheal injection of normal saline; intratracheal hydrochloric acid; and intravenous meclofenamate or indomethacin before intratracheal hydrochloric acid. Wet-to-dry lung weights were measured. Peak airway pressures increased immediately (p < .001 vs. baseline; ANOVA) in all intratracheal groups, hydrochloric acid producing even greater (p < .05) increases than saline-effects unaltered by meclofenamate or indomethacin. The increased (p < .001 vs. baseline) 2-h pulmonary artery pressures in hydrochloric acid-treated groups were unaltered by meclofenamate or indomethacin. All hydrochloric acid-treated groups demonstrated increases (p < .05) in weight that were unchanged by meclofenamate or indomethacin. These data suggest that the beneficial effects of these medications described elsewhere, using a variety of in vivo lung injury experimental models, may be attributed to their experimental design, or to contributions from organs/systems outside the pulmonary circuit.

Acute Disease↗
PubMedDate not supplied

Comparison of novel synthetic materials with traditional methods to repair exposed abdominal wall fascial defects.

Repair of large abdominal wall defects is a challenge, particularly when full-thickness tissue loss prohibits coverage of the fascial repair. Two novel synthetic materials (TMS-1 and TMS-2) have been shown to be better accepted than expanded polytetrafluoroethylene (Gore-Tex), and polypropylene (Marlex) in the closure of clean and contaminated fascial wounds that are immediately covered by skin/soft tissue. Therefore, 1-cm2 abdominal wall defects were created in each of the four quadrants of rat groups. Gore-Tex, Marlex, and TMS-1 or TMS-2 were used to repair three defects, the fourth being primarily closed. To ensure that each repair remained exposed, skin edges were sutured to underlying muscle. Additional animal groups underwent the same protocol; however, peritonitis was induced at surgery using a fecal inoculum technique. Animals were sacrificed 2 weeks later, at which time a blinded observer assessed the surface area and severity of adhesions. In clean wounds, the surface area of formed adhesions was less (p < .004) after primary closure than each synthetic material; among the synthetics, TMS-2 caused significantly (p < .01) less extensive adhesions than Marlex. In addition, the severity of adhesions to TMS-2 was comparable to that of defects closed primarily, and less severe (p < .02) than those formed to Gore-Tex and Marlex. In animals with peritonitis, primary closure caused less extensive (p < .03) adhesions than Marlex and Gore-Tex and significantly (p < .002) less severe adhesions than Marlex, Gore-Tex, and TMS-2. However, the severity of adhesions formed to TMS-1 repairs proved comparable to primarily closed wounds. These experiments reaffirm the tenet that, whenever possible, abdominal wounds should undergo primary fascial closure. When soft tissue coverage over the repair cannot be achieved, TMS-2 is well tolerated in clean wounds. However, the superiority of TMS-1 over the other synthetic materials in contaminated wounds suggests it may also ultimately prove to be of clinical utility.

Abdominal Muscles↗
PubMedDate not supplied

Subeschar tissue fluid: a source of cell-mediated immune suppression in victims of severe thermal injury.

Thermal injury results in pronounced physiologic alterations in microcirculation at the site of tissue damage. The consequence of these changes is an increase in microvascular permeability, leading to the accumulation of tissue edema, or subeschar tissue fluid (STF). One of the adverse properties of edema is its capacity in vitro to inhibit cell-mediated immune function. Since previous studies evaluated STF collected 5 to 7 days after thermal injury, the present study was designed to determine the time frame during which STF demonstrates its immune suppressive nature. Seven patients with severe thermal injury (30% to 100% total body surface area) were entered into the study. STF was collected in serial fashion, beginning as early as 9 hours after injury and continuing until fascial excision or patient death (maximum of 139 hours after injury). The addition of STF to cultures of lymphocytes obtained from healthy donors resulted in complete inhibition of mitogen-induced lymphocyte proliferation (MILP). Serum collected concomitantly from this group of patients was also capable of inhibiting MILP. From its inception, STF possesses the ability to inhibit MILP; this suppressive nature is stable, persisting for prolonged periods of time. The gradual absorption of STF likely contributes to the serologic evidence of cell-mediated immune suppression documented in victims of severe thermal injury.

Adolescent↗