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Biomedical subjects

R E Dean

Publications and source records attributed to R E Dean.

At least 19 recordsLinked to original sources
PubMed1992

Mechanism of the beneficial effects of ATP-MgCl2 following trauma-hemorrhage and resuscitation: downregulation of inflammatory cytokine (TNF, IL-6) release.

Although ATP-MgCl2 improves hepatocellular function in a nonheparinized model of trauma-hemorrhage and crystalloid resuscitation, it remains unknown whether the beneficial effects of this agent are due to downregulation of the release of the inflammatory cytokines, tumor necrosis factor (TNF), and interleukin-6 (IL-6) under those conditions. To study this, rats underwent a 5-cm laparotomy (i.e., trauma induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of maximum bleedout volume was returned in the form of Ringer's lactate (RL). The animals were then resuscitated with four times the volume of shed blood with RL over 60 min. ATP-MgCl2 (50 mumoles/kg body weight each) or an equivalent volume of normal saline was infused intravenously for 95 min. This infusion was started during the last 15 min of RL resuscitation. Plasma levels of TNF and IL-6 were measured at 1.5 hr after the completion of resuscitation by cytokine-dependent cellular assays. Hepatic blood flow was determined by in vivo indocyanine green clearance (corrected by hepatic extraction ratio for indocyanine green), radioactive microspheres, and [3H]-galactose clearance techniques. The results indicate that the levels of circulating TNF and IL-6 increased significantly in the hemorrhaged-resuscitated animals. ATP-MgCl2 treatment, however, markedly decreased the synthesis and/or release of these cytokines to levels similar to the sham group. The markedly decreased hepatic blood flow (as determined by three different methods) and hepatic extraction ratio for indocyanine green were also restored by ATP-MgCl2 treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1992

Interferon-gamma attenuates hemorrhage-induced suppression of macrophage and splenocyte functions and decreases susceptibility to sepsis.

Although it is known that interferon-gamma synthesis and macrophage functions are depressed after hemorrhage, it remains to be determined whether systemic administration of interferon-gamma has any effect on hemorrhage-induced depression of macrophage and splenocyte functions. To study this, C3H/HEN mice were bled to a mean blood pressure of 35 mm Hg, maintained for 60 minutes, and followed by adequate fluid resuscitation. The mice then received either 1000 units interferon-gamma or saline solution (vehicle). Peritoneal (pM phi) and splenic (sM phi) macrophages and splenocytes were isolated 24 hours later. PM phi antigen presentation was measured by coculturing pM phi with the D10.G4.1 cell clone. Major histocompatibility complex class II (Ia) antigen expression was determined by direct immunofluorescence. Cytokine release by pM phi, sM phi, and splenocytes was assessed with specific bioassays. For survival studies, mice were subjected to sepsis 3 days after hemorrhage. Treatment with interferon-gamma restored (p less than or equal to 0.05) hemorrhage-induced suppression of pM phi antigen presentation capacity and Ia antigen expression and increased (p less than or equal to 0.05) interleukin-1 and tumor necrosis factor release by pM phi and sM phi, as well as splenocyte proliferation (p less than or equal to 0.05). Interferon-gamma also decreased (p less than or equal to 0.007) the susceptibility to sepsis after hemorrhage. Thus interferon-gamma represents a potent agent for treating hemorrhagic shock-induced immunosuppression and for increasing the ability of the host defense system to combat bacterial infections after hemorrhage.

Animals↗
PubMed1991

ATP-MgCl2 restores the depressed hepatocellular function and hepatic blood flow following hemorrhage and resuscitation.

Although ATP-MgCl2 produces a myriad of beneficial effects following organ ischemia and simple hemorrhagic shock in animal models which involved heparinization and/or blood resuscitation, it is not known whether ATP-MgCl2 has any salutary effect on the depressed active hepatocellular function (AHF) and hepatic microvascular blood flow (HMBF) in a nonheparinized model of trauma and severe hemorrhage in the absence of blood resuscitation. To determine this, rats underwent a midline laparotomy (i.e., trauma induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum shed blood volume was returned in the form of Ringer's lactate (RL). The animals were then resuscitated with four times the volume of shed blood with RL. ATP-MgCl2, 50 mumoles/kg body weight (BW) each or an equivalent volume of normal saline, was infused intravenously for 95 min during and following crystalloid resuscitation. At 1.5 and 4 hr after resuscitation, AHF (Vmax, maximal velocity of indocyanine green clearance; Km, efficiency of the active transport process) was determined without blood sampling by using an in vivo indocyanine green clearance technique. HMBF was measured with laser Doppler flowmetry. Results indicate that Vmax, Km, and HMBF decreased significantly at 1.5-4 hr after hemorrhage and resuscitation. ATP-MgCl2 infusion restored the depressed Vmax, Km, and HMBF and prevented the occurrence of hepatic edema. The restoration of AHF with ATP-MgCl2 treatment may be due to its direct salutary effect on the active indocyanine green transport process and/or due to improvement in hepatic microcirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1991

Adequate crystalloid resuscitation restores but fails to maintain the active hepatocellular function following hemorrhagic shock.

Studies have shown that active hepatocellular function is depressed early after trauma-hemorrhage and persists despite resuscitation with two or three times (x) the volume of maximum bleedout (MB) with lactated Ringer's solution (LR). However, it is not known if a larger volume of fluid resuscitation corrects this dysfunction. To study this, rats were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the MB volume was returned in the form of LR, and then resuscitated with 4x or 5x the volume of MB with LR. Three doses of indocyanine green (ICG) were given intravenously and [ICG] measured in vivo using an in-vivo hemoreflectometer. The initial velocity of the clearance of ICG was calculated. Maximal velocity of the clearance (Vmax: the number of functional ICG receptors) and kinetic constant (Km: the efficiency of the active transport) were determined from the Lineweaver-Burk plot. Vmax decreased during hemorrhage, was restored to control levels at 0-4 hours after resuscitation, but decreased at 4-8 hours after resuscitation despite restoration of cardiac output following resuscitation with 5x LR. This could be the result of increased TNF release. The Km also decreased during hemorrhage, but increased at 0-1.5 hours and remained at control levels even 4-8 hours after resuscitation. Thus the failure of Vmax to remain at control levels following adequate fluid resuscitation may form the basis of cellular dysfunction and multiple organ failure after severe hemorrhagic shock.

Adenine Nucleotides↗
PubMed1991

Diltiazem administration after crystalloid resuscitation restores active hepatocellular function and hepatic blood flow after severe hemorrhagic shock.

Studies have shown that active hepatocellular function is depressed after hemorrhagic shock, despite crystalloid resuscitation. It is also known that calcium antagonists produce various beneficial effects on cell and organ function after ischemia and shock. However, it remains unknown whether such agents have any salutary effects on the depressed active hepatocellular function and hepatic blood flow in a nonheparinized model of trauma and hemorrhage. To study this, rats underwent a midline laparotomy (trauma-induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum bleedout was returned in the form of Ringer's lactate. They were then resuscitated with four times the volume of shed blood with Ringer's lactate over 60 minutes, during and after which diltiazem (400 micrograms/kg body weight) was infused intravenously over 95 minutes. Active hepatocellular function (Vmax and Km) was determined with an in vivo indocyanine green clearance technique. Effective hepatic blood flow (EHBF) was determined by Fick principle and corrected by the indocyanine green extraction ratio. Hepatic microvascular blood flow (HMBF) was measured by laser Doppler flowmetry. Results indicate that Vmax, Km, EHBF, and HMBF decreased significantly at 1.5 and 4 hours after resuscitation. Diltiazem infusion restored the depressed Vmax, Km, EHBF, and HMBF and prevented the occurrence of hepatic edema. Thus, diltiazem may be a useful adjunct in the treatment of trauma and severe hemorrhage even in the absence of blood resuscitation.

Analysis of Variance↗
PubMed1990

Decreased Fc receptor expression on macrophages following simple hemorrhage as observed by scanning immunoelectron microscopy.

Although it is known that macrophage (M phi) functions such as phagocytosis and antigen presentation are depressed following hemorrhage and resuscitation, the mechanism remains unknown. The aim of this study was to determine, using scanning immunoelectron microscopic techniques, whether there is any alteration in the Fc receptors on the M phi after hemorrhage. To study this, male C3H/HeN mice were bled to a mean blood pressure (BP) of 35 mm Hg and maintained at that pressure for 1 hr, then resuscitated with their own blood and adequate fluids. Twenty-four hrs later, Kupffer cells from livers and splenic adherent cells were isolated, incubated for 16 hr, and then exposed to polysterene beads conjugated with antimouse IgG that specifically binds to Fc receptors. The cells were then prepared for observation by scanning electron microscopy. At least 100 cells from each animal were examined. The number of Kupffer cells from posthemorrhage mice that exhibited specific receptor labeling was significantly decreased (41.0 +/- 2.6, P less than 0.05) compared with control (64.2 +/- 7.5). The number of splenic adherent cells from posthemorrhage mice exhibiting specific receptor labeling was also significantly decreased (35.7 +/- 2.5, P less than 0.01) compared with control (61.2 +/- 3.9). The internalization of markers was also seen in some cells. The cause of the decrease in receptor labeling following hemorrhage may be the loss, inactivation, and/or internalization of receptors. Thus the decreased number of functional macrophages may contribute to the depression of antigen presentation and to the enhanced susceptibility to sepsis following hemorrhage.

Animals↗
PubMed1989

Mechanism of immunosuppression following hemorrhage: defective antigen presentation by macrophages.

The mechanism by which simple hemorrhage profoundly impairs the proliferative response of T lymphocytes to mitogen and alloantigen, produces a defect in interleukin-2 generation, and increases the susceptibility to sepsis remains unknown. Since antigen presentation (AP) by the macrophage (M phi) plays a critical role in the antigen-specific activation of T-helper cells and lymphokine production, we investigated whether the function of the M phi as an AP cell is altered following hemorrhage. C3H/HEJ mice were bled to a mean BP of 35 mm Hg, maintained at that level for 1 hr, and then resuscitated. There was no mortality with this model. Control mice were not bled but otherwise treated identically. Immediately after resuscitation the mice were sacrificed and peritoneal M phi (PM phi) as well as splenic adherent cells (SAC) were harvested. AP function was tested by coculturing different numbers of PM phi and SAC with D10.G4.1 cells (2 x 10(4) cells/well) in the presence of conalbumin (300 micrograms/ml). This T-helper cell clone proliferates upon recognition of conalbumin in the context of Iak (a M phi surface membrane glycoprotein), thus directly reflecting M phi AP capability. After 72 hr of incubation, the cultures were pulsed with [3H]thymidine and harvested. D10.G4.1 proliferations induced via AP by PM phi and SAC from hemorrhaged-resuscitated mice were 29 and 24% of control, respectively (P less than 0.05). Thus, we conclude that AP by M phi following hemorrhage is defective despite adequate resuscitation, a mechanism which could explain the state of immunosuppression and enhanced susceptibility to sepsis.

Animals↗
PubMed1988

Effect of blood transfusion on antigen presentation function and on interleukin 2 generation.

To study the effect of blood transfusion (BT) on cell-mediated immunity, we examined the antigen presentation function of peritoneal macrophages and interleukin 2 (IL-2) generation by splenocytes. C3H/HEJ mice were transfused with 0.2 mL of fresh allogeneic blood obtained from C57BL/6 mice; they were killed on days 1, 3, and 7 after BT. A second group of C3H/HEJ mice was transfused with 0.2 mL/d of the same allogeneic blood on three successive days; they were killed on day 7 following the last BT. The antigen presentation function of peritoneal macrophages was measured by utilizing a D10.G4.1 T-helper cell clone; IL-2 activity in supernatants of concanavalin A-stimulated splenocytes was tested by utilizing an IL-2-dependent HT-2 cell line. The results indicate that although antigen presentation function remains unaffected after single and multiple BTs, the ability of splenocytes to generate IL-2 decreases significantly even after a single BT. Thus, the increased susceptibility to infection and the additional immune perturbations in malignant neoplasms following BT may be due in part to decreased IL-2 generation.

Animals↗
PubMed1988

Prostaglandin E2 depresses antigen-presenting cell function of peritoneal macrophages.

Eicosanoids play a prominent role in trauma. Such mediators of inflammation negatively influence cell-mediated immunity (CMI). There is, however, no information available on the effect of eicosanoids on a critical event in CMI, i.e., antigen-presenting (AP) cell function of macrophages (M luminal diameter), a cellular process responsible for the activation of T and B lymphocytes. The aim of this study, therefore, was to examine the effect of prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) on AP cell function of the peritoneal M luminal diameter. To study this, a T-helper-cell clone, D10.G4.1 was employed. This cell clone proliferates in the presence of Iak (Class II glycoprotein, MAC product) bearing M luminal diameter and specific antigen (conalbumin A) thus directly reflecting the AP capability of the M luminal diameter. Peritoneal M luminal diameter were harvested from B10.BR mice (H2k) and their AP was tested in vitro by incubating varying numbers of M luminal diameter with 2 X 10(4) D10.G4.1 cells/well and conalbumin (400 micrograms/ml) in the presence and absence of different concentrations of PGE2 or TXB2. Cultures were incubated for 72 hr, pulsed with [3H]-thymidine, and harvested. At concentrations of 10, 30, and 100 nM of PGE2, D10.G4.1 proliferations were 38, 35, and 20% of control, respectively (P less than 0.05 compared to control). TXB2 added at the above-mentioned concentrations did not suppress the proliferative response of D10. Thus, PGE2 but not TXB2 has a potent immunosuppressive effect on AP of peritoneal M luminal diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Use of magnesium-ATP following liver ischemia.

The role of Mg in cardiomyopathies of different etiologies is well known; however, relatively little is known about the changes in hepatic Mg levels following ischemia to the liver. The available information indicates that tissue and mitochondrial Mg levels are altered following global hepatic ischemia and reflow and that such alterations may be responsible for the depressed cellular function during those conditions. Administration of MgCl2 alone following ischemia was ineffective in improving tissue and mitochondrial Mg levels and cellular functions. ATP administration alone following ischemia was also ineffective. However, administration of ATP complexed with MgCl2 increased tissue and mitochondrial Mg levels, tissue ATP stores and cellular functions and proved beneficial for the survival of animals. The potential mechanisms of the beneficial effects of ATP-MgCl2 are discussed. A multicenter clinical trial of ATP-MgCl2 in patients with various adverse circulatory conditions is being initiated in this country.

Adenosine Triphosphate↗
PubMed1987

Surgical treatment of peptic ulcer disease before and after introduction of H2 blockers.

This retrospective study was undertaken to determine if the advent of H2 blockers has altered the surgical treatment and outcome of patients with peptic ulcer disease (PUD). The records of patients having surgery for PUD at Butterworth Hospital, Grand Rapids, Michigan, from 1971-73 (Group 1) and 1981-83 (Group 2) were reviewed. Data recorded included patient and disease characteristics, surgical procedures, morbidity, and mortality. There was a significant difference in mean age: 54 years in Group 1 and 60 years in Group 2. Group 2 had a higher incidence of concomitant medical illnesses. Indications for operation were predominantly of an emergent nature in Group 2, with a marked decline in elective surgeries from 75 per cent to 55 per cent. There was a 15 per cent incidence of nonsurgical complications in Group 2, as opposed to 9 per cent in Group 1. This study demonstrates that the use of H2 blockers and changes in patient characteristics have altered the surgical treatment and outcome of patients with PUD.

Adult↗
PubMed1987

Depressed antigen presentation function and membrane interleukin-1 activity of peritoneal macrophages after laparotomy.

Although major tissue trauma produces profound depression of cell-mediated immunity, it is not known whether surgical trauma (i.e., midline laparotomy) has any adverse effect on the antigen presentation function and membrane interleukin-1 (IL-1) activity of peritoneal macrophages. To study this, C3H/HEJ (endotoxin-tolerant) mice were anesthetized. An approximately 1-inch midline abdominal incision was made, followed by abdominal closure. On days 1, 3, 5, and 7, peritoneal macrophages were harvested by means of peritoneal lavage, and antigen presentation capability was tested by incubating various numbers of peritoneal macrophages with 2 X 10(4) D10.G4.1 cells per well in the presence of conalbumin (400 micrograms/ml). The T helper cell clone (D.10.G4.1) proliferates on recognition of conalbumin in the context of Iak and also proliferates in the presence of membrane-bound IL-1 plus concanavalin A. To measure membrane IL-1 expression in peritoneal macrophages, Concanavalin A (10 micrograms/ml) was substituted for conalbumin. Cultures were incubated for 72 hours, pulsed with tritiated thymidine, and harvested. Peritoneal macrophages from laparotomized mice induced significantly less T helper cell proliferation on days 1 and 3 in the antigen presentation assay (37% and 30%, respectively; p less than 0.05) and in the membrane IL-1 assay (14% and 10%, respectively; p less than 0.05) as compared with the control. This difference was not detectable on day 5. More effective antigen presentation capability (167% of control; p less than 0.05) was seen on day 7. Thus laparotomy by itself produces marked depression of both antigen presentation function and membrane IL-1 activity of peritoneal macrophages, which may enhance susceptibility to intra-abdominal sepsis.

Animals↗
PubMed1986

Addition of branched-chain amino acids to parenteral nutrition of stressed critically ill patients.

We compared the efficacy of a total parenteral nutrition solution supplemented with 44.6% branched-chain amino acids (BCAA) to standard total parenteral nutrition (19.0% BCAA) in the support of critically ill patients. After a 4-day administration of a randomly assigned solution, amino acids were assayed from femoral venous and arterial samples. The BCAA-supplemented solution caused increases in arterial concentrations of valine, isoleucine, and leucine compared to the control solution. The femoral arteriovenous differences for these BCAA were more positive in patients given the control solution. There were no significant differences in nitrogen balance. Since previous studies showing promotion of nitrogen balance with BCAA did not use a balanced substrate for nonprotein caloric support, the lack of a significant difference in the present study may be due to effective utilization of lipid as a fuel source by both groups.

Adult↗
PubMed1985

Comparison of the diagnostic methods used in maxillofacial trauma.

A prospective study was performed to evaluate the diagnostic methods used in acute maxillofacial trauma. Clinical examination, routine facial x-rays with linear tomography, and computer tomography were compared in 49 patients. Computer tomography was found to be the most accurate test in the diagnosis of facial bone injury, especially complex fractures. Computer tomography also provided valuable information regarding soft-tissue injury of the face. The radiation doses of linear tomography and computer tomography were calculated to be below the level known to cause cataract formation. Computer tomography is a safe, reliable adjunct in the diagnosis of acute maxillofacial trauma and should be strongly considered after initial screening measures are completed.

Adolescent↗
PubMed1985

Fibronectin. A new nutritional parameter.

Acute and chronic malnutrition is associated with increased morbidity and mortality in surgical patients. Plasma fibronectin levels have been shown to correlate with reticuloendothelial function and are reduced in burns, shock, trauma, and sepsis. Patients failing to show an increase in fibronectin levels after stress have been shown to do poorly. Starvation studies in human volunteers have demonstrated decreasing plasma fibronectin levels until feeding was resumed. The purpose of this study is to examine the usefulness of fibronectin as an assessment parameter in nutritionally depleted hospitalized patients. Eight patients initiated on parenteral nutrition were studied. Plasma fibronectin, albumin, and transferrin levels were drawn before TPN and repeated at various intervals after total parenteral nutrition (TPN) was begun. Mean pre-TPN transferrin was 198.1 +/- 16.1 gm/dl (nl 220-400). Transferrin levels remained statistically unchanged after 8 to 11 days of TPN. Mean pre-TPN albumin was 3.0 +/- 0.2 gm/dl (nl 3.6-4.8) and also remained statistically unchanged after 8 to 11 days of TPN. The mean fibronectin level pre-TPN was 236.4 +/- 24.4 microgram/ml (nl 370-410). Fibronectin rose statistically (P less than 0.005) after 1 to 4 days of TPN to a mean of 341.9 +/- 30.1 microgram/ml and remained elevated and statistically unchanged after 8 to 11 days of TPN. Six of the eight patients studied survived and had demonstrated at least a 30 per cent increase in fibronectin after 1 to 4 days of TPN. Both patients who died demonstrated minimal increase in fibronectin levels after 1 to 4 days of TPN.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Polytetrafluoroethylene versus autogenous vein grafts for vascular reconstruction in contaminated wounds.

A high incidence of dissolution and disruption of infected autogenous vein grafts has been demonstrated. PTFE, on the other hand, has been shown to maintain its structural integrity in the presence of well-entrenched infection, with a relatively small incidence of anastomotic disruption related to host artery necrosis. In addition, PTFE performed as well as autogenous vein when antibiotics were administered. Therefore, PTFE graft material is advocated for controlled clinical trials in patients with contaminated vascular injuries.

Animals↗