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Biomedical subjects

W M Abbott

Publications and source records attributed to W M Abbott.

At least 73 records · Page 4Linked to original sources
PubMed1993

Compliance of vascular anastomoses with polybutester and polypropylene sutures.

PURPOSE: Polybutester suture is more easily stretched than other vascular sutures and may produce more compliant anastomoses. The effects of using polybutester and polypropylene sutures were compared acutely in arterial autografts and in chronic implants of cephalic vein grafts into the femoral arteries of dogs. METHODS: Paraanastomotic profiles of diameter and compliance were measured with echo-tracked ultrasonography, and profiles of intimal thickening were generated from histologic sections of the vessels harvested after 3 months. RESULTS: Polybutester produced more compliant anastomoses, compared with polypropylene, in arterial autografts (in vitro: 5.9% +/- 2.0% vs 3.3% +/- 0.6% diameter change/100 mm Hg, p < 0.01; in vivo: 3.1% +/- 1.1% vs 1.6% +/- 0.5%, p < 0.05), but this difference was not observed with vein as the graft material, either initially (1.1% +/- 1.2% vs 1.7% +/- 0.5%) or after 3 months (2.1% +/- 1.2% vs 2.4% +/- 0.8%). This dichotomy may reflect a governing influence of the stiffer veingrafts, compared with host artery (2.6% +/- 1.0% vs 5.4% +/- 1.2%), or the use of suboptimal tension on the polybutester suture when creating the anastomosis. CONCLUSIONS: Both sutures produced similar compliance and thickness profiles. Polybutester initially produces a more compliant anastomosis when both artery and graft are compliant, reducing anastomotic compliance mismatch. However, this benefit may not apply when the anastomosis includes a vessel of low compliance.

Anastomosis, Surgical↗
PubMed1993

The potential for lower extremity revascularization without contrast arteriography: experience with magnetic resonance angiography.

PURPOSE: We report an initial experience with 24 patients studied between March 1990 and April 1992 with magnetic resonance angiography (MRA) for lower extremity occlusive disease. METHODS: All patients underwent vascular intervention with either balloon angioplasty or bypass grafting, and in six patients this intervention was based on MRA findings alone. Eighteen patients were studied with both MRA and contrast arteriography, and there was observed agreement between the two studies in 98% of all arterial segments examined. RESULTS: Agreement between MRA and contrast arteriography was uniform for arterial segments below the inguinal ligament. Intraoperative findings and favorable early results of seven bypass grafts performed in six patients after MRA alone suggested this was a valid approach for patients at prohibitive risk of complications from contrast arteriography. CONCLUSIONS: Magnetic resonance angiography is accurate in demonstrating relevant anatomy in peripheral arterial occlusive disease and in selected patients may eliminate the need for contrast arteriography before lower extremity revascularization.

Angiography↗
PubMed1993

Angioscopic evaluation of unilateral aortic graft limb thrombectomy: is it helpful?

PURPOSE: Graft thrombectomy is often an effective method for restoring inflow in an occluded limb of an aortobifemoral graft. A major determinant for its success is the completeness of thrombus removal from the graft, verification of which can be performed by angioscopy. METHODS: A retrospective review since January 1989 identified 51 unilateral graft limb thrombectomy operations in 35 patients. At the discretion of the surgeon 20 of these procedures included angioscopic inspection of the graft for significant retained thrombus, which was found and retrieved in 11 (55%). RESULTS: Visualization of the graft limb was very good, but inspection of the graft body was not possible. There were no angioscopy-related complications. Within the first 4 months after graft limb thrombectomy and reconstruction, four of 20 patients in the group inspected by angioscopy and nine of 31 in the conventionally treated group had reocclusion of the treated limb. CONCLUSIONS: These results suggest that angioscopy can be a helpful adjunct in the successful inflow management of aortic graft limb thrombectomy to verify the completeness of clot removal.

Angioscopy↗
PubMed1993

Sequencing of cDNA from 50 unrelated patients reveals that mutations in the triple-helical domain of type III procollagen are an infrequent cause of aortic aneurysms.

Detailed DNA sequencing of the triple-helical domain of type III procollagen was carried out on cDNA prepared from 54 patients with aortic aneurysms. The 43 male and 11 female patients originated from 50 different families and five different nationalities. 43 patients had at least one additional blood relative who had aneurysms. Five overlapping asymmetric PCR products, covering all the coding sequences of the triple-helical domain of type III procollagen, were sequenced with 28 specific sequencing primers. Analysis of the sequencing gels revealed only two nucleotide changes that altered the structure of the protein. One was a substitution of threonine for proline at amino acid position 501 and its functional importance was not clearly established. The other was a substitution of arginine for an obligatory glycine at amino acid position 136. In 40 of the 54 patients, detection of a polymorphism in the mRNA established that both alleles were expressed. The results indicate that mutations in type III procollagen are the cause of only about 2% of aortic aneurysms.

Adult↗
PubMed1993

Ambient oxygen tension modulates endothelial fibrinolysis.

PURPOSE: Vascular procedures reoxygenate ischemic endothelial cells (EC) and arterialize saphenous vein (HSV) EC. The balance between the EC-derived fibrinolytic components, plasminogen activator (tPA), and plasminogen inhibitor (PAI-1) contributes to maintaining thromboresistance. This balance also affects proteolysis through plasmin generation, mediating matrix metabolism endothelial migration, angiogenesis, and theoretically affecting the development of intimal hyperplasia. METHODS: To explore the impact of varying oxygen tensions on EC fibrinolysis, HSV and human umbilical vein (HUV) were subjected to Po2 of 40 mm Hg for 24 hours with restoration of Po2 to 150 mm Hg for 24 hours. The tPA and PAI-1 antigen and tPA/PAI-1 antigen ratio in conditioned media (CM), expressed as increases or decreases % change, normalized for cell count, versus controls, were analyzed by enzyme-linked immunosorbent assay. Cellular tPA and PAI-1 mRNAs were assessed by Northern analysis. RESULTS: The tPA but not PAI-1 was significantly decreased after the first 24 hours in HSVEC and significantly decreased after 48 hours in both HUVEC and HSVEC when compared with controls. Messenger RNA for tPA was unchanged but PAI-1 mRNA increased significantly for HSVEC and HUVEC after 24 hours of Po2 of 40 mm Hg, returning to baseline within 24 hours of Po2 to 150 mm Hg restoration. CONCLUSIONS: These data support the hypothesis of a fibrinolytic shift after altered ambient O2 tensions exposure in endothelium and demonstrate that HSVEC are more sensitive to altered O2 tension than HUVEC. Altered O2 tensions depress EC fibrinolysis in this model.

Atmospheric Pressure↗
PubMed1993

Hemodynamics and aneurysm development in vascular allografts.

PURPOSE: Mechanical and immunologic factors may play a role in the development of native arterial and biologic graft aneurysms. We developed an experimental rat aortic allograft aneurysm model in which segments of infrarenal aorta were transplanted between hypertensive and normotensive rats to study these factors in this model. METHODS: Aortic allografts and autografts were inserted into spontaneously hypertensive (SHR) and normotensive Wistar Kyoto (WKY) rats. Effects of immunologic and antihypertensive therapy were evaluated. Graft diameters were followed up with magnetic resonance imaging and at harvest. Direct-pressure measurements were taken and dp/dtmax (force of ventricular contractions) was calculated before harvest. RESULTS: Autografts remained isodiametric and maintained their histologic architecture. Aneurysmal dilation of transplanted segments occurred in SHR host allografts but not in WKY host allografts. Histologic examination of all allograft specimens noted a rejection reaction characterized by inflammatory cell infiltration and medial smooth muscle cell loss. Antigenic enhancement accelerated aneurysm development in SHR hosts but had no significant effect on WKY hosts. Rates of allograft enlargement and final allograft diameters were similar in antihypertensive treated and untreated SHR hosts. The dp/dtmax in untreated SHR hosts was greatest and differed significantly from that in the WKY rats but only marginally from that in treated SHR hosts. CONCLUSIONS: Immunologic rejection but not abnormal hemodynamics is necessary for development of allograft aneurysm in this model.

Animals↗
PubMed1992

Subunit molecular mass assignment of 14,654 Da to the soluble beta-galactoside-binding lectin from bovine heart muscle and demonstration of intramolecular disulfide bonding associated with oxidative inactivation.

The soluble dimeric beta-galactoside-binding lectin (subunit molecular mass, approximately 14 kDa) of bovine heart muscle, in common with the 14-kDa lectins of several other animal species, displays carbohydrate-binding activity when it is in the reduced state, but the purified lectin loses this activity upon oxidation. In the present study, the presence of any post-translational modification and the mechanism of the oxidative inactivation have been investigated by analyses of the reduced and oxidized forms of the purified bovine lectin by electrospray ionization-mass spectrometry (ESI-MS) and by liquid secondary ion mass spectrometry (LSIMS) of tryptic and peptic peptides. By ESI-MS, the molecular mass of the reduced lectin is determined to be 14,654.6 +/- 0.9 Da, and that of the oxidized lectin is 14,649.3 +/- 1.1 Da. These masses correspond to the amino acid sequence of the protein with the cysteines having free sulfhydryl groups in the reduced state and forming disulfide bonds in the oxidized state. There is no evidence of post-translational modification in either lectin form except for monoacetylation already predicted for alanine at the blocked N-terminal end. Pronounced differences in charge distribution in the electrospray ionization mass spectra of the reduced and oxidized lectin, reflecting a change in the number of accessible protonation sites in the oxidized protein, are consistent with the protein being held in an altered conformation by covalent bonding. The results of LSIMS analyses of tryptic and peptic peptides in conjunction with Edman sequencing indicate that disulfide bonding occurs predominantly between Cys2 and Cys130, Cys16 and Cys88, and Cys42 and Cys60. There is no evidence of oxidation of Trp68. These results, taken together with observations that almost the complete polypeptide chain is necessary for the functional integrity of the carbohydrate recognition domain (Abbott, W. M., and Feizi, T. (1991) J. Biol. Chem. 266, 5552-5557) point to intramolecular disulfide bonding with a change in protein folding and conformation as the mechanism of oxidative inactivation of the purified bovine lectin.

Amino Acid Sequence↗
PubMed1992

Magnetic resonance imaging of small arteries.

Magnetic resonance imaging (MRI) with receive-only surface coil technology was used to visualize and quantitative luminal diameters of small arteries in the rat. MRI measurements of normal and aneurysmal aortas, over a diameter range of 1-3 mm, were closely correlated with direct measurements made visually at laparotomy: measured differences averaged 0.16 mm, and the least-squares regression line (R2 = 0.97, P < 0.001) compared favorably to the line of equivalence, X = Y. This noninvasive but precise imaging modality demonstrates the potential value of using MRI to evaluate the diameter of small vessels, including the postoperative monitoring of arterial bypass graft patency in peripheral regions.

Abdomen↗
PubMed1992

Prothrombotic and fibrinolytic function of normal and perturbed endothelium.

Endothelium mediates thrombosis and fibrinolysis in part through cell-based production and binding of coagulation factors and anticoagulant moieties. A variety of biologically active agents (homocysteine, interleukin-1, and endotoxin) and environmental factors (mechanical injury and hypoxia) can upset the homeostasis of the coagulation system leading in vitro and in vivo to abnormal propensity for thrombin formation. None of the above agents or any similar agents have been demonstrated to inhibit clotting factors or thrombosis formation. As one would expect, injury to endothelium even on a sublethal basis promotes a procoagulant response. This procoagulant response appears to be multifactorial and multiphasic. Gross injury leads to factor release by dead or dying cells with rapid promotion of thrombosis by neighboring infact cells. A more subtle prothrombotic state promulgated by viable cells appears after sublethal perturbation and is characterized by protein synthesis-dependent production of endothelial-produced clotting factors in the early stages of injury with subsequent return to normal levels of these factors by 24 hr. A second phase of abnormal levels of fibrinolysis inhibitors and possible reduction in fibrinolysis promoters appears to follow up to 48 hr after the initial injury. Thus the cell can be viewed as producing means of promoting thrombus formation followed by preventing thrombus dissolution. The data presented in this article are primarily cell culture data and are thus limited both in physiologic applicability and in ability to define over long periods the relevance of those findings to other cells in the hemostatic system. Nonetheless, in vivo data of endothelial perturbation correlate with the in vitro findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation↗
PubMed1992

The impact of selective use of dipyridamole-thallium scans and surgical factors on the current morbidity of aortic surgery.

Preoperative cardiac testing in patients undergoing vascular surgery remains controversial. We have advocated selective use of dipyridamole-thallium scans based on clinical markers of coronary artery disease before aortic surgery. The present study assessed both the efficacy of this policy and the role of surgical factors in the current morbidity of aortic reconstruction. Two hundred two elective aortic reconstructions (151 abdominal aortic aneurysms, 51 aortoiliac occlusive disease) performed in the period from January 1989 to June 1990 were reviewed. Preoperative dipyridamole-thallium scanning was performed in 29% of all patients, prompting coronary angiograms in 11% and coronary artery bypass grafting/percutaneous transluminal coronary angioplasty in 9% of patients before aortic reconstruction. The overall operative mortality rate was 2%, with one cardiac-related death. Major cardiac (nonfatal myocardial infarction, unstable angina) and pulmonary complications occurred in an additional 4% and 6%, respectively, of patients. Coronary artery disease clinical markers and surgical factors were analyzed with stepwise logistic regression for the prediction of operative mortality rates and major cardiopulmonary complications. Variables retaining significance in predicting postoperative death or cardiopulmonary complications included prolonged (more than 5-hour) operative time (p less than 0.004), operation for aortoiliac occlusive disease (p less than 0.010), and a history of ventricular ectopy (p less than 0.002). Prolonged operative time (p less than 0.006) and the detection of intraoperative myocardial ischemia (p less than 0.030) were predictive of major cardiac complications after univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Femoropopliteal reconstruction with knitted, nonvelour Dacron versus expanded polytetrafluoroethylene.

No ideal prosthetic conduit exists for femoropopliteal reconstruction. Expanded polytetrafluoroethylene (PTFE) has gained much greater popularity than the less expensive Dacron, despite disappointing long-term patency for each material. Few direct comparisons of results with the two materials have been performed. The concurrent experience of a single surgeon with femoropopliteal reconstructions of PTFE (n = 85) or knitted, nonvelour Dacron (KNVD, n = 38) was reviewed. Risk factors were comparable in the two groups. Overall patency was significantly better for KNVD than for PTFE (p = 0.0096 by log rank; p = 0.039 by Cox proportional hazards; 48% vs 27% at 5 years). Since in this series the overall performance of KNVD was significantly better than PTFE, a reassessment of the prosthetic materials used in femoropopliteal reconstruction is necessary. These results justify a prospective comparison of PTFE and KNVD.

Aged↗
PubMed1992

The current surgical management of carotid body paragangliomas.

To determine if recent trends in evaluation and therapy have contributed to the successful surgical management of carotid body paragangliomas, we reviewed our experience over the past decade. Nineteen carotid body paragangliomas were identified in 17 patients. Eleven patients underwent complete, preoperative embolization of their afferent arteries with one complication. Calculated carotid body paragangliomas surface areas did not differ between the embolized 64.6 +/- 43.3 cm2 and nonembolized 63.0 +/- 57.9 cm2 lesions. Intraoperative blood loss was lower (p = 0.02) in the patients treated with embolization (372 +/- 213 ml) compared with their cohorts (609 +/- 564 ml). However, the operative times were equivalent 4.1 hours versus 4.5 hours in both groups. Intraoperative electroencephalographic (EEG) monitoring was used in 10 patients; in one patient the EEG indicated intraoperative thrombosis of the carotid artery, which was successfully treated by thrombectomy without complications. Two patients required carotid bifurcation resection and vascular reconstruction to remove the entire tumor; a late stroke manifested by contralateral hand weakness developed in one of these patients. The incidence of cranial nerve injury was low at 16%, with one transient ramus mandibularis paresis and two instances of vocal cord dysfunction. Two additional patients had a postoperative Horner's syndrome. We conclude that by diminishing intraoperative blood loss through complete and careful preoperative embolization and use of intraoperative EEG monitoring along with careful surgical technique, the complications associated with this challenging operation are facilitated and diminished.

Adult↗
PubMed1992

Arterial laser welding with a 1.9 micrometer Raman-shifted laser.

A new 1.9 micron Raman-shifted neodymium:yttrium aluminum garnet (Nd:YAG) laser was used for small vessel welding. Bursting pressures and stresses of sutured and laser-welded arteriotomies created in the rat femoral artery and aorta were measured. Sutured arteriotomies had a significantly higher burst stress than laser-welded arteriotomies. Although there were no significant differences in burst stress at the various laser powers tested, an optimal power was identified. The laser was also used to weld transected rat aortas. The average power delivered was 200 mW for 30 seconds per anastomosis. The average time for completing an anastomosis was 6 minutes compared with 18 minutes when sutures were used. In relation to proximal aortic diameter, there was a 7.9% decrease at the anastomosis immediately (n = 4), and a 6.6% and 4.9% increase occurred at 24 hours (n = 4) and 10 weeks (n = 5), respectively. Acute anastomotic compliance, and compliance at 24 hours and 10 weeks were decreased by 47.2%, 39.5%, and 47.8%, respectively, and were similar to sutured anastomoses. Histology showed little thermal denaturation of the aorta within 0.6 mm of the anastomosis, approximately 1 mm of medial cell death, and nearly normal elastic fiber alignment. One focal false aneurysm was noted at 10 weeks. Although the sutured and laser-welded anastomoses share similar compliance changes, the laser-welded anastomoses are more isodiametric. This preliminary experience with the 1.9 micron laser shows the distinct advantages of a handheld fiber, no requirement for cooling irrigation, speed, and no difference in compliance from sutured anastomoses.

Analysis of Variance↗
PubMed1992

Heparin fails to suppress intimal proliferation in experimental vein grafts.

Heparin has been shown to suppress both vascular smooth muscle cell proliferation in vitro and intimal hyperplasia in animal models of arterial injury. We investigated the effect of heparin on early postoperative smooth muscle cell proliferation and intimal thickening in vein grafts placed in the rat infrarenal aorta. Experimental animals (n = 6) received subcutaneous heparin (800 units/kg with levels monitored by activated factor X assay) every 12 hours for 3 days after surgery to coincide with the known period of maximal vascular wall DNA synthesis after injury. Control animals (n = 7) received identical vein grafts but no heparin. Grafts were harvested with perfusion fixation 14 days after insertion. Tritiated thymidine autoradiography was used to derive a mitotic index in regions of interest along the grafts, and computerized planimetric measurements of intimal and medial thickness were made in the same regions. Evans blue lumenal staining at harvesting revealed confluent endothelial coverage of both experimental and control grafts. The mitotic index of the vein graft's midsection and perianastomotic regions was significantly higher (p less than 0.005) than that of the native aorta in all animals, indicating cellular proliferation within all grafts, with no differences noted between heparinized and control animals. Similarly, both groups exhibited vein graft intimal and medial thickening at the anastomoses relative to the midsection of the vein graft (p less than 0.001). Heparin, administered in the equivalent of pharmacologic clinical doses, failed to suppress cellular proliferation and intimal hyperplasia in this model of vein grafting.

Animals↗
PubMed1991

Studies of the binding specificity of the soluble 14,000-dalton bovine heart muscle lectin using immobilised glycolipids and neoglycolipids.

The aim of the present study has been to investigate the binding specificity of the soluble 14,000-dalton lectin of bovine heart muscle towards immobilised oligosaccharides in clustered form. To this end, chromatogram overlay assays and quantitative plastic-microwell-binding assays have been performed using several natural glycolipids and neoglycolipids containing one or more of the disaccharide units, beta-D-Galp-(1----4 or 3)-D-GlcNAc or beta-D-Galp-(1----4)-D-Glc and related structures. The microwell assay gave the most consistent results. It was observed that for binding by the soluble lectin the optimal sequence, which is beta-D-Galp-(1----4 or 3)-D-GlcNAc, must occur at the nonreducing end of longer oligosaccharides when linked to lipid. These oligosaccharides may be of poly(N-acetyllactosamine) type or they may be mono- or multi-antennary, complex-type chains in which the disaccharide is joined directly to a trimannosyl core. The lectin bound to such immobilised lipid-linked oligosaccharides on which the terminal D-galactosyl groups are substituted with alpha-L-Fucp-(1----2), alpha-D-Galp-(1----3), or alpha-NeuAc-(2----3) groups. However, no binding was detected if the terminal D-galactosyl groups were substituted with an alpha-NeuAc-(2----6) group or the subterminal N-acetylglucosamine units with an alpha-L-Fucp-(1----3 or -4) group. Internally located N-acetyllactosamine units where the D-galactose units are disubstituted by beta-D-GlcNacp-(1----3) and -(1----6) units, as in branched poly(N-acetyllactosamine) backbones were not bound by the bovine lectin. These results are in accord with previous observations on the bovine lectin and the corresponding human and rat lectins, using structurally defined oligosaccharides as inhibitors of binding. The results of comparative binding experiments using paragloboside and ceramide hexasaccharide which contain one and two N-acetyllactosamine units, respectively, joined in linear sequence to the lactosylceramide core, were equivocal with respect to the availability of the internal N-acetyllactosamine units for binding by the bovine lectin.

Animals↗
PubMed1991

Soluble 14-kDa beta-galactoside-specific bovine lectin. Evidence from mutagenesis and proteolysis that almost the complete polypeptide chain is necessary for integrity of the carbohydrate recognition domain.

The soluble beta-galactoside-specific bovine lectin of subunit 14 kDa has been expressed in vitro by transcription and then translation in a rabbit reticulocyte lysate. The protein thus expressed shows the predicted binding to lactose coupled to Sepharose. Several mutants of the 134 amino acid protein have been expressed and insight gained into (a) the polypeptide length required to form the carbohydrate recognition domain and (b) the functional importance of some of the highly conserved amino acids. The following amino acids have been deleted: 1-9, 1-23, 88-122, 88-134, 107-134, or 124-134. In addition, a frame-shift mutant has been made in which the 23 amino acids at the C-terminal end were completely changed. Among these seven mutants only mutant 1-9 shows carbohydrate binding but with congruent to 30% of the activity of the wild-type protein (as assessed by the percentage of the protein bound to lactose-Sepharose). On the other hand, carbohydrate binding is relatively well preserved (75-90%) in mutant proteins where the C-terminal octapeptide sequence of the bovine lectin has been changed to sequences that resemble those in the chick 14-kDa lectin. When the single tryptophan at position 68 is changed by point mutagenesis to phenylalanine or to a leucine residue, a weak binding activity (congruent to 20%) is retained only with the former. When either of the cysteines 2 or 60 is changed to serine, binding activity is reduced to congruent to 60%, and when both are changed, to congruent to 20% of that for the wild-type protein. The susceptibility of the lectin to oxidative inactivation is unaffected when these 2 cysteines and cysteine 130 are changed to serine individually or in tandem (cysteines 2 and 60). In a second approach we show that the natural protein isolated from bovine heart is protected from proteolysis by trypsin and V8-protease in the presence of saccharide ligand. Although further work is required to identify residues which come into contact with the carbohydrate ligand, these results indicate that almost the complete polypeptide chain is necessary for the integrity of the carbohydrate recognition domain.

Amino Acid Sequence↗