The effect of surgical trauma on muscle protein turnover in rats.

The rate of synthesis and catabolism of sarcoplasmic- and myofibrillar-muscle protein was measured in operated, sham-operated and food-restricted rats by using Na2 14CO3. The food-restricted group underwent sham operations and were limited to the food intake of the operated animals. Protein synthesis and catabolism were increased in the sarcoplasmic-muscle fraction in operated rats compared with that in sham-operated or food-restricted rats. The rate of synthesis of the myofibrillar protein decreased in operated animals, but the rate of catabolism was not altered in the myofibrillar-muscle fraction of the operated animals compared with that in food-restricted and sham-operated animals. In the operated animals, there was a net loss of protein from the muscle. Thus the rats that underwent surgery lost muscle protein, primarily as a result of a decrease in synthesis of myofibrillar protein. The changes in protein turnover in operated animals were not due to decreases in food intake, since protein turnover in sham-operated animals that were restricted to the food intake of the operated rats was not different from that in sham-operated rats fed ad libitum.     

Compensatory growth of adipose tissue after partial lipectomy: involvement of serum factors

The regulation of body weight/fat was studied by investigating mechanisms for compensatory adipose tissue growth after removal of bilateral epididymal fat pads from male adult Wistar rats. Food intake during the first 4 weeks and energy expenditure on Days 8-10 postsurgery were not different between lipectomized and sham operated rats. During Days 29-31 post surgery, a small (2.4%) but significant (P < 0.05) increase in heat production per metabolic body size was detected in lipectomized as compared with sham operated rats. The carcass composition of lipectomized and sham operated rats was not significantly different 16 weeks after surgery. The compensatory growth was fat pad-specific: mesenteric, retroperitoneal, and inguinal fat pads, but not perirenal fat pads, were heavier in lipectomized rats than in sham operated rats as early as 4 weeks postsurgery. Examination of fat cell size distribution in the compensating pads indicated a shift toward larger cells in retroperitoneal fat, but not in inguinal fat of lipectomized as compared with sham operated rats. Serum from lipectomized rats, but not media conditioned by exposure to retroperitoneal fat pads from lipectomized rats, stimulated proliferation of preadipocytes in vitro more than that from sham operated rats. Thus, compensatory adipose tissue growth after lipectomy may be mediated, in part, by blood-borne factors that are derived from tissues other than adipose tissue.     

INSERTION OF AN INTRAAORTIC BALLOON THROUGH A LIMB OF AN AORTOFEMORAL GRAFT AFTER AORTIC VALVE REPLACEMENT, DOUBLE CORONARY ARTERY BYPASS, AND RESECTION OF AN ABDOMINAL AORTIC ANEURYSM

This case report describes a useful and unusual route for insertion of an intraaortic balloon in 63-year-old man who was operated upon for calcific aortic stenosis, coronary atherosclerosis involving the left anterior descending and right coronary arteries, and a large abdominal aortic aneurysm. Aortic valve replacement was accomplished with a porcine heterograft prosthesis. Bypasses to the left anterior descending and right coronary arteries were constructed with reversed saphenous vein grafts, and the abdominal aneurysm was resected and repaired with a bifurcated woven Dacron vascular graft. An electively placed intraaortic balloon was inserted through the right limb of the aortic graft prosthesis and used to assist the patient during the immediate postoperative period. Uneventful recovery ensued.     

Removal of olfactory bulbs in rats of different ages: repercussion on some metabolic constants.

The object of this investigation is to study effects of bulbectomy on female rats operated on at 15 and 30 days of age (prepubescent), 50 days (pubescent) and 120 days (adult), with respect to various parameters: these comprise corporal weight, liver weight, blood sugar, liver glycogen, glucose tolerance test and serum free fatty acid. Results were as follows. Body weight: in all groups this was significantly less than in controls except for rats operated on at adult age. Liver weight: (% of body weight) decreases in all groups, but significantly only in animals operated on when 15 days old. Blood sugar: significantly lessened in rats operated on when 30 and 120 days old. Liver glycogen: lessens in rats operated on at 30 and 120 days of age, but significantly only in the former. Glucose tolerance test: the coefficient k is found to increase in rats operated on at 15, 30 and 120 days of age; there is a significant increase in the first two groups. Serum free fatty acids: no marked alterations in any of the groups.     

Assessment of late results in surgical treatment of lower limb ischemia in obliterative atheromatosis of the femoral-popliteal region]

The results of treatment of arterial incompetence localized in femoro-popliteal region in the selected 14 centres have been assessed after 24 and 60 months. Eight hundred fifty five patients were operated in the selected centres during 12 months i.e. 50% of all patients operated for obliterative atheromatosis of the lower limbs. Perioperative mortality rate was 4%. During a 5-year follow up, 30% of patients died, and 15% did not return supplied questionnaire, and their fate is unknown. The limb was preserved in 70% of patients operated with any technique except the primary amputation. Markedly worse results were noted in patients operated for necrosis or resting pain and in patients who underwent surgery which did not directly improve blood flow in the affected limb. The authors conclude that the most favourable results are produced by the implantation of vascular prosthesis during the period of intermittent claudication distance shortening before the development of resting pain or necrosis. Such operation are loaded with the lowest rate of failures and complications.     

Digital automated RSA compared to manually operated RSA

The accuracy of digital Roentgen stereophotogrammetric analysis (RSA) was compared to the accuracy of a manually operated RSA system. For this purpose, we used radiographs of a phantom and radiographs of patients. The radiographs of the patients consisted of double examinations of 12 patients that had a tibial osteotomy and of double examinations of 12 patients that received a total hip prosthesis. First, the radiographs were measured manually with an accurate measurement table. Subsequently, the images were digitized by a film scanner at 150 DPI and 300 DPI resolutions and analyzed with the RSA-CMS software. In the phantom experiment, the manually operated system produced significantly better results than the digital system, although the maximum difference between the median values of the manually operated system and the digital system was as low as 0.013 mm for translations and 0.033° for rotations. In the radiographs of the patients, the manually operated system and the digital system produced equally accurate results: no significant differences in translations and rotations were found. We conclude that digital RSA is an accurate, fast, and user friendly alternative for manually operated RSA. Currently, digital RSA systems are being used in a growing number of clinical RSA-studies.     

Emotional problems in children; the uses of drugs in therapeutic management

The repair of intracardiac defects under direct vision by opening the heart to expose the operative field, with the aid of hypothermia or a pump-oxygenator, is now a practical clinical method. Twelve patients were operated upon by this method. In eight patients an atrial septal defect was repaired during total circulatory occlusion under hypothermia. The seven patients in this group who had uncomplicated atrial defects survived the operation and are doing well after a short follow-up period. One patient with an unrecognized, associated ventricular defect died at the time of operation. Four patients were operated upon during total cardiac by-pass with the DeWall bubble-oxygenator. The first three patients survived operation and are continuing to do well after a brief follow-up period. In the fourth patient an atrioventricularis communis was repaired by the reconstruction of an atrial and ventricular septum with a plastic prosthesis. This patient died at the end of operation.     

Prosthesis for child amputees; the program at University of California at Los Angeles

The Child Amputee Program has operated jointly for the past three years at the University of California at Los Angeles under the Department of Engineering and the School of Medicine. The following seven points have been evolved after three years of operation:1. Team effort for involved rehabilitation problems seems to be more effective than any other approach.2. Psychological effect on both the patient and family is much deeper than was realized.3. The optimum age for first fitting of a prosthesis is much earlier than had been generally believed-under one year, as opposed to age five or later.4. Training adequate for efficient and easy use of the prosthesis is absolutely essential and must be followed with periodic training in new skills.5. Comfort and function must be provided or a prosthesis will not be used.6. Scaled-down adult components are helpful, but do not supply all the needs of growing children. Special types of tools are needed for the many varied activities of childhood.7. At the outset of the program, disability was calculated in terms of the site of amputation. Now it is realized that the true determination of disability is above the ears.     

Effect of myenteric denervation on intestinal epithelium proliferation and migration of suckling and weanling rats

The effects of myenteric denervation on the cell kinetics of the intestinal epithelium of suckling and weanling rats were investigated. The myenteric plexus of an ileal segment was partially ablated by serosal application of benzalkonium chloride (BAC) in three groups of rats: those that underwent surgery at 13 days and were killed 15 (13/28-day-old) or 23 (13/36-day-old) days after treatment, and those that were operated at 21 days (21/36-day-old) and were killed 15 days after treatment. The extent of denervation was assessed in whole-mount preparations. The cell bodies of myenteric neurones were stained by NADH-diaphorase histochemical technique. Cell proliferation was estimated by the mitotic index (MI) and morphometric analysis of villus and crypt lengths using an image analysis system. Thickness of the muscle layers was also assessed by morphometry. Cell migration on the villi was estimated by the position of the leading labelled cell 24 h after tritiated thymidine injection. The number of neurones was reduced by around 80% in rats operated at 13 days, and reduced by 98% in those operated at 21 days. The thickness of the muscle layers was increased in all groups of treated animals. MI was significantly higher 15 days after BAC-treatment in the 13/28 group. Morphological changes in the intestinal mucosa were observed 15 days after BAC-treatment, when there was an increase in villus height (13/28 group) and crypt depth (13/28 and 21/36 groups). Cell migration rate was accelerated in the 21/36 group. No differences where found in the 13/36 group. These results show the strong effect of myenteric ablation on cell proliferation and migration in the ileal epithelium in the first 15 days of treatment in suckling and in weanling rats, and the subsequent recovery of intestinal mucosa homeostasis later on.     

Dissecting aneurysm as a cause of acute non-traumatic ischemia of the lower limbs]

The results of the treatment the acute non-traumatic ischemia of the lower limbs caused by dissecting aneurysm are discussed. Out of 726 analysed patients 8 of them suffered from dissecting aneurysm, i.e. 1.1%. Dissecting aneurysm was more frequent in male patients. All patients with lower limbs ischemia caused by the dissecting aneurysm were operated. Vascular prosthesis was used in 6 cases, and restoration of arterial patency in 2 cases. Seven patients died during the early postoperative period and one was released home with proper blood flow.     

Effect of lesions of the medial and lateral portions of the amygdala on motor activity in rats

In four groups of rats: with medial amygdala lesions, AMe, sham operated medial, AMe-C, with lateral amygdala lesions, LA, and sham operated lateral, LA-C,--motor activity was tested in small electro-magnetic cages before and after ablations. The obtained data showed an increase of motor activity only in AMe rats. Possible functional differentiation of modulatory mechanisms of the amygdala is discussed.     

PROSTHESIS FOR CHILD AMPUTEES—The Program at University of California at Los Angeles

The Child Amputee Program has operated jointly for the past three years at the University of California at Los Angeles under the Department of Engineering and the School of Medicine. The following seven points have been evolved after three years of operation:1. Team effort for involved rehabilitation problems seems to be more effective than any other approach.2. Psychological effect on both the patient and family is much deeper than was realized.3. The optimum age for first fitting of a prosthesis is much earlier than had been generally believed—under one year, as opposed to age five or later.4. Training adequate for efficient and easy use of the prosthesis is absolutely essential and must be followed with periodic training in new skills.5. Comfort and function must be provided or a prosthesis will not be used.6. Scaled-down adult components are helpful, but do not supply all the needs of growing children. Special types of tools are needed for the many varied activities of childhood.7. At the outset of the program, disability was calculated in terms of the site of amputation. Now it is realized that the true determination of disability is above the ears.     

Forelimb muscle activity following nerve graft repair of ventral roots in the rat cervical spinal cord

Current research on the cellular mechanisms of nerve regeneration suggests the application of nerve growth factors at the repair sites to be beneficial. To test the effectiveness of this approach, we performed transections of the C6 and C7 ventral rootlets from their original sites in the spinal cord of 18 rats. We investigated the electrophysiological changes in three groups of rats operated on by different repair strategies. Six rats comprised the control group (G1). In the other 12 rats, 24 rootlets were implanted into the spinal cord by means of an intercostal nerve graft through the pia mater immediately after transection. Six rats (G2) had fibrin glue applied at the incision. The last 6 rats (G3) had grafts with acidic fibroblast growth factor (aFGF) added to the fibrin glue. The rats' functional recovery was evaluated electrophysiologically at 6 weeks and 6 months after the operation. Needle electromyography showed profound fibrillation potentials (Daube's scoring system) in the deltoid, biceps, and triceps of the operated forelimbs in all groups 6 weeks after the operation. After 6 months, there was a significant decrease in the amount of fibrillation potentials in all groups (G1, G2 and G3, p < 0.0001, 0.0001, 0.0009, respectively, generalized estimating equation, repeated measures) and a significantly high probability for motor units present in sampled muscles of G2 and G3 as compared to G1 (log odds ratio in G2 = 51.8316, G3 = 57.4262, generalized estimating equation). We conclude that several cervical roots can regenerate through intercostal nerve grafts applied using fibrin glue. Adding aFGF may increase the efficacy of sprouting.     

Effect on the plasma renin-aldosterone system of lesions to suprachiasmatic nuclei and central serotonin depletion in rats

Renin activity, angiotensin-converting enzyme activity and aldosterone concentration were measured in the plasma of 8 experimental groups of rats: I--sham operated non-treated rats, II--suprachiasmatic nuclei (SCN) lesioned non-treated: III--sham operated + furosemide (4 mg/kg i.p.), IV--SCN lesioned + furosemide, V--shams + 24-hour water deprivation: VI--SCN + 24-hour water deprivation, VII--intact rats + saline: and VIII--intact rats + p-chlorophenylalanine (pCPA, 300 mg/kg, i.p.). No significant changes in basal levels of the three parameters were found after SCN, lesions in comparison with sham operated controls. Furosemide caused a similar increase in all three parameters of both sham and SCN lesioned rats. Similar changes were observed in SCN rats 24 hours after water deprivation and in intact rats 48 hours after serotonin depletion by pCPA: suppressed renin activity together with increased aldosterone concentration. It is concluded that the central serotonergic system and SCN play a similar role in control of the renin-aldosterone system in rats under conditions of negative water-salt balance.     

Altered expression of angiotensin AT1a and vasopressin V1a receptors and nitric oxide synthase mRNA in the brain of rats with renovascular hypertension.

Previous studies revealed that the brain angiotensinergic, vasopressinergic and nitrergic systems are involved in regulation of blood pressure and that their function is altered in various forms of hypertension. The purpose of our investigation was to determine whether expression of AT1a angiotensin receptors (AT1aR) mRNA, V1a vasopressin receptors (V1aR) mRNA and neuronal nitric oxide synthase (NOS1) mRNA is altered in the brain of rats with the renovascular hypertension. Eight male Sprague Dawley (SD 2K,1C) rats were subjected to constriction of the left renal artery in order to produce the renovascular hypertension whereas nine SD rats underwent the sham surgery. In both groups blood pressure was determined before and after the surgery. Four weeks after the surgery the brain fragments were harvested for determination of mRNA expression. Competitive PCR method was applied for relative quantitative analysis of V1aR mRNA, AT1aR mRNA and NOS1 mRNA in the preoptic, diencephalic, mesencephalopontine, medullary and cerebellar fragments of the brain. Blood pressure was significantly higher in the 2K,1C than in the sham operated rats. In the preoptic, mesencephalopontine and medullary regions AT1aR mRNA expression was significantly lower in the 2K,1C rats than in the sham operated rats. The 2K,1C rats manifested also significantly higher expression of V1aR mRNA and NOS1 mRNA in the preoptic brain region in comparison to the sham operated rats. The study provides evidence for significant changes of expression of AT1aR mRNA, V1aR mRNA and NOS1 mRNA in the specific brain regions of rats with the renovascular hypertension.     

Comparison of early and delayed results of unilateral patency restoration and transplantation in aortoiliac obstruction]

Early and delayed results of the treatment of aortoiliac unilateral incompetence in 144 patients were compared. Eighty seven (60%) patients were treated with aortoiliac prosthesis whereas 57 (40%) with arterial patency restoration. Fifty seven patients of group I reported to the control examination. Favourable effect was found in 47 (82.5%) patients, i.e. in 54% of all operated patients. Thirty six patients of group II reported to the control examination. Favourable effect was noted in 27 (75%) patients, i.e. in 47.4% of all treated patients. Twenty two (25.3%) of patients of group I and 9 (15.8%) of group II died. It was noted also that in 20% of operated patients with unilateral aortoiliac incompetence the disorders in the opposite limb develop despite the type of surgery. Therefore, indications to the implantation of bifurcated prostheses should be extended in some cases.     

Capsular contracture around saline-filled fine textured and smooth mammary implants: a prospective 7.5-year follow-up.

In a previous prospective randomized clinical study comparing in the same patient textured and smooth saline-filled mammary implants (Biocell) with large pore size (300 to 600 microm), we saw no difference in capsular contracture. This study was undertaken in a similar way to compare capsular contracture around smooth and textured saline-filled prostheses with pores of small size. During a period of 7.5 years, the breast hardness was followed up, and at the end of the study patient satisfaction was evaluated.Twenty healthy women with a mean age of 30 years were operated on for breast augmentation. Two surgeons performed all operations in a standardized way. Each patient received subglandularly a Siltex textured saline-filled prosthesis with a pore size of 30 to 70 microm in one breast, and a smooth saline-filled prosthesis in the other. The hardness of the breasts was evaluated after 0.5, 1, and 7.5 years using Baker grading and applanation tonometry. Eighteen patients completed 1-year and 7.5-year follow-up. Two breasts with smooth prostheses were contracted after 6 months (Baker III or IV). After 1 year, four patients with smooth prostheses and one with a textured prosthesis had capsular contracture (p = 0.34). Seven and one-half years after surgery, six patents with smooth and four with textured implants had contracture (p = 0.66). On two patients with smooth prostheses and one patient with a textured prosthesis, the capsule around the implant hardened between 6 and 12 months. Between 1 year and 7.5 years, three breasts with smooth and textured implants contracted and one with a textured implant softened.The patients reported on a Visual Analogue Scale (1 to 10) the impact of the augmentation on their quality of life to be 9 +/- 1. Four patients preferred the breast with the smooth prosthesis, three preferred the breast with the textured prosthesis, and the others found both breasts equal. This study showed no significant difference of contracture with smooth versus fine textured implants. The majority of the patients preferred the smooth implants. The patients reported that the breast augmentation had had an extremely high impact on their quality of life.     

Brain cortical amino acids measured by intracerebral dialysis in portacaval shunted rats

The extracellular amino acid content was measured in the parietal cortex in portacaval and sham operated rats, using the brain dialysis technique. The amino acid content of the perfusate was determined for 10 min before and during stimulation with potassium chloride. Basal levels of aspartate, glutamine, glycine, methionie, valine, phenylalanine and leucine were 2-to 6-fold higher in the PC-shunted as compared to the sham operated rats. For glutamate, taurine, and GABA no differences were observed between the two groups. After KCl stimulation the release of glutamate and GABA increased significantly in both groups. For GABA this rise was approximately twice as high in the PC-shunted rats (+300%,P<0.01) as in the sham operated rats (+150%,P<0.01 as compared to basal). In the sham operated, but not in the PC-shunted rats, methionine and valine levels rose significantly (+200%,P<0.05) and glutamine release decreased (–50%,P<0.05). These findings suggest that the brain metabolism of amino acids is altered after a portacaval shunt. This could in turn alter the neurotransmission and partly explain the low spontaneous motor activity seen in these animals.     

Use of balloon catheters for intraoperative control of resting myocardial pressure during cardioplegia

Twenty-two patients operated on for aortal, mitral and multivalvular prosthesis under pharmacological cardioplegia were examined for the purpose of monitoring myocardial resting tension by the tensometric method and by using modified balloon catheters. The results demonstrated that the use of the balloon catheters permits making not only qualitative and quantitative assessments of myocardial lesions and a prompt evaluation of the function of the arrested heart but also the initial myocardial contractility and the restoration of myocardial contractility after cardioplegic arrest by controlling the contraction and relaxation myocardial rate.     

Renal Artery Surgery in Patients with Presumptive Renovascular Hypertension

The authors review their experience with 29 patients who were operated upon for renal artery stenosis and had been followed up for longer than one year postoperatively. The preoperative assessment should include an aortogram and split-function test. A bypass prosthesis was the most useful operative technique. One year following surgery 40% were cured, 40% significantly improved and 20% unchanged. The results in patients with a longer follow-up (to seven years) were similar.A plea is made for more frequent preoperative renal biopsies and a greater willingness to perform bilateral repairs at the time of the initial operation.