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1.
J Neurol Sci ; 236(1-2): 1-7, 2005 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-16024047

RESUMO

Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disorder. While most cases of ALS are sporadic, 10-15% are familial, and of these 15-20% possess a mutation in the gene that codes for the enzyme Cu/Zn superoxide dismutase (SOD1). In families of ALS patients with specific SOD1 mutations, affected members demonstrate significant heterogeneity of disease and a large variation in age of onset and severity, suggesting that there are genetic modifiers of disease expression. Transgenic mice expressing mutant forms of SOD1 demonstrate symptoms similar to those seen in patients with ALS. We have observed in our colony of G93A SOD1 transgenic mice a milder phenotype in mice in a C57BL/6J background than the C57BL/6JxSJL/J hybrid background used by Jackson Laboratories to maintain their colony. To investigate the effect of genetic background on phenotype, we have constructed congenic lines on two genetic backgrounds, C57BL/6J (B6) and SJL/J (SJL). We report the influence of background and gender on the survival of these congenic lines compared to the hybrid C57BL/6JxSJL/J background. The mean survival of G93A SOD1 mice in the hybrid B6/SJL background was 130 days, with females surviving significantly longer than males. When compared to the hybrid B6/SJL background, the survival of mice in the SJL background significantly decreased, and the gender difference in survival was maintained. On the other hand, mean survival in the B6 background significantly increased, and in contrast to the B6/SJL and SJL backgrounds, there was no difference in survival between males and females. Transgene copy numbers were verified in all animals to ensure that any phenotypic differences observed were not due to alterations in copy number. This is the first report of a shortened lifespan when the G93A SOD1 transgene is placed on the SJL/J background and an increased survival with the loss of gender influences when the transgene is placed on the C57BL/6J background.


Assuntos
Esclerose Lateral Amiotrófica/genética , Esclerose Lateral Amiotrófica/mortalidade , Modelos Animais de Doenças , Caracteres Sexuais , Fatores Etários , Animais , Genótipo , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Superóxido Dismutase/genética , Sobrevida
2.
J Vasc Surg ; 32(6): 1091-100, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11107080

RESUMO

PURPOSE: Over the past 20 years, there have been numerous advances in our ability to detect and to treat abdominal aortic aneurysms (AAAs). We hypothesized that these advances would lead to (1) an increase in the rate of elective repair and a decrease in the incidence of ruptured AAA (rAAA) and (2) a decrease in operative deaths for both elective AAA (eAAA) and rAAA. METHODS: To test these hypotheses, we investigated the incidence and outcomes of eAAA and rAAA surgery between 1979 and 1997, using the National Hospital Discharge Survey. This data set is a randomized, stratified sample representing discharges from the nation's acute care, nonfederally funded hospitals. Codes from the International Classification of Diseases, Ninth Revision were used to identify our study population. RESULTS: Over the past 19 years, there has been no change in the incidence rate of eAAA repair (range, 44.1-77.9 per 100,000). Moreover, the incidence of rAAAs presenting to the nation's hospitals has not changed (range, 6.6-16.3 per 100,000). There has been no consistent improvement over time in operative deaths associated with either eAAA or rAAA repair (average rates over the study period: eAAA, 5.6%; rAAA, 45.7%). Significant predictors of death from eAAA in patients included an age older than 80 years, African American race, congestive heart failure (CHF), and diabetes (P<.0001 for all). Significant predictors of death from rAAA in patients included age older than 70 years, African American race, female sex, renal failure, and a hospital bed size more than 500 (P<.05 for all). CONCLUSION: On a national level, over the past 19 years, our ability to identify and to treat patients with AAA has not improved. Advances in technology and critical care have not affected outcome. Regionalization of care, screening of high-risk populations, and endovascular repair are strategies that might allow further improvement in the outcome of patients with aneurysmal disease.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Negro ou Afro-Americano , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico , Aneurisma Roto/epidemiologia , Aneurisma Roto/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/mortalidade , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Distribuição Aleatória , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
3.
J Neurochem ; 74(4): 1666-73, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10737625

RESUMO

Transgenic mice expressing a mutated (G93A) human Cu/Zn superoxide dismutase (SOD1) develop motor neuron pathology and clinical symptoms similar to those seen in patients with amyotrophic lateral sclerosis. Loss of motor neurons is most prominent in lumbar, followed by cervical cord and then brainstem. No significant cell death has been reported in motor cortex. The integrity of the cortical glutamate reuptake systems was evaluated using intracerebral microdialysis and western immunoblot assays for the glutamate transporters GLT-1, GLAST, and EAAC1. The basal extracellular fluid levels of aspartate, glutamate, glutamine, 3,4-dihydroxyphenylacetic acid, and 5-hydroxyindole-3-acetic acid were evaluated by HPLC. The extraction fraction of L-3H]glutamate, corrected with [14C]mannitol, was also evaluated. GLT-1, EAAC1, and GLAST protein levels were determined by semiquantitative chemiluminescence immunoblot of proteins from membrane-enriched fractions. The relative optical density of film was translated into relative protein level by comparison with a standard control mouse. The SOD1 mutant mice demonstrated a significant (p < 0.05) increase in basal levels of extracellular aspartate and glutamate. In addition, when the glutamate extraction fraction was challenged with exogenous unlabeled glutamate (500 microM) by reversed microdialysis, the glutamate extraction fraction in the mutant SOD1 mice was decreased significantly from control levels. The SOD1 mutant mice demonstrated no difference in the cortical protein levels of the glutamate transporter subtypes. This study demonstrates that in areas of no visible pathology and no loss of glutamate transporter proteins, SOD1 mutant mice have elevated extracellular fluid aspartate and glutamate levels and a decreased capacity to clear glutamate from the extracellular space.


Assuntos
Córtex Cerebral/enzimologia , Ácido Glutâmico/metabolismo , Superóxido Dismutase/genética , Ácido 3,4-Di-Hidroxifenilacético/metabolismo , Transportadores de Cassetes de Ligação de ATP/análise , Sistema X-AG de Transporte de Aminoácidos , Esclerose Lateral Amiotrófica/metabolismo , Animais , Ácido Aspártico/metabolismo , Córtex Cerebral/química , Espaço Extracelular/metabolismo , Regulação Enzimológica da Expressão Gênica , Humanos , Ácido Hidroxi-Indolacético/metabolismo , Camundongos , Camundongos Mutantes Neurológicos , Camundongos Transgênicos , Microdiálise , Fenótipo
4.
J Vasc Surg ; 30(6): 1024-33, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10587386

RESUMO

OBJECTIVE: Recently published data from the North American Carotid Endarterectomy Trial revealed a benefit for carotid endarterectomy (CEA) in symptomatic patients with moderate (50% to 69%) carotid stenosis. This benefit was significant but small (absolute stroke risk reduction at 5 years, 6.5%; 22.2% vs 15.7%), and thus, the authors of this study were tentative in the recommendation of operation for these patients. To better elucidate whether CEA in symptomatic patients with moderate carotid stenosis is a proper allocation of societal resources, we examined the cost-effectiveness of this intervention. METHODS: A decision-analytic Markov process model was constructed to determine the cost-effectiveness of CEA versus medical treatment for a hypothetical cohort of 66-year-old patients with moderate carotid stenosis. This model allowed the comparison of not only the immediate hospitalization but also the lifetime costs and benefits of these two strategies. Our measure of outcome was the cost-effectiveness ratio (CER), defined as the incremental lifetime cost per quality-adjusted life year saved. We assumed an operative stroke and death rate of 6.6% and a declining risk of ipsilateral stroke after the ischemic event with medical treatment (first year, 9.3%; second year, 4%; subsequent years, 3%). The hospitalization cost of CEA ($6,420) and the annual costs of major stroke ($26,880), minor stroke ($798), and aspirin therapy ($63) were estimated from a hospital cost accounting system and the literature. RESULTS: CEA for moderate carotid stenosis increased the survival rate by 0.13 quality-adjusted life years as compared with medical treatment at an additional lifetime cost of $580. Thus, CEA was cost-effective with a CER of $4,462. Society is usually willing to pay for interventions with CERs of less than $60,000 (eg, CERs for coronary artery bypass grafting at $9,100 and for dialysis at $53,000). CEA was not cost-effective if the perioperative risk was greater than 11.3%, if the ipsilateral stroke rate associated with medical treatment at 1 year was reduced to 4.3%, if the age of the patient exceeded 83 years, or if the cost of CEA exceeded $13,200. CONCLUSION: CEA in patients with symptomatic moderate carotid stenosis of 50% to 69% is cost-effective. Perioperative risk of stroke or death, medical and surgical stroke risk, cost of CEA, and age are important determinants of the cost-effectiveness of this intervention.


Assuntos
Estenose das Carótidas/economia , Endarterectomia das Carótidas/economia , Idoso , Aspirina/administração & dosagem , Aspirina/economia , Estenose das Carótidas/mortalidade , Estenose das Carótidas/cirurgia , Estudos de Coortes , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Cadeias de Markov , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/prevenção & controle , Taxa de Sobrevida
5.
J Vasc Surg ; 30(1): 189-92, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10394169

RESUMO

Mycotic processes occasionally complicate atherosclerotic aortic disease and usually require aggressive surgical therapy to control sepsis and prevent arterial rupture. Rarely, fungal organisms are responsible for primary infection of the abdominal aorta. We report the first case of Cryptococcal aortitis presenting as a ruptured abdominal aortic aneurysm. The surgical, pathologic, and microbiologic aspects of fungal aortitis are discussed.


Assuntos
Aneurisma Infectado/complicações , Aneurisma Roto/etiologia , Aneurisma da Aorta Abdominal/etiologia , Aortite/microbiologia , Criptococose/complicações , Antifúngicos/uso terapêutico , Aortite/complicações , Criptococose/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Vasc Surg ; 29(1): 140-9, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9882798

RESUMO

PURPOSE: The surgical management of chronic atherosclerotic renal artery occlusion (RA-OCC) was studied. METHODS: From January 1987 through December 1996, 397 consecutive patients were treated for atherosclerotic renal artery disease. Ninety-five hypertensive patients (mean blood pressure, 204 +/- 31/106 +/- 20 mm Hg; mean medications, 3.0 +/- 1.1 drugs) were treated for 100 RA-OCCs. Eighty-four (88%) patients had renal dysfunction, defined by serum creatinine levels >/=1.3 mg/dL (mean serum creatinine level, 2.8 +/- 2.0 mg/dL). Demographic characteristics, operative morbidity and mortality, blood pressure/renal function response, and postoperative decline in renal function were examined and compared with that of 302 patients treated for renal artery stenosis (RAS). RESULTS: After operation, there were 5 perioperative deaths (5.2%), 2 (2.8%) after revascularization and 3 (12%) after nephrectomy (P =.11), compared with 12 (4.0%) perioperative deaths in the RAS group (P =.59). After controlling for important covariates, estimated survival and blood pressure benefits did not differ between RA-OCC patients treated by nephrectomy or revascularization (P =.13; 87% vs 92%, P =.54). Excretory renal function was considered improved in 49% of 79 RA-OCC patients with renal dysfunction, including 9 patients removed from dialysis-dependence. Among patients treated for unilateral disease, revascularization for RA-OCC was associated with significant improvement in renal function (P <.01); however, nephrectomy alone did not increase renal function significantly. Improved renal function after operation was associated with a significant and independent increase in survival (P <.01) and dialysis-free survival (P <.01) among patients treated for RA-OCC. In addition, blood pressure benefit, renal function response, and estimated survival did not differ significantly after reconstruction for RA-OCC or RAS. CONCLUSION: Among hypertensive patients treated for RA-OCC, equivalent beneficial blood pressure response was observed after both revascularization and nephrectomy. In patients who underwent bilateral renal artery revascularization, the change in excretory renal function attributable to repair of RA-OCC cannot be defined. In patients treated for unilateral disease, however, improvement in function was observed only after revascularization. Moreover, improved renal function demonstrated a significant and independent association with improved survival. This experience supports renal revascularization in preference to nephrectomy for RA-OCC in select hypertensive patients when a normal distal artery is demonstrated at operation.


Assuntos
Endarterectomia , Nefrectomia , Obstrução da Artéria Renal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/cirurgia , Feminino , Oclusão de Enxerto Vascular , Humanos , Hipertensão Renovascular/cirurgia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Artéria Renal/cirurgia , Obstrução da Artéria Renal/mortalidade , Obstrução da Artéria Renal/fisiopatologia , Taxa de Sobrevida , Resultado do Tratamento
7.
Arterioscler Thromb Vasc Biol ; 18(11): 1730-7, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9812911

RESUMO

Because the beta3-antagonist abciximab (c7E3 Fab) has significantly improved late outcomes after coronary angioplasty, the beta3 integrins have been implicated in the arterial response to injury. However, the mechanisms underlying this benefit are unknown. The observation that c7E3 binds beta3 integrins on vascular cells (alphavbeta3) with affinity equal to that for the platelet glycoprotein IIb/IIIa integrin has led to the hypothesis that c7E3 may act directly on the artery wall to prevent restenosis after angioplasty. To test this hypothesis, we studied the effects of c7E3 on structural changes within the artery wall after angioplasty or stent angioplasty in 23 male cynomolgus monkeys with established atherosclerosis. Animals were randomly assigned to receive either a bolus of c7E3 (0.4 mg/kg IV, n=11) followed by a 48-hour infusion (0. 2 microg. kg-1. min-1) or an equal volume of vehicle (n=12). Animals received weight-adjusted aspirin and heparin and then underwent unilateral iliac artery experimental angioplasty and subclavian artery stent angioplasty (Palmaz). Iliac artery lumen diameter (LD) was determined by angiography at baseline (LDPre), after angioplasty (LDPost), and 35 days later (LDDay35). Arteries were then fixed by perfusion and removed for analysis. Lumen, intima, media, and external elastic lamina (EEL) areas were measured in iliac artery cross sections. Values from each injured iliac artery were normalized to the contralateral uninjured iliac artery to control for interanimal variability in baseline artery size and atherosclerosis extent. Intimal area was also measured in subclavian stent cross sections. c7E3 blocked platelet aggregation and prolonged the bleeding time from 2.8+/-1.1 to 19.8+/-2.5 minutes, P<0.001. Experimental angioplasty increased LDPost an average of 28%, and the initial gain was similar in both groups (P=NS). Despite an anti-platelet effect, c7E3 did not inhibit iliac lumen narrowing (LDDay35-LDPost: c7E3, -0.69+/-0.17 versus vehicle, -0.99+/-.17 mm, P=0.35); intimal hyperplasia (neointima area: c7E3, 1.12+/-.28 versus vehicle, 1.22+/-.20 mm2, P=0.77); or decrease in artery wall size (EEL area [percent of uninjured control]: c7E3, 101+/-7% versus vehicle, 121+/-7%). Stent intimal hyperplasia was also unaltered by c7E3 treatment (neointimal area: c7E3, 1.09+/-0.16 versus vehicle, 1. 28+/-0.11 mm2, P=0.36). These results suggest that the benefits of c7E3 treatment in coronary angioplasty were not from inhibition of intimal hyperplasia or improved artery wall remodeling. Alternative mechanisms should be explored to explain improved late outcomes after angioplasty in patients treated with c7E3.


Assuntos
Angioplastia Coronária com Balão , Anticorpos Monoclonais/uso terapêutico , Arteriosclerose/terapia , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Integrinas/antagonistas & inibidores , Inibidores da Agregação Plaquetária/uso terapêutico , Abciximab , Animais , Artérias , Coagulação Sanguínea/efeitos dos fármacos , Terapia Combinada , Avaliação Pré-Clínica de Medicamentos , Testes Hematológicos , Hiperplasia/tratamento farmacológico , Lipídeos/sangue , Macaca fascicularis , Masculino , Stents , Resultado do Tratamento
8.
J Vasc Surg ; 28(2): 340-4, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9719330

RESUMO

Endovascular infections after percutaneous transluminal renal angioplasty with stenting (PTRAS) are rarely reported. Because strict longitudinal follow-up of patients undergoing PTRAS is lacking, the true incidence of such complications remains obscure. We report the first case of a patient with an infected renal artery pseudoaneurysm and de novo mycotic aortic aneurysm after PTRAS. This case serves to illustrate several important points, including (1) the retrieval of renal function in patients with renal artery occlusion, (2) the pathogenesis of infection after PTRAS, (3) the diagnosis and management of endovascular infection after percutaneous vascular intervention, and (4) recommendations for periprocedural antibiotic prophylaxis during PTRAS.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/terapia , Angioplastia com Balão/instrumentação , Aneurisma da Aorta Abdominal/cirurgia , Cálculos Renais/cirurgia , Nefrectomia , Complicações Pós-Operatórias/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Obstrução da Artéria Renal/terapia , Artéria Renal , Infecções Estafilocócicas/cirurgia , Stents , Idoso , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Antibioticoprofilaxia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia , Prótese Vascular , Feminino , Seguimentos , Humanos , Politetrafluoretileno , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Obstrução da Artéria Renal/diagnóstico por imagem , Reoperação , Infecções Estafilocócicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Ann Surg ; 227(5): 678-89; discussion 689-90, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9605659

RESUMO

OBJECTIVE: This report examines the blood pressure and renal function response in 20 consecutive patients after secondary renal revascularization following failed operative repair. SUMMARY BACKGROUND DATA: Most reports describing operative failure of renal artery (RA) repair emphasize the technical aspects of redo RA reconstruction and the immediate blood-pressure response to secondary operation. This report examines the eventual renal function and estimated survival after secondary intervention. METHODS: Primary methods of RA reconstruction, primary blood pressure and renal function responses, and causes of failed RA repair were defined for 20 patients requiring reoperation for recurrent hypertension or renal insufficiency. These parameters were compared with secondary procedures and eventual blood pressure and renal function response. The eventual outcome for these 20 patients was compared with 514 patients managed by primary renal revascularization during the same period. RESULTS: Failure of primary RA repair correlated with complex fibromuscular dysplasia requiring branch ex vivo reconstruction (p = 0.020). RA thrombosis frequently required nephrectomy (83%), whereas RA stenosis was successfully reconstructed (91 %; p = 0.001). Primary and secondary blood-pressure responses were equivalent (94% vs. 95% cured or improved); however, primary and eventual renal function responses differed significantly (p = 0.015), with seven patients dialysis-dependent on follow-up. Eventual dialysis dependence was associated with preoperative azotemia (p = 0.022), bilateral failure of primary RA repair (p = 0.007), and an increased risk of follow-up death (p = 0.002). Considering all 534 patients, failed RA repair demonstrated a significant and independent association with eventual dialysis dependence and decreased dialysis-free survival. CONCLUSIONS: Contemporary rates of reoperation after surgical RA repair are low. In properly selected patients, beneficial blood-pressure response is reliably observed after both primary and secondary operative procedures. However, secondary procedures are associated with a significant and independent risk of eventual dialysis dependence.


Assuntos
Arteriosclerose/cirurgia , Displasia Fibromuscular/cirurgia , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Adulto , Idoso , Pressão Sanguínea , Criança , Endarterectomia , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nefrectomia , Diálise Renal , Reoperação , Falha de Tratamento
10.
Am J Med Sci ; 315(5): 337-42, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9587093

RESUMO

Hypertension in blacks differs in a quantitative sense from hypertension in whites; it occurs in blacks with greater frequency and severity and at a younger age when compared with whites. In addition, elevated blood pressure at any level is associated with increased cardiovascular morbidity and mortality in black patients. Several mechanisms have been suggested to account for this form of hypertension, implying that hypertension in black patients is intrinsically different from that in whites. Although these mechanisms remain unproven, it has generally been accepted that correctable renovascular disease and renovascular hypertension (RVH) occur infrequently in blacks; the authors, however, will review preliminary population-based data which suggest that the presence of renal artery disease is not determined by race or ethnicity. In addition, the prevalence of renovascular disease in a large group of consecutive hypertensive subjects will be presented. Finally, the blood pressure and renal function response after surgical renal artery repair in blacks will be compared with whites treated at the authors' institution. Taken collectively, these data and clinical experience support the search for and treatment of renal artery disease in properly selected hypertensive blacks.


Assuntos
População Negra , Hipertensão Renovascular/epidemiologia , Hipertensão Renovascular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Feminino , Humanos , Hipertensão Renovascular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Renal/cirurgia , Sudeste dos Estados Unidos/epidemiologia , Resultado do Tratamento , População Branca
11.
J Vasc Surg ; 26(3): 465-72; discussion 473, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9308592

RESUMO

PURPOSE: This retrospective review examines the results of atherosclerotic renal artery (RA) repair in consecutive hypertensive African-Americans treated at our center and compares these results with Caucasians treated during the same period. METHODS: From Jan. 1987 through Sep. 1996, a total of 485 patients underwent operative RA repair. Of these, 28 African-Americans and 370 Caucasians were managed for atherosclerotic renovascular disease. These cohorts were compared on the basis of preoperative blood pressure and renal function, extent of renal disease, extrarenal atherosclerosis, response to operation, and estimated survival. RESULTS: The African-American cohort included nine men and 19 women (mean age, 62 years) with hypertension (mean blood pressure, 204 +/- 31/109 +/- 20 mm Hg) for an average of 10.2 +/- 7.5 years. Ischemic nephropathy (serum creatinine level, > 1.3 mg/dl) was present in 82% (n = 23) of the African-American group. RA reconstructions were unilateral in nine patients and bilateral in 19 patients (including repair to two solitary kidneys), for a total of 45 RA reconstructions (30 RA bypass procedures; eight transrenal/transaortic RA endarterectomy procedures; two RA reimplantations; five nephrectomies). Nine patients underwent combined aortic procedures (four abdominal aortic aneurysm; five occlusive disease). There was one perioperative death in the African-American group as a result of sepsis and multiple organ failure. Among surgical survivors, 20 African-American patients (74%) had a beneficial hypertension response (7% cured, 67% improved). Mean estimated glomerular filtration rate improved significantly from 34 to 42 ml/min/1.73 m2 (p < 0.001). In the 23 patients with ischemic nephropathy, 13 (57%) demonstrated greater than 20% decrease in serum creatinine level. In comparison with the 370 Caucasians (191 men, 179 women), the African-American cohort had significantly more preoperative heart disease (congestive heart failure or left ventricular hypertrophy; 68% vs 46%; p = 0.03) and tended toward more severe renal dysfunction (mean serum creatinine level, 2.5 vs 2.1 mg/dl; p = 0.25). However, African-Americans demonstrated a beneficial blood pressure and renal function response after operation, similar to Caucasians. CONCLUSIONS: Our results indicate that the majority of selected African-Americans have a favorable blood pressure and renal function response to operative renal artery repair. This beneficial clinical response appears equivalent to the response observed in Caucasian patients and supports the search for RA disease in hypertensive African-Americans.


Assuntos
População Negra , Artéria Renal/cirurgia , Adulto , Idoso , Arteriosclerose/diagnóstico , Arteriosclerose/etnologia , Arteriosclerose/fisiopatologia , Arteriosclerose/cirurgia , Pressão Sanguínea , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etnologia , Hipertensão Renovascular/fisiopatologia , Hipertensão Renovascular/cirurgia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Período Pós-Operatório , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etnologia , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/cirurgia , Estudos Retrospectivos , População Branca
12.
Surg Clin North Am ; 77(2): 397-407, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9146721

RESUMO

Although a number of methods for mesenteric artery reconstruction have been suggested, we believe that patients with atherosclerotic stenosis and occlusion of mesenteric vessels presenting with either acute or chronic visceral ischemia are best managed by either antegrade aortomesenteric bypass or transaortic mesenteric endarterectomy. Antegrade bypass is the most versatile technique and is therefore best adapted to extensive mesenteric disease. Transaortic mesenteric endarterectomy lends itself well to simultaneous renal artery endarterectomy when clinically significant osteal atherosclerosis is present at both sites. With any method of reconstruction, the technical adequacy of repair should be defined intraoperatively. In this regard, intraoperative duplex sonography provides both anatomic and hemodynamic data necessary to ensure technical success and late patency.


Assuntos
Arteriopatias Oclusivas/cirurgia , Endarterectomia/métodos , Isquemia/cirurgia , Artérias Mesentéricas/cirurgia , Arteriosclerose/cirurgia , Humanos
13.
J Neurosci ; 13(10): 4301-15, 1993 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8410189

RESUMO

In culture, hippocampal neurons initially establish several short, minor processes. The initial step in the emergence of polarity is marked by the rapid and selective growth of one of these processes, which becomes the axon. Subsequently the remaining processes become dendrites. We examined the ultrastructure of hippocampal neurons before and after the emergence of the axon. The minor processes in cells that had not yet formed axons were somewhat variable in appearance, but we found no ultrastructural feature that indicated which minor process might become the axon. The emergence of the axon was marked by several changes in its ultrastructure. The axon contained a sevenfold lower density of polyribosomes than the minor processes. In addition, axonal growth cones contained a pronounced concentration of membranous elements that resembled endoplasmic reticulum, elements that were rare in the growth cones of minor processes. Axons and minor processes did not differ in microtubule density. In order to gauge how rapidly these ultrastructural changes occur, we examined cells with short axons that, from their length, were estimated to have emerged only hours earlier. The preferential exclusion of polyribosomes from the axon and the concentration of reticular membrane in the axonal growth cone were already evident in such cells. These observations demonstrate that exclusion of ribosomes from the axon occurs early in development, about as soon as the axon can be identified. In contrast, previous work has shown that the differences in microtubule polarity orientation that distinguish mature axons and dendrites, and that have been proposed to account for the selective segregation of some constituents in neurons, first appear at a later stage of development (Baas et al., 1989). These observations also demonstrate that the accumulation of reticular membrane elements in growth cones, which has been noted previously, occurs preferentially in axonal growth cones and is closely correlated in time with the initial specification of the axon. The selective concentration of these elements in axonal growth cones could be associated with the uniquely rapid rate of axonal growth.


Assuntos
Hipocampo/citologia , Neurônios/ultraestrutura , Organelas/ultraestrutura , Animais , Axônios/fisiologia , Axônios/ultraestrutura , Células Cultivadas , Feto , Complexo de Golgi/ultraestrutura , Hipocampo/ultraestrutura , Microscopia Eletrônica , Microtúbulos/ultraestrutura , Mitocôndrias/ultraestrutura , Neurônios/citologia , Ratos
14.
J Electron Microsc Tech ; 18(1): 82-90, 1991 May.
Artigo em Inglês | MEDLINE | ID: mdl-2056354

RESUMO

Studies of labeled neurons at the light-microscopic level often pinpoint a substructure of particular interest, i.e., a synapse or a spine. An ultrastructural investigation would explain a lot about how these structures arose, how they function, and how they are regulated. Finding a small region in a large block can require constant checking during sectioning, until past the structure. In our pursuit of the synaptic structure of varicosities on the axons of neurons identified physiologically and morphologically at the light level, we have combined confocal scanning laser microscopy (CSLM) with conventional and high-voltage electron microscopy (EM). CSLM images were collected in the reflection mode to view neurons filled with horseradish peroxidase and stained with nickel-intensified diaminobenzidine, which is compatible with EM. The CSLM optical sections provided a record of what one should expect to see at regular intervals throughout the depth of the tissue block. We have shown that the CSLM greatly simplified the task of localizing small structures in brain tissue prepared for EM.


Assuntos
Hipocampo/ultraestrutura , Microscopia de Fluorescência , Neurônios/ultraestrutura , Animais , Corantes Fluorescentes , Processamento de Imagem Assistida por Computador , Lasers , Ratos
15.
J Microsc ; 160(Pt 3): 265-78, 1990 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2084264

RESUMO

Neurons intracellularly filled with biocytin and labelled with nickel-intensified diaminobenzidine (DAB/Ni) can be imaged on the confocal scanning laser microscope in order to obtain three-dimensional and optical section images of neurons. Intensification of the DAB reaction product with nickel was found to be crucial for obtaining a workable signal level. On the other hand, the high absorption of light by the reaction product severely attenuated the detection of structures lying directly underneath, and the intensity of the unattenuated laser used for imaging faded or damaged DAB/Ni reaction product. We have determined that reduction of the laser intensity combined with the use of proper objective lenses and non-laser-based imaging for preliminary adjustments of the specimen all work to reduce or eliminate damage, and also improve the image. These items must be kept in mind when imaging and analysing DAB-labelled structures in the laser-based confocal microscope.


Assuntos
3,3'-Diaminobenzidina , Peroxidase do Rábano Silvestre , Lasers , Microscopia/métodos , Neurônios/ultraestrutura , Animais , Dendritos/ultraestrutura , Hipocampo , Ratos , Espectrofotometria
16.
J Neurosci Methods ; 33(1): 61-76, 1990 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-2122132

RESUMO

We have assessed the properties and usefulness of confocal scanning laser microscopy in the reflection mode for the study of neuronal morphology. In this mode, the confocal microscope detects the light reflected off the specimen as opposed to the light emitted by a fluorescent label. Neurons in slices of rat hippocampus were filled with biocytin and reacted sequentially with avidin-horseradish peroxidase and nickel-intensified diaminobenzidine (DAB/Ni). In all parts of the neuron the DAB/Ni reaction product produced a strong reflection signal in the confocal microscope. The stereo images revealed aspects of three-dimensional hippocampal cell morphology such as the conical shape of the dendritic fields and a characteristic branching pattern of the axon. Labelling neurons intracellularly is an established technique for identifying physiologically-characterized neurons. Recently, confocal microscopy has become a powerful method for examining the three-dimensional morphology of biological specimens. The resulting images in this paper show that reflection-mode confocal microscopy provides an excellent representation of the filled neurons in three dimensions and presents an opportunity for correlative electrophysiological and morphological studies and extension to the electron-microscopic level.


Assuntos
Hipocampo/citologia , Lasers , Lisina/análogos & derivados , Neurônios/ultraestrutura , 3,3'-Diaminobenzidina , Animais , Avidina , Hipocampo/ultraestrutura , Peroxidase do Rábano Silvestre , Níquel , Ratos
17.
J Comp Neurol ; 281(2): 234-58, 1989 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-2708575

RESUMO

This study describes qualitative and quantitative changes in dendritic ultrastructure during the rapid atrophy of nucleus laminaris (NL) dendrites following deafferentation. The dendrites of n. laminaris neurons in the chick auditory system are segregated into dorsal and ventral dendritic tufts, which receive spatially separated innervation from the ipsilateral and contralateral nucleus magnocellularis, respectively. We have previously shown that removing the input to the ventral side of NL results in the rapid atrophy of the ventral dendrites, whereas the nondeafferented dorsal dendrites of the same cells do not change in length. The ultrastructure of NL was examined in normal animals and after deafferentation. Changes in dendritic ultrastructure were not qualitatively apparent 4 hours after deafferentation. Between 12 and 48 hours the cytoplasm of the ventral dendrites became progressively more lucent, and a gap formed in the transition between the soma and ventral dendritic cytoplasm. Many of the dendrite tips, however, appeared normal even 2 days after deafferentation. Degeneration of dendrite plasma membrane was not visible until 2 days after deafferentation. On the other hand, quantitative measurements revealed a 30% decrease in microtubule density in the initial portion of the ventral dendrite by 4 hours, and a 50-60% decrease from 12 to 48 hours after deafferentation. Neurofilament density in the initial ventral dendrites decreased 50% by 12 hours, and 70% by 2 days after deafferentation. Many of the terminals of the severed afferents remained attached to the atrophying dendrite until 2 days after surgery, when they were in advanced stages of degeneration. Glia apparently were not involved in dendrite loss. The implications of these results on the role of cytoskeleton in the production and maintenance of dendritic shape are discussed.


Assuntos
Dendritos/ultraestrutura , Animais , Astrócitos/patologia , Astrócitos/ultraestrutura , Atrofia , Axônios/patologia , Axônios/ultraestrutura , Galinhas , Dendritos/patologia , Denervação , Filamentos Intermediários/patologia , Microscopia Eletrônica , Microtúbulos/patologia , Fatores de Tempo
18.
J Comp Neurol ; 281(2): 259-68, 1989 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-2708576

RESUMO

N. laminaris dendrites begin to atrophy almost immediately after they are deafferented. Accompanying this rapid change in shape is a loss of microtubules and neurofilaments at the base of the dendrite, and a decrease in the density of the dendritic cytoplasm. However, degenerative changes in the dendritic plasma membrane were not evident until 2 days after deafferentation. Thus it was unknown what happened to the volume and membrane lost from the atrophying dendrites before this time. The soma was investigated in this study as a possible recipient of the volume of the atrophying dendrite. Soma size increased significantly by 2 hours after deafferentation and continued to increase for 1-8 days after deafferentation. The nucleus, which is normally concentric with the soma, moved continuously to the dorsal pole of the soma, toward the innervated side of the cell. The cytoplasm on the ventral side of the soma showed a decrease in density and loss of cytoskeleton similar to what was found in the initial portion of the ventral primary dendrites in the accompanying paper. These changes are interpreted as indicative of a rapid resorption of the ventral dendrite back into the soma following deafferentation.


Assuntos
Dendritos/patologia , Neurônios/patologia , Animais , Atrofia , Galinhas , Dendritos/ultraestrutura , Denervação , Microscopia Eletrônica , Microtúbulos/patologia , Neurônios/ultraestrutura , Fatores de Tempo
20.
Proc Natl Acad Sci U S A ; 85(21): 8335-9, 1988 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-3054884

RESUMO

We have analyzed the polarity orientation of microtubules in the axons and dendrites of cultured rat hippocampal neurons. As previously reported of axons from other neurons, microtubules in these axons are uniform with respect to polarity; (+)-ends are directed away from the cell body toward the growth cone. In sharp contrast, microtubules in the mid-region of the dendrite, approximately 75 microns from the cell body, are not of uniform polarity orientation. Roughly equal proportions of these microtubules are oriented with (+)-ends directed toward the growth cone and (+)-ends directed toward the cell body. At distances within 15 micron of the growth cone, however, microtubule polarity orientation in dendrites is similar to that in axons; (+)-ends are uniformly directed toward the growth cone. These findings indicate a clear difference between axons and dendrites with respect to microtubule organization, a difference that may underlie the differential distribution of organelles within the neuron.


Assuntos
Axônios/citologia , Dendritos/citologia , Hipocampo/citologia , Microtúbulos/ultraestrutura , Neurônios/citologia , Animais , Microscopia Eletrônica , Microscopia de Contraste de Fase , Ratos
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