Relationships between plasma lipoprotein concentrations and insulin action in an obese hyperinsulinemic population.

Relationships have been observed between lipoprotein concentrations and insulin action. These relationships may be important in explaining the association of insulin resistance and abnormalities of lipoprotein metabolism found in obesity, diabetes, and hypertriglyceridemia. We have measured plasma lipoprotein concentrations and indices of insulin action in 85 men and 56 women, all of whom were normolipidemic and had normal glucose tolerance.

Comparison of body composition, adipocyte size, and glucose and insulin concentrations in Pima Indian and Caucasian children.

Pima Indian adults with normal glucose tolerance have higher plasma glucose and insulin concentrations than Caucasian adults. To estimate the age of onset of these differences, and to assess their relationship to abdominal and gluteal adipocyte size, we measured adiposity, adipocyte size, and glucose and insulin concentrations during a glucose tolerance test in lean (less than 20% body fat), prepubertal children from each race. The Pima (n = 13) and Caucasian (n = 10) groups were of similar age, percent body fat, and weight.

Amino acid sequence of beta-galactoside-binding bovine heart lectin. Member of a novel class of vertebrate proteins.

A variety of animal tissues contain beta-galactoside-binding lectins with molecular masses in the range 13-17 kDa. There is evidence that these lectins may constitute a new protein family although their function in vivo is not yet clear. In this work the major part of the amino acid sequence of the 13 kDa lectin from bovine heart muscle has been determined.

Neurologic sequelae with internal carotid artery occlusion.

A retrospective review of the clinical course surrounding internal carotid artery occlusion (ICO) was undertaken in 97 patients with 106 instances of ICO. No neurologic symptoms could be attributed to more than half of the ICOs. Of the 52 symptomatic occlusions, 19 (37%) were associated with transient ischemic attacks and 33 (63%) with fixed strokes.

Adult human vascular endothelial cell attachment and migration on novel bioabsorbable polymers.

We studied the ability of polymers from which vascular prostheses (VPs) are or could be fabricated to support attachment and migration of adult human vascular endothelial cells (AHVECs) in an in vitro system. Polymers included Mylar, Teflon, two novel bioabsorbable polymers with different biologic half-lives (BR1 and BR2), and an elastic nonabsorbable biocompatible polymer (EBN). Both BR1, BR2, and EBN supported AHVEC attachment well (56%, 62%, and 71%, respectively, of plated cells at one hour, respectively) but differed in their ability to support AHVEC migration.

Reoperation for aortofemoral graft limb occlusion: optimal methods and long-term results.

To determine optimal methods of reoperation, experience with 157 secondary procedures for unilateral aortofemoral graft limb occlusion in 110 patients during a 16-year period was reviewed. In earlier years, inflow was reestablished by direct replacement of the graft limb or entire graft (11%); more recently, graft limb thrombectomy has been used most frequently (68%) with equal success, durability, and less morbidity. Femorofemoral grafts from the patent contralateral graft limb were employed in 18% of patients, usually those in whom thrombectomy was not attempted.

The evolution of morphologic and biomechanical changes in reversed and in-situ vein grafts.

A comparative study of experimental reversed (RV) and in-situ (INS) vein grafts with respect to the evolution of morphologic and compliance characteristics was done in a canine model. In addition, the compliance characteristics in a series of human INS vein grafts were recorded as a function of time after operation. At 6 months after implantation, all experimental grafts displayed well-developed intimal hyperplasia.

Coordination of very low-density lipoprotein triglyceride and apolipoprotein B metabolism in humans: effects of obesity and non-insulin-dependent diabetes mellitus.

To understand the relationship between very low-density lipoprotein (VLDL) triglyceride and VLDL apolipoprotein (apo) B, we studied their metabolisms simultaneously in 53 subjects with a range of obesity and glycemia. Obese subjects had increased production of both VLDL apo B and VLDL triglyceride and more VLDL of normal composition. Compared with nondiabetics, diabetic subjects had decreased clearance of both VLDL apo B and VLDL triglyceride, increased production of VLDL triglyceride but not of VLDL apo B, and more VLDL of abnormal composition.

Effect of compliance mismatch on vascular graft patency.

The hypothesis that a mismatch in compliance between a vascular graft and its host artery is detrimental to graft patency was tested by implanting paired arterial autografts, prepared with differential glutaraldehyde fixation of carotid arteries in the femoral arteries of dogs. These grafts differed only in circumferential compliance: they were 100% (compliant) vs. 40% (stiff) as compliant as the host artery.

Continuous monitoring of oxygen tension with a transcutaneous sensor during hypotensive anesthesia.

Transcutaneous oxygen tension (TCPO2) is a useful noninvasive technique for monitoring arterial oxygen tension under stable circulatory conditions. This study was undertaken to determine if TCPO2 is also reliable during sodium nitroprusside-induced hypotension under general anesthesia. Arterial blood gases and TCPO2 were measured prior to inducing hypotension (baseline), at 20-min intervals during hypotension, and when systemic arterial pressure had returned to within 10% of the control (pre-hypotension) value.

Extending the limits of limb salvage.

Over the past several years a combination of diverse steps has culminated in a significant improvement in our ability to save ischemic extremities. Encompassing all phases of vascular surgery, these advances in diagnosis, therapy, and long-term management are outlined. These and future improvements hold promise for extended limb salvage with lower mortality than previously considered possible.

Use of tritiated thymidine as a marker to compare the effects of matrix proteins on adult human vascular endothelial cell attachment: implications for seeding of vascular prostheses.

We have developed a technique to measure attachment of adult human vascular endothelial cells to test surfaces with tritiated thymidine used as a marker. With this technique, we measured attachment of adult human vascular endothelial cells to a series of extracellular matrix proteins, including fibronectin-coated (10 micrograms/cm2), laminin-coated (10 micrograms/cm2), and collagen-coated (1% gelatin) surfaces because of the role of these proteins in promoting cell attachment and growth. For a typical experiment, in the presence of serum, initial attachment (at 1 hour) was greatest on fibronectin-coated (63%) and gelatin-coated (60%) tissue culture plastic (polystyrene) and was least on laminin-coated (28%) or untreated polystyrene (18%).

Gamma-glutamyl-glutathione. Natural occurrence and enzymology.

The natural occurrence of gamma-glutamyl-glutathione (gamma-glutamyl-gamma-glutamylcysteinylglycine) in bile was established by analytical and chromatographic studies on the isolated and chemically synthesized materials. Evidence that it is formed in kidney was obtained. The origin of gamma-glutamyl-glutathione was explored through studies on the interaction of glutathione with gamma-glutamyl transpeptidase.

Body composition, adipocyte size, free fatty acid concentration, and glucose tolerance in children of diabetic pregnancies.

Previous studies show that children of women who are diabetic during pregnancy are more obese and have a higher prevalence of non-insulin-dependent diabetes mellitus (NIDDM) than children of women who first developed NIDDM greater than 1 yr after the pregnancy (prediabetic mothers) and children of women who have never developed diabetes (nondiabetic mothers). To determine whether lean and obese children of glucose-intolerant pregnancies can be distinguished from similar children of glucose-tolerant pregnancies, we measured body composition, abdominal and gluteal adipocyte size, fasting free fatty acid (FFA), and fasting and stimulated glucose and insulin concentrations during an oral glucose tolerance test in prepubertal children of glucose-intolerant and prediabetic mothers. Each group ranged in adipocity from 6 to 40% body fat.

Attempts to obtain anti(D2 dopamine receptor) antibodies via the anti-idiotypic route.

Five stable hybridomas have been obtained that secrete monoclonal antibodies against the D2-dopamine receptor-selective drug spiperone. Each monoclonal antibody has been characterized in terms of its ability to bind a range of dopamine-receptor-selective ligands. One monoclonal antibody has been purified by Protein A affinity chromatography and used to immunize mice.

The effect of dextrose and amino acids on respiratory function and energy expenditure in morbidly obese patients following gastric bypass surgery.

Hypocaloric dextrose administration results in a diminished minute ventilation, metabolic rate, and ventilatory responsivity to hypercapnea and hypoxia which is rapidly reversed by provision of amino acids in individuals of normal weight. This study compared the effects of peripheral intravenous dextrose and amino acid infusion on respiratory parameters and energy expenditure in 25 morbidly obese patients undergoing gastric bypass surgery. On the first postoperative day, respiratory rate increased (P less than 0.

Mural degeneration in the glutaraldehyde-tanned umbilical vein graft: incidence and implications.

After discovering an aneurysm in a glutaraldehyde-tanned umbilical vein (GTUV) graft that resulted in graft thrombosis, we reevaluated all patients from our institution who had GTUV grafts implanted for more than 2 years. Of 60 patients identified, 14 of 15 patients with patent grafts were recalled and had either digital subtraction or standard angiographic studies. Angiographic changes in the grafts were graded on a scale of 0 to 3, from normal (grade 0) to frank aneurysmal degeneration (grade 3).

Migration of adult human vascular endothelial cells: effect of extracellular matrix proteins.

An ideal vascular prosthetic graft should support rapid endothelial coverage and allow maximal rates of endothelial cell migration on its surface. To study this we modified and developed a method to measure rates of migration of adult human vascular endothelial cells (AHVECs) on test surfaces using an O-ring fence technique. We measured the rates of AHVEC migration on a variety of extracellular matrix proteins of interest because of their ability to support cell attachment.

Compliance changes in glutaraldehyde-treated arteries.

Glutaraldehyde tanning of carotid arteries was used to develop a model for studying the effects of compliance on arterial graft performance, independent of other graft parameters. Canine carotid segments were filled with dilute phosphate-buffered glutaraldehyde (0-0.5%, pH 7.

Familial dependence of the resting metabolic rate.

Human obesity is known to be a familial disorder. We studied 130 nondiabetic adult southwestern American Indians (74 men and 56 women) from 54 families to determine whether the resting metabolic rate, as measured by indirect calorimetry, is a familial trait that is independent of individual differences in fat-free mass (estimated mass of metabolically active tissue), age, and sex. We found that most of the variance in the resting metabolic rate (83 percent, P less than 0.

Glucose storage is a major determinant of in vivo "insulin resistance" in subjects with normal glucose tolerance.

In vivo "resistance" to the action of insulin on glucose uptake is commonly found in obesity and is characteristic of noninsulin-dependent diabetes mellitus in obese subjects. To investigate the relationship among glucose uptake, glucose oxidation, and nonoxidative glucose disposal (storage) in subjects with normal glucose tolerance, we studied 25 caucasians and 79 southwestern American Indians, including lean and obese subjects in both groups. The euglycemic clamp technique with simultaneous indirect calorimetry was used to determine rates of glucose uptake and glucose oxidation.

Suture technique and para-anastomotic compliance.

We previously described a para-anastomotic hypercompliant zone (PHZ), located 3 to 4 mm from end-to-end continuous anastomoses in canine femoral arteries, in which arterial compliance first increases approximately 50% above adjacent reference values before falling to a minimum at the anastomosis. To determine if PHZ is affected by suture technique, 16 interrupted and 21 continuous end-to-end anastomoses were studied. Pulsed ultrasound was used to obtain detailed longitudinal profiles of compliance and diameter vs.

Omental transposition for recurrent breast carcinoma following limited surgical excision and radiation therapy.

Failure to control local disease following limited surgical excision and radiotherapy for primary treatment of breast carcinoma often precludes the use of conventional mastectomy techniques. This series reports the use of mastectomy and omental transposition on a gastroepiploic pedicle and delayed skin grafting in 17 such patients. The transposition of omentum permits removal of neoplastic and secondarily infected tissue including sternum, ribs and chest wall muscles if necessary.

Intrahepatic transport and utilization of biliary glutathione and its metabolites.

Glutathione transported by hepatocytes into the bile canaliculi is metabolized by the actions of gamma-glutamyl transpeptidase and dipeptidase located on the biliary ductular epithelium. This pathway is revealed by the finding of high levels of cyst(e)inylglycine, gamma-glutamylglutathione, gamma-glutamylcyst(e)ine, glutamate, glycine, and cyst(e)ine in bile, by studies in which intrahepatic metabolism of glutathione was inhibited by administration of a potent inhibitor of gamma-glutamyl transpeptidase and by experiments in which glutathione synthesis was inhibited. Canalicular transport of glutathione, as estimated from totals of metabolites found, is much greater than the glutathione found in bile.