P. Blais

Aggregation of insulin, containing surfactants, in contact with different materials

The aggregation of insulin and of insulin protected with surfactants was studied by shaking at 37°C in glass, in polypropylene and polystyrene vials, and in CPI and Auto-Syringe insulin syringes and infusion sets. Surfactants such as Pluronic 17R8 and 25R5 hastened the aggregation, whereas Pluronic F68 was effective in preventing it. Furthermore, there was no change in the immunoreactivity of insulin containing Pluronic F68 even after 8 days of shaking. Unprotected insulin aggregated in all the vials. There appears to be little problem with the commercial syringes tested, but the infusion sets could cause aggregation of insulin if used over an extended period of time. Although Pluronic F68 prevented insulin aggregation in situ, it extracted more impurities from the contacting plastics. Further development in materials and design of insulin sets and insulin containers appears necessary.

Degradation of explanted polyurethane cardiac pacing leads and of polyurethane.

Polyurethane cardiac pacing leads explanted at autopsy and from reoperated patients were examined for degradation in the insulation. Scanning electron microscopy (SEM) analysis showed cracks on the polyurethane surface which were both parallel and perpendicular to the longitudinal axis of the lead. Surface analyses of leads were performed using Fourier-Transform Infra-red (FT-IR) spectrophotometry in the attenuated total reflectance mode. The FT-IR spectra of visibly deteriorated polyurethane from explanted lead sheaths were compared with that of unused polyurethane tubing used for such sheaths. Changes were most evident in the regions of 3000-2800, 1730 and 1368 cm-1. The observed alterations in the FT-IR spectra were consistent with a degradation mechanism involving oxidative chain cleavage in the polyurethane amorphous regions. New polyurethane tubing (Pellethane-Type 80A) was exposed to sodium hypochlorite to simulate a possible in-vivo process and generate reference material. Degradation with associated decreases in tensile strength and molecular weight was recorded. This study showed that polyurethane insulation used in pacing leads is susceptible to oxidative degradation.

Another Look at the Sparks-Mandril Arterial Graft Precursor for Vascular Repair - Pathology by Scanning Electron Microscopy -

The Sparks-Mandril blood vessel precursor system, an autogenous tissue growth-promoting device, in spite of its ingenuity and its surgical elegance, has received only limited usage. At technique for peripheral blood vessels by several authors. In the latter period, this laboratory also undertook similar work. The results of seven implantations in dogs and two in patients are reported here in the context of a program on the evaluation of blood vessel substitutes, their mode of operation and their long term performance. The clinical status and the pathology of the grafts at time of failure were investigated using techniques of scanning electron microscopy. This work confirms the findings of other centres regarding the generally unsatisfactory performance of the Sparks-Mandril system. Possible causes for failure in mandril-formed blood vessels are discussed.

Endothelial Lesions Associated with Vascular Clamping - Surface Micropathology by Scanning Electron Microscopy

The endothelial cell pavement in normal blood vessels is very fragile. In cardiovascular surgery, the need for secure clamping of the aorta results in trauma which may be followed by thrombosis or occlusion. Various types of vascular clamps and other related devices offered commercially were clinically investigated in canine models and their effects on the vascular endothelium were ascertained with the aid of scanning electron microscopy. On the basis of these studies, the Fogarty silicone filled clamp appeared to be the least traumatic. However, further technical developments in this area are needed in order to obtain a completely atraumatic method of temporarily closing major blood vessels.

Processed human umbilical veins as arterial substitutes — evaluation in canine models

Human umbilical cord vein segments have been used as vessel substitutes for damaged or occluded arteries, as aorto-coronary by-passes and as arterio-venous fistulae for dialysis. The Dardik-Biograft fixed with glutaraldehyde and the Mindich-Bioflow, fixed with ethanol and dialdehyde starch, are commercially available. They were implanted in dogs as replacements for a segment of the abdominal aorta. Post-implantation status was followed by angiography. They were evaluated after removal from sacrificed animals with the aid of scanning electron microscopy and histological techniques. Attention was focused on vessel patency, dimensional stability, integrity of the anastomosis line, lumen wall microstructure, evidence of suture damage and thrombus deposition pattern. Both types of grafts gave functional by-passes for at least until 6 months post-implantation. The Dardik-Biograft appeared more prone to thrombus formation near the anastomosis. Sparse cellular development was also noted. The Mindich-Bioflow gave rise to a prosthesis of superior thromboresistance which was more subject to mechanical damage.

Chemically fixed human umbilical cord vein grafts as arterial substitutes: potential and limits.

In spite of reported successes, synthetic fabric grafts and microporous and plain synthetic conduits have proven unsuitable for aorto-coronary bypasses and showed weaknesses below the knee. Readily available and uniform diameter vascular substitutes with biological and mechanical properties comparable to human vessels would be of paramount interest. Following reported successes with chemically fixed human umbilical veins (HUV), we have attempted to develop smaller diameter blood conduits and have improved the currently prevalent techniques of fixation, preparation and storage to generate more convenient surgical products. In vitro assessment of the processed HUV demonstrated that the HUV can be easily processed to make an arterial substitute that can be preserved either in a liquid medium or as a dry product. However, the in vivo implantations in dogs led to disappointing results for liquid-preserved or albuminated veins. Critical-point dried grafts gave better results, unfortunately they do not heal and they can only degrade after implantation.

Defibrinogenation as an alternative to heparinization in prolonged extracorporeal circulation

SummaryComplications arising from difficulty controlled bleeding and thrombus formation during procedures which require extracorporeal circulation with heparin as anticoagulant motivate the search for better hemostasis and anticoagulant technology. An enzyme (Defibrase), having a specific interaction with fibrinopeptide A such as to cause fibrin depletion in a soluble form, has been proposed as an alternative to heparin. Defibrase, in contrast to heparin, does not affect blood platelet function. Heparin and Defibrase as anticoagulants were compared in 8 h perfusion studies using arterio-venous extracorporeal blood circuits in dogs; the circuitry included pumps, membrane oxygenators and filters serially. Thrombus formation, in the filters and the oxygenators as well as pathology of the perfused animal were investigated. The results suggest that defibrase-like enzymes have potential for enhanced control of hemorrhagic and thrombotic phenomena. Although impeded by a latency of several hours before the full anticoagulant properties are developed in vivo, it appears that enzymatically mediated defibrinogenation of blood may be a valuable alternative to heparinization in extracorporeal circulation procedures.

In Vitro Performance Assessment of Tubular Membrane Oxygenators

The definite advantage in oxygen transfer performance of staged (single, double and triple) tubular membrane oxygenators (TMO) is compared with reference to flat membrane oxygenators (Travenol or Landé Edwards). The overall construction of staged TMO with a blood mixing chamber is a very good way to destroy the blood boundary layer and modify the blood stagnant zone in the device. Four sizes of staged TMO were studied using the principle that gases dissolve in water in concentrations linearly proportional to the partial pressures of the gases when in equilibrium with the liquid. The experimental results show that the oxygen transfer rate and the corresponding overall oxygen mass transfer coefficient of staged TMO are increased by the same order as those of the reference membrane oxygenators. Furthermore the essential parameter analysis prove that oxygen transfer increases with the number of stages and decreases with the length of the blood tubular modules. The multistage design of TMO revealed an increase in the hydrodynamic resistance occurring in the apparatus. However the highest relative oxygen transfer efficiency suggests that better fluid distribution as well as better uniformity of oxygenation prevail in the staged devices.