Celiac territory ischemic syndrome in a patient on chronic hemodialysis.

Mesenteric ischemia among chronic dialysis patients is usually of the nonocclusive type. Chronic occlusive mesenteric ischemia has been reported rarely in the dialysis population. The subset of"celiac-territory ischemic syndrome" has not been described in dialysis. The current report involves a 66-year-old female on chronic dialysis for 11 years. She experienced abdominal pain following sessions of hemodialysis, that later became more pronounced after eating. Abdominal angiography showed heavily calcified aorta, celiac trunk and superior mesenteric artery (SMA), with a 50% narrowing of the celiac and superior mesenteric arteries. During the following 9 months the symptoms worsened and weight loss set in. She was admitted with an episode of upper abdominal pain. Acalculous cholecystitis was found, along with multiple gastric and duodenal erosions including the second part, with an antral ulcer and multiple duodenal bulb ulcers. Repeated abdominal angiography showed progression of the stenotic lesions with significant narrowing of both the celiac trunk and the SMA. A stent was placed in the SMA. Following the procedure, the patient noted marked symptomatic improvement. On follow-up gastroduodenoscopy, all ischemic ulcers had healed completely. Serum albumin rose from a nadir of 31 to 40 g/l, and an extremely elevated c-reactive protein of 205,000 microg/l returned to normal (8,000 microg/l). The diagnosis of chronic occlusive mesenteric ischemia should be suspected among dialysis patients with post-prandial pain and weight loss in the face of calcified vessels. Predominant celiac territory ischemic syndrome presents as gastric and duodenal erosions and ulcers with or without acalculous cholecystitis.

Temporal relationships of statin and terminin expression in ventral lobe of rat prostate following castration.

The purpose of this study was to determine the temporal relationships, in the rat prostate following castration, the expressions of terminin, a cytoplasmic marker for senescence, and, statin, a nuclear marker for cell quiescence and senescence. The presence of these two proteins was determined at 0, 1, 2, 4, 8, 24 and 48 hours in the ventral lobe of the prostate following castration. Immunofluorescence techniques for double labelling were used and assessed with confocal microscopy. At 0 hour the mean % labelling index (LI) for terminin was 0% and 98% for statin. One hour following castration a complete reversal of expression of these two markers occurred indicating that the terminin marker is expressed at the start of programmed cell death or apoptosis. The mean % LI for terminin at 1, 2, 4, 8, 24 and 48 hours following castration were 54, 82, 63, 39, 44 and 41% respectively. The mean % labelling index of statin remained at zero during these time intervals. It is concluded that following castration, the prostatic ventral lobe exits from the quiescent phase to reenter cell cycle traverse. This is coupled by the loss of statin and the expression of the cytoplasmic marker terminin at the start of programmed cell death prior to the appearance of any histologic features of apoptosis.

The differential expression of statin in the nuclei of human colonic crypts adjacent to a cancer: an immunohistochemical study.

Statin, a non-proliferation-specific nuclear antigen, was used here to assess the colonic crypt kinetics of the mucosa bordering a human colon cancer. Mucosal strips adjacent to a colon cancer obtained from operative specimens were immediately cut into five one cm segments and stored in liquid nitrogen. An immunohistological technique using the statin antibody as a nuclear marker was used to determine the labelling indices of the non-cycling compartment at the varying distances. Optical density measurements of the nuclear reaction product served to objectively identify the statin-positive nucleus. The results indicate that there is a statistically significant reduction (P < 0.0001) in the statin-positive labelling index in the entire crypt length for a distance of three cms. The division of the entire crypt into four levels (A, B, C and D) demonstrates that this effect is principally due to the upward extension of the statin-negative cell mass into levels B and C with a corresponding decrease in the labelling index of the statin-positive nuclei in these levels. The in vivo expression of nuclear statin demonstrates its usefulness in accurately determining the size of the non-proliferative compartment in the human colonic crypt adjacent to a colon cancer.

Immunohistochemical expression of mutant p53 oncogene in transitional mucosa adjacent to human colon cancer.

The purpose of this study was to analyze the expression of a mutant (MUT) p53 oncogene protein in the mucosal crypts adjacent to a human colon cancer. Five 1-cm mucosal segments were taken from the surgical specimens over a 5-cm distance from the tumor. Immunohistochemistry was performed using a monoclonal antibody (Ab3) to the MUT p53 and examination by light microscopy. The mean % labelling index (LI) of 10 crypts/cm segment was determined by image analysis. The LI for the entire crypt length for the first cm segment was 33.51 +/- 4.2 and for the second cm segment was 29.26 +/- 5.4 (p < 0.02). Due to the unequal distribution of the label within the crypt length, it was divided into halves so that the LI of these levels could be determined. The LI for the upper and lower crypt levels for the first cm segment were 28.67 +/- 3.2 and 78.23 +/- 4.6 (p < 0.01); for the second segment, the LI were 22.0 +/- 5.1 and 68.66 +/- 4.7 (p < 0.01). No expression of MUT p53 nuclear protein was noted distally at 3-5 cm. The localization of MUT p53 protein product to the crypt stem cell nucleus supports the contention that a malignant field change exists in the transitional mucosa adjacent to a human colon cancer.

The femoral artery-femoral vein polytetrafluoroethylene graft: a 14-year retrospective study.

BACKGROUND: The use of the femoral vessels for permanent haemodialysis access has been neglected during the last two decades. Since 1981 femoral artery-vein loop polytetrafluoroethylene grafts have been constructed in our chronic haemodialysis patients. This study examines results obtained in patients with this particular graft over the last 14 years. METHODS: This clinical study is retrospective in nature. Overall 35 patients, with 37 femoral grafts, are included. Inclusion and exclusion criteria for this type of graft are given and the surgical procedure detailed. RESULTS: Seven patients had femoral grafts used as primary dialysis access. Twenty-eight patients had femoral grafts used after multiple access failures. There was no perioperative mortality. Immediate thrombotic non-function of the graft occurred in three patients. In the long term no patient death was related to the femoral grafts. Twenty-seven (73%) grafts had no long-term complications. The leading cause for graft 'loss' was patient death; in the first year 10 grafts were lost, eight because of patient death. All eight patients died with functioning grafts. Median graft survival was 21 months in all patients and 28 months in non-diabetic patients. Twenty-seven (73%) grafts were patent at the end of the first year, 33% of grafts were still patent after 5 years. Worsening claudication occurred in four patients; one diabetic required foot amputation. Four patients had late graft thrombosis; only two patients had bacteraemia originating from the femoral graft. Urea reduction ratio greater than 60% was measured in 87.5% of patients. CONCLUSION: The femoral artery vein graft is a good primary and secondary haemodialysis access. Both infection and thrombosis rates are low and graft survival is comparable, if not superior to, that of upper-limb grafts. The graft is easy to cannulate, can be used early, is easily protected, and is cosmetically acceptable.