Nonrandom changes of chromosome 10 in bladder cancer. Detection by FISH to interphase nuclei.

Fluorescence in situ hybridization (FISH) to interphase nuclei has been a valuable method for examining the chromosome copies in tumor cells in clinical practice. Twelve cases of transitional cell carcinoma (TCC) of the bladder were investigated with a biotin-labeled repetitive DNA probe to detect numerical aberrations of chromosome 10 in interphase nuclei. The cells containing one fluorescent signal were screened in two of seven non-invasive tumors and in four of five invasive tumors. Two patients presented two FISH spots of different sizes. More than two signals were seen in one invasive tumor. The findings suggest that partial or complete loss of a chromosome 10 is a nonrandom aberration in bladder cancer.

EC CO2R: oxygenator or hemodialyzer? An in vitro study.

In respiratory support of patients with acute respiratory distress syndrome (ARDS), the extracorporeal CO2 removal (EC CO2R) technique should be the earliest and easiest procedure so as to have the lowest blood flow rate. Extracorporeal circulation (ECC) can be achieved using an oxygenator for CO2 removal under the dry form (dissolved CO2) or a hemodialyser for CO2 removal under the wet form (bicarbonates). This study investigated different methods allowing an increase in CO2 transfer, using liquid flow rates up to 0.330 l/min. The experimental set-up employed heated (38 degrees C) aqueous polyelectrolytic solutions mimicking the venous blood (pH 7.20, PCO2 53 mmHg). Four in vitro methods were tested: Series I: a DIDECO D702 oxygenator without blood (= liquid) acidification, Series II: D702 oxygenator with inlet HCl acidification, Series III: a HOSPAL H10-10 hemodialyzer without dialysate alkalinisation, Series IV: H10-10 hemodialyzer with NaOH dialysate alkalinisation. Maximum gas flow in the oxygenator and dialysate rate in hemodialyzer were 5 and 0.55 l/min respectively. For the four series the CO2 transfer (TCO2) (mean +/- S.E. ml/min) and pH out were: [table: see text] The difference between the four series was statistically significant (t-test). Acidification using the oxygenator increased CO2 transfer by 80%, but CO2 elimination was better with hemodialysis.

Closed loop control of PaCO2 during ECC.

A prototype for the control of blood gases during extracorporeal circulation (ECC) has been built. It is composed of a CDI300 continuous gas blood analyzer, a programmable gas blender and an IBM PC. The air blender is composed of three mass flow controllers (air, oxygen and total flow rate). The microcomputer commands these controllers in order to obtain the desired mixture of air and oxygen. The system acquires the data sent by the blood gas analyzer every 6 seconds and commands the gas blender in order to maintain the desired arterial dioxide partial pressure (PaCO2) in the arterial line. The first experimental results on sheep show that if blood gas parameters are stable when beginning the closed loop control, then the desired PaCO2 value may be obtained. Otherwise, the value of PaCO2 under control is slightly different but a stable value is obtained after 10 minutes. More experiments must be done in order to establish the real limits of such a system and optimize the gain of the control system.

Extracorporeal circulation in European Economic Community (ECC in EEC): 1979-1989.

This study determines the evolution of ECC in EEC. After recollecting the great stages of ECC since its routinely use in open heart surgery, the study situates its position in the entire world taking into account several indexes like the Gross National Product (GNP) and its evolution, the life expectancy and some other factors either technical or economical. Only a coarse analysis could be done for Europe due to an unsteady evolution. A more detailed analysis has been achieved for France thanks to a greater number of data. In such a study the major difficulty is to estimate the relevance and consistency of data which can change very quickly and are provided either by companies or by other organization.

Cardiopulmonary dynamics during pumpless arteriovenous bypass for respiratory assistance.

The effect of a pumpless arteriovenous bypass with a microporous membrane oxygenator (MO) on the cardiopulmonary dynamics of dogs revealed an increase in cardiac output and cardiac work proportional to the increase in extracorporeal blood flow. Several current MOs offer so little resistance to blood flow that shunt flows exceeding a third of the normal cardiac output can easily be obtained. This should be enough for CO2 extraction covering metabolic production, and would add a non negligible amount of O2 to the blood.

Monitoring of blood gases during extracorporeal circulation with an artificial lung.

During cardiopulmonary bypass, the heart-lung machine and the patient's gas exchange systems (uptake and elimination) form an undissociable couple. Changes in one of the components lead to corresponding changes in the other. In the artificial lung, like in the natural lung and peripheral tissues, gas exchanges depend on several parameters: blood inlet conditions, blood flow rate, temperature, composition of the gas mixture used for ventilation, blood tissue perfusion, O2 consumption, etc. The perfusionist's primary objective is to obtain from the artificial lung adequate O2 delivery to and CO2 removal from the tissues. This paper discusses the main parameters which must be taken into account and analyses the main sensors currently available for in-line measurement of blood gases.

ESCA studies on heparin-like materials used for extracorporeal shunts.

Amino-acids sulfamide substituted polystyrene surfaces exhibit an heparin-like activity. Similar treatments were achieved on small diameter tubings made of polystyrene grafted on polyethylene. Electron spectroscopy for Chemical Analysis (ESCA) appeared as the suitable method for a chemical characterization of the surface (approximately 50-100 A depth) to be in contact with circulating blood. These tubings were implanted as extracorporeal shunts on dogs. The variations of local concentrations of labelled platelets, red cells and fibrinogen were recorded in situ. Depending on the conditions of preparation and implantation, a slight adhesion of platelet was observed. By using such type of materials with an improved mechanical compliance, small diameter antithrombogenic tubings could be developed, provided the chlorosulfonation prior to amino-acid grafting is mild.

Thrombosis of angiographic catheters in humans: experimental study.

One of the major problems in the use of catheters is their thrombogenicity since the embolization of clots near the central nervous system or the coronary arteries can cause permanent damage. Catheter thrombogenicity was evaluated in humans during angiographic procedures by their tendency to become occluded. Characterization of catheters was achieved using roughness measurements, FTIR with ATR, DSC and ESCA. The catheters were 5 commercially available catheters, made mainly of polyethylene, Pebax or polyamide sterilized and ready for clinical use. Thirty-one patients due to have an angiographic procedure and with normal blood and hemodynamic parameters were included in the study. The 50 cm catheter test sample was inserted through an introducer into the femoral artery at the beginning of an angiographic procedure. The outcoming blood flow rate (BFR) was continuously monitored by a special computerized device for 15 min or until the total amount of blood reached 30 ml. The angiographic procedure was then normally resumed. DSC and FTIR showed results consistent with the expected composition of catheters. ESCA results showed very high Si/C ratios and could not be explained in all instances. Occlusion of the catheters occurred in 44% of the cases and the average time to obtain occlusion was 8.5 min (3-15 min). Values of the decrease rate of BFR in ml/min2 allowed separation of the catheters into 3 groups of low, medium and high thrombogenicity. However, occlusion occurred at least one time for each type of catheter. Blood volume and BFR curves vs. time allowed the determination of 3 main types of thrombotic behavior: type I shows no significant reduction of BFR; type II shows a progressive decrease in flow rate; type III is much less frequent and shows an abrupt decrease of BFR either quickly followed by a compensatory increase and resuming of a steady flow or by abrupt occlusion. In type II curves the pattern of occlusion follows a classical diffusion model because the Peclet number is greater than 1 and then the classical Higbie solution for diffusion could be used. The most thrombogenic material was the smoothest. There was no correlation between surface chemical composition and thrombogenicity. However, catheters that were based on PE appeared less thrombogenic than PA catheters in this study.

[Influence of the type of arterial anastomosis on the development of endothelial hyperplasia]. / Influence du type d'anastomose artérielle sur le développement des hyperplasies endothéliales.

This study was designed to evaluate intimal hyperplasia distal to the suture line in two types of vascular anastomosis: end to end and end to side. 49 aorto-iliac homografts have been performed on rabbits New-Zealand. The aortic anastomosis was side to end, iliac anastomosis were end to end on one side, end to side on the other one. Scanning electronic microscopical study and histological evaluation were carried out at various time of survival from 2 hours to 180 days. The scanning microscopy has evidenced the surface changes: early platelets adhesion and the healing process. Histological evaluation demonstrated that the intimal proliferation was prevailing at the level of the suture line in both anastomosis, and at the opposite to the mouth of the anastomosis in the end to side one. Intimal thickness was measured on arterial section immediately distal to the suture line. In the end to end anastomosis, hyperplasia was absent on the 5th post-operative days, it reached 120 mu +/- 33 on the 40th days, and decreased to 40 mu +/- 35 on the 150th post-operative day. In the end to side anastomosis evolution was the same: 0 mu on the 5th, 106 mu +/- 49 on the 40th day and 53 mu +/- 45 on the 150th post-operative day. In conclusion, this experimental study gives some support to the fact that the type of anastomosis, per se, end to side or end to end does not influence the development of intimal hyperplasia.

[CO2 elimination via extracorporeal circulation in respiratory assistance: artificial lung or kidney? Experimental study]. / Circulation extracorporelle (CEC) d'élimination de CO2 en assistance respiratoire: poumon ou rein artificiel? Etude expérimentale.

In the context of a respiratory assistance protocol dissociating oxygenation of the blood from elimination of carbon dioxide, it is possible to rest the lungs which are used for oxygen exchange by diffusion via functional zones. CO2 is eliminated via extracorporeal circulation. In order to simplify this method, the authors investigated the optimal conditions for this elimination at flow rates similar to those used for haemodialysis (0.33 l/min). This study was designed to evaluate the in vitro elimination of CO2 obtained by a membrane artificial lung with and without "doping" by acidification (10 ml/min of 0.01 N HCl) of the blood inlet compared with that obtained with a haemodialysis machine with and without alkalinisation (0.5 ml/min of 0.5 N NaOH) of the dialysate inlet. The results obtained showed that haemodialysis with an alkaline bath ensured CO2 elimination 36% superior to that of the artificial lung associated with acidification.

[Use of extracorporeal circulation oxygenators (CEC) in the European Economic Community (EEC)]. / Utilisation des oxygénateurs en circulation extra-corporelle (CEC) dans la Communauté Economique Européenne (CEE).

This study analyses the growth of CPB in the EEC. The study situates its position in the world taking into account several indexes such as the Gross National Product and its growth the life expectancy and other technical or economic factors. Only a broad analysis could be performed for Europe to the irregular development of CPB. A more detailed analysis was performed for France thanks to a greater number of data. In this type of study the most important problem is to estimate the relevance and consistency of the data provided either by companies or by other organizations because they can change very quickly.

[Secondary tumor of the ureter. Metastasis of breast carcinoma]. / Tumeur secondaire de l'uretère. Métastase d'un carcinome mammaire.

The authors present a case which is essentially interesting because of its rarity. A metastasis of the left pelvic ureter was discovered following an episode of renal colic in a woman treated for known breast cancer. The patient's age, 49 years, encouraged conservative treatment. The functional urological and radiological outcome were satisfactory with a follow-up of 3 years.

[18 cases of surgically treated parathyroid adenoma responsible for urinary calculi]. / Dix-huit cas d'adénomes parathyroïdiens opérés responsables de lithiases urinaires.

The development of urinary lithiasis as a result of parathyroid lesions is not an exceptional occurrence and should be routinely looked for. Among the 30 cases of parathyroid adenoma identified during a 25-year period in a department of urology in a medium-sized town, 18 were detected following the occurrence of urinary lithiasis. Clinical features in these 18 cases, as well as the investigations that led to the discovery of the adenoma are reported. The surgical cervicotomy technique used by the same operators is briefly described. In other countries (Germany, Switzerland, Italy), the detection and management of parathyroid adenomas is often considered as within the field of urology.

[A case of adrenal gland metastasis of a cutaneous melanoma treated by excision with 3-year survival]. / A propos d'un cas de métastase surrénalienne d'un mélanome cutané traité par exérèse avec survie de 3 ans.

Case report of a 38-year-old man who, 14 months after resection of a malignant melanoma from the right shoulder in September 1990, presented with a tumour of the right adrenal gland. Resection confirmed metastatic melanoma. Chemotherapy was administered for 3 months. The patient was followed until his death in March 1995, i.e. three years after resection of the secondary adrenal tumour.

Determination of left ventricular heat production in working dog heart.

1 degree Total left ventricular heat production was reliably estimated from the coronary blood flow, the coronary arteriovenous thermal difference and the thermodilution curve areas recorded in aortic root and in coronary sinus after injection of cold glucose solution into the left ventricular cavity. The assumption was made that the distribution of a cold solution, purposely introduced into the coronary arteries, obeys the same law as the heat generated by the myocardium. 2 degrees Temperature measurements were achieved with thermistors and a linear ohmmeter. Experiments were performed on thoracotomized dogs, allowing the utilization of an ultrasonic method for determination of the entire coronary sinus blood flow diverted through a cannula positioned in the coronary sinus. The spontaneous changes in acid-base balance and hemodynamic state, which were not systematically avoided, provided a fairly large interval of variation for coronary flow and myocardial oxygen consumption. 3 degrees Within the power interval of 0.5-2.2 watts per 100 g of left ventricular weight, there was a good linear correlation between left ventricular oxygen consumption and the sum of left ventricular heat production and external pressure power. 4 degrees These results suggest that the proposed method is a valuable approach for determination of the cardiac energetics in the in situ working heart. This method permitted repeated determinations of left myocardial heat production and may lead to a practical approach for measuring the left ventricular efficiency in intact animals.