Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations.

PURPOSE: To prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS: The outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14-78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. RESULTS: The mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1-8) and 4.4±3.9 (SD) (range, 1-17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. CONCLUSION: VSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

Basic study on gene therapy of human malignant glioma by use of the cationic multilamellar liposome-entrapped human interferon beta gene.

For gene therapy of human malignant glioma, we adopted positively charged multilamellar liposomes entrapping the human interferon beta (hIFN-beta) gene. One week after the transplantation of human malignant glioma U251-SP cells to produce glioma in nude mouse brain, the liposomes entrapping the gene (500 ng of DNA per 25 nmol of lipids per 2 microl) were injected into the same site of the cell transplantation once every second day for a total of five injections; and by this means the tumor completely disappeared. To confirm the antiproliferative effect of hIFN-beta, we performed an in vitro study using a plasmid containing a secretion signal sequence-deleted hIFN-beta gene and one containing the hIFN-beta gene inserted in reverse. In both cases, there was no hIFN-beta release into the medium and no growth inhibition effect. On addition of anti-hIFN-beta antibody to the medium, the growth inhibition effect was abolished. As this cell line expresses IFN-alpha/beta receptor, the hIFN-beta produced in the transfected cells could be released and acted in a paracrine manner. For 120 days the body weight change of normal mice treated by the same procedure as used in the curing experiment was not significant among the groups injected with empty liposomes, plasmid only, and liposomes entrapping the gene. In all of these three groups, death, abnormal behavior, and significant histological changes were not observed.

[Mandibular tumor with spicule formation in multiple myeloma].

A 40-year-old male complained of swelling of the right mandible. It was a hard bone tumor which was 70 x 50 x 45 mm in size without tenderness. In serum, the level of IgG was 5814 mg/dl, IgA 95 mg/dl and IgM 8 mg/dl with monoclonal increasing of gamma and lambda-chain. No Bence Jones protein was detected. In a bone marrow aspirate atypical plasma cells were 7.3% in nucleated cells in slightly hypocellular marrow. X-ray examination disclosed a spicule formation surrounding the osteolytic focus in the mandible. In addition, a osteolytic tumor without spicule formation was found in a rib. The histological examination of biopsy specimen obtained from the mandibular tumor revealed that atypical plasma cells infiltrated the fibrous tissue with new bone formation. Spicule formation in the bone lesion of multiple myeloma is unusual.

Judgment of gender through facial parts.

Japanese male and female undergraduate students judged the gender of a variety of facial images. These images were combinations of the following facial parts: eyebrows, eyes, nose, mouth, and the face outline (cheek and chin). These parts were extracted from averaged facial images of Japanese males and females aged 18 and 19 years by means of the Facial Image Processing System. The results suggested that, in identifying gender, subjects performed identification on the basis of the eyebrows and the face outline, and both males and females were more likely to identify the faces as those of their own gender. The results are discussed in relation to previous studies, with particular attention paid to the matter of race differences.

Localization of small pulmonary nodules for thoracoscopic resection: use of a newly developed hookwire system.

We developed a stainless steel spring hookwire, 0.28 mm in diameter and 10 mm in length, with a 30-cm-long, 5-0 nylon monofilament suture firmly attached to its funnel-shaped end. A 21-gauge, 10-cm-long cannula was used as an introducer, and a 24-gauge, 10-cm-long blunt-pointed needle as a pusher. The hookwire was successfully placed into the target pulmonary parenchyma under computed tomography guidance in two patients with a small pulmonary nodule. The attached string served as a clear guide at thoracoscopy. Flexibility of the exposed suture through the skin eased wire management after placement. No wire dislodgement occurred.

In vitro and in vivo testing of an implantable motor-driven left ventricular assist device.

A totally implantable motor-driven left ventricular assist device (LVAD) has been developed and tested. The performance of this LVAD was tested in a mock circulatory system. This pump provided 8 L/min of output against a mean afterload of 120 mm Hg with a filling pressure of 20 mm Hg when the pump was operated in the fill/empty mode. The right and left pumps were tested in a mock loop. The right pump afterload was kept in the range from 23-32 mm Hg. With increase in the left pump afterload, the pump power output varied from 1.64 to 2.37 W. The instantaneous motor power input varied from 22.6 to 30.6 W with the total system efficiency ranging from 6.7 to 9.4%. To date, 4 in vivo studies have been conducted for up to 12 h. Two animals survived 12 and 10 h, respectively. Termination was due to bleeding in 1 animal, vent tube obstruction in 1, and respiratory failure in 2. All animals died of technical failure. Another experiment is to be undertaken, and a newly designed cannula is now being manufactured.