Ultrasound-guided antegrade femoral access: comparison between the common femoral artery and the superficial femoral artery.

PURPOSE: The aim of this study was to compare ultrasound-guided access of the superficial femoral artery and the common femoral artery. MATERIAL AND METHODS: 100 patients were randomized to ultrasound-guided access either into the SFA or the CFA. The two groups were compared with respect to technical success, access time and complications. In addition, a subgroup analysis was performed to compare the complication rate using manual compression versus closure devices for haemostasis. RESULTS: In the SFA group 49/50 patients were successfully accessed in the assigned location, compared to 41/50 in the CFA group (p = 0.016). The median access time was significantly faster in the SFA group (3 min 25 s) compared to the CFA group (5 min 26 s) (p < 0.001). The most frequent complications in the SFA group were pseudoaneurysms (16.3%) whereas access site haematomas (14.6%) were the most common complication in the CFA group. However, when looking at subgroup with closure devices there was no difference between the SFA group compared to CFA group (p = 1.000). CONCLUSION: Accessing the SFA was more often successful and significantly faster than puncturing the CFA. The pseudoaneurysm rate was higher in the SFA group when using manual compression, but similar when using closure devices.

Complications following oral piercing. A study among 201 young adults in Strasbourg, France.

OBJECTIVE: This study was designed to identify and quantify the number and type of complications relating to the oral environment following piercing of tissue in the oral sphere. METHODS: The epidemiological survey included patients attending the University of Strasbourg Dental Hospital, students frequenting the University of Strasbourg canteen, and members of the public attending piercing conferences in Strasbourg, France between the months of February and June 2005. No dental examination was performed as part of this survey. RESULTS; 201 people were interviewed in this study. The average subject age was 22.7 years and 73.6% were smokers. Women comprised 72.6% of the sample population. Post-piercing complications occurred in 23.4%, but frequency depended on piercing location in relation to the oral sphere. Gingival recession occurred in 8.5%, and chipped teeth in 6.9% of the group who were aware of complications. Titanium, stainless steel and Teflon were associated with recession in 52.9%, 23.5% and 9%, and chipped teeth in 35.7%, 42.9% and 14.3% of this group respectively. CONCLUSION: The occurrence of complications was high. There is a need for public education and a further study with a dental examination.

Xenon does not induce contracture in human malignant hyperthermia muscle.

Xenon has many characteristics of an ideal anaesthetic agent. It is not known whether xenon is a safe alternative to the potent inhalational anaesthetics in patients susceptible to malignant hyperthermia (MH). We investigated the effect of xenon, halothane and caffeine on muscle specimens of 31 individuals, referred to the MH Unit of the University of Ulm, and performed genetic epidemiology. Thirteen individuals were classified as MH susceptible and 18 as MH negative. Xenon 70% did not cause an increase in baseline tension of any MH-susceptible muscle specimen in contrast to halothane and caffeine. The evoked twitch response increased transiently in MH-susceptible and normal specimens indicating a mechanism independent of MH susceptibility. These results suggest that xenon, in concentrations up to 70% may be a safe anaesthetic for MH-susceptible patients.

Gastrointestinal stenting.

Acute obstructions of the gastric outlet, the duodenum, or the large bowel require rapid treatment to relieve symptoms of retention or ileus. Large-caliber stents of 16 to 22 mm offer a new non-surgical alternative for treating these patients with minimal risks and high success rates. For gastroduodenal outlet obstructions palliated by self-expanded metal stents, clinical success rates are in the range of 80-100 %. Preoperative treatment of colorectal obstructions successfully relieves acute symptoms of ileus in 87-100 % allowing primary anastomosis and thereby reducing the costs caused by multiple operations and the need of intensive care by approximately 25 %. It is the purpose of this review to familiarize the reader with the indications, possibilities, and limits of intestinal stenting.

The prevalence of human thymic lymphoid follicles is lower in suicides.

In an autopsy study we determined the prevalence of thymic lymphoid follicles in 311 accident victims in whom the time interval between accident and death was known. We found that the prevalence decreased abruptly in those surviving 48 h or more (P=0.000008). We then compared the prevalence in 271 accident and 168 suicide victims, all of whom had died less than 48 h after the incident and found that the prevalence was significantly lower in the suicide group (P=0.03). We conclude that this difference may be related to the effect on the thymus of high levels of psychological stress likely to have been experienced by the suicides in the days prior to the act. The use of the term hyperplasia to indicate the presence of lymphoid follicles in the thymus and the methodology appropriate for determining the prevalence of thymic lymphoid follicles are discussed.

Characterisation of a subtype of colorectal cancer combining features of the suppressor and mild mutator pathways.

BACKGROUND: 10% of sporadic colorectal cancers are characterised by a low level of microsatellite instability (MSI-L). These are not thought to differ substantially from microsatelite-stable (MSS) cancers, but MSI-L and MSS cancers are distinguished clinicopathologically and in their spectrum of genetic alterations from cancers showing high level microsatellite instability (MSI-H). AIMS: To study the distribution of molecular alterations in a series of colorectal cancers stratified by DNA microsatellite instability. METHODS: A subset of an unselected series of colorectal cancers was grouped by the finding of DNA MSI at 0 loci (MSS) (n = 51), 1-2 loci (MSI-L) (n = 38) and 3-6 loci (MSI-H) (n = 25). The frequency of K-ras mutation, loss of heterozygosity (LOH) at 5q, 17p and 18q, and patterns of p53 and beta catenin immunohistochemistry was determined in the three groups. RESULTS: MSI-H cancers had a low frequency of K-ras mutation (7%), LOH on chromosomes 5q (0%), 17p (0%) and 18q (12.5%), and a normal pattern of immunostaining for p53 and beta catenin. MSI-L cancers differed from MSS cancers in terms of a higher frequency of K-ras mutation (54% v 27%) (p = 0.01) and lower frequency of 5q LOH (23% v 48%) (p = 0.047). Whereas aberrant beta catenin expression and 5q LOH were concordant (both present or both absent) in 57% of MSS cancers, concordance was observed in only 20% of MSI-L cancers (p = 0.01). CONCLUSIONS: MSI-L colorectal cancers are distinct from both MSI-H and MSS cancers. This subset combines features of the suppressor and mutator pathways, may be more dependent on K-ras than on the APC gene in the early stages of neoplastic evolution, and a proportion may be related histogenetically to the serrated (hyperplastic) polyp.

Angiogenic factor VEGF is decreased in human colorectal neoplasms showing DNA microsatellite instability.

Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are two important determinants of angiogenesis in human cancers. Expression of VEGF and bFGF was examined by immunohistochemistry in 120 colorectal cancers. Neoplasms were classified according to the presence or absence of microsatellite instability determined at six microsatellite loci and labelled as a high microsatellite instability (MSI-H), low microsatellite instability (MSI-L) or microsatellite stable (MSS). Only 4/30 MSI-H cancers expressed VEGF (13 per cent), compared with 24/64 MSS cancers (38 per cent; p< 0.01). Fewer MSI-H cancers showed bFGF expression (38 per cent) than MSS cancers (53 per cent; p< 0.09). MSI-L cancers showed the same pattern as MSS cancers. Western blotting and immunohistochemistry showed that the tumour suppressor gene p53 was mutated infrequently in MSI-H cancers (8 per cent; p< 0. 001). Microvessel density counts using CD31 and UEA-1 demonstrated no difference in the number of blood vessels in MSI-H and MSS cancers. Although these results are consistent with the known role of wild-type p53 in down-regulating VEGF, no association was found between a mutation in p53 and VEGF or bFGF levels in all colonic neoplasms. This is the first evidence that MSI-H cancers may follow a different pathway to angiogenesis. The low frequency of VEGF expression amongst MSI-H cancers may partially explain why these cancers are less aggressive, with a better overall prognosis.

Cell survival or death in renal tubular epithelium after ischemia-reperfusion injury.

A major contributor to the development and progression of ischemia-reperfusion (IR)-induced acute renal failure (ARF) is the loss of functioning tubular epithelial cells by means of various cell deletion or death processes. Although the term "acute tubular necrosis" is still used to describe the pathology of ARF, this is a misnomer because apoptotic cell death, as well as necrosis, occurs [1, 2] along with desquamation and loss of viable epithelial cells [3]. Apoptosis was first described in renal disease in 1987 in an animal model of hydronephrosis [4]. In ARF, with reference to only the death processes, the relative contribution of necrosis or apoptosis possibly depends on the extent of the initiating events. For example, after prolonged total renal ischemia, necrosis or "accidental cell death" occurs from the resultant negation of the cell's energy and protein levels. In apoptosis, the cells use their own energy processes and proteins to die, and often the initiating ischemia is more mild [5]. Finally, despite prolonged ischemia, within the heterogeneous renal cell populations there are those that are more sensitive to ischemia, such as the proximal straight tubule and to some extent the thick ascending limb (TAL) of the loop of Henle. It may be hypothesized that these cells tend to undergo necrosis in comparison with the less sensitive segments that undergo apoptosis. Because apoptosis is gene driven, its identification is important because of the possibility of its modulation via molecular controls. However, despite these new concepts of ARF, patient death remains high, at approximately 30 to 50% of ARF cases. Recovery from ARF depends not only on the replacement or regeneration of cells deleted by death, the theme of many recent studies, but also on protection of cells from death. Both processes are dependent on many of the cellular and molecular controls that have evolved in multicellular organisms to manage normal development, differentiation and growth processes, but that then become involved in the pathogenesis and progression of many renal diseases, including ARF.

Molecular controls of radiation-induced apoptosis in the neonatal rat kidney.

The incidence of cell death due to radiation was examined in a neonatal in vivo model. Differences in the induction of apoptosis, amount of cell proliferation, S-phase cell death, Bcl-2 and p-53 expression could best be explained by the differences in the zonal state of differentiation and development. The present in vivo model may thus be useful in testing radiation therapies for renal cancer.

Embolization of the vasa recta in acute lower gastrointestinal hemorrhage: A report of five cases.

PURPOSE: To present our preliminary experience in embolization of the vasa recta in acute gastrointestinal hemorrhage. METHODS: In four of five patients with acute gastrointestinal hemorrhage superselective embolization of the vasa recta was performed. In one patient in whom superselective catheterization of the bleeding vas rectum was technically impossible, the origin of this vessel was embolized at the level of the terminal arcade. The following embolization materials were used: microcoils and polyvinyl alcohol particles (355-500 microm), n = 2; microcoils only, n = 2; Gelfoam particles, n = 1. RESULTS: Bleeding was found in two patients in the small bowel (jejunum and ileum) and in three patients in the colon. Immediate hemostasis was achieved in all patients. No signs of ischemia or infarction were observed after intervention. CONCLUSIONS: Superselective embolization of the vasa recta proved efficient and safe in our small patient group. Advantages of this technique are reduction of the embolized area to a minimum and direct control of hemostasis.

Expression of Bcl-2 protein is decreased in colorectal adenocarcinomas with microsatellite instability.

Bcl-2 is known to inhibit apoptosis and is thought to play a role in colorectal tumour development. Studies of the promoter region of bcl-2 have indicated the presence of a p53 responsive element which downregulates bcl-2 expression. Since p53 is commonly mutated in colorectal cancers, but rarely in those tumours showing microsatellite instability (MSI), the aim of this study was to examine the relationship of bcl-2 protein expression to MSI, as well as to other clinicopathological and molecular variables, in colorectal adenocarcinomas. Expression of bcl-2 was analysed by immunohistochemistry in 71 colorectal cancers which had been previously assigned to three classes depending upon their levels of MSI. MSI-high tumours demonstrated instability in three or more of six microsatellite markers tested, MSI-low tumours in one or two of six, and MSI-null in none of six. Bcl-2 expression in tumours was quantified independently by two pathologists and assigned to one of five categories, with respect to the number of cells which showed positive staining: 0, up to 5%; 1, 6-25%; 2, 26-50%; 3, 51-75%; and 4, > or =76%. Bcl-2 negative tumours were defined as those with a score of 0. Bcl-2 protein expression was tested for association with clinicopathological stage, differentiation level, tumour site, age, sex, survival, evidence of p53 inactivation and MSI level. A significant association was found between bcl-2 expression and patient survival (P = 0.012, Gehan Wilcoxon test). Further, a significant reciprocal relationship was found between bcl-2 expression and the presence of MSI (P = 0.012, Wilcoxon rank sum test). We conclude that bcl-2 expressing colorectal cancers are more likely to be MSI-null, and to be associated with improved patient survival.

Superselective coil embolization in acute gastrointestinal hemorrhage: personal experience in 10 patients and review of the literature.

PURPOSE: To evaluate the safety and efficiency of microcoil embolization in upper and lower gastrointestinal hemorrhage. PATIENTS AND METHODS: Superselective microcoil embolization was performed in 10 patients (upper gastrointestinal bleeding, n = 3; lower gastrointestinal bleeding, n = 7) who had acute gastrointestinal hemorrhage. Embolization was performed as peripherally as possible with use of coaxial catheter systems. Embolization materials included microcoils (2-4 mm) alone (n = 5), microcoils and polyvinyl alcohol particles (355-500 microm) (n = 4), and microcoils and gelatin sponge particles (n = 1). RESULTS: Immediate hemostasis was achieved in eight patients. In two patients with dual blood supply of the bleeding site, significant reduction of hemorrhage resulted. In these two patients, it was technically impossible to place the coaxial catheter distally enough to allow safe embolization of both feeding vessels. No clinical signs of ischemia or infarction were observed after intervention. CONCLUSION: Microcoil embolization is a safe and efficient procedure for controlling acute lower gastrointestinal bleeding if performed in a superselective catheter position. In upper gastrointestinal bleeding, microcoil embolization is an established treatment and can be performed more proximally.

The prevalence and age distribution of human thymic B lymphoid follicles.

The reported prevalence of B lymphoid follicles in the normal human thymus differs widely between studies. In this histological study we have estimated the prevalence of these follicles, allowing for two factors which we believe may be largely responsible for such differences. One is the effect of stress of more than 48 hours duration, which has been shown to be associated with a decrease in prevalence, and the other is the considerable differences in prevalence found in different age groups. The 639 thymuses in this study were selected from individuals who died less than 48 hours after the onset of their fatal condition. No individuals with autoimmune diseases were included. The study group was divided into age groups to demonstrate the age related variations in prevalence. The follicles were identified by their morphology and by their reactivity with the B lymphoid cell marker L26. No follicles were found in the thymuses of infants in the first year of life. However the prevalence rose rapidly thereafter to a peak of 93% in individuals the first half of the second decade then gradually declined to only 9% in individuals older than 60 years. (The prevalence in young adults being approximately equal to that reported in young adults with autoimmune diseases.) It seems likely therefore that a considerable amount of the variation in prevalence found in previous studies is related to the inclusion in those studies of thymuses modified by stress as well as the grouping together of different age groups with differing naturally occurring prevalences of B lymphoid follicles. We concluded that B lymphoid follicles occur frequently in the thymuses of healthy individuals, that their prevalence varies considerably with age and that their mere presence should not be accorded any pathological significance.

Treatment of pelvic venous spur (May-Thurner syndrome) with self-expanding metallic endoprostheses.

PURPOSE: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. METHODS: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. RESULTS: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. CONCLUSION: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.

Origin of acinar cell regeneration after atrophy of the rat parotid induced by duct obstruction.

Acinar cell regeneration in the rat parotid gland after atrophy induced by a one week period of duct obstruction was examined using histology, immunohistochemistry and transmission electron microscopy (TEM). For immunohistochemistry, antibodies to 5-bromo-2'-deoxyuridine (BrdU), injected one hour before tissue collection, and cytokeratin were employed. When clips were removed from the duct, only ductal epithelial cells remained; all acinar cells had been deleted. Some duct cells were BrdU positive. After three days, newly-formed acini comprising immature acinar cells had appeared; many of the cells were BrdU positive and mitotic figures were readily identified. Thereafter progressive acinar cell maturation and proliferation occurred, parotid gland weight returning to control levels by 7 days. Peak BrdU labelling indices for duct and acinar cells were on days 0 and 4, respectively. By TEM, cytoplasmic organelles in epithelial cells of transitional duct-acinar structures seen at 2 days were poorly developed. Immature acinar cells seen on day 3 contained zymogen granules and had increased endoplasmic reticulum and mitochondria. By day 5, maturing acinar cells had abundant endoplasmic reticulum and zymogen granules, resembling acinar cells in control glands. These observations indicated origin of acinar cell precursors from duct cells during regeneration of the acinar cell-free atrophic gland. Subsequent expansion of the acinar cell population was dependent on maturation and proliferation of these newly-formed cells.

Expression and localization of the retinoblastoma gene during radiation-induced apoptosis in neonatal rat kidney.

An in vivo neonatal rat kidney model was used to study an association between expression and localization of the retinoblastoma tumor-suppressor gene (Rb), or its protein product (pRb), and localization of radiation-induced apoptosis. The rat kidney has two distinct zones of differentiation at birth-an outer nephrogenic zone, in which cells are undifferentiated and new nephrons are forming, and a differentiated zone internal to this zone that has essentially the adult kidney form. At 6 h after radiation (5 Gy), high levels of relatively synchronous apoptosis are induced in the nephrogenic zone, with little effect on the differentiated zone, and proliferation in the nephrogenic zone is almost totally inhibited by radiation treatment, again with little effect in the differentiated area. We have used our knowledge of this model to analyze control (sham-treated) and irradiated renal tissue for Rb mRNA transcript levels and localization (Northern blot and in situ hybridization (ISH)), pRb expression (Western blot and immunolocalization), apoptosis and mitosis (light and electron microscopy, and DNA gel electrophoresis for apoptosis), and cells in S-phase ([3H]thymidine uptake and autoradiography). Northern blots showed no detectable alteration in Rb transcript levels between control and irradiated tissues, whereas Western blots indicated increased expression of pRb in protein extracted from irradiated kidney compared with controls. ISH confirmed that Rb transcripts were not substantially altered in the nephrogenic and differentiated zones in control versus irradiated renal tissue. Immunolocalization of pRb demonstrated little effect in the differentiated zone, but in the nephrogenic zone pRb expression was increased, especially the S-shaped prenephrons, and was also found in many, but not all, apoptotic cells in this zone. The results link radiation-induced apoptosis and increased pRb expression in a zone of the neonatal kidney having a low level of cell differentiation.

Conformational characteristics of alternating stereo-co-oligopeptides of D- and L-norleucine: influence of an N-methyl group.

The conformational behavior of members of the series Boc-(L-Nle)m-(D-Nle-L-Nle)(n-m)/2-OMe (m = 0 or 1; n = total number of residues) with n < or = to 12, and of analogs of comparable chain length having a NMe-group on the (n - 3)th residue has been investigated. The study has shown that D,L-alternating oligonorleucines behave very differently from stereo-co-oligopeptides of D-alloisoleucine and L-isoleucine, D- and L-valine, or D- and L-leucine. In particular, it has been found that oligonorleucines do not form beta-helices as do the other oligopeptides. Instead, they form aggregates (very likely of the alpha-pleated sheet type), which are insoluble in common organic solvents even at moderate chain lengths. In marked contrast with this behavior, N-methylated analogs such as those studied, with n from 9 to 15, cannot generate very stable aggregates owing to the N-methyl group, and they prefer to form beta-helices. These beta-helices have been found by solution 1H NMR techniques to be almost exclusively of the types beta 4.4 (single-stranded with about 4.4 residues per turn) and decreases increases beta 5.6 (double-stranded, antiparallel, with about 5.6 residues per turn).

[Percutaneous transluminal treatment of stenoses and obstructions in the venous system using vascular endoprostheses (stents)]. / Perkutane, transluminale Behandlung von Stenosen und Verschlüssen im venösen System mittels Gefässendoprothesen (Stents).

Benign and malignant obstructions of the superior and inferior V. cava and large central veins are often difficult to treat by conservative and surgical means. In this overview we report a new technique which keeps obstructed veins patent by means of percutaneously-inserted metal endoprostheses. The technique allows rapid and lasting relief of the clinical signs of venous inflow obstruction. The high clinical success rate and longterm patency of 70 to 100% in malignant stenoses, and close to 100% in benign obstruction, makes this technique the method of choice for treating superior and inferior inflow obstructions secondary to diseases of the V. cava and the pelvic and brachiocephalic veins. Patients suffering from malignancies benefit in particular from rapid improvement of their quality of life using an effective method with a low complication rate. Vascular stents may also be used in venous outflow stenosis of hemodialysis shunts. However, because of the high recurrence rate secondary to intimal hyperplasia, particularly in peripheral stenoses in the region of the arm, we recommend a conservative attitude. The use of stents is only indicated after one or more trials with conventional balloon angioplasty.

Bioconversion of alpha-Damascone by Botrytis cinerea.

Bioconversion of alpha-damascone (compound 1) was studied with four strains of Botrytis cinerea in grape must (pH 3.2). As biotransformation products of compound 1, 3-oxo-alpha-damascone, cis- and trans-3-hydroxy-alpha-damascone, gamma-damascenone, 3-oxo-8, 9-dihydro-alpha-damascone, and cis- and trans-3-hydroxy-8,9-dihydro-alpha-damascone were identified. In addition, acid-catalyzed chemical transformation of compound 1 to the diastereomers of 9-hydroxy-8,9-dihydro-alpha-damascone was observed. Identifications were performed by capillary gas chromatography (HRGC) and coupled HRGC techniques, i.e., on-line HRGC-mass spectrometry and HRGC-Fourier transform infrared spectroscopy, after extractive sample preparation.

Possible discoid lupus erythematosus in newborn infant. Report of a case with subsequent development of acute systemic lupus erythematosus in mother.

Cases of a newborn infant with an eruption clinically and histologically consistent with lupus erythematosus and of his mother developing acute disseminate lupus erythematosus 11 months after delivery are presented. It is urged that in the future in cases of death of a fetus of a mother who has lupus erythematosus of any type or who gives a history of this disease, the fetus be examined for stigmata of lupus erythematosus. The possibility of a transmittable etiological agent of lupus erythematosus from mother to fetus is suggested.