[Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up]. / Endovaskuläre Therapie von abdominellen Aortenaneurysmen: Klinisch-radiologische Ergebnisse im mittelfristigen Verlauf.

PURPOSE: Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. MATERIALS AND METHODS: A total of 122 patients (9 females, 113 males, average age 70.9 +/- 7.9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovascular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year. RESULTS: Implantation was successfully completed in all cases without primary conversion surgery, laparotomy, or any significant complication. Mean follow-up was 29 +/- 21 months (maximum 84 months). The 30-day mortality was 0.8 % due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8 %), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n = 11), Wallstents for kinking and limb stenosis (n = 3), and secondary coil embolization of collateral vessels (n = 9). 24 surgical re-interventions included proximal graft extension (n = 6), new endovascular grafts (n = 3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks following ineffective secondary coil embolization (n = 1), and femorofemoral crossover bypasses (n = 4). A total of 10 secondary conversion operations were performed because of damage to the membrane (n = 4; 3 Vanguard endografts, 1 Talent endograft), significant caudal migrations (n = 5; 4 Vanguard endografts, 1 Talent endograft) associated with type-I endoleaks (n = 2), limb occlusion (n = 1), disconnection of graft components (n = 1), and significant endoluminal thrombus deposits (n = 1). One patient, who was followed for 82 months, suffered from a significant endoleak for 10 months with increasing aneurysm diameter but he refused surgery. He was admitted with aneurysm perforation and was successfully operated with aortic graft replacement. Compared to group II, the incidence and size of endoleaks was reduced in group I (incidence 19.2 % versus 29.9 %, p < 0.05). Group I demonstrated significantly better aneurysm shrinkage at 36 months follow-up (Delta sagittal diameter - 11.1 +/- 8.4 mm versus - 4.9 +/- 6.2 mm, p < 0.05). CONCLUSION: In selected patients, endovascular aneurysm treatment is an effective alternative to open surgery. It is safely performed in local anesthesia with low mortality rate and a low number of acute complications. Intermediate follow-up revealed re-interventions in around one quarer of all patients, especially when Vanguard or Stentor endografts were implanted. Primary coil embolization of all aortic branches prior to endovascular grafting improves clinical outcome. Insufficient proximal fixation and its consecutive complications remains a major problem of this method.

A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis.

OBJECTIVE: To examine the efficacy of chondroitin sulfate (CS) in the treatment of osteoarthritis (OA) on the basis of a metaanalysis of controlled clinical trials. METHODS: After personal, Medline, and Embase searches, a decision tree analysis of the available publications was performed, with respect to types of joint involvement studied, study designs, numbers of patients enrolled, and variables analyzed. The Lequesne index and pain rating on visual analog scale (VAS) were considered the main variables. Of a total of 16 publications found, 7 trials of 372 patients taking CS could be enrolled into the metaanalysis. Although all selected studies claimed to be randomized, double blind designs in parallel groups, it should be noted that CS was given along with analgesics or nonsteroidal antiiflammatory drugs, making required dosage of comedication an important factor. RESULTS: Following patients to 120 or more days, CS was shown to be significantly superior to placebo with respect to the Lequesne index and pain VAS. Pooled data confirmed these results and showed at least 50% improvement in the study variables in the CS group compared to placebo. CONCLUSION: CS may be useful in OA, but further investigations in larger cohorts of patients for longer time periods are needed to prove its usefulness as a symptom modifying drug in OA.

Three experimental measures of a digital beamforming signal processing algorithm.

Three studies were conducted to evaluate a prototype nonlinear digital beamforming hearing aid. The experiments all used contextually rich speech materials and subjective analysis methods and, on that basis, are grouped together in this report. In experiment 1, the beamforming was done off line and subjects wore their own hearing aids in an attempt to determine whether the processing reduced the interference of noise jammers. In experiments 2 and 3, subjects used portable, head-worn, real-time devices. The results of these experiments showed improvements in perceived ease of speech understanding for these types of subjective measures and lend encouragement to further development of this type of binaural hearing aid. Additional work is also required to develop methods of physically characterizing the nonlinear directional properties of the algorithms.

Folic acid and cyanocobalamin levels in serum and erythrocytes during low-dose methotrexate therapy of rheumatoid arthritis and psoriatic arthritis patients.

OBJECTIVE: To compare folic acid (FA) levels in patients being treated with methotrexate (MTX) with those of untreated patients in order to investigate potential folate depletion by MTX and its possible relationship to the drug's efficacy. METHODS: In 33 patients on low-dose MTX therapy and in 24 controls, FA and cyanocobalamin (B12) levels were determined in serum and red blood cells (RBC). In addition, MTX levels in the RBC and serum were measured, and clinical and laboratory measures of disease activity were evaluated. RESULTS: MTX treated patients had lower FA levels than controls (median 4.36 vs 7.37 ng/ml, p < 0.001). A significant correlation between serum FA and MTX/RBC (p < 0.01) and between the weekly dose and MTX/RBC (p < 0.01) was seen. There was apparently no correlation between FA and the cumulative total MTX. MTX patients had lower B12/RBC levels than the controls (p < 0.001); the serum levels of B12 were not different. Clinical features, ESR and CRP did not correlate with FA, B12 or MTX levels. CONCLUSIONS: The degree of folate depletion during MTX therapy depends primarily upon the weekly administered dose. Folate depletion may be related to B12 deficiency in RBC. Since FA levels were not related to parameters of disease activity it is conceivable that MTX does not exert its action in RA primarily by inhibiting dihydrofolatereductase. Therefore, additional folate compounds, if necessary, should not lead to a reduction in the efficacy of MTX.

Autoantibody to the nuclear antigen RA33: a marker for early rheumatoid arthritis.

Sera from 47 patients with early (< 3 months) arthritis of any type were investigated for anti-RA33, a new anti-nuclear autoantibody characteristic of RA, and the diagnoses determined within the following 8-14 months. In addition, seven patients with unclassified arthritis of > 4 months duration, who were all anti-RA33 positive, were followed for up to 2 years to establish their final rheumatologic diagnoses. Four of 47 early arthritis patients' sera were anti-RA33 positive at the initial evaluation; 14 of these 47 patients (30%) could be classified as RA (according to established criteria) at the final evaluation. All four anti-RA33 positive patients belonged to the RA group (27% of RA patients); of the 33 non-RA patients none had anti-RA33 (P = 0.005). Rheumatoid factor was found in four RA (none of whom had anti-RA33), but also in two non-RA patients (P = 0.05). Finally, the study involved seven additional patients with longer standing, initially unclassified, anti-RA33 positive arthritis: in all of them a diagnosis of RA could be established within 3 years of disease onset. These results suggest that anti-RA33 helps to discriminate early RA from other forms of early arthritis and, in the absence of an established diagnoses, it is predictive of RA. Its discriminative capacity appears to be better than and complementary to that of RF.

Aberrant MN bloodgroup inheritance in a German family: a 'silent' allele?

By means of extensive serogenetic testing of a family, RFLP analysis and biostatistic evaluation we present evidence for the rare transmittance of a 'silent' information at the MN blood group locus in a Caucasian family.

Myocardial fatty acid metabolism after acute ethanol consumption.

This study was undertaken to assess the effect of ethanol ingestion on myocardial fatty acid metabolism in man. Nine individuals with informed consent and with a habitual ethanol consumption of approximately 40 g per day, but without any clinical signs of heart and metabolic disease, were examined after i.v. injection of omega-123I-heptadecanoic acid (IHA). Eight days later, these individuals were similarly examined after 2 h of continuous ingestion of a body weight dependent amount of ethanol, which was calculated to produce a blood level of 100 mg per 100 ml (1%). Then the subjects had been asked to reduce their ethanol consumption rigorously for 15 months. Subsequently after 2 weeks of abstinence a follow-up investigation without ethanol loading was carried out. The investigations were performed with an Anger scintillation camera in LAO-45 degrees projection. The measurement period was 40 min. Tracer accumulation and regional elimination half-times of IHA were analysed. In all patients, acute ethanol loading produced significant changes in pattern of accumulation and/or regional elimination half-times. Ethanol-induced alterations in segmental accumulation did not appear to be predictably correlated with changes in segmental elimination half-times. After rigorous reduction of ethanol consumption followed by 2 weeks of abstinence a normalization of the tracer uptake was observed; the distribution pattern was almost homogeneous. Also the regional elimination half-times became normal. The data demonstrate the significant effects of both chronic ethanol consumption and particularly acute ethanol loading on myocardial fatty acid metabolism and the reversibility of the effects.

Extended polymorphism of the human esterase D isozyme system: description of a "new" allele EsD*11.

Using "new" techniques (malic acid thin layer agarose gel electrophoresis and/or isoelectric focusing), the polymorphism of the human red cell isozyme system esterase D (ESD) was shown to be extended. We report the gene frequencies observed among 312 unrelated Caucasian individuals living in the Düsseldorf area. The finding of a "new" allele at the ESD locus is also described.

[Keratoplasty for severe lagophthalmic keratitis in patients with long-term artificial respiration]. / Keratoplastik wegen schwerer Keratitis e lagophthalmo bei Langzeitbeatmeten.

The authors report on 2 patients who developed dense opacities of the thinned cornea during long-term unconsciousness under intensive care, due to insufficient care of the cornea in the case of lagophthalmic keratitis. Although the keratoplasty performed was finally successful, postoperative treatment was very difficult, because the very thin host cornea made re-suturing necessary. The authors recommend using a donor graft 0.2 to 0.3 mm larger in such cases. In order to prevent a keratitis with subsequent corneal opacities. It is very important to instruct the nursing staff to take care to apply eye ointments regularly in unconscious patients with lagophthalmus.

"New" phenotypes in the human red cell isozyme system ADA.

Two rare ADA phenotypes were observed in a German mother and her child. These phenotypes may be due to the allele ADA *9 previously found in Bulgaria.

Evidence for a "new" allele at the phosphoglycolate phosphatase locus.

An obviously new phosphoglycolate phosphatase (PGP) gene product (PGP Sumatra) was detected by use of horizontal starch gel electrophoresis (SGE). The observed phenotype PGP (1-Sumatra) can be distinguished from any known PGP type.

[Possible common partial antigens in human Ig allotype structure and ubiquitous bacteria, studied with the example of Escherichia coli]. / Zur Frage einer möglichen Partialantigen-Gemeinschaft zwischen der menschlichen Ig-Allotyp-Struktur und ubiquitären Keimen, untersucht am Beispiel von Escherichia coli.

As can be learned from the literature, bovine serum may contain antibodies directed against human immunoglobulin allotypes. This gave rise to the question of what the origin of those antibodies is. We tested bacteria (E. coli) by means of the haemagglutination inhibition assay, which is used to type either Gm or Km factors. Anti-G1m(2) and anti-G3m(10)-specific antibodies were inhibited by the bacteria in a clear-cut manner, as was anti-Km(1), albeit less significantly. In contrast, the bacteria tested almost totally failed to inhibit anti-G3m(21) serum. The results lead to the assumption that E. coli may carry both Gm- and Km-like antigenic structures, which are presumably the antigenic material leading to immunization of cattle. Furthermore, new attention is drawn to a mechanism for immunization which is discussed regarding the genesis of either AB0 isoagglutinins in man or other "naturally occurring" antibodies.

Failure to detect antihuman-immunoglobulinallotype-active antibodies in diagnostic sera directed against some enterobacteria.

Diagnostic sera to determine antigenic properties of bacteria were tested to clarify the question whether these sera also contain antibodies being active against human immunoglobulin allotypes. Sera directed against various strains of Escherichia coli, Salmonella, and Shigella were found to be negative for anti-Ig-allotype activity.

[Detection of Gm, Km, and EsD phenotypes in the dental pulp of human cadavers ]. / Gm-, Km- und EsD-Bestimmungen an der Zahnpulpa menschlicher Leichen.

Dental pulps of human cadavers (some of them putrefied) were investigated to determine the immunoglobulin markers G1m(1,2,3), G3m(5,10,21), Km(1), and the isozyme EsD. Reliable results were obtained in the Gm and Km typings, also in putrefied or skeletonized cadavers. EsD typings revealed that the phenotypes EsD(1) and EsD(2-1) are expressed in the dental pulp and can also be detected there in putrefied cadavers.