Pharmacological thrombolysis in Budd Chiari syndrome: a single centre experience and review of the literature.

BACKGROUND/AIMS: To review our experience of thrombolytic therapy in patients with acute Budd Chiari syndrome (BCS). METHODS: Records of 10 patients with BCS, treated by thrombolysis over a 12-year period were retrospectively analysed for demographics, clinical presentation/duration, primary disease, thrombolytic regimen, and follow-up. The same characteristics were also studied in previously reported patients. The agent used was recombinant tissue plasminogen activator (tPA) in all patients. RESULTS: Thrombolysis was used 12 times in 10 patients. Infusion was made systemically in three patients, into the hepatic artery in one patient, locally into a hepatic vein and/or IVC in four patients and locally within TIPS/portal vein in two patients. Only one infusion made systemically was partially successful. Adjunctive balloon angioplasty and/or stent insertion was undertaken for all eight procedures (in six patients) where local infusion was into the hepatic vein or TIPS. Six of these were ultimately successful (in five patients) and two were unsuccessful. Thrombolysis was more likely to be successful in the presence of a short history of thrombosis, when the thrombolytic agent was locally infused and when it was combined with a successful radiological procedure. Mean follow-up was 4.5 years (range 1-10 years). No serious bleeding complication occurred. CONCLUSIONS: We observed no benefit from thrombolysis when delivered systemically or arterially except in one case. Thrombolysis was useful in adjunctive management of BCS when the drug was infused locally into recently thrombosed veins that had appreciable flow following partial recanalisation. Thrombolysis was clearly of benefit in the repermeation of occluded/partially occluded hepatic veins/TIPS when early detection of new thrombus followed interventional procedures such as balloon angioplasty or stenting of hepatic veins.

Cell adhesion molecule expression in cultured human iris endothelial cells.

PURPOSE: To develop a method to isolate human iris microvascular endothelial cells (HIECs) for exploring their constitutive and inflammatory agent-modulated expression of intercellular adhesion molecules (ICAM)-1 and -2, vascular cell adhesion molecule (VCAM)-1, and E-selectin. METHODS: Endothelial cells from collagenase-digested irises were isolated on the basis of their expression of platelet endothelial cell adhesion molecule (PECAM)-1, using antibody-coupled magnetic beads. Cells were characterized as endothelial based on morphologic criteria, their expression of PECAM-1 and von Willebrand factor, their uptake of acetylated low-density lipoprotein, and their ability to form capillary-like networks on a synthetic basement membrane. Constitutive and inflammatory agent-modulated expression of ICAM-1 and -2, VCAM-1, and E-selectin was evaluated by the reverse transcription-polymerase chain reaction, enzyme-linked immunocellular assays (ELICAs), Western blot analysis, and functional studies of leukocyte adhesion to HIEC monolayers. RESULTS: HIECs constitutively expressed mRNA and protein for ICAM-1 and -2, but only low to nondetectable levels of VCAM-1 or E-selectin. When stimulated with endotoxin- or tumor necrosis factor (TNF)-alpha, ICAM-1, VCAM-1, and E-selectin were potently and time- and dose-dependently upregulated at both the message and protein levels. By contrast, ICAM-2 message and protein were slowly downregulated by inflammatory agents over time, but nonetheless remained present and functional. Overall, cytokine- or endotoxin-activation of HIECs resulted in enhanced adhesiveness for leukocytes. CONCLUSIONS: ICAM-1, VCAM-1, and E-selectin have been previously implicated in mediating anterior ocular inflammation. This is a report of the selective isolation of HIECs, with a demonstration of differential expression and regulation of these adhesion molecules in them. In addition, this is the first demonstration of the regulated expression of ICAM-2 in any ocular microvascular cells.

A prospective analysis of 4,041 consecutive cases in a West Indian accident and emergency department - abstract

Information on arrival, attendance and discharge times, age, sex, diagnoses, outcome, trauma classification and procedures and investigations performed was recorded in a specially designed form in 4,041 consecutive cases attending the Port-of-Spain General Hospital Accident & Emergency (A & E) department over a two-week period and was prospectively analyzed; 468 patients were referred to health centres, 1, 397 (35 percent) were admitted, and 2,171 (54 percent) were seen and discharged; 83 percent of all cases were seen without prior referral. The average time before being seen by a doctor was 31 minutes and the maximum period spent by any patient (admission - discharge) was 5 hours and 42 minutes. Medical procedures (adult and paediatric), general and orthopaedic surgery accounted for 78.4 percent of all cases. The most commonly encountered diagnoses in these specialities were asthma, lacerations and upper limb fractures. Based on these findings, the efficiency of the A & E department may be improved by increasing screening at the primary care level, training A & E officers in high-volume specialities, supplementing casualty staff with a paediatrician during peak hours and providing 'ensuite' plaster room for minor orthopaedi trauma (AU)

Multiple channel interferometer for metrology.

A multiple channel interferometer was developed and used for the remote monitoring of the dynamic behavior of a large-diameter antenna experiencing simulated solar irradiance in a space simulation chamber. Reversible fringe-counting techniques were employed to measure changes in the distance between the equipment located outside the chamber and each of seven optical retroreflectors mounted on the face of the antenna. After the initial measurement program was completed, the equipment was modified to improve its performance.