Effects of level and form of dietary zinc on dairy cow performance and health.

A basal mixed ration supplying 36 mg of Zn/kg of dry matter (DM) was supplemented with 1 of 4 concentrates differing in level and form of dietary Zn. The concentrates were fed at 2 kg/cow per day and contained 300 mg of Zn/kg (to supply the total recommended level, according to NRC (2001); R) or 60 mg of Zn/kg (to supply 0.66 of the total recommended level; L), either supplemented as ZnO (I) or organically chelated Zn (O). Forty-four Holstein-Friesian dairy cows (12 primiparous and 32 multiparous), on average 31 d (SD +/- 11.4) into lactation, were allocated to 1 of the 4 treatments. All cows remained on the treatment for 14 wk. The data was analyzed by ANOVA as a 2 x 2 factorial design. Dry matter intake averaged 23.5 kg/d and did not differ between treatments. Cows supplemented with organically chelated Zn at the recommended level of inclusion (RO) had a higher milk yield (37.6 kg/d) than those fed inorganic Zn at the recommended level (RI; 35.2 kg/d) or organically chelated Zn at the low level (LO; 35.2 kg/d), but was not different from those fed inorganic Zn at the low level (LI; 36.0 kg/d). Milk composition was unaffected by dietary treatment. Animals that received the low level of Zn (LI and LO) had higher somatic cell counts [3.97 and 3.93 versus 4.35 and 4.55 (log(e)) for RI, RO, LI, and LO, respectively] and milk amyloid A levels than those receiving the recommended levels (RO and RI). There was no effect of treatment on body condition score, body weight, or locomotion score. Hoof hardness improved over the duration of the study but there were no differences between treatments. Similarly, blood plasma mineral levels for Zn, Cu, Mo, and Fe were not affected by treatment, whereas there was a trend for increased ceruloplasmin levels in cows receiving the recommended compared with the low level of Zn, but there was no effect of mineral form. There was also no effect of treatment on superoxide dismutase activity or blood hematology. It is concluded that supplementing Zn at the recommended level reduced somatic cell counts and milk amyloid A levels, whereas supplementation in an organic form at the recommended level also increased milk yield.

Endoscopic gastroenteric anastomosis using magnets.

BACKGROUND: Current management of malignant obstruction of the upper digestive tract includes surgical gastrointestinal bypass or endoscopic insertion of self-expandable metal stents. The safety, efficacy, and long-term patency rates of anastomoses created using the novel technique of endoscopic gastroenteric anastomosis using magnets (EGAM) are evaluated in this study. PATIENTS AND METHODS: 15 patients (13 men, 2 women; mean age 64.5 years) with malignant obstruction, who underwent EGAM and had monthly follow-up between December 2001 and May 2003, were included in this study. RESULTS: The procedure was successful in 13 patients (88.66 %). The mean survival was 5.23 months. There were four minor complications (30.76 %) during the follow-up period. CONCLUSION: Our results demonstrate the feasibility, safety. and efficacy of this technique for creating a gastroenteric anastomosis. The success rate was 86.6 %, there were no immediate complications, and there was no mortality related to the procedure.

[Retrospective study of 130 patients with organconfined prostate cancer treated with brachytherapy]. / Estudio retrospectivo de 130 pacientes con cáncer prostático organoconfinado tratados con braquiterapia prostática.

INTRODUCTION: The prostate brachytherapy with I 125 seeds has an indication in patients with organconfined prostate cancer. Our objective is to describe the population treated in our institution with permanent I125 seeds implants, the dosimetric characteristics of the technique and the preliminary results of our group-study in terms of evolution and toxicity. MATERIAL AND METHODS: Between May 2000 and March 2003, 130 patients with permanent implants of I125 seeds were treated. Beforehand we did prostate volumetric with transrectum prostate echography in order to assess the configuration of the implant, number of seeds and their place in the prostate with the objective to get a fine coverage of PTV (planet target volume). Stage distribution: 75.72% T1c; 24.28% T2a; Gleason<6, 94%. The PSA pretreatment average was 6.38 ng/ml. The average prostate volume was 30 cc. The 16.67% of the patients included had hormonal treatment previously to get the implants. The average age was 64 years. The characteristic techniques of the implants were: the average width of the needle as 24 (14-35) and the average of the seeds 76 (46-111). Finally the average activity was 0.39 mCi/seed, which means average total implant activity of 80 mCi. RESULTS: We analyzed 130 patients with average follow up 6 months. A 1 to 2 year surveillance was carried out on 98.9% and the global free disease surveillance (biochemic relapse) of 98.9% at the year and of the 87.8% at the end of the 2 years. The relapse in the low risk patients was 98.8% after the first year and 88.7% at the end of 2 year. On the contrary in the middle risk was of 100% and 83% respectively, although the amount of patients in significantly less. As a relevant acute secondary effects we found slight rectitys or GI (RTOG scale) in 1.4 and that needs synthomatic medication or GII (RTOG scale) in 0.8%. We found slide hematuria or GI (RTOG scale) in the 53% and other measures or GII (RTOG scale) in the 2.64% was needed. Finally we had to set a urinary prove for acute retention in 4.3%. CONCLUSION: The prostate brachyterapy is a complex procedure that needs a multidisciplinary team participation in order to be able to carry out. It avoids a long term hospitalization and allows for the patient to have daily activity within a short period of time. Despite the fact of the brief follow-up, the results over biochemical relapse and toxicity were similar to the ones in the literature. Tolerance to the implant was good. It would necessary a longer follow-up in order to be able to come to long term conclusions.

Estudio retrospectivo de 130 pacientes con cáncer prostático organoconfinado tratados con braquiterapia prostática / Retrospective study of 130 patients with organconfined prostate cancer trated with brachitherapy

Introducción: La braquiterapia prostática con semillas de I125 está indicada en pacientes con cáncer de próstata organoconfinado. Nuestro objetivo es describir la población tratada en nuestra institución mediante implante permanente con semillas de I125, las características dosimétricas de la técnica y los resultados preliminares de nuestra serie en cuanto a evolución y toxicidad. Material y métodos: Entre mayo 2000 y marzo de 2003 fueron tratados 130 pacientes con implante permanente transperineal de semillas de I125. Previamente a todos se les realizó volumetría mediante una ecografía prostática transrectal para determinar la configuración del implante, número de semillas y su localización en la próstata con el fin de obtener una adecuada cobertura del PTV (planed target volume o volumen planificado para tratar). Distribución por estadios: 75,72% T1c; 24,28% T2a. Gleason < 6, 94,24%. La mediana del PSA pretratamiento 6,38 ng/ml. El volumen prostático mediano fue de 30 cc. El 16,67% de los pacientes cuando los recibimos llevaban tratamiento hormonal previo al implante. La edad mediana fue de 64 años. En cuanto a las características técnicas de los implantes: la mediana de agujas utilizadas fue de 24 (14-35), y la mediana de semillas: 76 (46-111). Finalmente la mediana de la actividad fue de 0,39mCi/semilla, lo que supuso una actividad total implantada media de 80 mCi. Resultados: Analizamos los 130 pacientes con un seguimiento mínimo de 6 meses. La supervivencia a 1 y 2 años fue del 99,1% y la supervivencia libre de enfermedad global del 98,9% al año y del 87,8% a los dos años La supervivencia libre de enfermedad bioquímica en los pacientes de bajo riesgo eran, al año de 98,8% y a los dos años del 88,7%. Por el contrario en los de riesgo intermedio eran del 100% y del 83,3% respectivamente, aunque el número de pacientes es significativamente menor. Como efectos secundarios agudos relevantes encontramos rectitis leve o GI (escala de la RTOG) en 1,4% y que necesitó medicación sintomática o GII (escala de la RTOG) en 0,8%. Se presentó hematuria leve o GI (escala de la RTOG) el 53%, y que precisaran otras medidas o GII (escala de la RTOG) en el 2,64%. Finalmente hubo que colocar sonda urinaria por retención aguda el 4,3%. Conclusión: La braquiterapia prostática es un procedimiento complejo que exige la participación de un equipo multidisciplinar en su realización. Evita una hospitalización prolongada y permite al paciente recuperar sus actividades cotidianas en un periodo corto de tiempo. Aunque la media de seguimiento es corta, los resultados en cuanto a supervivencia libre de recidiva bioquímica y toxicidad son comparables a los descritos en la literatura. La tolerancia al implante ha sido buena. Es necesario un mayor seguimiento para poder establecer conclusiones a largo plazo

Introduction: The prostate brachitherapy with I 125 seeds has an indication in patients with organconfined prostate cancer. Our objective is to describe the population trated in our institution with permanent I125 seeds implants, the dosimetric characteristics of the technique and the preliminary results of our group-study in terms of evolution and toxicity. Material and methods: Between May 2000 and March 2003, a 130 patients with permanent implants of I125 seeds were trated. Beforehand we did prostate volumetric with transrectum prostate ecography in order to asses the configuration of the implant, number of seeds and their place in the prostate with the objective to get a fine coverage of PTV (planet target volume). Stage distribution: 75.72% T1c; 24.28% T2a. Gleason<6, 94%. The PSA pretreatment average was 6.38 ng/ml. The average prostate volume was 30 cc. The 16.67% of the patients included had hormonal treatment previously to get the implants. The average age was 64 years. The characteristic techniques of the implants were: the average width of the needle as 24 (14-35) and the average of the seeds 76 (46-111). Finally the average activity was 0.39 mCi/seed, wic means average total implant activity of 80 mCi. Results: We analized 130 patients with average follow up 6 months. A 1 to 2 year surveillance was carried out on 98.9% and the global free disease surveillance (biochemic relapse) of 98.9% at the year and of the 87.8% at the end of the 2 years. The relapse in the low risk patients was, 98.8% after the first year and 88.7% at the end of 2 year. On the contrary in the middle risk was of 100% and 83% respectively, although the amount of patients in significantly less. As a relevant acute secondary effects we found slight rectitys or GI (RTOG scale) in 1.4 and that needs synthomatic medication or GII (RTOG scale) in 0.8%. We found slide hematuria or GI (RTOG scale) in the 53% and other measures or GII (RTOG scale) in the 2.64% was needed. Finally we had to set a urinary prove for acute retention in 4.3%. Conclusion: The prostate brachiterapy is a complex procedure that needs a multidisciplinary team participation in order to be able to carry out. It aboids a long term hospitalitzation and allows for the patient to have daily activity within a short period of time. Despite the fact of the brief follow-up, the results over biochemical relaps and toxicity were similars to the ones in the literature. Tolerance to the implant was good. It would necessary a longer follow-up in order to be able to come to long term conclusions

Providing letters and audiotapes to supplement a prenatal diagnostic consultation: effects on later distress and recall.

OBJECTIVES: Information provided at a mid-trimester fetal scan aims to improve patients' knowledge and minimize anxiety. This randomized controlled trial conducted at the Fetal Medicine Centre at Birmingham Women's Hospital aimed to assess the relative value of providing 1.standard information: a consultation and computer-generated ultrasound report (n = 29); 2.standard information plus a post scan written non-technical letter (n = 29); 3.standard information plus audiotapes of the consultation (n = 29); 4.standard information plus both non-technical letters and audiotapes (n = 30). It also aimed at exploring whether severity of diagnosis (none; mild; moderate-severe) interacted with the type of information provided to affect subsequent anxiety, depression and recall of information. PARTICIPANTS: Women (n = 550) referred with suspected fetal anomalies (without a previous history of anomaly or known psychiatric illness) were sent information regarding this study. One hundred and seventeen women consented and were randomly assigned to one of four information groups. The groups were similar with regard to age, education and marital status. MAIN OUTCOME MEASURES: State anxiety and depression were evaluated with the self-report State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) prior to consultation and two weeks post-scan. A structured telephone interview assessed recall of information approximately two weeks later. RESULTS: Two weeks after the initial consultation, women who received an audiotaped recording of the consultation reported significantly less anxiety than the control group (mean STAI 41.44 [95% CI 35.63-47.26] versus 44.92 [39.32-50.52]; difference = 10.70 [3.56-17.83], p < 0.01). Women who received a non-technical letter also reported less anxiety than the control group, an effect that approached significance (mean STAI 39.08 [95% CI 32.85-45.30]; difference = 6.48 [0.21-13.16], p = 0.058). There were no differences between the information groups on depression scores or recall of information. Women with a more severe abnormality reported higher anxiety and depression two weeks post-consultation, and had greater free recall but less cued recall of information. CONCLUSIONS: Provision of additional material (particularly an audiotape) following a prenatal scan appears to minimise anxiety compared with standard practice. Provision of audiotapes and non-technical letters do not appear to affect patient recall.

[Results of Iodine-125 radiotherapy in the treatment of uveal melanoma]. / Resultados de la radioterapia con placas de Iodo-125 en el tratamiento del melanoma de úvea.

PURPOSE: To evaluate our experience in the treatment of uveal melanoma by means of Iodine-125 brachytherapy. A reprospective case series study. MATERIAL AND METHOD: Patients diagnosed of uveal melanoma and treated with Iodine-125 brachytherapy in the Ciudad Sanitaria y Universitaria de Bellvitge (CDUV), from September 1996 to December 2000 and follow up of more than one year. RESULTS: During the period of study, 145 patients were diagnosed of uveal melanoma, of which, 77 were treated with Iodine-125 COMS type plaques; among these, 58 were elegible for this study. After a mean of 2.4 year follow up period (878 days) a mean reduction in height of 53.84% and a mean reduction in volume of 75.88% was observed. As for visual acuity, 32.7% of patients presented a vision of 0.1 or better in last follow up check; 13.5% presented low vision at the moment of diagnosis and continued the same up to last follow up check. The rest of patients experienced loss which conditioned vision to less than 0.1. As for complications, we have observed transient diplopia (8.6%), cataract (3.4%), vitreous bleeding (10.3%), neovascular glaucoma (6.8%), radiation retinopathy (17.24%), radiation neuropathy (6.8%), posterior scleritis (2%), pigmental scattering (2%), tumor progression (2%), endophtalmitis (2). Secondary enucleations were carried out in 6.8% of patients. Metastatic disease was observed in 15.5% of the patients. CONCLUSIONS: Brachytherapy with Iodine-125 may induce significant regression in most of patients affected of uveal melanoma, with good preservation of visual acuity and a low rate of complications.

Resultados de la radioterapia con placas de iodo-125 en el tratamiento del melanoma de úvea / Results of iodine-125 radiotherapy in the treatment of uveal melanoma

Objetivo: Evaluar nuestra experiencia en el tratamiento del melanoma maligno de úvea mediante braquiterapia con Iodo-125.Diseño: Estudio retrospectivo de una serie de casos. Material y métodos: Pacientes diagnosticados de melanoma de úvea y tratados mediante braquiterapia con Iodo-125 en la Ciudad Sanitaria y Universitaria de Bellvitge (CSUB), desde septiembre del 1996 hasta diciembre del 2000, y con un seguimiento superior a un año. Resultados: Durante el período de estudio hemos diagnosticado 145 pacientes de melanoma de úvea, de los cuales 77 fueron tratados mediante placas radioactivas tipo COMS cargadas con Iodo-125, de los cuales 58 eran elegibles para el estudio. Con un seguimiento medio de 2,4 años (878 días), se ha constatado una reducción media del grosor tumoral inicial de un 53,84 por ciento y una reducción media del volumen tumoral de un 75,88 por ciento. n cuanto a la agudeza visual, el 32,7 por ciento de los pacientes presentaban una visión en su último seguimiento igual o mejor a 0,1; el 13,5 por ciento presentaban una baja visión en el momento del diagnóstico y continuaban con ella en el último seguimiento; y el resto de los pacientes habían experimentado una pérdida que les condicionaba una visión inferior a 0,1.En cuanto a las complicaciones hemos observado, diplopía transitoria (8,6 por ciento), cataratas (3,4 por ciento), hemovítreo (10,3 por ciento), glaucoma neovascular (6,8 por ciento), retinopatía por radiación (17,24 por ciento), neuropatía por radiación (6,8 por ciento), escleritis posterior (2 por ciento), dispersión pigmentaria (2 por ciento), progresión tumoral (3,4 por ciento), endoftalmitis (2 por ciento).Se ha realizado enucleación secundaria en el 6,8 por ciento. Hemos observado la aparición de metástasis en el 15,5 por ciento de pacientes. Conclusiones: La braquiterapia con Iodo-125, es capaz de inducir una regresión significativa en la mayoría de pacientes portadores de un melanoma maligno de úvea, con buena preservación de su agudeza visual, y con índices de morbilidad bajos (AU)

Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival.

PURPOSE: To identify clinical and technical factors influencing the outcome of transcatheter embolotherapy for nonvariceal upper gastrointestinal (GI) hemorrhage and to quantify the impact of successful intervention on patient survival. MATERIALS AND METHODS: A retrospective review was performed of all patients (n = 163) who underwent arterial embolization for acute upper GI hemorrhage at a university hospital over an 11.5-year period. Clinical success was defined as target area devascularization that resulted in the clinical cessation of bleeding and stabilization of hemoglobin level. The clinical condition of each patient at intervention was defined by history, laboratory examination, and two composite indicator variables. With use of logistic regression, the dependent variable, clinical success, was modeled on two categories of clinical and technical variables. A final model regressed patient survival on clinical success and other clinical variables. RESULTS: None of the procedural variables analyzed had a significant influence on clinical success. Several clinical variables did impact clinical success, including multiorgan system failure (OR, 0.36; P =.030), coagulopathy (OR, 0.36; P =.026), and bleeding subsequent to trauma (OR, 7.1; P =.040) or invasive procedures (OR, 6.5; P =.009). Regardless of their clinical condition at intervention, patients who underwent clinically successful embolization were 13.3 times more likely to survive than those who had an unsuccessful procedure (CI, 4.54-39.2; P =.000). Nevertheless, patients with multiorgan system failure were 17.5 times more likely to die, independent of the outcome of the procedure (CI, 0.014-0.229; P =.000). CONCLUSION: Arresting nonvariceal upper GI hemorrhage with transcatheter embolotherapy has a large positive effect on patient survival, independent of clinical condition or demonstrable extravasation at intervention. Aggressive treatment with transcatheter embolotherapy is advisable in patients with acute nonvariceal upper GI hemorrhage.

A new twist on the Waltman loop for uterine fibroid embolization.

The usual ipsilateral approach for uterine artery embolization is to form a Waltman loop. Newer nonbraided 4-F catheters can be problematic because of their tendency to kink or unfold while the loop is being formed. Herein, a modification of the Cope suture technique is described by which a Waltman loop is formed with use of a 4-0 Tevdek suture that allows the catheter to be folded back on itself, drawing it into the ipsilateral iliac artery. If necessary, the catheter can be prevented from unlooping by twisting the catheter on itself to lock it in position. The technique allows for efficient catheterization of the ipsilateral uterine artery.

Long-term patency of experimental magnetic compression gastroenteric anastomoses achieved with covered stents.

BACKGROUND: Our aim was to evaluate the efficacy of a prototype "YO-YO"-shaped covered stent for keeping experimental magnetic compression gastroenteric fistulas patent for 6 months. METHODS: Magnets were introduced perorally with endoscopic and fluoroscopic guidance and were mated across the gastric and jejunal walls of 5 dogs. After a mean of 5.5 days a 12-mm diameter YO-YO stent was placed perorally in the resulting fistula. The gastroenteric anastomosis (GEA) with stent was observed endoscopically and gastrographically at 1- to 2-month intervals. RESULTS: There was no morbidity and there were no significant weight changes. The GEA was widely patent at necropsy at 6 months (n = 4); partial membrane separation occurred at 5 months in the fifth dog. There was minor breakage of the stent prongs in 2 animals. CONCLUSION: Peroral creation of a stented magnetic compression GEA is safe and provides long-term patency. This technique may be potentially useful for managing gastric outlet obstruction caused by malignancy.

Aneurysm sac pressure measurements after endovascular repair of abdominal aortic aneurysms.

OBJECTIVES: The goal of endovascular grafting of abdominal aortic aneurysms (AAAs) is to exclude the aneurysm sac from systemic pressure and thereby decrease the risk of rupture. Unlike conventional open surgery, branch vessels in the sac (eg, lumbar artery and inferior mesenteric artery [IMA]) are not ligated and can potentially transmit pressure. The purpose of our investigation was to evaluate the feasibility of various interventional techniques for measuring pressure within the aneurysm sac in patients who had undergone endovascular repair of AAAs. METHODS: Sac pressure measurements were performed in 21 patients who had undergone stent graft repair of AAAs. Seventeen of 21 patients had endoleaks demonstrated on 30-day computed tomographic (CT) scans. Access to the aneurysm sac in these patients was through direct translumbar sac puncture (5 patients), through a patent IMA accessed via the superior mesenteric artery (SMA) (9 patients), or by direct cannulation around attachment sites (3 patients). Four patients had perioperative pressure measurements obtained through catheters positioned along side of the endovascular graft at the time of its deployment. Two of these catheters were left in position for 30 hours during which time CT and conventional angiography were performed. Pressures were determined with standard arterial-line pressure transduction techniques and compared with systemic pressure in each patient. RESULTS: Elevated sac pressure was found in all patients. The sac pressure in patients with endoleaks was found to be systemic (15 patients) or near systemic (2 patients) and all had pulsatile waveforms. Elevated sac pressures were also found in patients without CT or angiographic evidence of endoleak (2 patients). Injection of the sacs in two of these patients revealed a patent lumbar artery and an IMA. CONCLUSIONS: It is possible to measure pressures from within the aneurysm sac in patients with stent grafts with a variety of techniques. Patients may continue to have pressurized AAA sacs despite endovascular AAA repair. Endoleaks transmit pulsatile pressure into the aneurysm sac regardless of the type. It is possible to have systemic sac pressures without evidence of endoleaks on CT or angiography.

Use of the vascular closure staple clip applier for microvascular anastomosis in free-flap surgery.

We report our initial experience using the vascular closure staple clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) for microvascular anastomosis in free-flap surgery. In total, 153 anastomoses were performed in 87 free flaps (174 potential anastomoses) using the vascular closure stapler between October of 1997 and June of 1999. In 66 flaps, both the arterial and venous anastomosis were performed with the clip applier, whereas in 21 flaps only the venous anastomosis was performed using the clips. A total of 146 anastomoses were performed in an end-to-end fashion, and seven were performed end-to-side. Of the 87 flaps there were 53 TRAM flaps, seven bilateral TRAM, five latissimus dorsi, four gastrocnemius, three rectus abdominis, two radial forearm fibula, and four Rubens fat-pad flaps. Seventy flaps were used for breast reconstruction, seven flaps for lower limb reconstruction, four flaps for head and neck reconstruction, and six flaps for chest wall/trunk reconstruction. There were no postoperative anastomotic complications of bleeding, thrombosis, or need for revision (100 percent patency rate), with a significantly reduced time for completion of anastomoses. The clip applier is a safe, reliable method for performing microvascular anastomoses, allowing reduced operating time and possible cost savings in free-flap surgery.

Determination of oxytetracycline in bovine kidney and medicated milk replacer by liquid chromatography.

Improvements and optimization of AOAC INTERNATIONAL Official Method 995.09 for the detection of oxytetracycline in bovine kidney at the new U.S. tolerance of 12 ppm are reported. Recoveries from kidney fortified at 4 concentrations over the range of 3-40 ppm averaged 84-98%. Results from the kidney of a calf fed medicated milk replacer containing oxytetracycline are also reported. Additionally, adaptation of this method to the detection of oxytetracycline in medicated milk replacer is discussed.

Stent placement of gastroenteric anastomoses formed by magnetic compression.

PURPOSE: To evaluate the use of stents for prolonging the patency of gastroenteric anastomoses (GEA) induced by magnet compression. MATERIALS AND METHODS: Rare earth magnets were inserted perorally and serially in 15 dogs so as to mate across the gastric and jejunal walls. After magnet excretion, the resulting GEA was identified endoscopically, dilated (n = 1), and stented with bare (n = 2) or partially covered (n = 6) flared 10-mm or 12-mm Z stents. The GEA was followed at 2-4-week intervals for patency; malfunctioning shunts were irrigated, or dilated with angioplasty balloons. Gross and histologic examination of the anastomotic tissues was performed in 14 animals. RESULTS: Magnet pairs were excreted in 5-7 days. Of the 19 magnet placements in 15 animals, stent placement was not possible because of early GEA closure (n = 6), failure to locate (n = 2), pancreatic abscess (n = 1), and magnet perforation with peritonitis (n = 1). Estimated duration of GEA patency was 19 days after balloon dilation, 40-64 days with bare Z stents, and 58-147 days (mean, 90 days) with partially covered Z stents. Shunt function was commonly hindered by bezoars. Stent narrowing or occlusion was caused by tissue overgrowth through bare stents (n = 2), between covered stent struts and through partially detached membrane (n = 2). Serious morbidity (n = 2) was due to malpositioned magnets across the pancreas in one animal and gastric perforation in the other. One dog was euthanized because of unsuspected kidney infection. CONCLUSION: Partially covered stents significantly extend the anatomic patency rate of magnetic GEA to 7 weeks or more. Functional patency is frequently impaired by bezoars. Ongoing improvements in covered stent design should provide longer-term GEA patency.

Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial.

PURPOSE: To prospectively assess the efficacy of percutaneous transabdominal thoracic duct catheterization and embolization in the management of patients with high-output chylothoracic effusions. MATERIALS AND METHODS: Eleven consecutive patients (four women and seven men; mean age, 53 years) were referred with chylothorax secondary to esophagectomy (n = 4), lobectomy (n = 1), lung transplant (n = 1), coronary artery bypass (n = 1), aortic graft (n = 2), lymphangioleiomyomatosis (n = 1), and gunshot wound (n = 1). Two patients were brought by ambulance and referred back to their hospital on the same day. Pedal lymphography was used to opacify the cisterna chyli or major retroperitoneal lymphatic trunks. When patent, these were punctured under local anesthesia with a fine needle and the thoracic duct was catheterized over a microguide wire with use of a 3-F catheter; the duct was embolized with platinum coils. Patients were followed up for decrease in thoracic drainage output and morbidity. RESULTS: There were no retroperitoneal ducts suitable for catheterization in six patients because of previous abdominal surgery, trauma, or lymphangioleiomyomatosis; the thoracic duct was successfully catheterized in five patients, a 45% technical success rate. Thoracic duct embolization was performed in four patients, with cure of effusion in two. In the other two patients, one with lymphangioleiomyomatosis and the other with nonchylous pleural fluid, continued effusion was successfully treated by means of pleurodesis. Of two patients with previous thoracic duct ligation, one was found to have the duct incompletely tied. The authors were surprised to find that previous major abdominal surgery, chronic aortic dissection, and lymphangioleiomyomatosis could obliterate major retroperitoneal lymphatic ducts and the cisterna chyli. Percutaneous study of the thoracic duct with aqueous contrast medium was more sensitive than lymphography with iodinated oil. There was no morbidity. CONCLUSIONS: Catheterization of the thoracic duct was possible in all patients who had patent major retroperitoneal lymphatic trunks. Thoracic duct embolization was curative in patients with demonstrable duct leakage. Previous abdominal surgery, aortic dissection, and lymphangioleiomyomatosis can lead to silent occlusion of retroperitoneal lymphatic trunks. Percutaneous thoracic duct catheterization and embolization is safe and can replace surgical ligation in some patients.

Ultrasonographic diagnosis of uterine artery pseudoaneurysm after hysterectomy.

The development of an arterial pseudoaneurysm is a rare but reported complication of pelvic surgery. Typically the lesion is discovered because the patient has symptoms related to delayed rupture of the pseudoaneurysm, causing hemorrhage. We report a case in which an uterine artery pseudoaneurysm was detected 14 days after vaginal hysterectomy by TVUS, which was performed prior to a transvaginal drainage procedure to treat an infected pelvic hematoma.

Chemoembolization of hepatocellular carcinoma with cisplatin, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol: prospective evaluation of response and survival in a U.S. population.

PURPOSE: To evaluate response and survival after hepatic chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol in a U.S. population of patients with hepatocellular carcinoma. MATERIALS AND METHODS: Thirty-eight consecutive patients were treated: 35% stage I, 62% stage II, 3% stage III. Fifty-one percent had cirrhosis. Chemoembolization was performed at approximately monthly intervals for one to seven sessions (mean, 2.2). Pretreatment and posttreatment cross-sectional imaging and alpha-fetoprotein (AFP) levels were obtained prospectively 1 month after treatment and then every 3 months. Thirty-day response was calculated by means of the the World Health Organization/Eastern Cooperative Oncology Group criteria. RESULTS: One patient was lost to follow-up. In seven patients, lesions became resectable after chemoembolization. Among 13 evaluable patients with initially elevated AFP level, 70% had a partial biologic response (>50% decrease in AFP), 15% had a minor response (25-50% decrease), and the remaining 15% remained stable. Among 25 patients evaluable for morphologic response, 36% had a partial response, 32% had a minor response, and 32% remained stable. No patients had progression of disease while receiving therapy. The cumulative survival was 60% at 1 year, 41% at 2 years, and 16% at 3 years. Two patients developed progressive hepatic failure. Thirty-day mortality was 3% (one patient). CONCLUSION: These results compare favorably to published response and survival data for chemoembolization of advanced hepatocellular carcinoma from Asia and Europe.

Challenge differentially affects cytokine production and metabolic status of growing and finishing swine.

Growing (35 kg body weight) and finishing (85 kg body weight) swine challenged with endotoxin (Escherichia coli O55:B5) at a dose of either 2 or 20 microg/kg produced tumor necrosis factor (TNF)alpha in a dose-response relationship as measured by bioassay. Peak TNFalpha plasma levels were observed 1-2 hr post-challenge, returning to basal values 4 hr post-challenge. However, both an enzyme-linked immunosorbent assay specific for swine TNFalpha and total human TNFalpha demonstrated no dose-response relationship; peak plasma levels of immunoreactive TNFalpha were also observed 1-2 hr post-challenge. Maximal plasma interleukin-6 levels occurred 1-2 hr post-challenge and remained elevated through 8 hr post-challenge; there was no effect of lipopolysaccharide dose or metabolic status. Although the metabolic status of the animals also affected glucose levels, with growing animals exhibiting greater sensitivity compared with finishing animals, endotoxin-induced decreases in blood glucose levels were primarily dose-dependent. In contrast, changes in plasma urea nitrogen and free fatty acid (FFA) levels were strictly related to the metabolic status. Urea nitrogen levels were unchanged in growing swine, whereas they were increased in finishing swine and remained elevated 24 hr post-challenge. FFA levels in growing and finishing swine increased 3-6 hr post-challenge. FFA levels returned to basal values for finishing swine 24 hr post challenge, but in growing swine remained elevated 24 hr post-challenge. Plasma aspartate transaminase levels were increased through 24 hr post-challenge; animals given a dose of 20 microg/kg exhibited the greatest increase. Similarly, swine challenged with a dose of 20 microg/kg also exhibited the greatest increase in levels of conjugated bilirubin; there was no effect on unconjugated (free) bilirubin. These results demonstrate that endotoxin challenge of swine result in a pattern of changes that are dependent on both the dose of endotoxin used and the metabolic status of the animal examined.