Fertility of undiluted ram epididymal spermatozoa stored for several days at 4°C.

In vitro preservation of the male gamete is a challenge in the development of artificial insemination techniques for domestic animals. Specific strategies and diluents have been developed for the preservation of the fertilizing ability of the semen for each species. However, the epididymal medium has been demonstrated to be the best sperm environment to maintain sperm viability over several days and weeks for mammals. The aims of this study were to evaluate the motility and in vivo fertility of ram epididymal spermatozoa when the semen was stored for up to 4 days at 4°C undiluted in epididymal plasma. The study was undertaken with two ovine breeds (Ile de France and Corriedale). The motility of epididymal spermatozoa was better preserved in the undiluted epididymal fluid than when epididymal spermatozoa were diluted in classic ovine extender such as skim milk. During storage, the decrease in the percentage of motile sperm was lower if the epididymal spermatozoa were collected immediately after epididymal sampling than 24 h after castration or animal death. The fertility obtained after cryopreservation of the stored sperm and subsequent intrauterine insemination ranged from 55% to 24% following 24 to 96-h sperm storage. There was a linear regression relationship between fertility and the number of motile sperm inseminated for both breeds. These results show that it is possible to keep epididymal sperm motile and fertile for several days without dilution. Such a method of sperm preservation could be a final possibility for animals of high genetic value or for endangered species when the collection of semen before death of the animal is not possible.

Early deterioration after excimer laser-assisted coronary angioplasty.

Coronary lumen changes after excimer laser coronary angioplasty, after adjunct percutaneous transluminal coronary angioplasty, and at 24 hours after intervention were assessed using quantitative coronary angiography. Lesions treated with this combined technique showed significant early deterioration within 24 hours.

Direct stent implantation without predilatation using the MultiLink stent.

The standard coronary stent implantation technique requires routine predilatation of the target lesion with a balloon catheter. In this study, we prospectively studied the feasibility and efficiency of elective coronary stent implantation without predilatation. In 94 patients who presented with various ischemic syndromes, direct implantation of 100 balloon expandable ACS MultiLink stents (7 over-the-wire, 93 rapid exchange) was attempted in 100 coronary lesions selected to have favorable characteristics. The stent crossed the lesion without predilatation in 97 cases (97%) and was successfully deployed in 93 (95.8%). In 4 patients, adjunctive high-pressure postdilatation was necessary to achieve optimal stent expansion. Reference vessel diameter was 3.12+/-0.77 mm and lesion length 8.8+/-2.7 mm. Minimal luminal diameter increased from 0.95+/-0.38 mm to 2.98+/-0.28 mm and diameter stenosis decreased from 71+/-11% to 8+/-11% after stenting. One occlusive dissection was treated by a second stent. There were no major in-hospital complications. At 1 month follow-up, 1 subacute thrombotic occlusion occurred. These results indicate that in a carefully selected coronary lesion subset, elective stent implantation without predilatation can be safely and effectively performed. The long-term results of this approach and possible advantages over the conventional implantation techniques remain unclear and need to be evaluated in further clinical studies.

Stent implantation in acute myocardial infarction.

Among 138 patients treated with coronary angioplasty during acute myocardial infarction (AMI), 35 (25%) had stent implantation. Mean age was 56 years and 83% were men. Mean onset of chest pain was 6.0 +/- 5.3 hours, and previous thrombolytic therapy was given to 10 patients (29%). Infarct location was anterior in 19 (54%), inferior in 14 (40%), and lateral in 2 patients (6%). Thrombolysis in Myocardial Infarction trial flows 0,1, and 2 were seen in 24 (69%), 6 (17%), and 5 patients (14%), respectively. The culprit vessel was the left anterior descending artery in 18 (51%), right coronary artery in 14 (40%), left circumflex in 2 (6%), and left main coronary artery in 1 patient (3%). Mean vessel diameter was 3.3 +/- 0.3 mm. Indications were: primary in 5 (14%), suboptimal result in 8 (23%), nonocclusive dissection in 14 (40%), and occlusive dissection in 8 patients (23%). Angiographic thrombus after initial angioplasty was present in 12 patients (34%). A total of 46 stents were implanted; mean balloon diameter and pressure were 3.4 +/- 0.4 mm and 15.5 +/- 2.2 atm, respectively. Residual diameter stenosis was 4 +/- 7%. There were 2 deaths; sudden 1, and after elective coronary artery bypass grafting in the other; 2 patients (6%) had groin hematomas. Mean hospitalization was 9.9 +/- 5.0 days. Repeat angiography revealed no stent occlusion. With initial intravenous heparin for 3 to 7 days, all patients received aspirin and ticlopidine for 1 month. Thus, AMI is not a contraindication for stent implantation. The benefits of stenting are a high success rte, low residual diameter stenosis, and low incidence of in-hospital recurrent ischemia. Reduction in restenosis rate in this setting is likely but remains to be determined.

Urinary protein/creatinine ratio in hypertensive pregnant women.

OBJECTIVES: To determine the correlation between the protein/creatinine ratio and 24-h proteinuria; to estimate the sensitivity and specificity of this ratio for the diagnosis of significant proteinuria; to establish its cutoff point with the best predictive value for the diagnosis of significant proteinuria in patients with systemic arterial hypertension. STUDY DESIGN: A cross-sectional study of 47 hypertensive patients who had been pregnant for 20 weeks or more seen at the Maternity of the University Hospital of Porto Alegre. The studied factor was the protein/creatinine ratio measured in a single random urine sample and the outcome was protein determination in 24-h urine. The level of significance was set at 0.05. RESULTS: The correlation coefficient between the protein/creatinine ratio and 24-h proteinuria was 0.94 when urine was properly collected. A receiver-operator characteristic curve was constructed to determine the sensitivity and specificity of the ratio for the diagnosis of significant proteinuria (> or = 300 mg in 24 h). Specificity and predictive positive value were 100% for a ratio > or = 0.8. The best values for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of proteinuria > or = 300 mg in 24 h were obtained when the protein/creatinine ratio was 0.5 (0.96, 0.96, 0.96, and 0.96, respectively). CONCLUSION: The protein/creatinine ratio measured in a single urine sample taken at random from hypertensive pregnant women showed good sensitivity and specificity for the diagnosis of 24-h proteinuria > or = 300 mg and was strongly correlated with 24-h proteinuria. A ratio of 0.5 mg/mg is predictive of significant proteinuria and can be used for the diagnosis and follow-up of hypertensive pregnant women.

Multiple stenting in acute myocardial infarction with double vessel occlusion, complicated with cardiogenic shock.

Stenting of the infarct-related artery during the acute phase of myocardial infarction is a controversial issue. We report a case of primary multiple stent implantation in 2 vessels in a patient with AMI, double vessel total occlusion and cardiogenic shock. No intracoronary thrombotic therapy was given. Stenting provides an optimal angiographic result which may decrease the need for repeat interventions. Primary stenting in AMI deserves further investigation.

Conservative management for an extensive type A aortic dissection complicating coronary angioplasty.

Aortic dissection is a recognized, though rare complication of percutaneous revascularization procedures. We report a case of an extensive type A dissection that occurred during an attempt to recanalize a chronic total occlusion of a right coronary artery. The patient was treated conservatively and was followed for 36 months, during which he remained well. We conclude that, even though surgery remains the preferred option, conservative management could also be considered in certain patients.

Clinical experience with a new biocompatible phosphorylcholine-coated coronary stent.

AIMS: The BiodivYsio stent is a new stent coated with phosphorylcholine, a biocompatible molecule designed to reduce the formation of thrombus and potentially the risk of restenosis. The feasibility, safety, and efficacy of elective and urgent implantation of this coated coronary stent were prospectively studied. METHODS AND RESULTS: We studied 224 patients who underwent elective (67%) or bail-out implantation of 303 BiodivYsio stents in 286 lesions. Most lesions (62%) had unfavorable characteristics (type B2 or C) and half of them (50%) had thrombus and/or chronic total occlusion. Clinical follow-up was obtained in all patients at one month and in the first 132 patients at six months. Repeat angiography was undertaken in all patients with recurrent ischemia. Successful stent deployment was achieved in 284 lesions (99.3%). One emergency coronary artery bypass graft (CABG) was required. Angiographic success rate was 98.3% (281/286). There was 1 (0.4%) subacute stent thrombosis associated with Q-wave myocardial infarction and two (0.9%) in-hospital deaths. Reference vessel diameter was 2.82 +/- 0.32 mm. Minimum luminal diameter (MLD) increased from 0.38 +/- 0.25 mm to 2.97 +/- 0.35 mm and diameter stenosis decreased from 83.8 +/- 12.1% to 5.8 +/- 9.7%. Clinical restenosis rate was 6.1% (8/132 patients) at 6-month follow-up. Target vessel revascularization rate at 6-month follow-up was 5.4%. CONCLUSIONS: This initial clinical experience indicates that the implantation of stents coated with phosphorylcholine appears to be safe and efficacious in the treatment of complex coronary lesions and is associated with an extremely low target vessel revascularization rate.

Experimental infection of Black Belly and INRA 401 straight and crossbred sheep with trichostrongyle nematode parasites.

Compared to INRA 401 lambs reared in France, Black Belly (BB) lambs reared in Guadeloupe (F.W.I.) were highly resistant to both primary and secondary experimental infection with Haemonchus contortus. To investigate this huge inter-breed difference, a nucleus flock of BB was constituted, and experiments were conducted to: (i) confirm this difference in lambs born in France, (ii) check whether it was similar for Trichostrongylus colubriformis and Teladorsagia circumcincta, and (iii) find out whether this difference was age-related. Forty BB lambs, 84 F1 lambs (BB siresxINRA 401 ewes) and 88 INRA 401 lambs born in two cohorts were used in an experimental design involving three host breeds, both genders and two age-groups (3.5- and 7-month-old when first infected). The limited availability of BB lambs made the study incomplete. Infection consisted of the administration of two doses of 10,000 infective larvae of one of the nematode species, separated by an anthelmintic treatment and an interval of 1 week before the second dose was administered. Fecal egg counts (FECs) were done on Days 28 and 35 after each infection; ewe lambs of the INRA 401 and F1 breeds were necropsied, the worm burden was established, the length of the female worms measured and the eggs in utero counted. For H. contortus and T. colubriformis, the FEC was lower in the BB than in the INRA 401 lambs, and the FEC found for the F1 lambs was intermediate. For T. circumcincta, only data for the F1 and INRA 401 lambs were available, and the FECs for these breeds were the same. In all three breeds, the FEC determined after the second dose was significantly lower than that found after the first dose in the ewe lambs, but not in the ram lambs. Infecting the lambs when they were 7- instead of 3.5-month-old significantly lowered egg excretion of both parasites in the F1 (P<0.0001), but not the INRA 401 lambs. Worm numbers in the F1 and in the INRA 401 ewe lambs confirmed the FEC data, many F1 lambs being free of T. colubriformis. The H. contortus female worms were shorter and had fewer eggs in utero in the F1 than in the INRA 401 lambs. A higher proportion of T. circumcincta was at the fourth larval stage in the F1 lambs. In conclusion, the BB breed is much more resistant than INRA 401 to H. contortus, with the F1 lambs being more like the BBs after the second dose. This difference was also found for T. colubriformis and, to a lesser extent, for T. circumcincta.

In vitro fertilization of sheep oocytes matured in vivo.

Incubating washed ram spermatozoa in a modified Brackett's defined medium buffered with Hepes (DM-H) containing 20% of heat-inactivated sheep serum appears to be a reliable method of capacitating sperm for in vitro fertilization. Raising the Ca(++) concentration in the fertilization medium (DM-H-SS) to 10 mM stabilized the fertilization rate of various rams (2). This study was designed to determine if the developmental competence of the oocytes fertilized under such conditions was normal. Thirty-seven ewes, treated with progestagen sponges, were superovulated with porcine follicle stimulating hormone (pFSH: 16 mg). An intramuscular injection of gonadotropin releasing hormone (GnRH: 100 mug); given 24 to 26 h after sponge removal, induced the synchronization of ovulations 24 h later. Ovulated oocytes (n = 229) recovered with flushing of the oviducts were inseminated in vitro and 17 h later either fixed in acetic/alcohol (n = 115) to evaluate fertilization or transferred (n = 114) into 38 synchronized recipients (three oocytes/recipient) to evaluate their developmental competence. Of the fixed oocytes, 82.6% were fertilized and 61.7% were monospermic. Nineteen of the recipient ewes (50%) were pregnant at Day 18, and 16 ewes produced a total of 26 live young (mean: 1.63/ewe). The results showed a high efficiency of in vitro fertilization of ovulated oocytes in sheep following a pFSH-GnRH treatment and the in vivo developmental competence of oocytes fertilized in the presence of elevated Ca(++) concentration.

Lamb production using superovulation, embryo bisection, and transfer.

In this study, 39 embryos from donor ewes superovulated with follicle stimulating hormone-pituitary (FSH-P) were bisected to produce pairs of monozygotic twin lambs for experimentation. Each pair obtained by bisecting 8-, 9- or 10-day-old embryos was immediately transferred surgically into a recipient ewe at the same physiological stage. Of the 39 recipients which received a pair of half-embryos by transfer into the uterine horn ipsilateral to the corpus luteum, 28 (72%) lambed. Eighteen of 28 recipients lambing (64%) produced pairs, i.e., 7 male and 11 female pairs. Ten of 28 lambings produced a single lamb, i.e., six males and four females. Overall yield (the number of lambs produced in relation to the number of embryos used) was 118%. This percentage tended to increase, depending on the day of collection (Day 8, 100%; Day 9, 118%; and Day 10, 131%).

[Intrapulmonary right-left shunt associated with liver cirrhosis: diagnosis by contrast echocardiography]. / Shunt droit-gauche intrapulmonaire associé à une cirrhose hépatique: diagnostic par échocardiographie de contraste.

The hypoxaemia associated with hepatic cirrhosis is classically attributed to an intrapulmonary shunt caused by small vascular abnormalities. Severe hypoxaemia (47 mmHg) associated with dyspnoea, cyanosis and clubbing was observed in a 57-year old man who presented with cirrhosis of the liver. At contrast echocardiography, a right-to-left shunt was demonstrated by the appearance of microcavities in the left atrium and ventricle after peripheral intravenous injection of the contrast medium. The intrapulmonary location of the shunt was determined by a 4 cardiac cycles interval between the arrival of the microcavities in the right heart and their appearance in the left heart. The right-to-left shunt was confirmed by the pure oxygen ventilation test and by pulmonary perfusion scintigraphy with radiolabelled albumin microaggregates. Pulmonary angiography proved normal. Thus, contrast echocardiography is capable of diagnosing right-to-left shunts associated with hepatic cirrhosis and to demonstrate their intrapulmonary location.

[Retrograde dissection of the common trunk of the left coronary vessel during angioplasty of left anterior descending coronary artery. Apropos of 2 cases]. / Dissection rétrograde du tronc commun coronaire gauche pendant une angioplastie coronaire de l'artère interventriculaire antérieure. A propos de 2 cas.

Acute dissection of the left main coronary artery during coronary angiography or angioplasty is a rare but well known complication; it is attributed to a mechanical trauma caused by the tip of the catheter guide wire. The authors present two cases of dissection at the site of coronary angioplasty with a retrograde extension to the left main stem requiring emergency coronary surgery.

[Myocardial infarction during or after exertion related to sports. Clinical and coronary angiographic analysis of 10 cases]. / Infarctus myocardique au cours ou décours de l'effort sportif. Analysis clinique et coronarographique de 10 cas.

The purpose of this study was to analyse characteristic of myocardial infractions that occur during, or immediately after sport-related exertion in subjects who are neither athletes nor professional sportsmen and who undergo coronary angiography. Ten cases where myocardial infraction developed during (n = 3) or immediately after (n = 7) a game were studied retrospectively. All patients were men aged from 21 to 61 years (mean 48.8 years); 8 of them were smokers and 5 had hypercholesterolaemia. The sports practised were tennis (3), cycling (2), football (2), skiing (2) and weight-lifting (1). The infarction was inferior or basal in 5 cases, lateral in 1 case and anterior or anteroseptal in 4 cases. Coronary lesions involved one vessel in 6 and two vessels in 2 patients aged from 47 to 61 years. They were absent in 2 patients aged 24 and 26 respectively, with methylergonovine-induced spasm in one case. The outcome over a 2.9 years follow-up period was favorable, except for one death 6 months after the infarction (patient aged 24, normal coronary arteries, spasm). The outstanding features in this study are: (1) the occurrence of infraction during the recovery period and the noxious role played by smoking; (2) the contrast between the presence of atherosclerotic coronary lesions in middle age subjects and their absence in younger subjects (infarction due to spasm or thrombosis?), and (3) the possible usefulness of an exercise test in sport players of more than 40 years of age.

[Spasm of the left main coronary artery resistant to intracoronary vasodilators. Apropos of a case]. / Spasme du tronc commun coronaire gauche, résistant aux vasodilatateurs intracoronaires. A propos d'un cas.

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.

[Coronary angioplasty combining rotational atherectomy and balloon dilatation. Results in 67 complex stenoses]. / Angioplastie coronaire associant athérectomie rotative et ballon. Résultats sur 67 sténoses complexes.

The treatment of complex coronary stenoses by conventional angioplasty is limited by a relatively low angiographic success rate, associated with a high risk of major complications. The role of new angioplasty techniques in the treatment of these lesions has not yet been determined. The aim of this prospective study was to evaluate the systematic association of rotational atherectomy (Rotablator) with balloon angioplasty on coronary stenoses characterised by at least 2 type B criteria of the ACC/AHA classification (type B2 lesions). The procedures was begun with rotational ablation with a medium-sized burr (50 to 70% of the reference diameter of the artery) and completed systematically by balloon angioplasty (balloon/artery ratio = 1), using the lowest possible inflation pressures for successful dilatation. This technique was used in 61 patients who had 67 coronary stenoses with a primary success rate (residual stenosis < 50% and no major complications) of 93.4% (57 patients). One emergency coronary bypass procedure was necessary and another patient developed transmural infarction on the 3rd day after the procedure. There were two technical failures (3.3%). The mean inflation pressure of the balloon was 4.1 +/- 1.2 atmospheres. There were no fatalities. During atherectomy, transient conduction defects were observed in 4 patients (6.6%): severe hypotension in 2 patients (3.3%) and complete spasm in 3 stenoses (4.5%). A significant increase in cardiac enzyme levels was observed in 4 patients (6.6%). The authors conclude that rotational atherectomy with a medium-sized burr, followed by systematic low pressure balloon dilatation allows treatment of certain complex coronary stenoses with a high primary success rate and few major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multi-instrumental revascularization adjusted to coronary lesions (MIRACLE). Current role of new technologies]. / Approche multi-instrumentale coronaire adaptée aux lésions (AMICALE). Place actuelle des nouvelles techniques.

Several new techniques have been developed to get round the limitations of conventional coronary angioplasty. Most entail ablation of the atheromatous plaques by mechanical (atherectomy) or photochemical (laser excimer) means, whilst others (stents) shore up the vascular walls. Their use with conventional coronary balloon angioplasty optimises the results of treatment of complex lesions. This report describes the authors' experience in 1,266 patients (1,668 lesions) treated between January 1992 to December 1993. The new techniques were used in 33% of patients and 30% of lesions (rotational) atherectomy: 20%; stents: 5%; directional atherectomy: 3%; laser excimer: 2%) because of the defavourable angiographic characteristics of the lesions (eccentricity, calcification, bifurcation, length, chronic total occlusion, thrombosis, ostial stenosis, ulceration, saphenous vein graft). The primary success rate was 91% in the whole group (94 to 97% for the patients treated by the new techniques). The global major complication rate was 1.7%. The multi-instrumental revascularization adjusted to the coronary lesions (MIRACLE) gives a high primary success rate in patients with coronary lesions difficult to treat by conventional angioplasty. Randomised trials will be necessary to determine the precise indications of each technique with respect to the morphological characteristics of each lesion.

[Coronary artery stenting without antivitamin K. Results after a month]. / Implantation de prothèses endocoronaires sans antivitamine K. Résultats à un mois.

This paper reports experience with a new antithrombotic agent prescribed to reduce the incidence of subacute occlusions during the first month after coronary stenting. Therefore, a powerful association of platelet antiaggregant agents was tested. From December 1992 to October 1994, coronary stenting was successfully achieved in 1,294 patients (1,118 men, average age 60.5 +/- 10 years) who were then treated with the association of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one month. This was covered with anticoagulation with a low molecular weight heparin for a variable period (one month, two weeks, then one week), according to the different phases of the study protocol. In all, 1487 stents were successfully implanted (1,330 Palmaz Schatz; 63 Cook; 80 Wictor; 13 AVE and 1 Strecker) in 1,326 vessels (520 left anterior descending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%): 14 myocardial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). There were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicenter trial of a protocol associating platelet antiaggregant agents and low molecular weight heparin for one month showed a low incidence of subocclusion after coronary stenting (1.7 +/= 2.5%) and should enable interventional cardiologists to widen the indications for coronary stenting.

[Stenosis of the common trunk of the left coronary artery: an unusual complication of percutaneous coronary angioplasty]. / Sténose du tronc commun coronaire gauche: une complication exceptionnelle de l'angioplastie coronaire percutanée.

The recurrence of angina-type pain within a few months of successful coronary angioplasty usually indicative of a diagnosis of coronary re-stenosis. A control coronary artery angiograph sometimes eliminates this diagnosis by detecting a fresh coronary stenosis. The authors report a case of a tight stenosis of the left major coronary trunk a few months after angioplasty of the circumflex artery. The onset of a stenosis of this type leads to the discussion of the possible role of a traumatic lesion of the wall of the major trunk by the catheter-guide.

[Multiple pulmonary coronary fistulae. Apropos of a case]. / Fistules coronaro-artérielles pulmonaires multiples. A propos d'un cas.

Coronary-pulmonary fistula is a rare congenital anomaly. It is usually detected fortuitously in adulthood during a coronary angiography carried out to assess signs of myocardial ischemia. Multiple coronary fistulae are still more rare. Coronary angiography evaluates the lesions and indicates the most appropriate treatment. The congenital lesions are frequently combined with atheromatous lesions. The case described is that of a double fistula in a 61-year old man which was revealed by angina; the stenoses and occlusions which accompanied the fistulae lead to a discussion of their atheromatous nature and the nature of the pathological link between them: is this fortuitous or are they a progressive complication? Treatment involves both exclusion of the fistulae and coronary revascularization.