Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.     

Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.     

Fetal lumbar spine: measuring axial growth with US

Ultrasound (US) can be used to visualize vertebral segments, suggesting a quantitative means of studying vertebral column growth in utero and thus a means of detecting developmental abnormalities. US images of the lumbar spine were obtained in 128 clinically normal fetuses between the gestational age of 11 through 41 weeks. A large-aperture, dynamically focused US system capable of regional magnification was used. Average lumbar spacing was calculated from distance between centrums of at least four lumbar bodies. The average distance between lumbar centrums increased nearly linearly throughout the second and third trimesters (r2 = 0.98). Enhanced anatomic display implies new capabilities for recognizing developmental abnormalities antenatally.     

Orale Zytologie

Zusammenfassung Die orale Zytologie erf?hrt eine Renaissance, die durch die Einführung der Bürste als Entnahmetr?ger und durch die Anwendung zus?tzlicher moderner Verfahren bedingt ist. Die Bürste kann tiefe Schichten der oralen Mukosa erfassen, in denen die squam?se intraepitheliale Neoplasie (SIN) beginnt. Zus?tzliche Verfahren zur Bewertung der biologischen Potenz der gewonnenen oralen Epithelzellen sind: die computerunterstützte Bildanalyse (OralCDx^?), die DNA-Zytometrie, die Immunzytochemie, die Dünnschichtzytologie und molekularbiologische Analysen. Alle genannten Verfahren sind geeignet, die Sensitivit?t (bis zu 100%) und Spezifit?t (bis zu 100%) der oralen Zytologie zu erh?hen. Dennoch gibt es Berichte über orale Plattenepithelkarzinome, die mithilfe der Bürstenbiopsie nicht erkannt wurden. Die Wertigkeit der einzelnen Verfahren kann aktuell aufgrund fehlender vergleichender Studien nicht abschlie?end beurteilt werden. Die Immunzytochemie mit kommerziellen Antik?rpern gegen Laminin 5 ist allseits verfügbar und methodisch einfach. Das nichtinvasive diagnostische Verfahren der methodisch unterstützten oralen Bürstenbiopsie kann einen Beitrag zur frühen Erkennung ausgew?hlter Mundschleimhautl?sionen leisten. Ein positiver Befund oder eine Progression der L?sion bei negativem Befund sind Indikationen zur überweisung des Patienten an Fachkliniken und zur dort durchgeführten Skalpellbiopsie mit histopathologischer Untersuchung. Die histopathologische Begutachtung bleibt der Goldstandard in der definitiven Diagnostik maligner oraler L?sionen.      

A diagnostic algorithm for male genital oedema

Male genital oedema can be defined as swelling or the appearance of swelling of the scrotum and/or the penile shaft and prepuce. Despite the various causes of genital oedema reported in the published work, a concise approach to the evaluation and management has not been sufficiently addressed.     

Deficient activation of microglia during optic nerve degeneration

Transection of an optic nerve (ON) is followed by slow removal of myelin. We studied microglia for the expression of molecules that characterize activated myelin phagocytosing macrophages: MAC-1, FcγII/III receptor (FcR), MAC-2, and F4/80. In-vitro, microglia expressed all molecules and phagocytosed myelin. In-vivo, intact ON displayed high levels of MAC-1, little FcR and F4/80, and no MAC-2. The expression of these molecules was upregulated differentially in in-vivo degenerating ON: MAC-1 uniformly, FcR and F4/80 variably, and MAC-2 sporadically. The distribution of MAC-2 expression correlated best with a pattern of sporadic structural degeneration. Thus in-vivo, ON injury is followed by deficient microglia activation, which we suggest contributes significantly to the slow clearance of myelin.