Laparoscopic bilateral nephrectomy for renin-mediated hypertension

Hypertension arising from retained native kidneys complicates the management of recipients of renal transplants. Reluctance to administer angiontensin-converting enzyme inhibitor (ACEI) drugs to patients taking cyclosporine has reopened the question of performing native nephrectomies for poorly controlled, renin-dependent hypertension. We report the first published cases of simultaneous bilateral laparoscopic nephrectomies in 2 patients: 1 in preparation for living-related donor transplantation and the other ten months following cadaver transplantation in a patient whose end-stage renal disease was from malignant nephrosclerosis. Both had very severe hypertension resistant to multiple drugs and both became normotensive with little or no antihypertensive medication following nephrectomies. A bilateral nephrectomy is currently feasible using a laparoscopic approach.     

Oligonucleotide mapping of picornavirus RNAs by two-dimensional electrophoresis.

Considerable differences have been found in two-dimensional polyacrylamide gel electrophoresis fingerprints of complete ribonuclease T₁ digestion products of the RNAs of representative members of the entero-, cardio-, and foot-and-mouth disease virus subgroups of the picornavirus family. Individual members of the different subgroups, serotypes of a virus, and even subtypes within a serotype can be distinguished by the use of this technique. The method has also facilitated the identification of homopolymeric regions within the different picornavirus genomes, and the presence of a poly(C) tract in the cardio- and foot-and-mouth disease virus subgroups has been confirmed. A poly(A)-rich tract of approx 40–100 nucleotides has been detected in all the picornaviruses studied. Oligonucleotide fragments possibly specific to the enterovirus subgroup were also detected and partially characterised.     

Contrast enhanced MRA of peripheral arteries with the automatic "floating table".

Magnetic resonance angiography (MRA) is increasingly used as a non-invasive alternative to digital subtraction angiography (DSA). Besides plain time-of-flight (TOF) and phase contrast (PC) MRA a new MRA technique using positive contrast agent has been introduced recently. A fast 3D gradient-echo sequence is applied to reach a significant reduction of measurement time for acquisition of the MRA within the first pass of the contrast agent, thereby avoiding venous overlap. A significant progress was yielded by MR systems allowing manual table movement for examination of the pelvis and the lower limbs in one examination with a single contrast agent bolus. However, in this case it is necessary to have a coworker in the examination room moving the table manually. In this paper we report a prototype system which allows automatic table movement ("floating table"). Using this novel system we examined a patient with an aneurysm of the abdominal aorta and peripheral arterial occlusive disease (PAOD). Diagnostic results of contrast enhanced MRA and DSA were equivalent. In summary, the automatic floating table system introduced in this paper allows comfortable non-invasive examination of pelvic and lower limb arteries. The value of this technique in comparison to DSA has to be determined in future studies.     

Neue Angaben zur chromosomalen Struktur des Sticker-Sarkoms

Zusammenfassung In allen den bisher untersuchten Fällen von Sticker-Sarkome des Hundes wurden die gleichen Chromosomenanomalien gefunden: 58–59 Chromosomen, darunter 13–17 metazentrische und 40–45 telozentrische. Ein beobachteter Tumor wies die doppelte Chromosomenzahl auf, auch die Zahl der metazentrischen Chromosomen machte etwa das Zweifache des bisher mitgeteilten Wertes aus. Dieser Chromosomensatz war auch in den Zellen von Transplantaten nachzuweisen. Es dürfte sich also um eine stabile polyploide Abart des Sticker-Sarkoms handeln.

---

A new chromosomal variant of the Sticker venereal sarcoma

Summary In all earlier investigations of the Sticker venereal sarcoma in dogs identical chromosomal aberrations were found; there were 58–59 chromosomes of which 13–17 were metacentrics and 40–45 telocentrics. In the tumour presented here the karyotype was similar to that recorded previously except that the chromosome number was doubled; thus all the characteristic chromosomes were present in duplicate. The same duplicate chromosomal set was preserved when the tumour was transplanted to other dogs. Thus the tumour may be regarded as a stable polyploid variant of the Sticker venereal sarcoma.

     

Dose-Dependent Effect of Renin-Angiotensin System Blockade Following Transcatheter Aortic Valve Replacement

BackgroundThere is growing body of evidence from retrospective studies that renin-angiotensin system (RAS) blockade is associated with improved outcome after transcatheter aortic valve replacement (TAVR). However, it remains unknown whether the effect of RAS blockade is dose dependent. The current study sought to assess the dose-dependent effect of RAS blockade on survival and left-ventricular (LV) remodelling after TAVR.MethodsPatients who were enrolled into our observational TAVR study at our institution were retrospectively assessed according to different doses of RAS blockade: group 1 (no RAS blockade), group 2 (25% of maximum daily dose), group 3 (50% of maximum daily dose), and group 4 (full daily dose).ResultsA total of 323 patients between January 2015 and September 2019 were included. Patients with higher doses of RAS blockade showed a trend toward higher overall survival at 3-year follow-up (56% with no RAS blockade vs 66% with the 25% dose vs 79% with the 50% dose vs 78% with the full dose; P = 0.063). After adjustment for baseline characteristics, the difference in survival was significant (P = 0.042). Besides New York Heart Association class and left-ventricular ejection fraction (LVEF), RAS blockade dose was identified as independent predictor for all-cause mortality (hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.54-0.97; P = 0.03). With respect to LV remodelling, a significantly larger reduction of LV mass index was observed during the follow-up with higher doses of RAS blockade.ConclusionsThe current study showed that the impact of RAS blockade treatment on clinical outcome and LV remodelling after TAVR is dose dependent.     

Location of Ribosomal Protein Binding Sites on 16S Ribosomal RNA

The distribution of ribosomal protein binding sites on the 16S ribosomal RNA molecule has been analyzed by limited ribonuclease hydrolysis of RNA-protein complexes, as well as by the interaction of individual proteins with RNA fragments purified from partial enzymatic digests. Of the six 30S subunit proteins known to interact directly with 16S RNA, proteins S4, S8, S15, S20, and, probably, S13 bind within a fragment produced by T(1) RNase (12S RNA) that comprises some 900 nucleotides and covers almost the entire 5'-terminal half of the 16S molecule. A fragment of 500-600 nucleotides (8S RNA) that is contiguous with 12S RNA and arises from the 3'-terminal portion of the 16S molecule is believed to contain the binding site for protein S7. Protein S15 interacts specifically with a sequence of about 135 nucleotides (4S RNA) that derives from 12S RNA after more extensive hydrolysis. Protein S4, but none of the other ribosomal proteins, binds to a 500-nucleotide fragment (9S RNA), generated by pancreatic RNase, that lies at the 5'-terminus of 16S RNA and is completely overlapped by the 12S fragment. A preliminary map of the binding sites is presented.     

Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial

Introduction and hypothesis

Intra-vaginal diazepam suppositories are commonly prescribed as a treatment option for high-tone pelvic floor myalgia. This triple-blinded placebo-controlled randomized trial sought to determine if 10 mg diazepam suppositories improve resting pelvic floor electromyography (EMG) compared with placebo.

Methods

Women ≥18 years of age with hypertonic pelvic floor muscles on examination, confirmed by resting EMG ≥2.0 microvolts (μv), administered vaginal suppositories containing either diazepam or placebo for 28 consecutive nights. Outcomes included vaginal surface EMG (four measurements), the Female Sexual Function Index (FSFI), the Short Form Health Survey 12 (SF-12), four visual analog scales (VAS), the Patient Global Impression of Severity (PGI-S), and the Patient Global Impression of Improvement (PGI-I). A priori sample size calculation indicated that 7 subjects in each group could detect a 2-μv difference in resting EMG tone with 90 % power.

Results

Twenty-one subjects were enrolled. The mean age was 36.1 (SD 13.9) years, mean body mass index was 28.56 (SD 9.4), and the majority (85.7 %) was Caucasian. When evaluating response to therapy, no difference was seen in any of the resting vaginal EMG assessments at any time point within subjects or between groups, nor was an interaction found. Additionally, no differences were noted in any of the validated questionnaires.

Conclusions

When used nightly over 4 weeks, 10 mg of vaginal diazepam was not associated with improvement in resting EMG parameters or subjective outcomes compared with placebo. This suggests such that therapy alone may be insufficient in treating high-tone pelvic floor dysfunction.