Discoid medial meniscus: report of a case treated by arthroscopy

A complete discoid medial meniscus with a longitudinal tear was found in a 41-year-old man and treated by arthroscopy. The symptomatology was characterized by a sharp pain corresponding to the medial joint line, slight intrarticular effusion without locking or loss of motion. A review of the literature is described.     

Effect of verapamil on regional coronary and myocardial perfusion during acute coronary occlusion

To elucidate the mechanism of action of the calcium antagonist verapamil, S-T segment mapping, retrograde coronary flow and regional coronary resistance were studied in 28 dogs subjected to acute coronary occlusion. Retrograde coronary flow was measured directly through catheterization of the distal occluded coronary artery. Regional coronary resistance was calculated by dividing mean distal coronary pressure by coronary flow. Verapamil (0.8 mg/kg) administered intravenously to eight dogs 30 minutes before coronary occlusion significantly reduced S-T segment elevation as compared with occlusion alone (p < 0.025); heart rate and diastolic pressure were also reduced (p < 0.05) but systolic pressure remained essentially unchanged. When verapamil was given to seven dogs within 30 minutes after coronary occlusion, there was a significant increase in retrograde coronary flow (p < 0.05) and a decrease in regional coronary resistance (p < 0.05). Simultaneously, heart rate and heart rate-blood pressure product declined significantly (p < 0.05), suggesting a reduction in myocardial oxygen consumption. Systolic blood pressure was unaltered, and diastolic pressure decreased only transiently. In 13 control dogs there was no significant change in any of these variables during the observation period. Thus, verapamil during acute coronary occlusion protects the ischemic myocardium by both increasing perfusion and reducing myocardial oxygen consumption.     

Control of Immune Response to Allogeneic Embryonic Stem Cells by CD3 Antibody–Mediated Operational Tolerance Induction

Implantation of embryonic stem cells (ESCs) and their differentiated derivatives into allogeneic hosts triggers an immune response that represents a hurdle to clinical application. We established in autoimmunity and in transplantation that CD3 antibody therapy induces a state of immune tolerance. Promising results have been obtained with CD3 antibodies in the clinic. In this study, we tested whether this strategy can prolong the survival of undifferentiated ESCs and their differentiated derivatives in histoincompatible hosts. Recipients of either mouse ESC–derived embryoid bodies (EBs) or cardiac progenitors received a single short tolerogenic regimen of CD3 antibody. In immunocompetent mice, allogeneic EBs and cardiac progenitors were rejected within 20–25 days. Recipients treated with CD3 antibody showed long‐term survival of implanted cardiac progenitors or EBs. In due course, EBs became teratomas, the growth of which was self‐limited. Regulatory CD4⁺FoxP3⁺ T cells and signaling through the PD1/PDL1 pathway played key roles in the CD3 antibody therapeutic effect. Gene profiling emphasized the importance of TGF‐β and the inhibitory T cell coreceptor Tim3 to the observed effect. These results demonstrate that CD3 antibody administered alone promotes prolonged survival of allogeneic ESC derivatives and thus could prove useful for enhancing cell engraftment in the absence of chronic immunosuppression.     

Treating pain related to inoperable pancreatic cancer in tropical areas: the advantage of CT-guided celiac plexus block and splanchnic nerves neurolysis

Many sub-Saharan African countries have recently acquired computed tomography scanners that make interventional radiology possible, especially for the treatment of cancer pain. We report the case of a patient with severe abdominal pain related to advanced pancreas cancer. After unsuccessful morphine treatment, he underwent CT-guided alcohol injection for neurolysis of the celiac plexus and splanchnic nerves. This report describes the technique and discusses its potential applications in tropical countries.     

Ten-year clinical laboratory follow-up after application of a symptom-based therapeutic strategy to patients with severe chronic aortic regurgitation of predominant rheumatic etiology

OBJECTIVES: This study was designed to assess the feasibility and the long-term results of a symptom-based strategy of aortic valve replacement in a Brazilian population with predominant rheumatic etiology. BACKGROUND: Optimal criteria for valve replacement in aortic regurgitation (AR) are still not entirely clear. The appearance of symptoms is an indication for surgery, but may be associated with myocardial damage. Although cardiac imaging data have provided a safer guide for such decisions, the use of symptom-based surgical indication has not been validated and might conceivably be better in populations with predominant rheumatic etiology and younger age. METHODS: Echocardiography and rest-exercise radionuclide ventriculography were performed in 75 patients with severe AR, age 28 +/- 9 years, over a period of 10 +/- 0.69 years. Thirty-seven patients developed symptoms and underwent aortic valve replacement surgery within six months. Thirty-eight patients remained asymptomatic and were managed medically. RESULTS: Survival was 100% in asymptomatic patients and 82% in symptomatic. Surgical treatment caused marked ventricular remodeling, with ventricular diameter involution and an improvement of rest-exercise ejection fraction percent variation. Multivariate analysis showed that the probability of developing symptoms within 10 years was 58% for a patient with a left ventricular end-diastolic diameter > or =70 mm and 76% for a patient with left ventricular end-systolic (LVESD) > or =50 mm. Logistic regression identified LVESD and age as the most predictive and specific, but not sensitive, indicators of symptom development. CONCLUSIONS: Application of a standardized therapeutic strategy to patients with severe AR and predominant rheumatic etiology resulted in 90.6% survival after 10 years of follow-up.     

A cocktail of metabolic probes demonstrates the relevance of primary human hepatocyte cultures in a microfluidic biochip for pharmaceutical drug screening

In this paper, we compare the biotransformation capacities of cryopreserved primary human hepatocytes cultivated in a liver microfluidic biochip and in plates. The hepatocytes were exposed to the CIME cocktail (Carte d'Identité MEtabolique), a mixture of seven probes (acetaminophen, amodiaquine, caffeine, dextromethorphan, midazolam, omeprazole and tolbutamide) for key enzymes involved in the xenobiotic metabolism and pharmacokinetics. The purpose of the cocktail was to give an overview of the metabolic profile of the hepatocytes due to concomitant exposure and a simultaneous mass spectrometric detection method of the metabolites. The results showed a greater activity for CYP1A2, CYP2C9, CYP2C19 CYP2D6, CYP3A and UGT1A1 after 4 h of incubation in the microfluidic biochip when compared to the plate cultures. Furthermore, the metabolic ratio time-course measured at 1 h, 3 h and 4 h indicated that the enzymatic activity increased when the hepatocytes were cultivated in the microfluidic biochip, in contrast with their response in the plate cultures. These results illustrated the functional relevance of liver culture in the PDMS microfluidic biochip. The original method based on a microfluidic culture coupled with CIME cocktail analysis allowed the maintenance and the evaluation of the metabolic performances of the primary human hepatocytes through a new rapid assay. This metabolic analysis can thus become the reference situation when parallel studies of drug metabolism and toxicities are planned with functional hepatocytes in biochips.