Acute leg ischaemia from thrombosed popliteal artery aneurysms: role of preoperative thrombolysis.

OBJECTIVE: to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms. SETTING: retrospective study; teaching hospital. MATERIALS: between 1990 and 2000, 109 popliteal artery aneurysms were operated on. In 24 patients acute leg ischaemia due to thrombosis of aneurysm was present. METHODS: ten patients underwent urgent surgical intervention (group 1); and 14 thrombolysis with urokinase, until patency of popliteal and tibial vessels was achieved or for a maximum of 3 days (group 2). Ultrasonographic follow-up was performed at 1, 3, 6 and 12 months and then annually. Early results and follow-up data were analysed by chi-square test and life-table analysis (Kaplan-Meier curve) and late results were compared by mean of log rank test. RESULTS: in group 1 early limb salvage was 70%; in group 2 it was 86% (p=n.s.). When thrombolysis was successful, patency and limb salvage were 100%. There was no local or systemic complications during thrombolysis nor worsening of ischaemia. Follow-up was completed in 91 cases, with a mean duration of 26 months. Forty-eight months primary patency rate was better, even if not statistically significant, in group 2 than in group 1. CONCLUSIONS: in patients with acute leg ischaemia due to thrombosis of popliteal artery aneurysms, preoperative thrombolysis can be considered a safe and effective alternative to urgent surgery.     

Beneficial effects of Batimastat (BB-94), a matrix metalloproteinase inhibitor, in rat experimental colitis.

Background and Aims: Matrix metalloproteinases (MMPs) represent a group of enzymes that regulate cell-matrix composition playing a major role in the inflammatory response. In the present study we evaluated the ability of the MMP inhibitor Batimastat (BB-94) to modify the course of experimental colitis induced in the rat by trinitrobenzensulfonic acid (TNB). Methods: Colitis was induced in 40 rats by intracolonic administration of TNB. Animals were divided into four groups of ten rats each: group 1 received only intracolonic TNB, group 2 received TNB+5 mg/kg intraperitoneal BB-94, group 3 TNB+10 mg/kg BB-94 and group 4 TNB+20 mg/kg BB-94. The MMP inhibitor was administered 30 min before induction of colitis and twice daily until death. Ten rats receiving only intracolonic 0.9% saline served as controls. Animals were killed after seven days; segments of colon were removed and used for histological score of inflammation and myeloperoxidase (MPO) activity. Results: Rats receiving only intracolonic 0.9% saline showed no evidence of colitis. The inflammation score was 0.9, MPO activity 0.235 U/mg. Group 1 (TNB-treated rats) exhibited a high inflammation score (12.4) and MPO activity (0.715 U/mg). Conversely, BB-94-treated rats showed, compared to the TNB group, a significantly lower inflammation score and MPO activity in a dose-dependent fashion. Group 2: inflammatory score 10.1, MPO activity 0.474 (p < 0.05 vs. TNB); group 3: inflammatory score 8.3, MPO activity 0.287 (p < 0.01 vs. TNB); group 4: inflammatory score 5.0, MPO activity 0.256 (p < 0.01 vs. TNB). Conclusions: Treatment with BB-94 has dose-dependent beneficial effects on the inflammatory alterations in rat experimental colitis. Thus, the inhibition of MMPs may represent a novel therapeutic approach for treatment of intestinal inflammation.     

Longitudinal changes of pulmonary function in workers with high wood dust exposure levels

BACKGROUND: It is well know that wood dust exposure can induce sino-nasal cancers, rhinitis and asthma; induction of chronic bronchial obstruction, pulmonary fibrosis and lung cancer are also suggested, but data are often inconclusive and in disagreement. OBJECTIVES: The study evaluated the decrease in lung function in a group of 31 non-smokers exposed to high levels of wood dust (> 5 mg/m3 also) and in 2 non-smokering control groups with comparable lung function tests at first examination: 39 mechanical workers without respiratory hazards (group 1) and 30 forestry workers (group 2). METHODS: Assessment of lung function was repeated at least 5 times during 11.2 +/- 2.4 years for wood workers and 12.3 +/- 4.2 years for group 1 (n.s.) and 15.0 +/- 2.6 years for group 2 (p < 0.0005). Linear regression for annual loss of VC and FEV1 was calculated from observed data for each subject. RESULTS: No significant differences were observed in VC loss or FEV1 loss between woodworkers and control group1 (20.67 +/- 16.9 vs 19.0 +/- 23.2 and 31.37 +/- 22.3 vs 36.2 +/- 22.4 ml/year respectively), while control group 2 showed an accelerated (p < 0.005) VC and FEV1 loss (32.8 +/- 22.1 and 46.6 +/- 21.2 ml/years respectively). In conclusion, the study did not show any alterations in the longitudinal decrease in pulmonary function due to high wood dust exposure levels, perhaps due to the poor inhalability of wood particles that are mostly trapped in the nose; further studies are needed to investigate chronic effects of wood dust exposure on development of Chronic Obstructive Pulmonary Disease, pulmonary fibrosis and also lung cancer.     

The spatial alignment effect in near and far space: a kinematic study

The present experiment aimed at verifying whether the spatial alignment effect modifies kinematic parameters of pantomimed reaching-grasping of cups located at reachable and not reachable distance. The cup’s handle could be oriented either to the right or to the left, thus inducing a grasp movement that could be either congruent or incongruent with the pantomime. The incongruence/congruence induced an increase/decrease in maximal finger aperture, which was observed when the cup was located near but not far from the body. This effect probably depended on influence of the size of the cup body on pantomime control when, in the incongruent condition, cup body was closer to the grasp hand as compared to the handle. Cup distance (near and far) influenced the pantomime even if it was actually executed in the same peripersonal space. Specifically, arm and hand temporal parameters were affected by actual cup distance as well as movement amplitudes. The results indicate that, when executing a reach-to-grasp pantomime, affordance related to the use of the object was instantiated (and in particular the spatial alignment effect became effective), but only when the object could be actually reached. Cup distance (extrinsic object property) influenced affordance, independently of the possibility to actually reach the target.     

Below-knee revascularization in patients with critical limb ischemia: long-term comparison of redo vs primary interventions

AIM: The aim of this study was to evaluate the authors' experience in below-knee revascularization in patients with critical limb ischemia, comparing long-term outcomes in primary and secondary interventions. METHODS: From January 2000 to December 2006, 140 consecutive below-knee revascularizations in patients with critical limb ischemia were performed at the Department of Vascular Surgery of the University of Florence (Italy). In 105 patients (75%) a primary intervention was performed (Group 1). Early and long-term results in terms of survival, patency and limb salvage were compared with those obtained in the remaining 35 patients (25%) secondarily operated on in the same period for a late (>30 days) bypass graft thrombosis (Group 2). RESULTS: One patient died in the early postoperative period. Thirty-day thrombosis and amputation rates were poorer in Group 2 than in Group 1 (17.1% and 4.8%, P=0.02; 37.1% and 16.2%, P=0.01, respectively). Mean duration of follow-up was 25.1 months. At 60 months there were no differences between the two groups in terms of survival (90.1% in Group 1 and 90.9% in Group 2; P=NS), primary patency (43.5% in Group 1 and 31.9% in Group 2; P=NS) and secondary patency (48.4% in Group 1 vs 43.8% in Group 2; P=NS). Estimated 60-month limb salvage rate was significantly poorer in Group 2 than in Group 1 (64.1% and 77.7%, respectively; P=0.05). In Group 2 prosthetic graft material significantly affects 60-month limb salvage rate. CONCLUSION: Redo below-knee revascularization in patients with critical limb ischemia provides acceptable long-term results in terms of primary and secondary patency; however, limb salvage appeared to be slightly worse in patients undergone redo surgery.