Quantitative Assessment of Superficial Venous Insufficiency Using Duplex Ultrasound and Air Plethysmography

OBJECTIVE: The purpose of this study was to quantitatively evaluate venous reflux in limbs with isolated superficial venous insufficiency using color duplex ultrasound. In addition, air plethysmography (APG) was used to investigate possible correlations of duplex-derived peak velocity, duration of reflux, and CEAP classification. METHODS: One hundred and forty-six legs in 109 patients with isolated superficial venous insufficiency refluxing throughout the length of the limb were selected for prospective study by duplex scan. Reflux was defined as duration of reflux >/=0. 5 seconds. This study was conducted in a university hospital. Venous reflux was evaluated with the patients standing, by the duration of reflux, retrograde peak velocity, reflux volume at the saphenofemoral and saphenopopliteal junction as well as the greater saphenous vein in the thigh. Values obtained by APG were the venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous fraction (RVF). A significant difference was defined as P <.05. Three groups of limbs were analyzed: group A limbs with a retrograde peak velocity greater than 30 cm/second and a duration of reflux of less than 3 seconds; group B with a retrograde peak velocity >/=30 cm/second and a duration of more than 3 seconds; and group C with a retrograde peak velocity of less than 30 cm/second and a duration of reflux of more than 3 seconds. RESULTS: Groups A and B contained 103 limbs, and 24 of these were in CEAP class 5 and 6. Group C contained 43 limbs, none of which were in class 5 or 6. APG demonstrated significant reflux in group A, and VFI was significantly higher compared to group B and group C (P =.0007 and P =.0064, respectively). A significant correlation was demonstrated between peak retrograde reflux velocity and VFI. CONCLUSIONS: Severe chronic venous insufficiency is found in limbs with high reflux velocity (greater than 30 cm/second) and the duration of reflux does not correlate with severe chronic insufficiency.     

Suppressed urinary excretion of aquaporin-2 in an infant with primary polydipsia

We observed severe overhydration in an 18-month-old Japanese girl with primary polydipsia. The secretion of antidiuretic hormone (ADH) was decreased, and urinary excretion of aquaporin-2, a vasopressin-sensitive water channel protein, was suppressed under basal conditions, but the response of aquaporin-2 to ADH was essentially preserved. These findings suggest that the water channel itself was intact and that overhydration resulting from polydipsia was responsible for the decreased ADH secretion and suppression of the water channel protein. Received: 4 October 1996 / Revised: 23 February 1999 / Accepted: 23 February 1999     

Effects of omeprazole and famotidine on fibroblast growth factor-2 during artificial gastric ulcer healing in humans

BACKGROUND AND AIMS: Endoscopic mucosal resection is a widely accepted technique for the treatment of early gastric cancers, while large ulcers induced by the treatment should be treated promptly. This study aimed to compare the effects of omeprazole and famotidine on ulcer healing and fibroblast growth factor-2 levels in gastric ulcers induced by endoscopic mucosal resection. METHODS: Sixteen patients indicated for endoscopic mucosal resection were enrolled. They were treated by using either omeprazole (n = 8) or famotidine (n = 8) after endoscopic mucosal resection. Endoscopy was performed on days 4, 7 and 28 during each treatment period. Levels of fibroblast growth factor-2 in biopsy specimens were measured by using an enzyme-linked immunosorbent assay at the time of and after endoscopic mucosal resection. Histological variables were also assessed. RESULTS: Ulcer healing rates under endoscopy were not different between the two treatment groups. In both groups, levels of fibroblast growth factor-2 slightly increased on day 4, but the values were not different at any time point. There were no differences in histological variables on days 4 and 7, but fibromuscular hyperplasia was significantly greater in the omeprazole group than in the famotidine group on day 28 (P < 0.05). CONCLUSIONS: Omeprazole and famotidine have an equivalent value for the treatment of ulcers induced by endoscopic mucosal resection. While omeprazole had a more potent effect on fibromuscular hyperplasia than did famotidine, such a difference does not seem to be explained by fibroblast growth factor-2.     

Transvenous Embolization for Carotid-Cavernous Fistula in a Patient with Vascular Type of Ehlers-Danlos Syndrome—Direct Superior Ophthalmic Vein Approach: Case Report

The vascular type of Ehlers-Danlos syndrome (vEDS) is an autosomal dominant hereditary disease characterized by connective tissue fragility throughout the body, including the arteries, viscera, and gastrointestinal tract. We report a case in which we performed transvenous embolization (TVE) via direct superior ophthalmic vein (SOV) approach to treat a direct carotid-cavernous fistula (CCF) in a patient with Ehlers-Danlos syndrome (EDS). The patient was a 37-year-old woman who developed tinnitus in her left ear and a headache during examination in the outpatient clinic of another hospital in order to make a definitive diagnosis of vEDS, and she was referred to our hospital and examined. Based on the results of all of the studies she was diagnosed with a CCF. Conservative treatment was attempted, but was not very effective. Because of progressing aphasia, TVE was performed via the SOV direct cut. There were no intraoperative or postoperative complications. It has been reported that cerebral angiography is generally contraindicated in vEDS and that the morbimortality associated with endovascular treatment is very high. When performing treatment it is necessary to be sufficiently aware of the risks it entails.     

Uncemented third-generation ceramic-on-ceramic total hip arthroplasty using metal acetabular shell with direct taper locking liner

Background

The ceramic-on-ceramic (CoC)-bearing couple in total hip arthroplasty (THA) was developed to reduce the wear debris and osteolysis. Although the mechanical strength of third-generation ceramic has improved over previous generations, the risk of osteolysis and ceramic fracture is still an important concern.

Methods

We studied 124 uncemented THAs with third-generation CoC-bearing couple implanted between 2000 and 2004. The ceramic liner and head were secured with the direct taper locking mechanism. One hundred and eleven hips were followed-up for minimum of 8 years, with an average follow-up period of 10.1 years (range 8.0–12.8 years). Patients were evaluated with a particular emphasis on the prevalence of the osteolysis and the ceramic fracture.

Results

The survivorship with the end point as implant revision for any reason was 94.9 % (95 % confidence intervals 90.0–99.3 %) at 12.8 years. Revisions were performed because of one ceramic liner fracture, three dislocations, and two deep infections. No radiographic evidence of wear or osteolysis was observed. The preoperative Merle d’Aubigne and Postel hip score increased from 11.6 to 17.1.

Conclusions

Patients, who received third-generation CoC THA had no detectable wear and osteolysis. One ceramic fracture occurred, and the main reason for revision was dislocation.     

Transient receptor potential 1 regulates capacitative Ca(2+) entry and Ca(2+) release from endoplasmic reticulum in B lymphocytes

Capacitative Ca(2+) entry (CCE) activated by release/depletion of Ca(2+) from internal stores represents a major Ca(2+) influx mechanism in lymphocytes and other nonexcitable cells. Despite the importance of CCE in antigen-mediated lymphocyte activation, molecular components constituting this mechanism remain elusive. Here we demonstrate that genetic disruption of transient receptor potential (TRP)1 significantly attenuates both Ca(2+) release-activated Ca(2+) currents and inositol 1,4,5-trisphosphate (IP(3))-mediated Ca(2+) release from endoplasmic reticulum (ER) in DT40 B cells. As a consequence, B cell antigen receptor-mediated Ca(2+) oscillations and NF-AT activation are reduced in TRP1-deficient cells. Thus, our results suggest that CCE channels, whose formation involves TRP1 as an important component, modulate IP(3) receptor function, thereby enhancing functional coupling between the ER and plasma membrane in transduction of intracellular Ca(2+) signaling in B lymphocytes.