Antihypertensive drugs and cognitive function

The increase in life expectancy is associated with a sharp rise in cognitive disorders, particularly after the age of 80 years. The identification and management of risk factors for these invalidating and distressing conditions must be considered a priority. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality, but also for cognitive impairment and dementia. The fact that antihypertensive treatment has been demonstrated to decrease those risks offers a new opportunity to reduce the prevalence of such related disorders and to promote healthy aging.     

Nasopharyngeal fibroma. Excision under hemodilution and delayed autotransfusion

The surgical treatment of juvenile naso-pharyngeal angiofibroma involved a potential haemorrhagic risk: the average intra-operative blood loss was estimated at between 1,300 and 2,800 ml in many reports. Two cases are reported in which haemodilution and autologous blood transfusion were used. The method consisted in pre-operative repeated phlebotomies ("leap-frog") and normovolaemic acute haemodilution; thus, 1,700 ml of autologous blood was collected in the first case, and 2,300 ml in the second one. Autotransfusion was carried out and no homologous blood transfusion was used in the peri-operative period. The use of this method, although compelling, had many advantages (financial saving, suppression of adverse reactions with homologous transfusion, transfusion of fresh blood, reduction of postoperative oedema).     

A case mix procedure for matching the clinical characteristics of patients with dual disorders to planned treatment and treatment costs

A procedure for matching the clinical characteristics of patients with a dual substance abuse psychiatric disorder to planned treatment resource consumption is described. The procedure uses current standards and practices within the mental health literature on dual diagnosed patients, providing an empirical basis for quality assurance, utilization review, and program evaluation. These procedures permit an empirical linking of clinical service performance to the costs of clinical resources, thereby providing a means of: (a) evaluating program costs in terms of the specific clinical characteristics of patients and (b) planning budgets based on the patients' clinical needs. The methods are sufficiently flexible so that as new clinical research recommend changes in assessment and treatment, the case mix definitions and evaluation procedures can be easily modified.     

Localized chromophobe carcinomas treated by nephron-sparing surgery have excellent oncologic outcomes

Objective

To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC).

Delayed recognition of human immunodeficiency virus infection in preadolescent children.

Thirty-two (18%) of 181 children cared for at our institution who were infected with the human immunodeficiency virus type 1 (HIV-1) were first seen, and HIV was diagnosed, when they were 4 years of age and older. Initial complaints or diagnoses for these children included the following: hematologic disorders (5) (3 idiopathic thrombocytopenic purpura, 1 neutropenia, 1 anemia); recurrent bacterial infections (10); Pneumocystis carinii pneumonia (3); developmental delay (1); skin disorders (2) (1 genital wart, 1 chronic zoster); weight loss (3); malignancy (1); and nephropathy (1). Eight children were referred for evaluation because of maternal HIV-1 infection. The risk factors for HIV-1 infection included maternal/perinatal exposure (22), perinatal blood transfusion (6), blood transfusion during infancy (2), and sexual abuse (2). Ten (31%) of the 32 children have subsequently died. The longest survival from perinatal infection was 12 years. HIV-1 infection in children can result in a prolonged clinical latency and can masquerade as other pathologic conditions. The absence of clinical symptoms in older children at risk for HIV-1 infection should not deter HIV testing.     

Experimental acquisition system for impedance tomography with active electrode approach

An experimental system for impedance tomography has been constructed. The acquisition system uses 16 multifunctional active electrodes, each including a current source and a voltage buffer. Images of active and reactive parts of different target impedances in a phantom filled with liquid have been obtained. The system performance has been compared with those of other systems using either a mesh phantom or rods as point sources used for the determination of the modulation transfer function.     

HER2 gene amplification assay: is CISH an alternative to FISH?

The HER2 proto-oncogene encodes a transmembrane protein, which is considered to function as a growth factor receptor. Overexpression of this protein found by immunohistochemistry in about 20% of infiltrating breast carcinomas, has a predictive value of response to treatment by trastuzumab, an anti-HER2 humanized monoclonal antibody. Search for HER2 gene amplification is necessary to adapt the immunohistochemical technique quality and also in the cases of delicate analysis or weak overexpression. It is usually carried out by Fluorescence In Situ Hybridization (FISH). A more recent hybridization technique, named CISH because of its chromogenic revelation is an alternative method, which gives highly correlated results with FISH. We present details of this technique, which may be more familiar for the pathologists than FISH, because reading analysis is similar to that of immunohistochemical staining.     

Anatomic bases of aorto-coronary bypasses: the internal thoracic artery and blood supply of the sternum

The internal thoracic a. is much used in cardiac surgery because of its anatomic position, but its mobilisation may lead to devascularisation of the sternum. The aim of this study was to establish a precise systematisation of the vascularisation of the sternum by means of dissections and radiography after injection of contrast medium in 15 subjects. It is based on the internal thoracic a. and its collaterals, which form multiple anastomoses. This anatomic basis provides an understanding of the problems of the devascularisation (partial and temporary) and the infections that may occur following the use of one or both internal thoracic aa. during coronary bypass operations. However, it should always be regarded as the graft of choice, given the longevity of these bypasses.This study was presented at the Société Anatomique de Paris on Friday 3 of March 1995     

Continuous determination of the cerebrovascular changes induced by bicuculline and kainic acid in unanaesthetized spontaneously breathing rats

Cerebral blood flow was sequentially determined (every 2-3 min) with helium clearance in two "vulnerable" structures: the hippocampus and the frontoparietal cortex during bicuculline (n = 11) and kainic acid (n = 9)-induced seizures in unanaesthetized, spontaneously breathing rats. Tissue partial pressures of oxygen and carbon dioxide were continuously and simultaneously evaluated in the same brain areas. All these variables were measured by mass spectrometry with a single gas sampling cannula previously implanted in each structure. The systemic variables, arterial blood pressure, arterial partial pressures of oxygen and carbon dioxide, pH, and bicarbonate concentration were also determined. Arterial and venous catheters were chronically implanted several days prior to the definitive experiments. Bicuculline induced short (about 15 min), recurrent, generalized seizures, with an abrupt rise in arterial blood pressure, an arterial metabolic acidosis and comparable blood flow increases (4-fold) in the hippocampus and the neocortex. A marked increase in tissue partial pressure of oxygen was always preceded by an increase in tissue partial pressure of carbon dioxide. After the seizures, in the 5 rats that survived, cerebral blood flow was significantly lowered; tissue partial pressure of oxygen and partial pressure of carbon dioxide also decreased, but to a lesser extent. Histological examination revealed two types of lesions: predominantly selective chromatolysis but also ischaemic cell change. Kainic acid first induced a decrease in arterial pressure and then hypertension during status epilepticus, with a return of arterial pressure towards basal levels during the recovery period (4 h after the injection). Respiratory alkalosis occurred throughout the experiment. Cerebral blood flow increased progressively to become maximal during status epilepticus. This vasodilatation was greater in the hippocampus (x 8) than in the neocortex (x 4). During recovery, cerebral blood flow tended to decrease but remained significantly elevated. In both structures, tissue partial pressure of oxygen was first lowered while tissue partial pressure of carbon dioxide was elevated; with the occurrence of the wet dog shakes, tissue partial pressure of O2 increased and tissue partial pressure of CO2 decreased. The changes in tissue gases were maximal during status epilepticus and tended to return to their basal levels thereafter, but no decrease in tissue partial pressure of O2 was observed, even 4 h after kainic acid administration. Histological analysis demonstrated ischaemic cell changes, particularly in the limbic system.(ABSTRACT TRUNCATED AT 400 WORDS)