Ferritin and transferrin levels in human breast cyst fluids: relationship with intracystic electrolyte concentrations

The concentrations of sodium and potassium and the content of ferritin and transferrin, proteins considered as potential markers for identifying cells undergoing divisional activity, were measured in fluid from 30 human breast cysts. On the basis of the relative electrolyte concentrations, two main classes of cysts were defined. When the cyst fluids were subdivided according to their Na+/K+ ratio, a significant difference was found between menstruating vs. menopausal patients. The relationship between the two major iron-binding proteins and the Na+/K+ ratio may indicate the expression of a local higher biosynthetic activity in apocrine cysts associated with higher cancer risk.     

Cervicovaginal cytology in women wearing intrauterine devices

Cervical and vaginal smears in 300 women using (a) intrauterine devices (IUD) and in 300 age matched control subjects (b), have been examined. In women using IUD, endometrial cells have been observed also in the second half of menstrual cycle, conversely these cells are present in women belonging to the control group, just in the first half of the cycle. Pattern of cervico-vaginitis due to Chlamydiae, Actinomyces and Eubacteria have been observed in higher percentage in women IUD wearers 58% of (a) group and 19.3% of (b) group (P less than 0.005). These patterns have often been characterized by the presence of repair cells. Implications in the evaluation of vaginal smears are discussed.     

Value of radiopaque markers in identifying partial small bowel obstruction

Confirming partial small bowel obstruction is often a diagnostic challenge. In this case report, 4-mm solid radiopaque markers were used in 4 patients to show partial small bowel obstruction. Results of enteroclysis were normal in 2 of the 4 patients, and the markers were used to challenge suspected partial obstruction. The markers coalesced in the region of the partial obstruction, which was confirmed at surgery. Enteroclysis is the examination of choice in the diagnosis of partial small bowel obstruction. However, examinations with false- negative results can occur, particularly with adhesive and/or intermittent obstructions. The use of radiopaque markers in these cases proved an effective and useful method of establishing the diagnosis of partial small bowel obstruction, particularly in the 2 cases in which enteroclysis results were normal. Prospective studies are needed to establish the feasibility of this novel technique. (Gastroenterology 1996 Jun;110(6):1958-63)     

A randomized trial comparing compression,perclose proglide™ and Angio‐Seal VIP™ for arterial closure following percutaneous coronary intervention: The cap trial

Objective: This prospective randomized trial compared the Angio‐Seal VIP? with Perclose Proglide? and to manual compression with respect to time to hemostasis and ambulation, patient satisfaction, and vascular complications following percutaneous coronary intervention (PCI). Background: The use of arterial closure devices for the reduction of vascular complications following PCI remains controversial. There have been no head to head trials comparing these most commonly used arterial closure devices following PCI. Methods: Two hundred patients undergoing PCI were randomized to manual compression, Perclose Proglide? or Angio‐Seal VIP?. Ambulation was allowed 3 hr after Perclose Proglide? or Angio‐Seal VIP? and 6 hr after compression. Results: There were 10 failures to deploy Perclose Proglide? and none for Angio‐Seal? (P < 0.01). Time to hemostasis was significantly shorter with Angio‐Seal VIP? compared with Perclose Proglide? (5.3 vs. 46.8 min, P < 0.01). Time to ambulation was shorter with Angio‐Seal VIP? than with Perclose Proglide? (261 vs. 334 min, P < 0.05) and the time to ambulation, as expected, was longest with compression (943 min, P < 0.01 vs. Angio‐Seal VIP? and Perclose Proglide?). Delay in ambulation was higher with Perclose Proglide? than with Angio‐Seal VIP? (18 vs. 9, P < 0.01). There was no significant difference in major vascular complications between groups. Compared with compression, patient discomfort was significantly improved with Angio‐Seal? (1.5 vs. 2.0, P < 0.01), but not with Perclose Proglide?. Conclusion: The Angio‐Seal VIP? device has a high rate of deployment success, which is significantly better than that of Perclose Proglide?. Angio‐Seal VIP? allows for earlier hemostasis and ambulation compared with both compression and Perclose Proglide? and is associated with greater patient satisfaction compared with compression. © 2008 Wiley‐Liss, Inc.     

在斋月前、中、后评价2型糖尿病患者甘精胰岛素和格列美脲联合治疗的安全性

在斋月前、中、后期比较甘精胰岛素和格列美脲联合治疗2型糖尿病患者低血糖事件发生的情况.在甘精胰岛素联合格列美脲联合治疗的方案下,斋月前、中、后期低血糖的发生没有差异(P=0.238).     

alpha-Actinin and vinculin in normal and thrombasthenic platelets

Recently, the contractile protein alpha-actinin was identified in normal human platelets by its antigenic cross-reaction with a monospecific antibody to purified muscle alpha-actinin. In this study, we extend that preliminary identification of platelet alpha-actinin. Amino acid analysis, one-dimensional peptide maps, and silver stain analysis on polyacrylamide gels demonstrate that human platelet alpha- actinin shows a greater degree of similarity to smooth muscle alpha- actinin than to striated muscle alpha-actinin. There is no evidence to suggest that alpha-actinin is a glycoprotein. In addition, we find that thrombasthenic platelets, which are deficient in glycoproteins IIb and IIIa (GPIIb and GPIIIa) contain normal amounts of alpha-actinin, confirming the recent finding that alpha-actinin and GPIIIa are different proteins in human platelets. We demonstrate that both normal and thrombasthenic platelets also contain vinculin, a 130,000-dalton polypeptide found in many cell types at sites of end-on attachment of microfilaments to the plasma membrane. Thus, the thrombasthenic defect in GPIIb and GPIIIa does not diminish the content of either alpha- actinin or vinculin.     

Durability of giant hiatus hernia repair in 455 patients over 20 years

Introduction

The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period.

Methods

This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms.

Results

Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15–93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0–1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1–5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5–10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications.

Conclusions

Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.