Percutaneous aspiration thromboembolectomy

Percutaneous aspiration thromboembolectomy (PAT) was used as an angioplastic tool to remove from arteries of the lower limbs thromboembolitic material originating from any source. PAT was performed with a custom-designed catheter/sheath system, alone or in combination with balloon dilatation and/or local lytic infusion therapy with streptokinase or urokinase. PAT completed the restoration of blood flow, thus improving the results of the preceding angioplastic interventions. Clinical improvement was high, with 93% success (42 of 45 procedures). Only one below-the-knee amputation occurred, and could not be prevented. No patient became worse because of PAT intervention. The Fogarty catheter technique remains the method of choice for removing emboli within the aorto-iliac region, but in the smaller vessels below the inguinal ligament-especially in the distal superficial femoral, popliteal, and tibial regions--in our experience PAT is superior. This has been substantiated also in studies of laboratory animals, using barium-impregnated emboli.     

The window for embryo transfer in oocyte donation cycles depends on the duration of progesterone therapy

In 192 oocyte donation cycles performed between January 1993 and July 1996, we examined the width of 'the window for embryo transfer' using standard hormonal replacement methods. All transfers were performed within 48 h of insemination. We varied the day of embryo transfer with regard to the initiation of progesterone therapy and, thus, the duration of endometrial exposure to progesterone and analysed the resulting pregnancy rates. Patients were divided into five groups (I-V) and embryo transfers were performed 2, 3, 4, 5 or 6 days following initiation of progesterone therapy. The number of pregnancies per transfer cycle achieved in groups I-V were 0 (0%), 3 (12%), 16 (40%), 29 (48.3%), and 10 (20.4%) respectively. The increased pregnancy rate in group III in comparison to group II is statistically significant (P < 0.03). Furthermore, the pregnancy rate in group IV (5 days of progesterone administration before embryo transfer) was significantly higher than in group V (6 days of progesterone administration before embryo transfer; P < 0.005). We also noted that, when embryos were transferred 4 or 5 days after initiation of progesterone therapy, the pregnancy rates were not significantly different between menopausal and cycling recipients (50% vs 43.7%). Our results indicate that the window for embryo transfer is dependent on duration of treatment with progesterone; it begins approximately 48 h after starting progesterone administration and lasts for approximately 4 days. The optimum period for transferring embryos at the 4- to 8-cell stage corresponds to cycle days 18 and 19. Transfers performed on the 17th and 20th days of the cycle can result in successful implantation, although the rates of implantation are highest when transfers are done on days 18 and 19.      

In vivo induction of type 1 and 2 immune responses against protein antigens

Polarization of the immune response towards Th1 or Th2 profiles is under the control of several, not yet well known, mechanisms. The present study was undertaken to investigate whether immune responses generated against major protein antigens, of parasitic (Schistosoma mansoni) and bacterial (Clostridium tetani) origin, present characteristic Th profiles. Mice were immunized with a single dose of S. mansoni 28 kDa glutathione-S-transferase (Sm28-GST) or tetanus toxin fragment c (TTc) in combination with different adjuvants, or Salmonelia typhimurium expressing these antigens as a fusion protein. Antigen- specific IgG isotypes and cytokine mRNA expression in vivo, as well as cytokine secretion after in vitro antigen stimulation were studied. Immunizations with either protein in aluminum hydroxide induced a strong Th2-associated antibody (IgG1) and cytokine (IL-4) response. In contrast, the recombinant S. typhimurium, expressing the TTc/Sm28-GST fusion protein, induced a Th1-like response, associated with the production of IFN-gamma and IgG2a antibodies against both antigens. When complete Freund's adjuvant was used, a non-polarized profile was observed, characterized by expression of both IL-4 and IFN-gamma, as well as strong specific IgG1 and IgG2a antibody responses. These results indicated that some protein antigens play a weak role in polarizing the immune response and that contrasting cytokine profiles could be induced against the same antigen, depending on the adjuvant employed.      

A follow-up study of Asian problem drinkers

This is a follow-up study of 70 patients referred for treatment of drinking problems. At the end of 12 months, it was found that 60% remained in abstinence, 8.5% social drinking, 28.5% relapsed or defaulted and 3% died. A poor outcome was observed in patients between 20 and 39 years old as compared to those between 40 and 59 years old. Patients with SADQ scores of less than 20 had good outcomes. However, there was no significant difference between Indian and Chinese patients. Marital status and social class were not useful predictors of outcome.     

Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings

Eleven patients who underwent abdominoperineal resection for rectosigmoid carcinoma were examined with magnetic resonance (MR) imaging for suspected recurrent tumor in the presacral space. There were 12 suspected masses in the 11 patients. Ten lesions were malignant, and in two lesions only nonneoplastic inflammatory tissue was found. The signal intensity (SI) of each lesion relative to that of muscle was determined visually and correlated with the histologic findings at surgery or biopsy. The SIs of malignant and benign lesions were indistinguishable. All lesions showed areas of high SI that correlated with carcinoma and tumor necrosis or with non-neoplastic inflammation and edema. Areas of low SI corresponded to reactive fibrous tissue (desmoplastic reaction) with small islands of tumor or to nonneoplastic fibrosis. MR imaging can be useful in determining the extent of suspected tumors, but SIs on T2-weighted images do not permit histologic diagnosis. In particular, distinction of benign from malignant tissue is difficult in tumors with a desmoplastic reaction.