INFLUENCE OF DIABETES ON METABOLISM OF VASCULAR SMOOTH MUSCLE

Abstract. Glucose utilization and the conversion of glucose to lactate, CO₂, glycogen and lipids are decreased in the aorta from diabetic rats and rabbits. In addition the incorporation of amino acid into protein is reduced in diabetic rat aorta. The metabolic changes produced by diabetes are counteracted by insulin treatment, but there is a time lag of about 2 days before the effect of insulin treatment appears. The membrane transport of glucose in smooth muscle is carried out by a specific transport system of the facilitated diffusion type. A rate limiting influence of membrane transport on glucose metabolism is found in bovine mesenteric arteries and rabbit colon smooth muscle. In these preparations the influence of glucose concentrations on glucose metabolism is most pronounced in the range 0–11.1 mmol exhibiting saturation at higher glucose concentrations. Insulin in a high concentration (0.1 U/ml) has acute (≤3 h) metabolic effects in vitro on smooth muscle which are qualitatively similar to those in skeletal muscle, but are weaker and appear later. The threshold concentration for the acute metabolic effects of insulin on smooth muscle in vitro is 10–100 times above the physiological levels, indicating a low acute sensitivity to insulin.     

RENAL TRANSPLANTATION IN CHILDREN

ABSTRACT: Henriksson, C., Andersen, H. J., Gustafsson Å. and Gelin, L.-E. (Department of Surgery I, Sahlgren's Hospital, Gothenburg, Sweden, and Department of Pediatrics, Odense Hospital, Odense, Denmark). Renal transplantation in children. Acta Paediatr Scand, 64: 833, 1975.–From July 1967 to September 1974, 26 kidney transplantations were carried out in 16 children aged 6 to 17 years, in Gothenburg. The average age at the primary transplantation was 12 years and average body weight 29.7 kg. Five patients had familial juvenile nephronophthisis, 5 chronic glomerulonephritis, 5 chronic pyelonephritis, and one bilateral Wilms's tumour. Four patients were predialytic. Fourteen grafts came from living related donors. The surgical technique was standard as was the immunosuppression with azathioprine and cortisone; exceptionally antilymphocyte globulin was used. Thirteen patients were alive in September 1974, observed 2–65 months, 8 with a normal serum creatinine, 3 with moderately elevated serum creatinine, and 2 on hemodialysis. The 6- and 12-month survivals of patients are 100% and 93% respectively. Normal growth and full rehabilitation in recipients of functioning grafts make renal transplantation justified as a therapeutic procedure in terminally uremic children.     

COMPARISON OF LAPAROSCOPIC AND OPEN NEPHROURETERECTOMY FOR BENIGN DISEASE

Purpose

We report our experience with laparoscopic nephroureterectomy for benign disease and compare the results to a contemporary group of patients undergoing open nephroureterectomy.

Materials and Methods

Between October 1994 and March 1997, 12 women and 4 men with a mean age of 50 years (range 22 to 70) underwent laparoscopic nephroureterectomy at our hospital. Indications for operation were nonfunctioning kidneys due to vesicoureteral reflux with recurrent episodes of pyelonephritis or analgesic nephropathy before a planned renal transplantation. In comparison 11 women and 4 men with a mean age of 40 years (range 18 to 64) underwent open nephroureterectomy for various benign diseases.

Results

Laparoscopic and open nephroureterectomy had no significant differences regarding operative times (100 versus 124 minutes) and complication rates (25 versus 20%). In the laparoscopy group conversion to open surgery was not necessary. Patients who underwent laparoscopic nephroureterectomy has significantly less consumption of morphine equivalent for postoperative pain control (12 versus 40 mg.), shorter time to achieve mobilization and oral intake (11 versus 39 hours), shorter hospital stay (6 versus 12.7 days) and faster return to normal activities (21 versus 39 days).

Conclusions

Laparoscopic nephroureterectomy in patients with benign disease has similar operative results but obvious postoperative advantages compared to the open approach.     

Liver distribution of γδ‐T‐cells in patients with chronic hepatitis of different etiology

The γδ T cells represent a minor unique T‐cell subpopulation long been considered as innate‐like immune cells. They are found in increased numbers in tissues from various inflammatory conditions. Their role in chronic hepatitis, however, is still discussed controversially. Fresh frozen tissues from 50 patients (18 cases hepatitis B infection, 25 hepatitis C, three cases with co‐infection of hepatitis B and C and four patients with autoimmune hepatitis) were investigated. Immunohistochemistry with primary antibodies detecting αβ and γδ TCR was used to evaluate their incidence and distribution in the different histological structures of the liver. The inflammatory infiltrate in all cases of chronic hepatitis was dominated by αβ T cells and was mainly localized in the portal tracts with formation of an interface hepatitis (95.3%αβ T cells; 4.7%γδ T cells). There were neither significant differences between inflammatory infiltrate nor the amount or percentage of γδ T cells between hepatitis B, C or autoimmune hepatitis. No accumulation of γδ T cells could be observed in cases of chronic hepatitis of different etiologies. The immune‐mediated phenomena in chronic hepatitis are dominated by αβ T cells. Thus, the adapted immune system is responsible for the inflammatory processes in chronic hepatitis.     

Transcatheter Closure of Patent Foramen Ovale in Patients with Paradoxical Embolism. Procedural and Follow-up Results after Implantation of the Starflex® Occluder Device with Conjunctive Intensified Anticoagulation Regimen

Background: Prevalence of patent foramen ovale (PFO) is higher in patients with paradoxical embolism and associated with increased risk for recurrent thromboembolic events. By percutaneous closure of PFO, surgical closure or permanent oral anticoagulation can be avoided. So far, published series included different occluder systems and various indications and regimens of postprocedural anticoagulation. The aim of the present study was to evaluate the short- and long-term results after implantation of the Starflex^® occluder in patients with PFO using an intensified anticoagulation regimen.
Methods and Results: 154 patients with PFO (94 men; age: 44 ± 13 years) and > 1 thromboembolic event were included. Other causes for embolism were excluded. PFO closure was successful in 147 patients (95.5%). All patients were treated with phenprocoumon (INR 2.5) and aspirin (100 mg/die) for 6 months. Transesophageal echocardiography (TEE) was repeated at 6 months. Mean clinical follow-up period was 26 ± 18 months.
After 6 months, five patients had a significant residual shunt, and five patients had suspected thrombus formation on the occluder. In three of these five patients, the occluder was surgically removed and foreign body reaction was noted. During follow-up, nine patients suffered from neurological events (two strokes, seven transient ischemic attacks [TIA]), though complete closure of the PFO was documented by TEE. Two patients died during follow-up; three patients had bleeding complications.
Conclusion: Percutaneous closure of PFO in symptomatic patients by Starflex^® occluder represents an effective therapy with a low incidence of periinterventional complications and recurrent thromboembolism. However, thrombus formation at the occluder system may occur in some patients despite an aggressive anticoagulation regimen.     

Pol-ethical considerations in public health: The views of Swedish health care politicians

Background: Public health policy is often concerned with theconflicting values emanating from the individually formulatedethics for curative care and more collectively oriented ethics.In this study we have focused on the pol-ethical considerationsinvolved in Swedish health care politicians' assessment of publichealth measures. Methods: We described a hypothetical situationin a questionnaire, where a community has a 50% excess mortalityfor disease X, compared to the national average. Scientificdisagreements were identified and discussed. The respondentsgave their preference for a specific intervention strategy andconsidered, on a graded scale, 17 different value statementsrelated to ethical principles and intervention strategies. Results:Only one out of 451 politicians preferred the alternative ‘nointervention’. The majority preferred an interventionincluding active involvement of primary health care. There wasoverall strong support for equity and beneficence. A factoranalysis gave a model for the association between ethical values,political affiliation and choice of intervention strategies.The relative weights of autonomy and equity were strongly relatedto political affiliation. Conclusions: Among Swedish healthcare politicians there is consensus about the value of performinginterventions in public health when the problem is large, evenif there is some uncertainty about the consequences. Their overallstrong support for equity and beneficence implies that theseprinciples are crucial when formulating policies for interventions.Politicians need to state their ethical standpoint explicitlyso that we as citizens can judge their decisions and actionsbased on our own political ideology and support for basic ethicalprinciples.     

Kinetics and sensitivity of ELISA IgG pertussis antitoxin after infection and vaccination with Bordetella pertussis in young children

Sera from 96 young children in a vaccine trial were analysed for kinetics of ELISA IgG anti‐pertussis toxin (anti‐PT) after a laboratory‐verified pertussis infection. The antibody decay curves after infection were biphasic and similar in shape to those after vaccination. The change from a rapid to a slower decay after the peak occurred about 4–5 months from the first day of cough. In a group of children given a two‐ or a five‐component acellular pertussis vaccine the proportion of sera above the tentative cut‐off values for anti‐PT of 20, 50 or 100 EU/ml 12 months after onset of the infection were 19%, 0% and 0% respectively. Corresponding figures for a whole‐cell or placebo vaccine group of infected children were significantly higher, 73%, 39% and 30%, i.e. the antibody decay after infection in young children depends on vaccination status as well as on the pertussis vaccine given. In a large group of non‐infected children vaccinated with the same five‐component acellular vaccine 13%, 0% and 0% had sera above 20, 50 and 100 EU/ml at 12 months after the third vaccine dose and all were below the minimum level of detection 2 years after vaccination. In conclusion, knowledge about anti‐PT kinetics is essential for the interpretation of seroepidemiological data but hardly offers the possibility to establish valid cut‐off values for anti‐PT in single sample serology. An option would be to identify a grey zone between the positive and negative ends of the distribution for follow‐up testing by a second serum.     

Electrocardiographic Characteristics in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Echocardiographic Parameters

The aim of this study was to determine the relation between (1) ECG fibrillatory wave amplitude and left atrial diameter and left atrial appendage (LAA) flow velocity using different ECG recording techniques, and (2) ECG fibrillatory frequency and frequency of LAA contractions in patients with nonrheumatic AF. In 36 patients (22 men, 14 women, mean age 61 +/- 11 years) with persistent AF, ECG recordings were performed using a standard 12-lead EGG and an orthogonal EGG lead system using a high gain, high resolution ECG. AF was classified as coarse (fibrillatory amplitude > or = 1 mm) orfine (fibrillatory amplitude < 1 mm) in leads I, aVF, V1 and corresponding leads X, Y, and Z. Fibrillatory frequency from the ECG was determined by subtracting averaged QRST complexes and applying a Fourier analysis to the resulting signal. Doppler flow was obtained from LAA during transesophageal echocardiography and LAA emptying velocity was determined. Fourier analysis was also applied to the Doppler signal generating the frequency of LAA contractions. Coarse AF was observed in 0, 9, and 18 patients in leads I, aVF, and V, respectively. It was more often (P < 0.05) detected in corresponding leads X (n = 13), Y (n = 31), and Z (n = 23). Fine AF in lead X was associated with a reduced LAA velocity (33 +/- 16 cm/s in coarse AF vs 22 +/- 13 cm/s in fine AF, P = 0.05). There was neither a relation between AF coarseness in any other ECG lead and LAA flow velocity, left atrial diameter, or echo contrast. In 25 patients with an active LAA flow, the mean frequency of LAA contractions was 6.8 +/- 0.8 Hz. The corresponding mean frequency obtainedfrom the EGG was 6.7 +/- 0.7 Hz (r = 0.85, P < 0.001). The mean difference between these two measures was 0.04 Hz, and the 95% confidence limits were 0.90 and- 0.82 Hz using the Bland-Altman method. In conclusion, AF coarseness and its relation to LAA flow velocity depend on the ECG recording technique used. LAA contractions represent one mechanical correlate of the electrical fibrillatory activity in AF.