Predictors of long-term results after treatment of iliac artery obliteration by transluminal angioplasty and stent deployment

Purpose: To investigate initial and long-term success rate after percutaneous treatment of iliac artery occlusion with angioplasty and stent deployment. To investigate the influence of vascular comorbidity, lesion length, stent placement and lesion coverage as possible predictors of outcome. Methods: Between January 1994 and December 1999, 80 iliac recanalizations were performed on 78 patients, median age 61.1 ± 11.5 (SD) years. All patients were followed up by clinical examinations, duplex ultrasound and intravenous digital subtraction angiography. Mean follow-up time was 2.0 ± 1.53 (SD) years. Multivariate Cox regression analysis was used to determine the influence of cofactors on patency. Results: One, 2 and 4 years after recanalization, primary patency was 78.1%, 74.5% and 64.0%; secondary patency was 88.8%, 88.8% and 77.9%, respectively. Patients with shorter occlusions, complete lesion coverage and patent ipsilateral femoral arteries had significantly longer patency rates. Complications included inguinal hematoma (n=1), technical failure (n=3) aortic dissection (n=1), embolic occlusions (n=7), gluteal claudication (n=1) and genital necrosis after subsequent urethral surgery in one patient with contralateral occlusion and ipsilateral overstenting of the internal iliac artery with subsequent stenosis. Complications were of permanent clinical significance in seven of 78 (9%) of the patients. In 17 (22%) cases, percutaneous reintervention was performed with angioplasty in the stent (n=16) or deployment of a new stent (n=1). Conclusion: Endoluminal stent placement has its place in an interdisciplinary therapeutic approach as a viable therapeutic alternative to major transabdominal bypass surgery and can be performed with comparable complication rates. Patients with short occlusions, patent femoral arteries, and stents covering the entire occlusion have significant longer patency.     

The effects of 1.5T magnetic resonance imaging on early murine in-vitro embryo development

Although no ionizing radiation is involved, patients undergoing magnetic resonance imaging (MRI) are exposed to powerful static magnetic fields, magnetic field gradients, and radio-frequency fields that may be potentially damaging. Our study aims to document the effect of MRI imaging sequences on early murine embryo development (two-cell to blastocyst stage) in vitro. Two-cell murine embryos were exposed to various lengths of MRI using pulse sequences employed in present day clinical imaging. Early murine embryo development was documented in vitro, and blastocyst development rates were computed for both the control and exposed groups. There were no significant differences detected in the rate of blastocyst formation between the control groups and the embryos exposed to MRI.     

Binaural sensitivity to temporal fine structure and lateralization ability in children with suspected (central) auditory processing disorder

Objective

Previous studies have shown that a subgroup of children with suspected (central) auditory processing disorder (SusCAPD) have insufficient ability to use binaural cues to benefit from spatial processing. Thus, they experience considerable listening difficulties in challenging auditory environments, such as classrooms. Some researchers have also indicated the probable role of binaural temporal fine structure (TFS) in the perceptual segregation of target signal from noise and hence in speech perception in noise. Therefore, in the present study, in order to further investigate the underlying reason for listening problems against background noise in this group of children, their performance was measured using binaural TFS sensitivity test (TFS-LF) as well as behavioral auditory lateralization in noise test, both of which are based on binaural temporal cues processing.

Neuropsychological outcome 6 months after unilateral carotid stenting

Percutaneous transluminal angioplasty with stenting (PTAS) has become a treatment option for severe carotid stenosis. The goal of our study was to determine prospectively neurocognitive outcome 6 months after unilateral stent-protected carotid angioplasty. Twenty consecutive patients who underwent stent-protected angioplasty for symptomatic (n=9) or asymptomatic (n=11) high-grade carotid stenosis were investigated and compared to an age and disease matched control group. Patients were administered preprocedurally and 6 months postprocedurally a battery of neuropsychological tests. We used reliable change indices methodology in order to control for practice and statistical effects unrelated to intervention. We found no cognitive change in approximately 90% of patients and cognitive improvement in approximately 10% of patients for concentration and attention variables. We further found no cognitive change in 61% of patients, cognitive improvement in 11% of patients and cognitive deterioration in 28% of patients for psychomotor speed. No cognitive change in 94% of patients and cognitive deterioration in 6% of patients was found for sustained attention; no cognitive change in 80% of patients, cognitive improvement in 15% of patients and cognitive deterioration in 5% of patients was found for verbal fluency; no cognitive change in 100% of patients was found for interference (Stroop test): no cognitive change in 95% of patients, cognitive improvement in 5% of patients was found for interference (c.I. test), respectively.Our study showed that 6 months after PTAS cognitive functioning did not change in most patients significantly. For some patients, however, significant improvement or deterioration in single neurocognitive domains can be expected. The reasons for these changes are unclear but may depend on variable type; magnitude of microemboli production; right vs. left cerebral vasculature, respectively.     

Glycinergic neurons expressing enhanced green fluorescent protein in bacterial artificial chromosome transgenic mice

Although glycine is a major inhibitory transmitter in the mammalian CNS, the role of glycinergic neurons in defined neuronal circuits remains ill defined. This is due in part to difficulties in identifying these cells in living slice preparations for electrophysiological recordings and visualizing their axonal projections. To facilitate the morphological and functional analysis of glycinergic neurons, we generated bacterial artificial chromosome (BAC) transgenic mice, which specifically express enhanced green fluorescent protein (EGFP) under the control of the promotor of the glycine transporter (GlyT) 2 gene, which is a reliable marker for glycinergic neurons. Neurons expressing GlyT2-EGFP were intensely fluorescent, and their dendrites and axons could be visualized in great detail. Numerous positive neurons were detected in the spinal cord, brainstem, and cerebellum. The hypothalamus, intralaminar nuclei of the thalamus, and basal forebrain also received a dense GlyT2-EGFP innervation, whereas in the olfactory bulb, striatum, neocortex, hippocampus, and amygdala positive fibers were much less abundant. No GlyT2-EGFP-positive cell bodies were seen in the forebrain. On the subcellular level, GlyT2-EGFP fluorescence was colocalized extensively with glycine immunoreactivity in somata and dendrites and with both glycine and GlyT2 immunoreactivity in axon terminals, as shown by triple staining at all levels of the neuraxis, confirming the selective expression of the transgene in glycinergic neurons. In slice preparations of the spinal cord, no difference between the functional properties of EGFP-positive and negative neurons could be detected, confirming the utility of visually identifying glycinergic neurons to investigate their functional role in electrophysiological studies.     

Fertility and contraceptive issues after kidney transplantation in women

PURPOSE: Our purpose was to investigate reproductive performance among kidney transplant recipients. MATERIALS AND METHODS: We studied 126 kidney transplanted women 15 to 68 years of age including 33 who were single and 93 who were married. RESULTS: Infertility was seen in 10.4% of those who desired pregnancy, a rate similar to the general population. The most common method of contraception was coitus interruptus (56%), 22% of patients had tubal ligation, 6% had husbands who had vasectomies, 14% were using condoms, and only 2% used oral contraceptives. Among 33 pregnancies, 16 were unintended (48.5%). Most of the patients with unwanted pregnancy were using coitus interruptus (93.7%). In the group with unintended pregnancy, abortion was induced in three, spontaneous abortion or intrauterine fetal death occurred in six, and only seven pregnancies resulted in a live birth (43.7%). CONCLUSION: Kidney transplantation greatly improves fertility, so those who do not desire pregnancy should be protected by an effective method of contraception.     

Screening for hepatocellular carcinoma

Liver cancer remains one of the most common causes of cancer death globally, and its cure rate has not improved for the past 20 years. Hepatocellular carcinoma develops in patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in screening program aiming to achieve early detection and effective treatment for HCC. Only those patients diagnosed with HCC who would benefit with the available treatment, should undergo the screening procedure. This is based on ultrasonography and alpha-fetoprotein every 3-6 months based on the prevalence and economic status of the community being tested.