Fluoroscopically assisted thromboembolectomy: An improved method for treating acute arterial occlusions

We performed bilateral femoral artery dissections in a single 50 kg mongrel dog. Digital fluoroscopic arteriograms documented the luminal diameter of the left iliac and right superficial femoral arteries. Balloon thrombectomy catheter passage was performed through hemostatic sheaths by 12 surgeons. Embolectomy balloons were filled with radiographic contrast material and the balloon catheter diameter was compared with the underlying vessel diameter. The percentage of overdistention of the embolectomy balloon relative to the arterial wall was 23%±5% in the iliac artery and 40%±13% in the femoral artery. Over a 25-month period, we used fluoroscopically assisted thromboembolectomy to treat 21 patients with acute arterial or graft occlusions. As the balloon was gently withdrawn to extract intravascular thrombus, deformities of the compliant balloon profile caused by underlying arterial lesions were identified fluoroscopically and their locations recorded to facilitate further treatment. After initial clot removal in these 21 patients, 15 residual lesions were documented. Repeat thrombectomy (n=8), balloon angioplasty (n=3), and placement of intravascular stents (n=4) eliminated all 15 lesions. Luminal continuity was successfully restored in all 21 of these patients, 10 of whom required distal open vascular reconstruction to correct existing outflow artery disease. Fluoroscopically assisted thromboembolectomy is a simple and safe method for treating acute arterial or graft occlusions in patients with diffuse arteriosclerosis. It minimizes arterial damage and blood loss during balloon thrombectomy and reduces the need for intravascular contrast agents. It also has the potential to facilitate accurate identification, localization, and treatment of significant underlying arterial lesions.Supported by grants from the United States Public Health Service (HL 02990-03), the James Hilton Manning and Emma Austin Manning Foundation, the Anna S. Brown Trust, and the New York Institute for Vascular Studies.Presented at the Ninth Annual Meeting of the Eastern Vascular Society, Buffalo, N.Y., May 5–7, 1995.     

Replicon typing characterization of plasmids encoding resistance to gentamicin and apramycin in Escherichia coli and Salmonella typhimurium isolated from human and animal sources in Belgium.

Escherichia coli and salmonella strains with plasmids conferring resistance to gentamicin and apramycin have been isolated with increasing frequency both from cattle and hospital patients in Belgium. The apramycin-gentamicin resistance plasmids were characterized in recipient strains by their profiles and molecular weights using agarose gel electrophoresis, by their antimicrobial resistance patterns and by replicon typing using a series of DNA probes specific for the genes controlling their systems of replication. Overall, most of the plasmids differed in their DNA electrophoretic patterns. Seventeen different antimicrobial resistance profiles were observed, and there were six different types of replicons. However, two replication genes predominated and had a preferential distribution in different bacterial species. The rep FIC.a plus rep Q multireplicon was found mainly in plasmids recovered from gentamicin- and apramycin-resistant E. coli while replicon of the type rep FIC.b largely prevailed in S. typhimurium. Identical replication genes were found in most animal and human strains, hence suggesting a high homology between apramycin-gentamicin plasmids in these communities. Finally, our results indicate that the rapid spread of apramycin-gentamicin-resistance in several species of Enterobacteriaceae isolated from animals and from humans in Belgium is not due to a single plasmid, but rather that the gene encoding AAC(3)-IV is carried by various replicons.     

Treatment of depression in Parkinson’s disease

Depression is one of the most common nonmotor features observed in Parkinson’s disease (PD), affecting approximately 40% of patients. Depression in Parkinson’s disease (dPD) significantly affects quality of life of both patients and their families and has been shown to be more predictive of distress than motor disability. Depression frequently goes unrecognized in this population, however, in part because the diagnosis is often complicated by the overlap of psychiatric and PD symptoms. The etiology of dPD is unclear; dopaminergic, serotonergic, and noradrenergic systems may be implicated. Options for managing dPD include antidepressant medication; cognitive-behavioral therapy; behavioral lifestyle interventions such as exercise; and, in refractory cases, noninvasive brain stimulation (electroconvulsive therapy, transcranial magnetic stimulation). Randomized controlled trials are needed to evaluate the efficacy of interventional approaches for dPD; several trials are currently underway.     

Multidrug-resistant urinary tract isolates of escherichia coli from Ribeir?o Preto, S?o Paulo, Brazil.

Multiple resistances to antimicrobial drugs arising in Escherichia coli isolates may complicate therapeutic management of urinary tract infection (UTI) by this organism. In order to assess the multidrug resistance (MDR) among urinary E. coli isolates, we have tested 11 antimicrobial drugs against 67 isolates from outpatients attended in a tertiary-care teaching hospital and of 78 isolates from a municipal health unit, respectively in Ribeir?o Preto, State of S?o Paulo, Brazil. Seventy-six percent and 22% of the isolates from the tertiary-care hospital and the municipal unit, respectively, were resistant to three or more different classes of agents, and were considered to present MDR. Among the isolates from the hospital patients, 73.0%, 65.0%, 58.0%, 58.0% and 31.0% were resistant to tetracycline, ampicillin, cephalothin, trimethoprim-sulfamethoxazole (TMP/SMX) and norfloxacin, respectively; resistance from the municipal unit patients were 31.0%, 37.0%, 8.0%, 29.0% and 12.0% respectively, to the same drugs. The predominant phenotype among the MDR isolates presented is ampicillin, TMP/SMX and tetracycline resistance. The high prevalence of drug resistance among UTI patients calls for continuous surveillance to assure effective control of this infection.     

Accurate determination of a joint rotation center based on the minimal amplitude point method.

In many computer-assisted surgery procedures in the field of joint replacement a joint rotation center must be located. To this end, joints such as the hip or the shoulder are approximated as spherical joints, and the most commonly used numerical method is the sphere-fitting algorithm. However, this method has a numerical instability where there is a limited range of motion caused by, for example, joint impingement. The aim of the present study was to develop an alternative kinematic method called the minimal amplitude point method. This method estimates the localization of the rotation center and can easily be integrated into program codes of computer-assisted surgery modules. It mainly consists of identifying the point of a mobile segment that moves least in the reference coordinate system of an immobile segment using an optimization procedure (genetic algorithm). The point determined can then be assumed to be the rotation center of the joint. To compare results of the two methods, an experimental set-up of two rigid solids linked by a spherical joint with known geometry was used to compute the rotation center. In contrast to the sphere-fitting method, the minimal amplitude point method permits the evaluation of the rotation center with an error of less than 4.1 mm, having a range of motion (ROM) of 5 degrees. An equivalent accuracy for the sphere-fitting method requires an ROM of 45 degrees.     

Tooth discoloration by blood: an in vitro histochemical study

Abstract An in vitro model, using a modification of a technique devised by Freccia & Peters, was developed to investigate tooth staining following pulpal haemorrhage. Samples of whole blood, erythrocytes, plasma and platelet concentrate and saline were individually placed in the pulp chambers of groups of five teeth and centrifuged twice daily for 25 min over a period of 3 consecutive days. This confirmed that the blood pigment responsible for the staining was found only in those samples containing erythrocytes. Teeth stained with packed red cells were then prepared for histological examination and subjected to four histochemical tests: (1) benzidine, (2) zinc leuco, (3) Perl's and (4) Turnbull Blue to analyse some of the biochemical changes following haemorrhage into the pulp chamber. These tests showed that, following haemolysis of erythrocytes within dentine, haemoglobin was found either intact or as one of the haematin molecules with no further breakdown of the haem structure and no evidence of any free ferric ions or haemosiderin.     

Immortalization of bipotential and plastic glio-neuronal precursor cells.

Permanent clonal cell lines from newborn mouse striatum have been established after transfer of the simian virus 40 large tumor oncogene by means of a retroviral vector. Some of the lines obtained displayed properties of bipotential and plastic glio-neuronal precursors. Depending on the culture conditions, these cells express either the glial fibrillary acidic protein or neurofilaments. In addition, the cells can display adrenergic, D1 and D2 dopaminergic, muscarinic, and 5-hydroxytryptamine type 2 serotoninergic receptors, which are coupled either to the adenylate cyclase or to the phosphatidylinositol signaling pathways. The panel of receptors for neurotransmitters exhibited by these lines closely resembles that of primary striatal neurons. Results suggest that plastic common precursors of astrocytes and neurons persist in the striatum at a late developmental stage. As these permanent cell lines constitute an unlimited source of homogenous cell material, we suggest that they should be useful for molecular and pharmacological studies on the mechanisms and regulation of signal transduction as well as the commitment, plasticity, and differentiation of neural cells.     

Overweight postmenopausal women lose bone with moderate weight reduction and 1 g/day calcium intake.

Overweight postmenopausal women may be more susceptible to bone loss with weight reduction than previously studied obese women. The influence of energy restriction and Ca intake on BMD was assessed in 66 individuals. Weight reduction resulted in bone loss at several sites in women consuming 1 g Ca/day and was mitigated with higher calcium intake at 1.7 g/day. INTRODUCTION: Bone loss is associated with weight loss in obese postmenopausal women and can be prevented with calcium (Ca) supplementation. However, because bone loss caused by weight loss may be greater in overweight than obese women, it is not clear whether Ca supplementation is also beneficial in overweight women. MATERIALS AND METHODS: We assessed the influence of caloric restriction at two levels of Ca intake on BMD and BMC in 66 overweight postmenopausal women (age, 61 +/- 6 years; body mass index, 27.0 +/- 1.8 kg/m2). Subjects completed either a 6-month energy-restricted diet (WL, n = 47) and lost 9.3 +/- 3.9 % weight or maintained weight (WM; 1 g Ca/day, n = 19). Participants in the WL group were randomly assigned to either normal (1 g/day; WL NL-Ca) or high (1.7 g/day; WL Hi-Ca) Ca intake. Regional BMD and BMC were measured at baseline and after 6 months. RESULTS: During normal Ca intake, trochanter BMD and BMC and total spine BMD were decreased more in WL than WM women (p < 0.05). The WL NL-Ca group lost more trochanter BMD (-4.2 +/- 4.1%) and BMC (-4.8 +/- 7.1%) than the WL Hi-Ca group (-1.4 +/- 5.6% and -1.1 +/- 8.1%, respectively; p < 0.05). There were no significant changes in BMD or BMC at the femoral neck in any group. Weight loss correlated with trochanter BMD loss (r = 0.687, p < 0.001) in the WL NL-Ca group. CONCLUSION: Despite an intake of 1 g Ca/day, bone loss occurred at some sites because of weight loss. Calcium intake of 1.7 g/day will minimize bone loss during weight loss in postmenopausal overweight women.