Intra-operative digital angiography as a control of the in situ saphenous vein by-pass grafts

Forty-two patients undergoing in situ saphenous vein by-pass grafting procedures, in two patients bilaterally, were examined intra-operatively with digital subtraction angiography. In 19 (43%) of the examinations the graft and the anastomoses appeared adequate. In 8 cases (18%) significant abnormalities were found, including stenoses (11%), deficient anastomoses (5%) and graft kinking (2%). Remaining arteriovenous fistulas were found in 17 patients (39%). In most cases immediate correction was possible avoiding later re-operation. At follow up 11 of the 44 grafts were occluded, 10 of these during the first five months and of these five during the first week.     

Intraarterial thrombolytic treatment for hepatic artery thrombosis immediately after living donor liver transplantation

Hepatic artery thrombosis (HAT) following living donor liver transplantation (LDLT) remains one of the major causes of graft failure and mortality in liver transplant recipients. This complication requires early diagnosis and revascularization to avoid graft loss. We have reported herein two cases of successful urokinase intraarterial thrombolytic treatment for HAT in the immediate postoperative period after LDLT. Significant elevation of liver transaminases was noted 6 and 4 hours after LDLT and HAT confirmed by three-dimensional computed tomogram and angiogram. Both patients were treated successfully with intraarterial thrombolysis using an urokinase infusion (a total dose of 200,000 to 250,000 IU over 20 to 25 minutes) immediately after HAT was confirmed. One patient underwent laparotomy and bleeder ligation owing to hepatic arterial anastomotic site bleeding after thrombolysis. These two patients remain in good condition without any ischemic graft sequelae at 7 and 8 months follow-up. In conclusion, intraarterial thrombolysis using an urokinase infusion could be considered as one of the treatment modalities of acute HAT following LDLT even in the immediate postoperative period.     

Acute respiratory distress syndrome with transiently impaired left ventricular function and Torsades de Pointes arrhythmia unmasking congenital long QT syndrome in a 25-yr-old woman

We report a case of recurrent episodes of Torsades de Pointesarrhythmia in the setting of transiently impaired left ventricularejection fraction, acute respiratory distress syndrome, transienthypokalaemia and QT-prolonging drugs, in a previously healthy25-yr-old female patient. In the course of the clinical andgenetic work-up this patient was newly diagnosed with a mutationin KCNH2 encoding the     

Hand-assisted laparoscopy for wandering spleen

A wandering spleen is a rare condition with an unknown incidence. The lack of short gastric vessels and suspensory ligaments is thought to result from a fusion anomaly of the dorsal mesogastrium of the spleen. The major risk in performing a splenectomy for patients with a wandering spleen is overwhelming postsplenectomy infection (OPSI). The incidence of OPSI is 0.13% to 8.1%, with a mortality rate of 30% to 60%. Laparoscopic splenopexy provides the benefits of minimally invasive surgery while avoiding the complications of splenectomy. The reported case presents a patient with a wandering spleen. The patient, an 18-year-old woman, experienced a malarial infection at the age of 5 years and had a computed tomography (CT) scan documenting her spleen in the normal anatomic position. When she was 18 years old, a CT scan showed her spleen located in the right lower quadrant (RLQ). At laparoscopy, the presence of the spleen in the RLQ was confirmed. The spleen could not be easily manipulated with laparoscopic instruments, so a hand port was used to mobilize the spleen to the left upper quadrant (LUQ). No evidence of attenuated suspensory ligaments was seen. The spleen was secured in the left subdiaphragmatic location by the use of a Vicryl mesh bag. An omental sling was used to support the spleen further. A 1-year follow up CT confirmed that the spleen still was located in the correct anatomic position. This is a unique case in that the patient was known to have a normally located spleen at a young age and then found to have a wandering spleen later in life. This could have resulted from a congenital fusion anomaly or attenuation of the patient’s suspensory ligaments caused by her previous malarial infection and splenomegaly.     

Determination of an ensemble of structures representing the intermediate state of the bacterial immunity protein Im7

We present a detailed structural characterization of the intermediate state populated during the folding and unfolding of the bacterial immunity protein Im7. We achieve this result by incorporating a variety of experimental data available for this species in molecular dynamics simulations. First, we define the structure of the exchange-competent intermediate state of Im7 by using equilibrium hydrogen-exchange protection factors. Second, we use this ensemble to predict Phi-values and compare the results with the experimentally determined Phi-values of the kinetic refolding intermediate. Third, we predict chemical-shift measurements and compare them with the measured chemical shifts of a mutational variant of Im7 for which the kinetic folding intermediate is the most stable state populated at equilibrium. Remarkably, we found that the properties of the latter two species are predicted with high accuracy from the exchange-competent intermediate that we determined, suggesting that these three states are characterized by a similar architecture in which helices I, II, and IV are aligned in a native-like, but reorganized, manner. Furthermore, the structural ensemble that we obtained enabled us to rationalize the results of tryptophan fluorescence experiments in the WT protein and a series of mutational variants. The results show that the integration of diverse sets of experimental data at relatively low structural resolution is a powerful approach that can provide insights into the structural organization of this conformationally heterogeneous three-helix intermediate with unprecedented detail and highlight the importance of both native and non-native interactions in stabilizing its structure.     

Microfluidic devices for studies of primary cilium mediated cellular response to dynamic flow conditions

We present the first microfabricated microfluidic devices designed specifically for studies of primary cilium mediated cellular response to dynamic flow. The primary cilium functions as a mechano-sensor in renal tubular epithelium, sensing the extracellular fluid flow. Malfunction of cilia has been implicated in e.g. polycystic kidney disease and other pathological conditions. Bending of the primary cilium by fluid flow has been shown to give rise to an intracellular calcium signal, however little is known about the sensitivity to flow duration, magnitude and direction. This paper presents a novel method for studying cilia forming cells in asymmetric microfluidic environments. The microfluidic devices presented here were designed for a dynamic control of the local fluid flow on a cellular level, and thus, enables studies of cellular responses to an amplitude, frequency and direction controlled cilium movement.     

Changes in seroprevalence to four herpesviruses over 30 years in Swedish children aged 9-12 years.

BACKGROUND: Changing social conditions and life-styles in Sweden may have affected the spread of varicella-zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). OBJECTIVES: To study possible changes over 30 years in prevalence of antibodies against VZV, HSV, CMV, and EBV in Swedish children, using modern serological methods. STUDY DESIGN: Serum samples from 819 Swedish children who were 9-12 years old in 1967-1968, in 1977-1978 (two cohorts), and in 1997, respectively, were examined. IgG antibodies against VZV, HSV, and CMV were measured by well validated enzyme-linked immunosorbent assays and against EBV by indirect immunoflourescense. RESULTS: The seropositivity for VZV for 9-12 years old children was 50% in 1967-1968, 74-82% in 1977-1978, and 98% in 1997. The corresponding figures were 31%, 53%, 50%, and 58% for CMV, 35%, 35%, 32%, and 38% for HSV, and 64% in 1967-1968 and in 1977-1978 (both cohorts), and 62% in 1997 for EBV. CONCLUSIONS: The seroprevalence for VZV increased significantly from 1967-1968 to 1997, and there was also a significant but smaller increase in the CMV seroprevalence, while seroprevalence to HSV and EBV remained relatively stable.