Permanent access to the portal system for cellular transplantation using an implantable port device.

A novel application of the implantable Port-a-Cath (PAC) system is described in the context of cellular transplantation. A silicone catheter was inserted in a collateral branch of the portal vein and connected to a port device positioned subcutaneously on the left thoracic cage. This permanent vascular access allowed iterative intraportal infusions of allogenic hepatocytes without the need of repeated transhepatic catheterization of the portal vein. Using this technique, repeated infusions of cryopreserved and / or fresh hepatocytes were successfully carried out in 3 children with inborn errors of liver metabolism, with the aim of progressively providing a sufficient mass of transplanted liver cells to stabilize the metabolic condition of the patients. We suggest that this technique might also be valuable in pancreatic islet cell transplantation.     

Benefits of arthroscopic tuberculoplasty in posterior ankle impingement syndrome

The purpose of this work was to describe the posterior ankle impingement syndrome related to the posterolateral tubercle of the talus bone and to present a retrospective analysis of our results after arthroscopic plasty of the tubercle in 15 ankles with a mean 3-year follow-up. Fifteen cases of posterior ankle impingement (PAI) underwent arthroscopic excision of an impinging bone spur. All the patients (13) were retrospectively evaluated at an average of 36 months after index surgery. There were seven women (bilateral in two of them) and six men. Ten were involved in different kinds of sport and three were professional ballet dancers. Preoperative symptoms included pain localized in the posterior ankle, limitation of motion, weakness and swelling. All patients had failed a course of conservative therapies. Surgery was performed through posterolateral and posteromedial portals as described by van Dijk. After soft tissue debridement, partial resection of the posterolateral process was performed until there was complete plantar flexion without bone impingement. Postoperatively, all patients followed the same rehabilitation protocol. Improvement in their impingement symptoms was recorded in all of them according to AOFAS score. One of them (7%) still had occasional discomfort. The results suggest that arthroscopic bone decompression of the posterolateral tubercle in cases of PAI resistant to non-surgical therapies is an effective treatment.     

Extracorporeal oxygenation in newborn infant born to diabetic mother with severe hypertrophic myocardiopathy]

Hypertrophic cardiomyopathy is a common complication in infants born to diabetic mothers but it is rarely life threatening. CASE REPORT: A neonate born to a diabetic mother with a severe hypertrophic cardiomyopathy with life threatening respiratory and haemodynamic distress was successfully supported by extracorporeal membrane oxygenation. CONCLUSION: Extracorporeal membrane oxygenation can be an efficient transitory therapy for very severe hypertrophic cardiomyopathy in infants of diabetic mothers.     

Hemodynamic response to intracoronary injection of a vasodilator during coronary angiography. A randomized comparative study of trinitrin and linsidomin

Intracoronary injection of a vasodilator agent in an almost systematic practice during coronary angiography or angioplasty because of the dynamic information that it provides concerning the stenosis, the artery in the unstenosed segment and spastic phenomena. Nitroglycerin is the reference drug with, however, a significant dose-dependent hypotensive effect. The aim of this randomised open trial was to compare the effects of Linsidomine, the active metabolite of molsidomide with the reference product. Eighty patients aged 59.2 +/- 10.4 years received either 0.15 mg of nitroglycerin or 0.8 mg of linsidomine during coronary angiography. Aortic pressure and heart rate were monitored continuously over 3 minutes; at the 3rd minute and injection of contrast was performed under fluoroscopic control under the same conditions as the basal injection for an experienced coronary angiographist to judge semi-quantitatively the quality of vasodilation at the site of stenosis and in the whole artery. In the linsidomine group, the only significant change was a moderate fall in systolic pressure from the 1st to the 3rd minute. In the nitroglycerin group, all pressure parameters fell from the 30th second. The heart rate remained stable in both groups. The maximal pressure differences were significantly different in the two groups: -4 +/- 7.3 mmHg versus -11.3 +/- 9.2 mmHg (linsidomine versus nitroglycerin), p less than 0.001 for systolic pressure; -0.1 +/- 5 mmHg versus -3 +/- 5.4 mmHg respectively for diastolic pressure (p less than 0.05); and -1 +/- 6 mmHg versus -5.3 +/- 6.4 mmHg (p less than 0.01) for mean pressure. These pressure changes were not associated with any detectable untoward clinical effect in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Biochemical actions of chronic ethanol exposure in the mesolimbic dopamine system

In previous studies, we have demonstrated that chronic administration of morphine or cocaine produces some common biochemical adaptations in the ventral tegmental area (VTA) and nucleus accumbens (NAc), components of the mesolimbic dopamine system implicated in the reinforcing actions of these and other drugs of abuse. Since this neural pathway is also implicated in the reinforcing actions of ethanol, it was of interest to determine whether chronic ethanol exposure results in similar biochemical adaptations. Indeed, as seen for chronic morphine and cocaine treatments, we show here that chronic ethanol treatment increased levels of tyrosine hydroxylase and glial fibrillary acidic protein immunoreactivity, and decreases levels of neurofilament protein immunoreactivity, in the VTA. Also like morphine and cocaine, ethanol increases levels of cyclic AMP-dependent protein kinase activity in the NAc. These actions of ethanol required long-term exposure to the drug, and were in most cases not seen in the substantia nigra or caudate-putamen, components of the nigrostriatal dopamine system studied for comparison. Altered levels of tyrosine hydroxylase in catecholaminergic cells frequently reflect altered states of activation of the cells. Moreover, increasing evidence indicates that ethanol produces many of its acute effects on the brain by regulating NMDA glutamate and GAB_A receptors. We therefore examined the influence of chronic ethanol treatment on levels of expression of specific glutamate and GABA receptor subunits in the VTA. It was found that long-term, but not short-term, ethanol exposure increased levels of immunoreactivity of the NMDARl subunit, an obligatory component of NMDA glutamate receptors, and of the Glu Rl subunit, a component of many AMPA glutamate receptors; but at the same time, long-term ethanol exposure decreased immunoreactivity levels of the α1 subunit of the GABA_A receptor complex. These changes are consistent with an increased state of activation of VTA neurons inferred from the observed increase intyrosine hydroxylase (TH) expression. These results demonstrate that chronic ethanol exposure results in several biochemical adaptations in the mesolimbic dopamine system, which may underlie prominent changes in the structural and functional properties of this neural pathway related to alcohol abuse and alcoholism. © 1995 Wiley-Liss, Inc.     

A study on OX39, a murine anti-rat interleukin 2 receptor antibody

OX39, a murine IgG1 monoclonal antibody (MoAb) that recognizes the 55 kDa alpha chain of the rat interleukin 2 receptor (R-IL2), was studied in vitro for its ability to interfere with IL2 binding and IL2-induced proliferation on rat concanavalin A (ConA) blasts and in vivo in a model of rat heart allografts. In vitro studies indicated that OX39 MoAb interacts with a single class of sites on the alpha chain of the rat R-IL2 with a high affinity (K_D=0.8 nm) and competes with IL2 binding on this chain (K_I=0.53 nm). In contrast, OX39 MoAb was found to be 10–20 times less efficient in competing with IL2 binding to the high-affinity R-IL2 (K_I10 nm). It is proposed that the epitope recognized by OX39 on the alpha chain (low-affinity R-IL2) is modified on (or buried in) the high-affinity R-IL2 configuration. Accordingly, OX39 was found to be a weak inhibitor in vitro on IL2-induced proliferation and in vivo on allograft rejection. Allograft survival was unaffected by doses of OX39 of 20 and 50 g/rat for 9 days; only a borderline effect was noted when doses as high as 250 g/rat were used. A significant, but restricted, effect of OX39 could be further detected when combined with low doses of cyclosporine A (1.5 mg/kg), which were ineffective by themselves. Together, our data suggest that in order to be efficient in vivo, anti-R-IL2 MoAbs must bind with high affinity to epitopes involved in the high-affinity IL2 binding site.     

Définition et évolution du statut nutritionnel au cours d'une greffe osseuse allogénique (15 malades): Rôle de la nutrition parentérale et de l'apport azoté

Our work concerned 15 patients (9 males, 6 females) with a mean age of 29.5 years, having a hematologic malignant disease and undergoing allogenic bone marrow transplantation.We studied :

1. The metabolic disorders induced by the conditioning regimen (chemotherapy and total body irradiation) pregraft accompanying cytolysis (day −7, −5, −2).

2. The corrective effect of a total parenteral nutrition introduced 2 days before the transplantation and pursued during 30 days post-graft (day −2 to day 30).

3. The interest of a high calorie intake (BEE × 2) and, after randomisation, of a variable nitrogen intake (24% of the total calorie intake for group A [8 patients] and 14% for group B [7 patients]). The patient characteristics of these two groups were closely comparable. Urinary parameters were studied daily (3-methylhistidine, cratinine, nitrogen) and blood parameters weekly (transferrin, pre-albumin, albumin, retinol binding protein).

We observed globally :

-- An excellent result of the nutritional support without significant weight loss;

-- protein catabolism stopped with a recovery of synthesis of RBP after day 7 and pre-albumin from day 7;

-- a decrease in muscle catabolism.

The randomized study showed :

-- a significant difference in nitrogen excretion between group A and group B;

-- earlier and better protein synthesis recovery in group A, particularly with regard to RBP and pre-albumin.

In conclusion, we recommend for the patients undergoing bone marrow transplantation :

-- nutritional support should be introduced before the conditioning regimen;

-- a high calorie intake (BEE × 2) with a nitrogen intake between 14% and 24% of the total calorie intake;

-- cyclic parenteral nutrition should be pursued during the second and third month post-graft.

Role of the mesenteric arteries in the arterial blood supply to the lower limbs

Summary The arteries of the gut, and in particular in the inferior mesenteric artery (a. mesenterica inferior), normally play a minimal role in supplying blood to the lower limbs. However, this is far from being the case in aorto-iliac obstruction. The anatomical anastomoses between the intestinal arterial system and the arteries of the lower limb hypertrophy and in one case out of ten become predominant.In the present study the path taken and the relations of the collaterals of the intestinal arteries and of their anastomoses have been traced, and several collateral pathways are described.

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Rôle des artères mésentériques dans la revascularisation artérielle des membres inférieurs

Résumé Les artères digestives, et en particulier l'artère mésentérique inférieure (a. mesenterica inferior), jouent à l'état normal un rôle minime dans la vascularisation des membres inférieurs. Il n'en est pas de même en cas d'oblitération aorto-iliaque. Les anastomoses anatomiques entre le système artériel digestif et les artères du membre inférieur s'hypertrophient et, dans un cas sur 10, deviennent prédominantes.Dans cette étude, le trajet et les relations des collatérales des artères digestives et leurs anastomoses sont étudiés. Plusieurs voies collatérales sont possibles.

     

Visualizing cytokine-secreting cells in situ in the rhesus macaque model of chronic gut inflammation

Cytokine-producing cells in gut-associated lymphoid tissues of rhesus macaques with chronic enterocolitis were studied. The confocal microscopy technique that we developed enables simultaneous in situ visualization of multiple extra- and/or intracellular antigens at a resolution higher than that allowed by light or epifluorescence microscopy. The presence of interleukin-6 (IL-6)-, tumor necrosis factor alpha (TNF-alpha)-, and IL-1-alpha-producing cells was focally intense in the colon lamina propria of the affected animals. The IL-1-alpha-producing cells were T lymphocytes (CD3+), while the TNF-alpha-producing cells were both macrophages (CD68+/HAM56+/LN5+) and T lymphocytes (CD3+). The IL-6-producing cells within the colon consisted of T lymphocytes and macrophages. The amount of IL-6-producing cells seen in macaques with enterocolitis was significantly higher (P<0.001) than that seen in the healthy control animal, while TNF-alpha- and IL-1-alpha-producing cells were seen only in macaques with enterocolitis. Most of the T lymphocytes that produced cytokines were detected in the lamina propria, while the macrophages were most prominent in highly inflamed regions of the lamina propria. Taken together, our findings indicate that there might be immunological similarity between chronic enterocolitis of rhesus macaques and humans, suggesting the potential use of the nonhuman primate model for the validation of novel therapies.