Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty

Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD ± SD) and repeatability coefficient (2 × SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. Results: MD ± SD for repeated measurements at rest and during flow augmentation were 0 ± 2 mmHg and 1 ± 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 ± 7 mmHg at rest and 17 ± 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty. Received: 0/00/00/Accepted: 0/00/00     

Infectious meningitis with atypical cerebrospinal fluid cells

Cytologic evaluation of the CSF is often difficult when trying to distinguish between truly neoplastic and reactive cells. Several non-neoplastic conditions may be associated with atypical cells in the CSF, a fact the clinician has to consider to avoid inadequate aggressive theraphies. We report here three patients with infectious meningitis (due to Herpes zoster virus in two, and neuroborreliosis in one) and cytologically atypical cerebrospinal fluid lymphocytes. Further characterization showed that the pleocyrosis in these patients was of reactive origin. Cytomorphology is frequently insufficient and histochemical, immuncytochemical and cellular genome analysis techniques may help differentiate atypical reactive cells from neoplastic cells.     

The effect of outdoor fungal spore concentrations on daily asthma severity.

The relationship between day-to-day changes in asthma severity and combined exposures to community air pollutants and aeroallergens remains to be clearly defined. We examined the effects of outdoor air pollutants, fungi, and pollen on asthma. Twenty-two asthmatics ages 9-46 years were followed for 8 weeks (9 May-3 July 1994) in a semirural Southern California community around the air inversion base elevation (1,200 ft). Daily diary responses included asthma symptom severity (6 levels), morning and evening peak expiratory flow rates (PEFR), and as-needed beta-agonist inhaler use. Exposures included 24-hr outdoor concentrations of fungi, pollen, and particulate matter with a diameter < 10 microns (PM10; maximum = 51 micrograms/m3) and 12-hour day-time personal ozone (O3) measurements (90th percentile = 38 ppb). Random effects longitudinal regression models controlled for autocorrelation and weather. Higher temperatures were strongly protective, probably due to air conditioning use and diminished indoor allergens during hot, dry periods. Controlling for weather, total fungal spore concentrations were associated with all outcomes: per minimum to 90th percentile increase of nearly 4,000 spores/m3, asthma symptom scores increased 0.36 (95% CI, 0.16-0.56), inhaler use increased 0.33 puffs (95% CI, -0.02-0.69), and evening PEFR decreased 12.1 l/min (95% CI, -1.8-22.3). These associations were greatly enhanced by examining certain fungal types (e.g., Alternaria, basidiospores, and hyphal fragments) and stratifying on 16 asthmatics allergic to tested deuteromycete fungi. There were no significant associations to low levels of pollen or O3, but inhaler use was associated with PM10 (0.15 inhaler puffs/10 micrograms/m3; p < 0.02). These findings suggest that exposure to fungal spores can adversely effect the daily respiratory status of some asthmatics.     

Notions of child health: mothers' accounts of health in their young babies

This paper is concerned with mothers’ understandings of child health in their young babies. To explore how child health is depicted, explained and contextualised by mothers, altogether 29 mothers in Stockholm and London were interviewed through the baby's first months about day-to-day experiences of the baby's health and well-being. The analysis of the mothers’ accounts reveals how the mothers, in the process of assessing health, try to ‘read’ the bodily signs and reactions in their babies. Some major themes emerge on how the mothers identify and characterise threats to the health of the baby; here described as threats of abnormalities, threats to the survival of the baby, threats to the thriving of the baby and threats from illnesses. Notions of child health are discussed in relation to the ‘bodily’ and the ‘social’, and how the embodied images of child health are intertwined with the mothers’ presentations of themselves as responsible for the health of their children and as ‘worthy’ parents.     

Transport of drugs through human erythrocyte membrane. Structure-activity relationship of benzoic acid and its derivatives between membrane transport and partition coefficient]

The transport properties of benzoic acid and its eighteen derivatives such as o-, m- or p-hydroxybenzoic acid (o-, m- or p-HBA), aminobenzoic acid (o-, m- or p-ABA), toluic acid (o-, m- or p-TA), fluorobenzoic acid (o-, m- or p-FBA), chlorobenzoic acid (o-, m- or p-CBA) and bromobenzoic acid (o-, m- or p-BBA) through human erythrocyte membranes were examined. The drugs having a hydrophilic ortho-substituent and those having a hydrophobic meta- or para-substituent showed higher transport. The ratio of free drugs in erythrocytes, fuR, did not relate to the partition coefficient (P). However, fuM (the ratio of free drugs in the plasma) and Kp (the ratio of partition between erythrocytes and plasma) related to the P: fuM = -0.3128 x log P + 0.9727 (R2 = 0.8722***), Kp = -0.2558 x log P + 0.8642 (R2 = 0.8413***). In p-nitrophenol-glycosides, the fuM and the Kp that were predicted from these equations were compatible with the experimental results. It was suggested from these results that the fuM and the Kp may be predictable from the P.     

Covalent binding of 7,12-dimethylbenz[a]anthracene to lymphoid and nonlymphoid tissues following oral administration to B6C3F1 mice.

Previous studies have shown that 7,12-dimethylbenz[a]anthracene (DMBA) is cytotoxic to various murine lymphoid tissues, including the spleen, thymus, mesenteric lymph nodes (MLNs), and Peyer's patches (PPs). In the present studies, we measured the amount of covalent binding of [3H]DMBA to lymphoid and nonlymphoid tissues and correlated these findings with the overall levels of [3H]DMBA (and derived substances) present in various tissues following a single oral administration to mice. Results show that [3H]DMBA was taken up relatively rapidly from the GI tract and that it was nearly completely eliminated within 24 hr via the feces. Peak plasma levels were obtained approximately 6 hr after gavage, and most organs (including brain, heart, liver, lung, kidney, spleen, and thymus) achieved their peak level of DMBA at this time. Maximal concentrations of DMBA were detected in gut-associated lymphoid tissues (i.e., PPs and MLNs) at 4 hr, during which time covalent binding of [3H]DMBA was also maximal. The time course for covalent binding was different in the liver, lung, thymus, and spleen, peaking at 6-12 hr. The amount of covalent binding of [3H]DMBA and derived metabolites in the spleen was more than twice that seen in the other tissues examined. Since the spleen has previously been found to be less sensitive to DNA fragmentation induced by DMBA than the PPs, these results suggest that covalent binding may not be the primary determinant of lymphotoxicity in these organs.     

VS38: a new monoclonal antibody for detecting plasma cell differentiation in routine sections.

AIMS--To characterise a new mouse monoclonal antibody, VS38, which recognises an intracytoplasmic antigen of 64 kilodaltons present in normal and neoplastic plasma cells; and to establish its value as a diagnostic reagent for routine pathological practice. METHODS--A range of normal and neoplastic tissue sections, both frozen and routinely fixed, were immunostained, using the microwave method of antigen retrieval for routinely fixed specimens. The antibody was also tested on blood and bone marrow specimens and a range of human cell lines. The molecular weight of the antigen recognised by the antibody was obtained by western blot analysis. FACS analysis was used to demonstrate the cellular location of the antigen and its presence on tonsil cell suspensions and myeloma cases. RESULTS--VS38 recognised normal and neoplastic plasma cells in all of the tissues, including all routinely fixed plasma cell neoplasms tested. The antibody also weakly stained epithelial elements within the tissue but was absent from haemopoietic cells of other lineages. CONCLUSION--Antibody VS38 is of potential value in identifying myeloma or plasmacytoma in bone marrow or other tissues. It differentiates lymphoplasmacytoid lymphoma from lymphocytic and follicular lymphoma. It also subdivides large cell lymphomas into two groups which may be a more reliable method of separating these tumours than morphology alone.     

X-Ray Study of the Cat Hindlimb During Treadmill Locomotion

With pulsed X-ray cinematography we have analysed the angular excursions of the distal hindlimb joints (proximal interphalangeal, PIP; metatarsophalangeal, MTP; ankle) in cats walking on a treadmill. These distal joints transmit the body weight and the dynamic forces onto the ground. We have included the knee and hip joints in the analysis to relate the angular excursions of the proximal and distal joints and to verify the data previously obtained with external markers on the kinematics of the proximal joints. At the beginning of the stance phase the PIP joints flexed rapidly, the MTP joints extended slowly and the ankle and knee yielded under body weight. Whereas the PIP joints maintained a rather constant angular position of −75° throughout the stance phase, extension continued in the MTP joints from −230° at touch-down to −270° at the end of the stance phase. Around 50 ms before lift-off the MTP joints flexed rapidly. Early (−30 ms) after lift-off this flexion changed into a slow extension. The PIP joints extended swiftly at the stance-swing transition and moderately at the end of the swing phase. During the middle part of the swing phase they flexed slowly. Small rotatory movements around the long axis of the foot took place in the last 100 ms of the swing phase. The results of this study on the distal joints are discussed in relation to the placing of the paw, to the translation of forward propulsion into a MTP movement and to the lifting of the paw (conventionally described as toe curling). They show a differentiated mechanical interaction between the different distal limb joints during these different phases, which must be known in detail to interpret the corresponding electromyographic data and to understand how the hip is moved forward over the MTP joints which serve as the final pivot during stance.