Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.     

Immunoreactive relaxin in human serum during the menstrual cycle.

Immunoreactive relaxin was measured in serum obtained at the same time each day from one woman during a normal menstrual cycle and eight other women using selected bleeding schedules. In addition to relaxin immunoactivity, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, estradiol 17beta, and progesterone were measured in the same samples. The data was combined according to the day of the LH peak. Serum relaxin immunoactivity was found to be high over the period of menstruation, its concentration then decreased until the middle of the follicular phase when a peak equal in amplitude to the menstrual peak occurred. Relaxin immunoactivity remained fairly constant throughout the preovulatory LH surge; however, as the LH levels dropped, relaxin immunoactivity increased reaching maximal levels for the whole cycle. Relaxin immunoactivity then increased gradually over the luteal phase and reached a peak when progesterone levels were declining; it then dropped to low levels until menses ensued. It is not possible with the present radioimmunoassay to determine whether the immunoactive relaxin was ovarian or uterine in origin.     

Percutaneous extraction of urinary calculi: use of the intercostal approach

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.     

Radio ultrasound observations of the fetotoxic effects in sheep from ingestion of Conium maculatum (poison-hemlock)

Fetal movement in pregnant ewes gavaged with Conium maculatum (poison-hemlock) was reduced significantly, but temporarily. Fetal movement was observed by radio ultrasound at 45, 54 and 60 days of gestation in control ewes and on days 45, 54, and 60 of gestation immediately before and 1 hour following poison-hemlock feeding in treated ewes. Fetal movement was significantly reduced (P less than 0.01) 1 hour after poison-hemlock administration, but returned to normal within 18 hours post treatment. At parturition seven of eleven lambs born to seven treated ewes had varying degrees of front limb abnormalities. Modest to moderate flexure of the carpal joints, some lateral deviation in the front limbs at the pastern joint and kinked tails were observed. These malformations were transient and resolved spontaneously by 8 weeks after lambing.     

Development and validation of a direct homologous quantitative sandwich ELISA for fathead minnow (Pimephales promelas) vitellogenin

Vitellogenin (Vtg) is an established and sensitive endpoint for analysis of exposure to (anti-)oestrogens and their mimics in fish [Sumpter, J.P., 1995. Feminized responses in fish to environmental estrogens. Toxicol. Lett. 82, 737-742; Arukwe, A., Goks?yr, A., 2003. Eggshell and egg yolk proteins in fish: hepatic proteins for the next generation: oogenetic, population, and evolutionary implications of endocrine disruption. Comp. Hepatol. 2, 4. ]. In some instances, links have been drawn between high level induction of Vtg and adverse health effects in fish [Herman, R.L., Kincaide, H.L., 1988. Pathological effects of orally administered estradiol to rainbow trout. Aquaculture 72, 165-172; Schwaiger, J., Spieser, O.H., Bauer, C., Ferling, H., Mallow, U., Kalbfus, W., Negele, R.D., 2000. Chronic toxicity of nonylphenol and ethinyloestraiol: haematological and histopathological effects in juvenile common carp (Cyprinus carpio). Aquat. Toxicol. 51, 69-78]. The widespread use of Vtg as a biomarker has led to the development of a variety of assays to quantitatively measure Vtg concentrations in tissue samples from fish, and hence a need for a standardization of the performance criteria and validation of such assays [Goks?yr, A., Eidem, J.K., Kristiansen, S.I., Nilsen, B.M., 2003. On the need for a standardized set-up for validation studies of fish vitellogenin assays as an endpoint in endocrine disruptor testing and screening-a proposal. ]. One of the most popular test fish species for assessing chemical effects is the fathead minnow (Pimephales promelas), which is now used widely for studies into endocrine disruption [Panter, G.H., Hutchinson, T.H., Lange, R., Lye, C.M., Sumpter, J.P., Zerulla, M., Tyler, C.R., 2002. Utility of a juvenile fathead minnow screening assay for detecting (anti)estrogenic substances. Environ. Toxicol. Chem. 21, 319-326; Hutchinson, T.H., Yokota, H., Hagino, S., Ozato, K., 2003. Development of fish tests for endocrine disruptors. Pure Appl. Chem. 75, 2343-2353]. This paper describes the development and validation of a new, homologous enzyme-linked immunosorbent assay (ELISA) for quantification of Vtg in this fish species.