Correlation of intragraft blood flow with characteristics of stenoses found during diagnostic fistulography

PURPOSE: To determine if intragraft blood flow measurements correlate with the anatomical characteristics of stenoses found during diagnostic fistulography. MATERIALS AND METHODS: This investigation was a retrospective review of 40 patients with decreased intragraft blood flow (<600 mL/min) in patent polytetrafluoroethylene hemodialysis grafts who underwent diagnostic fistulography and angioplasty. Intragraft blood flow was measured with the ultrasonic dilution technique. The fistulogram images were reviewed and the anatomic characteristics of all stenoses were measured and recorded. These characteristics were correlated with the intragraft blood flow values. RESULTS: The mean intragraft blood flow was 476 mL/min (range, 270-600 mL/min). Fistulography revealed a total of 71 stenoses and all 40 patients had at least one lesion with > 50% stenosis. There was no correlation between the intragraft blood flow and the location, length, or number of stenoses. There was a moderate inverse correlation between the intragraft blood flow and the degree of stenosis (P =.08). Fifty-nine stenoses were treated with angioplasty. The mean postangioplasty blood flow was 796 mL/min (range, 470-1565 mL/min). The mean change in blood flow after angioplasty was 311 mL/min (range, 15-1154 mL/min) There was no association between the change in blood flow after angioplasty and the number, length, or degree of residual stenosis. CONCLUSION: Intragraft blood flow < 600 mL/min is an excellent predictor of the presence of at least one significant (>/=50%) stenosis. There was an inverse correlation between intragraft blood flow and the degree of stenosis. There was no association between the intragraft blood flow and the location, length, or number of stenosis.     

Highly diffusion-sensitized MRI of brain: dissociation of gray and white matter.

The brains of six healthy volunteers were scanned with a full tensor diffusion MRI technique to study the effect of a high b value on diffusion-weighted images (DWIs). The b values ranged from 500 to 5000 s/mm(2). Isotropic DWIs, trace apparent diffusion coefficient (ADC) maps, and fractional anisotropy (FA) maps were created for each b value. As the b value increased, ADC decreased in both the gray and white matter. Furthermore, ADC of the white matter became lower than that of the gray matter, and, as a result, the white matter became brighter than the gray matter in the isotropic DWIs. Quantitative analysis showed that these changes were due to nonmonoexponential diffusion signal decay of the brain tissue, which was more prominent in white matter than in gray matter. There was no significant change in relation to the b value in the FA maps. High b value appears to have a dissociating effect on gray and white matter in DWIs.     

Urinary retention after operations for benign anorectal diseases

PURPOSE: This study was undertaken to determine the incidence and risk factors for urinary retention after operations for benign anorectal diseases. METHODS: We reviewed 1,026 consecutive operations for benign anorectal diseases from 1989 to 1994. Risk factor analysis was done for patients undergoing hemorrhoidectomy (Group I) and other procedures (Group II) using logistic regression analysis. RESULTS: The number of procedures and urinary retention rate was as follows: 344 (34 percent) hemorrhoidectomies, 159 (2 percent) fistulotomies, 95 (5 percent) incision/drainage, 247 (4 percent) lateral internal sphincterotomy, 181 (17 percent) combinations of the above four procedures, and overall 1,026 (16 percent). In Group I, four-quadrant excision (odds ratio, 3.3;P=0.0004), three quadrant excision (odds ratio, 2.4;P=0.003), morphine equivalents >33 (odds ratio, 1.8;P=0.01), and male gender (odds ratio, 1.7;P=0.02) were independent risk factors. In Group II, more than one operation (odds ratio, 3.0;P=0.004), older age (odds ratio, 3.1;P=0.005), intraoperative fluids (odds ratio, 2.6;P=0.03), and postoperative fluids (odds ratio, 2.7;P=0.02) were independent risk factors. Urinary obstructive symptoms for both groups and perioperative fluids for Group I were NOT independent risk factors. Hospital stay was prolonged significantly in patients with urinary retention (P=0.0001). CONCLUSIONS: Urinary retention is a common postoperative complication that increases hospital stay. It is most common after hemorrhoidectomy. Disease severity (quadrants excised and analgesia requirement for Group I and number of operations for Group II) is an important risk factor for both groups studied. Older age in Group I and perioperative fluid in Group II may be important risk factors.Read at the meeting of The American Society of Colon and Rectal Surgery, Seattle, Washington, June 9 to 14, 1996.     

Purification and characterization of glia maturation factor beta: a growth regulator for neurons and glia.

A protein has been isolated from bovine brains by using a modification of the procedure used to purify glia maturation factor. The method consists of ammonium sulfate precipitation, chromatography with DEAE-Sephacel, Sephadex G-75, and hydroxylapatite columns, passage through a heparin-Sepharose column, and finally fractionation by reverse-phase HPLC with a C4 column. The isolated protein reacts strongly with the mouse monoclonal antibody G2-09 and has a molecular weight of approximately 17,000 and an isoelectric point of pH 4.9. The N terminus is blocked, but tryptic digestion releases 28 peptides, 8 of which have been sequenced. The total known residues add up to more than two-thirds of the entire 140-residue protein, estimated from amino acid composition, and show no sequence homology with any known protein. Reversible thermal renaturation greatly enhances its biological activity. The purified protein stimulates differentiation of normal neurons as well as glial cells. It inhibits the proliferation of the N-18 neuroblastoma line and the C6 glioma line while promoting their phenotypic expression. We designate this protein glia maturation factor beta.     

Task Sharing of Injectable Contraception Services in Pakistan: A Randomized Controlled Trial

Provision of injectable contraceptive services by lay health workers is endorsed by normative bodies, but support for this practice is not universal. We assessed whether lay providers (lady health workers, LHWs) could perform as well as clinically trained providers (family welfare workers, FWWs) on appropriate screening, counseling, and injection of intramuscular and subcutaneous depot medroxyprogesterone acetate (DMPA) using a randomized controlled trial. In the urban sample (n = 355), 88 percent of FWW DMPA clients were appropriately screened versus 77 percent of LHW clients (noninferiority test p = 0.88). In rural facilities (n = 105), over 90 percent of both providers’ clients were screened appropriately. Appropriate counseling was low overall, but LHWs were significantly noninferior to FWWs (p = 0.003). Notably, LHWs demonstrated better injection technique than FWWs. We could not conclude that LHWs screened new DMPA users as well as FWWs from an urban sample of providers but results from the rural sample suggests that service delivery context played an important role.     

A clinico-epidemiological study of pyogenic meningitis in children

The study was conducted among the inpatients of the pediatric ward of J.N. Medical College Hospital, Aligarh Muslim University in India, from January 1989 to December 1991, to determine the etiological factors and the prevalence of pyogenic meningitis. Personal and family histories were recorded. Of 8168 patients admitted to the pediatric ward during the study period; 226 (2.73%) had pyogenic meningitis. 48.23% were under 3 years old, 17.73% were 9-14 years old. A male predominance (male to female ratio = 1.89 : 1) was observed. 67.94% of patients with pyogenic meningitis were urban dwellers, 71.05% lived in overcrowded conditions, and 82.75% belonged to large families. Seasonal variation of pyogenic meningitis was also noted with the peak (58.25%) in winter months. Mothers of 57.96% patients with pyogenic meningitis were illiterate. Proportional mortality was 3.7%. Maximum cerebrospinal fever rate (CFR) was noted in children under 3 years old (41.79% in males and 45.23% in females), belonging to large families (38.09%), those with illiterate mothers (49.01%), and those residing in rural areas (48.82%). CFR was highest (52.82%) among the patients who had to travel more than 10 km to reach the hospital and who were hospitalized 6-9 days after the onset of symptoms (52.45%). Since younger people are at risk of developing meningitis, health care services should also integrate facilities for early diagnosis and treatment of pyogenic meningitis, with an ambulance available at the primary health center level.     

Dietary Sources of Lutein and Zeaxanthin Carotenoids and Their Role in Eye Health

The eye is a major sensory organ that requires special care for a healthy and productive lifestyle. Numerous studies have identified lutein and zeaxanthin to be essential components for eye health. Lutein and zeaxanthin are carotenoid pigments that impart yellow or orange color to various common foods such as cantaloupe, pasta, corn, carrots, orange/yellow peppers, fish, salmon and eggs. Their role in human health, in particular the health of the eye, is well established from epidemiological, clinical and interventional studies. They constitute the main pigments found in the yellow spot of the human retina which protect the macula from damage by blue light, improve visual acuity and scavenge harmful reactive oxygen species. They have also been linked with reduced risk of age-related macular degeneration (AMD) and cataracts. Research over the past decade has focused on the development of carotenoid-rich foods to boost their intake especially in the elderly population. The aim of this article is to review recent scientific evidences supporting the benefits of lutein and zexanthin in preventing the onset of two major age-related eye diseases with diets rich in these carotenoids. The review also lists major dietary sources of lutein and zeaxanthin and refers to newly developed foods, daily intake, bioavailability and physiological effects in relation to eye health. Examples of the newly developed high-lutein functional foods are also underlined.