Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.     

Biologic effects of leukocytes present in transfused cellular blood products

A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as CMV, HTLV-I/II, and EBV as well as other viruses. An interesting development that has occurred coincidentally in transfusion medicine is that agencies responsible for the provision of blood products are being designated manufacturers of biologicals. The trend among manufacturers of biologicals is to try to produce pure products to provide for the specific therapeutic need of patients. Thus, with the realization that allogeneic leukocytes and their products may have adverse biologic activities, there is increasing pressure from various sources for the reduction of the leukocyte content in allogeneic blood components to minimize the occurrence of their adverse effects. Although the threshold leukocyte number below which these effects might no longer occur is still to be determined, a 2 to 3 log10 leukocyte reduction, provided by the currently available commercial leukocyte filters, has been shown to reduce the frequency of many of such reactions. On the other hand, the immunosuppressive effects produced by the infusion of allogeneic leukocytes might be beneficial for some patients, ie, for the maintenance of kidney allografts, in possibly reducing the relapse rate in patients with inflammatory bowel diseases, and in ameliorating recurrent spontaneous abortion. Moreover, therapeutic granulocyte transfusions may be of benefit in certain well- defined categories of patients infected with bacteria, yeast, and/or fungi. These include neonates with bacterial sepsis associated with bone marrow failure as well as severely neutropenic leukemic patients with an infection unresponsive to appropriate and specific antibiotic therapy. Many of the results obtained with the use of leukocyte depletion filters are tantalizing, but the actual clinical benefit of leukodepletion has not been established in most instances, because much of the available data are retrospective or from uncontrolled clinical trials. Moreover, issues of cost-effectiveness and quality control have not been considered adequately. Properly designed prospective clinical trials are essential to provide data with which to answer such questions and also to help define the optimal conditions required for the preparation of blood components ultimately destined for clinical use. Only with the availability of such data can sound decisions be made about the clinical value of leukodepletion.     

The Enhancing Effect of Spawning on Elimination of a Persistent Polychlorinated Biphenyl from Female Yellow Perch

The Enhancing Effect of Spawning on Elimination of a PersistentPolychlorinated Biphenyl from Female Yellow Perch. VODICNIK,M. J., AND PETERSON, R. E. (1985). Fundam. Appl. Toxicol. 5,770–776. Distribution and elimination of 2,5,2',5'-tetrachloro[¹⁴C]biphenyl.(4-CB) were studied for 6 months after exposing sexually maturefemale yellow perch to the compound in water and transferringthem to flowing 4-CB-free water. Perch that were exposed inJanuary spawned in May, and the study was terminated in June.During the first 4 months after exposure, the t for whole-bodyelimination was 22 weeks, primarily by elimination of 4-CB fromthe viscera and carcass. During spawning, enhanced elimination(t < 0.7 weeks) was due to the voiding of eggs containing4-CB. After spawning, whole-body elimination returned to a slowerrate (t = 16.3 weeks). Prior to the enhancement in 4-CB eliminationrate during spawning, there was a redistribution of 4-CB residueswithin the body of the perch which was characterized by a transferof 4-CB residues from primarily the carcass and viscera to eggs.Two weeks after exposure, 30% of the initial 4-CB body burdenwas distributed to the eggs, whereas just prior to spawning,about 50% was present in this tissue. These findings demonstratethat egg maturation and spawning result in a significant reductionin the body burden of a persistent polychlorinated biphenylin a lean-fish species.     

Long-Term Follow-Up of Corridor Operation for Lone Atrial Fibrillation:

Late Results of Surgery for AF. Introduction: Currently, surgery- and catheter-mediated ablation is applied when drug refractoriness of atrial fibrillation is evident, although little is known about the long-term incidence of new atrial arrhythmia and the preservation of sinus node function.
Methods and Results: To address this issue, 30 patients with successful corridor surgery for lone paroxysmal atrial fibrillation and normal preoperative sinus node function were followed in a single outpatient department. Five years after surgery, the actuarial proportion of patients with recurrence of atrial fibrillation arising in the corridor was 8%± 5%, with new atrial arrhythmias consisting of atrial flutter and atrial tachycardia in the corridor 27%± 8%, and with incompetent sinus node requiring pacing therapy 13%± 6%. Right atrial transport was preserved in 69% of the patients without recurrence of atrial fibrillation and normal sinus node function. Stroke was documented in two patients.
Conclusions: Corridor surgery for atrial fibrillation is a transient or palliative treatment instead of a definitive therapy for drug refractory atrial fibrillation. This observation strongly affects patient selection for this intervention and constitutes a word of caution for other, non-pharmacologic interventions for drug refractory atrial fibrillation.     

蒙药益智温肾十味丸质量标准

目的:建立蒙药益智温肾十味丸的显微、薄层、理化鉴别方法和高效液相含量测定方法,提高其质量控制水平.方法:在显微镜下观察本品粉末,以种皮厚壁细胞、石细胞群和体壁碎片为指标,鉴别本品中益智、苦石莲、冬葵果和方海;提取挥发油,点样于硅胶GF254薄层板上,环己烷-乙酸乙酯(9∶1)展开,以标准药材为对照,鉴别本品中的益智;理化方法鉴别白硇砂中氯化铵和方海中碳酸钙.对荜茇中胡椒碱进行含量监控,用ODS填充的色谱柱,甲醇-水(77∶ 23)为流动相,343 nm波长下测定.结果:方法可有效鉴别本品中益智、苦石莲、冬葵果、方海和白硇砂5味药材,高效液相含量测定方法在0.040 4～0.282 8 μg线性良好(r=0.999 9),胡椒碱的平均回收率为98.1％,RSD 0.62％,含量限度为不得少于1.4 mg·g-1.结论:该方法可有效控制本品质量.     

Chromosomal abnormalities in untreated patients with non-Hodgkin's lymphoma: associations with histology, clinical characteristics, and treatment outcome. The Nebraska Lymphoma Study Group

We describe the chromosomal abnormalities found in 104 previously untreated patients with non-Hodgkin's lymphoma (NHL) and the correlations of these abnormalities with disease characteristics. The cytogenetic method used was a 24- to 48-hour culture, followed by G- banding. Several significant associations were discovered. A trisomy 3 was correlated with high-grade NHL. In the patients with an immunoblastic NHL, an abnormal chromosome no. 3 or 6 was found significantly more frequently. As previously described, a t(14;18) was significantly correlated with a follicular growth pattern. Abnormalities on chromosome no. 17 were correlated with a diffuse histology and a shorter survival. A shorter survival was also correlated with a +5, +6, +18, all abnormalities on chromosome no. 5, or involvement of breakpoint 14q11-12. In a multivariate analysis, these chromosomal abnormalities appeared to be independent prognostic factors and correlated with survival more strongly than any traditional prognostic variable. Patients with a t(11;14)(q13;q32) had an elevated lactate dehydrogenase (LDH). Skin infiltration was correlated with abnormalities on 2p. Abnormalities involving breakpoints 6q11-16 were correlated with B symptoms. Patients with abnormalities involving breakpoints 3q21-25 and 13q21-24 had more frequent bulky disease. The correlations of certain clinical findings with specific chromosomal abnormalities might help unveil the pathogenetic mechanisms of NHL and tailor treatment regimens.