Coronary vein flow velocity changes during transluminal balloon angioplasty: A study using the doppler guide wire

The coronary flow velocity changes in the great cardiac and middle cardiac veins, induced by intracoronary administration of nitroglycerine, adenosine, and during percutaneous transluminal coronary angioplasty, were evaluated in 12 patients with significant coronary stenoses, using the Doppler wire (Flowire). Optimal spectral signals of the time-averaged peak flow velocity were obtained in 10 patients. Nitroglycerine produced no significant flow velocity changes (P = 0.13). Adenosine caused a significant augmentation of flow velocity compared to baseline (P = 0.003). During balloon inflation, venous flow velocity decreased (P - 0.007); however, the venous outflow did not cease. A pronounced venous hyperemic response, following balloon deflation, was also documented. The utility of continuous vein flow velocity monitoring with the Flowire, during high-risk and complicated coronary interventions remains to be elucidated. Cathet Cardiovasc Diagn 40:85–91, 1997. © 1997 Wiley-Liss, Inc.     

Extramedullary paraspinal hematopoiesis in thalassemia: CT and MRI evaluation.

We present a comparative CT and MRI study of the paraspinal extramedullary hematopoiesis in 32 thalassemic patients. The patients were classified into four groups according to the MRI and CT imaging findings. Active recent extramedullary paraspinal hematopoietic masses show soft tissue behavior in both CT and MRI. Older inactive masses reveal iron deposition or fatty replacement. Combined imaging findings of paraspinal extramedullary hematopoiesis revealed the phase of its evolution and the correct diagnosis.     

Pacing strategy in simulated cycle time-trials is based on perceived rather than actual distance

This study determined the pacing strategies and performance responses of six well-trained cyclists/triathletes (peak O2 uptake 66.4+/-3.7 ml x kg(-1) x min(-1), mean+/-SD) during seven simulated time-trials (TT) conducted on a wind-braked cycle ergometer. All subjects first performed a 40 km familiarisation ride (TT1). They were then informed they would be riding a further four 40 km TT for the purpose of a reliability study. Instead, the actual distances ridden for the next three TT were a random order of 34 (TT2), 40 (TT3) and 46 km (TT4). The only feedback given to subjects during TT1-4 was the percentage distance of that ride remaining. During a further 40 km TT (TT5) subjects were allowed to view their heart rate (HR) responses throughout the ride. Despite the significantly different performance times across the three distances (47:23+/-4:23 vs 55:57+/-3:24 vs 65:41+/-3:56 min for the 34, 40 and 46 km respectively, P<0.001), average power output (296+/-48 vs 294+/-48 vs 286+/-40 W) and HR (173+/-11 vs 174+/-12 vs 173+/-12 beats x min(-1)) were similar. The true nature of the first part of the study was then revealed to subjects who subsequently completed an additional 34 km and 46 km TT TT6-7) in which the actual and perceived distance ridden was the same. Power output and HR responses were similar for both unknown (TT2 and TT6) and known (TT4 and TT7) rides for both distances: 296+/-48 vs 300+/-55 W and 173+/-11 vs 177+/-11 beats x min(-1) (34 km) and 286+/-40 vs 273+/-42 W and 173+/-12 vs 174+/-12 beats x min(-1) (46 km). In conclusion, well-trained cyclists rode at similar power outputs and HR during time trials they perceived to be the same distance, but which varied in actual distance from 34 to 46 km.     

Cochlear implants in young children: the relationship between speech perception and speech intelligibility.

OBJECTIVE: To determine the relationship between measures of speech perception and speech production after cochlear implantation of young children with profound congenital and prelingual deafness. DESIGN: A prospective study was undertaken on a consecutive group of children with profound deafness. There were 126 children at the preimplantation interval and 71, 50, 26, and 20 children, respectively, at the 2, 3, 4, and 5 yr follow-up after implantation. Speech perception and speech intelligibility were assessed using hierarchical rating scales. Spearman rank correlation coefficients were used to determine the statistical correlations. All patients were either congenitally deaf or deafened before the age of 3 yr and were implanted before age 7 yr. The patients all received the Nucleus multichannel cochlear implant system with the most appropriate speech encoding strategy. RESULTS: Speech intelligibility at 5 yr was strongly correlated with speech perception at the 2, 3, 4, and 5 yr intervals after implantation (Spearman coefficients 0.77, 0.81, 0.58, 0.58; p < or = 0.01). Speech intelligibility at the 2, 3, and 4 yr intervals also correlated in a similar manner with earlier speech perception abilities (p < or = 0.01). CONCLUSIONS: The results suggest that speech intelligibility between 2 and 5 yr after implantation in young children with congenital and prelingual profound deafness can be predicted by measures of earlier speech perception.     

Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications?

Introduction Otitis media with effusion is one of the most frequent diseases in children, and its management requires the attention of general practitioners, pediatricians and ear, nose and throat (ENT) surgeons. The main complications associated with tympanostomy tube insertion, are: (1) purulent otorrhea (10–26% of cases), in which local otic preparations might be effective, and biofilm-resistant tubes may decrease this complication in the future; (2) myringosclerosis (39–65% of operated ears), with usually no serious sequelae; (3) segmental atrophy (16–75% of cases); (4) atrophic scars and pars flaccida retraction pockets (28 and 21% of operated ears, respectively); (5) tympanic membrane perforations (3% of cases, although with T-tubes, the incidence may be as high as 24%); (6) cholesteatoma (1% of cases), although tympanostomy tubes may sometimes prevent, rather than contribute to its development; (7) granulation tissue (5–40% of instances), when the duration of tube retention is prolonged. Conclusion It would appear that the complications associated with tympanostomy tube insertion are more frequent than anticipated, reaching 80% of operated ears under specific circumstances and in certain subgroups of children. These complications may resolve with conservative management, but in persistent cases surgical removal of the tubes is mandatory.     

Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience

Background

Laparoscopic adrenalectomy (LA) is the “gold standard” approach to benign adrenal tumours. Retroperitoneoscopic adrenalectomy (RA) is an increasingly popular alternative. The purpose of this study was to compare our preliminary experience with RA to the more established LA.

Methods

Data on patients undergoing adrenalectomy over a 2-year period from 2010 were reviewed. Patients undergoing open adrenalectomy, bilateral adrenal surgery, or paraganglioma resection were excluded. The LA and RA patients were compared according to their operative time, time to first oral intake, complications, analgesic requirements, and length of hospital stay. Further analysis was performed on patients matched for all patient and disease-related criteria. Statistical analysis was performed using the χ ² test and the Mann–Whitney U test as appropriate.

Results

A total of 71 adrenalectomies that fit the inclusion criteria were performed during the period studied of which 36 patients underwent LA and 35 patients underwent RA. Mean tumour size differed between the two groups (2.83 cm in RA group vs. 4.1 cm in LA group; p = 0.033). Operative time, time to first oral intake, analgesic requirements, length of hospital stay, and postoperative complications were all significantly lower in the RA group. Analysis of matched patients showed a significant difference between RA and LA in analgesia requirements (5 vs. 8 paracetamol doses, p = 0.014; 2 vs. 10 tramadol doses, p = 0.042) as well as in the length of hospital stay (1.58 vs. 3.58 days, p = 0.038).

Conclusions

RA may be associated with reduced postoperative pain and length of hospital stay. It is a valuable alternative to LA in smaller tumours where it may prove to be superior.     

Off pump repair of left ventricular rupture following mitral valve replacement: The crucial assistance of the IntraAortic Balloon Pump

INTRODUCTIONLeft ventricular (LV) rupture is a not as frequent, but potentially lethal complication of mitral valve replacement or repair.PRESENTATION OF CASEWe report a case of a 67-year-old man who underwent mitral valve replacement and Cox Maze IV procedure. A massive bleed from the LV rupture was noted postoperatively while the patient was extubated. The control of bleeding was impossible until an IntraAortic Balloon Pump (IABP) was inserted. A bovine pericardial patch was applied, overlapping an extensive epicardial area, perimetrically of the hematoma. Between the epicardium and the pericardial patch we applied an autologous fibrin sealant.DISCUSSIONThe off-pump technique used to repair the LV rupture after a MVR, is more feasible when the patient is supported by an IABP that subsequently decreases the tension of the myocardial suture site.CONCLUSIONThe IABP, is a necessary device, that decreases the tension along the suture site post a left ventricular rupture following a MVR.     

Monoclonal antibodies raised against mid-gut carcinoid tumor cells

Three monoclonal IgG 2a antibodies were produced after immunization of mice with dispersed cells from a human mid-gut carcinoid tumor. Acetone-fixed cryosections of 57 primary and metastatic mid-gut carcinoid tumors as well as 2 hind-gut (rectal) carcinoids showed a conspicuous immunoreaction while a thymic carcinoid was essentially unstained with the antibodies. The 3 antibodies yielded a similar pattern of immunostaining. The immunoreaction comprised more than 95% of the carcinoid tumor cells, and it was more uniform and intense in primary tumors than in mesenteric, hepatic, and ovarian metastases of the mid-gut carcinoid tumors. Immunofluorescence studies on suspended carcinoid tumor cells showed that the antibodies bound to the surface membrane of the cells. The antibodies immunostained enterocytes of the small and large bowel, intestinal metaplasia of the stomach mucosa as well as colorectal adenocarcinomas. Endocrine pancreatic tumors producing vasoactive intestinal polypeptide, gastrin, somatostatin, and/or pancreatic polypeptide as well as the epithelium of pancreatic ducts were also stained with the antibodies, whereas a large number of other normal and abnormal human tissues, including benign and malignant insulinomas, were unreactive. The findings indicate that the antibodies recognize differentiation antigens on the carcinoid tumor cell surface preserved also on endocrine and nonendocrine cells of the normal bowel mucosa. The restricted tissue reactivity of the antibodies suggests that they may constitute useful tools in the histological characterization of carcinoid tumors. Further studies may reveal if they are applicable for immunolocalization and perhaps even immunotherapy of these neoplasms.

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Resumen Se produjeron 3 anticuerpos monoclonales IgG 2a mediante la inmunización de ratones con células dispersas de un tumor carcinoide humano del intestino medio. Criosecciones fijadas con acetona de 57 tumores carcinoides del intestino medio primarios y metastásicos, y de 2 carcinoides del intestino distal (recto), demostraron conspicua inmunoreacción, en tanto que un carcinoide tímico apareció esencialmente no coloreado con los anticuerpos. Los 3 anticuerpos produjeron un patrón similar de inmunocoloración. La inmunoreacción incluyó más de 95% de las células del tumor carcinoide y fue más uniforme e intensa en los tumores primarios que en las metástasis mesentéricas, hepáticas, y ováricas de los tumores carcinoides del intestino medio. Estudios de inmunofluorescencia en células tumorales suspendidas demostraron que los anticuerpos se ligan a la membrana de superficie de las células. Los anticuerpos también inmunocolorearon enterocitos del intestino delgado y del intestino grueso, metaplasia intestinal de la mucosa estomacal, así como adenocarcinomas colorrectales. Tumores pancreáticos endocrinos productores de polipéptido vasoactivo intestinal, gastrina, somatostatina y/o polipéptido pancreático, así como el epitelio de los canales pancreáticos, también resultaron coloreados por los anticuerpos, en tanto que un gran número de otros tejidos humanos normales y anormales, incluyendo insulinomas benignos y malignos, aparecieron no reactivos. Los hallazgos indican que los anticuerpos reconocen los antígenos de diferenciación sobre la superficie de la célula tumoral carcinoide, preservados también en células endocrinas y no endocrinas de la mucosa normal del intestino. La restringida reactividad tisular de los anticuerpos sugiere que éstos pueden constituir instrumentos útiles para la diferenciación histológica de tumores carcinoides. Estudios ulteriores pueden revelar si son aplicables para inmunolocalización y aún para inmunoterapia de estos tumores.

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Résumé On a obtenu la production de 3 anticorps monoclonaux IgG 2a après immunisation des souris avec des cellules dispersées provenant d'une tumeur carcinoïde de l'intestin grêle humain. Les coupes congelées, fixées à l'acétone, de 57 carcinoïdes primaires et métastatiques, ainsi que 2 tumeurs carcinoïdes rectales ont montré une réaction immune évidente, alors qu'une tumeur carcinoïde d'origine thymique restait non colorée avec les anticorps. Les 3 anticorps produisaient une coloration semblable. La réaction immune intéressait plus de 95% des cellules tumorales carcinoïdes, et était plus uniforme et plus intense dans les tumeurs primitives que dans les tumeurs métastatiques, mésentériques, hépatiques et ovariennes des tumeurs intestinales. L'étude en immunofluorescence des cellules de tumeur carcinoïde suspendues a démontré que les anticorps se fixaient à la membrane de surface de ces cellules. Les anticorps ont coloré les enérocytes du gros et du petit intestin, les cellules de la métaplasie intestinale de la muqueuse de l'estomac, et des cellules des adénocarcinomes colorectaux. Ont été également colorées les cellules des tumeurs pancréatiques endocrines produisant des polypeptides intestinaux vasoactifs, de la gastrine, de la somatostatine et/ou des polypeptides pancréatiques et de l'épithélium des canaux pancréatiques. Au contraire, la plupart des tissus humains normaux et anormaux, y compris ceux des insulinomes bénins et malins, n'ont pas réagi. Ces résultats indiquent que ces anticorps sont capables de reconnaître les antigènes de différenciation sur la surface cellulaire des tumeurs carcinoïdes qui sont préservées également sur les cellules endocrines et non endocrines de la muqueuse intestinale normale. L'activité bien définie des anticorps suggère qu'ils peuvent aider à caractériser histologiquement les tumeurs carcinoïdes. D'autres études sont nécessaires pour savoir s'ils peuvent servir à localiser ces tumeurs et peut-être même faire partie de l'arsenal thérapeutique contre ces néoplasies.

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Presented at the International Association of Endocrine Surgeons in Toronto, Ontario, Canada, September, 1989.

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Supported by the Swedish Cancer Society and Pharmacia Inc.