Different response to balloon angioplasty of carotid and coronary arteries: effects on acute platelet deposition and intimal thickening

PTCA is a well-established intervention to reduce the severity of atherosclerotic coronary stenosis. Its primary success rate is seriously handicapped by the high incidence of late restenosis. Given the clinical and social importance of this proliferative process, new strategies are needed to prevent or reduce restenosis. Several animal models as well as different arteries have been used to study neointimal proliferation after arterial injury. A number of agents have shown to reduce neointimal proliferation after arterial injury in the carotids and iliac arteries of rodent models. Unfortunately, these results have not been replicated in humans. We have compared the acute and late response to vascular injury of the carotid and coronary arteries in the pig. Arterial injury was induced by performing balloon angioplasty of the carotid (elastic) and coronary (muscular) arteries in swine. Acute platelet-thrombus formation was evaluated by quantitation of Indium-labeled platelets deposited on the injured segments 1 h after procedure. Measurement of intimal area was performed by morphometry of the most stenotic cross-section at 28 days after balloon angioplasty. Platelet deposition after mild and severe injury in carotids (4±1 and 56±13×10⁶ platelets/cm², respectively) and coronaries (15±5 and 141±20×10⁶ platelets/cm², respectively) are significantly greater in deep, than in mild injury (P<0.005), and significantly greater in coronary than in carotid arteries after deep injury (P<0.05). Likewise, late neointima formation was significantly greater (P<0.05) after mild and severe injury in coronary (17±0.5 and 56 ±2%, respectively) than in carotid arteries (5±0.5 and 12±1%, respectively). Acute platelet-thrombus formation and late neointimal thickening are modulated by the degree of injury induced during the interventions; and after disruption of the internal elastic lamina, coronary arteries always had significantly more acute thrombus and neointimal thickening. This study emphasizes the importance of the animal species, the type of injury and the artery chosen for studies on restenosis post interventions.     

Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system

Objectives

To evaluate the validity, interobserver reliability, and intraobserver reproducibility of a digital templating system, the Mdesk? in preoperative templating in cemented and reverse hybrid total hip arthroplasty (THA).

Materials and methods

Validity was evaluated by comparing the planned cup size, stem size, CCD angles, and neck length with the components used in 129 patients operated with cemented and reverse hybrid THA. The reliability was measured by comparing the templating results of two surgeons with each other (interobserver) and the results of two templatings carried out by first surgeon (intraobserver). The leg length discrepancy was measured before and after the operation to assess the templating ability to correct it.

Results

The Mdesk? system showed good validity (kappa value ranged from 0.64 to 0.96), especially when one size over and under the planned size were included. No difference between cemented and cementless stems was found. The interobserver reliability ranged from fair (kappa 0.23) to substantial (kappa 0.61) while the intraobserver reproducibility ranged from substantial (kappa 0.70) to excellent (kappa 0.82). Templating and intraoperative measures succeeded to restore the leg length.

Conclusions

The Mdesk? system has comparable validity and reliability with other templating systems used in clinical practice. We recommend that the same surgeon who does the preoperative radiographic templating to also perform the operation. Further studies are required to evaluate the results of succeeded templating in the long run.     

Effects of urodilatin on natriuresis in cirrhosis patients with sodium retention

Background  

Sodium retention and ascites are serious clinical problems in cirrhosis. Urodilatin (URO) is a peptide with paracrine effects in decreasing sodium reabsorption in the distal nephron. Our aim was to investigate the renal potency of synthetic URO on urine sodium excretion in cirrhosis patients with sodium retention and ascites.     

Donor performance of combat readiness skills of special forces soldiers are maintained immediately after whole blood donation

BACKGROUND: Bleeding is a major cause of death in combat settings, and combat casualties in shock may benefit from fresh whole blood (FWB) transfusion. “Buddy transfusion” is a well‐known lifesaving intervention, but little is known about donor combat safety aspects immediately after blood donation. The objectives of this study were to explore the effects of donation of 1 unit of blood on physical and combat‐related performance among active duty soldiers. We also investigated the feasibility of a short training program to teach nonmedics buddy transfusion. STUDY DESIGN AND METHODS: Twenty‐five fit male soldiers from a special forces unit were divided into three groups and tested on 1) a Bruce protocol treadmill stress test, push‐ups, and pull‐ups; 2) a 50‐round rapid pistol shooting test; and 3) an uphill hiking exercise carrying a 20‐kg backpack. After baseline testing, the soldiers performed the tests again (2‐6 min) after donating 450 mL of blood. The training program included blood collection and reinfusion procedures and we measured success rate of venipuncture, time for blood collection, and success in placing sternal intraosseous needle and reinfusing 1 unit of autologous blood. RESULTS: We did not find any significant decrease in performance either in physical or in shooting performance after donating blood. Nonmedic soldiers had a 100% success rate in blood collection and also infusion on fellow soldiers after a short introduction to the procedures. CONCLUSION: This study supports the fact that buddy transfusion may be feasible for healthy well‐trained soldiers and does not decrease donor combat performance under ideal circumstances.     

Analysis of backscattered ultrasound from normal and diseased arterial wall

Intra-arterial ultrasonic imaging has several features which affect the feasibility of clinical tissue characterization when compared with trans-thoracic ultrasound. The short distance from transducer to tissue, fluid path, high frequencies, and special characteristics of the tissues of interest all contribute to making practical tissue characterization by measurement of the backscattered signal more probable in intra-arterial imaging. The properties of backscattered ultrasound, and methods of characterizing such signals, are discussed with special reference to intra-arterial applications.     

Pulmonary distributions of lead in human subjects

Summary The concentration of lead in five lung segments and in regional lymph nodes was determined post mortem in ten subjects by atomic absorption technique. In each case there was a considerable variation in the concentration of lead in different lung segments, and, in general, the apical segment in the upper lobe tended to be more contaminated than segments in the lower lobes. With one exception, the lead levels in the regional lymph nodes exceeded those of the lung segments. Individual differences in the distribution of lead in the lungs may be due to differences both in exposure and physiological response. When comparative analyses are made, we suggest that samples be taken from the same and preferably the basal segments of the lung.     

3H-imipramine binding sites in platelets from psychiatric patients

High-affinity binding of ³H-imipramine to platelet membranes from control subjects and psychiatric patients was studied. Maximal binding (βmax) in depressed manic-melancholic patients was higher than in euthymic manic- melancholic patients, psychiatric controls, and normal controls.     

Fracture of the glenoid fossa and dislocation of the mandibular condyle into the middle cranial fossa

Reported cases of dislocation of the mandibular condyle into the middle cranial fossa have been rare, and treatment modalities have varied. The case presented represents an instance of successful closed reduction. Numerous factors should be considered when determining the technique of reduction. Primary goals in selecting the method of treatment are stabilization of the neurologic status, control of the bone fragments in the brain, reduction of the occlusion, maintenance of ramus height for facial symmetry, preservation of growth potential, and assurance of satisfactory long-term function of the mandible.     

Viral and bacterial antibody responses in multiple sclerosis

An imprint electroimmunofixation method (IEIF) was used to characterize antibodies to eight viral antigens (measles, mumps, rubella, herpes simplex type 1, varicella-zoster, vaccinia, cytomegalovirus, adenovirus) and four bacterial antigens (β-hemolytic streptococcus, Hemophilus influenzae type B, Escherichia coli, enterococcus) in serum and cerebrospinal fluid (CSF) of 12 patients with multiple sclerosis (MS). Twelve patients matched for age and sex served as controls. Evidence for intrathecal synthesis of oligoclonal antibodies to one or more antigens was found in all 12 MS patients and in 1 of the controls. In the MS group, antibodies to viruses with neurotropic properties were more frequently associated with local synthesis than antibodies to other viruses and bacteria. The types and number of locally synthesized antibodies showed no correlation with disease duration and severity. The antibodies were not associated with oligoclonal CSF IgG and appear to account for only a minor fraction of the locally synthesized CSF IgG in MS.