Epicardial ultrasound in off-pump coronary artery bypass grafting: potential aid in intraoperative coronary diagnostics

BACKGROUND: In off-pump coronary artery bypass surgery (OPCAB), epicardial ultrasound may aid in several intraoperative dilemmas. The aim of this study was to test a new mini-transducer for intraoperative coronary diagnostics. METHODS: A 10 MHz mini-transducer (15 x 6 x 9 mm) was applied epicardially in eight open chest and two closed chest porcine OPCAB procedures (using robotics) and on four postmortem human hearts. The transducer fitted in between the suction pods of the cardiac stabilizer and passed an 11-mm port. RESULTS: In the open chest cases the internal mammary arteries (including the side branches) could be visualized totally (n = 12). The left anterior descending coronary artery could be located over its entire course. Vascular anatomy, side branches, and septal perforators (diameter > or = 0.2 mm) could easily be discerned. In the closed chest cases the left anterior descending coronary artery, its side branches, and septal perforators could be visualized in both cases. In the postmortem human hearts the left anterior descending coronary artery could be visualized totally under the thick epicardial fibro-fatty layer and pathologic conditions could be identified. CONCLUSIONS: The 10 MHz ultrasound mini-transducer showed promise as a diagnostic tool in both open and closed chest coronary procedures on the beating heart.     

Induction of antibodies to viscotoxins A1, A2, A3, and B in tumour patients during therapy with an aqueous mistletoe extract

Mistletoe extracts exert immunomodulatory properties on immunocompetent cells of the innate as well as the specific immune system. These effects have been mainly ascribed to mistletoe lectin 1 (ML-1) present in most of the extracts. However, it became evident that also other components of these extracts may induce immunological reactions, and especially viscotoxins (VT) may be of relevance. Aim of the study was, therefore, to evaluate whether VT like ML-1 could activate B-cells and lead to the production of VT-specific antibodies. Sera from 26 patients with different tumours who were treated with the mistletoe extract ABNOBAviscum Mali (AM) 4 for at least 18 weeks were analysed before therapy and after 3, 6, 9, 12, and 18 weeks. Sera were tested by ELISA against the four viscotoxins A1, A2, A3, B, as well as against ML-1. Within the observation period twenty-four (92%) of the 26 patients developed antibodies to at least one of the four VT and 25 (96%) to ML-1. In most instances, anti-VT antibodies appeared after 6-9 weeks of treatment. The antibodies were predominantly of the IgG type belonging preferentially to the IgG1 and IgG3 subclass. IgE antibodies were found only to VT-B and to ML-1. There was no relation between the development of antibodies to VT and ML-1, and also cross-reactivity could be excluded with high probability. These data indicate that not only ML-1 but also VT induce immunological responses in patients treated with mistletoe extracts. Whether there is any relationship to the postulated anti-tumour effect of mistletoe extracts has, however, still to be evaluated.     

The composition of the major molecular species of adipose tissue triacylglycerols of rats reflects those of dietary rapeseed, olive and sunflower oils

We report the composition of constituent fatty acids and molecular species of adipose tissue triacylglycerols of male weaned Wistar rats fed diets containing, in addition to 20 g corn oil/kg feed, 120 g per kg feed canola-type rapeseed oil, olive oil or conventional sunflower oil for 10 wk. The composition of fatty acids and molecular species of the triacylglycerols of subcutaneous, epididymal and perirenal adipose tissues did not differ among groups (P > 0.01), broadly reflecting the corresponding compositions of the dietary oils. The major molecular species of dietary triacylglycerols, especially trioleoylglycerol (OOO) and linoleoyl-dioleoylglycerols (LOO) in the rapeseed oil and olive oil diets, dioleoyl-palmitoylglycerols (OOP) in the olive oil diet, dilinoleoyl-oleoylglycerols (LLO) in the rapeseed oil and sunflower oil diets, and dilinoleoyl-palmitoylglycerols (LLP), linoleoyl-oleoyl-palmitoylglycerols (LOP) as well as trilinoleoylglycerol (LLL) in the sunflower oil diet were also prominent constituents of the corresponding adipose tissue triacylglycerols. On the other hand, predominant molecular species containing alpha-linolenoyl (Ln) moieties, e.g., alpha-linolenoyl-linoleoyl-oleoylglycerols (LnLO) and alpha -linolenoyl-dioleoylglycerols (LnOO) from the rapeseed oil diet were not prominent constituents of rat adipose tissue triacylglycerols, whereas LOP from rapeseed oil and olive oil diets and OOP from rapeseed oil and sunflower oil diets were distinctly enriched in the corresponding adipose tissues. Most of the minor molecular species of the dietary triacylglycerols from all the three diets were distinctly present in the corresponding adipose tissues. Thus, despite numerous biochemical processes involved in the metabolism of dietary triacylglycerols, a substantial proportion of the molecular species of adipose tissue triacylglycerols containing linoleoyl (L), oleoyl (O) and palmitoyl (P) moieties resemble those of dietary triacylglycerols.     

Dystonia: clinical features,genetics, and treatment

PURPOSE OF REVIEW: The present review covers recent advances in dystonia research related to dystonia genetics and treatment. These have led to the discovery of novel dystonia genes and loci, to changing classification schemes, and to the introduction of improved and new treatment options. RECENT FINDINGS: Currently 13 different forms of dystonia can be distinguished on a genetic basis (dystonia types 1-13). Recently, a novel gene locus (DYT13) was detected in a family with segmental dystonia, and the gene causing myoclonus-dystonia was identified (SGCE). Furthermore, a novel mutation in the DYT1 gene is associated with a myoclonus-dystonia phenotype. Regarding dystonia treatment, patients refractory to botulinum toxin type A can now be treated with botulinum toxin type B. Selective peripheral denervation remains an effective form of treatment for patients with secondary, but probably not with primary botulinum toxin treatment failure. Finally, a renaissance of functional surgical ablative procedures has taken place, with high frequency deep brain stimulation being introduced in dystonia treatment. Bilateral pallidotomy or pallidal stimulation may provide major benefit especially in patients with generalized, disabling dystonia with the most dramatic improvements in dystonia type 1 patients. Neurostimulation may also be effective in primary segmental axial dystonia, myoclonus-dystonia, and tardive dystonia. SUMMARY: The recent mapping of additional dystonia gene loci, the identification of novel dystonia genes, and the characterization of proteins encoded by these genes have enhanced our understanding of various forms and aspects of the dystonias and have opened up new avenues for research. Treatment options include both medical and surgical therapies, with deep brain simulation being the most recent development.     

Cerebral organization in a right-handed trilingual patient with right-hemisphere speech: a positron emission tomography study

Using the method of positron emission tomography, combined with word-generation tasks, we had the opportunity to examine the cerebral representation of multiple languages in the brain in a right-handed patient, RA, with known right-hemisphere speech representation as determined by intracarotid sodium amobarbital testing. Similar patterns of cerebral blood flow were observed across all three languages (French, Spanish and English), when synonym generation was compared with a silent resting baseline. In particular, several regions in the right inferior frontal cortex were activated. These foci are in locations corresponding to those observed in the left hemisphere in normal right-handed volunteers with presumed left-hemisphere dominance, and in patients known to be left-hemisphere dominant for speech. The lack of anatomical separation of the three languages within the same individual, who acquired two languages early and one language later in life, suggests that at least at this single-word level of analysis, age of acquisition was not a significant factor in the determining of functional organization in the brain.     

Stages of exercise behavior and caloric expenditure

BACKGROUND: This study assessed the ability of the stages of exercise behavior to differentiate caloric energy expenditure, by stage, based upon self-report of energy expenditure (EE). METHODS: Volunteer male and female participants (n=890) reported current stage of physical activity; physical activity mode, duration, and frequency; and demographic information (height and weight). Data calculated from reported information included EE, body mass index (BMI), and BMI category. EE profiles were established by average estimated EE (kcal/wk), average total time (min/wk) for physical activity, average activity frequency (times/wk), average session duration (min/session), moderate and vigorous EE levels (kcal/wk), and categorized activity level (sedentary, moderate, vigorous). RESULTS: There were no significant within gender differences across stages of exercise behavior for height. Terminators differed significantly for weight from all other groups, and BMI was significantly less across groups, by gender. All males were identified in the "Mildly Obese" BMI level, while only females in the non-active (precontemplation, contemplation, and preparation) groups were so identified. All other females were at the "Acceptable" BMI level. Regardless of gender, all groups were significantly different from the sedentary precontemplation and contemplation group for EE. Male and female preparation groups reported EE in the moderate level, and were significantly different from the action, maintenance, and termination groups, who reported EE in the vigorous level. Across subsequent stages of exercise behavior, female participants demonstrated increased EE. Male participants were similarly profiled, with the exception of one group (action stage), which was considerably greater than all other groups. CONCLUSIONS: This study confirmed the earlier examined premise, by Cardinal, that self-selected stage of exercise behavior differentiates EE by stage.