Initial results of laser angioplasty under angioscopic guidance for salvage of an ischemic lower limb: preliminary report

From March to July 1989, nine patients at risk for peripheral artery disease underwent intraoperative Nd:YAG laser angioplasty using angioscopy at the Veterans General Hospital (Taipei, Taiwan, Republic of China). Following the laser angioplasty, balloon dilatation was performed in all cases. Eight men and one woman at an average age of 68 were included in the study (range: 58 to 78 years old). Ischemic symptoms included five patients with disabling claudication, four with pain at rest and one with gangrene on the toes. Eight of the nine patients had complete occlusions ranging from 2 to 19 cm in length. Two patients had high degree multiple segmental stenosis of the superficial femoral artery from 1 to 2 cm in length. Initial clinical success (indicated by relief of symptoms and increase in Doppler ankle pressure and index) and improvement in the angiographic luminal diameter was noted in 9 of 10 occluded vessels (90%) that underwent Nd:YAG laser treatment which was delivered at 10 to 12 watts through laser probes. Prelaser intraluminal diameter increased from 0.05 +/- 0.07 to 0.53 +/- 0.07 mm, Doppler ankle pressure index rose from 0.51 +/- 0.12 to 0.81 +/- 0.12, Doppler ankle pressure increased from 62.44 +/- 16.10 to 104 +/- 21.21 mmHg and the amplitude of pulse volume recorder at ankle level rose from 5.77 +/- 2.80 to 12.11 +/- 2.77 mm as compared with prelaser therapy (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Histidine pKa shifts accompanying the inactivating Asp121----Asn substitution in a semisynthetic bovine pancreatic ribonuclease.

A semisynthetic RNase, RNase-(1-118).(111-124), consisting of a noncovalent complex between residues 1-118 of RNase (obtained from the proteolytic digestion of RNase A), and a synthetic 14-residue peptide containing residues 111-124 of RNase, exhibits 98% of the enzymatic activity of bovine pancreatic ribonuclease A (EC 3.1.27.5). The replacement of aspartic acid-121 by asparagine in this semisynthetic RNase to form the "D121N" analog reduces kcat/Km to 2.7% of the value for RNase A. In the present work, 1H NMR spectroscopy has been used to probe the ionization states of His12, His105, and His119 in this catalytically defective semisynthetic RNase. A comparison of the observed resonances of D121N with those previously determined by others for RNase A enabled us to assign the C2 proton NMR resonances to individual residues; the assignment of His119 was confirmed by titrating D121N with the fully deuterated peptide, [Asn121]-RNase-(111-124). The observed pKa values of His12, His105, and His119 decrease 0.18, 0.16, and 0.02 pH unit, respectively, as a result of the D121N replacement. Values calculated by using a finite difference algorithm to solve the Poisson-Boltzmann equation (the DELPHI program, version 3.0) and a refined 2.0-A coordinate set for the crystal structure of D121N differ significantly for active site residues His12 (delta pKa = -0.58) and His119 (delta pKa = -0.55) but not for His105 (delta pKa = -0.10). The elmination of bound water from the calculations reduced, but did not reconcile, these discrepancies (His12, delta pKa = -0.36; His119, delta pKa = -0.41).     

Alopecia syphilitica, a simulator of alopecia areata: histopathology and differential diagnosis

Alopecia syphilitica (AS) may be "moth-eaten" or diffuse, clinically, and be confused with alopecia areata (AA) or other alopecias. The English language literature contains scant information regarding the histopathology of AS, and the resemblance between AS and AA has not been given adequate recognition. We report the histopathological findings of AS from nine patients with secondary syphilis and acute hair loss. The alopecia was moth-eaten in four patients and diffuse, but slightly moth-eaten, in five. Microscopically, the dermoepidermal interface was not involved. The numbers of hair follicles were diminished, with increased numbers of catagens and telogens. Lymphocytic infiltration was present around the hair bulbs and fibrous tracts in eight cases. Plasma cells were present in four biopsies. Other less common findings included lymphocytes in the isthmus, parabulbal lymphoid aggregates, and granulomatous infiltrate in the upper dermis. The findings, save for the follicular changes, resembled those of macular/maculopapular syphilides outside the scalp. With the follicular changes, the overall patterns resembled AA closely. The modified Steiner stain did not reveal spirochetes in any of our cases and failed to differentiate between AS and AA. Comparing the AS cases to 13 cases of AA, we found only a few differentiating features. The presence of peribulbal eosinophils strongly suggests AA. Without peribulbal eosinophils, the presence of plasma cells, abundant lymphocytes in the isthmus, or parabulbal lymphoid aggregates suggests AS.     

Cancer statistics of Chinese Versus Americans

Cancer incidence and mortality rates of Chinese in China (Shanghai, Kwangtung), Hong Kong, and the United States (San Francisco, etc.) are presented. The rates for the U.S. white population are included for comparison. Additional mortality rates of Chinese in Japan and incidence rates of Chinese in Singapore and British Columbia are also available. Such statistics emphasize both the distinctions and the similarities in cancer problems among chinese living abroad and Chinese living in China. Some ethnic and cultural differences, as well as differences in age, site distribution, and histological subtype, of certain cancers are discussed.     

Unicentric osteosarcoma of bone with subsequent skeletal metastases

Five cases of unicentric osteosarcoma with subsequent skeletal metastases are reviewed. Skeletal metastases may occur prior to pulmonary metastases in such patients. Initial and periodic bone scanning is therefore justified since early detection of distant bone lesions may have important therapeutic implications. A classification of multiple site osteosarcoma based upon clinical, pathologic, and radiologic characteristics is proposed.     

Astrocytes in hemangioblastomas of the central nervous system and their relationship to stromal cells

Summary Thirteen cases of CNS hemangioblastoma were examined with the immunoperoxidase technique for glial fibrillary acidic protein (GEAP) to determine if there were astrocytic elements among the stromal cells of these tumors.In six cases, including two leptomeningeal hemangioblastomas, none of the stromal cells were positive on GFAP stain. Seven cases, however, showed variable presence of GFAP positive cells, including clusters of heavily lipidized cells deep within cerebellar hemangioblastomas. These GFAP positive cells were indestinguishable by other stains from interstitial or stromal cells.Thus, it appears that in at least some hemangioblastomas of the CNS parenchyma, a few or many stromal cells are lipidized astrocytes. All stromal cells, however, cannot be of astrocytic origin, as proposed by Jakobiec et al. (1976), in view of our six cases where no GFAP-positive cells were found in the tumors.It is suggested that cells identified as stromal cells of hemangioblastomas on light microscopy are a heterogeneous group of cells including astrocytic as well as other elements and that they resemble each other on ordinary stains because of the equalizing effect of cell lipidization.     

Interaction of diazepam with synaptic transmission in the in vitro rat hippocampus

Summary Diazepam (5×10^–8–10^–6 M) was found to augment recurrent inhibition of pyramidal neuron firing in a dose-dependent manner in rat hippocampal slices. To determine possible loci of this effect, diazepam was locally administered by pressure ejection from a micropipette, while recording action potentials from single inhibitory (basket) interneurons. Diazepam induced reversible and reliable increases in interneuron firing in response to stimulation of Schaffer collateral and commissural afferents. Taken together with previous electrophysiological reports, these data suggest that benzodiazepines may augment central inhibition by increasing either the excitability of inhibitory interneurons, or by increasing the strength of excitatory afferents to these cells.     

A rating scale for tardive dyskinesia

A rating scale for tardive dyskinesia was developed, consisting of nearly all signs seen by two groups of investigators over a 5-year period. Thirty-four items were included in the scale with a possibility of writing in idiosyncratic signs. The scale was shown to have good reliability and validity in studies carried out by both the New York and Boston groups. It is recommended as a suitable instrument for describing the breadth of tardive dyskinesia syndrome and also for quantifying the disorder. A second scale, the abbreviated dyskinesia scale, contains 13 items which are more global than the items in the original scale. It also has been shown to be both reliable and valid. Its use is suited to situations requiring less extensively detailed assessments.