Age-related aspects of balloon angioplasty for postsurgical aortic recoarctation

Balloon angioplasty is now the elective technique for relief of aortic recoarctation, since it has low mortality, low morbidity, and good results at follow-up. Some concern exists concerning the possible increased risk in young children. To investigate such age-related aspects, we examined 58 children undergoing consecutive balloon angioplasty for postsurgical recoarctation. Of the children, 30 were younger and 28 older than 1 year. Recoarctation was more frequent with ventricular septal defect or other cardiac anomalies (p < 0.001). Systolic hypertension was present in 70% of children aged less than 1 year, but in only 32% of those older than 1 year (p < 0.001). The initial gradient was inversely related with the age at dilation (r = -0.28, p < 0.05), and correlated with systolic blood pressure (r = 0.81, p < 0.01). The procedure was successful in 87% of children older than, and 86% of those under 1 year. Age was not related with residual gradient, nor with the percentage increase of diameter of the site of stenosis. After balloon angioplasty, systolic hypertension was still present in 37% of children younger than 1 year, and in 25% of those older than 1 year (p < 0.05). Three complications occurred in children younger than 1 year, and 6 in those older (p < 0.05). Our results show, first, that recoarctation occurs earlier in the setting of complex disease, second that children suffering recoarctation at a younger age are more likely to be hypertensive, either before or after balloon angioplasty, third, that balloon angioplasty has the same rate of success in children below or above the age of one year, although the procedure still carries a not negligible risk. Finally, the procedure does not carry a higher risk for those children below the age of 1 year.     

Responsiveness of plasma catecholamines to intracerebroventricular injection of glucagon in Muscovy ducklings

Summary. Recent investigations have demonstrated a modulatory action of glucagon on shivering via the central nervous system in ducklings. The aim of this study was to investigate the effects of intracerebroventricular injection (i.c.v.) of glucagon on metabolic rates (MR) and plasma catecholamines in control ducklings (TN) and in ducklings exhibiting nonshivering thermogenesis after chronic glucagon treatment: (GT). At thermoneutrality (25°C, Ta), i.c.v. injection of glucagon had no thermogenic effects in TN and GT ducklings. At cold (+4°C, Ta), i.c.v. glucagon injection elicited a concomitant decrease of plasma norepinephrine (NE) and MR in TN ducklings, whereas in GT ducklings, the plasma catecholamines and the MR remained unchanged. These results indicate that glucagon treatment rendered the catecholaminergic system of GT ducklings insensitive to cold or i.c.v. glucagon injection. Received April 19, 2000; accepted February 1, 2001     

Uretero-uterine fistula: what is the role of ureteroscopy?

We present a case of uretero-uterine fistula that occurred following cesarean section complicated by postoperative peritonitis subsequent to failure of the uterine sutures. The distal and the proximal ends of the ureter were successfully explored by ureteroscopy. We discuss the contribution of ureteroscopy in ureter exploration and endoscopic treatment of uretero-uterine communications.     

The etiologic role of the osteo-meatal complex in the pathogenesis of sinusitis: a retrospective study of clinical,CT and endoscopic findings in 143 patients

The etiological role of the osteo-meatal complex (OMC) in the pathogenesis of sinus disease is a debatable issue. The charts of 143 patients who underwent endoscopic sinus surgery at the American University of Beirut Medical Center between 1992 and 1995 were reviewed. Clinical symptoms included facial pain, nasal obstruction, headache, and postnasal drip. CT scan and endoscopic findings were reviewed. The presence of OMC disease radiologically was correlated with all the clinical, nasal endoscopic and other radiologic findings (disease in the rest of paranasal sinuses, or presence of concha bullosa). Its etiological role in patients with sinusitis is discussed. RESULTS: No endoscopic findings could be statistically correlated with the OMC disease. Facial pain and postnasal drip were the only clinical symptoms that statistically correlated with the OMC disease (p-value = 0.009 and 0.008, respectively). The OMC disease correlated with the radiological evidence of sinusitis in any of the sinuses.     

Expression of CD40 ligand (CD154) in B and T lymphocytes of Hodgkin disease: potential therapeutic significance

BACKGROUND: The malignant Hodgkin and Reed-Sternberg (H/RS) cells of Hodgkin disease (HD) express CD30 and CD40 receptors that can activate nuclear factor kappa B and transduce survival signals. The authors have reported previously that the B lymphocytes of HD express CD30 ligand (CD30L, CD153). Furthermore, they and others have reported previously that the CD40L survival pathway is augmented in patients with B-cell malignancies, as CD40L was constitutively expressed by the malignant B cells and infiltrating T cells, and sera from those patients contained elevated levels of soluble CD40L. In this study, the authors investigated the hypothesis that the survival of H/RS cells was similarly promoted by an augmented CD40L signals in HD patients. METHODS: The expression of CD40L on lymphocyte subsets of patients with classic HD was determined by two-color fluorescent-activated cell sorter analysis. Serum soluble CD40L levels were determined by enzyme linked immunosorbent assay. RESULTS: CD40L was constitutively expressed on both the T and B cells of HD patients but was more prominently expressed on the B lymphocytes. Soluble CD40L was detected in the serum of 17 of 37 patients (45%) and was higher than 1 ng/mL in 4 patients (10%). Both interleukin (IL)-4 and IL-10, which are known to be secreted by H/RS cells and surrounding T cells, up-regulated CD40L expression on normal B cells. CONCLUSIONS: Thus, the expression of CD40L and CD30L on the B cells of HD patients suggests that B lymphocytes may play a role in the regulation of H/RS cell growth in vivo. Depriving H/RS cells from CD30L and CD40L survival signals by eliminating B cells from HD lesions may be of therapeutic value.     

Monoarthritis secondary to joint metastasis. Two case reports and literature review

Synovial metastases from neoplasms are uncommon. We report two cases of knee monoarthritis due to joint metastasis. Joint fluid cytology established the diagnosis. In one patient, an epidermoid carcinoma of the ureter metastasized to the left knee. The other patient had chronic monoarthritis of the left knee unresponsive to conventional treatment and was found to have distal femoral metastases from a lung adenocarcinoma. Only 28 cases of synovial metastases from solid tumors have been reported in the literature. The knee is the most common target, the lung the most common site of the primary (12 cases), and adenocarcinoma the most common histological type (12 cases). Joint metastasis carries a poor prognosis with a mean survival of less than 5 months.     

Effect of phorone-induced glutathione depletion on the metabolism and hepatotoxicity of carbon tetrachloride and vinylidene chloride in rats

Although the depletion of hepatic glutathione in male rats following treatment with phorone (diisopropylidene acetone) did not affect the xenobiotic-metabolizing microsomal enzyme system, the metabolic elimination of vinylidene chloride (VDC) from the atmosphere of a closed exposure system was inhibited. However, the hepatotoxicity of VDC was enhanced after GSH-depletion, although no enhancement of VDC-induced in vivo lipid peroxidation was observed. In contrast, GSH depletion had no influence on the metabolic elimination of carbon tetrachloride, but augmented both the hepatotoxic response to and the in vivo lipid peroxidation induced by CCl4. In the case of VDC GSH-depletion hepatoxicity was increased because of a change in the metabolic pathway, resulting in production of intermediates of greater toxicity: lack of GSH in CCl4 treated rats renders membrane phospholipids more susceptible to peroxidative damage.     

Influence of cadmium chloride, mercuric chloride, and sodium vanadate on the glutathione-conjugating enzyme system in liver, kidney, and brain of mice

Sublethal doses of CdCl2 (3 mg/kg iv), HgCl2 (2 mg/kg iv), or NaVO3 (6 mg/kg iv) did not alter the content of reduced glutathione (GSH) in the livers of mice during the 24-h observation period. In the kidneys, a tendency to increased GSH content was seen, especially after HgCl2 treatment; in lung and brain the GSH levels were significantly lowered upon the treatment with all three metals. The activities of GSH S-transferase toward an aryl substrate (CDNB; 1-chloro-2,4-dinitrobenzene) was enhanced in all tissues by the administration of HgCl2 greater than NaVO3 greater than CdCl2. The activity of GSH S-transferase toward an epoxide substrate [1,2-epoxy-3-(p-nitrophenoxy)propane was only measurable in the livers and was inhibited 1 and 2 h after the administration of HgCl2 and NaVO3. It is concluded that sublethal doses of CdCl2, HgCl2, or NaVO3 do not impair the GSH concentration and GSH-conjugating enzyme activities toward the aryl substrate in different target organs of their toxicity, which is in contrast to results obtained in vitro.