Thrombophilia and arterial disease. An up-to-date review of the literature for the vascular surgeon.

Thrombophilia may be defined as the tendency to arterial or venous thrombosis. Thrombophilia can be acquired or hereditary. Acquired conditions leading to arterial thrombosis are commonly encountered in vascular surgical practice, but less well known is the potential influence of genetic factors. In recent years, evidence has accumulated for a crucial role of genetic factors in the pathogenesis of venous thrombosis, many previously unknown genetic defects having been recently identified. The role of genetic predisposition for the pathogenesis of arterial occlusive disease on the other hand is unknown, although recent publications suggest a definite link. This may have implications for the vascular surgeon in the management of patients with arterial disease. A medline search was performed in order to identify papers published between 1990-2002 on thrombophilia, arterial disease and peripheral arterial occlusive disease (PAOD). With regard to venous thrombosis we obtained a much wider knowledge about genetic defects leading to thrombophilia. This has altered the diagnostic and therapeutic approach to patients with venous thrombosis, and has had an important influence on counselling and screening of family members, especially females of childbearing age. With regard to arterial thrombosis, certain thrombophilic disorders have a definite pathophysiological role. Hyperhomocysteinaemia, inherited or acquired, has been demonstrated to be an independent risk factor for athero-thrombosis. The antiphospholipid antibody syndrome (APS), an acquired condition, also predisposes to arterial thrombosis. Other thrombophilic conditions, such as prothrombin gene G20210A variant or factor V Leiden, have been investigated, but current evidence does not unequivocally support the hypothesis of a pathophysiological role in athero-thrombosis. Routine screening for thrombophilia in patients with athero-thrombosis is therefore not generally recommended on the basis of current evidence, but there is a role for selective screening.     

Multilevel surgery for obstructive sleep apnea: short-term results.

OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 +/- 20.0 vs 20.7 +/- 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful. EBM rating: B-2b.     

微创内固定系统治疗复杂股骨转子部骨折的初步报告

目的探讨微创内固定系统(LISS)治疗复杂股骨转子部骨折的可行性、手术技术及指征,并总结其近期临床治疗效果。方法自2005年6月～2006年5月,应用LISS治疗复杂股骨转子部骨折12例。骨折采用AO分类法,其中转子间骨折5例：31-A2．2型2例,31-A2．3型2例,31-A3．3型1例；转子下骨折7例：32-A3．1型1例,32-B1．1型3例,32-B2．1型1例,32-B3．1型2例。记录手术时间、术中出血量、术后住院时间,术后观察有无感染、下肢深静脉血栓、心肺疾患、应激性溃疡等并发症。术后1、2、3、6、12个月时常规随访。结果手术时间50～90 min,平均65 min；出血量50～400 mL,平均142 mL,术后住院时间6～15 d,平均9．3 d。无死亡病例。所有患者均未出现切口感染、下肢深静脉血栓、术后心肺疾患、应激性溃疡等并发症。12例均获得3～14个月(平均7．2个月)随访。10例在术后3个月复查骨折时达到临床愈合,1例假体周围骨折术后4个月、1例病理性骨折术后6个月达到临床愈合。所有患者在最后一次随访时均无骨折再移位、髋内翻畸形、内固定切出、内固定失败及股骨头坏死。结论微创反向使用股骨LISS从生物力学和解剖结构上都能满足股骨近端骨折内固定要求,并具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点,尤其适用于老年人合并内科疾病、骨质疏松较重的转子间骨折及复杂的股骨近端骨折。熟练掌握间接复位技术,正确放置A孔导针,避免过早负重是手术成功的关键。     

News for the Practitioner

News for the Practitioner     

Structure-activity relationship between (E)-5-(2-bromovinyl)- and 5-vinyl-1-beta-D-arabinofuranosyluracil (BV-araU, V-araU) in inhibition of Epstein-Barr virus replication.

The structure-activity relationship between (E)-5-(2-bromovinyl)- and 5-vinyl-1-beta-D-arabinofuranosyluracil (BV-araU and V-araU) in inhibition of Epstein-Barr virus (EBV) was evaluated. Both V-araU and BV-araU effectively inhibited EBV replication in virus-producer P3HR-1(LS) cells, as determined by DNA-DNA hybridization. The 50% effective doses (ED50) for viral DNA replication were 0.005 and 0.3 microM for V-araU and BV-araU, respectively. The in vitro therapeutic index was 4000 for V-araU and 1300 for BV-araU. Synthesis of EBV-induced polypeptides with molecular weights of 145,000 (145, 140, 130, and 110 kDa) was significantly inhibited by both drugs. Only V-araU inhibited the synthesis of 85-, 55-, and 32-kDa polypeptides by approx. 50%. Kinetic analysis of inhibition and reversibility of EBV DNA replication after removal of the drugs indicated that BV-araU has a more prolonged inhibitory effect than V-araU. These results indicate that the substitution of H by Br in the 5-vinyl group results in marked reduction in anti-EBV activity while prolonging the drug effect and diminishing cytotoxicity.     

Follow-up of men with genital papilloma virus infection. Psychosexual aspects.

Genital papilloma virus infection (GPVI) is in many patients a longlasting, relapsing disease for which no effective treatment is available. This fact and the association between the virus and cancer puts much stress on the afflicted patient. Of 41 men with GPVI interviewed, 17 (40%) reported a negative effect of the disease on their sexual life. Most distressing was the fear of transmitting the disease to their partner. After 18 months, 15 (37%) of the 41 men still exhibited signs of GPVI. In the care of patients with GPVI, more attention needs to be paid to the psychosexual effects of the disease.     

RBE and OER measurements on the p(66) + Be neutron beam at Faure, South Africa.

Results reported are for single dose exposures and refer to 60Co-gamma-irradiation. The RBE determined by V79 cell survival and based on the Do ratio was found to be 1.70 +/- 0.4 ranging from 1.5 to 1.8. In the case of the regeneration of mouse jejunal crypts the RBE was calculated at ten cell survival and was found to be 1.68. The maximum acute mouse skin reaction at a skin score of 2.0 was found to be 2.1 while the average skin reaction was 1.7. Growth retardation of Vicia faba bean roots measured at the level of 50% indicated an average RBE of 3.0 and a range of 2.7 to 3.7. The OER obtained for V79 cell survival was found to be 1.7 to 1.8. Comparison is made with the RBE and OER measurements for the neutron facilities at Clatterbridge, Fermilab and Louvain-la-Neuve which produce neutrons by the same nuclear reaction and whose physical specifications closely resemble those of the Faure neutrons. This comparison indicates that the Faure beam shows no unusual biological features and that its biological effectiveness is in line with that expected from its physical characteristics.     

An account of the ticks of the northeastern of Spain (Acarina: Ixodidae).

The tick species commonly collected at the Northeast of Spain are reported in this paper. Data on hosts, temperature and humidity requirements, vegetation relationships, altitudinal distribution, and seasonal activity are included. R. sanguineus is commonly collected in areas with Mediterranean vegetation, esteppe, and semi-desertic esteppe, ranging from 190 to 1,000 meters above the sea level. R. sanguineus is related with sparse vegetal areas, and it is absent from areas with dense shrub or forests of every kind; sometimes, small populations may be collected in ecotones between Pinus spp. and esteppe formations. R. pusillus is closely related to areas of Mesomediterranean vegetation, sometimes subordinate to Pinus spp. and Quercus spp. The climate to which the species ally is always of continental type, with a hot and dry summer, and cold winter; although the species is commonly restricted to its main host, Oryctolagus cuniculus, several specimens have been collected from V. vulpes. Our data display the clear affinity of I. ricinus to the Supramediterranean vegetation (Aceri-Quercion faginae), places of Quercetum-Buxetum, as well as the Iberian Oromediterranean vegetation (Pinus sylvestris-Buxus sempervirens). Captures are scarce in forest of Fagus sylvatica, but data suggest that the species may be locally common on such places. Climate for the zones of collection of I. ricinus is Atlantic attenuated, with mild summers and humid winters. D. marginatus is strongly related to the xerophilic vegetation, widely spread through the Mediterranean, Supramediterranean, and hill levels, but does not colonize the true Oromediterranean vegetation. In our captures, the species is commonly collected in pubescent oak formations, but it does not penetrate in true forest associations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Conservative management of placental abruption complicated by severe clotting disorders.

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.