Pseudoaneurysm detection with Tc-99m-labeled red blood cells

A technique for the noninvasive diagnosis of pseudoaneurysms is described. This method employs in vivo labeling of red blood cells with Tc-99m to allow better delineation of the vascular anatomy than standard radionuclide angiography. Four cases are illustrated.     

Intraoperative arteriography: comparison of conventional screen-film with photostimulable imaging plate radiographs

This prospective study compared images obtained with a photostimulable imaging plate with matched images obtained with a conventional screen-film combination in 26 patients undergoing intraoperative arteriography. Diagnostic accuracy of the two techniques was assessed objectively, and image quality was assessed subjectively. In 16 patients (62%), the radiation exposure was reduced by 50% for the imaging plate technique by decreasing the mAs level generally used for the screen-film combination. Because of the dynamic range of the imaging plate system, no repeat examinations were necessary, while 12% of the screen-film studies had to be repeated because of over- or under-penetration. Imaging plate studies required 6% more time for processing than screen-film studies. Receiver-operating-characteristic analysis indicated no difference in diagnostic accuracy between the two imaging techniques. Subjective evaluation also revealed no difference in observer preference for imaging plate or screen-film studies. The imaging plate technique is an excellent alternative to screen-film studies in the operating room.     

An 11 base pair duplication in exon 6 of the SMN gene produces a type I spinal muscular atrophy (SMA) phenotype: further evidence for SMN as the primary SMA-determining gene

The gene for autosomal recessive spinal muscular atrophy (SMA) has been mapped to 5q12 in a region that contains repeated markers and genes. Three cDNAs that detect deletions in SMA patients have been reported. One of these, the survival motor neuron (SMN) cDNA, is encoded by two genes (SMNT and SMNC) which are distinguished by base changes in exons 7 and 8. Exon 7 of the SMNT gene is not detectable in approximately 95% of SMA cases, due either to deletion or sequence conversion. There is limited information on the mutations in SMA patients that have detectable SMNT, these are critical for confirmation of SMNT as the SMA gene. Using SSCP analysis of the SMN exons we screened our SMA patients that possess at least one intact SMNT allele for mutations in SMNT. We identified one type I SMA patient with an 11 bp duplication in exon 6 which causes a frameshift and premature termination of the deduced SMNT protein. Dosage and SSCP analysis of SMNT in this family indicated that the father contributed a SMNT-deleted allele to the affected child whereas the mother passed on the 11 bp exon 6 duplication SMNT allele. Analysis of RNA by RT-PCR conclusively demonstrated that the 11 bp duplication is associated with the SMNT locus and not SMNC. This mutation provides strong support for SMN as the SMA-determining gene and indicates that disruption of SMNT on its own is sufficient to produce a severe type I SMA phenotype.      

Characterization of peripheral blood CD8/11b cells in bone marrow transplant recipients. III. Subsets of CD8/11b cells differentially regulate immunoglobulin production.

Recovering bone marrow transplant (BMT) recipients have 20-70% circulating lymphocytes which co-express CD8 and CD11b (normals = 5-15%). These CD8/11b cells comprise at least two subpopulations distinguished by their expression of CD3. The CD3+ CD8/11b cells are T lymphocytes which exhibit in vitro suppressor activity (Ts); the CD3- CD8/11b cells express CD16 and are natural killer (NK) cells. In this study, we investigated whether such cells influenced circulating levels of IgA and IgM in 18 BMT recipients who each had greater than 30% circulating CD8/11b cells. We observed that in all patients whose CD8/11b cells were Ts lymphocytes (7/7) IgM and IgA levels were less than 10% of normal. Among those patients whose CD8/11b cells were NK cells (n = 11), two groups were distinguished. In one group (n = 5), less than 35% of patient NK cells expressed CD57 and serum levels of IgM and IgA were less than 10% of normal. In the second group (n = 6) greater than 60% of the NK cells expressed CD57 and serum levels of IgM and IgA were normal. In summary, our data indicate that BMT recipients have at least three distinct subsets of CD8/11b lymphocyte populations which may differentially regulate IgM and IgA production in vivo.     

Clinical outcome of transfemoral embolisation in patients with arteriovenous malformations of the liver in hereditary haemorrhagic telangiectasia (Weber-Rendu-Osler disease)

Background—Arteriovenous malformations of theliver in Osler's disease may present as high output cardiac failure. Afew case reports suggested that treatment with arterial embolisationmay have beneficial effects in such patients.
Aims—To investigate the efficacy and safety ofthis treatment modality in a prospective pilot study.
Patients and methods—Four women and one man (aged39-59 years) with the dominant hepatic manifestation of Osler'sdisease presented with symptoms of cardiac failure and elevated cardiac output. Arteriovenous malformations were treated in three to five sessions with arterial embolisation using coils. The outcome was analysed by measurement of cardiac output and scoring of clinical symptoms.
Results—Embolisation was technically feasible inall patients and adequate occlusion of vascular malformations wasachieved in four patients. After completion of therapy symptomsimproved in four patients, while one patient suffered from abdominalpain due to cholangitis. One patient died seven months after theembolisation treatment from variceal bleeding. Mean cardiac outputsignificantly decreased from 14.2 (range 12-17.3) l/min to 8 (range5.9-10.6) l/min (p=0.043). After a median follow up of 23 months(range 7-50 months), three of five patients had a long lastingimprovement of clinical symptoms and cardiac function.
Conclusions—This first treatment series ofpatients with dominant hepatic involvement in Osler's diseaseindicates that arterial embolisation may prevent cardiac failure bysignificantly lowering cardiac output.

Keywords:hereditary haemorrhagic telangiectasia; Weber-Rendu-Osler disease; hepatic vascular malformation; cardiacfailure; embolisation therapy

     

Impact of improved glycaemic control on rates of hypoglycaemia in insulin dependent diabetes mellitus

Increased emphasis on strict glycaemic control of insulin dependent diabetes mellitus (IDDM) in young patients may be expected to cause increases in rates of significant hypoglycaemia. To evaluate whether this is the case for a large population based sample of IDDM children and adolescents rates of severe (coma, convulsion) and moderate (requiring assistance for treatment) hypoglycaemia were studied prospectively over a four year period. A total of 709 patients were studied yielding 2027 patient years of data (mean (SD) age: 12.3 (4.4); range 0-18 years, duration IDDM: 4.9 (3.8) years). Details of hypoglycaemia were recorded at clinic visits every three months when glycated haemoglobin (HbA1c) was also measured. Overall the incidence of severe hypoglycaemia was 7.8 and moderate was 15.4 episodes/100 patient years. Over the four years mean (SD) clinic HbA1c steadily fell from 10.2 (1.6)% in 1992 to 8.8 (1.5)% in 1995. In parallel with this there was a dramatic increase in the rate of hypoglycaemia, especially in the fourth year of the study, when severe hypoglycaemia increased from 4.8 to 15.6 episodes/100 patient years. This increase was particularly marked in younger children (< 6 years) in whom severe hypoglycaemia increased from 14.9 to 42.1 episodes/100 patient years in 1995. It is concluded that attempts to achieve improved metabolic control must be accompanied by efforts to minimise the effects of significant hypoglycaemia, particularly in the younger age group.     

铒激光擦皮术后色素沉着的防治对策

０　引言　东方人接受皮肤磨削术治疗后色素沉着的发生率明显高于西方人．尽管采用了目前被认为是最适宜亚洲人的铒激光治疗,色素沉着仍可发生．因此,在实施该手术治疗前应严格掌握适应证,制定严密的预防治疗措施,使得色素沉着的发生率降至最低,从而最大限度的防止医疗纠纷的发生．１　对象和方法１．１　对象　２１例患者,男２例,女１９例,平均年龄２９．２（０８～４８）岁．皱纹祛除８例,浅表疤痕７例,浅咖啡斑、黑子５例,不良纹眉１例．铒激光其它适应证：①老年斑;②细小皱纹;③“白皮肤”雀斑;④痤疮后疤痕⑤色素减退…