Intraoperative coronary artery endarterectomy with excimer laser

Compared with continuous-wave lasers, excimer lasers exhibit several in vitro advantages: nonthermal ablation process and linear relation between the number of pulses and the depth of the crater. A 308 nm, 20 nsec pulse duration, 1 to 5 repetition rate laser was specifically designed for clinical application. At the time of cardiopulmonary bypass in 10 symptomatic patients, before bypass grafting, a 1 mm diameter core specifically ultraviolet-tipped fiberoptic scope was introduced via the coronary arteriotomy and placed upstream (seven patients) and downstream (three patients) in contact with the stenosis. Laser power was increasingly delivered up to the clearing of the stenosis or occlusion. Quality of angioplasty was controlled by calibration of the neolumen, cardioplegic solution output through the laser-treated segment, and an eighth day or sixth month coronary arteriogram. In the first three patients studied on the eighth day, all laser-treated coronary artery segments showed an early parallel-linked patent neolumen despite competitive bypass graft flow. In the patients studied after 6 months, all recanalized segments were patent except one; in one patient the venous graft was occluded, but the upstream laser angioplasty was patent. The main limitation of the method lies in the fact that laser coronary recanalization is confined to the fiber core diameter. We conclude that (1) excimer laser angioplasty may be safe and efficient during surgical procedure and (2) as catheter flexibility remains the most critical problem, we are now assuming an appropriate tool with a multifiber system that is suitable for intraoperative as well as percutaneous routes.     

A case of pheochromocytoma with severe paralytic ileus

We report herein a rare case of a 26 year old woman with pheochromocytoma complicated by paralytic ileus. She presented with remarkable abdominal distension and respiratory difficulty but was effectively treated by surgical removal of the tumor with preoperative and operative management using alpha and beta adrenergic blocking agents. An excessive and persistent catecholamine production from large tumors or massive metastases characterizes this rare complication, and a review of the English and Japanese literature is given following this report.     

Theoretical calculation of the longitudinal spherical aberration of rigid and soft contact lenses

Although previous investigators have attempted to calculate the longitudinal spherical aberration inherent in soft and rigid contact lenses both on and off the eye, the use of inappropriate assumptions on which to base their calculations has left the problem unresolved. In this study, the longitudinal spherical aberration of both soft and rigid contact lenses was calculated surface by surface both in air and on the eye using a two-dimensional, exact ray tracing program. The erroneous assumptions made by previous investigators were avoided by using an elliptical model for the anterior corneal surface and assuming that the posterior surfaces of soft lenses aligned exactly with the anterior corneal surface after flexure onto the eye. The results demonstrated that, with a 6-mm pupil, contact lenses induce significant levels of spherical aberration in the ocular system for soft lenses of back vertex power greater than +3.00 D or -6.00 D and for rigid lenses of powers more positive than -3.00 D. It is suggested that visual disturbance due to induced spherical aberration has not been a major clinical problem in the past because these conditions fall outside those experienced by a large proportion of the contact lens-wearing public.     

Influence of insulin on cholesterol removal from macrophages and cholesterol ester uptake by HepG2 cells

The fact that an increased blood insulin level is observed in patients with coronary artery disease (CAD) confirms the hypothesis that insulin promotes the development of atherosclerosis. The low high-density lipoprotein (HDL) concentration observed in such patients may contribute to alteration in reverse cholesterol transport and promote the accumulation of sterols in vascular tissue. We examined the effect of insulin (20−1000μUmL⁻¹) on cholesterol efflux into HDL₃ particles from human blood monocyte/macrophages and rat peritoneal macrophages preloaded with labelled cholesterol esters, and the influence of insulin on the accumulation of sterols by rat liver cells and HepG2 cell line in vitro models. Insulin at concentrations up to 250μUmL⁻¹ inhibited the efflux of cholesterol from rat macrophages and promoted high uptake of sterols by both types of hepatic cells. Pharmacological concentrations higher than 250μU mL⁻¹ exerted the opposite effect. In the case of human macrophages, an insulin concentration of 20μUmL⁻¹ increased cholesterol removal, whereas 100−200μU mL⁻¹ insulin inhibited cholesterol removal from cells, and very high concentrations (>350μUmL⁻¹) again increased cholesterol removal. We have shown that insulin excess counteracts the beneficial effects of HDL in removing cellular cholesterol and, therefore, may promote development of atherogenesis.