The CarboMedics®"Top Hat" Supraannular Prosthesis in the Small Aortic Root

Twenty-three patients, 11 men and 12 women, with a mean age of 64 (range, 34 to 78) underwent aortic valve replacement (AVR) with a CarboMedics®“Top Hat” supraannular prosthesis between March 1993 and August 1994. The top hat supraannular prosthesis, a standard bileaflet valve with the cuff transferred to the valve inflow level, allowed implantation of 21-mm, 23-mm, and 25-mm valves, where a standard 19-mm or 21-mm valve would have usually been placed. One patient who had been in preoperative cardiogenic shock died in the perioperative period. Another had an intraoperative cerebral embolism with permanent impairment. Follow-up on 22 of 23 patients over a mean period of 9 months revealed mean Doppler gradients of 18 ± 6 mmHg, 15 ± 2.8 mmHg, and 11 mmHg, for the 21-mm, 23-mm, and 25-mm valves, respectively. Functional improvement was noted, with 17 patients in New York Heart Association (NYHA) Class I and 6 in NYHA Class II, postoperatively, compared with 0 in Class I, 9 in Class II, 10 in Class III, and 4 in Class IV, preoperatively. One patient showed reduced postoperative ventricular function with fractional shortening below 25%. Pandiastolic regurgitation intrinsic to the valve graded as slight was noted in all patients. Other postoperative complications included one patient with anticoagulant-related gastrointestinal bleeding and one other with prosthetic valve endocarditis successfully treated with antibiotics. The CarboMedics® top hat valve allows a gain in prosthesis size of 2 mm to 4 mm in the aortic position over standard prostheses, resulting in favorable postoperative hemodynamics.     

Contact allergy to cocamidopropyl betaine

Cocamidopropyl betaine is an amphoteric surfactant used increasingly in cosmetic products. We describe 20 cases of cosmetic allergy to cocamidopropyl betaine; all were caused by shampoo or shower gel. 8 patients were hairdressers, who had occupational allergic contact dermatitis from shampoos. We recommend patch testing cocamidopropyl betaine 1%. aq. routinely in hairdressers with dermatitis of the hands, and in all patients suspected of suffering from cosmetic allergy.     

New iodinated progestins as potential ligands for progesterone receptor imaging in breast cancer. part 1: synthesis and in vitro pharmacological characterization

Five putative iodinated progesterone receptor (PR) binding ligands were synthesized and evaluated as potential imaging agents for PR-positive human breast tumours. Two compounds (E- and Z-17-hydroxy-21-iodo-19-nor-17-pregna-4,20-dien-3-one; E- and Z-IPG1) were previously described, but are re-evaluated. The other three were novel compounds: two nortestosterone analogues derived from ORG 3236 (E- and Z-13-ethyl-17-hydroxy-21-iodo-11-methylene-18,19-dinor-17-pregna-4,20-diene-3-one; E- and Z-IPG2) and one norprogesterone analogue derived from ORG 2058 (21-[4-iodophenoxy]-16-ethyl-19-norpregn-4-ene-3,20-dione; IPG3). The E-iodovinyl nortestosterone compounds were obtained by a new route of synthesis. Competitive binding studies were performed to determine their binding affinities for the PR in three types of tissue (human MCF-7 breast tumour cells and rat uterine and mammary tumour tissue) and for the androgen receptor (AR) in human MCF-7 breast tumour cells, as well as for the sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) in human plasma. All four 17-iodovinyl nortestosterone derivatives displayed high binding affinity for the human PR, that of Z-IPG1 and E- and Z-IPG2 being even higher than that of ORG2058. Their affinities for the rat PR were somewhat lower, especially those of both E-isomers. The affinity of IPG3 was lower for both the human and rat PR. The nortestosterone derivatives also showed AR binding, the relative binding affinities ranging from 4.3 to 17.0% as compared with 5DHT. Additionally, neither of these steroids displayed any significant binding to either SHBG or CBG in human plasma. We conclude that the in vitro binding properties of all four 17-iodovinyl nortestosterone derivatives warrant evaluation of the distribution characteristics of their ¹²³I-labelled analogues to determine their usefulness as PR imaging agents.     

Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: Association study in an inmate’s sample

The association between different impulsive-disinhibited personality traits with 5-HTTLPR and 5-HTTVNTR genetic polymorphisms was examined in an imprisoned male sample. Higher scores of the impulsive-disinhibited personality traits tended to be associated with carrying one or two copies of the 5-HTTPLR S allele (S/S homozygous and S/L heterozygous), and carrying two copies of the 5-HTTVNTR 12 allele (12/12 homozygous). Genotype, allele, haplotype and extended genotype distribution between low and high impulsive-disinhibited groups confirmed this association. Allele S and genotypes S/S+S/L at the 5-HTTLPR locus and allele 12 and genotype 12/12 at the 5-HTTVNTR locus were overrepresented in the high scoring group. Accordingly, allele S and allele 12 conferred a trend for risk to be in the high scoring group with an odds ratio (OR) of 1.8 (p < 0.035) and 1.7 (p < 0.014), respectively. In addition, extended genotype distribution shows that those S allele carriers (S/S homozygote and S/L heterozygote) that were also 12/12 homozygote, were overrepresented in the high scoring group (OR = 3.2; p < 0.004). The main risk of being in the high scoring group was assigned to those carrying two copies of the S-12 haplotype (OR = 5.7; p < 0.0007). We discuss the possible relationship between the two genetic serotonin polymorphisms and the personality impulsive-disinhibited traits investigated.     

Structural Chromosome Aberrations in Lymphocytes from Children Previously Treated for Wilms' Tumor or Hodgkin's Disease

Nineteen children treated for Wilms' tumor (thirteen cases) or Hodgkin's disease (six cases) with cytostatic agents and/or radiotherapy were studied cytogenetically on lymphocytes cultivated from blood samples drawn after at least 1 year of complete remission after end of therapy. A reference group of children was matched for age, sex, and residence. The frequencies of sister chromatid exchange (5.4 versus 5.6 SCE/cell), and chromosome damage type gaps (6.6 versus 7.1%) and breaks (1.9 versus 1.9%) were not different in the two groups, but exchange type aberrations were more frequent in the patients (0.9 versus 0.06%). Fifty karyotypes were analyzed in all but two cases of Hodgkin 's disease. The overall frequency of stable (3.1 versus 3.8%) and unstable (1.7 versus 1.4%) structural chromosome changes such as translocations, deletions, chromatid exchanges, and dicentrics were not different in the patient and the control groups. If the chromosome data reflect a general cancer risk, this risk cannot be considerably higher among the cancer-treated children.     

Study of Dieffenbachia-induced edema in mouse and rat hindpaw: Respective role of oxalate needles and trypsin-like protease

The stem juice of Dieffenbachia plants produces prominent edema when injected into the paws of mice and rats. To determine the components responsible for this activity, we prepared and injected different preparations of stem juice and measured the degree of edema they induced. In mice treated with crude Dieffenbachia stem juice, swelling of the paw reached a peak within 4 hr after injection when the weight of paws treated with 40 μl of crude juice was approximately doubled. After centrifugation of crude juice the insoluble fraction, containing numerous calcium oxalate crystals, induced a similar swelling. The soluble fraction showed a trypsin-like proteolytic activity but led to only a slight edema (35% weight increase with 40 μl of preparation). A suspension of oxalate needles (0.1 g% which was the same concentration as in crude juice), isolated from plant stems, caused minimal edema (10% weight increase) which was not further increased by the presence of the proteolytic fraction. We concluded that the oxalate needles and the protease were not the principal phlogogenic substances of Dieffenbachia. In the rat, the pharmacological characterization of the paw edema was approached by oral pretreatment with cyproheptadine (10 mg/kg) or indomethacin (2.5,5, and 10 mg/kg). Our results suggested that histamine and/or serotonin played a role in the early response, and prostaglandins in the plateau phase (3–4 hr after injection of the crude juice). The soluble fraction of stem juice hydrolyzed the synthetic substrate N-benzoyl-dl-arginine-para-nitroenilide) specific for trypsin-like hydrolytic activity, but did not release bradykinin-like substance from plasma in vitro. In vitro bradykinin-like release was obtained with a purified fraction of Dieffenbachia stem juice that had specific proteolytic activity five-fold higher than crude juice. Our results explain the origin of the slight edema due to the soluble fraction of stem juice. However additional studies are required to define the role played by the protease in Dieffenbachia intoxication.     

End groups in poly(vinyl chloride) and their influence on the thermal stability

End groups in a low molecular weight fraction of a commercial suspension poly(vinylchloride) were analysed by means of ¹H NMR and IR spectroscopy and by size exclusion chromatography. The following groups were identified and quantified: ethoxycarbonyloxy (1) , 1,2-dichloroethyl ( 2 ), trans- and cis-4-chloro-2-butenyl ( 3 and 4 ), 2-chloroethyl ( 5 ), and 2-chloroethylidene ( 6 ). The influence of these groups on the degradation at 180°C was determined.