Ultrastructural localization of blood group antigen A in normal and neoplastic urothelium

The subcellular distribution of the blood group antigen A in the transitional epithelium of the urinary tract and its neoplastic growths was studied using transmission immuno-electronmicroscopy. Sixty-five tissue specimens from 50 blood group A1 patients were processed according to an immunogold procedure which was optimized for preservation of both antigen and ultrastructure. The reactions were stronger in the glycocalyx of the luminal surfaces and at the interdigitating cytoplasmic processes of the cells. In the intracellular compartment the reactions were associated with tubulovesicular membrane-bound structures and with the Golgi complexes. Secretory products, intra- or extra-cellular, were also positive. The greatest variability was noted in the cell surface reactions, which were positive in 88% of normal but only 41% of neoplastic urothelial specimens. An inverse correlation was found between malignant behaviour and cell surface, but not intracellular, reactions. We conclude that, in transitional cell carcinomas, there is a quantitative defect in the processing of substance A which affects predominantly the cell surface component and may involve either the transport-insertion steps, the plasma membrane-associated glycosyltransferases or internalization of blood group antigen A.     

Mechanisms and patient compliance of dust-mite avoidance regimens in dwellings of mite-allergic rhinitic patients

We report on the mechanisms, the environmental changes and patient compliance with regard to conventional and new dust and mite avoidance measures to prevent allergic symptoms caused by mite allergens, taking into account both allergen contamination and the developmental success of pyroglyphid Acari. Twenty patients with persisting rhinitic complaints were selected and matched. Although the patients had performed some conventional dust and mite avoidance measures (patient compliance was 90%), the dwellings proved to be a stimulus for mite development. Moisture problems due to faulty construction and excessive moisture production were common. Since humidity conditions could not be changed at short notice, the 20 homes were subjected to the new variants of mite allergen avoidance based on intensive cleaning without (control) and with an acaricide incorporated (acaricidal cleaner [Acarosan]). After the carrying out of conventional avoidance measures, these patients still had allergic symptoms, and dust from only 23 to 52% of their textile objects was under the proposed guanine (mite faeces indicator) risk level. Only the acaricidal cleaner was able to decrease the allergenic mite load (and the burden of the patients) significantly in this 12 month period. With respect to mite-extermination, acaricidal cleaning was 88% better than intensive cleaning. Reduction of guanine was 38% better in the Acarosan treatment group. Clinical results have been reported elsewhere. A significant difference in favour of the acaricidal cleaning was seen in both subjective (as regards symptoms) and in objective data (total IgE). Another 50 patients were questioned. About 90% were willing to spend two weekends (70%), or at the most one weekend (20%) per year sanitizing the dwelling by cleaning it with the whole family. The authors of this report consider acaricidal cleaning to be a significant improvement in the management of mite-allergic diseases, such as rhinitis. Compared with the replacement of home textiles, this treatment is less expensive and more effective. Patient compliance is acceptable, but depends on acceptance by physicians and the initial motivation and consequent burden on the patient.     

Acute Efficacy and Chronic Follow-Up of Patients with Non-Thoracotomy Third Generation Implantahle Defibrillators

Non-thoracotomy implantation of implantable cardioverter defibrillators (ICDs) has simplified the process of device inserfion, promising to decrease associated procedural coniplications while providing sudden death protection at least equal to epicardial systems. This study presents the acute and chronic results of 110 patients who underwent attempted non-thoracotomy ICD impiuntation wiih the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an epicar-dial patch. One patient died 1 week postoperatively of septic shock related to the implantation (0.9% perioperative mortality). During folloiv-up of 16 ± 11 months, 45% of the patients had an event detected as ventricular tachycardia; 26% of these detections were felt clinically to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminated by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 65% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therapy. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respectively. Only one patient had sudden cardiac death, occurring at 13 months postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable ai terminating arrhythmias and maintaining a low rate of sudden cardiac death in this high risk popuiation.     

The effect of taprostene in patients with acute myocardial infarction treated with thrombolytic therapy: results of the STARTstudy

Taprostene is a prostacyclin analogue that inhibits plateletaggregation and thus might be a useful adjuvant to thrombolyticagents in acute myocardial infarction. In a placebo-controlled dose rising study, taprostene or placebowas intravenously infused in 80 patients treated with the thrombolyticagent saruplase (rscu-PA) for acute myocardial infarction. Threedoses of taprostene were used: 6.25; 12.5; or 25.0 ng.kg^–1.min^–1.Taprostene or placebo was infused for 48 h, followed by a 24h tapering period. All 80 patients had short symptom-to-treatmentdelay and marked ST segment elevation. Patency at 90 min was documented in 58/78 patients (two patientshad no angiography). Success rate varied from 67–82% inthe four treatment arms (P=0.33). Patency after rescue PTCAwas seen in 10 out of 13 patients. Of the 58 patients havinga patent artery at 90 min, none of the 43 taprostene patientsand one of the 15 placebo patients had a reoccluded artery atthe second angiography at 32–48 h (5/58 patients had norecatheterization). Conversely, of nine patients who had successfulrescue PTCA, three of four placebo patients had a re-occludedartery at the second angiography compared to one of five taprostenepatients (one placebo patient had no recatheterization) (P=0.33). Safety evaluation revealed no major difference betweenthe placebo plus saruplase and the taprostene plus saruplasegroups. Taprostene was well tolerated up to 25 ng.kg^–1 .min^–1.Although taprostene did not affect 90 min patency, there wasa trend to better maintenance of patency after rescue PTCA.     

Fetoscopy in the assessment of unexplained fetal hydrops

Summary. Pure fetal blood samples, obtained fetoscopically from 30 patients with unexplained fetal hydrops at 16 to 32 weeks gestation were investigated for cytogenetic, haematological, biochemical and virological properties. In two patients with oligohydramnios, the fetoscope was introduced transabdominally into the fetal peritoneal cavity and sampling was undertaken from the intra-abdominal portion of the umbilical vein; in all the other patients an umbilical cord vessel was sampled. Ten (33%) of the fetuses had chromosomal abnormalities, one an erythroblastic process, possibly erythroleukaemia, one α-thalassaemia and one cytomegalovirus infection. Blood-film abnormalities were seen in 23 (88%) of 26 fetuses that had this examination. Biochemical analysis of fetal plasma was undertaken in 18 fetuses and hypoproteinaemia was found in all cases. One fetus was subsequently found to have a paroxysmal tachyarrhythmia that responded to digitilization. Three (10%) of the fetuses survived.     

Effect of antagonizing residual neuromuscular block by neostigmine and atropine on postoperative vomiting

Eighty patients undergoing outpatient surgery under generalanaesthesia were allocated randomly to two groups: in groupA residual neuromuscular block was antagonized with a mixtureof neostigmine 1.5 mg and atropine 0.5 mg; in group B spontaneousrecovery was allowed. The patients were assessed after operationin hospital and 24 h after discharge. We found a significantdifference (P<0.05) in requirements for antiemetic therapywith a smaller need in the group which received neostigmine(in group A four of 40 patients received an antiemetic comparedwith 12 in group B). There was no significant difference infrequency of nausea or vomiting between the two groups. Theincidence of postoperative nausea was 14 in group A and 18 ingroup B and the number of patients with postoperative vomitingwas 10 in group A and 15 in group B.