Catheter-Assisted Vein Sclerotherapy: A New Approach for Sclerotherapy of the Greater Saphenous Vein with a Double-Lumen Balloon Catheter

OBJECTIVE: We sought to optimize sclerotherapy of the greater saphenous vein (GSV) by targeted application of foamed sclerosant by using a catheter. METHODS: We designed a new double-lumen catheter that is inserted into the GSV. Via one lumen, a balloon at the tip of the catheter can be inflated to stop the blood flow. Via the second lumen, the sclerosing agent can be injected and aspirated. This method enabled us to perform a targeted application of the sclerosing agent [catheter-assisted vein sclerotherapy (KAVS)]. In an open study, outpatients suffering from varicosis of the GSV received a foam sclerotherapy under ultrasound guidance, using the newly developed KAVS catheter. RESULTS: Thirty patients with an insufficiency (reflux) of the GSV were treated with the newly developed KAVS method using foamed polidocanol. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), we found a closure of the GSV at control visits 6 weeks, 3 months, and 6 months after treatment. CONCLUSIONS: The KAVS method represents a feasible approach for sclerotherapy of the GSV. The efficiency and treatment modalities need to be explored in further studies.     

Left ventricular peak filling rate, heart failure and 1-year survival in patients with acute myocardial infarction

Radionuclide left ventricular (LV) peak filling rate (PFR) wasdetermined in 185 survivors of acute myocardial infarction (AMI)and expressed in units of (1) end-diastolic volume per second( EDV s^–1), (2) stroke volume per second (SV s^–1),or (3) actual millilitres of blood filled into the left ventricleper second (ml s^–1). The purpose of the study was to assessthe interrelationship between the three expressions of PFR,and to analyse their significance with regard to signs of congestiveheart failure and 1-year survival in patients with AMI. PFREDVs^–1, PFRSVs^–1 and PFR mis^–1 had a poorrelationship to each other, were all influenced by L V volumesand ejection fraction, and supplied contradictory informationwith regard to LV filling in patients with heart failure. Noneof the three expressions of LV peak filling rate had an associationto heart failure that was independent of LV volume and ejectionfraction. A low PFR EDVs^–1 in contrast to a high PFR SVs^–1 was associated with a high 1-year cardiac mortality,suggesting that these ‘normalized’ indices of LVpeak filling rate signalled LV size and stroke volume ratherthan actual LV filling behaviour. No association was presentbetween PFR mis^–1 and 1-year mortality. We conclude thatthe clinical use of radionuclide LV PFR in patients with AMImay lead to spurious results, unless the influence of LV sizeand ejection fraction is taken into consideration.     

Increased lymphatic vascular density is seen before colorectal cancers reach stage II and growth factor FGF‐2 is downregulated in tumor tissue compared with normal mucosa

Lymphangiogenesis is an important event in progression of colorectal cancer (CRC), and the estimated lymphatic vascular density (LVD) probably indicates facilitated lymphatic tumor cell invasion and metastasis. However, at what time point during tumor progression this process is triggered, is unclear. The aim of this study was twofold. Firstly, to examine LVD in paired samples of CRC tissue and normal mucosa with specific emphasis on possible difference in LVD between tumors stages II and III, and secondly, the expression of the lymphangiogenic growth factor fibroblast growth factor‐2 (FGF‐2). Eighteen patients were studied. Immunostaining for podoplanin was performed to highlight lymphatic vessels. FGF‐2 mRNA expression was determined by quantitative real‐time RT‐PCR, whereas protein expression was quantitatively assessed by densitometric analysis of Western blot signal intensity. The immunoblots were further validated by FGF‐2 immunostaining of histological sections. LVD was significantly increased in tumor tissue compared with the normal mucosa but no changes in LVD between stages II and III CRC was observed. FGF‐2 was found to be downregulated both at the mRNA and protein level in tumor tissues compared with normal mucosa. Lymphangiogenesis was triggered early in tumor development. An increased LVD was established before the tumor reached stage II. FGF‐2 was downregulated in tumor tissue. The importance of this finding remains unclear.     

C‐type natriuretic peptide in prostate cancer

C‐type natriuretic peptide (CNP) is expressed in the male reproductive organs in pigs. To examine whether the human prostate also expresses the CNP gene, we measured CNP and N‐terminal proCNP in prostate cancer tissue extracts and performed immunohistochemical biopsy staining. Additionally, proCNP‐derived peptides were quantitated in plasma from patients with prostate cancer. Blood was collected from healthy controls and patients before surgery for localized prostate cancer. Tissue extracts were prepared from tissue biopsies obtained from radical prostatectomy surgery. N‐terminal proCNP, proCNP (1–50) and CNP were measured in plasma and tissue extracts. Biopsies were stained for CNP‐22 and N‐terminal proCNP. Tissue extracts from human prostate cancer contained mostly N‐terminal proCNP [median 5.3 pmol/g tissue (range 1.0–12.9)] and less CNP [0.14 pmol/g tissue (0.01–1.34)]. Immunohistochemistry demonstrated the presence of the peptides in prostatic epithelial cells. The N‐terminal proCNP concentrations in plasma were marginally lower in patients with localized prostate cancer compared with control subjects [13.8 pmol/l (11.0–17.2) vs. 15.1 pmol/l (10.4–23.2), p=0.002] but not enough to justify the use of N‐terminal proCNP as a cancer marker. Further research is needed to establish whether measurement of proCNP‐derived peptides may offer clinical information.     

Urinary Excretion of Kallikrein before and after Operation for Aldosterone-producing Adenoma

ABSTRACT. Hesse B, Rasmussen S, Lund JO, Christensen P, Damkjær Nielsen M. (Department of Clinical Physiology, Glostrup Hospital, and Institute for Experimental Medicine, Copenhagen, Denmark.) Urinary excretion of kallikrein before and after operation for aldosterone-producing adenoma. Urinary kallikrein excretion (UKal), determined by the esterase method, was measured in 10 normotensive volunteers, 10 patients with essential hypertension and in 7 patients with primary aldosteronism before and after operative removal of the adenoma. UKal values were low in 5 of the patients with essential hypertension. Preoperative UKal values in the patients with aldosteronism did not differ significantly from those of the normal subjects, but decreased in all after operation in parallel with changes in urinary excretion of tetrahydroaldosterone and plasma aldosterone concentration. The study supports the assumption of an association between the renal kallikrein-kinin system and the mineralo-corticoid state in man.     

PSEUDOHYPOALDOSTERONISM Clinical, Biochemical and Morphological Studies in a Long-term Follow-up

ABSTRACT. A boy with pseudohypoaldosteronism was followed from birth to the age of 7 years. Failure to thrive, vomiting, dehydration, hyponatraemia and urinary sodium loss were prominent findings. Urinary excretion of corticosteroid metabolites was normal. Before treatment, excessively high plasma renin concentration was found, associated with a marked activation of aldosterone secretion. A renal biopsy showed pronounced hypertrophy of the juxtaglomerular apparatus. Persisting metabolic acidosis and an insufficient urinary acidifying capacity suggested the presence of distal renal tubular acidosis. Treatment with sodium bicarbonate and sodium chloride from 19 to 31 months of age resulted in normal growth and normal physical and mental development. The plasma electrolytes were normalized but a pronounced activation of the renin–aldosterone system persisted after therapy, and on sodium restriction this system responded with a considerable further activation.