Heparin–coated circuit during cardiopulmonary bypass

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint–attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin–coated equipment (CBAS) and reduced i.v. heparin (1.5 mg kg^-1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg–kg^-1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ngml^-1±1.2 to 27.5 ng ml^-1 ± 4.8 on day 2 and in the CBAS group from 10.7 ng ml^-1 ± 1.2 to 35.6 ng ml^-1 ± 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups. The present results confirm the feasibility of reducing general heparin when using heparin–coated systems but the study does not support the superiority of such coating with regard to biocompatibility in short procedures with a Theologically optimized circuit. The potential benefit from reduced heparin and protamine has not been fully evaluated.     

Randomized Evaluation of an Inflatable Femoral Artery Compression Device After Cardiac Catheterization

Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure < 160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterization .     

Haemorrhage-induced splenic vasodilation in the rat is mediated by sympathetic vasomotor nerves

A marked decrease in splenic vascular resistance, with an increase in blood flow to the spleen, occurs already 5 min after an acute and severe hypotensive bleeding in awake rats. This response is virtually abolished in rats pretreated with a β-adrenergic blocking agent. We have now studied the contribution of the sympathetic vasomotor innervation and of adrenal gland-derived catecholamines to the splenic vasodilation. Splenic blood flow was determined with the microsphere method in heavily bled (1.5% of body weight) awake rats. The sympathetic neurones in one group of rats had been chemically destroyed with 6-hydroxydopamine. In another group of rats we had removed the adrenal glands. In the control and in sympathectomized rats, splenic vascular resistance fell to 35 and 64%, respectively, of baseline 5 min after bleeding. Splenic blood flow about doubled during this period in the control rats, and then declined gradually to baseline over the next 24 h. In the sympathectomized rats, splenic blood flow decreased gradually over the first 12 h to reach 66% of baseline. The removal of the adrenal glands did not appreciably influence the splenic vascular response to bleeding. We conclude that an increased activity in the splenic sympathetic vasomotor neurones is a prerequisite for the observed vasodilation and concomitant large increase in splenic blood flow after haemorrhage in intact, awake rats. Catecholamines from the adrenal glands did not contribute detectably to the splenic vasodilation.     

INTERLEUKIN-8 SECRETION AND 15-LIPOXYGENASE ACUVTTY IN RHEUMATOID ARTHRITIS: IN VITRO ANTI-INFLAMMATORY EFFECTS BY INTERLEUKIN-4 AND INTERLEUKIN-10, BUT NOT BY INTERLEUKIN-1 RECEPTOR ANTAGONIST PROTEIN

We have examined the ability of interleukin-4 (IL-4), interleukin-10(IL-10) and interleukin-1 receptor antagonist protein (IL-lra)to regulate spontaneous interleukin-8 (IL-8) production in culturedSF mononuclear cells (SFMC) from RA. Furthermore, we examinedwhether IL-4, IL-10, or IL-lra could influence the productionof the arachidonic acid products leukotriene B₄ (LTB₄), 12-hydroxy-eicosatetraenoicacid (12-HETE) and 15-hydroxy-eicosatetraenoic acid (15-HETE).IL-4 induced a maximal suppression of 75% in the IL-8 secretionin SFMC from 10.0 ng/ml down to 2.5 ng/ml after 24 h and from17.2 ng/ml to 4.2 ng/ml after 72 h of culture. IL-10 induceda 55% inhibition of the IL-8 secretion at 24 h and a 40% inhibitionat 72 h. IL-lra did not change the spontaneous IL-8 secretionfrom rheumatoid SFMC. We also examined, whether addition ofIL-4, IL-10 or IL-lra was able to modulate formation of thearachidonic acid products LTB₄,12-HETE and 15-HETE in culturedSF cells, stimulated with the calcium ionophore A23187. 15-HETEwas not detected in untreated cultures, nor in IL-10 or IL-lratreated cultures. IL-4, however, stimulated the formation ofthe anti-inflammatory mediator; 15-HETE (23 ng/10⁶ cells). Theseresults suggest that IL-4 or IL-10, could have beneficial anti-inflammatoryeffects in RA. KEY WORDS: Interleukin-4, Interleukin-10, Interleukin-1 receptor antagonist protein, 15-Hydroxy-eicosatetraenoic acid, Rheumatoid arthritis     

AN IMMUNOHISTOCHEMICAL STUDY OF TAL-1 PROTEIN EXPRESSION IN LEUKAEMIAS AND LYMPHOMAS WITH A NOVEL MONOCLONAL ANTIBODY, 2TL 242

Fifty formalin fixed, paraffin-embedded cases of T-acute lymphoblastic leukaemia (T-ALL) from 12 bone marrow trephines and 38 lymph nodes were stained with a new monoclonal antibody, 2TL 242, raised against recombinant TAL1 protein. The antibody recognizes TAL-1 polypeptides of molecular weight 39 and 41 kD (full length). In addition, a variety of other leukaemias and lymphomas were also stained with 2TL 242. Twenty-four of the 50 cases of T-ALL showed nuclear positivity, ranging from 10 to 90 per cent of leukaemic cells. A positive staining reaction was nuclear and stippled in pattern. Nuclear staining was not seen in any other type of leukaemia or lymphoma. Five cases of follicular lymphoma showed diffuse cytoplasmic staining of variable intensity. Although some background staining is obtained with this antibody, positive nuclear staining is easily distinguishable. This monoclonal antibody has a potential role in primary diagnosis and in the detection of minimal residual disease in T-ALL.     

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.     

CASE REPORT OF A 6-WEEK-OLD BOY WITH BLAND- WHITE-GARLAND SYNDROME

Bland-White-Garland syndrome is a rare syndrome with anomalous origin of the left coronary artery （ LCA ） arising from the pulmonary artery, resulting in left ventricular failure. It could occur shortly after birth. We here reported the case of a 6-week-old boy with aortostenosis. Coronary angiography revealed an anomalous LCA arising from the pulmonary artery. Representation of a prominent right coronary artery （ RCA ） delivered numerous collateral vessels to the LCA area, The patient underwent a correction operation with translocation of the LCA and re-implantation into the ascending aorta. One month after operation, clear decrease in the expanded ventricle was noted with an increase in the contractibility.     

Idiopathic Right Ventricular Outflow Tract Tachycardia: A Clinical Approach

Right ventricular outflow tract (RVOT) tachycardia is the most common form of idiopathic ventricular tachycardia (VT). Phenotypically, RVOT tachycardia segregates into two predominant forms, one characterized by repetitive monomorphic nonsustainnd VT and the other by paroxysmal exercise induced sustained VT. There is an increasing body of evidence to support the concept that both forms of tachycardia reflect disparate clinical manifestations of an identical cellular mechanism (i.e., cAMP-mediated triggered activity), which is identified clinically by the tachycardia's sensitivity to adenosine. The clinical characteristics, natural history, and approaches to therapy of RVOT tachycardia are delineated herein.