[The percutaneous treatment of surgical and catheter-angiographic vascular complications]

PURPOSE

Technical innovations of angioplasty have introduced new therapeutic options in the treatment of symptomatic arteriosclerotic disease. Atherectomy devices, aspiration catheters and vascular endoprostheses can be used not only for angioplasty purpose but also for correction of iatrogenic dissections and thromboembolic complications.

MATERIAL AND METHODS

54 patients with vascular complications after surgical (n = 7) and percutaneous (n = 47) interventions were observed in a 5 years period. The complications included acute dissections in 34 cases, acute thrombosis in 4 cases, distal embolism after angioplasty in 14 cases, and two cases with arterial rupture after balloon dilatation.

RESULTS

34 patients with dissections and 18 patients with acute thrombosis were treated. Stent implantation for repair of vessel dissection was successful in 33 of 34 cases. Percutaneous catheter aspiration in combination with local thrombolysis was successful in 4 cases with local thrombosis. Distal emboli after angioplasty were successfully removed using aspiration catheters in 13 of 14 patients. Vessel rupture after angioplasty was closed with prolonged balloon dilatation in two patients avoiding emergency surgery.

CONCLUSION

Using newly developed intravascular technologies such as atherectomy, stents, and catheter aspiration, many iatrogenic complications after vascular surgery or vascular interventions can be treated. These technologies should be available in every radiology department performing angioplasty.

Pathways of degradation of buserelin by rat kidney membrane

The pathways of in vitro degradation of the gonadotropin-releasing hormone (GnRH) analog buserelin [pGlu-His-Trp-Ser-Tyr-D-Ser(tBu)-Leu-Arg- ProNHEt, B1-9] by the rat kidney membrane fraction was investigated using high-performance liquid chromatography for the separation of the peptide products and electrospray mass spectrometry for their identification. The N-terminal peptides B1-4, B1-3, B1-2, C-terminal peptides B3-9, B4-9, B5-9, B6-9, middle sequence B3-4 and the amino acids Trp, Ser and Tyr were found to be formed. However, due to extreme differences in the stability of the peptides toward the battery of membrane enzymes (B1-2, B6-9 >> B1-3, B5-9 >> B1-9 >> B1-4 > B4-9 > B3-9, B3-4), the final products of buserelin degradation were B1-2, B1-3, B5-9, and B6-9 and the amino acids Ser and, corresponding to the formation of B1-2 and B6-9, Trp and Tyr, respectively. The sequences B3-9, B4-9 and B3-4 were clearly detectable only when the inhibitors of aminopeptidases amastatin and bestatin were included in the incubations.(ABSTRACT TRUNCATED AT 250 WORDS)

Coupled-column liquid chromatographic analysis of epirubicin and metabolites in biological material and its application to optimization of liver cancer therapy

A specific, sensitive and fully automated coupled-column LC method for the determination of the anthracycline cytostatic epirubicin and four metabolites in the biological materials human plasma, liver homogenate and liver tumour homogenate has been developed. System-integrated sample processing was achieved using a new restricted access silica precolumn packing. This porous Alkyl-Diol Silica (ADS) was specially designed for the direct and repetitive injection of proteinaceous samples. It consists of a hydrophilic and electroneutral external particle surface (glyceryl-residues) and a hydrophobic reversed-phase internal surface (butyryl-, octanoyl- or octadecyl-residues). These bimodal chromatographic properties allow retention of low molecular analytes by classical RP-chromatography exclusively at the lipophilic pore surface. Macromolecular constituents of the sample matrix (e.g. proteins) are size-excluded by 5 nm pores and quantitatively eliminated in the interstitial void volume. On-line analysis was performed by coupling a C4-Alkyl-Diol precolumn (20 x 4 mm i.d., particle size 25 microns) and LiChrospher RP Select B analytical column (250 x 4 mm i.d., particle size 5 microns) via an electrically driven six-port valve. Separation of the parent compound and its metabolites was achieved with a mobile phase consisting of water (0.1% triethylamine, v/v, pH 2.0 adjusted with trichloroacetic acid)-acetonitrile (70:30, v/v) at a flow rate of 1 ml min-1. The analytes were detected using their natural fluorescence (excitation 445 nm, emission 560 nm). The method described is used for the determination of pharmacokinetics of epirubicin and its metabolites in order to evaluate and optimize treatment regimen of liver cancer chemoembolization therapy.

[Chemoembolization in primary liver cell carcinoma. Results of a prospective study]

A remarkable progress was made in the palliative treatment of unresectable hepatocellular carcinoma using transcatheter arterial chemoembolization (TAC). The combination of doxorubicin as cytotoxic drug and of Lipiodol as carrier, which is selectively accumulated within the tumors is an effective treatment. Prolonged survival has been demonstrated in several clinical studies. In a prospective trial the effect of regional TAC with temporary ischemia of the liver was evaluated concerning liver function, systemic reactions and tumor response. Temporary ischemia of the liver was well tolerated even in patients with liver cirrhosis. Revascularization of the liver after TAC was observed in all cases. Systemic side effects of the cytotoxic drug were mild. In patients with Child C cirrhosis or tumor volume of more than 60% of the liver no impact of the treatment on the survival time was observed. In the entire patient group a survival rate of 70% after 15 months was achieved.

[Percutaneous transluminal angioplasty of arterial stenoses after kidney transplantation]

Over a period of 11 years, percutaneous transluminal angioplasty (PTA) was performed in 47 patients with post-transplantation renal artery stenosis. In 42 of 47 patients (89%) PTA was technically successful. Complications or technical failure (n = 5) were observed in the beginning of the series and were due to technical problems. Within a five-year follow-up period in 33 patients, blood pressure (BP) remained constant in 18% and mean pressure was improved in 48%. In 33%, normal BP was reached without any need for medication. Systolic and diastolic BP were reduced from 175.9/105.7 (mean values) before PTA to 146.9/91.0 six months after PTA. Depending upon the initial value, serum creatinine was reduced after PTA by from 0.0 to 1.0 mg/dl with noticeable difference between individual values. An account of this effect, renal function was of reduced value for controlling the effectiveness of PTA. The morphology of the stenoses corresponded only partially with the clinical results: in five patients mean BP after successful PTA remained constant, while two patients with reduced therapeutic result (remaining stenosis > 30%) had either markedly improved BP (n = 1) or normal BP (n = 1). The technical improvement of PTA instrumentation has broadened the spectrum of indications and improved the safety of the procedure.

Temperature Dependence of the Superconducting Gap Anisotropy in Bi 2 Sr 2 CaCu 2 O 8+x

Detailed data on the momentum-resolved temperature dependence of the superconducting gap of Bi(2)Sr(2)CaCu(2)O(8+x) are presented, complemented by similar data on the intensity of the photoemission superconducting condensate spectral area. The gap anisotropy between the Gamma-Mand Gamma-X directions increases markedly with increasing temperature, contrary to what happens for conventional anisotropic-gap superconductors, such as lead. Specifically, the size of the superconducting gap along the Gamma-X direction decreases to values indistinguishable from zero at temperatures for which the gap retains virtually full value along the Gamma-M direction. These data rule out the simplest type of d-wave order parameter.

Intralesional interferon alpha-2b therapy for Buschke-Loewenstein tumour

A patient with a Buschke-Loewenstein tumour associated with human papillomavirus type 6/11 is reported. He was intralesionally treated with human recombinant alpha-2b interferon (9 x 10(6) IU/day) three times weekly. The tumour completely disappeared within 5 months of continuous treatment which was well tolerated. Sixteen months after completion of therapy the patient remains well and free of disease.

Percutaneous transjugular intrahepatic stent shunt for treatment of intractable varicose bleeding in paediatric patients

Two 10-year and 11-year-old children with oesophageal and gastric varicose haemorrhage unresponsive to medical treatment and repeated endoscopic sclerotherapy underwent percutaneous transjugular intrahepatic portosystemic shunting (TIPSS). A newly developed introducing system was used. The procedure was performed to avoid the increased risk of emergency liver transplantation in children with hepatic failure. Immediately after the procedure bleeding stopped and the patient's condition improved. Ascites disappeared and liver function improved. The stent shunt was shown to be patent by angiography and Doppler ultrasound for a follow up period of more than 1 year.

CONCLUSION

TIPSS may be of benefit in children with severe portal hypertension. It allows control of intractable bleeding, and stabilizes the patients preparing them for subsequent elective orthotopic liver transplantation.

[Radiological diagnosis in lung transplant patients]

Based on the imaging studies obtained from 13 patients after lung transplantation, radiological findings have been correlated with the clinical charts. The intention was to describe the radiological manifestations of the particular transplant complications of these patients. 12 episodes of reimplantation response were seen in the early postoperative period as a perihilar accented perivasal consolidation with typically short-termed appearances. 16 episodes of acute rejection showed various manifestations on the radiographs. They were characterised by immediate response to a bolus therapy with corticosteroids. This decisive observation allows the exclusion of other causes contributing to a condition following thoracotomy with similar radiological manifestations. Stenoses of the pulmonary or the bronchial anastomoses occurred once each and were confirmed in the course of further examinations. Chest radiograph proved to be the appropriate tool for the diagnosis of technical complications following iatrogenic measures (pleural effusion, pneumothorax). Clinical symptoms and follow-up observations are necessary for the interpretation of the radiographs. Chest radiography represents an important help concerning problems in differential diagnosis and further therapeutic decisions.

[Depression in independently living elderly, a study with the Zung-12]

The psychometric properties of the Zung-12, a short rating scale for the measurement of depression, were studied in a random sample (N = 79) taken from an elderly population living in their own homes in a medium sized town. Both internal and test-retest reliability of the Zung-12 are satisfactory. According to factor analyses the rating scale has a unidimensional structure. High correlations with the Befindlichkeitsskala and the SSWO support the convergent validity. No relation is found between depression score and age, amount of help received and household composition. Women and subjects with lower education appeared to have higher depression scores than respectively men and subjects with higher education. Administration of the Zung-12 in the morning produces higher depression scores than in the afternoon. 10% of the subjects score above the cutting point on one of the occasions, 4% on both occasions. Reliable change scores were calculated to indicate the statistical significance of differences between two administrations.

Liquid chromatographic-mass spectrometric studies on the enzymatic degradation of gonadotropin-releasing hormone

Gonadotropin-releasing hormone (GnRH) derivatives are used in cancer therapy, but relatively little is known about their metabolic fate in the organism. This paper describes the application of high-performance liquid chromatography combined with electrospray mass spectrometry to identify the degradation products resulting from the incubation of two GnRH analogues, D-Phe6-GnRH and DSer(OtBu)6-desGly10-GnRH-ethylamide (buserelin) with rat kidney membranes. Reversed-phase columns were applied with gradient elution using a flow-rate of ca. 2 microliters/min to the mass spectrometer. Post- and precolumn stream splitting were employed to adjust the flow-rates for columns of 2 and 0.32 mm I.D. The pattern of peptide degradation products obtained with this method indicates that a defined proteolytic membrane enzyme system is responsible for these catabolic processes.

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radio-scapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.

[Surgically treated thoracic aortic dissection. The angiographic follow-up of the perfusion relations]

Control angiography in arterial DSA technique was performed in 27 patients after operative treatment of acute aortic dissection (17 patients with type A dissection) respectively chronic aortic dissection (9 patients with type A dissection/1 patient with type B dissection). The mean interval between surgery and angiography was 59 months. All patients were free from symptoms due to organ complications or redissection. Persistent patency of a false lumen was observed in 40.7% (52.9% after operative treatment of an acute dissection; 20% after operative treatment of a chronic dissection). In all cases with a persistent false lumen the dissection originated at the distal anastomosis. In all patients the beginning of the dissection and the perfusion of the supra-aortal, visceral and iliac vessels whether by the true or false lumen could be shown. In 54.5% the Tr. brachiocephalic trunk was involved in the dissection. In 45.5% the left renal artery was solely perfused by the false lumen. Angiography in arterial DSA technique is evidently a valuable technique to document the beginning and extension of a dissection, sufficiency of the aortic valve, re-entries of the dissection, perfusion of the aortal branches, and the flow in both channels.

[Fine mesh metal endoprostheses for treatment of extensive cervical and intrathoracic tracheomalacia]

The treatment of tracheal stenoses caused by tracheomalacia is mainly carried out by means of sleeve resection, tracheopexy with ring support or other tracheoplastic operative procedures. If patients cannot be treated by surgical operative strategies, conventional stents are usually used to dilate the trachea. The use of a self-expanding elastic metal prosthesis in 5 patients with tracheal airway obstruction caused by tracheomalacia proved to be a true alternative in the therapy of tracheobronchial stenoses. We report on the long term use of 5 patients with tracheal stenoses treated by implantation of elastic metal wallstents. The implantation of the stents resulted in immediate improvement in respiratory function in all 5 patients. None of the patients experienced complications secondary to the stent placement. The stents were well tolerated (long-time follow-up 26 months). The implantation of self-expanding metal stents type "wallstent" seems to offer alternative possibilities for the treatment of tracheomalacia.