Altered villus vessel fibronectin in preeclampsia

Fibronectin is a high molecular-weight glycoprotein found in most tissues and body fluids. Maternal plasma fibronectin levels have been shown to be elevated in preeclampsia, but little is known about placental fibronectin in preeclampsia. Fibronectin tissue distribution in placental villi was "blindly" graded by two examiners using placentas from eight nonpreeclamptic and six preeclamptic pregnancies. Selected frozen sections of normal-appearing areas from each placenta were incubated with rabbit antihuman fibronectin antiserum and then stained with fluorescein isothiocyanate-conjugated goat antirabbit immunoglobulin G and examined by fluorescent microscopy. We found less intensity of fetal vessel fibronectin staining in villi from placentas from preeclamptic pregnancies than in those of normal pregnancies (p less than 0.02, Mann-Whitney U test). It is unclear why fetal villous vessels in preeclampsia have decreased tissue fibronectin, but this may reflect an additional vascular abnormality associated with the preeclampsia syndrome.

Use of two-photon excitation in resonance ionization mass spectrometry

We report the detection of a series of elements via 2 + 1 (photons to resonance + photons to ionize) resonance ionization mass spectrometry. The efficiency of this process is demonstrated, as the two-photon step can often be saturated. Examples are given where experimental observations of ion yields are compared to theoretical calculations based on a simple formalism used for two-photon transition rates, coupled with a rate-equations calculation of the total ionization rate. Advantages of 2 + 1 ionization compared with more widely used 1 + 1 processes are discussed.

Reduced anastomotic bleeding using new sutures with a needle-suture diameter ratio of one

Reduction of blood loss from a vascular anastomosis, especially when one is using a polytetrafluoroethylene (PTFE) graft, is of great interest; even when a technically perfect anastomosis has been performed, there can still be significant and often bothersome bleeding from the needle holes. Currently, sutures have a needle-to-suture ratio of 2:1 or 3:1. Two new sutures, one made of PTFE and the other of polypropylene, were designed to have a needle-to-suture diameter ratio of 1:1. Theoretically, this allows the suture to completely fill the graft needle hole and control bleeding. These sutures were evaluated in a heparin-treated canine in vivo model to measure graft needle-hole bleeding. The materials were also tested by an independent laboratory to compare the basic physical characteristics. Twenty centimeters of 6 mm PTFE graft was interposed in an end-to-end fashion to the infrarenal canine aorta. The graft was then transected at its midpoint and a series of end-to-end, graft-to-graft anastomoses were performed with alternate experimental and control sutures. The experimental PTFE suture bled a mean of 12.46 ml per anastomosis. The experimental polypropylene bled 4.32 ml per anastomosis, while a control suture of polypropelene with a needle-to-suture ratio of 1.94 (5-0 prolene with a C-1 needle), produced a mean blood loss of 33.35 ml per anastomosis. These data are based on a total of 82 anastomoses. The results were analyzed with a two-tailed paired t test. As the data indicate, both experimental sutures allowed significantly less bleeding than the controls (p = .05). The testing of physical properties of the suture included diameter, tensile strength, needle pull-off strength, and elongation percent and were performed by an independent laboratory. These findings are included along with subjective evaluations of the sutures' handling qualities. We believe that sutures produced with needle-to-suture ratios of 1:1 greatly reduce graft needle-hole bleeding and will be a useful addition to the vascular surgeon's armamentarium.

Angiography in the in situ saphenous vein bypass

In situ saphenous vein bypass is a technique of lower-extremity revascularization that is gaining popularity as an alternative to the reversed saphenous vein graft. In the latter, the saphenous vein is removed from its bed and reversed before arterial anastomosis. The former uses the vein in situ after the venous valves are made incompetent and the perforators are ligated. Only the proximal and distal ends of the vein are mobilized for anastomosis. The radiologist assists in the management of these patients by performing preoperative venography, intraoperative arteriography, and postoperative arteriography when required. Techniques of these procedures, along with normal and abnormal findings, are discussed.

A simple rapid technique for vena cava clip replacement

A method to facilitate clipping of the inferior vena cava is presented. The inferior surface of the clip is protected by a red rubber catheter while being passed behind the vena cava. This avoids any trauma to the posterior wall that may be caused by the serrations or sharp edges of the clip and facilitates passage. Once in place, this catheter is then advanced off the clip and a previously placed silk tie is secured. The operation is then finished expeditiously. Although inferior vena caval clipping has become a less frequently used method of vena cava interruption, definite indications remain for its use and it must be kept in the armanentarium of the surgeon. This method should facilitate the execution of this procedure.

Femoral pseudoaneurysm following nonpenetrating trauma in a patient with aortic insufficiency

Although not uncommon after penetrating vascular trauma, arterial pseudoaneurysms rarely develop following blunt trauma. A patient is described in whom indirect trauma led to pseudoaneurysm of the profunda femoris artery, and persistent bleeding required surgical intervention. In this case, the coexistence of significant aortic valvular regurgitation suggests that wide pulse pressure may predispose to this arterial complication.

Rupture of surgically thrombosed abdominal aortic aneurysm

A case of late rupture of an abdominal aortic aneurysm that had been successfully treated by surgically induced thrombosis is presented. After emergency surgery consisting of ligation of the neck of the aneurysm, the patient survived and is doing well. The literature on surgically induced thrombosis of abdominal aortic aneurysm is reviewed. It is stressed that complete thrombosis of aortic aneurysm induced by distal ligation does not preclude rupture, and if patients present with symptoms of expansion or rupture, they should undergo emergency surgery.

Long-term prolongation of cardiac allografts by subtherapeutic levels of cyclosporine in rats conditioned with pretransplant blood transfusions and cyclosporine

This study was aimed at ascertaining whether long-term graft survival was achievable with short term cyclosporine (CsA) therapy or with subtherapeutic doses of CsA in rats conditioned with blood transfusions (BT) combined with CsA. Previous studies had shown that donor-specific transfusions combined with a short course of CsA interacted synergistically, resulting in considerable prolongations of ACI and BUF grafts in LEW hosts receiving no postoperative treatment. The donor-specific depression of alloreactivity was confirmed in the present study by showing a depression of mixed-lymphocyte reaction (MLR) reactivity as well as of humoral antidonor responses in BT-CsA conditioned rats. The effects of postoperative CsA were then studied in recipients conditioned with BT-CsA or BT alone. ACI and BUF cardiac graft survival in LEW hosts conditioned with BT and treated with a five-day postoperative course of CsA (20 mg/kg/day) were indistinguishable from graft survival in untransfused hosts (ACI: 35.6 +/- 15.5 vs. 38.8 +/- 7.4; BUF: 58.4 +/- 39.8 vs. 48.0 +/- 21.7) indicating no interaction between BT and CsA under these conditions. In contrast, the effect of a post-operative five-day course of CsA (10 mg/kg/day) was extended by conditioning the recipients with donor-specific BT and CsA (ACI:41.7 +/- 7.0 vs. 27.4 +/- 11.6; P less than 0.05). More remarkably, a thirty-day course of subtherapeutic doses of CsA (2.5 mg/kg/day) resulted in long-term prolongation (greater than 100 days) of ACI grafts in a large proportion of hosts conditioned with donor-specific BT and CsA, while the majority of controls conditioned with nonspecific BT and CsA or CsA alone rejected their grafts within three weeks (P less than 0.01). The possible mechanisms of this phenomenon are discussed.

Comparison of the sensitivity of commercial APTT reagents in the detection of mild coagulopathies

This study was undertaken to evaluate the precision and sensitivity of three different commercial APTT reagents containing the activators kaolin, micronized silica, or ellagic acid. These reagents varied greatly in their ability to detect mild coagulopathies. The ellagic acid reagent was able to detect the mildest deficiencies for the most common coagulopathies. This reagent was sensitive to 50% levels of Factor VIIIC, whereas the APTT with the kaolin reagent was not prolonged until levels of 35% or less were attained. The micronized silica reagent was the least sensitive to Factor IX deficiency, detecting levels of 12% or less. Precision was similar for all reagents when tested with normal and slightly abnormal plasmas. Since methods and instrumentation vary, each laboratory should evaluate their APTT reagent to determine its precision and sensitivity.

Infected false aneurysms of the subclavian artery: a complication in drug addicts

Two cases of infected false aneurysms of the subclavian artery in drug addicts are described. The clinical findings related to the location of these rare lesions are presented, together with an attempt to explain their pathophysiology. The signs and symptoms include a tender supraclavicular mass in an obviously septic patient associated with brachial plexus palsy, a swollen edematous arm, Horner's syndrome, and hemoptysis. Because of the complexity of symptoms, delay in diagnosis is common. It is emphasized that the recognition of this constellation of symptoms should prompt the physician to perform emergency angiography followed by immediate surgery.

Male sexual dysfunction as related to alcohol consumption: a pilot study

Personal interviews were conducted with 44 male volunteers consecutively admitted to outpatient treatment in a county alcoholism program. Fifty-three per cent of the subjects were still drinking minimally or in moderation at the time of the interview. Quantity, frequency, and duration of drinking, from onset of regular drinking to present, were related to sexual dysfunctions. During heavy drinking. 59% of patients experienced erection dysfunction, 48% reported ejaculation incompetence, and 84.4% had experienced at least one kind of sexual dysfunction.

Effect of technetium Tc 99m pertechnetate on bacterial survival in solution

Survival of Staphylococcus epidermidis (10(2) organisms/ml) in solutions containing various levels of radioactivity was assessed. Six test preparations contained nonbacteriostatic 0.9% sodium chloride solution; four of these contained technetium Tc 99m pertechnetate (99mTcO-4) in various quantities (80, 250, 500, and 750 mCi). A fifth contained technetium that had decayed to an essentially nonradioactive form, and a sixth contained 0.9% sodium chloride solution only. Each of the six 20-ml solutions was inoculated with 2 ml of single-strength trypticase soy broth (TSB) containing 10(3) organisms/ml. At various times up to 12 hours after inoculation, 1-ml aliquots of each test solution were withdrawn and passed through 0.22-micron filters, thereby preventing further irradiation of the filtered organisms. The filters were incubated in single-strength TSB at 37 degrees C, and samples were examined for turbidity at 24, 48, and 72 hours. After 24 hours, 25 of the 36 sample tubes showed turbidity; after 48 hours, the turbid samples totaled 28. Bacteria in the two nonradioactive solutions remained viable throughout the 12-hour sampling period. Accumulated doses of radiation obtained in the 250-, 500-, and 750-mCi samples inhibited bacterial growth. To be a valid quality-control measure, sterility monitoring of prepared radiopharmaceutical dosage forms may need to be performed concurrently with their preparation.

Evaluation of three methods for detecting low-level bacterial contamination in intravenous solutions

The accuracy of three sterility-testing methods in detecting low-level contamination in deliberately contaminated intravenous solutions was studied. One-liter bags of 5% dextrose (D5W) and 0.9% sodium chloride (saline injections were contaminated with Staphylococcus epidermidis and Pseudomonas aeruginosa; approximately 10(1) viable bacteria were injected into each bag. Two membrane-filtration methods (Ivex-2 and Addi-Chek) and one aliquot method [twice concentrated trypic soy broth (2X-TSB)] were used to test each of 10 diliberately contaminated solutions for both D5W and saline; 500 ml of each liter bag was filtered or added to 2X-TSB. Incubation containers were stored at 37 degrees C and inspected at 24, 48, and 72 hours for turbidity. There was no significant difference among the three methods in the detection of contaminated saline solutions. The Addi-Chek system was significantly less effective in detecting contamination in D5W than either of the other methods. It is concluded that the Ivex-2 system is accurate and the easiest-to-use system of the three tested.