Stent-angioplasty of an anastomotic stenosis of the pulmonary artery after lung transplantation

Anastomotic stenosis of the pulmonary artery after lung transplantation is a rare complication, which commonly necessitates surgical correction. Transesophageal Doppler sonography and pulmonary arteriogram are standard diagnostic means for visualization of venous and arterial anastomoses. Balloon dilatation combined with implantation of a vascular endoprosthesis was successfully used for treatment of severe anastomotic stenosis of the pulmonary artery after lung transplantation.

[The results of a long-term follow-up of patients with a percutaneous cholecystostomy]

19 out of 37 patients with percutaneous cholecystostomy were followed up for assessment of gallbladder function after percutaneous drainage. 17 out of 19 of the patients remained free from symptoms of gallbladder disease during a mean follow-up period of 25.8 months. Contractility of the gallbladder calculated by measurement of the sonographic diameter of the gallbladder with provocation tests was 62%. One patient was operated upon for choledocholithiasis three years after percutaneous cholecystostomy. Histology showed signs of chronic cholecystitis. It can be concluded that cholecystectomy is not routinely necessary after percutaneous cholecystostomy provided biliary excretion is normal.

Balloon dilatation and stent placement of suprahepatic caval anastomotic stenosis following liver transplantation

We present an unusual case of suprahepatic caval anastomotic stenosis after adult liver transplantation in the early postoperative period. Color flow Doppler sonography and cavography were used to confirm the clinical diagnosis. Successful nonoperative treatment of the obstruction was achieved by balloon dilatation and subsequent implantation of a vascular stent.

[Neurogenic intermittent claudication of the femoral nerve caused by occlusion of the common iliac artery]

A 52 year old heavy smoker complained of paresthesiae and pain at the ventral side of the right thigh and the antero-medial side of the right lower leg as well as weakness of the right quadriceps femoris during exercise. Clinical examination revealed a paresis of the right quadriceps, hypesthesia and hypalgesia in the area of the femoral nerve and a reduced right patellar reflex after 10 min walking. An occlusion of the right common iliac artery was diagnosed by angiography. Following transluminal angioplasty and implantation of an intravascular stent, the patient was free of symptoms. On the basis of the clinical observations following recanalisation of the common iliac artery, the symptoms can best be explained by a reduced perfusion of the iliolumbar artery supplying the upper part of the femoral nerve, causing ischemia of the femoral nerve during exercise. In conclusion, stenosis/occlusion of the common iliac artery should be considered as a differential diagnosis of quadriceps weakness and paresthesia in the area of the femoral nerve associated with exercise.

Disposition of the 3H-labeled gonadotropin-releasing hormone analog buserelin in rats

The short-time disposition of 3H-labeled D-Ser(TBU)6-desGly10-GnRH-ethylamide ([3H]buserelin) was studied in rats after bolus intravenous and subcutaneous injections and killing the rats after 1 and 3 hr, respectively. When estimated as the percentage of the injected dose, 3H-activity within the whole blood rapidly declined from 25.5% at 2 min to 4.7% at 60 min after intravenous injection and remained nearly constant at 3.4% from 30 to 180 min after subcutaneous injection. More than 94% of the blood activity was confined to plasma. 3H-Activity was highly concentrated in the pituitary, as seen from the concentration ratio of activity tissue/plasma (ti/pl), being 12.6 and 8.0 at 60 and 180 min, respectively. A transient accumulation of activity was observed in kidney (ti/pl 9.5 and 2.2 at 60 and 180 min, respectively). All the other tissues studied (liver, spleen, adrenal, testis, epididymis, muscle, lung, fat, skin, heart, thyroid, stomach, and intestine) showed ratios ti/pl below 2.0, mostly below 1.0. The tissues within the blood-brain barrier cortex/thalamus and hypothalamus had the lowest ti/pl (0.08 at 60 min). Within 24 hr after intravenous injection of [3H]buserelin into rats, 58% of the administered 3H-dose was recovered in urine, 21.6% of the urinary radioactivity being identified as intact buserelin. Only 3.6% of the 3H-dose were found in the feces. It is concluded that buserelin is concentrated specifically only in its target organ pituitary, whereas kidney accumulates the peptide transiently due to glomerular filtration and presence of the peptide in the primary urine, part of the peptide being degraded to smaller peptides in the kidney tubuli before being excreted into urine.(ABSTRACT TRUNCATED AT 250 WORDS)

[The implantation of elastic metal endoprostheses in tracheal stenosis and tracheomalacia. The initial results with 4 patients]

Narrowing of the trachea due to tracheomalacia or compression can lead to life-threatening asphyxia and may require tracheotomy with intubation or endoscopic introduction of a stent. The use of a self-expanding elastic metal prosthesis in 4 patients with airway obstruction has proved a satisfactory alternative to conventional plastic prostheses, both in the acute phase and over a long period of time. After 4 weeks total epithelium cover of the stent could be demonstrated; biopsies after 3 and 4 months showed differentiation into respiratory ciliated epithelium. Patient acceptance was excellent since there was no sensation of a foreign body, retention of secretions or cough. The physical properties of the wall stent made it a suitable mechanical replacement for an unstable or narrowed trachea during the period of observation.

[Fulminant pulmonary embolism in the 35th gestational week. Sonographic detection of a thrombus in the inferior vena cava with normal cavography]

Pulmonary embolism is the most common cause of maternal death during pregnancy. CASE REPORT. We report a 28-year-old obstetric patient (35th gestational week) who was admitted to the hospital because of intermittent vaginal bleeding caused by placenta totalis et accreta. Eleven days after admission she suffered a cardiac arrest. After cardiopulmonary resuscitation, an emergency caesarian section was performed and a healthy child was delivered. Abdominal sonography (B-mode) showed a floating thrombus in the inferior vena cava. Perfusion scintigraphy and cavography were normal; a computed tomography i.v. contrast medium study confirmed the presence of the thrombus. An open thrombectomy was performed to protect the patient from further pulmonary emboli. After 8 days she left the intensive care unit without residual complications. CONCLUSION. This case emphasises the importance of bedside sonography as a diagnostic method of identifying the source of a thrombus in patients with suspected pulmonary embolism.

Diabetes and its complications may be caused by inadequate circulation. A new concept

Students of diabetes have noted that the so-called vascular complications of the disease appear with little or no consistency. Uncontrolled patients may have no vascular problems. Contrarywise obsessive compulsive individuals who follow every dietary regimen perfectly and take their prescriptions faithfully may have horrendous vascular difficulties. These experiences brought me to the conclusion that the 'complications' were really a component of the disease rather than the result of it. In an effort to find a unified concept of the disease it seemed reasonable to conclude that inadequate circulation to the islets may be a cause of the chemical constellation that we call diabetes. Vascular pathology may appear haphazardly in various arteries. Thus some will develop cerebrovascular disease, others coronary manifestations while still other patients will experience peripheral vascular symptoms. Is it not possible that defective circulation to the pancreas might be an aetiological factor in the development of diabetes? These observations lend credence to the concept that arterial pathology may actually precede the appearance of clinical diabetes.

Hepatocytes and macrophages express an identical cytokine inducible nitric oxide synthase gene

Polymerase chain reaction amplification of reverse transcribed RNA (RNA-PCR) was used to isolate overlapping cDNA clones encoding an inducible form of nitric oxide synthase (NOS) from purified rat hepatocytes. NOS gene expression in hepatocytes is dependent upon bacterial lipopolysaccharide (LPS) and cytokine treatment. The predicted amino acid sequence of rat hepatocyte inducible NOS is 94% identical with that from the mouse macrophage cell line, RAW264.7. Differences between the two sequences occur as sporadic amino acid substitutions with no major gaps or insertions. These differences are most likely the result of species variability which suggests that hepatocytes and macrophages express the same NOS gene upon induction.

Precocious puberty due to a lipid-cell tumour of the ovary

A 4-year-old girl with a lipid cell tumour of the ovary showed isosexual precocious pseudopuberty. The endocrine activity of the tumour led to elevated plasma levels of dehydroepiandrosterone sulphate, oestradiol, testosterone and androstenedione. After tumour resection the clinical signs of abnormal hormonal stimulation disappeared within 10 months. The girl developed precocious puberty again 2 years later without any sign of relapse. Therapy with luteinizing hormone releasing hormone agonist was effective although premature activation of the hypothalamic-pituitary-gonadal axis could not clearly be demonstrated by hormonal investigations.

[Acute cholecystitis: percutaneous transhepatic drainage]

Despite emerging endoscopic techniques for treatment of gallbladder diseases the operative cholecystectomy is the treatment of choice in acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment modality in poor surgical risk patients. In 19 out of 36 patients with percutaneous cholecystostomy no subsequent cholecystectomy was performed. A long-term observation of these 19 patients showed normal function of the gallbladder in ultrasound studies, thus percutaneous drainage can be a definitive treatment for acute cholecystitis in selected cases.

Characterization of a new repetitive sequence that is enriched on microchromosomes of turkey

We cloned and characterized a new highly repetitive, species-specific DNA sequence from turkey (Meleagris gallopavo). This repeat family, which accounts for approximately 5% of the turkey genome, consists of a 41 bp repeated element that is present in tandem arrays longer than 23 kb. In situ hybridization to turkey metaphase chromosomes (2n = 80) demonstrated that this sequence was located primarily on certain microchromosomes: approximately one-third of the 66 microchromosomes showed a positive signal. With respect to the macrochromosomes, hybridization was seen only in a pericentric position on nos. 2 and 3. The turkey microchromosome (TM) sequence shares motifs (alternating A3-5 and T3-5 clusters separated by 6-8 bp) that have been found previously in other avian tandemly repeated elements, e.g. a chicken microchromosomes sequence, and W (female) chromosome-specific sequences of chicken and turkey. However, the TM sequence does not cross-hybridize under moderately stringent conditions with these other sequences. The spread and amplification of related repetitive sequence elements on microchromosomes and W chromosomes is discussed.

Cold haemagglutinin disease complicating Mycoplasma pneumoniae infection in a child under cytotoxic cancer treatment

Acute cold haemagglutinin disease, most commonly associated with underlying mycoplasma infection, is rare in children. A 3-year-old girl who developed this auto-immune disease under intensive cytotoxic treatment for rhabdomyosarcoma is presented. Clinically, a livedo reticularis skin pattern upon exposure to cold which was reversible at room temperature and a spontaneous red cell agglutination of blood samples in vitro led to the diagnosis. Together with bronchopneumonia the girl developed hyper-IgM, high antibody titres against Mycoplasma pneumoniae, as well as high titres of cold agglutinins. Laboratory signs of mild intravascular haemolysis were found. Positive direct antiglobulin test resulted from coating of red cells with C3d and C4. Three different antibodies were identified in serum: nonspecific cold agglutinins without complement activation, anti-I specific cold agglutinins with complement activation, as well as a weak biphasic Donath-Landsteiner haemolysin. Under antibiotic treatment and a short course of predisolone the clinical course was mild.

[The Zung-12: a questionnaire for depression in the elderly]

The reliability and validity for use in psycho-geriatric practice of a short and experimenter-rated version of the Zung (Self-rating) Depression Scale, the Zung-12, was studied. The subjects (N = 237) were aged 62 years or older and lived independently, in adapted dwelling, in homes for the aged, or received psychogeriatric daycare in psychogeriatric nursing-homes. It was concluded that the Zung-12 was sufficiently reliable (Cronbachs alpha = 0.85). According to factor analyses the test had high loadings on a depression factor and there were no loadings on a dementia factor. Age did not correlate with depression-scores. In comparison with other living situations the percentage of depressive persons in homes for the aged appeared to be high. Norms in the form of percentile scores were calculated separately for the homes for the aged and the remaining living situations.