Angiographic follow-up after coronary implantation of the Multilink stent: a prospective observation

BACKGROUND

A growing variety of coronary stents is becoming available on the market. Results of randomized trials may be difficult to apply to less selected patients, and experience with every device cannot be obtained in every center. Detailed information about the immediate and long-term results achieved with one device can be a helpful reference for interventional cardiologists. The aim of this study was to test the applicability and the clinical and angiographic results, both immediate and at 6 months, of the Multilink coronary stent in a cohort of unselected patients undergoing coronary angioplasty.

METHODS

From March 1997 to June 1998 coronary angioplasty was performed in 391 patients in our center, with the use of stents in 339 patients.

RESULTS

Three hundred and seventeen Multilink stents were successfully implanted in 295 lesions in 277 patients; an acute coronary syndrome was present in 209 cases (75%), and lesion types B2 and C accounted for 30% of lesions. In 7 cases (2.4%) the Multilink stent did not cross the lesion, and another device was implanted. Subacute stent occlusion occurred in 1 patient (0.36%) after primary angioplasty. After 6 months from the procedure, clinical follow-up data were available for 252 out of 254 patients: none had died, and angina or myocardial ischemia occurred in 25 patients (9.9%). A control angiogram was performed in 239 out of 254 patients (94%) at 178 +/- 34 days. Restenosis occurred in 44/239 patients (18.4%) and in 48/247 lesions (19.4%). In patients with vs without restenosis the original lesion was longer (p = 0.009), and diabetes mellitus was more frequent (p = 0.002), as was the use of multiple stents (p = 0.005). In single 15, 25 and 35 mm long stents restenosis occurred in 13.9, 15.5 and 46.2% of cases, respectively (p = NS).

CONCLUSIONS

The Multilink stent showed a low rate of subacute occlusion (0.36%) and could be used safely also in patients with acute coronary syndromes. The use of a single, 15 or 25 mm long Multilink stent was associated with a low angiographic recurrence rate (14-16%).

Effects of sodium selenite on vascular smooth muscle reactivity

The effects of sodium selenite (Na(2)SeO(3)) on the vascular smooth muscle reactivity of rabbit aorta were studied. In isolated rabbit aorta, Na(2)SeO(3) inhibited contractile response to phenylephrine and developed a lasting contracture in the vascular tissue. Relaxation in phenylephrine-precontracted aortic rings induced by sodium nitroprusside and 8-bromo-guanosine 3':5'-cyclic-monophosphate was also inhibited. Preliminary data obtained with ascorbic acid suggested a partial involvement of an oxidative mechanism. Excluding the possibility that Se damages actin or modifies its distribution (immunohistochemical evaluation), results indicate that Se alters vascular smooth muscle reactivity by inhibiting both its contracting and relaxing properties. Calcium-dependent mechanisms appear to be primarily involved and an interference with calcium re-uptake by sarcoplasmic reticulum as a possible site of Se vascular action could be hypothesized.

Systemic therapy for renal cell carcinoma

PURPOSE

We review the status of systemic therapy for patients with advanced renal cell carcinoma.

MATERIALS AND METHODS

A literature search was performed on MEDLINE and CANCERLIT to identify results of systemic therapy for patients with renal cell carcinoma published from January 1990 through December 1998. Treatment results of chemotherapy agents, immunotherapy, combination programs and adjuvant therapy were reviewed.

RESULTS

No chemotherapy agent has produced response rates that justify its use as a single agent. Interferon-alpha and interleukin (IL)-2 demonstrated low response rates ranging from 10% to 20%. The results of 2 randomized trials suggest that treatment with interferon-alpha compared to vinblastine or medroxyprogesterone achieves a small improvement in survival. Response rates in patients treated with low dose IL-2 are similar to those achieved with a high dose bolus schedule but whether the responses are as durable is being addressed in an ongoing randomized trial. A randomized trial of interferon-alpha plus IL-2 compared to monotherapy with either agent showed increased toxicity but no improvement in survival. In 3 randomized trials no survival benefit was associated with adjuvant interferon-alpha therapy following complete resection of locally advanced renal cell carcinoma.

CONCLUSIONS

Despite extensive evaluation of many different treatment modalities, metastatic renal cell carcinoma remains highly resistant to systemic therapy. A few patients exhibit complete or partial responses to interferon and/or IL-2 but most do not respond, and there are few long-term survivors. Preclinical research, and clinical evaluation of new agents and treatment programs to identify improved antitumor activity against metastases remain the highest priorities in this refractory disease.

Cigarette smoking patterns in patients after treatment of bladder cancer

BACKGROUND

Assessment of smoking status and identification of those most likely to continue smoking are important in the management of patients who have bladder cancer, because continued smoking following diagnosis and treatment increases the likelihood of treatment-related complications, recurrence, second primary malignancies, and morbidity and mortality.

METHODS

Patients (n = 224) receiving follow-up care of previously treated bladder cancers completed a brief written survey assessing their post-diagnosis smoking patterns.

RESULTS

Despite the risks of continued smoking, 69% of the patients who had been active smokers at the time of diagnosis (n = 84) reported smoking at some point following the diagnosis and 45% reported smoking at the time of assessment. Patients diagnosed at earlier stages were more likely to continue smoking. Patients diagnosed at later stages were 2.80 times more likely to be continuous abstainers than those diagnosed sooner (95% CI, 1.08-7.25).

CONCLUSIONS

The findings underscore the need to assess smoking status and provide smoking-cessation advice and counseling within routine comprehensive care of bladder cancer patients.

The type of urinary diversion after radical cystectomy significantly impacts on the patient's quality of life

BACKGROUND

In this study, we used a previously well-validated survey to assess the impact of different forms of urinary diversion on overall quality of life in patients with bladder cancer.

METHODS

A total of 92 patients, having three different forms of urinary diversion after radical cystectomy, completed by mail the SF-36, a validated quality-of-life survey. All patients had local/regional disease at the time of cystectomy and are currently without evidence of disease. Completed surveys were then analyzed into physical (PCS) and mental (MCS) component quality-of-life scores per published protocols. Results were then compared with published age-based norms.

RESULTS

A total of 38 men who had cystectomy and ileal neobladder had a mean PCS (+/- SD) of 48.4 (7.8) and a mean MCS of 51.0 (7.4); 16 men and women who had cystectomy and Indiana Pouch had a mean PCS of 48.4 (8.9) and a mean MCS of 55.7 (3.8). None of these results is statistically different from published age- and sex-based population norms. Thirty-eight men who had cystectomy and ileal conduit had a mean PCS of 41.4 (8.5) and a mean MCS of 48.2 (10.7). The PCS is not statistically different from the population-based norm; however, the MCS is significantly decreased from the published norm (P = .01).

CONCLUSIONS

Patients with ileal conduits have significantly decreased mental health quality of life whereas patients with continent urinary diversions do not. Therefore, when not medically contraindicated, patients should be offered a continent diversion as the diversion of choice after cystectomy.

Risk factors for surgical wound infection and bacteraemia following coronary artery bypass surgery

BACKGROUND

There has been no consensus from previous studies of risk factors for surgical wound infections (SWI) and postoperative bacteraemia for patients undergoing coronary artery bypass graft (CABG) surgery.

METHODS

Data on 15 potential risk factors were prospectively collected on all patients undergoing CABG surgery during a 12-month period.

RESULTS

Of 693 patients, 62 developed 65 SWI using the Centres for Disease Control definition: 23 were sternal wound infections and 42 were arm or leg wound infections at the site of conduit harvest. There were 19 episodes of postoperative bacteraemia. Multivariate analysis revealed that: (i) diabetes, obesity and previous cardiovascular procedure were independent predictors of SWI; and (ii) obesity was an independent risk factor for postoperative bacteraemia.

CONCLUSIONS

These findings suggest that improved diabetic control and pre-operative weight reduction may result in a decrease in the incidence of SWI. But further prospective studies need to be undertaken to examine (i) whether the increased SWI risk in diabetes occurs with both insulin- and non-insulin-requiring diabetes, and whether improved peri-operative diabetes control decreases SWI; and (ii) what degree of obesity confers a risk of SWI and postoperative bacteraemia, and whether pre-operative weight reduction, if a realistic strategy in this patient group, results in a decrease in SWI.

Italian norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A

Norms for an Italian translation of the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) by Shor and Orne (1962) are presented. Subjects recruited from 1986 to 1989 were pooled, resulting in a sample of 376 participants (297 women and 79 men). The normative data were generally congruent with earlier normative studies in score distribution, item difficulty levels, and reliability. Women had significantly higher hypnotizability scores and item pass rates than men. The reliability scores of the Italian adaptation of the HGSHS:A were the same as a previously reported Danish sample and higher than a German sample, but lower than those of the Australian, Canadian, and original American samples. These results suggest that the Italian version of the HGSHS:A is an efficient tool for initial hypnotizability screening in an Italian context.

Interaction between the pRb2/p130 C-terminal domain and the N-terminal portion of cyclin D3

An association between cyclin D3 and the C-terminal domain of pRb2/p130 was demonstrated using the yeast two-hybrid system. Further analysis restricted the epitope responsible for the binding within the 74 N-terminal amino acids of cyclin D3, independent of the LXCXE amino acid motif present in the D-type cyclin N-terminal region. In a coprecipitation assay in T98G cells, a human glioblastoma cell line, the C-terminal domain of pRb2/p130 was able to interact solely with cyclin D3, while the corresponding portion of pRb interacted with either cyclin D3 or cyclin D1. In T98G cells, endogenous cyclin D3-associated kinase activity showed a clear predisposition to phosphorylate preferentially the C-terminal domain of pRb2/p130, rather than that of pRb. This propensity was also confirmed in LAN-5 human neuroblastoma cells, where phosphorylation of the pRb2/p130 C-terminal domain and expression of cyclin D3 also decreased remarkably in the late neural differentiation stages.

Quercetin and anti-CD95(Fas/Apo1) enhance apoptosis in HPB-ALL cell line

Several malignant cell lines are resistant to CD95-(Apo1/Fas)-mediated apoptosis, even when the CD95 receptor is highly expressed. Sensitivity to CD95-induced apoptosis can be restored using different molecules. In this study, we showed that quercetin, a naturally occurring flavonoid, in association with the agonistic anti-CD95 monoclonal antibody, increases DNA fragmentation and caspase-3 activity in HPB-ALL cells. These cells have been selected for their known resistance to CD95-induced apoptosis. At molecular level, quercetin lowers the level of intracellular reactive oxygen species, reduces mitochondrial transmembrane potential, thereby leaving the expression of CD95 receptor unchanged.

Urinary diversion after total pelvic exenteration for rectal cancer

BACKGROUND

Total cystectomy is indicated for the treatment of bulky primary rectal cancers as well as previously treated, locally recurrent tumors that invade the bladder, prostate, seminal vesicle, or urethra. We review a 10-year Memorial Sloan-Kettering Cancer Center experience with urinary diversion in this setting.

METHODS

Between April 1988 and June 1998, 47 patients underwent urinary diversion during a total pelvic exenteration for rectal cancer. Charts and operative records were reviewed to determine pathological findings, short-term and long-term urological complications, and survival.

RESULTS

Forty-seven patients (25 males and 22 females; median age, 62 years; age range, 27-79 years) were included. Sixteen (34%) patients underwent cystectomy for a primary rectal tumor (including 1 for rectal sarcoma and 1 for synchronous invasive bladder cancer), and 31 (66%) patients underwent surgery for a locally recurrent rectal cancer. Thirty (64%) patients underwent preoperative, 18 (38%) underwent intraoperative, and 11 (23%) underwent postoperative radiotherapy. Twenty-six (55%) patients received preoperative and 16 (34%) underwent postoperative chemotherapy. Two patients had continent ileal cecal reservoirs, 1 a colonic conduit, and the remaining 45 had ileal conduits. The tumor invaded the bladder in 24 (51%) patients, the prostate in 5 (11%) patients, and the seminal vesicle in 5 (11%) patients. Complete resection was achieved in 42 (89%) patients. There were a total of eight complications in eight (17%) patients. There were three early complications, two of which were ileoureteral anastomotic leaks, one managed by reoperation, the second by percutaneous drainage, and one moderate hydronephrosis managed expectantly. There were five late complications; three patients had ureteral stricture/stenosis, leading to nephrectomy in one patient and percutaneous stenting in two patients. Two patients developed late hydronephrosis, so far managed expectantly. There was one perioperative death. After a median follow-up of 16.83 months, 20 patients were dead of the disease, 6 were alive with disease recurrence, 2 were dead of other causes, and 19 had no evidence of disease. Three-year actuarial disease-specific survival was 34%.

CONCLUSIONS

Complete resection of bulky primary or locally recurrent rectal cancer can be performed with acceptable urological morbidity. Complete resection was obtained in 89% of patients, with 72% having urological organ invasion. Overall urological complications of 17% are acceptably low despite intensive perioperative radiation and chemotherapy. Disease-specific survival in these patients remains limited.

Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder

BACKGROUND

The aim of this study was to assess the influence of tobacco exposure, at the time of diagnosis, on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma (TCC) of the bladder.

METHODS

A retrospective cohort study was performed using the MSKCC Registry to identify all institutional cases of "noninvasive" TCC (n = 1632) between 1985 and 1995. After employing exclusion criteria, 286 cases of incident tobacco-associated superficial TCC were divided into 3 strata of tobacco exposure (127 ex-smokers, 51 quitters, and 108 continued smokers) by chart review and post hoc questionnaires (n = 82). Measured outcomes included recurrence free survival and survival free of adverse events (defined a priori as disease progression or other urinary tract TCC).

RESULTS

There were no significant differences among ex-smokers, quitters, and continued smokers in terms of stage, grade, tumor size, multifocality, up-front bacillus Calmette-Guérin therapy, or median follow-up. Ex-smokers presented at a later age than individuals who continued to smoke. Post hoc questionnaires and chart reviews were compared in terms of smoking status at time of diagnosis, and reliability was excellent (kappa = 0.89). Multivariate analyses revealed diminished recurrence free survival among continued smokers versus quitters or ex-smokers. Univariate analyses revealed diminished adverse event free survival among continued smokers versus quitters or ex-smokers. Multivariate models assessing adverse event free survival revealed a similar trend (P = 0.06).

CONCLUSIONS

Continued smokers experience worse disease-associated outcomes than patients who quit smoking. Smoking cessation should thus be employed as a tertiary prevention strategy for patients with superficial TCC.

Upper tract recurrences following radical cystectomy: an analysis of prognostic factors, recurrence pattern and stage at presentation

PURPOSE

We study the incidence and pattern of upper tract recurrences following radical cystectomy for bladder cancer, and analyze the prognostic factors.

MATERIALS AND METHODS

A retrospective study was performed on 529 patients who underwent radical cystectomy and urinary diversion at Memorial Sloan-Kettering Cancer Center between July 1989 and June 1997. Data related to upper tract recurrence were analyzed.

RESULTS

Of the 529 patients 16 (3%) had upper tract recurrence. Median followup was 16.9 months for the entire group and 49.1 months for patients with upper tract recurrence, with a median time to recurrence of 37.2 months. Of 12 upper tract recurrences 7 (58%) were locally advanced at surgery (p3a or greater with or without lymph node metastasis) and 5 of 16 patients with recurrence (31.3%) had bilateral tumors (2 synchronous and 3 metachronous). Overall survival from the time of diagnosis of upper tract recurrence after radical cystectomy was poor, with a median of 10 months (confidence interval 1 to 19).

CONCLUSIONS

The incidence of upper tract recurrence following radical cystectomy is low (3%). However, the incidence of bilateral tumors (31.3%) and locally advanced stage at the time of operation (58%) is higher than expected for upper tract tumors in the general population. Survival of patients with upper tract recurrence is poor, with a median of 10 months.

Sex differences in hemisphere preference as assessed by a paper-and-pencil test

The present study examined sex differences in hemisphere preference (HP) assessed by the Preference Test (PT). This instrument is designed to measure the extent to which normal subjects rely on right-hemisphere or left-hemisphere cognition. Factor analysis on the total sample (N = 1,057; 473 men and 584 women) revealed a clear two-factor structure (i.e., left-HP and right-HP), although separate analyses for men and women suggest that this structure is more straightforward in men than in women. The main differences between men and women have to do with PT items relevant to language abilities, where women tend to be more symmetrically distributed across the two factors. However, the frequency of right- and left-HP is similar in men and women and does not change for men when PT scores are recalculated after removal of unspecific items. Furthermore, once the items that assess verbal abilities were excluded, the corrected PT value for women showed higher right-HP. Our results provide some indications of a less pronounced lateralization of hemisphere-linked cognitive abilities in women.

Sudden unexpected deaths in infancy: what are the causes?

OBJECTIVES

To determine the incidence of various causes of sudden unexpected death (SUD) within an entire population and to assess the relative importance of an expert autopsy, as well as age of demise, in predicting the likelihood of finding a cause of death.

METHODS

We reviewed all cases of SUD in infants aged 1 week to 18 months that occurred in the province of Quebec (Canada) between 1987 and 1996.

RESULTS

We identified 623 cases of SUD; in 80% the diagnosis was sudden infant death syndrome (SIDS). Infection was the most common non-SIDS diagnosis (7.1% of all SUDs), followed by cardiovascular anomalies (2.7%), child abuse or negligence (2.6%), and metabolic or genetic disorders (2.1%). The percentage of non-SIDS deaths was much higher for autopsies performed in centers with expertise in pediatric pathology (18% vs 6%, P <.005). The likelihood of a non-SIDS diagnosis was much higher at age ranges atypical, as compared with typical, for SIDS (33% at 7 to 27 days, 19% at 6 to 12 months, and 64% at 12 to 18 months [atypical] vs 15% at 1 to 6 months [typical]; P =.003).

CONCLUSION

The study of an entire population provides more reliable data regarding causes of SUDs than does the study of small groups. We recommend that in addition to a thorough investigation of each SUD, autopsies be performed in centers with expertise in pediatric pathology. This recommendation takes on added significance in this era of decreasing SIDS rates.

Susceptibility to FAS-induced apoptosis in human nontumoral enterocytes: role of costimulatory factors

FAS-FAS ligand interaction has been implicated in increased enterocyte apoptosis seen in immune-mediated bowel injury. However, scant information exists on the role of FAS in physiological enterocyte turnover. In the present study, the regulation of enterocyte FAS and FAS ligand expression by cytokines and its functional role in human intestinal epithelial cell apoptosis and proliferation were analyzed with two different models: a nontransformed human intestinal epithelial cell line (HIEC) and normal colonic explant cultures. HIEC constitutively expressed FAS, as analyzed by flow cytometry. However, stimulation with agonistic anti-FAS antibody (1-500 ng/ml) did not induce HIEC apoptosis. In contrast, in the presence of tumor necrosis factor alpha (TNFalpha) and/or interferon gamma (IFNgamma), HIEC became highly susceptible to FAS-induced apoptosis. The sensitizing effect to FAS-induced apoptosis was mediated via TNFalpha- and IFNgamma-induced upregulation of FAS expression (maximally 348%). Receptor studies showed that the effect of TNFalpha on FAS was mediated via the p55 TNF receptor. In colonic organ cultures, IFNgamma and TNFalpha also enhanced colonocyte FAS expression, resulting in a markedly increased apoptotic response to stimulation of this receptor, as shown by in situ terminal deosyuridine triphosphate nick-end staining. Neither FAS ligand expression nor its induction by cytokines was observed in HIEC or colonic explants. Proliferation studies showed that FAS is not implicated in regulating HIEC growth. These findings suggest that, despite the fact that normal human enterocytes express FAS, costimulatory factors, such as TNFalpha or IFNgamma, abundantly secreted under inflammatory conditions, are necessary to sensitize intestinal epithelial cells to FAS-induced apoptosis by upregulating this receptor.

A comparative economic analysis of simvastatin versus atorvastatin: results of the Surrogate Marker Cost-Efficacy (SMaC) study

Health care payers have become increasingly interested in economic analyses to guide the allocation of limited health care resources. The Surrogate Marker Cost-Efficacy (SMaC) study was undertaken to assess the economics of treatment with simvastatin versus treatment with atorvastatin in reducing low-density lipoprotein cholesterol (LDL-C) in patients in 10 European countries, based on the results of a 1-year, double-blind, parallel-group clinical trial. Participants were between 18 and 80 years of age (n = 177; median age, 57; 94 men and 83 women). Entry criteria were a baseline LDL-C value between 4.2 and 7.8 mmol/L (160 to 300 mg/dL) and a triglyceride value < or =4.5 mmol/L (400 mg/dL). Patients were randomly assigned to receive simvastatin 10 mg or atorvastatin 10 mg. At 16 weeks, any patients not reaching their appropriate LDL-C level received simvastatin 20 mg/d or atorvastatin 20 mg/d. Patients were then followed up for a total of 52 weeks. The overall euro cost analysis was based on the weighted average price of each product across all the independent pharmaceutical markets based on official euro conversion rates. Individual country analyses also were conducted in each local currency. Over the 52-week study, there were no significant differences in the percentage of patients achieving an appropriate LDL-C level (simvastatin 48%, atorvastatin 50%). In the overall euro cost analysis, the cumulative cost of atorvastatin (134 euros) was 33% more than for simvastatin (101 euros) during the first 16 weeks. After titration to 20 mg, the total cost of treatment during the 52-week study remained significantly lower in the simvastatin group than in the atorvastatin group (429 vs 538 euros; P<0.0001). In individual country analyses, therapy with simvastatin was significantly less expensive than therapy with atorvastatin in 8 of 10 countries (P = 0.001 to 0.003). In the remaining 2 countries, there was no significant difference in cost. Across the countries included in the evaluation, there was a significant reduction in the cost of getting patients to appropriate LDL-C levels with simvastatin compared with atorvastatin. These results should provide useful information for physicians and payers; however, additional long-term clinical trials are required to assess fully how treatment with atorvastatin affects patient outcomes, safety, and costs.

Susceptibility to FAS-induced apoptosis in human nontumoral enterocytes: role of costimulatory factors

FAS-FAS ligand interaction has been implicated in increased enterocyte apoptosis seen in immune-mediated bowel injury. However, scant information exists on the role of FAS in physiological enterocyte turnover. In the present study, the regulation of enterocyte FAS and FAS ligand expression by cytokines and its functional role in human intestinal epithelial cell apoptosis and proliferation were analyzed with two different models: a nontransformed human intestinal epithelial cell line (HIEC) and normal colonic explant cultures. HIEC constitutively expressed FAS, as analyzed by flow cytometry. However, stimulation with agonistic anti-FAS antibody (1-500 ng/ml) did not induce HIEC apoptosis. In contrast, in the presence of tumor necrosis factor alpha (TNFalpha) and/or interferon gamma (IFNgamma), HIEC became highly susceptible to FAS-induced apoptosis. The sensitizing effect to FAS-induced apoptosis was mediated via TNFalpha- and IFNgamma-induced upregulation of FAS expression (maximally 348%). Receptor studies showed that the effect of TNFalpha on FAS was mediated via the p55 TNF receptor. In colonic organ cultures, IFNgamma and TNFalpha also enhanced colonocyte FAS expression, resulting in a markedly increased apoptotic response to stimulation of this receptor, as shown by in situ terminal deosyuridine triphosphate nick-end staining. Neither FAS ligand expression nor its induction by cytokines was observed in HIEC or colonic explants. Proliferation studies showed that FAS is not implicated in regulating HIEC growth. These findings suggest that, despite the fact that normal human enterocytes express FAS, costimulatory factors, such as TNFalpha or IFNgamma, abundantly secreted under inflammatory conditions, are necessary to sensitize intestinal epithelial cells to FAS-induced apoptosis by upregulating this receptor.

N-acetylcysteine in pig liver transplantation from non-heart-beating donors

Lipid peroxidation due to oxygen free radicals (OFR) seems to play a major role in loss of liver graft viability after warm ischemia, preservation, and transplantation. N-acetylcysteine (NAC) is an antioxidant that has a direct effect on OFR, and is also a glutathione precursor, another antioxidant. This study was designed to evaluate the efficacy of NAC in preventing ischemia-reperfusion damage of liver grafts harvested from non-heart-beating donors. Liver transplantation was performed on pigs divided into five groups: group 1 (control group; n=5) received livers from heart-beating donors; livers were subjected to 30 min of warm ischemia in groups 2 (n=3, no NAC) and group 3 (n=3; NAC treatment); warm ischemia time lasted 60 min in groups 4 (n=4; no NAC) and 5 (n=5; NAC treatment). Studied parameters included graft survival for more than 3 days, aspartate aminotransferase plasma levels, liver histology, and hepatic total glutathione concentrations. Graft survival was 100% in groups 1, 2, and 3, 0% in group 4, and 20% in group 5. NAC treatment did not influence initial mean aspartate aminotransferase release which was greater in warm ischemic livers than in controls. NAC treatment had no effect on liver hepatic total glutathione after reperfusion of animals receiving warm ischemic grants. Finally, no effect on liver histology was observed with NAC treatment. Our study suggests that in liver transplantation from non-heart-beating donors, NAC has no effect in both graft viability and lipid peroxidation. The role of OFR in primary dysfunction of transplanted warm ischemic livers remains controversial.

Effects of hypothermosol, an experimental acellular solution for tissue preservation and cardiopulmonary bypass, on isolated newborn lamb coronary vessels subjected to ultra profound hypothermia and anoxia

Ultra profound hypothermia (4 to 10 degrees C) is an experimental method aiming at safely prolonging organ and total body preservation. For this purpose, Hypothermosol (HTS), an investigational acellular solution for blood substitution, was demonstrated to be beneficial in animal models undergoing cardiopulmonary bypass. We investigated the beneficial versus deleterious effects of cold preservation and the role of HTS on isolated coronary arteries (CA) during cold exposure, rewarming, and post-rewarming exposure to anoxia. Newborn lamb CA rings were studied using a tissue bath technique. CA were subjected to cold (7 degrees C for 3 h) and treated with either Krebs' buffer (Krebs/hypothermia) or HTS (HTS/hypothermia) (n = 15 each). A third group maintained at 37 degrees C (Krebs/normothermia) (n = 18) served as a time control. After rewarming (37 degrees C), precontracted CA were exposed to anoxia. In Krebs/hypothermia a substantial hypercontraction (g) occurred during rewarming (1.21+/-0.07) (mean +/- SEM) but not in HTS/hypothermia (0.79+/-0.03); P<0.05. Precontraction force generated by indomethacin/U46619 was identical in all three groups. However, Krebs/hypothermia vessels demonstrated a significantly higher relative vasoconstriction (percentage) in the early (approximately 10 min) and late (30 min) anoxia exposure than the HTS/hypothermia and time control (119.5%+/- 3.7 vs. 109.5%+/-4.4 and 101.5%+/-3, and 71%+/-7.6 vs. 38.9%+/-7 and 51.5%+/-5.9, respectively; P<0.05). In conclusion, Ultra profound hypothermia promotes coronary vasoconstriction upon rewarming, which is detrimental to relaxant response to hypoxia. Both phenomena are alleviated by performing ultra profound hypothermia under HTS protection.

Lack of association between renal cell carcinoma and non-Hodgkin's lymphoma

OBJECTIVES

To determine the incidence of non-Hodgkin's lymphoma (NHL) and renal cell carcinoma (RCC) after a diagnosis of the other malignancy.

METHODS

The 1973 to 1994 Surveillance, Epidemiology, and End Results (SEER) data base was used to determine the age-, sex-, race-, and calendar year-specific incidence rates for each year for RCC and NHL. The expected number of second cancers for each sex, race, and follow-up period (less than 1, 1 to 5, 5 to 10, and 10 or more years) was obtained by multiplying these incidence rates by the age-, sex-, race-, and calendar year-specific number of person-years at risk, with these products summed over the different age groups and calendar years. The standardized incidence ratio (SIR) was calculated (observed/expected number of second cancers), with statistical significance determined using the Poisson test.

RESULTS

From 1973 to 1994, 32,293 individuals in the SEER data base were diagnosed with RCC and 63,997 with NHL. NHL was diagnosed after RCC in 67 cases versus 59.8 expected (SIR 1.12, P = 0.19) and RCC after NHL in 96 cases versus 56.1 expected (SIR 1.71, P <0.0001). Only white males and females had a significantly increased risk of RCC after NHL, which was limited to the first year of follow-up. Excluding the first year of follow-up, NHL was diagnosed after RCC in 54 cases versus 49.3 expected (SIR 1.10, P = 0.27) and RCC after NHL in 54 cases versus 45.1 expected (SIR 1.20, P = 0.11).

CONCLUSIONS

When the first year of follow-up is excluded, there is no increased risk of NHL after RCC or vice versa.

Prevalence of HNPCC in a series of consecutive patients on the first endoscopic diagnosis of colorectal cancer: a multicenter study. The Italian Collaborative Group

BACKGROUND AND STUDY AIMS

It is difficult to measure the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in geographical areas that do not have tumor registers, as is the case in the present study, and it was therefore decided to assess the prevalence in Italy using different methods.

PATIENTS AND METHODS

The pedigree was established for 485 of 501 colorectal cancer patients diagnosed with colorectal carcinomas. Patients were included consecutively in 13 gastroenterology centers; they had not taken part in prevention examinations. Information was collected regarding the neoplastic pathology observed in the families, confirmed in 90% of cases among 3515 first-degree relatives and in 79.5% of cases among 7068 second-degree relatives.

RESULTS

In the 3515 first-degree relatives (1002 parents, 1560 siblings and 953 children), 61 colorectal carcinomas, 29 carcinomas in the digestive tract outside the colon, and 99 carcinomas in other locations were reported. Only five of the 485 patients (1%) satisfied the Amsterdam criteria (three cancers, two of which were in first-degree relatives in different generations and one in a relative younger than 50). When broadening the criteria that we are proposing (satisfying only two of the three Amsterdam criteria), the prevalence would increase to 3% (15 cases).

CONCLUSIONS

Modifying the criteria makes it easier to identify new mutations or confirm the existence of those already known, as well as allowing preventative treatment in relatives who are apparently healthy.

[Heart catheterization via the femoral artery with a 4 French and mobilization at 2 hours]

The use of small catheters for cardiac catheterization, as well as for other diagnostic and interventional procedures, can reduce iatrogenic trauma on cardiac and vascular structures. Early patient mobilization may thus reduce both patient discomfort and the length and cost of stays. The performance of 4 French catheters was evaluated in a pilot cohort of consecutive in patients who underwent coronary arteriography with the use of the femoral Judkins technique and who had no restriction to full ambulation. Patients were helped to resume full ambulation two hours after the procedure, and the femoral access site was inspected 24 hours later upon discharge. Coronary arteriography with 4 French catheters was performed in 45 patients (10 women) aged 62 +/- 10 years. In one patient with anomalous origin of the right coronary artery, selective catheterization of the coronary ostium required a catheter style available only in 5 French. In all cases, selective opacification with 4 French catheters was adequate for diagnosis. Forty-three patients were mobilized 115 +/- 10 minutes after the end of manual compression. Hematoma, bleeding or limb perfusion disturbances were absent in all cases upon inspection 22 +/- 4 hours later. This pilot experience indicates that coronary arteriography with femoral 4 French Judkins catheters is technically feasible and that patient ambulation 2 hours later is safe. This data requires confirmation in a larger patient cohort and can lead to new standards for both patient comfort and the use of hospital resources in coronary arteriography.

Solitary nodular disease and multinodular goiter: a retrospective study on suppressive versus replacement levothyroxine therapy

The aim of the present study was to ascertain whether patients affected by solitary nodular disease of the thyroid or multinodular goiter had a different clinical outcome when treated with suppressive levo-thyroxine (L-T4) therapy rather than replacement L-T4 therapy. We evaluated, by a retrospective analysis, 36 patients who had received TSH-suppressive L-T4 therapy according to TSH value and 55 who had received replacement L-T4 therapy. Fine needle aspiration cytology and thyroid scan after 131I were evaluated before L-T4 administration, while echographic monitoring of number and dimensions of nodules was recorded prior to and during L-T4 treatment. No difference in duration of L-T4 treatment (about 3 years) was registered between the TSH-suppressive therapy group and replacement therapy group. L-T4 administration in a TSH-suppressive or replacement manner did not induce a numerical or volumetric significant decrease of the main nodule or of the total nodule volume. Our data show that chronic TSH-suppressive therapy does not seem to be better than replacement therapy. Moreover, TSH-suppressive therapy presented a higher risk of adverse events than replacement therapy, thus requiring a more careful check with a higher cost of care.