Feasibility of C-arm-supported CT fluoroscopy in percutaneous abscess drainage procedures

PURPOSE

Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures.

METHODS

Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed.

RESULTS

When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 +/- 3.7 min versus 14.8 +/- 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test).

CONCLUSION

Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.

Xylem conduits of a resurrection plant contain a unique lipid lining and refill following a distinct pattern after desiccation

The axial and radial refilling with water of cut dry branches (up to 80 cm tall) of the resurrection plant Myrothamnus flabellifolia was studied in both acro- and basipetal directions by using 1H-NMR imaging. NMR measurements showed that the conducting elements were not filled simultaneously. Axial water ascent occurred initially only in a cluster of a very few conducting elements. Refilling of the other conducting elements and of the living cells was mainly achieved by radial extraction of water from these initial conducting elements. With time, xylem elements in a few further regions were apparently refilled axially. Radial water spread through the tissue occurred almost linearly with time, but much faster in the acropetal than in the basipetal direction. Application of hydrostatic pressure (up to 16 kPa) produced similar temporal and spatial radial refilling patterns, except that more conducting elements were refilled axially during the first phase of water rise. The addition of raffinose to the water considerably reduced axial and radial spreading rates. The polarity of water climbing was supported by measurements of the water rise in dry branches using the 'light refraction'(and, sometimes, the 'leaf recurving') method. Basipetal refilling of the xylem conduit exhibited biphasic kinetics; the final rise height did not exceed 20-30 cm. Three-cm-long branch pieces also showed a directionality of water climbing, ruling out the possibility that changes in the conducting area from the base to the apex of the branches were responsible for this effect. The polarity of water ascent was independent of gravity and also did not change when the ambient temperature was raised to c. 40 degrees C. At external pressures of 50-100 kPa the polarity disappeared, with basipetal and acropetal refill times of the xylem conduit of tall branches becoming comparable. Refilling of branches dried horizontally (with a clinostat) or inverted (in the direction of gravity) showed a pronounced reduction of the acropetal water rise to or below basipetal water climbing level (which was unaffected by this treatment). Unlike water, benzene and acetone climbing showed no polarity. In the case of benzene, the rise kinetics (including the final heights) were comparable with those measured acropetally for water, whereas with acetone the rise height was less. Transmission electron microscopy of dry branches demonstrated that the inner surfaces of the conducting tracheids and vessels were lined with a continuous osmiophilic (lipid) layer, as postulated by the kinetic analysis and light microscopy studies. The thickness of the layer varied between 20 and 80 nm. The parenchymal and intervessel pits as well as numerous tracheid corners contained opaque inclusions, presumably also consisting of lipids. Electron microscopy of rehydrated plants showed that the lipid layer was either thinned or had disintegrated and that numerous vesicle-like structures and lipid bodies were formed (together with various intermediate structural elements). These, many other data and the physical-chemical literature imply that several (radial) driving forces (such as capillary condensation, Marangoni forces, capillary, osmotic and turgor pressure forces) operate when a few conducting elements become axially refilled with water. These forces apparently lead to an avalanche-like radial refilling of most of the conducting elements and living cells, and thus to the removal of the 'internal cuticle' and of the hydrophobic inclusions in the pits. The polarity of water movement presumably results from high resistances in the basipetal direction, which are created by local gradients in the thickness of the lipid film as a result of draining under gravity in response to drought. There are striking similarities in morphology and function between the xylem-lining lipid film and the lung surfactant film lining the pulmonary air spaces of mammals.

Inhibitory control of synaptic activity in goldfish Mb bipolar cell terminals visualized by FM1-43

To investigate the physiology and plasticity of mixed rod-cone ON-bipolar cells (Mb) in the goldfish retina, we established a slice preparation which allows us to optically monitor the synaptic activity of bipolar cell axon terminals. We used the styryl dye FM1-43 which is incorporated into active axon terminals due to synaptic vesicle cycling and thus reflects synaptic activity. Different activity states of the axon terminals were revealed when slices prepared from light-adapted retinae were incubated in the presence of FM1-43 under various conditions. Depolarizing high K+ Ringer (50 mM) and the gamma-butyric acid (GABA) antagonist bicuculline (100 microM) resulted in more than two-fold increase in the number of stained terminals compared to slices stained in normal Ringer. In contrast, GABA treatment (0.5 mM) reduced the frequency of stained terminals. Thus, in light-adapted retinal slices the synaptic activity of Mb axon terminals can be modulated towards higher and lower activity states. The fact that the GABA antagonist bicuculline had similar effects as stimulatory high K+ Ringer suggests that inhibitory control is an important component in the regulation of synaptic activity and transmitter release in Mb terminals.

Effects of long-term spectral deprivation on the morphological organization of the outer retina of the blue acara (Aequidens pulcher)

To investigate the developmental plasticity of colour vision, we reared fish with a trichromatic cone system (Aequidens pulcher) under three near-monochromatic lights, differentially stimulating each spectral cone type from the larval stage to the age of at least one year. Control conditions comprised white lights of two intensities. The treatments did not affect the visual pigments, hut led to significant changes in cone outer segment lengths. Furthermore, in the blue-reared group the density of single cones within the retina was reduced by two-thirds after 18 months of exposure, while no changes were observed in the other groups. The connectivity of cone horizontal cells with the single cones was influenced by the intensity and spectral composition of the rearing lights: H1 cells were more sensitive to the spectral component, whereas H2 cells responded to intensity cues. In the blue-light group the dynamics of horizontal cell synaptic spinule formation and degradation were severely compromised. These observations show that long-term spectral deprivation leads to significant morphological changes at the level of photoreceptors and horizontal cells. While the reactions of photoreceptors may be interpreted mostly in terms of compensation, the functional consequences of the changes observed on the horizontal cell level remain to be determined electrophysiologically.

Foveate vision in deep-sea teleosts: a comparison of primary visual and olfactory inputs

The relative importance of vision in a foveate group of alepocephalid teleosts is examined in the context of a deep-sea habitat beyond the penetration limits of sunlight. The large eyes of Conocara spp. possess deep convexiclivate foveae lined with Müller cells comprising radial shafts of intermediate filaments and horizontal processes. Photoreceptor cell (171.8 x 10(3) rods mm(-2)) and retinal ganglion cell (11.9 x 10(3) cells mm(-2)) densities peak within the foveal clivus and the perifloveal slopes, respectively, with a centro-peripheral gradient between 3:1 (photoreceptors) and over 20:1 (ganglion cells). The marked increase in retinal sampling localized in temporal retina, coupled with a high summation ratio (13:1), suggest that foveal vision optimizes both spatial resolving power and sensitivity in the binocular frontal visual field. The elongated optic nerve head is comprised of over 500 optic papillae, which join at the embryonic fissure to form a thin nervous sheet behind the eye. The optic nerve is divided into two axonal bundles; one receiving input from the fovea (only unmyelinated axons) and the other from non-specialized retinal regions (25% of axons are myelinated), both of which appear to be separated as they reach the visual centres of the central nervous system. Comparison of the number of primary (first-order) axonal pathways for the visual (a total of 63.4 x 10(6) rod photoreceptors) and olfactory (a total of 15.24 x 10(3) olfactory nerve axons) inputs shows a marked visual bias (ratio of 41:1). Coupled with the relative size of the optic tecta (44.0 mm3) and olfactory bulbs (0.9 mm3), vision appears to play a major role in the survival of these deep-sea teleosts and emphasizes that ecological and behavioural strategies account for significant variation in sensory brain structure.

The primary and memory immune response to Epstein-Barr virus infection in vitro is characterized by a divergent production of IL-1beta/IL-6 and IL-10

Reactivation of latent Epstein-Barr virus (EBV) infection is considered to exert substantial immunomodulating activities. Little is known about EBV's modulating activities on cytokine production upon primary, in contrast to reactivated, infection. Therefore, we investigated the cytokine production of latently infected EBV-positive (EBV-pos) adults upon in vitro EBV stimulation compared to nonimmune age-matched EBV-negative (EBV-neg) donors. Production of interleukin (IL)-1beta and IL-6 was strongly decreased in peripheral blood mononuclear cell (PBMC) cultures of EBV-pos adults; in contrast, IL-10 and IL-1 receptor antagonist exhibited significantly higher levels. As expected, interferon (IFN)-gamma production was almost exclusively observed in EBV-pos donors; it was accompanied by a significantly higher IL-12 synthesis. Experiments employing T cell-depleted PBMC showed similar cytokine levels between EBV-pos and EBV-neg individuals suggesting that reactivation of EBV-specific memory T cells was responsible for the divergent cytokine profiles. Production of viral IL-10 was excluded as a reason for higher IL-10 levels in EBV-pos individuals. In conclusion, our results do not appear to relate to any primary immunological differences between EBV-neg and EBV-pos adults, but show that the EBV-specific memory response to latent EBV infection is characterized by some anti-inflammatory effects. This might be of relevance upon reactivation of latent EBV infection in vivo and provides further evidence that EBV infection acts in an immunomodulating fashion.

Magnetic resonance colonography and virtual magnetic resonance colonoscopy with the 1.0-T system: a feasibility study

RATIONALE AND OBJECTIVES

An ex vivo study and a clinical, prospective, patient study were undertaken to evaluate the feasibility of magnetic resonance (MR) colonography with a 1.0-T system.

METHODS

An ex vivo colon model was scanned. A cleaned pig colon was prepared with six simulated sessile polyps (diameters of 4-12 mm) and one simulated pedunculated polyp (diameter of 5 mm). Subsequently, five patients (aged 39-81 years; four women, one man) were examined with MR colonography, immediately followed by endoscopic colonoscopy. After preparation for colonoscopy, the colon was filled with a Gd-DTPA/water solution (1:100). A breath-hold 3D gradient-echo sequence was acquired in both the prone and supine positions and after intravenous Gd-DTPA administration. Images were analyzed interactively by using multiplanar projections, maximum-intensity projection, and a virtual endoscopic view. The MR results were compared with the findings of the fiberoptic endoscopy.

RESULTS

All seven simulated lesions of the colon model could be detected by MR imaging. In one patient, an advanced colon cancer as well as an additional small polyp was depicted. In the other four patients, single polyps with a diameter of 1 to 2.5 cm and a large adenoma were visualized by MR colonography. Contrast enhancement of the polyps was noted only after subtraction.

CONCLUSIONS

The 1.0-T system is feasible for MR colonography. Reduced requirements for hardware could contribute to establish the novel technique as a screening method for colorectal polyps.

Are covered stents really effective at closing esophagotracheal fistulas? Results of an animal study

PURPOSE

To determine whether covered self-expanding metal stents successfully exclude experimentally created esophagotracheal fistulas.

METHODS

Esophagotracheal fistulas were surgically created in the upper third of the esophagus in 12 minipigs and immediately sealed by implantation of a covered self-expanding metal stent (20 mm expanded diameter) in the esophagus. Before the animals were killed, after 3, 7, 14, 28, 30, and 36 days, the position of the stent and the sealing of the fistula were monitored fluoroscopically. The esophagus, trachea, and both lungs were examined histologically.

RESULTS

Creation of an esophagotracheal fistula was successful in all cases. All fistulas were widely patent at autopsy. The technical success rate for stent deployment and initial sealing of the fistula was 100%. During follow-up, five stents migrated distally, but none into the stomach. Therefore, the fistula was no longer excluded in five animals. In seven animals the stent sealed the fistula until the death of the animal. Tracheal narrowing necessitated additional tracheal stenting in three animals. Two minipigs died due to aspiration of food. Histologic examination showed signs of aspiration in all animals with stents in place for longer than 2 weeks.

CONCLUSION

This experimental animal study revealed worse results for sealing of esophagotracheal fistulas with covered self-expanding metal stents than have been reported for the clinical use of these devices.

Real-time polymerase chain reaction (RQ-PCR) for the monitoring of Epstein-Barr virus (EBV) load in peripheral blood mononuclear cells

Measurement of Epstein-Barr virus (EBV) load is useful in peripheral blood for detecting primary and reactivated EBV-infections especially in immunosuppressed patients being at high risk for developing posttransplant lymphoproliferative disorder. For quantification of EBV DNA in peripheral blood of patients two real time polymerase chain reaction (RQ-PCR) assays were developed detecting sequences specific for the BAM HI-W and BAM HI-K region of EBV. In order to determine the optimal material of peripheral blood for RQ PCR analysis, DNA preparations of whole blood, peripheral blood mononuclear cells (PBMC) and B cells from 11 healthy, EBV-seropositive individuals were analysed in parallel and compared with regard to efficiency and sensitivity. While in whole blood preparations inhibitors of RQ PCR were detected influencing sensitivity, analysis of B cells being most sensitive is limited by being too labour intensive. In contrast, analysis of DNA preparations of PBMCs is sensitive enough to frequently detect EBV-specific sequences in all individuals tested and the preparation of PBMCs itself needs only a reasonable time. Thus, longitudinal monitoring of EBV load in peripheral blood of patients is possible by RQ-PCR, the optimal material for analysis being PBMCs.

Agonist-induced cytoplasmic volume changes in cultured rabbit parietal cells

Concomitant Na(+)/H(+) and Cl(-)/HCO(3)(-) exchange activation occurs during stimulation of acid secretion in cultured rabbit parietal cells, possibly related to a necessity for volume regulation during the secretory process. We investigated whether cytoplasmic volume changes occur during secretagogue stimulation of cultured rabbit parietal cells. Cells were loaded with the fluorescent dye calcein, and the calcein concentration within a defined cytoplasmic volume was recorded by confocal microscopy. Forskolin at 10(-5) M, carbachol at 10(-4) M, and hyperosmolarity (400 mosmol) resulted in a rapid increase in the cytoplasmic dye concentration by 21 +/- 6, 9 +/- 4, and 23 +/- 5%, respectively, indicative of cell shrinkage, followed by recovery to baseline within several minutes, indicative of regulatory volume increase (RVI). Depolarization by 5 mM barium resulted in a decrease of the cytoplasmic dye concentration by 10 +/- 2%, indicative of cell swelling, with recovery within 15 min, and completely prevented forskolin- or carbachol-induced cytoplasmic shrinkage. Na(+)/H(+) exchange inhibitors slightly reduced the initial cell shrinkage and significantly slowed the RVI, whereas 100 microM bumetanide had no significant effect on either parameter. We conclude that acid secretagoguges induce a rapid loss of parietal cell cytoplasmic volume, followed by RVI, which is predominantly mediated by Na(+)/H(+) and Cl(-)/HCO(3)(-) exchange.

Mid-term follow-up after percutaneous hydrodynamic thrombectomy in lower limb ischemia: initial experience with two-dimensional MR imaging and three-dimensional MR angiography

PURPOSE

To assess noninvasively mid-term patency, reocclusion, and mid-term changes of the arterial wall after percutaneous hydrodynamic thrombectomy in patients with acute lower limb ischemia using magnetic resonance (MR) imaging/MR angiography (MRA).

MATERIALS AND METHODS

Arterial wall and luminal changes were evaluated in 16 patients (10 men, six women; mean age, 70 years), with a minimum follow-up of 12 months after percutaneous thrombectomy with a hydrodynamic catheter for acute lower limb ischemia (embolic, n = 5; thrombotic, n = 11). Adjunctive PTA was performed in 44%. The mean follow-up was 23 months +/- 7.6 (range, 12-33 months). MR imaging and MRA were performed on a 1.0 T system using an extremity coil and two-dimensional (2D) time-of-flight, turbo spin echo, 2D gradient echo, and contrast enhanced three-dimensional (3D) gradient echo sequences.

RESULTS

In one patient, a complete reocclusion was noted and, in two patients, a hemodynamically insignificant restenosis (< or = 50%) was identified with MR imaging. This was in accordance with color flow duplex sonography, physical examination, ankle/brachial index measurements, and the treadmill test. The MR morphometry documented an increase of the entire vessel area from 48.9 mm2 +/- 3.3 (control segments) to 55.5 mm2 +/- 2.8 at the treated segments (+13.3%; P < .05). The vessel wall area increased from 31.7 mm2 +/- 1.8 to 39.4 mm2 +/- 2.3 (+24.4%; P < .05). The mean area stenosis grade was 12%.

CONCLUSION

MR imaging with use of morphometric analysis is a possible tool to noninvasively determine the mid-term patency and restenosis/reocclusion and remodeling process after percutaneous thrombectomy and other interventional procedures.

Epstein-Barr virus-associated post-transplant lymphoproliferative disease after bone marrow transplantation mimicking graft-versus-host disease

In contrast to solid organ transplantation (Tx), the incidence of post-transplant lymphoproliferative disease (PTLD) after hematopoietic stem cell Tx (HSCT) is generally low. This risk, however, is significantly elevated in patients receiving human leukocyte antigen (HLA) mis-matched or T-cell-depleted grafts, or after treatment for severe graft-versus-host disease (GvHD). An 18-yr-old patient with positive Epstein-Barr virus (EBV) serology received a fully matched, unmanipulated bone marrow graft from an unrelated EBV-positive donor for treatment of acute myeloid leukemia (AML) in second complete remission. GvHD prophylaxis was performed with cyclosporin A (CsA) and a short course of methotrexate. Four months after Tx, the patient developed ulcerative tonsillitis that was unresponsive to antibiotic treatment. Diarrhea appearing simultaneously was interpreted as gastrointestinal GvHD and steroids were added to CsA. A few days later the patient was admitted to hospital because of generalized seizure and pneumonia. Despite reduction of immunosuppression, intensification of anti-viral treatment, and subsequent mechanical ventilation, the patient died of acute respiratory distress 6 days later. Autopsy demonstrated disseminated EBV-induced, multi-nodular lymphoma infiltration of the entire colon but no signs of GvHD. Moreover, both lungs, paratracheal lymph nodes, kidneys, thyroid gland, and liver were infiltrated with large B-cell non-Hodgkin's lymphomas. This case underlines the rapid and aggressive course of EBV-induced disseminated PTLD after HSCT, initially mimicking intestinal GvHD because of massive colonic lymphoma infiltration. Tissue biopsies should be performed early for establishing correct diagnosis, thus enabling specific therapy, e.g. infusion of donor leukocytes with cytotoxic T-lymphocytes.

Prospective comparison of magnetic resonance sialography and digital subtraction sialography

We sought to compare the diagnostic utility of magnetic resonance sialography (MRS) and digital subtraction sialography (DSS) in patients with suspected sialolithiasis or sialadenitis. Sixteen consecutive patients (4 female and 12 male, mean age 51+/-16 years) with suspected sialolithiasis or sialadenitis underwent DSS by a standard technique and MRS. MRS was obtained with a T2-weighted single-shot TSE sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds) using a quadrature head (n = 16) and a surface coil (n = 8). Nineteen symptomatic glands were investigated with DSS: eight submandibular glands in 6 patients (two bilateral) and unilateral parotid glands in 11 patients. MRS was always carried out to visualize gland ducts bilaterally. The ductal system was visualized in all glands examined by MRS. DSS depicted the ductal system in all 11 parotid glands, but only 4 of the 8 submandibular glands (50%). Sialolithiasis was diagnosed in three cases (one parotid, two submandibular glands) by MRS and in two cases by DSS. DSS demonstrated tertiary branching ducts and MRS secondary branching ducts. MRS is able to visualize the ductal system of the parotid and submandibular gland noninvasively and is thus not dependent on successful cannulation of the orifice of the ductal system. Our preliminary data indicate that MRS is useful for diagnosing sialolithiasis. MRS allows diagnosis of sialadenitic changes, but DSS achieves a better diagnostic performance due to higher spatial resolution.

Comparison of C-arm CT fluoroscopy and conventional fluoroscopy for percutaneous biliary drainage procedures

PURPOSE

To conduct a prospective randomized evaluation of C-arm computed tomography (CT) fluoroscopy for external biliary drainage procedures in comparison with conventional fluoroscopic guidance to reduce the number of transhepatic punctures as a primary endpoint.

MATERIALS AND METHODS

In 18 patients with biliary obstructions, 20 external percutaneous biliary drainage procedures were prospectively performed with use of either C-arm CT fluoroscopy or conventional fluoroscopy alone. The number of hepatic punctures, procedure time, and fluoroscopy time, were analyzed separately for both methods.

RESULTS

C-arm CT fluoroscopy resulted in a reduced number of transhepatic punctures, with decreased procedure and fluoroscopy times (P < .05; t test). When compared with conventional external biliary drainage procedures, a mean of 1.8+/-1 versus 4.8+/-2.8 hepatic punctures at a fluoroscopy time of 3.4+/-1.5 versus 11.4+/-7.4 minutes was required for C-arm CT fluoroscopy, while procedure times were 11+/-3.6 versus 16.2+/-9.3 minutes.

CONCLUSIONS

C-arm CT fluoroscopy is associated with decreased procedure and fluoroscopy times, while fewer transhepatic punctures are required to establish external biliary drainage.

Effect of melatonin agonists and antagonists on horizontal cell spinule formation and dopamine release in a fish retina

The crucian carp retina was used to study the effects of the melatonin antagonist p697 (N-pentanoyl 2-benzyltryptamine) and the melatonin agonists [+]- and [-]-AMMTC (N-acetyl-4-aminomethyl-6-methoxy-9-methyl-1,2,3,4-tetrahydrocarbazol e) on horizontal cell spinule formation, an indicator of the state of retinal adaptation. DH97 was capable of both counteracting dark-adaptive spinule degradation and inducing light-adaptive spinule formation at the beginning of the dark phase. Addition of dopamine receptor blockers opposed the action of DH97 on spinules, with SCH 23930, a D1 dopamine receptor antagonist, being more effective than the D2 receptor antagonist sulpiride. DH97 induced a twofold increase in dopamine release. We conclude that melatonin acts as a dark signal within the teleost retina by inhibiting the dopaminergic system. In accordance with this, both enantiomers of AMMTC prevented light-induced spinule formation, and reduced dopamine release to below dark-adaptive baseline levels. We suggest that the suppression of spinule formation by AMMTC may be due to either a direct inhibitory interaction between the melatonin agonist and horizontal cell dopamine D1 receptors, or an inhibitory effect on the activity of the dopamine-releasing interplexiform cells.

Rheolytic hydrodynamic thrombectomy for percutaneous treatment of acutely occluded infra-aortic native arteries and bypass grafts: midterm follow-up results

RATIONALE AND OBJECTIVES

To evaluate the efficacy of a rheolytic thrombectomy catheter (RTC) for treatment of acutely occluded infra-aortic native arteries and bypass grafts and to determine midterm primary patency, death, and amputation-free survival rates.

METHODS

From March 1995 to September 1997, 112 patients with occluded arteries or bypass grafts were primarily treated with RTC at two centers. Thrombus removal was evaluated by two angiographers.

RESULTS

More than 75% of the thromboembolic material could be removed with RTC alone. Mean activation time of RTC was 280 +/- 163 seconds. Residual mural or organized thrombi (29%) required adjunctive fibrinolytic therapy or aspiration thrombectomy. Remaining stenoses were treated with percutaneous transluminal angioplasty and additional stent implantation. For acute reocclusions, surgical intervention was required. Technical success after the entire procedure was 88.4%. RTC-associated complications included distal embolization, dissection, vessel perforation, and technical failure of RTC. Mean follow-up time was 14.8 months +/- 11.5, rates of primary patency, secondary patency, death, and amputation-free survival were 60%, 84%, 16%, and 75% after 2 years, respectively.

CONCLUSIONS

RTC is a rapid and efficient technique for mechanical thrombectomy of acutely thrombosed native leg arteries and bypass grafts. Midterm results are comparable to the results of alternative treatment modalities such as Fogarty balloon thromboembolectomy or local fibrinolysis.

[Expert-assessment of suitability for a driving license in otorhinolaryngology]

An absolute requirement for acquiring a driving license according to German law consists in the suitability for driving a motor vehicle. The "driving license decree" defines these requirements; in case of doubt the administrative authority may demand a medical certificate. According to law (enactment: 1.1.99) these medical certificates must be refunded by either appropriate medical specialists, company doctors or public health officers. The criterions for appraisal are set down in the guidelines for driving ability which are edited by the advisory board for traffic medicine; a new edition will be published soon. Concerning otorhinolaryngology hearing impairment and dizziness are the most relevant diseases. Bilateral deafness is no general exception for conferring a driving license for the classes A and B; for classes C and DE hearing loss, established from the pure tone audiogram must not exceed 60%; an exceptional case is a three year demonstration of reliability in class B. Permanent dizziness or vertigo attacks are in most cases incompatible with conferring driving licenses. The most important issue for medical appraisal is to determine the amount of compensation of the impaired sense organ. Therefore in cases of multiple disabilities more stringent criterions must be established.

[Angiography detection of closed palmar arcs]

PURPOSE

Angiographic evaluation of the prevalence of an anastomosis between the superficial and deep palmer arcs in our patients.

MATERIALS AND METHODS

Between January 1st 1991 and December 31st 1997, all selectively performed angiographies of the upper extremities were evaluated retrospectively with special focus on an anastomosis between the superficial palmer arc (SPA) and the deep palmer arc (DPA). The indications for performing a selective angiography of the upper extremity were presurgical planning of a skin/muscle transplantation (n = 42), creation of a hemodialysis fistula (n = 4) and evaluation of vascular diseases such as vasculitis (n = 9), peripheral occlusive disease (n = 3) and M. Winiwarter-Buerger (n = 8).

RESULTS

66 selective angiographies of the palm of 60 patients (39 male, 21 female, mean age 52 years old) could be used for evaluation. Angiographies of both hands were performed in 6 patients. Closed superficial palmar arcs and closed deep palmar arcs were detected in 31.8% and 84.8% of the patients, respectively.

CONCLUSIONS

The rates of anastomosed superficial and deep palmar arcs in our study are comparable with those of former angiographic investigations, but they are considerably lower than the rates based on anatomical or sonographical studies. Reasons for the discrepancy are discussed.

Immunolocalization of protein kinase C isoenzymes alpha, beta1 and betaII in rat kidney

Protein kinase C (PKC) significantly contributes to the control of renal function, but little is known about the renal function or localization of PKC isoenzymes. Therefore, the localization of PKC isoenzymes alpha, betaI, and betaII was studied in rat kidney. Immunoblot analysis identified immunoreactive bands corresponding to PKC a, betaI, and betaII in total cell extracts of both renal cortex and medulla. Immunohistochemistry using confocal laser scanning microscopy revealed immunostaining for PKC alpha within the glomerulus including podocytes and mesangial cells. PKC betaI was detected in mesangial cells, whereas anti-PKC betaII labeled neither podocytes nor mesangial cells. PKC betaII, however, was detected in cells within the mesangial area, which expressed MHC II, a marker for antigen-presenting cells. None of the three isoforms was detected in glomerular endothelial cells. A prominent immunostaining with anti-PKC alpha and betaI was localized to the brush border of S2 and S3 segments of proximal tubule, whereas S 1 segments were not stained. Along the loop of Henle, both PKC a and PKC betaI were found in the luminal membrane of cortical and medullary thick ascending limb. In addition, anti-PKC betaI labeled the luminal membrane of thin limbs. In the cortical collecting duct (CCD), immunofluorescence for PKC alpha was observed at the apical membrane of both peanut agglutinin (PNA)-negative cells and part of PNA-positive cells, whereas in the medullary collecting duct (MCD), PKC a was detected at the basolateral membrane. In comparison, PKC betaI was localized at the luminal membrane of PNA-positive cells only in CCD and at the luminal membrane of MCD. Unlike PKC a or betaI, there was (1) no detectable immunostaining with anti-PKC betaII in the proximal tubule, the loop of Henle, or the CCD and (2) a distinct staining for PKC betaII of interstitial cells in cortex and medulla (including MHC II-positive dendritic cells). Furthermore, PKC betaII was detected in the luminal membrane of MCD. In summary, a distinct and differential expression pattern for PKC alpha, betaI, and betaII was shown in rat kidney, which may contribute to a better understanding of the specific role of these isoenzymes in the control of renal function.

Morphological changes in the retina of Aequidens pulcher (Cichlidae) after rearing in monochromatic light

We investigate the processing of chromatic information in the outer retina of a cichlid fish, Aequidens pulcher. The colour opponent response characteristics of some classes of cone-specific horizontal cells in the fish retina are the result of feedforward-feedback loops with cone photoreceptors. To interfere with the reciprocal transmissions of signals, animals were reared in monochromatic lights which preferentially stimulated the spectrally different cone types. Here we report the effects on the cones. Their absorbance spectra were largely unaffected, indicating no change in photopigment gene expression. Significant changes were observed in the cone outer segment lengths and the frequencies of spectral cone types. Quantum catch efficiency and survival of cones appear to be controlled in a spectrally selective way. Our results suggest that the retina responds to spectral deprivation in a compensatory fashion aimed at balancing the input from the different cone types to second order neurons.

Analysis of Epstein-Barr virus (EBV) receptor CD21 on peripheral B lymphocytes of long-term EBV- adults

Primary infections with EBV are rarely observed after the age of 20. Some individuals even remain seronegative all their lives. Previously, a lack of EBV receptors on B cells of persistently EBV- adults was described as a reason for long-term EBV-seronegativity. The present study examined the CD21 receptor status of 20 repeatedly EBV- healthy adults and 32 EBV+ volunteers by means of flow cytometry. CD21 molecules on the surface of CD19+ B cells were quantified using anti-IgG-coated microbeads. The percentage of CD19+/CD21+ B lymphocytes was slightly lower in the peripheral blood of EBV- donors, but the CD21 antibody binding capacity on CD19+ B cells showed no significant differences between EBV- and EBV+ adults. In vitro studies showed an equally good EBV transformability of peripheral B lymphocytes of EBV- and EBV+ donors. Since HLA-DR was recently described as a co-receptor for EBV infection of B cells, we also determined HLA-DRB1 alleles in the EBV- group. We found a significant negative association of EBV-seronegativity with HLA-DR13 in comparison with 111 healthy blood donors. In summary, a biologically significant lack of the EBV receptor CD21 on peripheral B lymphocytes of persistently EBV- adults was excluded as a reason for long-term EBV-seronegativity.

Effects of retinal dopamine depletion on the growth of the fish eye

We investigated the suitability of fishes as animal models to study the involvement of the retinal dopaminergic system in the visually guided control of eye growth (emmetropization). Advantages of such a model system are (i) that all dopaminergic cells in the retina can be destroyed without apparent damage to other neurons, (ii) simple optical design and short depth of field of the eye, and (iii) continuous growth throughout life. Depleting the retina of dopamine in Aequidens pulcher (Cichlidae) had no apparent effect on refractive state, since size and focal length of the eye were reduced by the same amount. Furthermore, imposed defocus was compensated at a normal rate in spite of the absence of retinal dopamine. In A. pulcher, the dopaminergic system of the retina trus appears not to have an essential role in emmetropization. Our results furthermore suggest that in eyes of more complicated optical design, manipulation of the retinal dopaminergic system may lead to unrelated effects indistinguishable from direct interference with emmetropization. A major disadvantage of the fish model was that refractive state of the eye could not be measured accurately in vivo with standard methods.

Multifocal lenses compensate for chromatic defocus in vertebrate eyes

The focal length of the vertebrate eye is a function of wavelength, i.e. the eye suffers from longitudinal chromatic aberration. Chromatic defocus is a particularly severe problem in eyes with high light-gathering ability, since depth of field is small due to a pupillary opening that is large in relation to the focal length of the eye. Calculations show that in such eyes only a narrow spectral band of light can be in focus on the retina. For the major part of the visual spectrum, spatial resolution should be limited by the optics of the eye and far lower than the resolving power achievable by the retinal cone photoreceptor mosaic. To solve this problem, fishes with irises unresponsive to light have developed lenses with multiple focal lengths. Well-focused images are created at the wavelengths of maximum absorbance of all spectral cone types. Multifocal lenses also appear to be present in some terrestrial species. In eyes with mobile irises, multifocal lenses are correlated with pupil shapes that allow all zones of the lens, with different refractive powers, to participate in the imaging process, irrespective of the state of pupil constriction.

Effects of nitinol Strecker stent placement on vascular response in normal and stenotic porcine iliac arteries

PURPOSE

This experimental study was conducted to evaluate neointimal thickness, lumen diameters, and histologic changes in normal and stenotic porcine iliac arteries following placement of self-expanding nitinol Strecker stents.

MATERIALS AND METHODS

Neointimal trauma causing slight vascular stenosis was induced unilaterally within external iliac arteries of 12 swines by means of endothelial abrasion and high cholesterol diet. Nitinol Strecker stents were placed within the stenotic and the normal contralateral vascular segments. For histopathologic evaluation, the pigs were killed 12 or 24 weeks after stent placement and luminal diamters were evaluated angiographically.

RESULTS

Excluding one occlusion, 15% narrowing of the lumen diameter was induced unilaterally (P = .002). Initial luminal gain after stent placement was greater for stenotic than for normal arteries. The amount of neointima thickness was not different between stenotic and normal vessels (P > .05). Comparing vascular diameters before stent placement and at follow-up, luminal loss due to neointima proliferation was 22% within normal arteries (P = .0002), while a luminal gain by 15% was found within the stenotic arteries (P = .008). Maturation of neointima and endothelial coverage were complete after 24 weeks.

CONCLUSIONS

Even though nitinol Strecker stents induce excessive neointimal proliferation, stenotic arteries seem to profit from great early luminal gain resulting in 15% of vascular expansion at follow-up while slight stenosis is induced within normal iliac arteries.

[Mortality and morbidity conference in radiology]

PURPOSE

To establish a morbidity and mortality conference in a radiology department as an instrument of quality assurance.

METHODS

Since April 1995 a monthly conference is held in the radiology department. Complications of invasive diagnostic procedures (angiography and biopsy) and minimal invasive interventions are presented. Cases of morbidity (major complications) and mortality (deceased patients, who were examined or treated in the radiology department before) are discussed. The identification of cases was possible due to a data base that included all such procedures prospectively.

RESULTS

Twenty cases of major complications were identified and discussed during 18 morbidity and mortality conferences in 1996 and 1997. Out of the 9 patients who died in our hospital and previously had an interventional procedure in the radiology department, one case was identified as being procedure-related. An analysis of this case was performed.

CONCLUSION

With a formalised structure of case detection, the morbidity and mortality conference becomes a tool of a complete analysis of complications and a meaningful instrument for the solution of problems concerning procedure-related complications.

Adaptation-dependent plasticity of rod bipolar cell axon terminal morphology in the rat retina

We chose synaptic terminals of rat rod bipolar cells as a model system to study activity-related changes in the overall morphology and the fine structure of synaptic sites. Using confocal laser scanning microscopy in conjunction with three-dimensional reconstruction and electron microscopy, we examined the effect of light and dark adaptation on axon terminals identified by protein kinase C (PKC) immunoreactivity. Rod bipolar cell axon terminals consisted of 2-3 polymorphic boutons situated close to the ganglion cell layer and a single ovoid swelling located more distally. Both components of the terminal complex showed adaptation-dependent differences in the distribution of PKC immunoreactivity and in their morphology. In light-adapted rod bipolar cell axon terminals, PKC immunoreactivity was homogeneously distributed throughout the cytoplasm, whereas terminals from dark-adapted animals showed PKC immunoreactivity preferentially localised in the submembrane compartment and a reduced staining of the more central cytoplasm. In three-dimensional reconstructions of optical sections and at the ultrastructural level, the shape of light-adapted axon terminals was round and smooth and exhibited more convexly curved synaptic membranes. In contrast, dark-adapted terminals had irregular contours, numerous dimples and a concave synaptic curvature. No spinules of bipolar cell terminals were observed in dark-adapted material. These observations are discussed in the context of activity-related morphological plasticity of central nervous system synapses and of the functions of PKC in the cycle of vesicle fusion and retrieval at the tonically active ribbon synapses of the rod bipolar axon terminal.

[Bacteremia in intra-arterial angiography, percutaneous transluminal angioplasty and percutaneous transhepatic cholangio-drainage]

PURPOSE

Prospective evaluation of the rate of bacteremia attributed to invasive radiological techniques.

METHODS

Aerobic and anerobic blood cultures were obtained in 100 patients (62 men, 38 women; mean age 65 +/- 14 years) undergoing intra-arterial angiography (N = 50), PTA (N = 30) or percutaneous transhepatic biliary drainage (PTCD; N = 20). Samples were taken before the treatment (T0), immediately after puncture of the vessel or bile duct (T2), and 30 min after the termination of the procedure (T3).

RESULTS

The overall rate of bacteremia was 18%. During diagnostic angiography a 16% rate of temporary bacteremia (no positive T3 samples) was observed. During PTA the rate was 27% (no clinically significant infectious disease) and during PTCD the rate was 10% (5% cholangitis with septicemia). We isolated staphylococci (S. epidermidis: N = 7, S. species: N = 3, S. aureus: N = 1), streptococci (N = 2), Propionibacterium acnes (N = 5), E. coli (N = 1), Enterococcus faecium (N = 1), Enterobacter species (N = 1), and Clostridium perfringens (N = 1). Apart from the one patient with cholangitis no clinical infectious complication occurred.

CONCLUSION

Temporary bacteremia is rather frequent during invasive radiological procedures. Strictly aseptic conditions and antibiotic prophylaxis, specially in case of implantation of a permanent foreign body, is warranted.

Pre-eruptive varicella encephalitis: case report and review of the literature

Varicella-related neurological complications usually appear after the rash. Pre-eruptive neurological complications of primary varicella zoster virus infections have been rarely described. We report on a 5.5-year-old boy who developed encephalitis 4 days before the onset of a mild vesicular skin rash and 5 days after known exposure. Primary varicella zoster virus infection was confirmed serologically. Cranial magnetic resonance imaging revealed temporary inflammatory oedema in the right cerebellar peduncle.

CONCLUSION

Neurological complications of varicella may appear up to 2.5 weeks before the onset of the exanthema. Physicians treating patients with ataxia or encephalitis should inquire about exposure to varicella zoster virus.

The eyes of deep-sea fish. II. Functional morphology of the retina

Three different aspects of the morphological organisation of deep-sea fish retinae are reviewed: First, questions of general cell biological relevance are addressed with respect to the development and proliferation patterns of photoreceptors, and problems associated with the growth of multibank retinae, and with outer segment renewal are discussed in situations where there is no direct contact between the retinal pigment epithelium and the tips of rod outer segments. The second part deals with the neural portion of the deep-sea fish retina. Cell densities are greatly reduced, yet neurohistochemistry demonstrates that all major neurotransmitters and neuropeptides found in other vertebrate retinae are also present in deep-sea fish. Quantitatively, convergence rates in unspecialised parts of the retina are similar to those in nocturnal mammals. The differentiation of horizontal cells makes it unlikely that species with more than a single visual pigment are capable of colour vision. In the third part, the diversity of deep-sea fish retinae is highlighted. Based on the topography of ganglion cells, species are identified with areae or foveae located in various parts of the retina, giving them a greatly improved spatial resolving power in specific parts of their visual fields. The highest degree of specialisation is found in tubular eyes. This is demonstrated in a case study of the scopelarchid retina, where as many as seven regions with different degrees of differentiation can be distinguished, ranging from an area giganto cellularis, regions with grouped rods to retinal diverticulum.

A fluorescent double stain for visualization of neural tissue by confocal laser scanning microscopy

We present a fast and simple method for a general, fluorescent double stain that differentially labels various cellular components and visualizes all cells in confocal laser scanning microscopy. The technique is useful for two- and three-dimensional visualization of neural tissue and facilitates quantification of a variety of neuroanatomical parameters. Examples from cerebellum and retina are shown to demonstrate the broad applicability.

Characterization of the novel, pediatric Hodgkin disease-derived cell line HKB-1

BACKGROUND

A novel Hodgkin disease (HD)-derived cell line, designated HKB-1, was established from pulmonary HD of nodular sclerosing subtype of a 14-year-old-girl.

PROCEDURE AND RESULTS

Immunophenotypically, HKB-1 cells are of B cell in phenotype, being also positive for markers CD15, CD25 and CD30. Transformation of the cell line by Epstein-Barr virus (EBV) was excluded by failure to detect EBV antigens and EBV DNA in cultured cells. Chromosome studies of HKB-1 showed a pseudodiploid karyotype with complex clonal structural aberrations. The detection of a monoclonal immunoglobulin heavy chain (IgH) gene rearrangement confirmed the derivation of the HKB-1 from the B cell lineage and its monoclonality. HKB-1 produced high amounts of interleukin (IL)-6 as detected in culture supernatant whereas no secretion of IL-1 beta, IL-2, IL-4, IL-10, IL-12 or interferon (IFN)-gamma was detected.

CONCLUSIONS

Our studies indicate that this cell line is of tumor origin.

Correlation of flow velocity measurements by magnetic resonance phase contrast imaging and intravascular Doppler ultrasound

RATIONALE AND OBJECTIVES

The authors compare the magnetic resonance (MR) phase contrast flow velocity measurements in varying concentric stenoses with invasive measurements obtained with a Doppler guidewire.

METHODS

Flow velocity measurements were obtained using a calibrated 0.018 inch 12 MHz Doppler guidewire and a 1.0 T MR imaging system in a pulsatile hydraulic model with variable arterial stenoses. Velocity measurements were performed proximal, intrastenotic, and distal to the stenoses. The cross-sectional area of stenosis was calculated from the data of both methods. For MR imaging measurements, fast low-angle shot two-dimensional phase contrast sequences with different velocity encodings were used.

RESULTS

Phase contrast flow measurements correlated well (r = 0.95, Pearson) with Doppler guidewire-based flow velocity data. Generally, flow velocities obtained with MR imaging were lower when compared with the Doppler-based data (P < or = 0.001, Wilcoxon matched pairs test). However, the ratios and the calculated cross-sectional area of stenoses showed a high correlation (r = 0.96) with the predefined area of stenoses.

CONCLUSIONS

The assessment of flow alterations in vitro due to variable stenoses using MR phase contrast flow measurements is very well correlated with the Doppler guidewire. Consequently, these results required in vivo measurements of atherosclerotic lesions to evaluate the clinical impact.

A craniospinal enterogenous cyst: case report

An enterogenous cyst of the craniospinal region producing medullary compression is reported in a 4.5-year-old boy. The patient presented with stiffness of the neck and headache, but otherwise without neurological deficits. Magnetic resonance imaging (MRI) demonstrated a high-intensity mass extending from the cerebellomedullary cisterna to the second cervical vertebra flattening the medulla and the upper cervical cord. Complete recovery ensued following total excision of the cyst. Histologically, the cyst was lined by a single layer of PAS-positive columnar epithelium. Presentation of this unusual case is discussed together with a review of the literature.

K-ras oncogene mutations indicate malignancy in cystic tumors of the pancreas

OBJECTIVE

To evaluate clinical parameters, presurgical diagnostic tests, histologic findings, and the presence of K-ras oncogene mutations in cystic tumors of the pancreas to determine which best predict malignancy.

SUMMARY BACKGROUND DATA

Because presurgical, intraoperative, and final pathologic differentiation is difficult in cystic tumors of the pancreas, it would be a major benefit to identify markers that accurately predict malignancy in these rare tumors. The role of K-ras oncogene mutations as an indicator of malignancy has not been determined in these tumors.

METHODS

Nineteen patients with cystic tumors of the pancreas were evaluated, including K-ras mutation analysis based on polymerase chain reaction and restriction digestion assays and direct DNA sequencing, to screen for parameters that accurately predict malignancy.

RESULTS

All malignant cystic pancreatic tumors (five cystadenocarcinomas and three mucin-producing adenocarcinomas) harbored K-ras mutations at codon 12 or 13. K-ras mutations were also detected in the percutaneous fine-needle aspirates of two of these patients. In contrast, none of nine benign cystadenomas or the solid-papillary neoplasm had K-ras mutations. None of the patients with a benign tumor carrying K-ras wild-type sequences developed recurrent disease after a mean follow-up of 50 months. Seven of the 8 malignant cystic pancreatic tumors, but none of the 11 benign tumors, showed dilatation of the main pancreatic duct on computed tomography or endoscopic retrograde cholangiopancreatography.

CONCLUSIONS

K-ras mutation analysis seems to be a powerful tool to determine the malignant potential of cystic pancreatic tumors before and after surgery. Dilatation of the main pancreatic duct on computed tomography or endoscopic retrograde cholangiopancreatography is highly suggestive for malignancy in these rare tumors.

Development of multibank rod retinae in deep-sea fishes

We studied the development of multibank rod retinae by monitoring the size-related addition of new layers of rod inner and outer segments in four species of deep-sea fishes and found two different growth paradigms. In the mesopelagic Chauliodus sloani, new banks of rod inner and outer segments are added as long as the fish increases in size, as observed earlier by Locket (1980). By contrast, in three bathybenthic species (Antimora rostrata, Corvphaenoides (Coryphaenoides) guentheri, and Coryphaenoides (Nematonurus) armatus), the final complement of banks is reached when the specimens have grown to between 20 and 47% of their maximal size, suggesting that the visual system is mature only after this stage. Increase in retinal area, density of rod nuclei, and densities of rod inner and outer segments were also studied in these and additional species. Taken together with previous data on rod proliferation patterns and outer segment membrane synthesis, our findings indicate that at least in species with no continual addition of new banks, there is no major functional difference between the innermost and outermost banks of rod inner and outer segments. While Chauliodus spends all its life in the mesopelagic environment, the three bathybenthic species live in this environment during early development and descend towards greater depths only upon maturation. We speculate that this coincides with the stage when the full complement of rod banks is formed in the retina, as a possible prerequisite for a life outside the reach of sunlight.

[Infrapopliteal angioplasty: a forgotten region?]

Although percutaneous transluminal angioplasty (PTA) has become established as an endovascular technique--in the more strict sense as a balloon dilatation but being increasingly supplemented by stent implantations--for many vascular regions, reports on infrapopliteal angioplasties are rather scarce. With the development of hydrophilically coated guide wires, improved catheter materials, and dedicated balloon catheters for infrapopliteal use, dilatation treatments distal of the popliteal artery are now standard procedures. Major advances in peri-interventional drug management have also made their contribution. The initial technical and clinical results obtained are excellent. For the majority of the patients, the main concern is for limb salvage. In this context, infrapopliteal PTA also achieves satisfactory results. However, the long-term results must still be considered as unsatisfactory since recurrences are frequent and require repeat interventions. Therefore new therapeutic strategies are required that can reduce re-stenoses especially in this peripheral vascular segment.

[Relevance of transmission of Epstein-Barr virus through blood transfusion]

In order to investigate the risk of transmission of Epstein-Barr Virus (EBV) by red cell concentrates (RCCs, bottom and top system), we examined 15 EBV-seronegative pediatric patients who received EBV-seropositive red cell concentrates prior to and up to 11 weeks after transfusion. None of these children showed serological or clinical signs of active EBV infection. To further explore this situation we estimated the number of EBV genomes in RCCs in comparison with whole blood units and found a significant reduction (1-2 EBV genomes in one RCC compared with 600-700 in one whole blood unit, p < 0.1%). The use of modern leukocyte depletion systems dramatically reduces the number of EBV-positive cells in RCCs, minimizing the risk of EBV infection. As there were no hints of transmission of EBV in current transfusion practice, the provision of EBV-seronegative RCCs for patients with high risk of infection does not seem to be necessary.

Local intravascular drug delivery: in vitro comparison of three catheter systems

PURPOSE

The aim of this in vitro study was to compare different catheter systems for local drug delivery with respect to the penetration depth of a biotin marker solution delivered into the vessel wall.

METHODS

Post-mortem carotid arteries from pigs were locally infused with a biotin solution using three different catheter systems. With all catheters (microporous balloon catheter, hydrogel-coated balloon catheter, and spiral balloon catheter) we used the same pressure of 405 kPa (4 atm) and infusion times of 60, 90, and 300 sec. After infusion the arteries were histologically prepared and stained using a biotin-specific method. With a light microscope an observer, blinded to the catheter type, scored the amount of biotin within the vessel wall, measured as staining intensity, and the penetration depth of the biotin.

RESULTS

Delivery with the hydrogel-coated balloon catheter was limited to the intima and the innermost parts of the media. The spiral balloon and microporous balloon catheter showed both a deeper penetration and a larger amount of delivered biotin compared with the hydrogel catheter, with a slightly deeper penetration using the microporous catheter. The penetration depth showed a correlation with infusion time for the spiral balloon and microporous catheters, but not for the hydrogel-coated catheter.

CONCLUSION

Different catheter designs lead to different patterns of local drug delivery. The differences in penetration depth and amount of the substance delivered to the vessel wall should be known and might be useful for targeting specific areas within the vessel wall.

Rapid thrombectomy with a hydrodynamic catheter: results from a prospective, multicenter trial

PURPOSE

To evaluate efficacy and safety of a hydrodynamic rheolytic thrombectomy device for rapid percutaneous treatment of acute thromboembolic occlusions of native lower-extremity arteries and bypass grafts.

MATERIALS AND METHODS

In 50 patients, thrombectomy was performed with the rheolytic catheter at four centers. Patients had acute occlusions of native lower-extremity arteries (n = 39) or acute thrombosis of lower-limb bypass grafts (n = 11). Estimated occlusion age was 5 days +/- 5. Mean thrombus length was 15 cm +/- 11. Clinical success was measured on a scale of -3 (deterioration) to +3 (improvement) with established criteria.

RESULTS

With the thrombectomy catheter, the majority of thrombus material was removed and antegrade blood flow was reestablished in 45 (90%) patients. Technical success (residual luminal narrowing < 50%) was 52% with use of the device alone. Adjunctive therapy was performed in 45 patients. Clinical improvement after intervention was +3 in 25 (50%) patients, +2 in 10 (20%), +1 in six (12%), and 0 (no improvement) in nine (18%). Clinically unimportant complications related to use of the device were one (2%) distal embolization and two (4%) dissections. Laboratory analysis revealed hemolysis without clinical sequelae. Primary patency rates were 76% after 30 days, 74% after 3 months, and 69% after 1 year.

CONCLUSION

The hydrodynamic catheter appears to be safe and effective for rapid thrombectomy.

The precise determination of vascular lumen and stent diameters: correlation among calibrated angiography, intravascular ultrasound, and pressure-fixed specimens

PURPOSE

Luminal diameters measured in vivo by calibrated-catheter angiography and by intravascular ultrasound were correlated with those obtained from pressure-fixed histologic cross-sections to determine the accuracy of both methods.

METHODS

Angiographic and endosonographic diameter measurements were performed in the center of stents placed in the iliac arteries of 10 miniature pigs and were compared with luminal and stent diameters in postmortem, pressure-fixed, histologic cross-sections from identical locations.

RESULTS

Compared with histologic diameters, magnification-corrected angiographic measurements still magnified vascular luminal diameters by 0.7 +/- 0.71 mm (r = 0.41, Pearson; p < 0.003, Wilcoxon, matched pairs), whereas intravascular ultrasound measurements proved to be almost identical to the histologic lumina (r = 0.95, Pearson; p > 0. 5, Wilcoxon, matched pairs). Similarly, stent diameters correlated well between endosonographic and histologic measurements (r = 0.91; p = 0.002), and less well between angiographic and histologic diameters (r = 0.62; p = 0.002).

CONCLUSION

Since calibrated angiography still overestimates vascular lumina, endosonography is the preferred technique for accurate in vivo measurements.

Connectivity patterns of cone horizontal cells in blue acara (Aequidens pulcher, Cichlidae) reared in different light regimes

Two types of cone horizontal cells were identified morphologically in the retina of a trichromatic fish by fluorescent labelling with Lucifer Yellow and confocal laser scanning microscopy. H1 cells are located adjacent to the outer plexiform layer, have large somata, small dendritic fields, and contact all cone types. H2 cells are positioned vitread to the H1 cells, have small somata, and large dendritic fields. Their dendrites invaginate the synaptic pedicles of short wavelength sensitive single cones and show a significant preference for one of the spectrally different members of the double cones, presumably the middle wavelength sensitive member. We tested the impacts of different visual environments on the development of these connectivity patterns and found minor changes induced by rearing in white light of different intensities or monochromatic blue light.

Local intraarterial thrombolysis: in vitro comparison of various infusion catheters

PURPOSE

Catheters are compared in vitro to evaluate the efficacy of thrombolysis during urokinase infusion within the thrombus.

METHODS

Six catheters were introduced individually into human thrombus within a stenotic flow model. Urokinase was infused continuously into the thrombus. To quantify the efficacy of thrombolysis, pressure gradients were recorded proximal and distal to the thrombus and during the course of infusion. Uniformity of lysis was assessed radiographically.

RESULTS

The fastest and most homogeneous thrombolysis was achieved with the EDM and the straight-flush catheter, shown by decreasing transthrombotic pressure gradients. All other catheter designs showed less homogeneous and delayed thrombolysis (p </= 0.001, Friedmann-Test, Schaich-Hamerle). There was no significant difference in the efficacy of thrombus dissolution between the EDM and the straight-flush catheter (Wilcoxon, matched pairs, p > 0.7).

CONCLUSION

The EDM catheter and the straight flush catheter achieved the most homogeneous and fastest thrombolysis, apparently due to the best urokinase distribution within the thrombus.

[Combined intraoperative retrograde stent implantation and thrombendarterectomy of the carotid artery]

HISTORY AND CLINICAL FINDINGS

A 63-year-old man developed recurrent transitory ischaemic episodes of vertigo and weakness in the legs 6 weeks before admission. 3 weeks later he had a left amaurosis fugax. A stenotic murmur was heard over the left carotid artery.

INVESTIGATION

Intraarterial digital subtraction angiography of the arteries to the head revealed occlusion of the right internal carotid artery (RICA) and marked narrowing at the origin of the left common carotid artery (LCCA), which could not be passed by catheter.

TREATMENT AND COURSE

As a catheter could not be passed into the LCCA, a stent was at operation placed retrogradely into it. Intraoperative angiography showed subtotal stenosis of the left ICA, which was treated by thrombendarterectomy and dacron patch-plasty. The postoperative course was without complication and the patient was free of symptoms. Follow-up angiography was unremarkable.

CONCLUSION

If a stenosis of the carotid artery cannot be passed by catheter, intraoperative retrograde placement of a stent is an alternative to percutaneous antegrade transluminal angioplasty or surgical bypass.

[In vitro evaluation of the intravasal Doppler guide wire: determination of hemodynamic effects of stenoses in a flow model]

PURPOSE

In a pulsatile hydraulic model, haemodynamic changes caused by stenoses were assessed using an intravascular Doppler guide wire.

MATERIAL AND METHODS

In defined stenoses (25, 50, 75 and 87.5% diameter ratio), and with and without collateral flow, a 0.018 inch (0.46 mm) 12 MHz Doppler guide wire was assessed. Flow velocity measurements were taken 20 mm proximal, in, and 20 mm distal to the stenoses. Average peak velocity (APV) and ratios of pre-/poststenotic velocities and pre-/intrastenotic velocities of APV were compared with the grade of stenosis. The degree of the stenosis calculated by the ratio of the cross-sectional area, using the pre- and intrastenotic APV, was correlated with the actual stenosis.

RESULTS

The intrastenotic APV increased significantly (APV proximal to the stenosis 15.15 +/- 4.5 cm/s, intrastenotic APV 134.8 +/- 130.9, p < 0.01, Wilcoxon-Mann-Whitney test). The difference between APV pre- and poststenotic was not significant (p > 0.5). Concerning the grade of stenosis the ratio APV pre-/intrastenotic and the consecutively calculated cross-sectional area stenoses was the best predictor (correlation with the known cross-sectional area stenosis r = 0.94 Pearson).

CONCLUSION

Using the Doppler guide wire, APV measurements pre- and intrastenotic enable a reliable quantification of the grade of stenosis. The stenosis calculated via the cross-sectional area correlates significantly with the actual stenosis.

[Must the patient fast before intravascular injection of a non-ionic contrast medium? Results of a controlled study]

PURPOSE

Prospective evaluation of food and fluid restriction before the intravascular injection of a non-ionic contrast medium.

MATERIAL AND METHODS

1000 patients (657 men, 343 women; average age 59 +/- 1/4 5 years) undergoing intravascular contrast injections (CT, phlebography, angiography, urography) were randomly allocated to two groups. Group A had no fluid or solids for at least four hours before the injection (499 cases); group B were allowed unlimited food and fluid (501 cases). Both groups were comparable in all other respects and all were given the non-ionic contrast medium iopamidol (300 mg l/ml).

RESULTS

The incidence of acute complications was 3.5%. There was, however, no statistically significant difference between the two groups (p = 0.29). Late adverse reactions were seen in 3.9% patients. There was again no difference between the two groups (p = 0.33). No serious or life threatening complications occurred.

CONCLUSION

Restriction of food and fluid before intravascular injection of contrast medium does not reduce the number of adverse side effects. For reasons of patient comfort and compliance, and to achieve adequate hydration, the patient should not fast before injection of contrast.

Density ratio of dopaminergic versus serotonergic cells correlates with cone-to-rod ratio in teleost retinas

Dopaminergic and serotonergic cells were visualised immunohistochemically with antibodies against tyrosine hydroxylase and serotonin in retinal wholemounts of eight teleosts from different habitats and with different rod-to-cone ratios. The cell densities were calculated, and the density ratio of dopaminergic cells versus serotonergic cells was compared among these fish species. The density ratio was high (1.9-2.7) in three out of the four species of cichlid fish studied with cone densities roughly equalling rod densities, medium in roach (0.8) where rods dominate cone numbers, and low in deep-sea fish (0.2-0.4) with pure rod retinas. These observations confirm earlier findings on the species-specificity of the ratio of dopaminergic versus serotonergic cells in the retina and further demonstrate a close correlation between the rod-to-cone ratio, and the density ratio of dopaminergic versus serotonergic cells in the inner retina. The possible significance for the processing of photopic and scotopic information in the inner retina is discussed.

Lytic replication of Epstein-Barr virus in the peripheral blood: analysis of viral gene expression in B lymphocytes during infectious mononucleosis and in the normal carrier state

Epstein-Barr virus (EBV) has been shown to establish latency in resting B lymphocytes of the peripheral blood. This creates a virus reservoir in contrast to lytic virus replication, which is thought to be restricted to differentiated epithelial cells in vivo. So far, the route of transmission between B cells and the production of progeny virus in the epithelial tissue has remained unclear. Reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemistry analysis of 16 patients with acute infectious mononucleosis (IM) and 25 healthy seropositive donors was performed to detect lytic replication gene products in B lymphocytes of the peripheral blood. Transcriptional activity was found in peripheral blood B lymphocytes (PBLs) for BZLF1 in 88%, BALF2 in 50%, and BcLF1 in 25% of the tested IM patients. All positive results were further confirmed in enriched B-cell populations by antigen determination using immunostaining with the APAAP technique. Furthermore, we detected transcripts for BZLF1 in 72% and for BALF2 in 16% of peripheral B lymphocytes of healthy seropositive donors. In contrast to patients with IM, no signals for BcLF1 were ever found in healthy seropositive donors. In these individuals, lytic replication of EBV is probably restricted by immunologic and gene regulatory mechanisms, whereas in the absence of immunologic control, reflected here by IM patients, the production of infectious virus becomes visible in PBLs.