[Results of vascular reconstruction in lower limbs ischemia: a six-year clinical experience]

During the period between Dec. 1982 to Nov. 1988, a total of 412 patients with 471 limbs at risk of peripheral arterial occlusive disease underwent vascular surgical treatment at the Veterans General Hospital. There were 382 men and 30 women, who ranged in age from 20 to 84 years (mean 63.17 +/- 11.85 years). 95 cases were isolated aortoiliac occlusive disease, 94 cases were combined aortoiliac and femoropopliteal disease, 169 cases were femoropopliteal occlusive disease and 54 cases were femorotibialperoneal occlusive disease. Various reconstructive procedures were performed in the these patients. The cumulative limb salvage rate (LSR) exceeded cumulative patency rate (CPR) in all categories and the result of LSR and CPR were 97.6% and 91% for aortoiliac reconstructive surgery in six years, 96% and 77% for above-knee femoropopliteal saphenous vein bypass (SVB) in six years, 79% and 74% for below-knee femoropopliteal SBV and 63% and 34% for femoro-distal SVB in five years. 88% and 76% for above-knee femoropopliteal human umbilical vein (HUV) bypass in four years. 67% and 45% for femoro-distal HUV bypass in three years follow-up period individually. The immediate good symptomatic results of the vascular reconstruction was 88% encountered in isolated aortoiliac disease, 63% in combined aortoiliac and femoropopliteal disease, 70.4% in isolated femoropopliteal disease and only 26% in femorotibial-peroneal disease (FTP). No change symptoms was still higher (33%) in FTP than the other vascular reconstruction due to poor distal runoff in this series. The early postoperative mortality rate was 1.6%, the late mortality rate was 2.7%, the incidence of postoperative complication rate was 13.6%. The major lower limb amputation rate was low as 7% in our series.(ABSTRACT TRUNCATED AT 250 WORDS)

MR findings in neonatal herpes simplex encephalitis type II

The CT findings in neonatal herpes simplex encephalitis (HSE) type II have been previously described, whereas magnetic resonance (MR) findings as yet have not. Early CT findings can be subtle and difficult to detect. However, as the abnormalities evolve, most notably the strikingly increased density of cortical gray matter, they appear highly characteristic of neonatal HSE type II. This case report with neuropathologic verification describes serial MR and CT findings in HSE type II that suggest an etiology of the increased density characteristically seen on CT scans; it does not appear to be hemorrhage or calcification.

Tryptophan use and fasciitis

Images

Mediastinal radiographic abnormality caused by anomalous venous drainage: how often is it seen in Afro-Americans?

An abnormal superior mediastinal density seen on a chest x-ray led to computerized tomography scan detection of an enlarged azygous vein produced by anomalous embryologic development of the inferior vena cava. This potentially clinically important abnormality is uncommon and statistics indicating its frequency are best available from the Japanese. In addition to alerting clinicians to this abnormality, a plea is made for review of autopsy series in Afro-Americans by pathologists in order to determine potential risks in a variety of surgical procedures.

Molecular cloning of new human TR2 receptors: a class of steroid receptor with multiple ligand-binding domains

Previously we isolated a new group of cDNA clones from human testis cDNA libraries which might code for new steroid receptors. The cDNA and predicted amino acid sequences of two of these receptors, named TR2-5 and TR2-7 receptors, were determined. We report here the nucleotide and deduced amino acid structures of two other receptors that we named TR2-9 and TR2-11 receptors. The calculated MW of TR2-5 receptor, TR2-7 receptor, TR2-9 receptor and TR2-11 receptor are 52,982, 20,528, 50,849 and 67,223 respectively, which match well with the apparent MW of in vitro translated products. The 26 amino acids involved in the formation of "Zn-fingers" are conserved. The ligand-binding domain of TR2-9 receptor is 16 amino acids shorter and has 3 different amino acids compared with TR2-5 receptor. The TR2-11 receptor has a ligand-binding domain which is longer and quite different compared with the other TR2 receptors. The multiple ligand-binding domains of TR2 receptor could be the products of different genes or may be due to RNA splicing errors. So far, we have failed to find binding activity with any known steroid hormone; this promotes the possibility that an unidentified steroid hormone may be involved.

Isolation and characterization of human TR3 receptor: a member of steroid receptor superfamily

Complementary DNAs (cDNAs) encoding a member of steroid receptor super-family, named TR3 receptor, were isolated from a human prostate lambda gt11 cDNA library on the basis of homology of oligonucleotide probes to the DNA-binding domain common to members of the steroid receptor super-family. Expression of TR3 receptor cDNA produced a 64 kDa DNA-binding protein in a rabbit reticulocyte lysate. Nucleotide sequence analysis showed that TR3 receptor cDNA contains two regions of sequences which correspond to the DNA- and hormone-binding domains of members of the steroid receptor super-family. The amino acid sequences in the hormone-binding domain of the TR3 receptor shares about 20% homology with estrogen receptor and less than 15% homology with other known steroid receptors. The DNA-binding domain of the TR3 receptor has about 55% homology with all other known steroid receptors. TR3 receptor had 86% nucleotide and 91% amino acid sequence homology with mouse NUR/77, suggesting that TR3 receptor may be a human homologue of mouse NUR/77 gene product.

[A new operation for the management of gastric varix bleeding]

Gastric varices is a special oriental type manifestation of gastroesophageal collaterals in portal hypertension patients. It has gained more attention in recent years following the popularity of endoscopy and sclerotherapy. Catastrophic bleeding from ruptures of gastric varices is a life threatening emergency. Gastric varices are generally located at the greater curvature side of the cardiofundic region. Neither a Sengstaken-Blakemore balloon tube nor a Linton balloon tube can stop the bleeding. This area is also beyond the field of sclerotherapy. Surgery is the only definite therapy. Devascularization procedures as described by Dr. Hassab sometimes fail to control active bleeding and also fail to adequately decongest the whole varices area. The radical resection procedures such as terminal esophagectomy, proximal gastrectomy or cardiectomy as proposed by Japanese groups interrupts the normal esophgo-gastric continuity and is also too invasive for a cirrhotic patient. In between, besides terminal esophago-proximal gastric devascularization and splenectomy, we use a TA-90 stapler to perform an oblique cardiofundectomy to resect en bloc the tortuous gastric varices area. From Nov. 1983 to May 1988, at the Veterans General Hospital-Taipei, 16 patients received this new operation to manage gastric varices bleeding. Ten of them were on an emergency basis and 6 were elective surgery. Only one patient in the emergency group died. All catastrophic bleeding in the emergency group was dramatically controlled and all other patients recovered rapidly. With a follow-up range from 6 months to 4.5 year and an average of 19 months, there was no recurrent bleeding and no hepatic encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Smooth muscle cells can express cytokeratins of "simple" epithelium. Immunocytochemical and biochemical studies in vitro and in vivo

Cytokeratins are a set of 19 proteins that together constitute the class of intermediate filament protein expressed by epithelial cells and tumors. Using a panel of 9 different monoclonal anti-cytokeratin antibodies, the authors have performed immunocytochemistry on methanol-fixed, frozen sections and methacarn-fixed, paraffin-embedded tissue of human myometrial specimens. Anomalous cytokeratin expression (ACE) by smooth muscle cells was found in all specimens. Immunoblots of this tissue confirmed the presence of cytokeratin 19, and possibly 8. In addition, immunocytochemical studies demonstrated ACE in human fetal tissues within the intestinal muscularis and the heart, especially in the region of the aortic outflow tract, and in 8 of 19 cases of leiomyosarcoma from adults. Indirect immunofluorescence studies were also performed on cells explanted from myometrial tissue; the overwhelming majority of cells derived from these cultures were smooth muscle cells as verified by expression of muscle actins, and a subpopulation of these cells was found to be cytokeratin-positive. ACE was confirmed in vitro by double labeling experiments demonstrating simultaneous expression of muscle actins and cytokeratins within the same cell. The significance of this smooth muscle cell ACE is unknown, but it may be a phenotypic marker of smooth muscle in a proliferative state. ACE could be a source of confusion in the immunocytochemical analysis of poorly differentiated malignancies if a complete panel of antibodies is not employed.