Rotational atherectomy: improved procedural outcome with evolution of technique and equipment. Single-center results of first 1,000 patients

We present our single-center experience of rotational atherectomy (RA) in the first 1,000 consecutive patients divided arbitrarily into three different time periods corresponding to significant changes in technique or equipment for RA. Period I (August 1994 to April 1995; 172 cases) is characterized by early experience, longer ablation, and frequent use of intra-aortic balloon pump; period II (May 1995 to January 1996; 254 cases) is characterized by short ablation runs (20-30 sec) and use of rotaflush; period III (February 1996 to February 1997; 574 cases) is characterized by ReoPro use, neosynephrine boluses to avoid hypotension, and rota floppy wire and flexible shaft burrs. The procedural success rate has improved and complication rates have progressively declined over these three time periods. The incidence of lesion complexity (long and type C lesions) and patients with unstable rest angina have increased over these time periods of RA. Therefore, modification in procedural techniques and equipment over time have made RA a safe technique despite its use in very complex lesion subsets.

Prevalence and pattern of psychiatric morbidity in children

Present study was carried out at child guidance clinic of Guru Teg Bahadur Hospital, Delhi. Sample consisted of 300 children (175 boys and 125 girls of aged 2-12 years) from November, 1994 to October, 1996. Diagnoses were made by using ICD-10 criteria. The major diagnoses were mental retardation (20.6%), epilepsy (20%), hysterical conversion reaction (6.3%), ADHD (5%) and childhood depression (6%).

Umbilicosculpture: a concept revisited

After birth the umbilicus is the only naturally formed visible scar on the body. To reconstruct a neo-umbilicus following abdominoplasty various local interposition flaps have been described to circumvent a circular scar contracture and to recreate a superior hood. The additional scarring with these techniques can give an operated look to the neo-umbilicus. The importance of gravity in the formation of a superior hood is highlighted and the issue of circular scar contractures is addressed. Emphasis is placed on sculpturing the peri-umbilical fat to enhance contour and on placing the circular scar deep in the neo-umbilicus.

Measurement of faecal alpha 1-antitrypsin: methodologies and clinical application

Presence of the serum protein, alpha 1-antitrypsin, in the faeces is a potentially useful marker for gastrointestinal disease and/or blood loss. In an effort to simplify faecal sampling procedures, we evaluated the performance of measuring alpha 1-antitrypsin in eluants of thin smears of faeces made on filter paper, relative to conventional measurement in aqueous extracts of stool. Faecal specimens and smears were collected from healthy subjects (n = 22) and from patients with gastrointestinal bleeding (n = 12) or inflammation (n = 22), colorectal neoplasia (n = 15), or miscellaneous diseases with a low risk of excessive faecal protein loss (n = 30). alpha 1-Antitrypsin was measured by ELISA and haem porphyrins (as a measure of blood loss) by HemoQuant. Results from smears were highly correlated (r = 0.81; P < 0.001) with faecal alpha 1-antitrypsin. The smear method detected an elevated faecal alpha 1-antitrypsin with 93% specificity and 75% sensitivity. Sensitivity was high ( > 88%) where levels were markedly elevated in inflammatory and bleeding groups and low ( < 62%) where abnormal levels were mildly elevated (neoplasia and miscellaneous groups). Elevated alpha 1-antitrypsin detection by either method positively predicted > 90% of patients with gastrointestinal inflammatory disease when levels were elevated 6-fold and 1.5-fold or more, respectively. In 15 patients with colorectal neoplasia, faecal alpha 1-antitrypsin was elevated in 10 patients, haem porphyrins in nine patients and either in 12; however, smear eluant levels were elevated in only six patients. Blood loss was probably a major contributor to elevated faecal alpha 1-antitrypsin in some patients but not in the inflammatory group as a whole. The sampling and aesthetic advantages of the smear eluant method are offset by reduced sensitivity, precluding its use as a screening test for colorectal neoplasia. However, its performance in predicting inflammatory disease is equivalent to that of conventional measurement and warrants a prospective evaluation as an early investigative test. Concurrent evaluation of blood loss may improve its interpretation.

Modulation of primary antibody response by protein A in tumor bearing mice

Protein A (PA) is a cell wall glycoprotein of Staphylococcus aureus Cowan I, which possess a number of immunomodulatory and antitumor properties. We have previously shown that PA suppresses the anti-sheep erythrocyte primary antibody response in normal mice. The present investigation evaluates the effect of protein A on the anti-sheep erythrocyte primary antibody response in tumor-bearing mice. The primary antibody response in tumor-bearing mice immunized with sheep red blood cells (SRBC) was suppressed by the intraperitoneal administration of PA in a dose-dependent fashion. The plaque forming cell (PFC) assay was used to assess this response. Maximum suppression of the PFC response was observed at 12 micrograms PA/animal (p < 0.001) and could be observed at doses as low as 1 microgram PA/animal (p < 0.01). The amount of suppression was proportional to the number of PA doses administered. In addition this effect was critically dependent on the timing of PA administration. PA showed no significant effect on PFC when injected after immunization, but it produced pronounced suppression when injected prior to the immunization with SRBC. Maximum suppression of the PFC response was observed when PA was administered one day before the antigen challenge. PA also reduced splenic localization of 51Cr labeled SRBC to 42% (p < 0.01). The altered localization of antigen in spleen may be responsible for reduced PFC response in tumor-bearing mice. Depletion of B-lymphocyte is reported to exhibit tumor inhibition. Therefore, we propose that the suppression of the primary antibody response by PA helps in tumor regression by reducing the soluble immunosuppressive immune complexes.

Visualization of myocardial cellular architecture using acoustic microscopy

The resolution of an ultrasound transducer depends on its frequency. The resolution improves when higher frequency transducers are used. A 1000 MHz transducer has a resolution of approximately 1 micron. Acoustic microscopy utilizes very high-frequency ultrasound (600 to 1000 MHz) to visualize structures on a microscopic level. Unstained, deparaffinized, 5 microns sections of myocardial biopsy specimens from 10 patients were placed on a slide and imaged using an Olympus UH3 scanning acoustic microscope. To compare with light microscopy, the section used for acoustic microscopy was subsequently stained with hematoxylin and eosin and a serial section from the paraffin block was stained with PTAH stain. Myocytes, myofibrils, and interstitial tissue were accurately imaged. Pathologic phenomena such as cell fallout, interstitial fibrosis, and lymphocytic infiltration were identified by acoustic microscopy. Intramural vessels, nuclei of endothelial cells, and the media were clearly identified by this technique. There was close correlation between findings by acoustic microscopy and light microscopy. Acoustic microscopy permitted the visualization of cardiac cellular detail with a resolution similar to that of light microscopy. Unlike light microscopy, acoustic microscopy requires no staining of the specimen.