[Percutaneous lumbar diskectomy]

The results after percutaneous lumbar discectomy were evaluated in 52 patients with low back pain corresponding to the L5 or S1 root. All patients were examined with a median follow-up time of 14 weeks. The patients were divided in two groups. Group 1: patients with an obvious indication for surgery (29 patients) and group 2: patients with a relative indication for surgery (23 patients). The follow-up results for patients in group 1 were comparable with the results after conventional discectomy. The results concerning follow-up low back pain in groups 1 and 2 were good or excellent in 69% and 43% of the patients respectively. The corresponding results for sciatica were 69% and 65% respectively. It is concluded that percutaneous lumbar discectomy is a possible alternative to conventional discectomy in selected patients.

In vivo validation of an experimental adaptive quantitative coronary angiography algorithm to circumvent overestimation of small luminal diameters

The reliability of quantitative coronary angiography (QCA) measurements is of fundamental importance for the study and practice of interventional cardiology. In vivo validation results have consistently reported a tendency for QCA systems to overestimate small luminal diameters. Such a systematic error may result in the underestimation of luminal gain during intracoronary procedures and in the underestimation of progression of coronary artery disease during longitudinal studies. We report the in vivo validation results of an experimental adaptive edge-detection algorithm that was developed to reduce overestimation of small luminal diameters by incorporating a dynamic function of variable kernel size of the derivative operator and variable weighting of the first and second derivatives of the brightness profile. The results of the experimental algorithm were compared to those of the conventional parent edge detection algorithm with fixed parameters. Dynamic adjustment of the edge-detection algorithm parameters was found to improve measurements of small (< 0.8-mm) luminal diameters as evidenced by an intercept of +.07 mm for the algorithm with variable weighting compared to +0.21 mm for the parent algorithm with fixed weighting. A slope of < 1 was found for both the parent and experimental algorithms with subsequent underestimation of large luminal diameters. Systematic errors in a QCA system can be identified and corrected by the execution of objective in vivo validation studies and the consequent refinement of edge-detection algorithms. The overestimation of small luminal diameters may be overcome by the incorporation of a dynamic edge-detection algorithm.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial conjugation mediated by plasmid RP4: RSF1010 mobilization, donor-specific phage propagation, and pilus production require the same Tra2 core components of a proposed DNA transport complex

DNA transfer by bacterial conjugation requires a mating pair formation (Mpf) system that specifies functions for establishing the physical contact between the donor and the recipient cell and for DNA transport across membranes. Plasmid RP4 (IncP alpha) contains two transfer regions designated Tra1 and Tra2, both of which contribute to Mpf. Twelve components are essential for Mpf, TraF of Tra1 and 11 Tra2 proteins, TrbB, -C, -D, -E, -F, -G, -H, -I, -J, -K, and -L. The phenotype of defined mutants in each of the Tra2 genes was determined. Each of the genes, except trbK, was found to be essential for RP4-specific plasmid transfer and for mobilization of the IncQ plasmid RSF1010. The latter process did not absolutely require trbF, but a severe reduction of the mobilization frequency occurred in its absence. Transfer proficiency of the mutants was restored by complementation with defined Tra2 segments containing single trb genes. Donor-specific phage propagation showed that traF and each of the genes encoded by Tra2 are involved. Phage PRD1, however, still adsorbed to the trbK mutant strain but not to any of the other mutant strains, suggesting the existence of a plasmid-encoded receptor complex. Strains containing the Tra2 plasmid in concert with traF were found to overexpress trb products as well as extracellular filaments visualized by electron microscopy. Each trb gene and traF are needed for the formation of the pilus-like structures. The trbK gene, which is required for PRD1 propagation and for pilus production but not for DNA transfer on solid media, encodes the RP4 entry-exclusion function. The components of the RP4 Mpf system are discussed in the context of related macromolecule export systems.

Comparative validation of quantitative coronary angiography systems. Results and implications from a multicenter study using a standardized approach

BACKGROUND

Computerized quantitative coronary angiography (QCA) has fundamentally altered our approach to the assessment of coronary interventional techniques and strategies aimed at the prevention of recurrence and progression of stenosis. It is essential, therefore, that the performance of QCA systems, upon which much of our scientific understanding has become integrally dependent, is evaluated in an objective and uniform manner.

METHODS AND RESULTS

We validated 10 QCA systems at core laboratories in North America and Europe. Cine films were made of phantom stenoses of known diameter (0.5 to 1.9 mm) under four experimental conditions: in vivo (coronary arteries of pigs) calibrated at the isocenter or by use of the catheter as a scaling device and in vitro with 50% contrast and 100% contrast. The cine films were analyzed by each automated QCA system without observer interaction. Accuracy and precision were taken as the mean and SD of the signed differences between the phantom stenoses, and the measured minimal luminal diameters and the correlation coefficient (r), the SEE, the y intercept, and the slope were derived by their linear regression. Performance of the 10 QCA systems ranged widely: accuracy, +0.07 to +0.31 mm; precision, +/- 0.14 to +/- 0.24 mm; correlation (r), .96 to .89; SEE, +/- 0.11 to +/- 0.16 mm; intercept, +0.08 to +0.31 mm; and slope, 0.86 to 0.64.

CONCLUSIONS

There is a marked variability in performance between systems when assessed over the range of 0.5 to 1.9 mm. The range of accuracy, intercept, and slope values of this report indicates that absolute measurements of luminal diameter from different multicenter angiographic trials may not be directly comparable and additionally suggests that such absolute measurements may not be directly applicable to clinical practice using an on-line QCA system with a different edge detection algorithm. Power calculations and study design of angiographic trials should be adjusted for the precision of the QCA system used to avoid the risk of failing to detect small differences in patient populations. This study may guide the fine-tuning of algorithms incorporated within each system and facilitate the maintenance of high standards of QCA for scientific studies.

Indomethacin in controlling "normal perfusion pressure breakthrough" in a case of large cerebral arteriovenous malformation

Control of "normal perfusion pressure breakthrough" is difficult and controversial. We describe a case in which indomethacin was used with success. We recommend extensive cerebral monitoring including regional cerebral oximetry when using indomethacin to detect impending cerebral ischemia.

Coronary arteriography for quantitative analysis: experimental and clinical comparison of cinefilm and video recordings

Although use of videotape for the recording of coronary angiograms continues to grow, the validity of quantitative coronary angiographic analysis of video images remains unknown. To estimate the reliability of angiographic images recorded on videotape, experimental and clinical angiograms were recorded simultaneously on both 35 mm cinefilm and super-VHS videotape with normal images and with spatial filtering of the images (edge enhancement) on a digital cardiac imaging system. The experimental angiographic studies were performed with plexiglass blocks and stenosis phantom of 0.5 to 3.0 mm in diameter. The clinical angiograms were recorded in 20 patients undergoing percutaneous transluminal coronary angioplasty (31 frames before and 20 frames after percutaneous transluminal coronary angioplasty). The cinefilm and corresponding videotapes were analyzed off-line with the new version of the coronary angiography analysis system. For the experimental study, measurements of minimal luminal diameter obtained from cinefilm, normal-image videotape, and edge-enhanced videotape were compared with the true phantom diameter. In the clinical study the agreement between measurements obtained from cinefilm and measurements from normal-image videotape and edge-enhanced videotape was examined. In the phantom series the accuracy and precision of quantitative coronary angiography measurement for cinefilm were -0.10 +/- 0.08 mm, for normal-image videotape -0.11 +/- 0.18 mm, and for edge-enhanced videotape -0.10 +/- 0.11 mm (mean +/- SD). In the clinical series, the differences between measurements from cinefilm and normal-image videotape were 0.14 +/- 0.20 mm and from cinefilm and edge-enhanced videotape 0.04 +/- 0.13 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Can intracoronary ultrasound correctly assess the luminal dimensions of coronary artery lesions? A comparison with quantitative angiography

In 62 patients with angina pectoris Canadian Class III and IV, the luminal dimensions of 25 pre-PTCA and 56 post-PTCA lesions without occlusion were examined with a 4.3 F 30 MHz mechanical ultrasound imaging catheter, and analysed off-line using ultrasound cross-sectional area (U-CSA) measurements from s-VHS video images (n = 81). In addition, 42 angiographically normal coronary segments were examined. At the site of the examination, the U-CSA was integrated centrally to the leading edge echo of the inner contour of the vessel wall and the corresponding angiographic cinefilm images were analysed by edge detection using the Cardiovascular Angiography Analysis System. The obstruction diameter (at the lesion) and the mean vessel diameter (at normal sites) were used to calculate the angiographic cross-sectional area (A-CSA) assuming a circular model. U-CSA values were compared with the corresponding A-CSA values using t-test and linear regression analysis. The study showed that larger CSA are measured with ultrasound than with angiography. (P < 0.0001). An acceptable correlation was found between U-CSA and A-CSA values in normal coronary segments (correlation coefficient: r = 0.73, mean diff. = 1.44 +/- 1.22 mm2). However, the correlation was poor at the site of pre-PTCA lesions (r = 0.62, mean diff. = 1.81 +/- 1.14 mm2) and deteriorated following PTCA (r = 0.47, mean diff. = 1.28 +/- 2.20 mm2). No correlation was found between the degree of lumen eccentricity measured with intracoronary ultrasound (ICUS) and the individual differences between U-CSA and A-CSA values.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized trial comparing two devices: the Palmaz-Schatz stent and the Strecker stent in bail-out situations

To assess whether differences in design (geometry, flexibility) and material (electrostatic behavior) may influence the acute and late outcome following intracoronary stent implantation in the treatment of acute or threatened closure after prolonged balloon inflations, 50 patients were randomized to receive either a Palmaz-Schatz stent (n = 25) or a Strecker stent (n = 25).

RESULTS

[table: see text]

CONCLUSION

Both Palmaz-Schatz and Strecker stents are equally effective in restoring vessel patency in bail-out situations. The incidence of complications is high and similar for both stents if they were used after failed prolonged balloon inflations. Differences in design and material do not seem to influence the results.

[Cerebral arteriovenous malformations. 10 years of therapeutic results]

Results of treatment of 92 supratentorial and 19 infratentorial cerebral arteriovenous malformations from a 10 year period are discussed. The role of interventional embolization is emphasized. The results seems comparable to major international centres. Danish incidence evaluations indicate that it will be possible to gain further experience and thus better results by centralizing the treatment of larger arteriovenous malformations.

[Interventional neuroradiology. A presentation with preliminary results]

During two periods (1.1.1981-3.1.1985 and 1.1.1988-31.12.1992) 57 patients were treated or attempted treated with endovascular embolization. The patients suffered either from arteriovenous malformations (AVM), dural arteriovenous malformations (DAVM), carotico-cavernous fistulas (CCF), giant aneurysms or meningenomas. During the first period the balloon-technique was mainly employed and only one isobutyl-2-cyanoacrylate (IBCA) embolization was carried out. Six AVMs and 11 CCFs were treated, and the complication rate was 33%. During the second period histoacryl/N-butyl-cyanoacrylate (NBCA) embolization was the treatment of choice for AVM and DAVM, and the balloon technique reserved for CCF and test occlusions. The complication rate was 8%. In 83% of the AVMs occlusion of more than 50% of the nidus was achieved. Three of five CCFs were occluded with one occluded internal carotid artery. There were no complications in test occlusions. Two DAVMs were reduced in size and the symptoms reduced. The patient material during this period consisted of 19 AVMs, two DAVMs, five CCFs, nine giant aneurysms (test occlusion) and five basal meningenomas with involvement of the internal carotid artery (test occlusion). The treatment of these relatively rare patients consists of close cooperation between the interventional neuroradiologist and the neurosurgical team.

Quantification of intracoronary volume by videodensitometry: validation study using fluid filling of human coronary casts

Changes in intracoronary volume reflect the hemodynamic significance of progression or regression of diffuse coronary artery disease where intracoronary catheters cannot be applied for direct measurements due to small vessel dimensions. We have validated the videodensitometric measurement of intracoronary volume with epoxy casts of postmortem human coronary arteries. The volume of 31 coronary segments (cross-sectional areas in a range of 2-13 mm2) measured by fluid-filling using a precision dispenser was compared with the respective single plane intracoronary volume assessments obtained by the videodensitometric algorithm of the new generation Cardiovascular Angiography Analysis System (CAAS II). The true and measured values of volume were compared by calculation of the mean of the signed differences +/- standard deviation and by linear regression analysis. Videodensitometric measurement of intracoronary volume correlate well with fluid-filling of human coronary artery casts (correlation coefficient: r = 0.99, y = 1.96 +/- 0.99x, standard error of estimate: SEE = 3.96) with a significant trend towards overestimation of true volume values (mean difference = 1.73 +/- 3.64 mm3, P < 0.05). Intracoronary volume estimations can be used to measure changes of luminal dimensions of coronary arteries and may offer a new approach to assessment of progression or regression of diffuse coronary artery disease.

How to get rid of the shunt: a comment

The aspects to be considered before removal of a shunt placed earlier for treatment of hydrocephalus are reviewed. The methods proposed so far for determination of whether a shunt is still needed are described. Their low reliability is stressed, as are the risk inherent in shunt removal.

Aluminum to oxygen cross-polarization in alpha-Al2O3 (corundum)

Experimental results concerning the cross-polarization of two quadrupolar, I = 5/2 nuclei are presented. It is shown in particular that 27Al spins in alpha-Al2O3 (corundum) can be spin-locked, and magnetization transferred to the 17O spin system. Cross-polarization between pairs of quadrupolar nuclei can cause considerable signal-to-noise ratio gains over conventional one- (or two-) pulse excitation and should be of use in investigating a number of inorganic solids.

Natural neural sensing and artificial muscle control in man

In the intact organism, specialised sensors in the skin, muscles and joints provide sensory feedback information that is normally used by the central nervous system to regulate and update the motor output. Many sensory functions remain intact after spinal cord injury or stroke. Here we demonstrate that natural sensory nerve activity in man can be chronically recorded, and that the recorded neural activity can provide sensory feedback signals for an event-driven artificial reflex control of paralysed muscles.

Temporal variability and correlation with geometric parameters in vasospastic angina: a quantitative angiographic study

Long-term changes in vasocontractility were examined in 23 coronary segments from 20 patients with variant angina using computer-based quantitative coronary angiography and ergonovine provocation tests repeated at an interval of 42 +/- 14 months. Measurements of vasospasticity at the sites of fixed stenoses were compared with values predicted by an elementary geometric theory based on the assumption that the cross-sectional area of a vessel wall is constant regardless of its state of vasoconstriction. While all patients were symptomatic initially, only 11 remained symptomatic at follow-up. At the initial provocation test, the response was correctly predicted in four segments, was lower than expected in one, and was stronger in 18. At follow-up, only one of the four segments in which the response had been initially predicted correctly again showed the predicted response and the remaining three showed a response weaker than expected; the one segment which was initially hypocontractile remained hypocontractile at follow-up; and of the 18 segments which were initially hypercontractile, 12 exhibited hypercontractility again, four had the predicted value and the remaining two showed hypocontractility. In only one of 23 segments did the geometric theory predict the behaviour of vasospasticity at the site of fixed stenosis on both tests. Vasospastic responsiveness is a dynamic process demonstrating temporal variability and is not directly predicted by geometric theory.