Risk of incontinence with transurethral resection of the prostate after radiation therapy for prostate cancer

BACKGROUND

It has been reported that transurethral resection of the prostate (TURP) after definitive radiation therapy for prostate cancer is associated with a significant risk of incontinence. The presumed reason for incontinence is external sphincter damage from TURP or pre-existing damage from either extension of prostate cancer or radiation therapy.

METHODS

We reviewed seven recent cases of TURP for bladder outlet obstruction in patients who had undergone radiation therapy for clinical stage T(3-4)M(0)N(0) adenocarcinoma of the prostate. All seven men progressed to either chronic retention or debilitating obstructive symptoms with weak peak flows from 3.4 to 5.1 cc/s (mean 4 cc/s). Each of them subsequently underwent a limited TURP.

RESULTS

Voiding symptoms were reduced in all patients and peak flows were improved to 6.3 to 20 cc/s (mean 14.8 cc/s) with mean follow-up 35 m. No patient developed stress urinary incontinence postoperatively.

CONCLUSION

These results suggest that TURP can be performed successfully after radiation therapy with minimal risk of stress incontinence.

High-fat sunflower and olive oil diets affect serum lipid levels in steatotic rat liver differently

This work describes the long-term effects of two different diets, one rich in olive oil and the other in sunflower oil, on serum lipid and lipoprotein levels after the establishment of fatty liver in rats 8 and 15 months old. The serum lipid and lipoprotein levels as well as the steatotic process have been evaluated by biochemical and histological methods, respectively. The results showed that fatty liver was well developed with both long-term high-fat diets, and hepatocytes were filled with many lipid droplets. This process was more evident in the portal zones, where fat hepatocytes were more numerous. Serum total cholesterol (TC) and HDL-C levels were highest in the sunflower oil fed rats, whereas the TG and LDL-C levels were highest in the olive oil group. Finally, the atherogenic indexes (HDL/TC, HDL/LDL, HDL/(TC-HDL)) were higher in the sunflower oil diet group than in the olive oil group.

Results at 43 months' follow-up of a double-blind, randomized, prospective clinical trial using intravesical interferon alpha-2b in the prophylaxis of stage pT1 transitional cell carcinoma of the bladder

OBJECTIVES

To assess the intravesical efficacy of 60 million units of interferon (IFN) alpha-2b in preventing recurrences of Stage pT1 transitional cell carcinoma of the bladder, as well as to assess its local and systemic toxicity.

METHODS

A total of 90 patients were included in a double-blind, randomized, prospective clinical trial and divided into two groups of 45 patients. After complete transurethral resection, 60 million units IFN alpha-2b was instilled in one group; in the other, double-distilled water was used. The therapeutic regimen consisted of weekly instillation for 12 weeks, followed by once-monthly instillation until patients had completed 1 year of treatment.

RESULTS

Only 78 patients were evaluable. After 12 months of follow-up, the relapse rate was 28.2% (11 of 39) for the IFN group and 35.8% (14 of 39) for the control group (P = NS). After 43 months (range 9 to 67), relapse rates were 53.8% (21 of 39) and 51.2% (20 of 39), respectively (P = NS). Progression, mortality, and local or systemic toxicity were similar in both groups. Flu-like syndrome was not reported.

CONCLUSIONS

At the dose used in this study, IFN alpha-2b proved ineffective in the prophylaxis of Stage pT1 transitional cell carcinoma of the bladder compared with a control group. Toxicity was virtually absent.

Effects of Palmaz-Schatz stents on angled coronary arteries

This review of consecutive, single Palmaz-Schatz stent implantations reveals that coronary lesion angulation does not result in suboptimal results or increased restenosis after stenting. The implantation of a rigid stent at an arterial hinge point is associated with an increased restenosis rate.

Preferential induction of chromosome 1 multibranched figures and whole-arm deletions in a human pro-B cell line treated with 5-azacytidine or 5-azadeoxycytidine

5-Azacytidine (azaCR) causes genomic demethylation and decondensation of juxtacentromeric heterochromatin in chromosomes 1, 9, and 16. We determined the karyotypes of a pro-B cell line (FLEB14) treated with azaCR or its deoxynucleoside analog (azaCdR). About 80% of the induced rearrangements were in chromosome 1, and almost 90% of these involved its pericentromeric region. Multibranched figures with up to seven chromosome 1 arms, as well as whole-arm deletions of this chromosome, were the predominant anomalies, often with one normal homolog of chromosome 1 present. Isochromosomes 1 and fusions in the pericentromeric regions of chromosomes 1 and 16 or chromosomes 1 and 9 were also seen. The overlap of the spectrum of chromosomal rearrangements in azaCR- or azaCdR-treated FLEB14 cells and in mitogen-stimulated lymphocytes from patients with a rare genetic disease (ICF) associated with localized DNA hypomethylation supports the hypothesis that the DNA demethylating activity of azaCR is essential for the induction of these pericentromeric rearrangements. These studies may help elucidate the overrepresentation of chromosome 1 pericentromeric rearrangements in many types of cancer cells.

Intracoronary ultrasound before coronary interventions: a prospective comparison of two different catheters

Intravascular ultrasound (IVUS) provides unique information about the coronary arterial wall that can be used to guide transcatheter therapy. In this prospective study, two different IVUS systems were compared with respect to feasibility of imaging before intervention and angiographic changes induced by the simple advancement of the catheter across the lesion. Eighty-five patients (mean age 59 +/- 10 yr, 11 female) were studied with IVUS before intervention. In 34 patients, a 4.8 F (1.6-mm) IVUS catheter was used (Group I), whereas in the remaining 51 patients, a 3.5 F (1.2-mm) IVUS catheter was used (Group II). Quantitative angiography was performed before and after the IVUS study to determine potential changes in lumen diameter. Clinical and angiographic characteristics were similar in the two groups. A successful IVUS interrogation of the target lesion was obtained more frequently in Group II (45/51 (88%) vs. 19/34 (56%) patients, P < 0.01). After the IVUS study, a change in minimal lumen diameter was seen in Group I (baseline 0.84 +/- 0.2 vs. final 1.17 +/- 0.2 mm, P < 0.001) and Group II patients (baseline 0.80 +/- 0.3 vs. final 1.03 +/- 0.4 mm, P < 0.01). In the 64 lesions successfully crossed, the absolute gain in lumen diameter was significantly higher in Group I (0.40 +/- 0.2 vs. 0.23 +/- 0.2 mm, P < 0.05). In addition, an inverse correlation was found between baseline minimal lumen diameter and the absolute lumen gain induced by the IVUS study in Group I (r = -0.47, P < 0.05) but not in Group II patients (r = -0.16, NS). Neither angiographic nor echogenic lesion characteristics were associated with the change in lumen diameter. When multivariate analysis was applied, catheter size was the only independent predictor of lumen gain induced by IVUS after adjustment. Thus, the advancement of IVUS catheters across severe coronary lesions induces significant angiographic changes consistent with plaque remodeling and a Dotter effect. The use of smaller catheters not only allows a higher number of lesions to be studied before intervention, but also lessens the mechanical disruption of the plaque, yielding a more accurate and veracious picture of baseline plaque characteristics.

Narrative development in late talkers: early school age

Children with slow expressive language development (SELD) as toddlers and a control group of children with normal language development (NL) were followed to early school age. Children with SELD were, at that point, subdivided into two groups: those who had moved within the normal range of expressive language (the History of Expressive Language Delay [HELD] subgroup); and those who continued to score below the normal range in expressive language at school age (the Expressive Language Delay [ELD] subgroup). During their kindergarten, first, and second grade years, they were administered a narrative generation task. Narratives were analyzed for MLU, lexical diversity, amount of information included, proportion of complete cohesive ties, and overall stage of narrative maturity. In kindergarten, children with normal language history scored significantly higher than those with HELD and ELD on lexical diversity and narrative stage; and higher than those with ELD in proportion of complete cohesive ties. In first grade, children with normal language history again scored significantly higher than those with HELD and ELD on narrative maturity, with no other significant differences. In second grade, there were no significant differences among the groups.

Percutaneous mitral valvuloplasty for rheumatic mitral stenosis associated with cor triatriatum

A patient with rheumatic mitral stenosis associated with cor triatriatum is described. The anomalies were detected by two-dimensional echocardiography and confirmed by transesophageal echocardiography. Percutaneous mitral valvuloplasty was successfully performed with the inoue technique. The clinical and technical implications during the procedure of this previously unreported association are discussed.

Percutaneous mitral valvuloplasty with the Inoue technique in a patient with heavily calcified interatrial septum

A 75-year-old woman with severe rheumatic mitral stenosis was admitted for percutaneous mitral valvuloplasty. Two-dimensional echocardiography disclosed severe calcification of the posterolateral left atrial wall and interatrial septum. Percutaneous mitral valvuloplasty, using the inoue technique, was successfully performed after a transseptal puncture through the calcified interatrial septum, avoiding the need for surgical intervention.

A cohort study on childhood asthma admissions and readmissions

BACKGROUND

Admissions to hospitals for childhood asthma seem to be increasing, even though admissions for other childhood conditions are decreasing. We studied admissions and readmissions for childhood asthma in Ontario in an attempt to uncover factors relating to the admission patterns.

METHODS

Using the hospital discharge data from the Canadian Institute for Health Information, 28,646 children with diagnoses of asthma were identified from April 1, 1989, to March 31, 1992.

RESULTS

The admission rates for asthma among children in Ontario showed a 14.8% decrease from 1987 to 1992. This decline was observed primarily in 5- to 17-year-olds. Younger children had a fourfold risk of hospital admission for asthma. In the 4 years studied, 10,427 children (36.4%) were readmitted at least once, representing 22,114 readmissions, 16,196 (73.2%) of which were for asthma. The 6-month probabilities of readmission for asthma were 20.0% (0- to 4-year-olds) and 11.7% (5- to 17-year-olds). The estimated relative risks (RRs) indicated that younger children had a significantly higher risk of readmission for asthma (RR, 1.38; 95% confidence interval, 1.30 to 1.46) or asthma-related causes (RR, 5.02; 95% confidence interval, 4.16 to 6.05).

CONCLUSIONS

The observed increasing trend in admissions for asthma among children in the 1970s and 1980s leveled off in the early 1990s. The declining admission rates were largely caused by the lower admission rates among school-aged children from 5 to 17 years. The relatively high admission and readmission rates of preschool children are still a concern. Further research is necessary to examine factors that influence admissions for asthma among young children.

Mutations in the endo domain of Sindbis virus glycoprotein E2 block phosphorylation, reorientation of the endo domain, and nucleocapsid binding

Exposure of the carboxyl terminus (endo domain) of Sindbis virus membrane glycoprotein E2 to the cell cytoplasm is critical for the interaction of the nucleocapsid with viral envelope proteins in modified cell membranes. We have shown that the endo domain of PE2/E2 is initially translocated into membranes of the endoplasmic reticulum and subsequently drawn back into the cell cytoplasm during virus assembly. We suggested that phosphorylation of PE2/E2 might be responsible for the reorganization of the PE2/E2 carboxyl terminus. To test this hypothesis, two potential phosphorylation sites in the endo domain of E2, Thr398 and Tyr400, were changed by site-directed mutagenesis. Virus structural proteins are produced at normal levels in BHK-21 cells transfected with RNA containing the double mutation, nucleocapsids are formed, and the envelope proteins are exported from the endoplasmic reticulum; however, no virus is produced. The double mutation prevents phosphorylation of PE2/E2, and electron microscopy of cells transfected with the double mutant RNA reveals no attachment of nucleocapsids to cell membranes. The double mutation blocks exposure of the carboxyl terminus of E2 to the cytoplasm. Revertants of the double mutant to virus production all restored tyrosine at position 400 and restored the ability of the E2 protein to be phosphorylated. Although the threonine at position 398 is conserved among the alphaviruses, no revertant restored threonine at this position.

[Therapy of extension deficits of the knee joint by arthroscopic arthrolysis and dorsal capsulotomy]

Loss of full knee extension is a typical complication of knee ligament surgery and is difficult to treat. We present a technique that is indicated especially in longstanding extension deficits and that combines arthroscopic arthrolysis and posterior capsulotomy. The intra-articular pathology is first treated by arthroscopic debridement and arthrolysis. Then a posteromedial arthrotomy is performed with the knee flexed 90 degrees. the posterior adhesions are divided under direct vision and finally the posterior capsule is detached completely from the distal femur. Twenty-one of 24 patients treated with arthroscopic arthrolysis and posterior capsulotomy from 1989 to 1993 were reviewed with a mean follow-up of 18 months (6-38). The mean extension deficit preoperatively was 17 degrees (10-30 degrees); symptoms persisted from 6 months to 7 years. The gain in extension by this procedure averaged 15 degrees; no patient had more than 5 degrees of extension deficit at follow-up. The knee function improved significantly (Lysholm score preoperatively 62, postoperatively 88, Tegner scale preoperatively 2.2, postoperatively 4.0). We conclude that posterior capsulotomy is a safe and efficient additional procedure to arthroscopic arthrolysis and is indicated in cases with chronic extension deficit after ligament surgery.

The NEUROD gene maps to human chromosome 2q32 and mouse chromosome 2

The Neurod gene is a basic-helix-loop-helix gene that regulates neurogenesis and is identical to the hamster beta2 gene that was cloned as a regulator of insulin transcription. Here we report the cloning of human NEUROD and mapping of the gene to human chromosome 2q32 and to mouse chromosome 2.

Spread of murine cytomegalovirus to inner ocular structures following disruption of the blood-retina barrier in immunosuppressed BALB/c mice

PURPOSE

The aims of this study were to determine whether disruption of the blood-retina barrier (BRB) increases spread of murine cytomegalovirus (MCMV) to the eye after intraperitoneal inoculation and whether systemic immunosuppression influences the location of MCMV in the ocular compartment.

METHODS

The BRB of the left eye of normal and immunosuppressed mice was disrupted by supraciliary inoculation of tissue culture medium followed 2 hours later by intraperitoneal injection of MCMV. Plaque assay of homogenized ocular tissue was used to determine the frequency of virus-positive eyes and the titer of virus in the eyes. Beta-galactosidase staining of frozen sections was used to locate virus in the eyes.

RESULTS

In nonimmunosuppressed mice, the frequency of virus isolation, as well as the titer of virus, were significantly higher in eyes in which the BRB had been disrupted. Although the frequency of virus isolation was the same in both eyes of immunosuppressed mice, the titer of virus was significantly higher in the eye in which the BRB had been disrupted. The most striking result was that the location of virus was different in the nondisrupted eyes of immunosuppressed mice than it was in the disrupted eyes of immunosuppressed mice. In the former, virus was seen only in the outer ocular structures (conjunctiva, sclera, lacrimal gland), whereas in the latter, virus was observed in the retina and anterior segment (iris, ciliary body) as well as the outer ocular structures.

CONCLUSIONS

The results of these studies suggest that ocular damage followed by increased spread of virus to and within the eye during systemic infection with CMV may be one mechanism by which development of CMV retinitis is facilitated in patients with acquired immune deficiency syndrome.

Autoregulation of renal and splanchnic blood flow following infra-renal aortic clamping is mediated by nitric oxide and vasodilator prostanoids

OBJECTIVE

This study examines the hypothesis that nitric oxide and vasodilator prostanoids contribute to the autoregulation of renal artery and superior mesenteric artery (SMA) blood flow following infra-renal aortic clamping.

EXPERIMENTAL DESIGN

Renal and SMA artery blood flow were measured in anesthetized rats. The rats received bolus injection of saline carrier, L-NAME (25 mg/kg) or indomethacin (15 mg/kg) prior to sham or infra-renal aortic occlusion. In vivo blood flow was measured 1, 30 and 60 minutes during aortic occlusion and 1, 30, and 60 minutes following release of the aortic cross clamp.

RESULTS

Aortic occlusion transiently increased SMA blood flow but did not alter renal artery blood flow. Aortic clamp release resulted in a 40% decrease in both SMA and renal artery blood flow. L-NAME or indomethacin pretreatment decreased both SMA and renal artery blood flow at 60 minutes following infrarenal aortic occlusion. Indomethacin decreased SMA blood flow at 1 minute following unclamping of the aorta and L-NAME decreased SMA blood flow at 30 and 60 minutes following aortic clamp release. Both L-NAME and indomethacin markedly decreased renal artery blood flow at all time periods following aortic clamp release.

CONCLUSIONS

These data suggest that renal and splanchnic vascular beds utilize endogenous vasodilator eicosanoids and nitric oxide to maintain blood flow during cross clamping and unclamping of the infra-renal aorta.

Polymerase chain reaction for the detection of Mycobacterium tuberculosis DNA in tissue and assessment of its utility in the diagnosis of hepatic granulomas

A polymerase chain reaction (PCR) assay for the rapid identification of Mycobacterium tuberculosis, based on amplification of the IS6110 insertion sequences, was tested in paraffin-embedded tissue from 64 biopsy samples with either positive or negative cultures for Mycobacterium tuberculosis. The utility of this PCR assay in the diagnosis of tuberculosis among patients with hepatic granulomas (HGs) was then tested by examining 43 liver biopsy samples. They were classified as either having definitive or probable tuberculosis or as being of nontuberculous origin, on the basis of clinical and microbiologic data and on their response to antituberculous treatment. PCR was 100% sensitive in the diagnosis of culture-positive M. tuberculosis infection in the lymph node, lung, and liver. The sensitivity of the PCR in the diagnosis of HG of definitive tuberculous origin was 58%, and the specificity was 96%. PCR is a valuable test for the demonstration of mycobacterial DNA in tissues. Although it is not highly sensitive, the DNA amplification method may also be more sensitive than culture in the diagnosis of M. tuberculosis-associated HG.

Has laparoscopic cholecystectomy changed patterns of practice and patient outcome in Ontario?

OBJECTIVE

To examine the effect of the introduction of laparoscopic cholecystectomy (LC) on patterns of practice (number of cholecystectomy procedures, case-mix and length of hospital stay) and patient outcomes in Ontario.

DESIGN

Cross-sectional population-based time trends using hospital discharge data.

SETTING

All acute care hospitals in Ontario where cholecystectomy was provided.

PATIENTS

All 119,821 Ontario residents who underwent cholecystectomy between 1989-90 and 1993-94. After exclusions (initial bile duct exploration, cancer, incidental cholecystectomy, or missing codes for age, sex or residence) 108,442 patients remained.

OUTCOME MEASURES

Number of cholecystectomy procedures, proportion of patients with acute or chronic gallstone disease, length of hospital stay, and rates of death, readmission, and bile duct injury and other in-hospital complications after cholecystectomy by year.

RESULTS

The number of cholecystectomy procedures increased by 30.4% between 1989-90 and 1993-94. The number of patients with chronic gallstone disease increased by 33.6%, and the number who underwent elective surgery increased by 48.3%. The proportion of procedures performed as LC increased from 1.0% in 1990-91 to 85.6% in 1993-94. Patients who received LC tended to be younger female patients with chronic gallstone disease with no coexisting conditions undergoing elective operations. The mean length of stay, adjusted for case-mix differences, was significantly lower in 1993-94 than in 1989-90 (2.6 days v. 7.5 days) (p < 0.05); the values for LC and open cholecystectomy in 1993-94 were 1.8 days and 7.3 days respectively. The decrease in the crude death rate over the study period (0.3% to 0.2%) was not significant (relative odds 1.10, 95% confidence interval [CI] 0.72 to 1.69). In 1993-94 the adjusted risk of readmission to hospital within 30 days was 1.38 (95% CI 1.19 to 1.58) as compared with 1989-90. Over the 5 years the rate of bile duct injuries tripled (0.3% in 1989-90 v. 0.9% in 1993-94). The adjusted risk of having at least one complication after cholecystectomy in 1993-94 was 1.90 (95% CI 1.75 to 2.07) as compared with 1989-90.

CONCLUSIONS

LC has had a substantial effect on the number of cholecystectomy procedures performed, the type of patient having the gallbladder removed and the length of hospital stay. Death rates are unchanged, but the odds of readmission and in-hospital complications are both increased. Future research should be directed toward determining the reasons for the overall increase in rates, developing methods to reduce bile duct injuries and identifying other relevant outcomes, such as patient satisfaction with the procedure.

Pitfalls in nonrandomized outcomes studies. The case of incidental appendectomy with open cholecystectomy

OBJECTIVES

To assess the short-term outcomes of incidental appendectomy through analysis of hospital administrative data and determine the consistency and plausibility of the observed results.

DESIGN

Population-based historical cohort study.

SETTING

All general hospitals in Ontario between 1981 and 1990.

PATIENTS

Patients undergoing open primary cholecystectomy with (7846 exposed) and without (191,599 unexposed) incidental appendectomy.

MAIN OUTCOME MEASURES

In-hospital fatality rates, complication rates, and lengths of hospital stay.

RESULTS

Crude comparisons showed a striking and paradoxical reduction in mortality after cholecystectomy when incidental appendectomy was performed (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23 to 0.57; P < .001); mean length of stay was also lower by -0.46 day (P < .001). After adjustment for confounding differences, such as comorbidity and nonelective surgery, mortality and lengths of stay were similar for exposed and unexposed patients; but exposed patients showed a significant increase in nonfatal complications (OR, 1.53; 95% CI, 1.39 to 1.68; P < .001). Adverse effects from incidental appendectomy emerged consistently for all three outcomes only after restricting the analysis to subgroups of patients at low surgical risk. The increased mortality for exposed patients was largest among low-risk groups; for example, among those younger than 70 years undergoing elective surgery, the OR was 2.65 (95% CI, 1.25 to 5.64; P < .001).

CONCLUSION

These findings suggest that incidental appendectomy is associated with a small but definite increase in adverse postoperative outcomes. However, plausible and consistent findings were only obtained after restricting the analysis to low-risk subgroups in which unmeasured differences in patients' baseline characteristics were less likely to confound adjusted outcome comparisons. This exercise highlights the potential pitfalls in nonrandomized outcomes comparisons using data sources with limited clinical detail, such as hospital discharge abstracts.

Peritoneal migration of an abdominally implanted epicardial pacemaker: a cause of intestinal obstruction

We report the case of a 10-year-old child with an abdominally implanted epicardial pacemaker that eroded through the peritoneum and migrated to an intraperitoneal location, resulting in partial and then complete intestinal obstruction. This potentially life-threatening complication should be considered when a patient with an abdominally implanted pacemaker presents with abdominal pain.

Usefulness of the codification of multiple causes of death in mortality statistics

BACKGROUND

The codification of multiple causes of death began in the US in 1917 and systematic publication of this data started in 1984. In Spain this began in 1988, and the data from this year have been taken as the basis for investigation. They have also been studied for regional differences.

METHODS

A representative sample (595) of Spanish Standard Death Certificates (DC) was collected in Asturias for the year 1988. All were coded according to the International Classification of Diseases and a separate coding was made for each nosological entity included in the certificate (coding of multiple causes). The median, mode and the multiple cause/underlying cause ratio were also calculated.

RESULTS

More than 80% of the certificates studied contained more than one cause of death. Chronic diseases are those which are accompanied by a greater number of causes and acute diseases those which appear alone. The highest ratios appear for diseases which are ill defined and also in those which are chronic.

CONCLUSIONS

Our data show that information is lost in the production of the statistics of mortality and there are repercussions for the usefulness of these statistics.

Differential effects of acute thermal injury on rat splanchnic and renal blood flow and prostanoid release

This study examines the hypothesis that acute thermal injury decreases renal and splanchnic blood flow which correlates with altered endogenous vasodilator eicosanoid release. Anesthetized male Wistar rats were subjected to sham or a non-resuscitated 30% total body surface area burn. At 1, 2, 4, 8, and 24 h post-burn mean arterial pressure as well as superior mesenteric and renal artery in vivo blood flow were measured. The superior mesenteric and renal arteries were cannulated and perfused in vitro with their end organs with Krebs buffer (pH 7.4, 37 degrees C). Renal and splanchnic 6-keto-PGF1 alpha (PGI2), PGE2, and thromboxane B2 (TXB2) release were measured by EIA at 15 min of perfusion. Renal and superior mesenteric artery blood flow decreased by 40% or more at 1 and 2 h post-burn despite mean arterial pressure remaining unchanged. The major eicosanoids released were PGI2 from the splanchnic bed and PGI2 and PGE2 from the kidney. Splanchnic PGI2 and TXB2 release and renal TXB2 increased 2-3 fold at 1 h post-burn but returned to the sham level at 2 h post-burn. By 24 h post-burn the vasodilator eicosanoids were increased in both the splanchnic and renal vascular beds. These data show that decreased renal and splanchnic blood flow was associated with increased endogenous release of the potent vasoconstrictor TXB2. By 2 h post-burn, renal and splanchnic blood flow began returning toward the sham level as endogenous release of TXB2 from both organs fell to sham levels. These data suggest that increased endogenous release of TXB2 may contribute to the short-term decrease in renal and splanchnic blood flow in the immediate post-burn period and thus may contribute to ischemia of both vascular beds.

Findings of coronary angioscopy in angiographically normal coronary segments of patients with coronary artery disease

Compared with pathologic studies coronary angiography is a relatively insensitive technique to detect early atherosclerosis. Coronary angioscopy is a new technique providing direct information on luminal vessel surface. To determine whether coronary angioscopy may detect the presence of atherosclerotic disease on angiographically normal coronary segments, 52 patients underwent a study with coronary angioscopy before coronary angioplasty. The mean age was 59 +/- 10 years; 46 patients were men and 6 were women. The reason for coronary angioplasty was unstable angina in 36 patients, stable angina in 8 patients, and silent ischemia in 8 patients. In seven patients angiography revealed luminal irregularities on the coronary segment proximal to the culprit lesion, and all these patients also had proximal disease as demonstrated by coronary angioscopy. In the remaining 45 (87%) patients angiography revealed a smooth-vessel contour proximal to the target lesion. On quantitative angiography these "normal" coronary segments measured 2.8 +/- 0.4 mm in luminal diameter. In 30 (67%) of these patients angioscopy revealed proximal disease on the vessel wall, but in 15 (33%) patients the luminal surface of these segments also appeared normal on angioscopy. Disease as detected by angioscopy in angiographically normal segments included yellow plaque in 19 patients, mural thrombus in 5, mixed plaques in 4, and small flaps in 2 patients. In eight patients coronary angioscopy detected that atherosclerotic disease extended proximally from the target lesion, but in the remaining 22 patients the angioscopic findings appeared to be discrete and well separated from the angiographic lesion. All these plaques were relatively small and did not protrude into the coronary lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of aortic intramural hematoma by intravascular ultrasound imaging

Our findings indicate the value of IVUS in the study of aortic intramural hematomas in ruling out other aortic diseases such as classic aortic dissection. This technique appears especially attractive for patients with suspected aortic dissection and a normal aortography.

Acute burn down regulates rabbit splanchnic and renal prostanoid release

This study examines the hypothesis that acute thermal injury decreases renal and splanchnic vasodilator eicosanoids. Anesthetized rabbits were subjected to sham or a 25% total body surface area burn and fluid resuscitated. At 2, 4, 6, 12, and 24 h postburn the superior mesenteric and renal arteries were cannulated and perfused in vitro with their end organs with Krebs buffer (pH 7.4, 37 degrees C). Renal and splanchnic prostaglandins (PGs) 6-keto-PGF1 alpha (PGI2), and PGE2, and thromboxane B2 (TxB2) release were measured by EIA at 15 min of perfusion. The major eicosanoids released were PGI2 from the splanchnic bed and PGI2 and PGE2 from the kidney. Renal PGE2 and PGI2 and splanchnic PGI2 release were decreased by 50% or more 12 h postburn (p < 0.01) but were restored to sham burn levels 24 h postburn. Loss of these endogenous renal and splanchnic vasodilators 12 h postburn may contribute to ischemia of both vascular beds at this critical time period following acute burn injury.