Treatment of de novo femoro-popliteal lesions with a new Drug Coated Balloon: early experience of a single Center in the first 50 patients

Angioplasty with drug-coated balloon (DCB) is an emerging and reliable method for the treatment of femoro-popliteal lesions. We report our experience with the Stellarex™ DCB in the first 50 patients.

METHODS

From July 2015 to November 2017, 50 patients (41 M, 9F), medium age (64 ± 7.4 year) were subject to 33 angioplasties (PTAs) for femoro-popliteal lesions with a paclitaxel-coated balloon (Stellarex™). Based upon clinical data sixteen patients had severe claudication (56% - Rutherford class 3); ten patients suffered from ischemic rest pain (34% - Rutherford class 4); and five presented minor tissue loss (10% - Rutherford class 5). 42% of patients showed femoro-popliteal lesion TASC-II B, and 58% presented lesions pertaining to TASC-II C.

RESULTS

Immediate technical success was 100% without perioperative complications. Primary patency rate was 94% at twelve months. In three cases restenosis (6%) was detected within a year from procedure, and a further PTA DCB was performed with primary assisted patency rates of 100% at twelve months. Two patients underwent major lower limb amputation. Three patients died during follow-up and one patient was lost at follow-up.

CONCLUSION

DCB angioplasty with Stellarex™ is a viable alternative to traditional endovascular procedures proving satisfactory primary patency rates at twelve months. Based on our experience, treatment with DCB is a first choice technique for non-complex de novo lesions of the femoro - popliteal tract.

Implant of Autologous Mesothelial Cells in Animals and a Peritoneal Dialysis Patient

Success in culturing human and animal peritoneal mesothelial cells for the purpose of study, led us to determine whether these cells could be autoimplanted in animals and man during peritoneal dialysis in cases of acute and extensive loss of mesothelial surface area. Using an original biopsy technique, we were able to cultivate and characterize from the structural and caryological point of view, human and rabbit peritoneal mesothelial cells. Staphylococcal peritonitis was provoked in 12 rabbits with in-dwelling peritoneal catheters and after 4 days of antibiotic therapy, 6 of them were autoimplanted with cultured mesothelial cells. In the animals sacrificed on the third and sixth days, direct morphological observation and autoradiographic techniques showed that the transplanted cells had taken and revealed a different picture from that in the non-transplanted rabbits.

In a 56 year old female diabetic patient, upon insertion of the first peritoneal catheter, a specimen of mesothelial cells was cultured and then frozen. Seven months later after an episode of peritonitis from Candida which dictated removal of the peritoneal catheter, since there was a sufficient number of cultured mesothelial cells and the patient consented, the implant was performed. Peritoneal biopsy by laparoscopy three and six days later showed that the cells had taken. The purpose of the study was merely to show that autoimplant of mesothelium in man and animals is possible.

Abstract P5-09-13: The effect of bone pain–specific education vs general chemotherapy side-effect education on reported bone pain in patients (pts) with breast cancer receiving chemotherapy and pegfilgrastim

Background: Mild-to-moderate bone pain is the most commonly reported adverse event (AE) associated with pegfilgrastim, but pt education has not been specifically studied in the management of pegfilgrastim-related bone pain. We investigated the effect of pt education on reported bone pain in pts with breast cancer receiving adjuvant or neoadjuvant chemotherapy and pegfilgrastim.

Methods: In this single-blind study, female pts ≥ 18 years of age with newly diagnosed stage I–III breast cancer, planning ≥ 4 cycles of neoadjuvant or adjuvant chemotherapy with pegfilgrastim support starting in cycle 1, were randomized 1:1 to view one of two 2-minute educational DVDs: a general educational DVD (GE-DVD) on chemotherapy side effects or a more specific DVD on bone pain following chemotherapy and pegfilgrastim (BP-DVD). Pts were excluded if they were not able to understand English, were scheduled to receive weekly chemotherapy, had ongoing chronic pain requiring treatment, had received chemotherapy for cancer within the last 5 years, or had previously received G-CSF. Pts were required to watch the DVD on 2 separate days during clinic visits up to and including the visit for pegfilgrastim administration in cycle 1. In each of the four cycles of the study period, pts completed a brief bone pain survey once per day for 5 days, beginning the day they received pegfilgrastim; severity of pain was rated on a scale of 0–10. Pts also recorded any medications taken to alleviate bone pain. Pts were asked about AEs at the beginning of each chemotherapy cycle and at the safety follow-up visit.

Results: Of the 312 pts screened, 304 were enrolled, and of those, 300 received pegfilgrastim in cycle 1: 149 in the GE-DVD arm and 151 in the BP-DVD arm. Baseline demographics and characteristics were largely balanced between the arms, but fewer pts in the GE-DVD arm were Hispanic/Latino (3.4% vs 7.9%). Fewer pts in the GE-DVD arm were ER positive (59.1% vs 69.5%) and PR positive (46.3% vs 59.6%), while more were HER2 positive (30.2% vs 18.5%). Receipt of taxane-based chemotherapy regimens was balanced between the arms. Pt-reported maximum bone pain was similar in the GE-DVD arm vs the BP-DVD arm (cycle 1, 3.2 vs 3.5, P = .3479; across all cycles, 4.1 vs 4.6, P = .2196). Pt-reported mean bone pain was also similar between arms (cycle 1, 1.6 vs 1.8, P = .3188; across all cycles, 1.5 vs 1.6, P = .5846) as was area under the curve for pt-reported bone pain (cycle 1, 6.7 vs 7.6, P = .3346; across all cycles, 6.3 vs 6.6, P = .6255). All-grade bone pain and grade 3/4 bone pain from AE reporting were similar between the arms. Pt-reported bone pain and bone pain from AE reporting were highest in cycle 1; pain decreased thereafter and remained stable in cycles 2, 3, and 4. Bone pain medication usage was similar between the arms; usage was highest in cycle 1 and decreased with each subsequent cycle. Pain therefore appeared to be truly stable in cycles 2, 3, and 4, not just better medicated.

Conclusions: Our bone pain–specific educational program did not improve perceptions of bone pain reported by this pt population. Bone pain was highest in cycle 1, decreased in cycle 2, and then remained stable.

Citation Format: Maxwell CL, Guinigundo AS, Vanni L, Morrow PK, Reiner M, Shih A, Klippel Z, Blanchard E. The effect of bone pain–specific education vs general chemotherapy side-effect education on reported bone pain in patients (pts) with breast cancer receiving chemotherapy and pegfilgrastim. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-13.

Microcirculation and tissue metabolism in peripheral arterial disease

It is now clear that different pathophysiologic mechanisms have a profound influence on the extent of the functional impairment in intermittent claudication. In particular, metabolic derangements, including impaired oxygen delivery and/or extraction, reduced nitric oxide synthesis, reduced glucose oxidation, accumulation of toxic metabolites and reduction in carnitine availability are correlated with disease severity. Therefore, metabolic interventions aimed at counteracting these alterations may represent a valid therapeutic approach to the treatment of this condition. To date, verapamil and L-arginine efficacy has been proven in few patients; a large scale clinical trial, conversely, reports that propionyl-L-carnitine appears to be an effective and well tolerated drug for the treatment of intermittent claudication.

Collagen breakdown products and lung collagen metabolism: an in vitro study on fibroblast cultures

BACKGROUND

In fibrotic diseases such as pulmonary fibrosis there is evidence suggesting enhanced synthesis and degradation of lung connective tissue components, including collagen. It has therefore been hypothesised that products of collagen degradation may have a role in the promotion of collagen deposition. In support of this hypothesis, it has recently been shown that intravenous injection of lung collagen degradation products in experimental animals stimulated collagen synthesis leading to increased collagen deposition and diffuse interstitial lung disease.

METHODS

Rabbit and human fibroblast cultures from lung and skin were used as an in vitro model to study the responses of these cells to rabbit collagen degradation products. The effects of an acute exposure to collagen degradation products on synthesis of collagen and noncollagenous protein have been studied in confluent cultures by [3H]-proline incorporation. The effects of collagen degradation products on fibroblast proliferation and production of genetic types of collagen have also been investigated.

RESULTS

The acute exposure of rabbit lung fibroblast cultures to collagen degradation products significantly increased collagen synthesis without affecting non-collagenous protein synthesis. This effect was dose related, specific for lung fibroblasts, and species specific. Collagen degradation products altered the rate of synthesis of genetic types of collagen with a consequent decrease of type III/I+III collagen ratio (0.26 (0.04) treated with collagen degradation products; 0.45 (0.02) controls). These effects occurred without the intervention of serum factors. In addition, collagen degradation products neither affected fibroblast proliferation nor selected specific clones emphasising one type of collagen.

CONCLUSIONS

These results suggest that collagen degradation products can influence lung collagen metabolism by stimulating collagen synthesis. The regulation of collagen mass by collagen degradation products may be of importance in lung collagen homeostasis in vivo.

[Blood zinc levels in patients with dermatologic and neurologic disorders]

Plasma zinc levels in patients of both sexes suffering from an heterogeneous group of dermopathies were examined and compared with those in patients suffering from psychiatric-neurologic pathologies, in which recent literature has also suggested the role of low zinc levels. The results of the study show a prevalence of effective zinc deficiency in 9.2% of dermatologic patients and 3.9% of neurologic patients, as well as low plasma zinc levels with a different mean, mode and s.d. in comparison to other patients in the control group. These results were statistically significant. The findings are discussed and compared with those reported in the literature.

[Echography applied in dermatologic diseases. A comparative preliminary study of the use of high-frequency transducers]

Ultrasonography (US) was first used in dermatology in 1979. During the last few years, US has evolved thanks to technological progress and its use has been on the increase, in dermatology, to study both localized and diffuse skin diseases. In this paper, the authors review and compare the results obtained with a 20 MHz transducer with those obtained with 7.5 MHz and 10 MHz transducers in the study of skin alterations. Three parameters were considered: lesion identification, spatial evaluation and US structure. Fifty-eight cases of localized and 48 of diffuse skin diseases were examined. The localized forms were benign in nature in 18 patients (3 nevi, 2 seborrheic keratoses, 3 ulcus cruris cases, 6 sebaceous and 2 liquid cysts). The other 40 patients had malignant neoplastic lesions (16 epitheliomas, 13 primitive melanomas, 1 metastatic melanoma, 8 lymphomas and 2 Kaposi's sarcomas). The 48 cases of diffuse conditions included 27 systemic sclerosis, 18 psoriasis and 3 lichen planus cases. The comparative analysis of the results obtained using the different types of transducers in the study of localized dermatoses showed no differences in lesion identification and in the depiction of their US features. On the other hand, the 20 MHz transducer was much more accurate than the others as regards the spatial evaluation of the lesions measurable in millimeters, whereas it poorly demonstrated the lesions > 1.5 cm. However, only the 20 MHz transducer could demonstrate the US features of diffuse conditions.

Conflicting aspects of renal leiomyoma with different imaging techniques

A case with benign renal leiomyoma examined by all the imaging techniques currently available is described. The aspects were conflicting, particularly with regard to sonography and magnetic resonance imaging, and the sole technique which provided more reliable information was the CT scan.

Autologous peritoneal mesothelial cell implant in rabbits and peritoneal dialysis patients

Human and rabbit peritoneal mesothelial cells have been successfully cultured and autoimplanted. An original biopsy technique was used to take samples of peritoneal mesothelial cells and after culture they were characterized from the structural and caryological points of view. Staphylococcal peritonitis was induced in 12 rabbits with indwelling peritoneal catheters and after 4 days of antibiotics 6 of them were autoimplanted with cultured autologous mesothelial cells previously marked in 3 cases with thymidine (H3TdR). Direct morphological observation and autoradiography were used to compare the mesothelium of control rabbits and implanted rabbits sacrificed on days 3 and 6 and showed that the cell implants had taken. Four uremic CAPD patients recovering from severe peritonitis were implanted with about 300 million autologous peritoneal mesothelial cells, previously cultured and frozen. Morphological signs of taking were evident from peritoneal laparoscopy biopsies performed 3 and 6 days after implant. The aim of the study was merely to demonstrate that such implants are possible; however, the techniques may have interesting applications not only in peritoneal dialysis, but also in the vaster fields of medicine and surgery.

[Preoperative staging of rectal carcinoma by transrectal echography combined with pelvic computerized tomography]

The accurate staging of rectal carcinoma is very important for treatment planning. The histological data obtained from the surgical specimens of 22 patients with rectal carcinoma were compared with pre- and postoperative endorectal US findings and with preoperative CT results. According to an adapted version of the Astler and Coller classification, the different degrees of tumor spread into the rectal wall were represented as follows: stage A: 1 patient; stage B1: 5 patients; stage B2: 6 patients; stage C1: 1 patient; stage C2: 8 patients and stage D: 1 patient. Preoperative staging, based on the overall results of CT and US, was in agreement with histology in 19 of 22 cases. Individual analysis of US and CT results, in comparison with histological data, showed US staging accuracy to be 77.3% (17/22 patients). US accuracy in demonstrating tumor spread into the rectal wall (stages A, B1, C1) was 100% (7/7 patients); US was 70% accurate in lymph node detection (7/10 patients) and 93.3% accurate in demonstrating perirectal infiltration (14/15 patients). CT diagnostic accuracy was 66.7% (10/15 patients) in the evaluation of perirectal lymph nodes, but tumor spread into the rectal wall (stages A and B1) could not be evaluated. While admitting the primary role of US in the staging of rectal carcinoma, according to our results a combination of US and CT yields a more accurate preoperative diagnostic picture.

Autologous implant of peritoneal mesothelium in rabbits and man

With the purpose of studying peritoneal physiology, original biopsy methods were devised and human and rabbit peritoneal mesothelial cells cultured and characterized. It was then decided to verify whether these cells could be implanted autologously during peritoneal dialysis in cases of acute loss of mesothelial surface. Staphylococcal peritonitis was induced in 12 rabbits and after 4 days of antibiotics, 6 of them were autoimplanted with cultured mesothelial cells, previously marked in 3 cases with thymidine (H3TdR). Implanted rabbits sacrificed after 3 and 6 days showed taking of the new mesothelial cells both by direct morphological observation and by autoradiography. Four uremic CAPD patients recovering from severe peritonitis were implanted with 300 million of their own peritoneal mesothelial cells, previously cultured and frozen. Morphological signs of taking were evident by laparoscopy and from peritoneal biopsies performed 3 and 6 days after implant. The fact that such implants are possible may have interesting applications in medicine and surgery.

[High resolution vascular ultrasonography. Personal experience]

Personal experience in the use of two-dimensional echography (B-scan) in vascular diagnosis is reported, stress being laid on its advantages with respect to other non-invasive investigations (rheography, photoplethysmography, Doppler measurement) and conventional arteriography. The importance of the technique is considered and special attention paid to the system of Biosound for defining small and initial parietal changes whose consequences, particularly if located in the carotid district, can be very serious. The result of an 18-month study using real-time Doppler ultrasonography is reported. 147 carotids and 88 lower extremities were involved and percentages were matched against conventional arteriography where the latter was carried out.

Tachykinins activate guinea-pig alveolar macrophages: involvement of NK2 and NK1 receptors

1. The effects of substance P (SP), neurokinin A (NKA) and neurokinin B (NKB) were evaluated on superoxide anion (O2-.) production by guinea-pig alveolar macrophages (AM). 2. SP dose-dependently (ED50 = 0.7 nM) evoked O2-. production from guinea-pig AM; the N-terminal heptapeptide, SP(1-7), was ineffective. In the presence of thiorphan (10(-5) M), an enkephalinase inhibitor, the stimulating effects of SP were not significantly modified. NKA and NKB were both able to induce O2-. production from guinea-pig AM, ED50 values being 0.1 and 1.3 nM, respectively. Therefore, the rank order of activity of natural tachykinins was NKA greater than SP greater than NKB. Tachykinin-evoked effects were quantitatively similar to those elicited by the autacoid mediator PAF-acether and less than those induced by the synthetic peptide N-formylmethionyl-leucyl-phenylalanine (FMLP). 3. The NK2 receptor agonist [beta-Ala8]-NKA (4-10) dose-dependently evoked O2-. production from guinea-pig AM; the NK1 receptor agonist [Pro9]-SP sulphone acted only at high concentrations, while the NK3 receptor agonist [Me,Phe7]-NKB was ineffective. 4. These findings indicate that guinea-pig AM possess NK2 and possibly some NK1 tachykinin receptors and further suggest tachykinin involvement in lung pathophysiology.

Motor responses of Halobacterium halobrium to sinusodial light stimuli

Sinusoidal light stimuli have been used to elicit photoresponses in Halobacterium halobium at various periods of the stimulus. Cycle histograms and histograms of the times between consecutive reversals are used to illustrate the responses, and the method used to obtain sinusoidally modulated intense light (with periods up to 1 s) is described.

Implant of autologous mesothelial cells in animals and a peritoneal dialysis patient

Success in culturing human and animal peritoneal mesothelial cells for the purpose of study, led us to determine whether these cells could be autoimplanted in animals and man during peritoneal dialysis in cases of acute and extensive loss of mesothelial surface area. Using an original biopsy technique, we were able to cultivate and characterize from the structural and caryological point of view, human and rabbit peritoneal mesothelial cells. Staphylococcal peritonitis was provoked in 12 rabbits with in-dwelling peritoneal catheters and after 4 days of antibiotic therapy, 6 of them were autoimplanted with cultured mesothelial cells. In the animals sacrificed on the third and sixth days, direct morphological observation and autoradiographic techniques showed that the transplanted cells had taken and revealed a different picture from that in the non-transplanted rabbits. In a 56 year old female diabetic patient, upon insertion of the first peritoneal catheter, a specimen of mesothelial cells was cultured and then frozen. Seven months later after an episode of peritonitis from candida which dictated removal of the peritoneal catheter, since there was a sufficient number of cultured mesothelial cells and the patient consented, the implant was performed. Peritoneal biopsy by laparoscopy three and six days later showed that the cells had taken. The purpose of the study was merely to show that autoimplant of mesothelium in man and animals is possible.

Modulation of neutrophil functions by a beta-interferon of human origin

The effects of a beta interferon (beta-IFN) of human origin on different parameters of human neutrophil functioning were evaluated in vitro. In the concentration range 10(2)-10(4) IU/ml beta-IFN enhanced superoxide anion (O2-) production evoked by the peptide N-formylmethionyl-leucylphenylalanine (FMLP), 10(-7) M, when O2- production elicited by FMLP in the absence of beta-IFN treatment was 2.43 +/- 0.32 nmol cytochrome C reduced/10(6) cells/min. The enhancement afforded by 10(3) and 10(4) IU/ml beta-IFN was statistically significant. When FMLP-induced O2- generation was 4.55 +/- 0.3 nmol cytochrome C reduced/10(6) cells/min, no increase was detected after beta-IFN treatment. Phagocytosis was enhanced by beta-IFN in one case, with no effect in four others. Chemotaxis was not affected by exposure to beta-IFN. These results indicated that beta-IFN could exert modulating effects on some neutrophil functions that varied according to the extent of cell response to the stimuli.

Effects of CO2 laser on the healing of experimental colon anastomoses

Anastomotic leakage after colonic resection still remains a troublesome complication of major clinical significance. Systemic (nutritional status, blood viscosity) or local factors (contamination by local germs, suture technique) seems to be implicated in the healing process of the suture line. The CO2 laser as a cutting procedure in colonic resection should provide a useful tool for its accuracy and the bactericidal properties. We have tested the strength of an end-to-end anastomosis of rat colon resected by CO2 laser, scalpel and diathermy, respectively, by measuring the bursting pressures at different postoperative days. The present study shows that the use of CO2 laser resulted in a significant increase of colonic bursting pressure at the anastomotic site.

Liver regeneration after atypical hepatectomy in the rat. A comparison of CO2 laser with scalpel and electrical diathermy

Rats were subjected to partial hepatic lobectomy with removal of about two thirds of the liver either by scalpel, by CO2 laser, or by electrical diathermy. Macroscopic examinations of livers at various days after surgery indicated that CO2 laser surgery results in minor tissue damage, reduced complications from inflammation and infections, and faster healing compared to electrical diathermy, but it is less satisfactory than the scalpel with respect to all these parameters. Rat liver regeneration was followed at the molecular level by measuring the changes of protein biosynthesis activity in the liver, as monitored by modifications of ribosome organization. Activation of the protein biosynthesis process started 1 day after surgery when hepatectomy was performed by scalpel, while 2 days were required when CO2 laser or electrical diathermy were used instead.

[Sequential hepato-biliary scintigraphy and percutaneous cholangiography in the diagnosis of benign diseases of the biliary tract Indications and limits]

Attention is drawn to the results of a study of 45 patients with bile duct calculosis designed to assess the soundness and the limits of two diagnostic examinations (HIDA and PTC) in determining the morphological and functional characteristics of the hepatoenteric tract. The results indicated that HIDA is a useful first step in average to serious cases of icterus as a means of evaluating the functional state of liver cells and the bile ducts by determination of activity-time curves for preselected areas, whereas PTC is more important in cases of serious icterus, since it also enables the patient to be suitably prepared for surgery.

[Hyperthyroidism as a rare cause of "false acute abdomen"]

4 patients affected by hyperthyroidism presenting a feature of "false acute abdomen" as main clinical sign are presented. The low incidence of that association, according to the literature, and the difficulties of a correct diagnosis, which could lead to a useless laparotomy is pointed out. The conclusion is drawn that tests of thyroid functions should be done whenever the feature of acute abdomen presents without any past history of gastro-enteric lesions.

[Primary leiomyosarcoma of the mesentery]

A case of primary leiomyosarcoma of the mesentery is described. Only seven other cases have been reported in the literature, which means that this was an accidental finding. The histological features of the case are illustrated. It is suggested that this tumour originates in the muscle cells of the mesenteric vessels. The view that surgical management is incapable of improving the fatal prognosis is expressed.