Sonographic and clinical pattern of extracranial and cranial giant cell arteritis

OBJECTIVES

The aim of our study was to describe the sonographic pattern and clinical manifestations of extracranial (i.e. carotid and proximal arm arteries) and cranial arterial involvement in patients with giant cell arteritis (GCA).

METHODS

One hundred and ten consecutive patients with an established diagnosis of GCA between January 2002 and June 2010 were identified retrospectively from a database. All patients underwent colour duplex sonography (CDS) of the superficial temporal, carotid, and proximal arm arteries at the time of diagnosis. Circumferential, homogeneous, hypoechogenic wall thickening was regarded as a typical sign for GCA. Sonographic and clinical characteristics of patients with and without extracranial vessel involvement were compared.

RESULTS

Extracranial GCA was observed in 59 of 110 subjects (53.6%). The axillary artery (48.2%) was most frequently affected and bilateral vessel involvement was present in almost all patients (94.8%). Compared to patients with cranial GCA, patients with extracranial GCA were significantly younger, frequently did not meet the American College of Rheumatology (ACR) criteria for classification of cranial GCA, exhibited a lower rate of permanent visual impairment, and were diagnosed later after onset of clinical symptoms (all p < 0.01). With increasing age, a continuous shift from GCA with extracranial arterial involvement to cranial GCA was observed.

CONCLUSION

Using CDS, extracranial GCA is a common finding, most frequently observed in the axillary arteries. The clinical pattern of GCA with extracranial arterial involvement differs from that of cranial GCA.

Endothelialization of PTFE vascular grafts under flow induces significant cell changes

Background

To minimize thrombogeneity of small diameter PTFE grafts they are usually coated in vitro with endothelial cells under static culture conditions. The disadvantage of this technique is that a cell layer is formed that fails to withstand shear stress typical in normal blood flow.

Method

Since the in vivo functional and structural status of endothelial cells correlates with the applied shear stress, we developed a computer-controlled perfusion system to seed and culture cells on PTFE-grafts up to a confluent monolayer under the influence of increasing shear stress. The confluence of endothelial coating was defined by immunohistological staining of cross sections, and by upper light microscopy of flattened graft samples. In addition, the expression of fibronectin as an important adhesion molecule was estimated.

Results and discussion

The application of pulsatile shear stress (6.6 dyn/cm2, 5 min) to grafts endothelialized under perfusion (n = 7) did not lead to a disruption of the confluent cell layer. In contrast, a 5 min long shear stress of 3 dyn/cm2was sufficient to wash more than 50% of cells off the PTFE-graft cultured under static conditions (n = 6). The perfusion cultures showed a significantly higher proliferation rate in comparison with static cultures. This effect was reproducibile in both serum-containing and serum-free culture media. The expression of fibronectin by endothelial cells was significantly higher in the perfused graft compared to the static one. These results suggest the practicability of endothelialized PTFE vascular grafts, preconditioned to shear rates similar to the in vivo situation, as an alternative bypass material in cardiac surgery.

Acute limb ischemia after femoral arterial closure with a vascular sealing device: Successful endovascular treatment

We report on successful catheter therapy of acute occlusions of popliteal and crural arteries due to distal embolization from a vascular sealing device. A 45 years-old male patient underwent percutaneous coronary angiography. After primary successful closure of the right femoral artery by a sealing device the patient developed acute ipsilateral lower limb ischemia, most probably due to embolization of a collagen/thrombin plug. Occlusions of the popliteal and crural vessels were successfully treated by percutaneous thrombectomy, thrombolysis and ballon angioplasty. Combined percutaneous catheter therapy is a therapeutic option for occlusions of popliteal and crural vessels due to embolization from a vascular sealing device.

Clinical characteristics and course of plantar vein thrombosis: a series of 22 cases

Objectives

To evaluate the clinical presentation and disease course of symptomatic plantar vein thrombosis.

Patients and methods

Patients with a first diagnosis of symptomatic plantar vein thrombosis at our institution were retrospectively identified from a prospectively maintained database. All patients underwent complete venous compression sonography extended to the plantar veins because of local symptoms at the sole of the foot. Clinical characteristics were obtained from the medical records.

Results

Between 2005 and 2013, 22 patients were diagnosed with a first episode of plantar vein thrombosis (64% women, mean age at diagnosis 58.2 years, range 32–79 years). All patients reported moderate to heavy pain of the sole of the foot. The lateral plantar veins (96%) were more frequently affected than the medial plantar veins (41%) and extension into the deep calf veins was common (27%). Half of the episodes were idiopathic, with subsequent diagnosis of occult malignancy in two of these patients. In seven patients (32%), plantar vein thrombosis occurred in association to physical strain to the foot. All patients were treated with anticoagulation. Symptomatic pulmonary embolism was not observed and during a mean follow up of 21 months, the post-thrombotic syndrome did not occur. However, recurrences were common (27%) and frequently again affected the plantar veins.

Conclusion

Plantar vein thrombosis should be considered as an important differential diagnosis of acute foot pain.

An autonomous lab on a chip for space flight calibration of gravity-induced transcellular calcium polarization in single-cell fern spores

This report describes the development of lab-on-a-chip device designed to measure changes in cellular ion gradients that are induced by changes in gravitational (g) forces. The bioCD presented here detects differential calcium ion concentrations outside of individual cells. The device includes sufficient replicates for statistical analysis of the gradients around multiple single cells and around control wells that are empty or include dead cells. In the data presented, the degree of the cellular response correlates with the magnitude of the g-force applied via rotation of the bioCD. The experiments recorded the longest continuous observation of a cellular response to hypergravity made to date, and they demonstrate the potential utility of this device for assaying the threshold of cells' g-force responses in spaceflight conditions.

In a pig model ePTFE grafts will sustain for 6 weeks a confluent endothelial cell layer formed in vitro under shear stress conditions

OBJECTIVE

to investigate in a pig model whether small diameter ePTFE grafts will sustain a confluent endothelial cell layer formed in vitro under shear stress conditions.

MATERIALS AND METHODS

thirteen ePTFE (4 mm) grafts were implanted end to end in the right femoral artery of; 8 grafts had been endothelialized in vitro. Grafts were left in situ for 6 weeks then evaluated with ultrasound and histology.

RESULTS

seven endothelialized graft were patent with confluent endothelial cell lining. None of the control grafts were patent or showed evidence of an endothelial lining.

CONCLUSION

in this pig model ePTFE grafts sustained for 6 weeks a confluent endothelial cell layer formed in vitro under shear stress.

Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis

OBJECTIVES

To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis.

METHODS

Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman's correlation analysis.

RESULTS

Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68).

CONCLUSIONS

Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities.

[Investigation of the practical use of a vaccination device ("Pullet Vaccinator") for young layers]

OBJECTIVE

To evaluate the safety of layer vaccination of the vaccination device "Pullet Vaccinator", its publicised increased operational safety and the practicality of the device using serological monitoring of the vaccination success.

MATERIALS AND METHODS

In a first trial, two veterinarians experienced in the syringe method vaccinated hens using the syringe and the vaccination device, respectively. After 1 hour, the equipment was switched and both veterinarians continued to vaccinate for a further hour. The second trial proceeded as in the first trial, except with untrained persons. For each of the four vaccination groups (experienced/syringe; experienced/device; untrained/syringe; untrained/device), the number of vaccinated hens was counted and 20 hens were dissected from each group to compare the impact of both inoculation methods on the animals. To monitor vaccination success, blood was collected for serological screening. On the final blood collection day, further hens per group were dissected to evaluate possible long-term injuries.

RESULTS

The vaccination device offers greater occupational safety compared to the syringe method. Vaccination injuries to the hens' breast muscles were more pronounced with the syringe application. For experienced persons, the number of vaccinated animals per hour was approximately doubled using the syringe compared to the device. For the untrained, a comparable number of vaccinated animals was recorded for both methods. Serological monitoring did not show any significant differences in antibody response to the vaccination between both methods.

CONCLUSION AND CLINICAL RELEVANCE

In certain points, the device proved technically imperfect and should be revised for improved use in the field.

Fever of unknown origin as initial manifestation of large vessel giant cell arteritis: diagnosis by colour-coded sonography and 18-FDG-PET

OBJECTIVES

To evaluate the clinical characteristics and imaging results (CDS, 18-FDG-PET) of patients with large vessel giant cell arteritis (LV-GCA) presenting as fever of unknown origin (FUO).

METHODS

From a series of 82 patients with GCA we identified 8 patients with FUO as initial disease manifestation. Clinical characteristics and results of CDS and 18-FDG-PET were analysed. Patients with FUO and those with other clinical manifestations of GCA were compared.

RESULTS

18-FDG-PET-scans were available for 6/8 patients, revealing enhanced tracer uptake of the thoracic aorta and the aortic branches in all patients. CDS was performed in 8/8 patients, with detection of hypoechogenic wall thickening related to LV-GCA in 7/8 patients. Subjects with FUO were significantly younger (60.9 vs. 69.3 years, p<0.01) and had a stronger humoral inflammatory response (CRP 12.6 vs. 7.1 mg/dl, p<0.01; ESR 110 vs. 71 mm/hour, p<0.01), when compared to the other GCA-patients.

CONCLUSIONS

LV-GCA should be considered as important differential diagnosis in patients with FUO. In addition to 18-FDG-PET, which is known to be a valuable method in the diagnostic work-up of FUO, we recommend CDS of the supraaortal and femoropopliteal arteries for the initial diagnostic work-up.

Untersuchungen zum Einsatz des Impfautomaten „Pullet Vaccinator“ in der Junghennenaufzucht

Gegenstand und Ziel: Überprüft werden sollten Sicherheit und Unbedenklichkeit der Vakzination von Hühnern mit dem Impfautomaten „Pullet Vaccinator“, die vom Hersteller propagierte höhere Arbeitssicherheit und die Praktikabilität des Systems mit anschließender serologischer Kontrolle des Impferfolgs. Material und Methoden: Im ersten Versuchsabschnitt impfte je ein mit dem Spritzenverfahren geübter Tierarzt parallel mit der halbautomatischen Spritze und mit dem Automaten. Nach 1 Stunde wurden die Impfgeräte getauscht und für eine weitere Stunde geimpft. Der zweite Versuchsteil verlief analog zum ersten, doch führten hier im Impfen ungeübte Personen die Vakzination durch. Die Anzahl der geimpften Hennen wurde gezählt und von jeder der vier Impfgruppen (geübt/Spritze; geübt/Automat; ungeübt/Spritze; ungeübt/Automat) wurden 20 Tiere seziert, um die Auswirkungen der beiden Methoden zu vergleichen. Weiterhin erfolgte eine serologische Untersuchung zur Prüfung des Impferfolgs. Für die Evaluierung möglicher Spätfolgen der Vakzination wurden am letzten Termin der Blutentnahme weitere Hennen seziert. Ergebnisse: Der Impfautomat bietet eine höhere Arbeitssicherheit als die halbautomatische Spritze. Nach Spritzenapplikation lagen ausgeprägtere Impfschäden in der Muskulatur der Hühner vor. Geübte Personen impften mit der Spritze pro Stunde etwa doppelt so viele Tiere wie mit dem Automaten. Wurden die Impfungen von ungeübten Personen vorgenommen, war die Zahl geimpfter Tiere bei beiden Verfahren annähernd gleich. Die serologische Untersuchung ergab keine signifikanten Unterschiede zwischen den zwei Methoden in Bezug auf den Impferfolg. Schlussfolgerung und klinische Relevanz: Technisch ist der Impfautomat in einzelnen Punkten noch nicht ausgereift und sollte überarbeitet werden, um im praktischen Einsatz bestehen zu können.

OT2-03-05: Evaluation of the Prevalence and Prognostic Significance of VEGF165b in Breast Cancer Patients Compared to Healthy Women

Background: VEGF165b mRNA was first isolated in 2002 by RT-PCR out of renal cortex tissue which resulted in a shorter PCR product than predicted from previously identified isoforms. This isoform was subsequently identified and cloned in both primary epithelial cells as well as in stable immortalized podocyte cell lines. Because of the nature of this splice variant and its distal splicing of the 3'-untranslated region of the VEGF mRNA, most previously investigated expression studies will not have distinguished VEGF165b form other isoforms. This may explain some of the data that does not show clear relationships between VEGF expression and angiogenesis. Moreover recent studies showing that VEGF-neutralizing antibodies could be more effective by targeting the proangiogenic splice variants rather than a pan-VEGF strategy. There has been only limited in vitro data regarding the role of VEGF165b but no in vivo data regarding the level of expression of VEGF165b in breast cancer or its possible correlation with disease progression.

Trial design: This is a monocentric observational cohort study with the primary objective to estimate the prevalence of VEGF165b in breast cancer patients compared to healthy controls and correlate it with existing clinical data. There are two groups of patients included in this study; patients with newly diagnosed breast cancer and healthy volunteers.

Eligibility criteria: The eligibility criteria for the breast cancer group are newly diagnosed ductal, lobular or inflammatory breast cancer at stage I-IV, no prior treatment, above 18 years of age. The eligibility criteria for the healthy volunteers are healthy women with no history of cancer with no current medical therapies and above 18 years of age. Specific aims: The primary objective of this trial is to estimate the prevalence of VEGF165b in breast cancer patients and healthy volunteers. The secondary objective is the correlation of VEGF165b with clinical characteristics over time.

Statistical method: The statistical analysis being used in this study will be primarily descriptive with the calculation of mean and median and confidence intervals. The difference in distribution of the values will be examined in a one way variant analysis. We will also correlate results from different biospecimens and correlate the prevalence of variant presence or absence.

Material and methods: The samples will be analysed using a specific ELISA as well as immunohistochemistry. The accuracy and sensitivity of the available ELISA are of utmost importance in this setting. Bates et al have done previous work evaluating the ELISA used in this study and have shown that it underestimates the value for VEGF165b but that it is specific for VEGF165b. Since we will rather look at individual variation over the course of time, it will not have an effect regarding the expected results but it prohibits a direct comparison of the measured levels of VEGF165 to VEGF165b if they are not corrected for this lack in sensitivity.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-03-05.

Endothelialization of PTFE vascular grafts under flow induces significant cell changes

BACKGROUND

To minimize thrombogeneity of small diameter PTFE grafts they are usually coated in vitro with endothelial cells under static culture conditions. The disadvantage of this technique is that a cell layer is formed that fails to withstand shear stress typical in normal blood flow.

METHOD

Since the in vivo functional and structural status of endothelial cells correlates with the applied shear stress, we developed a computer-controlled perfusion system to seed and culture cells on PTFE-grafts up to a confluent monolayer under the influence of increasing shear stress. The confluence of endothelial coating was defined by immunohistological staining of cross sections, and by upper light microscopy of flattened graft samples. In addition, the expression of fibronectin as an important adhesion molecule was estimated.

RESULTS AND DISCUSSION

The application of pulsatile shear stress (6.6 dyn/cm2, 5 min) to grafts endothelialized under perfusion (n = 7) did not lead to a disruption of the confluent cell layer. In contrast, a 5 min long shear stress of 3 dyn/cm2 was sufficient to wash more than 50% of cells off the PTFE-graft cultured under static conditions (n = 6). The perfusion cultures showed a significantly higher proliferation rate in comparison with static cultures. This effect was reproducibile in both serum-containing and serum-free culture media. The expression of fibronectin by endothelial cells was significantly higher in the perfused graft compared to the static one. These results suggest the practicability of endothelialized PTFE vascular grafts, preconditioned to shear rates similar to the in vivo situation, as an alternative bypass material in cardiac surgery.

["Vibration white finger" syndrome in 8 grinders of a large metal manufacturing industry]

PATIENTS

Eight patients with vibration white finger syndrome (VWF) were seen in our angiological outpatient department. They were all turbine grinders working in the same large factory. One patient presented with a pronounced Raynaud's phenomenon only, while all the others additionally complained of numbness, weakness and pain affecting both hands.

FINDINGS

We requested an intra-arterial DSA of the right hand of all patients, which in some patients revealed, in addition to severe vasospasm, also blood vessel breaks. The patient who apparently was exposed to vibration the longest also had aneurysms affecting the capillaries of all fingers.

[Duplex ultrasound for diagnosis of carotid stenosis. Detecting stroke candidates]

In the hands of an experienced examiner, and with consideration being given to defined criteria, duplex sonography of the extracranial arteries supplying the brain is a valid, noninvasive, nonstressful, reproducible and comparatively inexpensive examination procedure. The indication for this examination is established after a cerebral ischemic event, or in patients with an appropriate risk profile. Nevertheless, anatomical variants or technical problems make necessary a further diagnostic work-up in the form of MR or conventional angiography.