Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.

Genome duplication in soybean (Glycine subgenus soja)

Restriction fragment length polymorphism mapping data from nine populations (Glycine max x G. soja and G. max x G. max) of the Glycine subgenus soja genome led to the identification of many duplicated segments of the genome. Linkage groups contained up to 33 markers that were duplicated on other linkage groups. The size of homoeologous regions ranged from 1.5 to 106.4 cM, with an average size of 45.3 cM. We observed segments in the soybean genome that were present in as many as six copies with an average of 2.55 duplications per segment. The presence of nested duplications suggests that at least one of the original genomes may have undergone an additional round of tetraploidization. Tetraploidization, along with large internal duplications, accounts for the highly duplicated nature of the genome of the subgenus. Quantitative trait loci for seed protein and oil showed correspondence across homoeologous regions, suggesting that the genes or gene families contributing to seed composition have retained similar functions throughout the evolution of the chromosomes.

Divalproex sodium in the treatment of aggressive behavior

Divalproex sodium was given to a series of agitated individuals with a variety of psychiatric illnesses. Objective measures of agitation were then used to assess the effect of the divalproex sodium on such behavior. Demographic, diagnostic, medical, and physiological data were compiled on the subjects and the variation in the amount of time spent in an agitated state was evaluated in an attempt to account for the variation. We found that divalproex sodium reduced agitation in a variety of psychiatric conditions. It seems to be especially effective in the treatment of the agitated patient with bipolar illness or borderline personality disorder.

Auditory hallucinations, posttraumatic stress disorder, and ethnicity

The occurrence of intrusive auditory perceptions has rarely been addressed in the study of posttraumatic stress disorder. This study examined the background of 59 individuals with combat-related posttraumatic stress disorder. Subjects with and without auditory hallucinations were compared on demographic military and symptom variables. The occurrence of hallucinations among veterans with posttraumatic stress disorder appears to be more frequent among subjects of Hispanic ethnicity. This may have been related to higher combat exposure or social stresses. The occurrence of hallucinations was unrelated to drug abuse and did not appear to be associated with any particular war.

Synthesis of transforming growth factor-beta 1 by megakaryocytes and its localization to megakaryocyte and platelet alpha-granules

We have directly demonstrated that megakaryocytes are a major site of synthesis and storage of transforming growth factor-beta 1 (TGF/beta 1) by combined immunohistochemical, immunocytochemical, and in situ hybridization methods. The presence of TGF/beta 1 messenger RNA (mRNA) in mature megakaryocytes in adult rat spleen and bone marrow (BM) was established by in situ hybridization. Localization of TGF/beta 1 protein to intact alpha-granules of megakaryocytes, its putative storage site, was accomplished in glycol-methacrylate embedded porcine BM with an immunoperoxidase technique and light microscopy. The TGF/beta 1 was sequestered in intracytoplasmic granules in a pattern virtually identical to that of another alpha-granule marker protein, fibrinogen. This observation strongly suggests packaging of TGF/beta 1 into this organelle within megakaryocytes. That TGF/beta 1 mRNA was localized to megakaryocytes suggests that the TGF/beta 1 found in the alpha-granules in platelets originates with megakaryocyte synthesis. The alpha-granule localization of TGF/beta 1, as well as fibrinogen, was also demonstrated in isolated platelets at the ultrastructural level by electronmicroscopy (EM) and postembedding colloidal-gold immunocytochemistry, thus directly demonstrating that alpha-granules are the final storage site for TGF/beta 1 in mature platelets.

Pre-operative nutritional support in children with end-stage liver disease accepted for liver transplantation: an approach to management

Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120-150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58-100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branched-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.

The effect of gender and subtype on platelet MAO in alcoholism

Decreased platelet MAO activity has been identified in male alcoholics with suggestions that this is primarily true of Type 2 alcoholics as defined by criteria from the Stockholm Adoption Study. Little information has been available regarding platelet MAO activity in female alcoholics. This study evaluated a group of 71 alcoholics receiving inpatient treatment, including 16 female alcoholics, for platelet MAO activity compared to controls. Female alcoholic's platelet MAO was significantly lower than controls and not different from activity levels in male alcoholics. Among male alcoholics, both Type 1 and Type 2 subgroups were lower than controls and Type 2 levels did not differ from Type 1 levels. Thus, we were unable to replicate a gender and subgroup low platelet MAO specificity among alcoholics, but did find significant differences between alcoholics and controls.

Lung abscess secondary to xanthogranulomatous pyelonephritis

In a patient with xanthogranulomatous pyelonephritis the initial clinical and radiological picture suggested a diagnosis of lung abscess.

Intervening sequence-specific in situ hybridization: detection of the pro-opiomelanocortin gene primary transcript in individual neurons

We describe here the in situ hybridization procedure which we have used to detect the pro-opiomelanocortin (POMC) gene primary transcript in nuclei of individual neurons in the periarcuate region of the hypothalamus. An exon-intron RNA probe was used to detect POMC primary transcript and mature mRNA in nuclear extracts of nucleic acids using a sensitive S1 nuclease protection assay. The levels per cell of nuclear primary transcript were similar to those seen in the anterior pituitary, suggesting that intervening sequence in situ hybridization should be feasible. A nonrepetitive complementary RNA probe specific for the first intervening sequence of the rat POMC gene (POMC IVS-A) was used to detect the POMC primary transcript in hypothalamic tissue sections by in situ hybridization. The distribution of nuclear localized autoradiographic grains was similar to that previously reported for immunocytochemically defined POMC neurons, suggesting that the procedure is also effective in brain cells.

The effect of contrast medium viscosity on the blood-brain barrier after intracarotid injection in the rabbit

This study was undertaken to investigate the role of contrast medium viscosity in blood-brain barrier disruption after carotid angiography. Test solutions were injected into the carotid arteries of rabbits, and the degree of disruption was assessed by using 99mTc-pertechnetate and Evans blue as quantitative and qualitative markers, respectively. The seven test solutions consisted of basic solutions of physiological saline, iopromide, or methylglucamine iothalamate plus solutions derived from these by the addition of sufficient gelatin to augment their viscosities considerably. The solutions were injected over a 30-sec period, resulting in doses that varied inversely with viscosity. One of the high-viscosity solutions was also injected as a fixed dose, equal to the mean injection volume of its low-viscosity counterpart, without regard to the time used. Statistical comparison between the effects of the solutions showed that, under the conditions of the study, contrast medium viscosity, either by itself or as a consequence of its association with hyperosmolality, has no significant effect on the blood-brain barrier. However, under conditions of constant injection volume, higher viscosity solutions may require increased injection times, and this may lead to increased disruption of the blood-brain barrier.

Diazepam binding inhibitor gene expression: location in brain and peripheral tissues of rat

Diazepam binding inhibitor (DBI), an endogenous 10-kDa polypeptide was isolated from rat and human brain by monitoring displacement of radioactive diazepam bound to specific recognition sites in brain synaptic and mitochondrial membranes. The cellular location of DBI mRNA was studied in rat brain and selected peripheral tissues by in situ hybridization histochemistry with a 35S-labeled single-stranded complementary RNA probe. DBI mRNA was heterogeneously distributed in rat brain, with particularly high levels in the area postrema, the cerebellar cortex, and ependyma of the third ventricle. Intermediate levels were found in the olfactory bulb, pontine nuclei, inferior colliculi, arcuate nucleus, and pineal gland. Relatively low but significant levels of silver grains were observed overlying many mesencephalic and telencephalic areas that have previously been shown to contain numerous DBI-immunoreactive neurons and a high density of central benzodiazepine receptors. In situ hybridizations also revealed high levels of DBI mRNA in the posterior lobe of the pituitary gland, liver, and germinal center of the white pulp of spleen, all tissues that are rich in peripheral benzodiazepine binding sites. The tissue-specific pattern of DBI gene expression described here could be exploited to further understand the physiological function of DBI in the brain and periphery.

Examination of the nephrographic potential of iotrol by computed tomography

The x-ray attenuation of the renal cortex of dogs, as determined by computed tomographic (CT) scanning, was measured over a three-day period after an intravenous bolus of 600 mg I/kg of iotrol or iopamidol. A slightly higher density observed 24 hours after injection of iotrol was not considered significant, and was not considered sufficient to warrant clinical application of iotrol for specific, prolonged renal enhancement.

A comparison of blood-brain barrier disruption by intracarotid iohexol and iodixanol in the rabbit

A rabbit model was used to compare the effect on the blood-brain barrier of the intracarotid injection of two new contrast media: iohexol, a nonionic monomer, and iodixanol, a nonionic dimer. It was hypothesized that the low osmolality of iodixanol (272 mOsm/kg at 300 mgl/ml) would cause less disruption of the blood-brain barrier than the relatively higher osmolality of iohexol (690 mOsm/kg at 300 mgl/ml). The degree of blood-brain barrier disruption was assessed qualitatively, by observing the degree of cortical staining with Evans' Blue dye, and quantitatively, by calculating the difference in uptake of 99mTc-pertechnetate between injected and noninjected hemispheres. Statistical analysis of the results showed that both iodixanol and iohexol had a significantly greater effect on blood-brain barrier disruption than did isotonic saline (0.005 greater than p greater than .001), but that the effect of iodixanol was not significantly different from that of iohexol with respect to either Evans' Blue staining (p greater than .05) or pertechnetate uptake (.75 less than p less than .90). Thus, the low-osmolality iodixanol has no significant advantage over iohexol in terms of blood-brain barrier disruption after experimental carotid angiography.

Metabolism and DNA-binding in vivo of aflatoxin B1 in medaka (Oryzias latipes)

1. The medaka (Oryzias latipes), a small aquarium fish, was shown to possess the capacity to rapidly activate AFB1 in vivo at 25 degrees C to intermediates that bind to DNA. 2. The dose-response for in vivo AFB1-DNA binding was linear over the range 70-550 micrograms AFB1/kg body weight. 3. Maximum binding occurred within the first 24 hr after i.p. injection of [3H]AFB1, followed by a rapid loss of adducts. 4. Aflatoxicol (AFL) and unreacted AFB1 were found by HPLC analysis to be the major products excreted into water after AFB1 exposure, with excretion of AFL as early as 2 min after AFB1 injection. 5. These studies show that medaka possess enzymatic systems similar to rainbow trout (Salmo gairdneri) for biotransformation of AFB1 to the epoxide and to other phase I and phase II metabolites.

Rate of clearance of intrathecal iopamidol in the dog

The incidence of post-myelographic side-effects has been significantly reduced since the advent of the new generation of water-soluble, non-ionic, contrast media (CM). One of these CM, iopamidol, has recently been released for clinical intrathecal use in Australia. Clinical evaluations have shown iopamidol to give excellent diagnostic results. However, many adverse side-effects have been cited in the literature. Reactions to iopamidol following myelography are thought to be due to the lack of a physiologic barrier between the extracellular fluid of the brain parenchyma and the CSF, thereby allowing CM to penetrate the brain parenchyma tissue, following subarachnoid injection. This study investigates the rate of clearance of intrathecal iopamidol from the brain in dogs by performing coronal CT scans at intervals over a 48 h, post-injection period. Analysis of similar regions of interest (ROI) for each time period indicate that iopamidol can be detected in canine brains for at least 48 h following intrathecal injection (P less than 0.05). Furthermore, the disappearance of iopamidol from the brain parenchyma is approximately logarithmic in form, with a half-life of approximately 22 h.