Regional cerebral blood flow and cerebrospinal fluid amino acid analysis in elderly dementia

Regional cerebral blood flow and amino acid concentration in the cerebrospinal fluid were studied in 12 cases of vascular dementia, 12 cases of Alzheimer's disease, 12 cases of chronic alcoholism, and 12 age-matched healthy controls. In vascular dementia, blood flows were decreased in the cerebral cortex, frontal white matter, thalamus, caudate nucleus, and putamen and alpha-aminobutyric acid and glutamic acid concentrations were increased in the cerebrospinal fluid. In Alzheimer's disease, blood flows were decreased in the frontal cortex, parietal cortex, temporal cortex, and frontal white matter and alanine concentration was increased in the cerebrospinal fluid. In chronic alcoholism, blood flows were decreased in the cerebral cortex, thalamus, and putamen and urea, alanine, and glycine concentrations were increased in the cerebrospinal fluid.     

MR imaging in pretruncal nonaneurysmal subarachnoid hemorrhage: is it worthwhile?

BACKGROUND and PURPOSE: The cause of pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage is not known. MRI of the brain or spine is often performed to exclude any other vascular abnormalities. Its diagnostic value is not known. METHODS: We used MR imaging of the brain with routine sequences, gadolinium enhancement, and additional thin T1-weighted axial sections following a triple dose of contrast. RESULTS: We performed MR imaging of the brain in 18 patients with a pretruncal nonaneurysmal subarachnoid hemorrhage. The focal nature of the subarachnoid hemorrhage exclusively in front of the brain stem was confirmed in 14 patients studied within 7 days of the ictus. No vascular abnormalities were found in 17 cases, including 14 patients with gadolinium enhancement. An incidental capillary telangiectasia was found in 1 patient. Fluid-attenuated inverse recovery MR additionally documented blood in the sulci due to cerebrospinal fluid recirculation of blood. Five patients underwent MR imaging of the spine, and no arteriovenous malformations were found. CONCLUSIONS: MR imaging did not reveal a source of pretruncal subarachnoid hemorrhage. The cost of MR imaging probably outweighs the benefit in the evaluation of this variant of subarachnoid hemorrhage.     

Subdural hygroma in infants with congenital toxoplasmosis (author's transl)

Cytological examination of the fluid from subdural hygromas revealed congenital Toxoplasmosis in 14 of 43 infants (32,5%). Conversely, subdural hygroma was a significant clinical symptom in 42 cases of congenital Toxoplasmosis. In 9 cases trophozoites or cystes of Toxoplasma Gondii were found in the subdural fluid, and in 4 of these in the cerebrospinal fluid as well. Since serological investigations in young infants and particularly severe infections often remain inconclusive the cytological examination of cerebrospinal fluid is emphasized importance of.     

Expression of endothelin-1 in amniotic fluid embolism and possible pathophysiological mechanism

Since endothelin is a potent vasoconstrictor and bronchoconstrictor, endothelin-1 expression in the lung was investigated using immunohistological techniques in two cases of amniotic fluid embolism. Intense expression of endothelin-1 was observed in amniotic squames while weaker staining was seen in alveolar epithelium, bronchiolar epithelium and intraalveolar macrophages and focally in vascular endothelium. Endothelin-1 may play a role in the early and transient haemodynamic alteration of pulmonary hypertension in amniotic fluid embolism.     

Transverse lesion of the cord syndrome in chondrodystrophic dwarfs (author's transl)

More than 70 transverse lesion of the cord syndromes in chondrodystrophic dwarfs have been described in the literature. 43 of these were adequately described and/or accessible for the authors. In 22 cases, a mechanical cause (including 14 lesions of the intervertebral disk) was directly responsible and, in 14 cases, no direct spinal cord suppression was found. In the latter group, 10 had a negative myelography, 3 positive and 1 case myelography was not performed. Of the 12 laminectomized cases, only 3 made a good recovery, 4 showed severe deterioration and 2 conservatively treated cases (including the case described here) were clearly improved. Of the 16 laminectomized cases with limited mechanical impediment, 8 showed good results, 3 indifferent and 5 unknown. The cause of the vascular myleopathy was assumed to be a combination of the narrowness of the bony vertebral canal and an increasing kyphotic process. The authors suggest that laminectomy for tranverse lesion of the cord syndrome in dwarfs should be made only after several controls and an established stop correlating with the location of the neurological lesions. We reject decompression laminectomy for vascular myleopathy because of the already endangered vascular situation and the poor results. We prefer orthopedic measures.     

Electron paramagnetic resonance studies of cobalt-substituted angiotensin I-converting enzyme

The traditional treatment of high-flow vascular malformations consists of selective embolization, surgical removal, or a combination of both. Recurrence of the lesion and bleeding control are still the main problems, and the result of treatment is sometimes disappointing. We suggest treatment of these lesions with surgical ligation of the distal major feeding arteries followed by intravascular injection of a sclerosing agent (3% tetradecyl sulfate), and surgical excision and reconstruction when indicated. We have found this to be an effective treatment regimen. We present 14 cases of high-flow vascular malformations of the head and neck area treated with this approach, of which 4 cases developed skin necrosis. Three of these 4 cases of skin necrosis were later treated with skin grafting and, in 1 case, an upper arm skin tube flap was used for nasal tip reconstruction. Three cases underwent delayed reconstruction using tissue expanders. From a symptomatic and aesthetic point of view, preliminary satisfactory results were obtained. We feel that this approach is a good option for treating difficult, high-flow vascular malformations.     

Antimicrobial activity of ethanol, glycerol monolaurate or lactic acid against Listeria monocytogenes

Cytogenetic data about 145 chorionic villus samples obtained between the 13th and 35th week of gestation are reported. 'Late' chorionic villus sampling (CVS) was used to resolve different situations: failed amniotic fluid cell cultures (5 cases); confirmation of an abnormal karyotype, previously diagnosed as mosaic (14 cases); and ultrasound fetal malformation (23 cases). Most of the samples (103 cases) were analysed for the classical indications and in these cases, the principal aim was to obtain a rapid fetal karyotype. Excluding the cases used to check fetal karyotype, a chromosomal aberration was found in 11 out of 131 biopsies. In four cases of the group in which the fetal karyotype was checked (14 cases), the pathology observed at the first diagnosis was confirmed, while in the remaining ten cases the anomaly was not observed.     

The significance of fibronectin in cryoprecipitation in rheumatoid arthritis and other diseases

Fibronectin, a glycoprotein produced by mesenchymal cells, was present in 11 of 16 plasma cryoprecipitates and 12 of 14 synovial fluid (SF) cryoprecipitates. In some SF cryoprecipitates it was the major protein component. Fibronectin levels were related to the development of serum turbidity in the cold and fibronectin was involved in the development of cold turbidity induced by some charged polysaccharides in plasma, serum, and SF. It is suggested that fibronectin, which is synthesized by vascular endothelial cells and synovial lining cells, is involved in the development of some cryoprecipitates in patients with rheumatoid arthritis and other diseases.     

Autoradiographic and scintillationspectrographic studies of 14C-zolimidine in rats after i.v. and oral application (author's transl)

The relative distribution of radioactivity after i.v. (5 mg/kg) and oral (25 mg/kg) application of 14C-Zolimidine [2-(p-methyl-sulfonylphenyl)-imidazo-(1,2-a)-pyridine-2-14C] was examined in male rats by whole-body autoradiography and scintillation fluid spectrometry. 14C-Activity was remarkably concentrated in the stomach of i.v. treated animals, probably as a result of secretion from the pyloric and/or fundic part of the mucous membrane. 14C-Zolimidine also accumulated in the aortic vascular walls, the adrenal gland, and in the excretory organs, liver, kidney, and intestine, after both routes of drug administration. Much less radioactivity could be measured in brain and spinal cord. The estimation of nearly 80% gastrointestinal absorption of 14C-zolimidine and the suggestion of one or more metabolites were in accordance with previously reported results. The elimination of radioactivity from brain occurred more rapidly than from other organs. No striking results were found in the reproductive organs of the rats.     

Solid tumors of the liver. Diagnostic and therapeutic problems

The diagnostic and therapeutic problems involved in 29 cases of isolated hepatic tumors have been presented. In nine cases the hepatoma was discovered during emergency treatment for complications. Selective arteriography was the most accurate method of establishing the etiologic diagnosis. Suprahepatic phlebography indicated the possibilities for surgical treatment. These possibilities are not influenced by the volume of the tumor, but are closely dependent on damage to the suprahepatic vascular system. Effective surgery was performed in 22 cases, of which 14 were excisions.     

Special surgery of blood vessels injuries in abdominal trauma

The analysis of the results of treatment of 41 victims with large vessels injuries in abdominal trauma was carried out. According to their location, all the injured vessels were divided in 5 groups: 1) on median line above the mesocolon (9 cases); 2) on median line under the mesocolon (14 cases); 3) in superior lateral part of the abdominal cavity (2); 4) in interior-lateral part of abdominal cavity (8); 5) in the region of hepato-duodenal ligament and retrohepatic area (13). Combined vascular injuries were observed in 5 patients. Basic aspects of diagnosis, surgical policy and treatment are discussed, 14 patients died.     

Placental histopathology in premature rupture of membranes. Its relationship with microbiological findings, maternal, and neonatal outcome

BACKGROUND: There is a close relationship between premature membrane rupture, bacterial infections and premature labor. AIM: To study placental histological changes in patients with preterm membrane rupture. To establish a relationship between pathological findings, amniotic fluid and lower genital tract microbiological studies, maternal and neonatal outcome. PATIENTS AND METHODS: Patients with premature membrane rupture of membranes between 24 and 34 weeks of gestation participated in this study. On admission, patients had no evidence of clinical chorioamnionitis, labor or fetal distress. Microbiological studies of the amniotic fluid and cervicovaginal secretions were performed and the placenta was sent for pathological study. RESULTS: Seventy one placentas were available for the study. The main pathological findings were acute chorioamnionitis in 58%, trophoblastic proliferation in 38%, funisitis in 37%, villitis in 16%, fetal vascular lesions in 14% and no findings in 17%. Microbial invasion of amniotic cavity was present in 89% of acute chorioamnionitis. Sixty one percent of trophoblastic proliferation and all fetal vascular lesions were associated with negative amniotic and cervical cultures. Newborns with acute funisitis had a higher frequency of neonatal death (29%), severe asphyxia (42%) and neonatal infections (29%). CONCLUSIONS: Acute chorioamnionitis is the most frequent finding in patients with preterm membrane rupture and microbial invasion of amniotic cavity. In the absence of intra amniotic infection, proliferation of the trophoblast and the presence of fetal vascular lesions predominate. Acute funisitis is strongly associated with adverse fetal outcome.     

Vascular MADs: two novel MAD-related genes selectively inducible by flow in human vascular endothelium

Vascular endothelium is an important transducer and integrator of both humoral and biomechanical stimuli within the cardiovascular system. Utilizing a differential display approach, we have identified two genes, Smad6 and Smad7, encoding members of the MAD-related family of molecules, selectively induced in cultured human vascular endothelial cells by steady laminar shear stress, a physiologic fluid mechanical stimulus. MAD-related proteins are a recently identified family of intracellular proteins that are thought to be essential components in the signaling pathways of the serine/threonine kinase receptors of the transforming growth factor beta superfamily. Smad6 and Smad7 possess unique structural features (compared with previously described MADs), and they can physically interact with each other, and, in the case of Smad6, with other known human MAD species, in endothelial cells. Transient expression of Smad6 or Smad7 in vascular endothelial cells inhibits the activation of a transfected reporter gene in response to both TGF-beta and fluid mechanical stimulation. Both Smad6 and Smad7 exhibit a selective pattern of expression in human vascular endothelium in vivo as detected by immunohistochemistry and in situ hybridization. Thus, Smad6 and Smad7 constitute a novel class of MAD-related proteins, termed vascular MADs, that are induced by fluid mechanical forces and can modulate gene expression in response to both humoral and biomechanical stimulation in vascular endothelium.     

Glucose effectiveness, peripheral and hepatic insulin sensitivity, in obese and lean prepubertal children

Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.     

Percutaneous drainage of abdominal fluid collections guided by computer tomography

During the war, June 1992,-August 1994, at the Institute 20 percutaneous fluid collections and abscesses drainages in the belles were done, controlled by the CT. The percutaneous drainage we started in 1984, until now we had 141 cases, 20 cases in the war time, 14 of them were wounded, while the rest was suffering from a malignant process in stomach, pancreas, kidneys. Both groups had post-operative complications after liver injuries. 7 underwent the percutaneous drainage. The length was 1-64 days, drainage contents quantity was 60-5.000 m. The drainage was successful with 14 patients, while in 5 cases we had to repeat, change the catheter place. Only with 1 patients the drainage was not done, but an aspiration. The contents were send to microbiologic analysis. It was a retro-peritoneal abscess collection. Based on our ten-years experience, we are of an opinion that the CT controlled percutaneous drainage is a very efficient, simple and acurata urgent radiology procedure. According to our experiences, nearly all cases were successful.     

Intraperitoneal pressure: ascitic fluid and splanchnic vascular pressures, and their role in prevention and formation of ascites

Seventeen patients with ascites due to cirrhosis underwent hepatic venous catheterization and pressure measurement in the ascitic fluid. Intraperitoneal fluid hydrostatic pressure (IFP) ranged 3.5-22, mean 11.2 mm Hg, and correlated closely to the pressure in the inferior vena cava (r = 0.97, P < 0.001), which was on average 1.8 mmHg above that of ascitic fluid (P < 0.005). Wedged hepatic venous pressure (WHVP) (range 19-43, mean 32 mmHg) correlated directly to IFP (0.89, P < 0.001) and was significantly higher than that of ten cirrhotic patients without ascites (range 12-27, mean 20 mmHg, P < 0.005). After diuretic therapy WHVP decreased to an average of 20 mmHg. Mean plasma colloid osmotic pressures were 20 mmHg (range 18-24 mmHg)( and 23 mmHg (range 19-29 mmHg) in patients with and without ascites, the values being significantly different (P < 0.05). Colloid osmotic pressure of ascitic fluid ranged 1-14, mean 4.9 mmHg. Mean ratio between albumin concentration in ascitic fluid and plasma was 0.31 (range 0.12-0.77). In five pigs portal venous pressure (PVP) increased during infusion of fluid into the peritoneal cavity. The increase in PVP was smaller than that of IFP (P < 0.02), indicating that ascitic fluid stems the pressures in the splanchnic venous vascular bed up to a higher level, but that the transmural hydrostatic pressure difference decreases simultaneously. The results are discussed in relation to the local 'oedema-preventing' mechanisms: (a) increased interstitial hydrostatic fluid pressure, (b) decreased interstitial fluid colloid osmotic pressure, (c) increased lymph flow, and it is concluded that the peritoneal space can be considered as a special part of the interstitium in which IFP is considered to play an important role in regulation of ascitic fluid.     

Varicella in pregnancy

We report six cases of hyperplastic mesothelial cells located in the sinuses of lymph nodes. All patients but one had a concurrent serosal fluid collection (two pericardial, two pleural, one abdominal) at the time of the lymph node biopsy. All effusions cleared with treatment of the underlying disorder, which included lymphoproliferative processes, congestive heart failure, and inflammatory diseases (Dressler syndrome, vasculitis, and glomerulonephritis). Four cases were associated with vascular prominence of the involved nodal sinuses, a feature that may reflect the cause of the underlying effusion or support the transient persistence of benign mesothelial cells in lymph nodes. Two cases were characterized by distention of the nodal sinuses by sheets of mitotically active mesothelial cells. The differential diagnosis includes metastatic carcinoma, keratin-positive dendritic cells native to lymph nodes, and metastatic malignant mesothelioma. Because the latter shares both clinical and morphological features with cases of benign mesothelial cells in lymph nodes, we believe that this distinction may not always be possible in a given biopsy specimen and therefore that careful clinical follow-up is required in such cases.     

Fatal amniotic fluid embolism during induced abortion, 1972-1975

From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hystereotomy (one case). Performance of abortion in the first trimester and use of curettage technics could minimize the risks of this catastrophe.     

Intermittent complete vascular exclusion of the liver during hepatectomy: technique and indications

BACKGROUND/AIMS: Complete intermittent vascular exclusion of the liver (IVEL) combines clamping of the hepatic pedicle with clamping of the hepatic veins without interruption of the caval flow. The major advantages of this technique are that patient preclamping fluid overload is avoided, major haemodynamic changes due to caval clamping are escaped, and it allows a very long clamping time. Disadvantage of this technique is the necessity of looping the terminal part of the hepatic veins. METHODOLOGY: In this prospective study, 41 cases of IVEL (Representing 19% of the hepatectomies carried out for cancer during the same period) used for difficult hepatectomies were analyzed, and the operative technique is presented. RESULTS: IVEL was feasible in 90% of the 46 attempted cases, and completely controlled the bleeding in 90% of the cases. The mean duration of IVEL was 69.2 minutes (Range: 37 to 140), and was greater than 130 minutes in three patients. No liver failure occurred during the postoperative course. CONCLUSION: We conclude that IVEL without caval clamping is a new, and valuable, technique of vascular exclusion of the liver. Its application is indicated in the following conditions: 1. For patients who should have classical vascular exclusion but cannot tolerate vena cava clamping (18% of the cases), 2. for patients with pathological liver parenchyma when intrahepatic venous pressure is high, 3. for patients with impaired liver parenchyma, requiring conservative surgery that leads to anatomic or non-anatomic resection close to a vein (Example: A tumor located in the dihedral angle of the terminal part of two hepatic veins), 4. for patients with tumors closely located to a hepatic vein that must be preserved and sharply dissected (Example: A left trisegmentectomy that requires pelting of the right hepatic vein), and 5. for the scarce patient with tumors infiltrating the major hepatic veins, constraining a hepatic vein reconstruction to preserve liver function.     

Intramyocardial small-vessel disease in chronic alcoholism

A morphologic study of the small (50 to 200 micron) intramyocardial coronary arteries was performed. The cases chosen for study were selected from a relatively young group of patients without clinical evidence of alcoholic cardiomyopathy or pathologic evidence of large coronary artery disease, in order to evaluate alterations in the small vessels which could possibly be attributed to the chronic alcoholic state. Five basic vascular abnormalities were described. The most common alteration found in all nine cases was vascular wall edema (48 per cent), followed by perivascular fibrosis (42 per cent), vascular sclerosis (36 per cent), subendothelial humps (13 per cent), and vascular wall inflammation (11 per cent). The significance and pathogenesis of these changes were discussed. Primary endothelial cell damage was proposed as a common pathogenic mechanism for all five types of vascular abnormality. It was suggested that following endothelial damage, fluid and macromolecules penetrate into the vessel wall or into the perivascular space where, by incompletely understood processes, they induce vascular wall myocytes to produce collagen, elastin, and basement membrane-like substances. Evidence supporting this mechanism was derived from the common observation of vascular wall edema, from the occasional presence of erythrocytes and leukocytes within the vessel wall, and from experimental data in the literature. Several possible etiologic agents were implicated in the pathogenesis of endothelial and vessel wall injury. These included alcohol itself, acetaldehyde, biogenic amines, and magnesium deficiency. It is probable, however, that there are multiple etiologic factors which affect the small cardiac vessels of the chronic alcoholic. Finally, the proposal was advanced that the nonspecific pathology of the myocardium in chronic alcoholism may be a result of ischemia secondary to disease of the small intramyocardial coronary ateries.