Psychosocial adjustment of children and adults with port wine stains

OBJECTIVE: To find out if lactulose can prevent the bacterial translocation that is induced by obstructive jaundice in rats. DESIGN: Laboratory experiment. SETTING: Teaching hospital, Turkey. MATERIAL: 50 male Wistar-albino rats. INTERVENTIONS: 10 rats were not operated on and used as controls; 20 rats underwent laparotomy and sham ligation of the common bile duct (CBD); 20 had the CBD ligated alone; and 20 had the CBD ligated and were given oral lactulose 2 ml/day until death. All rats were killed after 14 days. MAIN OUTCOME MEASURES: Presence of Escherichia coli in mesenteric lymph nodes (MLN), and bacterial overgrowth as indicated by counts of E coli in the caecum. RESULTS: There was significantly less bacterial translocation to MLN in the group that had been given lactulose compared with CBD-ligated and lactulose not given (2/20 compared with 8/20, p = 0.06). There was also a significant reduction in the number of Gram negative bacteria in that group (p = < 0.01). CONCLUSION: Lactulose seems to reduce the incidence of translocation from the gut to MLN in rats with obstructive jaundice.     

Experience in the argon laser therapy of port wine stains

A total of 202 patients with port wine stains have been studied and many aspects of their clinical condition detailed. Employing ther argon laser, 136 test spots have been carried out in 132 patients and the results have been analyzed and correlated with clinical aspects of the lesions. Altogether, 85 treatments were performed in 54 patients and the results were examined in the same way as the test spots. Good to excellent results were obtained in 75 percent of test spots and 60 percent of treatments in that significant lightening of treated areas was achieved. While elimination of lesions was rare, considerable amelioration was common. Scarring was uncommon but was the most appreciable complication. Residual lesion was the most common cause of fair or poor results. The value of secondary treatment is suggested but remains to be established. The directions of ongoing clinical study are outlined.     

Demographic study of port wine stain patients attending a laser clinic: family history, prevalence of naevus anaemicus and results of prior treatment

Two case studies are used to demonstrate the continuing dilemma experienced by some doctors in the United Kingdom--whether or not to disclose to cancer patients their diagnosis. The two schools of thought concerning truth disclosure are discussed, together with the ethical implications and differences in views as a result of culture. Truth disclosure and associated communications skills are seen as an important area of medical education.     

Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser

During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.     

Pigmentary changes after pulsed dye laser treatment in 125 northern European patients with port wine stains

A child with cystic dysplasia of the testis (CDT) that presented as a solid mass by ultrasound imaging is reported. The child also had ipsilateral multicystic dysplasia of the kidney (MCDK). A search of the literature revealed that unilateral renal agenesis (URA) is commonly associated with CDT. It is possible that CDT, MCDK, and URA share a common pathogenesis. Cystic changes in the epididymis were found in the patient and might be more frequently associated with CDT than previously reported. CDT should be considered in the differential diagnosis of a solid testicular mass detected by ultrasound.     

Overproduction of nitric oxide in pathophysiology of blood vessels

Sustained production of large amounts of nitric oxide (NO) is induced in blood vessels by inflammatory stimuli as a result of the expression of the inducible form of NO-synthase (NOS-2). This happens in systemic inflammatory reactions like septic shock and in local reactions produced by endothelium denudation and atherosclerosis. NOS-2 activity in blood vessels may protect tissues by virtue of the vasodilating, anti-thrombotic and leukocyte adhesion inhibitory effects of NO. It may also participate in vascular remodeling as a result of the antiproliferative and pro-apoptotic actions of NO. However excessive production of NO in blood vessels is involved in circulatory failure that takes place in systemic inflammatory reactions and it may be cytotoxic for surrounding tissues. For these reasons, inhibition of NO overproduction has been proposed in the treatment of septic shock. Selective inhibitors of NOS-2 activity or NO trapping agent, or both, might prove to be valuable drugs in the treatment of some inflammatory diseases. The conditions in which NO shifts from a tissue protective to a damaging role are not well elucidated. Recent findings suggest that the interactions with superoxide radicals, thiols, and metals (particularly with Fe2+) may be important not only in buffering excess NO produced by NOS-2, but also in channeling it from physiologically to pathophysiologically relevant targets. It has also been found recently that adventitial cells may play an important part in vascular NO production and generation of NO stores in the media layer. The ultimate effect of NO in blood vessels might depend on its site of production, local concentration, and interactions with other tissue components.     

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.     

The effects of treatment with lipopolysaccharide on responsiveness of rat blood vessels

Effects of treatment with lipopolysaccharide (LPS) both in vivo (intraperitoneal administration of 20 mg.kg-1 LPS for 6 hours) and in vitro (incubation with 1 microgram.kg-1 LPS for 6 hours) on the responsiveness of the rat thoracic aorta, carotid, renal, femoral, mesenteric, pulmonary arteries, and the femoral and mesenteric veins were examined. Intraperitoneal administration of LPS did not change the blood pressure of rats, but increased the heart rate significantly. The same amplitude of relaxation was produced by L-arginine in the aortic strips treated by LPS in vivo and in vitro, and the responses were inhibited by NG-nitro-L-arginine (L-NOARG). The contractile responses to phenylephrine in the aortic strips were reduced by LPS-treatment in vivo or in vitro, but the extent of inhibition was greater in vivo than in vitro. Further, the attenuation of contractile responses to phenylephrine was completely reversed by L-NOARG in the strips treated with LPS in vitro, whereas the reversal by L-NOARG was incomplete in the strips treated with LPS in vivo. Different amplitudes of relaxations were also produced by L-arginine or SNP in the blood vessels treated by LPS in vivo or in vitro. However, the tail artery treated with LPS in vivo or in vitro did not relax in response to L-arginine but did produce a relaxation to SNP. These results suggest that the hyporesponsiveness of rat blood vessels after treatment with LPS in vivo or in vitro may be related to an enhanced NO production in the smooth muscle cells and that there is a possible heterogeneity of regional induction or activation of L-arginine/NO pathway by LPS in rat blood vessels.     

Central neural regulation of heart and blood vessels in mammals

The study of the central regulation of the circulation in the past has been directed primarily at observing reflex responses to stimulation of peripheral receptors and at producing changes in cardiovascular parameters during electrical stimulation of central sites. These studies have demonstrated that the nervous system can regulate the circulation to different vascular beds with a high degree of specificity and that it has the ability to provide a range of coordinated responses which are appropriate to the metabolic needs of a particular behavioural pattern. In addition, it has become firmly established that the nervous system is capable of coupling cardiovascular changes with other autonomic and somatic activities to produce an integrated response. In the last decade it has become apparent that although the mode of operation of central cardiovascular regulation has been described in general terms, very little is known about the accurate anatomical localization of neuronal circuits and pathways and of impulse traffic corresponding to the changes in cardiovascular parameters that have been observed. This essay reviews recent information on discrete neuronal circuits and pathways and their mode of operation in electrophysiological terms. One of the most serious difficulties in this endeavour is the problem of demonstrating specificity of pathways and circuits because patterns of firing of afferent and efferent peripheral nerves can be usually identified, but the demonstration of specificity of central structures is a conceptual and technical challenge to the most skilled investigator. Several studies have been made in the last decade in an attempt to trace anatomically and functionally pathways involved in central cardiovascular regulation. Progress has been made especially with regard to the precise sites of termination of cardiovascular afferent fibres and the pattern of discharge of efferent cardiovascular neurons; some work has also been done to trace discrete pathways between the hypothalamus and the medulla and the medulla and the spinal cord. However, in view of the difficulties of establishing the specificity of cardiovascular pathways, progress will depend on the acquisition of a wiring diagram of simple cardiovascular reflex arcs before attempts are made to study the functional interactions of regions in the brain that have been traditionally associated with central regulation of the circulation. Future experiments should concentrate less on the demonstration of cardiovascular responses to stimulation or lesions in the central nervous system and more on the connections of discrete regions.(ABSTRACT TRUNCATED AT 400 WORDS)     

Morpho-functional characteristics of the uterine blood vessels and other systemic vessels of the abdominal cavity in pregnancy]

Biostereometrics-the spatial and spatio-temporal analysis of biological form and function based on principles geometry-is a modern approach to the measurement and analysis of biological form which recognizes that organic structures are irregular and three-dimensional (or four-dimensional, as in movement or growth). Stereometric sensors of various types are used to determine the coordinates of points distributed over the surface (internal or external). The resulting data provide a more comprehensive, parsimonious and unambiguous spatial quantification than heretofore possible using traditional lengths, breadths, and circumferences. Recent and prospective biomedical applications are described.     

Indications for contrast medium administration in MR-angiography of cerebral blood vessels

Time-of-flight MR-angiography of large volumes is limited by the occurrence of saturation effects, which lead to low signal in both veins and arteries. Alternatively to a number of other MRA-techniques, intravenous application of paramagnetic contrast media in combination with 3D-pulse sequences with or without flow refocussing allows the depiction of slow vessels in large volumes without technical extra expenses. The main intracranial indication is anatomical 3D-imaging of normal and dysplastic cerebral veins with high spatial resolution, and the additional depiction of the venous drainage in AVMs, when unenhanced MRA shows only the arteriel supply and the nidus. In large cerebral aneurysms, bridging veins and venous sinuses, partial thromboses can easily be differentiated from slow flow. Contrast-enhancing tumors can be depicted together with normal or displaced vessels. Improvements of arterial signal due to contrast media with currently used routine MRA techniques are clinically not significant. Signal loss due to spin dephasing in vessels with complex flow is not influences by contrast media. Results of contrast-enhanced MRA are determined by the timing of injection. Since arteries and veins are both imaged with high signal intensity, improvements of postprocessing procedures for secondary vessel segmentation are necessary.     

Treatment of pyogenic complications after reconstructive surgery on blood vessels with use of synthetic prosthesis

Factors influencing result of surgical treatment of patients with festered postoperative wounds have been studied. Algorythm of determination of tactics for examination and treatment of this category of patients was established. The results obtained are based on the analysis of personal surgical treatment autcomes in 1526 patients with decompensated ischemia of extremities and 57 patients with clinical symptoms of deep suppuration. Division of purulent complications into primary and secondary is suggested. Effectiveness of various modes of prophylaxis was studied--systemic and indirect endolymphatic route for introduction antibiotics, intraoperative application of pellicle ESBA, usage of antimicrobial vascular prosthesis "SISAN". The best results were obtained in the two latter methods. Various methods of surgical treatment in infected vascular prosthesis are reviewed.     

Localization and expression of tissue kallikrein and kallistatin in human blood vessels

Human lysosomal acid lipase/cholesteryl ester hydrolase (hLAL) is essential for the intralysosomal metabolism of cholesteryl esters and triglycerides taken up by receptor-mediated endocytosis of lipoprotein particles. The key role of the enzyme in intracellular lipid homeostasis is illustrated by two lysosomal storage diseases inherited as autosomal recessive traits. Wolman disease, associated with deficient hLAL activity, leads to massive intracellular substrate accumulation and is always fatal in early infancy. Cholesteryl ester storage disease (CESD), in contrast, is characterized by very low levels of enzymic activity sufficient to allow survival of the affected patients into adulthood. In order to elucidate the underlying molecular defects in Wolman disease, we have characterized the hLAL gene in two female Wolman patients of German and Turkish origin by SSCP and DNA sequence analysis. Our results demonstrate that the German proband was compound heterozygous for an 8-bp deletion in exon 3 and a 2-bp deletion in exon 4 of the hLAL gene. These frameshift mutations lead to protein truncation at amino acid positions 24 and 116 and to complete loss of hydrolytic activity. The Turkish proband, in contrast, was homozygous for a G(1064)-->T substitution in exon 10 of the hLAL gene which converts the completely conserved glycine (GGG) residue at position 321 of the mature enzyme to tryptophan (TGG). In vitro expression of the hLAL(Gly(321)-->Trp) cDNA construct revealed that the amino acid replacement results in a more than 99% reduction of neutral lipid hydrolysis. The mutations provide new insights into the molecular basis of Wolman disease which is apparently more heterogeneous at the genetic level than cholesteryl ester storage disease.-Lohse, P., S. Maas, P. Lohse, A. C. Sewell, O. P. van Diggelen, and D. Seidel. Molecular defects underlying Wolman disease appear to be more heterogeneous than those resulting in cholesteryl ester storage disease.     

Ultrastructure of bronchial blood vessels in chronic inflammation and endobronchial laser therapy

Structural metabolic changes in the biopsies of the large bronchi mucous membrane were studied in 99 patients with chronic lung diseases. Progressing sclerosis of the connective tissue stroma resulted in the reduction of endotheliocyte metabolism which usually represent plastically active zone of the strom. This considerably influences basal cell proliferation resulting in changes of differentiation in bronchial epithelium. Endobronchial laser therapy induces proliferative and metabolic processes in the tunica propria of the mucous membrane. Congestion, intensive leucodia pedesis, leucocytic infiltrates and granulations develop in the mucous membrane, proliferative and metabolic activity of endotheliocytes and stromal cells increases this resulting in formation of fine fibrillar connective tissue.