Two cold legs

Bilateral acute lower limb ischaemia is rare. Usually the diagnosis is based on clinical findings. In four patients, three women aged 51, 48, and 72 and a man aged 64 years, bilateral acute ischaemia of the lower limbs was diagnosed, due to different causes: arterial cardiac myxoma embolism, arterial thrombosis probably due to paraneoplastic coagulopathy, aortic dissection, and arterial thrombosis due to cardiac insufficiency, respectively. The management of these conditions includes restoring the circulation as soon as possible. Reperfusion can be achieved by thromboembolectomy or thrombolysis. In patients with underlying atherosclerosis angiography is useful, but time loss must be avoided. The outcome in patients with bilateral ischaemia of the lower limbs depends on the preoperative ischaemia time and the cardiac situation. The mortality varies between 20 and 50%.     

Interactions between growth factors and integrins: latent forms of transforming growth factor-beta are ligands for the integrin alphavbeta1

The multipotential cytokine transforming growth factor-beta (TGF-beta) is secreted in a latent form. Latency results from the noncovalent association of TGF-beta with its processed propeptide dimer, called the latency-associated peptide (LAP); the complex of the two proteins is termed the small latent complex. Disulfide bonding between LAP and latent TGF-beta-binding protein (LTBP) produces the most common form of latent TGF-beta, the large latent complex. The extracellular matrix (ECM) modulates the activity of TGF-beta. LTBP and the LAP propeptides of TGF-beta (isoforms 1 and 3), like many ECM proteins, contain the common integrin-binding sequence RGD. To increase our understanding of latent TGF-beta function in the ECM, we determined whether latent TGF-beta1 interacts with integrins. A549 cells adhered and spread on plastic coated with LAP, small latent complex, and large latent complex but not on LTBP-coated plastic. Adhesion was blocked by an RGD peptide, and cells were unable to attach to a mutant form of recombinant LAP lacking the RGD sequence. Adhesion was also blocked by mAbs to integrin subunits alphav and beta1. We purified LAP-binding integrins from extracts of A549 cells using LAP bound to Sepharose. alphavbeta1 eluted with EDTA. After purification in the presence of Mn2+, a small amount of alphavbeta5 was also detected. A549 cells migrated equally on fibronectin- and LAP-coated surfaces; migration on LAP was alphavbeta1 dependent. These results establish alphavbeta1 as a LAP-beta1 receptor. Interactions between latent TGF-beta and alphavbeta1 may localize latent TGF-beta to the surface of specific cells and may allow the TGF-beta1 gene product to initiate signals by both TGF-beta receptor and integrin pathways.     

The mutual relations of structures in the growing bill of chick (Gallus domesticus L.) and duck (Anas platyrhynchos L.) Embryos. IV. The size, shape, and position of the upper and lower bills in unilaterally microphthalmic duck embryos

Unilaterally microphthalmic duck (DUM) embryos studied in stage 39 were obtained by damaging the right eye in stage 17. The development between stages 19 and 39 was observed in samples. After prolonged incubation, one duck hatched and reached adulthood. In DUM embryos partial crossbeak develops. Both the upper and lower bills deviate lateralwards, the upper bill more than the lower. In stage 39 a small orbit is present on the treated side. In stained and cleared heads most of the elements of the skull (the bones surrounding the orbit, the brain-case, and the upper and lower bill elements) are translated in the direction of the rudimentary orbit on the treated side. The bills are twisted around each other at the tip. Measurements of external dimensions as well as those made in stained and cleared stage-39 DUM heads show elongation of the left part of the lower bill. Except for the crossed bills, the changes found in the embryos persisted in the adult. The findings support a hypothesis concerning the mutual influence of bills during morphogenesis. The coherence of the functional cranial components in the embryo is discussed.     

Double outlet right ventricle with L-position of the aorta, D-loop, subaortic VSD, and pulmonary stenosis

We describe a case of double outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis treated successfully with cardiopulmonary bypass. We consider the clinical history and angiocardiographic and surgical findings of this rare anomaly. We stress the difficulties of reconstruction of the outflow tract of the right ventricle, because of the anomalous pathway of the right coronary artery, the posterior situation of the pulmonary artery, and the abnormal anatomy present in the outflow tract of the right ventricle.     

Einfluß der Spannung auf die Empfindlichkeit eines austenitischen Chrom-Nickel-Stahles gegenüber Spannungsrißkorrosion

Influence of stress on the sensitivity of an austenitic chromium-nickel steel to stress corrosion cracking The transcrystalline stress corrosion cracking of a chromium-nickel steel (German designation X 5 CrNi I8 9) in 35 % magnesium chloride solution at 150°C exhibits a well defined limit at the 0.01 %yield stress. In the range of intermediate stresses the stress corrosion resistance increases as the load is increased. This behaviour may be interpreted in terms of the time required for the formation of stable cracks. This mechanism apparently follows the gliding step-repassivation model involving a reduction in height of the gliding steps and the influence of a cathodic protection due to the reduction of the mixed potential.     

A multicenter evaluation of a new continuous cardiac output pulmonary artery catheter system

OBJECTIVE: To validate a new system of continuous cardiac output monitoring. DESIGN: Multicenter, prospective, nonrandomized clinical study. SETTING: Four university hospitals. PATIENTS: Forty-seven adult intensive care unit patients. INTERVENTIONS: Pulmonary artery catheterization. MEASUREMENTS AND MAIN RESULTS: Continuous and bolus cardiac output measurements were obtained over 72 hrs. The 327 continuous cardiac output measurements compared favorably with bolus cardiac output measurements (bias = 0.12 L/min, precision = +/-0.84). The continuous cardiac measurement was not adversely affected by temperatures of <37 degrees C or >38 degrees C, high (>7.5 L/min) or low (<4.5 L/min) cardiac output values, or duration (72 hrs) of the study. CONCLUSIONS: This continuous cardiac output system provides a reliable estimate of cardiac output for clinical use if applied in conditions similar to this study. The combination of a continuous measure of cardiac output with other continuous physiologic monitoring (arterial and mixed venous oxygen saturation, oxygen consumption, etc.) may provide important information that no single parameter could achieve.