Mechanical myocardial support systems 1997: an overview of inta-aortic balloon counterpulsation to implantable left ventricular support systems

The development of cardiopulmonary bypass (CPB) to support the systemic circulation during cardiac surgical procedures became a clinical reality in 1953. Although the use of CPB for the treatment of post-infarction cardiogenic shock met with little success, intra-aortic balloon counterpulsation was used successfully in 1968 to reduce ischaemic injury in a patient with cardiogenic shock. Today, a broad spectrum of circulatory assist devices for short- and long-term application is available. Three major indication groups for the use of support devices are established. In low-cardiac-output syndrome after cardiac surgical procedures, short-term devices are utilised to enable myocardial recovery. In transplantation candidates suffering from drug-resistant pump failure, the implantation of long-term devices as a bridge to heart transplantation is indicated, and in NYHA class IV patients with contraindications to heart transplantation, the implantation of long-term devices as an alternative to transplantation is under discussion. In the literature, post-cardiotomy support survival is less than 30% on average. About 70% of mechanically bridged patients have survived to undergo heart transplantation and were transplanted with over 90% survival. Major problems during mechanical support are infection, bleeding, and thromboembolism. In view of patients' natural course without support, these clinical results are favourable.     

Mucosal addressin cell adhesion molecule-1 (MAdCAM-1). Its binding motif for alpha 4 beta 7 and role in experimental colitis

The integrin alpha 4 beta 7 and mucosal addressin cell adhesion molecule-1 (MAdCAM-1) are molecules involved in the normal recirculation of lymphocytes between the blood and the gastrointestinal tract. These molecules may play a complementary and significant role in animal models of colitis. We have investigated the structural interaction between alpha 4 beta 7 and MAdCAM-1. Site-directed mutagenesis studies of the MAdCAM-1 molecule has led to the identification of the amino acid residue (LDT) in the loop between beta strands C and D of the Ig-superfamily-like folds being involved in the adhesive and cell activation functions of MAdCAM-1 with alpha 4 beta 7.     

Bilateral lower limb oedema due to a distended urinary bladder

A 91-year-old Chinese man developed bilateral lower limb oedema due to venous obstruction resulting from a distended urinary bladder. After the bladder was decompressed by urethral catheterisation, the bilateral lower limb oedema promptly subsided. Although a distended urinary bladder is a rare cause of bilateral lower limb oedema, it can be easily recognised by palpation of the lower abdomen and the relief of symptoms by urethral catheterisation is most rewarding.     

Optimal erythropoietin expression in human hepatoma cell lines requires activation of multiple signalling pathways

The Drosophila wing is divided into anterior and posterior compartments, the latter characterized by the expression of the engrailed gene. A comparative analysis is presented here, and suggests that a primary conserved role of engrailed is to drive growth of limbs along the proximo-distal axis. The Apical Ectodermal Ridge in vertebrate limbs resembles the Antero/ Posterior compartment boundary in fly wings, particularly in molecular aspects. Multiple evidence suggests that the fly wing Antero/Posterior boundary is not the result of differential cell affinities between all anterior and posterior cells, but responds to the area of cell communication between anterior and posterior compartments. Arguments are presented here to support the notion that the compartment boundary is a consequence of decapentaplegic function in the control of growth. Patterning, on the other hand, requires the participation of several genes, among which are engrailed, invected and hedgehog. Finally, regulatory interactions between en/En-1 and hh/Shh may be significant in the context of morphogenetic regulation during normal development.