Intracranial aneurysms

MR angiography provides a rapid, accurate, and extremely flexible noninvasive evaluation of intracranial aneurysms without the cost and risk of conventional angiography. TOF and phase contrast techniques each have specific advantages and disadvantages that can be selectively exploited to optimize aneurysm evaluation. Present indications for MR angiography in aneurysm evaluation include: (1) the presence of incidental findings on a CT or MR examination that suggest the possibility of aneurysm (Figs. 7 and 8), (2) when angiography is contraindicated or when the risk is too high, (3) non-invasive follow-up of patients with known aneurysms, (4) patient refusal of contrast angiography, and (5) evaluation of patients with specific clinical symptoms (i.e., third cranial nerve palsy) or patients with non-specific subacute symptoms in whom an aneurysm might explain the clinical presentation. Although MR angiography certainly can detect aneurysms with a high rate of sensitivity and specificity, detailed decision analyses generally have not supported the overall benefit of this type of screening. Future technical advances as well as advances in the overall understanding of aneurysms may one day prove unequivocally the benefit of MR angiography in screening high-risk patient groups. MR angiography has not yet been clinically evaluated as a tool in the evaluation of acute subarachnoid hemorrhage. Potential obstacles to such an evaluation include the clinical instability of SAH patients, limited spatial resolution of the MR angiography acquisitions, the potential for subarachnoid blood or focal intraparenchymal hematomas to obscure or mimic small aneurysms, and the unreliability of MR angiography in demonstrating vasospasm. Currently these factors continue to provide an integral role for contrast angiography in aneurysm evaluation.     

Effects of group discussion and guided patient care experience on nurses'' attitudes towards care of patients with AIDS

An in vivo study was carried out to determine if capacitive coupled electrical stimulation increased the rate of recovery of strength of regenerate bone produced as a result of lengthening by the Ilizarov technique. Thirty-four adult male beagles underwent a right tibial mid-diaphyseal corticotomy, followed by a 5-day delay, and then 21 days of lengthening (1 mm/day). At the start of the post-distraction period (day 27), stimulation (3-6.3 V peak to peak, 5-10 mA root-mean-square at 60 kHz) was applied for 28 days to one group. The nonstimulated group (n = 17) underwent a 28-day period with no stimulation. From each group, four tibiae were prepared for histology; both ends of the remaining bones were embedded in polymethylmethacrylate and tested in torsion (internal rotation at 4.7 degrees/sec) until failure. Statistically significant changes included a 37% lower maximum torque capacity and a 40% decrease in strain energy to failure in the stimulated group compared with the nonstimulated group. The findings are supported by measured trends to a lower modulus of rigidity (37% decrease) and a smaller percentage of active osteoid perimeter (20% decrease) for the stimulated group. The experimental data suggest that when this dose of capacitive coupled electrical stimulation is applied to the regenerating bone created during distraction osteogenesis, it delays the recovery of bone strength compared with an untreated control.     

Induction of programmed cell death in human breast cancer cells by an unsymmetrically alkylated polyamine analogue

The need for antineoplastic compounds with novel mechanisms of action is great. One such agent is the recently synthesized polyamine analogue N1-ethyl-N11-((cyclopropyl)methyl)-4,8-diazaundecane (CPENSpm). Exposure of hormone-dependent and -independent human breast cancer cells to 0.1-10 microM CPENSpm led to both growth inhibition and induction of programmed cell death. Fragmentation of DNA to high molecular weight fragments and oligonucleosomal-sized fragments, both characteristic of programmed cell death, was determined to be time and concentration dependent. Depletion of natural polyamine pools and accumulation of the analogue was also demonstrated. These data provide the first evidence that a polyamine analogue induces programmed cell death.     

Effects of adenosine, ATP, and UTP on chloride secretion by epithelia explanted from fetal rat lung

To determine the role of intensive chemotherapy and allogeneic bone marrow transplantation (BMT) in treatment of refractory anemia with excess of blasts (RAEB) or RAEB-t (in transformation), the outcome of 37 consecutive children, 12 with RAEB and 25 with RAEB-t, diagnosed between 1985 and 1995 was analyzed. Fourteen patients received intensive chemotherapy according to the AML-BFM protocols 83, 87, or 93 (group 1). Seven patients were treated less intensively with the 6-week consolidation phase as induction (group 2). Allogeneic BMT was performed in 10 children of group 1 and 2 after, and in eight (group 3) without prior chemotherapy. Eight children received minimal or no chemotherapy (group 4). Of 21 children (groups 1 and 2) 17 (81%) achieved complete or partial remission after chemotherapy, 12 of them (10 of group 1) remained in remission, eight after BMT. Five-year survival in 29 children treated intensively (groups 1-3) was 46%, SE 12%. Two of the other eight children (group 4) remained alive, one after spontaneous remission. Outcome after BMT was related to the blast count in the bone marrow prior to BMT. None of 10 children (including two with minimal or no chemotherapy) with < or = 12% blasts before BMT relapsed, in contrast to five of eight patients with a higher blast count (P log rank 0.02). We conclude that a substantial number of children with RAEB or RAEB-t can achieve remission with intensive AML-specific chemotherapy. In patients responding to intensive chemotherapy an increase in long-term survival after allogeneic BMT can be expected.     

Requirement of Src kinase Lyn for induction of DNA synthesis by granulocyte colony-stimulating factor

Treatment of cells with granulocyte colony-stimulating factor (G-CSF) leads to tyrosine phosphorylation of cellular proteins. G-CSF stimulates both the activation of protein tyrosine kinases Lyn, Jak1, and Jak2 and the association of these enzymes with the G-CSF receptor. Wild-type, lyn-deficient, and syk-deficient chicken B lymphocyte cell lines were transfected with the human G-CSF receptor, and stable transfectants were studied. G-CSF-dependent tyrosyl phosphorylation of Jak1 and Jak2 occurred in all three cell lines. Wild-type and syk-deficient transfectants responded to G-CSF in a dose-responsive fashion with increased thymidine incorporation, but none of the clones of lyn-deficient transfectants did. Ectopic expression of Lyn, but not that of c-Src, in the lyn-deficient cells restored their mitogenic responsiveness to G-CSF. Ectopic expression in wild-type cells of the kinase-inactive form of Lyn, but not of the kinase-inactive form of Jak2, inhibited thymidine incorporation in response to G-CSF. These studies show that the absence of Lyn results in the loss of mitogenic signaling in the G-CSF signaling pathway and that activation of Jak1 or Jak2 is not sufficient to cause mitogenesis.     

Vitreoretinal surgery after inadvertent globe penetration during local ocular anesthesia

BACKGROUND: The efficacy of prophylactic epsilon-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context. METHODS: Patients (n = 134) received either epsilon-aminocaproic acid (15-g bolus + infusion of 1 g/h), high-dose tranexamic acid (10-g bolus + placebo infusion), or normal saline solution in a double-blind fashion. Anticoagulation and conduct of cardiopulmonary bypass were standardized. RESULTS: Tranexamic acid and epsilon-aminocaproic acid produced a significant reduction in postoperative blood loss compared with placebo (median loss, 438 mL, 538 mL, and 700 mL, respectively). Transfusion of red cells was similar in all three groups. Nonetheless, the percentage of patients receiving hemostatic blood products was significantly decreased in the epsilon-aminocaproic acid group compared with the placebo group (20% versus 43%; p = 0.03). Both tranexamic acid and epsilon-aminocaproic acid significantly decreased total exposure to allogeneic blood products compared with placebo (p = 0.01 and p = 0.05, respectively), and this reduction was clinically important (median exposure, 2, 2, and 7.5 units, respectively). Fibrinolysis was inhibited significantly in both treatment groups. CONCLUSIONS: We conclude that either high-dose tranexamic acid or epsilon-aminocaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.     

Micromolar L-glutamate induces extensive apoptosis in an apoptotic-necrotic continuum of insult-dependent, excitotoxic injury in cultured cortical neurones

Excitotoxicity induced by L-glutamate (Glu), when examined in a pure neuronal cortical culture, involved widespread apoptosis at concentrations of 1-10 microM as part of a continuum of injury, which at its most servere was purely necrotic. Cells, maintained in chemically defined neurobasal/B27 medium, were exposed at d7 for 2 h to Glu (1-500 microM), and cellular injury was analysed 2 and 24 h after insult using morphology (phase-contrast microscopy), a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) viability assay, nuclear staining with 4,6-diamidino-2-phenylindole (DAPI), terminal transferase-mediated dUTP nick end-labelling (TUNEL) and DNA fragmentation by gel electrophoresis. Glu-mediated neurotoxicity was prevented by MK-801 (5 microM), whilst CNQX (20 microM) attenuated injury by 20%. Exposure to intensive insults (100 and 500 microM Glu) induced necrosis characterized by rapid cell swelling (< 2 h) and lack of chromatin condensation, confirmed by DAPI nuclear staining. In contrast, mild insults (< 20 microM Glu) failed to produce acute neuronal swelling at < 2 h, but 24 h after injury resulted in a large number of apoptotic nuclei as confirmed by TUNEL and electrophoretic evidence of DNA fragmentation, which was attenuated by cycloheximide (0.1 microg/ml). Our findings indicate for the first time that physiological concentrations of Glu produce neuronal injury across a continuum involving apoptosis (< 20 microM) and increasingly necrosis(> 20 microM), dependent on the severity of the initial insult.     

Bougienage of esophagus in critical burn strictures

Bougienage was made in 625 patients with burn strictures of the esophague which made up 59.4% of all patients (1053) who have undergone treatment since 1966 to October 1977 in Research Center of Surgery. Indications and contraindications for bougienage are discussed. In patients with short strictures (146) good effect was obtained in 83.1% of cases, in long strictures (803) the bougienage was effective in 61.1% of patients, in total strictures (104) good and favourable results were obtained in 26.2% of cases. Bougienage is an important method of treatment for patients with burn strictures of the esophagus, as well as a method of preoperative preparation.     

Dynamics of indicators of blood inorganic phosphorus during gastrointestinal surgery

BACKGROUND: There is a more and more interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about local experiences. METHODS: This survey on obstetric anesthesia and analgesia in Abruzzo and Molise is based on data obtained from questionnaires of 28 questions sent to all the departments of anesthesiology in the two regions. DISCUSSION: Out of 24 questionnaires sent, 18 were returned. By analysing the replies obtained in this investigation it is clearly pointed out how the possibility of having peridural analgesia during labor is often not available. In fact, only one center is able to guarantee an operative service 24 hours a day. Many colleagues have reported this deficit and in order to improve the situation they have proposed to activate chargeable services for labor analgesia and to increase the staff of anesthetists. Also the data concerning treatment of post vaginal delivery pain are not satisfactory. With regard to the Caesarean sections, locoregional anesthesia is performed in 24% of all cases, while the highest scores are registered in the hospitals of Castel di Sangro and L'Aquila, where general anesthesia is practically never employed. Merely in 67% of all patients postoperative analgesia is carried out on a regular basis. CONCLUSIONS: The data obtained only confirm the extent of a well-known problem. In spite of the growing interest by the medical community, the attention shown for obstetric anesthesia and analgesia is, nevertheless, insufficient, especially due to financial and organizational problems which prevent from establishing a permanent pain therapy center.