Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study

OBJECTIVES: This study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC). BACKGROUND: We previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent. METHODS: We studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years. RESULTS: All 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7 +/- 2 to 19.9 +/- 3.5 mm (p < 0.0001), the caval pressure below the MOVC decreased from 23.6 +/- 8.5 to 12.0 +/- 6.5 mm Hg (p < 0.0001), and the enlarged liver size decreased from 6.5 +/- 1.5 to 2.0 +/- 1.5 cm below the right costal margin at the midclavicular line (p < 0.0001). Over a follow-up period of up to 8 years (7 to 8 years in 4 patients, 5 to 7 years in 12, 3 to 5 years in 11, 2 to 3 years in 6 and < 2 years in 9), MOVC returned in only 1 patient. This patient, our first, required a second PTBA 3 years later and a third 4.25 years after the second PTBA, in combination with stent placement for recurrence of stenosis. CONCLUSIONS: PTBA with the Inoue balloon catheter is an effective, safe and long-lasting alternative to surgical treatment of patients with BCS due to MOVC.     

Effects of preservation methods, parasites, and gut contents of black flies (Diptera: Simuliidae) on polymerase chain reaction products

The vesicle to micelle transition which results in the interaction of the Triton X-100 surfactant with phosphatidylcholine vesicles was studied by means of dynamic light scattering (at different reading angles) and by freeze-fracture electron microscopy techniques. Vesicle solubilization was produced by the direct formation of mixed micelles without the formation of complex intermediate aggregates. Thus, vesicle to micelle transformation was mainly governed by the progressive formation of mixed micelles within the bilayer. A subsequent separation of these micelles from the liposome surface (vesicle perforation by the formation of surfactant-stabilized holes on the vesicle surface) led to a complete solubilization of liposomes.     

Decreased expression of the cystic fibrosis transmembrane conductance regulator protein in remodeled airway epithelium from lung transplanted patients

The absence or mislocalization of cystic fibrosis transmembrane conductance regulator (CFTR) is regarded as being specific for cystic fibrosis (CF). In principle, the supply of a non-CF lung transplant to a CF patient should bring up normal CFTR expression in the lower airways. Immunolocalization of CFTR and of epithelial differentiation markers (ie, cytokeratins 13, 14, and 18, and desmoplakins 1 and 2) was carried out on 21 mucosal biopsies from the upper lobe of grafts in non-CF (n = 12) and CF patients (n = 9) retrieved between days 23 and 1,608 after lung transplantation. Biopsy specimens from seven non-CF and four CF patients presented either a pseudostratified respiratory epithelium or slight basal cell hyperplasia. CFTR was distributed at the apical membrane of the ciliated cells. In remodeled epithelia with basal cell hyperplasia or squamous metaplasia, CFTR was either weakly expressed in the cytoplasm of the superficial epithelial cells or was undetectable. The extent of epithelium remodeling was significantly correlated with an impairment of lung function. The results suggest that posttransplant airway epithelium dedifferentiation of the graft leads to the loss of properly targeted CFTR irrespective of the underlying disease of the recipient.     

Energy expenditure and symptom severity in men with heart failure

Our results demonstrate a graded increase in resting metabolic rate based on symptom severity as reflected in the New York Heart Association classification. This finding supports the hypothesis that clinical severity of illness corresponds to the magnitude of the increase in resting energy demands.     

Adenosine analogs inhibit the guanine-7-methylation of mRNA cap structures

The adenosine analogs neplanocin A and deazaneplanocin A were observed to inhibit the in vivo guanine-7-methylation of mRNA cap structure using a new assay for hypomethylated RNA. Treatment of cultured mammalian cells with these adenosine analogs resulted in the same extent of hypomethylation of cap structure as did ethionine injection in mice. Neplanocin A and its non-metabolizable analog 3-deazaneplanocin A show the same maximal level of inhibition of methylation suggesting that these adenosine analogs exert their effects by elevating S-adenosylhomocysteine levels rather than by conversion to other inhibitory compounds.     

P90 exceeding rate as a prognostic factor in primary malignant melanoma of the skin. A DNA image cytometric study

OBJECTIVE: To study the prognostic value of DNA image cytometry in primary skin melanomas. STUDY DESIGN: DNA image cytometry was performed on 62 stage I, Clark level II-V, primary skin melanomas. The DNA histograms were classified into three categories (diploid, nondiploid and aneuploid) according to the percentages of cells with higher-than-diploid and higher-than-twice-the-diploid DNA content (the P90 and 2P90 exceeding rates [ERs]). The prognostic value of P90ER, 2P90ER, type of DNA histogram, melanoma thickness, Clark level, and patient age and sex were analyzed for disease-specific survival with Cox's stepwise proportional hazards model. RESULTS: Aneuploid DNA histograms were as common in thin as in thick melanomas. Melanoma thickness and P90ER had prognostic value in univariate analysis, but in the multivariate analysis only P90ER had independent and significant prognostic value. CONCLUSION: Aneuploidy is a common feature of malignant melanoma, and it is as common in thin as in thick melanomas. P90ER has more prognostic value than the type of DNA histogram. The prognostic value of P90ER as compared with melanoma thickness should be studied further.