Primary culture and transfection of epithelial cells of human small intestine

OBJECTIVE: To evaluate perioperative and long-term morbidity in patients undergoing selective evaluation of coronary artery disease prior to abdominal aortic aneurysm (AAA) repair. DESIGN: Case series. SETTING: University and Veterans' Administration medical centers. PATIENTS: One hundred eighty-nine consecutive patients undergoing AAA repair between January 1989 and September 1996 were selectively evaluated for coronary artery disease and assigned to 1 of 3 groups: group 1, no abnormal cardiac history, normal electrocardiogram; group 2, minimal symptoms, history of myocardial infarction (MI), older than 70 years, diabetes mellitus, or congestive heart failure; or group 3, severe or unstable angina, ventricular dysfunction. INTERVENTIONS: Group 1 patients proceeded to AAA repair without further workup. Group 2 patients underwent pharmacologic or exercise stress testing followed by coronary angiography and intervention as required. Group 3 patients went directly to coronary angiography and intervention as needed. MAIN OUTCOME MEASURES: Perioperative MI, arrhythmias, or death. Long-term follow-up measures included MI and death. RESULTS: Adequate documentation was available on 171 patients. Twenty-four patients (14%) were in group 1. Of 136 patients (79.5%) in group 2, coronary angiography was performed in 36 (26%), followed by percutaneous transluminal coronary angioplasty (PTCA) in 9 (7%) and coronary artery bypass (CAB) in 5 (4%). Of 11 patients in group 3, 3 (27%) each received PTCA and CAB. Remote CAB or PTCA had been performed in 32 (19%) and 12 (7%) patients, respectively. Two perioperative deaths (1.1%) occurred in the 189 patients, one due to MI in a group 2 patient. There were 2 (1%) nonfatal MIs, both in group 2 patients who had no preoperative intervention. Arrhythmias and/or congestive heart failure occurred in 17 (9%) cases, 7 (39%) having had recent coronary revascularization (P = .001). By univariate analysis, only preoperative renal dysfunction predicted perioperative complications (P = .03) Overall survival by lifetable analysis was 87.9% and 69.7% at 3 and 5 years, respectively. CONCLUSION: Coronary artery disease is common in patients undergoing AAA repair, with 35.7% having preoperative coronary revascularization at some point. Selective preoperative coronary artery disease screening achieves excellent perioperative and late results in this population.     

Crack Interactions in Laminar Ceramics That Exhibit a Threshold Strength

Laminar ceramic composites have been fabricated with thin compressive layers, containing a mixture of alumina and mullite, sandwiched between thicker alumina layers. It has previously been shown that a single crack that extends within a thicker alumina layer can be arrested by the compressive layers to produce a threshold strength, i.e., a strength below which the probability of failure is zero. The behavior of multiple cracks within the laminate has been investigated, to observe the mechanisms of crack interaction and measure their influence on the threshold strength. It was found that when the cracks in adjacent thick layers were offset by a distance less than the thickness of two thick layers, the cracks would interact and decrease the threshold strength. The number of interacting cracks, their orientation, and location can also have an effect on the threshold strength.     

Renal artery stenosis and accessory renal arteries: accuracy of detection and visualization with gadolinium-enhanced breath-hold MR angiography

Extracellular volume (ECV) of arms, trunk, and legs determined from segmental bioimpedance data in 11 healthy men (31.6 +/- 7 yr) obtained at the end of a 30-min equilibration phase in the supine body position was compared with ECV determined from whole body measurements (ECVWB). ECV was calculated from extracellular resistance (RECV) identified from the bioimpedance spectrum for a range of 10 frequencies. Whole body RECV (527.6 +/- 55.6 Omega) was equal to the sum of RECV in the arms, trunk, and legs (241.6 +/- 36. 3, 49.2 +/- 5.1, and 236.3 +/- 25.5 Omega, respectively). The sum of equilibrated ECV in arms (1.31 +/- 0.25 liters), trunk (10.08 +/- 1.65 liters), and legs (2.80 +/- 0.82 liters) was smaller than ECVWB (20.90 +/- 2.59 liters). In six subjects who changed from a standing to a supine body position, ECV decreased in arms (-2.59 +/- 2.51%, P = NS) and legs (-10.96 +/- 3.02%, P < 0.05) but increased in the trunk (+4.2 +/- 3.2%, P < 0.05). ECVWB also decreased (-4.98 +/- 1. 41%, P < 0.05). However, the sum of segmental extracellular volumes remained unchanged (-0.06 +/- 0.07%, P = NS). The sum of segmental ECVs is not sensitive to changes in body position, which otherwise interferes with the estimation of ECV in bioimpedance analysis when ECVWB is used.     

Acute pancreatitis. Classification, diagnosis, therapy

Acute pancreatitis is a multietiologic entity with rather diverse clinical courses. Whereas edematous pancreatitis has a mortality of less than 1%, nowadays; still approximately 20% of all patients with the necrotizing form succumb to the disease. To further improve therapeutic results a standardized approach should be used. For effective treatment the differentiation between edematous and necrotizing pancreatitis is crucial. All patients with signs of pancreatic necroses during abdominal ultrasound and patients with organ insufficiencies should undergo a CT-scan to define exactly the nature and the extent of the disease. Primarily all patients are treated conservatively. Main indications for operative intervention are signs for infection of pancreatic necroses and an acute abdomen due to local complications of acute pancreatitis. In cases of biliary origin an elective cholecystectomy has to be performed during a free interval to prevent a recurrence.     

Coronary arterial anatomy in patients with left ventricular systolic dysfunction without chest pain or previous myocardial infarction

Patients with left ventricular systolic dysfunction without chest pain or previous myocardial infarction are unlikely to have 3-vessel coronary artery disease and are very unlikely to have coronary anatomy suitable for bypass grafting. Of our 108 subjects, only 3 (3%) had 3-vessel coronary artery disease thought to be suitable for revascularization.     

Daily noninvasive rejection monitoring improves long-term survival in pediatric heart transplantation

BACKGROUND: Acute rejection episodes and transplant vasculopathy (TVP) account for most of the late deaths after heart transplantation in both adults and children. Accumulating evidence indicates that fatal acute rejection and TVP are related to unrecognized and untreated early and ongoing acute rejection. Day-by-day surveillance of the heart and prompt treatment of any rejection may yield improved long-term survival. METHODS: In almost all patients having transplantation at our institution (978 patients since 1986), the intramyocardial electrogram (IMEG) was recorded routinely every day through a telemetry pacemaker and transmitted to our center by telephone modem. Earlier studies showed a substantial voltage drop in the IMEG QRS complex is highly indicative of acute rejection, including humoral rejection. In this study, we reviewed the data from 69 pediatric patients up to 16 years old for the incidence of acute rejection, TVP, and long-term outcome. Diagnostic endomyocardial biopsies were performed in only 10 patients, and recent coronary angiograms from 29 children were reviewed. RESULTS: In 50 children discharged after heart transplantation, IMEG surveillance data for a mean of 2.9 years indicated 72 acute rejection episodes. During follow-up of 1 month to 10.5 years (mean follow-up, 4.4 years), 2 patients died late of causes unrelated to either rejection or TVP. Another patient died of rejection during unrecognized underimmunosuppression nearly 8 years after transplantation and nearly 31/2 years after discontinuing IMEG recordings. Two patients without IMEG recording died of acute rejection or late TVP. In 1 patient, moderate TVP was seen on an angiogram after 41/2 years (incidence, 2.0%; 5-year incidence, 5.6%). CONCLUSIONS: Daily recording of the IMEG can reliably detect early stages of acute rejection episodes, and immediate rejection treatment seems to keep the incidence of TVP low. The IMEG appears better than all the other rejection monitoring protocols currently in use.     

Biologic material in needles and cartridges after insulin injection with a pen in diabetic patients

OBJECTIVE: To evaluate the frequency of non-inert material, including cells, in needles and cartridges after insulin injection with pen-like devices in diabetic patients. RESEARCH DESIGN AND METHODS: A prospective study was conducted in 120 insulin-treated diabetic patients who used pen-like devices. The patients, 46 women and 74 men, were 20-77 years old; 60% had type 1 diabetes, and 38% were overweight. Duration of diabetes ranged from 1 month to 40 years, and insulin therapy ranged from 1 month to 30 years. Insulin injection was performed by a trained nurse, using the patient's usual pen and cartridge. A cytopathological examination was performed on the material obtained from the needle and found in the cartridge after centrifugation. All slides were read by a single investigator. RESULTS: In 62% of the patients, non-inert material was found, including squamous (32%) and epithelial (58%) cells. Biologic material was found in 30% of the needles and 58% of the cartridges, and in both needle and cartridge in 25% of the population. Biologic material was found more frequently in patients who had a longer duration of diabetes, who were treated with insulin for a longer time, and who performed injection in the thighs or upper arms (P < 0.05). In multivariate analysis, the presence of biologic material was associated with the duration of diabetes (R2 = 0.09; P < 0.01). CONCLUSIONS: Our data suggest that biologic material can be trapped in the delivery system, including the cartridge, after an insulin injection with a pen-like device. Our results emphasize the strict need for individual use of insulin delivery systems, including cartridges and nonrefillable pens, especially in clinics and hospitals.     

Adhesive Strength of Deformed Epoxy and Polyester Coatings

The adhesive strengths of a soft, ductile polyester paint and a stiff, brittle epoxy resin on metal substrates equibiaxially strained to different levels were investigated by pull-off testing. The stress state in the samples after straining was estimated from relaxation tests on unsupported films. It was found that the epoxy behaved elastically at low strains and plastically at higher strains, whereas the polyester responded plastically at all levels of imposed strain. The pull-off stress of the polyester decreased strongly with increasing strain, indicating the formation of defects at the interface. No influence of the elastic strain in the epoxy coating on the pull-off stress could be detected. In both the epoxy and the polyester the location of failure moved towards the interface with increasing strain. After the onset of interfacial failure, the increase in area fraction interfacial failure with strain was found to proceed similarly in both materials.     

Differentiated thyroid cancers. 20 years' results of a protocol based on simple prognostic criteria

OBJECTIVES: To study the long-term results of an aggressive management protocol based on a new-simple classification and to determine the duration for patient follow-up according to this classification. MATERIAL AND METHODS: For the 509 patients with differentiated thyroid carcinoma, the classification was: group 1: cancer < 1 cm (n = 117), group 2A: cancer without extension in patients of age less than 45 years (n = 100), group 2B: cancer without extension in patients aged more than 45 (n = 94), group 3: cancer with nodal extension alone (n = 102), group 4: high risk cancer in patients having either distant metastases or local tissular extension or in whom after iodine-131 ablation, Tg level was > 3 micrograms/l off hormone therapy (n = 96). Total thyroidectomy was the rule except for group 1 and some patients of group 2A in whom the tumor was solitary, relatively small, well-differentiated, with no capsular or capillary invasion. Iodine 131 ablation was carried out after a total thyroidectomy and repeat treatments with iodine 131 were given whenever necessary. RESULTS: In group 1, 2A and 3, the 20 years death rate of cancer was 0 p. 100. For group 2B, patients cancer death rate was 8 p. 100 and for group 4 it was 32 p. 100. Distant metastases were the cause of death except for one patient who died from local recurrence. Clinical inspection, Tg measurement, iodine 131 whole-body scan and chest X-ray were all useful in discovering local or distant recurrences. CONCLUSION: Our results justify the use of an aggressive initial management for differentiated thyroid carcinoma and an appropriate scoring system. When this protocol is applied, patients of group 1, 2 and 3 should have an excellent prognosis. However patients follow-up should not be shorter than 15 years for patients of group 1 and 2A and than 20 years for all other groups.