Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin 200 IU/ml were injected between the balloons. The catheter was removed after 30 min and heparin treatment was continued for 24 h. Alpha-2-antiplasmin was initially reduced by 13% and normalized 2 h after SET, indicating that only small amounts of free plasmin were liberated during thrombolysis. No clinically relevant changes in plasma fibrinogen occurred. Two puncture site hemorrhages did not coincide with the coagulopathy induced by SET. One-year patency was 80%. Early rethrombosis occurred in 9% versus 41% in our previous series on standard PTA for femoropopliteal occlusions (p less than 0.001). Therefore, SET is considered beneficial in reducing the incidence of early rethrombosis.

Aged↗

PubMedDate not supplied

Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis.

This prospective study was performed to investigate epidemiological characteristics in terms of the age- and sex-specific incidence in patients with perforated and nonperforated appendicitis. The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts [n = 544 (37%)] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13-40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time, probably due to patient-related factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis.

Acute Disease↗

PubMedDate not supplied

Low molecular-weight proteins in human gingival crevicular fluid.

Samples of gingival crevicular fluid (GCF) were collected in 30 volunteers with inflamed gingiva, using either capillary tubes (cGCF) or Durapore strips (sGCF). They were examined, together with samples of serum from the same patients, by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and/or by two-dimensional electrophoresis, followed by silver staining. The results confirmed that the distribution of the major proteins in GCF is similar to that found in serum. However, an 8.5 kDa protein was found in gingival fluid but not in serum. The low molecular-weight protein appears to decrease with time of fluid sampling with both techniques, and does not originate either from blood or from the cellular fraction of GCF. Two-dimensional electrophoretic analysis suggested that it may consist of several polypeptides.

Adult↗