We observed an atypical Pneumocystis infection with spontaneous pneumothorax, bronchopleural fistulae, an apical cyst and Pneumocystis pleuritis after aerosolized pentamidine prophylaxis in an AIDS patient. These findings suggest a failure of pentamidine aerosol in controlling active Pneumocystis infection in peripheral pulmonary areas. A relapse of Pneumocystis carinii pneumonia (PCP) must be suspected when pneumothorax occurs during secondary prophylaxis with aerosolized pentamidine. It should always be confirmed by bronchoalveolar lavage or transbronchial or open biopsy. Cases presenting as atypical Pneumocystis pneumonia may additionally reveal extrapulmonary dissemination of Pneumocystis infection.

Acquired Immunodeficiency Syndrome↗

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Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): initial results and angiographic follow-Up.

PURPOSE: To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. METHODS: Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months). RESULTS: There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p << 0.001) from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. CONCLUSION: Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach.

Adult↗

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A comparison of the families of mothers with borderline and nonborderline personality disorders.

The purpose of this study was to evaluate the families of procreation of mothers with borderline personality disorder (BPD) on measures of family stability, family satisfaction, and family environment. Families of nine BPD mothers were compared with families of 14 mothers with other personality disorders using a semi-structured interview to evaluate family history, the Family Environment Scale (FES), and the Family Satisfaction Scale (FSS). Families of procreation of BPD mothers were more unstable than comparison group families. FES scores of BPD mothers were significantly lower than controls in cohesion and organization, but not in conflict. Instability and low family cohesion are common in families of BPD mothers, and may place their children at increased risk for development of psychopathology.

Adolescent↗

PubMedDate not supplied

Percutaneous transhepatic embolization of bile duct fistulas.

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Adult↗

PubMedDate not supplied

Short-term results with use of the Amplatz thrombectomy device in the treatment of acute lower limb occlusions.

PURPOSE: To evaluate the clinical efficacy of the Amplatz device for the treatment of acute occlusions of the lower limb arteries. MATERIALS AND METHODS: Forty patients with acute occlusion of the lower limb arteries (3 hours to 8 days; mean, 2 days) were treated using the Amplatz clot macerator. Acute thrombotic lower limb occlusion was due to an embolic event in 32 patients and to atherosclerotic disease in eight patients. RESULTS: Complete success, with complete clearing of thrombotic material without an adjunctive procedure, was achieved in 75% (30 of 40) of the patients. Mean thrombectomy time in these patients was 75 seconds. Partial success, with incomplete clearing of the thrombus, requiring additional procedures such as local thrombolysis, angioplasty, or atherectomy, was achieved in 20% (eight of 40) of the patients. The Doppler index increased significantly (P < .001) from .45 before intervention to .96 after intervention. There were two failures (5%). No major complications occurred. CONCLUSION: Mechanical thrombectomy with use of the Amplatz device is a promising approach for quick recanalization of acute peripheral thromboembolic occlusions. Further studies are needed to prove the long-term patency after mechanical thrombectomy with use of this device.

Acute Disease↗

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Thrombospondin-1 and transforming growth factor beta-1 upregulate plasminogen activator inhibitor type 1 in pancreatic cancer.

Controlled degradation of the extracellular matrix by proteases is crucial in tumor cell invasion. We have shown that thrombospondin-1 (TSP-1), through activation of transforming growth factor beta-1 (TGF-beta1), regulates the plasminogen/plasmin protease system in breast cancer. To determine whether this occurred in other epithelial neoplasms, we studied the role of TSP-1 and TGF-beta1 in the regulation of the plasminogen/plasmin system in pancreatic cancer. ASPC-1 and COLO-357 pancreatic cancer cells were treated with TSP-1 or TGF-beta1 at varying concentrations. The TSP-1 and TGF-beta1-treated cells were also treated with either anti-TSP-1, anti-TSP-1 receptor, or anti-TGF-beta1 antibodies. Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) expression was determined by enzyme-linked immunosorbent assay. TSP-1 and TGF-beta1 promoted a dose-dependent upregulation of ASPC-1 and COLO-357 PAI-1 expression. The TSP-1 effect could be blocked with anti-TSP-1 or anti-TGF-beta1 antibodies. The TGF-beta1 effect could be blocked only with anti-TGF-beta1 antibody. Anti-TSP-1 receptor antibody blocked the TSP-1 effect on PAI-1 expression but had no effect on TGF-beta1-mediated PAI-1 expression. Neither TSP-1 nor TGF-beta1 had an effect on uPA production. We conclude that TSP-1, in a receptor-mediated process that involves the activation of TGF-beta1, upregulates PAI-1 expression in pancreatic cancer without an effect on uPA production.

Antibodies, Neoplasm↗

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[Induction of bone tissue on different matrices: an in vitro and a in vivo pilot study in the SCID mouse].

AIM: Three resorbable biomaterials were evaluated regarding proliferation and osteogenic differentiation of human bone marrow stromal cells (BMSC) in vitro. In a second step, the new biomaterial, calcium-deficient hydroxyapatite (CDHA), was tested in a pilot in vivo study by subcutaneous implantation in the severe combined immunodeficiency (SCID) mouse. METHODS: CDHA, beta-tricalcium phosphate (beta-TCP), and demineralized bone matrix (DBM) were seeded with human BMSC and cultured in osteogenic supplements for 3 weeks. In the pilot in vivo study, CDHA was seeded with BMSC and kept in osteogenic media for 2 weeks (group A) before subcutaneous implantation in 8 SCID mice for 3 and 8 weeks. In addition, CDHA seeded with BMSC without prior osteogenic induction (group B) and empty ceramics were implanted in each mouse. RESULTS: Total protein content and the values for specific alkaline phosphatase (ALP) increased significantly in vitro on all matrices, but no significant difference between the groups was noted. In the pilot in vivo study all ceramics were well penetrated by cells. After 8 weeks 2 of 4 samples in group B and 1 of 4 samples in group A revealed cells resembling hypertrophic chondrocytes. Specific ALP was higher in the group B (p = 0.012, Z = - 2.5) compared to empty ceramics. There were no significant differences between groups A and B. Differences between group A and the empty control did not become significant (p = 0.069, Z = - 1.8). CONCLUSION: All three matrices promoted BMSC proliferation and differentiation to osteogenic cells in vitro. Human BMSC on CDHA showed signs of osteogenic differentiation after subcutaneous implantation into SCID mice.

Adolescent↗

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[High-energy extracorporeal shock-wave therapy (ESWT) in the treatment of pseudarthrosis].

PROBLEM: The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear. METHOD: In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients. RESULTS: The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed. CONCLUSIONS: Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

Adolescent↗

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[Extracorporeal shockwave therapy in epicondylitis humeri ulnaris or radialis--a prospective, controlled, comparative study].

AIM OF THE STUDY: Has extracorporal shockwave therapy in chronic golfer's elbow comparable results as in tennis elbow? METHOD: 30 patients for extracorporal shockwave therapy who suffered from chronic medial epicondylitis (group I) and 30 patients with persistent tennis elbow (group II) received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. The final follow-up examination was done after 24 weeks. RESULTS: Significant differences in relief of pain and improvement of function were observed in favour of group II. Good or excellent outcome was found in only 27% for the epicondylitis humeri ulnaris, but in 60% for epicondylitis humeri radialis. CONCLUSION: The indication for extracorporeal shock-wave therapy in medial epicondylitis must be questioned.

Adult↗

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Detection of drugs in vitreous humor with an enzyme immunoassay technique.

Vitreous humor is readily available at autopsy. The fact that it is a relatively "clean" biological fluid suggested that enzyme immunoassay techniques. EMIT, could be used to analyze this fluid for drugs. Vitreous humor samples from 76 Medical Examiner's cases were analyzed using EMIT-dau reagents. The results indicate that this method of screening would be useful for detecting overdoses of certain drugs.

Autopsy↗

PubMedDate not supplied