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PubMed1981

Influence of respiration on stroke volume determined by impedance cardiography.

The conventional method of calculating stroke volume (SV) with impedance has been to measure changes in thoracic impedance for only those beats of the impedance cardiogram (IC) which cross on a specific baseline. This severely limits the number of usable beats since respiration produces oscillation of the IC around this baseline. This study investigated the influence of respiration on SV calculated independent of the baseline in seven women, 20-44 years old, in each of three postures: seated, supine, and standing. SV was determined in three continuous respiratory cycles from the following beats: 1. all; 2. all inspiratory (I); 3. I on baseline; 4. all expiratory (E); 5. E on baseline; 6. all end-E; 7. end-E on baseline (conventional). The absolute values for SV, heart rate (HR), and cardiac output (Q) were posture dependent. SVs did not differ among the respiratory phases in the standing and seated postures; in the supine posture, the smallest SV occurred at end-E on baseline. HR varied with respiration in both the standing and seated postures but not in the supine posture. Despite significant changes in HR in the seated and standing postures, Qs did not differ among the respiratory phases. Supine Qs were significantly smaller during end-E due primarily to a small SV. Consequently, when reporting Q values for supine subjects, it is important to designate the respiratory phase and baseline criteria. Our results indicate that SVs calculated independent of the baseline in general agree with the more conventional method of calculation. Therefore, we recommend the calculation of SV independent of the baseline. The reliability of the data will be increased by increasing the number of observations and SVs can be determined under circumstances where it is difficult to obtain end-E beats on the baseline.

Adult↗
PubMed1995

Surgical video systems.

Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible. In this study, we evaluated 19 SVSs from 10 manufacturers, focusing on their use in laparoscopic applications in general surgery. We based our ratings on the usefulness of each system's video performance and features in helping clinicians provide safe and efficacious laparoscopic surgery. We rated 18 of the systems Acceptable because of their overall good performance and features. We rated 1 system Conditionally Acceptable because, compared with the other evaluated systems, this SVS presents a greater risk of thermal injury resulting from excessive heating at the distal tip of the laparoscope. Readers should be aware that our test results, conclusions, and ratings apply only to the specific systems and components tested in this Evaluation. In addition, although our discussion focuses on the laparoscopic application of SVSs, much of the information in this study also applies to other MIS applications, and the evaluated devices can be used in a variety of surgical procedures. To help hospitals gain the perspectives necessary to assess the appropriateness of specific SVSs to ensure that the needs of their patients, as well as the expectations of their clinicians, will be satisfied, we have included a Selection and Purchasing Guide that can be used as a supplement to our Evaluation findings. We have also included a Glossary of relevant terminology and the supplementary article, "Fiberoptic Illumination Systems and the Risk of Burns or Fire during Endoscopic Procedures," which addresses a safety concern with the use of these devices. While we made every effort to present the most current information, readers should recognize that this is a rapidly evolving technology, and developments occurring after our study was complete may not be reflected in the text. For additional information on topics related to this study, refer to the following Health Devices articles: (1) our Guidance Article, "Surgical Video Systems Used in Laparoscopy," 24(1), January 1995, which serves as an introduction to SVS terminology and includes a discussion of the significance of many SVS specifications; (2) our Evaluation, "Video Colonoscope Systems," 23(5), May 1994, which includes a detailed overview of video endoscopic applications and technology; and (3) our Evaluations of laparoscopic insufflators (21[5], May 1992, and 24[7], July 1995), which address issues related to the creation of a viewing and working space inside the peritoneal cavity to facilitate visualization in laparoscopic procedures.

Color↗
PubMed1996

Piccolo, a novel 420 kDa protein associated with the presynaptic cytomatrix.

In this study, we describe a novel 420 kDa protein, called Piccolo, found at a wide variety of adult rat brain synapses. High protein levels in the cerebellum, the olfactory bulb and the hippocampus were frequently observed to be associated with asymmetric type 1 synapses. Piccolo is selectively enriched in presynaptic terminals, but is not a component of synaptic vesicles (SVs). Immunogold electron microscopy revealed that Piccolo localizes to the amorphous material among SVs at the presynaptic plasma membrane. Biochemical studies showed that it is very tightly bound to this structure. Thus, we speculate that Piccolo is a structural component of the presynaptic cytomatrix which anchors SVs to the presynaptic plasmalemma.

Animals↗
PubMed1997

The soluble N-ethylmaleimide-sensitive factor attached protein receptor complex in growth cones: molecular aspects of the axon terminal development.

Soluble N-ethylmaleimide-sensitive factor attached protein (SNAP) receptor (SNARE) mechanisms are thought to be involved in two important processes in axonal growth cones: (1) membrane expansion for axonal growth and (2) vesicular membrane fusion for mature synaptic transmission. We investigated the localization and interactions among the proteins involved in SNARE complex formation in isolated growth cone particles (GCP) from forebrain. We demonstrated that the SNARE complex is present in GCPs morphologically without synaptic vesicles (SVs) and associated with growth cone vesicles. However, the apparently SV-free GCP was lacking in the regulatory mechanisms inhibiting SNARE complex formation proposed in SV fusion, i.e., the association of synaptotagmin with the SNARE complex, and vesicle-associated membrane protein (VAMP)-synaptophysin complex formation. The core components of the SNARE complex (syntaxin, SNAP-25, and VAMP) accumulated for several days before postnatal day 7, when SVs first appeared, and preceded the accumulation of marker proteins such as synaptophysin, SV2, and V-ATPase. Our present results suggest that the SNARE mechanism for vesicular transmitter release is not fully functional in growth cones before the appearance of SVs, but the SNARE mechanism is working for membrane expansion in growth cones, which supports our recent report. We concluded that the regulation of the SNARE complex in growth cones is different from that in mature presynaptic terminals and that this switching may be one of the key steps in development from the growth cone to the presynaptic terminal.

Animals↗
PubMedDate not supplied

[Avoidable hospitalization using ambulatory surgery in the Community of Valencia: a Delphi study].

BACKGROUND: To estimate the number of hospital admittance's avoidable by means of ambulatory surgery, according to surgeons and anaesthetists who currently work with the National Health System (NHS). METHOD: By means of a Delphi procedure of 25 surgeons or anaesthetists of the Valencia Health Survey (AServei Valencià de la Salut-SVS), a consensus was reached as to the objective criteria for excluding patients that could be treated outside a hospital and the percentage of certain operations that could be performed under day surgery. These criteria were applied to the Minimum Basic Data Set on hospital discharge within the Autonomous Region of Valencia in order to estimate the figure of hospital admittance and stays avoidable by means of ambulatory surgery in a selection of 29 surgery processes. RESULTS: 83% of medical personnel responded to the Delphi questionnaires. The median of the surveyed group's estimation on the proportion of cases that could be treated by means of external surgery varied from 40% for abdomen wall hernias or laparoscopic cholecystectomy and 90% for perianal tissue excision, anastomosis for dialysis or ganglionectomy. Application of the results of the Delphi survey would have meant that the SVS could have avoided 12,558 admittances in 1994, 75% of the operations surveyed, which is almost the same figure resulting from applying the medical personnel's opinion of the CMBD. CONCLUSIONS: SVS professionals consider it feasible to perform a much higher number of ambulatory operations than those currently carried out, and that it is likely that the causes for the lack of such operations lie in SNS financing and incentive criteria, rather than medical issues.

Ambulatory Surgical Procedures↗
PubMed2026

Targeted long-read genomic and epigenomic profiling enhances timely comprehensive variant discovery in hypotonia and muscle weakness.

BACKGROUND: Identifying the genetic basis of hypotonia and muscle weakness is critical for patient management and family counseling. However, diagnosis is often hindered by diverse genomic alterations, including repeat expansions, structural variants (SVs), and methylation defects. Standard-of-care testing, largely based on short-read sequencing, is limited in its ability to detect this heterogeneous variation landscape, leaving many patients undiagnosed or requiring lengthy sequential testing. Long-read sequencing represents a promising solution. However, its application as a first-tier diagnostic assay for hypotonia remains unexplored. METHODS: We retrospectively analyzed 227 patients with hypotonia to assess diagnostic yield, time-to-diagnosis, and costs associated with standard-of-care testing. A long-read whole-genome sequencing (LR-WGS) workflow with targeted analysis of hypotonia-associated genes was developed to detect and prioritize pathogenic SNVs, SVs, and CNVs, repeat expansions, and methylation changes at key disease loci. The workflow was validated in a reference-positive cohort with known diagnoses (n = 15) and applied to an unsolved cohort (n = 14). Variant interpretation followed ACMG guidelines and was confirmed with orthogonal methods. RESULTS: Standard-of-care testing achieved a diagnostic yield of 42% with an average time-to-diagnosis of 68.7 days; however, 30% of diagnosed patients experienced significant delays (average 169 days) due to sequential testing. The LR-WGS based approach identified all known pathogenic variants in the positive cohort, including SMN1 deletions, methylation defects at 15q11.2/Prader-Willi locus, FMR1 repeat expansions, and sequence and copy-number variants in > 100 genes underlying myopathies and muscular dystrophies. The targeted long-read pipeline reduced prioritized variant calls by 97.9-99.9% and, in the unsolved cohort, yielded one definitive diagnosis (de novo COL6A3 deletion) and one possible diagnosis (aberrant methylation and copy number at POMK), for an additional 14% yield. Among patients diagnosed after sequential testing (n = 29), LR-WGS is expected to reduce time-to-diagnosis by ~ 85% and decrease cumulative diagnostic delays, with projected healthcare cost savings of $396,000-439,000. Across the entire 227 patient cohort, LR-WGS is anticipated to reduce testing costs by 6.5%, yielding an average savings of $105 per patient. CONCLUSIONS: LR-WGS enables comprehensive discovery of genomic and epigenomic variants in hypotonia and muscle weakness, improving diagnostic yield, shortening diagnostic timelines, and reducing costs compared with current standard-of-care testing.

Humans↗
PubMed1981

Psychiatric diagnoses (Research Diagnostic Criteria) in symptomatic volunteers.

Symptomatic volunteers (SVs) are increasingly used as subjects for clinical research studies. A total of 362 SVs were recruited, psychiatric diagnoses were made according to Research Diagnostic Criteria (RDC), and standard symptom scale scores on the Hopkins Symptom Check list (HSCL) for the individual diagnostic categories were computed. Of these subjects, 221 were classified as having a depressive disorder (three categories), 112 as having an anxiety disorder (three categories), and 29 as having some other RDC disorder. The HSCL scale scores for the depressive- and anxiety-disorder subject groups were consistent with those for actual patient groups. There were significant differences in HSCL scores for some RDC categories within the broader depressive- or anxiety-disorder groupings. Individual RDC categories should be kept separate in reporting treatment results for depressive or anxiety disorders.

Adolescent↗
PubMed2001

Three-year outcome of endovascular treatment of superficial femoral artery occlusion.

HYPOTHESIS: Patency after primary percutaneous transluminal angioplasty (PTA) and stenting of superficial femoral artery (SFA) occlusions is better than historical experience with PTA alone. DESIGN: Consecutive case series of primary PTA with stenting, and follow-up with duplex imaging every 6 months (mean +/- SD follow-up, 32 +/- 15 months). SETTING: Veterans Affairs medical center. PATIENTS AND METHODS: Patients were 57 previously untreated men with 71 limbs having chronic atherosclerotic SFA occlusion with suprageniculate reconstitution and patent tibial runoff. Critical ischemia (Society for Vascular Surgery [SVS] category, 4-6) was present in 7 (10%), the remainder had intermittent claudication only (SVS, 1-3). INTERVENTIONS: Guidewire recanalization followed by PTA, Wallstent deployment, and adjunctive thrombolysis as necessary; 19 limbs (27%) required thrombolysis to manage periprocedural thrombosis. MAIN OUTCOME MEASURES: Cumulative patency, limb salvage, and complications. RESULTS: Length (mean +/- SD) of occlusion was 14.4 +/- 9.9 cm. Length of stented artery was 24.3 +/- 11.1 cm. Ankle brachial index increased from 0.59 +/- 0.14 to 0.86 +/- 0.16 (P<.001) after stenting. One- and 3-year patencies were as follows: primary, 54.6% +/- 6.3% and 29.9% +/- 6.6%; assisted primary, 72.3% +/- 5.6% and 59.0% +/- 6.8%; and secondary, 81.6% +/- 4.8% and 68.3% +/- 6.5%. Three-year secondary patency when periprocedural thrombolysis was required was 35.7% +/- 12.5% compared with 70.6% +/- 7.4% for limbs not requiring periprocedural thrombolysis (P=.02); the differences in occlusion length and severity of ischemia were not significant between these 2 groups. Limbs undergoing adjunctive PTA during angiography 6 to 12 months after initial stenting had 63.0% +/- 13.3% patency at 3 years compared with 100% patency in limbs not requiring PTA at 6 to 12 months angiography (P=.046). Periprocedural mortality and morbidity were 2.8% and 15.5%, respectively. Three of the 7 limbs with critical ischemia underwent amputation during follow-up compared with 2 (3%) of 64 limbs with functional ischemia (chi(2) test, P<.006). A mean of 1.8 endovascular interventions per limb were performed. CONCLUSIONS: Percutaneous transluminal angioplasty and stenting yielded higher patency rates than historical controls undergoing PTA alone. When periprocedural thrombolysis is required, subsequent patency appears to be significantly worse. Poor results after PTA and stenting of limbs with critical ischemia and the need for additional endovascular therapy limit the technique's utility.

Aged↗
PubMed2002

High-resolution localization of clathrin assembly protein AP180 in the presynaptic terminals of mammalian neurons.

Synaptic vesicles (SVs) assemble at the presynaptic compartment through a clathrin-dependent mechanism that involves one or more assembly proteins (APs). The assembly protein AP180 is especially efficient at facilitating clathrin cage formation, but its precise ultrastructural localization in neurons is unknown. Using immunoelectron microscopy, we demonstrate the presynaptic localization of AP180 in axon terminals of rat cerebellar neurons. In contrast, the assembly protein AP2 was associated with both the presynaptic plasma membrane and the cytosolic side of the membrane at postsynaptic and extrasynaptic sites. Furthermore, ultrastructural analysis of primate retina showed that AP180 immunoreactivity was preferentially and highly enriched at ribbon synapses, where glutamate is released tonically at high levels and rapid vesicle turnover is essential. To maintain functional synaptic transmission, neurotransmitter-filled SVs must be readily available, and this requires proper reassembly of new vesicles. The expression of AP180, in addition to AP-2, in the clathrin-mediated endocytic pathway might add another level of control to SV reformation for efficient assembly of clathrin, effectively controlling the size of assembled vesicles and faithfully recovering SV-specific components.

Adaptor Protein Complex 2↗
PubMed2006

MR spectroscopy: predicting long-term neuropsychological outcome following pediatric TBI.

PURPOSE: To identify useful acute indicators of long-term neurocognitive outcome beyond clinical variables for children and adolescents treated for a traumatic brain injury (TBI). MATERIALS AND METHODS: The efficacy of magnetic resonance spectroscopy (MRS) acquired 6+/-4 days after TBI in 20 children/adolescents in predicting intellectual and neuropsychological functioning one to four years post injury was assessed. Short echo-time single voxel MRS (SVS) from normal-appearing brain was compared to intermediate echo-time multivoxel MR spectroscopic imaging (MRSI) from normal-appearing and visibly-injured brain acquired through the level of the corpus callosum (CC). RESULTS: N-acetyl aspartate (NAA) was moderate to strongly correlated with cognitive scores. Mean NAA/creatine (Cre) from MRSI alone explained over 40% of the variance in cognitive scores and 18% of the variance above and beyond demographic and clinical variables alone. Mild to moderate associations were noted between SVS metabolites (glutamate/glutamine [Glx] and myoinositol [mI]) and cognitive scores, with no such associations apparent for choline (Cho) or Cre. Exploratory analyses revealed trends for regional neuroimaging data and specific cognitive abilities. CONCLUSION: Acute MR spectroscopy of the pediatric brain injury patient improves prognostic ability and may provide valuable information for early treatment and intervention planning.

Adolescent↗
PubMed2026

Optical genome mapping enhanced by refined variant interpretation in pediatric acute lymphoblastic leukemia.

Reliable detection of structural variants (SVs) and copy number variations (CNVs) is crucial in the contemporary diagnostics of pediatric B-cell acute lymphoblastic leukemia (B-ALL). However, limitations of commonly used conventional and molecular cytogenetic methods may hinder the accurate genetic characterization of patients. Optical genome mapping (OGM) offers a reliable alternative by enabling high-resolution, genome-wide detection of CNVs and SVs. Chromosomal aberrations were screened using OGM in 51 children with B-ALL. The results were compared with those of karyotyping, fluorescence in situ hybridization (FISH), digital multiplex ligation-dependent probe amplification (digitalMLPA), and targeted RNA sequencing (RNA-seq). OGM data showed high congruency with karyotyping and FISH findings, detecting clinically relevant variants beyond G-banding results and unraveling a complex KMT2A fusion undetected by FISH. Gene fusions involved in complex ETV6::RUNX1 translocations, but not detected by RNA-seq, were confirmed using FISH. Normalization of OGM copy number values with DNA-index-improved concordance with FISH-derived copy numbers in near-tri/tetraploid cases. In the peripheral regions of OGM variants (fringe-zones), a novel evaluation strategy called 'FriZone' was applied, which significantly improved the concordance between OGM and digitalMLPA. In addition, a co-segregation analysis revealed strong associations between ETV6::RUNX1 fusion and deletions of ETV6, RAG2, and NR3C2. OGM uncovered complex rearrangements undetected by widely used methods in 15% of cases, improving genetic classification and risk stratification in 10% of the patients. The FriZone analysis and normalization by DNA-index provide a refined, more accurate approach to OGM variant interpretation, facilitating the efficient application of OGM in clinical diagnostics. &#xa9; 2026 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Humans↗
PubMed1993

Theoretical analysis of the hemodynamic variables during sustained mechanical alternans: effect of variations in ventricular filling volume.

A comprehensive discrete analysis of the hemodynamic variables during sustained mechanical alternans (SMA) shows that these variables are governed by simple mathematical relations. The analysis shows that the value of the slope created by the two alternating beats on the stroke volume-end diastolic (SV-EDV) plane is gamma = (mu - 1).(1 + beta)/(mu - beta), where mu = SVS/SVW, SVS and SVW denote the strong and weak beats, respectively, in the presence of one contractile state of the beating heart, and the beats associated with the higher and lower contractile states, respectively, in the presence of two alternating contractile states; beta = FVS/FVW, FVS and FVW are the filling volumes following SVS and SVW, respectively. Two separate analyses show that this equation is valid, whether SMA is exhibited in the presence of one or two contractile states, and irrespective of the SV-EDV functional relationship. A criterion based on this slope, in terms of measurable parameters, is described to determine if SMA is caused by variations in EDV and FV. This comprehensive quantitative analysis enables a complete classification of the various types of SMA into subcategories with well-defined features. In particular, this analysis confirms former interesting theoretical consequence that when FV is constant, gamma attains the value of 2, independently of the value of mu or any other factor.

Hemodynamics↗
PubMed1989

Age-dependent changes of cerebral ventricular size. Part I: Review of intracranial fluid collections.

The age distributions of communicating hydrocephalus (CH), pseudotumour cerebri (PC) slit-ventricle syndrome (SVS), and chronic subdural haematomas (CSH) were reviewed in the medical literature. An age-related incidence was found: CH and CSH predominated in neonates less than 2 years and adults older than 55 years, while PC and SVS occurred mainly in older children and young adults. The latter two patient groups seem to show a greater resistance to ventricular dilatation in the presence of decreased CSF absorption. This may be related to larger volume and state of maturity of the cerebrum. On the other hand, neonates and the elderly more readily develop enlarged ventricles, in association with impairment of CSF absorption, or subdural fluid collections. Factors including status of cranial sutures, cerebral atrophy, cerebral water content, degree of cerebral myelination, and glial cell composition, may contribute to the age-related incidence of the four disorders investigated. Similarly, the development of ventriculomegaly may depend upon cerebral elastic properties besides the pri mary disturbance of CSF dynamics. The authors postulate that the size of cerebral ventricles in disorders of the cerebrospinal fluid (CSF) absorption is related to the elastic properties and volume of the brain. Furthermore, cerebral volume and elastic properties may also contribute to the age distribution of chronic subdural haematomas (CSH).

Adolescent↗
PubMed1992

Arguments against the prostatic origin of the R-3327 Dunning H tumor.

The Dunning tumor, originally described as a carcinoma of the rat dorsal prostate, has for long been used as an experimental model of prostatic cancer. We have recently presented a number of morphological findings that are incompatible with the prostatic origin of the H-subline of the Dunning tumor. In this paper, biochemical and immunohistochemical markers of rat prostate and mammary gland are studied in the R-3327 Dunning H tumor. Pieces of the H tumor were inoculated in male or lactating female rats. The electrophoretic protein pattern of Dunning tumor extracts was more similar to that of the mammary gland than the dorsolateral prostate. Proteins selectively appearing after metabolic labeling in Dunning tumors grown in lactating rats corresponded to labeled proteins in mammary glands from the same animals. Secretory proteins typical of the lateral prostate (SVS II) and dorsal prostate (transglutaminase) could not be detected immunohistochemically in the Dunning tumor. Western blot studies of tumor extracts and slot blot analysis of RNA preparations from the tumor confirmed the absence of SVS II and prostate specific transglutaminase from the Dunning tumor. On the other hand, the presence of mammary gland proteins such as milk fat globule membrane proteins, lactoperoxidase and lactalbumin were detected in the Dunning tumor by immunohistochemistry and Western blotting, but were absent from the dorsolateral prostate. Transferrin-mRNA, expressed in the male urogenital tract and also in the liver and other tissues, was detected in the mammary gland and Dunning tumor, but not in the dorsolateral prostate. The absence of mammary gland secretory beta-casein in the Dunning tumor was related to the elevated Ha-ras oncogene expression in the tumor, previously reported to suppress casein expression. The findings clearly demonstrate that the prostate cannot be the origin of the Dunning tumor, presently being used in prostatic cancer research. The designation prostatic adenocarcinoma for this tumor is therefore invalid. Furthermore, the data support our view that mammary gland might be the origin of the Dunning tumor, although the derivation from the bulbourethral or the parotid glands cannot strictly be excluded.

Adenocarcinoma↗
PubMed2003

Diagnosis and management of primary aldosteronism.

Identifying primary aldosteronism within the hypertensive population is an important clinical challenge, as most patients with a unilateral source of excess aldosterone secretion are amenable to surgical cure. At least 20% of patients with primary aldosteronism have normal serum potassium levels. Therefore, screening tests should not be based on recognition of hypokalemia alone. Rather, the diagnosis should depend on identifying renin suppression and measuring the ratio of plasma aldosterone concentration to plasma renin activity. The diagnosis may be confirmed by performing an aldosterone suppression test after oral salt loading. Once primary aldosteronism has been established, it is necessary to exclude glucocorticoid-remediable aldosteronism and then proceed to localization studies. Detecting a unilateral source of aldosterone, usually due to an adenoma (Conn syndrome), is achieved by postural hormonal testing and confirmed by selective venous sampling (SVS) with measurement of aldosterone concentrations (expressed as the aldosterone/cortisol ratio) in each adrenal vein. SVS is enjoying a revival in many institutions as it is more sensitive and specific than either cross-sectional imaging or scintigraphy and has the potential to influence significantly both the diagnosis and clinical decision-making. Patients with unilateral disease are ideally treated by laparoscopic adrenalectomy. Patients in whom localization is not achieved usually have bilateral adrenal hyperplasia and are treated medically.

Adrenal Cortex↗
PubMed2004

Selective venous sampling in recurrent and persistent hyperparathyroidism: indication, technique, and results.

Between 1992 and 2002, 542 patients underwent a surgical treatment for hyperparathyroidism in our department. Twenty-three selective venous sampling procedures (SVS) were performed because of the failure of the other methods of diagnosis. These patients have recurrent or persistent hyperparathyroidism. Noninvasive methods of topographical diagnosis have failed or they have given contradictory results. In our experience, the surgeon needs a precise localization of the pathological glands in these difficult cases. In our series of SVS, specificity was 85.7% and sensitivity was 94.7%. Our results show that a high postoperative gradient of parathyroid hormone in the internal thoracic veins indicates an ectopic pathological gland in the thymus. A high gradient in a vertebral vein indicates a pathological superior parathyroid gland, usually in a retro-esophageal position.

Adult↗
PubMed2005

Implications of early failure of superficial femoral artery endoluminal interventions.

Although the long-term (>30 days) effects of endoluminal treatment of superficial femoral artery (SFA) disease have been well studied, the implications of early (< or =30 days) failure are still unclear. We examined the consequences of early failure after endovascular treatment of the SFA. We anticipate that early failure will not be associated with significant morbidity and mortality and will not interfere with surgical bypass options. A prospective database of patients undergoing endovascular treatment of the SFA between 1986 and 2004 was maintained. Intention-to-treat analysis was performed. Angiograms were reviewed in all cases to assess lesion characteristics and pre- and post procedure runoff. Results were standardized to current Transatlantic Intersociety Consensus (TASC) and Society for Vascular Surgery (SVS) criteria. There were 441 limbs in 360 patients (70% male, average age 65 years) that underwent endovascular treatment. There was early failure in 39 procedures (8%). Twenty-nine cases (74%) failed immediately (<24 hr), and 10 cases (26%) failed within the first 30 days following intervention. Factors that predicted failure were TASC category D and preprocedural SVS symptom grade > or =5. The 90-day mortality in the group was 0%, and major morbidity was 4%. No emergent endovascular intervention, bypass, or unplanned amputation occurred within 30 days of these failures. There was no change in the level of amputation or the level of distal anastomosis of a bypass graft as a result of an early failure. Early failure of endoluminal therapy for SFA disease is not associated with significant morbidity and mortality. Options for surgical bypass are not compromised, and the amputation level is not altered. Aggressive endoluminal approaches to SFA disease should be considered as a first-line therapy in all patients.

Aged↗
PubMed2001

Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage.

OBJECT: To evaluate the prophylactic effect of repeated intrathecal administration of nicardipine associated with hypertensive hypervolemic hemodilution therapy (triple H) and sodium correction, we analyzed a consecutive series of 177 patients with subarachnoid hemorrhage. METHODS: All patients received aneurysmal clipping and placement of cisternal drainage within 48 hours of the onset. Intrathecal administration of 4 mg of nicardipine was performed every 12 h. Nicardipine concentrations in the cerebrospinal fluid (CSF) and blood before and after its administration were analyzed. Angiographic vasospasm (aVS), symptomatic VS (sVS), and clinical outcome 6 months after onset were also evaluated. RESULTS: Nicardipine concentration in CSF on day 9 was 231.44 +/- 51.51 ng/ml (mean +/- SD), and that of blood was 21.05 +/- 15.57 ng/ml. Twenty patients (11.3%) showed aVS, and ten of those (5.7%) showed sVS (six were transient and four were permanent). Those with good outcome (assessed as good recovery and moderately disabled) 6 months after onset were 89.2% of the total. The number of patients requiring a shunt operation was 33 of 177 (18.6%), and 11 patients presented intracranial infection. CONCLUSIONS: These results suggest that our strategy may well prevent VS. However, hydrocephalus and infection may be serious disadvantages that should be resolved.

Adolescent↗