PURPOSE: Evaluate retrospectively the long-term primary patency of directional atherectomy (DA) in the femoropopliteal arteries. MATERIALS AND METHODS: DA was used alone in 59 patients (47%) or in combination with predilatation to allow passage of the device (43%) or after thrombolysis (10%) to treat 127 (93%) excentric atherosclerotic stenoses and nine (7%) occlusions of the femoropopliteal arteries. Forty-eight patients were followed by telephone interview, scheduled outpatient visits, color-flow Doppler evaluation, and angiography for 1-36 months (mean 16.9 months). RESULTS: Technical success (reduction of the stenosis or occlusion to less than 30% luminal diameter) was achieved in 110 lesions (80.3%) during 48 procedures in 37 patients. Mean luminal diameter was increased 54% with a concomitant increase in mean ankle/brachial indices of 0.33. According to Kaplan-Meier survival curves, patency at 12 and 24 months was 88% and 75%, respectively. When patients who retained patency but developed restenosis were excluded, the probability of patency at 12, 24, and 36 months was 76%, 58%, and 32%, respectively. Major and minor complications occurred in 15 (21.4%) procedures each for a total complication rate of 42.8%. CONCLUSION: Based on our results, DA is an effective method for percutaneous treatment of atherosclerotic disease involving the femoropopliteal arteries. It has similar patency but a relatively high complication rate compared with PTA.

Actuarial Analysis↗

PubMedDate not supplied

Adult-onset minimal change disease among Taiwanese: clinical features, therapeutic response, and prognosis.

There are some racial differences in the prevalence and prognosis of idiopathic nephrotic syndrome; however, reports about minimal change disease (MCD) in Chinese were rare. We retrospectively analyzed 123 Chinese adults with idiopathic nephrotic syndrome, who received percutaneous renal biopsy in our institution within the last 10 years. In total, 46 patients (37.4%) were compatible with the pathological diagnosis of MCD. The male to female ratio was 1.2:1. The mean age of onset was 30.9 years, and 80% of the patients with MCD were less than 40 years. The mean daily proteinuria was 10.2 g, and serum albumin was 1.8 mg/dl. Azotemia occurred in 16 (35%) of 46 cases; hypertension, 13%; and microscopic hematuria, 13%. High selectivity index for proteinuria (SI <0.1) was noted in 12 (39%) of 31 cases; and high IgE level was found in 83.7% of the study subjects, although only one case had allergic history. Complete remission in 36 MCD patients treated with corticosteroid was achieved by 42% (15/36), 80% (29/36), and 94% (34/36) within 4, 8, and 12 weeks, respectively. The time interval to remission was similar between the younger group (<40 years old, 1.7 months) and older group (>40 years old, 1.6 months). Nineteen (56%) of 34 cases with steroid response did not relapse, and the other cases (44%) had a mean relapse rate of 1.5 times per patient within a period of 45 months. The age of onset in MCD cases was not significantly correlated with steroid-responsive rate, and the time interval to remission. However, a tendency existed between the onset in the young age and the sequentially relapsing rate (p = 0.06). Two cases with primary steroid resistance and 5 cases with frequent relapse or steroid dependence responded well to intravenous pulse therapy of cyclophosphamide, except one refractory case. No thrombotic episode was ever noted in our group. Regarding infectious complications, primary peritonitis occurred in one, pneumonia in one, and cellulitis in 6 cases during active nephrotic stage. Two mortality cases, one with E. coli-related necrotizing fasciitis and one from pneumonia, were noted. In brief, compared with children, adult patients with MCD had lesser high selectivity index for proteinuria, the same steroid-responsive rate (94%), but slower response, and significantly lesser relapsing rate. The intravenous pulse therapy of cyclophosphamide may be an alternative regimen for adult patients with steroid resistance or dependency. In addition, the Asian adult-onset MCD had younger age, male predominance, and lesser relapsing rate in comparison to those of the Western population.

Adolescent↗

PubMedDate not supplied

Blood pressure and left ventricular hypertrophy in patients on different peritoneal dialysis regimens.

OBJECTIVE: To examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Finally, to evaluate the differences in the clinical and cardiovascular characteristics between patients on continuous ambulatory PD (CAPD) and continuous cyclic PD (CCPD). DESIGN: An open, nonrandomized, cross-sectional study. SETTING: Divisions of nephrology and cardiology in a medical center. PATIENTS: Thirty-two uremic patients on maintenance PD therapy (22 patients on CAPD, and 10 on CCPD) without anatomical heart disease or history of receiving long-term hemodialysis. INTERVENTIONS: Home blood pressure (BP) and office BP were measured using the Korotkoff sound technique by sphygmomanometer. ABPM was employed for continuous measurement of BP. Echocardiography was performed for measurement of cardiac parameters and calculation of LVMI. MAIN OUTCOME MEASURES: Multivariate logistic regression analysis was performed for independent determinant of LVH in PD patients. The differences in clinical and cardiovascular characteristics between CAPD and CCPD patients were compared. RESULTS: Simple regression analysis showed positive correlations between LVMI and the duration of hypertension, ambulatory nighttime BP/BP load/BP load > 30%, serum phosphate, calcium-phosphate product, ultrafiltration (UF) volume, and percentage of UF volume during the nighttime. A negative correlation was noted between LVMI and dipping. In multiple regression analysis, the duration of hypertension was the only variable linked to LVMI. In multivariate logistic regression analysis, only ambulatory nighttime systolic BP load > 30% had an independent association with LVH. There were correlations between office/home BP and ambulatory 24-hour BP. In addition, CCPD patients had higher LVMI, UF volume during the nighttime, and percentage of UF volume during the nighttime than those of CAPD patients. CONCLUSIONS: In this study, ambulatory nighttime systolic BP load > 30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients.

Adult↗

PubMedDate not supplied

Enzyme markers in human prostatic carcinoma.

In an effort to develop a sensitive and specific method for detecting human prostatic cancer at early stages, we have studied the isoenzyme patterns of acid phosphatase in patients' sera as well as in benign hypertrophic and cancerous prostatic tissues using isoelectric focusing techniques. At least eight acid phosphatase isoenzymes at pI 4.1-5.5 could be observed. The sera with highly elevated acid phosphatase activity generally contained more isoenzymes with pI values of 4.5-5.0. The purified acid phosphatase isolated from benign hypertrophic and malignant prostatic tissues showed no qualitative difference in isoenzyme patterns although quantitative variations were observed. Malignant tissue contained more isoenzymes with pI values of 4.5-4.8. Patients' sera were found to contain isoenzymes of prostate origin. We have also investigated serum ribonuclease (RNase) activity in patients with prostatic cancer. The serum RNase activity of patients was significantly elevated. No significant correlation was observed between serum acid phosphatase and RNase activity. In some instances, where acid phosphatase activity was in the normal range, RNase activity was elevated. These data suggest that simultaneous measurements of RNase and acid phosphatase activities may be of value in the diagnosis of prostatic cancer. The purified RNase has been isolated from human prostatic tissue and its immunologic properties are being studied.

Acid Phosphatase↗

PubMedDate not supplied

Measurement of gentamicin by radioimmunoassay.

A sensitive, specific and precise procedure for the measurement of serum gentamicin by radioimmunoassay is presented. The method is rapid, convenient, and highly reliable for this very important measurement. Studies designed to evaluate the validity and reproducibility of the assay are presented and discussed.

Gentamicins↗

PubMedDate not supplied

A simplified radioimmunoassay for plasma aldosterone.

The analytical evaluation is described of a [125I]-aldosterone radioimmunoassay method for measuring aldosterone in human plasma, which requires no chromatographic purification before quantification by radioimmunoassay but does require organic solvent extraction. Rabbit anti-aldosterone serum is used, generated against aldosterone-3-oxime coupled to thyroglobulin. The antibody demonstrates negligible cross reactions with structurally-related steroids. The proposed method uses [125I]-labeled aldosterone as the radioactive ligand. The recovery of D-aldosterone added to human plasma averaged 98 percent. The parallelism and precision of the method are excellent. Seventy specimens were assayed by the proposed method and a [3H]-aldosterone reference procedure, which includes LH-20 column chromatographic purification prior to the radioimmunoassay step (y = 1.03X - 3.0; r = 0.99; p less than 0.01). The [3H]-aldosterone reference procedure uses an anti-aldosterone serum prepared against aldosterone-3-oxime coupled to rabbit serum albumin.

Aldosterone↗

PubMedDate not supplied

Cystic fibrosis in two Chinese infants in Taiwan.

Cystic fibrosis was diagnosed in two female infants, respectively nine months old (Case 1) and six months old (Case 2). Clinical presentation of these two infants showed frequent episodes of pneumonia, dehydration and poor weight gain, despite fair intake of food since birth. Hyponatremic, hypochloremic metabolic alkalosis had been found during their previous hospitalizations. In Case 1, stool fat was positive with negative trypsin test. Both cases had abnormal findings on chest X-ray films, but the pancreas showed no remarkable cystic changes from sonography. Plastic-bag method of sweat test showed Na/Cl: 155/185 nmol/L in Case 1, Na/Cl: 127/135 nmol/L in Case 2. A family history was suggested, since each one had an elder brother who had died in early infancy with similar clinical presentations. Both patients were put on special diet therapy as well as chest physical therapy. Case 1 died suddenly at 16 months of age. Autopsy revealed mucusplugged dilated ducts with atrophy of the exocrine portion of the pancreas. DNA analysis in Case 2 showed abnormal mutation point at 1898+5 G-->T on chromosome 7.

Cystic Fibrosis↗