PURPOSE: To present a peculiar anatomic portal veins variant and evaluate its clinical implications. METHODS: Among 118 consecutive patients undergoing transjugular intrahepatic portosystemic shunting (TIPS), six male patients were found to have an accessory portal vein, which was seen during direct portography.R ESULTS: In all six patients, portograms showed an accessory small-caliber vein parallel to the trunk of the main portal vein ending in the right lobe of the liver. Two of the six accessory portal veins drained blood from coronary veins, precluding access to coronary vein embolization during TIPS. CONCLUSION: An accessory portal vein is a rare anatomical variation with clinical significance for both surgical shunt placement and TIPS, as well as for transportal embolization of coronary veins.

Humans↗

PubMedDate not supplied

Frequency of arteriovenous shunts in hepatic cavernous hemangiomas in adults as seen on selective arteriography and postembolization radiography.

PURPOSE: To study the frequency and angiographic findings of arteriovenous shunts (AVS) associated with adult cavernous hemangiomas of the liver (CHL) on hepatic artery digital subtraction angiography (DSA) and optimize the imaging technique of DSA to improve its diagnostic efficacy. METHODS: We retrospectively analyzed 43 intraarterial DSA procedures performed on 30 adults with CHL. Of the 30 patients 22 were found to have an AVS. Transcatheter arterial embolization with Lipiodol (L-TAE) was performed on 21 of these and radiographs were taken immediately after embolization to observe the distribution of the injected iodized oil. The results were compared with those of the AVS found on DSA images. RESULTS: AVS were identified by DSA in 22 (73.3%) of 30 patients. All AVS were located in the peritumoral liver tissue and had a parallel track appearance, or early filling of small draining veins during the arterial phase of DSA. Radiographs taken immediately after L-TAE in 21 of the 22 cases with AVS showed iodized oil filling a few portal branches or draining veins as a result of incompletely occluded shunts in 11 patients. In 10 patients there was complete occlusion and no filling of any vein, or only the originating end of draining veins filled with iodized oil. No evidence of AVS was found in the other eight patients in this series, and in six of these the DSA was not considered diagnostic. CONCLUSION: The present study indicates that AVS are frequently seen in adults with CHL. DSA with high-quality images is helpful in identifying small AVS of CHL. The formation of an AVS in CHL may be closely related to the pathological changes in the peritumoral liver tissue.

Adult↗

PubMedDate not supplied

Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit.

OBJECTIVE: To determine the clinical impact and cost-effectiveness of two lateral rotation low air-loss therapy beds and their supporting protocols in the treatment of critically ill patients. DESIGN: Retrospective-cohort (2:1 design) study consisting of chart reviews of patients on two types of lateral rotation low air-loss therapy and their protocols from January 1992 through July 1993. SETTING: Three intensive care units (ICUs) (30 medical and surgical beds) in a 506-bed community hospital. PATIENTS: Fifty-six critically ill patients admitted to the ICU and prescribed lateral rotation therapy. Patients treated on both beds were excluded from the study. MEASUREMENTS: Data were collected on age, sex, Acute Physiology and Chronic Health Evaluation II score, Therapeutic Intervention Scoring System on admission to the ICU, and the time interval (number of days) from ICU admission until placement on a specialty bed (Lag Time). Outcome measurements included presence of pneumonia, adult respiratory distress syndrome, and multiorgan system dysfunction during the ICU stay, and the number of intubation days, ICU hours, hospital length of stay, and mortality during hospitalization. RESULTS: Statistically significant differences in group outcomes were found as follows: (1) pneumonia (p = 0.001), (2) adult respiratory distress syndrome (p = 0.002), (3) hospital length of stay (p = 0.04), and (4) hospital costs (p = 0.0001). CONCLUSIONS: In this study, patients treated by a prevention protocol with the Restcue beds (Support Systems International, Inc., Charleston, S.C.) had better clinical and financial outcomes than patients treated on Biodyne beds (Kinetic Concepts, Inc., San Antonio, Texas) with a more restricted, cost-conscious protocol aimed primarily at patients who have or who are at a higher risk for severe pneumonia, presence of septic shock, or adult respiratory distress syndrome.

Adult↗

PubMedDate not supplied

Construction and characterization of a recombinant chimeric plasminogen activator consisting of a fibrin peptide and a low molecular mass single-chain urokinase.

A recombinant chimeric plasminogen activator (f beta/scuPA-32k), with a fibrin beta-chain peptide (comprising Gly15 through Arg 42) linked to the N-terminal of a low molecular mass (32 kDa) single-chain urokinase (scuPA-32k, comprising Leu144 through Leu 411) via a 50 amino acid linker sequence, was produced by expression the corresponding chimeric cDNA in Escherichia coli cells. After refolding in vitro, the chimeric protein was purified to homogeneity by zinc chelate-Sepharose chromatography, Sephacryl S200 chromatography and benzamidine-Sepharose chromatography in sequence. The apparent molecular mass was 36 kDa shown by SDS-PAGE analysis. The special activity was 87,000 IU/mg detected by fibrin plate determination. F beta/scuPA-32k could directly activate plasminogen following Michaelis-Menten kinetics with K(m) = 0.52 microM and k(2) = 0.0024 s(-1). Mediated by plasmin, the single-chain molecule could be converted to the active two-chain molecule. The chimeric protein had 3.3 times higher fibrin affinity than scuPA-32k in the fibrin concentration of 3.2 mg/mL, while the chimeric protein inhibited the fibrin clotting and platelet aggregation. F beta/scuPA-32k showed a higher thrombolytic potency in vitro plasma clot lysis than scuPA-32k and depleted less fibrinogen in plasma. These results showed that the chimeric protein had not only higher fibrinolytic activity but also anti-thrombus activity. Further evaluation of the thrombolytic potential in appropriate animal models is required.

Binding Sites↗

PubMedDate not supplied

Cerebral benzodiazepine receptor binding and distribution in generalized anxiety disorder: a fractal analysis.

Data obtained from animal and human brain imaging studies indicate that frontal cortex and medial temporal lobe are involved in experiencing and controlling fear and anxiety. We tested the hypothesis that benzodiazepine receptor binding is decreased in the left temporal pole and increased in the right prefrontal area among patients suffering from anxiety. We studied 10 drug-naive female patients with generalized anxiety disorder (GAD) and 10 age- and gender-matched healthy controls with MRI and with SPET by using a new (123)I-labelled specific benzodiazepine receptor radioligand, NNC 13-8241. Blindly analyzed results showed that the benzodiazepine receptor binding of [(123)I]NNC 13-8241 was significantly decreased in the left temporal pole among patients with GAD when compared with age- and sex-matched healthy controls. This hemispheric asymmetry was studied further with a fractal analysis of the SPET images. The fractal dimension of the left hemispheric benzodiazepine receptor binding in patients with GAD was significantly higher than that of controls (1.28 +/- 0.09 and 1.17 +/- 0.07, respectively), whereas the intercept was decreased by 43 +/- 23% reflecting more homogeneous cerebral benzodiazepine receptor density distribution in patients with GAD. The finding is analogous to the decreased heterogeneity of myocardial blood flow observed in patients with ischemic heart disease. The results are consistent with the general hypothesis that high regional heterogeneity of perfusion, metabolism and receptor density is necessary to maintain adaptation ability in the living organism.

Adult↗

PubMedDate not supplied

Papillary carcinoma.

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Aged↗

PubMedDate not supplied

Lipogranuloma.

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Adult↗

PubMedDate not supplied

The effect of prestorage irradiation on posttransfusion red cell survival.

Transfusion-associated graft-versus-host disease (TA-GVHD) may occur whenever immunologically competent allogeneic lymphocytes are transfused to an immunocompromised recipient. Irradiation of blood components eliminates the risk of TA-GVHD but may damage the cellular elements in the transfused component, particularly if the cells are stored for prolonged periods in the irradiated state. To study the effect of irradiation on long-term storage of red cells, AS-1 red cells from eight normal subjects were prepared on two occasions. On one occasion, the units were stored as standard AS-1 red cells for 42 days at 4 degrees C; on the other, they were exposed to 3000 cGy radiation within 4 hours of collection and then were stored as AS-1 red cells for 42 days at 4 degrees C. The donations were at least 12 weeks apart. Irradiated units demonstrated significant elevations in poststorage plasma hemoglobin (Hb) (623 +/- 206 vs. 429 +/- 194 g/dL [6230 +/- 2060 vs. 4290 +/- 1940 g/L], p less than 0.02) and plasma potassium (78 +/- 4 vs. 43 +/- 9 mEq/L [78 +/- 4 vs. 43 +/- 9 mmol/L], p less than 0.01) and significant decreases in red cell ATP (1.9 +/- 0.2 vs. 2.1 +/- 0.3 microM/g Hb, p less than 0.04) and 24-hour posttransfusion red cell recovery (68.5 vs. 78.4%, p less than 0.02), as compared to nonirradiated units. It can be concluded that irradiation with 3000 cGy damages red cells and that long-term storage in the irradiated state may enhance this damage. Red cells should not be stored for 42 days after irradiation with 3000 cGy.

Blood Preservation↗

PubMedDate not supplied

Comparison of random-donor platelet concentrates prepared from whole blood units and platelets prepared from single-donor apheresis collections.

BACKGROUND: The use of fresh platelets results in better posttransfusion recovery and survival than does the use of platelets that have been stored before transfusion. Activation of platelets during preparation and storage may be one of the factors responsible for a number of storage-related changes in platelet membrane proteins. Blood centers commonly prepare platelet concentrates from both multiple units of whole blood and single-donor plateletpheresis collections. STUDY DESIGN AND METHODS: Seventeen plateletpheresis concentrates, anticoagulated with ACD, were compared to platelets prepared from whole blood from the same donor that was anticoagulated with CPDA-1 (random-donor platelets). After preparation, plateletpheresis and random-donor platelets were stored in plastic storage bags at 22 degrees C for 5 days. Platelet surface glycoproteins were examined by flow cytometry after platelets were fixed in dilute plasma with 1-percent formaldehyde and stained with fluorescein isothiocyanate-labeled monoclonal antibodies CD42b (anti-glycoprotein [GP]lb), CD41a (anti-GPllb/llla), and CD62 (anti-P-selectin). RESULTS: The binding of anti-CD42b was greater in plateletpheresis concentrates than in random-donor platelets on Days 3 and 5 (p < 0.01) of storage; binding of anti-CD62 was greater in the random-donor concentrates (p < 0.01) on Days 3 and 5. Plateletpheresis concentrate aggregation responses were greater on Day 5 (p < 0.01). To determine if the type of anticoagulant and the method of mixture with blood contributed to these changes, 10 samples were split into aliquots and prepared in two separate ways: One group of samples was prepared by allowing anticoagulant (ACD) and blood to flow into the tube at a rate of 3 microL per second, and the other group of samples was prepared by allowing blood to flow into tubes containing a measured amount of CPDA-1. The first samples bound more anti-CD42b than the second samples (p < 0.01). The second group of samples contained significantly more microvesicles that bound anti-CD41a than did the first group (p < 0.01). Samples prepared by the first method but anticoagulated with CPDA-1 contained more microvesicles but had the same amount of anti-CD42b binding as did similarly prepared samples anticoagulated with ACD (p < 0.05). CONCLUSION: Platelet concentrates prepared from single units of whole blood and anticoagulated with CPDA-1 bind less anti-CD42b and more anti-CD62 than do platelets obtained by apheresis. These differences may be attributed to platelet sedimentation and the transient exposure of some of the platelets in the blood that is first collected during whole-blood donation to high concentrations of anticoagulant.

Adenine↗

PubMedDate not supplied

Evaluation of methods for preparing and thawing cryopreserved CD34+ and CD34- cell lines for use as reagents in flow cytometry of hematopoietic progenitor cells.

BACKGROUND: Flow cytometry is used to quantitate CD34+ hematopoietic progenitor cells for transplantation. The present study evaluates methods for preparing and thawing cryopreserved CD34+ and CD34- cell lines for use as flow cytometry reagents. STUDY DESIGN AND METHODS: The human myeloid leukemic cell lines KG 1 a (CD34+) and K562 (CD34-) were grown in culture under standard conditions and then prepared on ficoll gradients of different densities to determine which gave the component that was most reproducible. After ficoll preparation, the cells were frozen in standard cryopreservation media and four methods of thawing were examined. Determination of the method that gave the cell component that was most reproducible was based on viability, percentage of cell recovery, and maintenance of CD34 antigenicity status. RESULTS: Ficoll gradient preparation improved the ease of flow cytometry analysis when original viability was low, and it produced a more uniform cell population. However, it resulted in significant cell loss for both cell lines. While the cell recovery for K562 cells was not significantly different with any of the densities of ficoll, recovery was significantly better for KG 1 a cells with ficoll at a specific gravity of 1.077. Of the thawing methods examined, all three that involved a rapid thaw at 37 degrees C were statistically equivalent to each other and were better than thawing at 4 degrees C. CONCLUSION: With a standardized method of preparing cell lines as reagents for quality control purposes, data comparison among cell processing laboratories may more readily be initiated. Such cell lines could also be useful as a teaching tool for flow cytometry and in proficiency testing.

Acute Disease↗

PubMedDate not supplied

Perimenstrual symptoms among Chinese women in an urban area of China.

We explored perimenstrual symptoms among 16 Chinese women in an urban area of southeastern China using a retrospective questionnaire, the Menstrual Distress Questionnaire (MDQ), and a prospective daily symptom diary, the Daily Health Diary (DHD), modified for cultural relevance. Mean scores on the DHD were significantly (p < .03) higher during the perimenstrual phase for the symptoms fatigue, increased sensitivity to cold, increased sleeping, abdominal pain/discomfort, painful or tender breasts, and decreased sexual desire. The women who reported higher DHD physical symptom scores prospectively were more likely to recall more severe physical symptoms retrospectively on the MDQ. However, there were remarkable discrepancies between the DHD and MDQ regarding psychoemotional symptoms. By retrospective MDQ, the percentages of women who experienced severe mood swings and irritability ranged from 13% to 25% during the premenstrual and menstrual phases; on the DHDs, however, these emotional symptoms were not statistically associated with the menstrual cycle. The failure of prospective charting to confirm the retrospective reports of cyclic psychoemotional symptoms agrees with findings of studies of U.S. samples. We conclude that perimenstrual distress in Chinese women may be affected by the data collection methods.

Adult↗

PubMedDate not supplied

Genetic diversity present within the near-complete mtDNA genome of 17 breeds of indigenous Chinese pigs.

The genetic diversity present within the near-complete mitochondrial genome (15,982 bp) was determined from 17 indigenous Chinese pig breeds and 3 European breeds. Animals were selected from 17 Chinese breeds that reflect the large phenotypic diversity of Chinese pigs and represent each of the six breed types, which are grouped based on morphological characteristics. Analysis of nucleotide diversity confirmed a high level of divergence between animals of European versus Asian origin; however, much more limited variation was observed between the 17 indigenous Chinese breeds. Each had a unique haplotype, but the lowest pairwise sequence divergence was only 0.01 +/- 0.01%, observed between the Tongcheng and Yushan Black. Comparison of control region sequence diversity revealed the 17 Chinese breeds contain a lower average pairwise distance (0.61 +/- 0.19%) than a group of European commercial breeds (0.91 +/- 0.21%). The dendrogram constructed from the near-complete mtDNA sequences showed the Chinese sequences loosely clustering into two groups. Although some correspondence with geographic origin was present, notable differences between the dendrogram and the traditional pig breed grouping system were observed.

Animals↗

PubMedDate not supplied

A novel "small round virus" inducing poult enteritis and mortality syndrome and associated immune alterations.

The role of a novel "small round virus" (SRV) isolated from poult enteritis and mortality syndrome (PEMS) cases in inducing PEMS and associated immune alterations was examined in this study. Specific-pathogen-free and conventional poults were orally challenged with SRV and/or turkey coronavirus and monitored for clinical signs. Intestines, thymus, bursa, and spleens were examined for SRV antigen at various days postinoculation (DPI). Peripheral blood lymphocytes (PBLs), thymocytes, and splenic lymphocytes from inoculated poults or lymphocytes isolated from healthy poults after incubation with SRV in vitro were examined for lymphoproliferative potential against concanavalin A (Con A). The incidence of lymphocyte subpopulations in the peripheral blood and thymic lymphocytes of SRV-challenged poults was examined by flow cytometry. The results of these studies showed that the SRV challenge induced diarrhea, growth suppression, and atrophy of thymus and bursa resembling those of PEMS in field and/or experimental infections. The SRV antigen was detected in intestinal tissues soon after infection (i.e., at 2 and 4 DPI), whereas lymphoid tissues such as thymus, bursa, and spleen were positive for SRV antigen starting at 4 DPI until 8 DPI, suggesting virus translocation to lymphoid organs. The responsiveness of PBLs to Con A at 2 DPI was significantly reduced in all virus challenge groups (e.g., 28% and 22% in the SRV-alone group in studies 1 and 2, respectively) below the uninfected group. However, this suppressed response was no longer evident in the SRV group by 7 DPI. The SRV incubation with normal thymocytes and splenocytes in vitro resulted in significantly reduced lymphoproliferative response against Con A (41.2% and 10.49% reductions at 1:50 SRV dilution vs. controls in thymocytes and splenocytes, respectively). Flow cytometry analysis revealed a sudden decline at 2 DPI in the numbers of CD4- CD8+ lymphocyte subset in PBLs of SRV-infected poults. However, by 8 DPI, SRV-challenged poults had relatively higher CD4- CD8+ lymphocytes in PBLs. On the contrary, thymocytes had higher percentages of CD4- CD8+ lymphocytes at 2 and 4 DPI and reached comparable levels at 8 DPI in controls and SRV-infected poults. No differences were observed in CD4+ CD8- lymphocyte numbers in controls vs. SRV-infected poults. The findings of these studies imply that SRV may be a promising primary etiologic agent of PEMS. Furthermore, the SRV infection may compromise the lymphocyte-mediated immune defenses by reducing lymphoproliferation and the CD4- CD8+ (presumably T-cytotoxic cells) lymphocytes during the acute stage of SRV infection.

Animals↗