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PubMed1985

Rest and exercise hemodynamics following aortic valve replacement. A comparison between 19 and 21 mm Ionescu-Shiley pericardial and Carpentier-Edwards porcine valves.

When aortic valve replacement is performed in a patient with a small anulus, significant obstruction of the left ventricular outflow tract may remain. Most prostheses are obstructive in the smaller sizes, and enlargement of the aortic anulus may be required to allow placement of a larger valve. To evaluate the hemodynamic performance of two commonly used tissue prostheses, the Ionescu-Shiley pericardial and Carpentier-Edwards porcine valves, 22 patients with either the 19 or 21 mm size were electively studied at rest and after exercise at a mean of 15 months after operation. The resting mean transvalvular gradient for 19 mm Ionescu-Shiley pericardial valves (n = 7), 10.6 +/- 9.2 mm Hg, was significantly lower than that for 19 mm Carpentier-Edwards valves (n = 3), 33.3 +/- 2.1 mm Hg, p less than 0.01. Following exercise, the mean gradient for 19 mm Ionescu-Shiley pericardial valves rose only to 13.8 +/- 8.5 mm Hg. No exercise data were available for the 19 mm Carpentier-Edwards valve. Among patients with 21 mm Ionescu-Shiley pericardial valves (n = 7), the mean transvalvular gradient at rest was 5.6 +/- 9.5 mm Hg, not significantly different from that of patients with 21 mm Carpentier-Edwards valves (n = 5), 9.8 +/- 18.3 mm Hg. After exercise, the gradients rose to 16.0 +/- 10.0 mm Hg and 25.5 +/- 23.8 mm Hg for the Ionescu-Shiley pericardial and Carpentier-Edwards valves, respectively (no statistical significance). Cardiac index was not different between groups. Gradients were not significantly higher in patients with body surface areas greater than 1.5 m2. It is concluded that the 19 and 21 mm Ionescu-Shiley pericardial valves possess excellent hemodynamics, even after exercise. This valve appears hemodynamically superior to the Carpentier-Edwards valve, particularly in the 19 mm size. Procedures to enlarge the aortic anulus are usually unnecessary when small Ionescu-Shiley pericardial valves are used, even in patients who have large body surface areas.

Adult↗

PubMed2002

Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT.

Our objective was to evaluate the ability of multiplanar reformatted (MPR) images combined with 0.5-mm axial images to depict the pancreatic and intrapancreatic bile ducts and compare the results with those of 0.5-mm axial, 2-mm axial, and 6-mm axial images alone. Seventy-seven patients without obstruction of the main pancreatic ducts (MPD) underwent dual-phase helical scanning of the pancreas using multislice computed tomography (MSCT). The MPR images were generated from 0.5-mm-thick images. Visualization of the pancreatic and intrapancreatic bile ducts and their confluence was graded on a four-point scale by a consensus of two radiologists. The results for 0.5-mm axial images in early-phase CT, 2-mm axial images in early-phase CT, MPR images combined with 0.5-mm axial images in early-phase CT, and 6-mm axial images in late-phase CT were then compared. The relationships of the focal pancreatic lesions with the pancreatic ducts were analyzed. The MPR images combined with 0.5-mm axial images were significantly superior to the other three types of images for the visualization of the pancreatic and intrapancreatic bile ducts and their confluence (p<0.01). The depiction rate of the MPD using MPR images combined with 0.5-mm axial images was 94, 94, 95, and 75%, respectively in the head, neck, body, and tail of the pancreas. Accessory pancreatic ducts, intrapancreatic bile ducts, and duct confluence were depicted in 48, 99, and 92%, respectively. In comparison with evaluation based on axial images alone, the use of MPR images more clearly demonstrated the relationship between the lesions and the pancreatic ducts in 14 of 19 lesions. The MPR images combined with 0.5-mm axial images improve the CT depiction of the pancreatic and intrapancreatic bile ducts in comparison with 0.5-mm axial, 2-mm axial, and 6-mm axial images alone.

Adult↗

PubMed2000

Incision sizes with 5.5 mm total optic, 3-piece foldable intraocular lenses.

PURPOSE: To determine incision sizes for 5.5 mm total optic, foldable intraocular lenses (IOLs) made of silicone or hydrophobic acrylic. SETTING: Johann Wolfgang Goethe-University, Department of Ophthalmology, Frankfurt am Main, Germany. METHODS: In a prospective randomized clinical study including 40 cataract procedures with a temporal limbal tunnel approach, incision sizes for 5.5 mm optic, 3-piece foldable IOLs were measured before and after phacoemulsification and before and after IOL implantation using calipers. Three 5.5 mm optic, 3-piece foldable IOLs were used: 2 silicone (Pharmacia CeeOn 912, Allergan SI-55NB) and 1 hydrophobic acrylic (Alcon AcrySof MA30BA). Ten lenses of each model were implanted with a forceps, and 10 SI-55NB IOLs were implanted with the AMO Unfolder injector. Measurements of the tunnel incisions at various times were statistically evaluated using an analysis of variance and the Tukey-Kramer multiple comparison test. RESULTS: Mean tunnel width before and after implantation, respectively, was 3.32 mm+/- 0.06 (SD) and 3.42+/- 0.06 mm for the CeeOn 912 using a Nichamin implantation forceps, 3.28+/- 0.09 mm and 3.42+/- 0.09 mm for the AcrySof MA30BA using a Buratto implantation forceps, 3.00+/- 0.07 mm and 3.10+/- 0.05 mm for the SI-55NB using a Fine Universal II Folder, and 2.66+/- 0.08 mm and 2.81+/- 0.11 mm for the SI-55NB using the AMO Unfolder. Incision sizes before and after implantation were statistically different between 2 IOLs (CeeOn 912 and MA30BA) and the SI-55NB groups. Implantation of the SI-55NB with the Unfolder was associated with significantly smaller incision sizes before and after implantation than implantation with the Fine folder. CONCLUSIONS: Incisions sizes of 2.8 to 3.4 mm were associated with 5.5 mm total optic, 3-piece foldable IOLs. The Allergan SI-55NB high-refractive-index silicone IOL implanted with the AMO Unfolder system provided the smallest postimplantation incision; however, the refractive optic of this IOL is 5.0 mm versus 5.5 mm for of the CeeOn 912 and AcrySof MA30BA.

Acrylic Resins↗

PubMedDate not supplied

Hyperopic laser in situ keratomileusis with 5.5-, 6.5-, and 7.0-mm optical zones.

PURPOSE: To evaluate the results of laser in situ keratomileusis (LASIK) for the correction of hyperopia and hyperopic astigmatism using a large 7.0-mm optical zone and to compare them with treatments using a 5.5- and 6.5-mm optical zone. METHODS: One hundred sixty-one eyes of 89 patients with a mean preoperative spherical equivalent refraction of +2.44 +/- 1.32 diopters (D) (range: +0.00 to +5.62 D, cylinder 5.25 to 0.00 D) were treated for hyperopia and hyperopic astigmatism using a 7.0-mm optical zone and were analyzed retrospectively. Postoperatively, patients were examined after 1 day, 1 week, 1 month, 3 months, and 1 year. Eyes treated previously at the same center by the same surgeons with 5.5- and 6.5-mm optical zone applications were used as controls. All treatments were performed with the Nidek EC 5000 CXII excimer laser system (Nidek, Gamagori, Japan). A nasal hinged flap was created using the Nidek MK 2000 microkeratome in all cases. RESULTS: The mean postoperative spherical equivalent refraction after 1 month (n=89) was +0.12 +/- 0.72 D (range: -1.75 to +2.75 D), +0.13 +/- 0.74 D (range: -1.88 to +1.62 D) at 3 months (n=70), and +0.20 +/- 0.69 D (range: -1.62 to +1.12 D) at 1 year (n=33). Regression between 1 month and 1 year was 0.08 D in the 7.0-mm optical zone group. Regression was 0.25 D in the 5.5-mm group and 0.02 D in the 6.5-mm optical zone group between 1 month and 1 year. In both the 5.5- and 6.5-mm optical zone groups, 13% of eyes lost one line in visual acuity (2% in the 7.0-mm optical zone group). The gain of one or more lines in visual acuity was 19% in the 5.5-mm group, 17% in the 6.5-mm group, and 27% in the 7.0-mm optical zone group. All data represent primary cases without retreatment. CONCLUSIONS: Increasing the optical zone size from 5.5 mm to 6.5 mm and to 7.0 mm seems to improve refractive results, stability, and safety of hyperopic and hyperopic-astigmatic LASIK treatments. Although some hyperopic and astigmatic eyes are endangered by loss of lines in best spectacle-corrected visual acuity, more eyes gain one or more lines.

Adult↗

PubMed1984

Creatine kinase MM isoenzyme subforms in myocardium, cardiac lymph and blood after coronary artery occlusion in dogs.

A time-varying pattern of creatine kinase MM (CK-MM) isoenzyme subforms has been found in the blood of patients after acute myocardial infarction, but the site of enzyme modification has not been identified. Therefore, we studied the CK-MM subform patterns in myocardium, cardiac lymph and blood of dogs after coronary artery occlusion. In five conscious dogs, serial blood samples were taken for 72 h after occlusion of the left anterior descending coronary artery. Samples of non-infarcted and infarcted myocardium were taken after 72 h. In five other anaesthetised, open-chest dogs, cardiac lymph and blood samples were taken for 6 h after coronary artery occlusion. CK-MM subforms were quantitated by an isoelectric focusing method. Before coronary occlusion, 64% of the total CK activity in blood appeared as the anodal subform CK-MM 1 (pI 6.3); 20% and 9% as the cathodal subforms CK-MM 2 (pI 6.6) and CK-MM 3 (pI 6.9), respectively. However, after 2 h of coronary occlusion CK-MM 2 and CK-MM 3 were increased (38% and 17% of total activity respectively) compared with CK-MM 1. Between 4 h and 10 h, CK-MM 2 and CK-MM 3 decreased as CK-MM 1 increased restoring the control relative activities of subforms. In contrast to the subform changes in blood, CK-MM 3 was the predominant subform in both non-infarcted and infarcted myocardium after 72 h of coronary occlusion and in cardiac lymph during 6 h of coronary occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1999

Induction of monocyte binding to endothelial cells by MM-LDL: role of lipoxygenase metabolites.

Treatment of human aortic endothelial cells (EC) with minimally oxidized LDL (or minimally modified LDL, MM-LDL) produces a specific pattern of endothelial cell activation distinct from that produced by LPS, tumor necrosis factor-alpha, and interleukin-1, but similar to other agents that elevate cAMP. The current studies focus on the signal transduction pathways by which MM-LDL activates EC to bind monocytes. We now demonstrate that, in addition to an elevation of cAMP, lipoxygenase products are necessary for the MM-LDL response. Treatment of EC with inhibitors of the lipoxygenase pathway, 5,8,11, 14-eicosatetraynoic acid (ETYA) or cinnamyl-3, 4-dihydroxy-alpha-cyanocinnamate (CDC), blocked monocyte binding in MM-LDL-treated EC (MM-LDL=118+/-13%; MM-LDL+ETYA=33+/-4%; MM-LDL+CDC=23+/-4% increase in monocyte binding) without reducing cAMP levels. To further investigate the role of the lipoxygenase pathway, cellular phospholipids were labeled with arachidonic acid. Treatment of cells for 4 hours with 50 to 100 microg/mL MM-LDL, but not native LDL, caused a 60% increase in arachidonate release into the medium and increased the intracellular formation of 12(S)-HETE (approximately 100% increase). There was little 15(S)-HETE present, and no increase in its levels was observed. We demonstrated that 12(S)-HETE reversed the inhibitory effect of CDC. We also observed a 70% increase in the formation of 11,12-epoxyeicosatrienoic acid (11, 12-EET) in cells treated with MM-LDL. To determine the mechanism of arachidonate release induced by MM-LDL, we examined the effects of MM-LDL on intracellular calcium levels. Treatment of EC with both native LDL and MM-LDL caused a rapid release of intracellular calcium from internal stores. However, several pieces of evidence suggest that calcium release alone does not explain the increased arachidonate release in MM-LDL-treated cells. The present studies suggest that products of 12-lipoxygenase play an important role in MM-LDL action on the induction of monocyte binding to EC.

12-Hydroxy-5,8,10,14-eicosatetraenoic Acid↗

PubMed1999

Hemodynamics revealed by Doppler sonography in patients who have undergone creation of transjugular intrahepatic portosystemic shunts: comparison of 10- and 12-mm metallic stents.

OBJECTIVE: The purpose of this study was to determine whether differences exist in baseline flow velocities in the main portal vein and the stent after the creation of transjugular intrahepatic portosystemic shunts with 10- and 12-mm Wallstents. SUBJECTS AND METHODS: We used Doppler sonography to determine baseline flow velocities in the stent and the main portal vein in 80 patients (38 patients with 10-mm Wallstents dilated to 10 mm and 42 patients with 12-mm Wallstents dilated to 12 mm) who had undergone creation of trans jugular intrahepatic portosystemic shunts without complications. RESULTS: We found no significant difference in the maximum flow velocity in the stent between the patients with 10-mm stents (160.3+/-34.3 cm/sec) and those with 12-mm stents (164.4+/-33.8 cm/sec). We also found no significant difference in the minimum flow velocity in the stent between the 10-mm group (132.4+/-28.9 cm/sec) and the 12-mm group (126.7+/-28.3 cm/sec). However, flow velocity through the main portal vein was significantly higher in the patients with 12-mm stents (53.6+/-18.4 cm/sec) than in those with 10-mm stents (45.1+/-13.8 cm/sec) (p < .03). CONCLUSION: After creation of transjugular intrahepatic portosystemic shunts, baseline flow velocities in the main portal vein in patients with 12-mm stents exceeded those in patients with 10-mm stents, although neither maximum nor minimum flow velocities in the stent differed between these two groups of patients. These findings suggest that criteria for shunt malfunction that use flow velocity in the main portal vein may need modification when 12-mm stents are being evaluated.

Blood Flow Velocity↗

PubMed1999

Short needles (8 mm) reduce the risk of intramuscular injections in children with type 1 diabetes.

OBJECTIVE: To study whether 8-mm needles can reduce the frequency of intramuscular injections in diabetic children. RESEARCH DESIGN AND METHODS: We conducted a prospective crossover study in 50 children whose BMI was < or = 60th percentile to compare two lengths of needles (12.7 and 8 mm) regarding the occurrence of intramuscular injections as assessed by ultrasonography. RESULTS: The frequency of intramuscular injections was 86% with the 12.7-mm needles and 38% with the 8-mm needles. The frequency of intramuscular injections was significantly reduced when using the 8-mm needles in the arms (P < 0.01) and thighs (P < 0.001). The efficiency of 8-mm needles, as defined by an intramuscular injection with a 12.7-mm needle and a subcutaneous injection with an 8-mm needle, was found for half of the children who injected in the arm and for two-thirds of the children who injected in the thigh. The subcutaneous tissue (SQT) thickness measured by ultrasonography with a skinfold was significantly higher (9.8 +/- 2.2 mm) in the group in which the 8-mm needles were efficient than in the group in which they were not efficient (6.8 +/- 2.1 mm, P < 0.0001). The efficiency of the 8-mm needle was not related to age, sex, BMI, percentile of BMI, injection device, or injection site. The sensibility and specificity of SQT thickness in predicting the efficiency of the 8-mm needles were both 79%. CONCLUSIONS: Needles that are 8 mm long significantly reduce the risk of intramuscular insulin injection in slim or normal-weight (BMI < or = 60th percentile) diabetic children and adolescents.

Adolescent↗

PubMed2004

Depth of cure of LED vs QTH light-curing devices at a distance of 7 mm.

PURPOSE: To determine the depth of cure of 5 blue LED curing devices compared to that obtained with 3 QTH curing devices. MATERIALS AND METHODS: The LED curing devices tested were 1) e-Light: 40 s; 2) Elipar FreeLight: 40 s; 3) Elipar FreeLight 2: 20 s and 40 s; 4) Ultra-Lume LED 2: 20 s and 40 s; 5) LEDemetron 1: 20 s and 40 s. The QTH curing devices tested were 1) Optilux 501: standard light guide 20 s and 40 s, turbo light guide 20 s; 2) Elipar TriLight: 40 s; 3) Astralis 10: 20 s. Surface hardness was measured (Zwick Z2.5/TS1S) 10 min after exposure on the top and bottom surface of resin samples (Tetric Ceram A3, 1 to 5 mm; 0.5 mm increment, diameter 5 mm, n = 9) which were cured at a distance of 7 mm from the bottom of the sample to the light-guide tip to simulate a Class II curing situation. A reference sample was cured under direct contact with the light guide. The reference sample with the greatest top surface hardness of all devices measured served as the overall control. A bottom/top surface hardness ratio of > or = 80% of the reference sample cured at zero distance was defined as clinically acceptable for safe curing. A descriptive statistical analysis was carried out. RESULTS: With QTH lamps, the mean maximum resin composite sample thickness which cured sufficiently (relative surface ratio > or = 80%) was: 3 mm for Optilux 501, standard light guide, 40 s; 2.5 mm for Trilight, 40 s; and 1.5 mm for Astralis 10, 20 s. The first-generation LED curing devices FreeLight and GC e-Light, both applied for 40 s, and the Optilux 501 operated for 20 s with the standard and the turbo light guide could not sufficiently cure a 1-mm-thick sample at a distance of 7 mm. The new FreeLight 2 and the Ultra-Lume LED 2 cured resin samples up to 2.5 mm thick in 40 s with a relative surface ratio > or = 80%, while no sufficient depth of cure was found after 20 s exposure time for the FreeLight 2. However, a 1.5-mm depth of cure with the Ultra-Lume LED 2 and the LEDemetron 1 with the 13/11 mm light guide was obtained after 20 s. The LEDemetron 1 equipped with a 13/8 mm light guide reached a depth of cure of 2.0 mm. No significant difference was found between the Elipar FreeLight 2, Ultra-Lume LED 2, and LEDemetron 1 in their overall curing potential (linear statistical model, 5% level, Bonferroni-correction) given 40 s or 20 s of exposure time. CONCLUSION: Application of the first-generation LED curing devices FreeLight and e-Light did not ensure clinically sufficient depths of cure, while the new high-power LED curing devices FreeLight 2, Ultra-Lume LED 2, and LEDemetron 1 showed a curing potential equal to the Optilux 501, given 40 s of exposure time.

Composite Resins↗

PubMed1985

The nature of post-translational formation of MM creatine kinase isoforms.

Isoforms (derived from the same isoenzyme but distinguished by differences in isoelectric point) of MM creatine kinase appear in plasma after myocardial infarction. They are formed by conversion of the tissue form of creatine kinase (MM-A, pI 7.80) to progressively more acidic species (MM-B, pI 7.50) and MM-C (pI 7.20) after release into the circulation. To define the changes responsible for myocardial MM creatine kinase isoform formation in humans and dogs, purified isoforms were treated with trypsin or cyanogen bromide. The digests were fractionated by reverse-phase high pressure liquid chromatography. Comparison of proteolytic maps showed that MM-A and MM-C were each characterized by a single, unique peptide peak. Maps of MM-B creatine kinase contained both of these peaks. Sequence analysis and comparison with the complete amino acid sequence of MM creatine kinase showed that the peptide unique to MM-A corresponded to the COOH-terminal tryptic or CNBr peptide. The peptide unique to MM-C was shown to have the same amino acid composition except for lysine (the COOH-terminal amino acid). Thus, isoform formation is characterized by the successive removal of the COOH-terminal lysine residue from one M subunit at a time resulting in the conversion of MM-A to isoforms MM-B and MM-C.

Amino Acid Sequence↗

PubMed1992

Hemodynamic evaluation by Doppler echocardiography of small (less than or equal to 21 mm) prostheses and bioprostheses in the aortic valve position.

To assess resting hemodynamics of an unselected group of patients with prostheses or bioprostheses sized less than or equal to 21 mm implanted into the aortic valve position during a 7-year period, 46 of 50 eligible patients were examined by Doppler echocardiography. The valves were Carpentier-Edwards (CE) supraannular 21 mm (n = 8), Medtronic-Hall (MH) 20 mm (n = 8) and 21 mm (n = 21), and the rest (n = 9) were other valves with only 1 to 3 patients in each group. Gradients, valve areas and dimensionless obstruction indexes (ratio of subvalvular/valvular velocities and velocity time integrals) were compared. By analysis of variance, gradients did not differ significantly between the CE supraannular 21 mm, the MH 20 and 21 mm prostheses (peak/mean 25 +/- 8/14 +/- 5, 31 +/- 13/16 +/- 6 and 25 +/- 10/13 +/- 5 mm Hg; p = not significant). Only 2 patients had a mean gradient greater than 25 mm Hg. The valve area was slightly larger for the MH 21 mm group compared with the CE supraannular 21 mm group (1.34 +/- 0.15 vs 1.16 +/- 0.14 cm2, p less than 0.05). The dimensionless obstruction indexes did not differ (CE supraannular 21 mm 0.36 +/- 0.07/0.40 +/- 0.07 (velocities/velocity time integrals), MH 20 mm 0.40 +/- 0.12/0.47 +/- 0.12, MH 21 mm 0.38 +/- 0.05/0.44 +/- 0.06; p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2026

A 7-mm Covered TIPS Reduces Hepatic Encephalopathy Without Increasing Rebleeding in Cirrhotic Patients With Small Liver: A Randomized Study.

BACKGROUND/AIMS: International guidelines recommend initiating transjugular intrahepatic portosystemic shunt (TIPS) placement with an 8-mm stent. However, there is an evident lack of randomized controlled trials evaluating TIPS diameters < 8 mm in cirrhotic patients with a relatively small liver. The aim of this study was to determine whether 7 mm-covered TIPS, compared with 8-mm stents, could achieve comparable shunt function with a lower incidence of hepatic encephalopathy (HE). METHODS: In this multicenter randomized controlled trial, patients with cirrhosis and relatively small liver were randomized 1:1 to receive TIPS with a 7-mm (n = 92) or 8-mm (n = 92) covered stent to prevent variceal rebleeding. The primary endpoint was the incidence of overt HE after randomization. All-cause rebleeding, orthotopic liver transplantation (OLT)-free survival and a composite of these outcomes, were designated as secondary endpoints. RESULTS: Among the 184 enrolled patients, the predominant etiologies of liver cirrhosis were hepatitis B virus infection (56.0%) and alcohol-related liver disease (20.7%). Over a median follow-up of 26.5 months, overt HE occurred in 19 patients (20.7%) in the 7-mm group and 33 patients (35.9%) in the 8-mm group. The 2-year cumulative incidence of overt HE was significantly lower in the 7-mm group than in the 8-mm group (21.4% vs. 37.2%, p = 0.02). Stent diameter, post-TIPS portosystemic pressure gradient, pre-covert HE and MELD-Na score were identified as independent risk factors for overt HE. The rates of shunt dysfunction were statistically similar between groups (8.7% vs. 8.7%, p = 1.0), as were 2-year rebleeding rates (10.9% vs. 9.8%, p = 0.81) and OLT-free survival rates (91.3% vs. 88.0%, p = 0.82). CONCLUSIONS: A 7-mm covered TIPS demonstrated comparable shunt function to an 8-mm covered stents, with a significantly lower risk of overt HE. These findings support consideration of 7-mm TIPS stents for preventing variceal rebleeding in cirrhotic patients with a small liver who are undergoing TIPS. TRAIL REGISTRATION: ClinicalTrials.gov, NCT02541825.

Humans↗

PubMed1993

Detection of focal hepatic lesions with spiral CT: comparison of 4- and 8-mm interscan spacing.

OBJECTIVE: The objective of this study was to determine if spiral CT with 4-mm interscan spacing results in increased confidence in or rate of detection of focal hepatic lesions when compared with spiral CT with 8-mm interscan spacing. MATERIALS AND METHODS: Spiral CT scans of the liver of 42 consecutive patients with suspected hepatic disease were independently reviewed by three senior radiologists in two sets: one set was reconstructed with 8-mm interscan spacing and one set was reconstructed with 4-mm interscan spacing. The slice thickness was 8 mm for both data sets. The number and sizes of focal hepatic lesions were documented. RESULTS: Thirty-three of the 42 patients had least one focal lesion. The lesion size varied from 2 mm to 21 cm. When 8-mm interscan spacing was used, 297 lesions were detected (212 were considered definite). When 4-mm interscan spacing was used, 318 lesions were detected (258 were considered definite). Therefore, 7% more lesions were detected with 4-mm interscan spacing than with 8-mm interscan spacing (p = .05), and 22% more were diagnosed definitively (p < .01). If lesions larger than 4 cm are excluded, 10% more lesions were detected with 4-mm interscan spacing, and 33% more were diagnosed definitively. Of the lesions detected exclusively with 4-mm interscan spacing, 69% were less than 1.0 cm in diameter. CONCLUSION: Spiral CT with smaller interscan spacing (4 instead of 8 mm) results in increased confidence in and rate of detection of focal liver lesions. The additional benefit is most significant with smaller lesions.

Adult↗

PubMed1991

Immune regulation of mouse 5T2 multiple myeloma. I. Immune response to 5T2 MM idiotype.

The transplantable murine multiple myelomas (MM) of the 5T series originated spontaneously in the aging C57BL/KaLwRij mice. These murine malignancies offer an excellent model for experimental studies on different aspects of the human disease. With the aim to look for new treatment modalities, the influence of idiotype-specific immune response on the 'take' and the development of the 5T2 MM was studied. In the first experiment, long-lasting subcutaneous immunizations of syngeneic mice with the 5T2 MM immunoglobulin (Ig) showed a dose dependent anti 5T2 MM Ig idiotype-specific response. The majority of the optimally immunized mice showed no 'take' or they had a prolonged survival after intravenous inoculation with the 5T2 MM cells. All control mice, nonimmunized or immunized with an irrelevant 5T14 MM Ig, developed 5T2 MM with a typical lethal course. In the second experiment, delayed type hypersensitivity (DTH) reaction to the 5T2 MM idiotype was studied. Subcutaneous immunizations of syngeneic mice with 5T2 MM Ig or with 5T2 MM bone marrow cells resulted in a specific DTH reaction 48 hours after challenge with 5T2 MM bone marrow cells. No DTH reaction was obtained when intravenous immunization was used. These results indicate that 5T2 MM is sensitive to idiotype-specific immune regulation; they constitute a basis for further studies on treatment of already established MM in vivo.

Animals↗

PubMed1991

Immune regulation of 5T2 mouse multiple myeloma. II. Immunological treatment of 5T2 MM residual disease.

The transplantable murine 5T2 multiple myeloma (MM) has been shown to be sensitive to idiotype-specific immunity, provided the recipient mice were immunized before transplantation. In the present study, anti-idiotype treatment was initiated after inoculation of the mice with 5T2 MM cells. Since in MM the serum idiotype concentration is far too high for anti-idiotype antibodies to reach the target cells, reduction of the MM to a minimal residual disease should be performed before. Intravenous (i.v.) or intraperitoneal (i.p.) administration of allogeneic (BALB/c) monoclonal anti-5T2 MM idiotype antibodies 3 days after i.v. infusion of the 5T2 MM cells into the mice, i.e. before 5T2 MM idiotype was serologically detectable, prevented the development of 5T2 MM in the majority of the animals. All mice that had not been treated with the anti-idiotype antibody became seropositive for 5T2 MM idiotype after 6 weeks. When mice with clearly developed 5T2 MM were treated with cyclophosphamide in order to obtain substantial tumor reduction, subsequent i.v. treatment with anti-5T2 MM idiotype antibodies resulted in prevention of myeloma growth in most animals. Injection of the antibody i.p. was, however, less effective. All mice that had been treated with cyclophosphamide only became seropositive for 5T2 MM and died. The results of these experiments demonstrated that passive anti-idiotype treatment of 5T2 MM is successful if the tumor mass is very small. The effector mechanisms of this treatment has to be investigated.

Animals↗

PubMed1993

Exercise hemodynamics in small (< or = 21 mm) aortic valve prostheses assessed by Doppler echocardiography.

Exercise Doppler echocardiography was used to assess hemodynamics in 25 patients with a < or = 21 mm aortic valve prosthesis (14 with a Medtronic-Hall 21 mm valve, three with a Medtronic-Hall 20 mm valve, three with a Sorin 21 mm valve, one with a Duromedics 21 mm valve, and four with a Carpentier-Edwards 21 mm valve). A symptom-limited upright bicycle exercise test was performed, and Doppler gradients were recorded during exercise. Gradients increased with exercise from 30 +/- 8/16 +/- 4 mm Hg (peak/mean) at rest to 46 +/- 12/24 +/- 7 mm Hg during exercise; both p < 0.001. Mean exercise gradient exceeded 30 mm Hg in five patients, and the highest mean gradient recorded was 37 mm Hg. Within the group of mechanical valves, gradients at exercise were similar for different types of valves. A linear relationship was found between gradients at rest and during exercise (peak r = 0.75, mean r = 0.77; both p < 0.001). Additional findings were midventricular velocities exceeding 1.5 m/sec in late systole in 10 patients (40%) and intraventricular flow (> or = 0.2 m/sec) toward the apex during isovolumic relaxation in 11 patients (44%). The patients with these velocity patterns had significantly smaller left ventricular cavities (end-diastolic diameter 39.8 +/- 4.8 vs 46.5 +/- 4.2 mm, p < 0.01; end-systolic diameter 24.2 +/- 3.0 vs 28.5 +/- 4.5 mm, p = 0.013).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

Isoelectric focusing of creatine kinase MM isoforms and its application for diagnosis of acute myocardial infarction.

CK MM isoforms (MM 3 having the highest isoelectric point, followed by MM 2, MM 1, and MM X) were measured in 35 patients with acute myocardial infarction (AMI) by isoelectric focusing on agarose gel. Blood samples were analysed every 2 h for the first 12 h, then every 4-8 h until 72 h after AMI. In the first sample, obtained 2.1 h after the onset of chest pain, the ratio of the isoforms MM 3:1 was 0.7 (range 0.2-1.8), equivalent to a normal value. Before the total CK exceeded normal, in 86% of the patients the ratio MM 3:1 rose to 2.2 (range 0.3-3.3). The maximal individual ratio MM 3:1 was 4 (range 0.9-12) after 7 h. It fell below 1 again after 27 h. Thus, the ratio MM 3:1 was useful in the early diagnosis of AMI by enzymatic methods and to estimate the time elapsed since the onset of infarction. Twenty patients with an open infarct vessel (angiographic data after thrombolytic therapy) showed similar peak enzyme activities as ten non-reperfused patients. They differed significantly in the time to the peak activity, mostly for CK MM 3 and CK MB (p less than 0.0005). A higher ratio CK MM 3:1 and a shorter time to the maximum CK MM 3 activity in reperfused patients helps to assess the success of thrombolytic therapy.

Animals↗

PubMed1998

Liver lesions: improved detection with dual-detector-array CT and routine 2.5-mm thin collimation.

PURPOSE: To determine the feasibility and clinical benefit of routine performance of helical computed tomography (CT) with 2.5-mm collimation for the detection of liver lesions. MATERIALS AND METHODS: Twenty patients with small (< or = 10-mm-diameter) liver lesions (total number of lesions, 167) were evaluated with a dual-detector-array CT scanner during the portal venous phase of contrast material enhancement. The acquisition was performed with 2.5-mm collimation during a single breath hold. The identical data set was used to perform reconstructions with 2.5-mm, 5.0-mm, 7.5-mm, and 10.0-mm section thicknesses with 50% section overlap. Each set of images was evaluated by three radiologists to determine lesion detection rates and conspicuity. RESULTS: Use of 2.5-mm-thick sections resulted in a 46% increase in detection rate versus use of 10.0-mm-thick sections (167 lesions vs 90 lesions), a 33% increase versus use of 7.5-mm-thick sections (167 vs 112), and an 18% increase versus use of 5-mm-thick sections (167 vs 137). Lesion conspicuity and radiologist confidence in lesion detection and characterization of lesion margins increased as section thickness decreased. CONCLUSION: CT of the liver can be performed routinely with 2.5-mm collimation with a dual-detector CT system, yielding greater conspicuity of small lesions and improved lesion detection.

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