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PubMed1984

Maternal, fetal, and neonatal lidocaine levels following local perineal infiltration.

Local infiltration of the perineum is a simple and commonly used technique for providing pain relief for episiotomy. It has always been considered safe and effective because a small amount of local anesthetic agent could be administered quickly and accurately to the perineum just prior to vaginal delivery and cord clamping. Because of the short time interval between local infiltration and delivery, very little anesthetic was thought to reach the fetus. However, the maternal and neonatal disposition of lidocaine following local perineal infiltration has not been well studied. The purpose of this study was to document placental transfer or nontransfer of lidocaine following local perineal infiltration. Fifteen normal parturient women at term and their infants were studied. After local perineal infiltration, the concentrations of lidocaine and two metabolites--monoethyl glycine xylidide and glycine xylidide --were determined in maternal plasma, in the umbilical cord vein at delivery, and in maternal and neonatal plasma or urine for 2 days post partum. Lidocaine and its metabolites were quantitated by gas chromatography-mass spectrometry. The pharmacologic results indicated the following: First, lidocaine is detected in maternal plasma as early as 1 minute after injection, and peak plasma concentrations occur within 3 to 15 minutes. Second, there is rapid placental transfer of lidocaine; the mean fetal/maternal ratio of 1.32 was significantly higher than that found following epidural anesthesia. Third, lidocaine and its active metabolites persisted in neonatal urine for at least 48 hours after delivery. This study suggests that local perineal infiltration with lidocaine for episiotomy should be considered similar to any other anesthetic technique in that it may result in significant neonatal drug exposure.

Adolescent↗

PubMed1996

Effects of ketoprofen and mesosalpinx infiltration on postoperative pain after laparoscopic sterilization.

OBJECTIVE: To determine whether preoperative ketoprofen and mesosalpinx infiltration, either alone or in combination, favorably influence postoperative recovery after outpatient laparoscopic sterilization. METHODS: In a double-blind, randomized, placebo-controlled study, 20 women received 100 mg of oral ketoprofen preoperatively, and each mesosalpinx was infiltrated with 5 mL of saline plus epinephrine 1:200,000; 20 women were given oral ketoprofen, and each mesosalpinx was infiltrated with 5 mL of bupivacaine 0.5% with epinephrine 1:200,000; and 20 women received a placebo capsule with mesosalpinx infiltration. Pain was assessed by a visual analogue scale and a self-assessment 11-point scale; outcome was assessed by discharge time, consumption of analgesics, incidence of nausea and vomiting, and the number of postoperative days to full recovery. RESULTS: Pain ratings in the ketoprofen-only group were significantly higher than in the two other groups (P < .001). Preoperative ketoprofen alone provided insufficient postoperative pain relief, necessitating the use of opiates and peripheral analgesics. Nausea and vomiting were highest in these subjects, as was intake of peripheral analgesics at home. Times to discharge were also the longest in this group (median 385 minutes, range 260-510) and differed significantly from both other groups (P < .001). It took 4-13 days to recover. In contrast, women with only a mesosalpinx block ambulated and recovered sooner, but times to discharge were still prolonged (median 240 minutes, range 105-375). Recovery usually occurred by the fourth postoperative day. The combination of preoperative ketoprofen and mesosalpinx block resulted in the shortest times to discharge (median 190 minutes, range 80-330), the least consumption of peripheral analgesics, and the lowest incidence of nausea and vomiting. Recovery occurred by the fourth postoperative day. CONCLUSION: Mesosalpinx infiltration has a favorable effect on postoperative recovery after day-surgery laparoscopic sterilization. Still better results can be obtained with a multimodal analgesic approach, combining mesosalpinx infiltration with preoperative ketoprofen.

Administration, Oral↗

PubMed1993

The pattern and phenotype of T-cell infiltration associated with human liver allograft rejection.

Although transplant biopsy remains the best means for assessing liver allograft dysfunction, the presence and degree of rejection often is difficult to determine by current histologic criteria. The added diagnostic and prognostic value of examining liver allograft biopsy specimens by immunopathologic methods, such as phenotyping inflammatory cell infiltrates, has been inconclusive. To examine the value of assessing the phenotype and location of T-cell infiltrates we compared findings in 20 liver transplant biopsy specimens obtained from patients undergoing allograft rejection with those in 20 biopsy specimens from patients with no evidence of rejection. Serial frozen sections from all biopsies were labeled by immunoperoxidase techniques using monoclonal antibodies to identify cells expressing CD3, CD4, CD8, CD45RA, and CD45RO. As expected, the median of average cell infiltrates was higher in the rejecting versus nonrejecting group for each cell phenotype and region. However, statistical comparisons indicated that only some combinations of cell phenotype and location were significantly greater in the rejecting versus nonrejecting groups. The median number of portal CD3+ T cells per high-power field was increased in the rejecting versus nonrejecting groups (15.15 v 5.00 cells/high-power field; P < .01). This primarily was the result of a significant increase in CD8+ cells (7.15 v 1.55 cells/high-power field; P < .0001). Examination of cells expressing CD45 isoforms also revealed a suggested increase (P < .04) in CD45RO+ "memory" but not in CD45RA "naive" T cells infiltrating portal areas. In lobular areas cell infiltrates of any examined phenotype were not significantly increased in the rejecting versus nonrejecting groups. These findings indicate that during liver allograft rejection the most characteristic changes involve an increase in T cells infiltrating the graft in portal regions and suggest that human liver allograft rejection preferentially involves memory CD8+ T cells directed at portal structures.

Antigens, CD↗

PubMed1991

Immunophenotypic analysis of leukocyte infiltration in the renal transplant.

Immunohistological analyses of transplant biopsy material can provide valuable insight into the intragraft events following transplantation. The magnitude, composition and phenotype of the leukocyte infiltration and up-regulation of parenchymal antigen expression within the renal allograft have been major areas of interest. Immunohistological analyses have demonstrated the presence of leukocyte infiltration not only during clinical rejection episodes, but also during periods of stable graft function. Nevertheless the infiltration is significantly increased during clinical rejection. Indeed, quantitation of the leukocyte infiltration using a morphometric point counting technique or image analysis can be used prospectively to diagnose rejection in the renal transplant recipient. Macrophages and T lymphocytes (both of the CD4 and CD8 phenotype) are the major infiltrating cells, B lymphocytes and NK cells being present, but in the minority. Activated and proliferating cells have been demonstrated during allograft rejection and may provide a means of identifying a functionally active infiltrate.

Antibodies, Monoclonal↗

PubMed1993

Clinical and immunologic studies in reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin.

BACKGROUND: Little is understood about reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin. OBJECTIVE: Our purpose was to define reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin further with focus on immunologic studies. METHODS: In patients with reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin, we measured circulating immune complexes before, during, and after therapy. We examined natural killer cells in a functional assay; we performed direct immunofluorescence and T- and B-cell marker studies in skin biopsy specimens. RESULTS: The infiltrate in reticular erythematous mucinosis is composed of helper T cells. Circulating immune complexes are increased in both reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin and decrease with hydroxychloroquine therapy and clinical clearing. Natural killer cell function is decreased in reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin. CONCLUSION: Changes in circulating immune complex titers accompanying therapy with hydroxychloroquine and clinical clearing, with recurrence of the condition and increase in circulating immune complexes on discontinuation of treatment, point to a possible relation between these events.

Adult↗

PubMed1995

Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain.

STUDY OBJECTIVE: To compare the efficacy of preincision wound infiltration with bupivacaine to wound infiltration at the end of the operation. DESIGN: A prospective, randomized, double-blind study. SETTING: University medical center. PATIENTS: 56 ASA status I and II women scheduled for abdominal hysterectomy were randomly assigned to one of three treatment groups. INTERVENTIONS: Group 1 (control) received no local anesthetic infiltration. Group 2 received subcutaneous infiltration with 40 ml of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Group 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg i.v., droperidol 50 micrograms/kg i.v., and sufentanil 0.5 microgram/kg i.v. and maintained with nitrous oxide 67% in oxygen and sufentanil 0.1 microgram/kg IV boluses as required. Postoperative pain was treated with morphine via a patient-controlled analgesia delivery system for 24 hours, followed by oral hydrocodone for 3 days. MEASUREMENTS AND MAIN RESULTS: The opioid consumption was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups. CONCLUSIONS: Wound infiltration, either preincision or postincision, had no clinically significant effect on the pain scores or analgesic requirements following abdominal hysterectomy.

Adult↗

PubMed2006

Ex vivo infiltration of fibroblasts into the tendon deteriorates the mechanical properties of tendon fascicles but not those of tendon bundles.

BACKGROUND: After ligament reconstruction, mechanical deterioration of the grafted tendon is observed with revascularization and cellular infiltration. However, the effect of cellular infiltration on the mechanical properties of the tendon matrix has not been fully understood. METHODS: Cultured fibroblasts derived from the rabbit patellar tendon were seeded around an acellular rabbit patellar tendon that had undergone freeze-thaw treatment. At time-0, 3, and 6 weeks after seeding the cells, we evaluated cellular distribution in the tendon using a confocal laser microscope and the mechanical evaluations of the tendon fascicles and the tendon bundles. FINDINGS: The confocal laser microscopic analysis showed fibroblast infiltration ex vivo into the acellular tendon matrix. We could not find significant effects of the cellular infiltration on the tangent modulus of the tendon bundle, although the ex vivo cellular infiltration significantly reduced the modulus of the tendon fascicle. In addition, the tangent modulus of the incubated tendon without fibroblasts significantly decreased with time, particularly in the tendon bundle levels. INTERPRETATION: The findings of this study suggested that the effects of ex vivo cellular infiltration on the mechanical properties of the tendon bundles are relatively small, compared with its striking effect on the tendon fascicles.

Animals↗

PubMed2004

Reduced dermal infiltration of cytokine-expressing inflammatory cells in atopic dermatitis after short-term topical tacrolimus treatment.

BACKGROUND: In several clinical studies, topical calcineurin inhibitors have been shown to be effective in the treatment of atopic dermatitis (AD). They target signaling pathways that control gene expression, particularly the expression of cytokines. OBJECTIVE: We examined the cellular infiltrate in skin lesions of 10 patients with AD and characterized the cytokine pattern expressed by the infiltrating cells before and after short-term topical therapy with tacrolimus 1% ointment. METHODS: Skin biopsies were examined for histologic alterations (hematoxylin and eosin staining), composition of the cellular inflammatory infiltrate (immunofluorescence), and cytokine expression (ribonuclease protection assay, ELISA, immunofluorescence) before as well as 1 and 3 weeks after initiation of tacrolimus therapy. For comparison, biopsies from nonlesional AD and normal skin were analyzed. Systemic immunologic effects were assessed by analyzing peripheral blood leukocytes (immunofluorescence) as well as in vitro stimulated pan-T-cell cytokine production (ELISA). RESULTS: All patients showed a significant improvement of their skin lesions associated with a marked regression of spongiosis, acanthosis, and density of the cellular infiltrate in the dermis. The last was a result of reduced infiltration of T cells, B cells, and eosinophils. In contrast, the numbers of mast cells did not change. Moreover, the expression of the T H 2 cytokines IL-5, IL-10, and IL-13 in CD4 + T cells was reduced after therapy. Interestingly, tacrolimus therapy was also associated with a reduction of CD8 + T cells expressing the T H 1 cytokine IFN-gamma. Furthermore, the numbers of epidermal CD1a + dendritic cells increased after treatment. In the peripheral blood, a decrease of granulocytes (eosinophils and neutrophils) but no changes in the distribution of lymphocyte subpopulations were noticed. CONCLUSION: Topical tacrolimus treatment has anti-inflammatory effects on AD skin as indicated by reduced infiltration of cytokine expressing inflammatory cells. No evidence for drug-induced systemic immunosuppression was obtained.

Administration, Topical↗

PubMed2004

Analytical solutions for reactive transport under an infiltration-redistribution cycle.

Transport of reactive solute in unsaturated soils under an infiltration-redistribution cycle is investigated. The study is based on the model of vertical flow and transport in the unsaturated zone proposed by Indelman et al. [J. Contam. Hydrol. 32 (1998) 77], and generalizes it by accounting for linear nonequilibrium kinetics. An exact analytical solution is derived for an irreversible desorption reaction. The transport of solute obeying linear kinetics is modeled by assuming equilibrium during the redistribution stage. The model which accounts for nonequilibrium during the infiltration and assumes equilibrium at the redistribution stage is termed partial equilibrium infiltration-redistribution model (PEIRM). It allows to derive approximate closed form solutions for transport in one-dimensional homogeneous soils. These solutions are further applied to computing the field-scale concentration by adopting the Dagan and Bresler [Soil Sci. Soc. Am. J. 43 (1979) 461] column model. The effect of soil heterogeneity on the solute spread is investigated by modeling the hydraulic saturated conductivity as a random function of horizontal coordinates. The quality of the PEIRM is illustrated by calculating the critical values of the Damköhler number which provide the achievable accuracy in estimating the solute mass in the mobile phase. The distinguishing feature of transport during the infiltration-redistribution cycle as compared to that of infiltration only is the finite depth of solute penetration. For irreversible desorption, the maximum solute penetration W/theta(r) is determined by the amount of applied water W and the residual water content theta(r). For sorption-desorption kinetics, the maximum depth of penetration z(r)(e, infinity ) also depends on the ratio between the rate of application and the column-saturated conductivity. It is shown that z(r)(e, infinity ) is bounded between the depths W/(theta(r)+K(d)) and W/theta(r) corresponding to the maximum solute penetration for equilibrium transport and for irreversible desorption, respectively. This feature of solute penetration explains the unusual phenomena of plume contraction after an initial period of spreading [Lessoff, S.C., Indelman, P., Dagan, G., 2002. Solute transport in infiltration-redistribution cycles in heterogeneous soils. In Raats, P.A.C., Smiles, D.,Warrick, A.W. (Eds), Environmental Mechanics: Water, Mass and Energy Transport in the Biosphere. American Geophysical Union, pp. 133-144]. Unlike transport under equilibrium conditions, when the solute is completely concentrated at the front, the solute under nonequilibrium conditions is spread out behind the front. Heterogeneity leads to additional spreading of the plume.

Adsorption↗

PubMed2006

Analysis of a mesoscale infiltration and water seepage test in unsaturated fractured rock: Spatial variabilities and discrete fracture patterns.

A mesoscale (21 m in flow distance) infiltration and seepage test was recently conducted in a deep, unsaturated fractured rock system at the crossover point of two underground tunnels. Water was released from a 3 mx4 m infiltration plot on the floor of an alcove in the upper tunnel, and seepage was collected from the ceiling of a niche in the lower tunnel. Significant temporal and (particularly) spatial variabilities were observed in both measured infiltration and seepage rates. To analyze the test results, a three-dimensional unsaturated flow model was used. A column-based scheme was developed to capture heterogeneous hydraulic properties reflected by these spatial variabilities observed. Fracture permeability and van Genuchten alpha parameter [van Genuchten, M.T., 1980. A closed-form equation for predicting the hydraulic conductivity of unsaturated soils. Soil Sci. Soc. Am. J. 44, 892-898] were calibrated for each rock column in the upper and lower hydrogeologic units in the test bed. The calibrated fracture properties for the infiltration and seepage zone enabled a good match between simulated and measured (spatially varying) seepage rates. The numerical model was also able to capture the general trend of the highly transient seepage processes through a discrete fracture network. The calibrated properties and measured infiltration/seepage rates were further compared with mapped discrete fracture patterns at the top and bottom boundaries. The measured infiltration rates and calibrated fracture permeability of the upper unit were found to be partially controlled by the fracture patterns on the infiltration plot (as indicated by their positive correlations with fracture density). However, no correlation could be established between measured seepage rates and density of fractures mapped on the niche ceiling. This lack of correlation indicates the complexity of (preferential) unsaturated flow within the discrete fracture network. This also indicates that continuum-based modeling of unsaturated flow in fractured rock at mesoscale or a larger scale is not necessarily conditional explicitly on discrete fracture patterns.

Calibration↗

PubMed1987

2-Chloroprocaine for local perineal infiltration.

Lidocaine was recently found to rapidly cross the placenta and result in considerable fetal exposure after local infiltration of the perineum for episiotomy. For this reason, a more appropriate agent for local perineal infiltration might be a drug with rapid metabolism and inactive metabolites. 2-Chloroprocaine, an ester-linked local anesthetic agent, is available but is not commonly used for this procedure. The purpose of this study was to evaluate the placental transfer of 2-chloroprocaine after local perineal infiltration. The drug was administered to 17 normal term pregnant women for episiotomy. After local perineal infiltration, the levels of 2-chloroprocaine and/or its metabolite, chloroaminobenzoic acid, were quantitated in maternal and neonatal plasma or urine. The pharmacologic data indicated that 2-chloroprocaine was nondetectable at delivery in maternal and umbilical cord vein; one patient had trace levels in the cord. Chloroprocaine was not detectable in neonatal plasma, but chloroaminobenzoic acid was detectable in both maternal and cord vein plasma. Mean levels of chloroaminobenzoic acid in maternal plasma at delivery were 1.04 +/- 0.32 micrograms/ml, and mean levels in cord vein were 0.35 +/- 0.54 micrograms/ml. Clinically, 2-chloroprocaine provided good analgesia. These results indicate that very little, if any pharmacologically active drug, reaches the fetus after local perineal infiltration with 2-chloroprocaine. Therefore 2-chloroprocaine appears to be preferable to lidocaine when used for local perineal infiltration.

Adult↗

PubMed2003

Characterisation of T and B lymphocytes infiltrating abdominal aortic aneurysms.

Cellular infiltrates consisting mainly of lymphocytes are commonly present in the arterial wall in abdominal aortic aneurysm (AAA). However, despite this, the precise nature of these populations has to date not been described in detail. The aim of this study was to perform an exhaustive phenotypic characterisation of the infiltrating lymphocytes in order to define the inflammatory process that develops in AAA. For this purpose, AAA-infiltrating lymphocytes from 25 fresh aneurysm wall samples and, as a control, peripheral blood (PB) lymphocytes from the same patients were purified. The expression of lineage specific markers, maturation molecules, activation antigens and adhesion molecules on T and B lymphocytes was examined by triple-colour immunofluorescence and flow cytometry analysis. The phenotype of AAA-infiltrating lymphocytes was compared with that of PB of the patients with AAA. The results reveal that AAA-infiltrating B and T lymphocytes consist of activated memory cells, with specific homing properties. In addition, they express molecules of B-T co-stimulation and, occasionally, exhibit phenotypical features indicative of the ectopic formation of lymphoid structures. These findings are discussed in the light of the similarities shared with the lymphoid infiltration occurring in other chronic autoimmune/inflammatory disorders.

Aged↗

PubMed2000

Conjunctival lymphocytic infiltrates associated with Epstein-Barr virus.

PURPOSE: To describe the clinicopathologic features of two patients with Epstein-Barr virus (EBV) associated conjunctival lymphocytic infiltrates. DESIGN: Two case reports. METHODS: The clinical histories and pathologic findings of two patients with salmon-colored conjunctival infiltrates are described. MAIN OUTCOME MEASUREMENTS: Clinical observation and pathologic examination of conjunctival biopsy specimens with accompanying immunohistochemical staining, flow cytometric immunophenotyping, and polymerase chain reaction analysis when appropriate. RESULTS: One patient had ipsilateral preauricular lymphadenopathy, elevated serum EBV titers, and a unilateral reactive lymphocytic infiltrate resulting in a conjunctival mass. The other patient had bilateral conjunctival lymphocytic infiltrates causing conjunctival masses. There was an expanded clonal population of B lymphocytes in the conjunctival mass in the second patient. Both patients had EBV antigen in their conjunctival lymphocytic infiltrates. CONCLUSIONS: Conjunctival lymphocytic lesions associated with EBV represent a spectrum of reactive infiltrates to monoclonal populations.

Adult↗

PubMed1997

Evidence that eosinophil infiltration in the OK-432/fibrinogen-injected Meth-A tumor in mice is mediated by locally produced IL-5.

It was previously demonstrated that a single injection of OK-432 (a penicillin-treated freeze-dried Streptococcus) mixed with fibrinogen into cancer tissues induces marked infiltration by eosinophils of the tumor stroma and leads to tumor necrosis. In the present study, we examined mechanisms regulating the local accumulation of eosinophils and the role of infiltrating eosinophils in tumor regression using the OK-432/fibrinogen injected Meth-A fibrosarcoma tumor. After injection of OK-432/fibrinogen into the tumor on the left flank of the BALB/c mice, eosinophil infiltration became obvious in the tumor stroma on day 3 following the accumulation of macrophages and neutrophils, was massive on day 5 and decreased by day 10. After the decrease in the infiltration of eosinophils, the tumor injected with OK-432/fibrinogen diminished markedly in size with ulceration as compared with control. Northern blot analysis revealed that expression of IL-5 mRNA in the tumor tissue was not detected on day 0, was significantly on day 3, reached the maximum on day 5, and thereafter decreased by day 10. Although intraperitoneal injection of rat anti-IL-5 monoclonal antibody in tumor bearing mice prior to OK-432 injection inhibited the infiltration of eosinophils, the antitumor effects of OK-432 persisted. In the blood, neither eosinophilia nor IL-5 activity was recognized during the course of the experiment. These results suggest that intratumoral injection of OK-432/fibrinogen induces local production of IL-5, which in turn recruits eosinophils into the tumor tissue, however, the infiltrating eosinophils do not play an important role in tumor regression.

Animals↗

PubMed1990

Immunohistochemical staining of infiltrates in oral lichen planus.

Immunohistochemical examination of lymphocyte and accessory cell infiltrates was performed in 24 cases of oral lichen planus using a double staining technique. The major population of the superficial stromal lymphocytes was T cells which were mostly composed of dominant CD 4+Leu8- (helper T cells) and lesser numbers of CD 8+11b- cells (cytotoxic T cells). Contrarily, many more CD 8+11b- cells than CD 4+Leu8- cells had infiltrated the epithelium. Some infiltrated T cells expressed interleukin-2 receptor and about half of cytotoxic T cells expressed class II antigen. HLA-DR-positive monocytes were also observed in both the superficial stroma and the epithelium. A number of HLA-DR-bearing CD 1+ cells (Langerhans/dendritic cells) and CD 11c+ cells (macrophages) were observed in the lower layers of the epithelium which were sometimes degenerative. Having significant correlation with the infiltration intensities of subepithelial macrophages and epithelial CD 8+ cells (cytotoxic/suppressor T cells), epithelial Langerhans cells variably infiltrated. Superficial stromal CD 8+ cells correlated with epidermal CD 8+ and CD 4+ cell (helper/inducer T cells) infiltrates. These findings are consistent with the notion that Langerhans cells and macrophages play an important role in antigen presentation, and suggest that cellular immunity, mediated by cytotoxic T cells with helper T cells, may be related to the pathogenesis of oral lichen planus.

Antigens, CD↗

PubMed1998

Monocyte infiltration into venous valves.

PURPOSE: Greater saphenous veins removed at surgery for correction of venous dysfunction have few valves. Those that are present may be shrunken, deformed, or monocuspid. This study was carried out to determine whether leukocyte infiltration is associated with valve damage. METHODS: Seventeen specimens were removed at surgery from five men and eight women (age, 29 to 80 years). These consisted of the proximal 15 cm of the duplex-confirmed, refluxing proximal greater saphenous vein, one proximal lesser saphenous vein, and one midportion of greater saphenous vein. The severity of venous stasis in each patient limb was classified by the CEAP formula. Twelve were class 2, two were class 3, and three were class 4. Control specimens were obtained from patients who underwent coronary artery bypass grafting. These were two men and two women, ages 72, 66, 62, and 60 years, free of venous insufficiency, with the specimens obtained from the proximal saphenous vein. Two of the control specimens contained venous valves corresponding to the test specimens. Longitudinal 10 microns paraffin sections were labeled with anti-CD64 monoclonal antibody, specific for tissue monocytes and macrophages, and studied by light microscopy. Five regions were chosen for quantification of the leukocyte infiltrate. Cells were categorized and counted directly. Volume proportions were calculated using stereologic techniques. RESULTS: Three of seven specimens studied for morphologic changes had clearly shortened valve leaflets. Collagen degeneration was noted in all seven specimens. Leaflets had essentially disappeared in three and were shortened to 100 to 2100 microns in five. Specific leukocyte staining was accomplished on 10 additional specimens. All specimens showed monocyte/macrophage infiltration in valve leaflets and venous wall. These were more numerous in the valve sinus and proximal wall both on and under the endothelium. Control specimens showed no monocyte/macrophage infiltration. CONCLUSIONS: These observations suggest that venous valve damage in refluxing saphenous veins is associated with a leukocyte (monocyte/macrophage) infiltrate. Cell activation and fluid dynamic factors, such as eddies recirculation, and stasis in the valve sinus may be a part of the process of leukocyte penetration of the endothelium. The magnitude of leukocyte infiltration in the vein wall and in the base of the valve leaflet may be important in the genesis of primary venous dysfunction.

Adult↗

PubMed1996

Improved immunogold labeling of epoxy sections by the use of propylene oxide as additional agent in dehydration, infiltration and embedding.

The purpose of this study was to examine how the intensity of the immunogold labeling on epoxy sections was affected by the use of propylene oxide as an agent in addition to ethanol in the dehydration and infiltration, and also to examine the effect on the immunogold labeling by adding small amounts of propylene oxide to the embedding mixture. Increased knowledge of the mechanism for antigen detection on resin sections was another aim. Thyroid tissue, kidney tissue, and fibrin were embedded in epoxy resin; some with ethanol as the only dehydration agent and others with propylene oxide as an additional agent in dehydration, infiltration or embedding steps in different ways. Immunogold labeling was performed with anti-thyroglobulin, anti-IgG, and anti-fibrinogen, respectively. A higher degree of immunogold labeling was achieved by increasing the concentration of accelerator during infiltration and embedding (Brorson and Skjørten, 1996a, Micron, 27, 211-217). The immunogold labeling of the sections that were based on additional dehydration and infiltration with propylene oxide showed significantly more intense labeling than the sections of tissues that had only been exposed to ethanol in the dehydration and infiltration steps. The embedding of tissues in a mixture of epoxy resin and 5-10% propylene oxide gave higher yields of immunogold labeling than if pure epoxy resin was used for the embedding. The improved labeling is explained by higher amplitudes of protruding antigens on the surface of the sections because antigens are less tightly incorporated in the polymer network when using propylene oxide as additional agent in dehydration, infiltration or embedding. These results illustrate the advantage of using propylene oxide as an additional agent when preparing specimens for immunoelectron microscopy with epoxy resin embedding.

Animals↗

PubMed2006

Randomized controlled trial to determine the effectiveness of the Nivatvongs technique versus conventional local anaesthetic infiltration for outpatient haemorrhoidectomy.

BACKGROUND: Conventional local anaesthesia in outpatient haemorrhoidectomy, using a diamond-shaped perianal block, is reliable, safe and inexpensive. It allows for early ambulation and short hospital stay. However, without sedation, local infiltration is perceived to be both uncomfortable and painful. Nivatvongs described a technique in which the anaesthetic is injected intra-anally into the insensitive area above the dentate line, allegedly causing less pain. METHODS: This randomized, controlled, parallel-group, single-blind clinical trial compared the effectiveness of the conventional and Nivatvongs techniques in reducing the pain of anaesthetic infiltration in adult patients undergoing outpatient haemorrhoidectomy. A total of 112 patients were randomized into either treatment (n=57) or control groups (n=55). Assigned surgeon-anaesthetists performed the local anaesthetic infiltration. The Milligan-Morgan technique was used for haemorrhoidectomy. Pain was assessed using a standardized visual analogue scale. Patient and surgeon satisfaction were measured with a pre-validated questionnaire. RESULTS: Median scores for pain assessment during local anaesthetic infiltration were 2 and 3 in the control and treatment groups, respectively. Patient satisfaction with the method of anaesthetic infiltration and the procedure itself were 3 and 2, respectively, for both groups. The surgeon's overall satisfaction with the technique of anaesthetic infiltration was similar in the two groups. There was no significant difference in any of the outcomes measured. CONCLUSION: Both local anaesthetic techniques for outpatient haemorrhoidectomy were generally effective and well tolerated. The Nivatvongs technique did not confer any significant additional benefit.

Ambulatory Surgical Procedures↗