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Photodynamic effects of exposure to hematoporphyrin derivatives and dye-laser radiation on human gastric adenocarcinoma cells.

The phototoxicity of hematoporphyrin derivatives (HPD) and dye-laser radiation on adenocarcinoma cells of the human stomach was examined by light and electron microscopy. Adenocarcinoma cells were obtained from human stomach tissue by endoscopic biopsy. The cells were incubated for 5 minutes in the patient's own serum that contained 0.6 mg HPD/ml and then were exposed to dye-laser radiation at 630 nm at an irradiance of 15 mW/cm2. Electron microscopy showed that cytotoxicity was mediated by mitochondrial damage, dilatation of the rough endoplasmic reticulum, and alterations of the nuclear membrane. The degenerative changes were greater and more frequent in poorly differentiated adenocarcinoma cells than in well-differentiated ones. No marked temperature rise was detected during irradiation. Neither the dye alone nor light alone had any effect. A singlet oxygen-trapping agent, 1,3-diphenylisobenzofuran, prevented adenocarcinoma cell degeneration that otherwise would result from exposure to HPD and dye-laser radiation. Thus singlet oxygen may be the cytotoxic agent in this system.

Adenocarcinoma↗

Laser iridectomy--a technique for blue irises.

A two-step technique for laser iridectomy in light blue irises is described, which simplifies penetration of these irises and allows success rates approaching 100%. Step one utilizes a high energy, long duration, predominantly thermal laser burn that destroys overlying iris stroma. In step two, the laser energy is reduced and exposure time is shortened to facilitate removal of remaining pigment epithelium.

Argon↗

[Transthoracic and transesophageal follow-up in patients with left atrial thrombosis].

The embolic risk and changes of thrombus location and size were investigated in 29 consecutive patients with echocardiographically proven thrombi in the left atrium. Inclusion criteria were the visualization of a left atrial thrombus using transesophageal echocardiography. Transesophageal follow-up echocardiograms were performed at a mean period of 18 months. In this period 6 cases of embolism were observed at an interval of 20 days to 26 months after the detection of thrombus. Thus, the embolic rate was 14% per patient year. All patients received phenprocoumon (n = 4) or aspirin at the time of embolism. Furthermore, in two patients after cardiac thrombectomy left atrial thrombi were seen again although patients were treated with anticoagulants. On the other hand, in 12 patients (5 received oral anticoagulation, 2 received aspirin) thrombi completely resolved. It can be concluded from these data, that the majority of patients receiving anticoagulation profit from this therapy, however, a complete protection against arterial embolism or reoccurrence of thrombi cannot be reached. Left atrial spontaneous echo contrast was the only risk factor significantly associated with thromboembolism in patients with left atrial thrombi.

Aged↗

[Trials in ab-interno sclerostomy with a pulsed dye laser using a scleral dye: reactive black 5].

Several reports have described the successful performance of ab interno sclerostomies using a pulsed dye laser (666 nm) a goniolens and methylene blue as a scleral dye. However, the laser energy was found to have a bleaching effect on the methylene blue; therefore, methylene blue was replaced by reactive black-5 (RB-5), which seemed to be a more stable dye. To assess laser parameters using RB-5 we compared the number of pulses needed to perforate excised human sclera at different pulse durations (4-8 microseconds), energy levels (50, 100, 130-150, 200, 300 mJ) and delivery angles (20 degrees, 30 degrees, 45 degrees, 90 degrees). Fewer pulses were needed at a shorter pulse duration and higher energy levels. Above 200 mJ, 8 pulses for perforation could not be reduced; however, the width of the fistula increased. With a decrease in the delivery angle, the number of pulses for perforation increased non-proportionally above the calculated increase of the length of the fistula. At an angle of 20 degrees no perforation could be achieved even if 200 pulses of the maximal energy of 200 mJ were applied. This indicates that eyes with flat anterior chambers cannot be successfully treated.

Coloring Agents↗

Evaluation and treatment of erectile dysfunction.

Erectile dysfunction has an organic etiology in most cases, with vascular disease the single most common cause. In addition to a thorough history and physical examination, clinical evaluation may include hormonal assessment, diabetes screening, nocturnal tumescence testing and color Doppler flow studies of the penile vasculature. Therapy for erectile dysfunction has progressed rapidly during the past decade, with alternatives including hormone supplements, vacuum constriction devices, penile self-injection therapy and penile prostheses. The majority of patients and their partners report satisfactory results with these treatments.

Aphrodisiacs↗

[Coronary-cardiac fistula as a cause of tricuspid endocarditis treated by mitral homograft].

The authors report a rare case which is interesting from three points of view: tricuspid valve endocarditis in a child complicating a fistula between the right coronary artery and right ventricle with negative blood cultures but a positive serology for Coxiella burnetii. This mutilating tricuspid endocarditis was complicated by multiple pulmonary embolism of the right lung. After two months of antibiotic therapy the coronaro-cardiac fistula was closed and the tricuspid valve replaced with a mitral homograft. All cases of blood culture negative endocarditis require serological investigation to detect intracellular organisms which are difficult to diagnose and justify specific prolonged antibiotic therapy. Control serological tests are essential in the long-term because of the risk of chronic infection, especially in cases with prosthetic intracardiac material. Treatment, based mainly on tetracyclines, should be continued for at least two years.

Anti-Bacterial Agents↗

Groin lymphorrhea postoperative nuisance.

Lymphorrhea is defined as the flow of lymph from disrupted lymphatic channels that drains externally or is contained within a wound. It complicates approximately 2% of vascular incisions in the groin. Of 116 patients who underwent different arterial reconstructions involving 186 groin wounds, lymphorrhea developed in 4 patients (3.4%) including 4 groins (2.1%). They have been managed in the Division of Vascular Surgery at King Khalid University Hospital (KKUH) in Riyadh, during a 3-year period ending in February 1996. There were 105 (90.5%) males and 11 (9.5%) females. The ages ranged from 32 to 96 years with a mean age of 63 years. All the 4 cases complicated with lymphorrhea were managed conservatively for a period of three to five weeks. In 2 cases, the lymphatic leak stopped and the patients discharged without other local complications. In the other 2 cases, lymphatic leakage stopped immediately and permanently following direct surgical ligation. The use of isosulphane blue for localization of the site of the lymphatic leak was a simple, reliable and accurate method during wound exploration. Follow-up of all cases for 6 months showed no recurrence, no sepsis and patent vascular graft.

Adult↗

Diagnosis of MCA-occlusion and monitoring of systemic thrombolytic therapy with contrast enhanced transcranial duplex-sonography.

A case of a successful systemic thrombolysis of an acute middle carotid artery occlusion is reported. The case underlines the role of contrast-enhanced transcranial color-coded duplex sonography as a noninvasive technique for rapid diagnosis of vessel occlusion in acute stroke. The diagnostic potential of transcranial color-coded duplex sonography for indication and monitoring of intravenous systemic thrombolytic therapy is demonstrated.

Acute Disease↗

Digoxin retinal toxicity. Clinical and electrophysiological evaluation of a cone dysfunction syndrome.

A 70-year-old man was studied both during and after resolution of clinical digoxin toxicity using color vision tests, ganzfeld electroretinography and electro-oculography. Concomitant administration of quinidine sulfate probably contributed to digoxin toxicity. Abnormalities in color vision and subnormal amplitude and prolonged implicit time for cone-mediated electroretinogram (ERG) responses suggested a cone dysfunction syndrome. The electro-oculographic light-to-dark ratio during clinical toxicity was high for our laboratory, but this is probably normal. Notable improvement was seen in color vision and the ERG after cessation of digoxin therapy. Inhibition of sodium-potassium adenosine triphosphatase by digoxin probably influences normal uptake of extracellular potassium by Müller's cells and other retinal neurons. This mechanism may contribute to subnormal, prolonged cone-mediated ERG responses in retinal toxic reactions from cardiac glycosides.

Adaptation, Ocular↗

Measurement of skin color: practical application and theoretical considerations.

Quantification of erythema and/or pigmentation is important for in vivo assessment of skin reactions to external stimuli such as ultraviolet radiation. Measurement of lesional color is also useful for quantitative evaluation of the efficacy of therapies for skin lesions. Several types of portable optoelectronic instruments have recently become available for these purposes and have been applied to research in dermatology, physiology, pharmacology, and cosmetic science. As color is not a genuine physical quantity but a sensory perception based on color vision, any colorimetric data obtained for the skin should be interpreted carefully. Erythema and melanin indices derived from skin reflectance data should also be evaluated in relation to the optical properties of the skin to avoid misuse. In this article, various methods for quantifying skin color and related parameters are reviewed and the characteristics of each method are discussed theoretically using an optical model of the skin.

Colorimetry↗

Quantified power Doppler US of tumor blood flow correlates with microscopic quantification of tumor blood vessels.

PURPOSE: To evaluate the ability of a quantified power Doppler ultrasonography (US) system to help quantitate differences in tumor vascularity after radiation therapy and administration of tumor necrosis factor (TNF). MATERIALS AND METHODS: Murine glioblastoma tumors were grown in the thighs of two sets of 25 mice each. Each mouse was assigned to one of four treatment groups: control (no treatment), radiation therapy, TNF therapy, or combination therapy (both radiation and TNF therapies). Mice were then evaluated with quantified power Doppler US, and a vascularity index (color area) was calculated for different tumor regions in each group. The tumors were then excised, and histologic evaluation was performed by using an immunofluorescence-tagged monoclonal antibody against blood vessel endothelium. The number of stained blood vessels per high-power field was correlated with the sonographically determined vascularity index. RESULTS: The color area of the total tumor decreased to 37% of that in the control group in mice treated with radiation therapy alone (P: =.02), 26% of that in the control group in mice treated with TNF alone (P: =.05), and 8% of that in the control group in those treated with both TNF and radiation (P: =.006). These results correlated well with the quantified results from immunofluorescent staining (r = 0.98). CONCLUSION: Quantified power Doppler US is a noninvasive method for the evaluation of tumor vascularity and blood flow.

Animals↗

[The vascular patient--diagnosis and minimally invasive therapy. Which technique for what illness?].

The non-invasive imaging modalities, color coded duplex sonography (CCDS), magnetic resonance tomography (MRT), and computed tomography (CT), have pushed conventional angiography out of most diagnostic fields. The experienced user will achieve fast, reliable answers with CCDS in dedicated clinical settings. MRT as well as CT are concurring imaging modalities for the most appropriate diagnostic answer. Not only pure image quality, but also patient management, and availability play a major role. Catheter based angiography will in the future still play a role in mesenteric ischemia (non occlusive disease) and for imaging of very small vessel pathology, e.g. on panarteritis nodosa. At the moment, peripheral leg run-offs are still best performed with conventional angiography, nevertheless, MR as well as CT seem to have the ability to perform diagnostic procedures. Ongoing studies will allow a solid judgement in the near future. The true value of catheter angiography is in the direct assessment, planning, and performance of interventional procedures, e.g. catheter based obliteration or revascularization. Implantation of stent devices and a whole range of different mechanical and pharmacological revascularization procedures have improved the interventional management of vascular stenoses and occlusions. The interventional radiologist is treating physician in the classical sense in this setting. Acute bleeding episodes, e.g. in the brain, thorax, abdomen, or pelvis, are best imaged with computed tomography. Conventional angiography still plays a major diagnostic and therapeutic role in bleeding into preformed cavities, such as the bile ducts or the intestine. In this setting, all available information including CT scans should be valued. For complex therapeutic regimens in oncology or in pure palliative situations, angiographic diagnosis followed by embolization and/or ablation therapy is established.

Angioplasty, Balloon↗

Ovarian cancer screening by transvaginal color Doppler ultrasonography.

BACKGROUND: The need for the early detection of ovarian cancer continues to be one of the most important issue in women's health care. The ovarian neoplasia characteristically have a scarce symptomatology for which it tries to create a sensitive and specific screening test so that the diagnosis could precociously be made and, consequently, improve the prognosis with a timely therapy. Our purpose was to assess the performance of transvaginal color Doppler ultrasonography in ovarian cancer screening. METHODS: In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples, in the period between January 1997 and December 1998, 60 women, divided into two groups (the 1st group included 30 women in fertile age with standard uterine dimensions, the 2nd group included 30 menopausal women), were submitted to transvaginal color Doppler ultrasonography. Color Doppler ultrasonography was performed with an ESAOTE ANSALDO AU5 HARMONIC ultrasound machine provided with a 6.5 MHz real-time sector electronic array endovaginal probe with a 5 MHz pulsed Doppler system and equipped with the color velocity imaging system for the color blood flow codification. The score used in the evaluation of the ovary are us follows: volume of the adnexa (from 1 to 5); presence of papillas and septa (from 1 to 5); wall thickness (from 1 to 5). An high score (> 12) corresponds to probability of presence of neoplasia. For the flow modifications the following parameters were considered: RI (Index of resistance); PI (Pulse Index); Vmax (Maximum Speed). CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45, PI < or = 0.58 Vmax < or = 60. RESULTS: Sonographic morphology evaluation and CD were suspicious in 11 cases and 9 of these were positive on histopathological analysis (true positive = 15%, false positive = 5%). All the women that had morphologically normal ovaries observed on ultrasound examination and were not suspicious on CD analysis, were also negative on histopathological analysis (true negative = 80%). CONCLUSIONS: The color Doppler ultrasonography revealed a decidedly valid method of screening of the first level, being non-invasive examination, painless, therefore well accepted by the patients, even if in some women, especially if in fertile age, the physiological modifications calls for repeated investigations and compare its parameters.

Adult↗

Childhood vitiligo.

Eighty-two children (ages 6 months to 12 years) with clinical and/or histopathologic diagnoses of vitiligo were evaluated; 35 were male and 47, female. Fifty-six were black, 25 white, and 3 classified as "other." Children were compared with control groups of children with other skin diseases and with adults with vitiligo. Children had an increased incidence of segmental vitiligo (p less than 0.01). Children had an increased incidence of autoimmune and/or endocrine disease and also of premature graying in their immediate and extended family members (p less than 0.001). Six of 33 children with vitiligo tested had positive organ-specific serum autoantibodies, which was a higher incidence than in the control group of children (p less than 0.05). Eighteen percent of children treated with topical psoralens and long-wave ultraviolet light (PUVA) therapy had an acceptable response, which was less than an adult group similarly treated. We have found childhood vitiligo to be a distinct subset of vitiligo, showing increased segmental presentation; strong autoimmune and/or endocrine disease background and high incidence of premature graying in the families of affected children; the presence of organ-specific serum autoantibodies and a poor response to topical PUVA therapy.

Adult↗