Local changes in collagen content in rabbit aortic atherosclerotic lesions with time

A video-microdensitometry method was used to quantify collagen on a pixel by pixel basis at specific locations within atherosclerotic lesions, induced by feeding New Zealand White rabbits a declining cholesterol diet. Probability mapping (done previously) showed the lesions occurred in predictable locations so the age of any one area of a lesion could be estimated. The oldest part of the lesion was on the lateral lip of the flow divider as lesions always developed there first. Serial sections through three lesions showed the distribution of collagen within the plaque. The measurement of all the lesions showed that early lesions had low collagen levels: 3-6% for the intercostals and 8-11% for the renals. Collagen increased consistently with time on the diet to 11-15%, for the intercostal and approximately 17% for the renal. The aorto-renal lesions were more severe; thicker and with a higher percentage of collagen. The greatest collagen content was on the lateral lip of the flow dividers, where controls had intimal thickening. No fibrous caps were seen. This study shows conclusively that collagen is not evenly distributed in lesions, but develops progressively in specific locations of fatty plaques with the duration of cholesterol feeding. Intimal thickening predisposes to early collagen development.

Familial thrombophilia and the prothrombin 20210A mutation: association with increased thrombin generation and unusual thrombosis

The 20210A prothrombin mutation has recently been associated with an increased risk of venous thrombosis, but the mechanism of the increased thrombotic risk in affected persons has not been elucidated. We report on a thrombophilic family in which the proband presented with cerebral vein thrombosis and homozygosity for the 20210A prothrombin mutation as her only identifiable risk factor for venous thrombosis. Extended genotyping of family members revealed seven other affected, but asymptomatic, first-degree relatives (one A/A homozygote and six G/A heterozygotes). Plasma levels of prothrombin, prothrombin fragments 1 + 2 and thrombin-antithrombin complexes were highest in A/A homozygotes, intermediate in G/A heterozygotes and lowest in those with the G/G homozygous normal genotype, while D-dimer levels were elevated only in A/A homozygotes. Our results suggest that the 20210A prothrombin mutation is associated with activation of coagulation and increased thrombin generation, not only in patients with a past history of thrombosis but also in otherwise healthy asymptomatic persons. In a similar fashion to the homozygous factor V Leiden mutation, patients with the homozygous 20210A prothrombin mutation could be at highest risk of thrombosis, as suggested by our patient who presented with unusual thrombosis.

Collection and recruitment of CD34+ cells during large-volume leukapheresis

Although sufficient progenitor cells for hematopoietic rescue following high-dose therapy may be obtained in a single leukapheresis, the majority of patients require multiple procedures. In an attempt to minimize the number of leukapheresis and maximize collection efficiency, we undertook large-volume leukapheresis in 17 patients with a variety of hematologic malignancies. Twenty-four procedures were performed over a 6-h period, with a mean of 21 L of blood processed. By employing a modified collection set, three separate 2-h collection bags were analyzed for a number of variables. CD34+ cells are collected at a steady rate throughout the procedure, with no evidence of exhaustion of progenitor cells. There was evidence of progenitor cell recruitment, with 1.4-fold more CD34+ cells in the collected product than were present in the blood at the beginning of the procedure. Initiation of leukapheresis was based on the blood CD34+ count, and this value was strongly correlated with the number of CD34+ cells in the collected product. The procedure is safe and relatively simple and minimizes the number of leukaphereses required to collect adequate progenitors for autologous transplantation.

Marfan's syndrome: a family affair

Marfan's syndrome (MFS), a heritable connective tissue disorder, may result in cardiac valvular insufficiency, aortic aneurysm or dissection, dislocated lens, and musculoskeletal abnormalities. During a 20-month period (1994-96), an interdisciplinary health care team at a central Virginia medical center evaluated the histories of 112 persons from 15 different families for the presence of MFS-related traits. Seventy-five had at least one MFS-related trait, and 27 subjects underwent echocardiography to evaluate for aortic root dilatation and valvular lesions. Forty-three patients (57.3%) in the above cohort demonstrated significant cardiovascular lesions, with 20 undergoing cardiac surgery. Thirty-one patients (41.3%) were initially seen with significant ocular lesions, and 38 (50.7%) displayed orthopedic deformities. The health care team developed strategies for long-term management of persons with MFS, including antihypertensive therapy, periodic testing, risk-factor modification, genetic counseling, and surgery for appropriate patients. Proactive, consistent management of MFS families will improve long-term health outcomes for this patient population.

Collagen quantitation by video-microdensitometry in rabbit atherosclerosis

A video-microdensitometry method was developed to measure the mass fraction of collagen in portions of tissue sections. A frame grabber and computer are used to capture micrographs and calculate the collagen fraction at each pixel. The method is based on the stoichiometric staining of collagen by picrosirius red stain, and was calibrated for glutaraldehyde fixed tissue; a detailed map of collagen distribution throughout a six-month rabbit atherosclerotic lesion was made. The method is reliable, fast and easily reproduced, since it uses readily available equipment.

Challenges with Takayasu's arteritis: a case study

Takayasu's arteritis (TA) is a systemic vasculitis that involves an autoimmune-mediated transmural degeneration of the aorta and its major branches, leading to severe arterial stenoses or occlusions with subsequent cerebral, cardiopulmonary, mesenteric, renal, or limb ischemia. Patient history and physical examination, arteriography, magnetic resonance imaging, and specific laboratory tests facilitate the diagnosis of TA. Major treatments for the condition include the use of corticosteroids, cytotoxic agents, antiplatelet drugs, percutaneous transluminal angioplasty (PTA), and surgical revascularization. Major nursing interventions for TA include teaching the patient and family about the progression and treatments of TA and performing periodic patient assessments for manifestations of systemic vasculitis, alterations in tissue perfusion, and alterations in coping.

A new probability mapping method to describe the development of atherosclerotic lesions in cholesterol-fed rabbits

A new probability mapping method was developed to quantify the size and location of lesions near aortic orifices. The precise location of any part of the lesion could be compared between rabbits. Colour photographs of lesions were projected onto a digitizing tablet, and coded as lesion or non-lesion. Next the orifices were warped onto a standard orifice, and then the lesion mapped to maintain the original length and angular location of the lesion from the edge of the orifice. This method, unlike the previously used polar mapping method, excludes neither absent lesions nor ones which surround more than one orifice. In contrast to other probability mapping methods it warps the orifice rather than the artery wall containing the lesion, and so is easier to use for correlation with histological studies. The eventual aim is to use the probability maps as a tool to estimate the age of various positions of the lesion and to identify areas for histological sampling. The method was used to describe the distribution of lesions in 21 rabbits fed a diet with cholesterol levels declining from 0.5% during the first week, to 0.25% during the next two weeks, to 0.125% for weeks 3-10, to 0.1% for weeks 11-24. This feeding protocol produces fatty lesions which are transformed into fibro-fatty and fibrous lesions with time.

The distribution of fibro-fatty atherosclerotic lesions in the aortae of casein- and cholesterol-fed rabbits

Atherosclerotic lesions were induced in the aortas of 50 rabbits by feeding a semi-purified cholesterol-free casein diet or normal rabbit chow with a low level of added cholesterol for 6 or 10 months. Following perfusion fixation, the aortae from these animals were opened along their length, stained with oil red O and photographed en face. Orifice associated lesions were mapped by measuring radial lesion length at 10 degrees intervals circumferentially around ostia. Histology of these lesions revealed abundant smooth muscle cells surrounded by collagen and elastin in the extracellular matrix, typical of fibrous plaques, as well as oil red O staining lipid and some macrophage derived foam cells. These fibro-fatty lesions were found distal and lateral to ostia, at the same locations as fatty streaks seen in rabbits fed a 2% cholesterol diet for 1 week to 2 months in previous studies. The results of this study show that in moderately hypercholesterolemic rabbits fed an atherogenic diet for 6 to 10 months, advanced atherosclerotic plaques develop in the same location as the fatty streaks seen in short term experiments.

Cysteamine protects gastric epithelial cell monolayers against drug induced damage: evidence for direct cellular protection by sulphydryl compounds

The sulphydryl containing drug cysteamine protects gastric mucosa in vivo against acute injury. It is not known whether this protection includes a direct effect on gastric cells. Using gastric epithelial cell monolayers derived from a well differentiated human cell line, we evaluated whether cysteamine protects against taurocholate or indomethacin induced damage in conditions which completely exclude the influence of vascular, hormonal, and neural factors. The effect of cysteamine on prostaglandin production by monolayer cells in vitro was also assessed. Cysteamine decreased damage brought about by sodium taurocholate and indomethacin by 40% (p less than 0.01) and 50% (p less than 0.01) respectively. The sulphydryl blocker iodoacetamide prevented the protective effect of cysteamine. Pretreatment with indomethacin, which inhibited prostaglandin E2 output by 60%, did not prevent protection by cysteamine; incubation with cysteamine decreased prostaglandin E2 production by cultured cells. We conclude that (i) cysteamine directly protected gastric epithelial cells in vitro (ii) this protection occurred with indomethacin, which interferes with cellular metabolism of prostaglandins, and taurocholate, whose damaging action at neutral pH is unrelated to interference with prostanoid metabolism, (iii) cysteamine protection in vitro is unrelated to endogenous prostaglandins and is probably mediated by endogenous sulphydryl compounds.

Prostaglandin production in cultured gastric mucosal cells: role of cAMP on its modulation

The effect of cAMP on prostaglandin production may depend on cell types. To clarify the relationship between PG and cAMP, we examined arachidonate's effects on PG synthesis and intracellular cAMP accumulation in monolayers of rat gastric mucosal cells. These cells produced PGE2, PGI2 and thromboxaneA2 (TXA2) in amounts of 316 +/- 18, 100 +/- 7 and 30 +/- 5 pg per 10(5) cells in 10 min, respectively, in response to 10 microM arachidonic acid (AA). The production of these PG, however, leveled off subsequently. Cells initially exposed to AA responded poorly to a subsequent stimulation by AA. AA simultaneously stimulated intracellular cAMP accumulation; this stimulatory effect on cAMP production was abolished by the pretreatment with indomethacin. Nevertheless, the pretreatments with dibutyryl cAMP (0.1-5 mM) did not alter the amount of subsequent AA-induced PGE2 production. Furthermore, the preincubation with 1mM isobutyl methyl xanthine also failed to affect PGE2 synthesis, while it increased intracellular cAMP accumulation. Our studies suggest AA stimulates intracellular cAMP formation in cultured gastric mucosal cells, linked with conversion of AA to cyclooxygenase metabolites, AA-induced PG production is limited in these cells, and it seems, however, unlikely that intracellular cAMP modulates AA metabolism to PG.

Continuing medical education: viewpoints of Canadian psychiatric residents

Continuing Medical Education (CME), relicensure and recertification are controversial issues for physicians today. The viewpoints of 142 Canadian psychiatric residents from 12 training centres across Canada were surveyed. The majority (73%) of the residents did not think that CME would pose a problem for them after certification. In fact, a large majority (77%) felt CME should be required after certification. Close to half of the residents favoured monitoring of CME by the Canadian Psychiatric Association. In contrast to these results, few favoured mandatory recertification. A formal relicensure examination was strongly repudiated. Individual reading and self-assessments as well as clinically oriented courses and workshops were the favoured methods of CME. Our recommendations arising from this survey are threefold. CME should remain a voluntary activity. The Canadian Psychiatric Association should be the monitoring body for CME for psychiatrists, and finally, individual readings and self-assessments should be used increasingly in providing CME.