Common Iliac Artery Access during Endovascular Thoracic Aortic Repair Facilitated by a Transabdominal Wall Tunnel

Purpose:

To describe a technique for common iliac artery (CIA) access during endovascular aortic aneurysm repair when unfavorable angulation between the CIA and the delivery sheath precludes direct arterial access.

Technique:

After retroperitoneal exposure of the CIA, a puncture site is chosen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or skin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcutaneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the proximal aorta. A CIA arteriotomy is performed and the delivery system introduced over the guidewire through the tunnel into the iliac artery.

Conclusions:

Retroperitoneal exposure of the CIA with tunneled transabdominal wall delivery of the stent-graft avoids both external iliac artery injury and creation of a temporary access conduit in patients with iliac tortuosity and/or occlusive disease.

ORION laser target diagnostics

The ORION laser facility is one of the UK's premier laser facilities which became operational at AWE in 2010. Its primary mission is one of stockpile stewardship, ORION will extend the UK's experimental plasma physics capability to the high temperature, high density regime relevant to Atomic Weapons Establishment's (AWE) program. The ORION laser combines ten laser beams operating in the ns regime with two sub ps short pulse chirped pulse amplification beams. This gives the UK a unique combined long pulse/short pulse laser capability which is not only available to AWE personnel but also gives access to our international partners and visiting UK academia. The ORION laser facility is equipped with a comprehensive suite of some 45 diagnostics covering optical, particle, and x-ray diagnostics all able to image the laser target interaction point. This paper focuses on a small selection of these diagnostics.

Need morphology always be required for new species descriptions?

Despite the widespread and common use of DNA-sequence data to estimate phylogenies, support or contest classifications, and identify species using barcodes, they are not commonly used as the primary or sole source of data for describing species. This is possibly due to actual or perceived pressure from peers to include morphology as the primary source of data for species descriptions. We find no compelling evidence to exclude DNA-only descriptions, or to insist that morphology always be included in a species description. It is not the data type per se that is important, but the science behind the taxonomic conclusions. Using alternative kinds of data for descriptions should not cause problems for taxonomy if links are kept with type specimens.

Nitrogen dioxide and ozone as factors in the availability of lead from lead-based paints

Lead-based paint remains a pervasive problem in U.S. cities, and an increasing problem in the developing world where it is still manufactured and used. Little attention has focused on the factors that increase the release of lead pigment granules from painted surfaces. Nitrogen dioxide (NO(2)) and ozone (O(3)) from transportation emissions in urban environments have the potential to react with and remove polymeric binders in paint, making pigment granules more available for subsequent transfer to hands on contact, or deposition in housedust. Here we show that exposure to NO(2) and O(3) increased the lead in wipe samples of stainless steel surfaces painted with alkyd low gloss solvent lead-based paint by 296% +/- 101 (or 0.24 microg/cm(2)) and 37% +/- 21 (or 0.025 microg/cm(2)), respectively, with corresponding changes in surface morphology indicated by reflectometry and scanning electron microscopy. Lead release from unexposed low gloss acrylic household paints was 40 times greater than comparable solvent based paints. Given that lead-based paint is still manufactured and used in many urban areas of the developing world where O(3) concentrations currently exceed historic U.S. concentrations, the interaction of air pollution with lead painted indoor surfaces may pose greater exposure risks for lead poisoning in children than previously anticipated.

Household CO and PM measured as part of a review of China's National Improved Stove Program

In 2001-2003, a team of researchers from the United States and China performed an independent, multidisciplinary review of China's National Improved Stove Program carried out since the 1980s. As part of a 3500-household survey, a subsample of 396 rural households were monitored for particulate matter less than 4 microm (PM(4)) in kitchens and living rooms over 24 h, of which 159 were measured in both summer and winter. Carbon monoxide was measured in a 40% subsample. The results of this indoor air quality (IAQ) component indicate that for nearly all household stove or fuel groupings, PM(4) levels were higher than - and sometimes more than twice as high as - the national PM(10) standard for indoor air (150 microg PM(10)/m(3)). If these results are typical, then a large fraction of China's rural population is now chronically exposed to levels of pollution far higher than those determined by the Chinese government to harm human health. Further, we observed highly diverse fuel usage patterns in these regions in China, supporting the observations in the household survey of multiple stoves being present in many kitchens. Improved stoves resulted in reduced PM(4) from biomass fuel combinations, but still not at levels that meet standards, and little improvement was observed in indoor pollution levels when other unimproved stoves were present in the same kitchen. As many households change fuels according to daily and seasonal factors, resulting in different seasonal concentrations in living rooms and kitchens, assessing health implications from fuel use requires longitudinal evaluation of fuel use and IAQ levels, combined with accurate time-activity information.

PRACTICAL IMPLICATIONS

Leaving aside the difficult issue of enforcement, it is uncertain whether Chinese household IAQ standards represent realistic objectives for current attainment given current patterns of energy consumption in rural China, which rely so heavily on unprocessed solid fuels. Even when used with chimneys, these fuels emit substantial pollution into the household environment. It is probable that low-emission technologies involving gaseous/liquid fuels or high combustion - efficiency biomass stoves need to be promoted in order to achieve these standards for the greater part of the population.

Respiratory responses to diverse indoor combustion air pollution sources

Diverse indoor combustion sources contribute to the indoor air environment. To evaluate the effect of these sources on human respiratory health, we examined associations between respiratory conditions and household factors in the 2360 children's fathers (mean = 38.4 years old) and associations between lung function and household factors in 463 primary school children (mean = 8.3 years old) from Wuhan, China. Factor analysis developed new uncorrelated 'factor' variables. Unconditional logistic regression models or linear regression models, controlling for important covariates, estimated the respiratory health effects. Coal smoke derived from home heating ('heating coal smoke') was associated with high adult reporting of persistent cough, persistent phlegm, and wheeze. Cooking coal smoke was associated with physician-diagnosed adult asthma and decreased forced vital capacity (FVC), and forced expiratory volume at 1 s (FEV(1)) in children. The presence of any home cigarette smoker was associated with more reports of persistent cough, persistent phlegm, cough with phlegm, and bronchitis. Our study suggests that in Wuhan, there may be independent respiratory health effects of different indoor combustion sources and their exposure factors for these study populations.

PRACTICAL IMPLICATIONS

We conclude that multiple indoor air pollution sources could have adverse respiratory health effects on both children and middle-aged men in the city of Wuhan, China. These results may have implications for the Wuhan local government, the Chinese government, or other related organizations in efforts on protecting public health through regulation of indoor air pollution from indoor combustion sources.

Radiological characterisation of photon radiation from ultra-high-intensity laser-plasma and nuclear interactions

With the increasing number of multi-terawatt (10(12) W) and petawatt (10(15) W) laser interaction facilities being built, the need for a detailed understanding of the potential radiological hazards is required and their impact on personnel is of major concern. Experiments at a number of facilities are being undertaken to achieve this aim. This paper describes the recent work completed on the Vulcan petawatt laser system at the CCLRC Rutherford Appleton Laboratory, where photon doses of up to 43 mSv at 1 m per shot have been measured during commissioning studies. It also overviews the shielding in place on the facility in order to comply with the Ionising Radiation Regulations 1999 (IRR99), maintaining a dose to personnel of less than 1 mSv yr(-1) and as low as reasonably practicable (ALARP).

Propagation instabilities of high-intensity laser-produced electron beams

Measurements of energetic electron beams generated from ultrahigh intensity laser interactions (I>10(19) W/cm(2)) with dense plasmas are discussed. These interactions have been shown to produce very directional beams, although with a broad energy spectrum. In the regime where the beam density approaches the density of the background plasma, we show that these beams are unstable to filamentation and "hosing" instabilities. Particle-in-cell simulations also indicate the development of such instabilities. This is a regime of particular interest for inertial confinement fusion applications of these beams (i.e., "fast ignition").

Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study

The National Human Exposure Assessment Survey (NHEXAS)/Minnesota Children's Pesticide Exposure Study (MNCPES) was a population-based study designed to characterize children's exposure to residential pesticides and to evaluate the contribution of residential and children's activities to children's exposure. Families of 168 children were surveyed for residential use of pesticides and children's activities. From these homes, families of 102 children between the ages of 3 and 13 years participated in a week-long intensive exposure study. Of the 102 children, 19 children were videotaped for four consecutive hours in their normal daily activities. The survey responses indicated that the youngest children were more likely to exhibit behaviors that would foster exposure to environmental contaminants. Comparison of questionnaire responses indicated that the videotaped subsample was representative of the exposure study population. The microactivities of the videotaped children that might contribute to their exposure via ingestion or dermal routes were quantified. Hand-to-mouth and object-to-mouth activities were observed most frequently among the youngest children. The youngest children were also most likely to be barefoot both indoors and outside. Gender differences were found in mouthing behavior and the proportion of observed time spent outdoors.

Influence of sebum and stratum corneum hydration on pesticide/herbicide collection efficiencies of the human hand

The adhesion of house dust particles and chemical residues to the hands after contact with a variety of surfaces can yield significant exposures to children. Chemicals present on the surface or absorbed into house dust particles may adhere to the hands and subsequently are available for ingestion or absorption through the skin under normal physiological conditions. Contact of a hand with a surface occurs primarily through a thin layer of sebum and sweat on the skin surface. The study presented here examined the effect of the composition of the sebum and sweat layer on the adhesion of a mixture of pesticides and a herbicide to a hand after contact with a house-dust-laden surface. Collection efficiencies on the hand for atrazine and malathion were correlated with sebum levels on the palm of an individual hand. The increase in sebum values measured in this study caused a 13 percent and 8 percent reduction in collection efficiency, respectively, for atrazine and malathion applied to house-dust-laden surfaces. Diazinon and chlorpyrifos collection efficiencies were correlated with skin hydration levels measured on the palm of the individual's hand. The increased skin hydration measured in this study caused a 7 percent and 5 percent reduction in collection efficiency, respectively, for diazinon and chlorpyrifos.

Embolisation of renal arteriovenous malformation (AVM) in pregnancy

A case of congenital renal arteriovenous malformation (AVM), presenting with profuse haematuria in the second trimester of pregnancy is reported. Selective embolisation with polyvinyl alcohol particles and absolute alcohol successfully ablated the lesion and a healthy infant was delivered at term five months later. Renal angiography at three years showed no evidence of the lesion.

Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak

PURPOSE

To assess the feasibility of embolization of aortic side branches and its impact on the incidence of type II endoleak after endovascular aneurysm repair.

MATERIALS AND METHODS

Endovascular aneurysm repair was performed in 74 patients. Aortic side branch vessels were evaluated on the preoperative angiogram and computed tomography (CT) and, where embolization of lumbar and inferior mesenteric vessels was considered technically possible, this was attempted prior to endovascular repair. Follow-up CT was used to assess the presence of type II endoleak.

RESULTS

Seventy-two patients were followed up for longer than 1 month. Embolization was attempted in 25 cases, successfully in 10, with partial success in 11, and failure in four. Twenty patients with successful or partly successful preoperative embolization were discharged and followed-up. Four (20%) had demonstrable type II endoleak during follow-up, with two of these persisting at latest follow-up. Of 43 patients without previous embolization, there were 10 (23.3%) type II endoleaks during the follow-up period, four of these persisting. In cases with type II endoleak, mean sac diameter change was -0.5 mm in the cases with previous embolization and +3.1 mm without. The mean period to onset of type II endoleak was 6.9 months without, and 15.3 months with, previous embolization.

CONCLUSION

Although the cohort size is below a level that would confer significance, the trend of these findings is such as to suggest a lack of influence of aortic side branch embolization on the incidence of type II endoleak during the follow-up period.

Graft distortion after endovascular repair of abdominal aortic aneurysm: association with sac morphology and mid-term complications

PURPOSE

To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.

METHODS

EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.

RESULTS

Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p = 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.

CONCLUSION

There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions.

Patient tolerance of cervical esophageal metallic stents

PURPOSE

To demonstrate that proximal esophageal stenoses and tracheoesophageal fistulas can be adequately palliated with use of metallic stents without significant foreign-body sensation.

MATERIALS AND METHODS

Between June 1994 and March 1999, 22 patients with lesions within 3 cm of the cricopharyngeus were treated by placement of metallic stents. The series was reviewed retrospectively. Twenty patients had surgically unresectable malignant lesions, two patients had benign disease. Ten patients had associated tracheoesophageal fistulas. In all, the upper limit of the stent was between C5 vertebral body inferior endplate and the T2 vertebral body superior endplate. The case-notes were reviewed until patient death (range, 6-198 days), or to date in the two surviving patients with benign disease.

RESULTS

Immediate technical success was 93% (27 of 29). Dysphagia scores improved from a median of 3 to 2 after stent placement. Eighteen of 22 (82%) patients reported no foreign-body sensation. There have been no cases of proximal migration, periprocedural perforation, or deaths. The two patients with benign disease experienced significant complications.

CONCLUSION

Lesions in proximity to the cricopharyngeus can be successfully palliated without significant foreign-body sensation in the majority of patients with use of metallic stents. The authors urge caution in placing stents in patients with benign disease.

House dust levels of selected insecticides and a herbicide measured by the EL and LWW samplers and comparisons to hand rinses and urine metabolites

During the Minnesota Children's Pesticide Exposure Study (MNCPES), comparisons were made between the insecticide/herbicide loadings obtained with two household dust/insecticide or herbicide samplers: the Edwards and Lioy (EL) press sampler (used for dust collection from carpets or other surfaces) and the Lioy, Waimnan and Weisel (LWW) surface wipe sampler. The results were compared with hand rinse levels, and urine metabolite levels obtained from 102 children (ages 3-13). All measurements were made during a 1-week sampling period, and information was obtained on household pesticide use and each child's activities. Of the homes, <5% had recent spot uses of a pesticide but none had recent general applications. The analyses focused primarily on atrazine (a herbicide), and malathion, diazinon, and chlorpyrifos (insecticides). Metabolites were measured for atrazine, malathion and chlorpyrifos. The atrazine levels obtained using the EL indicate that this compound was transported into the home by an unquantified transport mechanism (e.g. tracking of soil). Two malathion hand rinse values exceeded >170 ng/cm2, suggesting that since indoor surface levels were low, these children had other sources of exposure. Atrazine, chlorpyrifos and malathion were detectable in >30% of the homes by the EL, LWW or hand rinse. Only chlorpyrifos had detectable levels in > or = 50% of the samples for all types, i.e. compound or metabolite, which is consistent with it being a common household pesticide. The median (and maximum) chlorpyrifos levels for the EL surface, EL carpet, LWW surface (two rooms), hand rinse, and urine metabolites were: 0.07 (32.6) ng/cm2; 0.07 (44.5) ng/cm2; 0.34 (3.64) ng/cm2; 0.42 (14.4) ng/cm2; 0.03 (2.14) ng/hand and 6.9 (59.0) microg/g, respectively. A strong correlation was found for chlorpyrifos between the EL surface and carpet samples. Chlorpyrifos levels detected by LWW had a different distribution and concentration range than the EL, indicating that it collected more than the surface dislodgeable insecticide. EL was directly comparable to the hand rinse or urine levels, but only the LWW had a weak correlation with hand rinse levels, suggesting that the children had other sources of chlorpyrifos exposure. Thus, mechanistic exposure studies are needed to more accurately establish exposure dose relationships in residential settings.

Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches

PURPOSE

To compare the technical success and immediate and long-term outcomes of tunneled central venous catheters placed in comparative cohorts via the subclavian vein (SCV) and the internal jugular vein (IJV) routes.

MATERIALS AND METHODS

This was a prospective observational single-center study of consecutive procedures. Between November 1993 and June 1995, 99 catheters were placed via the SCV and between December 1997 and July 1998, 109 catheters were placed via the IJV. Procedural data were recorded in both cohorts by completion of a proforma by the primary operator.

RESULTS

Follow-up data were available in 96% of the SCV and 87% of the IJV cohorts. The average procedure time was significantly shorter in the IJV group and technical success was 100% versus 97% in the SCV group, but this did not reach statistical significance. The procedure-related pneumothorax rate and the rate of symptomatic venous thrombosis were significantly lower in the IJV cohort (P = .023, P = .015). Fewer catheters were removed prematurely due to sepsis in the IJV group (P = .043).

CONCLUSIONS

The IJV route is associated with comparable technical success, and lower major procedural complication and venous thrombosis rates, with fewer catheters removed prematurely. The right IJV approach with ultrasound guidance is recommended as the route of choice for the placement of tunneled central venous catheters.

The EL sampler: a press sampler for the quantitative estimation of dermal exposure to pesticides in housedust

Indirect sampling techniques to estimate dermal exposure to pesticides on housedust-laden indoor surfaces should demonstrate collection efficiencies, for both particles and pesticide residues, which are similar to those that would adhere to the human skin. A spring-loaded press sampler has been developed that approximated the particle- and pesticide-collection efficiencies of a hand press of a human participant. Particle-collection efficiencies for the hand press and EL sampler, using housedust sieved to <250 microm in diameter, indicated that both sampling techniques collected similar particle fractions over the range of particle sizes. Pesticide-collection efficiencies measured on the participants hand (seven paired tests) were 42+/-7% atrazine, 29+/-8% diazinon, 43+/-8% malathion and 21+/-5% chlorpyrifos. The EL sampler collected 35+/-5%, 31+/-3%, 32+/-5% and 18+/-3% respectively. The collection efficiencies of the two sampling techniques were highly correlated for atrazine, diazinon, and chlorpyrifos (correlation coefficient=0.840, 0.815, and 0.706), but not for malathion (correlation coefficient=0.086).

Seasonal deposition of housedusts onto household surfaces

Seasonal differences in the particle size fractions and mass loadings of household dust deposited on indoor surfaces were examined in four New Jersey homes. Housedust was collected during a 30-day period on non-electrostatic polyethylene sample plates on which a glass slide had been placed. In each home two samples were collected at a height of 1.5 m and two were collected at a height of 0.3 m above the floor. Dust samples were obtained from each home during a summer and winter collection period. Particle size measurement was completed using an adaptation of a Meridian ACAS 570 Interactive Laser Cytometer. Results indicated that the dust mass deposited on household surfaces during the summer was greater than during the winter. The arithmetic mean mass deposition rate for all houses was 0.37 +/- 0.13 microgram/cm2/day during the summer and 0.22 +/- 0.13 microgram/cm2/day during the winter. The total number of particles deposited, however, was greater during the winter than during the summer. The increase in winter time particle number was caused by greater numbers of particles with an equivalent spherical diameter < 2.5 microns. The most probable source of these particles was winter time combustion emissions within the residences and the subsequent particle deposition on household surfaces. The greater mass loadings measured on the low sampling plates during the summer were associated with a greater number of particles with an equivalent spherical diameter > 5 microns. In the winter, however, the particle mass and number loadings were similar at both heights. These results suggested that ventilation of the house during the summer allowed resuspended particles to enter which led to the higher levels of settled dust. Measurement of contaminant levels in housedust for exposure estimation therefore, should account for the seasonal and height differences in dust mass, and collect representative fractions of housedust that are available for human contact. Furthermore, since over 99% of the particles on indoor surfaces were < 50 microns any indirect sampling technique for dermal exposure estimation should have collection efficiencies similar to the hand of particles < 50 microns.

Renal artery stent placement in renal artery stenosis: technical and early clinical results

We report the technical and early clinical results of renal artery stent placement in 29 consecutive patients treated at a single centre over a 30-month period, employing the Palmaz balloon-expandable stent. Of 32 arteries treated, 23 (72%) were atheromatous, ostial stenoses. Immediate technical success was achieved in all 29 patients. Follow-up angiography was performed on 25 patients at 6.7 months (mean) and demonstrated a patient restenosis rate of 16%. All surviving patients were followed up for a minimum of 6 months. Blood pressure control was improved in eight (50%) of hypertensive patients, and renal function improved in seven (33%) and stabilized in six (29%) patients with chronic renal impairment (serum creatinine > 150 mumols/l). Complications occurred in seven (24%) of patients, including one procedure-related death. Our experience indicates that stent placement has an initial high technical success rate in renal artery stenosis and that this patency is maintained at repeat angiography with a low restenosis rate. Renal artery stenting is likely to extend the role of percutaneous renal revascularization especially in atheromatous ostial lesions. A randomized trial will be required to evaluate its role compared with balloon angioplasty.

Embolization of hepatic artery pseudo-aneurysm facilitated by selective injection of thrombin and thrombin-soaked coils

A case of recurrent haemobilia due to a pseudo-aneurysm of the right hepatic artery is presented. The patient required long-term anticoagulant therapy and, in order to achieve rapid haemostasis, thrombin was used as an adjunct to coil embolization. Rapid thrombosis of the pseudo-aneurysm occurred after selective injection of 200 units of thrombin, and thrombin-soaked coils were employed to occlude the arterial supply.

Benign bronchial stenosis treated with balloon bronchoplasty and metal stents

We report a case of a benign bronchial stenosis that presented clinically with recurrent respiratory infections and increasing dyspnoea. This was associated with transradiancy and oligaemia of the ipsilateral lung. Treatment with balloon bronchoplasty and self-expanding metal stents prevented recurrent pneumonia and led to a sustained improvement in exercise tolerance.

Cloning, sequence and expression of the gene (aprV5) encoding extracellular serine acidic protease V5 from Dichelobacter nodosus

The acidic protease V5-encoding gene (aprV5) from Gram- Dichelobacter nodosus virulent strain 198 was isolated from a cosmid bank by activity screening and sequenced. The 2371-bp nucleotide (nt) sequence contained an open reading frame coding for a protein precursor of 595 amino acid (aa) residues composed of a signal peptide, a pro-region, a mature active protease of 347 aa and a C-terminal extension region of 120 aa. The deduced aa sequence of the pre-pro-mature protease regions showed about 65% similarity to that of D. nodosus basic protease while the C-terminal extension region showed only about 26% similarity. The aprV5 gene, without its C-terminal extension region, was cloned and expressed in Escherichia coli. The acidic protease B5-encoding gene (aprB5) from non-virulent strain 305 was also cloned and sequenced. The aprB5 nt sequence showed 99% homology to that of aprV5 with two single-aa changes occurring in the precursor.

Case report: superior vena caval obstruction treated by thrombolysis, mechanical thrombectomy and metallic stents

We describe a case of superior vena caval obstruction (SVCO) due to bronchial carcinoma which was complicated by extensive central venous thrombosis. Partial clot lysis was achieved with thrombolytic agents, but therapy had to be discontinued due to bleeding from the gastrointestinal tract and puncture sites. Clot dissolution was completed using the Amplatz Thrombectomy Device, and the subsequent placement of a Gianturco Z-stent resulted in prolonged symptomatic relief.

Case report: percutaneous retrieval of a misplaced embolization coil

We report a case of percutaneous retrieval of a misplaced embolization coil which threatened the segmental arterial supply of a single kidney. The renal artery was steeply angulated due to a spinal scoliosis but retrieval was rapidly performed using an Amplatz gooseneck snare. This device is particularly useful when the arterial anatomy is tortuous.

Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization

Pelvic pain syndrome, without an apparent organic cause, is a common gynaecological complaint. Investigations, including laparoscopy are frequently negative but ovarian venography has demonstrated that pelvic varices are a consistent finding in these patients. The aetiology of pelvic varices has been the subject of debate, but it has recently been suggested that the primary problem is venous reflux in dilated, incompetent ovarian veins. Surgical ligation of the ovarian veins has been used effectively in small series of patients with this condition. We report a patient with the clinical and radiological features of this syndrome in which treatment by bilateral ovarian venous embolization produced prolonged symptomatic relief.

Case report: superior vena cava obstruction complicated by central venous thrombosis--treatment with thrombolysis and Gianturco-Z stents

Expandable wire stents can provide effective palliation of superior vena cava obstruction (SVCO). We describe a case of SVCO unresponsive to radiotherapy and chemotherapy, which was complicated by extensive central venous thrombosis. Successful thrombolysis occurred with low-dose streptokinase allowing subsequent stent placement.

Case report: pancreatic mediastinal pseudocyst--an unusual cause of palpitations

We describe a case of pancreatic mediastinal pseudocyst which presented atypically with palpitations due to marked cardiac compression. Computed tomography (CT) showed a large abdominal pseudocyst extending through the diaphragm into the posterior mediastinum. Surgical drainage produced rapid symptomatic relief and the pseudocyst resolved completely within 2 months.

Intrathecal morphine as analgesia for labor pain

In this descriptive study of intrathecal morphine sulfate used for pain control during labor, 49 parturients received morphine intrathecally, 78 were administered butorphanol tartrate (Stadol), and 34 received no analgesia. Significant differences for the intrathecal group included: (1) decreased requirement of nitrous oxide for delivery, (2) lower number of doses of postpartum intramuscular pain medication, and (3) increased use of forceps. The intrathecal morphine group showed no prolongation of labor and no major side effects in mothers or newborns. The results suggest that the use of lower levels of intrathecal morphine sulfate (0.5 mg) is as safe and effective as the more traditional intravenous analgesia for labor.

Studies on the purification of the leucocidin of Fusobacterium necrophorum and its neutralization by specific antisera

Leucocidin from several strains of Fusobacterium necrophorum was partially purified by gel filtration on Fractogel HW55 (F), the majority of the activity being present in the 50 ml of filtrate collected after 1.1 void volumes had passed through the column (termed Fraction 1, or #1). The material also contained lipopolysaccharide in 12.5% SDS-PAGE gels run under reducing conditions, but the protein did not migrate into 7.5% PAGE gels run under non-reducing conditions. Rabbit and bovine antisera to the leucocidin possessed antibodies against antigens in concentrated, washed culture supernates from toxigenic F. necrophorum and neutralized the leucocidal activity of such supernates. Absorption of the antisera with homologous, washed F. necrophorum cells reduced ELISA antibody titres by greater than 50%, but decreased neutralization titres by 15%. Absorbed rabbit IgG anti-#1 precipitated a single rocket in crossed immunoelectrophoresis and identified two proteins, of molecular weights (M.W.) 14 000 and 13 000, and 1 protein of M.W. 13 500 in immunoblots from toxigenic and non-toxigenic strains, respectively. An additional protein of M.E. 103 000 was present after SDS-PAGE separation of supernates from toxigenic but not non-toxigenic F. necrophorum and was not present in whole cell components. It was considered that the leucocidin may be present in a dimeric form in culture supernates from toxigenic strains. Antisera to leucocidins from several strains of F. necrophorum exhibited variable neutralization titres against leucocidins from heterologous bacteria.

Studies on immune responses to parasite antigens in mice. I. Ascaris suum larvae numbers and antiphosphorylcholine responses in infected mice of various strains and in hypothymic nu/nu mice

In terms of day 7 lung larvae numbers, mice vary markedly in their suscepibility to a first infection with the nematode worms, Ascaris suum, and the highly susceptible strain, C57Bl, is resistant to second infection. Time course studies suggested that the period of residence in the liver or migration to, or into, the lungs are stages of the life cycle in which natural or acquired resistance of the host is expressed. The traits, susceptibility and resistance to first infection, were under polygenic control and no linkage of susceptibility to the major histocompatibility complex of C57Bl mice (H-2b) was observed. Acquired resistance (to second infection) has not been dissected because of our inability to show adoptive transfer of resistance to naive recipeints. Studies in hypothymic BALB/c. nu/nu mice indicate that natural resistance (to first infection) is not affected by a lack of T cells. The T cell dependence of acquired resistance in C57Bl mice remains in doubt although in the relatively resistant strain BALB/c, hypothymic nu/nu mice after second infection contain as many larvae in their lungs and liver as are present after first infection. An eosinophilia is observed in infected intact mice but not in infected T cell-deficient mice. Partially T cell-dependent serum antibodies and plaque-forming cells to phosphorylcholine (PC) were present in mice infected with A. suum but no evidence was obtained that this anti-PC antibody response was in any way protective for the host. The cell membrane-acitive properties of PC and related molecules suggest that PC-containing parasite antigens may be tolerogens for certain of the B cells with specificity for parasite antigens. A state of partial tolerance involving high affinity antibody production may be one means whereby parasites survive in natural or unnatural hosts.

Studies on immune responses to parasite antigens in mice. III. Nippostrongylus brasiliensis infections in hypothymic nu/nu mice

Normal mice of several strains reject the nematode worm Nippostronglyus brasiliensis from the intestine within 14 days (and most often within 10 days) of injection of high numbers of infective third stage larvae (L3). Previously-infected mice are markedly resistant to a second infection. Hypothymic, nu/nu ('nude') mice continue to harbor worms long after intact mice have rejected the worm burden and an inoculum of T cells at the time of, or several days after L3 injection, leads to worm elimination within 14 days in nu/nu mice. As yet no evidence is available to indicate whether or not T cells with specificity for parasite antigens are required in a reconstitutive inoculum in nu/nu mice. Pretreatment of normal mice with cyclophosphamide, at doses reported to lead to temporary B cell hypofunction, does not result in delayed rejection of worms but the participation of B cell products (antibodies) cannot be discounted on the basis of this result. The nu/nu mouse - N. brasiliensis system will be useful in the search for, and characterization of, parasite antigens which gain access to the lymphoid organs and circulation of parasitized mice and in the analysis of T cell subtypes (both functional and surface Thy and Ly alloantigenic subtypes) involved in worm elimination.