Development of a three-dimensional prognostic score for patients with symptomatic peripheral artery disease: PAD3D score

Background

Peripheral artery disease (PAD) is a high-risk condition for cardiovascular Events, but no individual prognosis assessment exists.

Objectives

We aimed to establish an individual, clinically useful risk score based on the combined predictive value for mortality of (i) age, (ii) severity of PAD, and (iii) extent of atherosclerosis (PAD3D).

Methods

1310 patients with symptomatic PAD underwent follow-up for a mean of 50±26 months. We randomly subdivided the cohort into test and validation cohort. All-cause and cardiovascular mortality were prospectively analysed for the t PAD3D score and in combination with classical risk factors (PADRF).

Results

For test and validation cohort (n=655), all-cause and cardiovascular mortality was precisely predicted (both p<0.001) by the PAD3D score (Fig. 1 A+B). The additional inclusion of classical risk factors did not increase discrimination (Fig 1 C+D) compared to PAD3D score, as AU-ROCs were similar for both scores at 12 and 24 months (Fig. 2). Thus, the addition of classical risk factors did not further improve the prognostic value. The PAD3D score provides a risk gradient of a 4.5-fold increase in all-cause and cardiovascular mortality.

Conclusions

We established a score for precise prediction of all-cause and cardiovascular mortality. The PAD3D score promises to allow for personalized goals in risk intervention.

All-cause and cardiovascular mortality

Funding Acknowledgement

Type of funding source: None

Prognostic role of polyvascular involvement in patients with symptomatic peripheral artery disease

Background

Patients with peripheral artery disease (PAD) are at very high risk of future cardiovascular events. However, clinical experience suggests that PAD has a wide range of prognosis due to a different atherosclerotic extent with further vascular beds affected, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD).

Purpose

We hypothesized that patients with a polyvascular extent (+ CAD and/ or CeVD) of PAD have poorer prognosis compared to those with PAD alone.

Methods

Single center longitudinal observational study with 1380 symptomatic PAD patients over a period from 2009 to 2019 (mean observational time: 60±32 months). We related the atherosclerotic extent (PAD, +1 vascular region (+/− CAD or CeVD) (+1V), +2 vascular regions (+CAD and CeVD) (+2V) to all-cause and cardiovascular mortality as well as to cardiovascular event rate.

Results

Baseline demographics showed that polyvascular patients (+1V and +2V) were older, suffered more often from diabetes, hypertension, dyslipidemia and had more severe impairment of their kidney function (all p<0.0001) compared to PAD patients without further vascular beds affected. Polyvascular patients received more often a complete guideline conform treatment with anti-platelet therapy, ACE Inhibitors, smoking cessation and statin medication. This was mainly due to the low rate of statin use in PAD aonly patients compared to polyvascular patients (+1V and +2V; p<0.001). Despite of the adequate treatment, all-cause and cardiovascular mortality rate was higher in polyvascular patients (+1V: 22%; +2V: 35%) than in PAD only patients (13%; p<0.0001), as well as the rate of cardiovascular events (p<0.05).

Conclusion

PAD patients with a polyvascular involvement receive an adequate guideline conform treatment. Nevertheless, mortality is higher in this population. Conversely, our data suggest, that an intensified treatment for patients with PAD alone might help to avoid progression into a polyvascular disease and in consequence an increased mortality in this population.

PAD polyvascular outcomes

Funding Acknowledgement

Type of funding source: None

PAD patients present with poorer lipid target attainment than polyvascular patients – a call for intensified treatment

Background

Due to the very high risk of future cardiovascular events, strict lipid lowering therapy is recommended in patients with peripheral artery disease (PAD). However, data on target level attainment and statin adherence is scarce, especially when the atherosclerotic burden is extended to other vascular beds, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD).

Purpose

We hypothesized that patients with PAD alone have poorer lipid target attainment than polyvascular patients (+ CAD and/ or CeVD) and that an intensified statin therapy improves attainment of lipid targets and thus survival of patients with PAD only.

Methods

Single center longitudinal observational study with 1380 symptomatic PAD patients over a mean follow-up period of 60±32 months. We related statin adherence and LDL-C target attainment to all-cause mortality.

Results

Initially, 58% of the PAD only patients were on statins in contrast to PAD patients with one (+1V (79%)) or two (+2V (80%)) further vascular regions. At follow up we observed an increase to 87% statin use (p<0.0001) in PAD only patients. Statin use in +1V and +2V patients increased as well (+1V: 92%; +2V: 87%). Lipid target attainment in PAD only (<55 mg/dl) was observed in only 10%, but increased to 19%. Statin dosage in PAD only patients, normalized to simvastatin 40 mg, increased from 46 to 52 mg/ day (p<0.01), and was paralleled by a mean decrease of LDL-C from 103 to 84 mg/ dL (p<0.0001).

PAD only patients had a significant lower mortality rate (13%) than +1V (22%) or +2V patients (35%) (p<0.0001). Survival of PAD only patients significantly improved when having newly received a statin (11%), similar to those continuously on statins (10%). Moreover, patients on a high intensity statin medication had a low mortality of 10%. Those who terminated statin medication or never received a statin had a higher mortality (26%; p<0.01).

Conclusion

Patients with a PAD only have a lower mortality than PAD patients where progression to one or two vascular beds occurred. Our data suggest that for PAD only patients an intensified statin therapy is then associated with reduced mortality. A strategy of intensive and sustained statin therapy as early as possible is recommended.

PAD only Statin Therapy outcomes

Funding Acknowledgement

Type of funding source: None

411 Recompensation induces distinct changes in myocardial work in patients with acutely decompensated heart failure and reduced vs preserved left ventricular ejection fraction

Funding Acknowledgements

German Research Foundation (BMBF 01EO1004 and 01EO1504)

OnBehalf

Acute Heart Failure Registry

Background & Aim A new, less load-dependent echocardiographic tool to determine left ventricular (LV) myocardial work (MyW) based on longitudinal strain and blood pressure has recently been introduced and validated against invasive measurements. We investigated the impact of change in N-terminal pro-B-natriuretic peptide (NT-proBNP; i.e. surrogate of recompensation) during the hospital phase on changes in MyW (global work efficiency [GWE]; global constructive work [GCW]; and global wasted work [GWW]), in patients admitted for acutely decompensated heart failure (AHF).

Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed and NT-proBNP measured on the day of admission and within 72 hours prior to discharge. MyW assessment was performed off-line using EchoPAC (GE, version 202). In order to quantify changes in MyW and NT-proBNP, we used the respective discharge-to-admission ratio (DAR). Local polynomial regression was applied to model these associations in patients with LV ejection fraction (LVEF) <40% vs ≥40%.

Results We analyzed 111 patients: mean age 73 ± 11 yrs; 32% female; 46 patients (41.4%) with LVEF < 40%. The median [Q1, Q3] NT-proBNP level at admission was 5883 pg/ml (2589, 10188). Median length of stay in hospital was 12.0 days (9.0, 16.5). The DAR for NT-proBNP was 0.55 (0.34; 0.80) indicating that the majority of patients experienced a marked lowering of NT-proBNP. The figure demonstrates that the association between DAR of MyW parameters and DAR of NT-proBNP showed distinct profiles depending on admission LVEF. E.g., in panel A, the arrows indicate that a NT-proBNP reduction by 50% was associated with a 45% increment in GCW if admission LVEF was <40%, but with an 8% increment only if LVEF was ≥40%.

Conclusions Our preliminary analysis indicates that a decrease in NT-proBNP may be associated with an improvement in GCW and GWE in patients with reduced LVEF, while these parameters were non-responsive in the other patient group. Although these results require confirmation in a larger cohort, they encourage further research in to MyW as a less load-dependent measure of LV function, shedding new light on echocardiographically manifest alterations of myocardial texture and the timing of healing processes after an acute cardiac event.

Figure

Discharge-to-admission ratio (DAR) of A) global work efficiency (GWE, >1= improvement), B) global constructive work (GCW, >1= improvement), and C) global wasted work (GWW, <1 = improvement) as a function of discharge to admission NT-proBNP in acute heart failure patients with left ventricular ejection fraction ≥ and <40%.

Abstract 411 Figure

P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

OnBehalf

AHF Registry

Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF <40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF).

Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates.

Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF <40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table).

Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF.

Abstract P803 Figure.

[The role of contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT) in the preoperative diagnosis of renal lesions]

OBJECTIVE

The preoperative assessment of structural and functional changes in renal tumors using contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT).

MATERIALS AND METHODS

All consecutive patients referred to two tertiary hospitals for surgery on suspicion of a malignant renal lesion, who had been examined under the predefined study protocol using CEUS and CECT, were prospectively included in the study. All renal lesions suspected of being malignant were subjected to histopathological examination. Lesions expected to be benign were followed up according to the study protocol. The accuracy of CEUS and CECT with the final histology or follow-up results and the statistically significant difference between the two imaging techniques was calculated.

RESULTS

Over a period of 3 years (2008-2011), 68 of 93 patients examined met the study criteria. The prevalence of malignant tumors in the study was 72%. Fifty four (79%) patients underwent surgery and had a histologically confirmed renal tumor (clear cell carcinoma 45, urothelial papillocarcinoma 4, angiomyolipoma 1, oncytoma 3, xanthogranulomatous pyelonephritis 1) and 14 (21%) patients underwent regular follow-up. Specificity, sensitivity and area under the curve (AUC) reached 57.9%, 98% and 0.779 for CEUS and 52.6%, 98% and 0.753 for CECT.

CONCLUSION

The results show that both imaging methods can reliably rule out malignant disease due to absence of enhancement. Taking into consideration that CEUS can be carried out without severe risk or discomfort, it is time to reconsider CEUS as the method of choice for diagnosis, while CECT should be reserved for staging.

CRP genetic variants are associated with mortality and depressive symptoms in chronic heart failure patients

OBJECTIVE

Heart failure (HF) is a complex medical condition with a multitude of genetic and other factors being involved in the pathogenesis. Emerging evidence points to an involvement of inflammatory mechanisms at least in subgroups of patients. The same is true for depression and depressive symptoms, which have a high prevalence in HF patients and are risk factors for the development and outcomes of cardiovascular disease.

METHODS

In 936 patients of the Interdisciplinary Network Heart Failure (INH) program, CRP and IL-6 protein blood levels were measured and genetic variants (single nucleotide polymorphisms) of the CRP and IL6 gene analyzed regarding their influence on mortality.

RESULTS

Less common recessive genotypes of two single nucleotide polymorphisms in the CRP gene (rs1800947 and rs11265263) were associated with significantly higher mortality risk (p < 0.006), higher CRP levels (p = 0.029, p = 0.006) and increased depressive symptoms in the PHQ-9 (p = 0.005, p = 0.003). Variants in the IL-6 gene were not associated with mortality.

CONCLUSION

Our results hint towards an association of less common CRP genetic variants with increased mortality risk, depressive symptoms and peripheral CRP levels in this population of HF patients thereby suggesting a possible role of the inflammatory system as link between poor prognosis in HF and depressive symptoms.

[Network for Oncological Advisory Service (NOF) - a Pilot Project for (Long-Term) Follow-Up Care of Pediatric Cancer Patients]

Background: In Germany some 2 000 children and adolescent are diagnosed with cancer every year. Curing rates are increasing and therewith also the number of survivors is growing. Survivors frequently suffer from long-term effects of the disease and its treatment, but long-term follow-up care shows deficits. Method: The Network for oncological advisory service (NOF) started in 11/2013, researching and building up a network of available support in Lower Saxony. A telephone hotline was installed in 01/2014 in order to advice survivors on their problems. At the same time, an interview study on survivors needs was conducted throughout Germany. Results: In the first 2 years, the NOF gave advice to 79 patients. Whilst enquiries of medical or psychological nature were transferred to the cooperation partner, requests on psychosocial and social legal issues are being deled by the NOF due to lack of appropriate partners. The evaluation of 25 interviews shows key issues in long-term after-care: (1) transition from acute therapy to everyday life, (2) problems due to pediatric cancer and therapy, (3) patients perception of own disposition, (4) social reactions towards survivors, (5) structure of long-term follow-up care, (6) information flow. Conclusion: Many survivors suffer from long-term effects of cancer and treatment. The lack of available contact person and being in limbo between cured and simultaneously affected by the cancer treatment and chronic diseases is perceived as being problematic. This translates to various requirements on a patient-oriented long-term care, mainly in the psychosocial field.

Palliative treatment of the advanced gastric cancer by means of surgery and HIPEC

OBJECTIVES

We demonstrate a case report of the patient who suffered from advanced gastric cancer and was treated by means of surgery and HIPEC.

BACKGROUND

Gastric cancer is a therapeutic challenge in the European countries due to late diagnosis, advanced stages of the disease in time of diagnosis and early recurrence in cases where a radical surgery is possible.

METHOD

The patient with an advanced gastric cancer (pT3N2M1 - peritoneal and ovarian metastases) was treated by means of radical surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). Surgical treatment was followed by a standard chemotherapy. Due to recurrence, there was the second look surgery one year later again with HIPEC procedure.

RESULTS

Patient survived 32 months after diagnosis and despite intraperitoneal recurrence she never developed clinically significant ascites and she never suffered from intestinal obstruction.

CONCLUSION

This case demonstrate a potential benefit of new oncosurgical approach -radical surgery + HIPEC + EPIC in the treatment of gastric cancers (Tab. 2, Fig. 6, Graph 4, Ref. 18). Text in PDF www.elis.sk.

Influence of hepatitis C virus infection and high virus serum load on biliary complications in liver transplantation

BACKGROUND

Biliary complications (BCs) and recurrent hepatitis C virus (HCV) infection are among the major causes of morbidity and graft loss following liver transplantation. The influence of HCV on BCs has not been definitely clarified.

PATIENTS AND METHODS

We performed a retrospective cohort study to analyze risk factors and outcome of post orthotopic liver transplantation (OLT) BCs in 352 liver transplant recipients over 12 years in Munich, Germany (n = 84 with HCV; living donor and re-OLT were excluded). BCs diagnosed with imaging techniques and abnormal liver enzyme pattern, requiring an intervention, were considered.

RESULTS

In a multivariate analysis, HCV serostatus and a high pre-and post-surgery HCV RNA serum load were independent risk factors for anastomotic strictures. HCV positivity and BCs alone did not alter graft loss. HCV-positive patients with BCs, however, had a significantly worse graft outcome (P = 0.02). Non-anastomotic strictures, bile leaks, and the number of interventions needed to treat bile leaks led to worse graft outcome in all patients.

CONCLUSION

HCV positivity and a high HCV RNA serum load were risk factors for anastomotic strictures. BCs and HCV had an additive effect on graft loss.

[Axilloscopy--an option in axillary lymph nodes dissections in breast carcinomas]

Authors in this randomised prospective study, which occurred in years 2007 to 2008 on the St. Anne's First Surgical Clinic in 56 breast cancer female patients, compare the results of minimally invasive axillary dissection to those of the classical axillary dissection and point to the advantages and setbacks of this new method both for the patient and surgeon.

Orientational Order of a Liquid Crystal with Three Chiral Centers by a Combined 13C NMR and DFT Approach

In this work, the liquid crystal (S)-2-methylbutyl-[4'-(4' '-heptyloxyphenyl)-benzoyl-4-oxy-(S)-2-((S)-2')-benzoyl)-propionyl)]-propionate (ZLL 7/*) was investigated by means of 13C NMR spectroscopy. This compound has a very peculiar mesomorphic behavior, showing the following phases: paraelectric SmA, ferroelectric SmC*, antiferroelectric SmC*A, re-entrant ferroelectric SmC*re, and ferroelectric hexatic Sm*HEX. The structural and orientational ordering properties of ZLL 7/* have been determined by exploiting the nuclear chemical shielding properties of 13C. To this aim, solid-state NMR techniques such as CP, SPINAL-64, and SUPER have been used in combination with DFT calculations. The agreement between experimental and in vacuo DFT shielding parameters appears to be satisfactory. The orientational order parameters obtained from the 13C shielding analysis have been discussed, taking into account different data analysis approaches and comparing them to those previously obtained from an independent 2H NMR study.

[Venous injuries during a ten-year follow up, including vascular injuries managed in the Bulovka Surgical Department IPVZ]

The authors analyze twenty cases of vascular reconstructions, completed upon management of 118 vascular traumas, over a 10-year period. The traumas were, predominantly, of iatrogenic origin. The following trunks were treated: v. cava inferior, v. mesenterica superior, pelvic, femoral and popliteal veins. In most cases, the reconstruction included a direct vascular suture technique. Furthermore, in addition to the direct vascular suture technique, analogous vein-graft patches or interponates were used. In a single case, a thin-walled PTFE prosthesis was applied. Out of the patient study group, one patient exited as a result of septic complications of his traumas, connected to the v. cava inferior injury. In three cases, femoral and popliteal reconstructions were affected with thrombosis. Non of the reconstructions resulted in a lower extremity amputation.

Venous thrombosis in the surgical department

Currently, there are no standardized guidelines aimed to the prevention of DVT. Thus we recommend the introduction of a standardized scoring system that would ensure the effective prevention of DVT. (Tab. 6, Ref. 5.).

Photoneutron cross sections for unstable neutron-rich oxygen isotopes

The dipole response of stable and unstable neutron-rich oxygen nuclei of masses A = 17 to A = 22 has been investigated experimentally utilizing electromagnetic excitation in heavy-ion collisions at beam energies about 600 MeV/nucleon. A kinematically complete measurement of the neutron decay channel in inelastic scattering of the secondary beam projectiles from a Pb target was performed. Differential electromagnetic excitation cross sections d sigma/dE were derived up to 30 MeV excitation energy. In contrast to stable nuclei, the deduced dipole strength distribution appears to be strongly fragmented and systematically exhibits a considerable fraction of low-lying strength.

Mitotic degradation of cyclin A is mediated by multiple and novel destruction signals

Exit from mitosis requires Cdk1 inactivation, with the most prominent mechanism of Cdk1 inactivation being proteolysis of mitotic cyclins [1]. In higher eukaryotes this involves sequential destruction of A- and B-type cyclins. CycA is destroyed first, and CycA/Cdk1 inactivation is required for the metaphase-to-anaphase transition [2]. The degradation of CycA is delayed in response to DNA damage but is not prevented when the spindle checkpoint is activated [3, 4]. Cyclin destruction is thought to be mediated by a conserved motif, the destruction box (D box). Like B-type cyclins, A-type cyclins contain putative destruction box sequences in their N termini [5]. However, no detailed in vivo analysis of the sequence requirements for CycA destruction has been described so far. Here we tested several mutations in the CycA coding region for destruction in Drosophila embryos. We show that D box sequences are not essential for mitotic destruction of CycA. Destruction is mediated by at least three different elements that act in an overlapping fashion to mediate its mitotic degradation.

Cognitive consequences and central nervous system injury following treatment for childhood leukemia

OBJECTIVES

To determine the relationship between membrane damage and intellectual and academic abilities in children with acute lymphoblastic leukemia (ALL) and pilot test a math intervention for children with ALL who were affected.

DATA SOURCES

Research studies and review articles.

CONCLUSIONS

Despite the prophylactic central nervous system (CNS) treatment for long-term disease-free survival, many children with ALL subsequently experience declines in intellectual and academic skills.

IMPLICATIONS FOR NURSING PRACTICE

Improving academic abilities in children who have received CNS treatment is of high priority and may have longlasting implications on quality of life.

Thickness shear mode resonators ("mass-sensitive devices") in bioanalysis

A short overview of function and experimental set-ups of acoustic wave devices is given which, in contrast to other bioanalysis techniques, are based on a mechanical transduction mechanism. The most frequently used device is the thickness shear mode resonator (TSMR), which in the last few years was intensively employed in biosensor applications. TSMR biosensor studies in the field of nucleic acid interaction, adsorption of proteins to surfaces and immunosensing are reviewed. A main point concerns the interpretation of the sensor response not only in terms of mass loading, which underestimates the capabilities of these devices.

[Fatal Clostridium sepsis after preoperative hepatic artery embolization]

The authors describe the first case in the Czech literature of a death caused by Clostridium sepsis following embolization of the hepatic artery as the preparatory stage for resection of a hepatic tumour.

Smectic-A*-smectic-C* transition in a ferroelectric liquid crystal without smectic layer shrinkage

The smectic layer spacing of a nonfluorinated ferroelectric liquid crystal (FLC) compound with almost no shrinkage and only minor tendency to form zigzag defects was characterized by small angle x-ray diffraction. The material lacks a nematic phase. The smectic-A*-smectic-C* phase transition was studied by measuring the thermal and electric field response of the optical tilt and the electric polarization. These properties are described very well by a Landau expansion even without introduction of a higher-order Theta(6) term. This result suggests a pure second-order phase transition far from tricriticality and differs considerably from the typical behavior of the A*-C* transition in most FLC materials.

Temperature difference between bulk and surface transition in freely suspended smectic films

We report an ellipsometric study of freely suspended films of a chiral liquid-crystal compound possessing the phase sequence smectic-C-smectic-A-isotropic with a very broad (67 K) smectic-A phase range. We observe a smectic-C-smectic-A surface transition which is situated more than 60 K above the bulk smectic-C-smectic-A transition temperature. Possible reasons for this unusually large temperature shift are discussed.

GM-CSF gene expression and protein production in human colorectal cancer cell lines and clinical tumor specimens

Granulocyte-macrophage colony stimulating factor (GM-CSF) gene expression and protein production were investigated in colorectal cancer cell lines and surgical specimens. In 6 of 6 established tumor lines, expression of the GM-CSF gene was observed by reverse transcription polymerase chain reaction (RT-PCR). Furthermore, for 2 of the lines, the cytokine was detectable in > or = 100 pg/ml amounts in culture supernatants by enzyme-linked immunosorbent assay tests. Addition of recombinant GM-CSF at doses ranging between 30 pg and 30 ng/ml did not appear to affect the proliferation of colorectal cancer cell lines as measured by 3H-thymidine incorporation. GM-CSF gene expression was then examined in surgical specimens by a densitometry-assisted, semiquantitative RT-PCR technique. In the 10 samples analyzed, significantly higher expression was detectable in tumors, as compared with autologous healthy mucosa sampled in the vicinity (2 cm) or at distance (10 cm) from the neoplastic focus. Immunohistochemistry studies performed on 13 specimens led to the identification of intracytoplasmic GM-CSF in tumor cells in 9 samples. In 6 of these, positivity of stromal fibroblasts and lymphocytes adjacent to the tumor was also observed. In contrast, intracellular GM-CSF was only detectable in 2 cases in untransformed epithelial cells, close to the neoplasm, but never in healthy mucosa at distance from the tumor. Infiltration by dendritic cells (DC) was also investigated. In 5 of 8 colorectal cancers tested, DC aggregates accounted for more than 10% of stromal cells. Lower numbers were detectable in healthy mucosa. However, DC infiltration could not be correlated with the presence of GM-CSF-positive neoplastic cells in the tumor specimens. Remarkably, cultured DC were unable to exert significant cytotoxic activity against colorectal cancer cells in vitro.

[Spiral (helical) computer tomography]

The introduction of spiral (helical) computed tomography (CT) has revolutionized the way established body CT examination are performed and has created new examinations as CT angiography. The production of overlapping images from single short X-ray exposure, the minimization of motion artefact and the suppression of respiratory misregistration have all improved performance of routine CT examinations. These same technical advantages have also led to the development of new applications. With advanced 3-D postprocessing applications, simulated endoscopy is made possible permitting the radiologist the view anatomy from within any lumen or anatomic space within the body.

Continuous small-dose tranexamic acid reduces fibrinolysis but not transfusion requirements during orthotopic liver transplantation

Tranexamic acid (TA) is a synthetic drug that inhibits fibrinolysis. It has been administered to decrease the use of blood products during cardiac surgery and orthotopic liver transplantation when infused in larger doses. A small-dose infusion of aprotinin causes a reduction in fibrinolysis and blood product requirement during orthotopic liver transplantation without apparent risk of intravascular thrombosis. This prospective study was designed to investigate whether a small-dose infusion of TA would be equally effective in reducing fibrinolysis and blood product transfusions during orthotopic liver transplantation. A double-blind, controlled study was undertaken to compare the efficacy of a small-dose TA infusion with that of a placebo. Thirty-two consecutive patients were randomized either to the TA group (n = 16), which received an intravenous infusion of 2 mg x kg(-1) x h(-1), or to the control group (n = 16), which received an identical volume of normal saline. Coagulation values were measured, a field rating was made by the surgeon, and a thromboelastogram was produced at four predetermined intervals throughout the case-before TA infusion was started, after portal vein ligation, 10 min after reperfusion, and at the end of surgery. Intraoperative transfusion requirements were recorded during the procedure and for the first 24 h postoperatively. A record was kept of any intraoperative epsilon-aminocaproic acid administered for uncontrolled fibrinolysis. The thromboelastogram clot lysis index was significant for lysis in the control group during both the anhepatic and the neohepatic phases (P < 0.01 and P < 0.05, respectively) when compared with the TA group. Fibrin degradation products were significantly increased (>20 microg/mL) in the control group at reperfusion (P < 0.03) and at the end of surgery (P < 0.01). D-dimers were also significantly increased (>1 mg/L) in the control group at the end of surgery (P < 0.04). Nine of the 16 control patients versus 3 of the 16 TA patients required epsilon-aminocaproic acid rescue for fibrinolysis. There were no other significant differences between groups. Transfusion requirements during surgery and for the first 24 h postoperatively did not differ significantly between the two groups. We conclude that the use of small-dose TA reduces fibrinolysis but not transfusion requirements during orthotopic liver transplantation.

[Extensive metastases of Ewing's sarcoma in the adreno-renal area]

The authors refer to the observation of 43 years old woman with Ewing's sarcoma of the pelvic region, who displayed, a year after local extirpation of the tumour, clinically and radiographically, a metastasis in the adrenal-renal region. The patient died due to generalization of the tumour during the next year after an attempt to remove the metastasis, where a radical intervention proved impossible. Metastases of malignant tumours of locomotor apparatus into this region proved to be rare and such is the observation of the extensive affection in the Ewing's sarcoma.

New occlusive agent for therapeutic embolization tested in dogs

A new occlusive agent, Vilan 500, was used to embolize the arterial bed of the kidney in 12 dogs. This polyvinyl acetate, alcohol-soluble agent becomes gelantinous on contact with an aqueous environment and its low viscosity makes this material well suited for application through small-caliber catheters. Complete arterial occlusion of the embolized kidneys was observed in all animals. On histologic examination of tissue 4-6 weeks after the procedure, changes were seen such as shrinkage through fibrosis, diffuse necrosis and atrophic parenchyma. No signs of recanalization of the embolized artery or functional collateral circulation were noted in any dog.

[The morphological and functional integrity of cryo-preserved leukocytes]

Human peripheral blood lymphocytes were frozen by a simplified method which is described. Light and electron microscopic investigations of the frozen-thawed cells showed no significant morphological changes compared to the fresh cells; comparison of E-rosette formation and nonspecific acid esterase activity before and after cryoconservation afford evidence of a possible slight change in the percent relationship of T- and B-cells, whereas thymidine uptake values within normal range after stimulation with PHA and homologous cells demonstrate the functional integrity of the lymphocytes.