RESUMEN
Our aim was to examine hemodynamic implications of intravascular stenting in the canine venous pouch (sidewall or straight-vessel) and rabbit elastase (curved-vessel) aneurysm models. Flow dynamics in stented (Wallstent) and nonstented versions were studied by using computational fluid dynamics simulations and in vitro flow visualization, with a focus on stent placement effects on aneurysmal flow stagnancy and flow impingement. Results show that sidewall and curved aneurysm models have fundamentally different hemodynamics (shear-driven versus inertia-driven) and thus stent placement outcomes.
Asunto(s)
Circulación Sanguínea/fisiología , Modelos Animales de Enfermedad , Aneurisma Intracraneal/fisiopatología , Aneurisma Intracraneal/terapia , Stents , Animales , Velocidad del Flujo Sanguíneo/fisiología , Simulación por Computador , Perros , Técnica de Dilución de Colorante , Diseño de Equipo , Técnicas In Vitro , Modelos Cardiovasculares , Conejos , RecurrenciaRESUMEN
In this paper, we present a segmentation method for nuclei in microscopy images of tissue sections. The proposed method is completely automatic and performs well in the conflicting aims of speed efficiency, detection accuracy and shape fitting. It proposes an efficient alternative to existing methods ([1], [4]), in achieving the three main usual segmentation steps: (i) background extraction, (ii) seed finding and (iii) seed growing. Eventually, some significant results are depicted and discussed.
Asunto(s)
Trastornos de la Coagulación Sanguínea/diagnóstico , Encéfalo/diagnóstico por imagen , Hemorragia Cerebral/patología , Lóbulo Frontal/patología , Hematoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Humanos , Relación Normalizada Internacional/métodos , MasculinoRESUMEN
BACKGROUND: Pro-inflammatory interleukin (IL)-15 plays a major role in host defense and chronic inflammation by stimulating T-lymphocyte recruitment and growth. Expression of IL-15 and IL-15 receptor (IL-15R) in human prostate was examined. METHODS: Normal and benign hyperplastic (BPH) prostate specimens (n = 23) were analyzed for IL-15 and IL-15Ralpha-chain expression by immunohistochemistry and Real-Time-PCR/RT-PCR. Regulation of prostatic stromal cell (PSC) IL-15 mRNA and effect of IL-15 on prostatic cell growth were analysed in vitro. RESULTS: In normal prostate, anti-IL-15 and anti-IL-15Ralpha-chain reactivity were restricted to smooth muscle and stromal cells. However, in BPH, in addition epithelial cells frequently exhibited discrete anti-IL-15R and often intense, membranous anti-IL-15 reactivity. IL-15/IL-15R mRNA were detected in all prostatic cells types. In BPH tissues, IL-15 mRNA content was variable (15-fold). IL-15 mRNA synthesis of PSC was significantly up-regulated by IFN-gamma. Furthermore IL-15 strongly stimulated the growth of BPH-T-lymphocytes and weakly that of carcinoma cell lines, but not of stromal cells. CONCLUSIONS: Overexpression of IL-15 and IL-15Ralpha-chain in BPH and massive proliferation of BPH-T-lymphocytes induced by IL-15 suggest a role for IL-15 in prostatic inflammation. Since IFN-gamma, a T-lymphocyte product, stimulates prostatic IL-15 production; chronic inflammation might be triggered by this paracrine loop.
Asunto(s)
Interleucina-15/biosíntesis , Próstata/metabolismo , Hiperplasia Prostática/metabolismo , Receptores de Interleucina-2/biosíntesis , Adolescente , Adulto , División Celular/efectos de los fármacos , División Celular/fisiología , ADN Complementario/química , Técnica del Anticuerpo Fluorescente , Regulación Neoplásica de la Expresión Génica , Humanos , Inmunohistoquímica , Interleucina-15/análisis , Janus Quinasa 1 , Masculino , Próstata/patología , Hiperplasia Prostática/patología , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Proteínas Tirosina Quinasas/biosíntesis , Proteínas Tirosina Quinasas/genética , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Receptores de Interleucina-15 , Receptores de Interleucina-2/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estadísticas no Paramétricas , Células Tumorales CultivadasRESUMEN
OBJECTIVES: Automated external defibrillators (AEDs) provide an opportunity to improve survival in out-of-hospital, ventricular fibrillation (VF) cardiac arrest by enabling laypersons not trained in rhythm recognition to deliver lifesaving therapy. The potential role of emergency dispatchers in the layperson use of AEDs is uncertain. This study was performed to examine whether dispatcher telephone assistance affected AED skill performance during a simulated VF cardiac arrest among a cohort of older adults. The hypothesis was that dispatcher assistance would increase the proportion who were able to correctly deliver a shock, but might require additional time. METHODS: One hundred fifty community-dwelling persons aged 58-84 years were recruited from eight senior centers in King County, Washington. All participants had received AED training approximately six months previously. For this study, the participants were randomized to AED operation with or without dispatcher assistance during a simulated VF cardiac arrest. The proportions who successfully delivered a shock and the time intervals from collapse to shock were compared between the two groups. RESULTS: The participants who received dispatcher assistance were more likely to correctly deliver a shock with the AED during the simulated VF cardiac arrest (91% vs 68%, p = 0.001). Among those who were able to deliver a shock, the participants who received dispatcher assistance required a longer time interval from collapse to shock [median (25th, 75th percentile) = 193 seconds (165, 225) for dispatcher assistance, and 148 seconds (138, 166) for no dispatcher assistance, p = 0.001]. CONCLUSIONS: Among older laypersons previously trained in AED operation, dispatcher assistance may increase the proportion who can successfully deliver a shock during a VF cardiac arrest.
Asunto(s)
Desfibriladores Implantables , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Desfibriladores Implantables/psicología , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/psicología , Femenino , Paro Cardíaco/complicaciones , Paro Cardíaco/psicología , Paro Cardíaco/terapia , Humanos , Masculino , Competencia Mental/psicología , Persona de Mediana Edad , Factores de Tiempo , Fibrilación Ventricular/complicaciones , Fibrilación Ventricular/psicología , Fibrilación Ventricular/terapia , Washingtón/epidemiologíaRESUMEN
The authors report a case in which the lateral C-1 arch fractured in a patient with rheumatoid arthritis and an intact fusion mass; this patient had previously undergone a C1-2 Brooks-type fusion. This unique complication occurred secondary to continued resorption of the C1-2 rheumatoid pannus. Two years after occipitocervical fusion the patient has made a complete neurological recovery.
Asunto(s)
Artritis Reumatoide/complicaciones , Vértebras Cervicales/lesiones , Vértebras Cervicales/cirugía , Fracturas de la Columna Vertebral/etiología , Fusión Vertebral , Anciano , Articulación Atlantoaxoidea , Vértebras Cervicales/diagnóstico por imagen , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Masculino , Dispositivos de Fijación Ortopédica , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Insuficiencia del TratamientoRESUMEN
The aim of the study was to develop a novel system permitting automated analysis of multicolor immunofluorescence-staining of cells in solid tissues which would be comparable to the analytical capacity of flow cytometry. In the user friendly automated data acquisition and image processing system which was established, the software includes a set of pre-defined processing steps for improved object identification and can be either interactive or fully automatic. As with multi color flow cytometry, stained cells can be analyzed in a fully automated manner regardless of tissue type. The software organizes computerized sample movement, autofocus, laser readjustment, data capture and storage as well as calculation. Data are presented as histograms indicating the staining intensity and frequency of each antigen, and in dotplots with each channel plotted against the other. The calculated statistics give information about how many of the cells are single-, double- or triple-reactive and how intensely they react with the respective antibodies. Comparison of data generated by this automated fluorescence confocal laser scanning microscopy (AF-CLSM) with flow cytometry using triple stained peripheral blood lymphocytes revealed a highly significant correlation between the methods (P<0.001). A correlation was also observed when sections triple stained for anti-CD45, -CD3 and -CD8 were analyzed by AF-CLSM and the data were compared to visual/manual cell counting (P<0.01). The AF-CLSM system permits for the first time, fast (online) and reproducible analysis of immunofluorescence staining of an unlimited number of cells in tissue sections. The software, including a manual, is available for a small fee to cover the costs of printing and postage.
Asunto(s)
Técnica del Anticuerpo Fluorescente , Leucocitos/citología , Leucocitos/inmunología , Microscopía Confocal/métodos , Complejo CD3/metabolismo , Antígenos CD8/metabolismo , Estudios de Evaluación como Asunto , Citometría de Flujo , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Neoplasias Renales/inmunología , Neoplasias Renales/patología , Antígenos Comunes de Leucocito/metabolismo , Linfocitos Infiltrantes de Tumor/inmunología , Linfocitos Infiltrantes de Tumor/patología , Programas Informáticos , Coloración y Etiquetado/métodos , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/patologíaRESUMEN
Breast cancer cells frequently exhibit a reduction in expression of major-histocompatibility-complex (MHC) class I proteins which blocks cytotoxic T-lymphocyte (CTL) mediated apoptosis. Recent studies indicate that the 90 kD heat-shock-protein (HSP90) plays a major role in the transfer of antigenic peptides to the MHC class I complex. HSP90 is a molecular chaperone which is involved in signal transduction and regulation of apoptosis. Since HSP90 is described to be elevated in breast cancer, its relationship with MHC class I expression was investigated. Using immunohistochemistry we analyzed the expression and localization of HSP90 and MHC class I in 17 human breast tumors. Positive correlation (p < 0.025) between strong nuclear staining for HSP90 and high MHC class I expression was observed. In tumors with reduced MHC class I expression, no nuclear localization of HSP90 was detectable. These findings lead to the hypothesis that tumor cells with high MHC class I expression and susceptibility to CTL action may escape apoptosis by a mechanism which involves increased nuclear HSP90.
Asunto(s)
Neoplasias de la Mama/inmunología , Núcleo Celular/metabolismo , Proteínas HSP90 de Choque Térmico/metabolismo , Antígenos de Histocompatibilidad Clase I/inmunología , Regulación hacia Abajo , Humanos , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismoRESUMEN
Although word processing has become an accepted business function for many office professionals, physicians have been slow to recognize the many uses that it has to offer. The physician's office can achieve greater productivity and efficiency by the integration of word processing into both the clerical and clinical sectors of medical practice. The task begins with an organization of professional communications and is developed based on the needs of an individual practice.
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Administración de la Práctica Médica , Programas Informáticos , Comunicación , Sistemas de Computación , Dermatología/organización & administración , Humanos , Relaciones Interpersonales , Educación del Paciente como Asunto , Administración de PersonalRESUMEN
One hundred thirteen patients undergoing cardiopulmonary bypass were randomly assigned to receive either bovine or porcine heparin. Heparin was infused at 4.5 mg/kg during bypass and administered at the lesser of 70 units/kg or 5000 units/dose at 12-hour intervals postoperatively. Platelet counts decreased to 45% of preoperative levels during the first 3 days postoperatively (porcine, 44 +/- 13%, n = 50; bovine, 46 +/- 15%), but returned to preoperative levels by the seventh postoperative day. The average blood loss in the porcine heparin group significantly exceeded that of the bovine heparin group (porcine, 1350.7 +/- 727.8 ml; bovine, 1059.6 +/- 381.0 ml; p less than .01). Consequently, the platelet transfusion requirement was greater in the porcine heparin group (porcine, 1.7 +/- 3.9 units; bovine, 0.5 +/- 1.7 units; p less than .05); however, blood and blood component (with the exception of platelets) administration was not significantly different between the two groups. The four patients taking anticoagulants or antiinflammatory agents in the porcine group required a mean of 8.5 units of red blood cells (RBC) plus supplemental platelets. The seven such patients in the bovine group received a mean of 3.0 units of RBC and no platelets. Thus, the use of porcine heparin resulted in a generalized increase in postoperative bleeding with increased management problems in patients undergoing cardiopulmonary bypass.
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Puente Cardiopulmonar , Hemorragia/inducido químicamente , Heparina/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Trombocitopenia/inducido químicamente , Animales , Transfusión Sanguínea , Bovinos , Femenino , Humanos , Masculino , Recuento de Plaquetas/efectos de los fármacos , Transfusión de Plaquetas , Estudios Prospectivos , Especificidad de la Especie , PorcinosRESUMEN
Postcardiotomy sternal infection occurred in 20 (2%) of 1007 patients undergoing cardiac surgery between September 1985 and December 1987, a 10-fold increase over the preceding 33 months (4 [0.24%] of 1627 patients). Cultures were sterile in 5 patients and yielded staphylococci in 12 and a variety of bowel organisms in 3. The cause for the increased occurrence of sternal wound infection is unclear after multivariate analysis, although infections have precipitously dropped subsequent to changing to cefuroxime sodium antibiotic prophylaxis. Treatment has evolved to appropriate antibiotics and early débridement of involved sternum and cartilage. Rewiring the sternum is not attempted. If gross purulence is not present, primary closure is accomplished using muscle flaps (2 patients) or omental pedicle grafts (17 patients). In the presence of gross purulence, the wound is packed open for 5 days and then closed in the above fashion. Two patients required skin grafts for primary closure. The omental pedicle flap is preferred due to simplicity and improved coverage of the sternal defect inferiorly. Nineteen patients healed primarily. A superficial wound infection was drained in 1 patient. Midline incisional hernias developed in 3 muscular patients. Omentum is now harvested through a left subcostal incision. Hospital stay was under 2 weeks in 13 patients. One death occurred due to multisystem failure prior to completion of wound closure. In our experience, early sternal débridement and omental pedicle grafting with primary closure is appropriate therapy for postcardiotomy sternotomy infections. The presence of gross purulence may require 5 days of open packing prior to omental grafting. No significant complications occurred, and mortality was low. A left subcostal incision for omental harvesting is utilized to avoid the occurrence of delayed incisional hernias.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Epiplón/trasplante , Osteomielitis/cirugía , Esternón/cirugía , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/cirugía , Humanos , Tiempo de Internación , Masculino , Osteomielitis/etiología , Osteomielitis/microbiología , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/microbiologíaRESUMEN
During an 11 1/2-year period, 20 consecutive patients presenting with a traumatic disruption of the proximal descending aorta underwent an emergency operative repair. The mean age was 26 years (range 15 to 62), and 13 (65%) were male. Associated injuries were frequent and required additional major operative procedures in half of the cases. Two patients died as a result of associated intracranial injuries, for a hospital survival of 90%. The operative repair was accomplished by graft replacement of the involved segment of the aorta in all but one patient who underwent a primary repair. Simple aortic crossclamping was used in 8 patients (40%) and heparinless femoral-femoral venoarterial bypass in 12 patients (60%). Neither renal failure nor paraplegia in any of the patients. Four patients required thoracic reoperations. These results indicate that an aggressive multidisciplinary surgical approach can produce favorable results in patients with traumatic descending aortic injuries.
Asunto(s)
Aorta Torácica/lesiones , Heridas no Penetrantes/cirugía , Adolescente , Adulto , Aorta Torácica/cirugía , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A method for surgically limiting pulmonary blood flow in the critically ill neonate with truncus arteriosus is described. Two recent cases utilizing this technique are presented. Comparisons are made between this and other palliative surgical procedures used in truncus arteriosus.
Asunto(s)
Cuidados Paliativos , Arteria Pulmonar/cirugía , Tronco Arterial Persistente/cirugía , Constricción/métodos , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Recién Nacido , Masculino , Politetrafluoroetileno , Tronco Arterial Persistente/complicacionesRESUMEN
Systemic hypothermia became a major problem in one of our patients undergoing postcardiotomy mechanical circulatory support with a centrifugal pump. We have developed a technique to prevent systemic hypothermia in this setting by applying an adapted topical cardiac cooling device to the centrifugal pump heads.
Asunto(s)
Circulación Asistida/instrumentación , Corazón Auxiliar/instrumentación , Hipotermia/prevención & control , Adulto , Corazón Auxiliar/efectos adversos , Humanos , Factores de TiempoRESUMEN
Between February 1973 and December 1986, 4,787 patients underwent open heart surgery at Samuel Merritt Hospital. Retrospective analysis revealed 395 (8 percent) consecutive patients who required hemodynamic support with the intraaortic balloon pump. Thirty percent of the patients had preoperative placement, 56 percent needed the balloon in order to wean from cardiopulmonary bypass, and 14 percent required placement in the postoperative period. The intraaortic balloon pump was instituted with multiple techniques and insertion sites. Three hundred eighty-three balloon catheters (96 percent) were inserted through the groin by surgical cutdown or a percutaneous approach. The remaining devices were inserted through the aortic arch. A 12 F. catheter was utilized in 239 patients (61 percent) and a smaller 10.5 F. catheter was placed in 156 patients (39 percent). The hospital mortality rate was 47 percent. Seventy-two of the 395 patients (24 percent) sustained vascular complications related to balloon use. Major complications occurred in 43 patients. Twenty-nine patients sustained minor complications that resolved spontaneously with balloon removal. Risk factors evaluated included patient gender, New York Heart Association class, catheter size, method of introduction, duration of counterpulsation, and presence of symptomatic peripheral vascular disease. Since percutaneous placement was associated with a significant decrease in complications, we concluded that use of the smaller 10.5 F. catheter placed percutaneously is the safest means of employing the intraaortic balloon pump. A monitoring line is placed percutaneously through the femoral artery in high-risk patients before operation. This allows easier access for intraaortic balloon pump placement in hypotensive patients. The presence of a clinical history of peripheral vascular disease was also a highly significant risk factor for vascular complications. Other risk factors increasing the likelihood of vascular compromise included catheter size and duration of counterpulsation.