Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage.

OBJECTIVE: This study investigated bilateral uterine artery chemoembolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP). METHODS: Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m(2) methotrexate. RESULTS: BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2-3 months after treatment in all patients. CONCLUSIONS: BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.

Transendothelial macromolecular transport in the aorta of spontaneously hypertensive rats.

Leaky endothelial junctions occurring during cell turnover have been postulated to be a major pathway for enhanced lipoprotein transport across the vascular endothelial layer, which leads to the development of atherosclerosis. Because hypertension has been well documented as one of the major risk factors for atherosclerosis, we explored the possibility that hypertension accelerates atherogenesis by increasing the turnover of endothelial cells and hence the transendothelial macromolecular permeability. The investigations were performed on thoracic aortas of 10 male 3-4-month-old spontaneously hypertensive rats and eight male age-matched Wistar-Kyoto normotensive rats. In en face preparations of aortic specimens, mitotic endothelial cells were identified by hematoxylin nuclear staining; dying or dead endothelial cells containing cytoplasmic immunoglobulin G were detected by indirect immunoperoxidase technique; and endothelial leakage to Evans blue-albumin conjugate was visualized by fluorescence microscopy. The number of leaky foci per unit endothelial surface area in spontaneously hypertensive rats was found to be approximately three times that in Wistar-Kyoto control rats; the frequencies of both endothelial cell mitosis and death in spontaneously hypertensive rats were also approximately three times the corresponding values in Wistar-Kyoto rats. These findings indicate that hypertension in spontaneously hypertensive rats is accompanied by increased endothelial cell turnover and an attendant enhancement of permeability to macromolecules.

Significance of T wave abnormality in hypertension studied by spatial velocity electrocardiogram and vectorcardiogram.

The ST-T wave abnormality in hypertension has been considered to be an indicator of poor prognosis, but its precise pathophysiological significance remains unclear. The present study was aimed to correlate the electrocardiographic (ECG) change in T wave and left ventricular characteristics studied by echocardiogram. The T wave abnormality in the ECG represented hypertrophy of the left ventricle or abnormality of systolic function, but it was difficult to differentiate either of them by conventional ECG. It was shown in this study that the anterior displacement of the vectorcardiographic T loop was related to the ventricular hypertrophy and that the abnormal shape or inscription of the T loop was more closely related to the ventricular dysfunction rather than hypertrophy. These results suggested that the vectorcardiogram and spatial velocity electrocardiogram were useful for analysis of the T wave abnormality and add important information in addition to the conventional electrocardiogram.

Primary pulmonary angiosarcoma associated with multiple synchronous neoplasms.

A 60-year-old man presented with a 3-month history of shortness of breath. He was found to have a right thoracic mass involving the right middle and lower lobes, pulmonary hilum, and mediastinum. Diagnosis could not be established by pleural fluid cytology, pleural biopsies, bronchoscopy, and ultrasound-guided needle biopsies. A diagnostic exploratory thoracotomy was performed. Massive hemorrhage was encountered upon opening the pleura, and bleeding was controlled by performing a radical pneumonectomy. Histology revealed angiosarcoma, pulmonary primary. The patient survived for 68 days. At autopsy, he was found to have adenocarcinoma of the prostate, adenocarcinoma of the rectum, carcinoid of the ileum, and leiomyoblastoma of the stomach as well as diffuse metastases from the angiosarcoma. This represents the fourth reported case of primary pulmonary angiosarcoma.

ELISA for the detection of angiostrongylus cantonensis antibodies in patients with eosinophilic meningitis.

The enzyme-linked immunosorbent assay (ELISA) was used to examine sera from twelve Taiwanese children with eosinophilic meningitis suspected to be induced by infection with Angiostrongylus cantonensis. Polystyrene tubes were coated with Angiostrongylus cantonensis antigens (5 micrograms/ml protein) prepared from fourth-stage larvae recovered from the brains of experimentally infected rats. Alkaline phosphatase labelled goat antihuman IgG conjugate was used in a dilution of 1 to 500; sera were diluted 1 to 1000. Positive control sera were from patients with parasitologically confirmed infections; the negative control sera from healthy persons. The ELISA values for sera from suspected cases of angiostrongyliasis ranged from 4.5 to 23.1; the positive control sera, 12.7 to 34.4 and the negative control sera 1.3 and 2.2. The assay shows promise and with the use of more purified antigens, micromethods and automated ELISA readers it should become valuable in the presumptive diagnosis of angiostrongyliasis in endemic areas.

Differences among myosins synthesized in non-myogenic cells, presumptive myoblasts, and myoblasts.

Myosins synthesized in non-myogenic cells and replicating presumptive myoblasts differ from those synthesized in postmitotic mononucleated myoblasts and myotubes. Myoblasts and myotubes synthesize the definitive light chains, MLC1 and MLC2. These light chains display different molecular weights in sodium dodecyl sulfate-polyacrylamide gels from the fibroblast light chains FLC1 and FLC2 synthesized in non-myogenic cells and presumptive myoblasts. There are immunological differences between the myosin heavy chains synthesized in myoblasts and myotubes and those synthesized in non-myogenic cells and presumptive myoblasts. Fluorescein-labeled antibodies against skeletal light meromyosin are bound only along the lateral edges of emerging and definitive A-bands. This antibody to light meromyosin is not bound to the outside of, or the microfilaments subtending, the plasma membrane in non-myogenic cells or in myoblasts or in myotubes. These findings suggest that: (1) non-myogenic cells and replicating presumptive myoblasts synthesize similar myosin heavy and light chains; (2) replicating presumptive myoblasts synthesize a different set of myosins from those synthesized by their postmitotic daughters, the myoblasts; (3) the myosins associated with the plasma membranes of non-myogenic and myogenic cells are products of structural genes distinct from those coding for the myosins for skeletal myofibrils.

Synthesis of myosin heavy and light chains in muscle cultures.

The weight ratio of myosin/actin, the myosin heavy chain content as the percentage of total protein (wt/wt), and the kinds of myosin light chains were determined in (a) standard muscle cultures, (b) pure myotube cultures, and (c) fibroblast cultures. Cells for these cultures were obtained from the breast of 11-day chick embryos. Standard cultures contain, in addition to myotubes, large numbers of replicating mononucleated cells. By killing these replicating cells with cytosine arabinoside, pure myotube cultures were obtained. The myosin/actin ratio (wt/wt) for pure myotube, standard muscle, and fibroblast cultures average 3.1, 1.9, and 1.1 respectively. By day 7, myosin in myotube cultures represents a minimum of 7% of the total protein, but about 3% in standard cultures and less than 1.5% in fibroblasts cultures. Myosin from standard cultures contains light chain LC1, LC2, and LC3, with a relative stoichiometry of the molarity of 1.0:1.9:0.5 and mol wt of 25,000, 18,000 and 16,000 daltons, identical to those in adult fast muscle. Myosin from pure myotubes exhibits light chains LC1 and LC2, with a molar ratio of 1.5:1.6. Myosin from fibroblast cultures possesses two light chains with a stoichiometry of 1.8:1.8 and mol wt of 20,000 and 16,000 daltons. Clearly, the faster migrating light chain, LC3, found in standard cultures is synthesized not by the myotubes but ty the mononucleated cells. In myotubes, both the assembly of the sarcomeres and the interaction between thick and thin filaments required for spontaneous contraction occur in the absence of light chain LC3. One set of structural genes for the myosin light and heavy chains appears to be active in mononucleated cells, whereas another set appears to be active in multinucleated myotubes.