Genetic technologies. Bioengineered food--safety and labeling.

The safety and labeling of genetically engineered foods are two areas that have elicited considerable public concern and debate. This Policy Forum provides a legal analysis of these issues in the context of two bills that have been recently proposed in The U.S. Congress, the Genetically Engineered Food Safety Act and the Genetically Engineered Food Right to Know Act. Most transgenic components of foods currently on the market are plant-incorporated protectants or their inert ingredients. Therefore, they have been evaluated for safety by the Environmental Protection Agency (as well as the Food and Drug Administration), and their disclosure in labeling should not be required. If plant-incorporated protectants are considered safer than chemical pesticides, and chemical pesticides do not have to be disclosed in labels, then bioengineered foods should not be subject to stricter regulation, nor should they be required to be labeled. The two bills are inconsistent, in many respects, with well-established principles of food regulation.

Deep venous thrombosis with pulmonary embolus after selective embolization of an internal iliac artery aneurysm.

A 69-year-old man with an isolated right internal iliac artery aneurysm measuring 5.6 cm in diameter was treated with percutaneous embolization inducing thrombosis of the aneurysm. Four months later, he was seen with thrombosis of the right common iliac vein and pulmonary embolus. He subsequently underwent ligation of the aneurysm and repair of the right common iliac artery. Computed tomographic and operative findings suggested that the iliac vein thrombosis was the result of direct compression by the aneurysm itself, as well as perianeurysmal inflammation that encased the right common iliac vein. This report summarizes this case and presents a new potential long-term complication after successful selective embolization of an internal iliac artery aneurysm.

A comparative study of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy.

To determine whether the choice of material used for patch closure following carotid artery endarterectomy (CAE) affected the immediate operative results, the early follow-up results, or the incidence of early restenosis, a retrospective study of 275 consecutive carotid endarterectomies by two vascular surgeons was performed. Among 275 primary CAEs performed between July 1991 and August 1993, 159 (57.8%) were closed with saphenous vein (SV), 25 (9.1%) with double-thickness internal jugular vein (JV), and 91 (33.1%) with knitted Dacron (KD). Primary closure was not used in any of the arteries in this series. The overall perioperative mortality rate was 1.1% and the rate of major and minor morbidity was 4.4% There were four (1.5%) perioperative strokes: two (1.3%) in the SV group, one (4.0%) in the JV group, and one (1.1%) in the KD group. Two-hundred fifty-eight (93.8%) of the 275 endarterectomies were followed postoperatively for 2 to 35 months (mean 14.4). Two-hundred nineteen (79.6%) were evaluated using duplex scans during follow-up with a mean interval of 13.7 months. Of the arteries studied, four (3.6%) in the SV group, none in the JV group, and six (8.4%) in the KD group demonstrated restenosis of > 50% at the time of follow-up (NS). In addition, one (0.9%) artery in the SV group, one (5.6%) in the JV group, and none in the KD group demonstrated complete occlusion. Retrospective analysis of the data showed no statistically significant differences in perioperative morbidity, mortality, or early postoperative restenosis whether the artery was closed with saphenous vein, jugular vein, or knitted Dacron patches. Longer follow-up is needed to determine whether rates of late restenosis and aneurysmal dilation will differ between synthetic and autologous patches.

Retroperitoneal caval filter as a source of abdominal pain.

A patient with a Mobin-Uddin vena caval filter placed 10 years earlier was referred with abdominal pain, nausea, anorexia and weight loss. Diagnostic studies confirmed that the filter was in an extracaval position in the retroperitoneum, with the filter struts impinging on the right kidney, duodenum and colon. Following surgical removal of the filter the patient is now symptom-free with good appetite and weight gain.

Testicular calcifications and neoplasia in patient treated for subfertility.

A subfertile male with a history of left cryptorchism underwent scrotal ultrasound that revealed stippled calcifications, without associated mass, in the right testicle. Six months later, while on a regimen of clomiphene citrate, a testicular tumor became palpable. This was sonographically confirmed to be surrounding the calcifications. Testicular calcifications are most commonly associated with benign conditions. We review the literature regarding their relationship to neoplasms and the significance of the ultrasonic findings. Furthermore, this is the sixth reported case of testicular tumor developing during hormonal treatment for oligospermia. Although these cases may be circumstantial, closer surveillance and screening ultrasound may be indicated for subfertile males taking clomiphene citrate.