Inhibition of carotis venous bypass graft disease by intraoperative nucleic acid-based therapy in rabbits.

BACKGROUND: Bypass graft stenosis after venous revascularisation procedures is characterised by massive neointimal and vascular smooth muscle cell proliferation triggered via endothelin-1 synthesis in the vessel wall. Decoy oligodesoxynucleotides (ODN) against the transcription factor activator protein-1 (AP-1) inhibits pre-pro-endothelin-1 expression. METHODS: In 20 rabbits, an end-to-side jugular vein bypass to the carotid artery was performed: (group A) 8 grafts were treated with consensus AP-1 decoy ODN, (group B) 8 with mutated control ODN and (group C) 4 received no treatment. Explantation, histomorphometric and immunohistochemical evaluation was performed after 28 days. RESULTS: Median intimal thickness of groups: (A) 28.3 microm, (B) 48.4 microm, (C) 71.1 microm. The decoy ODN-treated group showed a significant reduction of neointima formation ( P = 0.029) and a downregulation of the endothelin receptor. CONCLUSIONS: In this model, neointima formation was reduced by local transfection with consensus decoy ODN against AP-1. Endothelin A and B receptor expression is downregulated. Molecular target nucleic acid-based therapies seem to be a future means of overcoming neointima proliferation in pressure-induced venous graft failure. Intraoperative local application makes it easy to use in routine revascularisation procedures.

[Capillary hemangioma of the colon as a rare cause of intussusception in adults]. / Kapilläres Hämangiom des Kolon als seltene Ursache einer Invagination beim Erwachsenen.

HISTORY AND ADMISSION FINDINGS: A 39-year-old patient presented with a history of constipation, abdominal pain and nausea. Magnetic resonance imaging showed a colonic tumour. Biopsy of the tumour did not reveal the diagnosis. INVESTIGATION: The abdomen was tense on palpation and inflammation parameters were elevated. On abdominal x-ray signs of obstructive colonic ileus could be seen. Endoscopic investigation revealed a tumorous stricture of the transverse colon presenting as intussusception with cockade phenomenon during sonography. TREATMENT AND CLINICAL COURSE: Because of obstructive ileus laparotomy was performed with extended right hemicolectomy and end-to-end ileotransversostomy. Histology showed the rare finding of colonic intussusception due to a capillary hemangioma. Post-operative clinical course was normal without any further signs or symptoms of systemic disease. CONCLUSION: Intussusception in adult patients can be a rare complication due to gastrointestinal hemangioma. Endoscopy and radiologic imaging may help to establish diagnosis. Surgical resection of the involved bowel segment seems to be a safe and effective treatment. Nevertheless congenital disease must be excluded to prevent further complications.

[Joint loose bodies in the mandible. Diagnostic criteria and pathways for therapy planning]. / Freie Gelenkkörper im KiefergelenkDiagnostische Kriterien und Wege zur Therapieplanung.

Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination.

Serum S-100beta protein release in coronary artery bypass grafting: laminar versus pulsatile flow.

BACKGROUND: Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values and which type might be more neuroprotective have not been made so far. METHODS: All 21 patients of the study were undergoing CABG for the first time and had no history of cerebral disease in whatever form. They were divided into two groups: laminar (n = 10) versus pulsatile (n = 11) pump flow. In all cases, a Stöckert roller pump (Fa. Stöckert, Munich, Germany) with a laminar and pulsatile running mode was used for cardiopulmonary bypass. Serum S-100beta levels were detected using a monoclonal immunoradiometric assay (Sangtec Medical AB, Bromma, Sweden). In total, 5 different samples were drawn per patient, starting before intubation and ending 36 hours after surgery. RESULTS: S-100beta peak values were found at skin closure. Median levels were lower in the pulsatile group. Due to the small study group and wide range, results are non-significant. CONCLUSION: The results indicate that pulsatile flow might have a more neuroprotective effect than laminar flow as S-100beta values were lower.

[Difficulties in noninvasive cardiac stroke volume determination in "small" blood circulation systems]. / Probleme der nichtinvasiven Herzzeitvolumenbestimmung in "kleinen" Blutkreisläufen.

Pulsewave velocity analysis is an option for the noninvasive determination of cardiac output and the evaluation of additional haemodynamic parameters. An algorithm we developed ourselves has been established as a method for the measurement of cardiac output in rabbits. The effectiveness of this program was investigated by monitoring controlled hypoxia-induced alterations in the circulatory system. Calculated values were compared with direct measurements of cardiac output with a Doppler flow probe placed in the ascending aorta. Within the physiological framework of blood gas analysis, a good correlation was found between the two methods. In the case of hypoxia-induced depression, however, the two methods showed diverging results, presumably due to arrhythmia-induced wave reflections within the arterial vascular tree. This makes an extension of the algorithm necessary to take account for these case.