Perinatal outcome in pregnancies with a positive serum screening for Down's syndrome due to elevated levels of free beta-human chorionic gonadotropin.
(17/1180)
OBJECTIVE: To evaluate the potential clinical use of maternal serum free beta-human chorionic gonadotropin (beta-hCG) and uterine artery Doppler investigation to screen for placenta-related adverse outcome in pregnancies at positive risk for Down's syndrome at 15-18 weeks. DESIGN: A cohort of 329 consecutive pregnant women with a singleton viable pregnancy and a positive risk for Down's syndrome was retrospectively investigated. This group was obtained from an unselected population of 3952 women attending the same hospital over a 2-year period. Using the results of this first analysis, we selected a group of 26 women with unexplained high levels of free beta-hCG and followed them prospectively with monthly ultrasound and uterine artery Doppler examinations. RESULTS: In the retrospective cohort, risk ratios stratified for maternal serum beta-hCG multiple of the median (MoM) values indicated that the highest incidence of adverse pregnancy outcome was in those women with values of > or = 5.0. In the prospective study, pregnancy outcome was complicated by uteroplacental disorders in eight cases. Analysis of the Doppler investigation indicated that, in women with a very high level of hCG, an abnormally high uterine artery pulsatility index (PI) had lower sensitivity and negative predictive value than early diastolic notch, whereas the specificity and positive predictive value were higher for a high uterine artery PI. CONCLUSIONS: These findings suggest an association between a high level of maternal serum beta-hCG at 15-18 weeks, the presence of an early diastolic notch in the uterine artery flow velocity waveform and adverse pregnancy outcome due to abnormal development of the uteroplacental circulation. Young women with an unexplained high beta-hCG level would benefit, apart from detailed sonography of the fetus and/or karyotyping, from uterine Doppler investigation and counselling about the follow-up and management of placenta-related pregnancy disorders. (+info)
Sexual function in women suffering from aortoiliac occlusive disease.
(18/1180)
OBJECTIVE: To describe the sexual function in women suffering aortoiliac occlusive disease (AIOD) and in an age-matched reference group. PATIENTS AND METHODS: Thirty-six women suffering from AIOD were included. Twenty were investigated before vascular intervention (untreated) and 16 different women after treatment (treated). Eighteen age-matched women served as a reference group. The patients answered a questionnaire including sexual, social and medical questions and a gynaecological examination was performed. RESULTS: Untreated patients with AIOD have a significantly impaired physical well-being compared to the other groups (p < 0.001). A negative effect of the vascular disease and its treatment on sexual life was experienced by 69% of treated compared to 40% affected among untreated (p = 0.05). Vulval sensibility was impaired in 44% of treated, 11% of untreated and 22% of reference patients. Defective anal sphincter function was found in 33% of treated, 17% of untreated and 6% in the reference group. Those differences were not statistically significant. CONCLUSIONS: Symptomatic AIOD in women is associated with a significantly impaired physical and sexual well-being. Though limited by size and methodology, the results indicate the possibility of iatrogenic nerve damage. (+info)
Aortoiliac stenting, determinants of clinical outcome.
(19/1180)
OBJECTIVES: To determine predictors of clinical outcome in stenting aortoiliac disease. DESIGN: Prospective/retrospective study. MATERIALS AND METHODS: One hundred and forty patients (163 limbs) underwent iliac artery stenting in the period 1994-1997. Ninety-eight occlusions and 65 stenoses were treated, either with primary stenting (n = 129) or after failed angioplasty (n = 34). Median follow-up 18 months (1-66). Factors analysed for their effect on outcome were: gender, age, Fontaine stage, ABI, lesion type/length/site, primary or secondary stenting, stent type, BP, smoking, diabetes, aspirin, cholesterol, residual gradient, overhanging and run-off. RESULTS: The immediate success was 95%. The primary successful clinical outcome was 90% at 12 months and 84% at 36 months; the primary-assisted successful clinical outcome was 95% at 12 months and 91% at 36 months and the secondary successful clinical outcome was 92% at 12 months and 87% at 36 months. Adverse factors affecting outcome were: residual pressure gradient (> 10 mmHg) and no treatment with aspirin (p < 0.05). Major complications occurred in 18% of patients with a re-intervention in 8%. The 30-day mortality was 5.5%. CONCLUSIONS: Stenting for aortoiliac occlusive disease has good short and long term clinical success, with low morbidity and mortality. Factors that might improve results further are ensuring that patients are taking aspirin and any residual pressure gradient is abolished. (+info)
A case of cervical pregnancy resistant to intramuscular methotrexate therapy is presented, which was successfully treated by intra-arterial methotrexate followed by selective prophylactic hypogastric artery embolization to avoid aggravating the vaginal bleeding. It is suggested that, in cervical pregnancies in which fertility preservation is desired, a stepwise conservative approach should be applied before resorting to surgical intervention. (+info)
Infrarenal aortic surgery with a 3-day hospital stay: A report on success with a clinical pathway.
(21/1180)
PURPOSE: This paper reports on an experience with a clinical pathway for elective infrarenal aortic surgery (AS) that targeted hospital discharge on postoperative day (POD) 3. The pathway incorporated early feeding, early ambulation, and selective use of the intensive care unit (ICU). METHODS: A review of 50 consecutive hospital discharges after AS (aneurysm repair and aortofemoral bypass grafting) by a single surgeon performed from April 1996 through June 1998 with this clinical pathway is reported. The data collected included morbidity rate, mortality rate, length of stay (LOS), and number of hospital readmissions. RESULTS: The average LOS for all patients was 3.0 days. Only six patients (12%) were admitted to the ICU. Discharge on POD 3 was achieved in 80% of the group (40 of 50), and increasing experience improved compliance, with 92% of the most recent 25 patients (23 of 25) being discharged by POD 3. Eleven of these 25 patients (44%) were discharged on POD 2. No patient was readmitted to the hospital within a 30-day period after discharge. There was no mortality after AS during this period. CONCLUSION: Factors that limit the discharge of patients recovering from AS include the ability to ambulate independently and to tolerate a diet. Ambulation and feeding on POD 1 were well tolerated by most patients, which shortened the period of hospitalization. Admission to the ICU was infrequently required when a monitored surgical step-down unit was available. Discharge by POD 3 for AS has been proven to be routinely achievable, safe, and well accepted by patients and to reduce the cost of hospitalization. (+info)
Glucocorticoid resistance caused by reduced expression of the glucocorticoid receptor in cells from human vascular lesions.
(22/1180)
Mechanisms that control the balance between cell proliferation and death are important in the development of vascular lesions. Rat primary smooth muscle cells were 80% inhibited by low microgram doses of hydrocortisone (HC) and 50% inhibited by nanogram concentrations of transforming growth factor-beta1 (TGF-beta1), although some lines acquired resistance in late passage. However, comparable doses of HC, or TGF-beta1, failed to inhibit most human lesion-derived cell (LDC) lines. In sensitive LDC, HC (10 microg/mL) inhibited proliferation by up to 50%, with obvious apoptosis in some lines, and TGF-beta1 inhibited proliferation by more than 90%. Collagen production, as measured by [3H]proline incorporation or RIA for type III pro-collagen, was either unaffected or increased in the LDCs by HC. These divergent responses between LDC lines were partially explained by the absence of the glucocorticoid receptor (GR) and heat shock protein 90 mRNA in 10 of 12 LDC lines, but the presence of the mineralocorticoid receptor and 11beta-hydroxysteroid dehydrogenase type II. Western blot analysis confirmed the absence of the GR protein in cells lacking GR mRNA. Immunohistochemistry of human carotid lesions showed high levels of GR in the tunica media, but large areas lacking GR in the fibrous lesion. Considering the absence of the GR in most lines, the effects of HC may be elicited through the mineralocorticoid receptor. Functional resistance to the antiproliferative and antifibrotic effects of HC may contribute to excessive wound repair in atherosclerosis and restenosis. (+info)
Pre-treatment with elastase improves the efficiency of percutaneous adenovirus-mediated gene transfer to the arterial media.
(23/1180)
The endothelium and internal elastic lamina (IEL) appear to be the main barriers to adenovirus-mediated gene transfer to medial smooth muscle cells (SMC). The present randomized study tested whether controlled incubation with elastase enhanced the efficiency of catheter-based gene transfer to medial SMC by adenoviral vectors. After an initial safety dose ranging study, rabbits underwent balloon abrasion of the iliac endothelium followed by local incubation of either elastase (2 x 10(-7) IU over 5 min) or saline using a double balloon catheter (DBC). Then, adenoviral vectors (5 x 10(9) p.f.u.) carrying Cmv-Luc or RSV-beta gal reporter genes were instilled for 30 min. Three days later, the number of medial SMC expressing lacZ was increased in the elastase-treated arteries compared with saline-treated arteries (7.2 +/- 2.5 versus 2.3 +/- 0.9 cells per section, P = 0.003). Likewise, the amount of luciferase protein product was increased (70 +/- 32 versus 36 +/- 15 pg luciferase/mg tissue, P = 0.03). No vessel enlargement, light or electron microscopic evidence of injury or inflammation was seen in elastase-treated arteries up to 7 weeks. Preincubation with elastase increased transduction efficiency of catheter-based gene delivery of replication-defective adenoviral vectors to rabbit iliac arteries without detectable arterial damage. (+info)
Pharmacological properties of J-104132 (L-753,037), a potent, orally active, mixed ETA/ETB endothelin receptor antagonist.
(24/1180)
J-104132 [(+)-(5S,6R, 7R)-2-butyl-7-[2-((2S)-2-carboxypropyl)-4-methoxyphenyl]-5-(3, 4-methylenedioxyphenyl)cyclopenteno[1,2-b]pyridine-6-carboxylic; also referred to as L-753,037] is a potent, selective inhibitor of ETA and ETB endothelin (ET) receptors (e.g., Ki: cloned human ETA = 0.034 nM; cloned human ETB = 0.104 nM). In both ligand-binding and isolated tissue preparation protocols, the inhibition of ET receptors with J-104132 is reversible and competitive. In vitro, J-104132 is a potent antagonist of ET-1-induced accumulation of [3H]inositol phosphates in Chinese hamster ovary cells stably expressing cloned human ETA receptors (IC50 = 0.059 nM), ET-1-induced contractions in rabbit iliac artery (pA2 = 9.70) and of BQ-3020-induced contractions in pulmonary artery (pA2 = 10.14). J-104132 is selective for ET receptors because it had no effect on contractions elicited by norepinephrine or KCl in the vascular preparations. The in vivo potency of J-104132 was assessed using challenges with exogenous ET-1. In conscious mice, 5 nmol/kg i.v. ET-1 causes death. Pretreatment with J-104132 prevents the lethal response to ET-1 when administered i.v. (ED50 = 0.045 mg/kg) or p.o. in fed animals (ED50 = 0.35 mg/kg). In conscious, normotensive rats, pressor responses to 0.5 nmol/kg i.v. ET-1 are inhibited by J-104132 after i.v. (0.1 mg/kg) or p.o. (1 mg/kg) administration. In anesthetized dogs, ET-1 was administered directly into the renal artery or brachial artery to generate dose-response (blood flow) curves, and the inhibitory potency of J-104132 (i.v. infusion) was quantified. J-104132 produced greater than 10-fold shifts in the ET-1 dose-response curves at 0.03 mg/kg/h (renal) and 0.3 mg/kg/h (brachial). Oral bioavailability of J-104132 in rats was approximately 40%. These studies indicate that J-104132 is a selective, potent, orally active antagonist of both ETA and ETB receptors and is an excellent pharmacological tool to explore the therapeutic use of a mixed ETA/ETB receptor antagonist. (+info)