22 patients with moderate and severe haemorrhages of the UAC were given endovenous doses of Pirenzepine (100 mg/48 hrs). The drug was effective in 86% of the cases and its effect on pH values was ...demonstrated by testing before and after administration (p less than 0.01). Better results were observed in the treatment of patients with moderate and severe DUS.
182 patients underwent axillo-femoral bypass between April 1974 and December 1981 (29 women and 153 men). Mean survival was 43 months. The mean age was 68 years (range: 40-90). 10.9% of patients were ...Leriche stage II, stages III and IV accounted for 69.7% of cases. All presented a high surgical risk with cardiac disease present in 43.4% and severe respiratory failure in 36.8%. Depending on the year studied, this procedure represented 10 to 15% of the aorto-iliac revascularisations carried out. Mortality was low (5 cases = 2.7%). Early complications (15%) included 11 cases (6%) of early thrombosis requiring reintervention, and late complications included 48 cardiac problems (26.3%). Analysis of the results in the long term was carried out according to an actuarial method over a period of 10 years. The secondary permeability rate was 86.4% at 5 years and 68.8% at 10 years with a 30% secondary thrombectomy rate (25% long term). Limb conservation at 5 and 10 years was respectively 91.1% and 82.7% while for the same periods survival was 46.7% and 19.7%, confirming the grave condition of the patients. We can conclude that axillo-femoral bypass remains a simple and reliable method with good long term results. When extra-anatomical revascularisation seems indicated, it is particularly suitable for subjects in very poor general health.
The Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) has recently been approved by the Food and Drug Administration for treatment of common iliac artery (CIA) ...aneurysms. Despite early excellent results in clinical trial, none of 63 patients were treated for bilateral iliac aneurysms. The goal of this study was to examine real-world experience using the Gore IBE for bilateral CIA aneurysms.
A retrospective review of an international multicenter (16 U.S., 8 European) experience using the Gore IBE to treat bilateral CIA aneurysms was performed. Cases were limited to those occurring after Food and Drug Administration approval (February 2016) in the United States and after CE mark approval (November 2013) in Europe. Demographics of the patients, presentation, anatomic characteristics, and procedural details were captured.
There were 47 patients (45 men; mean age, 68 years; range, 41-84 years) treated with bilateral Gore IBEs (27 U.S., 20 European). Six patients (12.7%) were symptomatic and 12 (25.5%) patients were treated primarily for CIA aneurysm (aorta <5.0 cm). Mean CIA diameter was 40.3 mm. Four patients had aneurysmal internal iliac arteries (IIAs). Two of these were sealed proximally at the IIA aneurysm neck and two required coil embolization of IIA branches to achieve seal in the largest first-order branches. Technical success was achieved in 46 patients (97.9%). No type I or type III endoleaks were noted. There was no significant perioperative morbidity or mortality. IIA branch adjunctive stenting was required in four patients (one IIA distal dissection, three kinks). On follow-up imaging available for 40 patients (85.1%; mean, 6.5 months; range, 1-36 months), 12 type II endoleaks (30%) and no type I or type III endoleaks were detected. Two of 80 (2.5%) IIA branches imaged were occluded; one was intentionally sacrificed perioperatively.
Preservation of bilateral IIAs in repair of bilateral CIA aneurysms can be performed safely with excellent technical success and short-term patency rates using the Gore IBE device. Limb and branch occlusions are rare, usually are due to kinking, and can almost always be treated successfully with stenting.
OBJECTIVEAlthough highly active antiretroviral therapy has been shown to lower plasma HIV-1 RNA in HIV infection, many patients do not reach the target goal of undetectable viremia. We evaluated ...whether risk of clinical progression varies by level of viral suppression achieved.
DESIGNPatients in the Collaborations in HIV Outcomes Research/United States cohort who maintained stable HIV-1 RNA levels of either <400, 400 to 20,000, or >20,000 copies/mL during a run-in period of at least 6 months were studied. Baseline was the first day after this period.
METHODSProportional hazards models were used to quantify the relation between baseline HIV-1 RNA levels and risk of a new AIDS-defining diagnosis or death after adjusting for CD4 count, age, gender, ethnicity, study site, prior AIDS-defining diagnosis, and antiretroviral therapy history.
RESULTSPatients (N = 3010) were followed for up to 4.3 years after the 6-month run-in period, with 343 deaths or AIDS-defining diagnoses reported. The risk of a new AIDS-defining diagnosis or death was not significantly different in the 400 to 20,000– and <400-copies/mL groups (6% vs. 7%, hazard ratio HR = 1.0, 95% confidence interval CI0.7–1.4; P = 0.9) but was significantly higher in the >20,000-copies/mL group (26%, HR = 3.3, 95% CI2.5–4.4; P < 0.001 vs. the <400-copies/mL group). Median CD4 count changes during the first year of follow-up showed increases of 75 and 13 cells/mm for the <400- and 400 to 20,000–copies/mL groups, respectively, whereas the >20,000-copies/mL group had a decrease of 23 cells/mm.
CONCLUSIONSPatients who maintained baseline HIV-1 RNA levels of 400 to 20,000 copies/mL for at least 6 months preserved immunologic status and were no more likely to die or develop a new AIDS-defining diagnosis in the time frame studied than those with baseline levels <400 copies/mL. Patients with HIV-1 RNA levels >20,000 copies/mL at baseline had greater clinical and immunologic deterioration. These data suggest that maintenance of moderate viremia may confer clinical benefit not seen when viremia exceeds 20,000 copies/mL, and this should be taken into account when considering the risks and benefits of continuing failing therapy.
Human tissue kallikrein (hK1) generates vasodilator kinins from kininogen and promotes angiogenesis by kinin-dependent and kinin-independent mechanisms. Here, we investigate the expression and ...functional relevance of hK1 in human gastrointestinal stromal tumour (GIST).
Vascularisation and hK1 expression of GIST samples were assessed by immunohistochemistry. In two GIST cell lines, hK1 expression was assessed by PCR, and hK1 protein levels and activity were measured by ELISA and an amidolytic assay, respectively. The effect of hK1 silencing, inhibition or overexpression on GIST cell proliferation, migration and paracrine induction of angiogenesis was studied. Finally, local and systemic levels of hK1 were assessed in mice injected with GIST cells.
Human tissue kallikrein was detected in 19 out of 22 human GIST samples. Moreover, GIST cells express and secrete active hK1. Titration of hK1 demonstrated its involvement in GIST invasive behaviour, but not proliferation. Furthermore, hK1 released by GIST cells promoted endothelial cell migration and network formation through kinin-dependent mechanisms. Gastrointestinal stromal tumour implantation in nude mice resulted in local and systemic hK1 expression proportional to tumour dimension.
Human tissue kallikrein is produced and released by GIST and participates in tumour invasion. Further studies are needed to validate hK1 as a diagnostic biomarker and therapeutic target in GIST.
Cette étude a eu pour but de vérifier la fibilité de la méthode de qualification française AFNOR P18-542 3 et de son équivalent canadien CSA A23.2-27A 4, lorsque ces dernières sont utilisées pour ...évaluer la réactivité potentielle alcalis-silice (A-S) de certains sables siliceux naturels d'origine italienne, dont le comportement en service à long terme était déjà bien connu. On a également mis au point une nouvelle méthodologie de qualification qui repose sur l'utilisation de l'examen pétrographique (ASTM C295) 9, de l'essai d'expansion sur mortier MICROBAR (AFNOR P18-588) 13 et d'une méthode de détermination du niveau de seuil des alcalis, NSA 8. S'il a été démontré que la méthode de qualification canadienne n'est pas la plus indiquée pour évaluer la réactivité potentielle A-S des sables examinés, l'évaluation diagnostique fournie par la méthodologie française semble quant à elle pleinement satisfaisante. Toutefois, ces deux méthodes semblent inadéquates lorsqu'il s'agit de prévoir, en termes rigoureux, le comportement expansif d'un granulat donné, en réponse à une variation de la composition et/ou des conditions d'exposition ambiante du béton. Par contre, la méthodologie de qualification proposée, qui repose essentiellement sur le niveau de seuil des alcalis, NSA, servant de paramètre de réactivité pour les granulats siliceux, semble présenter de meilleures garanties, tout du moins en ce qui concerne les sables examinés. In this study, the reliability of both the French (AFNOR P18-542) 3 and the Canadian (CSA A23.2-27A) 4 test methodologies for the qualification of aggregates susceptible of alkali-silica (A-S) reaction in concrete was verified on some Italian natural siliceous sands of known long-term field performance. A new test methodology, based on the utilization of the petrographic examination (ASTM C295) 9, the mortar-microbar expansion test (AFNOR P18-588) 13 and a method of determination of the threshold alkali level, TAL, 8 was also developed. It was found that the Canadian test methodology does not appear to be appropriate for evaluating the potential alkalireactivity of the tested sands. Conversely, a correct diagnosis for the A-S reactivity of these sands is obtained through the use of the French test methodology. However, both test methodologies do not appear suitable for strictly predicting the expansive behaviour of a given aggregate when subjected to variations of composition and/or environmental exposure conditions of concrete. The proposed test methodology, which is essentially based on the use of the threshold alkali level, TAL, as a reactivity parameter, appears to be more appropriate for such a prediction, at least for the sands investigated.PUBLICATION ABSTRACT
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