Embolization with Onyx in iatrogenic bleeding of the gluteal region

We report a unique method using transcatheter Onyx embolization in a bleeding due to morphine injection in the gluteal region. A 47-year-old man with a rare blood type presented a painful gluteal hematoma due to iatrogenic injury. A computed tomographic angiography verified bleeding from a suspected branch of the deep femoral artery. Because of the unbearable pain, the hematoma was evacuated by means of computed tomography (CT)-guided puncture and the insertion of a pigtail catheter combined with the injection of a human plasminogen activation agent (t-PA). The initial result was positive. To stop the bleeding, angiographic embolization with Onyx was successfully used. Onyx can be used in small vessel bleedings and might offer the advantage of selective embolization in cases where the access to the bleeding vessel is challenging or time-consuming.     

Increases of calcium and phosphorus in the uterine arteries with aging

To elucidate compositional changes of the uterine artery with aging, the authors investigated age-related changes of elements in the uterine arteries. After ordinary dissection by medical students at Nara Medical University was finished, the uterine arteries were resected from the subjects. The element content of the uterine arteries was analyzed by inductively coupled plasma-atomic emission spectrometry. The subjects ranged in age from 58 to 99 yr (average age=82.7±10.1 yr). It was found that the Ca, P, and Na contents increased progressively in the uterine arteries with aging. A significant accumulation of Ca and P in the uterine arteries was found in the sixties and increased markedly in the eighties. It should be noted that as far as the arteries in those over 70 yr of age, the extent of accumulation of Ca and P was the highest in the uterine arteries within the limits of the arteries analyzed by us. Regarding the relationships among elements, significant direct correlations were found among the contents of Ca, P, Mg, Zn, and Na. As Ca increased in the uterine arteries, P, Mg, Zn, and Na increased simultaneously in the arteries.     

Effect of cortisol on norepinephrine-mediated contractions in ovine uterine arteries

Cortisol potentiated norepinephrine (NE)-mediated contractions in ovine uterine arteries (UA). We tested the hypothesis that cortisol regulated alpha(1)-adrenoceptor-mediated pharmacomechanical coupling differentially in nonpregnant UA (NUA) and pregnant UA (PUA). Cortisol (10 ng/ml for 24 h) significantly increased contractile coupling efficiency of alpha(1)-adrenoceptors in NUA, but increased alpha(1)-adrenoceptor density in PUA. Cortisol potentiated NE-induced inositol 1,4,5-trisphosphate [Ins(1,4,5)P(3)] synthesis in both NUA and PUA, but increased coupling efficiency of alpha(1)-adrenoceptors to Ins(1,4,5)P(3) synthesis only in NUA. Carbenoxolone alone did not affect NE-mediated Ins(1,4,5)P(3) production, but significantly enhanced cortisol-mediated potentiation of NE-stimulated Ins(1,4,5)P(3) synthesis in PUA. In addition, cortisol potentiated the NE-induced increase in Ca(2+) concentration in PUA, but increased NE-mediated contraction for a given amount of Ca(2+) concentration in NUA. Collectively, the results indicate that cortisol potentiates NE-mediated contractions differentially in NUA and PUA, i.e., by upregulating alpha(1)-adrenoceptor density leading to increased Ca(2+) mobilization in PUA while increasing alpha(1)-adrenoceptor coupling efficiency and myofilament Ca(2+) sensitivity in NUA. In addition, the results suggest that pregnancy increases type 2 11 beta-hydroxysteroid dehydrogenase activity in the UA.     

Pregnancy-induced alterations of vascular function in mouse mesenteric and uterine arteries

Normal pregnancy involves dramatic changes to maternal vascular function, while abnormal vascular adaptations may contribute to pregnancy-associated diseases such as preeclampsia. Many genetic mouse models have recently emerged to study vascular pathologies of pregnancy. However, vascular adaptations to pregnancy in normal mice are not fully understood. Thus, we studied changes in vascular reactivity during normal mouse pregnancy. We hypothesized that pregnant mice will have enhanced endothelial-dependent vasodilation compared with nonpregnant mice, via an enhancement of the nitric oxide synthase (NOS) prostaglandin H synthase (PGHS), and other endothelial-derived hyperpolarizing pathways. Late pregnant (Day 17-18) C57BL/6J mice (n = 10) were compared with nonpregnant mice (n = 7). Uterine and mesenteric arteries were mounted on a wire myograph system and assessed for endothelium-dependent (methacholine) and -independent (sodium nitroprusside; SNP) relaxation responses. Endothelial-dependent relaxation was enhanced in pregnant uterine and mesenteric arteries, which was blunted after the addition of inhibitors of the PGHS or NOS pathways. In nonpregnant mice, these pathways had no effect in modulating relaxation in uterine arteries, whereas vasodilation in mesenteric arteries was reduced only by NOS inhibition. Both uterine and mesenteric vessels had nonnitric oxide- and nonprostaglandin-mediated relaxation, but this relaxation was not enhanced during pregnancy. Endothelial-independent relaxation was also enhanced in pregnant uterine but not mesenteric arteries. Our data indicate that uterine and mesenteric arteries from pregnant mice have enhanced vasodilation. Understanding vascular adaptations to normal mouse pregnancy is crucial for interpreting changes that may occur in genetic mouse models.     

Upregulation of eNOS in pregnant ovine uterine arteries by chronic hypoxia

We tested the hypothesis that chronic high-altitude (3,820 m) hypoxia during pregnancy was associated with the upregulation of endothelial nitric oxide (NO) synthase (eNOS) protein and mRNA in ovine uterine artery endothelium and enhanced endothelium-dependent relaxation. In pregnant sheep, norepinephrine-induced dose-dependent contractions were increased by removal of the endothelium in both control and hypoxic uterine arteries. The increment was significantly higher in hypoxic tissues. The calcium ionophore A23187-induced relaxation of the uterine artery was significantly enhanced in hypoxic compared with control tissues. However, sodium nitroprusside- and 8-bromoguanosine 3',5'-cyclic monophosphate-induced relaxations were not changed. Accordingly, chronic hypoxia significantly increased basal and A23187-induced NO release. Chronic hypoxia increased eNOS protein and mRNA levels in the endothelium from uterine but not femoral or renal arteries. In nonpregnant animals, chronic hypoxia increased eNOS mRNA in uterine artery endothelium but had no effects on eNOS protein, NO release, or endothelium-dependent relaxation. Chronic hypoxia selectively augments pregnancy-associated upregulation of eNOS gene expression and endothelium-dependent relaxation of the uterine artery.     

Cellular source in ewes of prostaglandin-endoperoxide synthase-2 in uterine arteries following stimulation with lipopolysaccharide.

Prostaglandin-endoperoxide synthase (PTGS) (also known as cyclooxygenase) converts arachidonic acid into several prostaglandins, many of which have roles in vasodilation and vasoconstriction under normal and pathological conditions. There are two isoforms of PTGS: PTGS-1 and PTGS-2; PTGS-1 is constitutively expressed in many tissues and is believed to be involved in the homeostatic maintenance of the body. In contrast, PTGS-2 is believed to have a "differentiative" role in the cells and is highly inducible during inflammation and in response to lipopolysaccharide (LPS). Endothelial cells as well as vascular smooth muscle cells can be a source of PTGS within the artery. The objective of this study was to determine the cell population(s) in uterine arteries that respond to LPS with an increase in PTGS-2 protein expression. Uterine arteries collected from ewes during the follicular (Day 0, Day 0 = estrus, n = 4) or luteal (Day 10, n = 4) phase were treated in vitro with LPS as intact artery segments, cut-open artery segments, or cut-open and denuded (endothelial cells absent) artery segments. After 24 h of LPS treatment, intact, cut-open, and denuded uterine artery segments were collected into homogenization buffer for determination of PTGS-2 protein levels by Western blot analysis. The culture medium was collected and used for detection of 6-keto-prostaglandin F(1alpha) (6-keto-PGF(1alpha)), the stable metabolite of prostacyclin, using an enzyme immunoassay. In addition, the location of PTGS-2 after LPS treatment was analyzed by immunohistochemistry in intact artery segments. Denuded arteries (endothelium absent) did not show increases in PTGS-2 protein in the homogenates or 6-keto-PGF(1alpha) in the culture medium after LPS exposure. In contrast, cut uterine arteries responded to LPS stimulation with a significant increase in PTGS-2 protein in homogenates and 6-keto-PGF(1alpha) in culture medium. Immunohistochemical staining for PTGS-2 was associated with both endothelial cells and vascular smooth muscle cells. These results suggest that while both endothelial cells and vascular smooth muscle cells are associated with PTGS-2, after LPS exposure it is the endothelial cells that are essential in uterine artery increases in PTGS-2 and prostacyclin in response to LPS stimulation.     

Arterial embolization in the treatment of bleeding uterine and bladder neoplasms

We evaluated effectiveness of transcatheter embolization for control of bleeding complicating bladder and uterine neoplasms in 60 patients. Post embolization, bleeding was completely controlled in 95% patients. Complications occurred in 5% of cases. Within 6 months interval haemorrhage recurred in 22% after embolization and its rate depended on selectivity of the procedure (14% vs 60% for proximal embolization). Arterial embolization is safe and effective for control of bleeding from bladder and uterine cancer.     

Adiponectin in patients with various stages of coronary heart disease - comparison of its concentration in coronary arteries and peripheral venous circulation

Adiponectin is an adipocytes-produced protein and showing a number of antiatherogenic effects. Adiponectin seems to be extensively deposited in the intersticium of venous lesions of persons with myocardial infarction. It may exhibit antiatherogenic and reparative effects. A decreased adiponectin concentration may be a risk factor of the origin and complications of atherosclerosis. AIM OF THE STUDY: 1) Do the adiponectin concentrations in venous blood of persons with acute coronary syndrome (ACS) differ from those in persons with stress angina pectoris? 2) In these persons do adiponectin concentrations in venous blood differ from those in main coronary arteries? 3) Do adiponectin levels differ in the infarction and non-infarction arteries in persons with STEMI (ST Elevation Myocardial Infarct) and delay within 4 hours after the onset? 4) In persons with ACS does any correlation exist between venous adiponectin and common risk factors of cardiovascular complications? Adiponectin concentration was determined in samples of blood collected from the peripheral vein and during coronarography in various localizations in 4 groups of examined persons (I. - no signs of CAD, II. - stable stress angina pectoris, III. - ACS over 48 hours without elevations of ST segment, IV. - STEMI during first 4 hours after its origin and proved occlusion of coronary artery at coronarography). Coronary angiography, risk factors and anamnestic data were analyzed. The software Medcalc was used to perform statistical analysis. We examined 73 probands with signs of myocardial ischemia (mean age of 61.5 years, 64 % males), who were subjected to coronarography and 21 healthy volunteers. A mean delay (delay from the origin of complaints to the performed coronarography) was 3.1 +/- 0.5 hours in individuals in the group IV. In patients with ACS we found lower adiponectin concentrations in venous blood compared to healthy individuals and persons with stress AP, but changes were not statistically significant (I.: -5.9 +/- 2.7 ng/l, II.: -4.9 +/- 1.2 ng/l, III.: -5.2 +/- 4.1 ng/l, IV.: -4.6 +/- 2.7 ng/l); no differences were found also with BMI. No significant difference was recorded between the samples of venous blood and those of coronary arteries, nor between the infarction and the non-infarction arteries in the group IV. (5.2 +/- 2.6 ng/l vs. 4.8 +/- -2.7 ng/l). Significant negative correlations were observed between adiponectin concentrations and BMI (correlation coefficient -0.29), triacylglycerols (correlation coefficient -0.4), AOPP (correlation coefficient -0.39), and positive correlations with HDL (correlation coefficient 0.32). No correlation was recorded between adiponectin and CRP. Adiponectin concentrations in persons with ACS are lower than in healthy persons or patients with stable angina pectoris, but differences are not statistically significant. The absence of adiponectin differences between the infarction/non-infarction artery may support the hypothesis of adiponectin uptake in the ischemic lesion with subsequent decrease in blood adiponectin. On the contrary, adiponectin decrease may be a risk factor independent of the origin and development of ACS.     

Determination of optimal planning target volume margins in patients with gynecological cancer

PurposeTo define optimal planning target volume (PTV) margins for intensity modulated radiotherapy (IMRT) ± knee-heel support (KHS) in patients treated with adjuvant radiotherapy.MethodsComputed tomography (CT) scans ± KHS of 10 patients were taken before and at 3rd and 5th week of treatment, fused and compared with initial IMRT plans.ResultsA PTV margin of 15 mm in anteroposterior (AP) and superoinferior (SI) directions and 5 mm in lateral directions were found to be adequate without any difference between ± KHS except for the SI shifts in CTV-primary at the 3rd week. Five mm margin for iliac CTV was found to be inadequate in 10–20% of patients in SI directions however when 7 mm margin was given for iliac PTV, it was found to be adequate. For presacral CTV, it was found that the most striking shift of the target volume was in the direction of AP. KHS caused significantly less volume of rectum and bladder in the treated volume.ConclusionsPTV margin of 15 mm in SI and AP, and 5 mm in lateral directions for CTV-primary were found to be adequate. A minimum of 7 mm PTV margin should be given to iliac CTV. The remarkable shifting in presacral CTV was believed to be due to the unforeseen hip malposition of obese patients. The KHS seems not to provide additional beneficial effect in decreasing the shifts both in CTV-primary and lymphatic, however it may have a beneficial effect of decreasing the OAR volume in PTV margins.     

Final products of lipid peroxidation in various liver diseases of alcoholic etiology

The content of lipid peroxidation products in the plasma of patients with various forms of alcohol-induced liver disorders was investigated. Plasma levels of lipid hydroperoxides in this group of patients were found to be the same as in healthy controls. Plasma content of fluorescent products of lipid oxidation was significantly elevated in patients suffering from acute alcoholic hepatitis and active alcoholic liver cirrhosis, and especially in patients with edematoascitic syndrome. The dynamics of fluorescent product plasma level reduction significantly correlated with the improvement of clinical status in the treatment of abstinent patients.     

Triplex Doppler evaluation of uterine arteries in cyclic and pregnant domestic cats

The aims were to determine resistance index (RI) and pulsatility index (PI) in the uterine arteries of cyclic and pregnant domestic cats comparing the left and right uterine horns, as well as the majority or minority uterine horns, based on fetus number per horn; to determine the presence or absence of an early diastolic notch (EDN) in the uterine artery of pregnant queens. Ten domestic cats were followed during one cycle and one pregnancy until 63rd days after mating. The estrous cycle length was 16 ± 9.57 days. The uterine horn with the highest number of fetuses (majority uterine horn - MUH) presented 2.0 ± 1.0 fetus and the lower (minority uterine horn - miUH) presentes 0.78 ± 0.67 fetus. There were no differences in indexes between uterine arteries during the cycles and pregnancies. The RI and PI of MUH were lower than miUH (P<0.05). Uterine artery of the MUH presented lower indexes than miUH during the acceptance period (P<0.05). On D14 of pregnancy, uterine artery presented reductions in both indexes for the miUH. On D56, the PI was reduced in the miUH. The indexes depended on the week of pregnancy. EDN was present on the uterine arteries of all cats until D35, but disappeared by D49. The blood flow varied according to the category of horn.