Simple Needle Research Articles

Low-volume jet injection for efficient nonviral in vivo gene transfer.

The transfer of naked deoxyribonucleic acid (DNA) represents an alternative to viral and liposomal gene transfer technologies for gene therapy applications. Various procedures are employed to deliver naked DNA into the desired cells or tissues in vitro and in vivo, such as by simple needle injection, particle bombardment, in vivo electroporation or jet injection. Among the various nonviral gene delivery technologies jet injection is gaining increasing acceptance because it allows gene transfer into different tissues with deeper penetration of the applied naked DNA. The versatile hand-held Swiss jet injector uses pressurized air to force small volumes of 3 to 10 microL of naked DNA into targeted tissues. The beta-galactosidase (LacZ) reporter gene construct and tumor necrosis factor alpha gene-expressing vectors were successfully jet injected at a pressure of 3.0 bar into xenotransplanted human tumor models of colon carcinoma. Qualitative and quantitative expression analysis of jet injected tumor tissues revealed the efficient expression of these genes in the tumors. Using this Swiss jet-injector prototype repeated jet injections of low volumes (3-10 microL) into one target tissue can easily be performed. The key parameters of in vivo jet injection such as jet injection volume, pressure, jet penetration into the tumor tissue, DNA stability have been defined for optimized nonviral gene therapy. These studies demonstrate the applicability of the jet injection technology for the efficient and simultaneous in vivo gene transfer of two different plasmid DNAs into tumors. It can be employed for nonviral gene therapy of cancer using minimal amounts of naked DNA.

The improvised atraumatic suture: a cost-reducing technique, not only for the tropics?

A simple technique to produce your own atraumatic suture is described. All that is needed is a simple injection needle and any kind of thread.The thread is introduced into the cavity of the needle and fixed by squeezing its end after having broken the hub. This method is very easy to apply and extremely economical.

Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin

Pleural effusion is a common diagnostic problem. The analysis of serum and body fluids for tumor markers has been intensively applied to clinical diagnosis. The aim of the present study was to determine the usefulness of simultaneous quantification of carbohydrate antigen 19.9, carbohydrate antigen 125, neuron specific enolase, mucinous-carcinoma-associated antigen, and ferritin in samples of pleural fluids in the malign pleural effusion and its differentiation from benign effusions. A total of 61 pleural effusions were collected from the patients, who were subjected either to simple needle aspiration or to tube drainage for the diagnosis of pleural effusion. Tumor markers were determined in benign patient groups with nonspecific pleurisy, tuberculous pleurisy, empyema, congestive heart failure and in malignancy groups consisting of adenocarcinoma, small cell lung carcinoma, mesothelioma, epidermoid lung cancer. The tumor markers CA-19.9, CA-125, NSE, and ferritin levels were quantified by the sandwich assay using the streptavidin technology of ELISA in an ES-300 Boehringer-Mannheim analyser. MCA was measured by employing a two-side solid phase EIA method. MCA measurements were done by the Cobas-Core. For all patients, the effusions correctly or incorrectly identified by the different procedures as being malignant or nonmalignant are defined as true positive, false positive, true negative, and false negative, the term ‘positive’ referring to histologically proven malignant pleural effusion while nonmalignant effusions are referred to as ‘negative’. Therefore, sensitivity, specificity, positive predictive value, and negative predictive value were defined as diagnostic parameters. The cut-off values calculated were 352 U/ml for CA-125, 54 U/ml for CA-19.9, 555 for ferritin, 11.1 for MCA and 8.7 for NSE. In our study, the highest sensitivity is found to be MCA with 100%; specificity, CA-19.9 with 97%; PPV, CA-19.9 and MCA with 95% and NPV, MCA with 100%. Our data imply that the co-measurement of MCA+CA-19.9+CA-125 levels may further improve their diagnostic value in malignant pleural effusion compared with that of each tumour marker alone and may be useful in distinguishing malignant from benign pleural effusions.

EFFECTS OF AN INTRAVENOUS CATHETER ON THE LOCAL PRODUCTION OF CYTOKINES AND SOLUBLE CYTOKINE RECEPTORS IN HEALTHY MEN

Like many aspects of physiology, functions of the immune system show considerable diurnal variation. Studies investigating diurnal variations in the circulating amounts of cytokines, in general, used blood samples obtained from an intravenous catheter. The results of such studies may be confounded by an effect of the catheter on local cytokine production. We measured the levels of IL-6, tumour necrosis factor α (TNF-α) and soluble TNF receptors (sTNF-R) p55 and p75 in 20 healthy men between 09:00 and 19:00h in plasma samples obtained from an intravenous catheter and in one additional sample obtained by a simple needle stick in the contralateral arm 10h after baseline. In plasma from the catheter the levels of IL-6 increased significantly over time, TNF-α levels slightly decreased and the time courses of TNF receptor levels showed significant trends of a higher order. Control levels of IL-6, TNF-α and sTNF-R p75 measured in plasma obtained by needle stick after 10h did not differ from baseline, and those of sTNF-R p55 were even higher. We conclude that local alterations in the production of cytokines and soluble cytokine receptors induced by an intravenous catheter represent an important confounding factor for studies investigating diurnal variations in immune functions.

Growth and Morphology of Nd3+, Er3+ and Cr3+ doped YAl3(BO3)4 Single Crystals

Nd3+, Er3+ and Cr3+ doped large single crystals of YAl3(BO3)4 were grown by spontaneous crystallisation and by top-seeded solution growth (TSSG) from a K2Mo3O10 and B2O3 flux. The crystals were grown in orientation with cooling rate 2.4°C/day. The small crystals grown by spontaneous nucleation usually had simple needle shape, while the large crystals grown by TSSG method had either isometrical habit or tabular one. The results suggest that the extremely large pinacoid faces appearing in the case of YAB:Cr3+ growth are due to a high temperature gradient in the flux, and evaporation of the solution. The lattice structure of crystals checked by powder X-ray diffraction is isomorphous to YAB with space group R32. The dependence of crystal habits and growth conditions is discussed.

Growth and Morphology of Nd3+, Er3+ and Cr3+ doped YAl3(BO3)4 Single Crystals

Nd 3+ , Er 3+ and Cr 3+ doped large single crystals of YAl 3 (BO 3 ) 4 were grown by spontaneous crystallisation and by top-seeded solution growth (TSSG) from a K 2 Mo 3 O 10 and B 2 O 3 flux. The crystals were grown in orientation with cooling rate 2.4°C/day. The small crystals grown by spontaneous nucleation usually had simple needle shape, while the large crystals grown by TSSG method had either isometrical habit or tabular one. The results suggest that the extremely large pinacoid faces appearing in the case of YAB:Cr 3+ growth are due to a high temperature gradient in the flux, and evaporation of the solution. The lattice structure of crystals checked by powder X-ray diffraction is isomorphous to YAB with space group R32. The dependence of crystal habits and growth conditions is discussed.

Diagnostic epididymal and testicular sperm recovery and genetic aspects in azoospermic men.

Various procedures for sperm recovery in azoospermic men have been described, from open testicular biopsy to simple needle aspiration from the epididymis and the testis. Fifty-one obstructive and 86 non-obstructive azoospermic men were treated to compare the recovery of spermatozoa obtained by percutaneous aspiration from the epididymis (PESA) and aspiration/extraction from the testis (TESA, TESE) with histopathology. If TESA failed, the work up proceeded with TESE. All patients were karyotyped. Spermatozoa were recovered by PESA or TESA in all obstructive men (51/51 patients). In 22 out of 86 patients with non-obstructive azoospermia, testicular spermatozoa could be successfully recovered by TESA. In five additional patients TESE was successful in recovering spermatozoa where TESA had failed. In 43 patients, neither TESA nor TESE was successful. Sixteen patients chose not to proceed with TESE. Seven out of 86 patients had an abnormal karyotype in the non-obstructive group (8%), none in the obstructive group. In the non-obstructive patient group testicular histopathology showed hypospermatogenesis, incomplete maturation arrest and germ cell aplasia with focal spermatogenesis in cases where spermatozoa were recovered and complete germ cell aplasia, complete maturation arrest and fibrosis in cases where no spermatozoa were found. Spermatozoa were recovered by PESA or TESA from all patients with obstructive azoospermia and from approximately 40% of patients with non-obstructive azoospermia by TESA or TESE. Retrieval of viable spermatozoa in the infertility work-up was highly predictable for sperm recovery in subsequent ICSI cycles. TESA performed under local anaesthesia seems almost as effective as more invasive procedures in recovering testicular spermatozoa, both in obstructive and non-obstructive azoospermic men.

Laparoscopic approach to hydatid liver cysts. Is it logical? Physical, experimental, and practical aspects.

In recent years attempts have been made to treat hydatid liver cysts laparoscopically. The purpose of this study was to evaluate different aspects of this approach and to examine whether a reasonable model could be developed. Three different subjects were analyzed. In the first, physical aspects related to transmembrane pressures were analyzed to demonstrate that evacuation of the cyst under pneumoperitoneum does not carry increased risk of spillage, and may even offer an advantage when the proper technique is used. In the second subject, an isolated liver model of a goat was used to study several techniques for evacuating hydatid cysts without spillage. This was tested qualitatively by demonstrating scolices in the fluid medium around the isolated liver after surgical manipulations. In the third subject, the implication of the technique was evaluated in human patients. According to basic physical assumptions, the following conclusions were reached: (1) The increase in intracystic pressure is equal to or less than the increase in intraperitoneal pressure after pneumoperitoneum. (2) Aspiration of parasitic cysts by laparoscopic needle through a large cannula under "vacuum" or by sealing the cannula and adhering it to the liver by cyanoacrylate or fibrin glue was found to be very safe. Simple needle aspiration failed to prevent spillage. (3) A new transparent cannula 18 mm in diameter with a beveled tip was designed that enables good accessibility to liver cysts and safe evacuation even of huge and complex cysts. The novel technique to manage hydatid liver cysts, described in the study, is feasible, sensible, and safe. The isolated goat liver containing hydatid cysts can be used as a reliable animal model to test new techniques in the future.

8 Intra-articular therapy in osteoarthritis

Although intra-articular therapy is widely used in the treatment of osteoarthritis (OA), those controlled clinical trials which include placebo groups suggest that there is little to be gained over joint aspiration alone, or even over a simple needle prick. Glucocorticoids may however offer a small additional symptom benefit over one or two weeks. Viscosupplementation may offer a slightly longer benefit. Intra-articular radiotherapy probably confers no benefit. Serious adverse effects are rare but local effects may occur in up to 10% of patients treated with viscosupplements. Future research should always include a placebo group in clinical studies, should clarify the possible benefits of viscosupplementation and should include in vitro work to consider the biological basis for possible actions of intra-articular therapy.

Silica thin films applied to Ni-20Cr alloy via combustion chemical vapor deposition

Amorphous silica thin films (<0.5 μm) have been deposited onto Ni-20Cr via combustion chemical vapor deposition (CVD) using two different nozzle assemblies, an oscillating capillary nebulizer (OCN) and a simple nebulizing needle. The deposition conditions were similar for the two different nozzles, although slightly different coating morphologies were observed. The OCN-deposited material was deposited onto rotating samples (4 rpm), and showed a morphology striated in thickness, presumed to be a result of thermal gradients present across the rotating sample. The samples deposited with a nebulizing needle did not show these striations, but rather, showed a nodular morphology. Protection to Ni-20Cr from the flame during deposition is reported, in addition to isothermal oxidation kinetic measurements which quantify the degree of protection provided by silica. Silica reduces the oxidation rate of Ni-20Cr, with less transient oxidation of Ni reported for silica-coated samples, as well as the rate constants of Ni-20Cr being reduced at all test temperatures by more than an order of magnitude. These reductions are attributed to the deposited oxides serving as reactive elements in the chromia scale.

Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection.

Needle Deflection and Sewability on Lockstitch Sewing Machine

It is established that in sewing operation, a needle could be deflected by factor such as sewn fabric structure. Empirically, however, this deflection is considered to be closely related to sewability, but without defining the proper correlation they may have. A series of studies are, therefore, undertaken to find out the correlation between sewabiliity and needle deflection in sewing operation. The present paper is aimed at a proposed method for evaluating the needle deflection. In the method, the deflect-ing force is measured by two gauges attached to the lateral surfaces of a needle shank, and then the deflection is estimated by using a simple needle model. Some model studies are carried out on synthetic paper and cotton fabrics, and their results are presented,

First line immunochemotherapy with cisplatin-based protocol by intraperitoneal and intravenous routes in ovarian cancer: technique and results of 82 cases

Objectives: The aim of this study, initiated in 1982, was to determine the feasibility and the interest of a first-line immunochemotherapy delivered by intraperitoneal (i.p.) and intravenous (i.v.) routes combined in ovarian cancer. Study design: Eighty-two naive patients with a common epithelial cancer entered the study from January 1982 to December 1990 (median follow up > 70 months). For i.p. infusion, we used a simple lumbar puncture needle left in situ for < 2 h. The first 18 patients received monthly by i.p. route: Adriamycin (DXR) 40 mg/m 2, Fluorouracil 1000 mg/m 2, Cisplatin (CDDP) 90 mg/m 2, Bleomycin 30 mg — DGZ (extract of vibrio cholerae) 60 mg/m 2. For the remaining 64 patients Aracytin 500 mg/m 2 replaced DXR and the dose of CDDP was more than doubled (200 mg/m 2) thanks to the use of sodium thiosulfate. All 82 patients received Ifosfamid 1300 mg/m 2 intravenously. Results: Local toxicity consisted in one subcutaneous abscess and one bacterial peritonitis out of 1508 abdominal punctures. Stage III turned out to be the most interesting group to evaluate the efficacy of a first-line protocol. In this group 34 out of 47 patients (72.3%) who underwent an initial incomplete surgery were in complete remission (CR) at second-look. Nevertheless, 21 out of the 34 patients in CR relapsed (61.7%) and 14 died (43.2%). Conclusion: These results show the efficacy of our regimen administered i.p., and the safety of the delivery by a simple needle which avoids the complications of the implantable systems. Nevertheless, the usefulness of a systematic second-line chemotherapy (Paclitaxel?), despite a prognosis situation as favorable as a CR at second-look, must be taken into consideration.

Evaluation of tumor-associated antigens and total sialic acid levels in effusions of malignant and benign origin.

Cytological examination is the most commonly used diagnostic procedure in the differential diagnosis of pleural effusions although the sensitivity of this method in malignancy compared with more invasive procedures is only about 60 'YO Several studies have tried to increase the sensitivity of the cytological examination by using additional immunological or serological methods such as the determination of lactate dehydrogenase, total protein content, tumor-associated antigens, DNA aneuploidea. or expression of different cellular antigens. While the analysis of cellular parameters requires some technical expertise, the detection of humoral factors is more simple. Especially tumor-associated antigens, released by the tumor cells into the effused fluid could possibly become significant in the diagnostic differentiation of the metastatic from the nonmetastatic or benign origin of effusions [ I ] . Of all tumor markers known to date, data are mostly available on CEA, indicating that the concentration of this antigen in effusions could improve the diagnostic accuracy of the cytological examination [ 2 , 3 ] . MCA (mucin-like carcinoma-associated antigen) is a high molecular weight glycoprotein (about 350 kD) which is also expressed in the majority of other adencarcinomas and in normal epithelial cells when detected by immunohistochemical methods[ I ] . Mucin-associated carbohydrate and peptide antigens are currently being investigated for their role in cancer diagnosis, monitoring for progression or metastases, immunotherapy and immunosupression 14-61, With respect to the premise that the new tumor marker MCA could be used as a diagnostic tool to detect metastasis-caused effusions, we determined the MCA concentrations in comparison wth the other carbohydrate antigens CA 19.9 and CA 125, as well as the well known tumor marker total sialic acid (TSA). in pleural effusions and in sera in lung carcinomas This study was undertaken in the Department of Biochemistrq., at Dokuz Eyliil University Medical Faculty, be twen September 1993 and February 1995: a total of 48 effusions were collected from 48 patients, who were subjected either to simple needle aspiration or to tube drainage for the diagnosis of a pleural effusion. Serum samples were obtained concurrently from all of these patients. All cytological examinations were carried out in the same sample as the tumor marker determinations. Classification of the groups were effectuated as follows ( I ) Malignant groups: 14 of those cases were suffering from histologically diagnosed lung malignancies (8 adenocarcinomas, 3 squamous cell carcinomas. 2 small cell carcinomas, and 1 malignant mesothelioma); (2) Benign group: 34 patients with various non-neoplastic disorders were included in this group (23 tuberculosis pleurisy, 5 pleuritis, 3 congestive heart disease, 2 pneumonia+cirrhosis, and I emppyema). The cut-off level between negative and positive ralues of each tumor marker was defined as the mean+2SD (% 95 percentile). Pleural effisions and uncoagulated blood samples were centrifuged at 2000 rpm for 10 minutes to remove cellular components. The supernatants were stored at -70 C until the performance of the tumor marker assays. The tumor markers MCA, CA 19.9 and CA 125 levels were measured in all samples by employing an enzyme-immunoassay method (EIA) (Hoffmann-La Roche, Basel, Switzerland). All measurements were done by the EIA photometer. automatically. The coefficients of lariation of the assays were determined to be as follows: the intra-assay coefficient of variation (CV) were 2.5 % for MCA, 3.4 %for CA 19.9, and 5.6 %for CA 125; the between-assay coefficients of variations ranged between 3.5 %and 9.6 % for MCA, 4.2 % and 11.5 % for CA 19.9, and 3.8 'Yo and 5.5 for CA 125. depending on the concentration of the control sera. TSA concentrations were determined by a modification of Ehrlich method. The reproducibility was checked at various sialic acid concentrations, and CV's were found to be <3.0 Yo in the whole measuring range. The lowest limit of detection defined as the concentration of N-acetylneuraminic acid that could be distinguished from blank with 95 YO confidence, was I mg/dl. The obtained tumor marker concentrations were statistically analyzed using the Student's-t test,Wilcoxon test, and Mann & Whitney test, accepting a p value below 5 Yo (p< 0.05) as significant. The results obtained for each group and for each tumor marker are presented in Table 1 Table I . MCA. CA 19.9. CA 125, and TSA in effusions and sera in lung cancer.

In vivo gene transfer and expression in rat stomach by submucosal injection of plasmid DNA.

Gastrointestinal nonepithelial tissue is a useful target for in vivo gene transfer. The aim of this study was to investigate whether gene transfer into this organ could be achieved by submucosal injection of plasmid DNA. Plasmid DNA carrying either the firefly luciferase or Escherichia coli LacZ reporter gene was injected directly into the gastric submucosa of adult rats. Gene expression was characterized by quantitative luciferase assay and qualitative in situ beta-galactosidase (beta-Gal) staining. Luciferase activity was detected as early as 1 day after injection, increased markedly at 2 days, and then decreased. Some of the rats showed detectable levels of luciferase expression at 14 and 21 days postinjection. Histochemical staining for beta-Gal demonstrated that expression of the recombinant genes was localized in smooth muscle cells of the muscularis mucosae and the muscular layer and mesenchymal cells in the lamina propria. Our results indicate that gene transfer into the gastrointestinal tract can be achieved by simple needle insertion of naked plasmid DNA into the submucosa.

A Puzzling Accidental Intraoperative Finding

To the Editor: A 15-yr-old ASA physical status II patient with a history of hereditary spherocytosis presented to the operating suite for laparoscopic splenectomy. A preexisting 18-gauge intravenous cannula was noted on the left dorsal forearm area just proximal to the radial styloid process. In view of the possibility of substantial blood loss, a 16-gauge intravenous cannula was sited on the dorsum of the right hand. The preexisting cannula was left in place and flushed with 2-5 mL 0.9% normal saline. Intraoperatively, the ETCO2 increased progressively to approximately 41 mm Hg as the pneumoperitoneum was established. For teaching purposes, a venous gas sample was sent for analysis. The initial sample (A) was taken for convenience from the unused preexisting access line. The results were as follows. Sample A, representing the sample taken from the preexisting line, had a pHa of 7.330, PaO2 of 134 mm Hg, and PaCO2 of 43.3 mm Hg. A repeat sample (B) had a similar result. Sample C from the ipsilateral ulnar artery had the following results: pHa of 7.387, PaO (2) of 119 mm Hg, and PaCO2 of 40.0 mm Hg. All results corresponded with ETCO (2) measurements at times of sampling. The possibilities initially explored were 1) inadvertent arterial cannulation, 2) aberrant radial vessel, 3) arteriovenous fistula, and 4) "arterialized" venous blood. The PaO2 results ruled out "arterialized" venous blood as a possibility. On examination, the cannula was clearly situated at some distance from the radial or ulnar arteries. An invasive arterial monitoring device was set up, but pulsatile waveform was not registered. The flow, while not pulsatile, did not appear typical of venous flow. At this point, a fine guidewire was passed gently through the cannula to approximately 15 cm. No resistance was encountered and no evidence of compromised palmar flow occurred. Waveform was again nonpulsatile. Therefore, it was concluded that this preexisting cannula was situated in an arteriovenous fistula. Venous access is a basic requirement for anesthetics. However, little has been published on the attending problems. Vascular access problems are not uncommon. A recent study of 2000 anesthetic incident reports found 65 associated with vascular access, 33 of which involved peripheral access [1]. Three of the latter cases involved cannulation of aberrant or tortuous radial arteries. Insertion of a cannula into a preformed fistula has not been described. Wolf et al. [2] described the development of an arteriovenous fistula after intravenous cannulation in the antecubital fossa. In one instance, fistula formation appears to have followed simple needle insertion for blood donation. Our patient had no previous history of intravenous cannulation but had frequent blood sampling for coagulation studies. It is possible that this anomaly may have resulted from repeated venous puncture or may be congenital. The complications of arterial injection of anesthetics, including the severe chemical endarteritis associated with thiobarbiturates, are well described [3]. It was fortunate that no drugs were infused through the preexisting line. This case highlights the need for careful inspection of preexisting cannulas prior to induction of anesthesia. It also serves as a reminder of the possible morbidity associated with peripheral vascular access. A. Hayes, FFARCSI D. Lohan-Mannion, FFARCSI Y. Gozal, MD Department of Anesthesiology--UHS2 Oregon Health Sciences University Portland, OR 97201

Testicular needle biopsy, open biopsy, epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia

Testicular or epididymal spermatozoa were obtained for in-vitro fertilization and intracytoplasmic sperm injection (ICSI) in 27 cycles out of 33 (in six men the azoospermia proved to have testicular causes). Testicular needle biopsy carried out in addition to surgical open biopsy proved to be an effective method to obtain spermatozoa for ICSI from patients with obstructive azoospermia. Thus it might be possible to replace scrotal operations by simple needle biopsies. Embryos resulting from ICSI with testicular spermatozoa were used in 19 transfers that resulted in six pregnancies. One pregnancy resulted from six embryo transfers from ICSI after microsurgical-epididymal sperm aspiration (MESA). The normal fertilization rates with testicular (37.3%) and MESA spermatozoa (53.7%) did not differ significantly from each other, but with testicular spermatozoa the rate was significantly lower than that obtained with ejaculated spermatozoa and ICSI (59.7%) in the matched couples. The abnormal fertilization of oocytes with one pronucleus was significantly higher with testicular spermatozoa than with ejaculated spermatozoa in the control couples.

Spontaneous Pneumothorax: Comparison of Thoracic Drainage vs Immediate or Delayed Needle Aspiration

In the first part of this study, 61 patients admitted for the first episode or the first recurrence of a spontaneous pneumothorax (SP) were randomly treated with thoracic drainage (TD; 28 patients) or with simple needle aspiration (NA; 33 patients). Success rate of therapy was significantly higher with TD than with NA (93%, CI 84 to 100 vs 67%, CI 51 to 83; p = 0.01). Hospital stay was similar between the two groups (7 +/- 4.6 vs 7 +/- 5.6 days), mainly because NA was delayed by 72 h in 26 patients. Recurrence rates at 3 months were 29% (CI 11 to 47%) after TD, and 14% (CI 0 to 29%) after NA (p > 0.20, NS). In the second part of the study, an additional population of 35 patients was treated by immediate NA, with a success rate of 68.5% (CI 53.5 to 83.5%), and a recurrence rate at 3 months of 30% (CI 10 to 50%). Taken together, our results indicate that NA may be proposed as a first-line treatment of SP, with a successful result in two thirds of patients and recurrence in one fifth of patients. In patients who do not heal with NA, a combined risk of TD failure and short-term recurrence of 50% may be an incentive for undelayed surgical procedures.

NMDA receptor-dependent and -independent immediate early gene expression induced by focal mechanical brain injury

In the present study we analysed, by in situ hybridization, the effects of an extremely localized mechanical brain injury, obtained by the simple needle insertion (30 g) in rat hippocampus or cortex, on the expression of several immediate early genes (c-fos, fosB, c-jun, junB, junD, zif/268). When the needle is deepened into the hippocampus through the cortex, a simultaneous ipsilateral activation of all examined IEGs is observed in both the cerebral cortex and in the dentate gyrus of hippocampus. Maximal effects are detected between 30 and 60 min with the following rank order of induction: zif/268 > c-fos > junB > fosB > c-jun > junD. On the other hand, when the penetration of the needle is limited to the cerebral cortex the activation of the IEGs (c-fos, fosB, junB and zif/268) spreads throughout the ipsilateral cortex but does not involve the hippocampal region. Systemic administration of ketamine, a non-competitive antagonist of N-methyl- d-aspartate (NMDA) receptors, blocks IEG expression induced by brain injury in the cerebral cortex and in the hippocampal dentate gyrus. Pretreatment with the anticonvulsant diazepam, the anaesthetic urethane, or the muscarinic receptor antagonist scopolamine do not affect the injury-induced genomic response. An important regional difference in the sensitivity to the blocking effect of ketamine can be observed analysing the results regarding the zif/268 gene expression in the hippocampus. A clear induction of this gene by needle insertion can be detected both in the dentate gyrus and in the hippocampal layers. However, the dentate gyrus induction is completely blocked by the ketamine pretreatment, while the induction in the hippocampal layers is not affected by this NMDA antagonist. The zif/268 induction in the hippocampal layers is not blocked even if the intracerebroventricular administration of a non-NMDA glutamate receptor antagonist is associated to the systemic pretreatment with ketamine. This result represents the first observation of injury-induced neuronal genomic responses that are not critically dependent on the NMDA receptor activity.

Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography

We evaluated the feasibility of transvaginal methotrexate injection of viable cervical pregnancies to avoid complications of the “classic” surgical procedures in use and to preserve future fertility. Five viable cervical pregnancies, at 6 to 8 weeks, were treated. In three patients a spring-loaded automated puncture device and in two a manually operated simple needle guide mated to and guided by a transvaginal ultrasonography probe were used with 21-gauge needles. The puncture and injection treatment was successful and without complications in all five cases presented. This procedure may become a useful alternative to other, more radical or complex surgical approaches. (AM J OBSTET GYNECOL 1994;170:737-9.)