The authors produced prostatic phosphatase antiserum in New Zealand rabbits with purified prostatic acid phospha tase. To polypropylene tubes coated with antiserum, patient serum samples and 1-125-labeled antigen are added, mixed, incubated for 45 hr at 4°C,aspirated, washed, and the remaining radioactivity measured in a gamma counter. En zymatic assay of serum prostatic acid phosphatase was per formed by the Besseymethod. Sera from 113patients with prostatic carcinoma were analyzed in conjunction with pathologic staging (Stage 1—24 patients, Stage 11—33 pa tients, Stage 111—31 patients, and Stage IV—25 patients). In addition, sera were measured from 50 controls, 36 patients with benign prostatic hyperplasia, 83 with other cancers, 20 with gastrointestinal disorders, and 28 with total prostatec tomies. With an upper limit set at 8.0 mg per ml, the radio immunoassay diagnosed prostatic cancer in 33, 79, 71, and 92% of patients with Stage I, II, III, and IV disease, respec tively. Comparably, the enzyme assayed demonstrated dc vated serum levels in 12, 15, 29, and 60%, respectively. No The authors describe the results of thyroid hormone ra dioimmunoassay (MA) on sera from 52 normal adults and 21 clinically overt hypothyroid and 21 hyperthyroid subjects. For each subject the total thyroxine concentration (TT4) and total triiodothyronone concentration (TT3) in whole serum were assayed. The corresponding non-protein bound fractions (FF4 and FF3) were performed on a serum clialysate. Mean ‘1T4and TT3 in the normal subjects were 108 ±23 and 1.66 ±0.31 nmole/1 (mean ±SD), whereas FF4 and FT3 were 10.35 ±3.15 and 10.08 ±2.80 pmole/l, respectively. Thus, the total T4:T3 hormone ratio was 65:1, with free hormone ratio being unity. The mean percentage of free-to-total hormone was OOl % for T4, and 0.6% for T3. There was no overlap of assay results in hyperthyroidism with those of the normal group from any of the four tests. for and FF3 (95% , 71.4% , 71.4% , and 23.8% , respectively). larty, the TF4 test had high diagnostic sensitivity in hypo thyroidism. A significant direct and linear relationship existed between corresponding free and total fractions of both T4 of normal FF3 and FF4 levels in a considerable number of symptomatic hypothyroids challenges an extant Bleomycin by a immunoassayand Microbiologic Assay a Com promised This study reports the pharmacokinetics of bleomycin in doses of 7.5 units/rn1 in a 24-year-old male who had an orchiectomy and retroperitoneal node dissection for em bryonal cell testicular carcinoma. Serum and plasma bleo mycin was assayed by existing microbiologic assay and ra dioimmunoassay (RIA). regional cerebral blood volume (rCBV) the and clearing extracerebral tissues. Subtraction of the 31 keV X-ray counts from the 81 keV gamma ray counts has been suggested as a means of correcting for the effect of the contamination on clear ance curves. The present study compares rCBF measure ments based on the total Xe-133 spectrum (X-ray plus gamma) with those obtained using the subtracted spec using compartment model for analysis of the curves. The sub tracted spectrum data gave substantially higher estimates of blood compartment. This along with a shift in the relative weights of the two compartments, indicated a decreased contribution of slow tissue compo nents, consistent with a reduction in extracerebral con tamination. Blood flow values obtained from the subtracted data showed good agreement with the intracarotid method. ratios. in Good image contrast between and normal tissues ap

The standard treatment of coarctation of the aorta is surgical. In the last 2 decades, however, treatment by catheter intervention has become more widespread, using either balloon angioplasty or primary stent implantation. Balloon angioplasty was originally used for recurrent coarctation after surgical repair but has now been shown equally effective for unoperated coarctation. The procedure produces a satisfactory gradient reduction in approximately 80% of patients, with transverse arch hypoplasia the main predictor of poorer outcome. Rates of restenosis and aneurysm formation are less than 10%. Primary stent implantation has been suggested as an option potentially superior to angioplasty alone. Stent implantation limits elastic recoil and potentially reduces aneurysm formation by reducing the amount of balloon stretch required. The incidence of suboptimal gradient reduction is low, probably 5% or less, as is the rate of restenosis. Aneurysm formation, vascular complications, and stent migration also occur in less than 5%. Catheter interventions are now an established treatment strategy for coarctation, with a good success rate and safety profile. The outcome for native and recurrent coarctation appears similar. The authors believe that for most adult patients with coarctation of the aorta, catheter intervention should be offered as initial therapy.

OBJECTIVE:To review the outcomes of transcatheter closure of atrial septal defects using the Cardio-Seal implant.DESIGN:A prospective interventional study.SETTING:Tertiary referral centre.PATIENTS:The first 50 patients (median age 9.7 years) who underwent attempted percutaneous occlusion.INTERVENTIONS:Procedures were done under general anaesthesia and transoesophageal guidance between December 1996 and July 1998.MAIN OUTCOME MEASURES:Success of deployment, complications, and assessment of right ventricular end diastolic diameter, septal wall motion, and occlusion status by echocardiography.RESULTS:The median balloon stretched diameter was 14 mm. Multiple atrial septal defects were present in 11 patients (22%) and a deficient atrial rim (< 4 mm) in 19 (38%). In four patients (8%), a second device was implanted after removal of an initially malpositioned first implant. There were no significant immediate complications. All patients except one were discharged within 24 hours. At the latest follow up (mean 9.9 months) a small shunt was present in 23 patients (46%), although right ventricular end diastolic dimensions (mean (SD)) corrected for age decreased from 137 (29)% to 105 (17)% of normal, and septal motion abnormalities normalised in all but one patient. No predictors for a residual shunt were identified. Supporting arm fractures were detected in seven patients (14%) and protrusion of one arm through the defect in 16 (32%), the latter being more common in those with smaller anterosuperior rims. No untoward effects resulted from arm fractures or protrusion. There were no complications during follow up, although five patients (10%) experienced transient headaches.CONCLUSIONS:The implantation of the Cardio-Seal device corrects the haemodynamic disturbances secondary to the right ventricular volume overload, with good early outcome.

Interventional cardiac procedures for patients with congenital heart disease, developed for the pediatric patient, have been adapted for the adult patient. In this review these unique procedures are reviewed with emphasis on the experience at The Toronto Congenital Cardiac Centre for Adults. Procedures directed to closing shunts include: occlusion of patent ductus arteriosus, coil embolization of aorto-systemic collaterals, coronary fistulas, and Blalock-Taussig shunts, and early attempts at nonsurgical occlusion of atrial septal defects. Balloon dilation procedures include management of pulmonary valve stenosis, peripheral pulmonary artery stenosis, and more recently the application of stents in dilation of coarctation of the aorta. Development of interventional techniques for adult congenital heart disease involves a diverse number of procedures which provide successful nonsurgical options for many patients with congenital heart disease.

Five years or more after receiving cardiac radiation, 41 patients with Hodgkin's disease and seminoma in remission were subjected to echocardiography. The abnormalities detected included pericardial thickening in 70%, thickening of the aortic and/or mitral valves in 28%, right ventricular dilatation or hypokinesis in 39%, and left ventricular dysfunction in 39%. In the 23 patients treated by an upper mantle technique with shielding, the incidence of right ventricular abnormalities and valvular thickening was significantly lower than in patients treated with modified techniques. Although no symptoms were attributable to the observed abnormalities, longer follow-up time may reveal important functional implications.

Count-based scintigraphic left ventricular end-diastolic (LVED) volume measurement was optimized using a reproducible method for determining left ventricular counts and an independently measured average apparent tissue attenuation coefficient (0.16 cm-1). Tissue depth was calculated by triangulation. Results were compared to single-plane contrast ventriculographic volumes by an area-length method, performed within one hour, in 18 patients. The overall correlation of measurements of LVED volume by the 2 methods was 0.96 with standard error of the scintigraphic estimate of 15.8 ml. For 6 patients with angiographically normal wall motion, the correlation of volume measurements was 0.99 with standard error of the estimate of 5.1 ml. The mean absolute difference in LVED volume by the 2 methods was 3.8 ml in the group with normal wall motion compared to 19.2 ml in the 12 patients with angiographically abnormal wall motion. Area-length LVED volume calculation assumes that the left ventricle conforms to a standard shape. Discrepancies in volume estimates with abnormal ventricular wall motion suggest that the area-length method is less accurate. Optimized count-based LVED left ventricular volume measurement is accurate and might be preferable to single-plane contrast angiographic volume measurement of abnormal ventricles.