G.J. Raff

Activation of Mitogen-Activated Protein Kinase in Porcine Carotid Arteries

The thin-filament protein h-caldesmon (the high molecular weight isoform of caldesmon) is phosphorylated in resting and contracted porcine carotid arteries. Phosphorylation of h-caldesmon in intact tissue occurs at sites that are covalently modified by mitogen-activated protein kinase (MAPK) in vitro. In this study, we have evaluated MAPK activation in arteries in response to mechanical load and pharmacological stimulation. MAPK was extracted from resting and stimulated porcine carotid arteries and then partially purified by anion-exchange fast-performance liquid chromatography. MAPK activity was separated into two peaks corresponding to the tyrosine-phosphorylated 42- and 44-kD isoforms of MAPK (p42MAPK and p44MAPK, respectively). Of the total MAPK activity, 42% was associated with p42MAPK, and 58% was associated with p44MAPK, this percentage was not altered by stimulation of the muscles with either KCl (110 mmol/L) or phorbol 12,13-dibutyrate (PDBu, 1 mumol/L). Both p42MAPK and p44MAPK, purified from porcine carotid arteries, phosphorylated h-caldesmon at the same sites and to levels approaching or > 1 mol phosphate per mole protein. In unloaded muscle strips, MAPK activity was 39 pmol.min-1.mg protein-1 when assayed with the peptide substrate APRTPG-GRR. MAPK activity increased in response to incremental mechanical loading to a maximum of 99 pmol.min-1.mg protein-1 at 16 x 10(3) N/m2. MAPK activity could be further increased in loaded muscles by pharmacological stimulation. With KCl stimulation, MAPK activities rose to a peak of 205 pmol.min-1.mg protein-1 at 10 minutes and then declined to basal values at 30 and 60 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Hand-assisted Laparoscopic Management of a Midtrimester Rudimentary Horn Pregnancy with Placenta Increta: A Case Report and Literature Review

Pregnancy in a rudimentary horn is an extremely rare but serious obstetric condition. It is associated with uterine rupture and increased maternal mortality. The standard treatment is excision of the pregnancy and rudimentary horn. Several case reports describe a successful laparoscopic approach for rudimentary horn pregnancies diagnosed in the first trimester. A midtrimester rudimentary horn pregnancy was managed with a hand-assisted laparoscopic technique. This patient sought prenatal care at 19 weeks without any symptoms. A routine ultrasound found an empty uterus and an abdominal pregnancy was suggested. She subsequently had a hand-assisted laparoscopic delivery of a 19-week fetus with excision of the left-sided noncommunicating rudimentary horn. Intraoperative and pathologic findings were both consistent with a noncommunicating uterine horn pregnancy with placenta increta. Midtrimester rudimentary horn pregnancy can be successfully managed via hand-assisted laparoscopy in a patient who is hemodynamically stable.

Laparoscopic Hysterectomy in Patients with Prior Renal Transplantation

With improvement in immunosuppression and surgical techniques, more women are undergoing renal transplantation for management of end-stage renal disease. Location of the transplanted pelvic kidney and transplanted ureter must be taken into consideration when performing pelvic surgery. Two cases in which laparoscopic hysterectomy was successfully performed in patients who had previously undergone renal transplantation are reported.

Laparoscopic-assisted vaginal hysterectomy in a patient with placenta percreta.

Delayed minimally invasive hysterectomy should be considered in women with placenta percreta in order to lessen morbidity and speed postoperative recovery.

Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy.

Laparoscopic supracervical hysterectomy demonstrated fewer preoperative complications and lower postoperative costs compared to laparoscopic-assisted vaginal hysterectomy in this report.