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NYC 9/11 Public Portal Document

AFIP Letter/Vol, 159. No. 5 / October 2001 17

Abstracts of Recent Publications by AFIP Staff Duet) were implanted at a 1:1 stent-to-artery ratio in the coronary arteries of swine with a conventional noncompliant balloon (n = 10) or Influenza RNA not detected suggests that most contemporary clinicians, a novel noncompliant balloon with short ta­ epidemiologists, and pathologists rejected the pered shoulders to prevent edge dissection (n = in archival brain tissues from 9). Quantitative coronary angiography and his­ theory that the 1918 influenza virus was di­ acute encephalitis lethargica rectly responsible for EL. Di sappearance of the tology were used tn evaluate balloon and artery cases or in postencephalitic acute form of EL during the 1920s has pre­ interactions and the chronic vascular responses cluded direct study of thi.s entity. However, to the stents. Nineteen stents were implanted in Parkinson cases the coronary arteries of seven swines at an modern molecular biology techniques have Sherman McCall, MD, James M. made it possible to examine archival tissue inflation pressure of 14 atm using a standard sample.s from victims of the 1918 pandemic in noncompliant (n = 10) or a unique short transi­ Henry,MD, Ann H. Reid, MA, and order to detect and study the genetic structure tional edge protection (n = 9) balloon. Histo­ Jeffery K. Taubenberger, MD, PhD logic analysis at 28 days demonstrated of the killer virus. Similarly, tissue samples Abstract. Encephalitis lethargica (EL) was a from EL victims can now be examined for balloon-associated barotrauma in 13 of 20 (65%) mysterious epidemic, temporally associated evidence of infection by the 1918 influenza of adjacent nonstented arterial segments with with the 1918 Spanish influenza pandemic. virus. the conventional balloon and only 3 of 18 Numerous symptoms characterized this dis­ (17%) of the adjacent nonstented arterial seg­ J Neiirnixill,,)/ Erp Neurol. 2()t) 1160:66.3-670, ease, including headache, diplopia, fever, fatal ments with the short transition edge protection coma, delirium, oculogyric crisis, lethargy, cata­ balloon (P = 0.022). In-stent neointimal area tonia, and psychiatric symptoms. Many pa- Coronary calcification: and % stenosis correlated with the severity of tienus who initially recovered subsequently de­ insights from sudden peristent arterial injury (r = 0.43, H = 0.01). veloped profound, chronic parkinsonism. The Ill-stent vessel injury score,s were similar for etiologic association of influenza with EL is coronary death victims .stent.s with peristent injury (1,0 + 0.3) versus controversial. Five acute EL autopsies and move stents without peristent injury (1.0 + 0.03, P = A. P. Burke, A. Taylor, A. Farb, Q. T. than 70 postencephalitic parkinsonian autop­ 0.73). In-stent neointimal area and % .stenosis Malcom, and R. Virmani were greater for stent.s with peristent injury sies were available in the Armed Forces Insti­ tute of Pathology (AFIP) tissue repository. Two Summary. We studied 108 cases of sudden (2.36 ± 0.74 mm‘, 32% ± 9%) as compared to of these 5 acute EL cases had histopathologic coronary death at autopsy. Any calcification stents without peristent injury (1.39 + 0.70 changes consistent with that diagnosis. The was present in 55% of men and women under 20% + 10%, P = O’OI). Arterial wall remaining .3 cases were classified a.s possible 40 years; all hearl.s showed some calcification injury adjacent to a stent after high-pressure acute EL cases as the autopsy material was by age 50 in men, and by age 60 in women. The deployment contributes to late in-stent insufficient For detailed histopathologic ex­ only risk factor independently associated with neointimal hyperplasia in thi.s model. These amination. RNA lysates were, prepared from 29 increased calcification was diabetes mellitus, experimental data suggest that further study i.s CNS autopsy tissue blocks from the 5 acute in women only. The degree of calcification was warranted to refine stent implantation tech­ cases and 9 lysate.s from bloek.s containing greatest for acute and healed plaque ruptures. niques and that modifications of balloon shape substantia nigra from 2 postencephalitic cases. and the least for plaque erosion. Calcification or material may be useful to optimize stent RNA recovery was assessed by amplification ill coronary atherosclerosis appears to be de­ deployment and reduce arterial trauma. ofbeta-2-microglobulin mRNAand65%ofthe layed in women, is greatest in women diabet­ Colhel Ctirtli/mm- lillm-enl. COOOi.SI :l I 2-1 19. tissue blocks contained amplifiable RNA. Re­ ics, and is associated with one type of plaque verse transcription-polymerase chain reaction instability, namely plaque rupture. (RT-PCR) for influenza matrix and nucleopro­ ZKanlinl. 2000;89(,sippl 2):IM9-n5.L Influenza A virus tein genes was negative in all cases. Thus, it i.s neuraminidase: regions of unlikely that the 1918 influenza viru.s was neu­ rotropic and directly responsible for the out­ Experimental evaluation of a the protein potentially break of EL. short transitional edge involved in virus-host -I NeumpolhnI Exp Neurol. 2(]() 1:6():696 704. protection balloon for interactions Experimenting on the past: intracoronary stent Thomas G. Fanning. Ann H. Reid, and the enigma of von deployment Jeffery K. Taubenberger Economo’s encephalitis Andrew J. Carter, David P. Lee, MD, Phylogcnetically informative amino acid posi­ tions (PlPs) were identified in influenza A lethargica Takeshi Suzuki, MD, Lynn Bailey, neuraminidases of subtypes Nl and N2. Alexandra Lansky, MD, Russ Jones, Ann H. Reid, MA, Sherman McCall, Neuraminidase evolves in a lineage-.specific and Renu Virmani, MD way as the virus adapts to a new host or changes MD, James M. Henry, MD, and Jeffery The purpose of thi.s study wa.s to determine if to evade the host’s immune system. Thus, many K. Taubenberger, MD, PhD balloon injury to the adjacent arterial wall dur­ PlP.s undoubtedly identify positions involved Abstract. Enccphatilis lethargica (EL) wa.s a ing intracoronary stent deployment influences in virus-host interactions. Phylogenetically complex and mysterious disease that appeared late in-stent neointimal formation. Stent design important regions (PIRs) are defined as several around the same time as the great influenza and deployment techniques are considered im­ PIPs near one another. There are 15 PIRs on N1 pandemic of 1918. The contcrnporaneou.s rela­ portant factors in determining acute and and 12 on N2, .seven of which are shared be­ tionship of the 2 diseases led to speculation that long-term .succes.s with intracoronary stenting. tween the two subtypes. Many PIRs are coinci­ they were causally related. Contemporary and Experimental and clinical studies support that dent with antigenic or glycosylation sites. Other subsequent observers conjectured that the in­ the extent of neointimal formation and the PIRs may represent additional antigenic sites fluenza virus, directly responsible for the deaths probability for restenosis are influenced by the or may be invol ved in other aspects of virus-host of more than 20 million people, might also have magnitude of arterial trauma induced with biology. been the cause of EL. A review of the extensive stenting. Nineteen 18-mm-long balloon­ Virology. 2000:276:417-423. literature by observers of the EL epidemic expandable stainless steel stents (MULTI-LINK

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