Septic dislocation of the hip with extension of emphysema

In a 58-year-old woman extension of emphysema was associated with septic arthritis and dislocation of the hip.     

Allogeneic blood transfusion requirements after minimally invasive versus conventional aortic valve replacement: a risk-adjusted analysis

BACKGROUND: Aortic valve replacement (AVR) through a partial sternotomy (mini-AVR) has been suggested to significantly reduce postoperative morbidity compared with conventional AVR. This study sought to investigate whether mini-AVR patients require fewer transfusions than patients who had conventional AVR. METHODS: Of 511 patients who had AVR, 56 had mini-AVR and 455 had conventional AVR. A matched-case logistic regression analysis was used to adjust for these imbalances between groups. RESULTS: No patient in the mini-AVR cohort required conversion to a conventional AVR. Cardiopulmonary bypass time was longer in the mini-AVR group compared with the conventional AVR group, with a median of 102 minutes (range, 78 to 119 minutes) versus 75 minutes (range, 61 to 96 minutes; p < 0.01) in the conventional AVR group. A total of 31 patients (55%) in the mini-AVR group and 336 patients (74%) in the conventional sternotomy group required transfusions during their hospital stay (p < 0.01). After adjusting for differences in preoperative risk factors, year of operation, and surgeon, by matching on propensity score, the differences were not statistically significant (odds ratio = 0.84, 95% confidence interval = 0.40 to 1.75, p = 0.63). CONCLUSIONS: Mini-AVR produces better wound cosmesis and less surgical trauma but requires more time to perform. Matched-case analysis failed to show a significant difference in blood transfusion requirements after mini-AVR compared with the conventional AVR approach.     

Mechanisms underlying DNA damage resistance in a Xiphophorus melanoma cell line

The Xiphophorus hybrid fish model is an important resource for investigating the genetics and molecular biology of melanoma. Consistent with studies using human melanoma cell lines, the Xiphophorus melanoma cell line PSM, survives the lethal effects of ultraviolet-B radiation (UV-B) radiation much better than a cell line derived from normal fish tissue. In contrast to human melanoma cells, which show enhanced nucleotide excision repair, we do not see any differences in the efficiencies of photoenzymatic or nucleotide excision repair in normal and melanoma cell lines. We do, however, observe a significantly reduced growth rate in the melanoma cell line compared with the normal cell line and considerably less effect of UV-B radiation on DNA synthesis. The data suggest that the UV resistance phenotype of PSM cells is due more to the rate of proliferation and increased ability to replicate on a damaged template rather than enhanced repair of DNA photoproducts as observed in human melanoma cells. The putative increase in lesion bypass by DNA polymerase could result in higher mutation frequencies and enhanced genetic lability in fish melanoma cells.     

Silastic drains vs conventional chest tubes after coronary artery bypass

STUDY OBJECTIVES: To investigate differences in drainage amounts and early clinical outcomes associated with the use of Silastic drains, as compared with the conventional chest tube after coronary artery bypass grafting (CABG). DESIGN: Retrospective nonrandomized case control study. SETTING: A tertiary teaching hospital. Patients and participants: Outcome data from 554 patients who underwent postoperative pericardial decompression using small Silastic drains were compared with those from 556 patients who had conventional chest tubes after first-time CABG at our institution between January 1 and August 1, 2000. Measurement and results: Univariate analysis of preoperative characteristics was used to ensure similarity between the two patient groups. Operative mortality, mediastinitis, reoperation for bleeding, and early and late cardiac tamponade occurred in 9 patients (1.6%), 6 patients (1.1%), 6 patients (1.1%), 6 patients (1.1%), and 1 patient (0.2%), respectively, in the Silastic drain group, compared with 11 patients (2.0%), 9 patients (1.6%), 4 patients (0.7%), 2 patients (0.4%), and 6 patients (1.1%) in the conventional group. No statistically significant differences between the two drains were identified. Drainage amounts (mean +/- SD) were 552.2 +/- 281.8 mL and 548.8 mL +/- 328.7 mL for the Silastic and conventional groups, respectively (p = 0.51). Postoperative length of stay was longer for the conventional chest tube group (median, 5 d; range, 1 to 119 d) when compared to the Silastic drain group (median, 4 d; range, 1 to 66 d; p = 0.01). CONCLUSIONS: We demonstrated that small Silastic drains are equally as effective as the conventional, large-bore chest tubes after CABG with no significant risk of bleeding or pericardial tamponade. Additionally, use of Silastic drains allows more mobility than the conventional chest tubes. As a result of this study, there was a change in our clinical practice toward the exclusive use of Silastic drains after all cardiac surgical procedures.     

Fluorescence in situ hybridization: method of choice for a definitive diagnosis of mantle cell lymphoma

Fluorescence in situ hybridization (FISH) using IGH/CCND1 probes was used to analyze 35 specimens including 27 paraffin sections, 3 bone marrow aspirates, and 5 peripheral blood smears. The 27 paraffin sections included 7 bone marrows, 10 lymph nodes, 3 spleens, 3 tonsils, 3 gastrointestinal biopsies, and 1 skin biopsy. Among these cases, 23 specimens were from 20 patients with mantle cell lymphoma (MCL) and 12 specimens were from 12 patients with non-MCL lymphomas/lymphoid hyperplasia. Specimens from all MCL patients showed positive results with FISH. In one patient, the archived paraffin sections were negative with FISH, but a fresh peripheral blood specimen showed a positive result. Negative results were obtained in all specimens from non-MCL cases. Flow cytometric analysis revealed that all cases of MCL showed CD19/CD5 staining, but the percentages of cells positive for CD23 and FMC-7 were variable, thus they cannot be depended upon for a definitive diagnosis of MCL. Immunohistochemical stains demonstrated positive staining for CD5 and CD20 and negative staining for CD23 in MCL cases but cyclin D1 was positive in only 10 of 13 MCL cases studied. Therefore, it appears that immunophenotyping alone is not sufficient to establish a definitive diagnosis of MCL. FISH should be routinely used when the diagnosis needs confirmation. FISH can be performed in a routine clinical laboratory, and it is applicable to archived material for retrospective studies. Other molecular cytogenetic techniques in comparison with FISH are discussed.     

Rejection of an MHC class II negative tumor following induction of murine syngeneic graft-versus-host disease

Cyclosporin A (CsA) has been used clinically to induce graft-versus-host disease following autologous bone marrow transplantation in an attempt to destroy residual leukemia cells and reduce relapse. To analyze the antitumor potential of murine syngeneic graft-versus-host disease (SGVHD), C3H/HeN mice were lethally irradiated, reconstituted with T cell-depleted syngeneic bone marrow (ATBM) and treated with CsA for 21 days. Graft-versus-leukemia activity was assessed by challenging groups of olive oil-treated control ATBM (OO-ATBM) and CsA-treated (CsA-ATBM) mice 1 week after CsA therapy with graded doses of the syngeneic 38C13 B cell lymphoma. Following CsA treatment, up to 70% of CsA-ATBM developed SGVHD and more than 70% of the animals injected with 500 38C13 cells exhibited long-term survival (MST >80 days). In contrast, none of the OO-ATBM control mice developed SGVHD, and more than 75% of these mice died following injection of 500 38C13 tumor cells (MST = 34 days). Long-term survivors were not resistant to tumor challenge suggesting that tumor-specific immunity did not develop. Finally, class II negative 38C13 cells cultured in IL-4 or IL-10 were not inducible for MHC class II molecules, demonstrating that class II-independent antitumor mechanisms exist in SGVHD mice.