Monitoring lung resistivity changes in congestive heart failure patients using the bioimpedance technique

The feasibility of a novel, dedicated system for monitoring lung resistivity in congestive heart failure patients, implementing a hybrid approach of the bioimpedance technique, was assessed in this preliminary study. Thirty-three healthy volunteers and 34 congestive heart failure patients were measured with the PulmoTrace system (CardioInspect, Tel Aviv University, Tel Aviv, Israel) during tidal respiration, and the ability to monitor the respective lung resistivity values was assessed. Mean left and right lung resistivity values of 1205+/-163 and 1200+/-165 ohm.cm for the control group and 888+/-193 and 943+/-187 ohm.cm for the congestive heart failure group were found, indicating a significant (p<2.10(-7)) difference between the two groups. The results of long-term monitoring of two patients during medical treatment are also shown. This hybrid approach system is believed to improve diagnostic capabilities and help physicians to better adjust medication dosage on a frequent basis.     

Regulatory T cells, derived from naïve CD4+CD25- T cells by in vitro Foxp3 gene transfer, can induce transplantation tolerance

BACKGROUND: Regulatory T (Treg) cells, generated in vitro by Foxp3 gene transfer into naive CD4+25- T cells, have been shown to inhibit the development of inflammation and autoimmune disease, but it is not known whether they are able to prevent allograft rejection. This study investigated whether Treg cells generated from naive CD4+ T cells by Foxp3 gene transfer could induce transplantation tolerance. METHODS: HY-specific, T-cell receptor (TCR)-transgenic CD4+25- T cells were retrovirally transduced with the Foxp3 gene. The phenotype, function, and cytokine profiles of the transduced cells were examined in vitro by fluorescence-activated cell sorter, T-cell proliferation assays, enzyme-linked immunosorbent assay, and intracellular cytokine staining. Adoptive transfer and skin grafting experiments were conducted to assess whether Foxp3-transduced HY-specific T cells could prevent the rejection of syngeneic male grafts. RESULTS: CD4+25- T cells retrovirally transduced with Foxp3 express a panel of cell surface and intracellular molecules closely associated with Treg activity. This Treg phenotype was stable during in vitro culture with some further maturation. In vitro, Foxp3-transduced cells were functionally anergic and suppressive T cells. In vivo adoptive transfer of Foxp3-transduced HY-specific TCR-transgenic CD4+ T cells protected male skin grafts from rejection by syngeneic females. Retroviral transduction of the Foxp3 gene into non-TCR-transgenic CD4+25- T cells, however, had no influence on male skin graft rejection. CONCLUSION: This study provides the first evidence that Foxp3-transduced T cells can control the rejection of an allogeneic transplant and suggests that T-cell Foxp3 gene transfer may have therapeutic value in clinical transplantation.     

Treatment of X-linked childhood cerebral adrenoleukodystrophy by the use of an allogeneic stem cell transplantation with reduced intensity conditioning regimen

Childhood cerebral form of X-linked adrenoleukodystrophy (X-ALD) is a rapidly progressive demyelinating condition affecting the cerebral white matter, which rapidly leads to total disability and death. The only known curative treatment for this condition is allogeneic hematopoietic stem cell transplantation (HSCT). Procedure-related toxicity is assumed to be the cause of death of patients with X-ALD. Three cases of ALD successfully transplanted with the use of non-myeloablative fludarabine based conditioning are described. Patients showed smooth peri-bone marrow transplantation course with fast and stable engraftment. In the 3- to 5 yr follow-up period, patients showed no deterioration in their clinical and neurological condition. Levels of very long chain fatty acids were very variable and had a tendency to decrease in at least one of the three patients. In another patient, an improvement of magnetic resonance imaging changes was found. Non-myeloablative HSCT should be considered as an early treatment for X-ALD.     

Lithium inhibitable enzymes in postmortem brain of bipolar patients

Despite considerable ongoing efforts at the epidemiological, genetic and molecular level, the etiology of bipolar disorder had not yet been elucidated. To study possible contributing components to the pathophysiology of this disorder, we have hypothesized that levels of enzymes inhibited by therapeutically relevant lithium ion concentrations in the brain of patients may differ from those in normal controls and may be involved in the etiology of the disorder. Three Li-inhibitable enzymes were studied in postmortem brain samples of bipolar patients and normal controls. The expression and function of the two enzymes that are obviously involved in signaling cascades, IMPase, involved in the second messenger system of the phosphatidylinositol cycle, and GSK-3, a mediator of an array of signaling cascades, were not found to be different in postmortem frontal and occipital cortex of bipolar patients and normal controls. Only PAP phosphatase protein levels, but not its mRNA levels or enzymatic activity, were found to be significantly decreased in frontal cortex of bipolar patients compared with normal controls.     

The prevalence and risk factors for donor corneal button contamination and its association with ocular infection after transplantation

BACKGROUND: One of the most serious complications of corneal transplantation is postoperative ocular infection, which may result in loss of the eye. Contamination of the donor corneal button before transplantation may result in such complication. PURPOSE: To evaluate the prevalence of donor corneal button contamination, the spectrum of the contaminating microorganisms, and their sensitivity to antimicrobial agents. To investigate the risk factors for contamination of the donor corneal buttons and the effect of corneal button contamination on the prevalence of ocular infection in corneal transplanted patients. SETTING: Tertiary referral medical center. MATERIALS AND METHODS: Four hundred sixty-nine corneal transplantations were included in the study. Microbial cultures from the corneoscleral rims of the donor corneal buttons were obtained for isolation of bacteria and fungi and for their sensitivity to antimicrobial agents. Ocular microbial cultures were also obtained from corneal transplanted patients with clinical signs of ocular infection (ie, corneal scrapes from corneal ulcers and vitreous tap from eyes with endophthalmitis). RESULTS: Seventy-nine donor corneal buttons (16.8%) had positive bacterial cultures, and none had positive fungal culture. Staphylococci (63.7%) and streptococci (11.3%) were the most common isolated bacteria. Sensitivity to vancomycin, amikacin, and gentamicin was found in 71.3%, 28.5%, and 22.3% of all isolated bacteria, respectively. Malignancy and cardiac diseases as causes of donor death were associated with donor button contamination (P = 0.043 and P = 0.011, respectively), and septicemia was a marginally significant risk factor (P = 0.059). Age and gender of the donor, duration from death to corneal button harvesting, and time from harvesting to transplantation were not found significant risk factors for contamination. Six of the corneal transplanted patients (1.27%) had infected corneal graft ulcer, and 1 (0.22%) had endophthalmitis. The infected corneal ulcer appeared between 3 and 14 days (average 5 days), and endophthalmitis was disclosed 8 months after transplantation. Two (33%) of the 6 patients with corneal ulcer had the same species as the donor corneal rim. Postoperative ocular infection occurred in 2 (2.5%) patients out of 79 who received contaminated corneal buttons compared with 5 (1.3%) out of 390 patients who received sterile corneal buttons (P = 0.335). CONCLUSIONS: Postkeratoplasty infection of the recipient eye is infrequent despite relatively high prevalence of microbial contamination of the corneal buttons, suggesting that other risk factors for postoperative ocular infection are involved.     

Risk factors for failure of simultaneous penetrating keratoplasty and cataract extraction

OBJECTIVE: To evaluate the indications, complications, and outcomes of simultaneous cataract extraction and penetrating keratoplasty (PKP) and the risk factors for failure of the procedure. SETTING: Tertiary referral medical center. METHODS: In a retrospective noncomparative interventional case series, the charts of 66 consecutive patients (70 eyes) who had simultaneous PKP and cataract extraction using the same surgical technique were reviewed. RESULTS: The mean follow-up was 32.4 months (range 6 to 125 months). The primary corneal graft remained clear in 48 eyes (69%) and failed in 22 eyes (31%). Sixteen eyes with a failed graft (73%) had 1 or 2 repeat keratoplasties; 8 (50%) were successful. At the end of follow-up, 56 eyes (80%) had a clear corneal graft. Nine eyes (41%) with a failed primary graft and 2 eyes (4%) with a clear primary graft had intracapsular cataract extraction (P<.001); 13 eyes (59%) and 46 eyes (96%), respectively, had extracapsular cataract extraction (P<.001). All eyes with a failed primary graft and 18 eyes (37%) with a clear primary graft had postoperative complications (P<.001). Eyes with a failed graft had more postoperative surgical interventions (P<.001). There were no statistical differences between eyes with clear grafts and eyes with failed grafts in sex, age, indications for surgery, corneal graft diameter, intraoperative vitreous loss, and intraocular lens placement. CONCLUSIONS: Intracapsular cataract extraction, postoperative complications, and postoperative surgical interventions may increase the risk for graft failure in simultaneous cataract extraction and PKP. Intraocular lens implantation did not increase the risk for graft failure.     

Atrial metastasis detected by two-dimensional echocardiography

With recent improvements in therapeutic procedures and prolongation of survival, the incidence of cardiac metastasis is likely to increase. The aim of the current study was retrospectively to analyze cases of atrial metastases detected by echocardiography at our center. We report on a series of 10 patients with various solid malignancies and secondary atrial involvement detected by echocardiography. Transesophageal and transthoracic echocardiographic studies were performed using an Acuson 128XP, Aspen or Sequoia (Mountain View CA). Seven patients had cardiac symptoms at the time of diagnosis of atrial metastasis. After diagnosis, therapy included surgery, chemotherapy or radiotherapy. Echocardiography was also used in monitoring response to therapy. One patient with Wilms' tumor has remained free of disease for 50+ months and a patient with Kaposi's sarcoma is alive with disease 20+ months after diagnosis. The remaining eight patients died with disease 3-24 months after being diagnosed with atrial metastasis. Atrial metastases can be diagnosed in patients without cardiac symptoms, and is probably more prevalent than was previously recognized. Echocardiography is a useful diagnostic tool in detecting secondary atrial tumors.     

Gastric Wall Necrosis following Late Prolapse after Laparoscopic Banding

A 20-year-old female, who had suffered from morbid obesity with a BMI of 41.2, was admitted 3 years after undergoing laparoscopic gastric banding. 3 days before her present admission, she began suffering from abdominal pain without vomiting. On admission investigation, gastric prolapse was diagnosed with complete obstruction of passage through the band. Emergency laparoscopy was performed, which showed devitalization of the stomach above the band. At the operation, the band was removed, and conservative treatment was begun with nasogastric aspiration, total parenteral nutrition, and close observation.