Salvage of Infected ICDs: Management Without Removal

During the 7-year period from August 1986 to December 1993, 242 patients with malignant ventricular arrhythmias underwent 242 ICD implantations and 50 subcutaneous generator changes. Wound infections developed in 5 patients (1.7%): in 3 cases, after primary implantation (3/242 [1,2%]); and in 2 following a generator change (2/50 [4.0%]). This difference was not statistically significant. Infection developed at the generator pocket and became clinically manifest between 6 weeks and 40 months, postoperatively. Our treatment approach with the first patient consisted of simple debridement of the pocket and reimplantation of the existing generator. This led to recurrence, and the generator was safely explanted. In the remaining four patients, our approach has been that of local treatment, with wide debridement of the pocket, and placement of a closed irrigation system with continuous irrigation with a bacitracin, polymyxin, neomycin solution, and culture-specific antibiotic therapy. We have successfully controlled the infection and salvaged the generator with this approach in all four patients, who are all alive and well at a mean follow-up of 25.0 ± 17.3 months with no recurrence. The good results obtained in these patients suggest that the concept of total explantation of the infected ICD should be reassessed.     

Foxp3体外诱导产生的调节性T细胞对小鼠心脏移植物存活的影响

目的研究Foxp3基因转染的受体na ve CD4 CD25-T淋巴细胞对小鼠同种异体心脏移植物存活的影响。方法将Foxp3重组逆转录病毒载体转染的CD4 CD25-T细胞于术前1d经尾静脉输入受体体内。实验分为3组:A组:Foxp3组,术前输入转染PLXSN-mFOXP3-IRES2-EGFP的受体CD4 CD25-T细胞;B组:调节性T细胞组,术前输入受体CD4 CD25 调节性T细胞;C组:空白对照组术前没有加任何干扰措施。术后第3天、第7天各组随机取2只小鼠,进行病理学检查。其余小鼠每日观察心脏移植物存活情况。结果4组移植物的存活时间分别为:A组(56.7±13.5)d(n=15),B组(59.1±11.5)d(n=15),C组(14.0±4.4)d(n=15)。A、B组移植物的存活时间较对照组显著延长,差异有统计学意义(P<0.01),但A、B两组之间差异无统计学意义(P>0.05),病理检查显示A、B组移植物排斥反应轻于C组。结论转染Foxp3基因的小鼠na ve CD4 CD25-T细胞,可以明显延长小鼠异位心脏移植物存活时间,其能力与自然发生的CD4 CD25 调节性T细胞相当。     

Predictive factors for organic central precocious puberty and utility of simplified gonadotropin-releasing hormone tests

BACKGROUND: The aim of the present study was to determine whether the clinical presentation of patients with central precocious puberty (CPP) permits differentiation between idiopathic and organic forms, and to examine whether luteinizing hormone (LH) determination in single blood sample after gonadotropin-releasing hormone (GnRH) administration is sufficient to diagnose CPP. METHODS: Potential clinical and laboratory predictors for the presence of central nervous system (CNS) abnormalities were assessed. Sensitivities and specificities of LH and follicle-stimulating hormone (FSH) levels at 0, 15, 30, 60, 90 and 120 min were compared after GnRH stimulation. RESULTS: In 45 girls with signs of breast development, 26 were diagnosed as having CPP. The age of onset in patients with organic CPP was 4.75 +/- 2.01 years (range 1.2-7.1 years, median 5.0 years), whereas the age in patients with idiopathic CPP was 7.09 +/- 0.87 years (range 5.0-7.9 years, median 7.0 years). This parameter is the only one showing statistical significance. In addition, the specimen at 30 min after GnRH stimulation yielded highest sensitivity for the diagnosis of CPP. CONCLUSIONS: The earlier the onset of disease, the higher the possibility of presence of CNS lesion. According to the mean GnRH-stimulated LH levels and sensitivity at each time, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose CPP.