Primary intraoral epithelioid hemangioendothelioma. Case report and review of the literature

Epithelioid Hemangioendothelioma (EH) is a vascular neoplasm of soft tissue, recently described by Weiss and Enzinger. The biologic al behavior of the tumor has a intermediate malignant potential, in the sense that it has an indolent course, with the potential for recurrence, but rarely metastasizes. This tumor arises from medium- to large-sized vessels, primarily involves the soft tissues of the extremities, as well as the liver, lung, and bone, and rarely occurs in the head and neck region. Only fifteen well--documented cases of Epithelioid Hemangioendothelioma involving the head and neck region have been reported. Nine cases have been recently reported in the oral cavity. This is a report of one additional case in the tongue. Because of the intermediate malignant potential of Epithelioid Hemangioendothelioma, complete tumor resection is recommended for intraoral lesions.     

A new method for encapsulation of living cells: preliminary results with PC12 cell line

A new method is described for encapsulation of living cells. PC12 rat adrenal pheochromocytoma cells, which have been shown to synthesize, store and release dopamine were employed. The particles are made first and the cells then incorporated in a gentle mechanical procedure. The morphology (by light and electron microscopic observation), stability, rheology, texture and permeability of these microcapsules provided by Kappa Biotech were investigated. Membrane permeability studies demonstrated exclusion of 69,000 Da human serum albumin, but equilibrium of D-glucose and inulin was within 24h, indicating a molecular weight cut-off in the 5000-70,000 Da range. The viability and the function of the encapsulated cells were evaluated by measuring the spontaneous release of dopamine by high performance liquid chromatography with electrochemical detection. The results show that dopamine-secreting cells can be sequestered in a semi-permeable capsule and still display good viability and proliferation for at least 1 month.     

Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy

BACKGROUND AND OBJECTIVE: Intraperitoneal administration of a local anaesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported except after laparoscopic cholecystectomy. This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy. METHODS: At the end of laparoscopic cholecystectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. There were 30 patients in each group: Group 1, physiological saline 30 mL; Group 2, bupivacaine 0.25% 30 mL; Group 3, bupivacaine 0.25% 30 mL plus morphine 2 mg. In addition, Group 2 received 2 mg intravenous (i.v.) morphine in 2 mL saline, and Groups 1 and 3, 2 mL saline intravenously. Patients' postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of metamizol administered by an i.v. patient-controlled analgesia (PCA) device. Pain, vital signs, supplemental analgesic consumption and side-effects were recorded for all patients for 24 h. RESULTS: There were no differences between the three groups regarding pain scores (at rest and coughing) during the study except in the first 2 h, when scores were lower for patients receiving intraperitoneal bupivacaine plus i.v. morphine (P < 0.05). Supplemental consumption of metamizol was significantly lower (P < 0.05) in Group 3 than in Group 1 during the first 6 h after surgery. However, the cumulative doses of metamizol were also lower in Group 2 than in Groups 1 and 3 over the entire study (2025 +/- 1044 mg vs. 4925 +/- 1238 and 4125 +/- 1276mg; P < 0.05). CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of morphine plus bupivacaine 0.25% reduced the analgesic requirements during the first 6 postoperative hours compared with the control group. However, the combination of intraperitoneal bupivacaine 0.25% and i.v. morphine was more effective for treatment of pain after laparoscopic cholecystectomy.     

Efficacy of augmentation of epidural analgesia for Caesarean section

Background. Extension of a labour epidural for Caesarean deliveryis thought to be successful in most cases and avoids the useof general anaesthesia. However, most previous studies thathave estimated the failure rate of pre-existing epidural catheterswere performed in small numbers of patients. Methods. Therefore, we undertook to retrospectively measurethe failure rate of indwelling epidural catheters in a largenumber of patients. Results. The anaesthetic team was available at all times andwas permanently led by a senior anaesthetist specialized inobstetrics. Extension was performed using lidocaine 2% withepinephrine (mean 18 (SD 6) ml), combined in most patients withsufentanil (9 (2.2) µg) and/or clonidine (75 µg).Among 194 consecutive extensions performed in a 1-yr period,general anaesthesia was required in five patients (2.6%) whilesedation and/or i.v. analgesia were used in 27 patients (13.9%).In three cases where general anaesthesia was required, the intervalbetween decision to incision was <10 min. No factorassociated with failure could be identified. Addition of a lipophilicopioid or of clonidine did not modify the efficacy of the block(i.e. general anaesthesia or supplementation were required ina similar proportion). Conclusions. The augmentation of labour epidurals for Caesareansection using lidocaine 2% plus epinephrine is a reliable andeffective technique. No factor associated with failure couldbe identified. Br J Anaesth 2003; 91: 532–5     

Resección quirúrgica ampliada en el tratamiento del timoma invasivo

In 10%–15% of patients, myasthenia gravis is associated with thymoma. Because of its site, this tumour can have an un-noticed clinical history over a considerable time and be diagnosed when adjacent structures such as mediastinal vessels, heart or trachea become infiltrated. We present a patient with thymoma and infiltration of the superior vena cava, and which represents an incipient vena cava syndrome. The surgical treatment consisted of complete resection of the tumour including partial replacement of the vena cava with a pericardial patch. The surgery was complemented with radiotherapy.     

Mapping of aggrecan, hyaluronic acid, heparan sulphate proteoglycans and aquaporin 4 in the central nervous system of the mouse

The extracellular matrix (ECM) of the central nervous system (CNS) is found dispersed in the neuropil or forming aggregates around the neurons called perineuronal nets (PNNs). The ECM mainly contains chondroitin sulphate proteoglycans (CSPG), hyaluronic acid (HA) and tenascin-R. Heparan sulphate proteoglycans (HSPG) can also be secreted in the ECM or be part of the cell membrane. The ECM has a heterogeneous distribution which has been linked to several functions, such as specific regional maintenance of hydrodynamic properties in the CNS, in which aquaporins (AQP) play an important role. AQP are a family of membrane proteins which acts as a water channel and AQP4 is the most abundant isoform in the brain. Nevertheless the importance of these proteins, their distribution and correlation in the whole CNS of mice is only partially known. In the present study, the histochemical and immunohistochemical distribution of PNNs, using Wisteria floribunda agglutinin (WFA), aggrecan, HA, HSPGs and AQP4 is described, and their perineuronal and neuropil staining has been semi-quantitatively evaluated in the whole CNS of mice. The results showed that the aggrecan, HA and HSPGs perineuronal distribution coincided partially and this could be related to ECM functional properties. AQP4 showed a heterogeneous distribution throughout the CNS. In some areas, an inverse correlation between AQP4 and ECM components has been observed, suggesting a complementary role for both in the maintenance of water homeostasis. A common location for AQP4 and HSPGs has also been observed in CNS neuropil.     

Lung necrosectomy in pediatric patients with necrotizing pneumonia

Introduction

Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.

Methods

Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.

Results

Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5?±?13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy?+?lung necrosectomy 1 (4.1%), and wedge resection?+?lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.

Conclusions

Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.

     

Impact of Genetic Polymorphisms on the Metabolic Pathway of Vitamin D and Survival in Non-Small Cell Lung Cancer

Vitamin D has been associated with risk, development, and progression of cancer. However, the genes involved in its metabolism are highly polymorphic, compromising its activity. The aim of this study is to evaluate the association between the gene polymorphisms involved in the metabolic pathway of vitamin D and survival in patients with non-small-cell lung cancer (NSCLC). The study was designed as an observational cohort which included 194 Caucasians patients from southern Spain with NSCLC. Real-time polymerase chain reaction was used to analyze the following polymorphisms: CYP27B1 rs4646536, rs3782130, and rs10877012; CYP24A1 rs6068816 and rs4809957; GC rs7041; CYP2R1 rs10741657; VDR rs1544410 (BsmI), rs11568820 (Cdx-2), rs2228570 (FokI), rs7975232 (ApaI), and rs731236 (TaqI). Progression-free survival (PFS) and overall survival were assessed. Cox regression showed that rs4646536 was associated with PFS in the general population (p = 0.0233) and in the non-resected NSCLC subgroup (p = 0.0233). In the resected NSCLC subgroup, rs11568820 was associated with OS (p = 0.0129) and rs7041 with PFS (p = 0.0447). In the non-resected NSCLC subgroup, rs6068816 was associated with PFS (p = 0.0048) and OS (p = 0.0089) and rs731236 and rs7975232 were associated with OS (p = 0.0005) and PFS (p = 0.0002), respectively. The other polymorphisms showed no effect on the results. The rs4646536, rs6068816, rs7041, rs11568820, rs731236, and rs7975232 polymorphisms are associated with survival in NSCLC and may have a substantial role as prognostic markers of the disease.     

Homogeneous and Heterogeneous Polymerization of ε‐Caprolactone by Neodymium Alkoxides Prepared In Situ

The synthesis of lanthanide(III) alkoxides has been described as a series of reactions for which the control of product purity is difficult. The possibility of using amide complexes, in the presence of alcohol, to produce alkoxides was investigated in homogeneous and heterogeneous media. The polymerization of ε‐caprolactone with alkoxides formed in situ was performed with and without excess alcohol. The latter system was efficient since the polymers were obtained in a short time period, with a well‐controlled molecular weight and low polydispersity. The alcohol functionalized all the polymer chains.