ABO antibody titres: a multisite comparative study of equivalency and reproducibility for automated solid-phase and haemagglutination titration,and manual dilution with gel column agglutination technology

BackgroundABO antibody titres are important in many clinical decisions; however, much variability is observed in titre results. For reliable and reproducible titre results, automated ABO titration methods have been developed. In this 10-site study, we evaluated the equivalency of the automated ABO titration assays on the Galileo NEO, a fully automated blood bank analyzer (Immucor, Inc.) to manual titration with gel Column Agglutination Technology (CAT), as well as the reproducibility of both methods.Materials and methodsTen different locations participated in this study. The equivalency study included 70 random samples at each site. The reproducibility study tested the same blinded 30-sample panel at each study site. Anti-A and anti-B IgM and IgG antibody titres were tested with both the automated and manual methods; additionally, dithiothreitol (DTT) treatment was used to inactivate IgM antibodies in the manual CAT method.ResultsThe equivalency between CAT manual method and Galileo NEO automated titres at each site ranged from 38 to 88%; equivalency for each isotype was 66.2% for IgM, 60.6% for IgG, and 88.5% for DTT-treated IgG. The reproducibility study evaluated the titre variation of each sample obtained from the 10 sites. The average titre ranges (in doubling dilutions) for the automated and manual methods, respectively, were 2.15±1.0 and 4.03±1.8 for IgM, and 1.53±0.7 and 4.10±1.9 for IgG; for the manual DTT-treated IgG, the average titre range was 3.45±1.8 doubling dilutions.DiscussionThe results demonstrated that the Galileo NEO automated and manual CAT ABO titres are not equivalent. However, the study also demonstrated that titre reproducibility is enhanced with the Galileo NEO automated ABO titration assays relative to the manual CAT ABO titration method. Therefore, to improve management of patients receiving care across multiple institutions, our study supports the use of automated ABO titration.     

Laparoscopic Treatment of Gastric <Emphasis Type="SmallCaps">Gist</Emphasis>: Report of 21 Cases and Literature’s Review

Background Although the feasibility of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) has been established, various aspects are debated. This paper describes the problems of minimally invasive resection of gastric GISTs and compares this experience with an extensive literature review. Study Design Between August 2001 and December 2006, 21 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a prospective study. A literature review of laparoscopic treatment was performed on Pubmed using keywords GIST and surgery. A comparison with authors’ experience with open wedge-segmental resection of GISTs (25 cases from November 1995 to December 2000) was also carried out. Statistical analysis was based on chi-squared test and t Student evaluation. Results Twenty-one patients, mean age 50.1 years (range, 34–68 years), were submitted to laparoscopic wedge- segmental gastric resections. Mean tumor size was 4.5 cm (range, 2.0–8.5 cm). Mean operative time was 151 min (range, 52–310 min), the mean blood loss was 101 mL (range, 10–250 mL), and the mean hospital stay was 4.8 days (range 3–7 days). There were no major operative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 35 months, all patients were disease-free. Morbidity, mortality, length of stay, and oncologic outcomes were comparable to the open surgery retrospective evaluation (p = not significant). Conclusions As found also in the literature review, the laparoscopic resection is safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by laparoscopic surgery, a minimally invasive approach should be the preferred surgical treatment in patients with small- and medium-sized gastric GISTs.     

Prevention of third molar development in dog with long pulse diode laser: a preliminary report

INTRODUCTION: Wisdom teeth continue to plague man with a high rate of frequency. It may be possible to prevent their development in children at an early age with a non- or minimally invasive technique, even before the tooth begins to form, by treating the soft tissue overlying the site of their development. A previous study that treated the intra-oral soft tissues of newborn rats with a 20 watt diode laser stopped third molar development up to 80% of the time with minimum observable side effects. This brief report describes a similar use of the diode laser in a limited number of young beagle pups. It is the first reported attempt at preventing third molar development in an animal model close in size to man. MATERIALS AND METHODS: Four 6-7 week old beagle pups were treated on one side of their mandibles with either a 20 or a 100 watt, 800 nm diode laser at a time third molar tooth buds are just beginning to form under the oral mucosa. Six months following treatment, the pups were examined intra-orally and radiographically for evidence of third molar formation. RESULTS: The two intra-oral sites that received the 20 watt diode laser treatment showed normal third molar development. The two intra-oral sites that received the 100 watt diode laser treatment did not develop third molars. CONCLUSIONS: The diode laser may be capable of selectively stopping third molar development and further studies are warranted.     

Air-Filled vs Water-Filled Intragastric Balloon: a Prospective Randomized Study

Background

The positioning of an intragastric saline-filled balloon has been developed as temporary and reversible therapeutic option for treatment of morbid obesity. Recently, an air-filled balloon was also developed. The aim of this study is to prospectively compare these two devices in terms of weight loss parameters, safety, and tolerance.

Methods

Sixty patients were randomized into two groups: group A (Bioenterics Intragastric Balloon?CBIB; n?=?30; 20?F/10?M, mean age 36.7?±?10.9; mean BMI 46.5?±?5.9) and group B (Endobag-Heliosphere; n?=?30; 20?F/10?M, mean age 37.8?±?10.6; mean BMI 46.1?±?5.6). All patients of both groups were sedated with midazolam (5?mg)?+?Propofol (2?mg/kg i.v.). The Heliosphere Bag was air-filled with 950?ml while BIB? was inflated with 500?ml of saline and 10?ml of methylene blue. Percentage of excess weight loss (%EWL) and body mass index (BMI) were evaluated. Student t test, Fisher exact test, and ?? ² test were used for statistical analysis.

Results

Similar weight loss parameters were observed in patients treated with liquid or air-filled balloon at time of removal: mean BMI was 40.8?±?6.2 and 41.9?±?6.5(p?=?ns), and mean %EWL was 20?±?12 and 18?±?14 (p?=?ns) in groups A and B, respectively. Significant longer extraction time, with high patient discomfort, was observed in group B due to difficult passage through the cardia and the lower pharynx.

Conclusions

Air-filled balloon can be another valid therapeutic option in the temporary treatment of obesity, but at this time, the quality of the device must be improved to ameliorate the patient compliance at removal and avoid the spontaneous deflations.     

Laparoscopic cholecystectomy in the morbidly obese

In the early days of video-assisted laparoscopic cholecystectomy (VLC), obesity was considered a contraindication for the procedure. We reviewed charts from 304 patients undergoing VLC; 90 patients were obese, and among these, according to a classification currently used by medical nutritionists and based on BMI, 45 were overweight (BMI > or = 25 < or = 29.9), 27 were considered conventionally obese (BMI > or = 30 and < 40) and 18 morbidly obese (BMI > or = 40). In this study we considered only the morbidly obese patients (5 males and 13 females). The average age was 42.3 years (range: 21-65) and the average weight 275 Ib (range: 186-331 Ib). Six patients had previously undergone abdominal surgery. All patients were symptomatic for gallstones, and 5 of them were suffering from acute cholecystitis. Mean operative time was 20 minutes (range: 10-45 minutes) longer than that of non-obese patients. No open conversion was necessary. No major postoperative morbidity and no cases of mortality occurred. The mean hospital stay and resumption of normal diet were similar to those of non-obese patients. Regardless of the higher postoperative risks after open cholecystectomy in obese patients (pulmonary complications, thromboembolism, wound infections and cardiovascular complications), we suggest VLC as the procedure of choice for cholecystectomy in these patients.     

The role of CD133 in the identification and characterisation of tumour-initiating cells in non-small-cell lung cancer

Objective: Emerging evidence suggests that specific sub-populations of cancer cells with stem cell characteristics within the bulk of tumours are implicated in the pathogenesis of heterogeneous malignant tumours. The cells that drive tumour growth have been denoted cancer-initiating cells or cancer stem cells (hereafter CSCs). CSCs have been isolated initially from leukaemias and subsequently from several solid tumours including brain, breast, prostate, colon and lung cancer. This study aimed at isolating and characterising the population of tumour-initiating cells in non-small-cell lung cancer (NSCLC). Methods: Specimens of NSCLC obtained from 89 patients undergoing tumour resection at the Cancer National Institute of Naples were analysed. Three methods to isolate the tumour-initiating cells were used: (1) flow cytometry analysis for identification of positive cells for surface markers such as CD24, CD29, CD31, CD34, CD44, CD133 and CD326; (2) Hoechst 33342 dye exclusion test for the identification of a side-population characteristic for the presence of stem cells; (3) non-adherent culture condition able to form spheres with stem cell-like characteristics. Definition of the tumourigenic potential of the cells through soft agar assay and injection into NOD/SCID mice were used to functionally define (in vitro and in vivo) putative CSCs isolated from NSCLC samples. Results: Upon flow cytometry analysis of NSCLC samples, CD133-positive cells were found in 72% of 89 fresh specimens analysed and, on average, represented 6% of the total cells. Moreover, the number of CD133-positive cells increased markedly when the cells, isolated from NSCLC specimens, were grown as spheres in non-adherent culture conditions. Cells from NSCLC, grown as spheres, when assayed in soft agar, give rise to a 3.8-fold larger number of colonies in culture and are more tumourigenic in non-obese diabetic (NOD)/severe combined immunodeficiency (SCID) mice compared with the corresponding adherent cells. Conclusions: We have isolated and characterised a population of CD133-positive cells from NSCLC that is able to give rise to spheres and can act as tumour-initiating cells.     

Presumed infectious endophthalmitis following cataract surgery in the UK: a case-control study of risk factors

AIMS: To study risk factors for presumed infectious endophthalmitis complicating cataract surgery in the United Kingdom. METHODS: Two hundred and fourteen clinically diagnosed patients with presumed infectious endophthalmitis were compared with 445 control patients throughout the United Kingdom in a prospective case-control study. The cases were identified through the British Ophthalmological Surveillance Unit reporting card system. Control patients undergoing cataract surgery from 13 'control centres' throughout the United Kingdom were selected randomly. Risk factors were identified by univariate and multivariate logistic regression analyses. Pertinent variables relating to the cataract extraction procedure, antimicrobial prophylaxis, ophthalmic and medical history were analysed with regard to postoperative infection. RESULTS: Statistically significant risk factors in the multivariate model included inpatient cataract surgery (P=0.001), surgery in dedicated eye theatres (P<0.001), consultant grade surgeon (compared to registrar) (P=0.001), posterior capsule tear during cataract surgery (P=0.001). The use of face masks by the scrub nurse and surgeon during cataract surgery (P<0.001) and the administration of subconjunctival antibiotics at the end of surgery (P<0.001) were protective against postoperative infection. CONCLUSIONS: In order to minimise the risk of postoperative endophthalmitis we would recommend the wearing of face masks by the surgeon and scrub nurse during cataract surgery and subconjunctival antibiotics at the end of surgery.     

Cardiofaciocutaneous (CFC) syndrome

An 11-year-old boy affected by mental retardation and seizures demonstrates congenital heart defect, many dysmorphic features and dry skin. His hair is sparse over the vertex with alopecia of the eyebrows and eyelashes. There are horny small papules evident in those areas. The diagnosis of cardiofaciocutaneous syndrome has been made. The relationship between cardiofaciocutaneous and Noonan syndrome is discussed.