Arterial thrombosis associated with malignant disease.

OBJECTIVE: The association between cancer and venous thrombosis is well established, however, that between malignancy and arterial thrombosis is less well described. Isolated cases have been reported and chemotherapy has been implicated as a cause though its significance compared with the malignant disease process itself is not known. This study examines the outcome of patients with malignant disease who present with arterial thrombosis. METHOD: Details of patients with malignant disease who presented with arterial thrombosis were analysed. RESULTS: Twenty patients presented with malignancy and arterial thrombosis, 16 presented in the last four years. The most common malignancy was metastatic breast cancer. Thrombosis involved the leg in 19 cases and the arm in one. Four patients also had venous thromboembolic events and one had a carotid artery thrombosis. Eight patients underwent operative treatment for their thrombosis. Five out of six thromboembolectomies and two out of three bypass procedures failed. Twelve had conservative or palliative treatment. Outcome was generally poor, two patients had major amputations and seventeen died at median follow-up of eight weeks. Survival rate from the time of presentation of arterial thrombosis was 50% at three months and 17% at one year. CONCLUSION: Patients with critical limb ischaemia due to atherosclerotic disease have an expected survival of approximately 80% at one year. The outcome of patients with arterial thrombosis associated with malignant disease is far worse. Arterial thrombosis is an agonal event in many of these patients. Conservative or palliative treatment may be the most appropriate management.     

Role of pulse oximetry during nonsedated upper gastrointestinal endoscopic procedures.

BACKGROUND: Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation, resulting in rare serious cardio-pulmonary events. OBJECTIVE: To determine the severity of oxygen desaturation during nonsedated upper gastrointestinal endoscopy and study the effect of various variables on oxygen saturation. METHODS: 126 patients underwent nonsedated upper gastrointestinal endoscopy (82 diagnostic, 44 therapeutic). Arterial oxygen saturation (SaO2) was monitored using a pulse oximeter. RESULTS: Baseline SaO2 was mean (SD) 97.8 (1.8%). It remained > 95% in 60.2% of patients during the procedure, whereas mild oxygen desaturation (SaO2 90%-94%) occurred in 23.7% and severe oxygen desaturation (SaO2 < 90%) occurred in 15.8% of patients. Six patients (4.7%) required supplemental oxygen administration sometime during the procedure. Desaturation occurred in patients undergoing diagnostic and therapeutic procedures but was severe in the latter group (p < 0.002). Patients aged more than 60 years (p < 0.001), hemoglobin < 10 g/dL (p < 0.001), history of smoking (p < 0.001), and underlying chronic obstructive airway disease (p < 0.001) were significantly related to oxygen desaturation. However, on multivariate analysis, no significant correlation was observed with hemoglobin value. CONCLUSION: Therapeutic intervention during nonsedated upper gastrointestinal endoscopy, old age, smokers and chronic obstructive airways disease are independent risk factors for oxygen desaturation. We recommend continuous monitoring of SaO2 in these high-risk patients undergoing upper gastrointestinal endoscopy.     

Characterization of antihuman IFNAR-1 monoclonal antibodies: epitope localization and functional analysis.

The type I interferon receptor (IFNAR) is composed of two subunits, IFNAR-1 and IFNAR-2, encoding transmembrane polypeptides. IFNAR-2 has a dominant role in ligand binding, but IFNAR-1 contributes to binding affinity and to differential ligand recognition. A panel of five monoclonal antibodies (mAb) to human IFNAR-1 (HuIFNAR-1) was produced and characterized. The reactivity of each mAb toward HuIFNAR-1 on native and transfected cells and in Western blot and ELISA formats was determined. In functional assays, one mAb, EA12, blocked IFN-a2 binding to human cells and interfered with Stat activation and antiviral activity. Epitopes for the mAb were localized to subdomains of the HuIFNAR-1 extracellular domain by differential reactivity of the mAb to a series of human/bovine IFNAR-1 chimeras. The antibody EA12 seems to require native HuIFNAR-1 for reactivity and does not map to a single subdomain, perhaps recognizing an epitope containing noncontiguous sequences in at least two subdomains. In contrast, the epitopes of the non-neutralizing mAb FB2, AA3, and GB8 mapped, respectively, to the first, second, and third subdomains of HuIFNAR-1. The mAb DB2 primarily maps to the fourth subdomain, although its reactivity may be affected by other determinants.     

BAFF binds to the tumor necrosis factor receptor-like molecule B cell maturation antigen and is important for maintaining the peripheral B cell population

The tumor necrosis factor (TNF) family member B cell activating factor (BAFF) binds B cells and enhances B cell receptor-triggered proliferation. We find that B cell maturation antigen (BCMA), a predicted member of the TNF receptor family expressed primarily in mature B cells, is a receptor for BAFF. Although BCMA was previously localized to the Golgi apparatus, BCMA was found to be expressed on the surface of transfected cells and tonsillar B cells. A soluble form of BCMA, which inhibited the binding of BAFF to a B cell line, induced a dramatic decrease in the number of peripheral B cells when administered in vivo. Moreover, culturing splenic cells in the presence of BAFF increased survival of a percentage of the B cells. These results are consistent with a role for BAFF in maintaining homeostasis of the B cell population.     

An assessment of between-recti distance and divarication in patients with and without abdominal aortic aneurysm

INTRODUCTION

The study assessed whether there is a greater incidence of divarication of the recti and whether between-recti distance is greater in patients with abdominal aortic aneurysm (AAA).

PATIENTS AND METHODS

The study consisted of two parts: a radiological and a clinical assessment. All patients with a confirmed AAA on computerised tomography were included and compared with patients in whom AAA was excluded with imaging. Between-recti distance was measured using a computerised image viewer and clinical divarication was assessed by a surgical registrar or consultant.

RESULTS

In the radiological part of the study, 108 patients with AAA were compared with 84 with colorectal cancer. Median between-recti distance was 38 mm (range, 25–59 mm) in the AAA group and 27 mm (range, 20–44.5 mm) in the non-AAA group (P = 0.006). AAA diameter did not correlate with between-recti distance. The clinical study included 50 patients (25 AAA). The groups were well matched, with only a greater incidence of diabetes in the AAA group (20% vs 0%; P = 0.018). AAA patients were more likely to have clinically detected divarication of the recti (76% vs 36%; P = 0.004).

CONCLUSIONS

Patients with AAA have greater radiological and clinical evidence of divarication. It is suggested that patients with divarication be screened for AAA.     

Radiographic results of combined Salter innominate and femoral osteotomy in Legg–Calvé–Perthes disease in older children

Purpose  Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and a congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods  We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 17 males and 3 females comprised 11 lateral pillar (LP) group B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results  Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two hips. One of the two LPC hips became SIII and the other one SIV. The three female patients had one LPB, one LPB/C, and one LPC hip, and surgery resulted in SIII hips in all three cases. Eight of these 20 cases were older than 11 years of age at the time of surgery, and all had fair or poor hips. Conclusions  Simultaneous femoral and Salter innominate osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor results to fair results.