Totally endoscopic robotic thymectomy for myasthenia gravis

The current recommendations for treating myasthenia gravis include surgical thymectomy for patients between puberty and 60 years of age. This is a report of a new method for surgical thymectomy using the robotic da Vinci surgical system for a totally endoscopic approach. This new procedure combines the potential advantages of minimally invasive methods with the efficacy of open procedures.     

Analysis of Navy Physical Evaluation Board diagnoses (1998-2000)

An analysis is provided from 19,265 Physical Evaluation Board diagnoses from 10,406 Navy personnel from 1998 to 2000. The leading diagnostic categories were musculoskeletal and mental disorders as well as for subgroups of women and officers. Musculoskeletal conditions were 41.6% of the diagnoses and decreased with advancing age (42.9% for <30 years; 41.1% for 30-40 years; 37.6% for >40 years; chi2 for trend [1 df] = 26.4; p = 0.000). Mental disorders were 11.8% of the diagnoses and also decreased with advancing age (14.1% for <30 years; 10.4% for 30-40 years; 8.8% for >40 years; chi2 for trend [1 df] = 84; p = 0.000). Diagnoses for injury and poisoning (8.9%), nervous system (7.6%), and ill-defined conditions (4.7%) completed the top five categories below age 40 years, whereas circulatory disorders were evident after age 40 years. These findings suggest priorities for reducing overall medical disability losses in our active duty Navy forces.     

In vivo protection of photoreceptors from light damage by pigment epithelium-derived factor

PURPOSE: To determine whether pigment epithelium-derived factor (PEDF) exhibits neurotrophic and neuroprotective activities in vivo for photoreceptor cells. METHODS: Sprague-Dawley albino rats were injected intravitreally with 2 microg PEDF or a mixture of 1 microg basic fibroblast growth factor (bFGF)/1 microg PEDF in a volume of 1 microl phosphate-buffered saline (PBS). Animals were exposed to constant light for different periods at an illuminance level of 1200 to 1500 lux. The electroretinogram (ERG) waveforms of both eyes in the same animal were simultaneously recorded to evaluate functional protection. The morphologic protection was evaluated by quantitative histology. RESULTS: Intravitreal injection of PEDF before exposure to constant light resulted in significant morphologic and functional protection of photoreceptor cells in the retina of light-damaged rats. This protection depended on the duration and severity of light damage. The protection was eliminated by extending the light exposure to 10 days. Injection of PEDF at 0, 1, and 2 days after constant light exposure did not provide significant protection above that seen in PBS-injected eyes. Combination of PEDF with bFGF improved functional protection of photoreceptor cells. CONCLUSIONS: The data demonstrate that PEDF protected photoreceptor cells against light damage. This is significant, because it may open new avenues for the study of molecular mechanisms underlying degenerative processes. This, in turn, may lead to the development of therapeutic strategies for the prevention and treatment of degenerative diseases of the retina.     

Comparison and clinical evaluation of hand-assist devices for hand-assisted laparoscopy

Hand-assisted laparoscopic surgery (HALS) is being used increasingly in urologic laparoscopy, particularly for laparoscopic nephrectomy. Hand-assist devices (HADs) facilitate the intra-abdominal placement of the hand during laparoscopy. There are currently three HADs available in the United States: the Pneumo Sleeve, the Handport, and the Intromit. The performance of each HAD is assessed regarding usage options, maintenance of pneumoperitoneum, device failure, exchange of intra-abdominal hands, adaptation to obese patients, and specimen removal. The use of these devices is reviewed based on our experience in more than 100 cases of HALS.     

Primary central nervous system non-Hodgkin's lymphoma (PCNSL): survival advantages with combined initial therapy? A final report of the North Central Cancer Treatment Group (NCCTG) Study 86-72-52

PURPOSE: We herein report updated survival and toxicity data on the entire cohort of 53 eligible patients treated on North Central Cancer Treatment Group (NCCTG) protocol 86-72-52, which is now closed. METHODS AND MATERIALS: An initial report was published in this journal in 1995. No substantive changes in the conclusions of that report were identified in this analysis. Median survival was 9.6 months for the entire cohort; median survival for the 20 patients who completed the prescribed protocol treatment was 20.7 months. The hematologic and non-hematologic toxicity distributions are virtually the same as those reported in the original paper. RESULTS: Results are given for the entire group and for subsets defined by age < or = 60 versus > 60 years, and < 70 versus > or = 70 years of age. CONCLUSIONS: No significant differences were observed in any of the outcome variables by age group. There was, however, a nonsignificant suggestion of poorer outcome in those who were > 60 years of age.     

Attenuated expression of interferon-β and interferon-λ1 by human alternatively activated macrophages

Macrophages can be polarized into classically (CAM) or alternatively (AAM) activated macrophages with IFN-γ or IL-4, respectively. CAM are associated with type 1 immune responses and are implicated in autoimmunity; AAM are associated with type 2 responses and are implicated in allergic diseases. An impediment in investigating macrophage biology using primary human monocyte derived macrophages is the wide inter-donor heterogeneity and the limited quantity of cells that survive in vitro polarization. To overcome this impediment, we established a protocol to generate CAM and AAM cultures derived from the THP-1 human promonocytic cell line. In this report, we demonstrate that THP-CAM and -AAM express gene and protein markers that define their primary human monocyte derived counterparts, such as IL-1β, CXCL10, and CXCL11 for CAM, and MRC1, IL-4 and CCL22 for AAM. In addition, we demonstrate that STAT6 is selectively activated in THP-AAM which, upon LPS stimulation, have an attenuated or delayed expression of IFN-β, IFN-λ1, and IFN α/β pathway genes compared to their CAM counterparts. Taken together, these findings may help further investigate human diseases associated with the alternatively activated macrophage phenotype using this reproducible in vitro macrophage model.