Use of aortic homograft conduit in bidirectional Glenn shunt

We present our experience with a patient in whom a homograft conduit was used to connect the superior vena cava (SVC) to the right pulmonary artery (RPA) in a functionally univentricular heart where corrective repair was impossible.     

Idiopathic CD4+ T lymphocytopenia is associated with increases in immature/transitional B cells and serum levels of IL-7

Idiopathic CD4+ T lymphocytopenia (ICL) is a rare heterogeneous disorder defined by CD4+ T-cell counts below 300 cells/muL in the absence of human immunodeficiency virus (HIV) infection or other known immune deficiency disorders. Here, we report the expansion of immature/transitional B cells in patients with ICL, which is associated with elevated serum levels of IL-7. Both the percentage of immature/transitional B cells and levels of IL-7 were inversely correlated with levels of CD4+ T-cell counts and directly correlated to each other. Further analyses of B cells indicated that, in contrast to the activating effects of HIV disease on mature B cells, the expansion of immature/transitional B cells in patients with ICL occurred at the expense of memory B cells. These findings extend previous reports on primary immunodeficiencies as well as HIV disease by suggesting that CD4+ T-cell lymphopenia has an impact on human B-cell development either directly or indirectly via the associated elevation of IL-7 levels.     

Spinal injuries in pedestrians struck by motor vehicles

STUDY DESIGN: Retrospective study of consecutive patients that were struck by motor vehicles and sustained spinal injuries over a 6-year period from 1997 to 2003. OBJECTIVE: To determine spinal injury patterns and associated injuries in pedestrians struck by motor vehicles. SUMMARY OF BACKGROUND DATA: Motor vehicle accidents involving pedestrians are associated with high morbidity and mortality rates. METHODS: All injured patients admitted to Level I Trauma and Regional Spinal Cord Injury Center were reviewed retrospectively to identify those who were struck by motor vehicles and sustained injury to the spinal column. Before 2001, clearance of the thoracolumbar (TL) spine was performed by plain radiographs. Beginning in 2001, such clearance was performed by helical truncal computed tomography of the chest/abdomen/pelvis (CT/CAP) that was performed to evaluate potential visceral injuries. RESULTS: Of the 1672 patients who were struck by motor vehicles, 135 patients (8%) were found to have spinal injuries. Cervical injuries were found in 35%, thoracic in 19%, lumbar in 37%, and sacral injuries in 27%. Associated injuries were present in 99% of the patients. By relative risk analyses, there were no regional associations between injuries of the TL spine and injuries to the chest and abdomen. Patients frequently had combinations of injuries in distant locations, presumably from a "double-impact" injury mechanism. Before initiation of the CT/CAP protocol to clear the TL spine, 7% of patients had injuries initially missed by TL radiographs. CONCLUSIONS: Spinal injuries in pedestrians struck by motor vehicles are more evenly distributed throughout the spinal column and more often coexist with injuries to remote organs compared with car occupants and motorcyclists where regional tendencies and isolated spinal injuries are more frequent. A systematic approach to both diagnosis and treatment is, therefore, necessary. Helical truncal CT, performed to evaluate visceral injury, effectively screens for TL fractures.     

Neonatal oral tumors: congenital epulis and epignathus

Oroparyngeal tumors in neonates protruding from the mouth are extremely rare. They have the potential to cause respiratory distress, or even death of the child during the perinatal period owing to airway obstruction and may need a multidisciplinary team approach at the time of birth. Congenital epulis and epignathus are the 2 rare lesions usually presenting like this and clinical manifestations depend on their position and size. They have an excellent prognosis, if treated properly. This paper will discuss our experience with these 2 lesions and review the literature.     

Histopathologic Description of Wingspan Stent in Acute Ischemic Stroke

Objective and Importance  

We report the histopathologic examination of Wingspan stent in acute ischemic stroke.