Intraluminal bypass of abdominal aortic aneurysm: feasibility study.

This study evaluated the feasibility of treatment of abdominal aortic aneurysm (AAA) by means of intraluminal bypass. Artificial aortic aneurysms with fusiform Dacron conduits were created at surgery , a weft-knit Dacron tube with balloon-expandable stents attached at both ends was inserted transfemorally through a 14-F introducer sheath and expanded at the aneurysmal level by means of inflation of a coaxial balloon. The transluminal bypass successfully excluded the aneurysmal lumen immediately after placement. In two dogs, a postplacement aortogram revealed torsion of the graft that caused early occlusion. The six other dogs had a patent bypass at 6 months follow-up. Four of these dogs had evidence of kinking of the graft as a result of shrinkage of the prosthetic aneurysm. Histopathologic studies revealed that endothelialization was complete on the stents and partial on the graft surface. It is concluded that transluminal bypass of AAA is feasible in the dog model.     

Bone Marrow Transplantation: Prognostic Factors of Peripheral Blood Stem Cell Mobilization with Cyclophosphamide and Filgrastim (r-metHuG-CSF): The CD34+ Cell Dose Positively Affects the Time to Hematopoietic Recovery and Supportive Requirements after High-Dose Chemotherapy

To prospectively analyze factors that influence peripheral blood stem cell (PBSC) collection and hematopoietic recovery after high-dose chemotherapy (HDC), 39 patients received cyclophosphamide 4 g/m(2) and rHuG-CSF (Filgrastim) 5 &mgr;g/kg/day. Leukapheresis was started when CD34(+) cells/mL were > 5 x 10(3). A minimum of 2 x 10(6) CD34(+) cells/kg was collected. Median steady-state bone marrow CD34(+) cell percentage was 0.8% (range, 0.1 to 6). Thirty-two patients received HDC with autologous PBSC transplantation plus Filgrastim. A median of 2 (range, 0 to 6) leukapheresis per patient were performed and a median of 6.3 x 10(6) CD34(+) cells/kg (range, 0 to 44.4) collected; four patients failed to mobilize CD34(+) cells. The number of cycles of prior chemotherapy had an inverse correlation with the number CD34(+) cells/kg collected (r = -0.38; p < 0.005). Patients with <7 cycles had a higher predictability for onset of leukapheresis than patients with (3) 7 (93% versus 50%; p < 0.005). The four patients who failed to mobilize had received >/=7 cycles. The number of CD34(+) cells/kg infused after HDC had an inverse correlation with days to recovery to 0.5 x 10(9) neutrophils/L and 20 x 10(9) platelets/L (r = -0.68 and -0.56; p < 0.005). The effect of these factors on mobilization and hematopoietic recovery were confirmed by multivariate analysis. Requirements for supportive measures were significantly lower in patients given a higher dose of CD34(+) cells/kg. Therefore, PBSC collection should be planned early in the course of chemotherapy. Larger number of CD34(+) cells/kg determined a more rapid hematopoietic recovery and a decrease of required supportive measures.     

Topical application of the adenosine A2A receptor agonist CGS‐21680 prevents phorbol‐induced epidermal hyperplasia and inflammation in mice

The nucleoside adenosine is a known regulator of immunity and inflammation that mediates, at least in part, the anti‐inflammatory effect of methotrexate, an immunosuppressive agent widely used to treat autoimmune inflammatory diseases. Adenosine A_2A receptors play a key role in the inhibition of the inflammatory process besides promoting wound healing. Therefore, we aimed to determine the topical effect of a selective agonist, CGS‐21680, on a murine model of skin hyperplasia with a marked inflammatory component. Pretreatment with either CGS‐21680 (5 μg per site) or the reference agent dexamethasone (200 μg/site) prevented the epidermal hyperplasia and inflammatory response induced by topical application of 12‐O‐tetradecanoylphorbol‐13‐acetate (TPA, 2 nmol/site) for three consecutive days. The histological analysis showed that both CGS‐21680 and dexamethasone produced a marked reduction of inflammatory cell infiltrate, which correlated with diminished myeloperoxidase (MPO) activity in skin homogenates. Both treatments reduced the levels of the chemotactic mediators LTB₄ and CXCL‐1, and the inflammatory cytokine TNF‐α, through the suppression of NFκB phosphorylation. The immunohistochemical analysis of the hyperproliferative markers cytokeratin 6 (CK6) and Ki67 revealed that while both agents inhibit the number of proliferating cells in the epidermis, CGS‐21680 treatment promoted dermal fibroblasts proliferation. Consistently, increased collagen deposition in dermis was observed in tissue sections from agonist‐treated mice. Our results showed that CGS 21680 efficiently prevents phorbol‐induced epidermal hyperplasia and inflammation in mice without the deleterious atrophic effect of topical corticosteroids.     

On the use of approximate entropy and sample entropy with centre of pressure time-series

Background

Approximate entropy (ApEn) and sample entropy (SampEn) have been previously used to quantify the regularity in centre of pressure (COP) time-series in different experimental groups and/or conditions. ApEn and SampEn are very sensitive to their input parameters: m (subseries length), r (tolerance) and N (data length). Yet, the effects of changing those parameters have been scarcely investigated in the analysis of COP time-series. This study aimed to investigate the effects of changing parameters m, r and N on ApEn and SampEn values in COP time-series, as well as the ability of these entropy measures to discriminate between groups.

Methods

A public dataset of COP time-series was used. ApEn and SampEn were calculated for m?=?{2, 3, 4, 5}, r?=?{0.1, 0.15, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5} and N?=?{600, 1200} (30 and 60?s, respectively). Subjects were stratified in young adults (age?<?60, n?=?85), and older adults (age?≥?60) with (n?=?18) and without (n?=?56) falls in the last year. The effects of changing parameters m, r and N on ApEn and SampEn were investigated with a three-way ANOVA. The ability of ApEn and SampEn to discriminate between groups was investigated with a mixed ANOVA (within-subject factors: m, r and N; between-subject factor: group). Specific combinations of m, r and N producing significant differences between groups were identified using the Tukey’s honest significant difference procedure.

Results

A significant three-way interaction between m, r and N confirmed the sensitivity of ApEn and SampEn to the input parameters. SampEn showed a higher consistency and ability to discriminate between groups than ApEn. Significant differences between groups were mostly observed in longer (N?=?1200) COP time-series in the anterior-posterior direction. Those differences were observed for specific combinations of m and r, highlighting the importance of an adequate selection of input parameters.

Conclusions

Future studies should favour SampEn over ApEn and longer time-series (≥ 60?s) over shorter ones (e.g. 30?s). The use of parameter combinations such as SampEn (m?=?{4, 5}, r?=?{0.25, 0.3, 0.35}) is recommended.

     

Paraffin Granulomata, ��Witch's Chin,�� and Nasal Deformities: Excision and Reconstruction with Reduction Chinplasty and Open Rhinotomy Resection

A 57-year-old Filipino woman had paraffin materials placed in her nose, chin, and cheeks approximately 15 years prior to consultation. Progressive enlargement of the chin had occurred, simulating a witch''s chin deformity, with a lesser degree of the distal nose and columellar area. Restoration of a relatively normal chin contour was accomplished by using tumescent bi-level anesthesia, mobilizing the protuberant tissues, hemi-ressecting the excess skin, and sculpting the subjacent tissue to an appropriate degree. The nose was then entered at the columellar junction with the upper lip, an open rhinotomy was accomplished, the supra-cartilaginous fibrous tissue was serially ressected to reform the profile, the cartilage was replaced to narrow the nasal configuration, and the nose structure was then replaced. Cosmetic improvement was significant.Contour defects of the face or skin, such as scars from acne, accidents, or reconstructive and cosmetic problems, may be treated by soft-tissue correction. Facial augmentation has been performed by using various materials, including organic substances, such as ivory, liquid paraffin, autologous fat, and coral. Inorganic substances, such as liquid silicone gel, injectable bovine collagen, and gelatin matrix implants, have likewise been used.¹Paraffinoma is defined as a tumefaction, usually a granuloma, caused by the prosthetic or therapeutic injection of paraffin. Parrafin oil, discovered in 1830, is a purified hydrocarbon from petroleum that has been used in the past as an augmentation material in various parts of the human body for restoration of body defects or aesthetic body contouring.² Paraffin injection was regarded as a simple and effective method of improving body contour. It was widely used in breast augmentation until the long-term complication of paraffinoma was recognized.³This procedure requires an undetermined number of repeated injections, which may lead to migration of foreign materials and host immune response. Paraffinoma in the breast can present as a painless breast mass; a destructive ulcer simulating breast carcinoma; a painful, hard mass clinically resembling cancer; or a hard mass with ulceration or sinus formation, usually associated with lymphadenopathy.^3–6 This makes it difficult to correctly diagnose and provide suitable treatment.Some practitioners, especially nonsurgeons and nonphysicians, use liquid injectable materials, such as liquid silicone or paraffin, to perform noselift and chin augmentation procedures. Klein et al⁷ reported scalp paraffinomas, which occurred 35 to 42 years after injection of paraffin for treatment of baldness. These procedures are considered unacceptable in dermatology, dermatological surgery, and cosmetic surgery because of the unstable nature of these materials. These injectable substances migrate to other parts of the face and tumor-like lesions develop after several months or even years. These tumors are known as siliconoma when liquid silicone is used or paraffinoma when paraffin is used.¹These tumors are very difficult to remove, even in the hands of a competent surgeon. The injected material eventually mixes with the tissue, which leads to disfigurement of the face. Long-term follow up is advised to determine the possibility of malignant degeneration after the use of these injectable substances.On the other hand, unabsorbable fatty material used for nasal packing may provoke an inflammatory reaction (variously termed as oleogranuloma, lipogranuloma, paraffinoma, oil granuloma, sclerosing lipogranulomatosis, and myospherulosis). A computed tomography (CT) scan excludes other causes for the deformity. Surgical excision of the tissue is indicated with an appropriate warning of possible recurrence.On CT scan of the face, paraffinoma appears as an ill-defined infiltration in the buccal fat pad and the subcutaneous fat with multiple punctate calcifications (Figure 1). When calcifications associated with soft tissue infiltration are incidentally noticed on CT, particularly bilaterally, the diagnosis of foreign body granulomas secondary to cosmetic cheek augmentation is highly possible and an appropriate review of the medical history is highly recommended.Open in a separate windowOpen in a separate windowFigures 1A and 1BA 54-year-old asymptomatic woman with history of paraffin injection 30 years earlier. Contrast-enhanced computed tomography scans show low density oil droplets with nodular and curvilinear calcifications in the subcutaneous fat layer of bilateral cheeks (large arrows) and nose (small arrow and arrowhead, B). Note other calcifications in bilateral buccal spaces (black arrows, A).¹⁶     

Surgical management of giant superior mesenteric artery aneurysm

The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.     

Prognostic factors in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: multivariate analysis of data from four randomized CUETO trials

OBJECTIVES: To evaluate the prognostic factors of recurrence and progression after intravesical adjuvant bacillus Calmette-Guérin (BCG) immunotherapy in patients with non-muscle-invasive bladder tumors. METHODS: From February 1990 to May 1999, the Spanish Club Urológico Espa?ol de Tratamiento Oncológico (CUETO) group has performed four randomized phase 3 studies comparing different intravesical treatments in patients with noninvasive bladder cancer. Data from 1062 evaluable patients treated only with BCG were analyzed. Most patients received BCG once weekly for 6 consecutive weeks and a short-term BCG maintenance (once every 2 wk 6 times more). Associated tumor in situ (TIS) was found in 7.5% (n=80) of cases. There were 22.1% (n=235) patients with T1G3 tumors, 22.9% of whom (n=54) were associated with TIS. Stepwise multivariate Cox regression models with stratification by study and dose were used to assess the independent effect of predictive factors and hazard ratios (HRs) were estimated from the Cox model. RESULTS: Multivariate analysis demonstrated that female gender (HR=1.71) compared to male gender, recurrent tumors (HR=1.9) compared to primary tumors, multiplicity, and presence of associated TIS (HR=1.54) increased the risk of recurrence. Recurrent tumors (HR=1.62) compared to primary tumors, high-grade tumors (HR=5.64) compared to G1 tumors, T1 tumors (HR=2.15) compared to Ta tumors, and recurrence at 3-mo cystoscopy (HR=4.6) increased the risk of progression. CONCLUSION: Significant independent predictors for recurrence were female gender, history of recurrence, multiplicity, and presence of associated TIS. Age, history of recurrence, high grade, T1 stage, and recurrence at first cystoscopy were independent predictors of progression by multivariate Cox analysis.