Surgery for left ventricular free wall rupture: patch glue repair without extracorporeal circulation.

Left ventricular free wall rupture is a dramatic complication after myocardial infarction. We present our experience with the simple, expedient technique of patch glue repair without extracorporeal circulation. Access is obtained via median sternotomy. Evacuation of blood and haematoma is undertaken and a Goretex patch exceeding the size of infarct is fashioned. The patch is applied to the epicardium using enbrucrilate surgical glue instilled with gentle pressure against the beating heart. We performed this technique on 17 patients from 1993 to 2001, with a operative (30-day) mortality of 23.5% with a post-discharge survival of 85% at 2.2 years.     

Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia

PURPOSE: The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space. METHODS: 16 anesthetized patients were sequentially studied in three steps: 1) without PEEP (ZEEP), 2) with 5 cm H(2)O of PEEP and 3) with 5 cm H(2)O of PEEP after an alveolar recruitment strategy (ARS). Ventilation was maintained constant. The single breath test of CO(2) (SBT-CO(2)), arterial oxygenation, end-expiratory lung volume (EELV) and respiratory compliance were recorded every 30 min. RESULTS: Physiological dead space to tidal volume decreased after ARS (0.45 +/- 0.01) compared with ZEEP (0.50 +/- 0.07, P < 0.05) and PEEP (0.51 +/- 0.06, P < 0.05). The elimination of CO(2) per breath increased during PEEP (25 +/- 3.3 mL.min(-1)) and ARS (27 +/- 3.2 mL.min(-1)) compared to ZEEP (23 +/- 2.6 mL.min(-1), P < 0.05), although ARS showed larger values than PEEP (P < 0.05). Pa-etCO(2) difference was lower after recruitment (0.9 +/- 0.5 kPa, P < 0.05) compared to ZEEP (1.1 +/- 0.5 kPa) and PEEP (1.2 +/- 0.5 kPa). Slope II increased after ARS (63 +/- 11%/L, P < 0.05) compared with ZEEP (46 +/- 7.7%/L) and PEEP (56 +/- 10%/L). Slope III decreased significantly after recruitment (0.13 +/- 0.07 1/L) compared with ZEEP (0.21 +/- 0.11 1/L) and PEEP (0.18 +/- 0.10 1/L). The angle between slope II and III decreased only after ARS. After lung recruitment, PaO(2), EELV, and compliance increased significantly compared with ZEEP and PEEP. CONCLUSION: Lung recruitment improved the efficiency of ventilation in anesthetized patients.     

Vertebral compression fracture as a presenting feature of acute lymphoblastic leukemia in children

Twenty-four (1.6%) of 1466 children with acute lymphoblastic leukemia (ALL) treated at St. Jude Children's Research Hospital had vertebral compression fractures at diagnosis. When compared with patients without this complication, they were more likely to have good prognostic features, including a leukocyte count of greater than 25 X 10(9)/l, a leukemic cell DNA index of greater than 1.15, and hyperdiploidy (greater than 50 chromosomes). Complete remission of ALL was induced in all patients, and symptoms of vertebral compression fractures abated following antileukemia therapy. Although the diagnosis of ALL was delayed for some patients because this unusual presenting complication was not recognized as such, their treatment outcome was as good as that for other children with "standard-risk" ALL.     

Cranial sutures and craniometric points detected on MRI

The main goal of the study was to determine on MRI the cranial sutures, the craniometric points and craniometric measurements, and to correlate these results with classical anthropometric measurements. For this purpose, we reviewed 150 cerebral MRI examinations considered as normal (Caucasian population aged 2049 years). For each examination we individualized 11 craniometric landmarks (Glabella, Bregma, Lambda, Opisthocranion, Opisthion, Basion, Inion, Porion, Infra-orbital, Eurion) and three measurements. Measurements were also calculated independently on 498 dry crania (Microscribe 3-DX digitizer). To validate the MRI procedure, we measured four dry crania by MRI and with compass or digital caliper gauges. Cranial sutures always appeared without signal (black), whatever the MRI sequence used, and they are better visualized with a 5 mm slice thickness (compact bone overlapping). Slice dynamic analysis and multiplanar reformatting allowed the detection of all craniometric points, some of these being more difficult to detect than others (Porion, Infra-orbital). The measurements determined by these points were as follows: VertexBasion height=135.66±6.56 mm; EurionEurion width=141.17±5.19 mm; GlabellaOpisthocranion length=181.94±6.40 mm. On the midline T1-weighted sagittal image, all median craniometric landmarks can be individualized and the GlabellaOpisthocranion length, VertexBasion height and parenchyma indices can be calculated. Craniometric points and measurements between these points can be estimated with a standard cerebral MRI examination, with results that are similar to anthropometric data.     

Estimation of estrogen receptor content in fine-needle aspirates from breast cancer using the monoclonal antibody 1d5 and microwave oven processing: Correlation with paraffin embedded and frozen sections determinations

We describe a method of immunocytochemically assessing estrogen receptor (ER) status on alcohol-fixed smears obtained by fine-needle aspiration (FNA) from breast cancer patients, using a commercially available monoclonal antibody (1D5) with microwave oven processing. A series of 31 cases of aspirates from breast cancer were analysed and the results were compared with assessment by ER immunocytochemical assay using the same procedure on formalin-fixed tissue and with assessment by ER-ICA assay on frozen sections. The results were scored semiquantitatively using a five grade scoring system. Of the 31 cases examined, 21 were positive at least by two methods and 10 were negative for all three determinations. The results obtained in the ER immunocytochemical assay on aspirates and paraffin-sections using the antibody 1D5 and those obtained on frozen sections using the antibody H222 were closely similar. In only one case was it not possible to interpret the reaction in the cytological specimen because there was a strong background in the smear. In general, we obtained more intense positivity with the antibody 1D5 in aspirates and formalin-fixed material than with the antibody H222 in frozen sections. The scoring results of the three methods were almost identical. We conclude that the application of ER method on alcohol-fixed smears will eliminate the need for using a special fixation procedure and will provide several advantages, such as: improvement in morphological concomitant analysis, utilization whenever malignancy is found without necessity to re-aspirate the patient, and adequacy of archival material. © 1995 Wiley-Liss, Inc.     

Soft-tissue angiomatosis in adulthood: a case in the forearm showing a prominent myxoid adipose tissue component mimicking liposarcoma

Soft-tissue angiomatosis is a rare condition characterized by diffuse proliferation of benign vascular structures, accompanied by mature adipose tissue, which affect a large segment of the body in a contiguous fashion. Most patients present in childhood or adolescence. We report a case of large soft-tissue angiomatosis, located in the left forearm of a 65-year-old man, which showed extensive intramuscular and intermuscular infiltration, and embracement of the radius and the main vascular and neural bundles of the forearm. Due to the deep location, large size, ill-defined limits and non-homogeneous composition with areas suggestive of an adipose component in the radiological examination, the lesion raised the possibility clinically of a liposarcoma. The myxoid adipose tissue component of the lesion, a feature previously undescribed, and the predominance of small, capillary-sized vessels were considered concordant with the clinical diagnosis. This presentation is rare. The features of the lesion made complete surgical excision impossible and amputation of the extremity was considered the best treatment. The main differential diagnoses include infiltrating lipoma, myxolipoma, angiomyxolipoma, angiolipoma, intramuscular angioma, liposarcoma and low-grade myxofibrosarcoma. In conclusion, angiomatosis might simulate liposarcoma, particularly if the mass is large, heterogeneous, myxoid and appears later in life.     

B7/BB-1 is a leucocyte differentiation antigen on human dendritic cells induced by activation.

Activation of a primary T-lymphocyte response requires additional signals apart from interaction of the T-cell receptor (TcR)/CD3 complex with major histocompatibility complex (MHC) antigens on the antigen-presenting cell. The CD28 antigen on T lymphocytes provides an important co-stimulatory signal to T lymphocytes and we therefore searched for the presence of its ligand, the B7/BB-1 antigen, on blood and tonsil dendritic cells (DC). Blood DC, prepared from peripheral blood mononuclear cells with a minimal period of in vitro culture, did not stain with the monoclonal antibody BB-1 using flow cytometry analysis. In contrast, tonsil DC stained weakly for B7/BB-1 compared to positive control cell lines. Polymerase chain reaction (PCR) was used to amplify a 605 base pair (bp) fragment from human B7/BB-1 mRNA and demonstrated significant amounts of B7/BB-1 mRNA in tonsil DC but no specific product was obtained from blood DC, confirming the surface-staining results. Weak expression of B7/BB-1 antigen was detected by immunofluorescence analysis following culture of blood DC with either interferon-gamma (IFN-gamma) or granulocyte-macrophage colony-stimulating factor (GM-CSF). These data support the concept that blood DC give rise to tissue and/or lymphoid DC, which acquire co-stimulatory ligands as a result of activation and/or differentiation.