Consequences of pulmonary inflations (sighs) on cerebral haemodynamics in neonates ventilated by high-frequency oscillation

High-frequency oscillation (HFO) is a technique frequently used in neonatal resuscitation, but which has yet to be evaluated. The use of intrathoracic pressures may have an effect on the cerebral circulation of immature neonates. The aim of this study was to examine the variations in cerebral blood velocity and oxygenation during brief pulmonary inflations (sighs), by focusing on alveolar recruitment. In this prospective study performed in 13 intubated and ventilated neonates (alpha = 5%; 1-beta = 80%), mean blood velocity and Doppler Resistance Index were measured, and variations in chromophores concentrations were evaluated by near infrared spectroscopy. Brief inflations at 4 cm H2O above the mean regulated intra-thoracic pressure did not cause any variation in the parameters measured. An explanation for this discordance with animal studies may be the level of pressure chosen, which could be more appropriate for the pulmonary compliance of neonates.     

The prognostic value of intraepithelial and stromal CD3‐, CD117‐ and CD138‐positive cells in non‐small cell lung carcinoma

Al‐Shibli K, Al‐Saad S, Andersen S, Donnem T, Bremnes RM, Busund L‐T. The prognostic value of intraepithelial and stromal CD3‐, CD117‐ and CD138‐positive cells in non‐small cell lung carcinoma. APMIS 2010; 118: 371–82. The major value of prognostic markers in potentially curable non‐small cell lung carcinoma (NSCLC) should be to guide therapy after surgical treatment. Although tumor‐infiltrating T lymphocytes and plasma cells have been documented in NSCLC, a clear association with clinical outcome, especially for the stromal component, has not been well established. The aim of this study was to elucidate the prognostic significance of these cells/markers in the epithelial and stromal compartments of NSCLC. Tissue microarrays from 335 resected, stage I‐IIIA, NSCLC were constructed by duplicate cores from viable neoplastic epithelial and stromal areas. Immunohistochemistry was used to evaluate the infiltration of CD3⁺, CD117⁺ as well as CD138⁺ cells in epithelial and stromal areas. In univariate analyses, increasing numbers of stromal CD3⁺ (p = 0.001) and epithelial CD3⁺ cells (p = 0.004) correlated significantly with an improved disease‐specific survival. No such relation was noted with CD3⁺ or CD117⁺ cells. In the multivariate analysis, stromal CD3⁺ cells was an independent prognostic factor for disease‐specific survival (HR 1.925, CI 1.21–3.04, p = 0.005). Increased presence of the pan T‐cell marker, CD3, which is an independent factor, correlates with improved clinical outcome in NSCLC. This prognostic impact of T cells is clearer in the tumor stroma. Neither plasma cells nor mast cells were prognostic indicators in our cohort.     

Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents

Original Gianturco expandable stents and their modifications were used to create an experimental intrahepatic portacaval anastomosis (EIPCA) in 30 young domestic swine without portal hypertension. The study focused on the design of a suitable stent, the technique of its application, and the evaluation of short-term patency of the EIPCA. A stent with a 2.5-cm-long body and wire skirts on both ends was most suitable for EIPCA creation. Well-positioned stents shunted most of the portal blood in the inferior vena cava circulation and remained patent for 4-6 weeks. Ingrowth of liver parenchyma and abundant proliferation of the intima and connective tissue inside the stent lumen in these rapidly growing animals gradually decreased EIPCA patency, and thrombus formation with diminished blood flow closed them completely.     

Non-Q wave and Q wave myocardial infarct: correlation with regional myocardial perfusion, wall function and prognosis within 1 year

The pathophysiologic substrate and the prognostic value of pathologic Q-waves after an acute myocardial infarction are still unclear. To elucidate this problem we stratified 52 postinfarction patients into those with Q-infarctions (n = 23) and those with non-Q-infarctions (n = 29). The localization and the extent of reversible and irreversible perfusion defects were assessed using dipyridamole-thallium-201 tomography (SPECT); in addition, coronary morphology, left ventricular wall motion, and prognosis were followed for 1 year. The Q-wave group showed a total defect size of 44.0 +/- 15.3% and a reversible defect size of 13.9 +/- 10% of the left ventricular myocardium. This was not significantly different from the non-Q-wave group, with a mean total defect of 35.2 +/- 20.7% and a mean reversible defect of 16.6 +/- 12.9%. However, the size of the irreversible defects in Q-wave infarctions was larger than in non-Q-wave infarctions (30.6 +/- 18.2% vs 18.6 +/- 17.5%; p less than 0.02). In addition, the relative portion of the reversible defect was larger in non-Q-infarctions than in Q-infarctions (55.9 +/- 25.7% vs 35.7 +/- 21.3%; p less than 0.01). Q-wave infarctions had a significantly lower LVEF of 55.7 +/- 15.4%, as compared to non-Q-infarctions (66.2 +/- 11.9%) (p less than 0.02). The extent of disease, as measured by coronary score and regional wall motion, was similar, but non-Q-wave infarctions were associated with a higher reinfarction rate (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Development of pulmonary aneurysm in primary pulmonary hypertension: a case report

Selected cases of severe primary pulmonary arterial hypertension and associated pulmonary vascular disease have been related to the oral ingestion of aminorex fumarate, an anorexigen obviously responsible for an epidemic of primary pulmonary hypertension in Western Europe between 1967 and 1970. This report describes a fifteen year follow-up of a female patient with aminorex fumarate related pulmonary hypertension and the uncommon finding of the formation of an excessive fusiform pulmonary trunk aneurysm in the late stage of the disease process. The progressive clinical course was followed by serial chest x-ray films and repeat right heart catheterization. The diagnosis of a main stem pulmonary artery aneurysm was noninvasively established by two-dimensional echocardiography and confirmed by contrast-enhanced computed tomography and radionuclide blood pool imaging. The patient is alive, thus no histologic correlate of this entity is available at present.     

Computed tomography and magnetic resonance imaging features of olfactory neuroblastoma: an analysis of 22 cases.

The computed tomography (CT) and magnetic resonance imaging (MRI) studies of 22 patients with a histologically proven olfactory neuroblastoma were retrospectively reviewed. The tumours displayed a variety of imaging characteristics and aggressiveness. The expansile tendency of olfactory neuroblastoma is characterised by bowing of the sinus walls. The destructive aspect is manifested as tumour replacing the turbinates, septum, and sinus walls with extension into contiguous areas. The density/signal and enhancement characteristics are non-specific. Olfactory neuroblastoma should be suspected in all ages following identification of a mass in the superior nasal cavity demonstrating both expansile and destructive growth patterns. The otorhinolaryngologist and the radiologist should be aware of this tumour entity, as early diagnosis appropriately guides therapy and predicts survival.     

Therapeutic strategies in inflammatory breast carcinoma based on prognostic factors

Prognostic factors were identified in a group of 210 patients with inflammatory breast carcinoma (IBC) treated at Institut Gustave Roussy from 1976–1985 with three successive induction protocols: Group A (n = 91), 1976–1980, doxorubicin, vincristine, methotrexate (AVM); Group B (n = 79), 1980–1982, doxorubicin, vincristine, cyclophosphamide, methotrexate, 5-fluorouracil (AVCMF); Group C (n = 40), 1983–1985, AVCMF. Groups A and B received 3 courses of respective chemotherapy (Ct) followed by radiotherapy (Rt), 45 Gy to breast and nodes and 65–70 Gy to the tumor. Group C after the third Ct course received split courses of Rt to equivalent doses so there was no time lag between Ct courses. Ct from fourth to ninth courses was AVM in all groups. Hormonal therapy, radiocastration (pre and perimenopausal) or tamoxifen (postmenopausal) was given all patients. Clinical characteristics of age, menopausal status, castration, N status, and degree of clinical inflammation (limited to tumor area [PEV 2] or involving the entire breast [PEV 3]) were similar in all groups. Groups B and C had identical disease-free and overall survivals, superior to Group A (p = 0.005). In multi-variate analysis, AVCMF was one of the important prognostic factors together with PEV and N status. Three prognostic classes were identified: I (n = 66) — PEV 2 and N0-1 (relative risk (RR) of relapse 0.80X) where AVM was as effective as AVCMF; II (n = 126) — either N2-3 or PEV 3 (RR 1.10X) where AVCMF was statistically superior to AVM and reduced the RR significantly (p = 0.02); III (n = 18) — PEV 3 and N2-3 (RR 1.9X) where Ct increased neither DFS nor OS over a historical Rt-only group. For class III a much more aggressive Ct such as initial myeloablative therapy with bone marrow autograft may be useful, which may also further improve survival in chemosensitive class II.     

Transient synovitis of the hip in children: role of US

Transient synovitis of the hip remains a common diagnostic problem for the clinician. The physical signs are not pathognomonic of the condition, and the classic technical examinations are of little help. Therefore, the authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions. In 20 of the 21 patients with a final diagnosis of transient synovitis, articular effusion was detected on ultrasound (US). Conventional radiography showed an increased medial joint space in only eight of these patients. Increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis. The high sensitivity of US in detecting intraarticular fluid was demonstrated by cadaver studies.     

Radiological diagnosis of cervical trauma at the level C7/T1

Summary After a car accident a 23-year-old man was found to have rotational luxation of the cervical spine at the level C7/T1. The diagnosis was suspected from indirect signs on the ap X-ray and subsequently confirmed by conventional lateral tomography. Neurological symptoms were not present. Magnetic resonance imaging demonstrated dorsal protrusion of the intervertebral disc.

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Zusammenfassung Nach einem Verkehrsunfall fand sich bei einem 23jährigen Mann eine einseitige Luxation der Halswirbelsäule im Segment C7/T1. Die Diagnose wurde aufgrund indirekter Zeichen auf der ap-Übersichtsaufnahme der Halswirbelsäule vermutet und anschließend durch konventionelle laterale Tomographie bestätigt. Eine neurologische Symptomatik lag nicht vor. Die Kernspintomographie zeigte die dorsale Protrusion der Bandscheibe des luxierten Segments.