Subpectoral biceps tenodesis

The long head of the biceps brachii (LHB) tendon has long been recognized as a source of shoulder pain. Surgeons have debated the merits of tenotomy versus tenodesis, open versus arthroscopic approaches, and various fixation methods. This article reviews the clinical findings associated with LHB pathology, describes the operative technique of subpectoral biceps tenodesis, and reviews the current literature related to treatment of the symptomatic LHB tendon. The miniopen subpectoral approach is technically less demanding than purely arthroscopic techniques, and offers the potential for improved pain relief without cosmetic deformity by removing most of the LHB and its associated tenosynovium. As the literature on the topic continues to grow, subpectoral biceps tenodesis has emerged as an effective treatment for pathology of the LHB.     

Comparison of hematopoietic progenitor cells in human umbilical cord blood collected from neonatal infants who are small and appropriate for gestational age

BACKGROUND: Cord blood has been used for transplantation. The purpose of this study was to compare numbers of hematopoietic progenitors in cord blood collected from neonatal infants who are small for their gestational age and those who are normal. STUDY DESIGN AND METHODS: Sixteen pregnant women diagnosed with intrauterine growth restriction were prospectively identified. Cord blood was collected at delivery. Fourteen cord blood samples were obtained from gestational age-matched, appropriately grown newborns. In vitro assays for hematopoietic progenitors were performed and results of the two compared. Comparisons were also made with numbers of hematopoietic progenitor cells previously found by this laboratory in samples collected with the possibility of use for transplantation. RESULTS: Gestational age, the women's pregnancy and delivery histories, maternal risk factors for intrauterine growth restriction, maternal age, delivery method, umbilical cord blood gases, and 5-minute Apgar scores were similar in the two groups. Newborns who were small for their gestational age had significantly lower birth weights and longer stays in the neonatal intensive care unit with no evidence for viral infections in the immediate neonatal period. The mean number of progenitors per collection of cord blood in the small newborns was about half that per collection from appropriately grown newborns, but in most cases, these differences were not significant in the two groups, and many numbers in the small newborns fell within the range associated with successfully engrafting cord blood collections. CONCLUSION: Hematopoietic progenitor cells in the small newborns may be adequate for transplantation purposes in many cases. Their possible use in this context should, however, involve careful consideration of the numbers of progenitors collected as well as of possible viral or other contamination.     

Procoagulant activity of lymphocyte-macrophage populations in rabbits: selective increases in marrow, blood, and spleen cells during Shwartzman reactions

The present experiments examine leukocyte procoagulant activity using mononuclear cell populations purified or enriched from rabbit bone marrow, blood, spleen, lymph node, thymus, and pulmonary alveoli. Cells from these six sites, obtained from control and endotoxemic animals and assayed without an intermediate culture step, were found to have procoagulant activity identified as tissue factor. Under control conditions, tissue factor activity was found to be at low levels in marrow and blood populations compared to median activities 3- and 11- fold higher in populations from spleen and lymph node, and 33- and 45- fold higher in thymus and alveolar populations. By contrast to respective controls, significantly increased amounts of tissue factor (35-, 15-, and 12-fold at median levels) were found in marrow, blood, and spleen populations from endotoxemic animals. The types of leukocytes in these latter three populations were morphologically and histochemically indistinguishable from respective controls, indicating that endotoxin induced increases of activity in cells with relatively low amounts under control conditions. Activity did not change significantly in lymph node, thymus, or alveolar populations after endotoxemia. These studies show that tissue factor is present in a range of leukocyte populations not previously reported to have procoagulant activity. In addition, the finding of widespread gains of tissue factor in the marrow-blood-spleen pool due to endotoxemia provides new evidence supporting the importance of leukocyte procoagulants in Shwartzman-like reactions.     

IMVP-16: an effective regimen for patients with lymphoma who have relapsed after initial combination chemotherapy

Results of second-line chemotherapy regimens against lymphoma have usually been poor. In this study, we used a combination of ifosfamide, methotrexate, and VP-16 to treat 52 patients with lymphoma who had either relapsed or who had failed to attain a complete remission on front-line treatment. Thirty-two patients (62%) responded (CR 37%, PR 25%) and 10 (19%) had a minor response. The median relapse-free interval of the responding patients was 12 mo, and the median survival of the whole group was 15 mo. Of the 18 patients who achieved complete remission, 10 still remain free of any evidence of disease. The factor that best predicted for response to IMVP-16 was the quality of the remission achieved on front-line therapy. In view of the poor prognosis associated with recurrent lymphoma, the results obtained with this study are considered most encouraging. Patients with recurrent lymphoma can be successfully salvaged by the use of this combination regimen, especially if introduced early after relapse or preferably before progressive disease develops.