Two smooth muscle tumors in the airway of an HIV-infected child

Tumors of smooth muscle origin are rare in childhood. We report a case of multiple bronchial leiomyomata in a seven year old girl with clinical HIV infection who presented with new onset of wheezing. Clinical details of this case have been published elsewhere, but without imaging studies [1].Editorial commentaryIn the past several years, scattered accounts of leiomyoma and/or leiomyosarcoma have been published in HIV infected pediatric patients who had prior LIP. The tumors have been noted in the liver, gastrointestinal tract but mostly in the lung, both in the trachea, bronchi and lung parenchyma.The tumor cells are Desmin positive and, on light and electron microscopy, are felt to be of smooth muscle origin. They must be distinguished from the collections of spindle cells that seem to be a pseudotumor in HIV patients with mycobacterium avium intracellulare; the cases of this latter pseudotumor have been in the adult HIV literature.W.E.Berdon (Managing Editor)     

Preparation and application of anti-HBx/anti-CD3 bispecific monoclonal antibody (BsAb) retargeting effector cells for lysis of human hepatoma xenografts in nude mice

Evidence indicated that the x gene of human HBV can cause cancer in transgenic mice, moreover, HBxAg was so far the most frequent and strong antigen among those HBV markers expressed in hepatocellular carcinoma (HCC) tissues. Aiming to enhance killing of HCC by effector cells, we established an anti-HBx/anti-CD3 hybrid-hybridomas by fusion of anti-HBx hybridoma cells with FITC-labeled anti-CD3 HAT sensitive cells, and followed by FACStar sterile cell sorting, HAT selection and eventually verified by ELISA and double bridging assay. Using two color cytometric analysis, we found that bispecific monoclonal antibody (BsAb) remarkably enhanced in vitro effector-target cell conjugates (48.3% vs. 8.5%). In in vivo study, BsAb retargeting effector cells were significantly more effective than that of effector cells alone in shrinkage of LTNM4 HCC xenografts (HBxAg positive) in nude mice, not only in fresh inoculated tumors but also in established tumors (p<0.01, p<0.01, respectively). Besides, pronounced apoptotic cell death and infiltration of lymphocytes in the peripheral of tumor nodules can also be witnessed in the tissues treated by BsAb plus effector cells, but not in the controls. The results demonstrated that antiHBx/anti-CD3 BsAb was able to redirect effector cells for lysis of HBxAg positive HCC cells both in vitro and in vivo and it also indicated that shrinkage of tumors in nude mice with therapy of BsAb retargeting effector cells was partially due to initiation of apoptotic cell death.     

Validity of a new portable indirect calorimeter: the AeroSport TEEM 100

The purpose of this study was to compare oxygen uptake ( ) values collected with a new portable indirect calorimeter (AeroSport TEEM 100 Metabolic Analysis System) against a more traditional large calorimeter system that has been reported to be valid and reliable (SensorMedics 2900 Metabolic Measurement Cart). Minute ventilations ranging from rest up to heavy exercise were compared with simultaneous measurements from a 120-1 Tissot gasometer. Each of the three TEEM 100 pneumotachs were tested. Three hundred and sixty-one separate ventilation tests were performed using the low-flow, medium-flow, and high-flow heads of the portable calorimeter. For each of the pneumotachs, the correlation between the portable calorimeter values and the gasometer values exceededr = 0.94. The standard error of estimate for the low-, medium- and high-flow pneumotach were 5.96, 4.89 and 9.0%, respectively, expressed relative to the mean gasometer value. Simultaneous measurements of using the portable calorimeter and the SensorMedics 2900 unit were compared during rest and at work rates starting at zero watts, increasing by 25 W to 150 W. Each work rate was of 4 min duration. The average of data from minutes 3 and 4 were used in all analyses. There was very close agreement between the two metabolic measurement systems. Except at the 100-W work rate, where the difference was small (3.9%), yet statistically significant, all of the other differences in were small and non-significant. The scatter plot of for the SensorMedics versus the portable Aero-Sport calorimeter revealed close agreement; the correlation wasr = 0.96, (SEE = 3.95%). It was concluded that the AeroSport TEEM 100 portable calorimeter system produces valid data at rest and at low to moderate work rates compared to a criterion, large system.     

Predictive value of balloon test occlusion of the internal carotid artery

Balloon test occlusion (BTO) of the internal carotid artery (ICA) is used in conjunction with single-photon emission computed tomography (SPECT) imaging to assess the cerebrovascular collateral reserve prior to surgical manipulation of the artery. The present report reviews 56 consecutive patients with tumors or vascular lesions at the base of the skull who underwent BTO and subsequent treatment on that basis within a 3-year period. Four patients underwent carotid sacrifice, since they tolerated the BTO and had normal SPECT imaging. Postoperatively, one patient had patchy infarcts in the frontal lobe, another a middle cerebral artery territory infarction, a third had a lacunar infarct, and the fourth had an impending stroke and was treated with an emergent revascularization procedure. There were 15 patients who underwent saphenous vein bypass grafting, of these there were three graft occlusions, one of which resulted in an infarction. There were two other infarctions due to technical difficulties, one being related to the revascularization procedure. Based on these results, we suggest that passing BTO with a normal SPECT study does not necessarily indicate that the patient is immune to stroke following carotid sacrifice. Revascularization should be considered, when ICA sacrifice is deemed necessary to treat the pathologic condition adequately, to minimize the likelihood of a stroke.     

Evaluating the value, accuracy, and operational feasibility of DUE criteria

The purpose of this investigation was to evaluate the value, accuracy, and operational feasibility of indicators/criteria in a drug use evaluation (DUE) examining IV histamine2-receptor antagonists (H2-RA). Pharmacists in 40 hospitals collected DUE data concurrent with hospital stays on a total of 1,200 patients. After completing the DUE, pharmacist data collectors were asked to evaluate each DUE criterion. Most reported that criteria relating to indications for use, therapeutic drug monitoring, and adverse drug reactions/drug interactions should be included in a DUE, but some criteria were not easy to collect or were inaccurate. The data suggest the need to carefully select DUE criteria that can be used for continuous improvements that meet JCAHO accreditation requirements.     

Does the station of the fetal head during epidural analgesia affect labor and delivery?

OBJECTIVE: To assess whether the station of the fetal head when lumbar epidural analgesia is administered influences the duration or the mode of delivery in low-risk laboring women. METHODS: We prospectively evaluated 131 consecutive cases of low-risk parturients at term who requested intrapartum epidural analgesia. Obstetric outcome of 65 parturients who underwent epidural analgesia when the fetal head was low in the birth canal was compared to 66 patients whose fetal head station was above the ischial spine. RESULTS: Both groups were similar in their obstetric characteristics. Cervical dilatation when performing the epidural analgesia was similar in both groups. The duration of labor and mode of delivery, as well as percentage of malpositions, were not significantly different in the two groups. CONCLUSIONS: The station of the fetal head while initiating epidural analgesia does not influence the duration of labor or the mode of delivery. Therefore, there is no justification to delay epidural analgesia in labor until the presenting fetal part is engaged.     

Meta-analysis of open and endovascular repair of popliteal artery aneurysms

Objective

Endovascular popliteal artery aneurysm repair (EPAR) is increasingly used over open surgical repair (OPAR). The purpose of this study was to analyze the available literature on their comparative outcomes.

Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States

The shortage of deceased‐donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009–2012 and State Inpatient Databases (SIDs) from 2008–2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi‐organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient‐level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009–2012, 96,028 (3.3%) were a “possible deceased‐organ donor.” The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased‐donors who become actual donors; range: 20.0–57.0%); and (2) organs transplanted per possible donor (range: 0.52–1.74). These metrics allow for comparisons of OPO performance and geographic‐level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.