A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.

Infants with esophageal atresia and right aortic arch: Characteristics and outcomes from the Midwest Pediatric Surgery Consortium

Purpose

Right sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF.

Procedural burden experienced by children with cancer during their terminal hospital admission

Background

Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA).

Morphologic changes in the canine urinary tract after ureteral reconstruction with the tunica albuginea (experimental study)*

Objectives: The problem of ureteral reconstruction has not been fully solved, despite dramatic developments in surgical methods. Many attempts to repair a ureteral damage with autologous or homologous organ grafts, or with organic substitutes have not really been satisfactory. Also, attempts to use alloplastic and heteroplastic prostheses made of synthetic materials have been equally disappointing. Experimental studies, particularly in dogs, indicate great regenerative abilities of ureters when appropriate surgical techniques are used. Materials and methods: In our experimental study, suitability of the tunica albuginea for reconstruction of the middle part of the ureter was investigated in 20 dogs. The dogs were divided into two groups according to a type of ureteral damage: partial (a patch graft) or complete (a tube graft). The ureteral damage was 2–3 cm long in 10 dogs and 3–3.5 cm long in the subsequent 10 dogs. Each dog underwent two operations. The first operation involved a fenestrating incision in the ureter, 23.5 cm long, so as to preserve the ureteral continuity, and then the produced injury was repaired with a patch of the tunica albuginea, with the 4 Charr catheter being inserted in the ureter. The second operation involved a complete excision of ureteral segments, 2–3.5 cm long, on the contralateral side. The excised length of the ureter was substituted with a tube graft of the tunica albuginea, also using the 4 Charr catheter. Thus, in 21 cases, a partial damage of the ureteral wall was repaired with a patch graft of the tunica albuginea. In 19 cases, a complete damage of the ureter was repaired with a tube graft of the tunica albuginea. Results: Four dogs died after the tube-graft implantation due to urinary infiltration and/or purulent inflammatory changes in the kidneys. Autopsies were performed in all the dogs after they had been put to sleep. Definitely poor results were obtained in case of the complete reconstruction of the ureteral loss with a tube graft of the tunica albuginea, 3–3.5 cm long. Within the graft area, we observed inflammatory infiltrates of varied intensity, fibrosis, cicatricial strictures or ureteral obstruction. Occasionally, necrotic foci, degenerative changes or hydronephrosis were found. In case of the reconstruction with a shorter tube graft, i.e. 2–3 cm long, similar changes were observed, however, they were less intense. Satisfactory results were obtained following the partial reconstruction of the ureteral loss with a patch graft of the tunica albuginea. In this case, we observed generally normal regeneration not only of the transitional epithelium but the muscular layer and ureteral structure as well, with full patency of the ureter preserved. The findings obtained in our study are compatible with the findings of other authors. Conclusions: (1) The success of reconstructive procedures in the ureters can be achieved if the continuity of the ureter is preserved and the catheter is removed after 14 days. (2) The substitution of a complete ureteral loss with a tube-graft of the tunica albuginea results in necrosis of the graft and restenosis. *Printed in part at the postdoctoral thesis of Tyloch Ferdynand MD: “An experimental study on the use of tunica albuginea for supplying at westage of ureters” (Badania doswiadczalne nad przydatnoscia blony bialawej jadra w operacjach plastycznych moczowodu) University School of Medical Sciences Bydgoszcz 1994.     

Blood and tissue selenium concentrations and glutathione peroxidase activities in patients with prostate cancer and benign prostate hyperplasia

Prostate cancer (PC) is the most common cancer in men and a leading cause of cancer death. Prostatic gland accumulates reasonably high amount of selenium (Se), the element that prevents the development of PC. It is hypothesized that some selenoproteins inhibit the transformation of normal prostate epithelium into neoplasm. We studied Se levels in whole blood, plasma and prostate of 32 PC and 40 benign prostate hyperplasia (BPH) patients and in the control group composed of 39 healthy subjects. The selenoenzyme glutathione peroxidase (GSH-Px) was also measured in the patients' red cells, plasma and prostate tissue. Se concentration in whole blood and plasma in both groups of patients was lower as compared with controls, while in prostate gland it was significantly higher in PC than in BPH patients and controls. Red cell GSH-Px activity was the same in PC patients and controls but significantly lower in BPH patients. Plasma GSH-Px activity was significantly lower in PC patients than in the control group, and prostate GSH-Px activity was significantly lower in PC patients as compared with BPH patients. Since Se has anticancer properties, it is very likely that its low level in blood may facilitate the development of cancer. A higher level of Se in prostate of PC patients has no influence on GSH-Px activity in the gland.     

Insulin secretion at the diagnosis of gestational diabetes is lower in multiparas than in primiparas

Gestational diabetes mellitus (GDM) has heterogeneous ethiopathogenesis, pathophysiology and clinical features. OBJECTIVES: The aim of the study was to evaluate some of anthropometric parameters, clinical features and indices of insulin resistance and beta cell function in GDM women in first pregnancy and in GDM women in third and following pregnancies. MATERIAL AND METHODS: 877 GDM women, aged 18-48 years were studied. Both groups were compared according to age, BMI before pregnancy, week of GDM diagnosis, weight gain during pregnancy, fasting blood glucose, fasting serum insulin level, HbA1c, insulin resistance and beta-cell function indices. All parameters except BMI were evaluated at GDM diagnosis. RESULTS: Multiparas were older, with higher BMI and lower beta-cell function indices. CONCLUSION: At the moment of GDM diagnosis, insulin secretion evaluated by HOMA indices are lower in multiparas in comparison to primaparas.     

HLA class I-restricted responses to vaccinia recognize a broad array of proteins mainly involved in virulence and viral gene regulation

We have analyzed by ex vivo ELISPOT the anti-vaccinia cytotoxic T lymphocyte responses of peripheral blood mononuclear cells from humans vaccinated with Dryvax vaccine. More than 6,000 peptides from 258 putative vaccinia ORFs predicted to bind the common molecules of the HLA A1, A2, A3, A24, B7, and B44 supertypes were screened with peripheral blood mononuclear cells of 31 vaccinees. A total of 48 epitopes derived from 35 different vaccinia antigens were identified, some of which (B8R, D1R, D5R, C10L, C19L, C7L, F12, and O1L) were recognized by multiple donors and contain multiple epitopes recognized in the context of different HLA types. The antigens recognized tend to be >100 residues in length and are expressed predominantly in the early phases of infection, although some late antigens were also recognized. Viral genome regulation and virulence factor were recognized most frequently, whereas few structural proteins were immunogenic. Finally, most epitopes were highly conserved among vaccinia virus Western Reserve, variola major and modified vaccinia Ankara, supporting their potential use in vaccine and diagnostic applications.     

Regulation of adaptive immunity by natural killer cells

Natural killer (NK) cells are well recognized as cytolytic effector cells of the innate immune system. In the past several years, the structure and function of NK cell receptors for the major histocompatibility complex (MHC) class I molecules and other ligands have been the subject of extensive studies. These studies have focused largely on the mechanisms of target cell recognition for lysis. Another aspect of NK cell function that seems to be underappreciated is their role in immune regulation. Since NK cells produce a number of immunologically relevant cytokines, it has been suggested that these cells may modulate the development of the adaptive immune response. But, is it the only mechanism by which NK cells interact with cells involved in the induction of antigen-specific responses? This article reviews some older and more recent studies and attempts to place NK cells in the context of potent immune regulators of T cell responses.