Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children.

Background/purpose: Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children.

Methods: We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement.

Rowing: sport-specific concerns for the team physician.

Rowing injuries occur mostly from overuse and are seen primarily in the back, rib, knee, and forearm. Many of these have a specific cause owing to the mechanics of the rowing stroke, which are discussed, as are sport-specific treatment strategies. Also discussed are specific injuries sustained on the rowing machine, emergency issues, and special population concerns.

Invasive mucinous cystic neoplasms of the pancreas.

Mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) of the pancreas both appear to have been included and intermixed in some early reports of pancreatic cystic neoplasms. Recognition of their distinguishing features evolved during the last decade of the twentieth century. One legacy of the early period is the statement that mucinous cystic neoplasms sometimes progress to invasive colloid carcinoma.

Rituximab mediates loss of CD19 on B cells in the absence of cell death.

Objective: To evaluate loss of the B cell-specific marker CD19 after the addition of rituximab (RTX) to healthy donor blood and to determine the role of complement-mediated cytotoxicity in these cells.

Methods: Whole blood and peripheral blood mononuclear cells (PBMCs) from healthy donors were evaluated for the loss of CD19 in the presence of RTX using flow cytometry. The effect of complement on CD19 loss was examined using serum-free media, C3- and C5-deficient sera, and a C5-blocking antibody.

The prognostic value of using the duration of acute kidney injury in cardiac surgery: an example using two antifibrinolytics.

Previously, we reported that the addition of duration to the Acute Kidney Injury Network (AKIN) definition of acute kidney injury (AKI) is a marker for more severe kidney injury and predicts long-term mortality. We aimed to evaluate an example of the utility of adding AKI duration to the AKIN definition by comparing the historical use of aprotinin with Amicar. In a single-center observational study, we followed 4987 consecutive patients undergoing cardiac surgery between 2002 and 2007 for postsurgery AKI.

Adjuvant and neoadjuvant therapy for primary GIST.

Adjuvant therapy for primary GIST has proven benefit in extending disease free survival. Defined risk factors for recurrent disease are based on GIST size, location, and mitotic rate and provide useful guidelines for selecting patients for adjuvant therapy considerations. Neoadjuvant therapy with tyrosine kinase inhibition has potential usefulness in primary GIST, although not yet as standard of care.

Duration of acute kidney injury impacts long-term survival after cardiac surgery.

Background: Acute kidney injury (AKI) after cardiac surgery is associated with worse outcomes. However, it is not known how adverse long-term consequences vary according to the duration of AKI. We sought to determine the association between duration of AKI and survival.

Discovery of a novel molecule that regulates tumor growth and metastasis.

The heparan sulfate proteoglycan, Glypican-1 (GPC1), significantly impacts the growth of pancreatic cancer cells in vivo and markedly attenuates tumor angiogenesis and metastasis in athymic mice. Interestingly, both cancer cell-derived and host-derived GPC1 play an important role in tumor development and spread. These data suggest that GPC1 may be a valid therapeutic target for pancreatic cancer.

14-3-3sigma Modulates pancreatic cancer cell survival and invasiveness.

Purpose: The purpose of the present study was to investigate the potential role of 14-3-3sigma in pancreatic ductal adenocarcinoma (PDAC).

Experimental Design: 14-3-3 isoform expression was determined by real-time quantitative PCR in laser capture normal pancreatic ductal cells and pancreatic cancer cells and in 5 pancreatic cancer cell lines. PANC-1 cells, with low levels of 14-3-3sigma, were stably transfected with a human 14-3-3sigma cDNA.

Silicone breast implants and magnetic resonance imaging screening for rupture: do U.S. Food and Drug Administration recommendations reflect an evidence-based practice approach to patient care?

Regular magnetic resonance imaging has been recommended for the purpose of screening for silicone implant rupture. However, when its use as a screening test is critically examined, it appears that evidence to support its use is lacking. For example, there is no conclusive evidence at this time to show that using magnetic resonance imaging screening of asymptomatic women leads to a reduction in patient morbidity.

Targeting angiogenesis in pancreatic cancer: rationale and pitfalls.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer responsible for over 20% of deaths due to gastrointestinal malignancies. PDAC is usually diagnosed at an advanced stage which, in part, helps to explain its high resistance to chemotherapy and radiotherapy. In addition, the cancer cells in PDAC have a high propensity to metastasize and to aberrantly express several key regulators of angiogenesis and invasion.

Glypican-1 modulates the angiogenic and metastatic potential of human and mouse cancer cells.

Cells isolated from many types of human cancers express heparin-binding growth factors (HBGFs) that drive tumor growth, metastasis, and angiogenesis. The heparan sulfate proteoglycan glypican-1 (GPC1) is a coreceptor for HBGFs. Here we show that both cancer cell-derived and host-derived GPC1 are crucial for efficient growth, metastasis, and angiogenesis of human and mouse cancer cells.

Pathology of non-infective gastritis.

The discovery of Helicobacter pylori and its intimate role in the development of the most common form of chronic gastritis has elicited a much-needed interest in non-neoplastic gastric pathology. This has been paralleled by an increase in upper endoscopic examinations, which allow recognition of novel patterns and distribution of mucosal injury. Numerous attempts at classification have been made, most based on the acuteness or chronicity of gastric mucosal injury.

Colonoscopy demand and capacity in New Hampshire.

Background: Screening for colorectal cancer has been clearly shown to decrease the incidence and mortality from this disease. Accurate information about the demand and capacity for screening, particularly with colonoscopy, is critical in planning screening strategies. National assessments have recently begun; estimates of smaller geographic regions should improve the accuracy of national estimates, as well as inform strategies for individual states.

Barrett's esophagus with high-grade dysplasia simulating metastatic adenocarcinoma in a fine needle aspiration biopsy.

An endoscopic ultrasound examination, performed to rule out invasive esophageal carcinoma in a patient with a history of Barrett's esophagus with high-grade dysplasia, disclosed an enlarged paraesophageal lymph node which was aspirated. The aspirate contained markedly atypical clustered large cells that displayed prominent nucleoli and mitoses, as well as lymphoid cells, suggestive of adenocarcinoma metastatic to a lymph node. The neoplastic-appearing cells were, in fact, dysplastic glandular cells that the needle traversed en route to a reactive lymph node.

Functional magnetic resonance imaging of the primary somatosensory cortex in piglets.

Object: The piglet is an excellent model for the developing human brain, and has been used increasingly in various centers for studies of traumatic brain injury and other insults. Unlike rodent or primate models, however, there are few behavioral scales for the piglet, and the available ones are used to test general responsiveness rather than specific functional outcome. The differing behavioral repertoires of animals of different ages provide an additional challenge when age-dependent injury responses are compared.

Restoration of Smad4 in BxPC3 pancreatic cancer cells attenuates proliferation without altering angiogenesis.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive human malignancy in which the transforming growth factor beta (TGF-beta) signal transducer, Smad4, is commonly mutated or deleted. BxPC3 human pancreatic cancer cells exhibit a homozygous deletion of the Smad4 gene, yet are growth inhibited by TGF-beta1. In the present study, we sought to determine whether reintroduction of Smad4 into BxPC3 cells alters their behavior in vitro and in vivo.

Lymphangioma of the posterior mediastinum in an adult: diagnosis via cytopathologist-assisted fine-needle aspiration biopsy with cell block.

Lymphangiomas are uncommon in the posterior mediastinum. We report a case of a lymphangioma in this location that was diagnosed by computed tomographic-guided fine-needle aspiration biopsy. The cell block of the lesion closely simulated a normal structure immediately adjacent to the target and could have been misdiagnosed as "normal tissue.

Smad7 abrogates transforming growth factor-beta1-mediated growth inhibition in COLO-357 cells through functional inactivation of the retinoblastoma protein.

Smad7 is overexpressed in 50% of human pancreatic cancers. COLO-357 pancreatic cancer cells engineered to overexpress Smad7 are resistant to the actions of transforming growth factor-beta1 (TGF-beta1) with respect to growth inhibition and cisplatin-induced apoptosis but not with respect to modulation of gene expression. To delineate the mechanisms underlying these divergent consequences of Smad7 overexpression, we studied the effects of Smad7 on TGF-beta1-dependent signaling pathways and cell cycle regulating proteins.

Factors affecting the professional image of physicians.

Objective: The purpose of this study was to use an experimental design to determine the effect of selected aspects of dress on the professional image of physicians in an adult outpatient setting by those who use the health care services the most (55+), the least (18 to 22), and other physicians on whom we depend for referrals.

Methods: Ten slides of physicians representing a variety of ages; ethnic and religious affiliations were shown to 3 populations across the United States and Canada. Set 1 (N = 216) was shown to undergraduates and rated on 10 attributes of professional image.