Synergy in induction of increased renal allograft survival after portal vein infusion of dendritic cells transduced to express TGFbeta and IL-10, along with administration of CHO cells expressing the regulatory molecule OX-2.

Dendritic cells (DC), generated from C57BL/6 mouse bone marrow cells cultured with GM-CSF and IL-4 for 9 days, were engineered to express constitutively the cytokines TGFbeta, IL-10, and IL-12, using adenovirus vectors constructed using an E1-deleted replication-deficient recombinant adenovirus carrying the appropriate cDNA for the relevant cytokines (Ad-TGFbeta, Ad-IL-12, or Ad-IL-10). C3H mice receiving nontransduced DC or pretransplant infusion of DC-Ad-LacZ showed increased survival of C57BL/6 renal grafts relative to that of control nonimmunized mice. Transfusion of Ad-IL-12-transduced DC abolished this increased survival, leading to a graft survival equivalent to that of controls with no DC.

Arthroscopic treatment of post-traumatic cysts of the talus.

We report on 9 patients with persistent ankle pain and radiographic evidence of a cystic lesion on the talus. All had a history of an inversion-type of ankle injury. Radiographs were initially negative, but a cyst developed about 6 months after the injury.

A stable isotope method using a [(2)H(5)]glycerol bolus to measure very low density lipoprotein triglyceride kinetics in humans.

We have developed a method using a bolus of [(2)H(5)]glycerol to determine parameters of VLDL-triglyceride (VLDL-TG) turnover and have compared the data to that obtained using simultaneously a bolus of [2-(3)H]glycerol in six young normolipidemic men. No measurable enrichment was found after 12 h for [(2)H(5)]glycerol; therefore, we could only perform a monoexponential analysis of its data. No differences in fractional catabolic rate (FCR) were seen when comparing the multicompartmental modeling of [2-(3)H]glycerol data (modeled over 48 h) either to the monoexponential analyses of the [2-(3)H]glycerol or that of the [(2)H(5)]glycerol data.

Impact of red cell salvage on transfusion requirements during elective abdominal aortic aneurysm repair.

Elective abdominal aortic aneurysm (AAA) surgery may result in substantial blood loss. Concerns regarding the safety, availability, and acceptability of homologous blood have led to initiatives toward reducing transfusion requirements at the time of aneurysm repair. This study was designed to determine if the routine use of intraoperative red cell salvage and autotransfusion resulted in a reduction in homologous transfusion at our institution.

Typhlitis.

Objective: To provide an overview of the pathophysiological features and management of the clinical entity typhlitis.

Data Sources And Study Selection: The data presented are derived from a review of the English-language literature on typhlitis. The majority of papers analysed were small clinical series.

Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus.

We report on 8 patients with persistent ankle pain after open surgery for osteochondritis dissecans of the talus. At an average of 35 months after initial surgery, arthroscopic treatment was performed in these patients. The patients had residual loose chondral and osteochondral debris at the site of the original lesion.

Arthroscopic treatment of osteochondritis dissecans of the talus.

We report on a retrospective study of 33 patients who underwent arthroscopic treatment for osteochondritis dissecans of the talus. Twenty-eight of the patients (85%) had a history of mild to moderate trauma. Arthroscopic treatment consisted of removal of the osteocartilaginous fragments, debridement of disrupted cartilage, and abrasion of the base to bleeding subchondral bone.

Should the pericardium be closed routinely after heart operations?

Background: Repeat coronary artery bypass grafting is more difficult if the right ventricle is firmly attached to the inner table of the sternum. Closure of the pericardium at the time of the initial procedure may prevent attachment of the right ventricle to the sternum. This study attempts to identify the geometric effects of pericardial closure early after isolated coronary artery bypass grafting.

Representation of the visual field in the human occipital cortex: a magnetic resonance imaging and perimetric correlation.

Objectives: To evaluate the retinotopic map of the human occipital cortex by correlating magnetic resonance imaging (MRI) findings with visual field defects in patients with occipital lobe infarcts and to assess the compatibility between our cliniconeuroimaging findings and the location of lesions predicted by the classic Holmes map and a revised map.

Methods: Magnetic resonance images were obtained in 14 patients with occipital lobe infarcts. Visual field analysis was performed with tangent screen, the Goldmann perimeter, and the Humphrey Field Analyzer.

The Hancock II bioprosthesis at 12 years.

Background: The Hancock II bioprosthesis has been used for heart valve replacement since 1982 in our institution. We previously reported its clinical performance at 8 years and at 10 years. This is a progress report on its performance at 12 years.

Myocardial aerobic metabolism is impaired in a cell culture model of cyanotic heart disease.

A human pediatric cardiomyocyte cell culture model of chronic cyanosis was used to assess the effects of low oxygen tension on mitochondrial enzyme activity to address the postoperative increase in lactate and decreased ATP in the myocardium and the high incidence of low-output failure with restoration of normal oxygen tension, after technically successful corrective cardiac surgery. Chronically hypoxic cells (PO2 = 40 mmHg for 7 days) exhibited significantly reduced activities for pyruvate dehydrogenase, cytochrome-c oxidase, succinate cytochrome c reductase, succinate dehydrogenase, and citrate synthase. The activity of NADH-cytochrome c reductase was unaffected.

Management issues for women with epilepsy: a review of the literature.

Objective: A review of literature referable to management issues for women with epilepsy (WWE) was undertaken for the development of a practice parameter.

Background: Epilepsy is a common neurologic condition with gender-related management implications. Although reviews of this topic often focus on pregnancy-related issues for WWE, specific health concerns for WWE are present throughout all phases of reproductive life.

Insulin stimulates pyruvate dehydrogenase and protects human ventricular cardiomyocytes from simulated ischemia.

Unlabelled: Impaired myocardial metabolism after cardioplegic arrest results in persistent anaerobic lactate production. Insulin may protect the heart from ischemia and reperfusion by enhancing myocardial metabolic recovery. However, the stimulation of glycolysis during ischemia may be detrimental because of an accumulation of metabolic end-products.

Aortic valve replacement with stentless and stented porcine valves: a case-match study.

Objectives: To assess the potential benefits of the hemodynamic superiority of stentless valves, we conducted a case-match study among patients who underwent aortic valve replacement with two types of porcine bioprostheses: the Toronto SPV and the stented Hancock II bioprosthesis.

Methods: Preoperative clinical variables predictive of death after aortic valve replacement were determined by a stepwise logistic regression analysis in a series of 908 consecutive patients who received porcine aortic bioprostheses during a 14-year interval. Advanced age, New York Heart Association functional class IV, left ventricular ejection fraction of less than 30%, and coronary artery disease were independent predictors of death.

Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures.

Objective: This study was carried out to evaluate the long-term results of mitral valve repair for mitral regurgitation caused by myxomatous disease of the mitral valve and the late effects of chordal replacement with expanded polytetrafluoroethylene sutures in this operation.

Methods: A total of 324 patients with mitral regurgitation caused by myxomatous disease underwent mitral valve repair from 1981 to 1995; the group comprised 241 men and 83 women whose mean age was 58 +/- 14 years. Chordal replacement with expanded polytetrafluoroethylene sutures has been performed in 165 patients since 1985.

Acute coronary artery occlusion likely due to thrombus occurring during coronary angiography: report of a case.

Twenty-five years ago, fatalities due to acute thrombotic coronary occlusion occurring during coronary angiography were reported not infrequently, but are thought to have been eliminated by changes in technique and equipment. We present a case with documentation of a normal coronary arterial tree just before the time of an abrupt occlusion, which had the angiographic features of clot. The likely source of the thrombus was the arterial sheath.

Aprotinin and dipyridamole for the safe reduction of postoperative blood loss.

Background: Aprotinin (APR) reduces postoperative blood loss but may induce thrombosis. Dipyridamole (DIP) limits platelet aggregation and may reduce the thrombotic complications associated with APR.

Methods: To evaluate the safety and effectiveness of combined APR and DIP, we undertook a prospective randomized trial in patients undergoing cardiac operations.

Primary bilateral adrenal lymphoma.

We report a case of primary bilateral adrenal non-Hodgkins lymphoma (NHL), with hypercalcemia at the time of presentation. Medical literature review showed that this is an extremely rare site for lymphoma, but presents a distinct clinical entity with many features that differ from NHL overall, extranodal NHL, and NHL in other endocrine organs. The diagnosis is frequently not suspected antemortem, and long delays between the onset of symptoms and the diagnosis are frequent.

Distinguishing Plasmodium falciparum treatment failures from reinfections by restrictions fragment length polymorphism and polymerase chain reaction genotyping.

The inability to distinguish recrudescent Plasmodium falciparum infections (treatment failures) from reinfections (new infections) is an important impediment to the evaluation of antimalarial treatment regimens. Ten paired primary and recrudescent isolates collected near the Thai-Cambodian border were analyzed by restriction fragment length polymorphism (RFLP) and by polymerase chain reaction (PCR) genotyping of the genes encoding the following proteins: circumsporozite (CS) protein, erythrocyte binding antigen (EBA)-175, ring-infected erythrocyte surface antigen (RESA), merozoite surface protein-1 (MSP-1), and MSP-2. Both methods demonstrated that the fingerprint pattern of each recrudescent isolate was identical to or was contained within the pattern of the primary isolate.

Aortic valve replacement with patch enlargement of the aortic annulus.

Background: Aortic annulus enlargement has long been advocated for the placement of valve prostheses larger than otherwise would have been possible. Little information exists, however, on the short- and long-term outcome of this surgical procedure.

Methods: We performed a retrospective review of 530 patients enrolled in a registry for patients who underwent aortic valve replacement using the Hancock II bioprosthesis and were followed up prospectively over the course of 11 years at a single institution.

Acute Myocardial Infarction in Sickle Cell Disease: Case Report and Review of the Literature.

Although vascular occlusion is a hallmark of sickle cell disease, documented myocardial infarction is an uncommon event in these patients. We report a case of an acute lateral myocardial infarction in a 25 year old male homozygous for HbS, who had previously had a relatively benign course of his sickle cell disease. Management of the case included an exchange transfusion and a 6 month period of chronic simple transfusions (2 units packed red cells every 3-4 weeks).