Sonographic findings in bone marrow transplant patients with symptomatic hepatic venoocclusive disease.

Sonographic findings were retrospectively compared between 19 patients with hepatic venoocclusive disease and 23 patients with other common causes of symptomatic liver dysfunction after bone marrow transplantation (14 grafts versus host disease and nine hepatitis). Doppler sonographic examination was available in all patients with venoocclusive disease, in nine of the patients with graft versus host disease, and in three of the patients with hepatitis. The hepatic artery resistive index and the overall flow direction, peak forward and retrograde velocities, and time-averaged mean velocities in the hepatic veins and main portal vein were compared.

CD28/B7 interactions are required for sustaining the graft-versus-leukemia effect of delayed post-bone marrow transplantation splenocyte infusion in murine recipients of myeloid or lymphoid leukemia cells.

Graft-vs-leukemia (GVL) can reduce relapse rates after bone marrow transplantation (BMT). Delayed lymphocyte infusion (DLI) post-BMT can mediate a potent GVL effect with less graft-vs-host disease (GVHD) than would be observed if given early post-BMT. In vivo CD28/B7 blockade can reduce GVHD lethality, and B7 ligand expression can augment an antitumor immune response in mice.

Transdiaphragmatic ventriculoperitoneal shunting: technical case report.

Objective And Importance: This report describes an important technical modification in ventriculoperitoneal shunting.

Clinical Presentation: A young woman presented with shunt malfunction caused by occlusion of the peritoneal catheter. Conventional sites for placement of distal catheter were unavailable or had been used up.

Syringomyelia in mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome): imaging findings following bone marrow transplantation.

We present the imaging findings in a patient with mucopolysaccharidosis (MPS) type VI (Maroteaux-Lamy syndrome) who developed holocord syringomyelia. This represents the only reported case of syrinx formation in a child with MPS VI. Clinical, neurologic and spinal magnetic resonance imaging findings are presented.

CD4+ and CD8+ T cells each can utilize a perforin-dependent pathway to mediate lethal graft-versus-host disease in major histocompatibility complex-disparate recipients.

Perforin-deficient (-/-) mice were used as T-cell donors for infusion into irradiated major histocompatibility complex (MHC)-disparate recipients to investigate the requirement for perforin-mediated cytolysis during graft-versus-host disease (GVHD) generation. Administration of 5x10(6) C57BL/6 (H2b) perforin -/- splenocytes was significantly less effective in inducing GVHD lethality when given to MHC class I + II disparate B10.BR (H2k) recipients, as compared with wild-type (+/+) controls.

Simultaneous pancreas-kidney transplant in two children with hemolytic-uremic syndrome.

Simultaneous pancreas-kidney (SPK) transplantation has rarely been performed in the pediatric population. This report describes successful SPK transplantation in a 12-year-old girl and a 14-year-old boy with renal and pancreatic insufficiency secondary to postdiarrheal hemolytic-uremic syndrome. All reported cases of pediatric SPK transplantation are reviewed.

ATG plus corticosteroid therapy for acute graft-versus-host disease: predictors of response and survival.

Innovative treatment strategies for acute graft-versus-host disease (aGVHD) have not replaced corticosteroids as the primary therapy. We retrospectively reviewed 74 patients who received equine antithymocyte globulin (ATG) in addition to corticosteroids as therapy for GVHD, 21 who received primary therapy and 53 who received ATG after progressing or failing to improve with corticosteroids alone. The groups were comparable in clinical characteristics and in timing and severity of GVHD.

Withdrawal of neuroleptic medications from institutionalized dementia patients: results of a double-blind, baseline-treatment-controlled pilot study.

Among dementia patients in long-term care facilities, neuroleptics (NL) are frequently prescribed for the treatment of agitation. Although good clinical practice and federal law mandate attempts at withdrawal of these medications, empiric data regarding the cessation of NL treatment are limited in this population. The objective of the present study was to assess through direct observation the effects of short-term NL withdrawal on physically aggressive behavior and other aspects of agitation.

Fentanyl pharmacokinetics in patients undergoing renal transplantation.

Study Objective: To describe the pharmacokinetics of fentanyl in patients undergoing renal transplantation.

Design: Prospective.

Setting: A large university teaching hospital.

Craniocephalic disproportion with increased intracranial pressure and brain herniation: a new clinical syndrome in anemic patients: report of two cases.

Objective And Importance: We describe a new clinical syndrome in two patients with chronic anemia. The major manifestation of the syndrome is herniation of the brain resulting in death caused by longstanding craniocephalic disproportion. The disproportion was caused by extreme thickening of the cranium because of erythroid hyperplasia.

The relationship between socioeconomic status and eating-disordered behaviors in a community sample of adolescent girls.

Objective: Although previous research has demonstrated a relationship between socioeconomic status (SES) and weight, the research has not been consistent regarding the relationship between SES and eating disorders. This analysis was designed to examine this relationship in a large community sample of adolescent girls (Grades 7 to 12).

Method: Items were selected from a comprehensive self-report health survey completed by 17,571 adolescent girls.

Two Novel Mutations in the Cystathionine beta-synthase Gene of Homocystinuric Patients.

Background: The continued identfication of new mutations in the cystathionine beta-synthase (CBS) gene is important in correlating the genotype/phenotype of patients with classic homocystinuria and in assessing whether heterozygosity of CBS deficiency is an important cause of mild hyperhomocysteinemia, an independent risk factor for occlusive vascular diseases. Methods and Results: Single-strand polymorphism and direct nucleotide sequencing were used to detect two novel mutations in the CBS gene of three homocystinuric patients from two unrelated families. The first mutation, a G-to-A transistion at nucleotide 1316 in exon 12, results in an amino acid substitution of arginine by glutamine at codon 439.

Recent advances in graft-versus-host disease (GVHD) prevention.

In the 1970s and 1980s, GVHD prevention approaches were limited in number. Recent advances in our understanding of the requirements for T-cell immune responses and for basic mechanism(s) involved in GVHD pathophysiology have led to exciting new strategies for GVHD prevention. This review focuses upon recent developments in GVHD prevention generated over the past 5 years.

Identification of a splice site mutation in the cystathionine beta-synthase gene resulting in variable and novel splicing defects of pre-mRNA.

We used single-strand conformational polymorphism and direct nucleotide sequencing to identify a novel mutation in the cystathionine beta-synthase (CBS) gene of two siblings with homocystinuria. Both patients are heterozygous carriers of the G919A transition and the novel mutation which involves a G-to-A transition in the intron 12 splice donor site. Reverse transcription of RNA harvested from transformed lymphocytes followed by PCR showed a normal size product along with two shorter products involving the deletion of either exon 12 alone or both exons 11 and 12.

Ruptured or intact: what can linear echoes within silicone breast implants tell us?

Objective: During sonographic evaluation of silicone breast implants for possible rupture, we have frequently encountered several patterns of linear echoes within the implants. To our knowledge, the significance of this finding has not been established in the literature. The purpose of this study was to determine whether internal echoes are significant in predicting implant rupture.

Correlation of the arterial resistive index in pancreas transplants of patients with transplant rejection.

Objective: This study was undertaken to determine whether arterial resistive indexes (RIs) in pancreas transplants correlate with biopsy-proven transplant rejection.

Materials And Methods: We retrospectively reviewed arterial RIs in pancreas transplants for all patients who underwent Doppler sonography within 1 week before transcystoscopic or percutaneous biopsy of pancreas transplants. RIs were correlated with type and degree of rejection in the 20 transplants for which biopsies provided sufficient tissue for diagnosis.

Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy.

Purpose: To prospectively evaluate the angiographic and clinical results of using catheter-directed thrombolytic therapy for the treatment of acute iliofemoral deep venous thrombosis (IFDVT).

Materials And Methods: All consecutive patients with acute IFDVT referred for thrombolytic treatment from July 1990 to December 1995 were included in this clinical data analysis. Infusions of urokinase were administered via a multisidehole infusion catheter.

The role of B7 costimulation by murine acute myeloid leukemia in the generation and function of a CD8+ T-cell line with potent in vivo graft-versus-leukemia properties.

Relapse is more frequent after autologous than allogeneic bone marrow transplantation (BMT), due in part to lack of T-lymphocyte mediated allogeneic graft-versus-leukemia (GVL) effects. Infusions of leukemia-reactive T cells to patients after autologous BMT may be a means for providing a GVL effect. Costimulation of T cells by binding of the CD28 receptor on T cells with B7-counter receptors on antigen presenting cells amplifies antigen-specific T-cell responses.

Transvenous closure of secundum atrial septal defects: preliminary results with a new self-expanding nitinol prosthesis in a swine model.

Background: Our purpose was to evaluate a new prosthesis for percutaneous closure of secundum atrial septal defects (ASDs).

Methods And Results: Percutaneous closure of surgically created fossa ovalis ASD was attempted in 15 minipigs. The mean balloon-stretched ASD diameter was 12.

The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes.

Based on experience, the authors believe that MR imaging is a useful tool in the assessment and management of stress fractures and stress phenomenum of bone. The use of standard, graded MR evaluation aides the assessment of a repetitive stress injury to bone by allowing a more accurate diagnosis of bone injury. This more accurate assessment has predictive value in estimating the duration of disability.

Treatment of unstable distal radius fractures: methods and comparison of external distraction and ORIF versus external distraction-ORIF neutralization.

Twenty-six closed unstable distal radius fractures were treated using a combination of internal fixation, external distraction (intraoperative), and, in some cases, up to 4 weeks of postoperative external fixation (neutralization). Intraoperative stability check determined the need for external neutralization. This combined technique allowed a comprehensive approach to even the most unstable fracture by merging the advantages of internal and external fixation.

Blood counts in healthy donors 1 year after the collection of granulocyte-colony-stimulating factor-mobilized progenitor cells and the results of a second mobilization and collection.

Background: Granulocyte-colony-stimulating factor (G-CSF)-mobilized blood cells are being used for allogeneic transplants, but the long-term effects of G-CSF on healthy individuals are not known. Furthermore, it is not certain how many CD34+ cells can be collected in a second mobilization and collection procedure.

Study Design And Methods: Nineteen people were given 2, 5, 7.

Use of MRI in evaluating postoperative changes in patients with bone and soft tissue tumors.

We reviewed the clinical, surgical and magnetic resonance imaging (MRI) findings in 80 patients who underwent resection of primary benign or malignant bone or soft tissue tumors. There were 18 benign and 62 malignant tumors. Although 31 patients were originally thought to have recurrence, on review only 20 patients were considered to have recurred.

Repairing holes in the head: a history of cranioplasty.

Cranioplasty is almost as ancient as trephination, yet its fascinating history has been neglected. There is strong evidence that Incan surgeons were performing cranioplasty using precious metals and gourds. Interestingly, early surgical authors, such as Hippocrates and Galen, do not discuss cranioplasty and it was not until the 16th century that cranioplasty in the form of a gold plate was mentioned by Fallopius.

Dialysis grafts arterial plug: retrieval using the tulip sheath device in vitro.

The "arterial plug" is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts.