Small-cell carcinoma of the lung manifesting as acute hepatic failure.

In this report, we describe four cases of small-cell carcinoma of the lung manifesting as acute hepatic failure. These cases were noteworthy for the presence of hepatomegaly and substantially increased serum lactate dehydrogenase and uric acid levels. The ratio of normalized serum lactate dehydrogenase to normalized serum alanine aminotransferase from the 4 cases reported herein (mean +/- SE, 3.

B-cell gene rearrangement in benign and malignant lymphoid proliferations of mucosa-associated lymphoid tissue and lymph nodes.

The polymerase chain reaction (PCR) with polyacrylamide gel electrophoresis was used to study patterns of immunoglobulin heavy chain (IgH) gene rearrangement (GR) in formalin-fixed, paraffin-embedded specimens of lymphomas and reactive conditions of mucosa-associated lymphoid tissue (MALT) and lymph node. DNA amplification was performed directly on sections obtained from paraffin blocks. Five patterns of PCR products were observed: a single band, two or more discrete bands, smearing, a single band overlying a smear, and two or more bands over a smear.

Dietary sodium chloride and potassium have effects on the pathophysiology of hypertension in humans and animals.

A diet high in NaCl can raise blood pressure in susceptible people and animals, probably by similar mechanisms. The possibly harmful effects of a high-NaCl diet are not unexpected because both prehistoric humans and mammals evolved in a low-NaCl environment. Evolutionary forces molded mammals to adapt well to a low sodium intake; modern high NaCl intakes go against this adaptation.

A third kidney transplant: cost-effective treatment for end-stage renal disease?

Given the organ donor shortage, some question whether a third kidney transplant can be justified. We studied the outcome of 51 third transplants (mean age 28 +/- 2 yr) done between 1 January 1985 and 31 December 1994. We compared hospital stay (mean +/- S.

Platelet antibodies.

The proper diagnosis of patients with immune-mediated thrombocytopenias can be accomplished by using the advances made in the field of platelet serology. These techniques range from solid phase red cell adherence to sequencing platelet antigen amino acids by polymerase chain reaction. This article describes platelet antigens, the clinical tests available to detect platelet antigens and antibodies, and the value of these tests in supporting clinical diagnoses.

The viability of Mycobacterium tuberculosis in formalin-fixed pulmonary autopsy tissue: review of the literature and brief report.

Formalin is commonly thought to decrease the risk of Mycobacterium tuberculosis infection. However, the true disinfection efficacy of formalin for tissue infected with M tuberculosis is unclear. We reviewed all pertinent literature from 1900 until the present regarding the disinfection efficacy of formalin for tissue infected with M tuberculosis.

CT-guided percutaneous biopsy of pancreas transplants.

Purpose: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction.

Materials And Methods: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts.

Cyclophosphamide associated bladder cancer--a highly aggressive disease: analysis of 12 cases.

Purpose: We gained knowledge of the etiology, treatment and prevention of cyclophosphamide associated urothelial cancer.

Materials And Methods: The medical records of 6 men and 6 women (mean age 55 years) with cyclophosphamide associated bladder cancer were reviewed.

Results: All tumors were grade 3 or 4 transitional cell carcinoma.

Protecting the immunocompromised patient: the role of the hospital clinical engineer.

While the discipline of clinical engineering has long been limited to the area of medical equipment management, few areas in hospital engineering practice so closely meet the literal definition of "clinical" engineering as the care of the immunocompromised patient. Although ventilation has been the domain of the plant maintenance department, the increasing numbers of clinical engineers being given responsibility for plant functions, as well as the critical nature of the topic, make the care of the bone marrow transplant (BMT) patient an appropriate area of clinical engineering practice. Further, as clinical engineering branches out of the equipment management area, the clinical engineer can be truly termed the "hospital engineer".

Addressing the human side of change: career development and renewal.

At no time in history has the pace of organizational change been so great. And while ample attention has been placed on the need for change, significantly less attention has been placed on the human side of these changes. Across the country, organizations are now recognizing the need for new and different strategies to respond to the ever-changing workplace and workforce needs.

Experimental evaluation of a new self-expanding patent ductus arteriosus occluder in a canine model.

Purpose: A new self-expanding patent ductus arteriosus (PDA) occluder was designed.

Materials And Methods: Percutaneous closure of surgically created aortopulmonary shunts was attempted in 19 dogs. The occlusion device consisted of a nitinol wire frame tightly woven into a cylinder with a flat retention disc.

Radiation doses during pediatric radiofrequency catheter ablation procedures.

Because RF catheter ablation procedures may be lengthy and are commonly performed in young patients, concern has arisen about radiation dose in this group of patients. This article investigates radiation doses in pediatric patients undergoing RF catheter ablation. Standard fluoroscopic equipment used for diagnostic electrophysiological catheterization studies is technologically capable of dose rates as high as 90 milligray (mGy) per minute to skin and adjacent lung and 260 mGy/min to vertebral bone.

Posttransplant T-cell lymphoproliferative disorders--an aggressive, late complication of solid-organ transplantation.

T-cell non-Hodgkin's lymphomas are an uncommon occurrence after solid-organ transplantation. We describe a morphologically and immunophenotypically distinct group of T-cell lymphoproliferative disorders that occurred late in the course of six patients with solid-organ transplants. The patients ranged in age from 31 to 56 years (median, 43).

Brain metastases. Histology, multiplicity, surgery, and survival.

Background: With the advent of new therapies for metastatic carcinoma to the brain, patterns of intracranial disease and factors influencing survival become important considerations when examining potential treatment options.

Methods: The records of 729 patients with metastases to the brain treated during the period between 1973 to 1993 were reviewed.

Results: Primary tumor histologic type in order of descending frequency included nonsmall cell lung carcinoma (NSCLC), breast carcinoma, small cell lung carcinoma (SCLC), malignant melanoma, renal cell carcinoma, gastrointestinal carcinoma, uterine/vulvar carcinoma, and unknown primary carcinoma.

Stereotactic radiosurgery in pediatric patients.

Although stereotactic radiosurgery has been studied extensively in adults, the data demonstrating its efficacy in children is limited. Medical records were reviewed to identify the indications for and outcomes of patients treated with this modality. Linear accelerator-based radiosurgery was used to treat 11 recurrent brain tumors and one posterior fossa arteriovenous malformation over 3 years.

Simultaneous detection and screening of T833C and G919A mutations of the cystathionine beta-synthase gene by single-strand conformational polymorphism.

Objective: We used single-strand conformational polymorphism (SSCP) to screen for mutations at nucleotides 833 and 919 of the cystathionine beta-synthase (CBS) gene in 13 patients with homocystinuria and 11 of their relatives.

Methods: Exon 8 of genomic DNA was selectively amplified by PCR using primers derived from intronic sequences of the human CBS gene. SSCP analysis was performed on the amplified products.

The history of spinal biomechanics.

The history of spinal biomechanics has its origins in antiquity. The Edwin Smith surgical papyrus, an Egyptian document written in the 17th century BC, described the difference between cervical sprain, fracture, and fracture-dislocation. By the time of Hippocrates (4th century BC), physical means such as traction or local pressure were being used to correct spinal deformities but the treatments were based on only a rudimentary knowledge of spinal biomechanics.

Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome.

Background: Intra-abdominal infections account for 15 percent of technical failures after pancreatic transplantation. Although some data are available about intra-abdominal bacterial infections, no study has analyzed the incidence, treatment, and outcome of intra-abdominal fungal infections.

Study Design: We retrospectively studied 445 consecutive pancreatic transplantations--45 percent were simultaneous pancreatic and renal, 24 percent pancreatic after renal, and 31 percent pancreatic transplantations alone--in patients with Type I diabetes mellitus.

Effect of transjugular intrahepatic portosystemic shunt on quality of life.

Objective: The objective of this study was to determine the effect of the transjugular intrahepatic portosystemic shunt (TIPS) procedure on the quality of life.

Subjects And Methods: Data were collected on 99 patients who underwent the TIPS procedure between September 1991 and September 1995. Quality of life was assessed by the Karnofsky scale before and at intervals after the procedure.

Anti-graft-versus-host disease effect of DT390-anti-CD3sFv, a single-chain Fv fusion immunotoxin specifically targeting the CD3 epsilon moiety of the T-cell receptor.

In a recent study, we showed that an immunotoxin (IT) made with a conventional monoclonal antibody targeting the CD3 epsilon moiety of the T-cell receptor (TCR) had a potent, but partial, graft-versus-host disease (GVHD) effect (Vallera et al, Blood 86:4367, 1995). Therefore, in this current study, we determined whether a fusion immunotoxin made with anti-CD3 single-chain Fv (sFv), the smallest unit of antibody recognizing antigen, would have anti-GVHD activity. A fusion protein was synthesized from a construct made by splicing sFv cDNA from the hybridoma 145-2C11 to a truncated form of the diphtheria toxin (DT390) gene.

Coronary sinus injury during retrograde cardioplegia: a report of three cases.

Coronary sinus injuries related to the use of retrograde cardioplegia are uncommon. In most cases injuries are encountered with overinflation of the coronary sinus catheter balloon or traumatic catheter insertion. This article describes three cases of coronary sinus injury during retrograde cardioplegia administration in patients with ventricular hypertrophy, while the heart was manually retracted to expose the posterior myocardium.

Repositionable vascular occluder: experimental comparison with standard Gianturco coils.

Purpose: To evaluate the efficacy and recanalization rates of a newly designed vascular occlusion device.

Materials And Methods: The self-expanding vascular occluder was braided from fine nitinol wires and filled with polyester fibers. The device was delivered through a 6-F polyethylene introducing sheath with use of a delivery cable with a microscrew adaptor.