Deep venous thrombosis and pulmonary embolism after lung transplantation.

The incidence of deep venous thrombosis or pulmonary embolism after lung or heart-lung transplantation has not been well defined. Pulmonary embolism may be of particular concern in the postoperative period owing to an inadequately developed or absent collateral bronchial circulation and potential risk of pulmonary infarction. Fourteen (12.

Spinal tuberculosis: a diagnostic and management challenge.

The authors reviewed 29 cases of spinal tuberculosis treated from 1973 to 1993 with an average follow-up time of 7.4 years. Clinical findings included back pain, paraparesis, kyphosis, fever, sensory disturbance, and bowel and bladder dysfunction.

Intracellular bacteria in blood smears in patients with central venous catheters.

The presence of intracellular bacteria in blood smears is usually associated with overwhelming sepsis and an ominous prognosis. Recently, the hematology laboratory at our institution documented this finding in a group of mostly asymptomatic patients. We studied seven adult patients from a tertiary care university hospital in whom intracellular bacteria were found incidentally on routine manual differential cell counts of 100 white blood cells during a 12-month period.

Maintaining accuracy in stereotactic radiosurgery.

Purpose: To provide the manufacture's specification for the base phantom of a commercially available stereotactic radiosurgery system so that its accuracy can be confirmed, and to describe a calibration device that allows the accuracy of the base phantom to be verified quickly and on a routine basis. Modifications to the target pointer system that make matching the pointer tips easier and less likely to damage the pointer tips are also described.

Methods And Materials: In stereotactic radiosurgery, spatial accuracy is the key factor for successful dose delivery.

Axial and lateral resolution of rotational intravascular ultrasound: in vitro observations and diagnostic implications.

Purpose: To determine the axial and lateral resolution of a rotating intravascular ultrasound system and the diagnostic implications for the diagnosis of early artherosclerosis.

Methods: The resolution of a 20 MHz rotating transducer was tested in a specially designed high-resolution phantom and in five aortic autopsy specimens with varying degrees of early atherosclerosis.

Results: The best lateral resolution is at the minimal distance between transducer and object.

Carcinoma of the head of the pancreas: evaluation of the pancreaticoduodenal veins with dynamic CT--potential for improved accuracy in staging.

Purpose: To determine if detection of abnormal dilatation of pancreaticoduodenal veins can improve the accuracy of computed tomographic (CT) staging of pancreatic adenocarcinoma.

Materials And Methods: CT scans obtained during bolus administration of contrast material in 86 patients (aged 34-85 years) with pancreatic head carcinoma were reviewed. The diameter of the small veins that surround the head of the pancreas was measured (normal diameter of gastrocolic trunk, < or = 7 mm; of anterior superior pancreaticoduodenal vein, < or = 4 mm; of posterior superior pancreaticoduodenal vein, < or = 4 mm).

Sociocultural factors in the use of prenatal care by Hmong women, Minneapolis.

Understanding the sociocultural context of prenatal care underuse by an immigrant population can suggest programmatic changes that result in more effective health care delivery. Ethnographic survey interviews of female Hmong clinic patients conducted in 1987/88 revealed that they objected to biomedical procedures and to being attended by several doctors; the women also reported poor communication with staff as a problem. Clinic reforms implemented in 1989/90 included hiring a nurse-midwife, reducing the number of pelvic examinations, expanding hours of operation, creating a direct telephone line to Hmong interpreters, and producing a Hmong-language prenatal health care education videotape.

Stereotactic radiosurgery for recurrent malignant gliomas.

Purpose: To evaluate the role of stereotactic radiosurgery in the management of recurrent malignant gliomas.

Patients And Methods: We treated 35 patients with large (median treatment volume, 28 cm3) recurrent tumors that had failed to respond to conventional treatment. Twenty-six patients (74%) had glioblastomas multiforme (GBM) and nine (26%) had anaplastic astrocytomas (AA).

Cyclosporine A toxicity presenting with acute cerebellar edema and brainstem compression. Case report.

A 38-year-old man receiving cyclosporine A after bilateral lung transplantation for cystic fibrosis presented with cortical blindness, generalized seizures, and cerebellar edema. Progressive brainstem compression necessitated emergency posterior fossa decompression. Replacement of cyclosporine A with an alternative immunosuppressive agent, FK506, was followed by rapid neurological recovery and dramatic resolution of radiographic abnormalities.

Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases.

Knotting of a peritoneal catheter around a loop of bowel is a rare occurrence, which may lead to bowel obstruction. The incomplete removal of two ventriculoperitoneal shunts resulted in two cases of iatrogenically knotted peritoneal catheters. One patient underwent a laparotomy for relief of obstruction and the other was successfully treated by uncoiling the catheter by means of a wire passed into its lumen.

Proctitis after conventional external radiation therapy for prostate cancer: importance of minimizing posterior rectal dose.

Purpose: To identify factors associated with the prevalence of radiation proctitis in patients with prostate cancer treated with external radiation therapy and to determine if a dose-response relationship exists.

Materials And Methods: The study included 101 prostate cancer patients treated at the University of Minnesota Hospital and Clinics between 1970 and 1987. Radiation therapy at a daily dose of 175-200 cGy was given for 5 consecutive days per week for 7 weeks with a 10-24-MV linear accelerator.

Integrating legacy laboratory information systems into a client-server world: the University of Minnesota Clinical Workstation (CWS) project.

The development of an innovative clinical decision-support project such as the University of Minnesota's Clinical Workstation initiative mandates the use of modern client-server network architectures. Preexisting conventional laboratory information systems (LIS) cannot be quickly replaced with client-server equivalents because of the cost and relative unavailability of such systems. Thus, embedding strategies that effectively integrate legacy information systems are needed.

In vitro and in vivo variation in transferrin receptor expression on a human medulloblastoma cell line.

The poor prognosis associated with pediatric central nervous system tumors such as medulloblastoma has led to the development and investigation of a variety of new treatment techniques. Therapeutic agents include targeted-toxin conjugates or immunotoxins that show significant in vitro activity against many brain tumors. Transferrin receptors (TRs) are specific, cell-surface antigens that are expressed preferentially on brain tumors rather than on normal human brain tissue.

Single-strand conformational polymorphisms (SSCP): studies of the genetic polymorphisms of exon 4 of apolipoprotein C III.

Objective: We used single-strand conformational polymorphism (SSCP). To screen for mutations/polymorphisms in exon 4 of the apolipoprotein C III in 45 patients with hypertriglyceridemia and 46 control individuals, single-strand conformational polymorphism was investigated using restriction endonuclease and amplification refractory mutations systems (ARMS).

Results: SSCP identified six patterns corresponding to six genotypes.

Heart-lung and lung transplantation.

Lung and heart-lung transplantation have evolved into successful therapeutic options in patients with end-stage cardiopulmonary disease. Imaging studies extend from pretransplant evaluation to posttransplant monitoring for complications. Although many radiologic features are considered nonspecific, improved understanding of underlying pathologic and physiologic conditions unique to this population will enhance the clinical impact of the radiologist involved in a transplantation program.

Dependency on intercellular adhesion molecule recognition and local interleukin-2 provision in generation of an in vivo CD8+ T-cell immune response to murine myeloid leukemia.

The immune response to a murine myeloid leukemia (cell line C1498) was studied in vitro and in vivo. Natural killer (NK) cells and CD8+ cytotoxic T lymphocytes (CTL) were shown to lyse C1498 in vitro through the binding of leukocyte function antigen-1 (LFA-1) on effectors and intercellular adhesion molecule-1 (ICAM-1) and ICAM-2 on C1498 target cells. However, the ability of nonimmunized mice to resist an in vivo challenge of a low dose (10(4)) of C1498 was NK-cell, but not T-cell dependent.

Long-term renal fate and prognosis after staghorn calculus management.

We analyzed retrospectively 177 consecutive staghorn calculus patients to determine risk factors for ultimate renal deterioration and renal cause specific death. Mean followup was 7.7 years.

Radiographic evaluation of the complications of long bone allografts.

Purpose: To study the long-term results of long bone allografts in patients with benign and malignant bone tumors.

Material And Methods: Forty patients for whom full clinical and radiological information was held were investigated in order to assess the overall incidence of complications including fractures, nonunion, hardware problems, infections, and bone resorption.

Results: There were four deaths; four more patients had distant metastases and one patient had a recurrent chondrosarcoma.

Hyperextension strain or "whiplash" injuries to the cervical spine.

Purpose: To define "whiplash" radiologically.

Material And Methods: A full cervical spine radiographic series (including flexion and extension views) was reviewed in 40 patients with clinically proven "whiplash" injuries and compared to the radiographs in 105 normal controls. The level and degree of kinking or kyphosis, subluxation, and the difference in the amount of fanning between spinous processes on flexion and extension films were measured in each patient.

Laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy versus radical retropubic prostatectomy for prostate cancer.

Objectives: The outcomes of patients with prostate cancer who were candidates for radical prostatectomy were compared with patients who underwent either: (1) radical retropubic prostatectomy (RRP); or (2) laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy (LN-SV-TPP).

Methods: The staging, surgical, and early postoperative characteristics of 10 consecutive patients treated by RRP were compared with 12 consecutive patients who underwent LN-SV-TPP.

Results: Patients who underwent LN-SV-TPP versus RRP had respective median blood loss of 450 versus 1250 cc (P = 0.

Coblockade of the LFA1:ICAM and CD28/CTLA4:B7 pathways is a highly effective means of preventing acute lethal graft-versus-host disease induced by fully major histocompatibility complex-disparate donor grafts.

We have developed an in vitro system in which C57BL/6 donor splenocytes are exposed to B10.BR host alloantigens in the context of deficient CD28:B7 signaling as a means of preventing graft-versus-host disease (GVHD). Although 54% to 82% of MLR alloresponse was inhibited by cytotoxic T-lymphocyte antigen 4 (CTLA4)-Ig treatment of host stimulator cells, treated splenocytes were still capable of causing GVHD when infused in vivo.

A survey of films for use as dosimeters in interventional radiology.

Analysis of radiation doses in interventional radiological procedures that can lead to deterministic radiation effects such as erythema and epilation would assist physicians in planning patients care after exposure and in reducing doses. Photographic films used to measure skin exposure in the past are too sensitive for the high doses involved in interventional procedures. Seventeen different types of films, many of which are generally available in hospitals, were surveyed to see if any would meet the demands of interventional radiology.

Laparoscopic marsupialization of the painful polycystic kidney.

Autosomal dominant polycystic kidney disease patients may present with intractable cyst pain. Common practice has been to attempt percutaneous drainage of the affected cyst and, if unsuccessful, to offer open surgical decortication. We report laparoscopic renal cyst marsupialization for painful autosomal dominant polycystic kidney disease among 6 patients who failed prior percutaneous drainage.

A microwave method that enhances detection of aberrant p53 expression in formalin-fixed, paraffin-embedded tissues.

Objective: Detection of aberrantly accumulated p53 protein by immunohistochemistry may have prognostic significance in many human neoplasms. We wished to identify a technique applicable to formalin-fixed, paraffin-embedded sections that would reliably yield results equivalent to frozen-section immunohistochemistry.

Design: We compared the frequency of p53 immunostaining obtained by applying monoclonal antibodies PAb1801, DO7, or DO1, a 1:1 PAb1801-DO7 cocktail, and a 1:1 PAb1801-DO1 cocktail to fresh-frozen and formalin-fixed, paraffin-embedded tissues from 36 lung and upper aerodigestive-tract carcinomas.