A reevaluation of the radiographically detectable complications of percutaneous venous access lines inserted by four subcutaneous approaches

As a result of prior studies elucidating the potential complications associated with the use of central venous access lines, the Food and Drug Administration and the manufacturers themselves have published guidelines and warnings outlining these dangers and describing the safest insertion techniques. We will attempt to determine whether this improved education has altered the number and type of complications, comparing the results from different types of hospitals, among the various medical services and among operators with varying degrees of experience. This is a prospective analysis of all central venous pressure (CVP) and Swanz-Ganz catheters (SGCs) inserted between July 1, 1995, and February 30, 1996, at a regional Veteran's Affairs hospital and an inner city university medical center. Three hundred seventy-five inpatients underwent 417 new percutaneous venous catheter placements while in the medical or surgical intensive care units or in the general care wards. A portable chest radiograph was obtained immediately after each procedure, and the position of the catheter and any associated complications were recorded, initially by the radiology resident in the emergency suite and subsequently as confirmed by a chest radiology attending. CVP lines were considered malpositioned when the tip was not located in the superior vena cava, and SGCs were recorded as misplaced when the tip was not found within the main, left main, right main, or either lower lobe pulmonary artery within 2 cm of the cardiac border. For patients undergoing CVP line placement, the right atrium was the most frequent site of tip malposition with 38 of 69 total misplacements (55%), whereas for SGCs, 22 of 55 malplacements (40%) were too distal in a lower lobe pulmonary artery. Only 1 of 248 CVP lines resulted in a pneumothorax (PTX; 0.4%), whereas 6 of 169 SGC insertions caused a PTX (3.5%), a significant difference (P=0.019). Five of 192 catheters (2.6%) placed via an internal jugular approach resulted in PTX, whereas only 2 of 150 subclavian cannulations (1.3%) caused this complication, revealing a trend, but not reaching statistical significance (P=0.473). However, there was a significant decrease in the rate of catheter misplacements in the third part of the month compared with the first 20 days (35% versus 24%; P=0.031), and the Veteran's Affairs hospital displayed a trend toward more complications for SGC insertions than the university hospital (47% versus 32%), but not for CVP lines. In general, individual medical and surgical services displayed a similar frequency of complications (29-38%), except for CVP lines inserted in the medical intensive care unit. Venous access catheter tip malpositions are very common in all settings, but easily recognized by radiography, whereas PTXs are unusual. In contrast to most older studies, PTXs are more frequently observed with internal jugular as opposed to subclavian cannulations and with SGCs rather than CVP lines. However, our data support prior studies that the right atrium and distal right lower lobe pulmonary artery are the most common sites for CVP and SGC misplacement, respectively, and that there is an improvement in success rates with increasing operator experience.

Inhibitory effects of isopropyl-2-(1,3-dithietane-2-ylidene)-2- [N-(4-methylthiazol-2-yl)carbamoyl]acetate (YH439) on benzo[a]pyrene-induced skin carcinogenesis and micronucleated reticulocyte formation in mice

Recently, a great deal of attention has been devoted to organosulfur compounds with potential cancer chemopreventive properties. Many sulfur-containing substances present in Brassica plants have been reported to possess striking anticarcinogenic and antimutagenic activities. Besides naturally occurring organosulfur compounds, certain synthetic sulfur-containing pharmaceuticals, such as oltipraz and sulindac, are known to exert substantial chemopreventive or chemoprotective effects. Isopropyl-2-(1, 3-dithietane-2-ylidene)-2-[N-(4-methylthiazol-2-yl)carbamoyl ]acetate (YH439) was initially developed for its possible use as a hepatoprotectant. The compound has been found to up-regulate the expression of cytochrome P-450 IA1 [I.J. Lee, K.S. Jeong, B.J. Roberts, A.T. Kallarakal, P. Fernandez-Salguero, F.J. Gonzalez, B.J. Song, Transcriptional induction of the cytochrome P-450 1A1 gene by a thiazolium compound YH439, Mol. Pharmacol. 49 (1996) 980-988.] which plays a pivotal role in metabolism of the majority of polycyclic aromatic carcinogens and mutagens, such as benzo[a]pyrene (B[a]P). In the present study, we found that oral administration of YH439 to CD-1 mice significantly suppressed B[a]P-initiated skin tumorigenesis. B[a]P-induced formation of micronuclei in mouse peripheral reticulocytes was also attenuated by YH439 pretreatment. Likewise, diallyl sulfide, a major volatile thioether present in garlic, also protected against B[a]P-induced skin tumorigenesis and micronucleated reticulocyte formation in mice.

Impact of gender on the renal response to angiotensin II

BACKGROUND

It is clear that women with renal disease progress to end stage at a slower rate than do men. We hypothesized that this protection may result from gender-mediated differences in responses to angiotensin II (Ang II), which has known hemodynamic effects that are thought to promote renal disease progression. We examined sex differences in renin-angiotensin system (RAS) function by measuring renal hemodynamic function and circulating plasma components of the RAS at baseline and in response to graded infusions of Ang II.

METHODS

We studied two groups of normal healthy subjects, 24 men and 24 women, mean age 28 +/- 1 years, ingesting a controlled sodium and protein diet. We examined baseline concentrations of angiotensin converting enzyme, plasma renin activity, Ang II, and aldosterone. Inulin and paraaminohippurate clearance techniques were used to estimate effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) at baseline and in response to graded Ang II infusion (0.5, 1.5, and 2.5 ng/kg/min).

RESULTS

Mean baseline values for mean arterial pressure and aldosterone were lower in women, whereas values for plasma Ang II, GFR, ERPF, and filtration fraction (FF) did not differ. In response to Ang II, both groups exhibited a similar increase in mean arterial pressure and a decline in ERPF. GFR was maintained during Ang II infusion only in men, resulting in an augmentation of FF. In women, GFR declined in parallel with ERPF, and the FF response was significantly blunted. 17beta-Estradiol plasma concentrations influenced the ERPF response to Ang II infusion, with higher levels predicting a blunting of the decrease. The GFR response was not affected.

CONCLUSIONS

The renal microcirculation in sodium-replete women may respond differently to Ang II than that of men, with the female sex predicting a lesser augmentation of FF and possibly a blunted increase in intraglomerular pressure. The mechanism remains obscure, but these contrasting responses may help to explain gender-mediated differences in renal disease progression.

Monoclonal and polyclonal antibodies recognizing acetaldehyde-protein adducts

Studies have investigated the hypothesis that metabolically derived acetaldehyde (AA) is capable of complexing with liver cell proteins to form AA-protein adducts that are capable of acting as antigens and inducing an immune response, as detected by the formation of unique antibodies. In an effort to better characterize and describe these adducts, mouse monoclonal and rabbit polyclonal antibodies specific for antigens prepared with AA under non-reducing (physiologic) and reducing (presence of sodium cyanoborohydride) conditions have been prepared. Two monoclonal antibodies were developed. The first antibody was RT1.1, which is specific to N-ethyl lysine (NEL); it is of the IgG2b isotype and recognizes all proteins modified with AA under reducing conditions. The other monoclonal antibody, NR-1, was of the IgG3 isotype; it recognizes proteins modified with AA under non-reducing conditions and cannot be inhibited by NEL. Affinity-purified and/or absorbed polyclonal antibodies were also produced to these epitopes. Using this panel of monoclonal and affinity-purified polyclonal antibodies, unique antigen-antibody binding occurred that: (1) detected only NEL; (2) reacted with the alpha-amino group on proteins prepared under reducing conditions; and (3) detected adducts on proteins prepared under non-reducing conditions. However, the only antibodies that recognized antigen(s) from alcohol-fed rat livers were those that were not specific to NEL or the alpha-amino group modified under reducing conditions. These data indicate that the relevant adduct in alcohol-fed rat livers is not NEL, and that it presumably is related to proteins modified with AA under non-reducing conditions.

Association of malondialdehyde-acetaldehyde (MAA) adducted proteins with atherosclerotic-induced vascular inflammatory injury

Atherosclerosis is a vascular injury characterized by elevated tissue levels of tumor necrosis factor-alpha (TNF-alpha), increased expression of endothelial cell adhesion molecules, and vascular wall inflammatory cell infiltration. Foam cells are associated with atherosclerotic plaque material, and low density lipoprotein (LDL) is a lipid component of foam cells. Malondialdehyde (MDA) is an oxidative product of unsaturated fatty acids and is also present in atherosclerotic lesions. MDA-modified (adducted) proteins, including MDA-modified LDL, are present in atherosclerotic human vascular tissue. Acetaldehyde (AA) is the major metabolic product of ethanol oxidation. Both MDA and AA are highly reactive aldehydes and will combine with proteins to produce an antigenically distinct protein adduct, termed the MAA adduct. This study demonstrates that proteins modified in the presence of high concentrations of MDA can produce MAA-modified proteins in vitro. In addition, MAA adducted proteins are capable of inducing rat heart endothelial cell cultures (rHEC) to produce and release TNF-alpha, and cause rHEC upregulation of endothelial adhesion molecule expression, including ICAM-1. These adhesion molecules are required for circulating inflammatory cells to adhere to endothelium which allows inflammatory cell tissue infiltration. Additionally, MAA modified proteins were defected in human atherosclerotic aortic vascular tissue but not in normal aortic tissue. Since atherosclerosis is associated with an inflammatory vascular injury characterized by elevated tissue TNF-alpha concentrations and inflammatory cell infiltration, these data suggest that MAA-adducted proteins may be formed in atherosclerotic plaque material and may be involved in the inflammatory reaction that occurs in atherosclerosis. These data further suggest that previous studies demonstrating MDA modified protein in atherosclerotic plaque may in fact have MAA modified proteins associated with them.

Enhancement of achievement and attitudes through individualized learning-style presentations of two allied health courses

This investigation analyzed the effects of the instructional resource Programmed Learning Sequence (PLS) on the achievement and attitudes of college students and correlated the findings with the individuals' learning styles. The subjects were enrolled in Sonography I and Cross-Sectional Anatomy in a college of health-related professions. Both classes were administered the Productivity Environmental Preference Survey to identify learning-style strengths, and alternately presented with lessons using a PLS in a book format and traditional lectures. The sonography class also was exposed to a PLS in multimedia computer format. The Semantic Differential Scale measured the students' attitudes comparing the instructional methods experienced, and class examinations measured content mastery. In both classes, examination scores were significantly higher (effect size for the sonography class was 1.42; for the anatomy class, 0.63) and students' attitude scores were significantly higher when PLS rather than the traditional method was used. In the sonography class, achievement was significantly higher with the book PLS than with the computer PLS (effect size, 1.11). Significant correlations emerged between learning-style elements and achievement: students who preferred learning with the book PLS required more quiet in the environment than did those who preferred the computer PLS; students who preferred learning traditionally and with the computer PLS required more light than those preferring the book PLS; and students who preferred learning with an authority figure favored the traditional method. Examination of the data for other correlations between learning-style preferences and attitudes using the book PLS also revealed many other significant findings, demonstrating its ability to accommodate diverse styles.

Factors related to family therapists' breaking confidence when clients disclose high-risks-to-HIV/AIDS sexual behaviors

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.

Tn5/IS50 target recognition

This communication reports an analysis of Tn5/IS50 target site selection by using an extensive collection of Tn5 and IS50 insertions in two relatively small regions of DNA (less than 1 kb each). For both regions data were collected resulting from in vitro and in vivo transposition events. Since the data sets are consistent and transposase was the only protein present in vitro, this demonstrates that target selection is a property of only transposase. There appear to be two factors governing target selection. A target consensus sequence, which presumably reflects the target selection of individual pairs of Tn5/IS50 bound transposase protomers, was deduced by analyzing all insertion sites. The consensus Tn5/IS50 target site is A-GNTYWRANC-T. However, we observed that independent insertion sites tend to form groups of closely located insertions (clusters), and insertions very often were spaced in a 5-bp periodic fashion. This suggests that Tn5/IS50 target selection is facilitated by more than two transposase protomers binding to the DNA, and, thus, for a site to be a good target, the overlapping neighboring DNA should be a good target, too. Synthetic target sequences were designed and used to test and confirm this model.

Benign fat necrosis simulating bilateral breast malignancy after reduction mammoplasty

Fat necrosis follows many forms of trauma to the breast, including surgery. In unusual cases, it may be extensive enough to present as a palpable mass on physical examination with mammographic features suggestive of cancer. In these instances, regardless of patient age, surgical history, or multifocality, a biopsy must be done to exclude carcinoma. We describe a young woman who was evaluated for bilateral breast masses with highly suspicious imaging characteristics 2 years after having reduction mammoplasty.

Chemopreventive effects of 2-(allylthio)pyrazine on hepatic lesion, mutagenesis and tumorigenesis induced by vinyl carbamate or vinyl carbamate epoxide

2-(Allylthio)pyrazine (2-AP), synthesized for its possible use as a hepatoprotective agent, has been found to selectively inhibit rat hepatic cytochrome P450 2E1 (Kim et al., Biochem. Pharmacol., 53, 261-269, 1997), while it enhances the activities of phase II detoxification enzymes such as glutathione S-transferase and epoxide hydrolase. As part of a program in evaluating the chemopreventive potential of 2-AP, we have determined its effects on hepatotoxicity, mutagenicity and tumorigenicity of vinyl carbamate (VC), a prototypic hepatocarcinogen preferentially activated by P450 2E1 to the ultimate carcinogenic metabolite vinyl carbamate epoxide (VCO), which undergoes detoxification by glutathione conjugation and oxirane hydrolysis. Administration of 2-AP (100 mg/kg body wt) to male Sprague-Dawley rats by gavage, 2 days, 1 day and 4 h prior to VC or VCO, markedly ameliorated the hepatotoxicity of these compounds as determined by decreased serum aspartate aminotransferase and alanine aminotransferase activities. Furthermore, 2-AP pre-treatment significantly suppressed the VC-induced hepatocarcinogenesis in infant male B6C3F1 mice. In a separate experiment, the multiplicities of skin tumors formed in female ICR mice treated with 5.8 micromol of VC or VCO were inhibited 58 and 70%, respectively, by pre-treatment with 2-AP by oral administration. The mutational spectrum of ras-oncogene in papillomas was not altered by 2-AP pre-treatment. 2-AP also inhibited the mutagenicity of VC in the Salmonella-microsome assay. Taken together, these findings suggest that 2-AP is a potential chemopreventive agent.

Delivery of ivermectin by injectable microspheres

A bioabsorbable, injectable microsphere formulation containing ivermectin in poly-(lactide-co-glycolide) copolymer (PLA/PGA) was developed to provide long-lasting delivery of the drug for control of livestock pests. A solvent-evaporation technique was used to produce the spherical beads containing approximately 30% ivermectin and ranging in size from 25-250 microns. The pattern of delivery of the drug into the blood stream of Spanish goats was characterized for a 50:50 PLA/PGA, a 90:10 PLA/PGA copolymer formulation, and a PLA monomer formulation. When the 50:50 PLA/PGA formulation was used in cattle at the rate of 2 mg (AI)/kg body weight, 2 peaks of 45-50 ppb of ivermectin in serum were observed. The 1st peak was at approximately 1 wk after injection and the 2nd peak, which was broader than the 1st, occurred at approximately 6-7 wk after injection. Percentage of inhibition of estimated larvae for the lone star tick, Amblyomma americanum (L.), placed on treated cattle was 100% for the first 8 wk after injection and was 75, 57, 46 and 44% for wk 9, 10, 11, and 12, respectively. The treatment provided 98-100% control of larval horn flies, Haematobia irritans (L.), in the manure of treated cattle for 10 wk. The bioassay results against lone star ticks and larval horn flies were in agreement with the serum concentration data. The injectable microsphere formulation of ivermectin should be useful in a variety of other applications ranging from the control of Boophilus spp. ticks in south Texas to heartworms in pets.

Locomotor advantages of Neandertal skeletal morphology at the knee and ankle

We quantified Neandertal knee extensor and ankle plantarflexor moments to determine whether differences between Neandertal and recent human skeletal morphology represent important functional differences. Neandertal skeletal differences in the patella, tibial tuberosity, and calcaneus were used to modify a computer model of recent humans to calculate the moment arms and moments of Neandertal knee extensor and ankle plantarflexor muscles. We also conducted sensitivity studies on the effect of musculotendon parameters on the Neandertal moments. As expected, we found that Neandertal moment arms were greater than recent humans at the ankle (122-141%); however, the magnitude of the increase was not well-predicted from measurements of size differences between Neandertal and recent human skeletons. At the knee, Neandertal moment arms were greater than those of recent humans in the locomotor range (108%) but less so at more flexed knee angles (102%). Not all Neandertal skeletal adaptations at the knee contributed to increased moment arm. Knee extensor moments were enhanced in the Neandertal models in the locomotor range (111%), regardless of musculotendon parameters. At the ankle, however, Neandertal plantarflexor moment was greater than that of recent humans (149-200%) at all joint angles only if muscle fiber length increased proportionately with moment arm. Our results demonstrate that Neandertal skeletal morphology, compared to that of recent humans, generated greater moments at both the knee and ankle in the locomotor range but not at higher angles of knee flexion or ankle plantarflexion.

Inhibition of vinyl carbamate-induced hepatotoxicity, mutagenicity, and tumorigenicity by isopropyl-2-(1,3-dithietane-2-ylidene)-2-[N-(4-methylthiazol-2- yl)carbamoyl]acetate (YH439)

Isopropyl-2-(1,3-dithietane-2-ylidene)-2-[N-(4-methylthiazol -2-yl)carbamoyl]acetate (YH439) is a novel dithioylidene malonate derivative developed for the treatment of hepatic injury. The compound has been found to down-regulate the expression of hepatic cytochrome P-450 2E1 (CYP2E1) at the transcriptional level (8). Certain organosulfur compounds present in garlic elicit protective effects on chemically induced carcinogenesis and mutagenesis and their chemopreventive activities are associated in part with inhibition of CYP2E1. As part of a program to determine the likely chemopreventive potential of YH439, we initially examined its effects on hepatotoxicity induced by vinyl carbamate (VC), a proximate carcinogen that is preferentially bioactivated by CYP2E1. A single i.p. injection of VC (125 mg/kg body wt) to male Sprague-Dawley rats resulted in severe hepatic lesions as demonstrated by elevated levels of serum enzymes such as alanine aminotransferase and aspartate aminotransferase. Histopathological evaluation of liver sections from VC-treated animals revealed that the hepatic damage mainly consisted of centrilobular necrosis with sinusoidal congestion. Oral administration of YH439 (200 mg/kg body wt) to male Sprague-Dawley rats 2 days, 1 day and 4 h prior to VC completely prevented the hepatic damage caused by this carcinogen. In another experiment, rat hepatic microsome-mediated bacterial mutagenicity of VC was suppressed by YH439 in a dose-related manner. Furthermore, pretreatment of female CD-1 mice with YH439 by gastric intubation resulted in diminution of VC-induced skin carcinogenesis.

Pancreaticopleural fistula. An unusual cause of persistent unilateral pleural effusion

There are a myriad of causes of a large persistent pleural effusion. Pancreaticopleural fistula is a rare entity seldomly included in the above differential. As it usually presents with thoracic rather than abdominal symptoms, a combination of imaging modalities, including chest radiography (CXR), computerized tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) is essential in obtaining the diagnosis.

Improving managed care through coding, monitoring, and trending quality-of-care concerns

With the rise of managed care, purchasers and payers are increasingly demanding value in healthcare. Traditionally, patient satisfaction surveys and focus groups have been used to elicit information regarding customers' perspectives. This article explores the use of an inexpensive alternative methodology--that of monitoring quality-of-care concerns and complaints. A nomenclature and a process for tracking, trending, and reporting quality-of-care issues are detailed; they encompass both the patient's and the provider's perception of a specific care experience. This methodology promotes the use of quantifiable data to support strategic planning and compliance with National Committee for Quality Assurance accreditation standards.

Predicting the rates of success and complications of computed tomography-guided percutaneous core-needle biopsies of the thorax from the findings of the preprocedure chest computed tomography scan

The authors attempted to determine whether the anatomic characteristics of thoracic lesions and the surrounding lung field, as assessed by the preprocedure chest computed tomography (CT) scan, can assist in predicting the yield of complications or positive results of pathologic examination resulting from percutaneous core-needle biopsies (PCNB). The pathologic diagnoses and procedural complications of 50 consecutive thoracic PCNBs (43 men, age range 19-81 years) performed under the guidance of a single operator (J.A.M.) were recorded. Prebiopsy chest CT findings, including the size, depth, location, and border appearance of the lesion, as well as presence or absence of adjacent emphysema, interstitial fibrosis, bullae, pleural effusions, and the age and smoking history of the patient were correlated with the biopsy results and any ensuing complications. The pathologic analysis in 42 patients (84%) was specific enough to positively impact patient management, with 29 malignant and 13 benign entities. The imaging variables that predicted obtaining adequate tissue for pathologic diagnosis were most importantly large size (especially >35 mm), although irregular lesion margins and increased depth were significant as well. Seven patients (14%) experienced a pneumothorax, only one of which (2%) was symptomatic and required thoracostomy. All patients experiencing a pneumothorax had CT evidence of emphysema or interstitial fibrosis and all biopsied masses in these individuals had spiculated borders, with six (86%) in an anterior location and only one involving the pleural surface. We conclude that the preprocedure CT scan can delineate several characteristics of both the patient and the lesion to be biopsied that can assist in predicting the rates of successful tissue retrieval or pneumothorax during PCNBs.

Fetal alcohol exposure and temporal vulnerability regional differences in alcohol-induced microencephaly as a function of the timing of binge-like alcohol exposure during rat brain development

In humans, microcephaly (small head for body size) is a common feature of fetal alcohol syndrome. An analogous measure, termed microencephaly (small brain for body size), can be used for evaluating the detrimental effects of the differential timing of alcohol exposure on brain development in animal model systems. Timed-pregnant rats were exposed to binge-like alcohol during either the first 10 days (first trimester equivalent) or second 10 days of gestation (second trimester equivalent), or the combination of first and second trimesters equivalent for prenatal treatments. Offspring from some of the animals exposed to alcohol during the combined first and second trimesters equivalent were raised artificially from postnatal day (P) 4 through P9 (part of the third trimester equivalent), and also received binge-like alcohol during this period, producing animals that were exposed to alcohol during all three trimesters equivalent. Offspring from untreated dams were also raised artificially and received alcohol only from P4 to P9, thus creating animals that were exposed to alcohol only during part of the third trimester equivalent. All pups were perfused on P10. Appropriate controls (nutritional and normally reared) were used for every alcohol treatment combination. Peak blood alcohol concentrations were not different among the treatment groups for a given sampling time. Significant somatic growth deficits occurred in offspring exposed to alcohol for the equivalent of all three trimesters, compared with offspring exposed to alcohol during other periods. Brain growth in offspring also was significantly affected by the timing of alcohol exposure. The whole brain, forebrain, and cerebellum to body weight ratios of pups exposed to alcohol during the third trimester had more significant brain growth deficits than pups in groups exposed to alcohol during other times of brain development. Although alcohol exposure during the third trimester had a significant detrimental impact on overall brain growth, significant differences in temporal vulnerability were also found for the brainstem to body weight ratios. Offspring of dams exposed to alcohol during the first trimester had the same magnitude of deficit as those exposed to alcohol during the third trimester, and those two groups were significantly deficient compared with the groups exposed to alcohol at other times, suggesting some differential vulnerability of this region to alcohol-induced injury at different times of development. This study is the first thorough examination of microencephaly and gross regional vulnerability of the developing brain as related to temporal factors of alcohol exposure in an animal model system, and the results support and expand on the findings of the available clinical literature. Furthermore, our results substantiate claims that the cessation of alcohol before the third trimester can lessen the severity of some alcohol-related birth deficits.

Prolonged production of NADPH oxidase-corrected granulocytes after gene therapy of chronic granulomatous disease

Little is known about the potential for engraftment of autologous hematopoietic stem cells in human adults not subjected to myeloablative conditioning regimens. Five adult patients with the p47(phox) deficiency form of chronic granulomatous disease received intravenous infusions of autologous CD34(+) peripheral blood stem cells (PBSCs) that had been transduced ex vivo with a recombinant retrovirus encoding normal p47(phox). Although marrow conditioning was not given, functionally corrected granulocytes were detectable in peripheral blood of all five patients. Peak correction occurred 3-6 weeks after infusion and ranged from 0.004 to 0.05% of total peripheral blood granulocytes. Corrected cells were detectable for as long as 6 months after infusion in some individuals. Thus, prolonged engraftment of autologous PBSCs and continued expression of the transduced gene can occur in adults without conditioning. This trial also piloted the use of animal protein-free medium and a blood-bank-compatible closed system of gas-permeable plastic containers for culture and transduction of the PBSCs. These features enhance the safety of PBSCs directed gene therapy.

Quantifying osteoarthrotic hip incongruence. An approach to optimizing osteotomies

Osteoarthrosis of the hip may be treated by osteotomy, but surgeons report variable results, and there is no consensus regarding which method to use in choosing the type of osteotomy. The authors defined three biomechanical measures of hip incongruence (characteristic point locus, joint space, and contact region) and developed a two-dimensional frontal plane model to compute joint incongruence over the joint range of motion during normal activities of daily living. The preoperative measures were calculated for 38 patients who had undergone osteotomy at least 5 years earlier. The authors calculated the measures throughout a functional range of motion after 13 stimulated varus or valgus osteotomies. A logistic regression analysis determined which, if any, of the three measures, in conjunction with other clinical variables, correctly predicted outcome. The average values for the characteristic point locus, joint space, and contact region measures ranged from 0.260 cm to 2.127 cm, 0.963 cm2 to 9.327 cm2, and 0.063 cm to 4.230 cm, respectively. Unimodal behavior between two of the three measures (joint space and contact region) and osteotomy angle were observed, suggesting these two would be the most useful in predicting an optimal osteotomy. The most significant independent variable predicting clinical outcome was the joint space measure. This supports the potential of an optimization approach for determining the best angle for a hip osteotomy.