A review of the mesotheliogenic potency of cleavage fragments found in talc

It has long been recognized that amphibole minerals, such as cleavage fragments of tremolite and anthophyllite, may exist in some talc deposits. We reviewed the current state of the science regarding the factors influencing mesotheliogenic potency of cleavage fragments, with emphasis on those that may co-occur in talc deposits, including dimensional and structural characteristics, animal toxicology, and the most well-studied cohort exposed to talc-associated cleavage fragments. Based on our review, multiple lines of scientific evidence demonstrate that inhaled cleavage fragments associated with talc do not pose a mesothelioma hazard.

Treatment of multidrug-resistant cytomegalovirus retinitis with systemically administered leflunomide

Multiresistant cytomegalovirus (CMV) infection is increasingly recognized in solid organ transplant recipients. Leflunomide is a novel drug with both immunosuppressive and anti-CMV properties. Herein we report a case of a renal transplant recipient treated with leflunomide for multiresistant CMV retinitis, and provide correlation between serum and vitreous levels of leflunomide. She had stabilization of her retinitis and measurable levels of drug in her vitreous fluid and serum. These initial findings suggest that leflunomide may be useful in the treatment of CMV disease, including retinitis in patients after solid organ transplantation.

Optic disk edema as a presentation of Propionibacterium acnes endophthalmitis

PURPOSE

To report a patient with an initial presentation of optic disk edema secondary to Propionibacterium acnes endophthalmitis.

METHODS

Interventional case report. The patient had surgery and treatment related to endophthalmitis. Nine months after cataract surgery with posterior chamber lens implant, a 79-year-old man receiving topical corticosteroids in the same eye presented with best-corrected visual acuity of 20/60, a superior visual field defect, and optic nerve edema without intraocular inflammation. One year postoperatively, the eye presented a further decrease in best-corrected visual acuity, and a dense white plaque was noted on the posterior capsule.

RESULTS

One year postoperatively, a partial capsulectomy with vitrectomy and injection of intravitreal antibiotics was performed. Hematoxylin and eosin stain of the posterior capsule plaque revealed gram-positive coccobacilli characteristic of P. acnes.

CONCLUSION

Propionibacterium acnes endophthalmitis may present after cataract surgery with intraocular lens implant with decreased vision, optic disk edema, and a visual field defect.

Pars plana vitrectomy for persistent, visually significant vitreous opacities

PURPOSE

To evaluate the role of vitrectomy in patients with persistent, visually disabling vitreous opacities.

METHODS

Six consecutive eyes of five men (age 58-66 years) with pseudophakia or aphakia and vitreous opacities resulting in visual symptoms for more than 1 year that underwent vitrectomy were retrospectively reviewed. Postoperative questionnaires regarding functional performance and quality-of-life issues were completed by the participants to assess subjective patient satisfaction.

RESULTS

Postoperative Snellen visual acuity was improved or equal to preoperative acuity in all cases (8-44 month follow-up) and there were no surgical complications. All patients expressed high satisfaction with overall visual function. Analysis of the National Eye Institute Visual Function Questionnaire-39 indicated that general vision, near activities, distance activities, mental health, role difficulties, and peripheral vision were significantly improved (P < 0.05) following surgical intervention.

CONCLUSIONS

Vitrectomy may be indicated in a select group of patients with visually disabling vitreous floaters, although objective assessment of visual dysfunction from vitreous floaters requires further evaluation.

The duration of antibiotic administration in penetrating abdominal trauma

BACKGROUND

The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries. Not only do multiple injuries increase the risk of infection, a very high risk of serious infection is conferred by immunosuppression from hemorrhage and transfusion and the high likelihood of intestinal injury, especially to the colon. Optimal timing and choice of presumptive antibiotic therapy has been established for penetrating trauma, but duration has not been studied extensively in such seriously injured patients. The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of infection in penetrating abdominal trauma.

METHODS

Three hundred fourteen consecutive patients with penetrating abdominal trauma were prospectively randomized into two groups: Group I received 24 hours of intravenous cefoxitin (1 g q6h) and group II received 5 days of intravenous cefoxitin. The development of a deep surgical site (intra-abdominal) infection as well as any type of nosocomial infection, as defined by the Centers for Disease Control and Prevention, (ie, surgical site infections, catheter-related infections, urinary tract, pneumonia), was recorded. Hospital length of stay was a secondary endpoint. Statistical analysis included chi-square tests for coordinate variables and two-tailed unpaired t tests for continuous variables. The independence of risk factors for the development of infection was assessed by multivariate analysis of variance. Significance was determined when P <0.05.

RESULTS

Three hundred patients were evaluable. There was no postoperative mortality, and no differences in overall length of hospitalization between groups. The duration of antibiotic treatment had no influence on the development of any infection (P = 0.136) or an intraabdominal infection (P = 0.336). Only colon injury was an independent predictor of the development of an intraabdominal infection (P = 0.0031). However, the overall infection incidence was affected by preoperative shock (P = 0.003), colon (P = 0.0004), central nervous system (CNS) injuries (P = 0.031), and the number of injured organs (P = 0.026). Several factors, including intraoperative shock (P = 0.021) and injuries to the colon (P = 0.0008), CNS (P = 0.0001), and chest (P = 0.0006), were independent contributors to prolongation of the hospital stay.

CONCLUSIONS

Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization. Infection was associated with shock on admission to the emergency department, the number of intra-abdominal organs injured, colon injury specifically, and injury to the central nervous system. Intra-abdominal infection was predicted only by colon injury. Prolonged hospitalization was associated with intraoperative shock and injuries to the chest, colon, or central nervous system.

Three-dimensional ophthalmic contact B-scan ultrasonography of the posterior segment

PURPOSE

A system to produce three-dimensional computer reconstructions of ophthalmic contact B-scan ultrasound was developed and investigated.

METHODS

Investigators used ocular phantoms to measure the accuracy and reproducibility of linear, area, and volume measurements.

RESULTS

In vitro calibration tests of linear and area measurements demonstrate accurate and reproducible findings throughout the imaged space. Phantom volume tests also show reasonable accuracy and reproducibility.

CONCLUSIONS

Three-dimensional ultrasonography is effective in measuring length, area, and volume in an experimental model. The in vitro accuracy and reproducibility of measurements warrants further investigation into the clinical utility of this method in posterior segment tumors and other posterior segment pathology.

Inflammatory breast carcinoma: a community hospital experience

BACKGROUND

Inflammatory breast cancer (IBC) is a rare form of rapidly progressive breast cancer. We reviewed the diagnosis, treatment, and outcome of IBC in our inner city community-based hospital and compared results with previous published reports.

STUDY DESIGN

Twenty-five patients were diagnosed and treated for IBC at the Catholic Medical Center of Brooklyn and Queens during the 6-year period of January 1989 through December 1995. Criteria for inclusion in this study were clinical or histopathologic evidence, or both, of inflammatory carcinoma.

RESULTS

IBC comprised 2.0% (25 of 1,257) of all breast cancer patients initially diagnosed during this study. All presented with clinical signs of IBC. Invasion of dermal lymphatics by neoplastic cells was demonstrated in 68% (17 of 25) of biopsy specimens. Sixty-eight percent (17 of 25) of patients presented with metastatic (ie, stage IV) disease and 28% (7 of 25) with stage IIIb; one patient (4%) died before staging. Estrogen and progesterone receptor studies were done on 72% (18 of 25) of all specimens. Of those patients who died, 85% were estrogen and progesterone receptor negative; of those surviving, 60% were estrogen receptor positive. Twenty (80%) of the 25 patients died, after a mean survival of 11.8 months and 5 (20%) remain alive, with a mean survival of 44.8 months. Of those who died, 85% were stage IV at presentation. All five survivors were stage IIIb at presentation. Patients underwent a variety of multimodal therapies. Survival was significantly associated with earlier stage at diagnosis and estrogen receptor positivity.

CONCLUSIONS

IBC is characterized by rapid progression and dismal outcome. Earlier stage at diagnosis and positive estrogen receptor status suggest a more favorable prognosis. Neoadjuvant chemotherapy, as part of a multimodal approach, has significantly improved the outcome for IBC, but this is limited to patients with stage IIIb disease. Most of our patients presented with stage IV disease. If improvement is to be realized at the community level, limited health care resources must be directed toward aggressive physician and public education.

Perforated colorectal carcinomas

BACKGROUND

Colorectal carcinomas that present with perforation are stated in the literature to carry a poor prognosis. This study is to verify or refute the dismal connotation associated with perforated colorectal carcinomas (PCCs).

METHODS

A retrospective analysis of 1551 patients with colorectal carcinoma revealed that 51 (3.3%) patients presented with perforation. Mary Immaculate and St. John's Queens Hospital Divisions of the Catholic Medical Center of Brooklyn and Queens chart and tumor board data were retrieved for the period 1983 through 1993.

RESULTS

Localized perforation with abscess formation occurred in 31 (61%) patients, and free perforation with generalized peritonitis in occurred 20 (39%) patients. Sixteen (31%) patients had distant metastasis at diagnosis with a mean survival of only 6 months. Overall operative mortality rate was 12%, and overall 5-year survival rate was 32%. By excluding 16 patients with documented Stage IV disease at diagnosis and 6 operative mortalities (3 of whom also had Stage IV disease at diagnosis), the remaining 32 patients had a mean survival of 59 months and a 5-year survival of 58%.

CONCLUSION

In view of the 58% survival in our subset of patients, aggressive management is recommended. This includes management of sepsis and radical surgical resection of adjacent involved organs. A negative attitude associated with PCC is not substantiated in this retrospective 10-year study.

Ocular deviation following excimer laser photorefractive keratectomy

We present a case of ocular deviation and diplopia that developed 9 months after monocular excimer laser photorefractive keratectomy. In this case, decompensation occurred because of a breakdown of fusion at distance. We suggest a cover test to assess the presence of significant phorias in all candidates for refractive surgery procedures.

Agenesis of the gallbladder revisited laparoscopically

Gallbladder agenesis is an extremely rare disease. Necropsy incidence has been reported to be 0.016%. Failure to locate the gallbladder at the time of a planned cholecystectomy can be very challenging. We report such a case during a laparoscopic cholecystectomy. The indication for surgery in these patients are complaints of gallbladder symptoms along with a false-positive ultrasound study. During exploration, an abnormal location of the gallbladder has to be excluded. Ectopic gallbladder locations include intrahepatic, lesser omentum, retroperitoneal, retrohepatic, within the falciform ligament, retroduodenal, and retrohepatic areas. Thorough exploration and cholangiography are essential. Embryologically, the gallbladder and cystic duct arise from the caudal portion of the hepatic bud. All of the previously reported cases of gallbladder agenesis have shown an absence of both the gallbladder and cystic duct. We report an embryological oddity wherein a patent cystic duct was found along with an agenetic gallbladder. This is the first case report of this finding, along with this being the first absent gallbladder discovered laparoscopically.

Body smuggling of illicit drugs: two cases requiring surgical intervention

The smuggling of illicit drugs by concealing them within the human body has become a widespread practice. Those individuals who transport packaged drugs are commonly known as "body packers" or "mules". "Body stuffers," on the other hand, are individuals who emergently place the contraband in a body orifice when they sense apprehension is imminent. In the latter instance, the drugs are not well packaged for transportation by human "consumption," hence the high risk for leakage. These individuals require prompt surgical attention under two circumstances: when they are found to suffer from drug overdosage caused by inadvertent leakage or when obstruction in the body is caused by the drug-laden bags. Two such cases are reported. The first patient presented with acute drug overdose and required an emergency laparotomy. The second patient presented with pyloric obstruction and was treated by endoscopic removal of the bag. One must be aware that these patients are walking time bombs, carrying drugs that may be well packed but have the potential to deliver a lethal dose without warning. Knowledge of the type of drug and type of packaging are essential in managing these patients. The overall plan should be close observation, careful monitoring, conservative therapy, and expectant rapid surgical intervention as needed.

Preferential looking and recognition acuities in clinical amblyopia

Although others have noted a correlation between grating and recognition acuities (RA) when both tests are performed on the same day, the value of preferential looking (PL) in predicting eventual visual outcome has not been studied. PL acuities of 64 preverbal patients considered at risk of amblyopia were measured. When these children became verbal, their visual acuities were determined using standard recognition acuity tests. Based on intervening amblyopia treatment between PL and RA measures, 40 patients were designated the minimal treatment group (MTG) and 24 the intensive treatment group (ITG). Chi-square analysis for the MTG showed agreement (P less than .005) between PL and RA in identifying better, equal, and worse eyes. Interocular ratios of PL and RA were significantly correlated for the MTG (P less than .001), but not for the ITG. Monocularly, a consistent correlation between PL and RA was not found. Our data suggest that PL is predictive of recognition acuity in patients whose visual acuity was expected to remain stable.

Laser palliation for colorectal carcinoma

A review was conducted of 27 patients with colorectal carcinoma treated palliatively with endoscopic neodymium:yttrium-aluminium-garnet (Nd:YAG) laser. There were 25 rectal carcinomas and 2 primary invasive sigmoid colon carcinomas. Of the 25 rectal carcinomas, there was 1 carcinoma in situ, 16 primary cancers, and 8 recurrent rectal carcinomas. The level of the lesions from the anal verge ranged from 0 to 25 cm, with a mean of 7.2 cm. The length of the lesions ranged from 1.5 to 8.5 cm, with a mean of 5 cm. The mean number of Nd:YAG laser treatments was three, with a range from one to nine. The duration of the treatments ranged from 30 to 90 minutes, with a mean of 40 minutes. Four of 27 patients (15%) developed complications. The success rate in terms of the relief of symptoms was established in 23 of the 27 patients.

A new method for studying cell cycle characteristics in ANLL using double-labeling with BrdU and 3HTdr

Ten patients with acute nonlymphocytic leukemia (ANLL) received bromodeoxyuridine (BrdU) at 100 mg/M2 intravenously over 1 h. BrdU is incorporated into the DNA by S-phase cells and was detected by using a monoclonal anti-BrdU antibody in the bone marrow aspirate (BM) and biopsy specimens obtained at the end of the infusion. Additionally, BM was incubated in vitro with tritiated thymidine (3HTdr) and processed by our previously described double-label method. This allowed us to measure the duration of S-phase (Ts) and total cell cycle time (Tc) of myeloblasts. Data revealed a higher number of S-phase cells from biopsies (21%) than BM (5%). The Ts ranged from 9 to 35 h and Tc ranged between 36 and 152 h in different patients. Using this method, data are available within 48 h and if shown to be clinically relevant, may be useful for prospective planning of therapy in individual patients.

Uridine diphosphate glucose:fatty acid glucosyl transferase activity of rape (Brassica napus L.) anther tissue

Particulate fractions from mature rape anther tissue catalysed the incorporation of glucose from UDPglucose into endogenous lipids. The UDPglucose:fatty acid glucosyl transferase was tightly bound to particulates that could be suspended in 0.1% Triton X-100. The apparent Km for UDPglucose was 3.5 . 10(-6) M. In Tris buffer the enzyme has a pH optimum of 8.0 and a temperature optimum of 30 degrees C. In the presence of NaF, the transferase activity was proportional to protein concentration, time, and other variables of the reaction mixture. ADPglucose, GDPglucose, and CDPglucose did not compete with the activity of the UDP-glucose-dependent glucosyl transferase. Gas chromatographic and high performance liquid chromatographic analyses indicated that the endogenous fatty acids glucosylated in vitro had carbon chain lengths of C16 to C20. This is the first report on the biosynthesis of non-phosphorylated glucosyl esters of fatty acids in higher plants.