Association of the HLA-DR2/DR4 phenotype with skin test responses to bovine dermal collagen: a potential interaction of two MHC alleles in regulating an immune response.

We examined the HLA-DR characteristics of a population of 30 healthy collagen responders. Each had previously exhibited a localized hypersensitivity response to an intradermal challenge with a bovine collagen implant. A one-tailed binomial test revealed a significant increase in the alloantigen DR2 (p less than 0.007) and an increase in DR4 which bordered on significance (p less than 0.06). These data are consistent with murine studies that demonstrate that the immune response to bovine collagen is under H-2 linked genetic control. Furthermore, the increased frequencies of DR2 and DR4 in these collagen responders were attributable to a statistically significant disruption in Hardy-Weinberg equilibrium in favor of the heterozygote DR2/DR4 (p less than 0.0001). This finding supports a model in which at least two interacting HLA-linked alleles may influence the immune response to bovine collagen.

Injectable collagen: a six-year clinical investigation.

An injectable form of bovine dermal collagen has been developed for use in correcting cutaneous contour deficiencies. This material is a sterile device composed predominantly of highly purified type I collagen dispersed in phosphate-buffered physiological saline containing 0.3% lidocaine. The safety and efficacy of injectable collagen, which is now in widespread clinical use in the United States, Canada, England, Germany, France, Switzerland, Brazil, and 11 other countries, were evaluated in a 6 1/2-year investigation in which 5,109 patients were evaluated by 728 dermatologists and plastic surgeons. The incidence of adverse treatment reactions was 1.3%, most of which manifested with localized swelling and erythema. Current data covering an estimated 100,000 patients indicate that the incidence of treatment reactions has not increased during the 3 1/2 years since the material was cleared for marketing by the United States Food and Drug Administration. Subjective assessment of efficacy indicated that the material may be employed successfully to elevate dermal contour defects associated with various etiological factors.

Collagen implantation in patients treated previously with silicone.

This multicentric, open study evaluated the efficacy and safety of Zyderm Collagen Implant (ZCI) in 158 patients with contour deficiencies of the dermis and a history of silicone fluid therapy. Following test implantation with ZCI, thirty-seven patients dropped out, including four patients who exhibited untoward responses to the implant material. Hence, 121 patients completed the course of therapy and were available for efficacy and safety evaluation. At 2-week intervals. ZCI was implanted intradermally in 327 sites; 186 (57%) were the identical sites that had been injected previously with silicone fluid. In 89% of patients, five injections or less of ZCI produced favourable clinical results. Moreover, of 176 sites injected five times or less, a consistent pattern of progressive improvement was observed with each additional injection, regardless of the aetiology of dermal lesions. Furthermore, no undesirable textural or pigmentary changes were apparent at any of the 327 treatment sites. An adverse effect consisting of localized swelling, induration and erythema at implantation sites occurred in one patient, but resolved spontaneously.

The immunogenicity of injectable collagen. I. A 1-year prospective study.

With the growing use of collagen-based biomaterials, questions have been raised regarding the immunogenicity of this protein in humans. Currently a bovine collagen implant is in widespread use for the correction of dermal contour deficiencies ( Zyderm Collagen Implant (hereafter referred to as "the implant"); Collagen Corporation, Palo Alto, CA). To investigate potential immunologic consequences of this material, sixty-one subjects were evaluated in a 1-year prospective study. Two of the sixty-one subjects (3%) experienced localized, self-limiting inflammatory responses to the implant material; only in these two subjects could elevated levels of anti-implant collagen antibodies be measured by radioimmunoassay. These antibodies did not cross-react with human dermal collagen nor did they result in elevated levels of circulating immune complexes. Routine blood and urine testing failed to reveal any results of clinical significance. Thus, this protein displayed only weak antigenic activity in this study population.

The immunogenicity of injectable collagen. II. A retrospective review of seventy-two tested and treated patients.

Sera were collected from seventy-two patients who had been exposed to a preparation of a bovine collagen implant in widespread clinical use for correction of dermal defects ( Zyderm Collagen Implant [hereafter referred to as "the implant"]; Collagen Corporation, Palo Alto, CA). Thirty-one of these patients had reported implant site reactions alone, thirty-five had reported generalized symptoms without implant site involvement, and six had reported implant site reactions accompanied by generalized symptoms. Results of a radioimmunoassay performed on these sera showed that elevated levels of anti-implant antibodies correlated significantly with localized responses at injection sites. Conversely, systemic complaints could not be correlated with either skin reactions or antibody titers. In previous clinical studies, increasing numbers of exposure to this material were not shown to increase the likelihood of an immune response developing at implant sites. Therefore, immune responses to this implant are typically localized reactions that manifest within the first two exposures to the implant material.

Carcinoma of urachus with extensive abdominal calcification.

Carcinoma of the urachus, a relatively rare genitourinary neoplasm, usually presents as a supravesical mass. This tumor may occasionally calcify, which together with other radiographic and clinical features may permit a specific preoperative diagnosis. The calcifications also enable an evaluation of recurrence via plain films. A case is presented, with the clinical, radiologic, sonographic, and radionuclide imaging characteristics reviewed.

Computerized radiographic reporting in a community hospital: a consumer's report.

This report analyzes a 30 month experience with a commerically available mark sense form-based automated radiographic reporting system (RAPORT) in the diagnostic radiology department of a 400 bed general hospital. By using the system, five radiologists were able to completely formulate readable diagnostic radiology reports in 65% of all cases, thereby bypassing a transcriptionist and decreasing report turnaround time dramatically without sacrificing reporting time. Moreover, billing and statistical capabilities provided by the system were found to capture enough lost charges to pay for its entire cost. Trade-offs for these efficiencies included learning of a new code by the radiologist, certain changes in his reading habits, and acceptance of a limited, repetitive, and somewhat stilted jargon both by the radiologist and the referring physician.

Delayed opacification in congenital multicystic dysplastic kidney, an important Roentgen sign.

Two cases of delayed opacification of multiple irregular cystic spaces are reported in unilateral congenital multicystic kidney. This finding should be added to the basic excretory urographic sings of poor function, cystic spaces on total body opacification, and calyceal crescents, and indicates the need for delayed films in all such cases. Reevaluation of the necessity for further diagnostic study and nephrectomy are discussed.

Regional myocardial function in idiopathic hypertrophic subaortic stenosis. An echocardiographic study.

To assess regional contractility in idiopathic hypertrophic subaortic stenosis (IHSS), a primary myopathic disorder with documented hyperdynamic ventricular contractions, systolic wall thickening and velocity of contraction of the septum and left ventricular posterior wall were measured in echocardiograms from 16 patients with IHSS and 16 normal subjects. The average thickening of the normal septum and posterior wall was 75.9+/-8.8% and 84.8+/-6.3%, respectively. The posterior wall in IHSS thickened by 75.1+/-6.8%. None of these values differed significantly. However, the increase in thickness of the IHSS septum averaged 22.5+/-2.4%, significantly less than that of either the IHSS posterior wall or the normal septum. Velocity measurements confirmed the impression of diminished septal function. The mean velocity of normal septal contraction averaged 37.0+/-2.3 mm/sec, normal posterior wall 42.3+/-2.0 mm/sec and IHSS posterior wall 55.7+/-3.5 mm/sec, whereas the septum in IHSS contracted at the rate of 26.0+/-2.5 mm/sec. Thus, the IHSS septum contracted significantly more slowly than the normal septum or IHSS posterior wall. However, the posterior wall velocity in IHSS was significantly more rapid than that measured in normal ventricles--perhaps to compensate for the septum. Normalization of all velocities for left ventricular end-diastolic internal diameter did not alter the sifnificance of the results. Consideration of IHSS as an asymmetric myopathy based on prior observations of predominantly septal hypertrophy and distorted septal cellular architecture is now supported by the above evidence of functional left ventricular asymmetry. Although the total left ventricular function in IHSS may be hyperdynamic, regional function is not uniform. The septum appears to be hypodynamic, while the contractile capacity of the posterior wall is increased.

Xeromammography in the early detection of breast cancer. Community hospital experience and approach.

Community hospitals can do much in the general effort toward earlier detection of breast cancer. Using xeromammography in the department of general radiology of one community hospital, 21 cases of occult carcinoma were detected in 2,392 patients in a two year period. Patients were both symptomatic and asymptomatic. This percentage is comparable to results in previously published series of similar patient populations, and can be expected to be slightly higher than screening populations of totally asymptomatic patients. In 24 percent of cases of occult carcinoma there was axillary node involvement, compared with 42 percent axillary node involvement in cases of nonoccult carcinoma. Early detection efforts are currently centered on improving thoroughness in physical examinations, stressing breast self-examination and identifying patients in high-risk categories. These, together with proper periodic use of mammograms, will yield the highest rate of early carcinoma detection until more sensitive biologic markers are developed.

Effects of anesthetics on splanchnic circulation and metabolism.

In the last 10 years intense interest in "halothane hepatitis" plus simpler and more reliable technology for measuring splanchnic blood flow have led to a fuller understanding of the splanchnic effects of anesthetics. For the first time, a rational choice of anesthetic technique can be made for the patient with splanchnic organ dysfunction.

Vesiculographic findings in cysts of the seminal vesicle.

Vasoseminal vesiculography showed medial displacement and stretching of the ampulla of the vas deferens in 3 patients with cysts of the seminal vesicle. In 2 a nonopacified mass separated the ampulla from the ipsilateral seminal vesicle. All 3 patients were managed without surgical intervention. If such a vesiculographic pattern is seen in a patient with a paraprostatic mass, the contents of the mass should be aspirated and contrast material injected to document its cystic nature.

Hypertension in the immediate postoperative period.

Sixty patients out of 1,844 recovery room admissions had significant postoperative arterial hypertension. Nearly 60% of them had a history of hypertension. The postoperative hypertension usually began within 30 min from the end of operation and lasted about 2 hours. In 20% of the patients it lasted 3 hours or longer. Complications attributable to hypertension were confined to this latter group. The principal factors possibly contributing to the pressure elevations were pain (35%), hypercarbia (15%) and emergence excitement (16%). Ten of the patients (17%) had no demonstrable cause for hypertension. The hypertension in this group appeared to have a shorter and more benign course.