Epithelioid hemangioendothelioma of the maxilla: case report and review of literature.

Epithelioid Hemangioendothelioma (EH) is a rare, low-grade malignant vascular tumor, first defined as a soft tissue tumor by Enzinger and Weiss in 1982. The tumor was later reported in virtually all sites, including liver, lung, brain, and bone. The epithelioid neoplastic cells are of endothelial origin, staining positive for Factor VIII and CD-34. In our review of EH of bone medline literature, and including the present case report, a total of 73 cases were found. Forty-one (56%) patients had multifocal bone involvement and thirty-two (44%) patients had solitary EH of bone. Resection was the primary recommended treatment. Visceral involvement appears to affect prognosis and survival adversely. We report a case of EH of the maxilla, which occurred in a 32-year-old male.

Reproductive consequences of an X-autosome translocation in a swine herd.

A survey was conducted on the chromosome makeup and breeding data of pigs housed at the Arkell Research Station, University of Guelph, to determine the reproductive impact of a reciprocal translocation previously identified as t(Xp+;14q-). Blood samples were cultured and chromosome spreads were examined to identify carriers in the herd. Gonadal features of carrier boars and piglets and their age-matched normal counterparts were studied, and the reproductive history of carrier sows, including the number of breedings required for conception, mean litter size, prevalence of still births and malformations, and sex distribution among the piglets, was compared with that of normal (noncarrier) sows. Our observations on testicular histology confirmed that X-autosome translocation-carrier boars are sterile, and the analysis of reproductive data showed that the most striking effects of t(Xp+;14q-) on sows are the 50% increase in the number of breedings required for conception and the over 25% reduction in litter size compared with that of normal sows. The reproductive impact of this and similar translocations on the herd and on the swine industry in general is discussed.

Laparoscopic appendectomy: comparison with open appendectomy in 720 patients.

We conducted a review of laparoscopic appendectomies (LA) and open appendectomies (OA) over a 3-year period, including 720 patients (253 LA, 467 OA) who underwent appendectomy during the study period. Computer records were reviewed with respect to demographics, length of stay, operating room time, operating room cost, hospital cost, and morbidity. All patients were sent surveys to assess their posthospitalization recovery. The LA patients had significant shorter hospital stays (2.06 days vs. 3.44 days, p < .001), lower morbidity rates (5 vs 14%, p < .02), and comparable overall hospital costs ($4,800 vs. $4,950). The LA patients also reported less postoperative pain and were able to return to work sooner. Our results show that LA can significantly decrease morbidity and hospital stay with a comparable hospital cost and result in quicker patient recovery.

Laparoscopic Nissen fundoplication: cost, morbidity, and outcome compared with open surgery.

We report a retrospective review of all patients undergoing both open and laparoscopic Nissen fundoplication from January 1990 through December 1993. Computer data were reviewed to determine the length of hospital stay, hospital costs, and perioperative complications. Questionnaires were sent to patients undergoing Nissen fundoplication. During the study period, 232 patients underwent Nissen fundoplication, and 72 patients underwent laparoscopic Nissen fundoplication. The open group had an average hospital stay of 6.1 days, the laparoscopy group, 1.5 days (p < < 0.001). Total hospital costs for the open group averaged $8,616 versus $4,331 for the group that underwent laparoscopic procedure (p < 0.001). Operating room time averaged 10 min longer for the laparoscopic procedure (p value, nonsignificant). In-hospital morbidity was significantly greater for the open group. In follow-up questionnaires, the laparoscopy group experienced an earlier return to "general health" (p < 0.005) and an earlier return to work.

Laparoscopic cholecystectomy: the Springfield experience.

Laparoscopic cholecystectomy has become an accepted alternative to open cholecystectomy. The purpose of this paper is to review the first 150 laparoscopic cholecystectomies performed at our institution. Hospital and clinic charts were reviewed to obtain demographic information. Anesthesia time and length of hospital stay were recorded. The incidence of intraoperative cholangiogram and laser use were calculated. The type and overall rate of complications were determined, as were complication rates for specific patient subsets. Learning curves by individual surgeons were plotted and hospital costs recorded. Six staff surgeons performed or attempted laparoscopic cholecystectomy on 150 (118 female, 32 male) symptomatic patients. The average age was 43.9 years (range, 18-77). Sixty-five patients (43.3%) had undergone previous abdominal surgery. The average duration of anesthesia was 120.8 min (SD +/- 43.5). Eighteen patients (12.0%) had intraoperative cholangiograms, and 16 procedures (10.7%) employed the laser for dissection. Ten procedures (6.7%) were converted to open cholecystectomy at the discretion of the individual surgeon. Three patients (2.0%) were found to have acute cholecystectomy. Average hospitalization was 1.4 days (SD +/- 1.64). The overall complication rate was 9.3%. Complication rate by age was 7.2% (age < 50 years) versus 13.2% (age > or = 50 years). The complication rate in overweight patients was 15.52% compared with a rate of 5.43% for those not overweight (overweight was arbitrarily defined as > 175 lb for women, > 200 lb for men). The complication rate in patients who had previous abdominal surgery was 8.5% compared with 9.9% in patients who had not had previous abdominal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Construction and expression of plasmids containing mutated diphtheria toxin A-chain-coding sequences.

We previously demonstrated that cells can be killed through transfection of an expression plasmid that encodes the diphtheria toxin A-chain fragment (DT-A). This report describes the construction of expression plasmids containing three mutant DT-A-coding sequences substituting glutamic acid 148 with aspartic acid, serine, or glutamine which are known to have 100- to 300-fold-reduced ADP-ribosylation activity measured in vitro. The toxicity of these constructs was determined in cotransfection experiments using HeLa and 293 cells with a luciferase expression plasmid as the reporter. Dose responses were compared for the three new DT-A mutant plasmids and for the corresponding plasmids containing wild-type DT-A and the previously characterized tox 176 mutant. The dose required to produce 50% inhibition of control luciferase expression in 293 embryonic kidney cells for the five plasmids ranged from 0.01 micrograms for wild-type DT-A to 1.2 micrograms for the least toxic plasmid, which replaces glutamic acid 148 with glutamine. In conclusion, a wide range of DT-A toxicity can be achieved by using plasmid expression vectors that encode different DT-A mutations.

Laparoscopic cholecystectomy: cost analysis.

Recently laparoscopic cholecystectomy (LC) has become an accepted alternative to the traditional open cholecystectomy (OP). The purpose of this study was to compare laparoscopic cholecystectomy to open cholecystectomy with respect to four variables: (a) operative time, (b) length of hospital stay, (c) total hospital cost, and (d) morbidity and mortality rates. The most recent 200 LCs performed at HCA West Side Hospital were selected for comparison in the study. Demographic data, including age and sex were collected for all patients. The medical record for each patient was then reviewed to obtain the study variables. A control group of 200 patients undergoing elective open cholecystectomy over the same period was selected. Complications occurred in 12 patients (6.0%) in the LC group with one postoperative mortality. Nineteen patients (9.5%) suffered complications in the OC group with no operative mortality. The difference between the two groups was not statistically significant. The average length of operation (recorded in minutes) in the OC group was 87.79 (SD +/- 20.69) as compared to 103.78 (SD +/- 29.01) in the LC group. This difference proved to be slight, but significantly greater (p < 0.0001). The average length of stay (recorded in days) in the OC group was 4.43 (SD +/- 1.29) versus 1.13 (SD +/- .93) in the LC group. Again, the difference proved to be statistically significant (p < 0.0001). The corrected average total hospital charge from OC was $3,006 (SD +/- 755) versus $2,312 (SD +/- 484) for LC, a difference that was statistically significant (p < 0.0001). Laparoscopic cholecystectomy is a safe, effective, and cost-efficient alternative to open cholecystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical palliation for pancreatic carcinoma.

A review of 122 patients treated for pancreatic adenocarcinoma from January 1978 through December 1984 was accomplished to determine patient survival and the effect of surgical palliation. One hundred patients underwent laparotomy, including biopsy only (n = 42), biliary bypass (n = 30), gastric bypass (n = 1), biliary and gastric bypass (n = 14), and curative resection (n = 13). Total patient median survival was 3.6 months and no patient lived 5 years. No significant difference in survival was found between the biliary bypass and combined biliary-gastric bypass groups. Only 1 of 30 patients (3.3%) undergoing biliary bypass alone without evidence of pre-operative gastric outlet obstruction developed late gastric outlet obstruction requiring gastrojejunostomy. Operative time and postoperative morbidity were greater in the biliary-gastric bypass group. These results do not support routine prophylactic use of gastrojejunostomy at the time of biliary bypass for patients with unresectable carcinoma of the pancreas.

Evaluation of possible traumatic thoracic aortic injury using aortography and CT.

To identify and compare the methods of evaluation for suspected traumatic aortic rupture, 1,031 trauma charts from 1983-1989 were reviewed. Fifty-nine patients were evaluated for possible aortic injury. Patients who died before completion of the CT or aortogram were excluded. Widening of the mediastinum on chest x ray was the most frequent indication for follow-up studies. Twenty-five had a CT of the aortic arch alone. No study showed disruption. There were no false negative studies. Thirty patients had only aortography. Twenty-four were read as normal (one false negative). Six were read as positive (one false positive). In four, both studies were performed (CT/aortography--TP/TP, TN/TN, TP/FN, FP/FP). (FP = False Positive, TP = True Positive, FN = False Negative, TN = True Negative.) Six received surgical repair of the aortic injury (one death). In this experience, CT was used successfully as a screening tool for aortic disruption. It was highly sensitive in recognizing aortic injuries when present (100% vs. 75% for aortography) and in most cases did not require aortographic verification. False positive rates were comparable (CT = 3.8%, aortography = 7.7%). Specificity was also comparable (CT = 96%, aortography = 92%). Overall, four aortograms were inaccurate while only one CT was inaccurate. We recommend the use of CT for the evaluation of widened mediastinum in the stable patient.

Guidelines for therapeutic decision in incidental appendectomy.

Incidental appendectomy is contraindicated in patients whose conditions are unstable, patients previously diagnosed with Crohn's disease, patients with an inaccessible appendix, patients undergoing radiation treatment, patients who are pathologically or iatrogenically immunosuppressed and patients with vascular grafts or other foreign material. In patients ten to 30 years of age--the age group associated with a higher incidence of acute appendicitis--who are otherwise healthy, incidental appendectomy is effective in preventing morbidity and death associated with acute appendicitis. In patients 30 to 50 years of age, incidental appendectomy should be left to the discretion of the surgeon. In this age group, the physician should give special consideration to the gender of the patient and the desire for future childbirth. In patients more than 50 years of age, the incidence of acute appendicitis decreases and the risk associated with operation and prolonged anesthesia is such that an incidental appendectomy is not beneficial. In mentally handicapped patients less than 50 years of age and who are physically healthy, incidental appendectomy should be performed. An inversion technique should be used in all instances of incidental appendectomy. In otherwise clean cases in which incidental appendectomy is anticipated, prophylactic antibiotics may be of value. Patients undergoing procedures that may compromise access to the appendix in the future should undergo incidental appendectomy.

The efficacy of preoperative computed tomography in patients with colorectal carcinoma.

A retrospective study was performed to evaluate and compare preoperative computed tomography (CT) scanning with less expensive tests that are used to identify hepatic metastases in patients with colorectal carcinoma. Thirty-three patients treated for colorectal carcinoma from January 1985 to December 1986 had preoperative CT scans performed as well as serum levels of lactose dehydrogenase (LDH), and carcinoembryonic antigen (CEA) measured. All patients underwent intraoperative evaluation of the liver. Only one patient had metastases found by CT exam that was not apparent at laparotomy. The sensitivity and specificity of the CT scan for detecting hepatic metastases were 1.00 and 0.96, respectively. The sensitivity and specificity of elevations in LDH or CEA when used in combination for detecting liver involvement was 1.00 and 0.54, respectively. Although the CT scan is effective in detecting hepatic metastases in patients with colorectal carcinoma we found that its routine use is unnecessary and expensive.

Acute focal bacterial nephritis or renal abscess? A sonographic diagnosis.

The radiological and sonographic findings of acute focal bacterial nephritis in 3 patients are presented. The sonographic appearance of a poorly marginated mass in the renal cortex, with echo amplitude less than the normal parenchyma and with poor transmission, should suggest the diagnosis of acute focal bacterial nephritis in a patient with pyrexia and a tender renal mass. These features of poor echogenicity and lack of posterior enhancement contrast with the presence of patchy echogenicity and posterior enhancement found in the renal abscess. This is of surgical importance, as the management may tend to be conservative in the one and surgical in the other.