Radiotracer localization of nonpalpable pulmonary nodules: A single-center experience.

OBJECTIVE: Multiple localization techniques to facilitate intraoperative identification of small or nonsolid pulmonary nodules have been developed. Radiotracer localization using technetium-labeled macroaggregated albumin has been our preferred localization method since 2009. We report our experience, including technical pitfalls and modifications, of our initial 77 patients who underwent this technique. METHODS: All patients undergoing preoperative radiotracer localization were identified from a prospective database. Medical records were retrospectively reviewed for patient demographic characteristics, nodule characteristics, procedure details, pathologic data, and outcomes. RESULTS: Seventy-seven patients underwent localization of 79 pulmonary nodules. Radiotracer localization had an overall success rate of 95%; however, 2 patients required a second localization procedure on the same day. Most failures occurred in nodules that were < 5 mm from the pleural surface, resulting in pleural spillage. Seventy-three patients underwent a diagnostic wedge resection, with 2 of these patients requiring 2 wedge resections. In 2 patients, the nodules were successfully localized; however, they were too deep for wedge resection and required anatomic resection. Two patients did not undergo resection. One patient developed pleural spillage and hemothorax and due to subsequent comorbidities, was never rescheduled. The second patient did not tolerate single-lung ventilation. The majority (86%) of lesions were malignant. Median length of stay was 2 days (range, 1-15 days). There was no 30-day mortality. The only morbidity was a prolonged air leak (>5 days) in 5 patients. CONCLUSIONS: Radiotracer localization is a simple and effective technique for intraoperative identification of small pulmonary nodules.

Robotic-Assisted Endovascular Pulmonary Artery Foreign Body Retrieval: A Case Report.

As intravascular robotics technology continues to evolve, so do the potential applications. The present case describes the use of the Magellan Robotic System within the pulmonary artery. A 61-year-old female was referred for retrieval of a transected port catheter, which had embolized into the pulmonary artery. After a failed attempt using a conventional technique, retrieval was ultimately successful with assistance of the Magellan system. The unique navigational capabilities and stability of the system may make it a valuable tool in pulmonary artery interventions.

Association of Phosphodiesterase 4D with ischemic stroke: a population-based case-control study.

BACKGROUND AND PURPOSE: The Phosphodiesterase 4D (PDE4D) gene was reported recently to be associated with ischemic stroke in an Icelandic population. The association was found predominately with large vessel and cardioembolic stroke. However, 2 recent reports were unable to confirm this association, although a trend toward association with cardioembolic stroke was reported. None of the reports included significant proportions of blacks. We tested for genotype and haplotype association of polymorphisms of the PDE4D gene with ischemic stroke in a population-based, biracial, case-control study. METHODS: A total of 357 cases of ischemic stroke and 482 stroke-free controls from the same community were examined. Single nucleotide polymorphisms (SNPs) were chosen based on significant associations reported previously. Linkage disequilibrium (LD), SNP, and haplotype association analysis was performed using PHASE 2.0 and Haploview 3.2. RESULTS: Although several univariate associations were identified, only 1 SNP (rs2910829) was found to be significantly associated with cardioembolic stroke among both whites and blacks. The rs152312 SNP was associated with cardioembolic stroke among whites after multiple comparison corrections. The same SNP was not associated with cardioembolic stroke among blacks. However, significant haplotype association was identified for both whites and blacks for all ischemic stroke, cardioembolic stroke, and stroke of unknown origin. Haplotype association was identified for small vessel stroke among whites. CONCLUSIONS: PDE4D is a risk factor for ischemic stroke and, in particular, for cardioembolic stroke, among whites and blacks. Further study of this gene is warranted.

Whole-genome amplification: relative efficiencies of the current methods.

Whole genome amplification (WGA) has emerged as a fundamental method for DNA analysis from limited quantities of genomic DNA in forensic analysis and disease gene discovery. Several strategies for WGA have been developed during the past decade, each with variable fidelity, yield and coverage of the amplified genome. In the search for a reliable and robust WGA method for genotyping short tandem repeat (STR) loci and single nucleotide polymorphic (SNP) markers, we initially tested four common methods, viz., degenerate oligonucleotide primed PCR (DOP), primer extension preamplification (PEP), improved-PEP (I-PEP) and multiple displacement amplification (MDA), typing the 13 CODIS tetranucleotide repeat loci. The results showed among all methods, I-PEP and MDA have higher genomic coverage. DOP and PEP produced locus and allelic dropouts. Therefore, we emphasized on the evaluation of I-PEP and MDA protocols, which shows that the two methods have their relative strengths and weaknesses. In general, the product yield of MDA is higher than that of I-PEP. However, the specificity of the I-PEP products appears to be higher, particularly in the analysis of STR loci. In the analysis of SNP markers, some loci amplify better using products obtained from I-PEP whereas some worked better with MDA. Our analyses also demonstrate that blood spots on FTA cards are a more efficient source of DNA for I-PEP as compared to MDA, especially for STR analysis.