Improvement in weight loss and ambulation outcomes after gastric sleeve surgery for a person with chronic motor-incomplete tetraplegia: clinical case report.

OBJECTIVE: To measure body mass index (BMI) and ambulation changes for a morbidly obese, 47-year-old man with chronic motor-incomplete tetraplegia after gastric sleeve surgery. DESIGN/METHOD: A morbidly obese man, BMI=44 kg m(-)(2), with chronic C5 AIS D tetraplegia underwent elective gastric sleeve surgery. Assessment of BMI and function via the 6-minute walk test (6MWT), 10-meter walk test (10MWT) and ambulation parameters (CIR Systems/GAITRite, Franklin, NJ, USA) was performed preoperatively and at 12, 24, 36 and 52 weeks postoperatively, and additionally after 3 weeks of both a prescribed coached (3 × /week facility based) and a non-coached (3 × /week home based) walking program initiated at 52 weeks. A step activity monitor assessed daily ambulation preoperatively, prior to and during the third and sixth week of the walking program. RESULTS: Results included a 34.3% peak BMI decrease at 52 weeks post surgery and a peak increase in 6MWT distance of 58% at 52 weeks post surgery, 10MWT preferred speed of 56% at 55 weeks and step activity monitor of 82% at 58 weeks post surgery. At 58 weeks, gait data demonstrated a decrease in double limb stance of 38% and decrease in base of support of 72%. CONCLUSION/CLINICAL RELEVANCE: This empirical case assessment of BMI and functional mobility before and after gastric sleeve surgery may encourage further investigation into mobility and general health effects post gastric procedures for people with chronic motor-incomplete spinal cord injury.

Reliability and relatedness of peak VO2 assessments during body weight supported treadmill training and arm cycle ergometry in individuals with chronic motor incomplete spinal cord injury.

STUDY DESIGN: Prospective assessment as part of initial evaluations for randomized-controlled trial participation. OBJECTIVES: To determine the test-retest reliability of peak VO2 testing during both robotically assisted body weight supported treadmill training (RABWSTT) and arm cycle ergometry and to assess whether a relationship exists between these two measurements in individuals with chronic motor incomplete spinal cord injury (CMISCI). METHODS: Twenty-one participants with CMISCI enrolled in a 3- month, RABWSTT randomized-controlled trial. As part of their baseline assessments, individuals underwent VO2 peak assessments twice on separate days during both RABWSTT and arm cycle ergometry using a metabolic cart. RESULTS: Peak oxygen consumption measured at baseline correlated significantly between repeated tests in the RABWSTT (r=0.96, P<0.01) and the arm ergometer (r=0.95, P<0.01). A Pearson correlation (r=0.87, P<0.01) existed between the peak VO2 measurements obtained using RABWSTT and arm ergometry, although Bland-Altman analysis suggested a more limited relationship with a bias of 1.1 favoring arm ergometry. This relationship was stronger for individuals with tetraplegia than for people with paraplegia. CONCLUSION/CLINICAL RELEVANCE: Determination of VO2 peak during both RABWSTT and arm ergometry in individuals with CMISCI is highly reproducible. Furthermore, a moderate correlation exists between peak VO2 measured during RABWSTT and arm cycle ergometry in this population for individuals with tetraplegia. This correlation offers implications for future cardiovascular testing of individuals with CMISCI, as two reliable peak VO2 measurement techniques are possible.

Evaluation of biocompatibility and anti-glioma efficacy of doxorubicin and irinotecan drug-eluting bead suspensions in alginate

INTRODUCTION: Chemotherapeutic drug-eluting beads (DEBs) are microspheres that are in clinical use for intraarterial chemoembolisation of liver cancer. Here we report on the biocompatibility and anti-tumour efficacy of DEBs after intratumoral application in a rat BT4Ca glioma model. METHODS AND RESULTS: Doxorubicin and irinotecan-eluting DEBs were suspended in a Ca(2+)-free aqueous alginate solution that provides a sol-gel transition when injected into the Ca(2+) rich brain tissue. In this way the DEBs are immobilised at the implantation site. Forced elution studies in vitro using a USP-4 flow-through apparatus demonstrated that the alginate excipient helped to reduce the burst effect and rate the elution from the beads. From the in vivo evaluation, doxorubicin DEBs demonstrated a significant local toxicity, while irinotecan-loaded DEBs showed good local tissue compatibility. Doxorubicin at higher concentrations and irinotecan-loaded DEBs were found to decrease tumour volume, increase survival time and decrease the Ki67 proliferation index of the tumour. Doxorubicin was shown by fluorescent microscopy to diffuse into the peritumoral tissue, but also penetrates along white matter tracts, to more distant areas. DISCUSSION: We conclude that the alginate suspension of irinotecan DEBs can be considered safe and effective in a clinical setting (AU)

Use of Encapsulated Stem Cells to Overcome the Bottleneck of Cell Availability for Cell Therapy Approaches.

Nowadays cell-based therapy is rarely in clinical practice because of the limited availability of appropriate cells. To apply cells therapeutically, they must not cause any immune response wherefore mainly autologous cells have been used up to now. The amount of vital cells in patients is limited, and under certain circumstances in highly degenerated tissues no vital cells are left. Moreover, the extraction of these cells is connected with additional surgery; also the expansion in vitro is difficult. Other approaches avoid these problems by using allo-or even xenogenic cells. These cells are more stable concerning their therapeutic behavior and can be produced in stock. To prevent an immune response caused by these cells, cell encapsulation (e.g. with alginate) can be performed. Certain studies showed that encapsulated allo- and xenogenic cells achieve promising results in treatment of several diseases. For such cell therapy approaches, stem cells, particularly mesenchymal stem cells, are an interesting cell source. This review deals on the one hand with the use of encapsulated cells, especially stem cells, in cell therapy and on the other hand with bioreactor systems for the expansion and differentiation of mesenchymal stem cells in reproducible and sufficient amounts for potential clinical use.

Production process for stem cell based therapeutic implants: expansion of the production cell line and cultivation of encapsulated cells.

Cell based therapy promises the treatment of many diseases like diabetes mellitus, Parkinson disease or stroke. Microencapsulation of the cells protects them against host-vs-graft reactions and thus enables the usage of allogenic cell lines for the manufacturing of cell therapeutic implants. The production process of such implants consists mainly of the three steps expansion of the cells, encapsulation of the cells, and cultivation of the encapsulated cells in order to increase their vitality and thus quality. This chapter deals with the development of fixed-bed bioreactor-based cultivation procedures used in the first and third step of production. The bioreactor system for the expansion of the stem cell line (hMSC-TERT) is based on non-porous glass spheres, which support cell growth and harvesting with high yield and vitality. The cultivation process for the spherical cell based implants leads to an increase of vitality and additionally enables the application of a medium-based differentiation protocol.

Lung infections in pediatric lung transplantation: experience in 49 cases.

OBJECTIVES: Pulmonary infections, and particularly cytomegalovirus (CMV) infections, are a major cause of morbidity after lung transplantation. We report here our results in 49 pediatric lung transplantations. METHODS: Between may 1988 and 1997, we have done 49 lung transplantations in 42 children (en bloc double lung transplantation (DLT):10, HLTx:7, sequential bilateral sequential-lung transplantation (BSLT):31, single-lung transplantation (SLT): 1). In seven, it was a retransplantation. Among these, 34 were cystic fibrosis (CF) patients, all with multiresistant organisms (Pseudomonas aeruginosa, Burkholderia cepacia, Achromobacter xylososydans, Staphylococcus aureus). All patients were treated with multiantibiotic prophylaxy adapted to the preoperative cultures. Donor-recipient CMV matching was possible in only 31 cases. CMV prophylaxy and immunosuppression protocols have evolved with time, with a current protocol of IV Gancyclovir prophylaxy for 3 months and triple drug immunosuppression without post-operative rabbit anti-thymocyte globulin (RATG) induction. There was no perioperative mortality in the primary transplantations and three early deaths in the whole group (6.1%). RESULTS: Only five patients had no pulmonary infection. The patients presented 3.2 infection episodes per year, 75% localized on the lungs, 41% during the first 3 months. Among the 13 deaths in the 1st year, 10 were directly related to infection, 60% due to CMV. After the 1st year, in all patients dying of pulmonary dysfunction or obliterative bronchiolitis (OB), bacterial infections were associated. There was no serious fungal infection. Actuarial survival at 3 months, 1, 3, 5 years were 85, 65.7, 47.5 and 28.5%, respectively. There was a significant difference in 3 year survival between patients receiving CMV negative organs (40%) and CMV positive organs (17%). CONCLUSION: In our experience, as in other's, pulmonary infection risk is important in lung transplantation. Bacterial infections were mainly an aggravating factor of secondary pulmonary dysfunction or OB, and were not the primary cause of death. CMV infections have been very severe and lead us, despite the scarcity of donors, to avoid positive donors in negative recipients, this leads to disastrous mid-term results in our experience, despite prophylaxis.

[KTP laser in the upper airways in children: preliminary study on 27 lesions]. / Le laser KTP dans les voies aériennes superieures de l'enfant. Etude préliminaire portant sur 27 lésions.

The KTP Laser was recently introduced in otolaryngology, and is increasingly used. This report describes treatment of 27 upper airway lesions in 24 children using KTP Laser over a two year and half period at the Children's Hospital of La Timone in Marseille. Comparison of results with CO2 Laser were made for the three most frequent pathologies of the series which were choanal atresia (n = 14), laryngotracheal stenosis (n = 6) and laryngeal paralysis (n = 3). The convenience of fiber delivery, concomitant telescopic control and low grade oedematous reaction are the main advantages over the CO2 Laser. As reported in the literature, we observed that healing was longer for KTP Laser than for CO2 Laser. Delay to healing may be an advantage in the management of choanal atresias and laryngeal stenosis.

[Laryngotracheal fissure in infants. Indications, technique, results]. / La laryngotrachéofissure chez le nourrisson. Indications, technique, résultats.

Since laryngotracheofissiure, or anterior cricotomy, has been introduced in 1980, the number of tracheotomies performed in infants has decreased as this procedure is an alternative to tracheotomy for difficult extubation. Since then, the indications of this procedure have become wider, but a number of preoperative criteria, such as the pulmonary capacity, must be strictly assessed. We report on our experience with 14 children who underwent laryngotracheofissiure during the past 4 years. The indications, the surgical technique and the results are evaluated.

[Changes in the blood and plasma volumes during diagnostic angiocardiography. Differences between high- and low-osmolality contrast media]. / Veränderungen des Blut- und Plasmavolumens während einer diagnostischen Angiokardiographie. Unterschiede zwischen Kontrastmitteln mit hoher und niedriger Osmolalität.

Changes in blood and plasma volumes were investigated in the course of diagnostic cardiac catheterizations, comparing the effect of a high and a low osmolar contrast medium in 30 patients (5 women and 25 men; mean age 53 [19-76] years) with coronary heart disease (n = 27) or valvular defect (n = 3). Using a randomized, double-blind protocol 15 patients received amidotrizoic acid (2.1 osmol/kg; mean dosage 166 +/- 68 or 2.2 +/- 1.1 ml/kg), while 15 patients received iopamidol (0.8 osmol/kg; mean dosage 154 +/- 78 ml or 2.1 +/- 1.0 ml/kg). The indocyanine-green method and the haematocrit were used to measure blood and plasma volumes immediately before and after the angiocardiography. Blood volume after amidotrizoic acid injection increased by a mean of 4.9% (228 +/- 242 ml) and by 0.4% (17 +/- 197 ml) after iopamidol (P less than 0.05). Plasma volume increased by a mean of 11.8% (331 +/- 150 ml) after amidotrizoic acid and 5.7% (157 +/- 97 ml) after iopamidol (P less than 0.01). The increase in plasma volume correlated with the dose of contrast medium: 2 ml per ml amidotrizoic acid (r = 0.93) and 1 ml per ml iopamidol (r = 0.82).--During angiocardiography blood and plasma volume may increase by up to 500 ml, an increase which depends not only on dosage but also on the osmolality of the injected contrast medium.

[Autologous hemotherapy in heart transplantation: a case report]. / Autologe Hämotherpie bei Herztransplantation: Ein Fallbericht.

The use of autologous blood in patients with organ transplantations is feasible only when the blood is stored in the frozen state, since the timing of the operation is not predictable. A 53 year-old patient with dilatative cardiomyopathy was selected for transplantation. By preoperative donation, four erythrocyte concentrates were prepared and frozen by high-glycerol low-temperature technique. The frozen blood was thawed, manually washed and made available for transfusion as required. The increment of hemoglobin after transfusion was 0.9 g/dl per unit. Quality control of the prepared erythrocyte concentrates was performed: Resistance to osmotic fragility of the erythrocytes was in the normal range, beginning hemolysis was found at 0.40 +/- 0.02% NaCl, complete hemolysis was found at 0.30 +/- 0.02% NaCl. The osmolarity of the supernatant fluid of the final washing was 0.314 +/- 0.116 mosmol/l. This case report stresses the feasibility to prepare and store autologous blood even if the time when the blood is needed cannot be determined.