Blue urticaria: a previously unreported adverse event associated with isosulfan blue.

The sentinel node hypothesis is predicated on the fact that a metastasis, if it exists, will have traveled on a direct path from the primary tumor through the efferent lymphatic channels to the first draining lymph node in the regional lymphatic basin, the sentinel node. Lymphatic mapping with isosulfan blue and sentinel lymphadenectomy is being increasingly used in the management of patients with melanoma, breast cancer, and other solid tumors. This trend is exposing an increasing number of patients to isosulfan blue. Although this compound is generally safe, severe reactions have been reported. We describe 2 patients who developed "blue hives" after isosulfan blue injection.

Selective inhibition of cell proliferation and DNA synthesis by the polysulphated carbohydrate l-carrageenan.

l-Carrageenan is a polysulphated carbohydrate that antagonises some heparin-binding growth factors. We assessed the effect of l-carrageenan on the proliferation of a panel of cell lines, some of which require heparin-binding growth factors for mitogenesis. The importance of growth factor antagonism for the anti-proliferative activity was also determined. Cell proliferation was determined by cell counts and a tetrazolium dye (MTT) assay, and DNA synthesis was determined by thymidine incorporation. The proliferation of the basic fibroblast growth factor (bFGF)-dependent endothelial cell line FBHE was inhibited by daily administration of l-carrageenan in a dose-dependent manner [concentration inhibiting cell growth by 50% (IC50 value), approx. 0.5 microgram/ml]. However, excess bFGF did not reverse the inhibitory effect. DNA synthesis was completely inhibited by concentrations of l-carrageenan that nonetheless allowed significant protein synthesis to occur. The proliferation of the androgen-dependent prostate-carcinoma cell line LNCaP was also inhibited by l-carrageenan (IC50 value, 5.5 micrograms/ml) and the cells were arrested at the G1/S boundary. l-Carrageenan inhibited DNA synthesis in MCF-7 cells stimulated by bFGF and transforming growth factor alpha (TGF alpha) but not in those stimulated by insulin-like growth factor 1 (IGF-1). Blocking IGF-1-mediated DNA synthesis with anti-IGF-1 receptor antibody alpha IR3 enhanced the inhibitory activity of l-carrageenan against MCF-7 cells grown in serum. A number of other transformed and non-transformed cell lines were either partially inhibited or not inhibited by l-carrageenan. l-Carrageenan had low anti-coagulant activity. l-Carrageenan is a selective anti-proliferative agent and warrants further investigation for anti-angiogenic therapy (in view of its activity against endothelial cells) and for the treatment of androgen-dependent prostate cancer.

In vitro adhesion of endogenous skin microorganisms to breast prostheses.

Bacterial proliferation on polymeric biomaterials varies with the material and microorganism. Subclinical infection is implicated frequently as the initiative factor in capsular contracture around breast prostheses. The ability of endogenous skin microorganisms to produce an exopolysaccharide "slime" is emerging as an important factor in biomaterial colonization. This study was designed to demonstrate the ability of microorganisms of varying slime productivity to colonize, in vitro, different kinds of breast prostheses. Six-millimeter disks from seven kinds of silicone prostheses and polyurethane foam were exposed to three radioactivity labeled strains of bacteria, one slime producer, and two non-slime producers, for 1 hour. Data were expressed as colony-forming units bound per disk. There was no significant difference in adherence between the bacterial strains used, suggesting that initial adherence was nonspecific. The adherence did not appear to be related to surface type, whether smooth or textured, nor to the polymeric composition of the implant material, whether silicone or polyurethane, nor to the presence or absence of slime. Also, adherence was consistent with expected nonspecific bacterial adherence to biomaterials.

Toxic shock syndrome after inguinal hernia repair. Report of a case with patient survival.

A 40-year-old man developed fulminant multisystem failure several days after elective repair of an inguinal hernia. Toxic shock syndrome (TSS) was diagnosed. There was, however, no evidence of wound infection at the time of multisystem failure. Only later in his hospital course did the wound drain. Staphylococcus aureus was cultured from the wound and was the presumed etiologic agent in the patient's life-threatening illness. The patient recovered fully with supportive care, antibiotics, and surgical debridement of the inguinal hernia site. This case is discussed in the context of existing literature on the toxic shock syndrome. The site of infection is typically nonsuppurative, but the systemic manifestations are typically life threatening. The responsible organism is commonly believed to be a strain of S. aureus that expresses a toxin (TSS toxin-1) that effects multisystem failure, but which also diminishes the local inflammatory response and explains the benign appearance of the wound. Although this is a rare clinical entity, elective surgical procedures complicated by fatal TSS have been reported. Surgeons should understand this disease and the management necessary to avert mortality.

Extrapleural exclusion of esophageal perforations.

Perforations of the esophagus require prompt treatment. We have described a patient in whom extrapleural exclusion of a primary repair was used. This procedure, which has not been previously reported, is not technically difficult and is similar to the approach used in the treatment of tracheoesophageal fistula. It allows good mediastinal drainage and prevents pleural soilage by providing an effective buttress to the esophageal repair.