Genetic profile of cumulative mutational damage associated with early pulmonary adenocarcinoma: bronchioloalveolar carcinoma vs. stage I invasive adenocarcinoma.

To detect the possible genetic alterations characteristic of bronchioloalveolar carcinoma (BAC) and to study molecular genetic factors responsible for determining the biologic aggressiveness of pulmonary adenocarcinoma, comparative analysis of loss of heterozygosity (LOH) on 9 chromosomal regions was performed in 14 BACs and in 20 stage I adenocarcinomas (AD). The most frequently affected chromosome regions in BAC were 8q and 17p. In stage I AD, more than 60% of the cases showed LOH of 1p, 3p, 5q, 7q, 17p, and 18q loci, and LOH of 1p, 3p, 7q, and 18q was observed with greater frequency than in BAC (P < 0.05). Fractional allele loss (FAL) was significantly greater in stage I AD than in BAC (P < 0.001). In cases with microdissection of multiple sites, intratumoral heterogeneity of LOH status was observed in 73% of BAC and 94% of stage I AD, and homogeneous distribution of LOH of 9p was unique to BAC. The high FAL value was associated with a poor prognosis of BAC, but this trend did not reach statistical significance (P = 0.098). In stage I AD, no correlation was found between LOH of particular chromosomal region or FAL and clinical outcome. LOH of 1p, 3p, 7q, and 18q was associated with invasive properties of pulmonary AD and may be useful in identifying invasive adenocarcinoma when conventional histomorphological tools are not helpful.

Intrapericardial caval injury due to blunt trauma.

BACKGROUND: Report of diagnosis and treatment of intrapericardial vena caval injury caused by blunt thoracic trauma, an unusual cause of cardiac tamponade. METHODS: A 43-year-old male motor vehicle accident victim suffered a lacerated intrapericardial inferior vena cava leading to cardiac tamponade. Positive clinical findings were hypotension and tachycardia without indication of external chest trauma. RESULTS: Abdominal computed tomography was negative, but ultrasound demonstrated cardiac tamponade and fluid in the abdomen. Pericardiocentesis was performed, and nonclotted blood was aspirated. Laparotomy showed intra-abdominal blood and splenic capsule avulsion. Sternotomy revealed a laceration of the inferior vena cava, which was repaired. CONCLUSIONS: Signs of cardiac tamponade and a history of blunt thoracic trauma caused by deceleration injury suggests intrapericardial inferior vena cava injury. Median sternotomy is the optimal choice for caval repair.

Activity of 2-chlorodeoxyadenosine (Cladribine) in 2-hour intravenous infusion in 94 previously treated patients with low grade non-Hodgkin's lymphoma.

The purpose of our study was to determine the efficacy of 2-chlorodeoxyadenosine (2-CdA) administered in 2-hour intravenous infusions in previously treated patients with low grade non-Hodgkin's lymphoma (LGNHL). We treated 94 LGNHL patients with 2-CdA at a dosage of 0.12 mg/kg/24h in 2-hour intravenous infusion for 5 consecutive days. The treatment consisted of from 1 to 7 courses (median 3), repeated usually at monthly intervals. All patients were refractory to or relapsed after standard chemotherapy. Of these 94 patients 78 (83%) had clinical stage IV of the disease. Complete response (CR) was obtained in 12 (12.8%) and partial response (PR) in 36 (38.3%) giving an overall response rate of 51.1%. In 12 (12.8%) grade 4 thrombocytopenia with haemorrhagic diathesis was noted, grade 4 neutropenia was observed in 12 (12.8%) and infections complicated the course of treatment in 38 (40.4%) patients. 2-CdA treatment was the cause of death of 3 patients. The results of our study show that 2-CdA given in 2-hour infusions is an effective agent in advanced, heavily pretreated patients with LGNHL.

[Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy]. / Ocena czynnosci prawej komory u chorych z kardiomiopatia przerostowa.

The aim of the study was the estimation of the right ventricular function in patients with hypertrophic cardiomyopathy (HC). 20 patients, 14 men and 6 women of age 23-50 with echocardiography diagnosed hypertrophic cardiomyopathy were examined. Equilibrium gated radionuclide angiography was performed in all patients. Right and left ventricle ejection fraction (EF), 1/3 first ejection fraction (1/3EF), maximal and average rate of emptying (MER, AER), time to peak emptying (TTPE), 1/3 first filling fraction (1/3FF), maximal and average rate of filling (MFR, AFR), time to peak filling (TTPF) and MFR/MER ratio were calculated. Analysing function of right ventricle in patients with HC impaired diastolic function was observed. MFR was 1.44 +/- 0.54EDV/s,AFR-0.95 +/- 0.24EDV/s, 1/3 FF-0.49 +/- 0.09. Positive correlation between right and left ventricle MFR was found (r = 0.62; p < 0.01). Mean value of RVEF was 40.8 +/- 7%, 1/3EF-17.5 +/- 5%, MER-1.88 +/- 0.4EDV/s, AER-1.59 +/- 0.4EDV/s. Decreased ejection fractions of the right ventricle in patients with the thickest interventricular septum were observed. Mean value of the time to peak emptying was short (x = 68.6 ms). Regional ejection fractions from septum region of RV were decreased. It was the result of the abnormal function of the interventricular septum in patients with hypertrophic cardiomyopathy. Indexes of RV function in the two groups of patients were also analysed: with and without left ventricular outflow tract obstruction. Mean value of RV systolic and diastolic function indexes were similar in two groups of patients. In conclusion, impairment of the right ventricle diastolic function in patients with hypertrophic cardiomyopathy is predominated. The more diastolic function of the RV deteriorates the worse diastolic function of the left ventricle remains in patients with HC.

The value of the left apical cap in the diagnosis of aortic rupture: a prospective and retrospective study.

The authors conducted a prospective and retrospective study of the radiographic findings in 45 patients with traumatic rupture of the aorta. In 7 cases, a left apical cap was the only clearly visible abnormality. In 11 cases a cap was present together with a poorly defined aortic knob, while in 13 cases both were seen along with mediastinal widening. In 14 cases, all of the classical signs of aortic rupture were present, but an apical cap was not seen or was not considered significant. Of 32 aortograms obtained, 12 were taken solely because of an apical cap; 2 were positive for aortic rupture and 10 were negative. No aortic rupture was found in patients with a left apical cap and fractures of the ribs, vertebral bodies, or scapulae.

Benign pneumoperitoneum following median sternotomy incision.

Because of the close anatomic relationship of the pericardium, diaphragm, and peritoneal cavity, a benign pneumoperitoneum may occur following median sternotomy incision and cardiac surgery. The pneumoperitoneum results from inadvertent opening of the peritoneal cavity during the initial surgical incision or during the subsequent cardiac surgery. It is generally of no significance to the patient, although it must be distinguished from pneumoperitoneum occuring secondary to intraabdominal pathology or to retrograde dissection of extraalveolar air in patients on ventilatory support. Two illustrative cases are presented.