Aortic graft infection: the value of percutaneous drainage.

OBJECTIVE: The goal of this study was to compare patients with aortic graft infection treated by primary percutaneous drainage with patients who initially underwent surgery. MATERIALS AND METHODS: A retrospective review of 23 consecutive patients treated for aortic graft infection was performed. Eleven patients were initially treated with percutaneous drainage and 12 were treated with surgery. The morbidity, mortality, and postprocedural reintervention rates and clinical outcome were analyzed for each group. RESULTS: The septic process resolved in nine (82%) of 11 patients treated with percutaneous drainage. Of these nine patients, four were treated with percutaneous drainage alone. Drainage was followed by removal of the infected prosthetic graft in the remaining five patients. In the surgical group, sepsis resolved in only four patients (33%) (p = .036). No periprocedural deaths occurred in the percutaneous drainage group, whereas six patients in the surgical group died in the perioperative period (p = .014). CONCLUSION: Percutaneous drainage can be used as an initial form of treatment in the management of aortic graft infections. Surgery after percutaneous drainage appears to be safer than surgery alone.

Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement.

UNLABELLED: The purpose of this study was to evaluate prospectively the sensitivity and specificity of scintimammography in the detection of both primary breast cancer and axillary lymph node involvement. METHODS: Sixty-five consecutive women referred for a suspicious breast lesion on clinical examination and/or with abnormal mammographies suggestive of malignancies were studied with scintimammography using planar prone imaging (with a chest positioning device with semicircular lateral aperture on the imaging table) performed 15 min postinjection of 25-30 mCi 99mTc-sestamibi. Three planar views, right and left lateral prone and anterior supine thoracic views, were obtained (8-10 min/view). The entire breast and ipsilateral axillary region were included in the field of view. Excisional breast biopsy and/or fine needle aspiration cytology were performed in all patients within 4 wk after scintimammography. Axillary node dissection was also performed. RESULTS: The largest primary tumor measured 2 x 3 cm. There were 47 primary breast cancers (8 different histologic types) and 18 benign breast lesions (5 histologic types). The sensitivity of scintimammography for detecting primary breast cancer was 91.5% (43 true-positive, 4 false-negative) and the specificity was 94.4% (17 true-negative, 1 false-positive). Metastatic axillary lymph node involvement was seen in 19 of 41 patients. The sensitivity of scintimammography to detect metastatic lymph nodes was 84.2% (16 true-positive, 3 false-negative) and the specificity was 90.9% (20 true-positive, 2 false-positive). CONCLUSION: This preliminary study confirms the results of some previous reports, which showed the high diagnostic accuracy of scintimammography in detecting breast cancer. This study also shows the potential value of this procedure to detect axillary lymph node involvement as concomitant information.

HLA class II polymorphism and IDDM susceptibility in the Greek population.

The frequencies of HLA-DQA1, DQB1 and DRB1 alleles were compared between 50 Insulin-Dependent Diabetes Melitus (IDDM) patients and 49 healthy controls in the Greek population. Statistically significant difference in the frequencies of HLA-DQA1*0501-DQB1*0201 (P = 10(-4)), DQA1*0301-DQB1*0201 (P = 0.01) and DQA1*0301-DQB1*0302 (P = 0.001) were observed. The DRB1*0405-DQA1*0301-DQB1*0201 was the only DR, DQ combination significantly associated with the disease. The unexpected increase of DRB1*0405 observed in the Greek IDDM may suggest as reported in Chinese and Japanese IDDM a contribution of DR beta and DQ alpha in susceptibility. Moreover, in contrast to the Asians, in the Greek, the DR beta, DQ alpha are found with the usual DQ beta 57-ve.

H chain V region sequences of three human monoclonal IgM with anti-myelin-associated glycoprotein activity.

The amino acid sequence corresponding to the V region H chain gene used by three monoclonal IgM directed to the myelin-associated glycoprotein (MAG) is presented. They all belonged to the VHIII variability subgroup, but each may well represent a new member of this family inasmuch as their homology with previously sequenced VHIII genes was less than 80%. Strikingly, there was no greater homology between the H chain V regions of the anti-MAG IgM. Partial amino acid sequence data indicated that these V regions were joined to as yet unidentified DH segments; however, two H chains used very similar DH, possibly indicating that this sequence was involved in the fine specificity of the IgM for MAG. All H chains included a JHIV region. These data, together with results obtained from the sequence of the three kappa L chains of the same IgM molecules (Mihaesco, E., H. Ayadi, N. Congy, M. C. Gendron, J. P. Roy, H. Heyermann, B. Frangione, and J. C. Brouet. 1989. J. Biol. Chem. 264:21481), indicate that the repertoire of VL and VH gene segments used by anti-MAG IgM is quite diverse, in contrast to previous structural data obtained for other human monoclonal IgM autoantibodies. Possibly, these differences reflect distinct pathogenesis.

Ubiquitin is a component of polypeptides purified from corpora amylacea of aged human brain.

Corpora amylacea (CA) are one of the conspicuous features of brain tissue in normal aging and neurodegenerative diseases. Quantitative protein determination of purified CA revealed a protein content of about 4% of total weight. Qualitative protein analysis revealed a broad range of polypeptides, with four being more abundant. High performance liquid chromatography (HPLC) fractionation of this protein material showed four peaks which are related to the four major polypeptides with molecular weights of 24 KD, 42 KD, 94 KD, and 133 KD. Amino acid content analysis of the 24 KD, 42 KD and 94 KD polypeptides indicated that distinct protein species are involved. N-terminal amino acid sequence analysis of the 24 KD and 42 KD polypeptides revealed in both cases homology with the N-terminal sequence of human ubiquitin.

Outpatient myelography with fine-needle technique: an appraisal.

Postmyelography headaches are produced mostly by CSF leakage at the dural puncture site and are therefore largely dependent on the size of the needle used. Our study of 300 consecutive outpatients who had lumbar myelograms performed with 25- and 26-gauge spinal needles shows that the procedure has become virtually innocuous. We recommend that 26-gauge spinal needles be widely adopted as the standard for fluoroscopically controlled intrathecal injections of contrast material.

Outpatient myelography with fine-needle technique: an appraisal.

Postmyelography headaches are produced mostly by CSF leakage at the dural puncture site and are therefore largely dependent on the size of the needle used. Our study of 300 consecutive outpatients who had lumbar myelograms performed with 25- and 26-gauge spinal needles shows that the procedure has become virtually innocuous. We recommend that 26-gauge spinal needles be widely adopted as the standard for fluoroscopically controlled intrathecal injections of contrast material.

Pyocolon: an unusual manifestation of colon ischemia.

An unusual manifestation of a large bowel ischemia was observed in two patients. Both had a left flank tubular fluid collection demonstrated respectively by computed tomography (CT) and ultrasonography (US). At surgery, pyocolon (i.e. ischemic, dilated large bowel segments filled with pus) was discovered and resected. Pyocolon should be suspected in patients with ischemic colitis and sepsis. US, although useful, may be misleading; CT is the investigation of choice to establish the diagnosis.

[Inflammatory aneurysm of the aorta. Value of x-ray computed tomography and ultrasonography in the diagnosis of a case and review of the literature]. / Anévrisme inflammatoire de l'aorte. Utilité de la tomodensitométrie et de l'échographie dans le diagnostic d'un cas et revue de la littérature.

Until recently inflammatory aneurysm of the aorta was discovered only at the time of surgery and confirmed by the pathologist. New imaging modalities, such as ultrasound and CT-scan now enable the radiologist to diagnose this entity before surgery, thus leading to a better surgical planning and reducing the operative morbidity. The authors report a case of inflammatory aneurysm of the aorta and review the literature on this entity.

Renal cell carcinoma presenting as multilocular cystic mass.

We report a case of a multilocular cystic mass that was erroneously labeled multilocular cystic nephroma at ultrasound and computerized tomography, thus leading to a partial nephrectomy; however the final histologic diagnosis was a multilocular cystic renal cell carcinoma. Only 1 similar case has been reported previously. The radiologic and surgical implications are discussed.

[Ureteral stenosis caused by epidermoid metaplasia of the urothelium]. / Sténose urétérale due à une métaplasie épidermoïde de l'urothélium.

Keratinizing desquamative squamous metaplasia ( KDSM ) of the upper urinary tract is infrequent and ureteral involvement is rare. The authors report a case of ureteral stenosis cause by KDSM of the urothelium and review the literature on this entity.

Narrowband teleradiology.

A narrowband communication system using the Canadian satellite ANIK-B was used to transmit radiographic images from northern Quebec to Montreal. This slow scan television (SSTV) system was used to study the accuracy of the radiologist's interpretation, both with samples of pre-selected films and current patients. Several hours of training in the technique of radiographic interpretation from a static image displayed on a TV monitor was an important factor affecting performance. In selected patients, based on a sample of 124 error-free direct viewing interpretations by four radiologists, SSTV reading by the same fully trained radiologists was correct in 84.5%. With actual patients, and assuming the interpretation from direct viewing to be the correct one, SSTV reading of the radiographs by the same radiologist gave a corresponding figure of 84.1% in a sample of 518 patients containing 73.4% of negative findings, and 89.4% in another sample of 305 patients, including 82% of negative findings. The present error rate on SSTV reading is twice as great as radiographic interpretation using a broadband television system.