Analysis of lower extremity embolic material after total knee arthroplasty in a canine model.

Emboli assumed to consist of fat, marrow, cement, and bone are generated during total knee arthroplasty. This study collected and identified the constituents of the embolic debris and assessed the effects of intramedullary cutting guides in a canine model. During cemented knee arthroplasties with or without the use of intramedullary guides, all embolic debris was collected in a single lobe of lung. In dogs using intramedullary guides, transesophageal echocardiography revealed a sustained embolic shower, and histologically marked amounts of emboli obstructed the pulmonary vasculature. The emboli were composed of fat cells and hematopoietic cells (marrow elements) interspersed with free fat globules. Marrow elements are the primary constituents of the emboli generated during total knee arthroplasty. Intramedullary guides increased debris generation.

Malignant paraganglioma of the prostate: case report, depiction by meta-iodobenzylguanidine scintigraphy and review of the literature.

OBJECTIVE: To describe the 123-I-MIBG scintigraphic, CT, MRI, operative and pathological findings in a case of malignant prostatic paraganglioma and to review the literature on this very rare tumor. EXPERIMENTAL DESIGN: Clinical imaging and pathological correlation of data in a referred patient. SETTING: Regional referral center and tertiary referral academic medical center. PATIENT: 17 year old man presenting with painless hematuria and a large prostatic mass. Interventions and measures. Renal ultrasound, transrectal ultrasound, ultrasound guided prostatic biopsy, pelvic CT and MRI, planar and SPECT 123-I-MIBG scintigraphy, and surgical exploration. RESULTS: The patient had a significant hydronephrosis of the left kidney and marked enlargement (120 ml) of the prostate gland by ultrasound. Ultrasound guided biopsies of the prostate and a left pelvic lymph node revealed a neuroendocrine tumor staining positive for chromogranin. CT and MRI revealed a large tumor of the prostate invading the seminal vesicles, bladder and rectum with extensive pelvic lymph node spread. The primary tumor and one of the nodes were shown to be 123-I-MIBG avid confirming the neuroendocrine nature of the tumor. The lesion was unresponsive to chemotherapy and unresectable at surgical exploration. CONCLUSIONS: To date there have only been 5 reports of prostatic paragangliomas. To our knowledge this is the first to have been studied by MIBG scintigraphy and like most paragangliomas it was MIBG-avid.

A market analysis approach to bidding for capitated clinical laboratory and pathology services contracts.

Traditional episodic, fee-for-service medical care and indemnity-type insurance are rapidly being replaced by managed health care plans that often include financial risk assumption by health care providers. This paper describes the application of marketing principles to the evaluation and capture of capitated clinical laboratory and pathology services contracts. It includes a method for developing capitation rates and describes advantages enjoyed by hospital-based laboratories that enhance their competitiveness in the marketplace.

Arthropathy in calcium pyrophosphate dihydrate crystal deposition disease. Pathologic study of 12 cases.

The pathologic features of calcium pyrophosphate crystal deposition disease (CPDD), particularly the synovial abnormalities, have not been adequately described or depicted in textbooks or journals; this report details the findings in 12 cases. Attention is drawn to the practical reasons for distinguishing CPDD arthropathy from other arthropathies, particularly osteoarthritis; clinical and gross pathologic features that should suggest CPDD arthropathy in cases that are not suspected preoperatively; and characteristics of the tophaceous deposits in CPDD.

Neuromuscular hamartoma--a benign "triton tumor" composed of mature neural and striated muscle elements.

Two infants with benign, hamartomatous tumors composed of well-differentiated and intimately admixed neural and striated muscle components are presented. Their histogenesis is discussed in light of embryologic concepts of the derivation of mesenchymal tissues from neuroectoderm and in reference to previous reports of benign and malignant tumors of the nervous system with striated muscle components.

Carcinoid tumor of the larynx.

A patient had a primary carcinoid tumor of the larynx. This is the second case reported in the American or British literature and the only one confirmed by a positive argyrophilic reaction and by the demonstration of neurosecretory-type granules by electron microscopy. The patient's clinical course was similar to that seen in most cases of tracheal and bronchial carcinoids.

Ossifying fibroma of long bone: its distinction from fibrous dysplasia and its association with adamantinoma of long bone.

Two cases of ossifying fibroma of long bones are presented. This tumor is confused with monostotic fibrous dysplasia, but can be distinguished by its intracortical location, as demonstrated radiographically, and by its histologic pattern. Distinction from fibrous dysplasia is important since ossifying fibroma of long bone is a more aggressive lesion with different therapeutic implications. It appears that ossifying fibroma and adamantinoma of long bones are somehow related, and that lesions resembling fibrous dysplasia in association with adamantinomas of long bones are actually ossifying fibromas.

Clinical enzymology in cancer.

It is fair to say that so far, and with few exceptions, the application of enzymology to clinical oncology has been disappointing. This is certainly true with regard to cancer screening and diagnosis. It is unlikely that any single enzyme or isoenzyme will emerge as a sufficiently sensitive or specific indicator of cancer, and it would seem more profitable to focus on multivariate or pattern analysis of several enzymes and other measurable body fluid constituents. Another suggested approach would be to establish the normal enzyme levels for individuals and then follow them for changes which might signal the development of a neoplasm. Finally, Weber's concept of key enzymes as the phenotypic markers of neoplasia and targets of chemotherapy would appear to open a new avenue for enzymology in clinical oncology.