Adult T-cell leukemia/lymphoma: a rare case in the USA and review of the literature.

Adult T-cell leukemia/lymphoma (ATLL), in its acute stage, is a uniformly fatal disease. ATLL is caused by the human T-cell lymphotropic virus I (HTLV-1), a retrovirus endemic in numerous areas throughout the world including Japan, the Caribbean, Central and South America and certain areas of the United States. Although the progression from HTLV-1 carrier status to ATLL occurs only rarely, ATLL is incurable and thus prevention of HTLV-1 transmission should be a primary goal. With the development of new anti-retroviral and monoclonal therapies, there exist potential cures or at least prolonged remissions for patients diagnosed with ATLL. We present a case of ATLL that, to our knowledge, is only the third reported case in Georgia. In addition, we present a brief review of the literature, including potential new treatment regimens that appear to have promise in the treatment of ATLL.

Leukemic leptomeningeal involvement in stage 0 and stage 1 chronic lymphocytic leukemia.

Central nervous system (CNS) involvement in early (Rai Stage 0 and Stage 1) chronic lymphocytic leukemia (CLL) is rare, with only five cases reported. We present the sixth reported case, a 77-year-old male with a 4 year history of Stage 0 CLL who presented with sudden onset of diplopia and headache. Workup revealed a leukemic involvement of his CNS and he responded well to treatment with intrathecal (IT) methotrexate. After his third IT treatment, he developed a change in his mental status, consistent with a chemotherapy induced encephalopathy, which was effectively treated with IT hydrocortisone. In addition to the case presentation, we review the previously reported cases in an effort to determine any characteristics common among the Stage 0/1 CLL patients with reported CNS involvement.

Tracheobronchial foreign body aspiration in children.

In this retrospective study, we reviewed the demographic and radiographic findings of 155 children with bronchoscopy-proven tracheobronchial foreign body aspiration (FBA). Two thirds of the patients were male, and most were children between 1 and 2 years of age. An aspirated peanut accounted for one third of all cases. Foreign body location was distributed nearly evenly to the right and left primary bronchi; tracheal foreign body was noted in 16 patients. The most frequent symptoms of FBA were cough (85 patients) and wheezing (60 patients). Although most patients were seen within 1 day of aspiration, 30 patients had symptoms that lasted at least 1 week before diagnosis. The most common radiographic findings were unilateral or segmental hyperlucency (59) or atelectasis (38). The trachea was the site of the foreign body in one half of children with a normal chest radiograph and FBA.

Crucial anatomic lessons for laparoscopic herniorrhaphy.

Laparoscopic herniorrhaphy is generally performed using a transabdominal approach, an approach to hernia repair that is unfamiliar to most general surgeons. There is sufficient published anecdotal experience to indicate that the relationships of structures near the internal ring are not generally known and that this may predispose to their injury. There is considerable variability of nerves that pass through, or deep to, the iliopubic tract lateral to the internal inguinal ring, making it potentially hazardous to place staples or sutures in this region. Medially, the surgeon must be conscious of the possible presence of an aberrant obturator artery or vein and unexpected iliopubic vessels and take appropriate precautions to avoid unexpected sources of hemorrhage. The human cadaver, especially in the unfixed state, can be an ideal model to learn the surgical anatomy for laparoscopic hernia repair and to avoid neurovascular injuries.

Comparison of adhesion formation in transperitoneal laparoscopic herniorrhaphy techniques.

Two techniques of transperitoneal laparoscopic inguinal hernia repair were studied to evaluate the incidence of short term adhesion formation. Two methods were evaluated in thirty pigs with induced bilateral inguinal hernia defects. Half of the defects were repaired by incising the peritoneum, placing the mesh over the muscle defect, securing the mesh with staples, and reapproximating the peritoneum over the defect with staples. The other hernias were repaired by positioning the mesh over the defect and securing the mesh with staples, with no reapproximation of the peritoneum. The animals were allowed to recover and were killed at the end of two weeks. At autopsy, the animals were examined for the presence of adhesions to bowel. A statistically greater number of adhesions were formed with peritoneal reapproximation, 43 per cent (13/30), compared with 10 per cent (3/30) when the peritoneum was not reapproximated. The simpler method of repair, with no reapproximation, resulted in a statistically lower incidence of adhesions.