The ex utero intrapartum treatment (EXIT) procedure in fetal neck masses: a case report and review of the literature.

Large fetal neck masses can cause airway obstructions with potential fetal demise after delivery. The relationship of the neck mass to airway structures can be defined prenatally with ultrasound and magnetic resonance imaging (MRI). The ex utero intrapartum treatment (EXIT) procedure can be used to obtain a fetal airway while feto-maternal circulation is preserved to optimise fetal outcome. We present a case in which prenatally a large fetal neck mass was diagnosed on ultrasound and a successful EXIT procedure was performed. A review of the literature is given and the prenatal use of ultrasonography and MRI in case of fetal neck masses is discussed.

Delayed appearance of carbon granulomas of the scalp after use of carbon fiber pins for refixation of a stereotactic head frame. Case report.

The authors present a case involving the formation of several carbon granulomas in the scalp of a woman 7 years after she underwent craniotomy. Her operation had included the use of carbon fiber pins for refixation of a stereotactic head frame. Carbon granulomas have been noted in multiple organs following surgical or traumatic carbon deposition, but have not been reported in association with neurosurgical carbon fiber pins used for head fixation. The lesions in this case arose a few months after initiation of chemotherapy for the patient's brain tumor. The relationship of carbon and cutaneous granuloma formation to adjuvant therapies and treatment strategies is discussed.

T cell adoptive immunotherapy of newly diagnosed gliomas.

Patients with newly diagnosed gliomas were treated with adoptive transfer of ex vivo activated T lymphocytes, derived from lymph nodes (LNs) draining autologous tumor vaccines, to determine the long-term toxicity of this treatment. Twelve consecutive patients were enrolled: 2 with grade II astrocytoma, 4 with anaplastic gliomas, and 6 with glioblastoma multiforme. Patients were injected intradermally with short-term cultured autologous irradiated tumor cells, admixed with granulocyte macrophage colony-stimulating factor, to stimulate draining LNs. The LN cells were activated with staphylococcal enterotoxin A for 48 h and then cultured in medium containing interleukin 2 for an additional 6-8 days and subsequently transferred i.v. to the patients. The number of cells obtained from the LNs ranged from 9 x 10(7) to 1.1 x 10(9), and the median cell proliferation was 41-fold. The dose of T cells infused ranged from 0.6 to 5.5 x 10(10) with a median of 1.1 x 10(10), the majority of which were CD 4+ (mean, 71%). The entire treatment was performed as outpatient therapy and was associated with a toxicity of grade 2 or less, consisting mainly of fever, nausea, and myalgias during the first 24 h. There were no indications of late adverse events from this treatment even among three patients with follow-up greater than 2 years post T cell transfer. Moreover, four patients demonstrated partial regression of residual tumor. This Phase I clinical trial of adoptive immunotherapy for patients with newly diagnosed malignant gliomas demonstrates feasibility, lack of long-term toxicity, and several objective clinical responses.

Basilar artery rethrombosis: successful treatment with platelet glycoprotein IIB/IIIA receptor inhibitor.

We describe the use of abciximab to prevent rethrombosis of the basilar artery after transluminal angioplasty. A 60-year-old patient with vertebral basilar insufficiency and acute occlusion of the basilar artery underwent revascularization with urokinase and angioplasty. Despite the repeated use of urokinase and angioplasty under anticoagulation with heparin, the basilar artery immediately rethrombosed. In a final attempt to prevent rethrombosis, abciximab was administered before the final angioplasty, resulting in a widely patent basilar artery and no rethrombosis.

Transcutaneous and arterial carbon dioxide tension at various conditions of fetal stress in lambs.

In an acute fetal lamb model the relation between arterial PCO2 (PaCO2), transcutaneous PCO2 (tcPCO2) and pH was studied at different conditions of stress. Occlusion of the maternal common iliac artery for 8 min, umbilical cord obstruction for 5 min and placental embolization were performed subsequently, every time with an interval of 1 h for fetal recuperation. During the first 2 experiments arterial values changed rapidly after occlusion and returned nearly to normal within 30-60 min after the end of occlusion. TcPCO2 started to increase several minutes after occlusion and reached its maximum about 5 min after the end of occlusion. Afterwards a gradual decrease towards the onset value was observed. During placental embolization tcPCO2 did not increase until 15 min before fetal death. It is concluded that tcPCO2 can follow a gradual trend, but not quick changes in PaCO2.

Transcutaneous and arterial carbon dioxide tension during intermittent umbilical cord occlusion in fetal sheep.

To study the relationship between arterial PCO2 (PaCO2) and transcutaneous PCO2 (tcPCO2) intermittent 2-min total umbilical cord occlusions were performed with a 3-min interval (n = 12) in 5 fetal sheep, tcPCO2 was measured continuously. Arterial acid-base balance was analyzed at the end of occlusion periods and at the end of occlusion intervals. During each occlusion, PaCO2 increased 1.9 kPa (p < 0.001) and pH decreased 0.07 units (p < 0.001). Partial recovery occurred between occlusion intervals resulting in development of mild fetal acidemia. The quick fluctuations in PaCO2 during occlusions were not followed by tcPCO2, but tcPCO2 was capable following the trend in PaCO2. Measurement of tcPCO2 may therefore be an additional tool in the detection of the development of fetal acidemia.

Dysmenorrhea related to gallstone spilling after laparoscopic cholecystectomy.

A 28-year-old woman is presented with severe dysmenorrhea since a previous laparoscopic cholecystectomy for cholelithiasis. Spilled gallstones were embedded in the Douglas cavity and the visceral peritoneum of the genitalia interna. Dysmenorrhea was treated successfully by laparotomic hysterectomy and removal of all gallstones.

Autonomic nervous system control of the heart: endurance exercise training.

The purpose of this study was to assess hemodynamic responses to lower body negative pressure (LBNP) to -45 torr with selective cardiac parasympathetic (using atropine sulphate), sympathetic efferent (using metoprolol tartrate), and combined (atropine+metoprolol) blockade prior to and following 8 months of endurance exercise training in eight young men. Training resulted in significant increases of maximal oxygen uptake (27%) and blood volume (16%) and a decrease of baseline heart rate (HR, from 66 +/- 4 to 57 +/- 4 bpm). This training related bradycardia was exclusively determined by an enhanced vagal tone as there was no significant difference in intrinsic HR pre- to post-training and only atropine (pre: 100 +/- 3 vs post: 101 +/- 3 bpm), not metoprolol (pre: 56 +/- 3 vs post: 49 +/- 4 bpm), abolished the HR difference. The reflex tachycardia in the control experiment was significantly diminished following training. However, the increase in HR at LBNP -45 torr between pre- and post-training was similar after either atropine (+13 +/- 2 vs +14 +/- 1 bpm) or metoprolol (+8 +/- 1 vs +8 +/- 1 bpm). Reflex tachycardia was greater during atropine than metoprolol blockade and the sum of the HR increase during selective blockade (21 and 22 bpm) was greater when compared with the control (no blockade, 16 +/- 2 vs 11 +/- 2 bpm). There was no difference pre- to post-training in SV or Qc response to -45 torr LBNP during the control condition. However, selective beta 1-receptor blockade resulted in a greater decrease in SV to -45 torr LBNP post-training compared to pre-training (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Reduction in LBNP tolerance following prolonged endurance exercise training.

Eight young men underwent an 8-month endurance exercise training program. Prior to and following the training program, the subjects' maximal oxygen uptake (VO2max), total blood volume (TBV) and plasma volume (PV), tolerance to lower body negative pressure (LBNP) assessed by the cumulative stress index (CSI) to presyncope, and their hemodynamic responses to 0 to -45 torr LBNP was determined. Hemodynamic measures included rebreathe carbon dioxide cardiac output (Qc), heart rate (HR), directly measured arterial blood pressures (ABP), and strain gauge determination of forearm blood flow (FBF) and leg volume changes (delta LgV). Calculated values of stroke volume (SV), forearm, vascular resistance (FVR), and peripheral vascular resistance (PVR) were made. Following training, each subject had an increased VO2max (mean = +27.4%, P < 0.001), TBV (mean = +15.8%, P < 0.02), and PV (mean = +16.5%, P < 0.02) and each subject had a decreased tolerance to LBNP (mean CSI = -24%, P < 0.001). Stepwise linear regression identified that the major factors to significantly predict the decreased CSI pre- to post-training were a reduced response of PVR to LBNP from -15 to -45 torr (Model R2 = 0.853), the delta TBV (model R2 = 0.981), and the greater post-training reduction in SBP to LBNP of 0 to -45 torr (model R2 = 1.0). These data suggest that physiologic adaptations associated with the increased VO2max and TBV resulting from a prolonged endurance exercise training program can alter the reflex control of vasomotion and cardiac output during LBNP and reduce the LBNP tolerance.

Gender differences in cardiovascular and metabolic responses to cold and exercise.

This study was conducted because of the paucity of information concerning gender differences in the cardiovascular and metabolic responses to cold stress. Lightly clad men (n = 8) and women (n = 8) were tested in 21 and 5 degrees C environments during a 20-min rest, followed by 20 min each of 50, 100, and 150 W of exercise. At 21 degrees C there was no gender differences in VO2 or cardiac output. Cold lowered skin temperature more in women than in men, but women demonstrated no differences in heart rate, stroke volume, or VO2 at 5 and 21 degrees C. The women's noradrenaline levels in the cold were higher than comparable 21 degrees C data at rest and 50 W and increased with work intensity in both tests. In contrast, men had a lower heart rate, higher stroke volume, and higher VO2 throughout the 5 degrees C treatment compared with 21 degrees C. The men's noradrenaline response to 5 degrees C was similar to that of women at rest and 50 W, but the level subsequently declined at 100 and 150 W. Thus, the women do not show a heart rate-stroke volume shift in either resting or exercising states in cold environments. Furthermore, the data fail to support that either skin cooling or changes in noradrenaline cause the bradycardia and enhanced stroke volume seen in men.