Assessing the safety of del Nido cardioplegia solution in adult congenital cases.

PURPOSE: del Nido cardioplegia solution (CPS) has been successfully used for myocardial protection in the pediatric population. We propose this solution can be used safely in adult congenital patients. The proposed benefit of this solution is the avoidance of the need for repetitive interruption of the operation to administer multiple doses of standard cardioplegia. METHODS: As part of a quality improvement initiative, 47 consecutive adult patients (mean age 40.9 years, range 18-71) undergoing congenital heart surgery were given del Nido CPS. Cardiac function was assessed pre- and post-operatively by echocardiography (ECHO). Inotrope use, troponin levels and restoration of cardiac rhythm were also evaluated. RESULTS: The average duration of the longest ischemic time was 52.5 minutes ± 15.57 minutes. In patients receiving a single dose (40%, n=19) of CPS, the average ischemic time was 49.8 minutes ± 18.8 minutes. No patients demonstrated any ventricular electrical activity while the aorta was cross-clamped. Post-operative ECHO showed that 94% (n=44) had no change in ejection fraction from the pre-operative ECHO. Patients requiring inotropic support at the time of leaving the operating room (OR) was 43% (n=20). The percentage of patients requiring inotropic support twenty-four hours post-operatively was 17% (n=8). Spontaneous restoration of cardiac rhythm (without the need for defibrillation) after cross-clamp removal occurred in 91% (n=43) of patients. The average troponin T level post-op was 1.86 ± 2.9 µg/L. CONCLUSIONS: del Nido CPS can be used for myocardial protection during adult congenital cardiac surgery without any apparent adverse effects. In addition, we were able to change our re-dosing protocol to 45 minutes with del Nido CPS compared to 20 minutes with our adult 4:1 blood CPS.

Effect of subgingival irrigation with tetrapotassium peroxydiphosphate on scaled and untreated periodontal pockets.

A total of 20 test and 20 control subjects completed an 8-week double blind clinical trial aimed at testing the therapeutic efficacy of a 7% tetrapotassium peroxydiphosphate (PDP) solution administered as a subgingival irrigant to scaled and untreated periodontal pockets. Each patient provided similar contralateral pockets with probing depths at base line of 5 mm or more (mean 6.25 mm). One pocket was selected at random for a thorough scaling, immediately following the base line examination (examination 1). The examination of each experimental site consisted of Plaque Index (P1I) and Gingival Index (GI) scores, probing depth (PD) and attachment level (AL) measurements (in mm), and a differential microscopic proportional count of certain subgingival bacterial morphotypes, namely coccoid cells, motile bacteria (not including spirochetes), spirochetes and all residual bacterial morphotypes. Test patients received coded irrigators containing the active ingredient PDP, while control patients received irrigators containing a placebo rinse similar to the test solution, but without PDP. The participants were instructed to irrigate the test sites twice a day. They were re-examined after four weeks (examination 2) and eight weeks (examination 3) from the base line examination. The results indicated that scaling and irrigation produced a significant decrease from the initial P1I and GI scores, and the PD and AL measurements. The proportions of coccoid cells were significantly increased, while the proportions of motile bacteria and spirochetes were significantly decreased. Irrigation of unscaled pockets resulted in a modest, but significant decrease in the P1I and GI scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinicopathologic study of retinoblastoma including MIB-1, p53, and CD99 immunohistochemistry.

UNLABELLED: Retinoblastoma is the most common intraocular tumor of childhood and has served as a model for the understanding or tumorigenesis. This study retrospectively examines the clinicopathologic features of 19 retinoblastomas and defines the MIB-1 (cell proliferation marker), p53 (tumor suppression gene), and CD99 (HBA71 or MIC2 antibody) immunoreactivity in 10 selected cases. Nineteen patients (11 boys), ranging in age from 6 to 47 months (mean, 20 months), were included for study. Clinical presentations included: leukocoria (n = 12), strabismus (n = 6), apparent decreased visual acuity (n = 5), and proptosis (n = 1). Five patients had bilateral tumors and one neoplasm arose in a patient with a known family history of retinoblastoma. All tumors were histologically characterized by a proliferation of small cells with high nuclear-to-cytoplasmic ratios. Commonly encountered histologic features included necrosis (n = 17, 89%), calcification (n = 16, 84%), fleurettes (n = 14, 74%), and Flexner-Wintersteiner rosettes (n = 11, 58%). Retinal involvement was noted in 18 tumors (95%) and optic nerve invasion in six cases (32%). The surgical optic nerve margin was positive in one case. Mitosis counts were evaluable in 18 cases and ranged from 1 to 42 mitotic figures/10 high power field (mean, 13 mitotic figures/10 high power field). Ten tumors were evaluated with MIB-1, p53, and CD99 antibodies by paraffin immunohistochemistry. MIB-1 labeling indices ranged from 31.4 to 77.1 (mean, 49.4). p53 immunostaining was observed in six tumors; less than 10% of tumor cells were noted to be p53 positive in each case. CD99 positivity was demonstrable focally in three tumors. Adjuvant chemotherapy and/or radiation therapy was administered in six patients. Tumor recurrence was not observed in any of the patients with a mean follow-up of 8.9 years. Only one patient died (20 years after enucleation) because of metastatic osteosarcoma. IN CONCLUSION: (1) Fleurettes and Flexner-Wintersteiner rosettes are variable findings in retinoblastoma. (2) Retinoblastomas are characterized by marked cell proliferation as evidenced by generally high mitosis counts and extremely high MIB-1 labeling indices, but this does not appear to adversely impact on prognosis. (3) Unlike peripheral primitive neuroectodermal tumors, most retinoblastomas do not stain positively with antibody to CD99. (4) Limited p53 immunostaining was present in 60% of tumors studied. (5) Enucleation with negative optic nerve margin is potentially curative in patients with retinoblastoma.

Rapid extrusion with fiberotomy.

Rapid extrusion with fiberotomy as an alternative to traditional crown lengthening modalities is described. Given appropriate anatomic conditions, rapid extrusion with fiberotomy may be utilized as a viable and esthetic crown lengthening procedure.

Amyotrophic lateral sclerosis with multiple sclerosis: a clinical and pathological report.

We report a 62-year-old woman with a past history of painful central visual loss who developed progressive quadriparesis and bulbar palsy. Neurological examination revealed widespread upper and lower motor neuron signs in the bulbar region and extremities. Electromyography demonstrated widespread active and chronic motor axon loss. Magnetic resonance neuroimaging studies revealed enhancing callosal and periventricular white matter lesions and cervical and thoracic cord hyperintensities. Cerebrospinal fluid analysis was consistent with multiple sclerosis. The patient died of respiratory failure two years after presentation, and autopsy revealed multifocal demyelination involving the corpus callosum, cerebellum and spinal cord as well as pathologic findings typical of amyotrophic lateral sclerosis. A review of the literature confirms the exceedingly unusual combination of amyotrophic lateral sclerosis with multiple sclerosis.