Safety of hematopoietic cell infusion in children with malignant and non-malignant diseases.

HPC infusions have been associated with a variety of adverse events related to either patient or HPC product-related factors. Studies documenting infusion-related AEs in children are limited. We reviewed HPC infusion records in 354 children. Infusion-related adverse events were classified as follows: grade 0-absent, grade I-mild, grade II-moderate, grade III-severe, grade IV-life-threatening, and grade V-death. The percentage of patients with grade 0, I, and II-IV AEs was as follows: 0 = 67%, I = 23.4%, and II-V = 9.6% (one patient had fatal anaphylactic reaction to dimethyl sulfoxide). The incidence of grade II-IV hypertension was 7.1%. There was a higher incidence of AEs with infusion of allogeneic bone marrow versus allogeneic PBSCs (47.4% vs 25.3%, P = .001). Cryopreserved products had a lower incidence of infusion-associated AEs compared with fresh HPC products (24% vs 39.4%, P = .003). Allogeneic HPC infusion volume (>100 mL) was a significant risk factor for infusion-associated AEs (P < .001). Patients >10 years who received autologous HPC infusions had higher risk of AEs when compared to patients <10 years (P = .01). Our study demonstrated that despite a high incidence of infusion-associated hypertension, HPC infusion is relatively safe in children. Investigating strategies to optimize management of hypertension in the setting of HPC infusion is warranted.

Impact and outcomes of routine microstaging of sentinel lymph nodes in breast cancer: significance of the pN0(i+) and pN1mi categories.

BACKGROUND: In 2003, the American Joint Committee on Cancer (AJCC) initiated the 6th edition staging criteria, including pN0(i+) and pN1mi categories for breast cancer. However, the clinical significance of these categories is debated in the literature. METHODS: A prospective registry was used to identify patients staged with sentinel lymph node (SLN) biopsy. SLN evaluation included routine serial sectioning and immunohistochemical stains. SLN biopsies performed before January 2003 were restaged according to the AJCC's 6th edition criteria. RESULTS: Of 954 SLN biopsies identified, on review, 491 N0i-, 86 N0i+, 73 N1mi, 146 N1a, 29 N2a, and 11 N3a patients were available for analysis with a median follow-up of 45.4 months. Significant prognostic and therapeutic differences existed between the groups. Differences in overall survival (OS) and recurrence-free survival (RFS) were only noted when the size of the metastases reached the N1a level. There were no statistically significant differences in OS or RFS between N0(i-) and N0(i+) or N1mi disease. Cases that were N0(i+) or N1mi were more likely to have other poor prognostic factors and to receive more aggressive therapy. CONCLUSION: SLN biopsy allows a more sensitive evaluation of lymph nodes for metastatic cells. This has led to the increased identification of very small axillary metastases. While the new microstaging categories are not yet clearly associated with a significantly decreased OS or DFS in this series, they are associated with other poor prognostic factors and more local/regional and systemic therapy. Further analysis of the microstaging categories is needed.

Altered uptake of infrared diode laser by retina after intravitreal indocyanine green dye and internal limiting membrane peeling.

PURPOSE: To report an altered uptake and possible complication associated with the use of indocyanine green (ICG) dye, internal limiting membrane (ILM) peeling, and infrared diode laser. DESIGN: Interventional case report. METHODS: In two eyes (two patients) three-port pars plana vitrectomy was performed. Indocyanine green was injected into the vitreous cavity according to previously published protocol. The ILM was removed with a bent-tipped microvitreoretinal blade and ILM forceps. Photocoagulation was performed with an 810-nm infrared diode endolaser. RESULTS: Photocoagulation of the retina stained with ICG in areas with intact ILM produced more intense and superficial appearing retinal burns than photocoagulation where the ILM had been peeled. The retinal burns in areas of intact ILM stained with ICG also appeared more superficial than those typical of this laser when ICG is not used. CONCLUSIONS: Indocyanine green absorbs infrared laser light and produces a photothermal effect. Unwanted damage to the inner retinal layers may occur. Laser energy may also be prevented from reaching the deeper retinal layers, reducing the efficacy of treatment.

Corneal tissue ablation depth and the Munnerlyn formula.

PURPOSE: To determine whether the error in ablation depth produced by approximations inherent in the Munnerlyn formula are clinically significant when estimating residual corneal stromal depth for the evaluation before refractive surgery. SETTING: Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA. METHODS: Using identical geometric assumptions, the exact ablation depth was calculated and compared to the approximate ablation depth predicted by the Munnerlyn formula. An adjustment factor was then derived for large optical zones and corrections. RESULTS: The exact ablation depth is always larger than the ablation depth predicted by Munnerlyn's formula. Analysis found the error in ablation depth varied as the fourth power of the optical zone and linearly with correction. The initial corneal radius had little effect on the difference. The ablation depth could be reasonably approximated by adding an adjustment factor for large optical zones and refractive corrections. CONCLUSIONS: In patients with large optical zones, it may be preferable to calculate tissue ablation depth using the exact formula. Alternately, the Munnerlyn formula can be used to calculate ablation depth and then an adjustment factor can be added.

Regional expression of cyclooxygenase isoforms in the rat kidney in complete unilateral ureteral obstruction.

PURPOSE: The cyclooxygenase (COX) pathway is activated in unilateral ureteral obstruction (UUO), contributing to renal hemodynamic alterations in different regions of the kidney. After the release of 24-hour UUO cortical vasoconstriction occurs but medullary hyperemia is seen. We examined the expression of the 2 COX isoforms COX-1 and COX-2 in different regions of the kidney in rats subjected to UUO. MATERIALS AND METHODS: Clearance experiments were performed after ureteral obstruction release in rats with 24-hour UUO or sham operated rats. COX-1 and COX-2 expression in the cortex and medulla were examined by Western blot analysis and immunohistochemistry. RESULTS: After UUO release the glomerular filtration rate and renal plasma flow were markedly lower in post-obstructed kidneys than in contralateral kidneys or in kidneys in sham operated rats (p <0.001). Western blot analysis showed that COX-2/beta-actin in the cortex of the obstructed kidney was 0.28 +/- 0.02 densitometry units, significantly lower than 0.67 +/- 0.12 densitometry units in the contralateral unobstructed kidney. In contrast, COX-2/beta-actin in the outer and inner medullae of the obstructed kidney was 7.85 +/- 1.09 and 2.51 +/- 0.14 densitometry units, significantly greater than 3.03 +/- 0.22 and 0.66 +/- 0.14 densitometry units, respectively, in the contralateral unobstructed kidney. The expression of COX-1/beta-actin in the obstructed kidney was similar to that in the contralateral unobstructed kidney in the cortex and medulla. CONCLUSIONS: Renal COX-2 expression is markedly altered in UUO. Decreased cortical expression of COX-2 and markedly increased expression in the medulla may contribute to disparate regional hemodynamic alterations in UUO.