Maximizing mesh mileage: evaluating the long-term performance of a novel hybrid mesh for ventral hernia repair.

PURPOSE: The objective of this study is to evaluate the safety and long-term outcomes of GORE Synecor™ in ventral hernia repair (VHR). METHODS: This retrospective, single-center case review analyzed outcomes in patients who underwent VHR with Synecor from May 2016 to December 2022. Primary outcomes were hernia recurrence and mesh infection rates. Secondary outcomes were 30-day morbidity, 30-day mortality, 30-day readmission, re-operation, surgical-site infection (SSI) and occurrence (SSO) rates, and occurrences requiring intervention (SSOI). RESULTS: 278 patients were identified. Mean follow-up was 24.1 (0.2-87.1) months. Mean hernia defect size was 63.4 (± 77.2) cm2. Overall hernia recurrence and mesh infection rates were 5.0% and 1.4% respectively. No mesh infections required full explantation. We report the following overall rates: 13.3% 30-day morbidity, 4.7% 30-day readmission, 2.9% re-operation, 7.2% SSI, 6.1% SSO, and 2.9% SSOI. 30-day morbidity was significantly higher in non-clean (42.1% vs 11.2%, p < 0.01), onlay (OL) mesh (37.0% vs preperitoneal (PP) 16.4%, p = 0.05 vs retrorectus (RR) 15.0%, p < 0.05 vs intraperitoneal (IP) 5.2%, p < 0.001), and open cases (23.5% vs 3.1% laparoscopic vs 4.4% robotic, p < 0.01). SSI rates were significantly higher in non-clean (31.6% vs 5.4%, p < 0.001), OL mesh (29.6% vs RR 11.3%, p < 0.05 vs PP 5.5%, p < 0.01 vs IP 0.0%, p < 0.001), and open cases (15.2% vs 0% laparoscopic vs 0% robotic, p < 0.05). CONCLUSION: Long-term performance of a novel hybrid mesh in VHR demonstrates a low recurrence rate and favorable safety profile in various defect sizes and mesh placement locations.

Simple preoperative risk scale accurately predicts perioperative mortality following esophagectomy for malignancy.

Surgery remains one of the major treatment options available to patients with esophageal cancer, with high mortality in certain cohorts. The aim of this study was to develop a simple preoperative risk scale based on patient factors, hospital factors, and tumor pathology to predict the risk of perioperative mortality following esophagectomy for malignancy. The Nationwide Inpatient Sample database was used to create the risk scale. Patients who underwent open or laparoscopic transhiatal and transthoracic esophageal resection were identified using International Classification of Diseases, 9th edition codes. Patients <18 years and those with peritoneal disease were excluded. Multivariate logistic regressions were used to define a predictive model of perioperative mortality and to create a simple risk scale. From 1998 to 2011, a total of 23 751 patients underwent esophagectomy. The observed overall perioperative mortality rate for this cohort was 7.7%. Minimally invasive techniques, and operations performed in higher volume centers were protective, whereas increasing age, comorbidities and diagnosis of squamous cell carcinoma were independent predictors of mortality. Based on this population, a risk scale from 0-16 was created. The calibration revealed a good agreement between the observed and risk scale-predicted probabilities. A set of sensitivity/specificity analyses was then performed to define normal (score 0-7) and high risk (score 8-16) patients for clinical practice. Mortality in patients with a score of 0-7 ranged from 1.3-7.6%, compared with 10.5-34.5% in patients with a score of 8-16. This simple preoperative risk scale may accurately predict the risk of perioperative mortality following esophagectomy for malignancy and can be used as a clinical tool for preoperative counseling.

Comparación de resultados posterior a la transferencia electiva de embrión único euploide en ciclos frescos vs criopreservados / Results after elective single embryo transfer: Fresh euploid embryo transfer versus frozen-thawed transfer cycles

Resumen OBJETIVO: analizar las tasas de implantación y embarazo en ciclos de fertilización in vitro con transferencia electiva de un solo blastocisto, con control del factor embriónico mediante transferencia de embriones euploides. MATERIALES Y MÉTODOS: estudio retrospectivo de pacientes atendidas entre los años 2010 a 2015 en un centro privado, en protocolo de fertilización in vitro y que tuvieron, por lo menos, un embrión euploide disponible para transferencia. Para fines de estudio las pacientes se dividieron en dos grupos: 1) transferencia de embriones frescos y 2) embriones desvitrificados. Las variables categóricas se analizaron con χ2 y prueba exacta de Fisher; las variables continuas con t de Student. Se estableció significación estadística con un valor de p < 0.05. Para el análisis estadístico se usó SAS-STAT versión 9.4. RESULTADOS: se incluyeron 637 ciclos (frescos: 243 vs criopreservados: 394). La tasa de embarazo fue de 75.5% (n = 289) vs 66.3% (n = 159), embarazo clínico 62.5% (n = 235) vs 53.1% (n = 127) que fue estadísticamente significativo a favor de los ciclos criopreservados. Las tasas de embarazo múltiple fueron bajas (1.7 vs 1.6%) en ambas cohortes. CONCLUSIONES: la transferencia de un solo embrión disminuye significativamente la incidencia de embarazos múltiples y la morbilidad materna y neonatal. El mejor pronóstico en ciclos de fertilización in vitro homólogos se consigue con la transferencia de un solo embrión genéticamente equilibrado, en un ciclo posterior de preparación endometrial sintética o natural.

Abstract OBJECTIVE: To analyze the implantation and pregnancy rates in cycles of in vitro fertilization with elective transfer of a single blastocyst, with control of the embryonic factor by transfer of euploid embryos. MATERIALS AND METHODS: Retrospective analysis who included patients that underwent IVF and had at least one euploid embryo available for transfer between 2010 and 2015 on a single academic private practice. Cohorts were segregated in fresh embryo transfers (ET) vs frozen/thawed ET. Categorical variables were analyzed with χ2 and Fisher test when appropriate. Continuous variables were analyzed with Students t test. P value < 0.5 was established as statistically significant. SAS/STAT 9.4 was used for analysis. RESULTS: Six hundred and thirty-seven euploid SETs cycles (fresh cycle: n = 243; frozen/thaw cycle: n = 394) were identified. Pregnancy (75.5% (n=289) vs 66.3% (n = 159)) and clinical pregnancy rates (PR) (62.5% (n = 235) vs 53.1% (n = 127)) were statistically higher in the frozen/thaw cycles. Low rates of multiple pregnancies (1.7 and 1.6%) were observed in both cohorts. CONCLUSIONS: In one of the largest studies to date, a euploid SET during a frozen/thaw cycle showed significantly improved pregnancy and clinical PR compared to embryo transfer in fresh cycles. Single embryo transfer significantly reduces the incidence of multiple gestation and improves maternal and neonatal outcomes. An optimal outcome is achieved by the performance of a SET in FET cycles.

[What is the true role of surgery in the infertility associated with endometriosis?]. / Cuál es el verdadero papel de la cirugía en la infertilidad asociada con endometriosis.

BACKGROUND: Endometriosis is one of the most challenging clinical conditions for gynecologists. Associated pain and infertility are often difficult to manage, and current treatment strategies remain limited. OBJECTIVE: This review reviews the current scientific evidence for general gynecologist and provides an overview of current information regarding the treatment of patients with endometriosis-related infertility, offering strong evidence to consider a less invasive approach, and highlights potential hazards of surgery within patients desiring to achieve a pregnancy.

Alcohol metabolism is not affected by sleeve gastrectomy.

INTRODUCTION: It has been published that patients who underwent gastric bypass surgery have impaired alcohol metabolism, predisposing them to higher rates of intoxication and DUI arrests. Yet the impact of laparoscopic sleeve gastrectomy (LSG) on alcohol metabolism and in particular the long-term effects are still unclear. We hypothesized that LSG does not alter alcohol metabolism. METHODS: A prospective cohort study of patients undergoing LSG was evaluated. Blood alcohol concentration (BAC) was extrapolated using a Breathalyzer(®). Alcohol metabolism was evaluated by determining BAC every 5 min after a single dose of alcohol (5 oz. glass of 14% v/v Malbec wine), until BAC was equal to zero. Subjects were queried about alcohol intoxication symptoms. All parameters were obtained and analyzed preoperatively and at 3 and 12 months postoperatively. RESULTS: Our study consisted of 10 patients (9 female) with a mean age of 46.6 ± 2.2 years and BMI of 43.5 ± 2.2 kg/m(2). The mean percentage excess weight loss was 39.5 ± 3.3 at 3 months and 55.6 ± 4.4 at 12 months. Peak BAC at 20 min was not different at 3 months (0.068 ± 0.007, p = 0.77) or at 12 months (0.047 ± 0.008, p = 0.19) when compared to the preoperative assessment (0.059 ± 0.014). In addition, the time to BAC equal to zero was not significantly different between baseline and the follow-up values (preoperative: 70 ± 9 min, 3 months: 95 ± 18 min, and 12 months: 57 ± 8 min, (p > 0.05). Symptoms of intoxication were not significantly different in patients before and after surgery. CONCLUSIONS: Our study suggests that LSG does not alter alcohol metabolism. Patients who undergo LSG do not have higher levels of intoxication following alcohol consumption and are therefore not prone to higher rates of DUI charges than the general public, in contrast to that previously reported following in patients who undergo gastric bypass surgery.

[Neonatal lupus erythematosus and neurologic involvement: an incidental association?]. / Lupus néonatal et atteinte neurologique: une association fortuite?

UNLABELLED: Neonatal lupus erythematosus is a rare disorder characterized by cutaneous lesions of the face and/or congenital heart block. The transplacental transfer of maternal anti-Ro/SSA, anti-La/SSB, or anti-U1RNP antibodies is responsible for the development of the disease. Few cases of neonatal lupus erythematosus with neurological involvement were reported in the medical literature. CASE REPORT: A 36-week GA female infant presented with neonatal lupus erythematosus comprising cutaneous, hematologic and hepatic disorders with a favorable outcome. However, cutaneous atrophy and hyperpigmentation persisted. Spastic paraparesis was diagnosed at the age of six months. CONCLUSION: The neurological lesions in neonatal lupus erythematosus could either be related to the presence of anti-Ro/SSA antibodies of maternal origin, or of anticardiolipin antibodies.

Vaccination with soluble low-molecular weight tumor-associated proteins suppresses chemically-induced mammary tumorigenesis in rats.

This study attempted to elucidate whether the soluble tumour-associated proteins (TAA) of 66 kDa and 51 kDa molecular weight could suppress chemically induced mammary tumorigenesis. An intragastric dose of dimethylbenzanthracene (DMBA) was administered to rats and some were simultaneously immunised with the TAA. A single dose of DMBA resulted in 38% of the rats developing mammary tumours. However, simultaneous vaccination with the TAA preparation was significantly tumour-suppressive: mortality declined from 50% to 0% (p < 0.05); survival was extended from 9.4 weeks to 13.0 (p < 0.05), and 83% of the animals remained tumour free, compared to 13% of the control animals (p < 0.05). In 33% of the immunised animals the malignant tumours regressed completely. Such vaccination was also effective, although to a lesser extent, when the carcinogen dose was doubled. Then, 33% of the immunised and 22% of the control animals remained tumour-free, the latent period of malignant transformation was extended from 10.0 to 11.7 weeks, the initial tumour-free period lasted 9.3 weeks instead of 8.3 weeks and 10% survived compared to 50% of the controls. Vaccination with the soluble low molecular-weight TAA had distinct tumour-suppressive effects on mammary gland tumorigenesis.

Transplacental effects of a 15% olive-oil diet on chemically-induced tumorigenesis in offspring.

We evaluated whether feeding pregnant female rats a diet high in olive-oil, that showed a tumor-preventive effect in adults, has a similar preventive effect on chemically-induced cancer in offspring (i.e. mammary glands and colon cancer in rats). The control group was fed the same 7% corn-oil diet as their mothers. Experimental group I was fed a 7% corn-oil diet while their mothers received a 15% olive-oil diet. Experimental group II was fed the same 15% olive-oil diet as their mothers. Female offspring were twice administered 7,12-dimethylbenz(a)antracene (DMBA) in doses of 10 mg/rat. Male offspring were injected 6 times with 1, 2-dimethylhydrazine (DMH) in doses of 20 mg/kg body weight. Effect of DMBA was manifested in a high rate of tumorigenesis: the number of tumor-bearing rats in control offspring reached 52.0%. This effect increased to 60.6% among offspring of experimental group II and to 67.7% in offspring of experimental group I. The mean tumor size increased significantly in control offspring. Following administration of DMH number of tumor-bearing rats was similar in all groups of offspring: 36.7%, 40.7% and 42.8%. Tumor types differed: the majority of tumors in the control group were benign polyps and adenomas (72.1%) and the number of adenocarcinomas was low (27.9%). The number of malignant tumors increased to 37.5% in offspring of experimental group II and to 45.5% in offspring of experimental group I. In control group offspring, a distinct tendency to increased body weight and a significant increase in spleen weight were seen. The findings indicate that feeding mothers a diet high in fat concentrations, even those with known tumor preventive significance in adults, lose this cancer-inhibiting role in offspring.

Response of the spleen of Balb/c and p53-transgenic mice to low doses of carcinogen and to polyclonal antibodies generated against the soluble 53 kDa protein.

BACKGROUND: We have previously reported that p53-transgenic mice are highly sensitive to low doses of a carcinogen and to vaccination with soluble 53 kDa antibodies, compared to normal mice. The splenic manifestation of this strain dependent hypersensitivity was investigated immunohistochemically and morphometrically. METHODS: The spleen was obtained from Balb/c and human p53 promoter-CAT transgenic mice. Mice had either been treated with the carcinogen dimethylhydrazine (DMH), vaccinated before DMH treatment with polyclonal IgG generated against the soluble 53 kDa protein, or left untreated. RESULTS: Significant differences in the splenic structures were found between the strains compared, including the area occupied by the white and red pulps, the periarterial lymphoid sheath (PALS) and the marginal zone, and in the number of lymphoblasts and lymphocytes. Exposure to DMH stimulated the immune response, but in transgenic mice the number of B and T lymphocytes and especially helper T lymphocytes was significantly lower than in Balb/c mice. Vaccination followed by DMH injections did not improve the insufficiency of the immune response in transgenic mice. In transgenic mice, the number of B lymphocytes in follicles was almost half and the total number of cells in PALS and the number of T lymphocytes were only 71% and 60% respectively in BALB/c mice. In the marginal zone, macrophages proliferated as lymphocytes decreased. CONCLUSIONS: Insufficiency of the immune system after exposure to a carcinogen is more pronounced in transgenic mice, and is mainly related to the B-cell system. It may stem from defects in B lymphocytes or from inherent differences in their maturation and regulation. The increase in the number of macrophages, dendritic cells and neutrophils illustrates the compensatory processes that can remedy this developing immune insufficiency.

Sexual attraction in the silkworm moth: structure of the pheromone-binding-protein-bombykol complex.

BACKGROUND: Insects use volatile organic molecules to communicate messages with remarkable sensitivity and specificity. In one of the most studied systems, female silkworm moths (Bombyx mori) attract male mates with the pheromone bombykol, a volatile 16-carbon alcohol. In the male moth's antennae, a pheromone-binding protein conveys bombykol to a membrane-bound receptor on a nerve cell. The structure of the pheromone-binding protein, its binding and recognition of bombykol, and its full role in signal transduction are not known. RESULTS: The three-dimensional structure of the B. mori pheromone-binding protein with bound bombykol has been determined by X-ray diffraction at 1.8 A resolution. CONCLUSIONS: The pheromone binding protein of B. mori has six helices, and bombykol binds in a completely enclosed hydrophobic cavity formed by four antiparallel helices. Bombykol is bound in this cavity through numerous hydrophobic interactions, and sequence alignments suggest critical residues for specific pheromone binding.

Peptide T blocks GP120/CCR5 chemokine receptor-mediated chemotaxis.

We previously reported that certain short gp120 V2 region peptides homologous to vasaoactive intestinal peptide (VIP), such as "peptide T," were potent inhibitors of gp120 binding, infectivity, and neurotoxicity. The present study shows that synthetic V2-region-derived peptides have potent intrinsic chemotaxis agonist activity for human monocytes and also act as antagonists of high-affinity (0.1 pM) gp120-mediated monocyte chemotaxis. Selectivity is shown in that peptide T is more potent at suppressing M-tropic than T-tropic gp120 chemotaxis. Peptide T was also able to suppress monocyte chemotaxis to MIP-1beta, a chemokine with selectivity for CCR5 chemokine receptors, while chemotaxis of the more promiscuous ligand RANTES was not inhibited, nor was chemotaxis mediated by SDF-1alpha. In order to determine if peptide T mediated its gp120 antagonistic effects via modulation of CCR5 receptors, RANTES chemotaxis was studied using a CCR5 receptor-transfected HOS cell line. In this case, RANTES chemotaxis was potently inhibited by V2-region-derived short peptides. Peptide T also partially suppressed (125)I-MIP1-beta binding to human monocytes, suggesting action at a subset of MIP1-beta receptors. The V2 region of gp120 thus contains a potent receptor binding domain and synthetic peptides derived from this region modulate CCR5 chemokine receptor chemotactic signaling caused by either gp120 or chemokine ligands. The results have therapeutic implications and may explain recent clinical improvements, in that HIV/gp120 actions at CCR5 receptors, such as occur in the brain or early infection, would be susceptible to peptide T inhibition.

Transplacental effects of IgG generated against soluble 53 kDa protein on the splenic lymph system of rat progeny exposed to carcinogen: rate of apoptosis, proliferation of lymphocytes and expression of Fas and Fas ligand proteins.

BACKGROUND: We have previously shown that vaccination with IgG generated against the soluble 53 kDa (s53) protein modified the splenic response to carcinogens. Here we studied whether such immunization could affect the splenic lymphatic system of the offspring. METHODS: Offspring of normal female rats or of rats immunized with anti-s53 IgG were exposed to a carcinogen (dimethyl-benz(a)antracene). After 4 months, their spleens were resected and evaluated immunohistochemically for lymphocyte proliferation, apoptosis and apoptosis-related proteins (Fas and Fas ligand), in tumor-free and tumor-bearing animals. RESULTS: Spleens of progeny of unvaccinated rats had a significant decrease in the areas of follicles, germinal centers and the mantle layer after exposure to carcinogens, while maternal vaccination resulted in a significant expansion of the progeny's splenic follicles and germinal centers, the zones of B cell proliferation. The area of periarterial lymph sheaths (PALS) expanded in these offspring, reflecting activation of the T-zone. Maternal vaccination also resulted in a significant rise of Fas ligand-positive lymphocytes in the follicles and PALS of their tumor-free offspring. Tumorigenesis stimulated the Fas activity of B and T cells in the spleens, and this was much enhanced by maternal vaccination. CONCLUSIONS: Maternal vaccination before pregnancy results in altered morphological and functional attributes of the splenic immune system of the offspring. This increased immunoreactivity could reduce the risk of tumors in progeny of vaccinated mothers.

Effects of low doses of carcinogen and different antibodies on the splenic lymphoid system of p53 transgenic mice: morphometric and immunohistochemical studies.

The role of the splenic immune system in the development of high sensitivity of p53 transgenic mice to low doses of carcinogen and vaccination was investigated immunohistochemically and morphometrically. Spleens were obtained from human p53 promoter-chloramphenicol acetyl transferase transgenic mice, grouped as follows: 1, untreated controls; 2, exposed to dimethylhydrazine (DMH); 3, and 4, vaccinated with polyclonal antibodies to soluble-53 kDa protein (s53); 5, vaccinated with monoclonal PAb DO1; 6, vaccinated with monoclonal PAb 421; 7, vaccinated with polyclonal alphaH-p53 antibody. Mice in groups 4-7 were treated with DMH after the course of vaccination. Six months later all the mice were tumor-free, but effects of the low dose carcinogen were distinct in the splenic immune system. They were mainly manifested in blast transformation: the total number of lymphocytes and lymphoblasts decreased to 56.5% of the controls. The total of lymphoid cells in the follicles (B zone) and periarterial lymph sheath (T zone) declined, reflecting moderate insufficiency of the spleen's lymphoid system. Vaccination of transgenic mice with antibodies to soluble-p53 elicited mainly a B system response, with lesser T system involvement. Only few signs of B system insufficiency were found in these mice. Vaccination of mice with different antibodies, with subsequent carcinogen treatment, caused changes in the spleen that were similar to those described for DMH alone, but varied with different anti-p53 antibodies. Vaccination with polyclonal antibodies to soluble-p53, or with monoclonal antibodies PAb DO1 or PAb 421, stimulated the splenic activity of T system, and therefore can decrease the tumorigenic effect of carcinogens.

Recurrent plantar keloid.

Keloids of the plantar foot present a unique challenge to the surgical dermatologist. Many of the established regimens often fall short of their desired goals. Some of the obstacles to overcome include the repetitive nature of ambulation, the inability to primarily close the plantar foot, and the exquisite tendency for even fine suturing of skin grafts to form keloids. The use of excision, postoperative electron beam therapy, and secondary intention healing provides a useful approach in the management of plantar keloids.

Usefulness of serological determinations of soluble 53 kDa protein in follow-up of melanoma patients.

The role of the soluble 53 kDa antigen (s53) determinations in follow-up of melanoma patient was studied. high performance liquid chromatography (HPLC) was used to measure serum levels of s53 antigen after its partial isolation on gel fiberglass (GFG) affinity chromatography columns. Two main proteins were isolated from these columns as representatives of soluble tumor-associated antigens (TAA) with molecular masses of 64 and 53 kDa. In a Western immunoblot analysis, the 53 kDa protein exhibited a strong positive reaction to the commercial p53 antibody. HPLC isolated both antigens with individual variations and significant differences in their concentrations in patients from different groups. The presence of metastases was manifested by a significant increase in the serum levels of both isolated TAA. This finding is in accordance with our previous observations on the role of the soluble 53 kDa protein in the development of colon and uterine cancers. We conclude that the determination of the serum level of the s53 antigen is of diagnostic significance in the monitoring of melanoma patients.

Tissue-specific expression of the p53 tumor-suppressor gene in the intestine of transgenic mice exposed to DMH and p53 antibodies.

We studied the tissue-specific expression of the p53 gene in different parts of the intestine of mice treated with low doses of a carcinogen and exposed to different p53 antibodies. The human p53 promoter-CAT transgenic mice were immunized with different p53 antibodies (monoclonal - PAb 421 and DO1, and polyclonal - H-p53 and anti-soluble p53 IgG) and then exposed to low doses of dimethylhydrazine (DMH). Enzymatic CAT activity was determined in the ileum and colon 8 weeks later after the final injection of DMH. Expression of the p53 transgene in the normal ileum was twice as high as in the colon. Treatment with DMH significantly decreased the expression of the p53 transgene both in the ileum (from 18% to 100%) and in the colon (from 10% to 52%). Vaccination of mice protected at least in part such a decrease. The most effective results were found after exposure of mice to polyclonal H-p53 and to a lesser extent to anti-p53 IgG. No difference was found in the effects of antibodies on the small and large intestines. We concluded that polyclonal antibodies were more effective than monoclonal ones in protection against anti-p53 action of DMH. The observation of these effects may make it possible to explain the higher antitumor activity of polyclonal antibodies.

Transplacental tumor-preventive effects of polyclonal antibodies generated against the soluble 53 kDa antigen on mammary tumorigenesis in offspring.

This study was designed to determine whether immunizing females with polyclonal antibodies generated against the soluble 53 kDa tumor-associated antigen (s53 TAA) has a tumor-preventive effect on their progeny and whether this effect is manifested in some biochemical characteristics. Rat females were immunized before mating with anti-s53 IgG (50 microg/rat in Freund's complete and incomplete adjuvant, three times during a month) and their 5-week-old offspring was exposed to the carcinogen (dimethylbenz(a)antracene, 10 mg/rat). Results of these experiments were studied 4 months later. Vaccination of mothers decreased the tumorigenic effects of DMBA on their offspring. Blood levels of soluble TAA were analyzed in offspring of different groups. Two TAA were isolated from the blood, with molecular masses of 64 and 53 kDa. Their concentrations differed in offspring obtained from different maternal groups. Vaccination itself resulted in a marked increase in the blood levels of TAA, not only in the mothers but also in their offspring, however, this increase was not significant in tumor-bearing animals. In offspring from non-vaccinated mothers, tumorigenesis resulted in high overexpression of s53. In offspring from vaccinated mothers, a high blood level of s53 was shown even in tumor-free animals, probably due to maternal vaccination. We conclude that maternal vaccination before pregnancy increases immunoreactivity in offspring and can reduce risk of tumors in those progeny.

Agrobacterium radiobacter as a cause of pseudobacteremia.

Agrobacterium radiobacter was isolated from 15 blood cultures collected from 15 newborns. Contamination of blood cultures was suspected because, in most cases, the babies' illnesses seemed incompatible with infection. A radiobacter was isolated from citrated tubes used for clotting-factor studies. Review of venipuncture technique revealed that occasionally the coagulation study tubes were being inoculated before the blood-culture bottles. This investigation demonstrated how an environmental source coupled with faulty technique caused a cluster of false-positive blood cultures.