Arytenoid granuloma: a single-institution experience of management of 62 cases.

OBJECTIVE: This retrospective study was undertaken to assess the outcome of the medical and/or surgical management of patients presenting with clinical features of arytenoid granuloma. METHODS: The records of 53 males and 9 females were reviewed for predisposing factors, types of treatment received and recurrence following the treatment. RESULTS: Most of the patients (48 out of 62, 77.4 per cent) were treated conservatively with medical management and voice therapy, which resulted in complete resolution of arytenoid granuloma in over two-thirds of the patients treated (32 out of 48, 66.6 per cent). Overall, 28 patients (out of 62, 45.1 per cent) required surgery (14 failed medical treatment cases and 14 surgery as first-line treatment cases). Of these, five patients (out of 28, 17.9 per cent) had recurrence, and were managed with revision surgery and concurrent local injection of Botox. CONCLUSION: Anti-reflux medication and voice therapy are effective first-line management options. Pre- and post-surgery adjuvant treatment improves the results of surgery. Local injection of Botox was successful in the treatment of failed surgical cases.

Pyogenic granuloma associated with bone loss in an eight year old child: A case report.

Soft tissue enlargements of the oral cavity often present a diagnostic challenge because a diverse group of pathologic processes can produce such lesions. An enlargement may represent a variation of normal anatomic structures, inflammation, cysts, developmental anomalies and neoplasm. Within these lesions is a group of reactive hyperplasias, which develop in response to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. The pyogenic granuloma is a reactive enlargement that is an inflammatory response to local irritation such as calculus, a fractured tooth, rough dental restoration and foreign materials. This article aims to present a case of pyogenic granuloma in 8 year old child patient associated with resorption of bone in relation to the tooth.

Circulating soluble tumor necrosis factor receptor as a marker for diagnosis of pulmonary embolus.

The purpose of this clinical study was to determine the relationship between plasma soluble tumor necrosis factor receptor (T.N.F.R.) and pulmonary embolism. The histological evidence of the interaction between leukocytes and the venous wall of a thrombosed vein, as well as the over-production of TNF in plasma prompted us to assay a more stable polypeptide, namely TNF receptor, as potential markers for pulmonary embolism. Five mL of plasma were obtained from twenty patients, ranging in the age from 24 to 74 years, who had been diagnosed as having pulmonary embolism through pulmonary angiography, and 20 healthy volunteers in the same age group. The samples were then studied by enzyme-link immunosorbent assay (ELISA) for measurement of soluble TNF receptor. Patients with pulmonary embolism maintained a higher serum concentration of soluble TNF receptors. It appears that plasma measurement of soluble TNF receptor could be used as a clinical test for diagnosis of pulmonary embolism.

Weekly prophylactic urokinase instillation in tunneled central venous access devices.

PURPOSE: To determine the safety and efficacy of weekly prophylactic urokinase therapy in tunneled central venous access devices (VADs). MATERIALS AND METHODS: A prospective, randomized study was performed in 105 patients who underwent tunneled VAD placement between March 1997 and April 1998. The patients were randomized to receive either twice-daily heparin flushes (14 heparin flushes per week; group A, n = 52) or twice-daily heparin flushes with once-weekly urokinase (UK) instillation (13 heparin flushes, one UK flush per week; group B, n = 53). Patients were followed up by examination and/or interview at 1, 3, and 6 months for signs and symptoms of delayed catheter-related complications. RESULTS: The total number of indwelling catheter-days was similar between groups (5,450 in group A, 5,276 in group B). The total number of infectious complications and fibrin sheaths formed was greater for group A (n = 11; 21.1%) than group B (n = 3; 5.7%) (P = .02). There were no side effects noted from the prophylactic UK administrations. CONCLUSION: Prophylactic UK is advantageous in preventing delayed catheter-related complications.

Left gastric artery arising from the superior mesenteric artery--case reports.

Two case reports of a left gastric artery replaced to the SMA are presented. Normal left gastric anatomy and development are described, and the importance of such anomalies is discussed.

The role of thrombolytic therapy in the management of paradoxical embolism.

Paradoxical emboli are considered a rare event, representing less than 2% of all arterial emboli. The most common intracardiac defect associated with paradoxical emboli is a patent foramen ovale. Most commonly, a pulmonary embolism is the cause of the acute increase in right atrial pressure leading to a reversal of intracardiac flow and passage of venous embolic material to the left heart. We present a patient with a pulmonary embolism and paradoxical emboli, and discuss therapeutic approach. We suggest that the treatment of choice for the patient with pulmonary embolism and non-limb-threatening acute ischemia due to a paradoxical emboli should be thrombolytic therapy and intracaval filter placement, followed by patent foramen ovale repair.

Patients with thrombocytopenia: outcome of radiologic placement of central venous access devices.

PURPOSE: To determine prospectively the outcome of radiologic placement of central venous access devices in patients with thrombocytopenia. MATERIALS AND METHODS: In 105 patients, 87 catheters, 10 arm port systems, and eight chest port systems were placed radiologically. Devices and patients were separated into group A (n = 37; platelet count < 50,000 x 10(6)/L [50 x 10(9)/L]), group B (n = 35; platelet count, 50-100,000 x 10(6)/L [0.05-100 x 10(9)/L]), and group C (n = 33; platelet count, > 100,000 x 10(6)/L [100 x 10(9)/L]). Patients in group A received platelet transfusions during implantation. Patients were followed up for up to 8 weeks (mean, 41.2 days). Success and complication rates (immediate and delayed) were determined for each group. RESULTS: There were no bleeding complications that necessitated intervention in patients with thrombocytopenia (groups A and B). There was no statistically significant difference in complication rates per "catheter days" among the three groups (4.2 per 1,000 catheter days in group A, 4.6 per 1,000 catheter days in group B, and 5.2 per 1,000 catheter days in group C). Postprocedure platelet counts increased only slightly (mean, 11,500 x 10(6)/L [11.5 x 10(9)/L]) in patients in group A. CONCLUSION: Radiologic placement of central venous access devices can be performed safely in patients with thrombocytopenia.

Physical and biological significance of peptide sequences mediating the interaction between high molecular weight kininogen and plasma prekallikrein.

HK31 (S565-K595) has previously been shown to encompass the binding domain for plasma prekallikrein (PK) within domain 6 of high molecular weight kininogen (HK). The complementary binding domain for HK within PK is mapped to PK56 (F56-G86), in the Apple 1 domain and to PK266 (K266-C295) in the Apple 4 domain. Isothermal titration calorimetry demonstrated that either PK peptide binds to HK31 in 1:1 stoichiometry. Binding of the alternate PK peptide into a ternary complex is facilitated nearly 2-fold. Fluorescence emission spectroscopy revealed that only the binding of PK56 caused a limited decrease in intrinsic tryptophane fluorescence emission intensity of HK31. We conclude that the two PK peptides bind to the HK peptide at different sites. To map the minimal sequence within HK31, truncated new peptides were tested for their ability to compete with HK for binding PK in a cell-free system. D567-T591, a 25-residue peptide which contains sufficient structural information for binding kallikrein in solution, blocked the binding of kallikrein to HK bound to endothelial cells and inhibited PK activation to kallikrein and the generation of kallikrein-activated urokinase on endothelial cell surfaces. HK-derived peptides could modulate excessive fibrinolysis and hypotension in sepsis and multiple trauma.

Direct evidence for multifacial contacts between high molecular weight kininogen and plasma prekallikrein.

HK31 (S565-K595) has previously been shown to encompass the binding domain for plasma prekallikrein (PK) within domain 6 of high molecular weight kininogen (HK). The complementary binding domain for HK within PK is mapped to PK56 (F56-G86), in the apple 1 domain, and to PK266 (K266-C295), in the apple 4 domain. Isothermal titration calorimetry was used to directly monitor binding among HK31, PK56, and PK266. Either PK peptide binds to HK31 in 1:1 stoichiometry, regardless of whether a binary complex is first formed between PK266 and HK31 or between PK56 and HK31. Binding of the alternate PK peptide into a ternary complex is facilitated nearly 2-fold. The ternary complex consists of 1:1:1 HK31:PK56:PK266. Furthermore, binary and ternary complex formation is entropically driven and thermodynamically favored, suggesting that the conformational changes accompany binding. Fluorescence emission spectroscopy revealed that binding of PK56 caused a limited decrease in intrinsic tryptophan fluorescence emission intensity of HK31 while binding of PK266 to HK31 or the complex of HK31/PK56 had no such effect. We conclude that the two PK peptides bind to the HK peptide at different sites. The binding between HK and PK is likely due to conformational changes which serve to juxtapose the PK binding domain within HK with the HK binding site involving two spatial proximity segments.

Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding.

Arteriovenous malformations of the gastrointestinal tract are a source of upper and lower gastrointestinal bleeding. We studied 40 patients with arteriovenous malformations. Eighteen percent had single lesions in either the distal transverse colon or the left colon (the angiographic distribution of the inferior mesenteric artery). Seventeen percent had concomitant colonic and extracolonic arteriovenous malformations. Only 6% of those who underwent surgery for removal of arteriovenous malformations rebled. We also studied the incidence of angiodysplastic lesions of the colon of 159 patients over the age of 55 with lower gastrointestinal bleeding; associated arteriovenous malformations were present in 21%. These data suggest: that to evaluate arteriovenous malformations as a cause of gastrointestinal bleeding, one must perform inferior and superior mesenteric and celiac angiography; the incidence of rebleeding is reduced when triple-vessel selective visceral angiography precedes surgical removal of arteriovenous malformations; and the incidence of associated arteriovenous malformations approaches that of diverticulosis in elderly patients with lower gastrointestinal bleeding.

Sidewinder catheter for conversion of retrograde into antegrade catheterization.

Conversion of retrograde into antegrade catheterization is accomplished through the use of a sidewinder catheter with a reformed loop that is subsequently lost during advancement of the catheter tip. This technique was used to perform eight percutaneous dilatations (PTD) in seven patients (one had bilateral disease). Other applications for antegrade catheterization are considered.

Arterial embolization for traumatic hemobilia with hepato-portal fistula.

A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hemobilia, was successfully treated by intra-arterial embolization. Laparotomy with liver resection or hepatic artery ligation--procedures that carry a high morbidity and mortality in a critically ill patient--were avoided. Embolization techniques can be a valuable alternative to surgery in the management of hepatic trauma with delayed hemorrhage in selected, high-risk cases.

Colonic ischemic necrosis following therapeutic embolization.

Transcatheter embolization of the middle colic artery for diverticular bleeding was followed by ischemic necrosis in the transverse colon at the site of previous anastomosis and stricture formation. This is a potential complication of intra-arterial embolization for colonic bleeding.

Renal carcinoma--unusual presentation and angiographic findings.

A case of papillary renal cell carcinoma with clinical and angiographic features of an abscess is reported. Papillary renal carcinomas constitute 14% of renal adenocarcinomas. These tumors have slower growth rate and better prognosis.