Development of Pyriform Sinus Suctioning Programs for Aspiration Pneumonia Prevention During the Acute Stroke.

Aspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable. With a view of unifying the quality and frequency of intervention, two programs to: initially confirm the safety of such suctioning; subsequently enhance/evaluate knowledge and skills related to the procedure (educational); and specify conditions for the implementation and criteria for determining its appropriateness (practical), were developed. The study involved 33 (mean age: 74.6 ± 12.4) and 30 (80.0 ± 8.8) control and intervention group members, respectively, 25 (83.3%) of the latter were treated with pyriform sinus suctioning for 5 days after a stroke. Pneumonia developed in 7 (21.2%) and 2 (6.7%) of the former and latter, respectively. As individuals with a Japan Coma Scale (JCS) score of III or a midline shift on head CT tend to develop pharyngeal dysphagia, the patients were also divided into 2 groups to compare the incidence of pneumonia based on the risk level: low: Japan Coma Scale scores of I-II without a midline shift on head CT; and high: scores of II-III with it. In the latter, the incidence after intervention was markedly lower (p = 0.06, φ = 0.326), while the former did not show changes (p = 0.574, φ = 0.066), supporting the effectiveness of pyriform sinus suctioning to prevent aspiration pneumonia among patients with a low risk level.

Impact of culture medium on the expansion of T cells for immunotherapy.

BACKGROUND AIMS: Encouraging evidence of clinical benefits from cancer immunotherapy is beginning to accumulate in several clinical trials. Cancer immunotherapy is based on two main methods, active vaccination and cell-transfer therapy. The ex vivo expansion of T cells is required to monitor vaccine-induced antigen-specific T cells or prepare large numbers of reactive lymphocytes for adoptive transfer. METHODS: We examined the influence of culture medium on T-cell growth, cytotoxicity and phenotype after activation using immobilized anti-CD3 monoclonal antibody or Zoledronate stimulation. Peripheral blood mononuclear cells (PBMC) were cultured in RPMI, AIM-V or OpTmizer with or without autologous serum. RESULTS: When supplemented with sufficient serum, RPMI was a good culture medium for T-cell expansion following anti-CD3 stimulation. Addition of autologous serum to AIM-V or OpTmizer increased the numbers of cells obtained to a similar extent, but their phenotype and function were quite different. Activated T cells cultured with OpTmizer mediated greater cytotoxicity than any other culture. Regardless of the media used, the main population expanded after CD3 stimulation was CD3(+) CD8(+). While more CD3(+) CD4(+) T cells were induced in RPMI and AIM-V, more CD3(-) CD56(+) cells and CD3(+) CD56(+) T cells were induced in OpTmizer. When cells were stimulated by Zoledronate for 14 days, approximately 7.2 times and 11.5 times more gammadelta T cells were obtained in OpTmizer than AIM-V or RPMI, respectively. CONCLUSIONS: Successful immunotherapy depends on the selection of appropriate culture media to support efficient expansion of the type of T cell desired.

Is finger palpation at operation indispensable for pulmonary metastasectomy in colorectal cancer?

BACKGROUND: The use of thoracoscopic techniques for pulmonary metastasectomy is controversial because small metastatic foci might be missed without thorough finger palpation of the lung. METHODS: We retrospectively examined preoperative findings of helical computed tomography and pathologic findings of pulmonary nodules obtained by open thoracotomy, including median sternotomy or thoracoscopy, in patients thought to have pulmonary metastasis from colorectal cancer. RESULTS: We performed 122 pulmonary metastasectomies (43 thoracotomies and 79 thoracoscopies) in 102 patients from 1999 to 2005. Repeat metastasectomies were excluded. Preoperative evaluation revealed 219 pulmonary nodules suspicious for pulmonary metastasis, and 250 nodules were resected; however, pathologic examination revealed that 47 (18.8%) of 250 nodules were not metastases. When the diameters of the pulmonary nodules were small, the rates of metastasis were also significantly lower. Finally, 4 thoracotomy (9.3%) and 5 thoracoscopy patients (6.3%) were found to have additional pulmonary metastases at operation. Recurrent pulmonary metastases were found at the ipsilateral side of the metastasectomy in 27 (34.2%) of 79 thoracoscopies and 27 (62.8%) of 43 open thoracotomies (p = 0.0023) within 2 years after the pulmonary surgery. These metastatic foci might have been missed at the time of pulmonary metastasectomy. CONCLUSIONS: The ability to detect pulmonary metastases in patients with colorectal cancer is limited by preoperative evaluation with computed tomography and surgical techniques, including open thoracotomy with bimanual palpation. Pulmonary metastasectomy by open thoracotomy or thoracoscopy may be a suboptimal intervention to remove metastatic foci in the lungs.

Compression of the iliac vein by a synovial cyst.

While a synovial cyst of the hip is a rare cause of lower limb swelling, a differential diagnosis of deep vein thrombosis is needed. A case of lower limb swelling due to compression of the external iliac vein by a synovial cyst is presented with a review of the literature. Sagittal views and three-dimensional images of a CT scan were very useful for the diagnosis. This is the first review in English of vessel compression by a synovial cyst of the hip.