Inferior vena cava filters in children: our experience and suggested guidelines

Although use of inferior vena cava (IVC) filters for prophylaxis against pulmonary embolism (PE) is well reported in adults, long-term studies in children are lacking. We performed retrospective review of imaging and clinical database of IVC filters for the last 12 years. Thirty-five patients (mean age: 15.5 y) underwent filter placement and/or retrieval. Indications for placement were contraindication to anticoagulation with known deep venous thrombosis (DVT) (18) or high risk of venous thromboembolism (5), recurrent DVT despite anticoagulation (1), and prophylaxis before endovascular thrombolysis (8). All filter placements were technically successful without any complications. Filter retrieval was successful in 15 of 19 attempted (79%) at a mean of 42 days. Two complications occurred during retrieval: IVC stenosis successfully treated with angioplasty and contained IVC perforation. Endothelialization of filter prevented retrieval in 4 patients. Mean follow-up was 29.3 months. No patients had IVC thrombosis, breakthrough pulmonary embolism, filter fracture, or embolism. Two patients had recurrent DVT. Our results indicate that IVC filters can be successfully placed and retrieved in children with minimal procedural complications; follow-up demonstrates acceptable complication rate owing to presence of filters. Prophylactic IVC filter placement may be considered before endovascular thrombolysis for lower extremity DVT. Retrievable filters should be used in children for appropriate indications.     

Bilateral lens subluxation in a case of lipoid proteinosis

We report a patient who presented with pain, redness, and diminution of vision in the right eye and low vision in the left eye. Ophthalmologic examination showed characteristic eyelid lesions, anterior dislocation of the crystalline lens in the right eye, and nasal subluxation in the left eye. The patient's voice was hoarse, and he had skin lesions. After histopathologic examination of the skin biopsy, lipoid proteinosis (LP) was diagnosed. Bilateral pars plana lensectomy was performed. The ophthalmic manifestations of LP are discussed.     

Whole body hyperthermia and preconditioning of the heart: basic concepts, complexity, and potential mechanisms.

Whole body hyperthermia (WBH) is a distinctive pathophysiological condition with significant impact on tissue metabolism and organ functions. WBH has been investigated as a promising adjunct therapy to the conventional chemo- or radiotherapy for treating certain types of cancer. Numerous studies have shown that WBH is associated with induction of heat shock proteins (HSPs), which in turn modulate cellular survival or death. A brief period of WBH (40-42 degrees C; 15-20 min) can induce delayed protection against lethal endotoxemia as well as various forms of injury in brain, heart, liver, lungs, small intestine, and skeletal muscle. This review article focuses on discussing the WBH-induced myocardial protection against ischemia/reperfusion injury. Most recently, possible involvement of protein kinase C, mitogen-activated protein kinases, nitric oxide, ATP-sensitive potassium channels, and neural peptides in the signal transduction pathways has been demonstrated. On the other hand, whether HSPs or antioxidant enzymes are the primary end-effector of the cardioprotection continues to be a matter of ongoing debates. It has also been recognized that the complex nature of WBH may be the responsible factor for the discordant results among various studies, especially across different animal species or strains, in terms of the time course and potency of WBH-induced cardioprotection. Nevertheless, a better understanding of the WBH-elicited myocardial ischemic resistance may have a wide spectrum of clinical implications as well as insightful inputs into the hyperthermic biology.     

Effects of cisplatin on parathyroid hormone- and human lung tumor-induced bone resorption

We have previously shown that dichlorodiamine platinum (DDP), or cisplatin, a cancer chemotherapeutic agent, is effective in the treatment of malignancy-associated hypercalcemia. In the present studies, we evaluated its effects on bovine parathyroid hormone (PTH)- or tumor-induced bone resorption in vitro in the neonatal mouse calvarial bone resorption assay. PTH alone or tumor extract (TE) of a human squamous cell lung cancer alone caused a significant increase in the bone resorption and in the number of osteoclasts in the calvaria. The addition of 3 and 10 micrograms/ml DDP inhibited the PTH- or TE-induced bone resorption. Lower doses of 1 and 2 micrograms/ml DDP, although not effective in inhibiting the PTH-induced bone resorption, were effective in lowering the TE-induced bone resorption. The number of osteoclasts was also reduced by DDP treatment. We therefore conclude that DDP is effective in the treatment of malignancy-associated hypercalcemia by virtue of its inhibitory effects on osteoclast numbers and on bone resorption.     

Lack of effects of neutralization of parathyroid hormone-related protein on calcium homeostasis in neonatal mice.

Large quantities of parathyroid hormone-related protein (PTHrP) are present in the milk of various species. It has been suggested that PTHrP may play a role in neonatal calcium homeostasis. In the present study we evaluated the effect of neutralization of amino-terminal PTHrP activity by passive immunization in 1-day-old mouse pups. Neutralization of amino-terminal PTHrP activity had no significant effect on serum calcium or whole-body calcium content in the neonatal mice. In additional studies, we demonstrated that subcutaneous administration of PTHrP-(1-34) increased serum calcium, whereas oral administration had no significant effect in 3-day-old pups. The studies therefore demonstrate that the amino terminus of PTHrP may not play a significant role in neonatal calcium homeostasis. Local effects of PTHrP cannot be excluded by the results of the present study.     

Effect of epidermal growth factor infusion on serum and urine calcium in mice

Transforming growth factors (TGFs) have been implicated in the pathogenesis of the hypercalcemia in malignancy (HM). In order to evaluate the role of these growth factors (epidermal growth factor (EGF) and TGF-alpha acting via the EGF receptor) in the development of HM, we studied the effect of 2 doses of EGF (0.1 and 0.3 microgram/g/day) given for 7 days as a continuous infusion on serum and urine calcium in athymic mice. These infusions had no effect on serum and urine Ca values in this study. In order to assess the biological activity of the infused EGF, other known effects on gastric and pancreatic weights were evaluated. EGF-infused animals had significantly greater gastric and pancreatic weights than controls. Thus, EGF infusion into mice in doses which elicited known biological effects failed to have an effect on serum and urine Ca. An infusion of bovine parathyroid hormone 1-34 at the dose of 0.1 microgram/g/day resulted in significant hypercalcemia.     

No increased mortality from donor or recipient hepatitis B‐ and/or hepatitis C‐positive serostatus after related‐donor allogeneic hematopoietic cell transplantation

Limited data exist on allogeneic transplant outcomes in recipients receiving hematopoietic cells from donors with prior or current hepatitis B (HBV) or C virus (HCV) infection (seropositive donors), or for recipients with prior or current HBV or HCV infection (seropositive recipients). Transplant outcomes are reported for 416 recipients from 121 centers, who received a human leukocyte antigen‐identical related‐donor allogeneic transplant for hematologic malignancies between 1995 and 2003. Of these, 33 seronegative recipients received grafts from seropositive donors and 128 recipients were seropositive. The remaining 256 patients served as controls. With comparable median follow‐up (cases, 5.9 years; controls, 6.7 years), the incidence of treatment‐related mortality, survival, graft‐versus‐host disease, and hepatic toxicity, appears similar in all cohorts. The frequencies of hepatic toxicities as well as causes of death between cases and controls were similar. Prior exposure to HBV or HCV in either the donor or the recipient should not be considered an absolute contraindication to transplant.