Laboratory and clinical evaluation of the impact Uni-Vent 750 portable ventilator

BACKGROUND: Transportation of critically ill, mechanically ventilated patients from intensive care units for diagnostic and therapeutic procedures has become common in the last decade. Maintenance of adequate oxygenation and ventilation during transport is essential. We evaluated the Impact Uni-Vent 750 portable ventilator in the laboratory and in the clinical arena to determine its usefulness during inhospital transport. MATERIALS & METHODS: In the laboratory, we determined the Uni-Vent 750's ability to assure tidal volume (VT) delivery in the face of decreasing compliance of a test lung and tested the alarm systems. Using a two-compartment lung model modified to simulate spontaneous breathing, we also evaluated the responsiveness of the demand valve. The clinical evaluation was accomplished by comparing arterial blood gas values and ventilator settings in the intensive care unit before transport to those during transport. RESULTS: As lung compliance was reduced from 0.1 to 0.02 mL/cm H2O [1.0 to 0.20 L/kPa], a slight, statistically insignificant decrease in delivered tidal volume was observed. All alarm systems operated according to manufacturer's specifications. The demand valve triggered appropriately with PEEP from 0 to 20 cm H2O [0 to 1.96 kPa]. Sensitivity settings less than -6 cm H2O [-0.59 kPa] sometimes resulted in inability to trigger the demand valve. During patient transport, arterial blood gas values and ventilator settings were comparable to those observed in the ICU. Because an FIO2 of 1.0 was used during transport, mean (SD) PaO2 was significantly greater 89 (26) vs 341 (78) [11.8 (3.5) vs 45.3 (10.4) kPa]. CONCLUSIONS: The Uni-Vent 750 is a reliable transport ventilator, capable of maintaining adequate oxygenation and ventilation in a majority of mechanically ventilated patients. The Uni-Vent 750's ability to (1) provide CMV, AMV, and SIMV; (2) provide low and high pressure alarms; and (3) provide PEEP compensation is unique among portable ventilators.     

Use of granulosa-luteal cell culture to evaluate low and high clinical responses to menotropin stimulation.

The cause of a poor response to human menopausal gonadotropin (hMG) remains unexplained. To determine whether aromatase activity of cultured granulosa cells obtained from relatively low estradiol (E2) responders (serum E2 < 1000 pg/ml) to hMG therapy differed from that of good responders (E2 > or = 1000 pg/ml), we prospectively compared serum E2 on the day of human chorionic gonadotropin administration to in vitro aromatase activity following a 72-h culture. Granulosa cells were obtained from seven women undergoing hMG therapy and oocyte aspiration. Follicle stimulating hormone (FSH) was added to one-half of the cultures. Serum E2 was determined by radioimmunoassay, and aromatase activity was determined indirectly by measuring tritiated water formed by aromatization of 1-beta [3H] androstenedione to estrogen in 1 h. In this study, luteinized granulosa cells from patients with a relatively low serum E2 produced less estrogen in cultures when compared to cells from higher responders (p < 0.01). Aromatase activity was not significantly increased by FSH in the relatively high responders, whereas FSH stimulated a significant increase in aromatase activity in cells from lower responders (p < 0.001). Our results indicate that the clinical response to hMG is at least partly due to the "quality" of granulosa cell aromatase activity. A clinically relevant "block" to FSH action may be present in vivo in low responders which can be reversed in culture by addition of FSH.     

Pseudo-angiomatous hyperplasia of mammary stroma: a case with gigantomastia

Pseudo-angiomatous hyperplasia of mammary stroma (PASH) is a histopathological entity which is a microscopic fortuitous finding in mammary biopsies performed for different reasons. It may be symptomatic and appears then as a palpable lump. The term pseudo-angiomatous emphasizes the characteristic aspect of the stroma simulating a vascular tumor. We report a case of PASH in a 71 year-old woman who presented a recurring breast mass with rapid swelling of the mammary gland (70 x 60 x 20 cm) treated by mastectomy. PASH must be distinguished from a well-differentiated angiosarcoma. It is ruled out by immunohistochemistry.     

Differential expression of extracellular matrix metalloproteinase inducer (CD147) in normal and ulcerated corneas: role in epithelio-stromal interactions and matrix metalloproteinase induction

Extracellular matrix metalloproteinase inducer (EMMPRIN) was originally identified on the tumor cell surface as an inducer of matrix metalloproteinase (MMP) production in neighboring fibroblasts. Here we demonstrate a role for EMMPRIN in MMP induction during corneal wound healing. MMP and EMMPRIN expression was analyzed in normal and ulcerated human corneas, as well as in corneal epithelial and stromal cells in culture using confocal microscopy, zymography, immunoblots, and real-time polymerase chain reaction. In normal cornea EMMPRIN was predominantly expressed in the epithelium but was markedly induced in the anterior stroma of ulcerated corneas. This coincided with MMP-2 induction that co-localized with EMMPRIN at the epithelio-stromal boundary. The role of epithelial-stromal interaction in MMP induction was investigated in an in vitro co-culture system and demonstrated an induction and co-localization of EMMPRIN and MMP-2 in the fibroblasts at the interface with epithelial cells. Direct contact of fibroblasts with EMMPRIN-containing purified epithelial cell membranes also induced MMP-1, MMP-2, and EMMPRIN and this was inhibited by a blocking anti-EMMPRIN antibody, suggesting that EMMPRIN was primarily responsible for this induction. These findings, and the up-regulation of EMMPRIN by epidermal growth factor and transforming growth factor-beta, demonstrate a role for EMMPRIN in wound healing and suggest that sustained local up-regulation of EMMPRIN and MMPs in chronic situations in which healing is delayed may lead to excessive matrix degradation and corneal melts.     

Cancer families: what risks are they given and do the risks affect management?

The numbers of referrals to genetics clinics for people with a family history of cancer is increasing rapidly. Although it is likely that presymptomatic testing will soon be available for some families, for the majority of people with a family history of malignancy, risk can only be assessed by examining their pedigrees and referring to standard texts. In order to find out if clinical geneticists are providing consistent risks and suggestions for management we surveyed consultant clinical geneticists with a questionnaire about four people with a family history of malignancy. The clinical geneticists replying to our questionnaire gave consistent advice for the person with a family history of colon cancer, but there was wide variation in suggested risks and management for those with family histories of breast and multisite cancers. This survey shows that deciding on appropriate management for cancer families can be difficult and that there is uncertainty about the most effective methods of screening young people at high risk of developing cancers. However, it is important to provide consistent advice in order to evaluate screening protocols and lack of consistency in advice given to different family members can cause anxiety and distress. Consistency may be achieved by the use of one model for risk calculation, and by representatives from several specialties, such as surgery, radiology, genetics, and public health working together in order to coordinate local and national screening policies.     

Comparison of immunofluorescence, enzyme immunoassay, and Western blot (immunoblot) methods for detection of antibody to human T-cell leukemia virus type I.

A total of 3,349 serum samples were screened by the immunofluorescence (IF) method for antibody to human T-cell leukemia virus type I (HTLV-I). Only 9 of 2,409 specimens from selected individuals, blood bank donors, patients with encephalitis-meningitis, and human immunodeficiency virus antibody-positive homosexual or bisexual men were reactive by IF. In addition, 940 serum samples from intravenous drug abusers were tested by IF and also by an HTLV-I enzyme immunoassay (EIA) method. Of these, 222 (24%) were positive for both HTLV-I and HTLV-II antigens by IF, and 191 of these 222 were also reactive in the HTLV-I EIA. Of the 31 IF-positive, EIA-negative serum samples, 20 exhibited optical density readings greater than or equal to 70% of the positive cutoff in the EIA, and 29 samples reacted with 1 or more bands in the Western blot (immunoblot) test. An additional 10 specimens that were EIA negative reacted only with HTLV-I by IF. Differences in staining morphology and in reactions on HTLV-I and HTLV-II antigens before and after absorption of the serum specimens with HTLV-I and HTLV-II-infected cell pellets revealed six distinct serological patterns by IF. These results indicate that infections by HTLV-I or by another closely related retrovirus(es) occur in California. Further studies utilizing statistically valid sampling methods are needed to estimate true prevalence rates among various groups. IF and Western blot tests should supplement the EIA method to maximize sensitivity and specificity of test procedures.     

Duplication 3q(q21 → qter) without limb anomalies

We report on a 2.5-month-old boy with hypertelorism, hypertrichosis, anteverted nostrils, malformed ears, thin lips, downturned corners of the mouth, micrognathia, short neck, cryptorchidism, and bilateral simian creases without limb anomalies. Cytogenetic studies showed a duplication 3q → qter 46,XY,der(6),t(3;6)(q21;p25)pat. The absence of limb anomalies is noteworthy; all 12 previously reported patients with the same duplication had limb anomalies. The uniqueness of this report provokes speculations regarding limb morphogenesis in embryos with chromosome anomalies. The concepts of chronogenetics, heterochrony, and developmental field defects appear relevant to yet another set of patients with chromosome anomalies.