Donald G. Guinee

Omental Roll-Up: A Technique for Islet Engraftment in a Large Animal Model

BACKGROUNDnAttrition of transplanted islets is significant after hepatic embolization. This study was designed to investigate a novel surgical technique for islet transplantation into the omentum. This site allows placement of the islets in a three-dimensional (3D) matrix, with growth factors, to temporarily culture the islets in vivo while revascularization progresses.nnnMATERIALS AND METHODSnFive female dogs (three partial and two total pancreatectomies) received an autologous islet transplant in the omentum. Islets were suspended in 1 mL of PBS containing 10 ug of vascular endothelial growth factor (VEGF). Fresh autologous plasma (10 mL) was mixed with the islet/VEGF suspension. The coagulum containing the islets and VEGF was then placed on the greater omentum. The leading edge of omentum was rolled up to secure the islet/VEGF/coagulum in position and to present the thin islet layer with two omental surfaces for implantation. Omentum was recovered at 2, 13, 21, 42, and 180 d.nnnRESULTSnImmunohistochemical staining for synaptophysin, glucagon, and insulin confirmed the presence of transplanted islets in all omenta. Insulin and C peptide production from the omental islets was confirmed in portal venous samples, and normalization of morning glucose levels beginning on day 7 was seen in the total pancreatectomy experiment.nnnCONCLUSIONSnAutologous islets implant in rolled-up omentum when placed as a VEGF/autologous plasma coagulum. This technique has potential benefits, including the opportunity to accelerate revascularization and to investigate local strategies for modulating the immune response.

Primary Pleural Neoplasia: Entities Other Than Diffuse Malignant Mesothelioma

CONTEXTnOverwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it is nonetheless the most common neoplasm primary to the pleura. Metastatic carcinoma and diffuse malignant mesothelioma each have their own prognostic and therapeutic characteristics. Other primary pleural neoplasms occur uncommonly or rarely, with their own prognostic and therapeutic characteristics.nnnOBJECTIVEnTo review primary pleural neoplasms other than diffuse malignant mesothelioma, to better ensure correct diagnosis and optimal assessment of prognosis and treatment.nnnDATA SOURCESnLiterature review and primary material from the authors institutions.nnnCONCLUSIONSnA nonexhaustive group of uncommon to rare benign and malignant primary pleural neoplasms--other than diffuse malignant mesothelioma--are presented, of which one must be aware in order to maintain an appropriate index of suspicion to include them in the differential diagnosis of a pleural tumor.

Case of the season: usual interstitial pneumonia with dendriform pulmonary ossification.

73-year-old man with progressive dyspnea on exertion and occasional cough with scant sputum production was seen for follow-up in a pulmonology clinic. He was diagnosed with “pulmonary fibrosis”for 3 years, which was postulated to be secondary to work-related asbestos exposure or occult connective tissue disorder based on an elevated serum antinuclear antibody level and nonspecific interstitial pneumonia (NSIP)-like appearance (predominantly peripheral groundglass opacity with subpleural sparing) on prior high-resolution computed tomography (CT) of the chest (not shown). The patient underwent evaluation for myocardial ischemia with multivessel stenting approximately 1 year ago. However, he did not recall having a myocardial infarction and did not have the typical symptoms of congestive heart failure. On physical examination, there were fine crackles in the lowerone-thirdofthelungsbilaterally.Atrest,intheroom,the patient’s oxygen saturation level was 95%; however, the saturation levels decreased to 85% during the walking oximetry test. Pulmonary function testing demonstrated

Vanishing lung syndrome and HIV infection: an uncommon yet potentially fatal sequela of cigarette smoking.

Persons with HIV infection have a higher risk of infectious pulmonary complications, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and pulmonary fibrosis than individuals not infected with HIV. Herein, we describe the clinical course of a patient with longstanding and well-controlled HIV infection and multiple previous pneumothoraces who presented to medical attention with insidious onset of shortness of breath and was diagnosed with vanishing lung syndrome (VLS). The VLS or giant bullous emphysema is a distinct clinical syndrome characterized by large bullae, predominantly in the upper lobes, occupying at least one third of the hemithorax and compressing surrounding normal lung parenchyma. It is a progressive disorder that typically occurs in young men, the majority of whom are smokers. As people with HIV/AIDS are now surviving well into middle age and beyond, clinicians are more likely to encounter VLS and severe obstructive lung disease, which are potentially fatal but preventable conditions.

Asthma and Related Eosinophilic Infiltrates

Eosinophils were first recognized by Ehrlich1 in 1879 as a distinct type of cell within the peripheral blood characterized by a bilobed nucleus with distinct cytoplasmic granules staining positively with eosin. Eosinophils are thought to have evolved as a major component in the defense against helminth parasites. The dense granules within eosinophils contain substances such as major basic protein, eosinophil-derived neurotoxin, peroxidase, cat-ionic protein, and activated oxygen species, which are toxic to helminth parasites.

AIDS-associated plasmablastic lymphoma presenting as a poorly differentiated esophageal tumor: a diagnostic dilemma.

Plasmablastic lymphoma (PBL) is a rare form of diffuse large B-cell lymphoma characterized by weak/absent expression of conventional B-cell markers and strong expression of plasma cell markers. It is strongly associated with human immunodeficiency virus (HIV) and Epstein Barr virus infection, and shows an unusual tropism to the oral cavity. Herein we describe a patient with AIDS who presented with weight loss and dysphagia owing to a large gastroesophageal mass. His radiographic and endoscopic findings and long history of cigarette consumption suggested carcinoma. Biopsy demonstrated a poorly differentiated tumor stained negatively to routine lymphoid markers including CD20. However, gene rearrangement studies confirmed a B-cell process and a more detailed immunohistochemical analysis revealed the cells stained positively for CD138 (plasma cell antigen). These findings were diagnostic of PBL. Our report reviews the wide differential diagnosis of PBL and underscores the importance of a broad array of viral and molecular studies needed to establish this diagnosis.