Philip R. Faught

A reproducible rat liver cancer model for experimental therapy: Introducing a technique of intrahepatic tumor implantation

To investigate therapeutic strategies for hepatoma, it is necessary to have a reproducible animal model with a tumor growth pattern allowing accurate assessment of results. Many techniques of intrahepatic tumor implantation (IHTI) have been devised for intrahepatic tumor models. Most of them, however, have the disadvantage of high rates of artificial tumor dissemination during tumor implantation, which interferes with the evaluation of therapy. To overcome this problem, we have developed a technique of IHTI in which a piece of Gelfoam is placed into a small incision in the liver for the purpose of both hemostasis and formation of a tension-free pocket to accept the tumor implant. In 583 ACI rats receiving IHTI with Morris hepatoma 3924A, the tumor take rate was 100%. Resembling the natural course of human hepatoma, the implanted tumor grows locally early in the course of disease and eventually invades the surrounding organs causing ascites and also metastasizes to the lung. Liver microangiography demonstrated that the tumor received blood supply mainly from the hepatic artery. This IHTI technique was also compared to two other methods of IHTI: insertion of fragments without using Gelfoam and implantation with a tumor cell suspension. A significantly lower rate of early lung metastases was achieved with our technique (0%) in comparison with other two techniques (41 and 80%). We conclude that this rat liver cancer model is reproducible and allows efficient evaluation of treatment modalities for liver cancer without interference from tumor at undesirable sites.

Experience with juvenile polyps in North American children: the need for pancolonoscopy

We report a recent experience with juvenile polyps (JP) in a large cohort of North American children to determine if a pancolonoscopy (PC) is needed in all children with suspected polyps. We reviewed hospital charts of all patients with JP seen over a 9-yr period (January, 1990–October, 1998). A total of 331 JP were encountered during 195 procedures in 184 patients (64% males, 88% white, mean age 5.93 yr [range 0.42–15.5 yr], median age 4.84 yr). Painless rectal bleeding was the commonest symptom. PC was performed in 42% (82/195) of procedures, and 177 JP were encountered: 54% (97/177) were in the rectosigmoid colon, 14% (24/177) were in the descending colon, and 32% (56/177) were proximal to the splenic flexure (i.e., proximal polyps). Overall, proximal polyps were seen in 37% (31/82) of PC. Only proximal polyps were noted in 12% (10/82) of PC. Five patients were re-endoscoped after an initial limited examination because of continuing symptoms from proximal polyps. All but one of the polyps had typical features of a JP on histological examination. Though most JP are located in the left colon, a PC should be the initial procedure because: 1) 37% of PC revealed proximal polyps, 2) 32% of polyps were located proximal to splenic flexure, 3) persistence of symptoms from missed proximal polyp(s) necessitates a repeat study with attendant risks, and 4) there is a possibility of malignant transformation in an unidentified JP.

Effect of omental, intercostal, and internal mammary artery pedicle wraps on bronchial healing☆

Bronchial transection and devascularization is necessary in the course of sleeve resection or lung transplantation, leaving distal bronchial segments ischemic and subject to stricture or dehiscence. Thirty mongrel dogs underwent left lung autotransplantation. The bronchial anastomosis was wrapped with omentum (n = 9), intercostal muscle pedicle (n = 9), or internal mammary artery pedicle grafts (n = 6). Six control animals underwent bronchial anastomosis without an external wrap. Bronchial revascularization by capillary ingrowth from the pedicle to the bronchial submucosal plexus was demonstrated with all three types of vascular pedicle grafts; however, more consistent and confluent vascular ingrowth was provided by internal mammary artery pedicle grafts. Additionally, the bronchial anastomotic cross-sectional area was significantly better in the internal mammary artery group (84.5 +/- 3.3) as compared with that of the omental (68.4 +/- 8.3), intercostal muscle (66.9 +/- 10.9), or control groups (70.2 +/- 7.6). An internal mammary artery pedicle graft and the presence of dense confluent submucosal vascular ingrowth from any pedicle graft were independently predictive (p less than 0.05) of minimizing bronchial anastomotic narrowing. These data are consistent with previous findings suggesting that omental and intercostal muscle pedicle grafts promote early bronchial revascularization; moreover, the data demonstrate the superiority of an internal mammary artery pedicle graft to provide submucosal vascular ingrowth and to minimize anastomotic stenosis.

At what age is a suction rectal biopsy less likely to provide adequate tissue for identification of ganglion cells

Objective:The objective of this study was to determine at what age suction rectal biopsy is less likely to provide adequate tissue to detect submucosal ganglion cells in a child being evaluated for Hirschsprung disease. Patients and Methods:Children ≥1 year of age undergoing a rectal biopsy at a single childrens hospital had 1 biopsy each obtained simultaneously with a suction biopsy device and a grasp biopsy forceps. The biopsies were examined by 2 pathologists for adequacy of the submucosa (none, scant, adequate, or ample) and the presence of ganglion cells. The 2 specimens were compared with each other. Results:One hundred fifty-two children 1 to 17 years of age were included. Fifty-three were female. Subjects were grouped into 4 age categories: 1 to 3 years (group A), 4 to 6 years (group B), 7 to 9 years (group C), and ≥10 years (group D). Similar numbers of patients were recruited for each group. Ganglion cells were identified in 73% and 90% by the suction and grasp devices, respectively, in group A. In groups B through D, ganglion cells were identified in 50% to 53% vs 92% to 97% of the suction and grasp biopsies, respectively (P < 0.001). Submucosa was present in 88% (suction) vs 98% (grasp) in group A, 70% vs 95% in group B, 69% vs 94% in group C, and 45% vs 92% in group D. Conclusion:The suction rectal biopsy is less likely to provide adequate submucosa for identification of ganglion cells after 3 years of age.

Disseminated toxoplasmosis resulting in graft failure in a cord blood stem cell transplant recipient.

Toxoplasmosis is an infrequent infection with a high mortality rate in hematopoietic stem cell transplant recipients, and is usually caused by reactivation of prior, latent infection upon intensive immunosuppression. We report a case of fatal disseminated toxoplasmosis, diagnosed at autopsy, in a 7‐year‐old boy who received a cord blood graft for recurrent acute lymphoblastic leukemia. This case represents both the first reported case of toxoplasmosis in an engrafted cord blood recipient, and also of graft failure due to toxoplasmosis. Recommendations for toxoplasmosis diagnosis, treatment, and prophylaxis in stem cell transplant recipients are reviewed. Pediatr Blood Cancer 2007;48:222–226.

On the spectrum of limb-body wall complex, exstrophy of the cloaca, and urorectal septum malformation sequence.

The limb‐body wall complex (LBWC) is characterized by abdominal wall and limb defects, exstrophy of the cloaca (EC) by lack of closure of the lower abdominal wall and lack of cloacal septation, and the urorectal septum malformation sequence (URSMS) by absent perineal and anal openings, ambiguous genitalia, colonic, and renal anomalies. We report here on three fetuses whom have overlapping features of these disorders. Also we have reviewed the literature for cases with overlapping features of two or three of the above conditions. From the description of the cases reported on here and those in the literature, we propose that the overlap of features found among LBWC, EC, and URSMS represent a continuous spectrum of abnormalities, rather than three separate conditions. As such, we suggest that all three conditions may share a common etiology or pathogenetic mechanism.

Pancreatic Cystadenoma in an Infant: Ultrastructural Study

A 10 x 6 x 4 cm multicystic cystadenoma arose in the pancreas of a 4-month-old male. Microscopically, the cysts were lined by short columnar or cuboidal cells that contained neither mucin nor glycogen. The lining cells had occasional nucleoli, contained electron dense vacuoles and apical aggregates of filaments, and were associated with a basal lamina. This is the youngest patient reported as having pancreatic cystadenoma, and the ultrastructure of the neoplasm was different from the 6 previously studied adult cases, suggesting that infantile and adult cystadenomas are different in nature.

Adenoid cystic carcinoma of the lacrimal gland in a six-year-old girl.

A 6-year-old white female was found to have an adenoid cystic carcinoma originating in a lacrimal gland. Eighteen months following diagnosis, the tumor recurred. Conservative surgery has been the sole mode of therapy. To date, after four operations and quadrimenstral imaging surveillance, there is no sign of disease progression. Our purpose is to record the unusual occurrence of an adenoid cystic carcinoma of the lacrimal gland in a child. An interim report, 32 months after diagnosis, is presented.

Peritracheal Fibrosis Induced by Sclerosing Agents: A Putative Treatment for Tracheomalacia

Tracheomalacia is a congenital or acquired deficiency of the cartilages of the trachea. Treatment procedures include formation of external support by insertion of cartilage; bone for foreign material into the peritracheal tissue. A sclerosing agent, sodium morrhuate, was injected in the peritracheal tissue, blindly or after skin incision and subcutaneous tissue. In both groups peritracheal granulation tissue and inflammation evolved into peritracheal fibrosis surrounding the cartilage at the site of injection. The reaction was more pronounced following incision of the skin. No fibrosis was observed in a control group following hypertonic saline injection. The results suggest that injection of sclerosing agents might be considered as a conservative mode of treatment in tracheomalacia, by producing peritracheal fibrosis as external support.

Carcinoma of thyroglossal duct remnants: Report of three cases and a review of the literature

Neoplastic transformation in thyroglossal duct (TGD) remnants is estimated to occur in about 1% of TGD cysts, with a total of 243 cases reported in the literature. Three new cases and a review of the literature are presented. All cases of TGD cysts at Indiana University Medical Center between 1981 and 1994 were examined. Of 70 cases of TGD cysts, 3 were found to have TGD carcinomas (papillary carcinoma [2] and follicular carcinoma [1]). The latter is the sixth reported case. About 80% of the reported cases were papillary thyroid carcinomas. In most cases of TGD carcinoma, the diagnosis was not clinically apparent. Few reports emphasize the role of needle aspiration and imaging procedures in the preoperative diagnosis of these tumors. The Sistrunk procedure is the standard treatment of TGD carcinoma; the need for thyroidectomy, however, remains controversial. Recommendations for management include: 1) fine needle aspiration as appropriate for presurgical evaluation; 2) the Sistrunk procedure alone when the diagnosis is papillary carcinoma and there is no clinical or radiologic evidence of thyroid gland involvement; 3) total thyroidectomy and radioactive iodine therapy for TGD follicular carcinoma; and 4) long-term thyroid hormone suppressive therapy in all cases.