Victor F. Kalasinsky

Embolized Crospovidone (poly[ N -vinyl-2-pyrrolidone]) in the Lungs of Intravenous Drug Users

Crospovidone is an insoluble polymer of N-vinyl-2-pyrrolidone that is used as a disintegrant in pharmaceutical tablets. It can potentially embolize to the lung when aqueous tablet suspensions are injected intravenously. In this report, we identified embolized crospovidone in autopsy-derived lung tissue from three adult IV drug users, 1 man and 2 women, whose ages respectively were 27, 38, and 40 years. Suspected crospovidone was compared with pharmaceutical-grade crospovidone by means of histochemical stains, transmission electron microscopy, and infrared spectroscopy. Similar particles were also observed by light microscopy in a 4-mg tablet of hydromorphone, a preparation prescribed to two of the patients. Two patients had sickle cell disease and were taking methadone and/or hydromorphone for pain management; the third was receiving parenteral hyperalimentation after small bowel resection. Crospovidone appeared as deeply basophilic, coral-like particles within pulmonary arteries and in extravascular foreign-body granulomas. Intrapulmonary crospovidone stained similarly to the pure substance, including intense staining with mucicarmine, Congo red, and Masson trichrome. With Movat pentachrome stain, both intravascular and purified crospovidone appeared orange-yellow, whereas most interstitial particles associated with giant cells stained blue-green. Alcian blue failed to stain intravascular or purified crospovidone but strongly decorated some phagocytized particles. Ultrastructurally, both purified powder and tissue deposits of crospovidone appeared as irregular, electron dense, laminated, and finely granular material. Intrapulmonary crospovidone was associated with inflammatory cells and exhibited degenerative changes. By infrared spectroscopy, crospovidone in tissue had the same spectral characteristics as pharmaceutical grade crospovidone and the library reference, polyvinylpyrrolidone (PVP). We conclude that crospovidone contributes to pulmonary vascular injury in some persons who illicitly inject pharmaceutical tablets. It is readily identifiable histologically and distinguishable from other tablet constituents, such as cornstarch, talc, and microcrystalline cellulose. The variable staining with Alcian blue and Movat suggests that crospovidone is altered in vivo by the inflammatory response.

Elemental analysis and clinical implications of calcification deposits associated with silicone breast implants.

Calcification of the fibrous capsule surrounding silicone breast implants is a well-recognized occurrence that increases with time following implantation. These mineralized deposits potentially confound mammographic breast cancer surveillance already made difficult by the obscuring effects of silicone breast implants. The authors performed elemental analysis of silicone breast implant-associated calcifications to define better their chemical composition as related to mammographic and clinical significance. Electron probe microanalysis and infrared spectroscopy revealed all of the calcification deposits to be calcium complexed with tribasic phosphate. No evidence of calcium oxalate, calcium carbonate, silicone, or talc was observed. Caution must be employed in interpreting mammograms in women with silicone breast implants as well as those who have had their silicone breast implants removed. High-density mammographic calcifications indicative of calcium phosphate associated with a silicone breast implant may represent an accepted consequence of implantation or nearby carcinoma. We recommend baseline mammography on women who have had their silicone breast implants removed to prevent unnecessary fine-needle aspiration or tissue biopsy of retained breast capsule calcifications during subsequent routine surveillance for carcinoma.

Biomedical Applications of Infrared and Raman Microscopy

INTRODUCTION The desire to analyze smaller and smaller amounts of material is a common goal as we push the limits of technology in trying to solve chemical and biochemical problems. In gas chromatography, fused-silica capillary columns (0.25 mm) have almost completely replaced larger-bore (1/4 and 1/8-inch) packed columns [1], and as detection limits are reduced in liquid chromatography, microbore columns with inner diameters of 1 mm or less are quickly replacing the more traditional 4-mm columns [2]. Capillary electrophoresis is likewise demonstrating advantages over conventional gel electrophoresis for many applications [3]. Mass spectrometers are now capable of detecting and identifying materials in the picogram to femtogram range [4]. Vibrational spectroscopic measurements which are the subject of this review currently utilize the experience of optical microscopists in configuring instrumentation to analyze extremely small specimens.

Scaled quantum mechanical force field for cis- and trans-glycine in acidic solution

Abstract We obtain one set of ab initio scale factors for two conformational isomers of glycine in acidic solution. Ab initio calculations are performed using the 4-31 G basis set. Force constants from two fully optimized glycine-H + ·4H 2 O supermolecules are scaled using vibrational frequencies of glycine in water at pH 0.8. Similar calculations are shown for methylamine-H + and acetic acid. Reasonable agreement is obtained between calculated and experimental frequencies for glycine-H + , acetic acid, and methylamine-H + . Comparisons between scale factors for these molecules show that scale factors for the same symmetry coordinates are similar in most cases and indicate the extent to which scale factors can be transferred between these molecules. These scale factors are being used to build a scaled quantum mechanical force field for alanine, and subsequently for peptides in aqueous solutions.

Characterization of acrylic polyamide plastic embolization particles in vitro and in human tissue sections by light microscopy, infrared microspectroscopy and scanning electron microscopy with energy dispersive X-ray analysis

Vascular embolization is a well-established practice for the treatment of tumors and vascular lesions. Rounded beads (microspheres) of various materials (collagen, dextran and trisacryl-polymer-gelatin) were developed to solve problems encountered with earlier versions of embolic material. We performed histochemistry, Fourier transform infrared microspectroscopy and scanning electron microscopy with energy dispersive X-ray analysis on two uterine and one hepatic specimen with unidentified intravascular foreign material, and examined a reference embolization product for comparison. The hematoxylin and eosin stained tissue sections showed multiple foci with unidentified intravascular foreign material and fibrous obliteration of vessel lumens. Only one case had a clinical history of previous embolization but without specifying the material used. One case was submitted for identification of a ‘parasite’. The material stained positively with Sirius red and mucicarmine, variably with Massons trichrome stain and Movat pentachrome, and did not stain centrally with periodic acid Schiff with diastase. Infrared spectrophotometric analysis of the material from all three cases demonstrated the spectrum of acrylic polyamide plastic. A control sample of EmboGold™ exhibited infrared microspectroscopic spectra similar to the three tissue specimens. Analysis by scanning electron microscopy with energy dispersive X-ray analysis demonstrated some differences in elemental composition between the tissue sections and the selected reference material. To our knowledge, this is the first report of infrared spectrophotometric analysis with scanning electron microscopy with energy dispersive X-ray analysis of an acrylic polyamide plastic embolization product both in vitro and in human histologic tissue sections. In cases lacking appropriate clinical information, identification by these methods and/or a panel of special stains may assist pathologists unfamiliar with this materials light microscopic appearance.

Wound complications following the use of FiberWire in lower-extremity traumatic amputations. A case series.

With the development of new arthroscopic approaches over the last decade, one innovation that has facilitated this trend has been the introduction of high-tensile-strength sutures. These nonabsorbable sutures allow for the reliable and secure fixation of soft tissues, such as the glenoid labrum and rotator cuff, to bone by means of anchors1,2. Similarly, these sutures have gained great acceptance in open procedures, such as tendon repairs and suture fixation of fracture fragments3. FiberWire (Arthrex, Naples, Florida) is one of the first members of this family of sutures. Currently, it is one of the most commonly used high-tensile-strength sutures in orthopaedic surgery. FiberWire is composed of an ultra-high molecular weight polyethylene multifilament core surrounded by a braided polyester jacket4. A silicone coating has been added to the surface of the polyester jacket to improve the handling and knot-tying characteristics of the suture. Ticron (Tyco, Waltham, Massachusetts) is the only other high-tensile-strength suture sold in the United States that has an outer silicone coating. The remaining high-tensile-strength sutures all employ proprietary blends of polyethylene and polyester without the use of a silicone coating. Over a two and a half-year period, we performed or revised 193 lower-extremity amputations at our institution in our treatment of injured soldiers. Because of its strength and the excellent documented clinical experience with FiberWire, we used it to suture the myodesis in 178 (92%) of the 193 transtibial and transfemoral amputations. Recently, five patients with similar-appearing draining sinuses through previously well-healed incisions presented during follow-up visits for the lower-extremity amputations. In all five patients, FiberWire had been used to secure the myodesis. This clustering of similar complications suggested a common cause. Thus, a quality assurance review was initiated. The purpose of this case series is to present the results of …

Scaled quantum mechanical force field for glycine in basic solution

We obtain scale factors for three glycinate-nH2O ab initio force fields, using the 4–31G basis set, that can be used in building a scaled quantum mechanical force field for alanine and, subsequently, for peptides in aqueous solutions. Force constants from the fully optimized glycinate-nH2O supermolecules were scaled by using experimentally determined vibrational frequencies of glycine in water at pH 13. Similar calculations were performed for methylamine and acetate. Scale factors for the stretching modes of acetate are within 2% of the related scale factors for glycinate. The scale factor for the NH2 scissor mode in methylamine is also in agreement with that of glycinate. Changes in the scale factors as a function of the number of hydrating water molecules were also similar between glycinate and acetate. Amine groups showed relatively small changes. Scale factors for glycinate with no hydrating molecules were extrapolated from the supermolecule results, since the optimized structure of isolated glycinate obtained with the 4–31G basis set yielded one imaginary frequency. Good agreements between calculated and experimental frequencies for glycinate, acetate, and methyl amine were obtained for each set of scale factors. Scaling appears to compensate for the systematic effects of hydration on force constants, making it possible to obtain reliable frequency predictions for amino acids in water without resorting to expensive super-molecule calculations.

Spectrophotometry of human hemoglobin in the midinfrared region

Absorbance spectra for the hemoglobin species, including oxy-, deoxy-, carboxy-, and methemoglobin in the midinfrared region, are presented. The absorbance spectra of all species in aqueous solution are similar with absorption bands centered at approximately 3280, 3080, 2964, 1653, 1541, 1456, 1396, 1302, 1248, and 1105 cm−1. The relationship of the midinfrared absorption bands to the near-infrared absorption bands of the same four hemoglobin species is discussed.

Wound Fragments from Cutaneous Sites of U.S. Military Personnel Deployed in Operation Iraqi Freedom: Clinical Aspects and Pathologic Characterizations

BACKGROUND A wide variety of materials present in current military conflict zones may be implanted and retained as “foreign bodies” or fragments in wounds. Analysis of removed fragments can be valuable to the patient, for research purposes, and for the protection of future potential victims. OBJECTIVES The objectives were to evaluate the composition of retained fragments in wounds from combat injuries and correlate this information with the mechanism of injury. METHODS Wound fragments from 10 U.S. military personnel wounded while deployed in Iraq for Operation Iraqi Freedom were removed from their skin and were subjected to gross examination, light microscopy, and scanning electron microscopy/energy-dispersive X-ray analysis (SEM-EDXA), with specimen radiography and infrared spectroscopy if indicated. RESULTS A variety of exogenous substances, including iron, lead, antimony, copper, aluminum, and acrylonitrile-styrene plastic were detected. No (depleted) uranium was detected. There was a high degree of correlation between the composition of the fragment removed and the wounding event. CONCLUSIONS Wound fragments may take months to years to manifest. Their gross appearance can be misleading. Establishing the composition of retained materials in wounds may assist in the clinical care of the wounded, provide forensic information, and have broader value in wound analysis and research.

Forensic visualization of foreign matter in human tissue by near‐infrared spectral imaging: Methodology and data mining strategies

Rapidity of data acquisition, high image fidelity and large field of view are of tremendous value when looking for chemical contaminants or for the proverbial “needle in the haystack” – in this case foreign inclusions in histologic sections of biopsy or autopsy tissues. Near infrared chemical imaging is one of three chemical imaging techniques (NIR, MIR and Raman) based on vibrational spectroscopy, and provides distinct technical advantages for this application.