Hand assessment.
In this article, David McKenna describes the basic anatomy and biomechanics of the hand and how these relate to hand examination and assessment of injury.
Biomechanical Phenomena↗
Biomedical subjects
David McKenna
Publications and source records attributed to David McKenna.
Successful adoptive transfer and in vivo expansion of human haploidentical NK cells in patients with cancer.
We previously demonstrated that autologous natural killer (NK)-cell therapy after hematopoietic cell transplantation (HCT) is safe but does not provide an antitumor effect. We hypothesize that this is due to a lack of NK-cell inhibitory receptor mismatching with autologous tumor cells, which may be overcome by allogeneic NK-cell infusions. Here, we test haploidentical, related-donor NK-cell infusions in a nontransplantation setting to determine safety and in vivo NK-cell expansion. Two lower intensity outpatient immune suppressive regimens were tested: (1) low-dose cyclophosphamide and methylprednisolone and (2) fludarabine. A higher intensity inpatient regimen of high-dose cyclophosphamide and fludarabine (Hi-Cy/Flu) was tested in patients with poor-prognosis acute myeloid leukemia (AML). All patients received subcutaneous interleukin 2 (IL-2) after infusions. Patients who received lower intensity regimens showed transient persistence but no in vivo expansion of donor cells. In contrast, infusions after the more intense Hi-Cy/Flu resulted in a marked rise in endogenous IL-15, expansion of donor NK cells, and induction of complete hematologic remission in 5 of 19 poor-prognosis patients with AML. These findings suggest that haploidentical NK cells can persist and expand in vivo and may have a role in the treatment of selected malignancies used alone or as an adjunct to HCT.
Acute Disease↗
Issues in the quality of umbilical cord blood stem cells for transplantation.
BACKGROUND: Because the frequency of umbilical cord blood (UCB) stem cell transplantation has increased, the quality of UCB available in banks is an important part of the success of UCB stem cell transplants. STUDY DESIGN AND METHODS: A quality assurance monitoring system was used to evaluate 268 UCB units provided to us for transplant by UCB banks in the United States and Europe. RESULTS: Quality issues were found in 151 (56%) of 268 units, and there were a total of 246 specific issues in 151 units. The issues involved quality control (54%), medical history (40%), and labels and documentation (6%). Risks to patients from these issues were likely in 10 percent, potential in 35 percent, and unlikely in 55 percent. CONCLUSION: Because standards have evolved over time, cord blood banks contain units that have different levels of quality. Some units have been placed in the usable inventory with incomplete test results and/or documentation or that may not meet the bank's own current criteria. Information about any quality or operating procedure deviation should be provided in sufficient detail and at the initiation of the search process so that transplant physicians can consider these quality issues against the unique value of a particular UCB unit.
Blood Banks↗
Antenatal sonographic diagnosis of massive subchorionic hematoma: a case report.
BACKGROUND: Massive subchorionic hematoma (MSH), described by Breus in 1892 (Breus mole), is a rare but serious condition in pregnancy in which a large amount of blood, mainly maternal, collects and dissects the chorionic plate from the villous chorion. CASE: A case of MSH was complicated by intrauterine growth retardation (IUGR) and intrauterine fetal death at 23 weeks' gestation. Pregnancy was complicated by advanced maternal age and chronic hypertension. There was no antenatal vaginal bleeding. Ultrasound at 19 weeks showed a small-for-gestational-age fetus, echogenic bowel and globular placenta. Amniocentesis revealed a normal male karyotype. At 23 weeks the patient presented with vaginal spotting, cramping and absent fetal heart tones. Labor was induced with misoprostol, and vaginal delivery occurred. The placenta showed an organized thrombus adherent to the chorionic plate, and a large subchorionic hematoma comprised at least half the disc volume. CONCLUSION: Antenatal sonographic diagnosis of MSH and IUGR can be achieved.
Adult↗
Decreasing infectious morbidity in cesarean delivery by changing gloves.
OBJECTIVE: To assess whether changing the entire surgical team's gloves intraoperatively, after delivery of the placenta, would reduce the rate of postcesarean wound infection. STUDY DESIGN: Women who underwent cesarean delivery were randomized to a group where the surgical team changed the surgical gloves after delivery of the placenta or to a control group, where surgical gloves were not changed during the cesarean procedure. RESULTS: Ninety-two patients were randomized to 2 groups of 46 patients each. The group where the surgical team changed their gloves had significantly less serosanguineous drainage 24 hours after surgery (3 vs. 8 patients, 8.3% vs. 22.2%, P = .2, RR 2.7, CI 0.7, 12.4) and fewer wound infections (2 vs. 9 women, 5.5% vs. 25%, P = .05, RR 4.5, CI 0.982, 29.8). CONCLUSION: Obstetricians may decrease the number of postcesarean wound infections by having the entire team change surgical gloves after delivery of the placenta.
Adult↗