Journal of Vascular Surgery Cases and Innovative Techniques, Mar 1, 2019
Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastr... more Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastric artery aneurysms (HAAs) are exceptionally rare. The general approach to HAAs has been exclusion and bypass, although when this is complicated by mycotic disease, endovascular techniques can provide unique approaches to management. We present the case of a patient with a mycotic HAA treated with endovascular coil and exclusion followed by aortic to external iliac artery bypass with cadaveric conduit.
More tban a century after Its original description, hereditary angioedema (HAE) has become a keys... more More tban a century after Its original description, hereditary angioedema (HAE) has become a keystone in both clinical medicine and biomedical research. To the clinician, this inherited disorder offers the challenge of accurate diagnosis, as well as the immense reward associated with curing a potentially fatal disease For the laboratory scientist, this protein deficiency l)ridges the worlds of complement, kinins, coagulation, and fibrinolysis. Hereditary angioedema is the most common genetically determined disease of the complement system. It is a disorder characterized clinically by recurrent attacks of acute circumscribed edema and biochemically by reduced functional activity of the inhibitor of the first component of the complement cascade, Cl esterase inhibitor (Cllnh). The defect is transmitted as an autosomal dominant trait but may occur spontaneously.' The prevalence of the disease in the United States is unknown but has been estimated to be approximately one in 500,000. HAE was described initially by Robert Graves in 1843 in his clinical lecture.Milton (1876)-' and Quincke (1882)' first recognized acute circumscribed edema of the skin without discoloration as a distinct clinical entity for which StriJbing'' in 1885 coined the term "angioneurosis." This term evolved from the faulty notion that the disease resulted from aberrant nervous control on the transudative ability of the vascular wall. Quincke, however, is credited by most as the first to describe the disease, and the eponym "Quincke's Edema" persisted well into the twentieth century. In 1888, William Osier described the first pedigree in which angioedema occurred in five generations of the same family and suggested its inherited nature.
Journal of Vascular Surgery Cases, Innovations and Techniques, 2019
Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastr... more Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastric artery aneurysms (HAAs) are exceptionally rare. The general approach to HAAs has been exclusion and bypass, although when this is complicated by mycotic disease, endovascular techniques can provide unique approaches to management. We present the case of a patient with a mycotic HAA treated with endovascular coil and exclusion followed by aortic to external iliac artery bypass with cadaveric conduit.
The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmic... more The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmicus (HZO). The child presented with a painless vesicular skin eruption covering the left forehead. There was only a history of household exposure to varicella zoster virus (VZV) and the child had not been vaccinated against VZV. PCR assays on vesicular fluid identified VZV DNA. Treatment with acyclovir was started early in the clinical course. In addition, the girl was treated with locally administered ophthalmological acyclovir ointment. Besides some dermal excoriations, a complete resolution of the HZO was achieved without sequelae.
Previous methods for purification of C1 inhibitor (C1 INH) have often resulted in a significant l... more Previous methods for purification of C1 inhibitor (C1 INH) have often resulted in a significant loss of the protein's inhibitory capacity. We have employed procedures which permit recovery of this alpha-globulin with an activity equal to that present in normal serum on a per weight basis. Pooled normal human plasma is precipitated with polyethylene glycol (PEG 4000) in the presence of epsilon aminocaproic acid (EACA). The 20 to 40% precipitate contains all the C1 inhibitor antigen. This precipitation results in the exclusion of C1 esterase and plasminogen and represents a 4-fold increase in the concentration of C1 inhibitor relative to plasma. The C1 inhibitor is chromatographed in DEAE cellulose permitting separation from α1 antitrypsin and the majority of albumin. The C1 inhibitor fractions are pooled and run sequentially on Sephacryl-200 and hydroxyapatite columns. The C1 inhibitor obtained after HT chromatography is devoid of contaminating proteins when subjected to disc gel...
Journal of Investigative Medicine High Impact Case Reports, 2021
In this article, we report a case of a 52-year-old female with no past medical history who presen... more In this article, we report a case of a 52-year-old female with no past medical history who presented with nausea, vomiting, and diarrhea following a naturopathic intravenous vitamin infusion that was administered in her home. She was found to have Pseudomonas fluorescens bacteremia, which is not commonly found in humans. We discuss when to suspect contamination, choosing the proper antibacterial regimen, and the potential risks of naturopathic medicine.
A 40-year-old woman with Sjögren's syndrome and mixed cryoglobulinemia, treated with corticos... more A 40-year-old woman with Sjögren's syndrome and mixed cryoglobulinemia, treated with corticosteroids, presented with small bowel obstruction temporally associated with cutaneous varicella-zoster (V-Z) infection. At laparotomy a portion of inflamed, necrotic small bowel was resected. Cells in the margin of the lesion exhibited characteristic intranuclear inclusion bodies. This case report emphasizes the multiple organ involvement that can occur with disseminated V-Z infection. Despite the rarity of gastrointestinal involvement, this infection must be included in the differential diagnosis of the acute abdomen in patients with cutaneous vesicles.
Complement and the spleen interact in host defense against the encapsulated Pneumococcus, respons... more Complement and the spleen interact in host defense against the encapsulated Pneumococcus, responsible for most OPSI. Splenectomized patients lack splenic phagocytes specialized to clear bacteria coated with only small amounts of IgG from the bloodstream, and they are unable to mount a sufficient antibody response for liver macrophages to overcome the defect.
To determine the effect of complement on the normal antibody response to T cell-dependent antigen... more To determine the effect of complement on the normal antibody response to T cell-dependent antigens, we immunized normal and C4 deficient guinea-pigs with bacteriophage phi X 174. Following primary immunization with a standard dose (2 X 10(9) PFU/Kg) given intravenously. C4 deficient guinea-pigs produced less antibody than normal guinea-pigs and were unable to maintain measurable antibody levels. Following secondary immunization, antigen clearance of C4 deficient guinea-pigs was delayed and the subsequent antibody response was identical to their primary response without amplification or isotype switch. Increased antigen dose and administration of antigen in adjuvants into footpads improved the responses but did not make them normal. The primary and secondary responses became essentially normal, however, when small amounts of normal guinea-pig serum were given to the deficient animals at the time of the primary (but not the secondary) immunization. We postulate that the contribution o...
Twenty cases of vertebral osteomyelitis from three community hospitals were reviewed. Routine spi... more Twenty cases of vertebral osteomyelitis from three community hospitals were reviewed. Routine spine radiographs were frequently normal in the setting of active vertebral osteomyelitis. Computed tomographic scanning of the spine frequently detected changes in the vertebral end plates that were diagnostic of vertebral osteomyelitis at a time when routine spine radiographs were unrevealing.
Journal of Vascular Surgery Cases and Innovative Techniques, Mar 1, 2019
Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastr... more Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastric artery aneurysms (HAAs) are exceptionally rare. The general approach to HAAs has been exclusion and bypass, although when this is complicated by mycotic disease, endovascular techniques can provide unique approaches to management. We present the case of a patient with a mycotic HAA treated with endovascular coil and exclusion followed by aortic to external iliac artery bypass with cadaveric conduit.
More tban a century after Its original description, hereditary angioedema (HAE) has become a keys... more More tban a century after Its original description, hereditary angioedema (HAE) has become a keystone in both clinical medicine and biomedical research. To the clinician, this inherited disorder offers the challenge of accurate diagnosis, as well as the immense reward associated with curing a potentially fatal disease For the laboratory scientist, this protein deficiency l)ridges the worlds of complement, kinins, coagulation, and fibrinolysis. Hereditary angioedema is the most common genetically determined disease of the complement system. It is a disorder characterized clinically by recurrent attacks of acute circumscribed edema and biochemically by reduced functional activity of the inhibitor of the first component of the complement cascade, Cl esterase inhibitor (Cllnh). The defect is transmitted as an autosomal dominant trait but may occur spontaneously.' The prevalence of the disease in the United States is unknown but has been estimated to be approximately one in 500,000. HAE was described initially by Robert Graves in 1843 in his clinical lecture.Milton (1876)-' and Quincke (1882)' first recognized acute circumscribed edema of the skin without discoloration as a distinct clinical entity for which StriJbing'' in 1885 coined the term "angioneurosis." This term evolved from the faulty notion that the disease resulted from aberrant nervous control on the transudative ability of the vascular wall. Quincke, however, is credited by most as the first to describe the disease, and the eponym "Quincke's Edema" persisted well into the twentieth century. In 1888, William Osier described the first pedigree in which angioedema occurred in five generations of the same family and suggested its inherited nature.
Journal of Vascular Surgery Cases, Innovations and Techniques, 2019
Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastr... more Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastric artery aneurysms (HAAs) are exceptionally rare. The general approach to HAAs has been exclusion and bypass, although when this is complicated by mycotic disease, endovascular techniques can provide unique approaches to management. We present the case of a patient with a mycotic HAA treated with endovascular coil and exclusion followed by aortic to external iliac artery bypass with cadaveric conduit.
The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmic... more The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmicus (HZO). The child presented with a painless vesicular skin eruption covering the left forehead. There was only a history of household exposure to varicella zoster virus (VZV) and the child had not been vaccinated against VZV. PCR assays on vesicular fluid identified VZV DNA. Treatment with acyclovir was started early in the clinical course. In addition, the girl was treated with locally administered ophthalmological acyclovir ointment. Besides some dermal excoriations, a complete resolution of the HZO was achieved without sequelae.
Previous methods for purification of C1 inhibitor (C1 INH) have often resulted in a significant l... more Previous methods for purification of C1 inhibitor (C1 INH) have often resulted in a significant loss of the protein's inhibitory capacity. We have employed procedures which permit recovery of this alpha-globulin with an activity equal to that present in normal serum on a per weight basis. Pooled normal human plasma is precipitated with polyethylene glycol (PEG 4000) in the presence of epsilon aminocaproic acid (EACA). The 20 to 40% precipitate contains all the C1 inhibitor antigen. This precipitation results in the exclusion of C1 esterase and plasminogen and represents a 4-fold increase in the concentration of C1 inhibitor relative to plasma. The C1 inhibitor is chromatographed in DEAE cellulose permitting separation from α1 antitrypsin and the majority of albumin. The C1 inhibitor fractions are pooled and run sequentially on Sephacryl-200 and hydroxyapatite columns. The C1 inhibitor obtained after HT chromatography is devoid of contaminating proteins when subjected to disc gel...
Journal of Investigative Medicine High Impact Case Reports, 2021
In this article, we report a case of a 52-year-old female with no past medical history who presen... more In this article, we report a case of a 52-year-old female with no past medical history who presented with nausea, vomiting, and diarrhea following a naturopathic intravenous vitamin infusion that was administered in her home. She was found to have Pseudomonas fluorescens bacteremia, which is not commonly found in humans. We discuss when to suspect contamination, choosing the proper antibacterial regimen, and the potential risks of naturopathic medicine.
A 40-year-old woman with Sjögren's syndrome and mixed cryoglobulinemia, treated with corticos... more A 40-year-old woman with Sjögren's syndrome and mixed cryoglobulinemia, treated with corticosteroids, presented with small bowel obstruction temporally associated with cutaneous varicella-zoster (V-Z) infection. At laparotomy a portion of inflamed, necrotic small bowel was resected. Cells in the margin of the lesion exhibited characteristic intranuclear inclusion bodies. This case report emphasizes the multiple organ involvement that can occur with disseminated V-Z infection. Despite the rarity of gastrointestinal involvement, this infection must be included in the differential diagnosis of the acute abdomen in patients with cutaneous vesicles.
Complement and the spleen interact in host defense against the encapsulated Pneumococcus, respons... more Complement and the spleen interact in host defense against the encapsulated Pneumococcus, responsible for most OPSI. Splenectomized patients lack splenic phagocytes specialized to clear bacteria coated with only small amounts of IgG from the bloodstream, and they are unable to mount a sufficient antibody response for liver macrophages to overcome the defect.
To determine the effect of complement on the normal antibody response to T cell-dependent antigen... more To determine the effect of complement on the normal antibody response to T cell-dependent antigens, we immunized normal and C4 deficient guinea-pigs with bacteriophage phi X 174. Following primary immunization with a standard dose (2 X 10(9) PFU/Kg) given intravenously. C4 deficient guinea-pigs produced less antibody than normal guinea-pigs and were unable to maintain measurable antibody levels. Following secondary immunization, antigen clearance of C4 deficient guinea-pigs was delayed and the subsequent antibody response was identical to their primary response without amplification or isotype switch. Increased antigen dose and administration of antigen in adjuvants into footpads improved the responses but did not make them normal. The primary and secondary responses became essentially normal, however, when small amounts of normal guinea-pig serum were given to the deficient animals at the time of the primary (but not the secondary) immunization. We postulate that the contribution o...
Twenty cases of vertebral osteomyelitis from three community hospitals were reviewed. Routine spi... more Twenty cases of vertebral osteomyelitis from three community hospitals were reviewed. Routine spine radiographs were frequently normal in the setting of active vertebral osteomyelitis. Computed tomographic scanning of the spine frequently detected changes in the vertebral end plates that were diagnostic of vertebral osteomyelitis at a time when routine spine radiographs were unrevealing.
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Papers by Stephen Hosea