Reticuloendothelial System Phagocytic Function in Patients with Hodgkin''s Disease

Phagocytic function of the reticuloendothelial system as measured by the clearance of (125)I-labeled aggregated human serum albumin (AA) was studied in patients with Hodgkin's disease. Each more advanced stage of the disease was associated with more rapid clearance of the AA. Production of remission by radiation therapy or by chemotherapy was associated in some patients with slowing of the clearance rate, whereas relapse seemed to be associated with acceleration. Thus, impaired phagocytosis cannot be implicated in the several defects in immunity known to be present in Hodgkin's disease. Furthermore, determination of the clearance rate of AA in patients with Hodgkin's disease may have clinical usefulness as another indicator of extent or activity of disease.     

Cardiorespiratory function in asymptomatic survivors of neonatal respiratory distress syndrome

We measured cardiopulmonary function at rest and during exercise in 15 healthy survivors of neonatal respiratory distress syndrome (RDS) and compared the results with those in 15 normal subjects. The mean birth weight of the RDS group was 1,771 g, and 12 of the 15 patients had required endotracheal intubation. The oxygen scores ranged from 79 to 3,322. Five of the 15 RDS patients had abnormal results of pulmonary function studies at rest. Peak expiratory flow was lower (P less than 0.05) in the RDS group (2.98 liters/min) than in the control group (3.57 liters/min). A negative correlation was noted between the forced expiratory flow between 25 and 75% of vital capacity and the oxygen score in these patients. Exercise tolerance was below normal in two of the RDS patients, both of whom also had abnormal pulmonary function at rest. One patient in the RDS group had systemic arterial hypertension at rest and during exercise. No significant differences in exercise tolerance or the cardiorespiratory response to exercise were observed between the two groups.     

Abnormalities of in vitro immunoglobulin synthesis by peripheral blood lymphocytes from untreated patients with Hodgkin''s disease

The immunoglobulin-synthesizing activities of peripheral blood mononuclear cells from 57 untreated patients with Hodgkin's disease and 47 normal subjects were compared. Cumulative amounts of IgM and IgG synthesized and secreted by unstimulated and pokeweed mitogen-stimulated cells over a 7-d period were determined in a solid-phase radioimmunoassay. Synthesis of IgM in unstimulated cultures and of both IgM and IgG in cultures stimulated with pokeweed mitogen was markedly reduced in patients with Hodgkin's disease, whereas the mean level of the spontaneous IgG synthesis was enhanced. The degree and frequency of in vitro abnormalities were not influenced by disease stage or histology. Depression of pokeweed mitogen-induced immunoglobulin synthesis did not correlate with excessive number of monocytes and it was unaffected by removal of phagocytic cells or addition to the cultures of monocytes from normal individuals. On the other hand, monocytes isolated from blood of patients with Hodgkin's disease were even more effective than normal monocytes in supporting pokeweed mitogen-induced immunoglobulin synthesis by normal phagocyte-depleted mononuclear cells. Synthesis of both IgM and IgG induced by pokeweed mitogen remained subnormal after addition to patient B cell cultures of autologous irradiated T cells or allogeneic normal T lymphocytes. T cells from patients with Hodgkin's disease appeared at least as effective as normal T cells in helping pokeweed mitogen-induced immunoglobulin production by normal B cells. However, when normal T cells were co-cultured with B cells from patients with Hodgkin's disease, spontaneous IgG synthesis declined, whereas the addition of patient T cells to normal B cells resulted in an increase of spontaneous IgG synthesis. In patients showing depression of pokeweed mitogen-induced immunoglobulin synthesis the lymphoproliferative response and immunoglobulin synthesis stimulated by Staphylococcus aureus bacteria of the Cowan first strain, a T cell independent B cell mitogen, were also markedly reduced. These studies demonstrate impairment of immunoglobulin synthesis by cultured lymphocytes from untreated patients with Hodgkin's disease after stimulation with polyclonal B cell activators and suggest that the in vitro abnormalities may be, at least in part, the result of a preexisting in vivo activation of lymphocytes in Hodgkin's disease patients.     

Considerations for resuscitation at high altitude in elderly and untrained populations and rescuers

With the development of transportation technologies, elderly people with chronic diseases are increasingly enjoying trekking and tours of nature resorts that include mountain highlands. Because of problems related to circulation, respiration, metabolism, and/or the musculoskeletal system in this population, the impact of high altitude on cardiopulmonary function is increased. Alpine accidents, therefore, tend to be more common in this population, and cases of cardiopulmonary arrest (CPA) at high altitudes seem to be increasing. However, relatively few studies have described cardiopulmonary resuscitation (CPR) at high altitudes. Although insufficient studies are available to standardize CPR guidelines at high altitude at this time, the aim of this review is to summarize previous studies relevant to physiologic changes after exposure to high-altitude environments and exercise, which may be a risk factor for CPA in elderly trekkers. In addition, we summarize our previous studies that described the effect of CPR procedures on cardiopulmonary function in untrained rescuers. The available data suggest that prolonged CPR at high altitudes requires strenuous work from rescuers and negatively affects their cardiopulmonary physics and subjectively measured fatigue. Alpine rescue teams should therefore be well prepared for their increased physical burden and difficult conditions. Elderly travelers should be made aware of their increased risk of CPA in alpine settings. The use of mechanical devices to assist CPR should be considered wherever possible.     

In vivo platelet function following cardiopulmonary bypass

In order to test the in vivo hemostatic function of platelets exposed to cardiopulmonary bypass, template bleeding times (TBT) were performed prebypass, three hours postbypass and 18 to 20 hours postoperatively in 22 patients undergoing open-heart surgery. The Harker-Slichter formula was applied to platelet counts below 100,000/cu mm to determine the expected TBT if the platelets function normally but were associated with a prolonged bleeding time merely from thrombocytopenia. Half of the patients received only frozen erythrocyte transfusions. Twenty of the 22 patients (91%) had normal or shorter than the expected TBT. Eight of the ten patients with platelet counts under 100,000/cu mm had shorter than predicted TBTs. All of the patients receiving only frozen erythrocytes had normal or shorter than predicted TBTs. It is concluded that in vivo platelet hemostatic function is usually normal postbypass, that routine platelet transfusions are therefore not necessary, and that most open-heart surgical procedures can be performed using frozen erythrocyte transfusions exclusively.     

Relationship between cardiopulmonary resuscitation and injuries of the cardiac conduction system: pathological features and pathogenesis of such injuries

OBJECTIVE: The purpose of this study was to assess the incidence, features, and pathogenesis of microscopic injuries to the cardiac conduction system caused by cardiopulmonary resuscitation. DESIGN:: Prospective study. SETTING: Autopsy unit of the university. PATIENTS: Victims who had been transferred to the emergency room due to cardiac arrest arising from nontraumatic cause plus age-matched control patients. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The cardiac conduction system of 80 hearts without gross injury from patients who had received cardiopulmonary resuscitation due to nontraumatic causes was examined. Of these 80 patients, seven (9%) showed fresh injuries, including a lesion that had gone unreported in the previous literature. Localized hemorrhage without inflammatory reaction was evident in six of these patients. Three of the six patients showed hemorrhage in the sinoatrial node, whereas the other three patients showed hemorrhage in the atrioventricular conduction system. The remaining one patient showed localized dissection of the atrioventricular node artery with the appearance of red blood cells in the false lumen. There was no significant difference with regard to age, gender, cause of cardiopulmonary arrest, whether victim had received electrical shock treatment, whether victim had received anticoagulants, and the duration of cardiopulmonary resuscitation between the seven patients with fresh injuries and the other 73 patients. Fracture of the sternum or rib was found in only one of the seven patients but in 14 of the 73 patients. No pathologic lesions were found in the 30 control patients who did not receive cardiopulmonary resuscitation. CONCLUSIONS: It can be presumed that injuries to the conduction system do occur in limited regions during cardiopulmonary resuscitation. Minute differences in the location of the cardiac silhouette or cardiac conduction system also need to be considered, rather than just the severity of force to the anterior chest, when determining the pathogenesis of these injuries.     

Anesthesia, cardiopulmonary bypass, and the pregnant patient

For the perioperative management of pregnant patients with severe cardiac or aortic disease who require a cardiac surgical procedure and cardiopulmonary bypass, a close, cohesive, working relationship must exist among several medical and surgical specialties. For appropriate management, the well-being of both the mother and the fetus must be considered. The best interests of the mother and the fetus may not coincide, and optimal therapy for one may be inappropriate for the other. We present 10 cases of severe cardiac or aortic disease in pregnant women who required surgical intervention. Eight patients underwent cardiopulmonary bypass during pregnancy, and two patients had cesarean section performed immediately before cardiopulmonary bypass. We also discuss the pertinent pharmacologic aspects related to the perioperative period and the management of cardiopulmonary bypass for the pregnant patient.     

Complications after megavoltage therapy of Hodgkin's disease.

56 patients with Hodgkin's disease treated with large field megavolt irradiation are presented. Complications in the parenchymal organs were few, although patients developed an appreciable grade of pulmonary radiofibrosis, two patients had a myocardial infarction and one patient thrombosis of the portal veins. Depression of the bone marrow frequently interfered with the radiation treatment. In five cases radiotherapy had to be discontinued. In three cases bone marrow depression persisted to the time of death. The total mode treatment was often to be discontinued and the treatment with cytostatics was started. The extended and total node treatment for Hodgkin's disease must be planned to spare as much of the bone marrow as possible.     

Relatives in the resuscitation room: their point of view.

OBJECTIVE: To investigate whether bereaved next of kin would like to have been present in the resuscitation room during attempted cardiopulmonary resuscitation of their relative, and their experience or knowledge of what is involved in cardiopulmonary resuscitation. METHODS: The next of kin of patients who had recently died after unsuccessful cardiopulmonary resuscitation in the accident and emergency department were contacted initially by telephone and then sent a postal questionnaire. RESULTS: Four (11%) of 35 respondents had been asked whether they wished to be present in the resuscitation room; 24 (69%) would like to have been offered the opportunity, even though not all would have accepted. The respondents had a wide variety of perceptions of what happens during resuscitation, few of which corresponded to clinical practice. CONCLUSIONS: Most relatives of patients requiring cardiopulmonary resuscitation would like to be offered the possibility of being in the resuscitation room; this could have several benefits.     

Paraneoplastic brachial plexopathy in a patient with Hodgkin's disease.

We describe a case of inflammatory brachial plexopathy that occurred in the context of a mild, diffuse sensorimotor peripheral neuropathy associated with Hodgkin's disease. Clinical, electrophysiologic, and pathologic studies helped distinguish this disorder from other causes of brachial plexopathy in patients with cancer. Treatment with corticosteroids seemed beneficial in this patient. We suggest that this may be another type of paraneoplastic condition associated with Hodgkin's disease.     

B Lymphocytes in Untreated Patients with Malignant Lymphoma and Hodgkin''s Disease

B and T lymphocytes in 37 untreated patients with malignant lymphoma and Hodgkin's disease were studied. B cells in the peripheral blood were investigated with respect to surface immunoglobulins and in a few patients with respect to intracytoplasmic immunoglobulins by means of immunofluorescence. T cell function was studied by direct phytohemagglutinin (PHA) microtest (from the same sample of whole blood), mixed lymphocyte culture (MLC), and by delayed hypersensitivity to various antigens. In the 13 patients with Hodgkin's disease the histologic subtype was nodular sclerosis in nine, lymphocyte predominant in two, mixed cellularity in two. Only one of these patients had disseminated disease (stage IV); he showed impaired cellular immunity, a very low percentage of B cells and low levels of serum immunoglobulins. Of the remaining patients with Hodgkin's disease, with one exception, normal percentages but rather low absolute numbers of B lymphocytes per mm(3) of blood were found. One patient with a low percent and low absolute number of B lymphocytes showed very high serum IgG. Of 24 patients with non-Hodgkin's malignant lymphoma, seven (29%) showed monoclonal B cell proliferation in the peripheral blood (five mukappa, two gammakappa). By morphologic criteria, 14 patients had involvement of bone marrow, five of these had involvement of peripheral blood. Four of the latter five patients showed marked increases in percentages and absolute numbers of B lymphocytes in the peripheral blood reflecting the monoclonal proliferation. In three additional patients monoclonal proliferation of lymphocytes was found by immunofluorescence although the blood smears appeared morphologically normal. Serum immunoglobulin abnormalities without monoclonal B cell proliferation in the peripheral blood were observed in six patients.     

机械心肺复苏对心脏骤停患者复苏效果影响的Meta分析

目的评价使用机械心肺复苏对心脏骤停患者复苏结局的影响。方法系统检索中国知网、维普、万方、PUBMED、Web of Science等数据库中关于机械心肺复苏和徒手心肺复苏的相关文献,提取有效数据后用RevMan5.3软件进行Meta分析。结果共计纳入20项临床研究,包含29 727例患者,其中11 104例患者在复苏过程中使用了机械心肺复苏,18 623例患者在复苏过程中全程使用徒手心肺复苏。Meta分析结果显示,机械心肺复苏相对于徒手心肺复苏不能有效改善心脏骤停患者的自主循环恢复发生率(RR=1.10,95%CI:0.99~1.23,P<0.01)、入院存活率(RR=1.01,95%CI:0.95~1.08,P=0.67)、出院存活率(RR=1.00,95%CI:0.86~1.15,P=0.14)、神经功能预后(RR=0.81,95%CI:0.61~1.06,P=0.69)。结论机械心肺复苏对比徒手心肺复苏,并不能显著改善心脏骤停患者的预后。不推荐机械心肺复苏完全替代徒手胸外按压。     

Depression and recovery of right ventricular function after cardiopulmonary bypass

Transient left ventricular dysfunction is commonly described in association with cardiopulmonary bypass (CPB). We evaluated changes in right ventricular (RV) function after elective cardiac surgery in 24 patients with normal preoperative cardiac function. In all, irrespective of distribution of coronary artery disease or use of pharmacologic support, a transient depression of RV systolic function with respect to both preinduction and initial postoperative (Postop) values occurred 262 +/- 116 min post-CPB as represented by a decrease in RV stroke volume index (25.0 +/- 1.7 vs. 33.4 +/- 1.9 ml/m2 Postop) and RV ejection fraction (31.0 +/- 2.2 vs. 45.6 +/- 2.5% Postop), and an increase in RV end-systolic and end-diastolic volume indices. This depression responded readily to pharmacologic therapy within 2 h, resolved within 24 h, and had no adverse consequences in these otherwise healthy patients. Further studies are needed to identify the cause of this phenomenon and its importance in patients with preexisting cardiac dysfunction.     

Current treatment strategies of the German Hodgkin Study Group (GHSG)

Hodgkin's Lymphoma (HL) has developed to one of the best curable human cancers and overall about 80% of patients experience long-term disease free survival. Therefore, current treatment strategies aim at further improving treatment outcome, thereby trying to by minimize therapy-induced complications, such as infertility, cardiopulmonary toxicity, and secondary malignancies. Ongoing trials investigate a reduction of chemotherapy in terms of dose or cycles given, and the application of lower radiation doses and smaller radiation fields. For patients with a specific high-risk profile, new approaches with more intense drug combinations are currently being investigated. Moreover, the advent of effective salvage high-dose therapy for relapsed disease and a better understanding of prognostic factors have further improved the management of HL. Here, we summarize current strategies of the German Hodgkin Study Group (GHSG) in diagnostics and treatment of primary and relapsed HL, together with recent approaches for specific subgroups of HL patients.     

慢性肺心病患者肺动脉血栓形成相关因素分析

目的 了解慢性肺心病肺动脉血栓形成的因素。方法 对20例慢性肺心病患凝血功能指标PT、KPTT、FIB；反映纤溶指标D—二聚体；反映血小板功能的活化血小板、PAgT进行研究，并对其急性发作期、缓解期与对照组进行比较。结果 慢性肺心病急性发作期的KPTT缩短，FIB、D—二聚体、活化血小板、PAgT升高，与对照组比较有显差异，血液处于高凝状态，且在缓解期有一定改善。结论 慢性肺心病由于缺氧、肺动脉高压等存在，造成血管内皮损伤、血小板功能改变、血液高凝状态，容易引起肺动脉血栓形成，呼吸功能的改善有助于缓解血液的高凝状态。     

摄氧效率斜率评价慢性阻塞性肺疾病患者心肺功能的价值

目的探讨摄氧效率斜率(OUES)评价慢性阻塞性肺疾病(COPD)患者心肺功能的价值。方法对54 例肺功能Ⅱ~Ⅳ级的稳定期COPD患者进行运动心肺功能的评价,采用症状限制性Steep 分级平板运动方案,同时测定摄氧量(VO2)、二氧化碳排出量(VCO2)、峰值摄氧量(VO2peak)、每分通气量(VE)、呼吸气体交换率(RER)。采用对数曲线拟合的方法,分析递增负荷运动试验中VO2与VE之间的关系,建立回归方程VO2=algVE+b,计算摄氧效率斜率(OUES),即a。同时测定无氧阈(VAT)。结果OUES与VO2peak呈显著正相关(均P<0.001)。75% OUES、90% OUES、100% OUES三者均值无显著性差异(F=0.239, P=0.830)。结论OUES可以反映COPD患者运动心肺功能,75% OUES可以作为亚极量运动水平心肺功能的评价指标。     

Breathing circuit respiratory work in infants recovering from respiratory failure

OBJECTIVE: To compare cardiopulmonary function during spontaneous breathing with three continuous-flow breathing circuits. The major difference between these circuits was the degree of flow resistance offered by the exhalation valve. DESIGN: Randomized crossover trial. PATIENTS: Twelve infants less than 12 months of age recovering from respiratory failure of variable etiology. Only patients weighing 3 to 10 kg were studied. INTERVENTIONS: The patients were connected to each respiratory circuit in a random sequence, with 15 min allowed for equilibration before assessment of cardiopulmonary function. Airway pressure (Paw) and FIO2 were maintained unchanged. MEASUREMENTS AND MAIN RESULTS: Ventilation, gas exchange, or circulatory function were not altered significantly by changing the breathing circuit. However, Paw and esophageal pressure fluctuations were altered and were largest during breathing with the circuit that had an exhalation valve with high-flow resistance. The Paw fluctuation recorded while the patient was breathing with the flow-resistor circuit increased with weight and exceeded 2 cm H2O in all patients weighing greater than 4.5 kg. Paw fluctuation could be decreased by greater than 2 cm H2O in ten of 12 patients by using the threshold-resistor circuit. CONCLUSIONS: The results indicate a need for evaluating the characteristics of respiratory circuits used for spontaneous breathing in infants and children, to avoid unnecessary equipment-related increase in respiratory work.     

低负荷小强度抗阻运动对卧床老年患者肌力和心肺功能的影响

目的 制订适合高龄老年卧床患者的低负荷小强度抗阻运动方案,评价其对患者肌力和心肺功能的影响。方法 便利选取北京市某三级甲等医院老年病房2020年3月—4月收治的80岁及以上疾病稳定期患者64例,随机分为试验组和对照组。试验组在常规治疗和护理的基础上,给予6个月的低负荷小强度抗阻训练,对照组给予常规治疗和护理,比较两组的肌力和心肺功能。结果 共有59例患者完成研究,试验组29例,对照组30例。试验组握力在3个月和6个月时高于对照组（P<0.05）,仰卧举腿和30 s反复坐起次数在6个月时多于对照组（P<0.05）。肺活量在6个月时高于对照组（P<0.05）,两组血压、心率、左心室射血分数等比较,差异均无统计学意义（P>0.05）。结论 低负荷小强度抗阻运动不仅能提高高龄卧床老年患者的肌力,还能有效改善患者的肺功能,但对改善心功能的效果不明显。     

Systematic review of percutaneous cardiopulmonary bypass for cardiac arrest or cardiogenic shock states

BACKGROUND: Cardiogenic shock and cardiac arrest are common, lethal, debilitating and costly. Percutaneous cardiopulmonary bypass is an innovative strategy for treating these disorders that consists of rapid initiation of cardiopulmonary bypass and extracorporeal maintenance of circulation until restoration of an effective cardiac output. Multiple case reports suggest that percutaneous bypass is efficacious in patients with these disorders but these experiences have not been collated. Therefore, we have reviewed systematically the published experience with percutaneous bypass in patients with cardiogenic shock or cardiac arrest. OBJECTIVES: The objectives were to describe the proportion of patients with cardiogenic shock or cardiac arrest who achieved restoration of spontaneous circulation or survival to discharge with percutaneous bypass. A secondary objective was to describe adverse effects associated with percutaneous bypass, if feasible. DESIGN: Articles were identified by using a comprehensive search of English-language MEDLINE from 1966 to September 2005. PATIENTS: Individuals in cardiogenic shock or cardiac arrest. INTERVENTIONS: Percutaneous cardiopulmonary bypass. ANALYSIS: Effects were summarized as inverse-variance weighted means, standard errors, median and interquartile range. RESULTS: Included were 85 studies of 1494 patients with cardiogenic shock, cardiac arrest or both. Studies were case reports, case-series or case-control studies of heterogeneous interventions in heterogeneous patients. The proportion of patients weaned was mean, 76.8+/-4.2%, and median, 66.0% (IQR 50%, 100%). The proportion of patients who survived to discharge was mean, 47.4+/-4.5%, and median 40.0% (IQR 20%, 75%). Fifty-two studies included 533 patients in cardiogenic shock. The proportion of patients who survived to discharge was mean, 51.6+/-6.5%, and median 38.5% (IQR 23.4%, 76.3%). Fifty-four studies included 675 patients in cardiac arrest. The proportion of patients who survived to discharge was mean, 44.9+/-6.7%, and median, 42.3% (IQR 15.4%, 75%). Five studies with 286 subjects had both patients with cardiogenic shock or cardiac arrest. CONCLUSIONS: Percutaneous bypass is an efficacious intervention in patients with cardiac arrest or cardiogenic shock. Adequately-powered experimental studies of current percutaneous bypass technologies are required to demonstrate whether it is safe, effective and cost-effective.     

E-RFC (T cells) and Ig-positive cells (B cells) in the peripheral blood of patients with lymphogranulomatosis and possible immunocorrection with levamisole

Forty patients with Hodgkin's disease were examined for cell-mediated immunity. Analysis of peripheral blood showed a decrease in the relative and absolute E-RFU counts depending on the disease stages. The changes in B-cells bearing surface immunoglobulins were negligible. E-RFC (T-cells) prevailed in the spleen of patients with Hodgkin's disease. However, some of the patients had a high enough count of B-cells in the spleen and peripheral blood. Multiple modality treatment for Hodgkin's disease, radiation therapy in particular, aggravated disorders of cell-mediated immunity. Thirty-one patients received levamisole at the definite stages of multiple modality treatment with a purpose of correcting cell-mediated immunity disorders. Two schemes of levamisole intake were tried. The drug was given in a dose of 150 mg for 21 days, the total dose amounting to 3, 150 mg, or in a dose of 150 mg for 4 days with a 10-day interval, the total dose being 2, 100 mg. Only two patients noted side effects one of them had a "gas taste" in the mouth, whereas the other one skin itch and urticaria that did not require any treatment. Application of levamisole increased the relative and absolute E-RFU counts, absolute lymphocyte count. Patients on levamisole noted the improvement of the well-being.