Low-voltage activated calcium channels: achievements and problems.

Low-voltage activated Ca2+ channels, which possess unique properties quite different from those of common (high-voltage activated) channels, were discovered 15 years ago but the first alpha1 subunit has only recently been identified which might provide their structural basis. However, simultaneously, extensive data are being accumulated on the functional diversity of low-voltage activated Ca2+ currents with regard to their pharmacological sensitivity, ionic selectivity, activation and inactivation kinetics. Such diversity corresponds to equally prominent heterogeneity in the location and function of the channels. This commentary summarizes the data available in an attempt to predict a possibly wider structural subdivision of low-voltage activated Ca2+ channels into subtypes.     

The problems of cataract surgery and intraocular correction: Russian school achievements and modern trends

The development of the safest and, at the same time, efficient methods of cataract surgery, is not only a topical task of medical science and practice, but also, taking the demographic situation into account, a solution to a social problem. The article describes the main achievements of academician S. N. Fyodorov's school in the field of cataract surgery with intraocular lense (IOL) implantation. Special attention is paid to the key components of cataract extraction technique named "small incision surgery", which is based upon the use of ultrasmall surgical approaches with self-sealing ability and no need for suturing. The main advantages and disadvantages of various types of cataract lense fragmentation, including ultrasound emulsification, mechanic and hydraulic fragmentation, and laser destruction, are described. Topical issues concerning cataract extraction technique under the conditions of complicating ophthalmopathology including the weakness of ciliary zonule system, high-degree myopia, glaucoma, pseudoexfoliative syndrome, small pupil, past injuries and eye surgery, are outlined. The paper also reflects a new qualitative step in the development of intraocular aphakia correction technique under modern conditions. Basic requirements to design parameters and IOL materials are determined from the position of reestablishing the accommodative function and fine visual functions. Ways of IOL design improvement are described especially for their application in non-standard and complicated cases.     

Current problems in haematology. 2: Hereditary spherocytosis.

Hereditary spherocytosis is a relatively common haematological disorder and will be encountered by all haematologists. The abundance of new information, dealing principally with molecular and genetic aspects of pathophysiology, is beginning to have implications for its investigation and management. While these advances have not yet exerted a large influence at therapeutic level, the promise of such advents as prenatal diagnosis make this an exciting field to watch.     

The changing relationships in transfusion medicine.

Maintaining quality in provision of transfusion services in the face of mergers, acquisitions, affiliations, and risk-sharing relationships between organizations that formerly conducted business in a traditional vendor-purchaser model is the ultimate challenge. Publications, both lay and professional, highlight the speed and nature of the impetus for change, especially in the United States, where managed care philosophies are driving a bottom-line mentality. Blood collection and transfusion organizations are developing new relationships, including entry of for-profit entities into a formerly virtually exclusively not-for-profit environment, provision of transfusion services by formerly exclusive blood collection entities and vice versa, outsourcing of selected portions, and other innovative relationships, with significantly more competitive marketing strategies. Measures of quality of transfusion services should benchmark current practices, if possible, before entering into new relationships to ensure that the quality of patient care remains high. Concerns about the fiscal viability of organizations should not minimize safety and availability of blood for transfusion when needed.     

Present condition and problems of the blood transfusion system in Yamanashi Prefecture

In order to investigate the condition and problems of transfusion inspection in Yamanashi Prefecture, a "transfusion operating questionnaire" was carried out. The questionnaire was sent to 30 top hospitals that use many blood components, and we received a reply from 28 hospitals. The blood-transfusion system was unified in 25 hospitals (89.3%). The blood-transfusion therapy commission added 1 hospital with the same function, and it was established in 24 hospitals (85.7%). However, the blood-transfusion therapy commission was only held 6 times or more per year in only 9 hospitals (37.5%). Although doctors responsible for transfusion were appointed in 20 hospitals (71.4%), only 1 hospital appointed full-time doctors. A full-time medical technologist responsible for transfusion was only available in 5 hospitals (17.9%). The activity of the Yamanashi Prefecture joint blood-transfusion therapy commission founded in 2005 is indispensable for the promotion of "safe and proper" blood-transfusion therapy.     

The VDRL test in a blood transfusion service.

A survey has been made of the results of 12 months' VDRL screening in a blood transfusion service. Positive VDRL tests were found on 318 of the 73 350 blood donations collected during 1974. Thirty-four tests confirming specific treponemal infection were found in 24 donors. A battery of confirmatory tests showed the remaining 284 positive VDRL reactions from 235 donors to be biological false positive (BFP) results, and, of these, one-third were considered entirely negative by the reference laboratory. BFP reactions were commoner in female donors than in males, and a higher incidence than expected was observed in younger female donors and older male donors. A marked seasonal incidence was noted, 65% of all BFP tests from the transfusion service being found in the four colder months of May to August. Although some differences exist between the group as a whole and the 36 donors (15.3%) found to have BFP results on more than one occasion during the year, there is little evidence from these studies to suggest that regular blood donation per se is a contributing factor to the finding of a BFP result in VDRL screening. It is probable that the population tested regularly by the blood transfusion service reflects a small but representative sample of the community as a whole.