Normal splenic volumes estimated using three-dimensional ultrasonography.

The purposes of this study were to determine splenic volumes using three-dimensional ultrasonography and to compare these measurements with two-dimensional splenic indices. Fifty-two healthy volunteers were studied. Two-dimensional volume measurements were based on length, width, and thickness, and the splenic index was calculated using the standard prolated ellipsoid formula (length x width x thickness x 0.523). Three-dimensional volume planar measurements were obtained with a slice by slice technique by manually drawing a region of interest around the spleen from one end of the sweep to the opposite end. These measurements were recorded three times by two observers. In addition, in vitro determination of splenic volume was performed using three cadaveric human spleens in a water bath. No statistically significant interobserver or intraobserver variability was present for either two-dimensional or three dimensional ultrasonography. Three-dimensional sonographic estimations of planar splenic volumes and ellipsoid splenic volumes were consistently smaller than two-dimensional sonographic estimations of splenic volumes. Three-dimensional sonographic splenic volumes calculated in vitro using the planar method were accurate to within 2% of in vitro water displacement volumes. Three-dimensional ultrasonography is potentially superior to two-dimensional sonography for evaluation of irregularly shaped objects, such as the spleen, and can provide improved accuracy over that of traditional two-dimensional techniques.     

Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography.

OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. METHODS: Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two- and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. RESULTS: Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 +/- 0.02 cm3) from that in those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02 cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic and three-dimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. CONCLUSIONS: Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors.     

Sonographic measurement of the volume of the left lateral segment of the liver

PURPOSE: The aim of this study was to evaluate the accuracy of sonography for measuring the volume of the left lateral segment of the liver. METHODS: The volume of the left lateral segment of the liver was measured with sonography in 101 consecutive patients who were hospitalized between December 1998 and January 2000 for hepatic, biliary, or pancreatic disease or who were donors for a living related liver transplantation. The results were compared with those obtained using CT. RESULTS: The mean calculated volume of the left lateral segment of the liver +/- standard deviation was 261 +/- 118 cm(3) by sonography compared with 274 +/- 123 cm(3) by CT. The relationship between the results of both imaging modalities was linear and statistically significant (r = 0.93; p < 0.0001). CONCLUSIONS: Our study demonstrated that sonography has an acceptable level of accuracy and reliability for routine measurement of the volume of the left lateral segment of the liver.     

上海市区2408例健康儿童末梢血血常规参数的参考区间调查分析

目的调查分析本实验室健康儿童末梢血血常规参数的参考区间。方法对体检合格的2 408名2～6岁儿童进行年龄分组(2-、3-、4-、5-),并做末梢血血常规分析,检测白细胞、红细胞、血红蛋白、红细胞压积、红细胞平均体积、红细胞平均血红蛋白含量和红细胞平均血红蛋白浓度等参数,不同年龄组之间各项参数做统计学分析,得出各项参数的参考区间。结果不同年龄组之间均数比较,白细胞参数差异有统计学意义(P<0.05),但各组均数与总体区间均数间相差<25%,不建议分组,其他各项参数差异无统计学意义(P>0.05),上述各项参数合并后白细胞为4.8～11.6(7.7)×109/L,红细胞为3.75～5.18(4.47)×1012/L、血红蛋白为110～145(126)g/L、红细胞压积为31.2～41.5(36.3)%、红细胞平均体积为76～88(81)fl、红细胞平均血红蛋白含量为25～31(28)pg和红细胞平均血红蛋白浓度为329～368(349)g/L、血小板为175～460(310)×109/L。血红蛋白、红细胞、红细胞压积等参考区间与长沙儿童末梢血作比较基本一致,但低于昆明儿童末梢血,血小板参考区间的上限和下限均高于长沙、昆明。结论不同地区、不同实验室应建立各自检测系统的参考区间。     

Role of Doppler sonography in the evaluation of accessory spleens after splenectomy.

OBJECTIVE: Splenectomy influences the Doppler blood flow pattern in the splenic artery. Blood flow in this vessel might return to normal if an accessory spleen increases in size after splenectomy. Our objective was to evaluate the resistive index of the splenic artery depending on the presence or absence of a hypertrophic accessory spleen in splenectomized patients. METHODS: The resistive index of the splenic artery was evaluated by duplex Doppler sonography in 19 splenectomized patients (8 with a hypertrophic accessory spleen) and in 8 healthy volunteers. The resistive index was measured within 3 cm of the origin of the splenic artery, and 3 different measurements were averaged. The presence or absence of a hypertrophic accessory spleen was diagnosed on the basis of sonography, computed tomography, magnetic resonance imaging, or scintigraphy, as well as by the presence or absence of Howell-Jolly bodies on a peripheral blood smear. RESULTS: The resistive index of the splenic artery in the splenectomized patients without a hypertrophic accessory spleen (mean +/- SD, 0.82 +/- 0.06; n = 11) was significantly (P < or = .0001) higher than in splenectomized patients with a hypertrophic accessory spleen (0.63 +/- 0.06; n = 8) and in control subjects (0.63 +/- 0.05; n = 8). CONCLUSIONS: In the splenectomized patient, a hypertrophic accessory spleen is associated with a normal resistive index in the splenic artery.     

Effects of knee surgery on cardiac function in soccer players

OBJECTIVE: To evaluate the effects of knee surgery on hematocrit and hemoglobin concentration and on resting cardiac parameters as measured by echocardiography. DESIGN: Ten soccer players who underwent knee surgery were evaluated before (T1) and after (T2) hospitalization within a 7-day interval. RESULTS: After hospitalization, end diastolic volume and stroke volume were significantly reduced (P < 0.05) by 14 and 22%, respectively. Despite a significant increase in resting heart rate (T1: 68 +/- 3.3 beats/ min, T2: 72 +/- 3.1 beats/min, P < 0.05), cardiac output was significantly decreased (T1: 4.89 +/- 0.56 liters/min; 3.95 +/- 0.62 liters/min, P < 0.05). The ejection fraction was 65% at T1 and fell to 58% at T2 (P < 0.05). After hospitalization, significant decreases in hemoglobin concentration and hematocrit were observed, suggesting a fall in blood volume. CONCLUSION: In soccer players, knee surgery leads to resting cardiac deconditioning, which is characterized by a significant reduction in stroke volume.     

老年人静脉血细胞分析参考值范围的调查研究

目的通过对健康成年人及老年人静脉血细胞分析调查研究,建立健康老年人静脉血细胞分析参考值范围。方法采集3302例健康成年人及老年人静脉血,用SymexKX-21N血细胞分析仪测定各参数,结果采用SPSS10．0软件进行数据处理。结果健康老年人（男、女）参考值范围,白细胞（WBC）：（3．57～9．00）&#215;10^9／L、（3．52～8．39）&#215;10^9／L;红细胞（RBC）：（3．78～5．42）&#215;10^12／L、（3．44～4．83）&#215;10^12／L;血红蛋白（Hb）：121．40～168．10、107．90～147．90g／L;红细胞比容（HCT）：36．62％～49．18％、32．82％～44．03％;平均红细胞体积（MCV）：85．10～100．60、84．70～100．60fL;红细胞平均血红蛋白（MCH）：28．54-34．48、28．20～34．10pg;红细胞平均血红蛋白浓度（MCHC）：322．00～357．00、320．00～352．00pg／L;红细胞体积分布宽度（RDW-CV）12．13％～15．10％、10．20％～17．12％;血小板（PLT）：（70．00～240．00）&#215;10^9／L、（77．00～262．00）&#215;10^9／L;血小板平均体积（MPV）：9．77-15．37、9．51-15．55fL;血小板体积分布宽度（PDW）：11．44％～27．77％;血小板压积（PCT）：1.10～2．73、1．13～2．99mL／L;大血小板比率（P-LCR）：24．35％～70．14％。老年人男、女间参数WBC、RBC、Hb、HCT、MCHC、PLT、PCT比较,差异有统计学意义（P〈0．01）;其余参数比较,差异均无统计学意义（P〉0．05）;老年人与成年人间WBC、MPV、PDW、P-LCR比较,差异无统计学意义（P〉0．05）;其余参数比较,差异均有统计学意义（P〈0．05）。与国内文献报道的成年人、老年人血细胞各参数比较,结果也存在明显差异（P〈0．05）。结论健康老年人、成年人参考值范围有明显差异,有必要科学、合理地建立本地区和本实验室健康老年人静脉血细胞分析参考值范围。     

Correlation of MRI liver volume and doppler sonographic portal hemodynamics with histologic findings in patients with chronic hepatitis C

PURPOSE: The purpose of this study was to correlate portal hemodynamics on sonography and liver volume on MRI with histologic findings in asymptomatic patients with chronic hepatitis C. METHODS: Portal blood flow in the left and right portal branches in 20 healthy volunteers and in 26 patients was measured using Doppler sonography during both fasting and postprandial states. Total liver and right-and left-lobe volumes were determined using MRI. The ratio between portal blood flow and liver volume determined the "portal flow index" of the right and left lobes. RESULTS: We observed a statistically significant difference (p < 0.01) between the volunteers and patients in the mean left-lobe volume (352 +/- 81 cm(3) versus 544 +/- 159 cm(3)) and in the mean left portal flow index (1.1 +/- 0.2 ml/minute/cm(3) versus 0.69 +/- 0.2 ml/minute/cm(3)) as measured before the subjects ate. After a meal, the portal blood-flow volume in the right lobe was similar in the 2 groups but in the left lobe was significantly lower in the patients (p = 0.0009). The left postprandial portal flow index was inversely correlated with the grade of liver fibrosis (r = 0.533). CONCLUSIONS: The left-lobe volume (positive predictive value, 83%; negative predictive value, 72%) and left postprandial portal flow index (positive predictive value, 86%; negative predictive value, 88%) are sensitive indicators of chronic hepatitis. The left postprandial portal flow index may be a useful test for differentiating patients with minimal or no fibrosis from patients with mild to severe fibrosis.     

Transvaginal sonography of postmenopausal ovaries with pathologic correlation

The sonographic appearance of 67 ovaries in 34 postmenopausal women who underwent preoperative transvaginal sonography (TVS) was correlated to findings on pathologic examination. Both ovaries were detected by TVS in 60% of the women examined; in 85%, at least one ovary was detected. The size of the normal, sonographically visualized postmenopausal ovary was 2.2 +/- 0.7 cm in transverse, 1.2 +/- 0.3 cm in anteroposterior, and 1.1 +/- 0.6 cm in longitudinal axes, with an average volume of 2.6 +/- 2.0 cm3. The average size of ovaries that were not detected by TVS was 0.7 x 0.4 cm (range, 0.3 to 1.3 cm); most of these (five of six) were atrophic on pathologic exam. The difference between actual and sonographically measured size was negligible (TVS overestimated by 0.3 cm). Four simple cysts that ranged from 0.5 to 3.5 cm were found by TVS and confirmed pathologically, as were three benign serous cystadenomas that ranged from 2.5 to 3.5 cm, one 3 x 6-cm tubal carcinoma, and one 1 X 4-cm paratubal cyst. TVS missed a 6-cm dermoid, a 2.5-cm cystadenoma, a 0.8-cm Sertoli cell tumor, and a 0.5-cm fibrothecoma that were nonpalpable but that were found on pathologic examination. None of the missed lesions were palpable preoperatively. The positive predictive value was 94% for detection of an ovarian mass; the negative predictive value for exclusion of an ovarian lesion was 92%. It is concluded that TVS can accurately delineate the ovaries in most, but not all, postmenopausal women and that only rarely will pathologic lesions not be detected by TVS.     

缺氧缺血性脑病患儿血常规结果分析及其临床意义

目的探讨27项血常规参数在新生儿缺氧缺血性脑病（HIE）中的变化及其意义。方法利用全自动血细胞分析仪对29例HIE患儿和30例健康新生儿进行白细胞、红细胞及血小板等参数检测,分析其结果和临床意义。结果H1E组与对照组比较,（1）白细胞参数：淋巴细胞比率、单核细胞比率、中性粒细胞比率差异有统计学意义（P〈0．05）,而白细胞计数、嗜酸性粒细胞比率、嗜碱性粒细胞比率差异无统计学意义（P〉0．05）;（2）红细胞参数：血细胞比容、红细胞平均体积、平均血红蛋白浓度（MCHC）、红细胞分布宽度CV、红细胞分布宽度SD、网织红细胞计数、网织红细胞百分比、未成熟网织红细胞、低荧光网织红细胞比率、高荧光网织红细胞比率、有核红细胞计数、有核红细胞百分比等12项红细胞参数差异有统计学意义（P〈0．05）,而红细胞计数、血红蛋白、平均血红蛋白含量、中荧光强度网织红细胞比率等参数差异无统计学意义（P〉0．05）;（3）血小板参数：血小板计数、血小’板：压积差异有统计学意义（P〈0．05）,而平均血小板体积、血小板分布宽度及大型血小板比率等参数差异无统计学意义（P〉0．05）。结论利用全自动血细胞分析仪对HIE患儿外周血进行常规筛查和动态监测,计数快速、准确,能很好地满足临床应用,协助临床诊断HIE。     

Collection of platelets with a new cell separator and their storage in a citrate-plasticized container

A new apheresis device using microprocessor control for the collection of a high-purity single-donor platelet concentrate was evaluated, as was the storage of platelets for up to 5 days in a citrate-plasticized polyvinylchloride blood bag. The study was conducted in three phases: collection of platelets for in vitro studies and determination of donor safety; autologous transfusion of platelets in healthy volunteers; and transfusion of platelets in patients requiring platelet transfusion therapy. Donors had mild hypocalcemia and minimal changes in blood counts except for a platelet count reduction from 288 +/- 50 x 10(3) (288 +/- 50 x 10(9)/L) to 217 +/- 43 x 10(3) per microL (217 +/- 43 x 10(9)/L). A mean of 3.36 +/- 1.24 x 10(11) platelets was collected in the mean volume of 214 mL with red cell and white cell contamination in the range of 10(7). Morphology and aggregation were as described previously in stored platelets. Platelet survival data in eight subjects showed a mean recovery of 61 +/- 11 percent and mean survival of 5.03 +/- 1.07 days by a weighted-mean model. Patients transfused with platelets had mean increments of 23,000 immediately and of 8000 at 24 hours; corrected count increments were 6000 at 1 hour and 4000 at 24 hours. The platelets were successful in providing hemostasis to these patients. Clinically useful 5-day-stored platelets are obtained by using this apheresis technology with a functionally closed system and a citrate-plasticized blood bag.     

Sonographic demonstration of the normal thoracic esophagus

PURPOSE: Although conventional sonography has been used widely in evaluation of the abdominal and cervical esophagus, its use in the thoracic esophagus is seldom mentioned. The aim of this study was to assess whether conventional sonography could demonstrate the thoracic esophagus and to determine this structure's normal sonographic appearance and measurements. METHODS: Transthoracic sonography was performed in 253 healthy volunteers ranging in age from 12 to 72 years (mean, 41 +/- 15 years). The subjects were examined while supine with their hands raised over their heads; the transducer was placed along the left side of the sternum sequentially from the first to the fifth intercostal spaces. The ultrasound beam was directed to the thoracic aorta using the heart as an acoustic window. The detectable length of the thoracic esophagus was measured in the longitudinal scan from the upper most part visualized to the point at which it penetrated the diaphragm. The esophageal thickness was measured on the anterior wall at the level of the left atrium. RESULTS: In 188 (74%) of the 253 subjects, the thoracic esophagus could be demonstrated by sonography, except for the portion under the first and second intercostal spaces. In 3 of these 188 subjects, the esophagus also was not visualized at the third intercostal space. In these 188 subjects, the esophageal wall was shown as 3 layers. The esophageal lumen appeared as 1 or 2 hyperechoic bands in longitudinal sonograms. In 163 subjects, gas artifact and the comet-tail sign, with downward movement, were seen in the esophageal lumen after swallowing. The mean demonstrable length of the thoracic esophagus was 10.2 +/- 1.9 cm and the mean thickness 3.2 +/- 0.3 mm. CONCLUSIONS: Most of the thoracic esophagus can be visualized by sonography, except for a short portion at the back of the left main bronchus. The heart and the thoracic aorta are 2 important landmarks in scanning.     

Effect of magnesium, high altitude and acute mountain sickness on blood flow velocity in the middle cerebral artery

Cerebral blood flow is thought to increase at high altitude and in subjects suffering from acute mountain sickness (AMS); however, data from the literature are contentious. Blood flow velocity in the middle cerebral artery (MCAv) may be used as a proxy measure of cerebral blood flow. Using transcranial Doppler sonography, MCAv was measured during normo- and hyper-ventilation in subjects who participated in a trial that tested the effect of magnesium supplementation on the prevention of AMS. First, MCAv was recorded at 353 m (baseline). Subjects were then randomized to receive oral magnesium citrate and matching placebo. A second measurement was taken after a 24 +/- 2 h ascent from 1130 m to 4559 m (altitude I), and a third after a 20-24 h stay at 4559 m (altitude II). Using multivariate linear regression, an association was sought between MCAv and magnesium supplementation, subjects' age and gender, altitude itself, a temporary stay at altitude, and the presence of AMS (Lake Louise Score >6 with ataxia, nausea and/or headache). Subjects with AMS had additional Doppler recordings immediately before and after rescue medication (oxygen, dexamethasone and acetazolamide). Forty-seven subjects had measurements at baseline, 39 (21 receiving magnesium and 18 placebo) at altitude I and 26 (13 receiving magnesium and 13 placebo) at altitude II. During hyperventilation, MCAv decreased consistently (for each measurement, P<0.001). Magnesium significantly increased MCAv by 8.4 cm.s(-1) (95% confidence interval, 1.8-15), but did not prevent AMS. No other factors were associated with MCAv. Eleven subjects had severe AMS [median score (range), 11 (8-16)] and, after rescue medication, the median score decreased to 3 (range, 0-5; P=0.001), but MCAv remained unchanged (65 +/- 18 cm.s(-1) before compared with 67 +/- 16 cm.s(-1) after rescue medication; P=0.79). MCAv was increased in subjects who received magnesium, but was not affected by exposure to high altitude or by severe AMS.     

Splenic thrombopoiesis after bone marrow ablation with radiostrontium: a murine model

Murine platelet production is normally supported by high-ploidy bone marrow megakaryocytes without significant contribution from splenic megakaryocytes with predominantly low-ploidy levels. We produced sustained bone marrow ablation using radiostrontium, and examined the processes by which splenic platelet production is initiated and maintained in the absence of bone marrow function. Bone marrow hematopoiesis, measured by total nucleated cell number and viability, megakaryocyte colony-forming cells, and granulocyte-macrophage colony-forming cells, was rapidly ablated in mice by using yttrium 90-free strontium 90. Platelet count declined from normal (1224 x 10(3)/microliters) to a nadir (98 x 10(3)/microliters) 11 days after 90Sr, and then rose to a stable level (705 x 10(3)/microliters) on days 20 through 115. Peripheral leukocyte concentration decreased rapidly and remained below 25% of normal in contrast to hemoglobin levels, which were minimally lowered. Mean spleen weight rose rapidly after 90Sr to 66% above normal. Splenic megakaryocyte frequency, measured by two-color fluorescence-activated flow cytometry, rose from basal levels (0.09% +/- 0.06%) to 0.15% +/- 0.07% (p less than 0.001), total spleen nucleated cells fell to 71% of normal, and the absolute number of spleen megakaryocytes was unchanged. Total spleen megakaryocyte colony-forming cells were not significantly increased above normal whereas total spleen granulocyte-macrophage colony-forming cells increased abruptly after day 13 to 10 times normal levels. Splenectomy after hematopoietic recovery from 90Sr bone marrow ablation resulted in a rapid decline of platelet levels, followed by death. Although the spleen became the sole site of platelet production, the splenic megakaryocyte ploidy distribution was only minimally changed from normal, and the modal ploidy class remained 2N. In contrast to experimental thrombocytopenia in mice with intact bone marrow, in which megakaryocyte ploidy is increased, thrombocytopenia associated with sustained bone marrow ablation does not result in upward regulation of splenic megakaryocyte ploidy as a compensatory mechanism.     

脑梗死患者血小板参数的水平观察和初步分析

目的探讨脑梗死与血小板各参数的关系。方法采用ABXPentrol-120型全自动五分类血细胞分析仪同时对66例脑梗死患者和50例健康对照者以及60例脑出血患者进行血小板计数（PLT）、血小板平均体积（MPV）、血小板分布宽度（PDw）、血小板压积（PCT）、大血小板比率（PLCR）测定。结果脑梗死患者MPV、PDW、PCT、P-LCR均明显高于健康对照组,差异有统计学意义（P〈0．01）;脑梗死组MPV、PDW、P-LCR比脑出血组明显增高,差异有统计学意义（P〈0．01）;且MPV空腹血糖呈正相关,差异有统计学意义（r=0．55,P〈0．01）。结论观察脑梗死患者的MPV、PDW、P—LCR值,可以为脑梗死的初步诊断和鉴别诊断提供线索。     

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones

PURPOSE: Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS: This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS: Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS: Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.     

Reference value of presenile human hematocrit and geographical factors

The aim of this study was to provide a scientific basis for a unified standard of the reference value of healthy presenile human hematocrit in China. We studied the relationship between the reference values of healthy presenile human hematocrit, tested according to Wintrobe's laws, and five geographical factors. It was found that altitude is the most important factor affecting the reference value of the hematocrit. As the altitude gradually increases, the reference value of the hematocrit also increases. The relationship is quite significant. By using the method of stepwise regression analysis, two multivariate regression equations were deduced: Y1 = 39.7 + 0.00328X1 + 0.00169X2 + 0.00117X5 +/- 2.3, Y2 = 38.8 + 0.00275X1 + 0.000578X2 -0.00298X4 +/- 2.2 In these equations, Y1 is the reference value of presenile men's hematocrit (%); Y2 is the reference value of presenile women's hematocrit (%); X1 is altitude (m); X2 is the average annual hours of sunshine (h); X4 is the average annual temperature (degrees C), and X5 is the average annual precipitation (mm). If the geographical index values in a particular area in China are known, the reference value of presenile human hematocrit in this area can be calculated approximately by means of the regression equations.     

Recovery of splenic infarction with anti-platelet treatments and platelet-apheresis in polycythemia vera.

Thrombo-embolic events in coronary and peripheral arteries, and cerebral, pulmonary, portal, hepatic, and deep veins are seen in 27-45% of patients with polycythemia vera (PV). A 79-year-old man was admitted with complaints of pruritus increasing after bath and left upper abdominal pain radiating to left shoulder for two months. On physical examination, ruddy and hyperemic appearances of his face and conjunctiva, tenderness on the left upper quadrant, and splenomegaly were noted. Hemoglobin level was 16.6g/dl, hematocrit 53.8%, white blood cell count 26x10(9)/l, and platelet count 1.032x10(9)/l. Bone marrow aspiration and biopsy revealed hypercellularity, megakaryocytic hyperplasia and dysplasia. The leukocyte alkaline phosphatase score was 190. The levels of serum vitamin B12 and D-dimer were 316 pg/ml and 744 ng/ml, respectively. Arterial O2 saturation was 96%. Red cell mass was measured as 43 ml/kg using radionuclide 51Cr labelled erythrocyte scintigraphy. On cytogenetic analysis, deletion of 20q was found. Computed tomography of whole abdomen showed diffuse splenomegaly and two hypodense areas indicating splenic infarction in 2.5x2 and 3.5x3 cm diameters in subcapsular localization of the spleen. The patient was treated with therapeutic platelet-apheresis, 40 mg/day aspirin, analgesic drugs, and 3g/day hydroxyurea. After 1.5 months, platelet counts dropped to less than 500x10(9)/l and splenic infarcts were not detected on computed tomography. Splenic infarction may be the first evidence of thrombosis in PV. The reduction of platelet counts with platelet-apheresis, anti-platelet drugs, and careful clinical observation may be satisfactory in the treatment of splenic infarction.     

Laser-light scattering,a new method for continuous monitoring of platelet activation in circulating fluid

We evaluated a novel technique of laser-light scattering (LLS) to detect platelet-volume changes continuously, reflecting platelet aggregation in circulating fluid. Carotid arteries from 20 dogs were mounted in a dual perfusion chamber. Balloon angioplasty (BA) was performed and arteries perfused with platelet-rich plasma (PRP). A He-Ne laser beam was passed through cuvettes connected to tubing draining the arteries. From the angle of incidence, the average volume of aggregates was measured by the ratio of scattering light at 1 to 5 degrees' spread on the diode array of a multichannel analyzer. Platelet volume varied linearly with the scattered light ratio at 1 to 5 degrees (y = -24.2 + 27.6 x [y = particle size, microm(3); x = scattered light ratio at 1/5 degrees]). For comparison, we used an electronic particle counter (Coulter counter) to measure platelet volume. P-selectin expression was measured to confirm platelet activation. Comparing 10 uninjured and 10 BA-injured arteries, we found that platelet volume as measured with LLS increased from 21.6 +/- 4.1 to 52.1 +/- 12.5 microm(3) (P < .003); as measured with the Coulter counter, it increased from 29.9 +/- 2.4 to 62.3 +/- 7.0 microm(3) (P < .005). Six BA-injured arteries perfused with PRP and aspirin (0.2 mg/mL) were compared with six arteries treated with BA alone. The aspirin decreased platelet volume as measured with LLS from 56.2 +/- 11.8 to 40.2 +/- 12.7 microm(3) (P < .01); the Coulter counter revealed a decrease from 51.9 +/- 18.5 to 38.8 +/- 14.2 microm(3) (P < .001). Coulter counter and LLS results were correlated: r = 0.74, P < .05. The peak of P-selectin expression coincided with peak platelet volume. These data demonstrate that increases in circulating-platelet size stimulated by endovascular injury can be reliably and continuously monitored with the use of LLS.     

Comparison of plateletpheresis on the Fresenius AS.TEC 204 and Haemonetics MCS 3p

This is an attempt at comparing two cell separators for plateletpheresis, namely the Fresenius AS.TEC 204 and Haemonetics MCS 3p, at a tertiary care center in India. Donors who weighed between 55-75 kg, who had a hematocrit of 41-43%, and platelet counts of 250x10(3)-400x10(3)/microl were selected for the study. The comparability of the donors who donated on the two cell separators were analysed by t-test independent samples and no significant differences were found (P>0.05). The features compared were time taken for the procedure, volume processed on the separators, adverse reactions of the donors, quality control of the product, separation efficiency of the separators, platelet loss in the donors after the procedure, and the predictor versus the actual yield of platelets given by the cell separator. The volume processed to get a target yield of >3x10(11) was equal to 2.8-3.2 l and equal in both the cell separators. Symptoms of citrate toxicity were seen in 4 and 2.5% of donors who donated on the MCS 3p and the AS.TEC 204, respectively, and 3 and 1% of donors, respectively, had vasovagal reactions. All the platelet products collected had a platelet count of >3x10(11); 90% of the platelet products collected on the AS.TEC 204 attained the predicted yield that was set on the cell separator where as 75% of the platelet products collected on the MCS 3p attained the target yield. Quality control of the platelets collected on both the cell separators complied with the standards except that 3% of the platelets collected on the MCS 3p had a visible red cell contamination. The separation efficiency of the MCS 3p was higher, 50-52% as compared to the 40-45% on the AS.TEC 204. A provision of double venous access, less adverse reactions, negligible RBC contamination with a better predictor yield of platelets makes the AS.TEC 204 a safer and more reliable alternative than the widely used Haemonetics MCS 3p.