Post-Transfusion Hyperhaemolysis in a Patient with Sickle Cell Disease: Use of Steroids and Intravenous Immunoglobulin to Prevent Further Red Cell Destruction

Delayed haemolytic transfusion reactions (DHTRs) are seen more frequently in patients with sickle cell disease (SCD) than in other groups of patients, and are characterised by a positive direct antiglobulin test and the appearance of previously undetected red blood cell (RBC) alloantibodies in the patient's serum. Recently a syndrome of post-transfusion hyperhaemolysis has been described in children with SCD, characterised by destruction of both autologous and transfused RBCs with negative serological findings: continuation of RBC transfusion exacerbated haemolysis further. We describe a case of life-threatening posttransfusion hyperhaemolysis in an adult patient with SCD in whom severe anaemia necessitated further RBC transfusion, which was successfully performed in conjunction with intravenous immunoglobulin. This approach may be useful in the management of post-transfusion hyperhaemolysis in SCD as well as in the management of severe DHTRs.     

The role of bacterial adherence in urinary tract infections in elderly adults

In an attempt to clarify host factors responsible for the acquisition of bacteriuria in elderly adults, bacterial adherence to uroepithelial cells obtained from 83 elderly participants and 40 young controls was studied. Seven uropathogenic strains of E. coli expressing different adhesions were used. Bacteria adhered significantly better to cells of young women than young men (p less than .0001) and elderly women than elderly men (p less than .03). The greatest adherence was in young women and the least in young men. In women without bacteriuria, aging was not associated with increased susceptibility to bacterial attachment. Moreover, there was no increase in the adherence of E. coil strains to uroepithelial cells of bacteriuric elderly women in comparison to abacteriuric elderly women. In men, however, aging was associated with increased bacterial adherence (p less than .02). Susceptibility to bacterial adherence does not appear to be responsible for the increased frequency of E. coli bacteriuria in elderly women but may be a permissive factor in elderly men.     

Effect of meal size and composition on the bioavailability of ketoprofen (Oruvail)

Seven young male volunteers received a single oral dose of Oruvail (ketoprofen 200 mg capsule) on two occasions, immediately after either a light/lean or a heavy/fatty meal at breakfast time. Administration of ketoprofen immediately following the heavy meal slightly, but significantly, delayed the absorption of the drug, as evidenced by mean (+/- S.D.)Tmax values of 6.7 (+/- 1.0) and 9.0 (+/- 1.4) hours respectively. Changing the type of meal had no statistically significant effect on the maximum plasma level, apparent plasma elimination half-life (t 1/2 h), area under the plasma level versus time curve, total plasma clearance, and urinary recovery of total ketoprofen, indicating that the bioavailability (and the systemic level) of ketoprofen was not affected by meal composition.     

Is growth hormone a radioprotective agent?

There is currently substantial clinical interest in growth hormone (GH) as a protective agent against radiation-related normal tissue injury. To further assess the potential radiation injury-preventive effects of GH, these effects were studied in rats by using a radiation-induced skin injury model. Group 1 received neither GH nor irradiation (control group). Group 2 received 30 Gy of gamma irradiation as a single dose to the right hind legs of the rats (radiation group). Group 3 and 4 received the same irradiation plus either 0.01 U/kg/day GH (RT + 0.01 GH group) or 0.02 U/kg/day GH (RT + 0.02 GH group) subcutaneously. Clinically and histopathologically, acute skin reactions were assessed by two independent experts in radiation oncology and pathology, respectively. Irradiation increased dermatitis in rats when compared with the control group. The severity of radiodermatitis in the rats in the RT + 0.01 GH and RT + 0.02 GH groups was significantly lower than that in the RT group; radiodermatitis developed earlier in the RT group than in the other groups. GH was efficacious in preventing epidermal atrophy, dermal degeneration such as oedema and collagen fibre loss, and hair follicle atrophy, but not better than in the control group. These results are preliminary to studies that will be performed with higher doses of GH in radiation-treated cancer patients, with the aim of reducing radiation-induced toxicity.     

Sources and intakes of sodium in the United Kingdom diet

The amounts of sodium in the average UK diet and the proportions of naturally occurring and added sodium in foods were calculated for the years 1984, 1985, 1986 and 1987. The results for total sodium intake from foods were in close agreement with other published sources and the breakdown of the figures revealed that 22 per cent of sodium in foods is naturally occurring and 78 per cent is added. When discretionary salt, used at the table and in cooking, is taken into account the proportions of sodium from various sources are estimated to be: 15 per cent discretionary, 84 per cent from food and approximately 1 per cent from water and medicines. Within the food category 18 per cent is natural, 59 per cent is from added salt and 7 per cent is from non-salt food additives.     

Aortic and renal artery thrombosis in a neonate: recovery with thrombolytic therapy

 This report describes a neonate with acute renal failure associated with extensive aortic and bilateral renal artery thrombosis attributed to inadequate breastfeeding and severe dehydration. Dialytic and general supportive care, together with concurrent anticoagulation, and continuous aggressive intrathrombic instillation of urokinase for 5 days resulted in near-complete thrombolysis. Renal functional recovery began 11 days after the onset of anuria. Despite ischemic atrophy of the left kidney, renal function and blood pressure were normal on follow-up. Thus, in neonates thrombolytic therapy may positively impact survival and recovery of renal function even in the setting of prolonged ischemic renal injury. Received November 7, 1996; received in revised form and accepted February 25, 1997     

First sexual intercourse: anticipation and communication. Interviews with young people in England

This study investigated anticipation and communication around first sexual intercourse through semi-structured interviews with young people (aged 16 to 29) in England. Ranging from surprise to pre-planning, several different levels of anticipation are explored. The main findings are as follows: communication plays a central role, mediating between the degree of anticipation and the degree to which first intercourse is wanted, protected and enjoyed. First intercourse tends to be characterized by silence, especially during early, spontaneous encounters. Silence does not imply lack of communication—non-verbal communication plays an important role. Where young people are ambivalent, verbal and non-verbal communication may send contradictory messages. The implications of the results for future safer sex campaigns are discussed.