Lithium therapy of canine cyclic hematopoiesis

Treatment of cyclic hematopoiesis in the grey collie dog with lithium carbonate eliminated the recurrent neutropenia and normalized the other blood cell counts. These findings suggest that human cyclic hematopoiesis may be successfully treated with lithium. The effects of lithium on the monocytes, platelets, and reticulocytes, as well as the neutrophils, suggest that lithium operates on basic regulatory mechanisms affecting the most primitive hematopoietic precursor cells.     

Management of combat related vascular injuries in a zonal hospital

Background: The extremity gunshot wound (GSW) and penetrating splinter injuries from mine blast present a surgical challenge in the treatment of arterial trauma especially at non-vascular surgery centre. Adherence to specific principles of management is required for optimal limb salvage.     

Density gradient isolation of peripheral blood mononuclear cells using a blood cell processor

Large numbers of mononuclear cells (MNC) are needed for hematologic reconstitution using peripheral blood stem cells. The possibility of isolating those cells by discontinuous Ficoll-diatrizoate density gradient centrifugation in two blood cell processors (the Haemonetics V50 [V50] and the Cobe 2991 [2991]) were examined. Buffy coats from peripheral blood containing 6.23 X 10(8) MNC were separated in the V50, resulting in a recovery of 75 percent. The purity of the cells, defined as the percentage of lymphocytes and monocytes among all leukocytes, was 95 percent. With larger cell loads (3 to 7 X 10(9) MNC), the yield was higher in the V50 than in the Cobe 2991 (92 versus 75%). After separation in the V50 or the 2991, the cloning efficiencies of hematopoietic progenitor cells (CFU-GM and BFUe) were not different from those of cells isolated on 5 ml Ficoll-diatrizoate gradients in centrifuge tubes. Both leukapheresis and MNC separation can be carried out with the same bowl and tubing set in the V50. With that approach, an average of 6 X 10(9) MNC were processed in 16 experiments. An average recovery of 82 percent with 95 percent purity was achieved. The authors conclude that, in terms of simplicity of operation, cost effectiveness, and maintenance of sterility, the V50 may be better suited than the 2991 for the purification of MNC from peripheral blood.     

The effect of various base/core materials on the setting of a polyvinyl siloxane impression material

Five resin-modified glass ionomers and amalgam, used as a base or core buildup material, were clinically evaluated for whether they effected polymerization of a low viscosity (light body) regular set polyvinyl siloxane impression material. A total of 20 samples per group was prepared according to the manufacturer's recommendations. Ten samples from each group were handled with latex gloves during mixing and the other 10 were handled with vinyl gloves. Five of the 10 samples had the outer surface prepared with a round diamond wheel. Impressions were made of all the samples. The impression materials were visually scored inhibited or noninhibited. Inhibited impression materials met at least one following criterion: (1) an oily substance on the surface of the impression readily collected on a sterile explorer tine as it was moved across the impression surface; (2) a rippled appearance on the surface of the impression material; or (3) unpolymerized impression material adherent to the prepared sample surface. If none of the criteria were observed, the impression was scored noninhibited. The data were analyzed with the chi square analysis (level of significance p = 0.05). Total chi square analysis revealed a significant difference between brands (p = 0.0001) and between prepared and non-prepared samples (p = 0.001). Interrater reliability data were analyzed with the kappa correlation analysis. Raters were in complete agreement (kappa = +1). The prepared samples of Vitrebond material had an inhibitory effect on the polymerization of Express impression material.     

Serum C-reactive protein is a useful marker for congenital infection

Serial quantitative measurements of C-reactive protein (CRP) were performed by reaction rate nephelometry on cord blood and scrum of 70 babies (60 preterm and 10 full term). There were 41 babies born to mothers with no risk factors for bacterial infection (Group 1) and 29 babies born to mothers with risk factors (Group 2), Maternal risk factors for congenital infection were: a history of prolonged rupture of membranes, maternal treatment with antibiotics, chorioamnionitis or positive cultures from high vaginal swabs. Twelve babies had raised CRP levels (>10 mg/1), 2 from Group 1 and 10 from Group 2, 9 of whom were subsequently found to have bacterial infections. One of the 2 babies without suspected infection had severe birth asphyxia. Specificity, sensitivity, positive and negative predictive values were calculated for CRP levels and total white cell counts (TWCC). Within Group 2, the specificity of raised CRP for diagnosis of congenital bacterial infection was 95% and the sensitivity was 100%, compared to the specificity of TWCC 95% and sensitivity 55%. CRP can be used as a marker for congenital bacterial infection and appears to be more sensitive than TWCC.     

Brachial plexus compression due to subclavian pseudoaneurysm from cannulation of jugular vein hemodialysis catheter

Jugular venous cannulation is generally safer than subclavian cannulation. The traumatic complications associated with jugular vein hemodialysis catheters are rare. A jugular vein, therefore, has become the preferred site for hemodialysis catheter insertion. We describe the first case of brachial plexus compression attributable to delayed recognition of a right subclavian pseudoaneurysm as a complication of jugular venous cannulation of hemodialysis catheter. We advocate that any neck swelling, new bruit, and the symptoms of brachial plexopathy after jugular venous cannulation warrant an intensive investigation to exclude arterial injury. Because delayed diagnosis may lead to a worsened prognosis in patients with brachial plexus palsy, physicians should exercise vigilance to detect and manage early the potentially serious and fatal complications of subclavian artery pseudoaneurysm and brachial nerve injury.     

Predicting outcome after appendicectomy

Aim To validate an intraoperative appendicitis severity score (IASS) and examine outcome following emergency appendectomy. Methods A prospective study was undertaken, enrolling consecutive patients undergoing emergency appendicectomy. Data were obtained independently on preoperative Alvarado scores, IASS (0-3: 0 no inflammation, 1 engorged appendix/no peritonitis, 2 peritoneal reaction/exudate or 3 evidence of perforation/abscess) and postoperative outcome parameters. Results There were 149 patients identified with a mean age of 20.7 years. There was no association between Alvarado score and length of hospital stay, septic complication, patient sex or duration of symptoms (p>0.05). IASS was found to be an independent risk factor for septic complication, wound infection (p<0.05) and length of hospital stay (p<0.001). There was no correlation between preoperative duration of symptoms or time until surgery and intraoperative score. Conclusions This simple scoring system can identify patients more likely to suffer morbidity following emergency appendicectomy. Specifically, this system identifies patients who have a high risk of sepsis and therefore could be of use when comparing healthcare performance.