The current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery

Objective: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. Methods: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. Results: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5±3.4 mL/kg. Intraoperative donation was 21.7 ±6.1 mL/kg in Group 1 and 12.8±4.0 mL/kg in Group 2 (p<0.001). On admission, serum hemoglobin was lower in Group 1 (12.2±1.0 g/dL versus 13.6±1.6 g/dL, p<0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2±1.4 versus 10.2±1.1 g/dL, p<0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p<0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. Conclusion: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.     

N10 potential as an antidromic motor evoked potential in a median nerve short-latency somatosensory evoked potential study.

When stimulating the mixed nerve to record evoked potential, both sensory and motor fibers are activated before entering the spinal cord. The N10 potential has been described as an antidromic motor evoked potential based on results obtained by recording at the anterior midneck. In the present study, we examined the changes in latencies of Erb's potential, N10, and N13 by stimulating the median nerve distally at the wrist and proximally at the elbow. The conduction velocity of N10 calculated by the difference between N10 latencies at the two stimulation points was consistent with motor conduction velocity, although N13 conduction velocity estimated by the same method reflected a sensory conduction velocity. A positive relation was also observed between the indirect latency from the stimulation point to the anterior root as calculated using the equation (F - M - 1) / 2 (ms) and the direct latency to the negative peak of the N10 potential. Our data support the notion that N10 represents antidromic motor potential originating in the spinal entry zone of the anterior root.     

CT导引下肝肾囊肿抽吸硬化治疗

目的：总结CT导引下肝肾囊肿穿刺抽吸硬化治疗的疗效和操作经验。材料和方法：肝囊肿11，肾囊肿15例，多囊肾1例，囊肿大小为3．5－12cm，均用15cm长20GGreene针穿刺治疗，抽出囊液量为21－550ml，囊液抽净后注入99．7％的无水酒精。结果：治疗后症状均有明显好转或消失，本组随访肝囊肿7例、肾囊肿11例，疗效指数I级1例（多囊肾），Ⅱ级肝肾囊肿各2例，Ⅲ级肝囊肿5例肾囊肿8例。穿刺操作顺利，无严重并发症发生。结论：CT导引下肝肾囊肿抽吸硬化治疗操作简便、创伤小、疗效高可作为替代外科手术的有效的治疗方法，多囊肾的单纯抽吸治疗可明显减轻症状，改善肾功能，是一种较好的治疗手段。     

Clinicopathologic and mucin histochemical analyses of 90 cases of ovarian mucinous borderline tumors of intestinal and müllerian types

Clinicopathologlc and mucin histochemical characteristics of 90 cases of ovarian mucinous borderline tumors (MBT) of Intestinal (IMET) and müllerian types (MMBT) were studied to determine whether IMBT and MMBT constitute distinct tumor subtypes. The IMBT (77 cases, 78 lesions) contained goblet cells, absorptive cells and endocrine cells, which represented Intestinal differentiation. The average diameter of IMBT was 13.4 cm. Five patients (6.5%) had stage III disease wtth pseudomyxoma perltonel and one of them died from tumor. Approximately 50% of IMBT demonstrated gastrointestinal characteistics on mucin histochemistry. The MMBT (13 cases, 14 lesions) consisted of mumus columnar cells and eosinophilic cells, with no Intestinal differentiation. MMBT accounted for 15.2% of MBT. MMBT averaged 8.4 cm in diameter, and 29% were associated with endometriosls of the ipsilateral ovary. All patients with MMBT had stage I disease, and none suffered from pseudomyxoma peritonel. All patients whose follow-up data were available were alive and well, without evidence of tumor recurrence. The mucin histochemical findings in MMBT resembled those of noml endocervix. Results of the present study suggest that IMBT and MMBT have different characteristics and constitute distinct subtypes of MBT.     

Dynamic gadolinium-enhanced echo-planar MR imaging of the liver: Effect of pulse sequence and dose on enhancement

To develop guidelines for clinical magnetic resonance imaging of the liver, the authors undertook an animal study to investigate the effect of dose and pulse sequence on liver signal intensity in gadopentetate dimeglumine—enhanced echo-planar imaging. Serial imaging of the liver was performed in anesthetized rats after intravenous administration of five different doses (0.01, 0.05, 0.1, 0.2, and 0.5 mmol/kg) of contrast agent, with six different pulse sequences. The results show that gadopentetate dimeglumine—enhanced echo-planar images obtained during the perfusion phase can yield either positive (due to increased T1 relaxation rates) or negative (due to susceptibility-induced increased T2 relaxation rates) liver enhancement depending on choice of pulse sequence and dose. At the current clinically recommended dose of 0.1 mmol/kg, maximal liver signal enhancement was seen with a T1-weighted inversion-recovery sequence, while maximal liver signal diminution was seen with a T2*-weighted gradient-echo sequence. The authors conclude that gadopentetate dimeglumine—enhanced echo-planar imaging can provide T1, T2, and T2* contrast that may be exploited for both lesion detection and lesion characterization.     

Usefulness of preoperative low dose cisplatin treatment for advanced esophageal cancer

In order to decrease the perioperative complications by preoperative cisplatin chemotherapy, the preoperative single administration of cisplatin (30 mg/m²) was performed weekly from one to six times in 36 consecutive patients with esophageal cancer classified as higher than Stage II. The survival curve of 17 patients in Stage III was significantly better (P<0.05) than that of patients who had been treated without preoperative cisplatin treatment. In 3 of the 12 patients who had locally invasive cancer, either the main tumors or the metastatic lymph nodes, which had invaded the trachea or the left main bronchus, sufficiently receded, so that a curative esophagectomy became possible; 2 of them have survived over 33 months while 1 died of pneumonia 33 months after surgery. The number of perioperative complications was minimal, and thus, we consider that the postoperative use of cisplatin and fluorouracil is indicated in patients in whom a histological response is noted in the resected specimens.This work was partially supported by Grant No. 02454315 from the Japanese Ministry of Education