Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients

Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.     

Adamantiades-Beh?et's disease. Clinical review]

Beh?et's disease is a chronic relapsing systemic vasculitis of unknown etiology, affecting predominantly oral and genital mucocutaneous tissues and also the eyes. The disease is spread worldwide with a higher prevalence rate in countries along the ancient Silk Route, but it is rare (1-10/100,000) in Central and Northern Europe. Genetic, environmental, immunologic, inflammatory and rheologic factors are involved in the pathogenesis and the course of the disease. Any vascularized organ may be affected. Eye involvement is frequent, and may eventually result in loss of vision. Further important complications are cerebral manifestations, thrombotic syndromes, and arterial aneurysms with a high risk of rupture. Diagnosis and therapy of Beh?et's disease are best managed by an interdisciplinary team. Skin lesions may be controlled by systemic treatment with colchicine, alternatively with dapsone, and in severe cases with thalidomide. Active systemic disease should be treated more aggressively using immunosuppressants. Despite advances in treatment relapses are still frequent, and systemic disease remains associated with an adverse prognosis.     

Kinetics of peripheral blood mononuclear cell mobilization with chemotherapy and/or granulocyte-colony-stimulating factor: implications for yield of hematopoietic progenitor cell collections

BACKGROUND: Peripheral blood progenitor cells (PBPCs) are commonly collected and used to reconstitute hematopoiesis after high-dose chemotherapy. However, strategies for optimal collection and assessment of leukapheresis components are not standardized. STUDY DESIGN and METHODS: Hematopoietic progenitor cell assays were performed on 369 leukapheresis components collected from 95 patients who had received doxorubicin-based chemotherapy and/or granulocyte-colony-stimulating factor (G-CSF). Precollection patient hematologic values, leukapheresis collection values, component hematopoietic progenitor cell assays, and patient outcome measures were summarized. The kinetics of mononuclear cell (MNC) and PBPC mobilization were assessed among four patient groups. RESULTS: Patient group was a significant predictor of the peripheral blood MNC count on the day of collection (p<0.0001), and that value was a significant predictor of granulocyte-macrophage– colony-forming unit (CFU-GM) yield (p<0.0001). This relationship between the peripheral blood MNC count on the day of collection and CFU- GM yield differed according to patient group (p<0.0001). CFU-GM made up a larger fraction of peripheral blood MNCs collected from patients who received chemotherapy plus G-CSF than collected from those who received G-CSF alone. Moreover, the peripheral blood MNC count and the corresponding CFU-GM yield increased significantly on consecutive days of collection in patient groups receiving chemotherapy and G-CSF but were unchanged or decreased in patients receiving G-CSF alone. CONCLUSION: The relationship between peripheral blood MNC count and leukapheresis component CFU-GM yield differed significantly between patients who received chemotherapy and G-CSF and those who received G- CSF alone for the mobilization of PBPCs. Patient peripheral blood MNC count and component CFU-GM yield are useful for both assessing and suggesting revisions to PBPC mobilization and collection strategies.     

预激态补骨脂素抑制 K562细胞增殖的实验研究

本研究的目的是观察预激态补骨脂素对K562细胞增殖的影响，为补骨脂素的临床应用提供实验依据。取预激态补骨脂素和晚激态补骨脂素处理的细胞，在培养后检测台盼蓝拒染细胞数和白血病细胞集落，并对它们在台盼蓝拒染细胞抑制率(TBIR)、细胞增殖抑制率(CPIR)和集落形成抑制率(CFIR)方面的差异进行比较。结果表明：预激态补骨脂素对K562细胞增殖有抑制作用；随着预激态补骨脂素浓度的增加，其抑制作用也随之增强；预激态补骨脂素与晚激态补骨脂素的TBIR、CPIR、CFIR各值比的差异不显著；为使预激态补骨脂素要充分发挥对K562细胞的抑制作用，补骨脂素的紫外线照射时间应在10分钟以上；与K562细胞作用时间也应大于12小时；抑制作用会因预激态补骨脂素预激后搁置时间的延长而下降，在6小时内作用最强。结论：预激态补骨脂素和晚激态补骨脂素对K562细胞的增殖均表现出抑制作用，有望作为临床的抗肿瘤用药。     

Donor screening for antibody to hepatitis B core antigen and hepatitis B virus infection in transfusion recipients

BACKGROUND: Testing for antibody to hepatitis B core antigen (anti-HBc) as a surrogate for hepatitis C viremia is no longer needed for blood donor screening. Currently, the important question is how much its use supplements hepatitis B surface antigen (HBsAg) donor screening in preventing transfusion-transmitted hepatitis B virus (HBV) infection. STUDY DESIGN AND METHODS: In a study conducted in the 1970s, 64 blood donors were associated with 15 cases of HBV (1.0%) in 1533 transfusion recipients. Sera from 61 donors at donation and 29 follow-up visits were available for present-day assays for HBsAg, HBV DNA, anti-HBc, and antibody to HBsAg (anti-HBs). RESULTS: HBsAg was found in four previously negative blood donors; HBV DNA was limited to three of these four. Anti-HBc was detected in six HBsAg-negative donors. Two other donors were negative in all assays at donation, but positive for anti- HBc and anti-HBs 2 to 4 months later. The remaining donors were negative for all HBV markers, which left five recipient cases unexplained. No HBV transmission was observed when anti-HBs sample-to- negative control values were > or = 10. CONCLUSION: Some 33 to 50 percent of cases of hepatitis B that could be transmitted by transfusion of blood from HBsAg-negative donors are prevented by anti- HBc screening. Anti-HBc-positive donors unequivocally positive for anti- HBs should be considered noninfectious for HBV and should be allowed to donate. Anti-HBc screening of paid plasmapheresis donors, supplemented by anti-HBs testing, would reduce the amount of HBV to be processed by virus inactivation and increase the content of anti-HBs in plasma pools.     

Akute Herzinsuffizienz und kardiogener Schock

Zusammenfassung Trotz verbesserter medikamentöser und interventioneller Therapieoptionen sterben nach wie vor mehr als zwei Drittel aller Patienten, die nach Myokardinfarkt akut herzinsuffizient werden und einen kardiogenen Schock erleiden. Frühe Diagnose und rasche Einleitung von Basismaßnahmen sind entscheidend, um die Zeit bis zur Revaskularisation zu überbrücken. Aufgrund der Schwere des Krankheitsbilds stützen sich viele Behandlungsstrategien nicht auf große randomisierte Studien, sondern auf empirisch gewonnene Erkenntnisse. Neue Entwicklungen betreffen zum einen das kontinuierliche hämodynamische Monitoring, das eine bessere Steuerung der Volumentherapie erlaubt. Zum anderen werden auch neue Prognosemarker und Pharmaka mit dem Ziel verbesserter Verlaufsbeurteilung und medikamentöser Beeinflussung des Schockgeschehens in ersten klinischen Studien erprobt. Spezielle Herausforderungen ergeben sich weiterhin durch ein begleitendes rechtsventrikuläres Pumpversagen oder hämodynamisch wirksame Herzrhythmusstörungen, die Auslöser oder Folgen des kardiogenen Schocks sein können.Ein Erratum zu diesem Beitrag können Sie unter finden.