Caring for rape victims

Students in the health professions are working with a variety of anxiety-provoking patients, such as victims of child abuse or sexual assault, suicidal and terminally ill patients. Faculty have a responsibility to assist these students in maximizing the growth potential of the experience. This study, involving 22 female and three male students at the University of New Mexico Colleges of Nursing and Medicine, examines the effects of such an experience. Each participant worked on a Sexual Assault Response Team at the Bernalillo County Medical Center for an average of 8.6 months; each saw an average of 16 rape victims for whom they provided counseling services and assisted in medical care and gathering evidence.All of the students reported heightened awareness of their own vulnerability. They began to develop cognitive and behavioral strategies to cope with the possibility of being raped. Approximately one third of the subjects developed symptoms similar to those experienced by rape victims. Those who did not develop symptoms attributed it to being able to work through their feelings at team meetings. Students became more aware of their attitudes toward rape victims, both positive and negative. Moreover, the most significant change they experienced was in their own perception of themselves as care givers; they felt more confident and competent, both in medical and counseling areas. Faculty are encouraged to meet weekly with students involved in such experiences.Drs. DiVasto, Kaufman, and Jackson are faculty members in the Department of Family, Community, and Emergency Medicine, School of Medicine, University of New Mexico, Albuquerque. Ms. Ballen and Ms. Seymour are recent graduates of the University of New Mexico College of Nursing. Ms. Duphorne is a faculty member in the College of Nursing. Requests for reprints should be addressed to Dr. DiVasto, Department of Family, Community, and Emergency Medicine, 620 Camino de Salud, N.E., Albuquerque, New Mexico 87131.     

Low dose total body irradiation followed by allogeneic lymphocyte infusion for refractory hematologic malignancy--an updated review

Allogeneic stem cell transplantation is curative for certain cancers, but the high doses of chemotherapy and radiotherapy used in conventional myeloablative conditioning regimens may lead to severe toxicity. In our initial study, we treated 25 patients with refractory cancers with 100 cGy total body irradiation (TBI) followed by allogeneic, non mobilized peripheral blood cells. Eighteen patients received sibling and 7 patients received unrelated cord blood stem cells. None of the 13 patients with solid tumors achieved donor chimerism or had a sustained response. Twelve patients with hematologic malignancies were treated, 1 received a cord blood transplant and 11 received sibling donor cells. Nine of these 11 patients achieved donor chimerism, ranging from 5% to 100%. Four patients had sustained complete remission of their cancers, and 2 are long-term survivors. The development of chimerism correlated with total previous myelotoxic chemotherapy (p < 0.001). This technique is now being extended into the haploidentical setting.     

Safety and cost of hyperhydration for the prevention of hemorrhagic cystitis in bone marrow transplant recipients

Hemorrhagic cystitis is a major cause of morbidity after bone marrow transplantation. Traditional methods of prevention have included mesna (2-mercaptoethane sodium sulfonate) and bladder irrigation. We report the use of hyperhydration as an alternative to these prophylactic measures. One hundred consecutive patients who underwent autologous or allogeneic bone marrow transplantation received high dose cyclophosphamide with hyperhydration using 5% dextrose normal saline at the rate of 250 ml/h and furosemide to maintain a urine output of >150 ml/h. Seventy-one of these patients also received high dose cyclophosphamide as mobilization chemotherapy. There were no episodes of hemorrhagic cystitis following mobilization chemotherapy. The incidence of hemorrhagic cystitis after transplant conditioning was 7% with 2 patients developing clinically significant hemorrhagic cystitis; one was a severe episode. The cost of hyperhydration was US$ 20 per course as opposed to US$ 1,500 per course for mesna, based on acquisition costs at our institution. We conclude that hyperhydration is a safe, inexpensive means of preventing hemorrhagic cystitis associated with high dose cyclophosphamide in bone marrow transplant recipients. Copyright Copyright 1999 S. Karger AG, Basel     

ENDOTHELIAL CELL CULTURE AND SEEDING OF PROSTHETIC VASCULAR GRAFTS: AN EXPERIMENTAL STUDY

Current synthetic vascular prostheses do not acquire lining of vascular endothelium in humans or dogs. Endothelial seeding of vascular grafts has been proposed as a means of reducing the thrombogenicity of these grafts. We examined feasibility of cultivating endothelial cells (EC) by tissue culture technique and their subsequent seeding onto small diameter polytetra fluoroethylene (PTFE) grafts. Twenty adult dogs underwent common carotid artery interposition with 4 mm PTFE grafts. Ten dogs received seeded and the remaining ten received unseeded grafts. Grafts were removed at 4 and 12 weeks and their gross/morphological features compared. Cumulative patency rates for seeded grafts were 70% as compared to unseeded ones 30%. Seeded grafts were completely surfaced with a mono-layer of endothelium by 4 weeks. Small graft patency appears to be related to the establishment of an endothelial surface, the development of which is clearly facilitated by seeding with autogenous endothelium.KEY WORDS: Endothelial cell seeding, Vascular grafts     

Detection of Schistosoma mansoni Membrane Antigens by Immunoblot Analysis of Sera of Patients from Low-Transmission Areas

Schistosoma mansoni surface membrane components play a relevant role in the host-parasite interaction, and some are released in vivo as circulating antigens. n-Butanol extraction favors the release of membrane antigens like alkaline phosphatase, which has been shown to be specifically recognized by antibodies from S. mansoni-infected humans and animals. In the present study, components in the n-butanol extract (BE) of the adult S. mansoni worm membrane fraction were separated by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis (1D SDS-PAGE [15%]) and further analyzed by immunoblotting (immunoglobulin G) using defined sera. S. mansoni-infected patient sera, but not sera of uninfected patients or sera obtained from patients infected with other parasite species, specifically and variably recognized up to 20 polypeptides in the molecular mass range of ~8 to >80 kDa. There were some differences in the number, intensity, and frequency of recognition of the BE antigens among sera from Venezuelan sites of endemicity with a different status of schistosomiasis transmission. Antigens in the 28- to 24-kDa molecular mass range appeared as immunodominants and were recognized by S. mansoni-positive sera from all the sites, with recognition frequencies varying between 57.5 and 97.5%. Immunoblotting with BE membrane antigens resulted in a highly sensitive (98.1%), specific (96.1.0%), and confirmatory test for the immunodiagnosis of schistosomiasis in low-transmission areas.