Preparation of packed red cells suitable for intravascular transfusion in utero

Intra-cardiac transfusion in utero is a recent development in the treatment of erythroblastosis foetalis. As with intra-umbilical cord transfusion, the procedure has been described as having a high risk of complication characterized by bradycardia and cardiac-arrest. Intra-coronary hyperkalemia was suspected as being a major contributing factor towards the complications experienced, particularly by the intra-cardiac delivery. The procedure is warranted, however, in cases where intra-umbilical cord transfusion is not possible. Therefore, studies comparing various methods of preparing packed cells for intravascular transfusion were initiated. The plasma potassium levels of gravity sedimented packed cells and saline washed red cells resuspended in either Ringer's lactate, pooled donor plasma or saline were measured. Products of saline washed/resuspended packed red cells transfused within 2 hours of preparation were found to have low potassium levels while exposing the fetus to minimal risk of transfusion transmitted infection and were therefore selected to be the most suitable product. Using this product, a significant decrease in the incidence of severe bradycardia resulting in cardiac-arrest, following intravascular transfusion (32 procedures) was observed.     

Effects of adrenaline and alpha adrenergic antagonists on platelet aggregation in whole blood : Evaluation of electrical impedance aggregometry

The effects of adrenaline and alpha adrenergic antagonists on platelet aggregation in whole blood were assessed by electrical impedance. These effects were then compared to those found in platelet rich plasma assessed by both optical and impedance methods. Our data demonstrate a number of difficulties in attempting to measure platelet responsiveness by electrical impedance and re-emphasise the need for caution in interpretation of in vitro platelet aggregation studies in terms of their clinical relevance.     

Primary and secondary histiocytic lymphoma of the brain: CT features

The authors examined 19 patients with diffuse histiocytic lymphoma of the brain, including 8 with primary disease and 11 with secondary disease. Both primary disease and secondary disease involving the brainstem and deep nuclei exhibited the characteristic CT appearance, consisting of a large, solid, homogeneously enhanced mass with varying amounts of edema. However, most secondary lymphomas outside the brainstem and basal ganglia contained large areas of low attenuation consistent with necrosis. Multifocal lesions were seen only in patients with secondary lymphoma. Systemic chemotherapy for extracranial lymphoma had no effect on the CT appearance of intracranial lesions. The authors suggest that these "unusual" CT patterns are actually typical of a distinct subset of histiocytic lymphomas.     

Chronic illness perception in adolescence: Implications for the doctor-patient relationship

To describe the inter-relationship of chronic illness severity as perceived by adolescents with both psychosocial well-being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.

Methods:

The psychological well-being of 48 adolescents with either cystic fibrosis (CF) or insulin-dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.

Results:

There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.

Conclusions:

For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well-being. Physicians do not accurately infer their patients' perception of illness severity.