Erythroid failure in Diamond-Blackfan anemia is characterized by apoptosis

Programmed cell death, also known as apoptosis, is frequently initiated when cells are deprived of specific trophic factors. To investigate if accelerated apoptosis contributes to the pathogenesis of Diamond- Blackfan anemia (DBA), a rare pure red blood cell aplasia of childhood, we studied the effect of erythropoietin (epo) deprivation on erythroid progenitors and precursors from the bone marrow of DBA patients as compared with hematologically normal controls. Apoptosis in response to epo deprivation was evaluated by enumeration of colony-forming unit- erythroid (CFU-E)- and burst-forming unit-erythroid (BFU-E)-derived colonies in plasma clot semisolid culture and by the identification of typical DNA oligosomes by gel electrophoresis from marrow mononuclear cells in liquid culture. In all DBA patients there was a marked decrease in CFU-E- and BFU-E-derived colony formation compared with normal controls at comparable time points of epo deprivation, with a complete loss of CFU-E-derived colonies in semisolid culture by 9 hours of epo deprivation versus 48 hours in controls. The BFU-E-derived colony response to epo deprivation displayed a similar pattern of decrement. Apoptotic changes assessed by the presence of characteristic DNA fragmentation began in the absence of epo deprivation and were readily detected within 3 hours of epo deprivation in DBA cultures versus 9 hours in controls. We conclude that DBA is characterized by accelerated apoptosis as measured by the loss of erythroid progenitor clonogenicity and increased progenitor and precursor DNA fragmentation leading to the formation of characteristic oligosomes, consistent with an intrinsic erythroid-progenitor defect in which increased sensitivity to epo deprivation results in erythroid failure.     

Enterocutaneous Fistulas and a Hostile Abdomen: Reoperative Surgical Approaches

Damage-control surgery and open-abdomen is an acceptable—and often lifesaving—approach to the treatment of patients with severe trauma, abdominal compartment syndrome, necrotizing soft tissue catastrophes, and other abdominal disasters, when closing the abdomen is not possible, ill advised, or will have serious sequelae. However, common consequences of open-abdomen management include large abdominal wall defects, enterocutaneous fistulas (ECFs), and enteroatmospheric fistulas (EAFs). Furthermore, in such patients, a frozen and hostile abdomen (alone or combined with ECFs) is not uncommon. Adding biologic mesh to our surgical armamentarium has revolutionized hernia surgery.     

Medical complications and outcomes at an onsite rehabilitation unit for older people

Background

The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

Aims

Enumeration of medical complications of patients admitted to a dedicated onsite rehabilitation unit for older people, and the extent of co-morbidity in the population with the effects that this had on the evolution of medical complications.

Methods

A retrospective analysis of patients admitted to a 58-bed onsite unit over a 1-year period was performed. Information collating co-morbidities, medical complications and functional outcomes was recorded.

Results

Medical complications occurred in almost 95 % of patients, where full data were available. Over one-third required intravenous therapy.

Conclusion

Twenty-four hour medical cover is required for older patients managed at onsite rehabilitation units. Further studies on offsite medical rehabilitation facilities for older patients are required.     

Interstitial hyperthermia in combination with brachytherapy

Flexible coaxial cables were modified to serve as microwave antennas operating at a frequency of 915 MHz. These antennas were inserted into nylon afterloading tubes that had been implanted in tumors using conventional interstitial implantation techniques for iridium-192 seed brachytherapy. The tumor volume was heated to 42-45 degrees C within 15 minutes and heating was continued for a total of 1 hour per treatment. Immediately following a conventional brachytherapy dose and removal of the iridium seeds the tumors were heated again in a second treatment. This interstitial technique for delivering local hyperthermia should be compatible with most brachytherapy methods. The technique has proved so far to be practical and without complications. Temperature distributions obtained in tissue phantoms and a patient are described.     

The Effect of Hemorrhage on Plasma Iron Turnover

The plasma iron turnover rate in rats following a single hemorrhage reachesa maximum in about 48 hours and returns to normal between the seventh andtenth day. There is considerable variation in individual rats in both the maximum rate attained and the time required for recovery. No significant difference in response was observed due to the severity of hemorrhage uponremoval of 2.7 to 18 per cent of total red cells.

Submitted on June 20, 1960 Accepted on November 20, 1960