Acquired Loss of Red-Cell Wj Antigen in a Patient with Hodgkin''s Disease

A patient with Hodgkin's disease became temporarily Wj-negative with alloanti-Wj in his serum. Four human autoantibodies, and 1 of 2 murine monoclonal antibodies, with serological characteristics of anti-Wj were nonreactive with his red cells, confirming that they have anti-Wj specificity. Six siblings of the patient are all Wj-positive. The patient was also temporarily Anton-negative, and cross-testing between Wj and Anton red cells and antisera showed mutual compatibility, indicating that the antigens are the same. The patient and 3 of his 6 siblings are also of the rare Lu: - 13 phenotype, providing the first evidence that this is an inherited characteristic.     

Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

Background  

Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data.     

Correlates of adolescent drug use by gender and geographic location

We examined the correlates of self-reported lifetime use of alcohol, marijuana, amphetamines, and cocaine within a sample of almost 7,000 high school sophomores in Arizona and Utah. Correlates of drug use (including parental attachment, religious attachment, educational attachment, conventional values, and drug-using friends) showed very similar patterns by gender, with some interesting differences by location. Drug-using friends are by far the best predictor of drug use for both males and females in Arizona and Utah.     

Bone morphogenetic protein augmentation grafting of resistant femoral nonunions. A preliminary report

Twelve patients with intractable nonunions of the femoral diaphyseal or metaphyseal-diaphyseal shaft were successfully treated by a combination of internal fixation and implants of human bone morphogenetic protein (h-BMP). There was an average of 4.3 surgical procedures per patient attempting union prior to h-BMP implantation. Union was obtained in 11 of 12 patients and in one patient with a repeat stabilization and implantation of h-BMP. Four patients received autogeneic cancellous bone graft and four patients received allogeneic bone grafts. The BMP implant was prepared in the form of an aggregate of h-BMP and bone matrix water-insoluble noncollagenous proteins (h-BMP/iNCP). Fifty to 100 mg of h-BMP/iNCP was either implanted in the fracture gap in ultra thin gelatin capsules, or incorporated in a strip of polylactic/polyglycolic acid copolymer (PLA/PGA) and placed as an onlay across the fracture gap. The average time to union was 4.7 months. Further clinical investigations are planned as a series of matched cases with and without BMP augmentation in order to distinguish h-BMP effects from new or improved methods of fracture fixation combined with autogeneic cancellous bone grafts.     

Quality of life after cystectomy. Comparison between patients with conduit and those with continent caecal reservoir urinary diversion

A questionnaire survey was carried out to assess the quality of life of 60 patients who had undergone cystectomy because of bladder carcinoma. Urinary diversion was by a continent caecal reservoir in 20 patients and by a conduit in 40. The patients' replies showed that cystectomy could cause severe problems in all aspects of life. Diversion with a continent caecal reservoir was associated with fewer stoma-related problems and seemed to allow the patients greater freedom to continue activities such as sport, travel and social life. Sexual problems, disturbed relationships with partners and emotional and mental problems were common and did not differ between the two groups of patients. It is recommended that patients judged to be prone to mental and emotional disturbance after cystectomy should be identified pre-operatively and given extra psychological support.     

Tuberculosis of the pancreas: a case report

A 73-year-old female died of adult respiratory distress syndrome (ARDS) and multiple organ system failure (MOSF) after a routine cholecystectomy for acute cholecystitis. An autopsy revealed disseminated tuberculosis with a tuberculous abscess of the pancreas.     

Antibiotic use during major head and neck surgery.

The appropriate use of prophylactic antimicrobial therapy in patients undergoing major contaminated surgery is an important issue for the head and neck surgeon. A series of five sequential, prospective, randomized, double-blind clinical trials of antibiotics for patients undergoing major contaminated oncologic head and neck surgery are reviewed and summarized. The information generated from the study of these 547 patients indicates that a number of drugs or drug combinations have similar efficacy when employed in adequate dosage. The bacteriologic spectrum of the prophylactic drug should include oral microflora, especially anaerobic bacteria. The administration of antibiotics effective against gram-negative aerobic bacteria may be unnecessary. Perioperative antibiotic administration should be initiated prior to surgery. To date, no evidence exists to support prolonged administration of antibiotics beyond the first 24 hours following surgery.     

Pathogenesis of postoperative hyponatraemia following correction of scoliosis in children

Eight paediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium, renin and aldosterone, and urine volume, sodium and osmolality were measured. These patients had an impaired ability to excrete a sodium-free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h postoperation are considered, the sodium-free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P less than 0.01). To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema, it is recommended that no more than 50 ml/kg sodium-free water be given until urine sodium falls and volume increases.     

DNA repair synthesis in individuals with and without a family history of cancer

The influence of family history on DNA repair synthesis, unscheduledDNA synthesis (UDS), was assessed in volunteers with or withouta family history of cancer. UDS, following treatment of mononuclearleukocytes with N-acetoxy-2-acetylaminofluorene, was measuredas the incorporation of [³H] into DNA in the presence of hydroxyurea.The positive family history group (n=71) had an average of 2.4first-degree relatives with cancer, defined as any major cancer,excluding skin cancer: 31 participants reported that canceroccurred in both their parents. The ‘no family history’comparison group (n=29) had no family history of cancer throughthe second degree. There was a significant reduction in UDSin cells from individuals with family history, compared to thosewith no family history (P>0.002). This relationship was notexplained by factors known to influence UDS, such as age, smokingor hypertension. We conclude that reduced UDS in mononuclearleukocytes is associated with a family history of any majorcancer, and is not confined to a history of cancer of any singleorgan site. This conclusion is further supported by the observationthat individuals (n=13) with parents who had an earlier onsetof cancer (<60 years) also had a significantly lower DNArepair synthesis than those (n=18) whose parents had later diagnosisof cancer (>60 years).