Autotransfusion and emergency surgery: preliminary report on an improved technique

A new improved technique of erythrocyte autotransfusion is described. Autologous blood aspirated from the operative field is centrifuged, washed and reinfused in 5-10 minutes. The systems is composed of a centrifuge and vacuum pump built into the machine. The disposable set is very easy to assemble, and cost-effective. Preliminary data of 19 patients operated as emergency cases are shown. None had postoperative bleeding. Platelet count and function did not change. Even in the cirrhotic patients there were no changes in coagulation two hours after autotransfusion. The system seems easy to use, cost-effective and particularly indicated in emergency surgery.     

A0001 in Friedreich ataxia: Biochemical characterization and effects in a clinical trial

This study tested the ability of A0001 (α-tocopheryl quinone; EPI-A0001), a potent antioxidant, to improve in vitro measures, glucose metabolism, and neurological function in Friedreich ataxia. We used an in vitro study of protection from cell toxicity followed by a double-blind, randomized, placebo-controlled trial of 2 doses of A0001 in 31 adults with Friedreich ataxia. The primary clinical trial outcome was the Disposition Index, a measure of diabetic tendency, from a frequently sampled intravenous glucose tolerance test, evaluated 4 weeks into therapy. Secondary neurologic measures included the Friedreich Ataxia Rating Scale. A0001 potently inhibited cell death in Friedreich ataxia models in vitro. For the clinical trial, mean guanine-adenine-adenine repeat length was 699, and mean age was 31 years. Four weeks after treatment initiation, differences in changes in the Disposition Index between subjects treated with A0001 and placebo were not statistically significant. In contrast, a dose-dependent improvement in the Friedreich Ataxia Rating Scale score was observed. Patients on placebo improved 2.0 rating scale points, whereas patients on low-dose A0001 improved by 4.9 points (P = .04) and patients on a high dose improved by 6.1 points (P < .01). Although A0001 did not alter the Disposition Index, it caused a dose-dependent improvement in neurologic function, as measured by the Friedreich Ataxia Rating Scale. Longer studies will assess the reproducibility and persistence of neurologic benefit.     

Femoral osteonecrosis in patients treated with radiochemotherapy of Hodgkin's lymphoma

Therapeutic progress has much improved the prognosis of Hodgkin's disease; therefore long-term complications of the treatment have become a major problem. Among these, the authors focused on osteonecrosis of the femoral head, and conducted a retrospective study on 182 patients treated with inverted-Y-field radiation therapy combined to MOPP chemotherapy in 129 cases. Femoral osteonecrosis was found in 6 patients (3.3%), 5 males and 1 female; 4 of them received combined modality treatment (inverted-Y radiation therapy + MOPP), and 2 radiation therapy alone. The interval between the end of treatment and the radiological finding of femoral osteonecrosis ranged from 23 to 54 months, with a mean of 35 months. On the whole, 10 cases of osteonecrosis of the femoral head (4 bilateral, and 2 unilateral) were observed, and 4 fractures involving the anatomic neck. According to our results, neither a safety dose-limit nor an optimal schedule of combination therapy could be fixed. Besides radiological features and the problems of differential diagnosis, the authors considered the pathogenesis of femoral head osteonecrosis in the patients with Hodgkin's disease treated with radiotherapy alone or combined to chemotherapy, and suggested the existence of a personal proneness to the lesion and the role of ionizing radiations, corticosteroids and cytotoxic agents, as inducing factors. Because of the different and unexpected reaction of each patient to the treatment, osteonecrosis prevention is very difficult: however, its complication may be reduced--or even avoided--by subjecting the treated patients to periodic clinical and radiological examinations.