Prediction of transfusions in extremely low-birthweight infants in the erythropoietin era

BACKGROUND: The purpose of the present paper was to detect the clinical factors most predictive of red blood cell (RBC) transfusion in extremely low-birthweight (ELBW) infants in the recombinant human erythropoietin era. METHODS: Between 1995 and 2000, 66 ELBW infants were admitted to a level III neonatal intensive care unit. Fifty-four of 66 infants were eligible for enrollment in the present study. Infants were treated with erythropoietin 200 IU/kg per dose s.c. twice a week with 4-6 mg/kg per day iron supplement. RESULTS: The mean gestational age and birthweight were 26.5 +/- 2.1 weeks and 776 +/- 134 g, respectively. Ten of 54 ELBW infants (18.5%) died during the first 21 days. Eight of 10 dead infants (80.0%) and 27 of 44 surviving infants (61.4%) received one or more RBC transfusions. The overall requirement for RBC transfusions in the surviving infants was 3.0 +/- 3.2 per infant/hospital course (range: 0-9) . There were significant differences in gestational weeks, birthweight, initial hemoglobin value, 5 min Apgar score, phlebotomy loss, phlebotomy loss/birthweight, duration of mechanical ventilation, duration of oxygen supplement, and incidence of both intraventricular hemorrhage and chronic lung disease between the transfused and non-transfused group. The predictive variables, initial hemoglobin level (odds ratio [OR] 2.61; 1 g/dL), birthweight (OR 3.00; 100 g), and gestational week (OR 1.89; 1 week), were found to be most predictive for transfusion on logistic regression analysis. CONCLUSION: ELBW infants are still the population at greatest risk for repeated blood transfusions after introduction of erythropoietin treatment. If labor develops, it is often impossible to extend the pregnancy period, therefore efforts should be made to increase hemoglobin level at birth.     

Local Recurrence after Sphincter-Saving Procedures for Carcinoma of the Rectum--An Analysis of 141 Cases--

During the past 18 years, 141 patients with rectal carcinomaunderwent curative sphincter-saving procedures. Local recurrencesoccurred in 17 patients, a recurrence rate of 12%. No significantcorrelation between the recurrence rate and the site of tumoror nodal involvement was found. Laparotomies were performedin 14 of the 17 patients with local recurrence. Thirteen patientsunderwent abdominoperineal excision. In five of them, the recurrentgrowths were completely resected, and they were thought to havedeveloped at the previously established suture line, while inthe remaining eight cases the operation was considered palliative.As the result of pathological study of these resected specimens,it is possible to draw the following conclusions:

1. The length of the distal margin of the normal bowel should bemore than 4 cm in locally advanced cases.
2. In patients whosesecond operation was not curative the recurrencesdid not developin the rectal stump or in the levator muscle,but in the pelvicwall.
3. Local recurrence after sphincter-saving procedures couldbeeffectively avoided by adequate clearance of the pararectalsoft tissues which could contain viable cancer cells, includingthe lymphatics and vessels as well as the lymph nodes.
4. Aftera sphincter-saving operation, the patient must be examinedundera strict follow-up regimen, because curative resectionof localrecurrent tumors by abdominoperineal excision willbe made possibleby earlier detection of the recurrence.

     

Catheter Ablation of Ventricular Tachycardia in Patients with Right Ventricular Dysplasia: Identification of Target Sites by Entrainment Mapping Techniques

Objective: To identify target sites for radiofrequency ablation of ventricular tachycardia (VT) by entrainment mapping techniques in patients with arrhythmogenic right ventricular dysplasia. Methods: Entrainment mapping and radiofrequency ablation of eight VTs was performed in seven patients. Radiofrequency ablation was applied at 31 reentry circuits sites that were classified based on findings during entrainment. Results: By entrainment criteria the 31 sites were classified as: exit sites (n = 12), proximal sites (n = 6), and outer loop sites (n = 13). Radiofrequency current application terminated VT at 7 of 31 sites: 2 of 12 exit sites (17%), 4 of 6 proximal sites (67%), and 1 of 13 outer loop sites (8%). Conclusion: Radiofrequency ablation terminated VTs most often at sites proximal to the exit as opposed to outer loop sites and exit sites (P = 0.05). The critical isthmus for ablation of VT in right ventricular dysplasia often may be distant to the exit.     

G－CSF对化疗后外周血干细胞动员作用的影响

通过对１１例急性白血病患者单独化疗与化疗后加用粒细胞集落刺激因子（Ｇ－ＣＳＦ）的对比，动态观察了Ｇ－ＣＳＦ对外周血造血干细胞（ＰＢＳＣ）的动员作用。发现化疗后加用Ｇ－ＣＳＦ比单用化疗的粒－巨噬细胞集落形成单位（ＣＦＵ－ＧＭ）增加５．１倍，红系爆式集落形成单位（ＢＦＵ－Ｅ）增加４．５倍。Ｇ－ＣＳＦ还可使ＣＦＵ－ＧＭ＞１００／ｍｌ和ＢＦＵ－Ｅ＞２００／ｍｌ的持续时间延长；化疗后ＣＦＵ－ＧＭ的最高值提早出现，而不影响ＢＦＵ－Ｅ／ＣＦＵ－ＧＭ比值。结果表明，化疗后加用Ｇ－ＣＳＦ可明显提高ＰＢＳＣ的收集效率，Ｇ－ＣＳＦ是一种有效的ＰＢＳＣ动员剂。     

Developmental status of young infants with congenital heart disease

BACKGROUND: Developmental status of young infants with congenital heart disease (CHD) is associated with physical and psychosocial factors. With the aim of obtaining basic data to perform developmental support, the study was conducted to examine the development and associated factors among these infants. METHODS: The Japanese Denver Developmental Screening Test was performed in 75 infants at 3-5 months of age, and a questionnaire was sent to their mothers about recognition of their child's development. Infants with and without developmental delay were compared using the characteristics of diagnosis of heart disease, symptoms and surgery, the state of growth of infants, and recognition of a child's development by its mother. To specify more adequate factors, a multiple logistic regression analysis was conducted. RESULTS: Of 75 infants, 14 (18.7%) had developmental delay. Weight gain of standard weight-2SD, Kaup index, and recognition of a child's development by mothers were associated with delayed development. In particular, infants gaining weight at <10 g/day were significantly more delayed than those gaining weight at >20 g/day. In addition, infants whose mothers recognized developmental delay were significantly delayed compared to those not recognized. CONCLUSIONS: Developmental status of young infants with CHD was found to be strongly associated with growth. In particular, weight gain <10 g/day appeared to be the critical point for delayed development, as well as mothers' recognition of their child's development.     

Endoscopic Resection of Small Gastric Adenoma

Abstract: We endoscopically resected 32 small adenomas of the stomach. The diagnosis was made using a bite biopsy technique in each case. On histological examination it was found that 34% of the totally resected specimens contained focal cancer. Endoscopic features, such as shape, surface texture and color, were not useful in identifying lesions harboring focal cancer. Nuclear DNA analysis of the biopsy specimens was not useful for differentiating between adenomas and lesions with focal cancer. We therefore recommend total endoscopic resection, as a biopsy, in all patients with a small adenoma of the stomach.     

Usefulness of Intraductal Ultrasonography (IDUS) for Diagnosing Mucin-producing Pancreatic Tumors

Abstract: While it is very important to detect protruded lesions in order to determine the optimal treatment modality for mucin-producing tumors of the pancreas (MPT), it can be very difficult to discriminate between mucinous substance and tumor. Intraductal ultrasonography (IDUS) (2.0 mm diameter, 15 or 20 MHz) was performed in five MPT cases. The sizes of the tumors were 2, 5, 12, 12 and 30 mm. Histological findings of the resected specimens demonstrated adenocarcinoma in two cases, adenoma in one, and hyperplasia in one. IDUS visualized all tumors, i. e. the visualization rate was 100%. The visualization rate for US and CT was 40% with 12 and 30 mm tumors, and that for EUS was 60% with 2, 12, and 30 mm tumors. We found IDUS to be a very useful method for visualizing small protruded lesions in MPT.