Citrate versus heparin anticoagulation in chronic haernodialysis patients

Anticoagulation with citrate at a rate of 0.68 mM/min in combinationwith a calcium and magnesium-free dialysate and i.v. supplementationof calcium and magnesium at rates of 0.18 mM/min and 0.08 mM/minrespectively, was compared with lowdose heparin. The heparindose was a loading dose of 2500 IU and a sustaining infusionof 750–1250 IU/h; or a loading dose of 1250 IU and a sustaininginfusion of 500–750 IU–h until I h before the endof the dialysis if the patlent was taking concomitantly coumarinanticoagulation for a Goretex shunt. Six chronic haemodialysispatients changed from heparin to citrate anticoagulation becausethey reported bleeding between dialyses. Heparin, after 2 hdialysis, induced a significant 10% prolongation of each patient'swholeblood activated clotting tlme (WBACT) as compared to thepredialysis value: while the WBACT at the dialyser outlet wasless than 3% prolonged as compared to the patient's WBACT. However,after 2 h cltratc the patient's WBACT was not prolonged butthe WBACT at the dialyser outlet was 20–100°A longer,indicating a better anticoagulation of the extracorporeal systemwithout systemic effects. With heparin the shunt pressure time(SPT). i.e. the time needed to stop bleeding from the puncturesites of the Goretex shunts. was 12 of 28 tlrnes 20 niln ormore Citrate reduced these episodes by 75%. Thus citrate should be considered for chronic haemodialysispatients who are at risk of bleeding because of the concomitantuse of anticoagulants. Other patients who could benefit fromcltrate are those with premorbid vascular abnormalities suchas intestinal arterlovenous malforniations. diabetic retinopathymalignant hypertension or adult polycystic kidney disease. Claimsthat cltrate gave improved biocompatibility. 1.e. less leukopeniaor thrombocytopenia. were not confirmed. lndications that citratecaused better dialysis efficiency were found. but should beconfirmed In a greater number of patients.     

Antibodies to components of neutrophil cytoplasm: a new diagnostic tool in patients with Wegener's granulomatosis and systemic vasculitis

Eleven patients with symptoms highly suggestive of Wegener's granulomatosis are described. In spite of extensive investigation, only in two patients was a firm histological diagnosis of Wegener's granulomatosis obtained, while the remaining patients were either diagnosed as having unclassifiable systemic vasculitis or had no histological diagnosis made. This sometimes resulted in diagnostic and therapeutic delay and irreversible organ damage. Antibodies to components of neutrophil cytoplasm--recently demonstrated to be specific for Wegener's granulomatosis--were detected by indirect immunofluorescence in 10 of 11 patients, and it appears likely that antibodies to components of neutrophil cytoplasm will prove to be of great value in early diagnosis.     

Incidental67Ga uptake into an appendiceal mucocele in a patient with sigmoid colon cancer

We report a case of sigmoid colon cancer in which visualization of an appendiceal mucocele was unexpectedly found during⁶⁷Ga scintigraphy, and discuss a proposed mechanism of uptake.     

Pleomorphic carcinoma of the lung producing granulocyte colony-stimulating factor: report of a case

We herein report a case of acute respiratory distress syndrome (ARDS) that appeared to be related to a granulocyte colony-stimulating factor (G-CSF)-producing lung cancer. A 77-year-old man with arterial sclerotic obstruction (ASO) underwent reconstructive surgery of the left femoral artery. He developed ARDS on the 5th postoperative day, which resolved following mechanical ventilation with steroid pulse treatment. Four months later, he was admitted with a fever and right arm pain. Chest computed tomography showed a malignant lesion in the right apical lung, and percutaneous needle biopsy demonstrated adenocarcinoma. Laboratory data revealed neutrophilia with elevated serum G-CSF levels. He underwent a right upper lobectomy with chest wall resection, and administration of sivelestat sodium to treat his postoperative pre-acute lung injury state. Pathology revealed a G-CSF-producing pleomorphic carcinoma. Retrospectively, a tumor shadow was noted on chest X-ray at the time of ARDS just after ASO surgery. The relationship between an abnormal G-CSF level and ARDS was considered, and the implications are herein discussed.     

An in vitro study demonstrating that haematomas found at the site of human fractures contain progenitor cells with multilineage capacity

We isolated multilineage mesenchymal progenitor cells from haematomas collected from fracture sites. After the haematoma was manually removed from the fracture site it was cut into strips and cultured. Homogenous fibroblastic adherent cells were obtained. Flow cytometry revealed that the adherent cells were consistently positive for mesenchymal stem-cell-related markers CD29, CD44, CD105 and CD166, and were negative for the haemopoietic markers CD14, CD34, CD45 and CD133 similar to bone-marrow-derived mesenchymal stem cells. In the presence of lineage-specific induction factors the adherent cells could differentiate in vitro into osteogenic, chondrogenic and adipogenic cells. Our results indicate that haematomas found at a fracture site contain multilineage mesenchymal progenitor cells and play an important role in bone healing. Our findings imply that to enhance healing the haematoma should not be removed from the fracture site during osteosynthesis.     

Longitudinal psychological effects of the Garuda Indonesia air disaster in Japan

We examined the general health and psychological symptoms among survivors of the 1996 Garuda Indonesia air disaster in Japan. We conducted a prospective study 6 months and 1 year (Study 1) after the disaster. A retrospective follow-up study was performed ten years after the disaster (Study 2). The mean score on the 28-Item General Health Questionnaire was 6.5 (SD=6.9) 1 year after the disaster. Those who witnessed the death of an acquaintance in the disaster were classified into the high risk group. In Study 2, more than one-third of respondents complained of a flying phobia. These findings indicate that the psychological burdens of air disasters may last as long as 10 years.