Experiences of the first 493 unrelated marrow donors in the National Marrow Donor Program

More than 410,000 people participated in the National Marrow Donor Program (NMDP) as of October 1, 1991, and more than 850 volunteers had donated marrow. While the incidence of serious morbidity as a result of bone marrow donation is rare, the incidence of lesser complications and the long-term consequences of marrow donation are not known. To determine the incidence of donor complications and measure the recovery time of volunteer, unrelated marrow donors, we analyzed the results of surveys of the first 493 persons who donated marrow through the NMDP. The marrows were collected at 42 centers. The median age of the donors was 37.9 years (range 19.1 to 55.6 years). The median volume of marrow collected was 1,050 mL (range 180 to 2,983 mL). Autologous red blood cells were transfused to 89.8% (439) of donors but only 0.6% (3) of donors received allogeneic blood. Acute complications related to the collection procedure occurred in 5.9% of donors; but a serious complication, apnea during anesthesia, occurred in only one donor. When donors were questioned approximately 2 days following discharge from their hospitalization, most donors described symptoms related to the collection; 74.8% experienced tiredness, 67.8% experienced pain at the marrow collection site, and 51.6% of the donors experienced low back pain. Donors were surveyed repeatedly until they felt that they had recovered completely. Mean recovery time was 15.8 days; however, 42 (10%) donors felt that it took them > or = 30 days to recover fully. The duration of the marrow collection procedure and duration of anesthesia both positively correlated with donor pain and/or fatigue following the collection; but the duration of the collection procedure had the highest correlation with post-collection pain and fatigue. The volume of marrow collected per unit of donor weight was more weakly correlated with donor pain and/or fatigue than the anesthesia and collection times. When multivariate analysis was used to analyze the correlation between donor recovery time and these variables, only the duration of the collection was found to correlate significantly with donor recovery time (P = .001). This analysis demonstrates that marrow donation is well tolerated with few complications. To decrease further the incidence of donor discomfort and recovery time following donation, the duration of the collection procedure, and probably the duration of anesthesia, and the volume of marrow collected, should be kept to a minimum.     

一个计量型制剂含量均匀度检查新方案的制订与评价

采用概率统计计算方法找到符台一定质量要求的制剂批单剂含量总体均值和标准差的轨迹,进行近似并确定了二次抽样范围,从而制订出一个以标示量为参考值、二次抽样的计量型含量均匀度检查新方案;然后用蒙特卡洛即统计模拟方法为该方案在4个不同允许废品率下绘制抽样特性(OC)曲线,同时统计平均样本容量,并与几个国家药典典型的含量均匀度检查法的对应指标比较;最后讨论了新方案的准确性、灵活性和在控制生产上的实用性等问题。     

Comparative study on the prevalence of myasthenia gravis in the provinces of Bologna and Ferrara, Italy

This cooperative study was performed in the provinces of Bologna and Ferrara to estimate the prevalence rate of Myasthenia Gravis (MG). Two independent groups used the same case collection method and diagnostic criteria. The study was performed from January 1, 1987 to March 1, 1988. Cases were collected through: 1) review of clinical files from neurology clinics in Bologna and Ferrara, and from the main North-Italian centers for MG (neurology clinics of Milan and Turin; thoracic surgery unit, Turin); 2) thoracic surgery and intensive care units in Bologna and Ferrara; 3) physicians prescribing anticholinesterase drugs. Prevalence rates of generalized MG per million population were 60.9 in the city and 41.0 in the remaining province for Bologna and 118.9 in the city and 87.9 in the remaining province for Ferrara. The difference in prevalence rates between the two areas was statistically significant. Our survey shows that prevalence studies on MG may be biased by factors that cannot be controlled and that most previous studies have probably underestimated the prevalence of MG.     

The process of donation after cardiac death: a US perspective

Donation after cardiac death (DCD) has the potential to significantly increase the number of organ donors nationwide by at least 10%, which is the current goal of the National Organ Donation and Transplantation Collaboratives. Several organ procurement organizations in the United States currently exceed this goal with nearly 20% of their organ donors being DCD donors. With the Joint Commission on Accreditation of Healthcare Organizations asking all hospitals in the United States to have a policy on DCD donation, the number of DCD donors nationwide is expected to increase. Likewise, the numbers of organs transplanted from DCD donors is expected to increase since transplantation results with kidneys, pancreata, livers, lungs, and, in two cases, heart transplantation, have been similar to results from brain-dead donors. Equally, if not more important, is the ability to offer the opportunity of organ donation as part of the continuum of care at the end of life for patients and families. The comfort and healing nature of being able to leave a legacy of life through organ donation is well known and should never be underestimated whether donation occurs in the DCD or brain-death setting.