An autologous blood program coordinated by a regional blood center: a 5- year experience

The Southern Arizona Regional Red Cross blood program offers preoperative autologous blood deposit to all patients and intraoperative autotransfusion services to all hospitals in the region. During a 5-year period, the amount of preoperatively deposited autologous blood and intraoperatively salvaged red cells available increased from 0.3 to 19.6 percent of the community's total collections. Further increases in the availability and use of autologous blood may be achieved by community-wide integration of services.     

Outcome for lymph node dissection negative T-1b, T-2 (A-2,B) prostate cancer treated with external beam radiation therapy in RTOG 77-06

One hundred four patients with stage T-1b, T-2 N-O M-O prostate cancer were treated with external beam irradiation as part of RTOG 77-06. Lymph nodes were negative by lymph node dissection in 16 patients with T-1b and 88 patients with T-2 cancers. Survival exceeds age matched expected survival for the 10 years of observation (63% vs 59% at 10 years). Patterns of failure at 10 years show 87% of patients were free of isolated local recurrence, 79% free of metastatic failure, 67% free of any failure, and cause specific survival shows 86% free of cancer death at 10 years. The outcome of this group is equal or superior to reports of radical prostatectomy in similar stage patients.     

Supracondylar fracture of the femur following prosthetic knee arthroplasty

Sixty-one supracondylar fractures above prosthetic knee replacements in 58 patients were reviewed with a mean follow-up time of 3.7 years (range, 9 months to ten years). The mean interim between arthroplasty and fracture was 2.9 years (range, intraoperative to ten years). Twenty-seven cases demonstrated notching of the anterior femoral cortex. Seventeen patients suffered from a severe neurologic disorder. Group A consisted of 30 patients with 31 fractures treated by open reduction and internal fixation or revision arthroplasty. Follow-up study revealed 25 unions, three malunions, one nonunion, and two above-knee amputations for deep sepsis. Four of 31 patients had increased pain levels or change in ambulatory status postoperatively. Group B consisted of 30 fractures in 28 patients treated by casting alone or traction followed by cast bracing. Follow-up examination showed 17 unions, seven malunions, and six nonunions. Fifteen of the 30 patients had increased pain levels or change in ambulatory status after treatment. Casting produced significant decreases in motion in both groups. The results indicate that this fracture is associated with anterior notching of the femoral cortex and preexisting neurologic disorders. Patients with a supracondylar fracture following prosthetic knee arthroplasty are best managed by secure internal fixation and early motion.     

Use of all-trans retinoic acid in the treatment of acute promyelocytic leukemia

Twenty-four patients with acute promyelocytic leukemia (APL) were treated with all-trans retinoic acid (45 to 100 mg/m2/day). Of these, eight cases had been either nonresponsive or resistant to previous chemotherapy; the other 16 cases were previously untreated. All patients attained complete remission without developing bone marrow hypoplasia. Bone marrow suspension cultures were studied in 15 of the 24 patients. Fourteen of these patients had morphological maturation in response to the retinoic acid (1 mumol/L). Chloroacetate esterase and alpha-naphthyl acetate esterase staining as well as electronmicroscopic examination confirmed that retinoic acid-induced cells differentiated to granulocytes with increased functional maturation (as measured by nitroblue tetrazolium reduction, NBT). The single nonresponder to retinoic acid in vitro was resistant to treatment with retinoic acid but attained complete remission after addition of low-dose cytosine arabinoside (ara-C). During the course of therapy, none of the patients showed any abnormalities in the coagulation parameters we measured, suggesting an absence of any subclinical disseminated intravascular coagulation. The only side effects consisted of mild dryness of the lips and skin, with occasional headaches and digestive symptoms. Eight patients have relapsed after 2 to 5 months of complete remission. The others remain in complete remission at 1+ to 11+ months and are still being followed up. We conclude that all-trans retinoic acid is an effective inducer for attaining complete remission in APL.     

Element release and cytotoxicity of Pd-Cu binary alloys.

The release of elements from a series of palladium-copper alloys into cell-culture medium was measured using atomic absorption spectroscopy. The effect of the alloys on the succinyl dehydrogenase activity of Balb/c 3T3 fibroblasts was also measured. Palladium inhibited the release of Cu in alloys up to 70 atomic weight percent Cu. Below 70 at. % Cu, Cu release was < 0.8 micrograms/cm2 at 72 hours. Palladium release was lower from pure Pd (0.08 micrograms/cm2) at 72 hours than from Pd-Cu alloys containing > 70 at. % Cu, where it increased to 1.2 micrograms/cm2. The cytotoxicity of the alloys correlated closely with the release of Cu, becoming markedly cytotoxic above 70 at. % Cu, when Cu release was greater than 2.2 micrograms/cm2.     

Cluster headache: increased incorporation of (1-14C)arachidonic acid into phosphatidylserine in polymorphonuclear cells

Vasoactive metabolites deriving from arachidonic acid (AA) have been considered as putative mediators in the pathogenesis of various types of headache. In the present study we therefore compare the ability to synthesize AA containing precursor phospholipids in polymorphonuclear cells (PMNs) from healthy controls and cluster headache patients. 3.7% ± 1.4 (mean ± SD) of the (1-¹⁴C)AA incorporated into total PMN glycerophospholipids (GPLs) was recovered in the phosphatidylserine (PS) in a group of cluster headache patients ( n = 12). This was almost twice the value of 1.9% ± 0.8% found in a corresponding group of 24 healthy controls ( p < 0.001). A significant decrease in the incorporation of (1-¹⁴C)AA into phosphatidylcholine (PC) ( p < 0.01) and an increase in the incorporation of (1-¹⁴C)AA into phosphatidyletanolamine (PE) ( p < 0.05) were also found in cluster headache patients when compared to the control group. The increased incorporation of (1-¹⁴C)AA into PS in PMNs from this group of patients is interesting because PS plays an important role in the activation of protein kinase C, an enzyme involved in transmembrane signalling. The clinical implications of the present findings in cluster headache, if any, cannot yet be defined.     

Proximal fallopian tube occlusion: diagnosis and treatment with transcervical fallopian tube catheterization

Transcervical fallopian tube catheterization (TFTC) was performed in 22 infertile patients with bilateral fallopian tube obstruction and a mean duration of infertility of 3.3 years. A high prevalence of previous ectopic pregnancy (n = 8, 36%), tubal ligation and/or reconstruction (n = 5, 23%), spontaneous or therapeutic abortion (n = 6, 27%), and previous intrauterine device use (n = 14, 64%) was noted. The authors successfully catheterized 40 (98%) of 41 tubes without serious complication and visualized the distal tube in 36 (88%) of 41 tubes. Free spill in at least one tube was seen in 17 (77%) of 22 patients. Nineteen patients had a history of previous laparoscopy or laparotomy for tubal disease, in 16 of whom laparoscopic results were available for review. Retrospectively, in 15 (94%) of 16 patients all clinically relevant abnormalities would have been detected by means of TFTC alone. Five patients conceived, three with intrauterine and two with ectopic pregnancies. Patients with intrauterine pregnancies had normal-appearing tubes after TFTC, while those with ectopic pregnancies had residual tubal abnormalities after recanalization. TFTC is a safe, accurate diagnostic procedure that provides more information than hysterosalpingography and, in most cases, as much or more information about the fallopian tubes than laparoscopy.     

γ-氨基丁酸对离体犬脑血管的作用

用离体犬脑血管(基底动脉)环标本,观察γ-氨基丁酸(GABA)对几种不同激动剂所致最大收缩反应的舒张作用。苯福林(PE)10μmol·L^-1,5-羟色胺(5-HT)10μmol·L^-1以及25mmol·L^-1的KCl均可使脑血管静息张力增加,GABA50μmol·L^-1对以上几种激动剂所致的收缩反应均有舒张作用。对较高浓度的KCI(45mmol·L^-1)所致的收缩无影响,但对由冷刺激(未预热的营养液,28℃)引起的收缩反应有明显的舒张作用。     

General surgical complications can be predicted after cardiopulmonary bypass.

OBJECTIVE: The authors review the general surgical complications of cardiopulmonary bypass, including newer procedures such as heart and lung transplantation, to identify patients at higher risk. SUMMARY BACKGROUND DATA: Although rare, the general surgical complications of cardiopulmonary bypass are associated with high mortality. The early identification of patients at increased risk for these complications may allow for earlier detection and treatment of these problems to reduce mortality. METHODS: A retrospective review was performed of 1831 patients undergoing cardiopulmonary bypass from 1991 to 1993. This was done to identify factors that significantly contributed to an increased risk of general surgical complications. RESULTS: Factors associated with an increased risk of general surgical complications included prolonged cardiopulmonary bypass (p < 0.005) and intensive care unit stay (p < 0.002), occurrence of arrhythmias (p < 0.001), use of inotropic agents (preoperatively or postoperatively p < 0.001), insertion of the intra-aortic balloon pump (preoperatively p < 0.005, postoperatively p < 0.001), use of steroids (p < 0.001), and prolonged ventilator support (p < 0.001). Multivariate analysis identified use of the intra-aortic balloon pump (p < 0.001) as the strongest predictor of the general surgical complications of cardiopulmonary bypass. A variety of factors not contributing significantly to an increased risk also were identified. CONCLUSIONS: Factors indicative of or contributing to periods of decreased end-organ perfusion appear to be significantly related to general surgical complications after cardiopulmonary bypass.