Evaluation of Splenectomy in Chronic Myelogenous Leukemia

Fifteen patients with CML who have undergone splenectomy havebeen presented. Our results would suggest that when splenectomyis performed during remission significant benefits in survivaland the quality of the survival can be offered to the patient,with minimal operative risk. On the other hand when splenectomyis performed during non-remission period a more operative riskand poor prognosis must be weighed.     

Clinical features in young adult patients with ischaemic colitis

The clinical, radiographic and endoscopic findings in 16 patients with ischaemic colitis, all of whom were <45 years of age, were analysed. The clinical features were characterized by an acute onset of abdominal pain and rectal bleeding, and persistent constipation prior to the onset of symptoms. Twelve of the 16 patients did not have any known predisposing factors. Barium enema examination and colonoscopy revealed longitudinal ulcers and oedema of the left side of the colon of these patients. These features were then compared with those found in patients with ischaemic colitis, who were > 70 years of age. Although the clinical symptoms, the site of involvement and the initial radiographic or endoscopic findings were similar between the two groups, the transient form of ischaemic colitis and constipation prior to the onset of symptoms were more frequently present in the young patients than in the old patients. These findings suggest that ischaemic colitis, which is not a rare condition even in young adults, is less severe in young patients than in old patients, and that constipation may be related to the pathogenesis of this disease in young adults.     

Cultrure and Transfer of Embryos as a Testing System for Embryo-toxicity of Chemicals*

ABSTRACT Culture system of mouse embryos from 2-cell stage to early post-implantation stage was established. To assess the growth and development of embryos, morphological, biochemical and cytogenetical endopoints were settled as follows: 1. Blastocysts formation (Day 4 of culture) after treatment of 2-cell, 4 to 8-cell and morula. 2. Retention of blastocoel fluid on Day 5 of culture after treatment of blastocysts on Day 4 of culture. 3. Formation of trophblast outgrowth, discrete inner cell masses (ICMs), and ICMs differentiating into the primary endoderm and ectoderm (two-layer ICMs) on Day 9 of culture. 4. Inhibitory effects on incorporation of ³H-thymidine into DNA and of L-(³⁵S) methionine into protein of embryonic cells after treatment with chemicals. 5. Induction of structural chromosome aberrations and sister chromatid exchanges (SCEs) after treatment of blastocysts. 6. Further development of the treated embryos after transfer of them into the uterine horns of foster mothers (Day 16.5). Mercuric chloride (MC), methylmercuric chloride (MMC), and 4-Nitroquinoline 1-oxide (4 NQO) were used for the experiment as model agents. The susceptibility of embryos to toxic effects of MMC changed as developmental stage progressed. The toxic effects of MC differed in manifestation from that of MMC. MMC was about 200 times as toxic to post-implantation development as MC. These results were chiefly due to the difference between the compounds as regards the penetration of cell membrane and the distribution in living embryonic cells. As for the effects of 4NQO, structural chromosome aberrations and SCEs were induced at the concentration lower than the threshold value for the inhibition of morphological development. 4 NQO treated embryos which were transferred to the uterine horns of recipient mothers were implanted lower rate than control embryos. The embryos could not be implanted at all when treated with 10^-8M. The fetuses originated from the treated (10^-10M and 10^-9M 4NQO for 24 hr) blastocysts showed a remarkable decrease in their body weights without signs of external malformations.     

Dansyl chloride derivatization of methamphetamine: a method with advantages for screening and analysis of methamphetamine in urine

The screening and quantitation of methamphetamine (MP) in urine using dansyl chloride (DNC) as the derivatization reagent were studied. Urinary MP derivatized with DNC could be detected by visual observation of the fluorescence in a solid-phase extraction column such as a Sep-Pak C18 cartridge to which the whole reaction solution was applied. The DNC-derivatized MP was eluted from the cartridge and then identified and quantitated by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC). In the GC-MS analysis with the MS detector in the electron-impact mode, DNC-derivatized MP and amphetamine (AP), exhibited diagnostic molecular ion peaks. The intensities of the molecular ions were 15% (DNC-MP) and 35% (DNC-AP) of the base peak (a fragment ion because of the loss of dimethylnaphthalene from M+), demonstrating that this method of derivatization has a major advantage for confirming APs by GC-MS. MP derivatized with DNC could be determined by HPLC with ultraviolet detection. Because a good correlation (r = 0.95) between the GC-MS and HPLC method for urinary MP was confirmed, both HPLC and GC-MS appear to be useful tools for determining urinary MP. The intensity of the cartridge fluorescence due to DNC-derivatized MP was approximately related to the urinary content of MP determined by HPLC or GC-MS, although a false positive in the visual fluorescence was observed in some urinary specimens from healthy volunteers. From these results, screening and confirmation/determination following DNC derivatization is proposed as a suitable method for the analysis of MP.     

Which Kt/V is the most valid for assessment of both long mild and short intensive hemodialyses?

It is unclear at present which mathematical modeling Kt/V(urea) is valid for assessment of both long mild hemodialysis (HD) and short intensive HD, the single-pool modeling Kt/V (Kt/Vsp) based on the pre- and postdialysis serum urea concentrations, double-pool modeling Kt/V (Kt/Vdp) based on the predialysis concentration and the estimated postdialysis equilibrated concentration, or Kt/V calculated on the basis of dialyzer urea clearance, HD session duration and urea distribution volume (Kt/Vdl). Thus, the respective Kt/V during a short intensive HD was compared with its counterpart Kt/V during a long mild HD, where the same amount of urea is removed during both HD treatments. It was found that the Kt/Vsp and Kt/Vdl during short intensive HD were significantly greater than the respective Kt/V during the long mild HD. On the other hand, there was no significant difference in the Kt/Vdp between the long mild and short intensive HDs. In conclusion, Kt/Vdp may be more valid for assessment of both long mild and short intensive HDs.     

New assays for monitoring haemophilia treatment

Summary.  Precise measurements of factor VIII (FVIII) or factor IX (FIX) activity are believed to be essential for clinical management in haemophilia, although discrepancies between factor levels and clinical severity have been recognized. Clot wave form analysis has demonstrated that different wave form patterns may be evident in severe haemophilia A patients with levels of FVIII activity <1 IU dL⁻¹, and this might explain, in part, the phenotypic heterogeneity seen in these patients. In addition, the relatively new technique of computer-assisted thrombelastography (TEG), in which coagulation is initiated by tissue factor, has revealed a considerable degree of variability in different patients in the presence FVIII levels, which are sufficient to normalize TEG parameters. In contrast, a global thrombin generation test (TGT) has been proposed as a sensitive and reliable method for assessing overall clotting function in haemophilia patients. Several studies have demonstrated a significant correlation between TGT and FVIII/FIX levels, and these measurements also appear to correlate with the clinical phenotype. The TGT may be very useful, therefore, for evaluating overall haemostasis in different clinical situations, although substantial inter-assay and inter-individual variations have been reported. Both the TEG and TGT have been found to be particularly helpful for monitoring haemostatic therapy with bypassing agents or conventional FVIII or FIX concentrates in patients with inhibitors. These global tests enable the selection of appropriate therapeutic agents in individual circumstances and offer the opportunity to tailor the most effective haemostatic treatment even during severe bleeding or major surgery.     

Scarless hepatectomy: natural orifice specimen extraction after left lateral sectionectomy

Background

The use of laparoscopy in liver surgery is well established and considered as the gold standard for small resections. The laparoscopic resections have lower morbidity and better cosmetic results, but still require an incision to remove the surgical specimen. The possibility of remove the specimen through natural orifices and avoid an abdominal incision may further improve the benefits offered by minimally invasive procedures.

Aim

To describe the technique of transvaginal extraction of the specimen after laparoscopic liver left lateral sectionectomy.

Method

The laparoscopic liver resection is performed in a standard fashion. After completing the resection, the specimen is placed into a retrieval plastic bag. To perform de extraction, a vaginal colpotomy is performed, guided by a 12 mm trocar introduced through the vagina. Then the extraction bag is removed pulling the bag through the extended incision in the posterior wall of the vagina. After the extraction, the colpotomy incision is closed laparoscopically.

Results

This technique was performed in a 74-year-old woman with a 3 cm lesion between liver segments 2 and 3. She had a fast and uneventful recovery.

Conclusion

This technique appears to be feasible, safe and avoid the complications of an abdominal incision.