Platelet utilization in a university hospital

Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions.     

Bilateral spontaneous scapho-lunate subluxation treated by limited carpal fusion

The case of a 19 year-old-girl who developed spontaneous bilateral snapping scapho-lunate subluxation is described. Her symptoms were successfully treated by bilateral triscaphoid fusion.     

Non-immune therapy of IgA glomerulonephritis

Summary: The involvement of the IgA immune system and complement components in IgA glomerulonephritis (IgAGN) has prompted the use of immunosuppressive drugs in therapy, but none has so far been shown to alter the natural course of the disease. Because most patients with IgAGN present during the chronic phase of their illness, at the time when the initiating immune events may no longer be active, nonimmune therapy which targets the common pathway of progressive renal injury is likely to be more useful. There is increasing evidence that angiotensin-converting enzyme inhibitors (ACEI) reduce proteinuria and renal injury in patients with IgAGN, and this effect may be observed in both normotensive and hypertensive patients. Yet to be determined is whether this effect is specific for ACEI and whatever other effective antihypertensive drugs may achieve a similar result. Fish oil has recently been shown to retard the progression of renal failure in patients with aggressive IgAGN, but a narrow therapeutic window appears to exist for this form of treatment. Antiplatelet agents on their own appear to be ineffective but in combination with anticoagulation (low dose warfarin) have been shown to have an antiproteinuric effect and may preserve renal function in patients with progressive disease. Future directions of non-immune therapy of IgAGN include evaluation of the renoprotective effect of angiotensin II receptor antagonists, free-radical scavengers and antilipid drugs. More work should also be done to identify factors which put the patients at risk of developing progressive disease and which predict therapeutic response, as has been done recently with the identification of the deletion polymorphism of the angiotensin-converting enzyme gene as a marker of progressive disease and therapeutic response to ACEI in patients with IgAGN.     

On the mechanism of increased potassium conductance by the potassium channel opener BRL 34915 in Isolated ventricular myocytes

The potassium conductance increased by BRL 34915 (BRL, cromakalim) was studied in single guinea pig ventricular myocytes by using a whole cell voltage-clamp technique. In control voltage-clamp recordings, the late current-voltage relation showed a distinct inward rectification. BRL (1–100 μM) shortened the action potential and diminished or abolished inward rectification but had no effect on the slope conductance and currents flowing during hyperpolarizing clamp steps. BRL did not decrease the slow inward current but accelerated the time constant of activation and amplitude of the outward current. Cd markedly decreased (0.2 mM) or abolished (0.4–0.6 mM) the slow inward current and BRL induced a faster outward shift of late current to a greater value. Glybenclamide (10 μM), a blocker of ATP-sensitive K⁺ channels, had little effect of its own on action potential, membrane currents, and I-V relation. However, in the presence of BRL, glybenclamide abolished BRL effects on action potential and currents and restored inward rectification. It is concluded that the mechanism by which BRL shortens the action potential is a faster growth of an outward current due to the reduction or abolition of the inward rectification of an ATP-dependent potassium channel. The reduction in force in non-isolated tissues appears to be an indirect result of the action potential shortening and not of a decreased slow inward current.     

Leukotriene receptor antagonists. 2. The [[(tetrazol-5-ylaryl)oxy]methyl]acetophenone derivatives

A series of [[(tetrazol-5-ylaryl)oxy]methyl]acetophenones was synthesized and evaluated as antagonists of leukotriene D4 induced contractions of guinea pig ileum. Substitutions at the 3-position of the acetophenone with ethyl (66), propyl (68), butyl (83), and isobutyl (84) gave -log IC50 values of 7.9, 8.0, 7.8, and 7.7, respectively. Equally potent compounds were obtained when the tetrazol-5-yl group was connected to the second benzene ring in the para position with a chemical bond (67), methylene (68), or ethylene (71). For retention of high antagonist activity, the acetophenone should be substituted in the 2-position by a hydroxyl group and the tetrazole ring should have an acidic hydrogen atom. 1-[2-Hydroxy-3-propyl-4-[[4-(1H-tetrazol-5-ylmethy) phenoxy]methyl]phenyl]ethanone (68, LY1632443) has undergone extensive pharmacologic evaluation for its potential as an antiasthma agent.     

Evaluation of several film/screen combinations for megavoltage radiation therapy treatment field verification

The introduction of a lower cost alternative to a film commonly used for megavoltage radiation therapy port films led to a comparison of two films (Kodak X-TL and X-OMAT G) in four metal screen cassette configurations. In addition to determination of H-D curves and point spread functions, images of humanoid phantom sections were obtained and evaluated for clinical "usefulness." The X-OMAT G film-screen combinations compared favorably with the X-TL film combinations with respect to the H-D Curves and point spread functions but there was a slight preference for X-TL film. There were no differences noted whether the film was used in the standard "ready pack" or naked in the cassettes.     

Pathological, immunocytochemical and microbiological findings in calf pneumonias associated with Haemophilus somnus infection

Pathological, immunocytochemical and microbiological findings in 32 cases of calf pneumonia associated with Haemophilus somnus infection are described. The majority of cases were "found dead" or died after a sudden onset pneumonia of less than 24 h duration. Lesions of exudative bronchopneumonia were present and the cases could be divided into two main groups on the basis of histopathological and immunocytochemical features. In group A, cases were dominated by necrotizing bronchiolitis, degeneration and necrosis of airway and alveolar exudates, severe alveolitis with accumulations of degenerate basophilic cells, interstitial inflammatory changes and the widespread distribution of H. somnus antigen in airways and alveoli. In Group B, necrotizing and degenerative changes were much less extensive and less severe and the overall appearance was of suppurative bronchopneumonia with H. somnus antigen much less widespread within the lungs. Alveolar oedema, hyaline membrane formation and alveolar epithelial hyperplasia were present in caudodorsal lung areas of several calves. No major differences were seen between the histopathology of lungs where H. somnus was the sole isolate and that of lungs where H. somnus was isolated along with other bacterial pathogens.