Orthopaedic-induced anemia: the fallacy of autologous donation programs

Total knee arthroplasty is associated with significant blood loss. Despite the initiation of various blood conservation modalities, allogeneic transfusion has yet to be eliminated. One hundred forty-eight patients who had unilateral primary total knee arthroplasties during a 3-year period were evaluated retrospectively for blood loss and transfusion rates. The patients were prescribed one unit of preoperative autologous donation that was to be transfused automatically on postoperative Day 1. Allogeneic transfusion was based on symptoms, and no numerical transfusion triggers were used. The preoperative autologous donation program resulted in increased preoperative anemia. Whereas only 26.2% of patients were in the high transfusion-risk group (hemoglobin >10 g/dL and < or = 13 g/dL) before surgery, 55.7% of patients were in this high-risk category after preoperative autologous donation. The patients did not recover from the autologous donations that occurred 4 weeks before surgery. A mean hemoglobin level of 14.0 g/dL was seen before donation, whereas the mean preoperative hemoglobin level decreased to 12.6 g/dL. We think that a preoperative autologous donation program leads to an increased risk of anemia before surgery.     

Polyarteritis nodosa presenting with a leg mass

We report an unusual presentation of polyarteritis nodosa in a 2-y-old child. The child presented with a mass of the left leg adjacent to the calf, and the biopsy showed polyarteritis nodosa. Further investigations confirmed systemic features, and X-rays showed a periosteal reaction.Conclusion: Childhood polyarteritis nodosa may present with a lower limb inflammatory mass.     

Ethnic differences in acetylcholinesterase inhibitor use for Alzheimer disease

Acetylcholinesterase inhibitors (AChIs) have been demonstrated to improve Alzheimer disease symptoms. Whether the use of AChIs varies by ethnicity is unknown. More than 2500 ethnically diverse patients (6% African American, 14% Latino, and 7% Asian patients) from the Alzheimer's Disease Research Centers in California were studied. Compared with white patients with AD, minority patients had 40% lower odds of AChI use (odds ratio 0.6, 95% confidence interval: 0.5 to 0.7).     

The significance of parameters of the acid-base status, blood gas and blood lactate level for the adequate resuscitation and prognosis in newborns with very low birth weight

The aim of this prospective study was to optimize the resuscitation guidelines for VLBW and ELBW premature newborns, to improve their life prognosis and to minimize the permanent complications of the perinatal asphyxia. RESULTS: The newborns were divided in 2 groups: main group--28 ELBW and 55 VLBW infants born from 01.10.01 to 30.06.02; and control group--52 ELBW and 78 VLBW infants, born in year 2000 in "Maichin dom". More intensive resuscitation was given to the VLBW newborns in the mean group--58% of them were intubated and ventilated in Delivery room (DR) infants compared with 40% from the controls. In the ELBW groups the rate of the assisted ventilation (AV) remains high (85% and 82%) but more often we insufflated Surfactant for prophylaxis of the RDS (71% compared with 52% in the controls). This, as well as the precisely monitoring of the early postnatal adaptation--pulsoxymetry, parameters of acid-base status (ABS) and homeostasis, resulted in significantly reduction of the mortality rate in ELBW infants from 46% to 18%. We found a reduction of the severe neurological injuries and high degree retinopathy of prematurity too. We evaluated the lactate values and the ABS parameters in blood from umbilical artery (u.a.) and from arterial blood 1 hour after birth. We found out that the low lactate levels in u.a. didn't correlate with the degree of the metabolic acidosis (pH and BE). Correlation between high lactate levels in u.a, low pH and BE were found predominantly in newborns with significant intrauterine retardation and chronic placental insufficiency. Levels > 5.0 mmol/l 1h after birth and the persistence of the metabolic acidosis despite an adequate resuscitation determinated in principle bad outcome and severe complications. CONCLUSIONS: The adequate DR resuscitation under strict monitoring of the cardio-pulmonary adaptation and the prophylactic Surfactant application improve the survival rate and the prognosis of the ELBW newborns. The persistence of high lactate levels in combination with a metabolic acidosis and intrauterine retardation are bad prognostic criteria for outcome.     

Methods for the detection of antisperm antibodies associated with immunologically-mediated human infertility

Among others, immunological factors can be the reason for human infertility. The aim of the present critical review was to the analyze the literature data, published in the last 20 years, as well as our experimental and clinical results concerning the most frequently used in the international centers methods for the detection of antisperm antibodies associated with immunologically--mediated human infertility.     

Knowledge use among occupational therapists for infant feeding assessments

BACKGROUND: Canadian occupational therapists practice in a variety of clinical settings and use different assessment approaches. To understand best practice, this study explored therapists' knowledge use for infant feeding assessments. This was chosen as one specific area of practice to study knowledge use. PURPOSE: The purpose of this qualtitative study was to investigate what therapists assess and what procedures they use to carry out their assessments. METHOD: Semi-structured interviews were conducted with 13 therapists with experience evaluating infant feeding. A constant comparative method of data analysis was used to identify common themes. RESULTS: Three themes emerged: the value of medical information, the importance of doing by observing and the need for an adaptive trial and error approach. PRACTICE IMPLICATIONS: These findings suggest therapists' experiential knowledge shape their best practice. This study informs us about the everyday knowledge used by therapists working with infants on feeding issues and helps us to understand why assessment practices may vary amongst therapists and across clinical settings.