A radiolabeled antiglobulin test for crossmatching platelet transfusions

Despite the use of HLA-matched platelets for alloimmunized recipients, transfusion failures occur. In order to reduce these failures, we investigated the use of a radiolabeled antiglobulin technique for platelet crossmatching. The principle of the test is that of an indirect Coombs test using 125I labeled goat anti-human IgG. Incompatibility is determined by calculating a radioactivity antiglobulin test (RAGT) index. Using this technique, we performed 89 crossmatches on 19 leukemic or aplastic patients who were refractory to random donor platelets and receiving varying degrees of HLA-matched platelets. Effectiveness of the transfusion was assessed from the posttransfusion corrected platelet count increment (CCI) determined at 1 and 20 hr. When the RAGT index was 1.9 or less, the mean CCI at 1 lhr was 17,570 +/- 7003/cu mm, n = 55. When the RAGT index was 2.0 or greater, the mean CCI was 4237 +/- 4100/cu mm, n = 34. At 20 hr when the RAGT index was 1.9 or less, the mean CCI was 8722 +/- 3143/cu mm, n = 33, and when the index was 2.0 or greater, the mean CCI was 571 +/- 1286/cu mm, n = 23. Using this technique, one false negative resulted. Nine positive crossmatches with good increments at 1 hr were found; at 20 hr, however, the survival of these units was zero. These data suggest that this method is a useful adjunct in the selection of platelets in the refractory patient.     

Interpretation of non-invasive breath tests using 13C-labeled substrates - a preliminary report with 13C-methacetin

Non-invasive breath tests can serve as valuable diagnostic tools in medicine as they can determine particular enzymatic and metabolic functions in vivo. However, methodological pitfalls have limited the actual clinical application of those tests till today. A major challenge of non-invasive breath tests has remained the provision of individually reliable test results. To overcome these limitations, a better understanding of breath kinetics during non-invasive breaths tests is essential. This analysis compares the breath recovery of a ¹³C-methacetin breath test with the actual serum kinetics of the substrate. It is shown, that breath and serum kinetics of the same test are significantly different over a period of 60 minutes. The recovery of the tracer ¹³CO₂ in breath seems to be significantly delayed due to intermediate storage in the bicarbonate pool. This has to be taken into account for the application of non-invasive breath test protocols. Otherwise, breath tests might display bicarbonate kinetics despite the metabolic capacity of the particular target enzyme.     

LIVER RESECTION FOR METASTASES FROM COLORECTAL CANCER

Five percent of patients with liver secondaries from colorectal carcinoma are potentially resectable and several studies have demonstrated significantly improved survival following resection. Two hundred and ten patients operated for colorectal carcinoma were followed up. Computed tomography confirmed potentially resectable metastasis to the liver in 38. On exploration 18 patients who had 4 or less hepatic metastases and no extrahepatic disease, underwent resection of their secondaries. Fourteen were males and 4 females with a mean age of 43.5 (SD 13.6, range 18-72) years. Ten patients presented with synchronous liver metastasis and 8 had metachronous disease. There was no post-operative mortality. All 18 have been followed up. for a median period of 23.5 (range 12-38) months. Seven patients are alive and well with no evidence of recurrence at a median period of 28 months (survival 39%). Four are alive with local recurrence in the liver. Median time to recurrence was 22 months. Seven patients have died of disseminated disease. The disease free survival at 28 months is 39% and the overall survival 61%. A close follow-up protocol for all patient undergoing curative surgery for colorectal cancer is essential, if such patients are to be selected early.KEY WORDS: Colorectal cancer, Liver resection, Metastases     

Pattern of disability among patients attending Taif rehabilitation center,Saudi Arabia

Purpose. Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia.

Methods. This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999 – 2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital.

Results. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16 – 45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (≥6 months).

Conclusions. The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.     

Endoxin antagonist lessens myocardial ischemia reperfusion injury

Endoxin antagonist lessens myocardial ischemia reperfusion injury@柯永胜$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 China @王德国$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 C     

Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490]

Background  

Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-to-day activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.