Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning

Twenty patients with fusions of the lumbar spine (seven with pseudarthrosis, 11 with solid bony fusions, and two with fusions that appeared solid but assessment was complicated by the presence of surgical hardware) underwent computed tomographic (CT) scanning in the supine position in the axial plane and, employing a specially designed seat, in the coronal plane. Three-millimeter contiguous sections were acquired. The direct coronal images were compared with those reformated from the axial images. The higher-resolution direct coronal images facilitated the diagnosis of pseudarthrosis and increased confidence in interpretation of normal studies. Direct coronal imaging is easy to perform and in many cases requires fewer scans and less radiation than reformations. Because it provides more useful diagnostic information, direct coronal imaging should replace current methods for evaluating fusions of the lumbar spine.     

Prospective study of atrial natriuretic peptide for the prevention of radiocontrast-induced nephropathy

Radiocontrast-induced nephropathy (RCIN) is a common cause of hospital-acquired acute renal failure and is associated with a high mortality rate. RCIN is potentially preventable, because administration of the radiocontrast agent is predictable, and a high-risk population has been identified. This multicenter, prospective, randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy of intravenous atrial natriuretic peptide (anaritide, ANP 4-28) to prevent RCIN. Patients with stable chronic renal failure (serum creatinine greater than 1.8 mg/dL or serum creatinine between 1.5 and 1.8 mg/dL with estimated creatinine clearance of < or = 65 mL/min) were assigned to receive either placebo or one of three doses of anaritide (0.01 microg/kg/min, 0.05 microg/kg/min, or 0.1 microg/kg/min) for 30 minutes before and continuing for 30 minutes after radiocontrast administration. All patients were given intravenous 0.45% saline for 12 hours before the radiocontrast procedure and continuing for 12 hours after the last dose of radiocontrast. Both ionic and nonionic radiocontrast agents were administered. RCIN was defined as either an absolute increase of serum creatinine of > or = 0.5 mg/dL or a percent increase of > or = 25% over baseline. Of the 247 patients who completed the study, 50% had diabetes mellitus. There were no statistical differences in baseline serum creatinine, change in serum creatinine, or the incidence of RCIN. The incidence of RCIN was placebo, 19%; anaritide (0.01), 23%; anaritide (0.05), 23%; anaritide (0.1), 25%. Patients with diabetes mellitus had a significantly greater incidence of RCIN: placebo, 26% versus 9%; anaritide (0.01), 33% versus 13%; anaritide (0.05), 26% versus 21%; anaritide (0.1), 39% versus 8% (diabetic v nondiabetic, P < 0.002). There was no effect in the diabetic or nondiabetic groups by anaritide on the incidence of RCIN. Comparison of the highest-risk group of patients, defined as patients with diabetes mellitus and a baseline serum creatinine > or = 1.8 mg/dL, with the lowest-risk group, defined as patients without diabetes mellitus and a baseline serum creatinine of 1.8 mg/dL or less, did not show a beneficial effect of anaritide administration. In conclusion, administration of intravenous anaritide before and during a radiocontrast study did not reduce the incidence of RCIN in patients with preexisting chronic renal failure, with or without diabetes mellitus.     

Consensus guidelines for 'rainy day' autologous stem cell harvests in New South Wales

Autologous stem cell transplantation (ASCT) has a well-established role in the treatment of haematological malignancies. Stem cells are commonly collected following salvage chemotherapy although there may be advantages in collecting earlier in the disease course. A 'rainy day' harvest (RDH) refers to the collection of autologous haemopoietic stem cells for long-term storage. Although there are few data to support RDH, there is increasing evidence that such harvests are being carried out, creating storage pressures in stem cell laboratories across New South Wales. The Bone Marrow Transplant Network New South Wales conducted a three-staged exercise to develop consensus-based RDH guidelines. Using available evidence, guidelines were developed supporting RDH for specific patients with acute and chronic myeloid leukaemias, follicular and other lymphomas, and multiple myeloma. Physician agreement with these disease-specific guidelines ranged between 58 and 100%. These consensus guidelines will improve equity of access to appropriate RDH and assist the planning of future storage requirements in New South Wales.     

Therapy for cessation of smoking

Tobacco dependence is a chronic relapsing medical illness. Unfortunately more than 1.1 billion people worldwide smoke tobacco. Tobacco consumption rate is very high in India. Providing three minutes counseling by physicians doubles the cessation rate as compared to no intervention. Nicotine replacement products (gums, transdermal patch, nasal spray, inhaler and lozenge), bupropion and varenicline used with counseling by physicians double the cessation rates at one year. There are drugs like buspirone, naltrexone, mecamylamine and silver acetate; some of which either alone or in combination with any of the above drugs may be routinely used in near future for smoking cessation in at least some specific groups of population. The most difficult problem for patients in smoking cessation is withdrawal symptoms. Counseling with continuous support from physician, family members, friends and overall from the society will help in achieving a higher rate of smoking cessation, with the final aim of making ours a tobacco smoke-free world for future generations.     

Evaluation of the polyethylene glycol-indirect antiglobulin test for routine compatibility testing

All specimens received in the blood bank over a 5-month period for crossmatch or group and screen requests were tested in parallel by a polyethylene glycol-indirect antiglobulin test (PEG-IAT) and a low-ionic-strength saline (LISS)-IAT. The sera of 41 of 1471 patients had reactions, with 50 antibodies being detected. Ten antibodies reacted only on the PEG-IAT and 14 only by the LISS-IAT; the remaining 26 antibodies were detected by both methods. Of the antibodies that reacted only by the LISS-IAT, one (anti-Jka) was considered clinically significant, whereas five of the antibodies that reacted only by the PEG-IAT (1 anti-c, 2-Fya, 1-Jkb, and 1-S) were considered significant. Two antibodies of questionable clinical significance were detected only by the PEG-IAT. In 97 percent of the sera tested, no reaction was detected by either method. The PEG-IAT is an acceptable technique for routine compatibility testing.     

Studies on the blood of a Dc(e) homozygote and her family

It has been reported previously that genes that have been called Dc- represent a heterogeneous group and that some of them would better be described as Dc[e] and Dc(e). We have studied the blood of a black proposita and some of her family members and have concluded that she is homozygous for Dc(e). The form of Dc(e) present in this family makes all the Rh antigens of common occurrence for which we were able to test. In this respect, it differs markedly from another form of Dc(e), which is seen in individuals whose red cells lack a very common Rh antigen and who become immunized against that antigen. We suggest the term Dc(e)R17 for the gene present in the family studied; our results indicate that its products are: normal amounts of D, c, G, Hr0, and Rh29; reduced amounts of e and f; and markedly reduced amounts of hrS and hrB. The expression of some antigens encoded by Dc(e)R17 are quantitatively but not qualitatively different from the products of R0.     

人视网膜色素上皮细胞增殖与川芎嗪的影响

目的:观察糖基化终产物(advanced glycation end products,AGEs)对人视网膜色素上皮细胞增殖的影响,以及川芎嗪对AGEs诱导的人视网膜色素上皮细胞增殖的拮抗作用。方法:实验于2003-09/2004-07在中南大学湘雅二医院中心实验室完成。①实验分组:原代培养人视网膜色素上皮细胞,第3￣8代用于实验,设空白对照组,DMEM培养基中不加入任何药物;AGEs对照物组,培养液中含100mg/L的AGEs对照物;AGEs组,培养液中含10,50,100,200,400mg/L的AGEs,分别干预视网膜色素上皮细胞24h及48h。②实验操作:川芎嗪干预实验:也设空白对照组;AGEs对照物组;AGEs组,培养液中含100mg/L的AGEs;AGEs 川芎嗪组,培养液中加入10,20,40,80,160,320,640mg/L川芎嗪30min后加入100mg/L的AGEs,分别干预视网膜色素上皮细胞24h。③实验评估:MTT微量酶比色法检测视网膜色素上皮细胞增殖情况。结果:①视网膜色素上皮细胞增殖情况:不同浓度AGEs组细胞增殖率均高于对照物组(P<0.01),100mg/LAGEs组增殖率(24,48h分别为39.45%,31.97%)高于其他组(P<0.01),48h与24h结果一致。②川芎嗪的抑制效应:与AGEs组比较,10,20,40,80,160mg/L川芎嗪对AGEs诱导的视网膜色素上皮细胞增殖无抑制作用(P>0.05),320及640mg/L川芎嗪有抑制作用,其抑制率为8.96%,15.08%(P<0.01)。结论:①AGEs可诱导人视网膜色素上皮细胞增殖。②低浓度川芎嗪对AGEs诱导的人视网膜色素上皮细胞增殖无抑制作用,高浓度川芎嗪具有抑制作用。