Surgery of the spleen

A normally functioning spleen is critical in providing adequate immune protection and in regulating blood homeostasis. Whereas primary disorders of the spleen can attenuate these important functions, absence of the spleen, most commonly as a result of surgical excision, carries the grave and lifetime risk of devastating systemic sepsis. With some historical exceptions, splenic surgery has classically involved removal of the entire organ at open surgery, either following traumatic injury or to supplement the medical management of haematological disorders. Performed primarily for this latter indication, laparoscopy has emerged over the last two decades as the strongly favoured approach for elective splenectomy, with very large splenic size being one of the few remaining reasons for a planned open approach. Even in skilled hands, laparoscopic splenectomy can prove technically demanding, where careful patient selection and recognition of major complications including haemorrhage, portal system thrombosis and pancreatic injury, requires considerable experience. Whether performed under emergency or elective circumstances and undertaken as an open or laparoscopic procedure, an optimal surgical outcome depends on the successful collaboration between surgeon, anaesthetist, haematologist and radiologist in the preoperative and postoperative phases. Finally, it is paramount that in patients undergoing splenectomy, sufficient attention is given to providing effective lifelong prophylaxis against post-splenectomy infection.     

银杏叶治疗原发性开角型青光眼的临床观察

目的:观察银杏叶治疗原发性开角型青光眼的临床疗效。方法:选择30(60只眼)名符合纳入标准的原发性开角型青光眼患者,比较使用银杏叶前后的视力、眼压和视野。结果:使用银杏叶前后,患者的视力差异没有显著性(P0.05);眼压及视野平均光敏感度(MS)和平均缺损(MD)的改变具有显著性(P0.05)。结论:银杏叶制剂对于治疗原发性开角型青光眼临床效果满意,值得推广。     

牙周支持治疗对维持基础治疗长期效果的作用

目的 观察牙周支持治疗对维持基础治疗长期效果的作用。方法 对在口腔医院接受过牙周治疗的患者进行回顾性研究,其中接受支持治疗16例,未接受支持治疗14例（对照组）。牙周临床检查包括牙周袋探诊深度(PD)、探诊出血(BOP)阳性位点(+),比较初诊,6周复诊以及最后一次复诊时的上诉各项临床检查指标。结果 6周复查时两组的PD和BOP(+)位点百分比明显降低,差异无统计学意义。最后一次复诊时支持治疗组的PD为2.83 mm,BOP(+)位点百分比为15.49%,与初诊比较差异有统计学意义;而对照组的PD为3.51 mm,BOP(+)位点百分比为60.42%,与初诊比较差别无统计学意义,与支持治疗组比较差别有统计学意义。结论 牙周基础治疗可以有效控制牙周炎症,但是其炎症控制的长期效果需要通过支持治疗来维持。     

Three-day treatment with imipenem for unexplained fever during prolonged neutropaenia in haematology patients receiving fluoroquinolone and fluconazole prophylaxis: A prospective observational safety study

BackgroundGuidelines advocate >7 d of broad-spectrum antibiotics for unexplained fever (UF) during neutropaenia. However, effective antimicrobial prophylaxis reduces the incidence of gram-negative infections, which may allow shorter treatment. This study evaluates the safety of discontinuing empirical broad-spectrum antibiotics if no microbial source is documented after an initial work-up of 72 h.MethodsProspective observational study at a tertiary-care haematology-unit in patients suffering from haematologic malignancies and treatment-induced prolonged neutropaenia of ?10 d. Oral fluoroquinolone and fluconazole prophylaxis was given from day 1. Fever was empirically treated with imipenem which was discontinued after 72 h if, following a standardised protocol, no infectious aetiology was documented. Duration of fever, antimicrobial therapy and overall mortality were registered.ResultsOne hundred and sixty six patients were evaluated during 276 neutropaenic episodes. One hundred and thirty six patients (82.5%) experienced ?1 febrile episode. A total of 317 febrile episodes were observed, of which 177 (56%) were diagnosed as UF. In 135 febrile episodes (43%), a probable/definite infectious origin was documented. Mean duration of fever in neutropaenic periods with 1 febrile episode was 5 d, and mean time of treatment with imipenem was 4.7 d. In patients without documented infection, mean time of imipenem treatment was only 3.7 d. Overall mortality 30 d after neutrophil recovery was 3.6% (6/166); no patient died from untreated bacterial infection.ConclusionDiscontinuation of broad-spectrum antibiotics during neutropaenia in haematology patients on fluoroquinolone and fluconazole prophylaxis is safe, provided that no infectious aetiology is established after 72 h.     

Evaluating the CELL-DYN® 3500 Haematology Analyser in an acute general hospital

The CELL-DYN® (CD3500) 3500 (Abbott Diagnostics Division, Santa Clara, CA, USA) is a multiparameter, automated haematology analyser system capable of producing 22 haematological parameters including a screening five-part differential. The evaluation was performed in a recently expanded acute care general hospital. Studies of linearity, carryover and precision were acceptable and within manufacturer's stated limits. Correlation of CD3500 with manual differential counts were good except for the basophil count. The white cell flagging system had a sensitivity of 83.6% and specificity of 88.9% with 85.6% agreement. The platelet flagging system also had comparable sensitivity and specificity rate of 88.4% and 94.5% and agreement rate of 92.2%. The overall false positive rate and false negative rate for both the white cell and platelet flags combined were 8.6% and 10.3%. All samples provided a differential with no rejection experienced. The MAPSS technology, together with the extended lyse mode and the investigational nine-part differential provides potential for future development in WBC differential.     

Age-related changes in the haematology of young koalas (Phascolarctos cinereus) up to one year old

Haematology and biochemistry of captive pouch young and back young koalas from 165 days to one year old were studied. Distinct changes with age were observed. Packed cell volume, haemoglobin, erythrocyte count, MCV and total plasma protein where lowest in the youngest animals less than 180 days old. Reticulocytes were highest in this age group. Haematological values differed from those of adult animals. Lymphocytosis occurred, especially between 210–330 days of age. Intense erythropoiesis was indicated by reticulocytosis and the presence of erythrocyte granular inclusions, anisocytosis and poikilocytosis on blood films, particularly up to 330 days of age. Microcytosis present on blood films throughout the study period could not be explained by iron deficiency.     

A comparison of the effect of bleeding site on haematological and plasma chemistry values of F344 rats: The inferior vena cava, abdominal aorta and orbital venous plexus

Of paramount importance to most toxicity studies in rats is the evaluation of haematological, coagulation and clinical chemistry parameters. In European and North American countries, the orbital venous plexus (OVP) is currently the most common route for obtaining blood, whereas in Japan the inferior vena cava (IVC) and abdominal aorta (AA) are the preferred routes. In order to compare clinical pathology parameters from the three bleeding sites, 11-week-old male F344 rats were anaesthetised by ether inhalation, and blood samples collected by IVC, AA or OVP for subsequent haematological, coagulation and plasma chemistry analysis. Collection methods utilised a plastic (5 ml) syringe and needle for IVC and AA, and glass capillary tubes (1.5 mm × 30 mm) for OVP. Ten haematology parameters, two coagulation and 22 plasma chemistry parameters were assayed, and the results compared between the three bleeding sites. The results showed there were no essential differences in the haematological or plasma chemistry values when blood was withdrawn from either the IVC or OVP. However, blood collected from the AA exhibited white cell counts of only 40%\2-60% of the values from the other two sites, and plasma glucose values showed slightly higher values. Other haematological, coagulation and plasma chemistry values showed no meaningful differences between the three bleeding sites, any differences being small and not considered to be biologically or clinically significant.Although some values may vary with the selection of bleeding site, careful and gentle sampling, avoiding stress and artefacts (e.g. tissue fluid) will minimise these differences. It is important therefore that clinical pathology assays during the course of a toxicity study should use the same sample site, preanalytical conditions and analytical methods.The results obtained in this study will be used as baseline data for haematology and clinical chemistry characteristics for the three bleeding sites in male F344 rats.