Relapse of Philadelphia chromosome positive acute lymphoblastic leukaemia after marrow transplantation: sustained molecular remission after early and dose-escalating infusion of donor leucocytes

We present a patient who underwent sibling allogeneic BMT because of refractory Ph+ve ALL and remained BCR-ABL-positive after marrow grafting. Haemopoietic precursor cells were predominantly BCR-ABL-negative and of donor origin. In T cells an exclusively donor genotype was demonstrated. Despite donor leucocyte infusion (DLI), 20 weeks after BMT BCR-ABL fusion mRNA increased in semiquantitative polymerase chain reaction and leukaemic infiltration of the patient's bone marrow was seen. After a second course of DLI the patient achieved sustained molecular remission but he developed severe graft-versus-host disease (GvHD) and died from bacterial sepsis 9 months after DLI.     

Evaluation of insulin resistance during inhibition of endogenous insulin and glucagon secretion by somatostatin in non-obese subjects with impaired glucose tolerance

Summary Insulin resistance was studied in seven non-obese male subjects with impaired glucose tolerance and four healthy, age and body-weight matched male control subjects by means of a continuous intravenous infusion of somatostatin, glucose and insulin over 150 min. Glucose tolerance was evaluated by means of a 2-h glucose infusion test. Endogenous insulin (C-peptide), growth hormone, and glucagon secretion were suppressed by somatostatin in both groups. Steady-state plasma insulin and glucose levels were achieved between 90–135 min. Since similar steady-state levels of exogenous insulin were achieved, the resulting steady-state plasma glucose level provided a direct estimate of the ability of insulin to dispose of the infused glucose. The glucose levels were higher in subjects with impaired glucose tolerance with values of 14.6 ± 1.8 mmol/1 compared with 5.1 ± 1.2 mmol/1 in control subjects (p < 0.01), thus indicating insulin resistance. There was a direct correlation between the steady-state plasma glucose level and glucose tolerance suggesting that the degree of glucose intolerance is proportional to the degree of insulin resistance. These results revealed that decreased insulin sensitivity is found in non-obese subjects with impaired glucose tolerance.     

舒芬太尼靶控输注对非体外循环冠状动脉旁路移植术患者麻醉效果的影响

目的:比较不同效应室浓度的舒芬太尼靶控输注对非体外循环冠状动脉旁路移植术(OPCAB)患者麻醉效果的影响。方法:42例择期OPCAB的患者随机分为3组,分别在术中使用0.4ng/mL(组Ⅰ)、0.6ng/mL(组Ⅱ)和0.8ng/mL(组Ⅲ)固定效应室浓度的舒芬太尼靶控静脉麻醉。观察患者术中血流动力学及脑电双频普指数(BIS)值,记录术中舒芬太尼、丙泊酚、多巴胺用量,术后恢复时间及围手术期心肌酶谱[肌酸激酶(CK)与肌酸激酶同工酶(CK-MB)]。结果:3组患者术中都能维持满意的血流动力学。术中丙泊酚、多巴胺的用量,术后恢复时间和围手术期心肌酶谱差异无显著性(P>0.05)。但Ⅱ组与Ⅲ组患者舒芬太尼用量多于Ⅰ组(P<0.01),Ⅲ组患者心脏指数(CI)在手术开始时低于Ⅰ组(P<0.05),心率(HR)自搭桥开始后增快(与搭桥前比较P<0.01),Ⅰ组患者术中BIS值高于Ⅱ组与Ⅲ组(P<0.05)。结论:采用0.4ng/mL、0.6ng/mL或0.8ng/mL固定效应室浓度的舒芬太尼靶控静脉麻醉对OPCAB患者术中均可以维持满意的血流动力学,但0.6ng/mL为最合适的靶控浓度。     

The response to intravenous glucose infusion in normal and diabetic subjects

Summary Data from single injection studies on 23 normal subjects led to development of an intravenous primed — constant infusion test. The plasma glucose response to this test was determined in 48 normal and 24 diabetic subjects. Variation in plasma glucose concentration at equilibrium was minimal in normal and marked in diabetic subjects — assessed by the difference between maximum and minimum glucose concentration over the final 25 min of a 50 min infusion. This parameter was used successfully in predicting the course of 16 pregnant women with clinical suspicion of prediabetes unresolved by oral glucose tolerance tests.Submitted as part fulfillment of the requirements for Doctor of Medicine, Monash University, Melbourne, 1967.     

Blood glucose regulation using closed- and open-loop insulin delivery systems

Summary Glucose was infused into anaesthetized dogs before and after pancreatectomy. In the diabetics blood glucose was regulated first by closed-loop and then by open-loop insulin delivery schemes. Insulin requirements for the latter were determined by resolving the former into a sequence of 3 different infusion rates: during the baseline and recovery periods, basal insulin was delivered at 0.37±0.02 mU/kg/min, while during the 60 min glucose infusion (10 mg/kg/min) there was an 8 min infusion at 4.96±0.37 mU/kg/min and a 52 min component at 1.85±0.08 mU/kg/min. With the open-loop method under these highly standardized conditions glycaemia was similar to normal controls but IRI levels were significantly higher, 13.5 vs 8.0 U/ml (p<0.05) in the baseline and recovery periods and 74 vs 25 U/ml (p<0.05) during the glucose infusion. It was concluded that: constant normogly-caemia can be maintained in the basal state by a constant rate of peripheral insulin delivery but at rates resulting in peripheral hyperinsulinaemia; the glycaemic response to glucose infusion can be normalized by a two component waveform of insulin delivery; and the closed-loop method can serve as a useful guide in determining insulin requirements.     

Blood glucose regulation using an open-loop insulin delivery system in pancreatectomized dogs given glucose infusions

Summary This study characterizes the glycaemic and insulin responses of a group of 5 anaesthetized dogs to a portal glucose infusion of 10 mg/kg/min before and after pancreatectomy. Insulin was administered intraportally to the pancreatectomized dogs according to a simple preprogrammed waveform composed of a constant basal rate of 0.35±0.02 mU/kg/min which was increased to 2.00mU/kg/min at the time of the 60 minute glucose challenge. When this square waveform was applied the glycaemic response was similar to that seen in the normal controls in the baseline and challenge periods. Blood glucose concentration differed significantly (p<0.05) only from 20 to 100 minutes after the end of the challenge when it was higher by 20±1 mg/dl. Insulin levels were not significantly different from controls. It may be concluded that normoglycaemia and normoinsulinaemia can be maintained by a simple constant rate of portal insulin delivery while the blood glucose response to a glucose infusion can be ostensibly normalized without hyperinsulinaemia simply by enhancing insulin delivery during the challenge. The feasibility of this approach implies that with further development of the preprogrammed waveforms and with a greater understanding of their characteristics portable insulin delivery systems may be realized which accomodate more physiological challenges. The portal route for insulin delivery may however be necessary if peripheral hyperinsulinism is inappropriate.     

Intraosseous infusion: an alternative route of pediatric intravascular access

Substantial difficulties can be encountered when establishing rapid intravascular access in critically ill children. The historic technique of tibial intraosseous infusion is presented as an alternate intravenous route in children less than 3 years old. Review of the literature reveals this technique to be a rapid, reliable method with an acceptably low complication rate. Substances absorbed through the marrow, flow rates, technical difficulties, and complications are discussed.     

静脉用药调配中心优化院内感染控制管理对患者静脉输液质量及降低医院感染率的影响

目的:探究静脉用药调配中心(PIVAS)优化院内感染控制管理对患者静脉输液质量及降低医院感染率的影响。方法:抽取2015年1月—2016年12月间PIVAS 1586例患者资料(优化管理前);另抽取2017年1月—2019年1月实施优化管理后的1865例患者资料(优化管理后);优化管理前后PIVAS工作人员均为25名;比较优化管理前后静脉输液质量及医院感染率的差异。结果:与优化管理前相比,优化管理后化疗药物的包装、输液配制质量及操作台环境的满意度均较高(P<0.05),院内感染发生率低于优化管理前(P<0.05)。结论:PIVAS实施优化院内感染控制管理,有效提高了静脉输液质量,遏制了院内感染的发生,保证了患者用药的安全性。