Serum erythropoietin levels for predicting bone marrow recovery following chemotherapy in leukaemia

Summary To investigate whether serum erythropoietin (EPO) levels are influenced by the intensity of bone marrow erythroid activity, we used a radioimmunoassay (Nippon DPC Co., Japan) to study EPO levels in three acute leukaemia patients during treatment with intensive chemotherapy. We also measured the reticulocyte count and reticulocyte maturity using an automated reticulocyte analyser (Sysmex R-2000) to detect erythropoietic activity. From the day after the initiation of chemotherapy, EPO levels increased markedly without any change in Hb levels, suggesting that some other mechanism was regulating serum EPO. A decrease in EPO after chemotherapy was accompanied by an increase in high fluorescence ratio, an index of immature reticulocvtes, but the actual increase in the reticulocyte count was delayed for 3-4 days after this. These findings suggest that the decrease in serum EPO levels was closely related to the early stage of red cell production and that EPO levels may be a useful marker for the recovery of erythropoietic activity after chemotherapy.     

Laparoscopic pyeloplasty for ureteropelvic junction obstruction: Outcome of initial 12 procedures

BACKGROUND: Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25 months (range, 12-42 months). METHODS: Between March 1999 and September 2001 we performed laparoscopic pyeloplasty on 12 ureters in 11 patients presenting with symptomatic hydronephrosis, secondary to a short stenosis of the UPJ or to ventrally crossing vessels; bilateral pyeloplasty was performed as a single procedure in one patient. We performed dismembered Anderson-Hynes pyeloplasty, Fenger plasty and Y-V plasty in eight, two and two ureters, respectively. All procedures were carried out transperitoneally. RESULTS: The procedure was completed successfully in all cases. Crossing vessels were noted in six of 12 ureters (50.0%). Mean operative time and blood loss in 11 patients (including one bilateral case) were 272.8 min (range, 175-480 min) and 96.4 mL (range, 20-340 mL), respectively. Postoperative complications were noted in two patients (18.2%): one instance of prolonged urine leakage and one anastomotic re-stricture. Eleven of 12 ureters (91.6%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 12 months. CONCLUSION: Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. Laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for UPJ obstruction.     

Clinical significance of red blood cell distribution width in the elderly: a potential indicator of bone marrow stimulation by erythropoietin

Summary To investigate the clinical significance of red blood cell distribution width (RDW) and haemoglobin distribution width (HDW) in the elderly and their relationships with erythropoietin (EPO) secretion, we measured red cells parameters using a Technicon HI system and serum EPO using a radioimmunoassay in 247 elderly subjects (normal: n= 150; preanaemic iron deficiency: n= 24; iron deficiency anaemia: n= 8; senile anaemia: n= 65). RDW was slightly higher in the elderly subjects with preanaemic iron deficiency (14.1 ± 1.1%) than in the normal elderly subjects (13.5±0.7%). It was highest in iron deficiency anaemia (16.1 ± 1.3%), while the increase in senile anaemia was limited (13.9 ± 1.2%). The HDW increased only in iron deficiency anaemia. There was a strong positive relationship between EPO and RDW in iron deficiency anaemia (r= 0.817, P<0.01). Moreover, this correlation was also found in preanaemic iron deficiency (r= 0.456, P < 0.05), but not in senile anaemia, suggesting that bone marrow hypoactivity may partly play a role in the pathogenesis of senile anaemia. All the eight subjects with iron deficiency anaemia had a RDW ≥ 14.9% (mean + 2SD of normal subjects), while 55 (85%) of the 65 with senile anaemia had a RDW < 14.9%. Both the RDW and EPO levels of six anaemic subjects with high RDW values (≥ 14.9%) after oral iron therapy for 56–78 days decreased significantly. Our results suggest that RDW is useful to distinguish iron deficiency anaemia from senile anaemia, and may be a potential parameter of bone marrow stimulation by EPO.     

Etched-Porcelain Resin-Bonded Onlay Technique for Posterior Teeth

ABSTRACT: porcelain to enamel and dentin. This evolution has dramatically changed restorative dentistry and has produced a new, highly esthetic, and strong restoration-etched-porcelain resin-bonded restorations. These restorations can be placed with confidence on posterior teeth. They are virtually indistinguishable from natural tooth structure and, thus provide additional treatment alternatives for patients who desire natural-appearing posterior teeth. Etched-porcelain resin-bonded onlays on posterior teeth not only are an excellent restorative modality for moderately broken-down teeth but also may be used to bring caries-free teeth into occlusion. The latter can be an option for stabilizing occlusion for some patients with posterior open bite due to various causes. This article presents clinical and laboratory techniques for etched-porcelain resin-bonded onlays on posterior teeth. Remarkable advances in adhesive dentistry have made it possible to strongly bond     

An inappropriate erythropoietic response to iron deficiency anaemia in the elderly

Summary This study was carried out to clarify the features of iron deficiency anaemia in the elderly. Subjects were chosen from residents undergoing an annual health check in a home for the aged and the features of anaemia in the elderly were compared with those in middle-aged adults under 60 years old. The red cell count, red cell size and haemoglobin content in an elderly group with iron-deficiency anaemia did not differ from those in middle-aged adults. No significant differences of the serum ferritin and iron levels were noted between the two groups. Total iron binding capacity was higher in the middle-aged adults than in the elderly, while the reticulocyte count was significantly lower in the elderly group. Immature reticulocytes showing a considerable amount of residual RNA by flow cytometry with fluorescent staining were also lower in the elderly group than in the middle-aged adults. Serum erythropoietin levels in both groups were significantly higher than in non-anaemic age-matched controls and no difference in erythropoietin levels was noted between them. The ratio of the reticulocyte count to the log-transformed erythropoietin level was low in the elderly group with iron-deficiency anaemia compared with the middle-aged adults with iron deficiency anaemia. The same result was seen when the immature reticulocyte count was related to the log-transformed erythropoietin level. These findings suggest that the red cell production response to erythropoietin in the elderly with iron-deficiency anaemia might be inappropriate compared with both non-anaemic and anaemic middle-aged adults.     

Cigarette smoking increases the mean platelet volume in elderly patients with risk factors for atherosclerosis

Summary To study the effects of cigarette smoking and atherosclerosis on platelet size, we measured the mean platelet volume (MPV) and other platelet parameters in 142 elderly smokers and nonsmokers with or without atherosclerotic risk factors. The MPV and the platelet count were highest and their inverse correlation was strongest in the atherosclerotic smokers (r= 0.54, P < 0.05) when compared with the nonsmoking and non-atherosclerotic groups. A 10% decrease of MPV was found in 8 smoking subjects in the atherosclerotic group, who successfully discontinued smoking (P < 0.05). These results suggest that smoking may increase platelet consumption in atherosclerotic vessels and that subsequently megakaryocytes are activated to produce larger platelets, which are more active. Thus, an increase in MPV due to smoking may also contribute to the acceleration of atherosclerosis and should be considered as a risk factor for atherosclerotic disease.     

Evaluation of three-dimensional glenoid structure using MRI

The tilting angle and the shape of the glenoid cavity are considered to relate closely to shoulder stability. They are also important when planning arthroplasty and developing new designs. This study examines the glenoid cavity using 3-dimensional MRI. Forty volunteers (20 men, 20 women; average age 21.4; range 18–35 y) were enrolled in the study. The tilting angles of the glenoid bone were measured in 5 consecutive axial planes perpendicular to the glenoidal long axis. Cross sections were divided into 3 types (concave, flat, convex) according to the shape on each plane.
The average tilting angles for the 5 planes from the bottom to the top were 3.3±4.1, 1.4±3.8, −0.6±1.9, −1.4±3.3, and −6.2±3.3 degrees anteriorly, indicating that the 3-dimensional bony structure of the glenoid was twisted anteriorly to posteriorly. Images on the bottom plane consisted of 82.5% concave type, 15% flat type and 2.5% convex type, while only 3 cases (7.5%) showed concave at the top plane. The shape of the glenoid cavity is thought to be conducive to glenohumeral motion and stability.