Utilization patterns of frozen autologous red blood cells. Experience in a referral center and a community hospital

The risks of homologous blood transfusion have motivated some blood centers and private industry to consider providing long-term storage of frozen, autologous red blood cells as a service. The usefulness of this practice is unknown. We performed a retrospective analysis of frozen autologous red blood cell use in two hospitals. Records were available for 21- and 9-year intervals, respectively. A total of 104 autologous units were cryopreserved for 41 patients. Fifteen (37%) of 41 patients received one or more of their stored units of red blood cells. Twenty-two patients had autologous units frozen in anticipation of elective surgery; 11 (50%) of these 22 patients received some or all of their stored units. Sixteen patients had autologous units stored because of potential transfusion problems related to rare blood types or to the presence of multiple blood cell alloantibodies, and another 3 patients had units frozen simply at their personal request. Only 4 (21%) of these latter 19 patients who donated without a specific planned use eventually received their frozen autologous red blood cells. Long-term autologous frozen red blood cell storage can improve medical management of some patients with anticipated surgical procedures or unusual requirements for transfusion. However, our study suggests that most autologous units frozen without specific planned use will not be transfused.     

Waldenstrom macroglobulinemia presenting as a pleural effusion

We describe a patient with Waldenstrom macroglobulinemia who presented with a lymphocytic pleural effusion. Pleural involvement in Waldenstrom macroglobulinemia is very rare. In addition, to our knowledge, there are no reports in the literature in which a primary diagnosis was made on the basis of pleural fluid analysis. The presence of small lymphocytes in serous cavity fluid can pose great difficulty in the differentiation between a low-grade lymphoproliferative disorder and reactive lymphocytosis. The diagnosis of malignancy in this case was established on the basis of morphologic testing, flow cytometry, and the detection of B-cell immunoglobulin gene rearrangement.     

Prostate Cancer Shared Decision: a CD-ROM educational and decision-assisting tool for men with prostate cancer

Prostate Cancer Shared Decision, a CD-ROM program produced with the guidance of leading prostate cancer specialists, educates prostate cancer patients and suggests possible treatments. As the first portable, interactive prostate cancer decision-making tool, Prostate Cancer Shared Decision offers expert, plain-language explanations of prostate anatomy, cancer diagnosis, and treatment options. Through answers to lifestyle and attitude questions entered into a series of user-friendly questionnaire screens, Prostate Cancer Shared Decision helps patients understand their disease and feel comfortable with their treatment decision. This type of educational tool is representative of the new technology that is becoming available to patients with prostate cancer.     

"Floating-socket" total shoulder replacement: anatomical, biomechanical, and surgical rationale

A prosthesis based on a new concept of gleno-humeral motion has been developed and clinically tested for the past 2 years. The "floating-socket" total shoulder replacement contains a nondislocatable, dual spherical bearing system consisting of a small sphere within a larger sphere with their centers offset to provide the physiologic "floating fulcrum" for mechanically advantageous motion. This geometric configuration allows a prosthetic range of motion in excess of anatomical limits to allow soft tissue structures to limit motion rather than mechanical impingement. The device is constructed from Co--Cr--Mo alloy and RCH-1000 polyethylene such that no metal--metal contact can occur. Experimental results in a 112-lb adult male chimpanzee and six clinical cases have revealed superior fixation strength of both glenoid and humeral components, as well as functional adaptation of the prosthesis without fracture of fixturing bone or prosthetic dislocation.