Venous and skin puncture blood counts compared

Venous and skin puncture blood counts were compared in 80 paired samples from 33 children, aged 6 months to 14 years, and 10 adults. Significantly higher mean values for Hb, RBC, haematocrit and neutrophils were found in skin puncture blood in children whereas platelet values were slightly higher in venous blood. Similar results were found in adult samples. Only occasionally were differences likely to be of clinical importance. The excellent comparability of paired platelet counts, at variance to that found in some previous studies, indicates that skin puncture blood can be used for platelet estimation providing an appropriate counting method is used.     

A modular aortouniiliac endovascular stent-graft is a useful device for the treatment of symptomatic and ruptured infrarenal abdominal aortic aneurysms: one-year results from a multicentre study.

INTRODUCTION: Endovascular repair (EVAR) of acute symptomatic and ruptured abdominal aortic aneurysm (rAAA) can be difficult without a large stock of suitable graft sizes. We report a prospective European multicentre study of a modular aortouniiliac stent-graft. PATIENTS AND METHODS: Seven centres, with elective EVAR experience, participated in the study. Sixty-five patients were enrolled from September 2002 - April 2005. Some 45 patients had rAAA and 20 were acutely symptomatic. Their median age was 74 (69-80.3) years, 49 (75%) were men. From a choice of 4 body and 4 limb sizes, stent-grafts were deployed under local or general anaesthesia. RESULTS: The endovascular delivery system was introduced and the aneurysm excluded from the circulation in a median of 40 (30-60) minutes from the first incision. The median operative duration was 150 (120-190) mins, blood loss 300 ml (200-800). 33 (51%) operations were performed by a vascular surgeon alone. There were a total of 4 (6%) peri-operative re-interventions, endovascular (n=1), open (n=2) and thrombectomy (n=1). The peri-operative mortality in the rupture group was 40% and 10% in the symptomatic group. CONCLUSIONS: Aortouniiliac stent-grafts provide rapid exclusion of rAAA. Suitably trained surgeons can do the operation without a radiologist's support. The mortality rate from rAAA treated with EVAR remains high.     

Term delivery in a woman with severe congenital neutropenia, treated with growth colony stimulating factor

The patient was diagnosed in childhood as having severe congenital neutropenia and had recurrent admissions with severe infections. In 1987, prior to getting married, she was sterilized. She continued to require i.v. antibiotics when she contracted a severe infection. On one occasion, she was treated with growth colony stimulating factor (G- CSF). Her increased neutrophil count was sustained following this treatment. In June 1993, she wished to start a family and underwent in- vitro fertilization (IVF) treatment. G-CSF was given prior to oocyte retrieval. She conceived on her first cycle and an ultrasound scan revealed a singleton pregnancy. Throughout the course of the pregnancy, her white cell count was monitored closely and remained at <1.0x10(9)/l. The pregnancy progressed uneventfully and at 37 weeks gestation she was admitted for G-CSF injections. At 38 weeks she was delivered of a boy weighing 3350 g, by elective Caesarean section. His white cell count was normal. This is the first case of G-CSF being used before conception and during pregnancy in a patient with congenital neutropenia. It shows that advances in cytokine therapy and close interdisciplinary liaison can lead to a successful outcome and help patients, who would otherwise remain childless, to achieve a family.      

Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure [published erratum appears in Hum Reprod 1998 Mar;13(3):780]

The aim of the study was to determine whether a prior diagnostic testicle biopsy can predict success or failure of testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia caused by testicular failure, and what is the minimum threshold of sperm production in the testis which must be surpassed for spermatozoa to reach the ejaculate. Forty- five patients with non-obstructive azoospermia caused by testicular failure underwent diagnostic testicle biopsy prior to a planned future TESE-ICSI procedure. The diagnostic testicle biopsy was analysed quantitatively, and correlated with the quantitative findings of spermatogenesis in patients with normal spermatogenesis, as well as with the results of subsequent attempts at TESE-ICSI. Men with non- obstructive azoospermia caused by germinal failure had a mean of 0-6 mature spermatids/seminiferous tubule seen on a diagnostic testicle biopsy, compared to 17-35 mature spermatids/tubule in men with normal spermatogenesis and obstructive azoospermia. These findings were the same for all types of testicular failure whether Sertoli cell only, maturation arrest, cryptorchidism, or post-chemotherapy azoospermia. Twenty-two of 26 men with mature spermatids found in the prior testis biopsy had successful retrieval of spermatozoa for ICSI, 12 of their partners became pregnant, and are either ongoing or delivered. The study suggests that 4-6 mature spermatids/tubule must be present in the testis biopsy for any spermatozoa to reach the ejaculate. More than half of azoospermic patients with germinal failure have minute foci of spermatogenesis which are insufficient to produce spermatozoa in the ejaculate. Prior diagnostic testicle biopsy analysed quantitatively (for the presence of mature spermatids) can predict subsequent success or failure with TESE-ICSI. Incomplete testicular failure may involve a sparse multi-focal distribution of spermatogenesis throughout the entire testicle, rather than a regional distribution. Therefore, it is possible that massive testicular sampling from many different regions of the testes may not be necessary for successful TESE-ICSI.      

Adhesion inhibitory activity of β-lactoglobulin isolated from infant formulae

β-Lactoglobulin was isolated from infant formulae that were ultra high temperature (UHT) -treated, sterilized or spray-dried. The effect of the isolated β-lactoglobulin on SfaII-fimbriae-mediated adhesion of Escherichia coli to human ileostomy glycoproteins was studied in vitro. β-Lactoglobulin isolated from sterilized formulae was found to perform significantly less well than preparations from spray-dried formulae (p = 0:05). Great heterogeneity was observed in the adhesion inhibitory capacity of β-lactoglobulin isolated from UHT-treated formulae. Therefore, no significant difference was observed between UHT-treated and sterilized formulae or spray-dried formulae (p < 0:10). It can be hypothesized that β-lactoglobulin from spray-dried and some UHT-treated infant formulae may affect the colonization of mucous membranes by E. coli strains causing neonatal septicaemia and meningitis.     

Life expectancy in British Marfan syndrome populations

A total of 206 patients with Marfan syndrome were ascertained throughout genetic clinics in Wales and Scotland during the period 1970–1990. There were 45 deaths representing 22% of the cohort. Mean age at death was 45.3 ± 16.5 years. 50% median cumulative survival in the total cohort (n = 206) was 53 years for males and 72 years for females. Multivariate analysis confirmed severity as the best independent indicator of survival. These findings and survival curves will assist in the counselling of British families and individuals with Marfan syndrome.