Biomedical subjects
Publications and source records attributed to C Waller.
The authors have reviewed 64 cases of preoperative autotransfusion in 60 patients in private practice of orthopaedic surgery. In 78 per cent of the cases no homologous blood was necessary. They state that this method is safe, effective and easy to organize.
A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.
A case is reported of a 23 yr old pregnant woman from Zaire in whom homozygous sickle-cell disease was discovered at her first obstetrical visit at 25 week amenorrhea. She had had two previous pregnancies: the first one had been voluntarily interrupted; the second one went to term, but the child, born in a state of apparent death, died on the third day. Despite severe normocytic anaemia (5 mmol.l-1 haemoglobin, 2.9 T.l-1 erythrocytes, 0.25 haematocrit, 93 fl mean globular volume), she was symptomless. The diagnosis was confirmed by haemoglobin electrophoresis: 0 haemoglobin A (HbA) and 0.854 haemoglobin S (HbS). Because foetal growth and maturation appeared satisfactory, no procedure to increase the HbA/HbS ratio was used before the 37th week of amenorrhea. At that time, erythrocytapheresis was carried out using a discontinuous flow cell separator. Eight phenotyped red cell packs without leukocytes (removed by filtration) were transfused; at the end of the procedure, there was 0.67 HbA and 0.25 HbS. At 39 week amenorrhea, haemoglobin electrophoresis gave 0.43 HbA and 0.47 HbS. No further treatment was therefore given. At the 40th week, she gave birth to a healthy girl, Apgar score 10 at 1 min. She was given two further red cell packs at start of labour, because her haemoglobin level had fallen to 6.4 mmol.l-1. In the immediate postpartum, her HbS level was 0.38. The aims, advantages and disadvantages of the different techniques available for the treatment of homozygous sickle-cell anaemia in pregnancy are discussed.
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Glanzmann's thrombasthenia is a thrombopathy which affects primary hemostasis due to a qualitative or quantitative abnormality of membrane glycoproteins IIb-IIIa. The treatment of hemorrhages is usually associated with the transfusion of packed red blood cells and platelet concentrates. If massive allo-immunisation occurs, the transfusion will prove to be inefficient. A case of a cesarean section was scheduled after therapeutic plasmapheresis and platelet transfusions in a massively allo-immunised patient with Glanzmann's thrombasthenia. The plasma exchange made it possible to reduce to trace levels the concentrations of anti-PLA1 and anti-PLA2 antibodies, thus making platelet transfusions hemostatically efficient. The cesarean section was therefore safely performed when the bleeding time was normalized.
A 27 year-old man developed after ingestion of mercury chloride, 6 g, a hypovolemic shock, an acute renal failure and a necrosis of the stomach which required a total gastrectomy. The anuria did not improve and required 42 hemodialyses. Subsequent evolution showed numerous complications and the patient died on the 91st day. On admission mercury plasma concentration was 5 mg/L and decreased slowly with an apparent half-life of 226 hours. Hemodialyses were ineffective for mercury elimination: mercury clearances varied between -10 and + 1.5 ml/min. Seventeen mg of mercury were removed by six plasma exchanges: the mercury clearance was mean 17.3 ml/min. Among the extracorporeal elimination methods, plasma exchange appears to be the most efficient for inorganic mercury and it could be usefull in association with chelation therapy at the early phase of the intoxication.
We have followed the evolution of leucocyte antibodies in patients receiving multiple blood transfusions of leucocyte-poor blood. The number of leucocytes present in one unit of transfused blood was always less than 1 X 10(8). We observed that such preparations were able to re-stimulate antibodies which had disappeared, but especially they were able to provoke a first immunisation in some patients never immunized in the past. The specificities of these antibodies corresponded to one or several antigens present in the donor of the transfused unit. This study shows that leucocyte immunisation cannot always be avoided in spite of the selection of blood products containing very few white cells.
By implantation of BSp73 ascites cells in a subcutaneous site and subsequent subcutaneous passage of either the local tumor node or metastatic lung tissue, variants were obtained which differed with respect to morphology and to metastatic capacity. The highly metastasizing variant ASML showed spherical morphology in culture, while the nonmetastatic variant AS showed adhesion and spreading. Upon cloning it was observed that colonies with fully expressed morphotypes were readily obtained from solid tissue of both variants. Parental ascites as well as the tumor line derived from the primary solid tumor gave rise to stable expression of either morphotype only after prolonged culturing. Mixing of established clones did not result in an interclonal adaptation of growth rates in vivo. Further characterization of variants AS and ASML revealed marked differences in the outer cell surface. Adhesion of AS cells onto plastic was found to be mediated by fibronectin, laminin and 4 out of 5 collagen types. ASML cells showed adhesion only with collagen type III at higher concentrations. Cytogenetic analysis revealed that the adaptation of BSp73 cells to ascitic growth ultimately led to an increase in chromosome numbers, and this was conserved in ASML cells (modal number 63, range 49-74). AS cells on the other hand showed a modal number of 47 (range 45-49). The chromosome count distribution was rather narrow in ascites cells in vivo, but it was very broad in clones derived thereof, indicating that diversity was obtained in culture rather than in vivo. The data are compatible with the assumption that the nonmetastatic variant was not preexisting in BSp73 ascites but represents a stable phenotype which infrequently arises in a particular microenvironment by chromosome loss from a hyperdiploid parental population.
Depletion of leukocytes from red blood cells can prevent transfusion reactions in HLA-sensitized patients. We describe a simple technique of aspiration of the buffy-coat after centrifugation of red blood cells concentrates, less than 6 days old. This method can remove 87% of the leukocytes. The average leukocyte count after aspiration is 2 x 10(8). This method is inexpensive and does not require any special equipment.
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HLA-A, B, C and Bf antigens were studied in 153 blood donors who developped a titre of greater than or equal to 25 i.u./ml antitetanus antibodies following tetanus anti-toxin vaccination. Antigen frequency was compared with that of 412-464 normal blood donors living in the same area. Few significant differences were demonstrated: absence of Bw21 antigen and slight increase of Bf F antigen were observed in "good responders".
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Measurement of myocardial perfusion is important for the functional assessment of heart in vivo. Our approach is based on the modification of the longitudinal relaxation time T1 induced by magnetic spin labeling of endogenous water protons. Labeling is performed by selectively inverting the magnetization within the detection slice, and longitudinal relaxation is measured using a fast gradient echo MRI technique. As a result of blood flow, nonexcited spins enter the detection slice, which leads to an acceleration of the relaxation rate. Incorporating this phenomenon in a mathematical model that describes tissue as two compartments yields a simple expression that allows the quantification of perfusion from a slice-selective and a global inversion recovery experiment. This model takes into account the difference between T1 in blood and T1 in tissue. Our purpose was to evaluate the feasibility and reproducibility of this technique to map quantitatively myocardial perfusion in vivo in rats. Quantitative maps of myocardial blood flow were obtained from nine rats, and the reproducibility of the technique was evaluated by repeating the whole perfusion experiment four times. Evaluation of regions of interest within the myocardium yielded a mean perfusion value of 3.6 +/- .5 ml x min(-1) x g(-1) over all animals, which is in good agreement with previously reported literature values.
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