bluuebunny/crossref_metadata_2025 huggingface dataset:
The Yield, Reliability, and Validity of a Postal Survey for Screening Community‐Dwelling Older People
Authors: Alessi Cathy A. , Josephson Karen R. , Harker Judith O. , Pietruszka Fern M. , Hoyl M. Trinidad , Rubenstein Laurence Z.
Published: March 2003

OBJECTIVES: To assess the yield, reliability, and validity of a postal survey developed to identify older persons in need of outpatient geriatric assessment and follow‐up services.

DESIGN: A longitudinal cohort study.

SETTING: Outpatient primary care clinic at a Department of Veterans Affairs teaching ambulatory care center.

PARTICIPANTS: Patients (N = 2,382) aged 65 and older who returned a Geriatric Postal Screening Survey (GPSS) that screened for common geriatric conditions (depression, cognitive impairment, urinary incontinence, falls, and functional status impairment). Validity and reliability testing was performed with subsamples of patients classified as high or lower risk based on responses to the GPSS.

MEASUREMENTS: Test‐retest reliability was measured by percentage agreement and kappa statistic. The diagnostic validity of the 10‐item GPSS was tested by comparing single GPSS items to standardized geriatric assessment instruments for depression, mental status and functional status, as well as direct questions regarding falls, urinary incontinence, and use of medications. Validity was also tested against clinician evaluation of the specific geriatric conditions. Predictive validity was tested by comparing GPSS score with 1‐year follow‐up data on functional status, survival, and healthcare use.

RESULTS: Respondents identified as high risk by the GPSS had scores that indicated significantly greater impairment on structured assessment instruments than those identified as lower risk by GPSS. The overall mean percentage agreement between the test and retest surveys was 88.3%, with a mean weighted kappa of 0.70. In comparison with a structured telephone interview and with a clinical assessment, individual items of the GPSS showed good accuracy (range 0.71–0.78) for identifying symptoms of depression, falls, and urinary incontinence. Over a 1‐year follow‐up period, the GPSS‐identified high‐risk group had significantly (P < .05) more hospital admissions, hospital days and nursing home admissions than the lower‐risk group.

CONCLUSION: A brief postal screening survey can successfully target patients for geriatric assessment services. In screening for symptoms of common geriatric conditions, the GPSS identified a subgroup of older outpatients with multiple geriatric syndromes who were at increased risk for hospital use and nursing home admission and who could potentially benefit from geriatric intervention.
Addition of sodium bicarbonate to lidocaine decreases the duration of peripheral nerve block in rat. (Harvard Medical School, Boston, MA) Anesthesiology 2000;93:1045–1052.
Authors: Sinnott Catherine J. , Garfield Joseph M. , Thalhammer Johannes G. , Strichartz: Gary R.
Published: March 2003

This study evaluated the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block. The study was broken up into two parts. Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. The study concluded that with 1% commercial lidocaine without epinephrine, sodium bicarbonate decreases the degree and duration of the block. However, in solutions with epinephrine, sodium bicarbonate hastens onset, without effecting degree or duration.

Comment by Octavio Calvillo, M.D., Ph.D. There is evidence that adding sodium bicarbonate to lidocaine without epinephrine improves the quality of epidural block, whereas adding sodium bicarbonate to lidocaine with epinephrine does not. The addition of 8.4% sodium bicarbonate to 2% lidocaine without epinephrine was shown to decrease the onset time and enhance the depth of the epidural block. When bicarbonate was added to 2% lidocaine with epinephrine neither onset time nor depth of the epidural block was affected. Most investigators have used epidural block as their paradigm. The authors in this study used the sciatic nerve block of the rat.
Maintaining quality of life at the end of life. (Mayo Clinic, Rochester, MN) May Clin Proc 2000;75:1305–1310.
Authors: Rummans Teresa A. , Bostwick J. Michael , Clark: Matthew M.
Published: March 2003

Despite the successful growth of the hospice movement during the past 30 years in the United States, almost 85% of Americans continue to die in hospitals or nursing homes. While the benefits of palliative care principles are well established, palliative care interventions remain underused in clinical practice in the settings in which most Americans die. Our premise is that physicians as a group perpetuate end‐of‐life suffering rather than ease the transition from life to death. We also believe that maintaining quality of life (QOL) at the end of life requires a multidimensional approach orchestrated by physicians drawing on the full range of available physical, psychological, social, and spiritual interventions. This article defines the meaning of QOL at the end of life and then examines the ramifications of failing to attend to QOL concerns in dying patients. It reviews strategies that physicians can use to advance palliative care approaches, thereby reducing terminally ill patients' suffering in the institutions in which most die.
Management of an Epidural Abscess After Continuous Epidural Catheter Infusion
Authors: Malak Osama A. , Mossad Sherif B. , Mekhail Nagy A.
Published: March 2003

Abstract: Objective:  • To increase awareness of the possibility of epidural infection after continuous epidural infusion.

• Outline the salient diagnostic features of epidural infection.

• Outline a strategy to manage epidural infection and minimize morbidity.

Setting: Academic multidisciplinary pain clinic

Patient: A patient with a left knee meniscal tear with a history of Chronic Regional Pain Syndrome Type I (CRPS I) of the left foot.

Interventions: Attempted control of CRPS I symptoms with a tunnelled epidural catheter infusion.

Results and Conclusions: The patient developed an epidural abscess diagnosed on the 11th postoperative day. The catheter was removed and the patient was treated successfully with intravenous antibiotics.
Amitriptyline and fluphenazine in the treatment of postherpetic neuralgia. (UCLA Pain Management Center, Los Angeles, CA) Clin J Pain 2000;16:188–192.
Authors: Graff‐Radford Steven B. , Shaw Leon R. , Naliboff: Bruce N.
Published: March 2003

In this double‐blinded, placebo‐controlled study, 49 patients with postherpetic neuralgia (PHN) were randomly assigned to 4 treatment groups: Group 1, amitriptyline; Group 2, amitriptyline and fluphenazine; Group 3, fluphenazine; Group 4, a placebo. An active placebo was used to mimic the anticholinergic side effects of dry mouth. The study lasted 8 weeks, with weekly progress evaluations with the use of visual analog scales, the McGill Pain Questionnaire, and a side‐effects scale. A statistically significant decrease was seen in pain Groups 1 and 2, and no significant changes were seen in Groups 3 and 4. There was no significant difference when fluphenazine was added to amitriptyline. Conclude that these data support the effectiveness of amitriptyline in the treatment of PHN, but do not support the addition of fluphenazine.

Comment by Lian‐Kah Ti, M.D. Amitriptyline is an established modality of treatment for postherpetic neuralgia. It is believed to exert its effect by its analgesic properties, rather than its antidepressant effect. It has been shown to raise the pain threshold, brought about by its prevention of serotonin re‐uptake.

Although isolated case studies suggested a role for fluphenazine in combination with amitriptyline in the treatment of postherpetic neuralgia, the authors could not demonstrate this benefit. This study highlights the difficulties in the treatment of this condition. The use of amitriptyline reduced the intensity of pain, but did not eliminate it (VAS scores decreased from 55.9 to 26.6). When MPQ scores were compared, there was no difference, suggesting that the qualitative aspect of the pain was not reduced. More importantly, the authors noted a ceiling effect for amitriptyline, effectively limiting its potency. Combining therapies may be the answer, but as this study clearly shows, a combination with fluphenazine is not.
Analgesia, virtue, and the principle of double effect. (Queen's University, Kingston, Ontario, Canada) J Palliative Care 2000;16:S24–S30.
Authors: Hawryluck Laura A. , Harvey: William R. C.
Published: March 2003

The principle of double effect is widely used to permit the administration of narcotics and sedatives with the intent to palliate dying patients, even though the administration of these drugs may cause hastening of death. In recent medical literature, this principle's validity has been severely criticized, causing health care providers to fear providing goo palliative care. Most of the criticisms leveled at the principle of double effect arise from misconceptions about its purpose and origins. This article explored how virtue‐based ethics can overcome the most important challenge to the principle of double effect's validity, that of its reliance on intention to determine whether the administration of analgesia is ethically acceptable.
Impact of migraine and migraine therapy on productivity and quality of life. (Merck Research Laboratories, Merck & Co., West Point, PA) Neurology 2000;55:S29–S35.
Authors: Solomon Glen D. , Santanello: Nancy
Published: March 2003

Migraine is an expensive disorder in terms of lost productivity and its deleterious impact on health‐related quality of life (QOL). In addition to lost wages and productivity due to absenteeism, many patients with migraine also experience reduced productivity while at work and disruption of their family, social, and leisure activities. Therefore, this article began with a discussion on the impact of migraine on work productivity and then measured the QOL in migraine sufferers. Pharmaceutical intervention was discussed. It was concluded that compared with usual care, rizatriptan had favorable effects on all five domains of the 24‐h Migraine QOL questionnaire.
an algorithmic approach. (Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA) Neurology 2000;55:S46–S52.
Authors: Silberstein Stephen D. , Goadsby Peter J. , Of Migraine: Richard B. Lipton: Management
Published: March 2003

This article provided practical suggestions for treating migraine pain. It covered an overall wellness program including exercise, rest, good nutrition, and avoidance of headache triggers. The authors pointed out that simple analgesics or nonsteroidal anti‐inflammatory drugs are often the first line of attack with combinations of analgesics and ergotamine preparations representing the second‐line of attack for patients with infrequent attacks. For patients unlikely to respond to simpler treatments, other options were provided. Patients suggested for preventive therapy were those with 3 or more days of headache‐related disability per month or with headache refractory to acute treatment.
A randomized, controlled trial of high‐dose dextromethorphan in facial neuralgias. (National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD) Neurology 2000;55:964–971.
Authors: Gilron I. , Booher S. L. , Rowan J. S. , Smoller B. , Max: M. B.
Published: March 2003

A randomized, double‐blinded, crossover trial compared 6 weeks of oral dextromethorphan with active placebo (low‐dose lorazepam) in 19 patients, stratified into three groups: 11 with facial pain and possible trigeminal neuropathy, 5 with anesthesia dolorosa, and 3 with idiopathic trigeminal neuralgia. Dosage was titrated in each patient to the highest level reached without disrupting normal activities. Patients completing the trial included 10 with possible trigeminal neuropathy, 4 with anesthesia dolorosa, and 2 with trigeminal neuralgia. In patients with possible trigeminal neuropathy and anesthesia dolorosa, dextromethorphan decreased pain by a mean of only 2% to 4%, and these estimates were not significant. Both patients with trigeminal neuralgia had more pain during dextromethorphan treatment than during placebo treatment. Of the 3 patients who demonstrated an analgesic response to dextromethorphan during the main trial, only 1 repeatedly responded in 4 subsequent confirmatory drug‐placebo crossovers. Conclude dextromethorphan shows little or no analgesic efficacy in pain due to possible trigeminal neuropathy and anesthesia dolorosa. Additional trials are necessary to conclusively evaluate the efficacy of NMDA‐receptor antagonists in trigeminal neuralgia.
Taxonomy of pain. (Lehigh Valley Hospital, Center for Pain Management, Allentown, PA) Clin J Pain 2000;16:S114–S117.
Authors: Nicholson: Bruce
Published: March 2003

This article discussed the way that research on the pathophysiology of chronic pain has started to challenge the traditional diagnostic and treatment paradigms for the patient with neuropathic pain. It stated that the heterogeneous nature of neuropathic pain indicated that more than one anatomic lesion is most likely responsible for the clinical presentation of a particular syndrome. Conclude that the current taxonomy often falls short of identifying the multifactorial nature of neuropathic pain syndromes and, therefore, may lead to imprecise management of those conditions. It is suggested that an integrated approach to the diagnosis and treatment of neuropathic pain that considers both etiologic factors and possible mechanisms will lead to more effective taxonomy, treatment paradigms, and outcomes.
Subdural Blood Patch for the Treatment of Persistent CSF Leak After Permanent Intrathecal Catheter Implantation: A Report of Two Cases
Authors: Dominguez Eric , Latif Osman , Rozen Dima , Sahinler Bolkar , Orbegozo Mauricio , Edmunds Ann , Lou Leland , Day Miles , Racz Gabor , Raj Prithvi
Published: March 2003

Abstract: A CSF leak that persists despite conservative therapy may significantly increase the morbidity associated with implantable intrathecal drug delivery systems. This report presents 2 cases where the application of a subdural blood patch led to the satisfactory resolution of a persistent CSF leak after previous epidural blood patches had failed.
Double‐blind comparison of ropivacaine 7.5 mg mL−1 for sciatic nerve block. (Ninewells Hospital and Medical School, Dundee, United Kingdom) British J Anesh. 2001;26:209–214.
Authors: Connolly C. , Coventry D. M. , Wildsmith J. A.
Published: March 2003

Two groups of 12 patients had a sciatic nerve block performed with 20 mL of either ropivacaine 7.5 mg mL−1 or bupivacaine 5 mg mL−1. There was no statistically significant difference in the mean time to onset of complete anesthesia of the foot or to the first request for postoperative analgesia. The quality of the block was the same in each group. Although there is no statistically significant difference in the mean time to peak plasma concentrations the mean peak concentration of ropivacaine was significantly higher than that of bupivacaine. There were no signs of systemic local anesthetic toxicity in any patient in either group.
α‐1 and α‐2 adrenergic antagonists relieve thermal hyperalgesia in experimental mononeuropathy from chronic constriction injury. (Emory University School of Medicine, Atlanta, GA) Anesth Analg. 2001;92:1558–1562.
Authors: Hord Allen H. , Denson Donald D. , Stowe Barry , Haygood Robert M.
Published: March 2003

Phentolamine, a nonspecific α1‐ and α2‐adrenergic antagonist, relieves pain in patients with reflex sympathetic dystrophy. This study sought to determine whether phentolamine, prazosin (α1 antagonist), or SKF86466 (α2 antagonist) relieve thermal hyperalgesia in rats with neuropathic pain. Four days after producing a chronic constriction injury (CCI), thermal hyperalgesia was tested by measuring paw withdrawal latency (PWL). After injection of phentolamine, prazosin, or SKF86466 each at doses of 1, 2, or 5 mg/kg, PWL tests were measured at 5 minutes and repeated at 15‐minute intervals for 1 hour. Phentolamine, prazosin, and SKF86466 1, 2, and 5 mg/kg provided statistically significant analgesia in rats with CCI for at least 65 minutes. PWL did not return to baseline levels after 1 or 2 mg/kg of prazosin or SKF86466 but did so after 35 minutes after phentolamine 2 mg/kg. After 5 mg/kg, for phentolamine, at 35 and 65 minutes for prazosin, and at 50 minutes for SKF86466, and at 50 minutes for SKF86466. Conclude that both α1 and α2 peripheral receptors of the sympathetic nervous system are involved in the thermal hyperalgesia caused by CCI and that thermal hyperalgesia can be reversed by both α1 and α2 antagonists in a dose‐dependent manner.
Effects of tramadol on T lymphocyte proliferation and natural killer cell activity in rats with sciatic constriction injury. (National Cheng Kung University, College of Medicine, Tainan, Taiwan) Pain. 2001;92:63–69.
Authors: Tsai Yu‐Chuan , Won Shen‐Jeu
Published: March 2003

This study investigated the effects of acute and chronic tramadol treatment on T lymphocyte function and natural killer (NK) cell activity in rats receiving chronic constriction injury (CCI) of the sciatic nerve. T lymphocyte function was evaluated based on concanavalin‐A (ConA)‐induced and phytohemagglutinin (PHA)‐induced splenocyte proliferation. NK cell activity was measured by lactic acid dehydrogenase release assay. The effects of tramadol on thermal hyperalgesia were also assessed by measuring paw withdrawal latency (PWL) in the rats. PWL was dose‐dependently reversed by tramadol after acute treatment (single subcutaneous injection) with 10, 20, and 30 mg/kg, respectively. There was no significant change among acute treatments groups in NK cell activity, whereas splenocyte proliferation induced by ConA and PHA was significantly suppressed starting from a dose of 20 mg/kg. The reversal of the thermal hyperalgesia persisted throughout a period of chronic tramadol treatment of 40 and 80 mg/kg per day, respectively, with continuous subcutaneous infusion for 7 days at a uniform rate via osmotic minipumps. No modulation of NK cell activity was found in either dose group. However, the activity of splenocyte proliferation was decreased in the 80 mg/kg per day group when compared with the saline and 40 mg/kg per day groups. Suggest that tramadol treatment has an immunological profile different from pure μ‐opioid agonists like morphine, which is known to suppress both NK cell activity and T lymphocyte proliferation at a subanalgesic dose in CCI rats. Conclude that tramadol treatment may be a better choice than morphine for treatment of chronic neuropathic pain, particularly in patients with compromised immunity.
The analgesic effect of codeine as compared to imipramine in different human experimental pain models. (University of Southern Denmark, Odense, Denmark) Pain. 2001;92:277–282.
Authors: Enggaard Thomas P. , Poulsen Lars , Arndt‐Nielsen Lars , Hansen Steen Honoré , Bjørnsdottir Inga , Gram Lars F. , Sindrup Søren H.
Published: March 2003

The hypoalgesic effect of single oral does of 100 mg imipramine and 125 mg codeineWas evaluated in this randomized, placebo‐controlled experiment that included 18 healthy volunteers. Pain tests were performed before and 90, 180, 270, 360, and 450 min after medication. The tests included determination of pain tolerance thresholds to pressure, single electrical sural nerve stimulation, and to repetitive sural nerve stimulation. Codeine significantly increased pressure pain tolerance, pain detection and pain tolerance thresholds. It was concluded that both imipramine and codeine inhibit temporal pain summation, whereas only codeine reduces cold pressor pain. Pain summation may be a key mechanism in neuropathic pain. Imipramine has a documented effect on such pain conditions on temporal summation. In addition, this study showed that codeine also inhibits temporal summation, which is in line with the clinical observations indicating that opioids relieve neuropathic pain.
Depression and anxiety in oncology: the oncologist's perspective. (Beatson Oncology Center, Glasgow, United Kingdom). J Clin Psychiatry. 2001;62:52–55.
Authors: Jones Richard D.
Published: March 2003

Depression and anxiety frequently occur in oncology patients and have a significant impact on patient quality of life, health care utilization, and even disease outcome. Depression and anxiety are eminently treatable and, therefore, psychiatric assessment and appropriate intervention should form an integral component of management strategy in patients with cancer. It is essential that patients are recognized at an early stage, so that resources can be targeted effectively at those most at risk of developing psychiatric morbidity. Evaluation techniques that can identify signs or symptoms of depression and anxiety and can be incorporated into the program of a busy oncology clinic or in the primary care setting are, therefore, needed. Diagnosis of depression and anxiety may be facilitated by using primary screening tools, such as family psychiatric history, levels of family support, and degrees of pain suffered by the patient. This article considered the issues surrounding diagnosis of depression and anxiety in cancer patients and the benefits of early intervention from the point of view of the oncologist.
Fibromyalgia Syndrome, Idiopathic Widespread Persistent Pain or Syndrome of Myalgic Encephalomyelopathy (SME): What Is Its Nature?
Authors: Mehendale Anand W. , Goldman Mark P.
Published: March 2003

Abstract: Context: Fibromyalgia is a disorder that is appearing more and more in the clinical practice but is poorly understood.

Objective:  This paper attempts to look at all available and reliable data on these conditions and will outline current, scientifically sound understanding of these disorders, treatment modalities and future directions for research. It also attempts to analyze the social and cultural implications.

Data Sources/Study Selection: Various terms used to describe these syndromes are fibromyalgia (FMS), and myalgic encephalomyelitis (ME). PubMed search was performed. Pertinent articles published in past 25 years and The National Academy of Sciences colloquium on Neurobiology of Pain was also reviewed. In addition, news‐articles in the lay press as well as the Internet were monitored for material posted by sufferers of these disorders.

Data Extraction: Studies were reviewed for clinical presentations, history of these disorders, comorbid conditions, etiology, biochemical and microbiologic abnormalities, abnormalities found on neuroimaging and functional neurophysiologic techniques. In addition patient postings on the Internet and articles appearing in lay press were reviewed and social implications are discussed.

Data Synthesis: Upon analysis of these materials the review was organized based on the quality of data and it's contextual scientific, cultural and political meaning for this disorder. This review appears to be pointing towards an entirely new paradigm in pain disorders; therefore, a hypothesis and future direction of research is repeatedly suggested.

Conclusion:  This study proposes an entirely new paradigm in these disorders based on scientific and cultural data.
Nutraceuticals: Potential Roles and Potential Risks for Pain Management
Authors: Kaye Alan D. , Kaye Adam M. , Hegazi Amr , Sabar Raj , Deaton Ben , Powell Jackie , Hofbauer Roland
Published: March 2003

Abstract: Over the past 2 decades, the world health market has been flooded with over the counter herbal products, also known as nutraceuticals. Although many of these products are neither recommended nor prescribed by conventional medical practitioners, an increasing number of people are taking these products on a daily basis. A recent survey at Texas Tech University School of Medicine in Lubbock, Texas concluded that 32% of patients scheduled for elective surgery or pain procedures were taking one or more herbal supplements; however, 70% did not disclose these during a routine anesthetic assessment.1 Pain physicians are also increasingly needed in the care of these patients. As many of these agents carry a potential to cause bleeding problems, we have reviewed here briefly, the basic mechanisms of coagulation and correlated the role of commonly used herbs known to possess side effects, which can cause excessive bleeding. In addition, we have reviewed a number of potential useful herbal derived agents for pain management.
Technical Aspects of Radiofrequency
Authors: Sluijter M. , Racz G.
Published: March 2003

Abstract: Radiofrequency (RF) is an alternating electric field with an oscillating frequency of 500.000 Hz. If the resulting current flows through a percutaneously introduced electrode, heat will be produced around the electrode because the body tissue acts as a resistor. RF can, therefore, be used to ablate nervous tissue in the treatment of chronic pain. This method has gained acceptance for percutaneous cordotomy and for the treatment of trigeminal neuralgia. For spinal pain, the method had little success initially, but since the introduction of small diameter instrumentation, the results have markedly improved.

he mechanism of action of RF has not been challenged until recently even though there was awareness that some observations were not consistent with the heat concept. The formation of heat is not the only occurrence during RF treatment, however. The tissue surrounding the electrode is also exposed to the RF electric field. This exposure has a biological effect as has been demonstrated both in cells in a cell culture and in the exposure to RF of dorsal root ganglia, resulting in transsynaptal induction of early gene expression in the dorsal horn. The mode of action of RF is, therefore, uncertain at the moment.

The method of pulsed RF is based on the concept that the production of heat has been a by‐product of RF treatment and that the clinical effect is due to exposure to the electric field. In pulsed RF, the generator output is interrupted to allow for the elimination of heat in the silent period. The early results have been encouraging, but the results of controlled, prospective studies are not yet available.

Since there are now 2 almost diametrically opposed views on the mode of action of RF, it is difficult to give recommendations for treatment. The decision is easy for indications for which heat RF has traditionally been contraindicated such as the treatment of peripheral nerves and trigger points. When the application of heat carries a potential risk, for instance if the dorsal root ganglion is the target structure, the use of pulsed RF is also recommended. As for the medial branch the situation is controversial. Since there are controlled studies available showing the effect of heat lesions, it is recommended that the technique should not be changed until further studies have been completed.

Finally, the equipment for RF treatment is described and safety issues are discussed.
The frequency of granulocyte‐specific antibodies in postpartum sera and a family study of the 6B antigen
Authors: Clay M. , Kline W. , McCullough J.
Published: March 2003

We examined sera from 2313 postpartum women as a potential source of granulocyte specific antibodies. Lymphocyte cytotoxic (LC) antibodies were detected in 397 (17.2%) specimens and granulocyte agglutinating (GA) antibodies in 291 (12.6%). Only two GA positive sera had reactivity for previously defined granulocyte specific antigens (one NA1 and NB1). One additional serum had GA reactivity similar to a serum previously reported by van Rood and called anti‐6B. The frequency of granulocyte specific antibodies (0.1 percent) in our study indicates that the productivity of random screening of parous sera for granulocyte specific antibodies is low. A four‐generation family study of the 6B antigen demonstrated a parallel association between HLA‐B7 and B40 and 6B reactivity in the LC, GA, and granulocyte immunofluorescence (GIF) assay. This illustrates that the granulocyte reactivity of anti‐6B is not granulocyte specific but is HLA related. This report provides additional evidence that HLA antibodies such as anti‐B7 (6B) can react with granulocytes bearing these antigens in the GA and GIF assays currently used to identify granulocyte specific antibodies.
Analysis of paternity. The use of HLA and red cell antigens
Authors: Davey FR , Hubbell CA , Lauenstein KJ , Tinnesz C , Henry JB
Published: March 2003

Over a 6‐year period, 866 cases were analyzed for disputed parentage. In 194 cases (22%), the alleged father was excluded as the biological father. One hundred and eight‐one cases (93%) were direct exclusions, and 13 cases (7%) were indirect exclusions. Ninety‐two percent of falsely accused men were identified by typing for HLA antigens alone. Exclusions based solely on red cell data occurred in 8 percent of the cases. When only HLA testing was performed, 177 of 362 (43%) cases had a probability of paternity of greater than or equal to 95 percent. When both HLA and red cell typings were performed, 110 of 160 (69%) cases had a probability of paternity of greater than or equal to 95 percent. No significant differences in the proportion of exclusions or proportion of alleged fathers with a probability of paternity of greater than or equal to 95 percent were observed between Caucasians or blacks. We conclude that typing for HLA antigens provides the most powerful data for excluding or including an alleged father. However, typing for red cell antigens adds significant data in excluding a falsely accused man and in determining the probability of paternity at a critical level (greater than or equal to 95%). In addition, the current study suggests that additional assays are needed to identify genetic characteristics of cases with probability of paternity less than 95 percent.
Iron stores in male blood donors evaluated by serum ferritin
Authors: Milman N. , Søndergaard M.
Published: March 2003

Iron stores were evaluated by serum ferritin measurements in 1348 male blood donors. Blood donation was associated with a decrease in serum ferritin concentrations. First‐time donors (n = 21) had a geometric mean serum ferritin concentration of 52 micrograms per l, and multiple‐ time donors (n = 1327) of 36 micrograms per l (p less than 0.01). In the donating population, 6.0 percent had serum ferritin values less than 15 micrograms per l (i.e., depleted iron stores), 33.9 percent had values from 15 to 30 micrograms per l (i.e., reduced iron stores), 52.5 percent had values from 31 to 90 micrograms per l, and 7.6 percent had values greater than 90 micrograms per l (i.e., normal iron stores). The frequency of donations per year was more predictive of decreased iron stores than the number of lifetime donations. Serum ferritin showed a moderate fall up to the fourth donation (p less than 0.001); thereafter serum ferritin levels showed only minor insignificant changes. An increase in donation frequency was accompanied by a significant decrease in serum ferritin; values less than 15 micrograms per l were found in 1.3 percent of donors bled two times per year, in 6.0 percent bled three times per year, and in 7.9 percent bled four times per year. Regular monitoring of iron stores by serum ferritin in blood donors seems justified in order to identify those with depleted iron stores who will benefit from iron supplementation.
Non‐A, non‐B hepatitis associated with blood transfusion
Authors: Wick Mark R. , Moore S. Breanndan , Taswell Howard F.
Published: March 2003

Posttransfusion hepatitis of the non‐A, non‐B variety continues to be a significant problem in current hemotherapy. This disorder is many times more common than transfusion‐associated disease caused by hepatitis B virus, cytomegalovirus, and Epstein‐Barr virus, and also seems to be viral in origin. Several potential etiological agents have been implicated, but none has been identified with certainty, despite concerted efforts at doing so. Clinical disease is usually attended by few symptoms and signs, but evolution to chronic liver disease is distressingly common; over 50 percent of all cases of non‐A, non‐B posttransfusion hepatitis manifest this transition. Efforts at prevention of non‐A, non‐B hepatitis associated with blood transfusion have thus far been hampered by the lack of reliable laboratory markers for carriers of this disease, and controversy exists over the implementation of screening tests on blood donors, using such nonspecific indicators of possible viral carriage as serum alanine aminotransferase levels. It is probable, however, that simple measures such as more restrained blood usage, encouraged by greater educational efforts within the medical community, could be beneficial in minimizing the number of new cases of non‐A, non‐B posttransfusion hepatitis seen each year in the United States.
Another example of the rare Ay phenotype
Authors: Drozda E. A. , Dean J. D.
Published: March 2003

The red cells of a patient typed as group O, but her serum lacked anti‐ A. Upon further testing, it appeared that the ABO phenotype was Am. Saliva studies demonstrated a normal amount of H substance but reduced A substance. Family studies established the ABO genotype of the proposita as A1O. The results suggest that modification of the cellular and salivary expression of the A antigen in this patient was the result of a double dose of the modifier gene y, and that the ABO phenotype, while having characteristics similar to that of an Am, was actually Ay.
The Lui elution technique. A simple and efficient method for eluting ABO antibodies
Authors: Feng C. S. , Kirkley K. C. , Eicher C. A. , de Jongh D. S.
Published: March 2003

The Lui elution and the heat elution techniques are the most simple techniques available for eluting antibodies from red cells. Both are very effective for eluting ABO antibodies. We compared the two techniques and found the Lui technique superior in that it more efficiently eluted ABO antibodies, required less hands‐on time, and allowed more flexibility in the procedure. We therefore recommend the Lui elution technique as the method of choice for eluting ABO antibodies, especially for the evaluation of hemolytic disease of the newborn.
Uneventful plasma exchange with albumin replacement in a patient with a previous anaphylactoid reaction to albumin
Authors: Edelman B. B. , Straughn M. A. , Getz P. , Schwartz E.
Published: March 2003

A patient who had a previous anaphylactoid reaction to albumin required plasma exchange for myasthenia gravis. She was rechallenged with albumin from a different manufacturer after premedication with diphenhydramine. No adverse reaction occurred during five exchanges over a 10‐day period. Possible pathogenic mechanisms and prevention of such reactions are discussed.
Extended storage of single‐donor platelet concentrate collected by a blood cell separator
Authors: Buchholz D. H. , Porten J. H. , Grode G. , Lin A. T. , Smith J. , Barber T. , Brda J. , Kozar I.
Published: March 2003

Use of a sealless blood pathway in a blood cell separator (CS‐3000, Fenwal) permits collection of platelets in a “closed system” when saline and anticoagulant solutions are integrally attached; this in turn allows storage of instrument‐collected platelet concentrates (PCs) beyond 24 hours. To evaluate extended storage of high yield PCs, cells collected with the instrument were stored (200 ml plasma) for 8 days (flatbed agitation) in either 3‐liter polyvinylchloride (PL 146) containers (n = 6), polyolefin bags (PL 732) (n = 8), or two 1‐liter polyolefin (double PL 732) containers (n = 8). A mean of 4.45, 4.09, and 3.94 × 10(11) platelets were stored in PL 146, single PL 732, and double PL 732, respectively; total white cells per container averaged 0.3, 0.2, and 0.2 × 10(9) for the three container systems. By day 1, platelet pO2 dropped to 14 and 16 torr in PL 146 and PL 732 PCs (pCO2, 127, and 82 torr). In contrast, double PL 732 maintained high pO2 (approximately equal to 80 torr) and low pCO2 (approximately equal to 30 torr) through day eight. Glucose declined at faster rates in PL 146 and single PL 732 containers, while lactate increased more rapidly (338 and 197 mg/dl of lactate on day four vs. 116 mg/dl for double PL 732 units). Morphology scores dropped from 400 to 98 (PL 146) and 216 (PL 732) at day four (pH values of 6.3 and 7.0), while a score of 330 was seen in double PL 732 PCs.(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of storage on the ganglioside content of human platelets
Authors: Koerner T. A. W. , Weinfeld H. M. , Yu R. K. , Bove J. R.
Published: March 2003

Gangliosides are glycolipids which contain sialic acid and are found in the membranes of mammalian cells. By analogy with recent studies of other cells, it is possible that gangliosides play a role in the membrane functions and in vivo survival of platelets. In order to determine if ganglioside destruction plays a role in the storage‐induced loss of platelet viability and function (storage lesion), the ganglioside content of platelets was measured after 24 and 96 hours of storage. Samples were taken from platelet concentrates that were stored either on a flat‐bed shaker (n=6) or on a circular rotator (n=6). Total ganglioside content was determined colorimetrically from the total lipid extracts of purified platelet pellets using the Svennerholm resorcinol method. Ganglioside GM3 content was determined by Folch partitioning, high performance thin‐layer chromatography, and densitometric scanning. Ganglioside content, measured as μg of lipid‐bound sialic acid per 1010 platelets, was significantly decreased (p<0.005) between 24 and 96 hours of storage, whether measured as total or GM3 ganglioside. The mean values ± SEM at 24 and 96 hours of storage were 9.4 ± 0.6 and 6.7 ± 0.6, respectively (n=12 for each). These data indicate that storage causes irreversible loss of membrane ganglioside, which may be detrimental to the function and in vivo survival of platelets.
Use of blood components containing red cells by donors of allogeneic bone marrow
Authors: Thompson H. W. , McCullough J.
Published: March 2003

Bone marrow transplantation is performed for an increasing number of disorders. Although much has been written about blood transfusion in bone marrow recipients, there is little information dealing with blood transfusion in bone marrow donors. We examined the records of 129 consecutive allogeneic bone marrow transplants to determine blood use by bone marrow donors. We attempted to correlate blood transfusion requirements with a number of variables in both donors and recipients of bone marrow. The volume of marrow harvested correlated closely with the number of units of blood transfused (r = 0.82). When these two variables were expressed as a percent of estimated blood volume, the correlation improved slightly (r = 0.85). Although the volume of marrow correlated highly with the total number of mononuclear cells harvested (r = 0.92), the correlation between total cells harvested and number of units of blood transfused was not as high (r = 0.75). By knowing the number of marrow cells the recipient requires for transplantation, the volume of donor marrow required and donor blood transfusion requirements can be estimated. In most instances, autologous blood could be used exclusively, thus eliminating the risks associated with homologous blood transfusion.
Isolation of leukocyte‐free platelets from standard platelet concentrates by centrifugation
Authors: Cott M. E. , Oh J. H. , Vroon D. H.
Published: March 2003

We evaluated centrifugation techniques to isolate leukocyte‐free platelets from standard platelet concentrates. Among various settings of centrifugation force and time, we found the setting at 300 ×g for 10 minutes or 370 ×g for 5 minutes to be efficient and reproducible for recovering sufficient quantities of platelets free of leukocytes.
A new method for monitoring the sterility of blood donation
Authors: Guéguen M. , Durand F. , Delamaire D. , Beauplet A. , Tardivel R. , Genetet B. , Chalumeau H. , Balme M. C.
Published: March 2003

Sterility of blood products is a cardinal contributor to patient safety. Bacteriologic controls of stable products comply with strict regulations, but legislation imposes only limited constraints in the case of perishable products, such as packed red cells (RBCs) or fresh‐frozen plasma (FFP). Therefore, it is essential to monitor the sterility of aseptic donations from uninfected donors. Such bacteriologic monitoring can now be carried out through a tertiary bag (containing a soybean casein culture medium) connected to the classical double‐pack system. This system does not jeopardize the sterility of the whole system, as the connection is tightly stoppered by a membrane. After the blood drawing, this tertiary bag is filled with 5 ml of blood, and separated from the rest of the system. It is then incubated for 3 days at 30° C and for 14 days at 22° C, to test for eventual bacteriologic or fungal contamination. In order to check the feasibility of this technique, we studied 76 blood drawings in the control laboratory of the blood center, and the results confirm the value of this system.
Nine days post‐thawing red cell conservation in a synthetic medium: Biochemical studies
Authors: Kane O. , George E. , Offner M. , Eber M. , Tromp C. , Goll S.
Published: March 2003

The expiration of thawed red cells (RBC) currently is 24 hours. This leads to problems in current transfusion practice, and often wastes rare and costly products. To remedy this situation, we developed a synthetic medium containing 0.085 g per I adenine, 5 g per I glucose, 48.0 g per I sucrose, 0.75 g per I NaH2PO4.H2O, 4 g per I Na2HPO4.2H2O, and 2.5 g per I NaCI, with a pH of 7.40, and an osmolarity of 320 mOsm. After 15 days post‐thawing storage at 4°C in our medium, the viability and function of RBC were maintained. We propose the storage of thawed RBC at 4°C in our medium for up to 9 days: sterility was maintained, pH was 6.80, and 2,3‐diphosphate glycerate was 50 percent, and adenosine triphosphate 100 percent of the original values. Free hemoglobin was 122 mg per unit, adenylate energy charge was 0.90, and RBC labeled 7 days after thawing showed 89 percent survival 24 hours after transfusion and a one‐half disappearance of 22 days.
Specificity of enzyme immunoassay for hepatitis B core antibody used in screening blood donors
Authors: Lee Hyo‐Suk , Rajagopalan M.S. , Chien David , Cordell Ruth , Perkins Herbert A. , Vyas Girish N.
Published: March 2003

ABSTRACT: Hepatitis B core antibody (anti‐HBc) is currently tested by a competitive inhibition enzyme immunoassay (EIA), using recombinant DNA‐ produced core antigen. We have used the anti‐HBc assay in routine screening of voluntary blood donors in San Francisco. The detection rate of anti‐HBc was 2.08 percent. The specificity of the antibody test was established by an absorption method using purified HBc antigen (HBcAg) produced by recombinant DNA technology and covalently coupled to Sepharose 4B. Bovine serum albumin was used in the preparation of a control conjugate. The absorption test demonstrated that out of 98 anti‐ HBc‐positive specimens, 97 could be specifically neutralized. Only one specimen was indeterminate. The absorption test was particularly useful in confirming the specificity of EIA in eight specimens inconsistently positive for anti‐HBc. We conclude that the current EIA for anti‐HBc is highly specific and we are of the opinion that it could be used as a rational basis for donor deferral since it gives evidence of active or previous HBV infection.
The probability of exclusion of the HLA‐A,B system in North American whites and blacks in parentage tests
Authors: Walker R.H. , Meyers M.A. , Phillips L.M.
Published: March 2003

The value of the HLA‐A,B system in excluding a man falsely accused of paternity, the power of exclusion (Ā), was examined by four different methods. Methods to define Ā were: analysis of artificially created false trios, calculation of the proportion of all exclusion cases (corrected for unexcluded men who were not fathers) in which the HLA system showed evidence of an exclusion, derivation from individual Random Man Not Excluded (RMNE) values, and derivation from individual Paternity Index (PI) values. The false trios were limited within the same ethnic group (whites and blacks) so that no mixed ethnic matings were considered. It was assumed that all of the men in the artificial trios were not fathers. Twenty‐one percent of the observed exclusions were based on A locus markers, 36 percent on B locus markers, and 43 percent on both A and B markers. Among 510 false white trios, the man was excluded in 476 cases, yielding a power of exclusion (Ā) for whites of 93.3 percent. One hundred thirty men were excluded in 140 black artificial trios, giving a value of 92.9 percent for Ā in blacks. Similar values, 94.4 percent for whites and 93.6 percent for blacks, were derived from the proportion of all exclusions detected by the HLA system. Ā was also derived by computer analysis on the same cases with formulas that use RMNE and PI values. These results also agreed. This concordance by all four methods enhanced the validity of the Ā values of about 93 to 94 percent for both whites and blacks. Analysis of the phenotypes of the two groups showed greater heterogeneity in the blacks at the HLA‐A locus that may have compensated for their higher frequency of blanks.
False‐positive results with chemically modified anti‐D
Authors: Jones E. C. , Sinclair M. , Unrau L. , Growe G.
Published: March 2003

Chemically modified anti‐D typing serum is considered to combine the reliability of saline IgM anti‐D with the convenience of slide and rapid tube anti‐D. This has led to its wide acceptance in modern blood bank practice. False‐positives are considered rare and are controlled by the ABO grouping. The extra step of an Rh control, which is necessary with IgG slide and rapid tube anti‐D serums, is thus eliminated. However, this report shows that adopting this practice can be misleading and dangerous. Two cases are reviewed in which the chemically modified anti‐D gave false‐positive results and the ABO typing did not act as an adequate control.
The effects of plastic bag extracts prepared in either mouse serum or phosphate‐buffered saline with ethanol on mouse splenic cells
Authors: Wierda D. , Hutenberg C. , Niday E.
Published: March 2003

Chemicals leached from plastic blood bags are potentially immunogenic when introduced parenterally into humans. The experiments reported here represent an attempt to sensitize B6C3F1 mice to parenteral injections of solutions used to extract potentially immunogenic material from plastic blood bags. Mice were given intraperitoneal injections: blood bag extracts prepared from phosphate‐buffered saline and ethanol; mouse red cells stored in extract solution; or blood bag extracts prepared from mouse serum. None elicited a significant in vitro immunologic reaction as determined by 3H‐thymidine or 3H‐leucine uptake into spleen cells. In contrast, intraperitoneal injections in mice of large amounts (0.5 ml) of the phosphate‐buffered saline and ethanol extracts decreased spleen cellularity to 59 percent of the control value and reduced spleen cell blastogenic activity in vitro. When solutions of either mouse serum extract or mouse cells stored in extract were given intraperitoneally to mice, no spleen toxicity or increased blastogenic activity was observed. In addition, the extracts obtained from plastic blood bags by using either allogenic serum or buffered saline and ethanol did not elicit an immunologic response when they were administered parenterally to mice.