bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological sequelae: Post‐traumatic stress reactions and personality factors among community residents as secondary victims
Authors: Chung Man Cheung , Easthope Yvette , Farmer Steven , Werrett Julie , Chung Catherine
Published: December 2004

The aims of the present study were twofold: first, to ascertain the severity of post‐traumatic stress among community residents as secondary victims exposed to a train disaster. Secondly, we aimed to identify the association between post‐traumatic stress and personality variables. Seven months after the train disaster in Stafford, United Kingdom, in 1996, 66 community residents were recruited and interviewed for the study. In the interviews, residents were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ) and the Eysenck Personality Questionnaire‐R Short Scale (EPQ‐R). Control group data were also collected, composed of 90 community residents who lived in another city and had not been exposed to the train disaster. They were assessed using the GHQ. The results showed that 51% of the residents scored at the high IES symptom level. No significant differences were found between the community residents who lived near and further away from the crash site in terms of the IES scores. Further analyses showed that the IES scores for the present two groups of community residents were significantly lower than those of Horowitz's standardized stress clinic samples, but higher than those of Danish rescue workers involved in a train rescue operation. The GHQ results showed that 35% could be considered to be psychiatric cases. The comparisons between the GHQ scores of the present community residents with those of the control group showed that there were significant differences in somatic problems, anxiety, depression and GHQ total. With regard to personality, the community residents who lived near to the crash site were significantly more introverted but less neurotic than Eysenck's standardized samples. The community residents who lived further away were significantly more introverted but less neurotic than the standardized samples. Regression analyses revealed that neuroticism predicted intrusion, avoidance and GHQ total. The conclusion was that there can be long‐term, severe post‐traumatic stress effects upon community residents, as secondary victims, after exposure to a train disaster. Residents with a neurotic personality tend to be associated with post‐traumatic stress reactions and general health problems.
Attitudes of nursing staff towards nutritional nursing care
Authors: Christensson Lennart , Unosson Mitra , Bachrach‐Lindström Margareta , Ek Anna‐Christina
Published: December 2004

Fulfilling nutritional requirements in residents with eating problems can be a challenge for both the person in need of help and for the caregiver. In helping and supporting these residents, a positive attitude is assumed to be as important as practical skill. The aim of this study was to test the hypothesis that nutritional education and implementation of a nutritional programme would change the attitudes towards nutritional nursing care among nursing staff with daily experience of serving food and helping residents in municipal care. The study was carried out as a before and after experimental design. An attitude scale, staff attitudes to nutritional nursing care (SANN scale), was developed and used. The response on the scale gives a total SANN‐score and scores in five underlying dimensions: self ability, individualization, importance of food, assessment and secured food intake. Nursing staff at eight different residential units (n = 176) responded to the attitude scale and, of these, staff at three of the units entered the study as the experimental group. After responding to the attitude scale, nutritional education was introduced and a nutritional programme was implemented in the experimental units. One year later, attitudes were measured a second time (n = 192). Of these, 151 had also responded on the first occasion. Education and implementation of a nutritional programme did not significantly change attitudes. Overall, nursing staff responded with positive attitudes towards nutritional nursing care. Most of the positive attitudes concerned items within the dimension importance of food. In contrast, items within self ability showed the lowest number of staff with positive attitudes.
Shame reactions after suicide attempt
Authors: Wiklander Maria , Samuelsson Mats , Åsberg Marie
Published: December 2004

Shame reactions were spontaneously described by 13 of 18 patients interviewed in a qualitative study investigating experiences of care following a suicide attempt. The shame data from the interview study were extracted, analysed separately, and are reported in this article. The shame reactions often occurred in conjunction with the suicide attempt. Feelings of shame were accompanied by impulses to hide or flee, i.e., fear of seeking help or impulses to leave the hospital. The attempted suicide patients often experienced the initial encounter at the hospital as difficult. Having attempted suicide and survived was often perceived as yet another failure, in addition to the problems leading to the attempt. The attempted suicide patients were sensitive to the attitudes and behaviours of the personnel. Experiencing the personnel as kind, respectful, and nonjudgemental seemed to contribute to a relief from shame for some patients. Some respondents expressed that a tolerant and flexible atmosphere in the psychiatric ward, with low demands on the attempted suicide patient, helped them accept treatment and made them feel less ashamed for not living up to the expectations of everyday life. On the other hand, feeling too exposed to others or experiencing negative attitudes from the personnel seemed to contribute to an exacerbation of shame for some patients. Being aware of possible shame reactions after a suicide attempt might help caring personnel to understand and interact with attempted suicide patients in a way that could make it easier for these patients to accept and benefit from psychiatric care after a suicide attempt.
Perceptions of health‐related quality of life of men and women living with coeliac disease
Authors: Hallert Claes , Sandlund Olga , Broqvist Mari
Published: December 2004

Women with long‐standing coeliac disease express poorer health‐related quality of life (HRQoL) than men do for unclear reasons. This led us to explore differences in their understanding of HRQoL using a phenomenographic approach. We interviewed 10 coeliac subjects (mean age 57 years, range 35–73) who had been on a gluten‐free diet for 10 years and had scored either high or low in the Short Form 36 Health Survey (SF‐36) General Health and Vitality scales. Three dimensions were revealed that pertained to their perception of HRQoL: bodily sensations, social consequences and coping strategies. Within these, the women experienced more bowel symptoms than men did, despite keeping to a strict diet. This item was the only one predicting the SF‐36 scores. The women also described more distress caused by the restrictions in daily life, closely related to their controlling of food contents. The coeliac men took advantage of using a problem‐oriented coping approach while the women seeking an emotionally oriented strategy showed less satisfaction with the outcome. We conclude that the intriguing difference in HRQoL between coeliac men and women may have some of its origin in the way living with the disorder is conceptualized and coped with. The results imply that in the management of coeliac patients, gender‐related aspects need to be taken into account to improve treatment outcome.
Risk factors for pressure ulcers among elderly hip fracture patients
Authors: Baumgarten Mona , Margolis David , Berlin Jesse A. , Strom Brian L. , Garino Jonathan , Kagan Sarah H. , Kavesh William , Carson Jeffrey L.
Published: December 2004

The purpose of this study was to estimate the incidence of hospital‐acquired pressure ulcers among elderly patients hospitalized for hip fracture surgery and to identify extrinsic factors that are associated with increased risk. We conducted a secondary analysis of data abstracted from medical records at 20 hospitals in Pennsylvania, Texas, New Jersey, and Virginia. Participants were patients aged 60 years and older admitted with hip fracture to the study hospitals between 1983 and 1993. The incidence of hospital‐acquired pressure ulcers was 8.8% (95% confidence interval 8.2%−9.4%). After adjusting for confounding variables, longer wait before surgery, intensive care unit stay, longer surgical procedure, and general anesthesia were significantly associated with higher pressure ulcer risk. Extrinsic factors may be important markers for high pressure ulcer risk in hospitalized hip fracture patients. Although it is not possible to eliminate factors such as requiring an intensive care unit stay or having a long surgical procedure, it may be possible to develop interventions that minimize pressure ulcer risk in patients who experience these factors. (WOUND REP REG 2003;11:96–103)
Treatment of periprosthetic soft tissue infection of the groin following vascular surgical procedures by means of a polyvinyl alcohol‐vacuum sponge system
Authors: Pinocy Jürgen , Albes Johannes M. , Wicke Corinna , Ruck Peter , Ziemer Gerhard
Published: December 2004

Deep groin infections after prosthetic vascular surgical procedures represent a serious complication of surgical practice. Septicemia and/or erosive hemorrhage can both be consequences. In this situation, removal of the graft appears to be the only option. However, if the infection is detected early (type Szilagyi III), local treatment to eradicate the infection could serve as an alternative. Twenty‐four patients with confirmed infection of the soft tissue adjacent to the prosthetic material in the groin were treated locally by implantation of a vacuum sponge system. Duration of this treatment was 2 weeks. All patients showed excellent tissue granulation of the wound area and the microbial stains were negative at the end of therapy. In 21 patients the wound could be primarily closed after explantation of the sponge. Three patients underwent open treatment because of a skin defect. After 12 months, the wounds had healed well in all patients. Histologic evaluation revealed a physiological healing process. Deep soft tissue infections of the groin adjacent to prosthetic vascular material (type Szilagyi III) can be treated effectively and safely with the vacuum sponge system. The treatment is inexpensive, easy to perform, and the initial vascular reconstruction can be preserved. (WOUND REP REG 2003;11:104–109)
Increased expression of interferon‐inducible protein‐10 during surgically induced peritoneal injury
Authors: Mrstik Megan , Kotseos Kristina , Ma Chunfeng , Chegini Nasser
Published: December 2004

Interferon‐inducible protein 10 (IP‐10) is a key regulator of neutrophils, monocytes, and lymphocytes, cells infiltration whose secretory products play a key role in peritoneal wound healing. The objective of the present study was to determine whether IP‐10 is expressed by parietal peritoneum and whether its temporal and spatial expression is altered following surgically induced peritoneal injury during healing. Peritoneal sidewall injuries were induced in mice (N = 60), and the severity of adhesions were graded at 12 hours and 1, 2, 4, and 7 days postsurgery. After collection of peritoneal washes, the injured peritoneum with associated adhesion and intact parietal peritoneum were collected to determine IP‐10 mRNA and protein expression using quantitative reverse transcription‐polymerase chain reaction, enzyme‐linked immunosorbent assay, and immunohistochemistry. Peritoneal injury resulted in adhesion formation with increased severity by day 7 postsurgery. The intact parietal peritoneum expressed IP‐10 mRNA, whose level of expression significantly increased following peritoneal injury and reached a maximum at day 4 (p = 0.001), declining to the uninjured control levels by day 7 post‐injury. The level of IP‐10 in peritoneal washes also increased as a result of peritoneal injury. Immunohistochemically, IP‐10 was localized to various inflammatory and immune cells, adhesion fibroblasts, and mesothelial cells, and its intensity increased during the course of wound healing. In conclusion, we showed that parietal peritoneum expresses IP‐10 and peritoneal tissue injury results in an elevated level of its expression throughout the early phase of wound healing. The results suggest that IP‐10 and its elevated expression may play a role in peritoneal cellular activities that influence the early phases of tissue repair and, possibly, the development of peritoneal adhesions.(WOUND REP REG 2003;11:120–126)
Sterile isolation and cryopreservation of human adherent monocytes/macrophages from mononuclear cell apheresis preparations
Authors: Wagner Stephen J. , Myrup Andrew , Xu Yanwen , Katz Alfred J.
Published: December 2004

There is evidence from animal and human study that suggests clinical use of monocytes/macrophages may be of benefit in wound healing, tissue regeneration, and cancer therapy. To facilitate further study, a method was developed for sterile isolation and cryopreservation of adherent monocyte/macrophages from mononuclear cell apheresis units collected from unstimulated normal human donors. Preparations contained approximately 1 × 108 total cells and were comprised of approximately 60% monocytes, 38% lymphocytes, and 2% granulocytes. Cells could be cryopreserved for up to 8 months and subsequently thawed and stored at 1–6°C for up to 4 hours with retention of viability and adequate phagocytic function. These cells can be used in clinical trials to determine their possible therapeutic benefit, e.g., whether administration of exogenously supplied cells improves the healing of chronic wounds or promotes the regeneration of transected nerves. (WOUND REP REG 2003;11:145–149)
THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Cardiovascular Disease in Chronic Renal Failure: Pathophysiologic Aspects
Authors: London Gérard M.
Published: December 2004

Cardiovascular complications are the leading cause of mortality in patients with end‐stage renal disease (ESRD). The excess cardiovascular risk and mortality is already demonstrable in early renal disease and in patients with chronic renal failure (CRF), with the highest relative risk of mortality in the youngest patients. The high risk for cardiovascular disease (CVD) results from the additive effect of multiple factors, including hemodynamic overload and several metabolic and endocrine abnormalities more or less specific to uremia. CVD includes disorders of the heart (left ventricular hypertrophy [LVH], cardiomyopathy) and disorders of the vascular system (atherosclerosis, arteriosclerosis), these two disorders being usually associated and interrelated. LVH is the most frequent cardiac alteration in ESRD, resulting from a combined pressure and volume overload. LVH in general is an ominous prognostic sign and an independent risk factor for arrhythmias, sudden death, heart failure, and myocardial ischemia. Regression of LVH needs a combined intervention to reduce hemodynamic overload and is associated with improved prognosis and survival. Clinical studies have shown that damage of large conduit arteries is a major contributing factor for the high incidence of congestive heart failure (CHF), LVH, ischemic heart disease (IHD), sudden death, cerebrovascular accidents, and peripheral artery diseases. Damage to large conduit arteries is principally related to highly calcified occlusive atherosclerotic lesions and to stiffening of large capacitive arteries. These two complications are independent risk factors for survival, and improvement of arterial stiffness is associated with better prognosis and survival. The present review summarizes the most recent works dealing with the pathophysiology of CVD and some aspects of the therapeutic approach.
THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Management of Heart Failure and Coronary Artery Disease in Patients with Chronic Kidney Disease
Authors: Murphy Sean W.
Published: December 2004

Cardiovascular disease (CVD) is a major contributor to the mortality and morbidity of patients who suffer from chronic kidney disease (CKD). Heart failure and ischemic heart disease (IHD) are both highly prevalent in this population. The diagnosis of myocardial dysfunction is usually based on echocardiography. As in the general population, systolic dysfunction is treated with a combination of diuretics, renin‐angiotensin system blockade, and β‐receptor antagonists. Diastolic dysfunction is best managed by eliminating the cause. Non‐invasive tests for coronary artery disease (CAD) may be less reliable in patients with renal disease compared with nonuremic patients. Medical therapy of IHD in this population is generally similar to that for other patient groups, but surgical revascularization appears to carry a higher risk of complications with poorer clinical outcomes. The choice of revascularization procedure (coronary artery bypass grafting versus percutaneous transluminal angioplasty) should be based on the specific coronary anatomy of a given patient as well as a consideration of other comorbid factors.
Immusorba TR and PH
Authors: Hirata Noriko , Kuriyama Toshiji , Yamawaki Naokuni
Published: December 2004

Abstract: Immusorba TR (IM‐TR) and PH (IM‐PH) were developed as adsorbentswith non‐biological materials as affinity ligands to remove pathogenicautoantibodies. The adsorbents of IM‐TR and IM‐PH are polyvinylalcohol gel immobilized with tryptophan and phenylalanine as ligand, respectively.IM‐TR is clinically applied for treatment of autoimmune neurologicaldiseases such as myasthenia gravis and Guillain–Barre syndrome.IM‐PH is used for not only neurological diseases such as GBS andmultiple sclerosis but also collagen diseases such as rheumatoidarthritis (RA) and systemic lupus erythematosus (SLE). As many autoantibodieswith different specificities have been found to have similar affinitiesto the ligand of Immusorba, it is expected that Immusorba will beapplied to more diseases and contribute to the clarification ofthe mechanisms of the development of diseases by the identificationof adsorbed unknown pathogenic substances with Immusorba.
Blood Purification Therapies Using Dextran Sulfate Cellulose Columns Liposorber and Selesorb
Authors: Asahi Takashi , Yamamoto Takashi , Kutsuki Hidetoshi
Published: December 2004

Abstract:  Liposorber is a column used for plasma purification that adsorbs low‐density lipoproteins with high selectivity, while Selesorb is a column that selectively adsorbs anti‐DNA antibodies, anticardiolipin antibodies, and immune complexes. Both columns are packed with carriers, where a dextran sulfate ligand is bound to porous cellulose beads. Liposorber is used to treat familial hypercholesterolemia (FH), peripheral arterial disease (PAD), and focal segmental glomerulosclerosis (FGS): Selesorb is used to treat systemic lupus erythematosus (SLE). Treatment utilizing both columns is being used effectively in patients with refractory disease that is resistant to pharmacotherapy.
Studies on the Mechanisms of Leukocyte Adhesion to Cellulose Acetate Beads: An In Vitro Model to Assess the Efficacy of Cellulose Acetate Carrier‐based Granulocyte and Monocyte Adsorptive Apheresis
Authors: Hiraishi Katsuya , Takeda Yuji , Shiobara Noriyuki , Shibusawa Hiromu , Jimma Fumie , Kashiwagi Nobuhito , Saniabadi Abby R. , Adachi Masakazu
Published: December 2004

Abstract: Granulocyte and monocyte adsorptive apheresis (GMA) using a column filled with cellulose acetate (CA) beads (carriers) has been associated with a significant clinical efficacy in patients with rheumatoid arthritis and ulcerative colitis. To obtain further understanding on the mechanisms of disease modification by cellulose acetate‐carrier‐based GMA, in the present study, we investigated the mechanisms of granulocyte and monocyte adhesion to CA beads following exposure of human peripheral blood to the carriers at 37°C for up to 60 min under controlled conditions. Cellulose acetate beads selectively adsorbed granulocytes, monocytes, CD19+ (B cells) and CD56+ (NK cells) lymphocyte subpopulations. The granulocyte and monocyte adsorption was inhibited by heat‐inactivated plasma and EDTA, indicating that the adsorption was plasma protein (immunoglobulin, complement) and calcium dependent. Accordingly, granulocyte and monocyte adsorption was markedly enhanced by coating the carriers with IgG. Similarly, C3b was adsorbed onto the CA beads as a marker of complement activation. The results indicated that IgG and active complement fragments mediated leukocyte adhesion to CA beads via the FcγR and/or leukocyte complement receptor like CR3. Additionally, CA beads induced loss of expression of TNF receptors on CD16+ granulocytes and CD14+ monocytes, but not on CD3+ lymphocytes. In conclusion, CA beads might be an appropriate biomaterial for inducing extracorporeal immunomodulation as a treatment for auto‐immune diseases which are associated with pathological leukocyte activity.
Heparin‐induced Extracorporeal Low‐density Lipoprotein Precipitation
Authors: Mellwig Klaus‐Peter
Published: December 2004

Abstract:Heparin‐induced extracorporeal low‐density lipoprotein (LDL) precipitation (HELP) is a selective and careful apheresis procedure. Through the application of heparin and lowering the pH value, lipoproteins and fibrinogen are reduced by 50–60%. In addition, adhesion molecules (ICAM‐1, VCAM‐1, p‐selectin) which play a key role in the development and progression of atherosclerosis, are also markedly reduced. A PET scan performed 20 h after LDL apheresis shows the improvement of coronary vasodilation capacity. This is supposed to be mainly due to the marked reduction of LDL cholesterol and fibrinogen with consecutive improvement of endothelial dysfunction and rheology.
A Case Report of Total Abdominal Hysterectomy Resulting in Acute Thrombotic Thrombocytopenic Purpura with Pancreatitis and Hepatitis: Complete Resolution with Plasma Exchange Therapy
Authors: Kathula Satheesh K. , Koduri Jhansi , Mall Sunita , Chang Jae C.
Published: December 2004

Abstract: Acute thrombotic thrombocytopenic purpura (TTP) is a life‐threatening disorder that has previously been described associated with various types of surgery. An association between total abdominal hysterectomy (TAH) and TTP has never been reported. Thrombotic thrombocytopenic purpura is classically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, azotemia and neurological manifestations. Atypical manifestations of TTP include hepatitis, pancreatitis, acute respiratory distress syndrome, non‐occlusive mesenteric ischemia and peripheral digital ischemia. This case report describes the occurrence of acute TTP following TAH and bilateral salpingo‐oopherectomy, which manifested with typical and atypical features (i.e. hepatitis, pancreatitis). Plasma exchange therapy resulted in the complete resolution of the process.
Clinical Effects of Direct Adsorption of Lipoprotein Apheresis: Beyond Cholesterol Reduction
Authors: Bosch Thomas , Keller Christiane
Published: December 2004

Abstract: Direct adsorption of lipoproteins (DALI) from whole blood is the first LDL hemoperfusion technique for extracorporeal LDL and Lp(a) elimination without initial plasma separation. Thus, this technique is characterized by high user‐friendliness. In a long‐term multicenter study, LDL and lipoprotein (a) (Lp(a)) reductions were 69% and 64%, respectively, per session. Adverse effects were rare, as 95% of the sessions were uneventful. Biocompatibility studies showed only minor blood–adsorber interactions for most parameters; however, there was a significant bradykinin generation. After a single session, significant reductions of plasma viscosity, erythrocyte aggregation and adhesion molecules were documented. A retrospective analysis of 18 chronic DALI patients revealed that in the majority of patients, symptoms like angina and dyspnea as well as their general status and subjective well‐being improved significantly. Moreover, the objective cardiovascular event rate (MACE) decreased from a total of 26 in the 3‐year period prior to DALI to 6 during a mean follow‐up of 3.8 years during chronic DALI therapy. Thus, the average event rate of 0.48 per patient year at baseline could be significantly reduced to 0.09 (P < 0.004) by DALI. This impressive improvement of symptoms and coronary events can hypothetically be related to the improvement of hemorheology and the transformation of unstable into stable plaques by DALI LDL apheresis.
Differential Indication of Lipoprotein Apheresis During Pregnancy
Authors: Klingel Reinhard , Göhlen Britta , Schwarting Andreas , Himmelsbach Frido , Straube Richard
Published: December 2004

Abstract: Lipoprotein apheresis is an effective treatment for severe disorders of lipid metabolism. It is the only life prolonging therapy for patients with homozygous familial hypercholesterolemia. Changes of lipid metabolism during pregnancy related to changes of hormone concentrations do not cause clinical complications in the majority of cases. However, in particular clinical situations there is the need to offer a therapeutic option. Increasing morbidity and mortality of mother and child due to severe disorders of lipid metabolism have to be prevented. In general, lipid lowering drugs are contraindicated during pregnancy. Therefore, lipoprotein apheresis offers an alternative, which could be used in select cases to treat acute or chronic hyperlipoproteinemia associated with pregnancy. This article summarizes experiences with patients, who became pregnant during chronic lipoprotein apheresis, or who were treated by lipoprotein apheresis because of acute disorders of lipid metabolism during pregnancy. In conclusion, after individual risk benefit analysis for mother and child lipoprotein apheresis can be safely performed during pregnancy.
Changes in C‐reactive Protein Plasma Levels During Low‐density Lipoprotein Apheresis
Authors: Kojima Shunichi , Shida Mikio , Yokoyama Hiroyuki
Published: December 2004

Abstract:  C‐reactive protein (CRP) is one of the important risk factors for atherosclerosis, and its serum level is lowered by popular cholesterol‐lowering drugs, statins. This study was undertaken to examine the changes of CRP levels during dextran‐sulfate (DS) low‐density lipoprotein (LDL) apheresis. In 15 apheresis sessions in seven patients with severe hypercholesterolemia (four men and three women, aged between 36 and 70 years), changes in CRP levels were examined. The efficiency in adsorption of CRP with DS column was evaluated by measuring CRP levels in both pre‐ and post‐column plasma. In one patient, the effect of repeated apheresis sessions on CRP preapheresis levels was examined. The changes in interleukin (IL)‐6 plasma levels were also examined in six sessions. Although IL‐6 levels after 3000 mL‐plasma treatment rose to 170% of preapheresis levels, CRP levels decreased significantly (from 1.91 ± 0.49 mg/L to 0.89 ± 0.24, P < 0.01). C‐reactive protein was almost completely adsorbed by the DS column and CRP preapheresis levels were decreased gradually by repetition of apheresis. CRP, a novel risk factor of atherosclerosis, was effectively removed by DS‐LDL apheresis. The decrease in CRP plasma levels may be involved in prevention of atherosclerotic vascular diseases due to DS‐LDL apheresis.
Rheopheresis in Patients with Ischemic Diabetic Foot Syndrome: Results of an Open Label Prospective Pilot Trial
Authors: Klingel Reinhard , Mumme Christian , Fassbender Thurid , Himmelsbach Frido , Altes Ulrich , Lotz Johannes , Pohlmann Thomas , Beyer Jürgen , Küstner Ernst
Published: December 2004

Abstract:  Rheopheresis is a specific application of membrane differential filtration, synonymous with double filtration plasmapheresis, for extracorporeal hemorheotherapy. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with ischemic diabetic foot syndrome. Eight patients with type 2 diabetes mellitus and non‐healing foot ulcers caused by severe ischemic diabetic foot syndrome were treated by a series of seven Rheopheresis sessions in a time span of 11 weeks. Wound healing had not been detectable under conditions of standardized wound care during at least 2 months. Wound status was classified by its morphology, severity and location, according to the criteria of Wagner. Transcutaneous oxygen pressure (tcPO2), laser Doppler flowmetry and vital capillary microscopy were repeatedly performed to monitor the effects of the Rheopheresis treatment series on microcirculation and skin blood flow. Laboratory parameters of blood rheology, endothelial function and inflammatory state were measured in addition to safety parameters. In four patients (baseline Wagner stage 2), Rheopheresis accelerated wound healing of foot ulcers and was associated with an improvement of Wagner stage and a pronounced increase in tcPO2. In two patients (baseline Wagner stage 2), wound healing was unchanged but mean tcPO2 increased, allowing successful minor amputation. Values of tcPO2 remained stable and enhanced for the 3 months follow‐up period. In two patients (baseline Wagner stage 4 or 5), no improvements in foot lesions were observed within the treatment period. As an adjunct therapeutic option, Rheopheresis may preserve a functional lower extremity, delay amputation or reduce the extent of amputation.
Determinants of Factor VIII Recovery in Cryoprecipitate
Authors: Kasper C. K. , Myhre B. A. , McDonald J. D. , Nakasako Y. , Feinstein D. I.
Published: December 2004

Many aspects of the production of cryoprecipitate were studied to determine which methods resulted in the greatest recovery of Factor VIII. The following recommendations resulted: 1) blood should be mixed with anticoagulant throughout phlebotomy; 2) blood should be centrifuged within a few hours of collection; 3) larger satellite bags should be used to contain the usual volume of plasma, for example, 200 ml of plasma should be frozen in a 600‐ml capacity bag; 4) plasma should be centrifuged as soon as thawing is complete; 5) cryoprecipitate should be refrozen on dry ice; 6) cryoprecipitate should be stored at or below –30 C; and 7) prolonged storage of frozen plasma or cryoprecipitate should be avoided.

Variations in Factor VIII content from one bag of cryoprecipitate to another, under uniform production conditions, depends largely on two donor‐specific attributes which tend to remain constant from time to time, namely, the donor's plasma Factor VIII level and the cryoprecipitability of his Factor VIII.
A Computer‐Based Interactive Planning System for Scheduling Blood Collections
Authors: Pegels C. C. , Seagle J. P. , Cumming P. D. , Kendall K. E.
Published: December 2004

Seasonal imbalances between supply and demand for blood products are common. This paper describes a planning system which utilizes conversational computer facilities to assist the manager of a regional or communitywide blood agency in scheduling bloodmobiles and fixed facility collections from one to 18 months in advance. The benefits from changes to only one day of a collection schedule recover the annual costs of using the system, estimated at 600 for a blood service which collects 65,000 units annually.
Another Potential Source of Error in Rh‐hr Typing
Authors: Reid M. E. , Ellisor S. S. , Frank B. A.
Published: December 2004

Three cases are presented in which the presence of sodium caprylate dependent albumin auto‐agglutinins in the patients' sera resulted in erroneous Rh‐hr phenotyping of their erythrocytes. In the initial testing, the albumin control was negative in each case. Since one of the cases was an Rh0(D) negative individual whose red blood cells might have been classified as Rh0(D) positive, a study was made using routine Rh‐hr typing reagents from different manufacturers. Attention is drawn to the fact that Rh‐hr typings should be performed using washed red blood cell samples when serum is known to contain albumin auto‐agglutinins.
Effect of Chilling on Platelet Cyclic Adenosine 3:5‐Monophosphate and Adenylate Cyclase Activity
Authors: Zappia G. C. , Steiner M. , Ando Y. , Baldini M.
Published: December 2004

Exposure of platelets to 1 C led to a transient increase in cyclic AMP levels (determined either by a protein binding method or by radioimmunoassay) within five to ten minutes reaching a maximum 10 to 15 minutes after chilling was begun and returning subsequently to baseline values. Addition of EDTA to the platelet suspension medium prevented this increase. Rewarming at 37 C produced a sudden reduction in platelet cyclic AMP. To determine whether the cold‐induced increase in cyclic AMP was due to a transient stimulation of platelet adenylate cyclase or a rapid inhibition of phosphodiesterase, these enzymes were assayed in ruptured platelet suspensions. Platelet adenylate cyclase activity was found to possess certain characteristics similar to those of the enzyme derived from other sources but there was a marked potentiation of fluoride‐stimulated adenylate cyclase activity by 0.001 M EDTA. This effect was limited to low EDTA concentrations. Exposure of platelets to 1 C for up to 60 minutes did not increase adenylate cyclase activity but lowered it substantially compared with controls kept at room temperature. Phosphodiesterase activity at 1 C was depressed sooner and to a greater extent than was adenylate cyclase. The transient rise in cyclic AMP levels in chilled platelets appears to be due to a disproportionate reduction of cyclic nucleotide phosphodiesterase activity.
Metabolic Changes during Platelet Storage
Authors: Rock G. , Figueredo A.
Published: December 2004

Platelet concentrates (PC) were stored in plastic bags with continuous shaking at 4, 22, and 37 C. Various metabolic parameters were examined over a 72‐hour period. At 22 C, the pH and PO2 declined over 72 hours while the Pco2 and lactate increased. Hypotonic shock declined to 70 per cent. This differed from the small amounts of CO2 and lactate found at 4 C and the marked accumulation of metabolites and almost complete loss of shock response at 37 C. Aggregation was always better maintained with 4 C storage.

The toxic effect of the accumulation of metabolites on the platelets was tested by adding lactate to fresh PC at zero time. This was effective in lowering the initial pH, markedly inhibiting the response to aggregation and decreasing the total accumulation of lactate during storage, but did not produce an inhibition of hypotonic shock response. The effect of accumulation of toxic metabolites was further investigated by using 72‐hour plasma and platelets and recombining each of them with fresh preparations.

Platelets were tested under degassed conditions to outline the requirements for oxygen and gaseous exchange. Surprisingly, there was less accumulation of lactate and CO2 and better hypotonic shock response.

These experiments have detected various changes in viability markers in platelets that are stored under actual blood bank conditions and indicate that the accumulation of lactate is not totally responsible for the toxic inhibition of platelet performance that is found upon storage at 22 C.
Clinical Importance of the Rare Erythrocyte Antibody Anti‐Jra
Authors: Kendall A. G.
Published: December 2004

Alloantibodies to high‐frequency antigens create serious problems for a transfusion service. It is obviously important to know the clinical significance of such antibodies. In the present study, an attempt was made to determine this with respect to the antibody anti‐Jra in a patient of the rare blood type Jr(a–). A small volume of 51Cr‐labeled Jr(a+) erythrocytes was infused intravenously and cell survival was monitored. The T½ of these cells was approximately 80 minutes indicating the in vivo potency of the antibody.
Variations in Cryoprecipitate Production
Authors: Rock G. , Tittley P.
Published: December 2004

Several variables influencing the recovery of Factor VIII in the cold‐precipitated protein fraction were examined. The actual rate at which the physical‐chemical conversion of plasma from a solid to a liquid state occurs does not seem to affect the yield. Rather, it is the amount of time immediately postthaw and prior to centrifugation that determines the Factor VIII activity in the cryoprecipitate. With prolonged periods at 4 C the Factor VIII activity leaves the cold precipitate and lifts into the supernatant. Even distribution of the plasma layer and close attention to the thawing procedure facilitate Factor VIII recovery.
Effect of initial storage at room temperature on human red blood cell ATP, 2,3‐DPG, and viability
Authors: Chapman RG , Rettberg WA , Dougherty S.
Published: December 2004

The concentrations of ATP and 2,3‐DPG and post‐transfusion viability were measured in human red blood cells exposed for one, four and seven hours to room temperature before refrigerated storage for 21 days. No effect of room temperature storage was observed on ATP or viability. Decrease in 2,3‐DPG was accelerated by room temperature exposure but the differences in 2.3‐DPG were small and unlikely to have a significant adverse effect on red blood cell oxygen delivery. Delays of up to seven hours in refrigeration of blood do not appear to have serious adverse effects on red blood cell viability or function.
Abdominal pain in donors during filtration leukapheresis
Authors: Wiltbank TB , Nusbacher J. , Higby DJ , MacPherson JL
Published: December 2004

An unusual donor reaction characterized primarily by lower abdominal and/or perineal pain occurs in 1.2 per cent of donors during filtration leukapheresis (FL). The reaction occurs almost exclusively in female donors. Corticosteroid pretreatment appears to be highly effective in preventing the reaction. The pathogenesis of this donor problem is speculative.
Red blood cell survival studies in patients with anti‐Cha, anti‐Yka, anti‐Ge, and anti‐Vel
Authors: Tilley CA , Crookston MC , Haddad SA , Shumak KH
Published: December 2004

The survival of red blood cells, which were strongly incompatible in vitro, was measured in five patients whose serum contained an antibody to a high‐frequency antigen. In the two patients with anti‐Cha, and in the patient with anti‐Yka, the cells survived normally. In the patient with anti‐Ge, a small proportion of the cells was destroyed at an increased rate during the first 24 hours, but the remaining cells survived normally. In the patient with anti‐Vel, the injected cells were rapidly destroyed.
The opsonic activity of stored blood
Authors: McClellan Mary Ann , Alexander J. Wesley
Published: December 2004

Experiments were performed to measure the stability of opsonins during storage of whole blood collected in CPD solution and stored at 4 C. Three units were collected, and aliquots removed and recalcified on days 0, 3, 7, 14, 21, and 28. Reconstituted serum was immediately frozen and stored at −70 C. The ability to opsonize Escherichia coli 075 and Pseudomonas aeruginosa immunotype 1, both of which require activation and utilization of the alternative pathway of complement for opsonization, were performed simultaneously for each organism and for each unit. Results showed that there was a slight but insignificant reduction in opsonic strength during storage for up to 28 days. The results indicate that standard collection and storage conditions using CPD as the anticoagulant retains functional activity of the alternative pathway. C3 measured by radial immunodiffusion using antisera against the B antigenic determinant showed that C3 had not been converted during storage.
Hemagglutination inhibiton in capillary tubes—a simple and reliable test for HBsAg
Authors: FSMLT(SA) L.V. Milner , (SA) J. L. Ellis Nat. Dip. Med. Lab. Tech. , Viljoen M.H. , (SA) T. Marimuthu Nat. Dip. Med. Lab. Tech. , (SA) J. Godefroy Nat. Dip. Med. Lab. Tech.
Published: December 2004

A technique is described which allows testing for HBsAg by hemagglutination inhibition in capillary tubes. The test is rapid, and compares favorably in sensitivity to radioimmunoassay. The equipment is simple, and its design eliminates the risk of infection from the HBsAg reagents.
Blood storage XXV: Ascorbic acid (vitamin C) and dihydroxyacetone (DHA) maintenance of 2,3‐DPG for six weeks in CPD‐adenine
Authors: Dawson R. B.
Published: December 2004

In experiments in which ascorbate was included in CPD‐adenine preservatives, 2,3‐DPG levels were maintained above normal for 28 days with an ascorbate concentration of 10 mM or higher and concentrations of 20 to 80 had no greater effect on 2,3‐DPG maintenance. Less ascorbate (5 mM) provided better 2,3‐DPG maintenance than was obtained with no ascorbate throughout six weeks of storage but was not as good as the higher concentrations after the third week. ATP concentrations were adversely affected by the presence of ascorbate. The highest ATP concentrations were without ascorbate, next highest with 5 mM, and the worst ATP was with 80 mM. The pH values did not differ from one preservative to another.
Exchange transfusion in sickle cell disease using a continuous‐flow blood cell separator
Authors: Kernoff L. M. , Botha M. C. , Jacobs P.
Published: December 2004

An exchange transfusion was performed preoperatively on a patient with sickle cell disease using a continuous‐flow blood cell separator. An exchange of 2,825 ml red blood cells achieved a hemoglobin A level of 90.8 per cent. The continuous‐flow blood cell separator appears to offer a safe and effective method of exchange transfusion in sickling disorders.
Reduction of Postperfusion Cytomegalovirus‐Infections following the Use of Leukocyte Depleted Blood
Authors: Lang D. J. , Ebert P. A. , Rodgers B. M. , Boggess H. P. , Rixse R. S.
Published: December 2004

After extracorporeal perfusion some patients develop evidence of cytomegalovirus (CMV) infection. It is proposed that antigenically stimulated donor and recipient leukocytes may divide and activate latent CMV associated with leukocytes. To test this hypothesis, alternate patients were perfused with leukocyte‐depleted or whole blood (controls). Four of six controls who were CMV antibody negative preoperatively seroconverted after perfusion. Virus was recovered from the blood of three and from the urine of two of these patients. One of four controls who were seropositive preoperatively developed a significant titer rise. Only one of eight patients perfused with leukocyte poor blood who were seronegative prior to surgery developed a viremia and became antibody positive; another manifested a viruria but remained antibody negative. These findings are consistent with the proposed hypothesis and suggest a means for reducing transfusion‐associated CMV infections.
Microaggregate Content and Flow Rates of Packed Red Blood Cells
Authors: Reiss R. F. , Katz A. J.
Published: December 2004

Platelet rich red cells (PRRC) and platelet poor red cells (PPRC) are both prepared in the course of red cell production. PRRC tend to have a higher hematocrit (82 + 7) than PPRC (77 + 5), (p < .001). There are more microaggregates present in PRRC (2.48 + 1.41 gm) than in PPRC (1.46 + 0.61 gm), (p < .001). The infusion rate for PRRC was 4.0 times 1.8 ml/minute, and this was significantly smaller than for PPRC which was 9.7 + 1.7 m/minute, (p < .001). This compares to a rate for whole blood of 32.8 ml/minute. The difference in flow rate of the two types of red blood cells is in part due to a difference in viscosity, but more importantly due to a difference in microaggregate content. Flow rate is normalized for both types of packed cells by the addition of 100 to 150 ml of saline, while infusion time is normalized by the addition of only 50 to 100 ml of saline to the packed cell units.
Chronic Liver Dysfunction in Multitransfused Hemophiliacs
Authors: Hasiba U. W. , Spero J. A. , Lewis J. H.
Published: December 2004

Liver dysfunction and exposure to the hepatitis B antigen were assessed by serum transaminase (SGPT and SCOT) levels and HBsAg and anti‐HBs during a three year period in a group of 118 patients with factor VIII or factor IX deficiency. The 107 HBsAg negative patients were divided into four groups according to their mode of therapy. Persistently abnormal transaminase values were present in 51 per cent of patients with a large exposure to factor VIII concentrates, in 43 per cent with a small factor VIII exposure and in 37 per cent exposed to prothrombin complexes. This was contrasted with abnormalities in 8 per cent of patients treated only with cryoprecipitate. The incidence and degree of serum transaminase abnormality appeared independent of a past history of jaundice. All patients without persistent antigenemia who had been treated with pooled plasma products showed antibodies to HBsAg. High titer anti‐HBs prior to initial fraction therapy appeared protective against jaundice. The eleven patients with persistent antigenemia had significantly higher transaminase levels than the HBsAg negative group.
Hemoglobin Function in Stored Blood: XIX. Inosine Maintenance of 2,3‐DPG for 35 Days in a CPD‐Adenine Preservative
Authors: Dawson R. B.
Published: December 2004

This study establishes that 10 mM inosine is a sufficient additive to maintain 2,3‐DPG levels in blood for five weeks of storage in CPD‐adenine. No previous experiments were done with CPD‐adenine (0.25 mM) using a design which would give statistical proof of the optimal concentration of inosine needed for maintenance of normal hemoglobin function (2,3‐DPG) for five weeks of blood bank storage.
A “Normal” Individual with a Positive Direct Antiglobulin Test Case Complicated by Pregnancy and Unusual Autoantibody Specificity
Authors: Henry R. A. , Weber J. , Pavone B. G. , Issitt P. D.
Published: December 2004

A “normal” individual with a positive direct anti‐globulin test is described. In common with many other “normal” persons in whom a similar finding has been made, there was no evidence of an increased rate of in vivo red blood cell destruction in this patient. The patient successfully completed a pregnancy during the time that detailed serologic studies on her autoantibodies were being performed. Although the maternal autoantibodies were demonstrable in both an eluate made from the red blood cells of her newborn infant, and in the cord serum, there was no reason to believe that the antibodies caused red blood cell destruction in the infant.

The case was of further interest because of the specificities of some of the autoantibodies. Although the mother and child were both C‐negative, eluates from their red blood cells contained what ostensibly appeared to be anti‐C. Studies that showed that the antibody could be totally adsorbed with C‐negative, as well as C‐positive red blood cells, proved that this was another example of an autoantibody mimicking an alloantibody. Although this autoantibody appeared initially to have anti‐C specificity it was eventually shown to be more closely related to anti‐Hr or anti‐Rh34, than to anti‐C.