bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomy of the lateral pharyngotomy approach
Authors: Stern Scott J.
Published: February 2007

The pace of progress in head and neck surgery is rapid and can be bewildering to practitioners and students alike. As education is one of the major missions of Head & Neck, this new series is devoted to a comprehensive discussion of basic anatomical concepts manifested in the diagnosis, treatment, and care of patients with diseases of the head and neck.

Although the anatomy of the head and neck region as related to surgical procedures will certainly be discussed, this will by no means be the only subject addressed. Other topics include the anatomic basis for specific pain syndromes encountered in patients with cancer of the head and neck, structural and lymphatic anatomy demonstrating patterns of disease spread, and constraints to standard surgical procedures because of anatomic “barriers.” As medical illustration is an extremely important aspect of anatomy education, a concerted effort will be made to present material with illustrations that are understandable, clear, and concise. It is hoped that these subjects will not only educate but will also engender other topics of interest to readers. I welcome your suggestions for appropriate topics, as well as original contributions in keeping with the series guidelines.
Hamartomas of the nose and nasopharynx
Authors: Graeme‐Cook Fiona , Pilch Ben Zion
Published: February 2007

Hamartomas are easily diagnosed entities when occurring in the lung and gastrointestinal tract. In the nose and nasopharynx, where such lesions are rare, biopsy of a hamartoma containing epithelial proliferation may lead to a misdiagnosis of cancer, with resultant radical and deforming surgery, particularly if they present in adulthood. We encountered three such lesions over 2 years in the Massachusetts Eye Ear Infirmary, and another was retrieved from the recent files. All presented with nonspecific obstructive symptoms of the nose or nasopharynx, and were treated by resection. Follow‐up is short, (4 months to 1 year), but in no case has there been recurrence. The clinical diagnosis was malignancy in 2 cases, inflammatory polyp in one. © 1992 John Wiley & Sons, Inc.
Fine‐needle aspiration of parotid gland lesions
Authors: Weinberger Mark S. , Rosenberg Wouter W. , Meurer William T. , Robbins K. Thomas
Published: February 2007

The results of 49 specimens obtained by fine‐needle aspiration biopsy of parotid gland lesions were compared with the pathologic diagnoses of the surgically resected specimens. Cytologically, 33 lesions were diagnosed as benign, with 30 of these confirmed histologically and three false‐negative results. Fourteen cytologic specimens were called malignant or suspicious for malignancy, with 11 of these confirmed histologically and three false‐positive results. The concurrence rate for distinguishing benign from malignant disease was 87.2%. The sensitivity for malignancy was 78.6% and the specificity 90.9%. The pathology of the misdiagnosed lesions will be reviewed. Based on our data and a review of the literature, we conclude that fine needle aspiration biopsy of parotid gland masses, with the observation of certain caveats, is a helpful adjunctive test for diagnosis and treatment planning. © 1992 John Wiley & Sons, Inc.
Twice‐a‐day radiotherapy for squamous cell carcinoma of the head and neck: The University of Florida experience
Authors: Parsons James T. , Mendenhall William M. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

Between March 1978 and March 1989, 419 patients with 439 moderately advanced or advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice‐a‐day radiotherapy (120 cGy per fraction with a 4‐ to 6‐hour interfraction interval). Seventy‐nine percent of the patients had AJCC stage III or stage IV cancers. The primary site in most patients was the oropharynx, hypopharynx, or larynx. All patients received radiotherapy alone to the primary site, with or without planned neck dissection after radiotherapy. Surgery at the primary site was reserved for salvage of radiotherapy failures. No patient received chemotherapy as part of the initial treatment plan. Total doses were 7440 cGy to 7920 cGy in the majority of patients. In 54 patients with oropharyngeal lesions, an interstitial implant was used to add a 1,000‐ to 1,500‐cGy boost after the basic dose. Local control results were compared on a site‐by‐site and stage‐by‐stage basis with the results of continuous‐course, once‐a‐day radiotherapy at the University of Florida; the control results were the same as or better than after once‐a‐day radiotherapy for each site and stage (T2 to T4). Severe complications of radiotherapy occurred in 4% of patients and correlated with tumor dose, T stage, and disease site (oropharynx or larynx/hypopharynx). The addition of a neck dissection 4 to 6 weeks after radiotherapy of patients with advanced‐stage neck disease was accomplished with an acceptable rate of morbidity and significantly improved the rate of control of neck metastases compared with radiotherapy alone.
Treatment of a nonfunctioning parathyroid cyst with tetracycline injection
Authors: Sánchez Ariel , Carretto Hugo
Published: February 2007

Parathyroid cysts are uncommon: about 200 cases have been reported. They can be functional (i.e., accompanied by signs of primary hyperparathyroidism), or nonfunctional. Preoperative diagnosis is difficult, although it has become increasingly frequent with the use of ultrasound and fine‐needle aspiration biopsy. Fluid of parathyroid cysts is almost invariably watery, colorless, and crystal clear, which should cause clinical suspicion. However, definitive diagnosis relies on the demonstration of high parathyroid hormone (PTH) levels in the fluid. Puncture may cure nonfunctioning cysts, but surgery is indicated when the lesion recurs after several fine‐needle aspirations. We report a case of a nonfunctioning parathyroid cyst in a 17‐year‐old boy, which reappeared after two punctures made 6 months apart. On the third occasion, 1 mL of a sterile tetracycline solution injected into the cyst cured the lesion. Tetracycline and other sclerosants have been recommended as a treatment of recurring thyroid cysts. We suggest that injection of a sclerosant should be considered as an alternative to surgery in recurring, nonfunctional cysts of the parathyroid glands.
Value of fine‐needle aspiration in the diagnosis of hürthle cell neoplasms
Authors: McIvor Nicholas P. , Freeman Jeremy L. , Rosen Irving , Bedard Yvan C.
Published: February 2007

The cytologic and histologic slides on all patients with a diagnosis of Hürthle cell tumor at Mount Sinai Hospital during the last 12 years were reviewed. There were 67 Hürthle cell tumors of which 15 (22%) were malignant. Four carcinomas (27%) occurred in a background of thyroiditis. Forty‐three patients with Hürthle cell tumors had undergone preoperative fine‐needle aspiration, of which 31 had satisfactory aspirates. For Hürthle cell neoplasia, fine‐needle aspiration cytology had a sensitivity of 83.8% (26 of 31) and positive predictive value of 93% (26 of 28), provided that the aspirate was of adequate cellularity. All 3 cases predicted as Hürthle cell carcinoma on the basis of cellular and nuclear atypia were correctly predicted, but 3 carcinomas composed of bland cells were incorrectly predicted as adenomas. We conclude that aspiration cytology can differentiate nonneoplastic from neoplastic Hürthle cell lesions with high accuracy, but that the differentiation between benign and malignant lesions is less reliable.
Primary site management following induction chemotherapy with cis‐platinum, 5‐fluorouracil, and leucovorin
Authors: Busse Paul M. , Clark John R. , Beard Clair J. , Dreyfuss Arnon I. , Lucarini James W. , Rossi Renee , Casey Donna , Norris Charles M.
Published: February 2007

A phase II clinical trial was initiated in 1987 to evaluate a new induction regimen of cis‐platinum, 5‐fluorouracil, and leucovorin (PFL) for patients with stages III–IV squamous cell carcinoma of the head and neck. Ninety patients were treated and followed for a median duration of 18 months. The median age was 55 and 87% of the patients had stage IV disease. The rates of complete and overall clinical response following three cycles of PFL were 57% and 80%, respectively; the rate of complete response at the primary site was 72%. Eighty‐four percent of patients were treated to the primary site with radiation alone (median dose 68 Gy in daily 1.8‐Gy fractions) irrespective of the location of the primary site or initial T‐stage. The acute tolerance to full‐course radiation following PFL was acceptable. The actuarial rate of primary site control for patients treated, with radiation was 67% at 36 months. An important prognostic indicator for primary site control was a complete clinical response to induction PFL. For patients who achieved a complete response, radiation or surgery followed by radiation controlled primary site disease equally well at 70%. Patients with a partial response did less well. For these patients, surgery and radiation appeared slightly better than radiation alone.
Cervical manifestations of fibrosing mediastinitis: A diagnostic and therapeutic dilemma
Authors: Meredith Scott D. , Madison Jennifer , Fechner Robert E. , Levine Paul A.
Published: February 2007

Fibroinflammatory and fibrosclerosing lesions involving the head and neck outside the thyroid and orbit are exceedingly rare. We present two cases of fibroinflammatory and fibrosclerosing lesions originating in the mediastinum which extended superiorly to involve soft tissues of the neck. These cases indicate that a subset of fibroinflammatory and fibrosclerosing lesions found in the head and neck originate in the mediastinum.
Tumors of the skull base: Outcome and survival analysis of 77 cases
Authors: Irish Jonathan C. , Gullane Patrick J. , Gentili Fred , Freeman Jeremy , Boyd J. Brian , Brown Dale , Rutka John
Published: February 2007

We reviewed our experience with combined approaches to lesions that transcend the bones of the skull base. Seventy‐seven skull base procedures were performed on 73 patients during a 10‐year period from 1982 to 1992. There were 34 patients (44%) with region I lesions (anterior), seven patients (9%) with region II lesions (anterior‐lateral), 25 patients (32%) with region III lesions (lateral‐posterior), and 11 patients (14%) with lesions that invaded more than one anatomic site. The histopathology in this series was quite variable, with 22 patients (29%) having squamous cell carcinoma and eight patients (10%) having basal cell carcinoma. Forty‐one patients had surgery by an anterior approach and 38 patients had lateral approaches, with 18 undergoing an infratemporal approach and 29 undergoing temporal bone resections. Overall, 44% of the patients had a postoperative complication. Survival of this heterogeneous group of patients is 79% at 2 years and 71% at 4 years, with those patients with region II disease having a statistically significant poorer prognosis with no survivors at 4 years. © 1994 John Wiley & Sons, Inc.
Congenital extraskeletal Ewing's sarcoma of the face: A case report
Authors: Lim Thiam Chye , Tan Walter Tiang Lee , Lee Yoke Sun
Published: February 2007

This is the first reported case of congenital extraskeletal Ewing's sarcoma (EES) in the head and neck region. The tumor arose from the medial aspect of the right lower eyelid and rapidly increased in size despite surgery and chemotherapy. Accurate histologic diagnosis is emphasized, and the differential diagnosis, pathology, and treatment are discussed. © 1994 John Wiley & Sons, Inc.
Benign tracheogastric fistula: A late complication of pharyngogastric anastomosis
Authors: Zitsch Robert P. , Vallery Samuel W. , Deese Lawrence
Published: February 2007

This report describes a benign tracheogastric fistula that developed 2 years after pharyngoesophagectomy, right radical neck dissection, and pharyngogastric anastomosis for recurrent peristomal squamous cell carcinoma. The fistula most likely developed as the result of inflammatory disease of the trachea, stomach, or both. We discuss the common complications of pharyngogastric anastomosis and its management, as well as the management of the tracheogastric fistula. © 1994 John Wiley & Sons, Inc.
Risk factors for complications in clean‐contaminated head and neck surgical procedures
Authors: Girod Douglas A. , McCulloch Timothy M. , Tsue Terance T. , Weymuller Ernest A.
Published: February 2007

Background. Contamination of a head and neck surgical wound with oropharyngeal secretions has been shown to dramatically increase the incidence of wound complications. Appropriate perioperative antibiotic prophylaxis has significantly reduced contaminated wound infection rates in several previous reports. The current study examined multiple patient parameters to determine risk factors for all perioperative complications following clean‐contaminated head and neck surgical procedures.

Methods. Retrospective review of medical records from 159 patients who underwent clean‐contaminated major head and neck surgical procedures at the University of Washington between 1985 and 1991. More than 30 preoperative and operative parameters were evaluated, and all complications were recorded. The data were examined using a multivariate statistical analysis.

Results. An overall complication rate of 63% included 22% with wound infections (oro/pharyngocutaneous fistula or purulent drainage), 22% with other types of infections, and 51% with noninfectious complications. The overall perioperative mortality rate was 1.2% (two patients). Prior radiotherapy, operative time, perioperative transfusion, and flap reconstruction were all associated with a significantly higher overall complication rate (p ≤ 0.05). Only prior radiotherapy therapy correlated with an increase in wound infection rate (p = 0.05).

Conclusions. Prior radiotherapy significantly increases the risk of perioperative complications and wound infections following clean‐contaminated head and neck surgical procedures. Other factors reflecting the complexity of the procedure also influence the overall complication rate. © 1995 Jons Wiley & Sons, Inc.
Surgical access to tumors of the cervicothoracic junction
Authors: Kraus Dennis H. , Huo Jerry , Burt Michael
Published: February 2007

Background. Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. Theses approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.

Method. Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.

Results. Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external‐beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3–47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.

Conclusion. The combined “trap door” technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sternoclavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging. © 1995 Jons Wiley & Sons, Inc.
Cell adhesion and regulatory molecules involved in tumor formation, hemostasis, and wound healing
Authors: van Waes Carter
Published: February 2007

Background. Dynamic changes in cell adhesion and migration are fundamental properties of the cells that are important in hemostasis, vascularization, and wound repair. Changes in cell adhesion and migration are very important in the formation of tumors, and invasion and metastasis by neoplasms.

Methods. Using immunolocalization and immunopurification techniques, expression of integrin molecules involved in cell adhesion has been characterized during tumor development and wound healing. The ability of cytokines to regulate expression and antibody and peptide inhibitors to inhibit function of integrins has been explored to better understand the role of integrins in pathogenesis.

Results. Increased suprabasilar expression of the integrins α6β4, α2β1, and α3β1 accompanies development of squamous cell neoplasms of the head and neck. Integrin αllβ3 is an integrin receptor which is important in platelet aggregation in hemostasis and formation of tumor metastases. Increased expression of integrin αvβ3 has been identified in angiogenesis in response to growth factors and tumor angiogenic factors. Cytokine TGF‐β and arachadonic acid metabolite 12(S)‐HETE are important signals in regulation of integrins and affect cell aggregation and migration in these processes. Ligands and inhibitors for some of these receptors have been identified which will be useful in determining their role during tumor development and progression.

Conclusions. Recent advances in understanding the functions of the integrin cell adhesion molecules may soon add new diagnostic methods and therapies to the armamentarium of the head and neck oncologic, microvascular, plastic, and reconstructive surgeon. Therapies directed at controlling integrin cell‐adhesion molecule expression and function are being explored to improve scar formation, bone synthesis, inhibition of vascular occlusion, and inhibition of tumor invasion and metastasis. © 1995 Jons Wiley & Sons, Inc.
Definitive radiotherapy for T1 and T2 squamous cell carcinoma of the tonsil
Authors: Moose B. Dawn , Kelly Maria D. , Levine Paul A. , Constable William C. , Cantrell Robert W. , Larner James M.
Published: February 2007

Background. To assess whether survival or local control of early squamous cell carcinoma of the tonsil has been compromised by a moderate‐dose approach.

Methods. Between 1970 and 1989, 185 patients with SCCa of the tonsil were seen at our institution. Fifty‐three patients with T1 (30) and T2 (23) lesions treated with definitive radiotherapy were reviewed. Median follow‐up was 60 months. The effects of total dose and site of the primary on survival and local regional control were analyzed.

Results. Three‐year determinate survival was 77%. Mean total dose was 63.1 Gy. Site of the primary significantly affected survival (86% for fossa, 54% for pillars, p < 0.025). Local control at 2 years was 81% and was independent of dose ≥ 63 Gy or site of the primary. Grade 4 complications defined by the RTOG/EORTC Acute Morbidity criteria occurred in three patients.

Conclusions. Tumor doses on the order of 63 Gy or less result in excellent local control and survival rates for T1 and T2 carcinomas of the tonsil. Local control rates are better for fossa lesions than for pillar lesions. © 1995 Jons Wiley & Sons, Inc.
An application of the unfolding model to explain turnover in a sample of military officers
Authors: Holt Daniel T. , Rehg Michael T. , Lin Jeffrey H. S. , Miller Jennifer
Published: February 2007

Questionnaire data from 182Air Force officers who had voluntarily separated from the service were used to test Lee and Mitchell's (1994) unfolding model of voluntary turnover. Specifically, Lee and Mitchell predict five distinct paths to voluntary turnover, explaining the sequence of deliberate and impulsive decisions individuals make as they choose to leave organizations, where individuals interpret an organizational event, assess their relation to the workplace, evaluate options, and enact a response. Results indicate that 47% of the participants followed those five paths. Model modifications were made that reflect the unique nature of military service where members have preexisting plans to leave the service after a defined period or event.These modifications capture an additional 36% to explain 83% of the turnover decisions.The implications of these findings are addressed. ©2007 Wiley Periodicals, Inc.
Modulation of zinc release from bioactive sol–gel derived SiO2‐CaO‐ZnO glasses and ceramics
Authors: Jaroch D.B. , Clupper D.C.
Published: February 2007

Zinc is an essential trace element which may be effective in promoting hard tissue healing. Glasses in the SiO2‐CaO‐ZnO system were synthesized via sol–gel methods. Using a constant silica content (70 mol %), the ratio of Ca to Zn was varied (1.5, 3.5, or 6.5), as was the stabilization temperature (650, 750, or 850°C), to examine such effects on the bioactive response and zinc release in simulated body fluid (SBF). XRD revealed the development of CaSiO3 and Ca2ZnSi2O7 crystalline phases during stabilization at 850°C only. N2 adsorption analysis determined that the specific surface area (BET) varied between 14 and 179 m2/g and was dependent on composition and stabilization temperature, as was the average initial pore size (51–125 Å). The formation of hydroxycarbonate (HCA) and amorphous calcium phosphate (ACP) was observed at 14 days for samples stabilized at 650 or 750°C. Only ACP layers were observed on such samples prior to 14 day. Relative to the Ca levels at 14 day (60–485 μg/ml), Zn levels in solution were relatively low (0.06–1.18 μg/ml). EDX and ICP data suggested that released Zn was incorporated into the forming calcium phosphate reaction layer, thereby preventing concentrations of the essential trace element from reaching potentially toxic levels. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res 2007
Evaluation of a parallel plate membrane plasma exchange system
Authors: Buffaloe George W. , Erickson Ross R. , Dau Peter C.
Published: February 2007

A new parallel plate membrane plasma exchange system (Centry TPE System) has been developed and clinically evaluated. A series of 27 consecutive plasma exchanges were performed on 14 patients with autoimmune diseases. Blood access was obtained by routine means identical to centrifugal procedures. The blood flow rate was 94±20 ml/min and plasma filtration rate was 37±9 ml/min, with an average patient hematocrit of 36%. The sieving coefficients for a wide range of plasma solutes including immunoglobulins, immune complexes, and lipids, clustered about 1.00, indicating nonselective plasma filtration. The average reduction in patient plasma solutes of 60 to 70% was in close agreement with the predicted value for unhindered plasma filtration. There was no appreciable loss of blood cells, as compared to a study with a centrifugal system showing a 56% reduction in circulating platelets. Complement activation measured by C3 conversion was undetectable in patient samples and either undetectable or minimal in plasma filtrate samples. The system was convenient to operate and problems were rare. No untoward patient effects attributable to the membrane system were observed. These results show that the parallel plate membrane plasma exchange system described in this report is capable of delivering safe, efficient plasma exchange.
Leukapheresis: Increasing the granulocyte yield with the fenwal CS‐3000
Authors: Loftus T. J. , White R. F. , Huestis D. W.
Published: February 2007

By premedicating the donor with 60 mg prednisone in divided doses and processing more donor blood at higher flow rates than those specified by the manufacturer, one can obtain high yields of granulocytes and platelets (mean of 3.3 × 1010 and 5.9 × 1011, respectively) with the Fenwal CS‐3000 blood cell separator. The steroid effect predominates over that of processing more blood. In the case of donors who are not stimulated by steroid, processing 10 L of donor blood at flow rates of 60 to 70 ml/minute results in a significantly improved yield of granulocytes (mean of 2.2 × 1010 as opposed to 1.4 in the case of 7 L) and of platelets (6.1 × 1011 versus 4.7). The concentrates contain about 50 to 60% less lymphocytes when donors are given steroid. With these modifications, the leukapheresis can still be accomplished in less than three hours and with minimal adverse effects on the donors.
Alternate dosage regimens for high molecular weight hydroxyethyl starch
Authors: Rock G. , McCombie N.
Published: February 2007

Six percent high molecular weight hydroxyethyl starch (HES) was used in the standard 500 nil dose and in various decreased doses to assess the efficacy of alternate dosage regimens for granulocyte procurement. When used in full strength, yields of 0.57±.15 × 1010per liter of blood processed (LBP) were obtained. When HES was used on only the first three passes, the subsequent three passes, done with Anticoagulant Citrate Dextrose Solution USP Formula A (ACD‐A); Fenwal Laboratories, Deerfield, IL), reduced the yield to 0.14 ± .06 × 1010/LBP. Reversing this procedure gave yields of 0.06 ± .05 × 1010/LBP (without HES) and 0.49 ± 0.36 × 1010/LBP when HES was added during the next three passes. When the HES dose was reduced to half‐strength on the second consecutive day of leukapheresis, the granulocyte yields were reduced from 0.57 ±.15 × 1010/LBP to 0.42 ±.07 × 1010/LBP. Use of half‐strength HES on virgin donors gave yields of only 0.35 ± .39 × 1010/LBP. Infusion of the entire 500 ml dose of HES 1/2 hour prior to the procedure produced low yields of 0.20 ± .12 × 1010/LBP, indicating that HES must be present during the centrifugation and separation procedure in order to enhance yields. The data suggest that alternate dosage regimens of this form of HES are not advisable and that optimal yields are produced when 500 ml of the six percent solution is used during the collection procedure.
Lymphocyte subpopulations of plateletapheresis products collected with the fenwal CS‐3000 cell separator
Authors: Mintz Paul D. , Normansell David E. , Innes Donald J.
Published: February 2007

To determine whether any lymphocyte subset is preferentially harvested and transfused as a consequence of plateletapheresis with the Fenwal CS‐3000 Blood Cell Separator, the proportions of lymphocyte subpopulations in platelet concentrates were compared to their proportions in the donors' peripheral venous blood immediately prior to platelet collection. There was no difference in the proportion of B cells (surface immunoglobulin positive), T cells (OKT3 positive), helper/inducer T cells (OKT4 positive), suppressor/cytotoxic T cells (OKT8 positive), and natural killer cells (Leu 7 positive) in the donors' peripheral venous blood and the plateletapheresis product. Thus, although previous studies have demonstrated the ability to separate lymphocyte subpopulations by density centrifugation and velocity sedimentation, plateletapheresis with the CS‐3000 harvests the lymphocyte subpopulations studied in the same proportions in which they circulate in donors' peripheral venous blood.
Multiple plasma exchanges successfully maintain a young adult patient with crigler‐najjar syndrome type I
Authors: Ahmed P. , Pratt A. , Land V. J. , Flye M. W. , Chaplin H.
Published: February 2007

Plasmapheresis has been shown to reduce total and free bilirubin levels in acute exacerbations of Crigler‐Najjar syndrome, type 1 (CNS‐TI), but its effectiveness in long‐term management has not been reported. An 18‐year‐old (yo) male with CNS‐TI, who required prolonged daily high‐intensity phototherapy to prevent cerebral nervous system symptoms, developed increasingly frequent bouts of confusion, nausea, and vomiting associated with free bilirubin concentrations (fbcs) >10–15 nmol/L. Pending consideration of orthotopic liver transplantation, plasma exchange (∼3 liters per procedure) was begun in 12/84 using the IBM/COBE 2997 with 5% albumin as replacement fluid. Frequency of treatments was guided by twice weekly fbcs, with plasma exchange for fbc >10–15 nmol/L. Pre‐exchange and postexchange fbcs ranged from 27.5 to 11 nmol/L and 9.2 to 2 nmol/L, respectively. Seventy‐two exchanges were performed over a 28 month period. Irreversible CNS damage did not occur, and the patient underwent successful liver transplantation in April of 1987, with complete correction of his metabolic disorder. He remains well 18 months following transplantation.
Minimal toxicity during protein a immunoadsorption treatment of malignant disease: An outpatient therapy
Authors: Snyder Harry W. , Henry David H. , Messerschmidt Gerald L. , Mittelman Abraham , Bertram Juergen , Ambinder Edward , Kiprov Dobri , Balint Joseph P. , MacKintosh F. Roy , Hamburger Max , Viola Michael V. , Fiore John , Louie James , Higby Donald J. , O'Brien Paul , Ainsworth Sterling , Fisher Lloyd D. , Perkins William , Jones Frank R.
Published: February 2007

Extracorporeal removal or modulation of circulating immune complexes (CIC) from plasma of animals and humans with malignant disease may be associated with induction of immune‐mediated anti‐tumor responses. Immunoadsorption columns containing heat‐killed and formalin‐fixed Staphylococcus aureus or staphylococcal protein A have been used for this purpose but treatments have often been associated with cardiopulmonary toxicity. Recently, an immunoadsorption device containing highly purified protein A covalently attached to a silica matrix (PROSORBA© column) was used to treat 142 patients with refractory malignancies and 22 of 104 patients evaluated for anti‐tumor response had objectively measurable reduction in tumor burden. In contrast to earlier experience with other devices, the procedures used in this trial were well tolerated and could be performed on an outpatient basis. The most common side effects observed among 1,306 treatments were chills (28% of treatments), low grade fever (28%), and musculoskeletal pain (16%). Side effects were mild to moderate and required no treatment or only symptomatic treatment. Treatment schedules were interrupted due to side effects for only six patients and there were no treatment‐related deaths. Of 64 patients available for long‐term follow‐up evaluation (mean of 11 months), none exhibited evidence of long‐term treatment‐related side effects. None of the patient deaths in that period were associated with short or long‐term treatment‐related side effects. Protein A‐lica (PROSORBA© columns) can be used safely for development of further experimental treatments of malignant disease.
Experience of a combined apheresis, blood collection, and blood transfusion unit in a large tertiary care medical center
Authors: Silva Victor A. , Dynis Marian , Chaplin Hugh
Published: February 2007

The Barnes Hospital Apheresis Blood Collection and Blood Transfusion Unit is part of Barnes Hospital Blood Bank. Because of its size and complexity, we report our experience which may be useful to administrators and physicians involved in the planning or management of similar services.

From 1985 through 1988 we collected platelets from 1,976 different donors, the majority of which (87%) were community donors. Sixty‐nine percent of 1,976 donors donated in 1988 an average of 4.9 times. Of 6,568 apheresis products collected, 1.1% were discarded because of positive screening tests and 0.7% were discarded because of outdating or presence of fibrin clot.

In 1988 a total of nine cell separators were used. All donor apheresis were done with seven blood separators, and on average a separator produced an apheresis product every 4.5 worked hours. All therapeutic apheresis (338) were done on two separators. Most of them (88%) were performed during work hours.

In 1988 donor and therapeutic apheresis were done by 17½ full‐time employees (FTEs) during work hours. Considering the Workload Unit Value per procedure given by the College of American Pathologists (CAP) and that each FTE worked 1,864 hours per year, the worked hour productivity for donor and therapeutic apheresis was 78.2%. Blood collections, therapeutic bleeds, and outpatient transfusions (1,127, 114 and 1,745 respectively) were accomplished by two FTEs, for a worked hour productivity of 35.5%. Because 95.1% of total worked units was produced by efficient donor and therapeutic apheresis activities, overall efficiency remained high at 73.8%.
Legal issues in apheresis
Authors: Cooper E. Shannon
Published: February 2007

There are many concerns about the impact of the law on the practice of apheresis and transfusion medicine. This discussion reviews the sources of laws, the processing of cases, and risk management. In addition, specific legal issues and employee concerns are included.
Collection of peripheral blood mononuclear cells as a byproduct of plateletpheresis with two different blood cell separators
Authors: Hogge D. E. , Lee C. Y. , Benny W. B. , Sutherland H. J.
Published: February 2007

Peripheral blood mononuclear cells (PBMC) were collected as a byproduct of plateletpheresis of normal blood cell donors using modifications to standard automated protocols on either the CS‐3000 or Spectra blood cell separator machine. Comparison of the PBMC products obtained showed X ± SD WBC yields of 5.3 ± 3.4 vs. 3.8 ± 2.0 × 109 with the CS‐3000 and Spectra, respectively (P < .0001). The majority of the cells were lymphocytes, with 13–15% monocytes with both machines. Sixteen percent of the WBC collected with the Spectra, but only 1% of those collected with the CS‐3000, were granulocytes. The CS‐3000 PBMC product contained fewer RBC (0.2 ± 0.1 × 1011 vs. 2.4 ± 0.6 × 1011) and more platelets (1.6 ± 0.6 × 1011 vs. 0.35 ± 0.39 × 1011) in a smaller volume (40 ± 14 ml vs. 229 ± 37 ml) than the Spectra products. Comparison of the platelet collections harvested when PBMC were also collected to platelets harvested using standard procedures on the same machine showed no change in platelet. WBC, or RBC yields for the Spectra. A significant increase in mean WBC contamination from 40 ± 56 × 107 to 112 ± 205 × 107 and a small, but statistically insignificant, decrease in platelet yield from 4.1 ± 1.2 × 1011 to 3.9 ± 1.8 × 1011 was observed in the CS‐3000 platelet collections when PBMC were harvested. There was no sustained change in donor lymphocyte counts and no change in acute donor side effects or time requirements when PBMC were collected. The procedural modifications were easily learned by multiple operators, and required about 15 and 5 min additional operator time on the CS‐3000 and Spectra, respectively. Thus, harvest of large numbers of PBMC as a byproduct of plateletpheresis can be readily accomplished with either of 2 different blood cell separator machines. The cells obtained have been useful for a variety of purposes in both clinical hospital and basic research laboratories. © 1992 Wiley‐Liss, Inc.
Single‐donor platelet concentrates produced along with packed red blood cells with the haemonetics MCS 3p: Preliminary results
Authors: Valbonesi Mauro , Frisoni Roberto , Florio Gaetano , Ruzzenenti Maria Rosaria , Capra Carlo , Merlo Mario , Parenti Raffaella
Published: February 2007

There has been an increasing interest in recent years over the qualitative superiority of single‐donor platelets in the management of hemato‐oncologic patients. The reasonable desire of both patients and physicians to limit the risks of transfusion along with the need for limiting the costs involved in this kind of therapy have led to application of multicomponent donations both in terms of double platelet concentrates and double products such as red blood cells (RBC) and platelets from the same donor. Single donor platelets and RBC have been collected in a semi‐automated mode and only the very recent introduction of the Haemonetics MCS 3p with its SDP/RBC protocol provides a totally closed‐system automated protocol for this combined collection. Twenty procedures have been carried out so far at our unit. In a mean of 87 minutes (6–7 passes), a mean of 3.1 × 1011 platelets were collected along with ∼220 mL of packed RBC. The leukocyte contamination of the platelet product was in the range of 0.4–1.1 × 107 (99% lymphocytes), and the quality of platelets was very satisfactory as measured by the hypotonic shock response, aggregation induced by ADP, collagen and ristocetin, morphology score, and membrane glycoproteins modifications. Equally satisfactory was the quality of the RBC concentrate, suspended in 80 mL of SAG‐M, with a total hemoglobin (Hb) content approaching 55 g as compared to the normal Hb content of a standard RBC concentrate that is approximately 62 g. No adverse effect has complicated the 20 procedures carried out so far, and the donors' evaluation of the procedure was favorable, except for the length of the procedure.
Matching blood donations to type‐specific product needs: A recruitment technique
Authors: Kuriyan M. , Wells S.
Published: February 2007

The conversion of multiple whole blood donors to apheresis donors is a challenge since a rapidly expanding apheresis donor base could erode homologous collections. We addressed this concern with a plan to enhance apheresis recruitment as well as donations among homologous donors with types O and B blood. Focusing the donor's attention on blood type as it relates to type‐specific product needs was the basis of our approach. A matrix was used to recruit the desired types for the desired procedures (whole blood, platelet/plasma apheresis). The matrix instructed donors of blood types O, A‐, and B‐ to primarily give whole blood and to give apheresis as a secondary donation. Donors AB, A+, and B+ were primarily directed to apheresis donations, whole blood donation being secondary. A+ and O‐ donors only gave their secondary donation if they were at maximum donations with the primary donation.

The collections by blood type in percentages for 12 months of 1992/93 for whole blood were O+ 38.9, 0‐ 7.3, A+ 29.5, A‐ 5.7, B+ 11.9, B‐ 2.1, AB+ 3.7, AB+ 0.7. For apheresis it was 0+ 36.2, 0‐ 6.7, A+ 33.0, A‐ 6.6, B+ 10.4, B‐ 1.2, AB+ 4.9, AB+ 1.0. In 1992/93, A+ and B+ apheresis collections as compared to total apheresis collections increased by 4.9% and 13.7%, respectively. For O group apheresis donations, a decrease of 2.5% was shown and A+ whole blood donations decreased by 5.35%. During the same period of time, total apheresis collections increased by 3,058 units. We demonstrated that integration of apheresis recruitment with type‐specific whole blood recruitment yielded significant increases of type‐specific products.
Efficacy of pentastarch in granulocyte collection by centrifugal leukapheresis
Authors: Lee Jong‐Hoon , Cullis Herb , Leitman Susan F. , Klein Harvey G.
Published: February 2007

The efficacy of 6% hydroxyethyl starch (hetastarch, HS) in enhancing granulocyte harvest by centrifugal leukapheresis has been described by a simple equation which predicts the granulocyte collection efficiency (GCE) based on an intrinsic donor variable, the erythrocyte sedimentation rate (ESR): GCE (%) = 1.3 ESR (mm/hr) + 45. Ten percent low molecular weight hydroxyethyl starch (pentastarch, PS) has been reported to be as effective as HS with potentially fewer adverse donor reactions (ADR). The derivation of an analogous equation for PS under conditions previously reported for HS may quantify PS efficacy and allow comparison to HS. We prospectively measured the in vitro and the in vivo effects of PS on the donor ESR in 53 granulocyte collections from 44 donors using the model CS‐3000 Plus blood cell separator (CS). We then correlated the findings with the GCE of each procedure and derived an equation which expresses GCE in terms of baseline donor ESR. The in vitro addition of PS increased the donor ESR 2.4‐fold, but its administration to a donor during a collection procedure did not appreciably change the ESR. Higher baseline donor ESR was more likely to result in more efficient cell collections: GCE (%) = 0.8 ESR (mm/hr) + 20; (r = 0.37). For granulocyte harvests using the CS and PS as the sedimenting agent 1) baseline donor ESR affects granulocyte harvests, but the poor correlation does not allow an accurate prediction of GCE and cell yield from the baseline donor ESR; 2) in comparison with HS (results from a previous study), PS may be less effective in vitro and not effective in vivo in elevating ESR, and may be less effective in enhancing granulocyte harvest; and 3) the parameters (slope, y‐intercept, correlation coefficient) which define the linear relationship between baseline donor ESR and GCE may serve collectively as a quantitative measure of the effectiveness of different hydroxyethyl starch agents in enhancing granulocyte harvests. These parameters may be helpful in rapidly assessing the clinical efficacy of new, potentially useful hydroxyethyl starch agents prior to initiating a randomized, controlled clinical trial.
Development of 3‐D equivalent‐circuit modelling with decoupled L‐ILU factorization in semiconductor‐device simulation
Authors: Li Szu‐Ju , Dai Jing‐Fu , Chang Chia‐Cherng , Huang Chau‐Hsin , Tsai Yao‐Tsung
Published: February 2007

In this paper, we develop a three‐dimensional (3‐D) device simulator, which combines a simplified, decoupled Gummel‐like method equivalent‐circuit model (DM) with levelized incomplete LU (L‐ILU) factorization. These complementary techniques are successfully combined to yield an efficient and robust method for semiconductor‐device simulation. The memory requirements are reduced significantly compared to the conventionally used Newton‐like method. Furthermore, the complex voltage‐controlled current source (VCCS) is simplified as a nonlinear resistor. Hence, the programming and debugging for the nonlinear resistor model is much easier than that for the VCCS model. Further, we create a connection‐table to arrange the scattered non‐zero fill‐ins in sparse matrix to increase the efficiency of L‐ILU factorization. Low memory requirements may pave the way for the widespread application in 3‐D semiconductor‐device simulation. We use the body‐tied silicon‐on‐insulator MOSFET structure to illustrate the capability and the efficiency of the 3‐D DM equivalent‐circuit model with L‐ILU factorization. Copyright © 2007 John Wiley & Sons, Ltd.
Biomechanical properties of bone and cartilage in growing femoral head following ischemic osteonecrosis
Authors: Koob Thomas J. , Pringle Douglas , Gedbaw Emily , Meredith James , Berrios Ricardo , Kim Harry K. W.
Published: February 2007

Legg‐Calve‐Perthes disease (LCPD) is one of the most common causes of a permanent deformity of the femoral head among pediatric hip disorders. Mechanical loading of the osteonecrotic femoral head undergoing repair is thought play a significant role in the development of the femoral head deformity. This study measured the mechanical properties in uniaxial unconfined compression tests of epiphyseal bone and cartilage from immature femoral heads following surgical induction of osteonecrosis using an established piglet model. Both the modulus and yield strength of bone cores from the infarcted heads were significantly lower by 50%–60% than those of the contralateral normal control heads by 2 weeks after surgery and they remained this low for 8 weeks. No consistent difference in the bone mineral or collagen content per dry weight in the bone cores was observed. Cartilage modulus and yield strength were significantly lower at 2 weeks and remained low for 8 weeks. Cartilage collagen and glycosaminoglycan content per dry weight did not differ significantly between control and infarcted heads at any time point. However, the relative proportion of chondroitin 6‐sulfate increased significantly over the 8‐week postoperative period, which correlated with an increase in cartilage thickness. These results indicate that the deterioration of the mechanical properties of the epiphyseal bone and cartilage likely plays a significant role in the pathogenesis of the femoral head deformity in LCPD. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25: 750–757, 2007
Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement
Authors: Saari Tuuli , Uvehammer Johan , Carlsson Lons , Regnér Lons , Kärrholm Johan
Published: February 2007

After total knee replacement (TKR) the bone mineral density (BMD) decreases in the proximal tibia. Our aim was to evaluate if changes in constraint of the cemented AMK TKR (DePuy, Johnson & Johnson, Leeds, UK) had any effect on postoperative bone remodeling in the proximal tibia. We used dual‐energy X‐ray absorptiometry in 43–53 knees to record changes in BMD in three regions of interest around the tibial component up to 5 years after operation with the AMK (DePuy) TKR. The knees had been randomly allocated to receive a flat or a concave tibial insert with retention of the posterior cruciate ligament when preoperative deformity was less severe, and either a concave or a posterior‐stabilized (PS) insert with resection of the posterior cruciate ligament when deformity was more pronounced. All designs were associated with loss of BMD in the proximal tibia. The mean bone loss varied from 5 to 23% depending on the region of interest. There were no statistically significant differences between the groups, and the alteration of tibial insert constraint did not influence the bone remodeling. However, low precision values may have impaired the detection of differences. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25: 798–803, 2007
Predictors of survival and recurrence in the surgical treatment of merkel cell carcinoma of the extremities
Authors: Senchenkov Alex , Barnes Sunni A. , Moran Steven L.
Published: February 2007

Purpose

Merkel cell carcinoma (MCC) is a rare and aggressive malignancy that originates within the extremities in about 40% of cases. Treatment approaches to this tumor have not been standardized. The purpose of this study was to examine treatment approaches to extremity MCC and to determine predictors of recurrence and patient survival.

Methods

A retrospective review of 38 consecutive patients with surgically treated extremity MCC was performed. Patient demographics, histologic tumor stage and location and pre‐existing malignancies were recorded. Patients were treated by wide‐local excision (WLE) or Mohs' technique. Clinically negative regional lymph nodes were either observed (n = 16) or staged with elective lymphadenectomy or sentinel lymph node dissection (SLND) (n = 17), and clinically positive nodes underwent therapeutic node dissection (n = 5). Adjuvant radiotherapy (n = 21) and chemotherapy (n = 6) were noted, as well as time to tumor recurrence and overall patient survival. Predictors of recurrence and survival were analyzed using Kaplan–Meier method and log rank test.

Results

There was no difference in local recurrence rates when comparing Mohs' technique to WLE for the treatment of primary tumors. Although there was no survival advantage to lymph node dissection, lymph node status was effective in predicting the risk of regional recurrence. Radiation reduced the local recurrence rate (HR = 0.29, 95% CI [0.10, 0.85]), but did not lead to improved overall survival.

Conclusion

Margin‐negative excision of the MCC remains the mainstay of treatment. Surgical staging, preferably with SLND, identifies patients that may develop regional recurrence. This study further supports the important role of adjuvant radiation therapy in improving locoregional tumor control in the patients with MCC. J. Surg. Oncol. 2007;95:229–234. © 2007 Wiley‐Liss, Inc.