bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma Exchange: The Cost/benefit Ratio and the Critical Revision of Indications
Authors: Valbonesi M. , Florio G. , Lercari G. , Carlier P. , Ruzzenenti M.R. , Frisoni R. 
Published: April 2018

The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency. Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years. Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.
Complications of Plasma-exchange
Authors: Belloni M. , Alghisi A. , Scremin L. 
Published: April 2018

Complications in apheresis affect on the average 40% of treated patients and 10-14% of the procedures. The mortality rate is 1/500 treated patients. The utilization of more complex techniques, central catheters, plasma infusion and even more the superimposition of different factors increase the incidence and gravity of side effects. Very influent are also the underlying pathologies and the clinical conditions; particularly at risk are patients with TTP/HUS and GBS. However, PE represents a relatively safe therapy in which prevention of complications requires a particularly diligent personnel and a careful evaluation of indications.
Autotransfusion Program: Integrated Use of Different Techniques
Authors: Mercuriali F. , Inghilleri G. , Biffi E. , Vinci A. , Colotti M.T. , Scalamogna R. 
Published: April 2018

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood. A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available. Results in 1992 in elective surgery: 98% enrolment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.
Predeposit Hemodilution and Intra- and Postoperative Blood Salvage in the Orthopaedic Surgery of Brain Damaged Children
Authors: Zanolli F.A. , Scremin A. , Negri M.G. , Braga A. , Majoni A. , Novello A. , Valenti S. , Dal Zotto I. 
Published: April 2018

The advantages of autologous transfusion are nowaday well known. It appears so very important to enlarge to the greatest number of kinds of pathologies, trying to overcome all possible problems and studying every counterindication. In this study, through a strict collaboration among orthopaedics, anhaestesia, transfusion medicine, neurological and pediatric specialists, we studied a peculiar protocol, suitable for enlarging the autologous techniques to brain damaged children and, after a regular application lasted globally for about two years, we did an evaluation of the results.
The Organization of the Autotransfusion-perioperative Blood Salvage at San Martino Hospital
Authors: Carlier P. , Ferrari G.M. , Florio G. , Fella M. , Ruzzenenti M.R. , Frisoni R. , Valbonesi M. 
Published: April 2018

Autologous transfusion is playing an important role in modern transfusion medicine. At San Martino hospital we use a combination of manual and mechanical techniques in order to improve autotransfusion procedures, control the hypertransfusion and avoid waste. Our autotransfusion program has determined a 55% reduction in the red cell concentrates used (from 42,000 in 1985 down to 19,400 in 1992). Proper training, cultural improvements and new applications on autotransfusion procedures will permit a better use of blood with less transfusion related complications, until a suitable substitute for blood will be available.
Autotransfusion in Major Orthopedic Surgery: Postoperative Evaluation
Authors: Borghi B. , Pignotti E. , Famelli G. , Baroncini S. 
Published: April 2018

The aim of this prospective study was to assess the postoperative progress of autotransfused patients (predonated blood + intra and postoperative blood salvage) in major orthopedic surgery. Patients 1,785 consecutively treated patients (1,198 females, 587 males), mean aged 62± 11 years, basal Hb 13.4± 1,4 g/dl. Surgery Total hip arthroplasty (THA, 1,229 pts), THA after the removal of internal fixation devices (RFD+THA THA 18), total knee arthroplasty (TKA 263 pts), hip revision (HR) (cup+stem THR 197, cupR 53, stemR 16 pts) and knee revision (KR 9 pts). Results Homologous tranfusions were carried out in 130 patients (7.3%). The need to use homologous transfusions was significantly associated to the female sex (8.5% vs 4.7%, p=0.0049), older age (67.8 vs 62.1 years; p=0.0001), lower baseline Hb (12.3 vs 13.5g/dl p=0.0001), use of Calcium Heparin (CaHe) for antithromboembolic prophylaxis (CaHe 18% vs low molecular weight heparin 7.8% vs Indobufen 5% p=0.0001), lower number of predeposits (zero 62.5% vs one 16.2% vs two 5.2% vs three 6.4% vs four 5.5%, p=0.0001), type of surgery (THR 16.2% vs cupR 11.3% vs RPS+THA 11.1% vs stemR 6.2% vs THA 6.1% vs TKA 5.7% vs KR 0%, p=0.0001), presence of coexisting diseases like coronary heart disease (15.7% vs 6.2%, p=0.0001), and nephropathy (18.7 vs 7.1%, p=0.031), higher ASA (ASA4 18.7% vs ASA3 10.1% vs ASA2 6.6% vs ASA1 0%, p=0.0001). Postoperative hospitalization was significantly shorter in patients only autotransfused (12.3 vs 16.5 days, p=0.0001). The result confirms the central role of the anesthesiologist in the application of blood saving techniques.
Quality Assurance of Platelet Concentrates Used in Routine Practice
Authors: Rebulla P. , Greppi N. , Marangoni F. , Riccardi D. , Sirchia G. 
Published: April 2018

Quality assurance of platelet concentrates should include regular determinations on sampled units of platelet concentrate volume, platelet count, pH value and an indicator of maintenance of platelet discoid shape. In regard to the latter, recent investigations suggest that the visual assessment of platelet swirling may provide meaningful and reproducible information with limited staff training and efforts. Other laboratory assays provide useful data that may prove beneficial particulary when new procedures and products are examined. In addition to laboratory tests, it is of utmost importance to regularly monitor the effectiveness of platelet support therapy at clinical level. This can be done using a number of indicators including the proportion of patients who show febrile, allergic and septic reactions, who become and remain refractory to random-donor platelet support, who develop and/or die of hemorrhage not prevented or corrected by platelet support.
Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses
Authors: Stumbo Scott P. , Yarborough Bobbi Jo H. , Yarborough Micah T. , Green Carla A. 
Published: April 2018

Purpose: Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Design: Cross-sectional; mixed methods. Setting: An integrated health system and a network of federally qualified health centers and safety net clinics. Participants: Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Measures: Semi-structured interviews and surveys. Analysis: Thematic analysis for qualitative data; frequencies for quantitative data. Results: More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Conclusions: Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
Cardioprotective Role of Colchicine Against Inflammatory Injury in a Rat Model of Acute Myocardial Infarction
Authors: Bakhta Oussama , Blanchard Simon , Guihot Anne-Laure , Tamareille Sophie , Mirebeau-Prunier Delphine , Jeannin Pascale , Prunier Fabrice 
Published: April 2018

Background: Inflammation plays a crucial role in the pathophysiology of myocardial ischemia/reperfusion (I/R) injury. A clinical trial has recently reported a smaller infarct size in a cohort of patients with ST-segment elevation myocardial infarction (MI) treated with a short colchicine course. The mechanism underlying colchicine-induced cardioprotection in the early MI phase remains unclear. We hypothesized that a short pretreatment with colchicine could induce acute beneficial effects by protecting the heart against inflammation in myocardial I/R injury. Methods and Results: Rats were subjected to 40-minute left anterior descending coronary occlusion, followed by 120-minute reperfusion. Colchicine (0.3 mg/kg) or a vehicle was administered per os 24 hours and immediately before surgery. Infarct size was significantly reduced in the colchicine group (35.6% ± 3.0% vs 46.6% ± 3.3%, P < .05). The beneficial effects of colchicine were associated with an increased systemic interleukin-10 (IL-10) level and decreased cardiac transforming growth factor-β level. Interleukin-1β was found to increase in a “time of reperfusion”-dependent manner. Colchicine inhibited messenger RNA expression of caspase-1 and pro-IL-18. Interleukin-1β injected 10 minutes prior to myocardial ischemia induced greater infarct size (58.0% ± 2.0%, P < .05) as compared to the vehicle. Colchicine combined to IL-1β injection significantly decreased infarct size (47.1% ± 2.2%, P < .05) as compared to IL-1β alone, while colchicine alone exhibited a significantly more marked cardioprotective effect than the colchicine-IL-1β association. Conclusion: The cardioprotection induced by a short colchicine pretreatment was associated with an anti-inflammatory effect in the early reperfusion phase in our rat MI model.
The Effect of ß Blockers on Retinal Blood Flow in Diabetic Patients
Authors: Newsom R.S.B. , Rassam S.M.B. , Kohner E.M. 
Published: April 2018

The effect of a single oral dose of propanolol 80 mg, dilevalol 200 mg, salbutamol 4 mg, and placebo on the systolic (BPs), diastolic blood (BPd), intraocular pressure (IOP), on retinal vessel diameter (D), blood velocity (Vmax) and volumetric retinal blood flow (RBF), was measured at baseline, 90 minutes and three hours after administration in normotensive diabetic volunteers. These drugs were chosen to demonstrate a range of 8 receptor activity. Propanolol is a non-specific ß blocker, affecting ß1 and ß2 receptors, dilevalol has ß1 antagonist and ß2 agonist effects and salbutamol has ß2 agonist effects. Retinal blood flow was measured by bidirectional laser Doppler velocimetry (BLDV) and red free photography. Dilevalol reduced the mean BPs by 10.4 mmHg (SD 4.2, P<0.05), the mean BPd by 7 mmHg (SD 3.8, P<0.05), whereas propanolol, salbutamol and placebo had no significant effect. Propanolol reduced the mean intraocular pressure by 4.88 mmHg (SD 1.8, P<0.01). No treatment had a significant effect on retinal perfusion pressure. In all treatments the vessel diameter and volumetric flow remained unchanged, and there was no significant difference between the treatments. The mechanisms of action of these drugs are analysed and the possible implications of their use in patients with retinal disease are discussed
Mononuclear Phagocytes in Proliferative Vitreoretinopathy (PVR). A Specific Role of Microglial Cells in Non-Traumatic Disease?
Authors: Weller M. , Esser P. , Heimann K. , Wiedemann P. 
Published: April 2018

Mononuclear phagocytes have been a focus of attention in the cellular biology of proliferative vitreoretinopathy (PVR) for more than ten years. The pattern of phagocyte participation in peri retinal traction membrane formation in PVR depends on the etiology, i.e. trauma, rhegmatogenous retinal detachment, previous therapy, i.e. multiple surgical interventions, and the clinical stage of the disease. We have recently identified microglial cells as a distinct cellular population, in membranes from patients with non-traumatic PVR. Current evidence of mononuclear phagocyte function in PVR suggests a role for resident phagocytes of the vitreous and retina in PVR subsequent to rhegmatogenous detachment, and a role for blood-derived monocytes in posttraumatic PVR. The cellular biology of PVR may be much more heterogeneous than previously assumed.
Kearns-Sayre Syndrome: A Case Report and Review
Authors: Gross-Jendroska M. , Schatz H. , Mcdonald H.R. , Johnson R.N. 
Published: April 2018

In 1958, Kearns and Sayre described a multisystem entity, now known as Kearns-Sayre syndrome (KSS). The syndrome is defined as exhibiting a triad of thus far unexplained degenerative conditions: progressive external ophthalmoplegia, retinal pigmentary degeneration, and heart block. Commonly accompanying findings include cerebellar dysfunction and CSF protein levels above 100 mg/dl. Symptoms usually appear in early childhood, but the onset has been seen occasionally in young adults. KSS is a mitochondrial disorder that occurs rarely; the actual incidence is unknown. Ocular findings consist of bilateral ptosis, chronic progressive external ophthalmoplegia, and pigmentary retinopathy. Corneal clouding and optic neuritis are infrequent. We herein report a classic case of Kearns Sayre syndrome and discuss the findings.
Argon Laser Lesions of the Retina; Occurence and Origin of Macrophages
Authors: Martini B. , Ryan S. J. 
Published: April 2018

Macrophage infiltration is frequent in the early stages of various proliferative eye disorders, including subretinal neovascularization. In this study, we set out to establish the origin of macrophages found in an animal model of laser-induced subretinal neovascularization. One primate received several intravenous injections of a colloidal carbon suspension. We then applied standard argon laser lesions to the retina of both eyes, which were enucleated eight days later and sectioned serially for histological examination. A quantitative estimate of carbon-laden and non-laden leukocytes was made based on morphological criteria. Mononuclear leukocytes accumulated in the laser lesions and the percentage of carbon-laden mononuclear leukocytes in relation to the total leukocyte number was higher in the extravascular area of the laser sites than in the systemic circulation. These findings indicate that the majority of mononuclear leukocytes that accumulate at the sites of laser lesions are derived from the systemic circulation.
Pressure Control in Glaucoma Patients after Cataract Surgery with Intraocular Lens
Authors: Calissendorff B.M. , Hamberg-Nyström H. 
Published: April 2018

In a retrospective study 97 patients with glaucoma and 16 with ocular hypertension were examined with regard to intraocular pressure (IOP) after extracapsular cataract extraction with implantation of a posterior chamber lens. During the follow-up 39 cases dropped out but 63 glaucoma patients and 11 patients with ocular hypertension were followed for three years. Compared to preoperative IOP 59% of the patients treated previously with Argon laser trabeculoplasty (ALT) had an IOP rise of > 10 mm Hg the day after surgery. The corresponding proportion among medically treated patients was 34% (P=0.01). A pressure rise of > 10 mm Hg was less frequent among patients treated with one drug than among those treated with two or three (P=0.05). During follow-up eight patients had a pressure rise which could not be controlled medically and they had to undergo additional ALT or surgery. All eight had been treated with ALT or with glaucoma filtering surgery prior to the cataract operation. After three years observation of 63 of the glaucoma patients, 63% were having less medical therapy than preoperatively, 30% an equal amount and 7% more; 49% (31 of 63) were still without any therapy. In the group of patients who preoperatively were only treated medically, no definite increase in therapy was needed in the long term.
Indocyanine Green Videoangiography: Current Status
Authors: Yannuzzi I.A. , Sorenson J.A. , Guyer D.R. , Slakter J.S. , Chang B. , Orlock D. 
Published: April 2018

Indocyanine-green (ICG) angiography has experienced a rejuvenated interest in the past few years because of improvements in technological systems. After three years of experience with evolving digital technology, we have reviewed our experience to provide an update on potential applications in a variety of choroidopathies. Based on 3,000 cases studied with ICG angiography, we evaluated the diagnostic value of the procedure in choroidal abnormalities including ischemic, tumor, idiopathic, inflammatory, and neovascularized diseases. ICG angiography is still of limited clinical value in ischemic diseases because of a relatively poor imaging potential for the choriocapillaris. The procedure has not yet provided information which is of significant value in the evaluation and management of choroidal tumors. Valuable information has been provided on the fundamental pathogenesis of certain idiopathic diseases. Preliminary experience in inflammatory diseases is very promising. A genuine advance in imaging of “occult”-choroidal neovascularization has been provided by the diagnostic technique. Improved delineation of these vessels offers opportunities for ICG-guided laser treatment.
Correlation of Microcirculation Architecture with Ultrasound Backscatter Parameters of Uveal Melanoma
Authors: Coleman D.J. , Rondeau M.J. , Silverman R.H. , Folberg R. , Rummelt V. , Woods S.M. , Lizzi F.L. 
Published: April 2018

Ultrasound tissue characterization parameters of size and acoustic concentration can be used to sub-classify uveal melanoma and estimate the patient's risk of death. Histologically determined microcirculation patterns have also been found to sub-classify uveal melanoma and predict patient's risk of death. This study examines the spatial relationship between tumor features detected by the two techniques. Three dimensional ultrasound images that depict the size and relative concentration of scattering elements in uveal melanoma within a range of ∼50- 120 μm were compared with PAS (without hematoxylin) stained histological sections graded and localized according to tumor microvascular patterns. Both ultrasound parameter imaging and histopathology were accomplished by workers masked to the other procedure. In three of five patients vascular networks were identified histopathologically. The predominant ultrasound feature seen in the regions of the histologically identified networks were clusters of scatterers in the range of ∼50-80μm. In the two cases without a network vascular pattern, lower range scatterers dominated the tumor volume. All the cases could be distinguished by the size and distribution of contiguous spatial clusters of acoustic scatterers. Scatterer size features detected in three dimensional ultrasound parameter images can identify tumor regions containing a specific microvascular pattern. Ultrasound tissue characterization features used to sub-classify uveal melanoma may have a biophysical basis related to patterns of tumor microcirculation.
Morphometric Study of Wound Healing in a Model of Filtering Surgery with Mitomycin-C
Authors: Pablo L. E. , Ramírez T. , Álvarez R. , González I. , Larrosa J. M. , Honrubia F.M. 
Published: April 2018

Background Failure of filtering surgery may be related to excessive wound healing in the surgical area. This effect diminishes with the use of antimetabolic agents. Mitomycin-C (MMC) has proved to be the most effective drug to reduce myofibroblastic proliferation in experimental in vivo and in vitro models. To our knowledge, the objective changes induced by mitomycin-C in the size of wound healing areas have not been investigated. Methods: Filtering surgery was performed on both eyes of 40 pigmented rabbits. Preoperatively one of the eyes received MMC (0.5 mg/ml), and the fellow eye received balance salt solution as placebo. Animals were killed on days 6, 15, 30 and 58. Microscopic healing areas were measured by digital procedures. The areas of target and fellow control eyes were compared by the Wilcoxon test. Results This study showed significant differences (p<0.05) between treated and untreated groups, the healing are a gradually becoming smaller. Conclusions Objective methods to quantify the microscopic effects of MMC can be useful to improve our knowledge about the action on this antimetabolite and to enable us to adjust more accurately the timing and dosage when applying the drug in glaucoma filtering surgery.
A Retrospective Study on the Effectiveness of Oral Acyclovir to Prevent Herpes Simplex Recurrence in Corneal Grafts
Authors: Van Rooij J. , Rijneveld W.J. , Remeijer L.J. , Beekhuis W.H. 
Published: April 2018

Objective A retrospective study of the effectiveness of prophylactic acyclovirn to prevent recurrent infections after penetrating keratoplasty for herpetic macula. Methods Follow-up data of 22 patients who where treated prophilactically with oral acyclovir (2×400 mg for the first three months after keratoplasy) and of 19 control patients were compared. All patients were operated between 1989-1991 after being free of recurrent Herpes simplex virus (HSV) infections for a minimal period of six months. Survival was defined as the probability of being free of HSV recurrence. Results The hazard ratio calculated for the data of a 24 month follow-up was 0.66 (95%CI: 0.47, 3.8). Survival probabilities at six months were 0.95 for the prophylaxis and 0.74 for the control group (95%CI of the difference: 0.07, 0.37); after 12 months these proportions were 0.72 and 0.54 respectively (95%CI: −0.13, 0.47). Conclusions In concordance with former studies we conclude that acyclovir may be effective as a prophylaxis in this category of patients. The probability of being free from recurrence was significantly different after six months but not after twelve, possibly indicating that the period of prophylaxis was too short.