bluuebunny/crossref_metadata_2025_split huggingface dataset:
Boston city hospital and the thorndike memorial laboratory: the birth of modern haematology
Authors: Elrod Jeffrey M. , Karnad Anand B. 
Published: December 2004

SummaryEstablished in 1923, the Thorndike Memorial Laboratory at Boston City Hospital was the first clinical research laboratory in a municipal hospital in the United States of America. Minot and Castle, who were the second and third directors of the Laboratory, were pioneer haematologists and clinical investigators of the highest calibre who created an atmosphere at the Laboratory that would foster patient‐centred research and attract the best physician‐scientists to work and train there. The haematology research division of the Laboratory made important original contributions to the understanding of the pathophysiology of anaemia, the mechanisms of red cell and platelet destruction and the phagocytic role of the spleen, the nature of haemoglobin (normal and sickle cell), the nature of haemophilia and its therapy and the early classification of lymphoma. It contributed to the Thorndike Memorial Laboratory's worldwide reputation as a model research laboratory and established its reputation as the birthplace of modern haematology.
In vitro aspirin resistance detected by PFA‐100TM closure time: pivotal role of plasma von Willebrand factor
Authors: Chakroun Tahar , Gerotziafas Grigoris , Robert Françoise , Lecrubier Chantal , Samama Meyer Michel , Hatmi Mohamed , Elalamy Ismail 
Published: December 2004

SummaryThe in vitro closure time (CT), determined by the Platelet Function Analyzer (PFA‐100TM), is used to monitor patients treated with aspirin. A relatively high percentage of in vitro aspirin resistance was reported despite an adequate inhibition of platelet response to arachidonic acid and we investigated whether high plasma levels of von Willebrand factor ristocetin cofactor activity (vWF:RCo) may contribute to this profile. Platelet aggregation test, CT [collagen adrenaline (CEPI‐CT) and collagen adenosine 5′‐diphosphate (ADP) (CADP‐CT)], and vWF:RCo levels were evaluated in 55 consecutive patients receiving aspirin (75–250 mg/d) versus 32 untreated control subjects. All the aspirin‐treated patients showed platelet aggregation responses that reflected the aspirin intake. However, CT data analysis enabled aspirin good‐responder (GR) and aspirin bad‐responder (BR) patients to be identified. All GR group subjects (n = 27), had a CEPI‐CT and a CADP‐CT longer than 300 s and 96 s respectively. The BR group (n = 28) had CEPI‐CT values below 200 s and all CADP‐CT were in the normal range (77 ± 19 s). Interestingly, the BR plasma vWF:RCo levels were significantly higher (159 ± 43%) than those of the GR group (121 ± 34%) (P < 0·01), which were similar to control values (114 ± 31%). A negative correlation between vWF:RCo and CT values was established. We demonstrate that in vitro aspirin‐resistance, revealed by PFA‐100TM CT prolongation failure, is correlated to increased plasmatic vWF:RCo levels, reinforcing its particular importance in PFA‐100TM cartridges performance.
Fludarabine, cytosine arabinoside, granulocyte‐colony stimulating factor with or without idarubicin in the treatment of high risk acute leukaemia or myelodysplastic syndromes
Authors: Virchis Andres , Koh Mickey , Rankin Peter , Mehta Atul , Potter Michael , Victor Hoffbrand A. , Grant Prentice H. 
Published: December 2004

SummaryThe combination of fludarabine (FDR), high dose cytarabine and granulocyte colony stimulating factor (FLAG) with or without idarubicin (Ida) was used in the treatment of poor risk acute leukaemia or myelodysplastic syndrome (MDS) in a single centre experience. A total of 105 patients were treated over a 4‐year period with 59% achieving a complete remission (CR); no statistical difference observed between FLAG and FLAG‐Ida. For patients responding to FLAG ± Ida, the median event‐free survival (EFS) was 11 months and 23% at 5 years. Such patients proceeded either to further chemotherapy or a haematopoietic stem cell transplant (HSCT). The median EFS (13 months vs. 8 months) and projected 5‐year survival (37% vs. 13%) of patients undergoing HSCT was significantly better than those who did not (P = 0.021). In all, 14 of 72 patients remain alive in continuing CR (median duration 43 months) with 10 of 31 having had a HSCT vs. four of 41 that did not (P = 0·033). Both regimens were well tolerated, with the majority of patients experiencing grade 1 or less non‐haematological toxicity (mainly nausea and vomiting). The median time to neutrophil and platelet recovery was 28 and 31 d, respectively. No significant differences were seen with the addition of ida. There was a 17% incidence of treatment‐related deaths, of which 39% was caused by invasive aspergillus infection. The results show that FLAG ± Ida is an effective and well‐tolerated remission induction regimen for poor risk leukaemia and MDS.
Eosin‐5‐maleimide binding to band 3 and Rh‐related proteins forms the basis of a screening test for hereditary spherocytosis
Authors: King May‐Jean , Smythe Jonathan S. , Mushens Rosey 
Published: December 2004

SummaryFlow cytometric analysis of eosin‐5‐maleimide (EMA) binding to red cells is a screening test for the diagnosis of hereditary spherocytosis (HS). The present study used chemical modifications to determine the integral membrane proteins that react with EMA. The predominant interaction of EMA, contributing c. 80% of fluorescence, was with the ɛ‐NH2 group of lysine in band 3 protein, as previously reported. The remainder of the EMA fluorescence was attributable to labelling of accessible sulfhydryl groups on intact red cells. This reaction was heat labile. Three molecules containing sulfhydryl groups were shown to be associated with the Rh blood group protein complex by sodium dodecyl sulphate polyacrylamide gel electrophoresis. These were CD47 and the Rh‐associated glycoprotein, both in the Mr 40–60 kD region, and the Rh blood group proteins in the 30–32 kD region. Immunoprecipitation, using specific monoclonal antibodies and antibody binding studies by flow cytometry, showed that the relative content of these three membrane proteins was lower in HS than normal red cells. Thus, the high predictive value of the EMA binding test for HS reflects changes in the relative amounts of the Rh‐related integral membrane proteins as well as band 3 in HS red cells.
Severe pulmonary hypertension: a frequent complication of stem cell transplantation for malignant infantile osteopetrosis
Authors: Steward C. G. , Pellier I. , Mahajan A. , Ashworth M. T. , Stuart A. G. , Fasth A. , Lang D. , Fischer A. , Friedrich W. , Schulz A. S. ,   the Working Party on Inborn Errors of the European Blood and Marrow Transplantation Group
Published: December 2004

SummaryThis report describes eight infants who developed acute severe pulmonary arterial hypertension (PAH) at days −2 to +89 after allogeneic stem cell transplantation (SCT) for malignant infantile osteopetrosis (MIOP). They were taken from a total of 28 children (frequency 29%) transplanted for this disease at three institutions between 1996 and 2002. Typical presentations were acute dyspnoea, hypoxia and brady/tachycardia usually in the absence of fever, crepitations or other evidence of infection. Six patients (75%) required assisted ventilation and five (62%) died. There was clinical or pathological evidence of veno‐occlusive disease (VOD) in three children, but absence of VOD in the remaining five suggests that a separate disease process may be responsible for the PAH. Responses to nitric oxide (NO), defibrotide (DF), nicardipine and steroids in varying combinations were disappointing. Three children showed sustained improvement after administration of epoprostenol (EP, prostacyclin) in conjunction with NO and/or DF and remain well and free of PAH 25, 31 and 32 months post‐transplant. PAH must therefore be excluded in any child who becomes acutely breathless after SCT for osteopetrosis.
Prevention of lumbar artery endoleaks following endovascular abdominal aortic aneurysm repair with the selective use of absorbable gelatin sponge
Authors: Walker S R , Macierewicz J , Hopkinson B R 
Published: December 2004

Abstract

Background
The aim of endovascular repair of an abdominal aortic aneurysm is to exclude the aneurysm from the systemic circulation in order to prevent aneurysm expansion and rupture. Lumbar artery (LA) endoleaks have been associated with continued expansion of the aneurysm sac and occur with a reported incidence of approximately 10 per cent. The aim of this study was to reduce the incidence of LA or inferior mesenteric artery (IMA) endoleaks.

Methods
Following deployment of an aortic uni-iliac graft an aneurysmograph was performed by injecting contrast into the aneurysm sac to look for patent aortic side branches. Patients with no visible side branches had an occluder deployed in the contralateral iliac artery. Patients with patent side branches had an absorbable gelatin sponge inserted into the aneurysm sac before occluder deployment. Patients had contrast-enhanced spiral computed tomography (CT) during follow-up at 1 week, and 3, 6 and 12 months.

Results
Fifty-four patients were studied. Eleven were excluded (two perioperative deaths, seven top endoleaks and two occluder endoleaks). Median follow-up was 2 (range 11–7) months. Of the 17 patients in whom patent vessels were demonstrated on an aneurysmograph, one had a patent IMA only, three had a patent LA and IMA, and the remainder had a patent LA. No patient within the study has had a LA or IMA endoleak identified at follow-up CT.

Conclusion
An intraoperative aneurysmograph can help select patients for aneurysm sac packing with gelatin sponge and has been successful in the short term in preventing LA and IMA endoleaks.
Benign anastomotic stricture following transthoracic subtotal oesophagectomy and stapled oesophago-gastrostomy: risk factors and management
Authors: Dresner S M , Lamb P J , Wayman J , Hayes N , Griffin S M 
Published: December 2004

Abstract

Aims
Benign anastomotic stricture (BAS) is a common cause of dysphagia following oesophagectomy. The aim of this study was to assess the incidence of BAS, identify risk factors for its development and evaluate the results of postoperative endoscopic dilatation.

Methods
A consecutive series of 234 patients undergoing oesophagectomy with a stapled intrathoracic oesophagogastric anastomosis (Autosuture CEEA gun) between April 1990 and April 1999 were studied. BAS was defined as dysphagia with anastomotic narrowing (XQ200 endoscope) and no suspicion of recurrence. Statistical analysis was by the χ2 and Mann–Whitney U tests.

Results
The postoperative mortality rate was 5 per cent (12 of 234) and the anastomotic leak rate 3 per cent (six of 234). One-third of patients (70 of 222) who survived surgery re-presented with dysphagia; 5 per cent (11 of 222) were found to have proven local recurrence and 27 per cent (59 of 222) BAS. The median time to development of BAS was 92 (range 24–210) days. BAS formation was significantly related to the size of the staple gun employed: 21 mm, 80 per cent (eight of ten); 25 mm, 32 per cent (25 of 78); 28 mm, 23 per cent (19 of 81); 31 mm, 19 per cent (seven of 37) and 34 mm, 0 per cent (none of five) (χ2 = 18·3, 4 d.f., P &lt; 0·01). All patients underwent radiographically controlled endoscopic dilatation with no complications. Recurrent BAS occurred in over half of these patients (32 of 59), who had a median of 2 (range 2–17) recurrences all resolving within 532 (mean interval 68) days. Recurrent BAS formation was also significantly related to the size of the staple gun employed (χ2 = 11·6, 4 d.f., P &lt; 0·05). Following the introduction of the Autosuture ‘tilt-top’ device in July 1995 the median size of gun used rose from 25 to 28 mm with an overall decrease in the incidence of BAS from 33 to 21 per cent (χ2 = 4·0, 1 d.f., P &lt; 0·05). All patients with anastomotic leaks survived and none subsequently developed BAS. Similarly, no association was found between the development of BAS and the anastomotic site (measured from incisors), tumour subtype, resection margin length, sex, age or preoperative cardiorespiratory status.

Conclusions
Staple gun size is an important risk factor for BAS formation and ‘tilt-top’ devices enable the use of a larger head with a subsequently lower incidence of BAS. Endoscopic dilatation is an effective treatment for BAS which rarely recurs and always resolves within 18 months.
Effect of stockings on calf muscle oxygenation in patients with venous insufficiency
Authors: Agu O , Seifalian A , Hamilton G , Baker D M 
Published: December 2004

Abstract

Background
The mechanism of action of stockings in symptom relief and treatment of venous insufficiency is still inadequately understood. Near-infrared spectroscopy (NIRS) provides continuous non-invasive monitoring of changes in tissue oxygen reserves and availability, by monitoring oxyhaemoglobin (HbO2), deoxyhaemoglobin (HbD) and cytochrome oxidase (CtO2). This study investigated the effect of stockings on calf muscle oxygenation during exercise using NIRS in patients with venous insufficiency.

Methods
Ten patients (mean(s.e.m.) age 56(5) years, seven women) with venous insufficiency participated in the study. Patients rested in a supine posture for 20 min. NIRS probes were attached to the calf at interoptodes spacing of 4 cm and initialized to zero. Calf oxygenation was continuously monitored during standing followed by a 5-min slow walk at 1·6 km h−1 with and without stockings chosen at random. A 30-min rest in the supine position was allowed between stockings. Pulse rate and peripheral oxygen saturation were monitored continuously by a pulse oximeter.

Results
Mean HbO2 concentration, HbD and mitochondrial oxygenation (CtO2) increased significantly with stockings during exercise.

Conclusion
Graduated compression stockings may achieve beneficial effects by improving calf muscle oxygenation during exercise in patients with venous insufficiency.
Carotid artery plaque morphology is related to time since last neurological event
Authors: Senaratne J W B , Handa A , Hands L J , Collin J , Morris P J , Green F R 
Published: December 2004

Abstract

Background
Conflicting conclusions have been drawn regarding the relationship of plaque morphology and symptomatology of carotid atherosclerosis. Previous papers have examined the nature of symptoms and the degree of stenosis. This study determined whether plaque morphology was related to symptomatology with regard to the nature, timing and amount of symptoms, and the degree of stenosis.

Methods
In 60 consecutive carotid endarterectomies the symptoms (transient ischaemic attack (TIA), cerebrovascular accident (CVA), amaurosis fugax (AF), other), time between last neurological event and surgery, number of episodes and the degree of stenosis were recorded prospectively. The plaques removed at surgery were examined immediately and by histology. The macroscopic appearance was recorded as stable (fibrous or fatty plaque with or without calcification) or unstable (plaques with ulceration, rupture or thrombosis). Microscopic grading as either stable or unstable was done using the criteria of a consensus document (Circulation 1995).

Results
There were more CVAs (11 of 34 versus four of 26), and fewer TIAs (17 of 34 versus 16 of 26) and instances of AF (six of 34 versus six of 26) when the plaque was deemed unstable, but this was not statistically significant. Twenty of 34 patients with an unstable plaque had an event in the 6 weeks preceding surgery compared with one of 26 with a stable plaque (P &lt; 0·001). Unstable plaques were associated with more events (12 of 34 patients had more than three events compared with one of 26 with a stable plaque; P = 0·012). Degree of stenosis was not related to plaque morphology. In a logistic regression model, the only predictive factor for finding an unstable plaque at surgery was the timing of the last neurological event (P &lt; 0·001).

Conclusion
The importance of time since the last neurological event in predicting plaque instability is shown. This factor may help to clarify future studies attempting to determine plaque morphology before operation by ultrasonography.
Mortality rate of elective abdominal aortic aneurysm repair is lower in screened men
Authors:   Gloucestershire Vascular Group, Irvine C D , Whyman M R , Poskitt K R , Heather B P , Earnshaw J J 
Published: December 2004

Abstract

Background
It is expected that the main benefit of abdominal aortic aneurysm (AAA) screening will be derived from differences in the mortality rate between elective and ruptured AAA repair. There may also be differences in elective AAA mortality rate between screened and non-screened patients, and the aim of this study was to compare mortality rates for these two groups using standard statistical analysis, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and P-POSSUM scoring.

Methods
Patients undergoing elective AAA repair were either from a current screening programme to detect men over 65 years with AAA (screened) or were referred from other sources (non-screened). All patients were scored using the POSSUM scoring system. Mortality data were studied. Agreement between observed and expected deaths for POSSUM and P-POSSUM for screened and non-screened patients was determined.

Results
Some 276 elective AAA repairs were performed with an overall mortality rate of 6·9 per cent (see Table below). The mortality rate of 2·7 per cent for 111 screened patients was significantly less than that of 9·7 per cent for 165 non-screened patients (Pearson χ2 = 5·06, P = 0·02). Actual versus predicted death ratio for all elective patients was 0·93 for POSSUM and 2·38 for P-POSSUM.

Conclusion
Screened patients have a lower mortality rate than non-screened patients for AAA repair. POSSUM scoring provides the best prediction of death in this elective AAA group.
Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss
Authors: Hafez H , Woolgar J , Robbs J 
Published: December 2004

Abstract

Background
The authors' experience of lower limb arterial injury (LLAI) management was analysed and risk factors associated with limb loss were identified.

Methods
Between 1987 and 1997, data on 550 patients with 646 LLAIs were analysed retrospectively.

Results
The mechanism of LLAI was gunshot wounds in 46 per cent, blunt trauma in 19 per cent, stabbing in 12 per cent and shotgun in 9 per cent. The most frequently injured vessel was the superficial femoral artery (37 per cent) followed by the popliteal (31 per cent), crural (11 per cent), common femoral (9 per cent) and profunda (59 per cent) arteries. In 3 per cent of patients there was a combined injury on either side of the knee. Associated injuries included bony injury in 35 per cent, nerve injury in 8 per cent and remote injuries affecting the head, chest or abdomen in 4 per cent. Surgery was carried out in 96 per cent of patients with a limb salvage rate of 84 per cent and a survival rate of 98 per cent. Despite a rising trend in LLAI, total and delayed amputation rates remained stable. On stepwise logistic regression analysis, significant (P &lt; 0·01) independent risk factors for amputation were blocked graft (odds ratio (OR) 16·7), combined above- and below-knee injury (OR 4·4), tense compartment at presentation (OR 4·2), arterial transection (OR 2·8) and associated compound fractures (OR 2·7). Factors such as simple fractures, venous injury/ligation and the use of synthetic grafts were not associated with increased risk of limb loss.

Conclusion
LLAI carries a high amputation rate. Stab injuries are the least likely to lead to amputation whereas injuries associated with severe soft tissue damage, such as high-velocity firearm injuries and blunt trauma with compound fractures, are the most likely to do so. The most significant independent risk factor for limb loss was failed revascularization.
Patch angioplasty reduces morbidity and restenosis following carotid endarterectomy
Authors: Ray S A , Lockhart S J , Dourado R , Irvine A , Burnand K G 
Published: December 2004

Abstract

Background
The role of patch angioplasty in the prevention of stroke and restenosis following carotid endarterectomy remains controversial, partly because of confounding variables such as surgical expertise and selective shunting.

Methods
A consecutive series of 177 carotid endarterectomies performed on 168 patients by, or under the supervision of, one surgeon between December 1992 and July 1999 with routine shunt insertion and completion arteriography was studied. Until April 1997 arteriotomies were closed primarily, with patch angioplasty reserved for small vessels or patients found to have occlusion of the internal carotid artery at operation. After April 1997 Dacron patch closure was performed routinely. All patients had duplex ultrasonography 3 months following endarterectomy.

Results
The indication for surgery and patient characteristics were similar in those who had primary closure and those with patch angioplasty. The postoperative morbidity and incidence of restenosis is shown in the Table.
One of two patients found at surgery to have a recently occluded internal carotid artery had a stroke. The only patient with patch angioplasty and postoperative reocclusion had the lupus anticoagulant and reported amaurosis. Two wound infections overlying Dacron patches resolved with antibiotics and there were no episodes of patch disruption.

Conclusion
This study provides further evidence that patch angioplasty following carotid endarterectomy may reduce postoperative morbidity and early restenosis.
Risk factors for delayed healing and long-term recurrence in chronic venous leg ulcers
Authors:   Gloucestershire Vascular Group, Barwell J R , Taylor M , Ghauri A S K , Bronder C , Phillips L , Poskitt K R , Whyman M R 
Published: December 2004

Abstract

Background
This study aimed to identify risk factors for delayed healing and increased recurrence of chronic venous leg ulcers.

Methods
Some 669 patients with chronic leg ulcers were assessed at a one-stop clinic over the 4 years to July 1999. Possible risk factors and venous reflux patterns, assessed with colour duplex, were recorded prospectively for each patient. Some 633 legs with an ankle: brachial pressure index greater than 0·85 were treated with weekly four-layer bandaging until healed, followed by class 2 compression stockings and regular follow-up. Patients with isolated superficial venous reflux were offered surgery.

Results
Cox regression analyses of possible risk factors are summarized in the Table below.

Conclusion
Age, ulcer chronicity and reflux in the popliteal vein are independent risk factors for delayed ulcer healing. Delayed ulcer healing and rheumatoid arthritis are independent risk factors for ulcer recurrence. Legs with surgically corrected superficial venous reflux are relatively protected from ulcer recurrence.