Use of combined plasmapheresis and immunosuppression in the treatment of Goodpasture's syndrome.

Five consecutive patients with well-documented Goodpasture's syndrome were treated with plasmapheresis and immunosuppression. In all patients, the antiglomerular basement-membrane antibody titers decreased with treatment. In three patients, hemoptysis responded promptly to plasmapheresis.

Surgical treatment of stages IB and IIA invasive carcinoma of the cervix by radical abdominal hysterectomy.

From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established.

Removal of bile acids and bilirubin by plasmaperfusion of U.S.P. charcoal-coated glass beads.

Removal of protein-bound cholephilic substances such as BA by sorbent perfusion might improve the quality of life of patients with severe inoperable cholestasis where the accumulation of BA is thought to be responsible for the often distressing pruritus. Since hemoperfusion is associated with hematological side effects, plasmaperfusion which, in addition, allows the use of novel, possibly more efficient sorbents, might be preferable, provided a substance with a high affinity for these protein-bound anions could be found. A number of sorbents suitable for plasma-perfusion were therefore tested in vitro as to their BA-adsorbing capacity.

Plasmaperfusion for the treatment of intractable pruritus of cholestasis.

A patient with primary biliary cirrhosis and intractable pruritus was treated with plasmaperfusion of charcoal-coated glass beads on two occasions. The procedures were well tolerated and resulted in the removal of about 70% (494 mumol) of the estimated chenic acid pool. There was, in addition, pronounced amelioration of the pruritus which enabled the patient to sleep through the night without awakening because of itching.

Hemolytic transfusion reaction. Recent experience in a large blood bank.

Data on 47 cases of hemolytic transfusion reactions are presented along with a review of the literature. Human error and limitations of current techniques of compatibility testing remain the major causative factors of hemolytic transfusion reactions.

Metastasis to the vagina from carcinoma of the breast.

Carcinoma of the breast, metastatic to the ovary, is encountered frequently. The potential routes of dissemination include transcoelomic spread, lymphatic spread and vascular (arterial or venous) transportation. A case report of vaginal metastasis secondary to bilateral breast carcinoma is cited and the potential mechanisms for dissemination described.

Autologous blood transfusion.

Autologous blood transfusion is a procedure in which blood is removed from a donor and returned to his circulation at some later time. Autologous transfusion can be performed in three ways: (1) preoperative blood collection, storage, and retransfusion during surgery; (2) immediate preoperative phlebotomy with subsequent artificial hemodilution and later return of the phlebotomized blood; and (3) intraoperative blood salvage and retransfusion. All three methods of autologous transfusion offer a potentially superior method of blood transfusion which eliminates many of the problems and complications associated with the banking and administration of homologous donor blood.

Transfusion reaction. An immunologic hazard of blood transfusion.

Twenty-three cases of delayed hemolytic transfusion reaction (DHTR) occurring at the Mayo Clinic from 1964 through 1973 are reviewed. Nineteen patients had clinical manifestations of hemolysis, of which fever was the most frequent presenting symptom. The degree of hemolysis served as an index of morbidity.

Complications of dorsal column stimulation.

The complications associated with 92 dorsal column stimulator implants are reported. They were of two types, technical and functional. In all there were 58 significant complications.

Continuous- and semicontinuous-flow blood centrifugation systems: therapeutic applications, with plasma-, platelet, lympha-, and eosinapheresis.

Blood centrifugation, with a continuous-flow or semicontinuous-flow system, was used in the treatment of 17 patients with various hematologic disorders. Total plasma exchange (TPE) controlled symptoms of hyperviscosity and arrested bleeding in three patients. In two patients, TPE made is possible to perform urgent surgical procedures.

Computed tomography in intracerebral hemorrhage.

Computed tomography is a practical and simple procedure for diagnosis of acute intracerebral hemorrhage. By this means, operable intracerebral hemorrhage was diagnosed in five patients; four were treated surgically. Computed tomography showed the size and location of the hematomas, making surgical treatment feasible despite occasional large extensions of the lesions.

Restoration of hemoglobin function in stored EDTA blood. Application in identification of hemoglobin variants with abnormal oxygen affinity.

The incubation of stored blood in a mixture of inosine, pyruvate, glucose, and phosphate restores the O2 affinity of hemoglobin to physiologic levels, as measured by the configuration of the dissociation curve and the P50. This regeneration of normal hemoglobin function not only is consistent for samples anticoagulated with EDTA and stored eight days at 4 C but also is demonstrable for at least 19 days of 4 C storage of EDTA-anticoagulated whole blood. This regeneration procedure is simple to perform and makes it possible to measure reliably O2 affinity in blood samples transmitted by mail.

Blood transfusion for the patient who is difficult to transfuse.

There are two types of patients who are difficult to transfuse because of the presence of red cell antibodies, those patients who have an antibody reactive against an antigen of high incidence and those who have multiple antibodies. Possible sources of blood for the patient who has an antibody reactive against a high-incidence red cell antigen include the patient's family, rare donors lacking the high-incidence antigen, and self-donation. Possible sources of blood for those who have multiple antibodies are limited to rare donors lacking the appropriate combination of antigens or to self-donation.

Chronic granulomatous disease and the Mcleod phenotype. Successful treatment of infection with granulocyte transfusions resulting in subsequent hemolytic transfusion reaction.

A young man with X-linked chronic granulomatous disease of childhood, who is of the rare McLeod phenotype with antibodies in his serum shown to be hemolytic and reactive against all red cells with normal expressions of the Kell antigens, developed a severe Nocardia pneumonia with abscess formation and was subsequently treated successfully with granulocyte transfusions in spite of the presence of anti-KX in the patient's serum. The anti-KX did not appear to alter significantly the effectiveness of the transfused granulocytes; it did, however, cause a mild hemolytic transfusion reaction. The patient made a remarkable recovery from this episode and his condition has progressed to a state satisfactory enough for him to donate his own blood for storage and possible use in the future.

Erythrocyte morphology in genetic defects of the Rh and Kell blood group systems.

Absence of KX antigen and of normal expression of the Kell system antigens is associated with bizarre red blood cell morphology when observed by either light or scanning electron microscopy. Numerous acanthocytes and dacryocytes have been observed in the peripheral blood smear of an apparently healthy individual with McLeod-phenotype blood, in a male patient with type II chronic granulomatous disease who had a shortened 51Cr red blood cell survival time, and in a minor population of the red blood cells of his carrier mother.

HLA antigens in patients with giant cell arteritis and polymyalgia rheumatica.

The frequency of 24 HLA antigens was determined in 43 patients with giant cell arteritis (25 of whom had polymyalgia rheumatica) and 12 others with polymyalgia rheumatica without evident arteritis. No haplotype was present in significantly increased frequency above controls in the total group nor when the patients were separated according to the presence or absence of polymyalgia rheumatica.

Exclusion of the HLA locus from a large portion of the long arm of chromosome 6.

HLA antigens were determined in two infants with multiple congenital anomalies and in their healthy parents and one sibling. One infant had a deletion of a major portion of the long arm of chromosome 6. The other child had a translocation of a similar piece of chromosome 6 to the short arm of chromosome 3.

Autologous blood transfusion.

Autologous blood transfusion is a procedure in which blood is removed from a donor and returned to his circulation at some later time. Autologous transfusion can be performed in three ways: (1) preoperative blood collection, storage, and retransfusion during surgery; (2) immediate preoperative phlebotomy with subsequent artificial hemodilution and later return of the phlebotomized blood; and (3) intraoperative blood salvage and retransfusion. All three methods of autologous transfusion offer a potentially superior method of blood transfusion which eliminates many of the problems and complications associated with the banking and administration of homologous donor blood.

Dorsal column stimulation and its prospects.

Results of a series of dorsal column stimulation implants in 76 patients are tabulated and correlated to implant location, type of electrodes used and pain causes; complications are also discussed.