Liberalized screening for blunt carotid and vertebral artery injuries is justified.

Background: Current literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons.

Colony-stimulating factors in stem cell transplantation: effect on quality of life.

Health-related quality of life (QOL) is poorest during the immediate post-transplantation period, but the impact of medical interventions during this period has not been studied. Colony-stimulating factors (CSFs), which are used to minimize short-term negative outcomes, might be expected to improve QOL; however, little is published about their impact on QOL during this period. We conducted a MEDLINE search to identify studies reporting on outcomes of stem cell transplantation (SCT) affected by the CSFs, mainly sargramostim and filgrastim.

Allogeneic bone marrow transplantation from partially mismatched related donors as therapy for primary induction failure acute myeloid leukemia.

The outcome of acute myeloid leukemia patients with primary refractoriness to conventional chemotherapy is extremely poor. Allogeneic bone marrow transplants with matched sibling or matched unrelated donors provide 10-20% disease-free survival in this setting. We analyzed our transplant experience using readily available partially mismatched related donor (PMRD) in patients with primary induction failure (PIF) AML.

AANA Journal course: update for nurse anesthetists--low molecular weight heparin: pharmacology and regional anesthetic implications.

Low molecular weight heparins were first introduced in the United States in May 1993 as an alternative to currently available anticoagulant therapy. Like standard heparin, these anticoagulants inhibit activation of a number of coagulation enzymes, but low molecular weight heparins have their primary inhibitory effect on factor Xa. A decrease in plasma protein binding by low molecular weight heparin results in greater bioavailability and a more predictable therapeutic response than that of standard heparin.

Evaluation of the half-life of intravenous human cytomegalovirus immune globulin in patients receiving partially mismatched related donor bone marrow transplantation.

Study Objective: To evaluate the pharmacokinetics and use of intravenous human cytomegalovirus immune globulin (CytoGam) in allogeneic bone marrow transplantation (BMT).

Design: Prospective, nonrandomized, nonblinded, single-center study.

Setting: University teaching hospital.

Silent polymorphisms within the coding region of human sodium/hydrogen exchanger isoform-1 cDNA in peripheral blood mononuclear cells of leukemia patients: A comparison with healthy controls.

We have examined the sequence of the cDNA encoding the sodium/hydrogen exchanger isoform 1 (NHE1), from 23 bases upstream of the start codon to 28 bases downstream of the stop codon. Template was prepared from (1) peripheral blood mononuclear cells (PBMC) isolated from 10 healthy unrelated Caucasian volunteers; (2) PBMCs isolated from 6 leukemic patients (acute lymphoblastic leukemia [ALL], n = 3; chronic lymphocytic leukemia [CLL], n = 1; chronic myelogenous leukemia [CML], n = 2); and (3) samples of 4 leukemic cell lines (ALL: CEM, MOLT4; AML: KG1a; CML: K562). NHE1 cDNA in normal PBMCs showed silent polymorphism of nucleotides 112 (N1: T, frequency 0.

Participants in the Program of All-Inclusive Care for the Elderly (PACE) demonstration: developing disease-impairment-disability profiles.

The Program of All-Inclusive Care for the Elderly (PACE) builds on On Lok's community-based care and financing model for disabled elderly people who are state certified as eligible for nursing home care. Yet PACE's diverse population has not been fully described. We obtained data for a complete cross-section of PACE participants from early 1997 (N = 2,917).

Partially mismatched related-donor bone marrow transplantation for pediatric patients with acute leukemia: younger donors and absence of peripheral blasts improve outcome.

Purpose: To extend access to bone marrow transplantation (BMT), we used partially mismatched related donors (PMRD) for pediatric patients with acute leukemia. In this report we sought to determine pretransplantation factors that might predict outcome.

Patients And Methods: Of 67 such patients, 43 had acute lymphocytic leukemia and 24 had acute myelogenous leukemia.

Healing Icons: art support program for patients with cancer.

Objectives: The purpose of this report is to describe the structure and process of an art support program for patients with cancer who are age 16 and older.

Materials And Methods: Healing Icons is a six-session art support program for cancer patients. During the program participants create a three-dimensional mixed-media art piece to convey a unique personal perspective on receiving a diagnosis of and being treated for cancer.

Apoptosis of leukemic cells accompanies reduction in intracellular pH after targeted inhibition of the Na(+)/H(+) exchanger.

The Na(+)/H(+) exchanger isoform 1 (NHE1) is primarily responsible for the regulation of intracellular pH (pH(i)). It is a ubiquitous, amiloride-sensitive, growth factor-activatable exchanger whose role has been implicated in cell-cycle regulation, apoptosis, and neoplasia. Here we demonstrate that leukemic cell lines and peripheral blood from primary patient leukemic samples exhibit a constitutively and statistically higher pH(i) than normal hematopoietic tissue.

Using ultrasound to determine external pacer capture.

Transcutaneous cardiac pacing is a temporary treatment of hemodynamically unstable bradycardias. However, the rhythmic skeletal muscle contractions that occur during external pacing can make it difficult to assess the hemodynamic status of the patient. We report a case of using bedside ultrasound to assess the effectiveness of transcutaneous pacer capture.

Expression of CD134 (0X-40) on T cells during the first 100 days following allogeneic bone marrow transplantation as a marker for lymphocyte activation and therapy-resistant graft-versus-host disease.

CD134 (OX-40) is an activation-associated antigen which functions as a costimulatory receptor for CD4+ T cells. In order to determine the expression of CD134 during immune recovery following allogeneic bone marrow transplantation (BMT), we measured its expression on T cells and T cell subsets during the first 100 days following BMT in 26 patients. CD4+CD134+ T could be seen approximately 14 days following BMT cells in patients who did not develop GvHD which required therapy (n = 20).

Appendix: education and information resources in hyperbaric medicine.

A comprehensive listing of hyperbaric medicine resources is provided. These resources serve the educational and information needs of those who wish to enter this medical specialty, as well as those who practice it. A selected hyperbaric specific bibliography is included, as is the methodology to stay current with the scientific and technological advances of this field.

Simultaneous pancreatitis and hepatitis associated with trimethoprim-sulfamethoxazole.

A 34-yr-old woman developed simultaneous pancreatitis and hepatitis following exposure to trimethoprim-sulfamethoxazole (TMP/SMX). The episode occurred 4 yr after a previous episode of hepatitis associated with TMP/SMX. This patient represents the second case of concurrent TMP/SMX-induced pancreatitis and hepatitis reported in the literature.

Actual vs perceived EMS response time.

Objective: To compare patients' perceptions of ambulance response times with the actual ambulance response times to aid quality assurance efforts in EMS management.

Methods: A convenience sample of patients presenting to an urban ED via EMS were asked a series of four questions pertaining to response time, scene time, time to definitive care, and their expectations of response time. These times were then compared with actual times from the EMS dispatch center.

Influence of T cell depletion method on circulating gammadelta T cell reconstitution and potential role in the graft-versus-leukemia effect.

Background: Our laboratory previously reported that leukemia patients who developed > or = 10% gammadelta+ T cells during the first six months after receiving an anti-TCRalphabeta T-cell-depleted (TCD) graft from a partially mismatched related donor (PMRD) had a disease-free survival (DFS) advantage. These gammadelta+ T cells were V81+CD3+CD4-CD8-CD69+HLADR+ and are cytotoxic to K562 cells.

Methods: In order to determine whether the anti-alphabeta TCD regimen was associated with these findings, we compared the reconstitution of gammadelta+ T cells from patients who received TCD PMRD grafts using the anti-TCRc4 MAb TIOB9-1A31 (previously reported) with similar patients who received grafts using the anti-CD3 MAb OKT3.

A cost-effectiveness model for analyzing two varicella vaccination strategies.

A model for estimating the cost-effectiveness of a program for vaccinating employees at a health care institution against varicella zoster virus (VZV) was studied. Three outcomes of varicella vaccination--cost-effectiveness, reduction in employee infections, and reduction in patient exposures--were stratified to estimate the incremental costs of vaccinating three employee groups. The groups consisted of all employees (vaccinate-all group), employees providing direct patient care (direct care group), and employees working in high-risk patient care areas (high-risk group).

Activation of the sodium/hydrogen exchanger via the fibronectin-integrin pathway results in hematopoietic stimulation.

The proliferative response of hematopoietic cells is regulated by many factors, including the presence and type of growth factors, the cellular microenvironment, and the physiochemical conditions prevailing in the tissue milieu. A process fundamental to all cells is the regulation of the intracellular acid-base conditions. One of the mechanisms by which intracellular pH (pHi) is regulated is through the sodium/hydrogen exchanger, a ubiquitous membrane protein which exploits the intra- and extracellular sodium ion gradient to drive hydrogen ions out of the cell.

Calculation of enhanced dynamic wedge factors for symmetric and asymmetric photon fields.

A method is introduced to calculate wedge factors for an enhanced dynamic wedge (EDW). An analytic formula has been derived that allows the determination of wedge factors at the center of symmetric and asymmetric photon fields. The formalism is an extension of the "MU fraction approximation," which holds that the dynamic wedge factor is equal to the fraction of MU delivered to the point of calculation.