Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial

Background

Hypoglycemia is a major cause of morbidity and mortality among preterm infants and its management remains a challenge in resource limited settings. Use of dextrose infusion by the recommended infusion pumps is not feasible in our environment due to their high costs and yet the current use of mini dextrose boluses with syringes as adapted at Mulago national referral and tertiary teaching hospital has unknown efficacy in prevention of hypoglycemia

Objective

We determined the efficacy of dextrose infusions by burettes versus two hourly dextrose boluses in prevention of hypoglycemia among preterms admitted in the first 72 hours at Special Care Unit, Mulago Hospital.

Methods

One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Blood glucose was measured at 0, two hourly for next 6 hours, 6 hourly for next 12 hours and thereafter 12 hourly until end of 72 hours following admission. Primary end point was incidence of hypoglycemia (random blood sugar (RBS) < 2.6mmol/l) which was expressed as relative risk (RR). Efficacy of the dextrose infusion was computed using 1-RR.

Results

From February 2012 to April 2012, 68 preterms in the bolus arm and 72 in the infusion arm were studied. Hypoglycemia was detected in 34% (48/140). The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the infusion arm (RR; 0.19, 95% CI; 0.09–0.37). Efficacy (1-RR) of infusion by burettes versus boluses in prevention of hypoglycemia among preterms was 0.81 (95% CI; 0.63–0.90).

Conclusion

Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital. (ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT01688674","term_id":"NCT01688674"}}NCT01688674)     

Infusion thrombophlebitis--histological and bacteriological study

In a study conducted over a four year period, 99 developed thrombophlebitis of the total of 560 intravenous infusions under similar infusion conditions. In all the patients who developed phlebitis, fluid from the bottle, first 5 ml. of fluid from the infusion set after removing the drip and the needle itself were subjected to bacteriological study. Only in two cases the culture was positive, indicating it was a non-bacterial inflammation. The vein was subjected for histopathology after obtaining a small segment. Histopathology showed thrombus in the lumen of the vein in the majority of the cases, destruction of endothelial lining with pyknosis of nuclei and leucocyte infiltration in the media.     

125I-fibrinogen uptake on peripheral venous cannulas: a comparison between different cannula materials and coatings

Using a similar technique as 125I-Fibrinogen uptake test for detection of deep venous thrombi, the radioactivity over cannulas inserted into veins on the dorsal aspect of the hands was measured 1, 2, 4 and 24 h after insertion. In three groups of 10 postoperative patients it was by random allocation inserted on one side a siliconized tetrafluorethylene cannula and on the other side one of either: a nonsiliconized tetrafluorethylene cannula and on the other side one of either: a nonsiliconized tetrafluorethylene, a heparinized tetrafluorethylene or a fluorethylenpropylene cannula. The same volume and type of infusion was given in both cannulas. No difference in protein deposition was seen between siliconized and nonsiliconized tetrafluorethylene. A tendency of lower protein deposition, especially at 24 h on heparinized tetrafluorethylene was found. The fluorethylenpropylene cannulas had both over cannula and adjacent vein higher protein deposition at all measurements compared to the siliconized tetrafluorethylene cannula (p less than 0.01). The results implicate that fluorethylenprophylene could induce a higher incidence of thrombophlebitis than tetrafluorethylene cannulas.     

An improved method of quadriceps thermocouple implantation

An improved method of quadriceps thermocouple implantation utilizing a commercially available teflon venous catheter is described. This catheter possesses an inner protruding steel needle, which can be withdrawn after catheter implantation, and a leur fitting which allows syringe attachment and infusion of pain blocker during catheter implantation. Compared to other methods of thermocouple implantation, the present method appears to minimize discomfort to subjects, significantly increases thermocouple longevity, and permits thermocouple replacement during exercise. We believe this technique will facilitate research involving the continuous measurement of muscle temperature during exercise.     

Plasma catecholamine concentrations during a 72-hour aminophylline infusion in children with acute asthma

To explore the possibility that theophylline may act through adrenomedullary secretion of catecholamines, we examined the time courses of plasma norepinephrine (NE), epinephrine (E), and theophylline concentrations and peak expiratory flow (PEF) in nine children with an acute exacerbation of asthma receiving a 72-hour constant infusion of aminophylline. These measurements were made before (baseline) and at 2, 24, 48, and 72 hours after the infusion began. Plasma theophylline concentrations were kept constant in a near midpoint therapeutic range (mean +/- SEM, 14.1 +/- 1.3 to 16.1 +/- 1.1 micrograms/ml) during the 24- to 72-hour infusion periods. Compared with the respective baseline values (383.8 +/- 56.0 and 67.6 +/- 11.8 pg/ml for NE and E), the following postinfusion plasma catecholamines reached statistically significant difference: 664.0 +/- 125.1 pg/ml for NE at 24 hours (p less than 0.05), and 214.9 +/- 57.8, 233.7 +/- 82.2, and 137.6 +/- 39.4 pg/ml for E at 2, 24, and 48 hours (p less than 0.01). Despite the fact that similar plasma theophylline concentrations were maintained, plasma E, which peaked at 24 hours after dose, returned toward the baseline at the end of infusion (99.7 +/- 24.1 pg/ml), whereas this trend was not observed for NE. The postinfusion PEF increased (p less than 0.01) in a stepwise fashion, compared with the baseline, as the infusion progressed. The change in PEF correlated significantly (p less than 0.002) with plasma theophylline concentrations but not with the increase in plasma E from the baseline. Theophylline concentrations did not correlate with the increase in plasma NE or E from the baseline.(ABSTRACT TRUNCATED AT 250 WORDS)     

Preoperative treatment with levosimendan in candidates for mechanical circulatory support

Left ventricular assist device (LVAD) implantation is a widely accepted treatment for end-stage heart failure. Preoperative conditions and right ventricular dysfunction are determinant parameters that influence outcome. We investigated the effect of preoperative levosimendan treatment in LVAD patients with moderate right ventricular dysfunction and right ventricular dilatation. Twenty-one patients treated with LVADs were included in the study. Before surgery, patients received levosimendan infusion (0.1-0.2 μg/kg/min) for 48 hours. Hemodynamic parameters and NT-proBNP were evaluated before, during, and 24 hours after the end of levosimendan treatment. During levosimendan treatment, all patients demonstrated a significant improvement in cardiac index (p = 0.014), pulmonary pressure (p = 0.003), and central venous pressure (p = 0.016). The hemodynamic condition worsened 24 hours after the end of the treatment in patients who died because of right ventricular failure while it was s in patients who survived. NT-proBNP was significantly higher (6733 vs. 8797 pg/ml) (p = 0.019) in patients who died because of right ventricular failure after 24 hours of levosimendan treatment. During levosimendan treatment, the median NT-proBNP value in patients who survived decreased by 39%, whereas in patients who died there was an increase of 3% (p = 0.008) at 72 hours. A reduction in NT-proBNP to below 25% is a predictor of mortality with sensitivity of 100% and specificity of 70%. Levosimendan treatment improves preimplant hemodynamic performance and permits the identification of patients who will develop right ventricular failure.     

Intravascular circulation and distribution of human 51Cr-DBBF stroma-free hemoglobin, 51Cr-plasma, 51Cr-saline, 59FE-plasma, and 125I-albumin in the mouse

Male B6C3HF1 mice were infused with human 51Cr-labeled DBBF (bis 3,5-dibromosalicyl fumarate) crosslinked stroma-free hemoglobin (SFH). In the first hour following SFH infusion, 11.2% of the infused radioactivity was found in the skin, 11.4% in muscle, 9.1% in the skeleton, and 5% in the liver. Twenty-four hours after infusion, 15.4% of the radioactivity was found in the skin, 10.3%, in the muscle, 16.6% in the skeleton, and 6.7% in the liver. The circulation and distribution of 51Cr-labeled DBBF-SFH were compared with levels of 51Cr labeled plasma, 51Cr in saline, 59Fe labeled plasma, and 125I albumin. The radioactivity in the blood was similar for 51Cr-DBBF-SFH, 51Cr-plasma, and 59Fe-plasma. During the 24-hour post-infusion period, extravascular distribution of the 51Cr-saline, 51Cr-plasma, and 125I albumin within the organs was similar to that of 51Cr-DBBF-SFH, with the highest levels being in skin, muscle, skeleton and liver, and no increase in the levels in the lung or spleen. The distribution of 59Fe compared to that of 51Cr-DBBF, 51Cr-plasma, 51Cr-saline, and 125I albumin can be explained by the fact that 59Fe is utilized in the production of new red blood cells.     

In vivo effects of stroma-free hemoglobin and polyhemoglobin on coagulation factors in rats

We studied the effects of rat stroma-free hemoglobin (rSFH), human stroma-free hemoglobin (hSFH), rat polyhemoglobin (rPoly), and human polyhemoglobin (hPoly) on coagulation factors in rats. Albumin and saline infused rats were controls. The infusion volume was 10% of the rat's blood volume. The concentrations of hemoglobin in this study were 7 g/dl. Measurements for prothrombin time (PT) and activated partial thromboplastin time (PTT) were at 5 minutes, 2, 6, 24 and 72 hours after infusion. Factor X, fibrinogen, plasminogen, antithrombin III, and antiplasmin were followed at 24 and 72 hours after infusion. Compared with saline infused rats PT and PTT did not change significantly in those rats infused with Hb preparations. There was a transient increase of PTT from 2 to 24 hours after infusion in albumin infused rats. Factor X, fibrinogen, antithrombin III and antiplasmin showed no significant differences between Hb infused groups and saline infused group. Twenty-four hours and 72 hours after infusion plasminogen decreased in all groups except the albumin infused rats at 24 hours after infusion when compared with normal rat plasma pool. However, there were no significant differences in plasminogen levels between the hemoglobin infused groups and the control saline group. Stroma-free and polyHb solutions (rSFH, hSFH, rPoly and hPoly) did not cause significant changes in prothrombin time and activated partial thromboplastin time in rats. The rats infused with hemoglobin solutions (rSFH, hSFH, rPoly, and hPoly) did not show significant differences in Factor X, fibrinogen, antithrombin III and antiplasmin levels compared with the control group.     

Comparative pharmacokinetics and renal accumulation of the iodized contrast media: ioxitalamic acid, ioxaglic acid and iohexol in the rabbit

Male and female rabbits were given a I.V. bolus injection of a single 5 ml/kg dose of either ioxitalamic acid, ioxaglic acid or iohexol. Animals were killed 2 hours, 8 hours and 24 hours after the injection. One group of animals received a continuous I.V. infusion of contrast agent at a constant rate of 2.5 ml/kg/hour of four hours. Animals were killed 30 minutes after the end of the infusion. Plasma and tissue concentrations of contrast agents were assayed using an HPLC method. A pharmacokinetic study was performed after the I.V. bolus injection. This study shows that: 1) Plasma elimination half-lives were identical in males and in females as well as for all three products. This half life is about 45 minutes. The distribution volume was identical in male and females as well as for all three products and was comprised between 20% and 26% of body weight. 2) For all three contrast agents, the renal cortical concentrations are higher than in the medulla or the papilla at all the observation times. The renal cortical accumulation of contrast agents is persistent in comparison to plasma concentrations. 3) Ionic and lipophilic properties of contrast agents seem to play an important role on the renal accumulation pattern.     

Trends in prostate needle biopsy diagnosis. A ten year experience of a medical center in Taiwan

Prostate cancer has seen a rapid rise in Taiwanese men. The current study was undertaken to evaluate trends of the disease diagnosed on prostate needle biopsy during a ten-year period at the Department of Pathology, Taipei Veterans General Hospital. The study included 8236 men who underwent a total of 9995 prostate needle biopsies at this institute from 1994 to 2003. Pathologic features pertinent to diagnosis of cancer were reviewed and compared for cases diagnosed before and after 1999. There were statistically significant increases of the overall cancer detection rate (from 17.6% to 19.9%), proportion of cases with a Gleason score ≤ 6 (from 16.6% to 40.9%) and focal adenocarcinoma (from 3.0% to 12.8%) in the latter 5 years. The incidence of high-grade prostatic intraepithelial neoplasia (HGPIN) increased from 0.1% to 1.5%. Patients with HGPIN had a significantly higher risk for subsequent cancer discovered on repeat biopsy than did those with a primary benign diagnosis (29.9% versus 13.7%). Despite a relatively lower incidence of cancer and HGPIN in Taiwanese men compared with that reported in Western studies, in recent years we have found an increase of relevant diagnoses, especially cancer of limited extent and lower grade, which may represent the progress in prostate cancer diagnosis.     

Nocturnal cyclic versus continuous total parenteral nutrition: food intake and feeding pattern in rats.

Total parenteral nutrition (TPN), providing the equivalent of 100% of mean daily oral intake for 24 hours, depressed spontaneous food intake (SFI) in rats by a mean greater than 80%. Whether TPN had the same effect on SFI when given either in 12-hour cycles (Cyclic-TPN) or in 24 hours (Continuous-TPN) for 8 days was tested in 16 rats with jugular catheters, placed in metabolic cages modified with an Automated Computerized Rat Eater Meter. This continuously measures food intake and its dependent indexes: meal number, meal size, meal duration, meal sniffs and intermeal sniffs. Both rat groups ate the same amounts of chow before TPN. On starting TPN, food intake decreased by greater than 80% in Cyclic-TPN and greater than 50% in Continuous-TPN during each first infusion period. A nadir in food intake was reached in 48 hours with Cyclic-TPN and in 72 hours with Continuous-TPN. Thereafter, there was no food intake during the 12 hours of Cyclic-TPN, with minimal food intake during the intervening 12 hours of non-TPN normal saline infusion period. In both forms of TPN infusion, a reduction in food intake was achieved by a reduction in meal number and size, and thus in meal duration. Feeding-related sniffing activity was decreased by similar amounts with Cyclic- or Continuous-TPN. Cyclic-TPN for 12 hours had no advantage over Continuous-TPN, in that there was no compensatory enhancement of food intake and meal-related behavior during the cyclic non-TPN normal saline period.     

Acquired deficit of antithrombin and role of supplementation in septic patients during continuous veno-venous hemofiltration

Continuous renal replacement therapy (CRRT) is widely used in the management of septic patients with acute renal failure (ARF). Short filter lifespan (<24 hours) is a major concern and may result of a procoagulating state. The aim of this study was to investigate the relationship between antithrombin (AT) deficit and early filter clotting, and whether supplementation of AT could increase filter lifespan. Two different methods for supplementation, bolus and continuous infusion were also compared. We conducted a two-center prospective study from March 2003 to May 2004. Twenty-seven patients with septic shock and ARF were included and treated by CRRT. Unfractionated heparin (UHF) was used for anticoagulation. The initial level of AT was low with a median level at 45.4% (16%-69%). Low AT activity was associated with shorter filter lifespan. Supplementation led to a longer filter lifespan (15.2-33.2 hours) (p < 0.05). Continuous infusion provided better results: 48.5 vs. 27.8 hours for bolus method. This study suggests that AT measurement should be considered in continuous veno-venous hemofiltration with clotting problems as supplementation could increase filter lifespan by more than 100%. Continuous infusion is preferable. Cost effectiveness should be evaluated shortly.     

Substitution of temazepam and midazolam in pentobarbital-dependent rats

The ability of temazepam and midazolam to substitute for pentobarbital and thus maintain the physical dependence state was used to assess the potential dependence liability of these two benzodiazepine compounds. Male Sprague-Dawley rats, weighing 175-200 g and having ad lib access to food and water, were determined to be dependent on pentobarbital following 12 days of continuous, intraperitoneal infusion of pentobarbital using an escalating drug infusion schedule. On day 13 (substitution phase) the pentobarbital was replaced with either temazepam, midazolam or vehicle and the rats were infused for an additional 24 hours. This was followed on Day 14 (withdrawal phase) by a 24 hr saline infusion period. Rats were observed for changes in overt behavior and alterations of body weight during both Day 13 and Day 14. Preliminary potency estimation studies had indicated that both drugs were more potent and longer acting than was pentobarbital. Temazepam, in doses of 32.5, 65 and 130 mg/kg/24 hr, was demonstrated to substitute for pentobarbital and provided dose-dependent suppression of overt behavioral signs indicative of withdrawal. Temazepam also suppressed the weight loss typically observed during withdrawal. Substitution of saline for temazepam resulted in an increased incidence of withdrawal signs and an approximate 10% decline in body weight. Midazolam, in doses of 60 and 120 mg/kg/24 hr, also substituted for pentobarbital and suppressed both overt behavior and weight loss. Following saline substitution on Day 14, a mild withdrawal syndrome was evident although body weight was noted to remain near control values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Heparin stability: effects of diluent, heparin activity, container, and pH.

The effects have been studied of diluent, heparin activity after dilution, container, and pH on the stability of heparin solutions stored under conditions resembling those present during heparin infusion by intravenous drip or syringe pump. Heparin activity was measured by activated partial thromboplastin time and thrombin clotting time (and, in one set of studies, also by factor Xa inhibitor assay and protamine sulphate neutralisation). Heparin activity was stable for 6 hours regardless of storage conditions. After 24 hours heparin activity was stable when the drug was diluted in 0.9% saline and stored in plastic, but a small loss of activity was observed in several studies after dilution in 5% dextrose or storage in glass. A more extensive comparison confirmed a 3-5% loss in heparin activity over 24 hours after dilution in 5% dextrose. Changing the pH to 3.5 or 10.0 had little effect on storage stability. We conclude that heparin activity in vitro remains stable during short infusions but recommend dilution in 0.9% saline and a plastic container when a heparin solution is infused over 24 hours.     

充气式温毯预保温联合液体加温对肺叶切除术患者体温及热舒适度的影响

目的本研究拟探讨充气式温毯预保温联合液体加温对胸科全麻肺叶切除术患者体温及热舒适度的影响。方法择期行胸腔镜(VATS)肺叶切除术患者46例,随机分为预保温(充气式温毯)+液体(温箱)保温组(T)和对照组(C),每组23例,记录预保温前后、麻醉过程中、术毕及进出麻醉术后恢复室(PACU)时患者鼓膜温及术后寒战、热舒适度、恢复室停留时间。结果在麻醉后1、2、3 h和术毕时4个时间点,与对照组相比,保温组患者术中的核心体温下降幅度小,更趋于稳定(P0.01);保温组患者术后低体温发生率,寒战发生率均较低(8.7%比56.5%,4.3%比34.8%,P0.05);保温组患者热舒适度评分高于对照组(8.52±0.94比7.65±0.83,P0.01)。结论术前预保温联合液体保温可维持全麻肺叶切除术患者术中体温平稳,降低低体温及寒战发生,提高热舒适度,为患者提供有效的体温保护。     

Response of pulmonary (circulating) megakaryocytes to experimentally induced consumption coagulopathy in rabbits.

The effects of slow temporary infusion of a tissue thromboplastin solution into the superior vena cava on pulmonary as well as circulating megakaryocytes were studied in 40 rabbits (2-48 hours after infusion) and related to 6 noninfused and 7 infused with normal saline. This is a simple and specific method of inducing a fall in blood platelet levels and thereby an activation of thrombocytopoiesis and megakaryocytopoiesis. The induced intravascular coagulation is probably counterbalanced by an activated fibrinolysis allowing the animals to survive the infusion and thereby offering the possibility of studying the long-term effects. An increase to about 300% of the normal values in circulating as well as pulmonary megakaryocytes was found 20 and 24 hours after the onset of the infusions respectively. The number of circulating and pulmonary megakaryocytes, showing great individual variations, however, dropped to normal levels within 28 hours after onset of the infusions, which means that megakaryocytes remain detectable for less than eight hours in the lungs. No increase was found in pulmonary megakaryocytes in the control (saline infused) group. In our opinion the entrance of megakaryocytes from the bone marrow into the blood circulation in an incidental event, the number in the circulation reflecting the activity of megakarycocytopoiesis. This experiment supports our suggestion that intravascular coagulation is one of the major pathophysiological mechanisms leading to an increase in pulmonary megakaryocytes.     

Haemophilus Influenzae Septic Thrombophlebitis Following Use of a ��Scalp-Vein�� Needle

Indolent Haemophilus influenzae type B septic thrombophlebitis developed in a 14-year-old boy two weeks after completing a course of intravenous antibiotics administered via a “scalp-vein” needle for an unrelated infection. Presumably, the primary disease (common variable immunodeficiency) contributed to the simultaneous occurrence of this uncommon complication of scalp-vein needle use, with an unusual pathogen.     

Rat pulmonary artery restructuring and pulmonary hypertension induced by continuous Escherichia coli endotoxin infusion

We have studied the effect of continuous endotoxin infusion on rat pulmonary structure and function (69.4 ng/100 gm body weight/min for 24 hours). After 6 days of endotoxin infusion, lack of filling of pre- and intraacinar arteries was evident on pulmonary arteriograms. Microscopy demonstrated lumen narrowing in preacinar arteries and occlusion of intraacinar arteries. Morphometry of patent intraacinar arteries established dilation and increased wall muscle. Widespread alveolar wall injury was evident. After 24 hours of infusion, pulmonary artery pressure was raised (delta 9 mmHg; p less than or equal to 0.001); it then fell but was again increased by day 6 (delta 6 mmHg; p less than or equal to 0.05). Pulmonary vascular resistance was markedly increased at 24 hours (day 0 = 0.1 +/- 0.011 dyne/sec/cm-5; 24 hours endotoxin = 0.572 +/- 0.102 dyne/sec/cm-5; p less than or equal to 0.02). It remained elevated during the infusion period but was not significant. At day 6 the alveolar-arterial oxygen diffusion gradient (A-aDO2) was increased (day 0 = 19.6 +/- 1.39 mmHg, day 6 endotoxin = 33.8 +/- 0.1 mmHg; p less than or equal to 0.001). The arterial oxygen tension (PaO2) was decreased (day 0 = 86.5 +/- 1.8 mmHg, day 6 endotoxin = 74 +/- 2.52 mmHg; p less than or equal to 0.05), as was the arterial carbon dioxide tension (PaCO2) (day 0 = 36.0 +/- 0.73 mmHg, day 6 endotoxin = 30 +/- 1.9 mmHg; p less than or equal to 0.05). Thrombocytopenia occurred during the first 72 hours of infusion (day 0 = 7.41 +/- 0.41 X 10(5)/mm3, day 1 endotoxin = 2.43 +/- 0.30 X 10(5)/mm3, day 3 endotoxin = 2.32 +/- 0.31 X 10(5)/mm3; p less than or equal to 0.001) but by day 6 the platelet count had returned to basal levels (9.9 +/- 0.65 X 10(5)/mm3). Endotoxin increased the number of leukocytes in peripheral blood (day 0 = 12.8 +/- 1.2 X 10(3)/mm3, day 3 endotoxin = 17.0 +/- 1.86 X 10(3)/mm3, day 6 endotoxin = 22.5 +/- 1.8 X 10(3)/mm3; p less than or equal to 0.01 for day 6). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased during the first 24 hours of infusion (day 0 = 0.56 +/- 0.076 ng/ml, 24 hours endotoxin = 0.27 +/- 0.026 ng/ml; p less than or equal to 0.05) and thromboxane (TX) B2 in the first 15 hours (day 0 = 0.23 +/- 0.058 ng/ml, 15 hours endotoxin = 0.09 +/- 0.14 ng/ml; p less than or equal to 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)     

Rapid Transport and Infusion of Hematopoietic Cells Is Associated with Improved Outcome after Myeloablative Therapy and Unrelated Donor Transplant

We evaluated effects of graft transport time on outcomes after transplantation of 938 unrelated donor bone marrow (BM) or 507 peripheral blood progenitor cells (PBPC) in patients with acute or chronic leukemia and myelodysplastic syndrome (MDS). BM grafts were collected at 107 centers and PBPC, 89 centers. Median time from end of collection to infusion was 14 hours for BM and 15 hours for PBPC. Platelet recovery was less likely in BM recipients when the interval from end of collection to receipt at transplant center was ≥20 hours (odds ratio 0.47, P = .010) and when the interval from receipt to infusion was ≥6 hours (odds ratio 0.57, P = .001). Mortality rates were higher in recipients of HLA-matched BM when the interval from end of collection to receipt at transplant center was ≥20 hours (relative risk 2.67, P < .001) after adjustment for other significant prognostic factors. Mortality after HLA-mismatched BM transplants was not associated with transport time. Transport times had no demonstrable effect on outcomes after PBPC transplants. These data support a general review of current transport procedures, especially for BM grafts requiring longer transport time and every effort made to minimize time from collection to infusion.     

Thrombosis and Pancreatic Carcinoma Revisited

A case of recurrent pulmonary embolism from thrombophlebitis associated with pancreatic carcinoma is reported. There is an increased incidence of thrombophlebitis with all tumors, but carcinoma of the pancreas is statistically more frequently responsible. The higher incidence of thrombophlebitis with tumors of the body and tail of the pancreas is probably due to the low trypsin levels associated with these tumors. Trypsin levels are directly related to plasma antithrombin levels and mucinous adenocarcinomas are more commonly associated with thrombus formation.