Leukocyte transfusions: Thinking twice

There is convincing evidence that leukocyte transfusions have a definite, albeit restricted, role in managing profoundly neutropenic patients and certain rare patients with qualitative disorders of neutrophil function. Nonetheless, leukocyte transfusion techniques have yet to meet a number of important conceptual challenges of neutrophil replacement. Even with pharmacologic manipulation of leukocyte donors, current methods of leukapheresis cannot provide neutrophils in numbers that match the body's normal use and turnover of these cells. Neutrophils have also proved to be fragile cells in the blood bank, readily losing normal function with certain collection procedures and during short periods of storage. Moreover, transfused neutrophils that are unable to function and circulate normally in recipients can produce serious toxic reactions. In light of the marginal demonstrable benefits of leukocyte transfusions, potential toxicity is necessarily an important consideration in decisions to use this form of hematologic support. The fact that leukocyte recipients are usually extremely ill does not alter the physician's responsibility to avoid bringing harm to the patient without benefit.     

1981 Meeting: The Society of Thoracic Surgeons

Recent successful use of a valved external conduit for an irremovable calcified mitral valve suggests that a similar procedure may be useful for correcting other forms of acquired and congenital mitral obstruction.     

The place of pelvic exenteration in the primary management of advanced carcinoma of the vulva

Over a 25-year period, 236 patients were treated surgically for carcinoma of the vulva. Of these, 13 (5%) were treated by radical vulvectomy with pelvic exenteration for Stage IV disease. Five of ten patients (50%) eligible for a 5-year survival were alive and well with no evidence of disease after this time. None of these five patients had lymph node metastases at the time of her surgery. A review of the English language literature from 1973 to date confirmed that the results with exenteration and radical vulvectomy in selected cases are good. Including our series, a total of 53 patients underwent this procedure, of whom 25 (47%) survived 5 years. In view of these findings, we feel that consideration should be given to the use of this procedure in patients with advanced, but resectable carcinoma of the vulva.     

The development of instruments to assess behavior therapy training

Training programs in behavior therapy are increasing rapidly. However, research on the efficacy of these programs is almost non-existent. With this in view, two instruments were developed to evaluate one set of therapist behaviors: social skill training (SST). The self report questionnaire of therapists' knowledge did not prove reliable. Observer ratings of therapist behavior (RTBS) in a simulated situation reached 0.85 reliability. Eight therapists experienced in social skill training proved superior to 8 inexperienced therapists on the total ratings of therapist behavior score.     

Humanizing the student-cadaver encounter

In a recently accredited medical school, the curriculum, which emphasizes the psychologic and social aspects of disease, includes innovative features aimed toward training students to provide humanistic health care in underserved areas. As part of this curriculum, an educational experiment was designed to explore issues concerning the medical student's first exposure to a cadaver. The authors describe the experiment as it evolved over a three-year period, and they discuss its value based on student evaluation and faculty opinion.     

Tined Transvenous Endocardial Electrodes: Results of a Randomized Prospective Study

The early (30-day) dislodgment rate of standard-use flange-tipped and of tined endocardial electrodes was compared in a randomized prospective clinical trial. Four of 16 (25%) of the flange-tipped leads and none of the 18 tined leads dislodged within 30 days of implantation (p = 0.01). We believe that the tined electrode represents a major improvement in electrode design and is clearly superior to the flange-tipped electrode in reducing the incidence of early dislodgment.     

Comparative evaluation of five peak flow devices

The Wright peak flow meter (WPFM), the pediatric WPFM, the mini-WPFM (MWPFM), the Vitalograph pulmonary monitor (VPM), and prototypes of the newly designed peak flow whistle (PFW) were evaluated and compared under controlled laboratory conditions. With steady flows, all devices compared significantly with the pneumotachygraph standard (p < 0.001). At transient flows there was distortion of the wave form by the VPM, with significant reduction in the generated peak flow. All devices except the PFW demonstrated progressive increases in resistance with higher flows. The PFW showed a progressive decrease. The WPFM and the pediatric WPFM demonstrated adequate calibration corrections for this increasing resistance. The MWPFM gave slightly higher values than the pneumotachygraph and graph standard. Results with all devices were found to be reproducible after 350 pulses of transient flow of 4 L/sec and no interinstrument variance was detected in the paired devices. Flow values measured at air temperature of 37 °C tended to be lower than those measured at 28 °C, but this was not significant at the p < 0.05 level.     

The preservation of ovarian function in young women undergoing pelvic radiation therapy

Because cervical carcinoma rarely metastasizes to the ovaries, it became logical to preserve ovarian function by the method of lateral ovarian transposition as part of the management of young women with this disease. This technique prevents castration should subsequent radiation therapy be planned or become necessary. Forty patients with carcinoma of the cervix or vagina underwent unilateral or bilateral ovarian transposition. Eighteen patients received radiation therapy. Of these, 16 had gonadotropin measurements and only 6 (37%) had levels elevated to the postmenopausal range. If patients whose ovaries were not shielded or who received paraaortic radiotherapy are excluded, then only two (17%) had elevated gonadotropin values. It is concluded that, if properly performed, lateral ovarian transposition and ovarian shielding will protect ovarian function in patients receiving pelvic radiotherapy.     

Age at beginning of coitus versus chronologic age as a basis for Papanicolaou smear screening: an analysis of 747 cases of preinvasive disease

Disease onset in 747 routinely screened women who developed cervical intraepithelial neoplasia was analyzed. Average age at diagnosis was 30 years; the range was 16 to 71 years. In 19% diagnosis was made after age 35, and in 1% after age 60. Grouping cases by age at beginning of coitus produced significant differences (p less than 0.001) in cumulative proportions of patients with the diagnosis made at any age. In 11% of patients initiating intercourse between ages 15 and 17 diagnosis was made after age 35; the figure was 19% for the 18 to 19 age group and 36% for the 20+ group. Screening by chronologic age is effective for women initiating intercourse early. Screening by years of exposure to intercourse produced a uniform distribution regardless of age at beginning of coitus. In 75% the diagnosis was made within the first 15 years of intercourse, in 88% by year 20; and in 97% by year 30. In 70% the diagnosis was made between 6 and 20 years. Cytologic surveillance should be concentrated during the sixth through twentieth years when most cases develop.     

The Measurement of Tidal Volumes in Spontaneously Breathing Children during General Anaesthesia using a Haloscale Infant Wright Respirometer

The accuracy of tidal volume measurements made with a Wright Haloscale infant respirometer in children breathing spontaneously during general anaesthesia was assessed by a bench test. The tidal volumes and peak flow rates of 20 spontaneously breathing, anaesthetised children were measured with a pneumotachograph before and during surgery, and similar volumes, at the same flow rates, were delivered by a calibrated syringe simultaneously to the respirometer and a pneumotachograph. The results reveal that the mean (+/- s.d.) peak gas flow rates of children aged 6 years and less, 7.5 (+/- 1.6) and 9.3 (+/- 0.1) l/min before surgery and during surgery respectively, are significantly less than the peak flow rates, 11.3 (+/- 1.0) and 11.9 (+/- 1.5) before and during surgery, respectively, of children aged more than 6 years; and that the respirometer underestimates tidal volume by 10% when the peak flow rate is 11 l/min, and the percentage error in tidal volume estimation by the respirometer increases as the peak gas flow declines below 10 l/min.