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1.
Int J Obstet Anesth ; 36: 34-41, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30245260

RESUMEN

BACKGROUND: Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol. METHODS: The retrospective PPH study cohort of two tertiary centers was identified using blood bank records, verified by patient electronic medical records. We identified women transfused with ≥3 units PRBC in a short time period within 24 hours of delivery. Since 2010, both centers have used a protocol using 1:1 FFP:PRBC ratios. Demographic, obstetric, and blood management data were retrieved from medical records. Outcome measures included estimated blood loss, blood product administration, and hematologic variables. RESULTS: 273 women were included, 112 (41.0%) prior to introduction of the protocol (2004-2009) and 161 (59.0%) afterwards (2010-2014). The frequency of women managed with 1:1 FFP:PRBC ratios was similar before 55/112 (49.1%) and after 83/161 (51.6%) introduction of the protocol (P=0.69). There was strong correlation between PRBC units transfused and the FFP:PRBC transfusion ratio (R-square 0.866, P <0.0001), demonstrating that as the number of transfused PRBC units increased, FFP:PRBC ratios became closer to 1:1. There were no outcome differences between women managed before and after introduction of the protocol. CONCLUSIONS: Among women with PPH receiving ≥3 PRBC units within a short period of time, it appears that factors other than the existence of our massive transfusion protocol influence the number and ratio of PRBC and FFP units transfused. Blood products were not transfused according to exact ratios, even when guided by a protocol.


Asunto(s)
Transfusión Sanguínea/métodos , Plasma , Hemorragia Posparto/terapia , Guías de Práctica Clínica como Asunto , Adulto , Estudios de Cohortes , Transfusión de Eritrocitos/métodos , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento
2.
Leukemia ; 19(11): 1919-28, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16167058

RESUMEN

Therapy-related leukemia or myelodysplasia (t-leuk/MDS) is a serious problem that is increasing in frequency. We studied the clinical characteristics of 96 patients (pts) with a mean age of 48 years, and analyzed the molecular parameters that could predispose to t-leuk/MDS. Hematological malignancies were the most common primary (53%), followed by breast and ovarian cancer (30% combined). The mean latency until the development of t-AML was 45.5 months. Median survival was 10 months. Cytogenetics was abnormal in 89% of pts. FLT3 internal tandem duplications were found in six of 41 (14.6%) pts, of whom four had an abnormal karyotype. Analysis of drug metabolism and disposition genes showed a protective effect of the CYP3A4 1*B genotype against the development of t-leuk/MDS, whereas the CC genotype of MDR1 C3435T and the NAD(P)H:quinone oxidoreductase1 codon 187 polymorphism were both noncontributory. Microsatellite instability (MSI) analysis using fluoresceinated PCR with ABI sequence analyzer demonstrated that 41% of pts had high levels of MSI in four or more of 10 microsatellite loci. Immunohistochemistry demonstrated reduced expression of MSH2 and MLH1 in 6/10 pts with MSI as compared to 0/5 of pts without MSI. In conclusion, genetic predisposition as well as epigenetic events contribute to the etiology of t-AML/MDS.


Asunto(s)
Predisposición Genética a la Enfermedad , Leucemia/inducido químicamente , Síndromes Mielodisplásicos/inducido químicamente , Síndromes Mielodisplásicos/genética , Neoplasias Primarias Secundarias/inducido químicamente , Neoplasias Primarias Secundarias/genética , Proteínas Adaptadoras Transductoras de Señales , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Proteínas Portadoras , Citocromo P-450 CYP3A , Sistema Enzimático del Citocromo P-450/genética , Femenino , Genes MDR , Humanos , Inmunohistoquímica , Cariotipificación , Leucemia/genética , Masculino , Repeticiones de Microsatélite , Persona de Mediana Edad , Homólogo 1 de la Proteína MutL , Proteínas de Neoplasias/genética , Proteínas Nucleares/genética , Reacción en Cadena de la Polimerasa , Pronóstico , Estudios Retrospectivos , Proteínas Quinasas S6 Ribosómicas 90-kDa/genética , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo
3.
Artículo en Ruso | MEDLINE | ID: mdl-1950263

RESUMEN

The improvement of prophylaxis and the decrease of morbidity rate in hepatitis B are possible on the basis of the introduction of the information subsystem of epidemiological surveillance into practical health service, including health service in rural areas. The necessity of ensuring the specificity of highly sensitive immunodiagnostic techniques by using the combination of these techniques and competitive radioimmunoassay, as well as increasing their availability by the cooperation of laboratories at the district and regional levels, is emphasized.


Asunto(s)
Hepatitis B/epidemiología , Sistemas de Información , Vigilancia de la Población/métodos , Portador Sano/diagnóstico , Portador Sano/epidemiología , Portador Sano/prevención & control , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Pruebas de Hemaglutinación , Hepatitis B/diagnóstico , Hepatitis B/prevención & control , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Técnicas para Inmunoenzimas , Ucrania/epidemiología
8.
Ann Oncol ; 16(3): 450-4, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15642707

RESUMEN

BACKGROUND: Central nervous system (CNS) involvement, a well-recognized complication of aggressive non-Hodgkin's lymphomas (NHL), has rarely been reported in indolent lymphomas. Large series have reported this complication in 3% of indolent NHLs, generally following histological transformation. PATIENTS AND METHODS: We retrospectively reviewed the disease characteristics and clinical course in seven patients (six females, one male) with indolent B-cell lymphomas who developed CNS involvement during various stages of their illness. RESULTS: The median ages at diagnosis of systemic and CNS lymphoma were 60 and 63 years, respectively. Histologies were: small lymphocytic lymphoma (two), follicular lymphoma grade I (two), follicular lymphoma grade II (two) and unclear low-grade histology (one). There were diverse neurological symptoms. Two patients had parenchymal involvement, three had leptomeningial involvement and two had both. Systemic lymphoma was found in all patients, all but one having bone marrow involvement. Four patients had a transformation to high-grade histology. Six patients were treated with systemic and intra-cerebrospinal fluid chemotherapy, and two received radiotherapy as well. Five patients achieved CNS response. Survival was 1-9 years for treated patients (median 2 years). Three patients died of CNS disease. CONCLUSIONS: CNS involvement is a rare and unexpected complication of indolent NHL, which should be considered in the differential diagnosis of patients presenting with new neurological signs. This condition is treatable and some patients have a long clinical course.


Asunto(s)
Neoplasias del Sistema Nervioso Central/patología , Linfoma de Células B/patología , Adulto , Edad de Inicio , Anciano , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/radioterapia , Femenino , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/radioterapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
9.
Ann Pharmacother ; 34(6): 740-2, 2000 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-10860136

RESUMEN

OBJECTIVE: To report a case of neutropenia and thrombocytopenia secondary to use of zuclopenthixol in a schizophrenic patient. CASE SUMMARY: A 66-year-old white man with chronic schizophrenia was referred to the hospital due to neutropenia and thrombocytopenia that developed shortly after initiation of zuclopenthixol therapy. Prior to zuclopenthixol administration, his white blood cell and platelet counts were 8.5 x 10(9) cells/L3 and 305 cells x 10(9)/L, respectively. Progressive reduction in leukocyte and platelet counts occurred, reaching a nadir of 2.9 x 10(9) cells/L3 (granulocytes 18.9%) and 109 cells x 10(9)/L, respectively. Zuclopenthixol was discontinued on admission, resulting in complete recovery within the next five days. DISCUSSION: Neutropenia and thrombocytopenia are well-known complications of antipsychotic drug therapy. Zuclopenthixol, a well-established antipsychotic agent, has relatively few adverse effects. The rapid decrease of white blood cell and platelet counts following the initiation of zuclopenthixol, as well as the rapid recovery, implicate zuclopenthixol as the predominant cause for neutropenia and thrombocytopenia in this patient. CONCLUSIONS: Although neutropenia and thrombocytopenia are rare complications of zuclopenthixol therapy, monitoring blood counts in patients receiving this agent seems to be justified.


Asunto(s)
Antipsicóticos/efectos adversos , Clopentixol/efectos adversos , Neutropenia/inducido químicamente , Trombocitopenia/inducido químicamente , Anciano , Humanos , Recuento de Leucocitos , Masculino , Recuento de Plaquetas , Esquizofrenia/sangre , Esquizofrenia/tratamiento farmacológico
10.
Artículo en Inglés | MEDLINE | ID: mdl-575382

RESUMEN

The prevalence of ornithosis and other Chlamydia infections among various groups of the population, some species of birds and mammals was studied in several regions of the Ukrainian SSR. Among the town population having no occupational contact with domestic fowl and farm animals, complement-fixing antibodies to group ornithosis antigen were found in 6.5% of the examined, among the inhabitants of rural localities in 8.4% and among the workers of poultry farms in 19.9%. During the examination of the immunological state of the workers of cattle-breeding farms, antibodies were detected in 15.1%. Pigeons, hens and ducks were investigated as probable sources of infection. The number of positively reacting individuals was 53.7, 13,7 and 24.9%, respectively. This indicates that they play a role in the spread of infection. The obtained data point out a considerable spread of Chlamydia infections among farm animals. Positive results of serological examination were recorded in pigs in 25.7%, in calves in 15.1% and in 8.6% of cases examined.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Psitacosis/epidemiología , Animales , Animales Domésticos/inmunología , Anticuerpos Antibacterianos/análisis , Chlamydia/inmunología , Infecciones por Chlamydia/inmunología , Chlamydophila psittaci/inmunología , Pruebas de Fijación del Complemento , Reservorios de Enfermedades , Humanos , Ocupaciones , Psitacosis/inmunología , Población Rural , Ucrania , Población Urbana
11.
Haemostasis ; 28(5): 250-5, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-10420074

RESUMEN

We describe a previously healthy male patient, with severe immune thrombocytopenic purpura (ITP) following CMV infection which was refractory to steroids and intravenous immunoglobulin, who developed massive intracranial bleeding. Despite an extremely low platelet count (2x10(9)/liter) which was refractory to platelet transfusions, successful emergency splenectomy was performed, with rapid resolution of the thrombocytopenia. Bleeding complications are extremely rare in viral-associated ITP. Emergency splenectomy should be considered in the presence of life-threatening bleeding when other modalities fail to produce a rise in the platelet count. Infection with CMV should be ruled out in cases of severe, treatment-resistant ITP.


Asunto(s)
Hemorragia Cerebral/cirugía , Infecciones por Citomegalovirus/complicaciones , Tratamiento de Urgencia , Púrpura Trombocitopénica Idiopática/complicaciones , Esplenectomía , Hemorragia Cerebral/inmunología , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas
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