Gel point and fractal microstructure of incipient blood clots are significant new markers of hemostasis for healthy and anticoagulated blood.

Here we report the first application of a fractal analysis of the viscoelastic properties of incipient blood clots. We sought to ascertain whether the incipient clot's fractal dimension, D(f,) could be used as a functional biomarker of hemostasis. The incipient clot is formed at the gel point (GP) of coagulating blood, the GP demarcating a functional change from viscoelastic liquid to a viscoelastic solid. Incipient clots formed in whole healthy blood show a clearly defined value of D(f) within a narrow range that represents an index of clotting in health, where D(f) = 1.74 (± 0.07). A significant relationship is found between the incipient clot formation time, T(GP), and the activated partial thromboplastin time, whereas the association of D(f) with the microstructural characteristics of the incipient clot is supported by its significant correlation with fibrinogen. Our study reveals that unfractionated heparin not only prolongs the onset of clot formation but has a significant effect on its fractal microstructure. A progressive increase in unfractionated heparin concentration results in a linear decrease in D(f) and a corresponding prolongation in T(GP). The results represent a new, quantitative measure of clot quality derived from measurements on whole blood samples.

Iodine-125 orbital brachytherapy with a prosthetic implant in situ.

PURPOSE: Brachytherapy is one method of irradiating the orbit after enucleation of an eye with a malignant tumor that has a potential to recur. It consists of 6 trains of I-125 seeds placed around the periphery of the orbit, a shorter central train, and a metal disc, loaded with seeds, placed beneath the eyelids. The presence of a prosthetic orbital implant requires omission of the central train and adjustment of the activity of the seeds in the anterior orbit around the prosthesis. PATIENTS AND METHODS: This is a retrospective review of the technical modifications and outcome of 12 patients treated in this manner: 6 with retinoblastoma, 5 with malignant melanoma, and 1 with an intraocular rhabdomyosarcoma. The median dose was 35.5 Gy in 73 hours for retinoblastoma and 56 Gy in 141 hours for malignant melanoma. Patients with retinoblastoma and rhabdomyosarcoma also received chemotherapy. RESULTS: The tubes can be placed satisfactorily around the prosthesis. The increased activity in the anterior half of the tubes produced comparable dose distributions. There have been no orbital recurrences, no extrusion of the prosthesis, and cosmesis is good. CONCLUSION: Insertion of a prosthetic implant at the time of enucleation greatly enhances the subsequent cosmetic appearance. This should be encouraged unless there is frank tumor in the orbit. Orbital brachytherapy without the central train continues to give excellent local control. The short treatment time and good cosmesis are added advantages. The patient is spared the expense and inconvenience of removing and replacing the prosthetic implant.

Post-operative treatment of malignant salivary gland tumours of the palate with iodine-125 brachytherapy.

BACKGROUND AND PURPOSE: Malignant minor salivary gland tumours are usually small and clinically indistinguishable from benign lesions. Surgery is the treatment of choice with post-operative radiotherapy for involved margins or unfavourable histology. We assessed the results of a series of such patients treated with iodine-125 brachytherapy in the form of a temporary applicator or implant. PATIENTS AND METHODS: There were nine patients with T1/T2 tumours of the hard and/or soft palate that had been excised. All had close or involved margins. Six were treated with a dental applicator alone, two with an applicator and additional I-125 seeds in tubes and one with an implant alone. The applicator consists of two layers of plastic made from a dental impression enclosing a predetermined number of I-125 seeds, 9-39, glued to one surface and a layer of ash metal to protect the tongue. It was inserted 1-3 months post-operatively and delivered 35-62 Gy, median 56 Gy, at 5-7 mm depth over 58-156 h, median 120 h, at 0.26-0.67 Gy/h, median 0.45 Gy/h. RESULTS: The patients have been followed up for 32-158 months, median 50 months, and there were no recurrences. The applicator was well tolerated. A confluent mucositis developed which lasted 3-4 weeks. One patient developed a mucosal ulcer which healed spontaneously. CONCLUSIONS: Brachytherapy is an effective way of delivering post-operative radiotherapy to the hard and soft palate in patients with malignant salivary gland tumours that have been incompletely excised or have unfavourable histology. Local control is excellent, treatment time is short and morbidity is minimal.

Determination of sulfonamide residues in the tissues of food animals using automated precolumn derivatization and liquid chromatography with fluorescence detection.

A liquid chromatographic method for the determination of sulfachloropyridazine, sulfadiazine, sulfadimethoxine, sulfadoxine, sulfaethoxypyridazine, sulfamethazine, sulfaquinoxaline, and sulfathiazole residues in the muscle, liver, and kidney of food animals using sulfapyridine as internal standard is reported. Tissues are extracted using a modified version of AOAC Official Method 983.31 (Sulfonamide Residues in Animal Tissues). The sample extract is reconstituted in pH 3.0 buffer-acetonitrile (60 + 40) and filtered into an autosampler vial. Using a programmable autosampler of a liquid chromatograph, a portion of the sample is derivatized precolumn with fluorescamine. The sulfonamide derivatives are separated by liquid chromatography using a C18 column with a mobile phase of 0.02M phosphoric acid-acetonitrile (60.5 + 39.5) and detected by fluorescence (excitation, 405 nm; emission, 495 nm). The method was applied to swine and cattle muscle, liver, and kidney; sheep and horse muscle and kidney; and chicken muscle and liver. The mean values for samples fortified with sulfonamides at levels between 0.05 and 0.2 microg/g agreed within 96-99% of spiked levels, with coefficients of variation ranging from 4-10%. The limit of detection (LOD) for all sulfonamides was 0.01 microg/g, with the exception of sulfaquinoxaline, for which the LOD was 0.015 microg/g.