Epoetin alfa facilitates presurgical autologous blood donation in non-anaemic patients scheduled for orthopaedic or cardiovascular surgery.

Patients expected to need at least three units of blood for their elective cardiovascular or orthopaedic surgery, were allocated randomly to receive intravenous (i.v.) Epoetin alfa 600 IU kg-1 (n = 27), 300 IU kg-1 (n = 30) or placebo (n = 23), on days 1, 4 and 7. Provided haemoglobin > or = 11 g dL-1, one unit of blood was collected on days 1, 4, 7, 11 and 14. Iron supplementation was given throughout the study. Surgery was scheduled between days 18 and 21. Significantly more patients treated with Epoetin alfa (100% for 600 IU kg-1; 97% for 300 IU kg-1) were able to donate > or = 4 units of blood compared with placebo (78%) (P = 0.011 and P = 0.032). No significant differences were seen in total patient exposure to homologous blood (7.4%, 3.3% and 17.4%, respectively). Mean red cell volume donated (P = 0.005 for 600 IU kg-1; P = 0.158 for 300 IU kg-1 both vs. placebo) and production (P < 0.001 and P = 0.012, respectively) were dose related. Twenty-four patients became iron deficient. No differences in the incidence of adverse events were seen between the groups.

[Preoperative normovolemic hemodilution using erythropheresis]. / Hémodilution normovolémique préopératoire par érythrophérèse.

Normovolaemic haemodilution was carried out by erythropheresis by the Blood Bank, 24 to 72 yours before surgery, using a plasmapheresis device. A special disposable haemodilution kit was used, with one plasma and three red cell collection bags and CPD as anticoagulant. Plasma was replaced by 4% albumin. One to 4 red cell packs with 75% haematocrit was obtained and stored for 10 days. This technique is indicated for surgery with an expected blood loss between 1,000 and 1,500 ml, or when the patient cannot be included in a preoperative blood donation programme. The contra-indications are the same as those of intentional normovolaemic haemodilution. This technique has been used in 101 patients due to undergo orthopaedic surgery. Compared with standard haemodilution bags, the advantages of this technique are the excellent asepsis of this product, its 10 days storage and high haematocrit, and the absence of anaesthetic drugs within the bags as well. This technique does not interfere with haemodynamic conditions during anaesthesia; it saves time for both anaesthetists and surgeons. In the authors' experience, this technique has in part replaced the more usual technique.

[Back pain after epidural anesthesia]. / Douleurs rachidiennes après anesthésie péridurale.

A 24-year-old female patient underwent a minor orthopaedic procedure under epidural anaesthesia. She had a past history of lumbar backache. The epidural anaesthetic was carried out with the patient sitting. However, she had an acute vagal reaction, with loss of consciousness and forward headfall. Thirty-six hours later, the patient complained of severe pains diffusing all over her vertebral column, together with sciatica and paravertebral muscle contraction which did not respond to drug treatment. An epidural abscess or haematoma was ruled out. The pain finally disappeared after a few days of wearing a cervical collar, taking anti-inflammatory drugs, and a few vertebral manipulations. The back pain was probably due to a posterior articular joint syndrome, worsened by the forward headfall. In view of the past history, an epidural anaesthetic should probably have been best avoided.

B-lymphocyte targeting of gene expression in transgenic mice with the immunoglobulin heavy-chain enhancer.

A hybrid gene containing rabbit beta-globin structural sequences (-9 to +1650), and a chicken conalbumin gene promoter (+62 to -102) in the place of the beta-globin promoter (upstream from -9), was inactive in 5 different transgenic mouse line. Adding the mouse immunoglobulin heavy-chain (IgH) enhancer to this construction specifically stimulated expression in B-cells. These results show that IgH enhancer is specifically active in B-cells. Expression of the hybrid gene was low compared to the endogenous immunoglobulin heavy and light-chain genes. Substituting the mouse immunoglobulin kappa light-chain gene (Ig kappa) promoter (+4 to -800) for the heterologous conalbumin promoter was not sufficient to restore gene expression to level of the endogenous genes. In addition to the reproducible B cell expression, we also found inheritable unexpected expression in certain tissues, which varied from line to line.

[Mediastinoscopy, technic and complications. Analysis of 230 cases]. / La médiastinoscopie, technique et complications. Analyse de 230 cas.

Anesthesia for mediastinoscopy requires no special techniques. However, because of the particular area of investigation involved during this procedure, lesions of neighboring structures may occur and require specific monitoring. Experience with 230 mediastinoscopies leads to the conclusion that such accidents are infrequent with adequately skilled endoscopists.