Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery.

In unilateral total knee replacement (TKR), perioperative blood loss, low transfusion thresholds and short hospital stay result in patients being discharged with low haemoglobin (Hb). We assessed the effects of perioperative administration of intravenous iron, with or without erythropoietin, plus a restrictive transfusion threshold (Hb < 80 g L(-1)) both on transfusion rate and recovery from post-operative anaemia. TRK patients received iron sucrose (2 x 200 mg per 48 h, iv) (Group IVI, n = 129). Patients with admission Hb < 130 g L(-1), also received erythropoietin (1 x 40 000 IU, sc) (Group EPO, n = 19). Perioperative clinical and laboratory data were obtained. Mean Hb loss was 36 g L(-1), but only seven patients were transfused (5%). Pre-operatively, 66 (45%) patients did not have enough stored iron to compensate Hb loss. At post-operative day 30, only 15% were anaemic, 70% of Hb loss and 92% of pre-operative Hb were recovered and ferritin increased by 73 microg L(-1) (P < 0.01), although erythropoietic response was higher in patients receiving erythropoietin (P < 0.05). No adverse effects of iron sucrose or erythropoietin were witnessed. This protocol seems to reduce allogeneic blood transfusion rate and may hasten the recovery from post-operative anaemia in TKR patients, without depleting iron stores. Further studies are needed to ascertain which patients may benefit of extended intravenous iron and/or erythropoietin administration.

Synthesis of tricyclic aromatic compounds by the intramolecular pauson-khand reaction promoted by molecular sieves(,)(1)

Pauson-Khand reactions are carried out with different substituted aromatic enynes, yielding tricyclic cyclopentenones related to natural products such as chromenes. Enynes are easily obtained in a two-step approximation from the corresponding salicylaldehydes. The reaction is promoted by dissolved TMANO (trimethylamine N-oxide) and/or 4 A molecular sieves. This new way of induction for the Pauson-Khand reaction increases yields remarkably, allowing the reaction of some substituted alkenes which fail to react in the absence of the zeolite. Isomerization of the double bond of the cyclopentenone ring is observed except when nonterminal triple bonds are used. For trisubstituted alkenes, an interrupted Pauson-Khand process is observed with moderate yields.

Melanotic adenocarcinoma of the anorectum.

A variety of tumors, besides those formed by melanocytes, may contain melanin pigment. Most of them have originated from the neural crest. Epithelial tumors with melanosomes are very unusual. We report the case of a 76-year-old woman with rectal adenocarcinoma that invaded the intestine and vagina extensively. At the anorectal site, melanin pigment was found in the cytoplasm of the malignant neoplastic epithelial cells, and melanosomes were ultrastructurally confirmed at various developmental stages. Melanocytes with cytoplasmic processes spreading between neoplastic cells were also present as the apparent source of the pigment contained in the neoplastic cells.

Catamenial pneumothorax with pleural endometriosis and hemoptysis.

One case of recurrent pneumothorax, coinciding with menstruation, is documented. The ethiopathogenesis of this syndrome remains unknown, after studying the 44 cases. Their association with pleural endometriosis has only been found in nine cases. This new publication with pleural endometriosis and menstrual hemoptysis supports an endometriosis etiology. The surgical treatment of pneumothorax is effective, and a main disclosure of this syndrome would facilitate the research and enlightenment of the ethiopathogenesis.