Optimal flagging combinations for best performance of five blood cell analyzers.

INTRODUCTION: Corelab automation needs increasingly more efficient hematology analyzers and algorithms to adequately detect abnormal samples. The aim of this study is to assess the effect of combining flags or to adjust their trigger level to identify positive samples for further detection within a smear. METHODS: Five hundred and seventeen EDTA samples from patients followed for hematological malignancies were randomly analyzed on Sysmex XE2100 and XN2000, Abbott Cell-Dyn Sapphire, Beckman Coulter DXH800 and Siemens ADVIA 2120. A blood smear as well as a buffy coat was further performed for each of them. RESULTS: Our results shows that depending on the flags, the combinations of them and the thresholds we use, analyzers can provide extremely variable results in their performances for detecting abnormal cells. ADVIA and XN2000 show remarkable performance for blasts detection. DXH800 is the most sensitive for the detection of abnormal lymphocytes, while XN outperforms the market for immature granulocytes and nucleated red blood cell. CONCLUSION: Flagging performances have been shown to be inconsistent among the different manufacturers. This article should help laboratory professionals in their quest for the best flagging schemes and give them a baseline in the selection of the most appropriate analyzer.

A dysfibrinogenemia leading to resistance to bovine thrombin.

INTRODUCTION: A 26-year-old woman presented to our institute for a routine check-up. Nothing was abnormal excepted a prolonged Thrombin Time and a low fibrinogen concentration determined by the Clauss method. Fibrinogen concentration was then measured by PT-derived method, and revealed normal levels. This was therefore suggestive for a dysfibrinogenemia. The patient had no history of haemostatic problems and was under no medication. Her family history revealed nothing relevant, but death of her father from a cerebrovascular accident. METHODS AND RESULTS: Complementary tests were performed: Platelet Function Assay, Factor VIII coagulant activity, von Willebrand antigen quantification, Ristocetin Cofactor activity, thromboelastogram and euglobulin lysis time were all within normal ranges. Finally, thrombin time and Clauss fibrinogen using a human thrombin instead of a bovine thrombine revealed normal results. DNA was then extracted for sequencing the genes coding for fibrinogen. This revealed the presence of a substitution Arg>Cys in position 275 of the γ-chain of the fibrinogen. DISCUSSION: This mutation has already been reported in the literature with four cases of thrombosis, three cases of haemorrhage and eight had no clinical signs. The gamma chain is implicated in several crucial interactions such as the primary polymerization 'a', the binding to calcium, the factor XIIIa-induced cross-linking, the binding to plasminogen and to tissue plasminogen activator. Results of the literature show that this mutation has several impacts on in vitro tests, and we proved that those can be corrected by the use of human thrombin.

Calving fluxes and basal melt rates of Antarctic ice shelves.

Iceberg calving has been assumed to be the dominant cause of mass loss for the Antarctic ice sheet, with previous estimates of the calving flux exceeding 2,000 gigatonnes per year. More recently, the importance of melting by the ocean has been demonstrated close to the grounding line and near the calving front. So far, however, no study has reliably quantified the calving flux and the basal mass balance (the balance between accretion and ablation at the ice-shelf base) for the whole of Antarctica. The distribution of fresh water in the Southern Ocean and its partitioning between the liquid and solid phases is therefore poorly constrained. Here we estimate the mass balance components for all ice shelves in Antarctica, using satellite measurements of calving flux and grounding-line flux, modelled ice-shelf snow accumulation rates and a regional scaling that accounts for unsurveyed areas. We obtain a total calving flux of 1,321 ± 144 gigatonnes per year and a total basal mass balance of -1,454 ± 174 gigatonnes per year. This means that about half of the ice-sheet surface mass gain is lost through oceanic erosion before reaching the ice front, and the calving flux is about 34 per cent less than previous estimates derived from iceberg tracking. In addition, the fraction of mass loss due to basal processes varies from about 10 to 90 per cent between ice shelves. We find a significant positive correlation between basal mass loss and surface elevation change for ice shelves experiencing surface lowering and enhanced discharge. We suggest that basal mass loss is a valuable metric for predicting future ice-shelf vulnerability to oceanic forcing.

Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: steps towards an international consensus.

AIM: Negative Pressure Wound Therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer-reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this communication the results of the study of evidence in chronic wounds including pressure ulcers, diabetic foot ulcers (DFU), venous leg ulcers (VLU), and ischaemic lower limb wounds are reported. METHODS: Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% agreement. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. RESULTS: The primary treatment goal of NPWT in most chronic wounds is to achieve wound closure (either by secondary intention or preparing the wound for surgical closure). Secondary goals commonly include: to reduce wound dimensions, and to improve the quality of the wound bed. Thirteen evidence based recommendations were developed in total to address these treatment goals; 4 for pressure ulcers, 4 for DFU, 3 for ischaemic lower limb wounds and 2 for VLU. CONCLUSION: The present evidence base is strongest for the use of NPWT in non-ischaemic DFU and weakest in VLU. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.

Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer)--steps towards an international consensus.

Negative pressure wound therapy (NPWT) is becoming a commonplace treatment in many clinical settings. New devices and dressings are being introduced. Despite widespread adoption, there remains uncertainty regarding several aspects of NPWT use. To respond to these gaps, a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In a previous communication, we have reviewed the evidence base for the use of NPWT within trauma and reconstructive surgery. In this communication, we present results of the assessment of evidence relating to the different NPWT treatment variables: different wound fillers (principally foam and gauze); when to use a wound contact layer; different pressure settings; and the impact of NPWT on bacterial bioburden. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence and drafting of the recommendations by a global expert panel. Evidence and recommendations were graded according to the Scottish Intercollegiate Guidelines Network (SIGN) classification system. In general, there is relatively weak evidence on which to base recommendations for any one NPWT treatment variable over another. Overall, 14 recommendations were developed: five for the choice of wound filler and wound contact layer, four for choice of pressure setting and five for use of NPWT in infected wounds. With respect to bioburden, evidence suggests that reduction of bacteria in wounds is not a major mode of action of NPWT.

Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus.

Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.

Treatment of hydrofluoric acid burns.

Hydrofluoric acid injuries have a potential for both systemic as well as severe local tissue destruction. In this article the different treatment modalities will be presented. Hydrofluoric acid is frequently found in the semiconductor industry, in rust removers and façade cleansers. The negligence or carelessness of workers and ignorance of the risks of hydrofluoric acid promote the incidence of these severe burns. To prevent these burns, adequate information for the workers is necessary. Splash goggles and neoprene gloves as well as laboratory coats should be worn at all times to prevent eye and skin contact. In cases of exposure, therapy should be accurate and immediate.

[Reconstruction of the retracted eye socket]. / Reconstructie van de geschrompelde oogzak.

The various methods of treatment of the contracted eyesocket are discussed according to the severity of the disease and are illustrated by examples of treated patients. A method to keep the newly grafted cavity expanded by means of a conformer, stabilised by external fixation to the frontal bone, is described.

[Zygomatic fractures]. / Les fractures zygomatiques.

In this article, the authors relate their experience in the management of zygomatic fractures, based on 168 cases treated in the Plastic Surgery Unit of Bruges between January 1971 and August 1980. The symptomatology and treatment of those fractures are discussed according to the type of fracture. The importance of the early treatment and the necessity of osteosynthesis when the fronto-zygomatic suture is distracted are stressed. Multifragmented fractures are treated in the same way by means of osteosynthesis. The use of a silastic sheet for blow-out floor fractures is advocated.

Reconstructive procedures after breast cancer surgery.

In reconstructive surgery after mastectomy or major resections of the chest wall, the greater omentum and the latissimus dorsi myocutaneous flap are very reliable procedures. The greater omentum, covered with skin grafts, allows reconstruction of large defects and is a very protective buffer. The latissimus dorsi flap as a compound muscle skin flap is the treatment of choice for cosmetic reconstruction after mastectomy.

[Reimplantation of severed fingers (author's transl)]. / La réimplantation de doigts amputés

Finger reimplantation is actually feasible. Two cases of complete amputation and three of partial amputation are presented. There were four successes out of five. A partial reimplantation failed on the 12th postoperative day. The technique and the postoperative care are presented. Success does not depend solely on technique. Physiopathology of the microcirculation at the level of the anastomoses, not well known at present, conditions vascular patency and survival of the reimplanted finger.