Evaluation of the potassium adsorption capacity of a potassium adsorption filter during rapid blood transfusion.

The concentration of extracellular potassium in red blood cell concentrates (RCCs) increases during storage, leading to risk of hyperkalemia. A potassium adsorption filter (PAF) can eliminate the potassium at normal blood transfusion. This study aimed to investigate the potassium adsorption capacity of a PAF during rapid blood transfusion. We tested several different potassium concentrations under a rapid transfusion condition using a pressure bag. The adsorption rates of the 70-mEq/l model were 76·8%. The PAF showed good potassium adsorption capacity, suggesting that this filter may provide a convenient method to prevent hyperkalemia during rapid blood transfusion.

Shorter unipedal standing time and lower bone mineral density in women with distal radius fractures.

UNLABELLED: Unipedal standing time was shorter and bone mineral density was lower in Japanese women aged 50 years and over with low-energy distal radius fractures resulting from falls than those in age-matched community-dwelling Japanese women without distal radius fractures. INTRODUCTION: The aim of this study was to compare unipedal standing time and bone mineral density (BMD) of women >or=50 years of age with distal radius fractures with those of age-matched women without fractures. METHODS: Fracture group was 54 Japanese women with low-energy distal radius fractures resulting from fall. Non-fracture group was 52 community-dwelling Japanese women without fractures. Unipedal standing time and BMD were measured. RESULTS: There were no significant differences in age and body mass index between the two groups. The percentage of women with unipedal standing time <15 s was 44.4% in the fracture group and 13.5% in the non-fracture group, while the respective frequencies for >120 s were 20.4% and 50.0%. The T-score of BMD was significantly lower in the fracture than non-fracture group. Logistic regression analysis identified unipedal standing time <15 s and T-score <70% as significant factors associated with distal radius fractures. Notably, T-score <70% was significant in subjects <65 years, and unipedal standing time <15 s was significant in those >or=65 years. CONCLUSION: Unipedal standing time was shorter and BMD was lower in women >or=50 years of age with distal radius fractures than those in age-matched women without fractures.

The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius.

A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance. The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating.

Kienböck disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core.

We hypothesised that using a palmaris longus tendon ball (PLTB) with bone core (w bc) after excisional arthroplasty for Kienböck disease would maintain post-operative carpal height compared to a PLTB without bone core (w/o bc). Seventeen hands of 16 consecutive patients with Kienböck disease at Lichtman stage IIIA or IIIB were treated by replacement of the lunate with a PLTB w bc or w/o bc. We evaluated the clinical and radiological outcomes at one, three and 12 months after surgery. According to Dornan and Lichtman criteria respectively, there were no significant differences between the two groups. In the w bc group, the post-operative values of the carpal height ratio (CHR) were maintained at the same level as pre-operative values for one year, while the post-operative CHR values in the w/o bc group were significantly lower than those in the w bc group. Our results indicate that in Kienböck disease, arthroplasty using a PLTB w bc can maintain CHR at one year after surgery compared to arthroplasty using a PLTB w/o bc.

Potassium-adsorption filter for RBC transfusion: a phase III clinical trial.

BACKGROUND: Within the past 2 years, three cases of cardiac arrest just after rapid transfusion of RBCs preserved for over 7 days after 15-Gy irradiation were found. This severe complication caused transient hyperkalemia. To prevent potassium (K(+)) overload by RBC transfusion at the bedside, a K(+)-adsorption filter made of sodium polystyrene sulfonate was developed. STUDY DESIGN AND METHODS: After in vitro and animal safety and efficacy tests, a Phase III clinical trial was conducted with 65 patients given transfusions via the newly developed filter (filter group) and 37 patients in whom the filter was not used (control group) and transfusions were given at twice the usual flow rate (20 mL/min). RESULTS: More than 85-percent (94.4+/-3.8%) removal of K(+) in RBCs in mannitol-adenine-phosphate (MAP) that had been preserved for more than 14 days or that were used 3 days after 15-Gy irradiation (calculated K(+): 3.8+/-1.3 mEq/bag) was achieved in 82 of 83 bags of MAP RBCs in the filter group, with 79.6 percent removed in the other, even in rapid transfusions. RBC recovery 1 day after transfusion, determined by increments in RBCs, Hb, and Hct, were 24 and 0.4 x 10(4) per microL, 0.7 and 0.3 g per dL, and 1.6 and 0 percent, respectively, in the filter and control groups. No adverse transfusion reactions, such as hypotension, anaphylactoid reactions, or asthma-like attacks, were observed, except for one case of urticaria in the filter group. Mild fever (within 1 degrees C) after transfusion was observed in both groups. Serologic markers of hemolysis rose slightly in both groups, but there was no significant difference between the two groups. CONCLUSION: The newly developed K(+)-adsorption filter is useful, especially in a rapid transfusion setting.

Endogenous inhibitors of human placental prostaglandin dehydrogenase.

The presence of endogenous inhibitors of NAD(+)-dependent 15-hydroxyprostaglandin dehydrogenase (PGDH) has been indicated by increasing total activity after the initial purification step of PGDH in human placenta. Based on this observation, we tried to characterize and analyze endogenous inhibitors of PGDH in human placenta in this study. The inhibitors were extracted from the supernatant by precipitation at pH 5.2 and partially purified by acetone precipitation and by thin layer chromatography. The inhibitors were stable to heating at 100 degrees C for 10 min, and to trypsin digestion. The pattern of inhibition was competitive with regard to PGE2 and uncompetitive with regard to NAD at pH 8.0. The Ki value for PGE2 was 18.9 microM. Analysis by gas chromatography and mass spectrometry indicated that the inhibitors consisted of fatty acids which were palmitic, stearic, oleic and linoleic acids. Myristic, palmitic and stearic acids were confirmed to exert an inhibitory action on PGDH and showed a competitive inhibition pattern. Stearic acid was less potent in inhibition than other fatty acids. These findings suggest that intracellular fatty acids may play a unique role in the control of PGDH activity.

Effects of saturated fatty acids on prostaglandin E 9-keto-reductase.

We examined the effects of three saturated fatty acids (myristic acid 14:0, palmitic acid 16:0, and stearic acid 18:0) on prostaglandin E 9-ketoreductase (PGE-9-KR, EC 1.1.1.189), which catalyzes the conversion of prostaglandin E2 (PGE2) into prostaglandin F2 alpha (PGF2 alpha). Palmitic acid inhibited PGE-9-KR activity dose-dependently, whereas the other two fatty acids had no effect. In spite of the structural similarity of these fatty acids, our findings suggest that, of the three, only palmitic acid has an inhibitory effect on PGE-9-KR.