Autoimmune thrombocytopenia.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets coated with mainly antibodies against platelet GPIIb/IIIa and GPIb/IX are destroyed in the spleen. Recent evidence suggests that platelets are also destroyed by cytotoxic T cells. The diagnosis is made by exclusion for other causes of thrombocytopenia. As routine blood counts are becoming more available, many mild cases of ITP (platelets >30 x 10(9) L(-1)) are being diagnosed and they usually do not require treatment. In patients with platelet counts persistently <30 x 10(9) L(-1), treatment with corticosteroids, and/or intravenous immunoglobulin (IVIG) or anti-D may be required. The primary goal of treatment is to maintain the platelet count at a safe level with minimal side effects. After 3-6 months, if spontaneous remission has not occurred and if the side effects are significant, splenectomy is recommended. This is the single most effective treatment of ITP. The refractory patients who fails splenectomy and subsequently first- and second-line therapies, is a management dilemma. Therapeutic options are limited, available treatments potentially toxic and the chances of sustained response low. Observation with no active treatment is a reasonable option. With the increased availability of the thrombopoietic agents in the future, there may be a good prospect of keeping the platelet counts of these refractory patients at a safe long-term level with one of these drugs.

GC-MS analysis of two types of mixed oils, a comparison of composition and weathering patterns.

In order to compare the effects of weathering on two types of mixed oil, simulated weathering experiments were performed. The first sample was a mixture of two fresh oils and the second sample was a mixture of one fresh oil and another oil sample that had undergone a serious weathering process. Comparative studies evaluated decay rates and changes in diagnostic ratios of some fingerprinting biomarkers. Results showed that the mixing process affected the weathering rate of some compounds in the oils and also that certain diagnostic ratios are more suitable for estimating mixing proportions. A Pr/n-C17 versus Ph/n-C18 plot can be used to identify the end-numbers of mixed oils and the (C13+C14)/(C25+C26) ratio is a useful diagnostic ratio to detect the degree of weathering. Finally, hopane, sterane, and alkylated PAH fingerprints were found to give useful insights about the sources of the mixed oils.

Dynamic three-dimensional echocardiographic assessment of intracardiac blood flow jets.

Transthoracic dynamic 3-dimensional reconstruction of the heart with tissue depiction has been proved to be feasible when using various methods of data acquisition. The same method can theoretically be applied to color Doppler flows to generate dynamic 3-dimensional images of intracardiac blood flow jets. To explore the feasibility of this approach, we studied 41 patients with various valvular disorders or intracardiac shunts. We acquired sequential 2-dimensional images along with color Doppler information using rotational scanning from a transthoracic or a subcostal window. Images were digitized and processed for 3-dimensional reconstruction using dedicated software. After adequate segmentation, the flow jets were displayed in 3 dimensions in a gray scale format. With use of this approach, 3-dimensional reconstruction of color Doppler flows was possible in all but 1 patient. Still frames allowed immediate appreciation of the shape of the jets, their location in the cardiac chambers, and their size related to that cavity. Dynamic display was even more striking by showing the flow in real time. Dynamic 3-dimensional images enabled visualization of flow jets in projections not available in conventional color flow Doppler, looking directly at the views of shunt and regurgitant flows, and also permitted 3-dimensional delineation of flow convergence zones. We conclude that dynamic visualization of various intracardiac flows in 3 dimensions using transthoracic echocardiography is possible. It provides a better understanding of the shape and size of the jets, and can potentially aid in flow quantification by displaying the actual shape of flow convergence regions.

Effect of acupuncture on cardiopulmonary function.

OBJECTIVE: To evaluate the relationship between acupuncture and cardiopulmonary function in healthy people. SUBJECTS AND METHODS: Healthy male volunteers were divided into 3 groups, 16 of persons each Group 1 was treated with acupuncture at points Neiguan (PC6) and Zusanli (ST36): Group 2 was treated with acupuncture at non-acupoints, and Group 3 was taken as control. The effects of resting cardiopulmonary functions were measured with gas analysis system. The resting heart rate (HR), oxygen consumption (VO2), and carbon dioxide production (VCO2) were recorded over a thirty-minute period at intervals of five minutes, 15 minutes, and 25 minutes. Electroacupuncture was given to Groups 1 and 2. The analysis of variance and t test were used in data analysis. RESULTS: In the acupuncture groups, resting heart rate and carbon dioxide production decreased (P < 0.05) and oxygen consumption also decreased slightly, although it was statistically insignificant (P > 0.05). CONCLUSION: Our results indicate that acupuncture can decrease the resting heart rate and carbon dioxide production, thus lowering the metabolic rate.

A partial nucleated differential cell count of the bone marrow aspirate that is independent of peripheral blood dilution.

In the bone marrow (BM) nucleated differential cell count (NDC), myeloblasts are enumerated as a percentage of total nucleated cells, which are inevitably diluted with peripheral blood nucleated cells (PBNC) during BM aspiration. We propose a partial NDC (PNDC) comprising only immature haemopoietic cells capable of division, i.e. myeloblasts, promyelocytes, myelocytes and erythroblasts. We show that the myeloid : erythroid (M : E) ratio of the PNDC remains approximately constant in progressively dilute aliquots of BM aspirates. We determined the PNDC in 22 healthy subjects and investigated the effect of peripheral blood dilution on disease stratification of 66 BM aspirates with myelodysplastic syndromes (MDS). NDC and PNDC myeloblast counts were compared and the equivalent PNDC myeloblast counts for NDC myeloblast threshold counts of 5, 10 and 20% were derived. Reclassification of MDS samples with the PNDC resulted in a change in disease category in 33.3% of 51 MDS samples with NDC myeloblast counts ranging from 3 to 26%. The PNDC is independent of PBNC dilution and can be determined in dilute BM samples. It alters the disease category in a significant proportion of BM aspirates with MDS and has the potential to better stratify MDS to improve clinical outcomes and treatment.

Continuous quality improvement: a survey of American and Canadian healthcare executives.

The continuous quality improvement (CQI) movement, while experiencing great popularity years ago, has been declining in interest across other industries. This article studied American and Canadian hospital executives who have embraced the concept of CQI and will continue to be committed to CQI efforts in the future. Executives of CQI hospitals strongly believe that CQI is not a fad and is essential to their organizations' survival. The majority of the hospital executives in the sample have a good understanding of CQI. The drive to provide quality service to both internal and external customers is the primary motivation for being involved with CQI. Some unsuccessful CQI efforts can be attributed to a lack of CQI skills, poor planning, and insufficient staffing. Close to 90 percent of the respondents expected their involvement with CQI to increase significantly in the future. This result implies that CQI is still being considered and will maintain its role as an effective management tool in the healthcare sector.

The implementation of business process reengineering in American and Canadian hospitals.

This study of more than 215 U.S. and Canadian hospital executives indicates that improved service quality to patients and enhanced financial performance are the driving forces for hospitals that undertake business process reengineering (BPR) activities. Despite reporting moderate success in achieving organizational objectives through BPR, these executives identified lack of staff cooperation, buy-in, and skill as important factors that derail BPR implementation efforts.

Mitral regurgitation after double balloon or Inoue balloon mitral valvuloplasty.

We performed serial color Doppler echocardiographic studies prospectively before and after double balloon or Inoue balloon mitral valvuloplasty in 44 patients (mean age 45 +/- 13, range 20-74) with pure rheumatic mitral stenosis (by angiography) selected in a case-control manner to compare the incidence and severity of mitral regurgitation. After balloon dilation, mitral valve area increased from 0.9 +/- 0.2 to 1.5 +/- 0.4 cm2 (p < 0.001) in the double balloon group and from 0.9 +/- 0.3 to 1.5 +/- 0.3 cm2 (p < 0.001) in the Inoue balloon group. Twenty-four hours after balloon dilation, 3 patients in the double balloon group and 12 patients in the Inoue balloon group developed moderate to severe mitral regurgitation (p < 0.05). The severity of mitral regurgitation tended to persist or progress during follow-up in both groups, although improvement could also be observed. Two patients with severe mitral regurgitation in the Inoue balloon group underwent mitral valve replacement during follow-up. In conclusion, double balloon and Inoue balloon techniques are both effective in relieving significant mitral stenosis. However, Inoue balloon technique may be associated with slightly higher frequency of mitral regurgitation.

Left ventricular opacification after peripheral venous injection of a modified albumin solution.

The usefulness of a modified albumin solution was assessed in 8 dogs after peripheral venous and inferior vena cava injections. The contrast agent is a mixed solution made of glucose, albumin and glycerin, with sonicated microbubble diameter of 5.0 +/- 2.3 microns. Multiple injections (8 ml each) of this contrast agent (total 80 injections) into peripheral vein and inferior cava were performed. The blood pressure from femoral artery was measured before, during and after injections. Two-dimensional echocardiograms were recorded in a modified long axis view on videotapes for play back analysis. The pulmonary transit time and left ventricular contrast persistent time was determined for each injection. The videodensity of the region of interest (ROI) at the center of right ventricle and left ventricle was measured. The background videodensity of both ventricles was evaluated. The videodensity over the ROI of both ventricles with peak contrast enhancement was measured in all frames for 3 consecutive cardiac cycles. The peak videodensity of right and left ventricle subtracting the background videodensity of each ventricles was further calculated respectively. The injections caused no change in blood pressure or heart rate. All injections produced right ventricular contrast echo. As much as 85% of peripheral venous and 82.5% of inferior vena cava injections resulted in left ventricular contrast which was 0.68 and 0.65 as bright as that produced in the right ventricle. Pulmonary transit time and left ventricle contrast persistent time of peripheral venous injection was 4.05 +/- 0.53 and 13.67 +/- 4.28 seconds respectively. No difference of these data (3.93 +/- 0.47 and 11.65 +/- 4.66 seconds) from those produced by inferior vena cava injections were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Which arterial and cardiac parameters best predict left ventricular mass?

BACKGROUND: Many cardiovascular and noncardiovascular parameters are thought to be determinants of left ventricular mass (LVM). Complicated interactions necessitate the simultaneous measurement and consideration of each to determine their individual and collective impact on LVM. We undertook such a comprehensive study. METHODS AND RESULTS: The influence of anthropometry, cardiac size and contractility, arterial structure and function, as well as indices of lifestyle, physical activity, and dietary salt intake on LVM (by two-dimensionally guided M-mode echocardiography) was analyzed in 1315 Chinese subjects who were either normotensive or had untreated hypertension. Effects of many cardiac and arterial factors were assessed. In univariate analysis, almost all measured noncardiovascular, cardiac, and arterial variables were significantly correlated with LVM. In multivariate linear regression analyses, when age, sex, body habitus, fasting serum C-peptide level, dietary salt, physical activity, and lifestyle were accounted for, the optimum multivariate linear regression main effects model had an adjusted model r2 of 0.740, with 98% of the model variance accounted for by the 5 independent determinants of LVM: stroke volume (49.6%), systolic blood pressure (30.7%), contractility (14.7%), body mass index (1.8%), and aortic root diameter (1.6%). Other proposed arterial indices were significant independent determinants of LVM only when blood pressure was removed from the model and, even then, these indices not only resulted in less powerful prediction but also accounted for only a very small percentage of the total variance of LVM. CONCLUSIONS: In a large population, we (1) confirmed that age, body habitus, and some indexes of arterial structure and function are independent determinants of LVM; (2) found aortic diameter to be an independent structural determinant of LVM; (3) demonstrated that the effects of the derived measures of arterial function were small and provided no better predictive power than blood pressure alone; and (4) showed that when the best measures of cardiac and vascular load were included, the single most potent predictor was an index of left ventricular size.