Evaluation of coagulation equilibrium at baseline and during factor VIII and factor IX replacement in haemophiliacs.

We designed a prospective unicentre study to evaluate the safety and efficacy of continuous infusion of different factor VIII (FVIII) and FIX concentrates in haemophilia A (n = 9) and haemophilia B (n = 4) patients undergoing surgical procedures. This study was designed to assess the potential risk of developing thromboembolic complications during different types of surgery and to provide some comparative data with respect to continuous infusion of clotting factor concentrates. Heparin prophylaxis was not used in most cases. As pointed out by others, we did not find any significant changes in prothrombin fragment F1+2 and D-dimers during a pharmacokinetic study using a bolus dose of 50 U/kg of a very high purity clotting factor concentrate. Moreover, prothrombin F1+2 and D-dimer serial assays were also carried out postoperatively, and compared with levels in control non-haemophilic patients who had undergone similar surgery with heparin prophylaxis. In haemophilia patients, despite (in most cases) an absence of heparin prophylaxis, no thrombotic complications occurred, and neither the coagulation cascade nor the fibrinolytic system were significantly over-activated, compared with the control group. From a clinical standpoint, all patients achieved excellent haemostasis without clinical evidence of thrombosis. This study emphasizes the convenient and safe administration of highly-purified FVIII and FIX concentrates in haemophiliacs undergoing surgical procedures, and constitutes a small comparative database for the evaluation of new products.

Biomechanical properties of human cadaveric ankle-subtalar joints in quasi-static loading.

The biomechanical properties of human ankle-subtalar joints have been determined in a quasi-static loading condition. The moving center of rotation was determined and approximated by a fixed point. The moment-angle characteristics of the ankle-subtalar joints about the fixed center of rotation have been measured under four basic movements: dorsiflexion, plantarflexion, inversion, and eversion. The method linearly increases rotation of the calcaneus until failure, and measures the moments, forces, and linear and rotational displacements. Failure was identified as the initial drop of moment on plot showing the moment representing gross injury or microfilament damage. In this study, 32 human ankle-subtalar joints have been tested to failure. The center of rotation of the ankle-subtalar joints was determined for a pure dorsiflexion (9 specimens), plantarflexion (7 specimens), inversion (8 specimens), and eversion (8 specimens). Failure in the joints occurred at an average moment of -33.1 +/- 16.5 Nm in dorsiflexion, 40.1 +/- 9.2 Nm in plantarflexion, -34.1 +/- 14.5 Nm in inversion, and 48.1 +/- 12.2 Nm in eversion. The failure angle was also determined in all four motions. Failure was best predicted by an angle of -44.0 +/- 10.9 deg in dorsiflexion, 71.6 +/- 5.7 deg in plantarflexion, -34.3 +/- 7.5 deg in inversion, and 32.4 +/- 7.3 deg in eversion. Injury was identified in every preparation tested in inversion and eversion, while it resulted in five of the nine preparations in dorsiflexion, and in three of the seven in plantarflexion. Injury occurred at -47.0 +/- 5.3 deg and -36.2 +/- 14.8 Nm in dorsiflexion, and at 68.7 +/- 5.9 deg and 36.7 +/- 2.5 Nm in plantarflexion. The results obtained in this study provide basic information of the ankle-subtalar joint kinematics, biomechanics, and injury. The data will be used to form a basis for corridors of the ankle-subtalar joint responses.

Efficacy and safety of continuous infusion of Mononine during five surgical procedures in three hemophilic patients.

We report here five surgeries successfully performed with a continuous infusion of Mononine (Armour Pharmaceutical Company, Kankakee, IL) in three hemophilic B patients. Before surgery the patients received a bolus dose of 40 to 100 U/kg according to the type of surgery. This injection was followed by a continuous infusion of Mononine, with an infusion rate of 3.5-7 U/kg/hr in order to maintain a factor IX level between 50 and 100% during the whole surgery and the following 6 days. The infusion rate was further adjusted according to the type of surgery until hospital discharge. This method appears to be safe and efficient, since no abnormal bleeding occurred during surgery and none of the patients presented any thrombotic complication. However, this alternative to intermittent administration of factor IX should be standardized and precisely evaluated, regarding the level and the amount of factor IX required, and the cost of the infused material. In our hands, this cost was decreased by 30-40% compared to previous therapeutic schedules at our institution.

A new device for the treatment of pleural malignancies: intrapleural chemohyperthermia preliminary report.

The prognosis of malignant pleural tumors remains extremely unfavorable. The aim of this study is to evaluate the combination of intrathoracic intrapleural chemotherapy and intrapleural hyperthermia (ITCH) in these diseases. Under anesthesia, 5 men were studied. After pleurectomy for mesothelioma (3/5) or adenocarcinoma (2/5), ITCH is carried out for over 60 min, either with mitomycin C (4/5) or cisplatin (1/5). No pre- or postoperative death occurred. The maximal pleural temperature is 42.6 degrees C. The blood level of mitomycin C never reached the systemic toxic level. All the patients were discharged from the surgical ward, 3 are still alive 15 months later. Therefore, ITCH appears to be a safe and reliable therapy.