Blood donation and patterns of use in southeastern Nigeria

A retrospective study of donor blood availability and patterns of use from 1984 through 1988 was conducted in a 400-bed university teaching hospital in Nigeria by extraction of data from the master registers for blood donors and recipients. Blood transfusion requests, number of persons who underwent phlebotomy, number of crossmatches performed, and blood use increased each year during the period of study. Average wastage rate and crossmatch-to-transfusion ratio were 3.5 percent and 1.61, respectively. Replacement blood donation constituted 98 percent of available donor blood. Obstetrics and gynecology and surgery patients used 70.4 percent of the donor blood. The donor blood units were used as whole blood (81%) because of a lack of infrastructure such as a refrigerated centrifuge. Less than 5 percent of the donors were females. It is concluded that the levels of voluntary blood donation and general blood supply are unacceptably low. The need for a functional National Blood Transfusion Service is highlighted.     

Analysis of the recent cluster of invasive fungal sinusitis at the Toronto Hospital for Sick Children

OBJECTIVE: The aim of this study was to review the eight histopathologically proven cases of invasive fungal sinusitis that occurred at the Toronto Hospital for Sick Children between 1985 and 1995, seven of which that clustered between March 1990 and February 1992. DESIGN: A retrospective review of the relevant cases and a review of the literature are presented. METHOD: A clinical review of this rare, life-threatening entity, occurring almost exclusively in severely neutropenic patients is presented and compared to the relevant clinical findings from an analysis of this series, the largest reported to date and first to document a significant clustering (p < .01). CONCLUSION: We conclude, based on epidemiologic evidence, that this clustering was directly related to the release of airborne fungal spores from dormant soil reservoirs disturbed during hospital construction. Therefore, we strongly advocate increased vigilance with respect to precautions against airborne pathogens wherever severely neutropenic hosts are treated.     

Gender discrepancies in living related renal transplant donors and recipients

Renal transplantation is the most successful treatment strategy for patients with ESRD to improve survival and quality of life. The study presented here examines the relationship of gender and living related (LR) transplantation donor and recipient rates in the United States. National data from the United States Renal Data System (USRDS) were used for this study. All LR transplants occurring between 1991 and 1993 among blacks and whites were included (N = 6193). Transplantation and donation rates for men and women were calculated. Poisson regression was used to calculate female/male transplantation and donation rate ratios. Overall, women were 10% less likely to receive a LR transplant than men (rate ratio [RR] = 0.90, P < 0.001). This gender difference increased over time from 1991 (Female/Male RR = 0.95, P = not significant [NS]) to 1993 (RR = 0.85, P < 0.001). In contrast, women were significantly more likely to donate a kidney than men (RR = 1.28, P < 0.001 and RR = 1.29, P < 0.001 among whites and blacks, respectively). Analyses by age subgroups revealed that only among ESRD patients aged 20 to 44 yr was the likelihood of receiving a LR kidney transplant equal for men and women. Higher donation rates among women compared with men were observed in all donor age and race subgroups except young blacks (aged 0 to 19 yr). Recipient gender appeared to influence donation rates. The female-to-male relative donation rates were higher when donations were to female, compared with male, recipients. This study of national data suggests an imbalance in LR donation and transplantation between men and women. Women are more likely to donate a kidney but are less likely to receive a LR transplant than men. Several potential explanatory factors are explored. These findings suggest a need for the development of gender-appropriate interventions to encourage donation among men and LR transplantation among women, to ultimately facilitate greater use of this ESRD treatment modality.     

Fibrinogen Claro--another dysfunctional fibrinogen variant with gamma 275 arginine-->histidine substitution

The author's experience using automated disc aspiration for the diagnosis of discitis indicates that skinny needle aspiration biopsy has a very high false-negative rate. A negative skinny-needle biopsy, therefore, must be followed by a procedure to obtain a better sample of pathologic material. Automated disc aspiration, because of its safety and ability to provide a large specimen, is the procedure of choice. Attention, however, must be paid to technical details of the procedure and the poor annular integrity of the infected disc to carry out the procedure safely.     

Population based study of prevalence of islet cell autoantibodies in monozygotic and dizygotic Danish twin pairs with insulin dependent diabetes mellitus

OBJECTIVE: To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. DESIGN: Population based study of diabetic twins. SETTING: Danish population. SUBJECTS: 18 monozygotic and 36 dizygotic twin pairs with one or both partners having insulin dependent diabetes. MAIN OUTCOME MEASURES: Presence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase (GAD65) in serum samples from twin pairs 10 years (range 0-30 years) and 9.5 years (2-30 years) after onset of disease. RESULTS: In those with diabetes the prevalence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase in the 26 monozygotic twins was 38%, 85%, and 92%, respectively, and in the dizygotic twins was 57%, 70%, and 57%, respectively. In those without diabetes the proportions were 20%, 50%, and 40% in the 10 monozygotic twins and 26%, 49%, and 40% in the 35 dizygotic twins. CONCLUSION: There is no difference between the prevalence of islet cell autoantibodies in dizygotic and monozygotic twins without diabetes, suggesting that islet cell autoimmunity is environmentally rather than genetically determined. Furthermore, the prevalence of islet cell antibodies was higher in the non-diabetic twins than in other first degree relatives of patients with insulin dependent diabetes. This implies that the prenatal or early postnatal period during which twins are exposed to the same environment, in contrast with that experienced by first degree relatives, is of aetiological importance.     

Express diagnosis of eye adenovirus infection by fluorescent antibody method

The human selenium status in 10 locations of Irkutsk region (n = 216) is estimated using serum and hair selenium as biological markers. Extremely low serum selenium was typical for the inhabitants of Angara area (63-84 mcg/l). Hair selenium varied from 504 mcg/kg to 718 mcg/kg, the lowest values being found in Shelehov and Angarsk, the highest--in Karam and Mama. Low selenium concentrations were found also in the main food products: cereals--49-89 mcg/kg, meat--234-489 mcg/kg of dry weight, bread--106-180 mcg/kg of dry weight.     

Behavioural adjustment in school of very low birthweight children

The school-based behavioural adjustment at 7-8 years of a cohort of 243 prematurely born, very low birthweight (< 1501 g) children and their normal birthweight controls is reported. The findings indicate that the children born preterm (both male and female) were rated by their teachers as expressing more behaviour problems than their controls, and were less well adjusted to the school environment. The deficits noted in the preterms applied across the social classes, with no amelioration noted in preterms of higher social class. It is speculated that the problem behaviours reflect a failure in self-regulatory functions.     

Pediatric case of the day. Hinman syndrome (nonneurogenic bladder [NNNB], detrusor-sphincter dyssynergia)

Two cases of spontaneous left main coronary artery dissection are reported. This condition is rare and may present as an urgent surgical dilemma. The presentation, diagnosis, and management of primary left main coronary artery dissection are reviewed. Causative factors and underlying pathology are clarified. Prompt diagnosis and surgical intervention with temporary ventricular support is safe and effective.     

Testicular torsion before 6 hours. I

BACKGROUND: Following the crash of a Boeing 737-400 aircraft on the M1 motorway at Kegworth, near Nottingham, England, on January 8, 1989, it became apparent that a large number of pelvic and lower limb injuries had been sustained by the survivors. Had there been a fire, these injuries would have severely hindered the ability of the occupants to escape. The mechanism of pelvic and lower limb injuries in impact accidents previously has been related to flailing of the limbs and axial loading of the femur as in automobile accidents. HYPOTHESIS: A bending load is the primary mechanism of femoral fracture in an impact aircraft accident rather than an axial load. METHODS: Two methods of study have been used to investigate the impact biomechanics of the pelvis and lower limb: a) clinical review of the injuries sustained in the M1 Kegworth accident; and b) impact testing. RESULTS: A clinical review of the M1 aircrash survivors suggested that axial loading was not the primary mechanism causing femoral fractures and suggested that a bending load might be applied to the femur. Impact testing confirmed that axial loading of the femur did not appear to be significant. CONCLUSIONS: Our study suggests that in the presence of intact occupant protection systems, a femoral bending mechanism involving the front seat spar of passenger seats is a primary cause of femoral fracture in an impact aircraft accident.