Clinical utility of human polymerized hemoglobin as a blood substitute after acute trauma and urgent surgery

We have previously documented the safety of 1 unit (50 gram) of human polymerized hemoglobin (Poly SFH-P) in healthy volunteers. This report describes the first patient trial to assess the therapeutic benefit of Poly SFH-P in acute blood loss. Thirty-nine patients received 1 (n = 14), 2 (n = 2), 3 (n = 15), or 6 (n = 8) units of Poly SFH-P instead of red cells as part of their blood replacement after trauma and urgent surgery. There were no safety issues related to the infusion of Poly SFH-P. The plasma hemoglobin concentration ([Hb]) after the infusion of 6 units (300 gram) of Poly SFH-P was 4.8 +/- 0.8 g/dL (mean +/- SD). Although the red cell [Hb] fell to 2.9 +/- 1.2 g/dL, the total [Hb] was maintained at 7.5 +/- 1.2 g/dL. Poly SFH-P maintained total [Hb], despite the marked fall in red cell [Hb] due to blood loss. The utilization of O2 (extraction ratio) was 27 +/- 16% from the red cells and 37 +/- 13% from the Poly SFH-P. Twenty-three patients (59%) avoided allogeneic transfusions during the first 24 hours after blood loss. Poly SFH-P effectively loads and unloads O2 and maintains total hemoglobin in lieu of red cells after acute blood loss, thereby reducing allogeneic transfusions. Poly SFH-P seems to be a clinically useful blood substitute.     

Measurements of phantom scatter factors for small field sizes in high energy x rays

An alternate method to measure the phantom scatter factor in small fields is provided for high energy photon beams. The measurement technique is based on the density scaling theorem described by O'Connor [Phys. Med. Biol. 1, 352-369 (1957)]. The phantom scatter factor (Sp) is measured in balsa and cedar wood to give effective field sizes in 3 x 3 to 0.5 x 0.5 cm2 water. The extrapolated zero area phantom scatter factor from the average data of balsa and cedar is 0.45. This indicates that the variation of output is largely due to a sharp decrease in the phantom scatter factor for small field sizes.     

MR of the heart under pharmacologic stress

Magnetic resonance imaging is one method for assessing cardiac function and perfusion at rest and under stress conditions. In this article, the potential of stress magnetic resonance imaging for evaluating ischemic heart disease is reviewed, and technical aspects of some developments that may contribute to comprehensive magnetic resonance imaging assessment of heart disease under rest and stress are discussed.     

Organ injury scaling: spleen and liver (1994 revision)

A case of haemangiopericytoma of the greater omentum is reported here. We discuss the presentation, treatment and prognosis of these rare tumours.     

Quantification of the nucleocytoplasmic distribution of wild type and modified proteins using confocal microscopy: interaction between 90-kDa heat shock protein (Hsp90 alpha) and glucocorticosteroid receptor (GR)

Elastin is a major protein component of the vascular wall and is responsible for its unusual elastic properties. Polymers of its repeating VPGVG sequences have been synthesised and shown to exhibit an inverse temperature transition where, as temperature rises, the polymer collapses from an extended chain to a beta-spiral structure with three VPGVG units per turn, each pentamer adopting a type II beta-turn conformation. These studies, however, have not established whether the temperature-driven conformational change is an intrinsic property of the individual pentameric sequences or a global, co-operative effect of many pentamers within the beta-spiral structure. Here, we examine by circular dichroism the behaviour of elastin-like peptides (VPGVG)n, where n varies between 1 and 5. Remarkably, we find that all lengths of peptide undergo an extended left and right arrow beta-turn transition with increasing temperature, suggesting that the induction of the beta-spiral occurs at the level of single pentameric units. The origin of this effect is a positive DeltaS term for the transition. At 35 degreesC, the average transition midpoint temperature, the value of TDeltaS is about 15 kcal mol-1. With larger oligomers (n=3), there is only a modest rise in DeltaS, suggesting that the dominant entropic effect resides within the monomer and that interactions between these units make only a small contribution to the energetics of the transition. Charges at the termini, and residue replacements or additions, regulate the transitions for the short peptides in a manner similar to that observed for the longer polymers. The behaviour of the same peptides in trifluoroethanol and SDS solutions is consistent with formation of the beta-turn being driven by interactions between non-polar groups. The significance of this behaviour for the rational design of temperature-induced responses in proteins is discussed.     

Fourier-transform Raman spectra of ivory. III: Identification of mammalian specimens

The FT-Raman spectra of six mammalian ivories, other than elephant and mammoth, are presented and spectral differences formulated into a protocol for the identification of animal species from the ivory samples. In this study, sperm whale, walrus, wart hog, narwhal, hippopotamus and domestic pig are considered. The results, which are obtained non-destructively from a variety of specimens, suggest that FT-Raman spectroscopy provides a potentially useful method for the identification of mammalian ivory.     

Radiographic sizing for meniscal transplantation

Allograft or synthetic meniscal replacement has the potential to delay the arthritic sequelae of the meniscectomized knee. Meniscal implants must, however, be side and size specific. A cadaveric study was performed in which medial and lateral menisci were painted with a radiopaque tantalum powder-cyanoacrylic mixture. Radiographs of this preparation demonstrated reproducible relationships between each meniscus and established bony landmarks. When corrected for magnification, meniscal size could be derived from plain films. Meniscal width equaled the distance (coronal) from the peak of the tibial eminence to the periphery of the tibial metaphysis on anteroposterior films. Meniscal length was measured from lateral radiographs. Medial meniscal length was 80%, and lateral meniscal length was 70% of the measured sagittal length of the tibial plateau. Measurement error averaged 7.8% by these parameters.