Inventory management

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

Progressive mucosal injury in patients with gastroesophageal reflux disease and increasing peripheral blood eosinophil counts

HYPOTHESIS

Peripheral blood eosinophil count increases with the degree of mucosal injury associated with gastroesophageal reflux disease (GERD).

DESIGN

Retrospective review.

SETTING

Single-institution tertiary hospital.

PATIENTS

Two hundred ninety-five patients (215 men and 80 women; median age, 57 years [interquartile range (IQR), 46-66 years]). One hundred had GERD without intestinal metaplasia, 100 had GERD with intestinal metaplasia, 40 had GERD with dysplasia, and 55 had GERD with intramucosal carcinoma. Results of complete blood count with differential and serum chemistry studies were compared among the groups using a nonparametric test for trend.

RESULTS

Patients with a higher degree of mucosal injury were older (P < .001). There were no differences between white blood count, percent neutrophil count, absolute neutrophil count, and hematocrit levels among the groups. Serum albumin level decreased as the degree of mucosal injury increased (P = .04) but lost significance when controlled for age (P = .53). Percent eosinophil counts were 2.0 (IQR, 1.3-2.8) in patients with GERD without intestinal metaplasia, 2.5 (IQR, 1.6-3.7) in GERD with intestinal metaplasia, 2.6 (IQR, 1.7-4.4) in GERD with dysplasia, and 2.7 (IQR, 1.5-4.3) in GERD with intramucosal carcinoma. This progressive increase in the percent eosinophil count was statistically significant (P = .006), remained significant after controlling for age (P = .04), and was also significant when measuring the absolute eosinophil count.

CONCLUSION

There is a progressive increase in the percent and absolute peripheral blood eosinophil count associated with progressive mucosal injury in patients with GERD.

Chromatin architecture near a potential 3' end of the igh locus involves modular regulation of histone modifications during B-Cell development and in vivo occupancy at CTCF sites

The murine Igh locus has a 3' regulatory region (3' RR) containing four enhancers (hs3A, hs1,2, hs3B, and hs4) at DNase I-hypersensitive sites. The 3' RR exerts long-range effects on class switch recombination (CSR) to several isotypes through its control of germ line transcription. By measuring levels of acetylated histones H3 and H4 and of dimethylated H3 (K4) with chromatin immunoprecipitation assays, we found that early in B-cell development, chromatin encompassing the enhancers of the 3' RR began to attain stepwise modifications typical of an open conformation. The hs4 enhancer was associated with active chromatin initially in pro- and pre-B cells and then together with hs3A, hs1,2, and hs3B in B and plasma cells. Histone modifications were similar in resting splenic B cells and in splenic B cells induced by lipopolysaccharide to undergo CSR. From the pro-B-cell stage onward, the approximately 11-kb region immediately downstream of hs4 displayed H3 and H4 modifications indicative of open chromatin. This region contained newly identified DNase I-hypersensitive sites and several CTCF target sites, some of which were occupied in vivo in a developmentally regulated manner. The open chromatin environment of the extended 3' RR in mature B cells was flanked by regions associated with dimethylated K9 of histone H3. Together, these data suggest that 3' RR elements are located within a specific chromatin subdomain that contains CTCF binding sites and developmentally regulated modules.

Expression of somatostatin receptors in arginine vasopressin hormone-secreting olfactory neuroblastoma--report of two cases

OBJECTIVE

Arginine vasopressin hormone-secreting olfactory neuroblastomas are extremely rare, with fewer than twenty cases reported in the literature. Two of these cases, both initially presenting with the syndrome of inappropriate antidiuretic hormone, are presented. The second tumour was successfully identified using somatostatin receptor (octreotide) radiographic scintography.

METHOD

The pathological specimens from both cases were examined immunohistochemically for somatostatin receptors.

RESULTS

Samples from both cases demonstrated positivity for somatostatin receptors.

CONCLUSIONS

This report demonstrates the potential use of somatastatin analogues in the investigation, follow-up and treatment of patients with olfactory neuroblastoma.

Spatio-temporal selectivity of loss of colour and luminance contrast sensitivity with multiple sclerosis and optic neuritis

Colour and luminance-contrast thresholds were measured in the presence of dynamic Random Luminance-contrast Masking (RLM) in individuals who had had past diagnoses of optic neuritis (ON) some of whom have progressed to a diagnosis of multiple sclerosis (MS). To explore the spatio-temporal selectivity of chromatic and luminance losses in MS/ON, thresholds were measured using three different sizes and modulation rates of the RLM displays: small checks modulating slowly, medium-sized checks with moderate modulation and large checks modulating rapidly. The colour of the chromatic stimuli used were specified in a cone-excitation space to measure relative impairments in red-green and blue-yellow chromatic channels. These observers showed chromatic thresholds along the L/(L+M) axis that were higher than those along the S-cone axis for all display sizes/modulation rates and both red-green and blue-yellow colour thresholds were higher than luminance-contrast thresholds. The principal change in thresholds with spatio-temporal changes in the display was a reduction in thresholds for L/(L+M) and S-cones with increasing check size and modulation rate. However, luminance contrast thresholds did not change with display size/rate. These results are consistent with MS/ON selectively affecting processing in colour pathways rather than in the magnocellular pathway, and that within the colour pathways neurones with opposed L- and M-cone inputs are more damaged than colour-opponent neurons with input from S-cones.

Chromatic and luminance losses with multiple sclerosis and optic neuritis measured using dynamic random luminance contrast noise

We measured thresholds for detecting changes in colour and in luminance contrast in observers with multiple sclerosis (MS) and/or optic neuritis (ON) to determine whether reduced sensitivity occurs principally in red-green or blue-yellow second-stage chromatic channels or in an achromatic channel. Colour thresholds for the observers with MS/ON were higher in the red-green direction than in the blue-yellow direction, indicating greater levels of red-green loss than blue-yellow loss. Achromatic thresholds were raised less than either red-green or blue-yellow thresholds, showing less luminance-contrast loss than chromatic loss. With the MS/ON observers, blue-yellow and red-green thresholds were positively correlated but increasing impairment was associated with more rapid changes in red-green thresholds than blue-yellow thresholds. These findings indicate that demyelinating disease selectively reduces sensitivity to colour vision over luminance vision and red-green colours over blue-yellow colours.

Audit of scope and culture techniques applied to samples for the diagnosis of Mycobacterium bovis by hospital laboratories in England and Wales

This audit examines the ability of English and Welsh laboratories to diagnose Mycobacterium bovis infection. All 164 clinical laboratories submitting samples to the PHLS Mycobacterium Reference Unit and Regional Centres for Mycobacteriology were surveyed. Twenty per cent of responding centres did not use a pyruvate-containing medium or incubate for the minimum recommended period of 8 weeks. This study demonstrates the potential for the underdiagnosis of M. bovis infection in England and Wales. Possible reasons for underdiagnosis are discussed together with strategies to optimize recovery of M. bovis.

Biomechanical analysis of cervical orthoses in flexion and extension: A comparison of cervical collars and cervical thoracic orthoses

The analysis of current cervical collars (Aspen and Miami J collars) and cervical thoracic orthoses (CTOs) (Aspen 2-post and Aspen 4-post CTOs) in reducing cervical intervertebral and gross range of motion in flexion and extension was performed using 20 normal volunteer subjects. The gross sagittal motion of the head was measured relative to the horizon with the use of an optoelectronic motion measurement system. Simultaneous measurement of cervical intervertebral motion was performed with the use of a video fluoroscopy (VF) machine. Intervertebral motion was described as (1) the angular motion of each vertebra and (2) the translational motion of the vertebral centroid. We used surface electromyographic (EMG) signal data to compare subject efforts between the two collars and between the two CTOs. Each orthosis significantly reduced gross and intervertebral motion in flexion and extension (p < 0.05). No statistically significant differences were found between the Miami J and Aspen collars in reducing gross or intervertebral sagittal motion, except at C5-6. Both CTOs provided significantly more restriction of gross and intervertebral flexion and extension motion as compared to the two collars (p < 0.05). The Aspen 2-post CTO and 4-post CTO performed similarly in flexion, but the Aspen 4-post CTO provided significantly more restriction of extension motion (p < 0.05).

Antibiotic resistant tuberculosis in the United Kingdom: 1993-1999

BACKGROUND

The re-emergence of tuberculosis as a global health problem over the past two decades, accompanied by an increase in tuberculosis drug resistance, prompted the development of a comprehensive national surveillance system for tuberculosis drug resistance in 1993.

METHODS

The UK Mycobacterial Resistance Network (Mycobnet), which includes all mycobacterial reference and regional laboratories in the UK, collects a minimum dataset on all individuals from whom an initial isolate of Mycobacterium tuberculosis complex has been isolated and submitted by source hospital laboratories. Data sought include susceptibility to first line antibiotics, demographic, geographical, and risk factor information.

RESULTS

There were 25 217 reports of initial isolates of M tuberculosis complex in the UK between 1993 and 1999. All were tested for sensitivity to isoniazid, rifampicin, and ethambutol and 12 692 of the isolates were also tested for sensitivity to pyrazinamide and streptomycin. A total of 1523 (6.1%) isolates were resistant to one or more drugs, 1397 isolates (5.6%) were resistant to isoniazid with or without resistance to other drugs, and 299 (1.2%) were multidrug resistant. Although the numbers of drug resistant isolates increased over the period, the proportions remained little changed. Certain groups of people were at a higher risk of acquiring drug resistant tuberculosis including younger men, residents of London, foreign born subjects, patients with a previous history of tuberculosis and those infected with HIV.

CONCLUSION

Although the proportion of drug resistant tuberculosis cases appears to be stable in the UK at present, more than one in 20 patients has drug resistant disease at diagnosis and more than one in 100 has multidrug resistant disease. Tuberculosis control measures should be strengthened to minimise the emergence of drug resistance through rapid diagnosis, rapid identification of drug resistance, supervised treatment, and maintenance of comprehensive surveillance.