Acute renal failure after low-dose irradiation. A complication of chronic lymphocytic leukemia

A middle-aged woman received low-dose irradiation for treatment of chronic lymphocytic leukemia: 1,000 rads to the spleen in four sessions over four days and 400 rads to each abdominal quadrant in eight sessions over eight days. Three days after the last irradiation session, acute hyperuricemic renal failure developed and conservative treatment was begun, with use of hydration, forced diuresis, alkalization, and short-term peritoneal dialysis. Uric acid levels were carefully monitored. Renal function promptly returned to normal.

Microaggregate counts in frozen-preserved erythrocytes: effects of washing in three blood processors and filtration

Since microaggregates have been implicated in posttransfusion pulmonary insufficiency, their elimination has become an active concern in blood transfusion. Various types of filters, as well as frozen-preserved erythrocytes, have been used to provide blood relatively low in microaggregates. We have counted particles in frozen-stored blood before deglycerolization, after washing in each of three cell processing systems, and after filtration through a 40-micrometer filter. Washing frozen erythrocytes reduced the total particle counts by an average of 89%. Slight differences were found among the three blood processors with respect to particle removal. Passing washed blood through a 40-micrometer filter did not result in significant further reduction in particle counts. Hence, the use of such filters in a frozen-preserved blood system is not warranted.

The use of frozen, thawed erythrocytes in blood banking: a report of 28 months' experience in a large transfusion service

A program of component therapy using largely frozen erythrocytes was initiated at Cook County Hospital in July 1973. Use of the three existing washing systems for routine preparation of frozen erythrocytes has shown that there are differences in the levels of free hemoglobin, hematocrit, and residual glycerol in the washed products. Adenosine triphosphate, 2,3-diphosphoglycerate, and extracellular potassium and sodium were found to be within acceptable limits. Some expired units were cultured and were found to be positive for Staphylococcus and Corynebacterium. The source of contamination has not been determined. Frozen blood, when available, has been given to all patients, regardless of age or clinical condition. The incidence of transfusion reactions has decreased from 0.57% prior to the inception of the component therapy program to 0.11% since that time. Two cases of possible posttransfusion hepatitis occurred in patients who had received non-frozen blood, and in three patients who received non-frozen erythrocytes and/or components as well as frozen blood. Although the goal of the program was the use of frozen erythrocytes exclusively, only 64% use was achieved, as sufficient quantities of blood for freezing were not available at all times.

Head injury admissions to a teaching hospital

A prospective study of head injury admissions to a city teaching hospital over one year has shown that most were minor. Of the 918 patients, 85% were discharged within 48 hours, only 3% required definitive neurosurgical care, and the overall mortality was 2%. Most cases came to hospital after 5.00 p.m. especially at the weekend. Head injuries accounted for almost one-third of emergency admissions to male general surgical wards.

Hemophiliac with hemolytic anemia resulting from factor VIII concentrate

Bilateral herniorrhaphy was successfully performed on a group AB hemophiliac with cirrhosis of the liver. Adequate hemostasis was maintained with infusions of commercial factor VIII concentrates and fresh frozen plasma. An anti-A antibody mediated hemolytic reaction occurred in the postoperative period. Hemolysis subsided after the cessation of commercial factor VIII infusions. The risk of such hemolytic reactions could be eliminated through the use of group-specific cryoprecipitated factor VIII.

Acute myelofibrosis and acute myeloblastic leukaemia

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Cyclophosphamide therapy and interstitial pulmonary fibrosis

Intersitial pneumonia and pulmonary fibrosis developed in a 72-year-old man during therapy with cyclophosphamide, vincristine, and prednisone. After extensive investigations, including an open lung biopsy, cyclophosphamide appeared to be the cause of the pulmonary disease. Complete disappearance of tachypnea and the pulmonary infiltrates occurred after the discontinuation of cyclophosphamide and the institution of prednisone therapy. We concluded that the diffuse pulmonary disease in this patient was a result of cyclophosphamide therapy. The clinical and pathologic findings in this case and a review of the literature of cyclophosphamide pulmonary toxicity are reported.

The relationship between alcohol and head injury and its effect on the conscious level

The incidence of head injury has risen in recent years and now accounts for almost one-third of acute male surgical admissions to the Western Infirmary, Glasgow. A prospective study has established that in Glasgow alcohol is a major associated factor, 62% of males and 27% of females having detectable levels in the blood (greater than 5 mg/100 ml); in these patients the mean level was 193 mg/100 ml in men and 165 mg/100 ml in women. The alcohol level was significantly higher in patients who had had 'a fall under the influence', or had been the victims of an assault, than in those involved in traffic or other accidents. This suggests that alcohol may be an important contributroy cause of head injuries in this city. Depression of the conscious level occurred at blood alcohol levels aroung 200 mg/100 ml, but a significant number of patients in coma had a serious head injury.

Blood ethanol concentrations in patients attending special clinics in Glasgow

Blood samples for measurement of ethanol concentration were taken on a routine basis from 543 male and 158 female patients attending Special Clinics in Glasgow. Ethanol was detected in 56 (10-3 per cent.) of the men and eight (5-1 per cent.) of the women, and at concentrations in excess of 0-1 g./l. in 37 (6-8 per cent.) and three (1-9 per cent.) respectively. In nine men and one woman, the blood ethanol concentration was over 0-8 g./l. when they attended the clinic. The majority (84 per cent.) of positive findings were obtained in specimens collected after 2 p.m. and one-quarter on Tuesday afternoons, the local half-day. The other peak periods related to attendance at football matches on Wednesday evenings, and to receiving wages on Friday mornings. Male new patients attending a clinic for the first time had the highest incidence, 32 (11-6 per cent.) having detectable amounts of ethanol among whom 26 (9-4 per cent.) had levels in excess of 0-1 g./l., compared with only 4-1 per cent. among those either returning to the clinics with a fresh infection or on surveillance. Only 5 per cent. of female patients attending for the first time and 3 per cent. of those on surveillance had detectable amounts of ethanol in the blood, compared with 9 per cent. of those few returning with fresh infections. Levels in excess of 0-1 g./1. were only found in promiscuous women. Those with concentrations in excess of 0-8 g./1. were unreliable attenders. Only one, a known alcoholic, completed surveillance; one defaulted after his fourth visit, four after the second, and four after the first visit.

Preparation and monitoring of marijuana smoke condensate samples

The objective of this study was the production of smoke condensate from the marijuana cigarettes on schedule for the bioassay study and involved quality control on each batch of smoke condensate. Examination of the condensate production data (tables 1 and 2) reveal that it is not possible to strictly control the butt length of cigarettes when smoked on a robot smoking machine thereby accounting for some variation in the yield of the dry particulate matter and increment9-tetrahydrocannabinol. No increment8-tetrahydrocannabinol was detected in any batch of the smoke condensate. Recently, Hoffman and co-workers (13) have reported that marijuana that exhibited carcinogenic potential similar to tobacco cigarette smoke condensate in the dermal assay in mice.

Attitudes towards alcoholism

An attitude survey of psychiatrists has shown that alcoholism is the least favoured of the organic and psychiatric illnesses. They considered that this attitude was shared by general physicians and surgeons. The unfavourable attitudes towards alcoholism are unlikely to improve the success of treatment programmes. It is suggested that education within the professions is needed.

Effect of teaching on students' attitudes to self-poisoning

The attitudes of students, resident house physicians, and medical social workers towards 10 medical conditions were assessed in relation to both personal attitudes and the opinions expressed of the attitudes of the medical profession. Final-year students and house physicians showed unfavourable attitudes towards self-poisoning in contrast to fourth-year students and medical social workers. The fourth-year students were given the opportunity to admit patients referred to hospital with self-poisoning and visited the family doctor and the patient after discharge. After this exposure there was a subjective impression that the students became more interested in the problems of use self-poisoned patients, and this was supported by a review of their attitudes at the end of the teaching project.

Attitudes towards self-poisoning

Self-poisoning now constitutes one of the prime emergencies in hospital medical practice. This paper describes the results of the study of the attitudes of physicians and senior nurses towards several common illnesses in the medical wards. The junior doctors and the nurses who frequently have primary responsibility for the care of the self-poisoners tend to show unfavourable attitudes towards these patients.