Coagulation and renal effects of voluven versus haes-steril in major orthopedic surgery

Hydroxyelhyl starch [HES] solutions are effective plasma volume expanders. Impairment of coagulation and renal junction occur with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES [Voluven] was developed to minimize hemostatic interactions. The aim of the study is to evaluate the benefit of voluven to reduce hemostatic interactions and preserve renal junction while preserving its efficacy in restoring plasma volume in comparison to HAES-steril [pentastarch]. After approval of our local institutional university ethical committee, and a written consent was obtained from each one. Fifty consecutive adult patients, ASA I and II, scheduled for elective major orthopedic surgery at Assiut University Hospital were included in the study. The patients were allocated into two equal groups [each of 25 patients] according to the type of the study solution used as plasma volume replacement. Group-A: received [Voluven]. Group-B: received HAES-steril. Hemodynamic parameters: central venous pressure [CVP], mean arterial blood pressure [MABP], and heart rate [HR] were recorded before anesthesia induction [baseline], one hour after induction of anesthesia, at the end of surgery, 5 h after surgery and 24 h after surgery. Coagulation profile: Screening tests: prothrombin time [PT], prothrombin concentration [PC], International Normalized Ratio [INR]], partial thromboplastin time [aPTT] and serum fibrinogen level. Specific tests of haemostasis: factor VIII concentration and von Willebrand factor [vWF], Renal function tests: blood urea nitrogen and serum creatinine. Measurements time: sample were collected one day before surgery ['baseline], at 5 h and 24h after surgery. Amount of given colloids [ml], blood loss [ml] and packed RBCs [ml,] were recorded in all patients in two groups. All patients in the two groups were subjected to the some anesthetic management. Data was statistically analyzed using SPSS program version 16, a p value < 0.05 was considered statistically significant. There were significant differences with time as regard PT, PC, and INR in both groups and there was significant difference between the two groups, more increase in PT, INR and more decrease in PC in Haesteril group than in Voluven group. Voluven produced less inhibitory effect on coagulation factor VIII and Von Willibrand factor concentration and consequently, aPTT in comparison with HA ES-steril. Blood loss and transfusion requirements were less with Voluven group than with HAES-steril group. BUN and serum creatinine significantly changed over time in both groups but still within normal range in Voluven groups, but in Haesteril group there were significantly changed over time, mildly elevated above normal range and there was significant difference between the two groups with more increase in Haestril group. Compared with HAES-steril, Voluven are more likely to produce less coagulation abnormalities and less renal impairment in patients undergoing major orthopedic surgery manifested by less blood loss and less erythrocytes transfusion

High expression of the wild type of ALK gene is associated with favorable prognosis in human neuroblastomas

Anaplastic lymphoma kinase [ALK] gene is a transmembrane receptor tyrosine kinase initially discovered as part of the NPM-ALK fusion protein, resulting from a chromosomal rearrangement frequently associated with anaplastic large cell lymphomas. ALK is a novel dependence receptor and normally expressed in the developing and adult nervous system. The mutated ALK gene has been identified as a potential oncogene in human neuroblastomas [NBLs]. However, the frequency of mutation is only 5-8%. The present study was performed to examine the level of ALK mRNA gene expression in primary neuroblastoma patient tumor tissue samples and to assess the relation between ALK gene expression and other previously reported prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA. and its prognostic value in primary neuroblastoma patients was analyzed by the statistical methods. Immunohistochemical staining was used to check the expression level of ALK proteins. In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada's pathological classification [p=0.0000], patient's age [p-0.0000], MYCN amplification status [p=0.0000], tumor stage [p=0.0000][and] TrkA expression level [p=0.0390], all these factors are known to be associated with good prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALK in ALK-ampllfizd tissues and cell lines. Furthermore, mutation results showed that ALK mutation represented about 4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Our findings suggested that, high expression of wild type ALK is associated with good prognosis of NBL and that, as the mutation and amplification of ALK are reported to play an important role in NBL, also the expression level of wild type ALK gene might also have some function in cell growth as well as differentiation in neuroblastoma