The efficacy and safety of lyophilized cryoprecipitate in hemophilia A.

This prospective study of assessing the efficacy and safety of lyophilized cryoprecipitate (LC), which was heat-treated at 60 degrees C for 25 hours, was conducted in 23 patients with hemophilia A (severe 13, moderate 9, mild 1) at the International Hemophilia Training Center, Bangkok from 1997 to 1998. A total of 223 infusions of LC were given. The status of the patients could be classified into 4 groups: group I, non-bleeding (n = 13); group II, severe bleeding requiring hospitalization (n = 9); group III, appendectomy (n = 1) and group IV, early bleeding controlled by modified home treatment (n = 200). Pharmacokinetic studies were conducted in groups I and II. The mean in vivo half-life of factor VIII clotting activity (F VIII:C) was 12.6 hours and the mean in vivo incremental recovery at baseline was 2.1 per cent/unit/kg. The mean clearance was 3.22 ml/kg/h. There was no statistically significant difference in these parameters between groups I and II (p > 0.05). The hemostasis was successfully achieved and 1 to 2 small urticarial wheals were observed in only 2 infusions. In addition, 9 out of 23 patients received LC exclusively for 1 year. None of them developed inhibitor to F VIII:C nor did any contract additional transfusion-transmitted infection except one who developed anti-hepatitis C virus seroconversion after receiving 16 bottles of LC in 4 months. Therefore, the more efficient virus-inactivation in the preparation of LC should be established.

Limb salvage for extremity sarcoma in Ramathibodi Hospital.

From May 1986 to July 1991, a retrospective review of 27 patients treated with limb salvage surgery for extremity sarcomas, was evaluated by our team. There were 12 males and 15 females with a mean age of 22.7 years (ranging from, 9 to 53 years). The mean of the follow-up period was 27.6 months. (ranging from 6 to 62 months). Twenty-four patients had bone sarcomas which included 20 osteosarcomas, 3 chondrosarcomas and one adamantinoma. The locations of bone sarcomas were the proximal tibia (6 cases), distal femur (5 cases), proximal humerus (4 cases), proximal fibula (3 cases), scapula (3 cases), proximal femur (1 case), tibial shaft (1 case) and pelvis (1 case). The remaining three patients had malignant fibrous histiocytomas located in scapular, tibialis anterior muscle, and knee regions. In total there were 1 stage IA, 2 stage Ib, 1 stage IIA and 23 stage IIB. Twenty-four cases had wide excisions; two had marginal excisions and one radical excision. There were 17 bone reconstructions consisting of 11 allografts and 6 autografts. At the most recent follow-up examination, 74 per cent of the patients are alive and the overall disease free survival was 63 per cent. Local recurrences occurred in 11 per cent. The major complication rate was 3 per cent and the minor complication rate was 33 per cent. With respect to a functional outcome, 84 per cent of the patients achieved excellent or good results.(ABSTRACT TRUNCATED AT 250 WORDS)