Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non-compressible hemorrhage in swine.

INTRODUCTION: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non-compressible hemorrhage, using a porcine liver injury model. METHODS: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. RESULTS: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg(-1)) was lower in Stasix-treated animals (22.2 +/- 3.5) than in control animals (34.7 +/- 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. CONCLUSIONS: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non-compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage.

Item 291--progress in cooperation between GPs and psychiatrists.

With a 12 month prevalence for mental health disorders at just over 17% and data indicating that 75% of those who seek help for a mental health problem do so in the first instance from a general practitioner, there is a strong need for GPs and psychiatrists to work together in providing mental health care for Australians.

Headspace/solid-phase microextraction/gas chromatography-mass spectrometry: a screening technique for the recovery and identification of volatile organic compounds (VOC's) in postmortem blood and viscera samples.

This paper describes the application of Headspace/Solid-Phase Microextraction/Gas Chromatography-Mass Spectrometry (HS/SPME/GC-MS) to the recovery and identification of volatile organic compounds in blood and viscera samples from deceased persons. The technique is used as a screening procedure to rapidly obtain information relating to toxicological investigations. The technique is suitable for the detection of volatiles (of wide boiling range) including butane, halothane, toluene, xylenes, and petrol residues in blood and viscera (lung, brain, and body fat).

Treatment of advanced pancreatic carcinoma with a combination of protracted infusional 5-fluorouracil and weekly carboplatin: a Mid-Atlantic Oncology Program Study.

BACKGROUND: Advanced pancreatic cancer is a rapidly fatal disease whose course has been little influenced by chemotherapy. Earlier studies have shown some modest promise for the combination of protracted infusional 5-fluorouracil (PIF) and cisplatin. We sought to evaluate a regimen of possibly lesser toxicity, PIF plus weekly carboplatin. PATIENTS AND METHODS: Fifty-four patients with advanced adenocarcinoma of the pancreas were treated with a regimen of protracted infusional fluorouracil 300 mg/m2/day for 70 days and carboplatin 100 mg/m2/weekly on weeks 1 through 10 of a 12-week cycle. After a two-week rest, cycles were repeated until progression. RESULTS: Median duration on treatment was 82 days (range 4-490 days). Toxicity was mild. Grade 3-4 toxicities were anemia 11%, leukopenia 6%, thrombocytopenia 2%, nausea/ vomiting 7%, diarrhea 9%, mucositis 9%, and renal 2%. Response was evaluable in 47 patients. There were two complete and seven partial responses (17% overall objective response rate among all patients). Stable disease for greater than 12 weeks was seen in 19 patients (40%) and progression in 19 (40%). The median overall survival was 22 weeks (1-99), with 61 weeks median survival in responders (22-99). One-year survival was 13%. CONCLUSIONS: Response and survival results with this regimen are at least equal to the best combination regimens reported, and were obtained with a low overall rate of serious toxicity.

Etoposide plus cisplatin followed by thoracic radiation for stage IIIB non-small cell lung cancer: MAOP study 2188.

Thirty-five patients with stage III B non-small cell lung cancer were treated with the combination of cisplatin (CDDP) 30 mg/M2/day and etoposide (VP16-213) 75 mg/M2/day administered as a 72-hour infusion. Twenty evaluable patients (67%) received subsequent thoracic radiation as definitive regional therapy following a clinical response or stable disease status. Complete plus partial responses to chemotherapy were observed in 15 patients (5CR and 10PR or 44%). Of the 20 patients who received radiation, six responded with five transitioning from stable disease to partial (2) or complete (3) responses. The overall response rate to the combined sequential chemotherapy plus radiation was therefore 20/35 or 59% with eight complete responders. Histopathology influenced the response rate to chemotherapy (53% versus 30% for epidermoid versus adenocarcinomas, respectively), but following radiation, the response rates were similar for the two pathologic subtypes (73% versus 71%). Median overall survival was 363 days with 20% of patients alive at 13 to 45 months. The response rate for CDDP plus VP16-213 chemotherapy administered as a 72-hour infusion was superior for stage III B non-small cell lung cancer compared with stage IV disease as previously reported by the Mid Atlantic Oncology Program (44% versus 25%). This difference between stage III B and stage IV was also reflected in median survival (363 days versus 190 days). The sequential addition of radiation therapy to this chemotherapy regimen is feasible in stage III B disease with a small proportion of patients demonstrating long-term survival.

Unemployment and cognitive difficulties.

Reported cognitive difficulties in a sample of unemployed men are described. Problems of slowing down and concentration were the most common. Longer duration since job loss was found to be associated with greater cognitive difficulties, and middle-aged unemployed men were particularly likely to report problems.