[Treatment of extreme anemia with polymerized bovine hemoglobin : Case report and review of the literature]. / Therapie einer extremen Anämie mit vernetztem Rinderhämoglobin : Fallbericht mit Literaturüberblick.

This article reports the case of a 29-year-old female Jehovah's Witness with severe anemia after intrauterine fetal death in the 25th week of gestation, complicated by vaginal bleeding, acute renal failure and hemolysis. Due to her religious beliefs the patient categorically refused blood transfusions. Despite adhering to the recommendations for patient blood management, the hemoglobin (Hb) level gradually decreased to 1.9 g/dl on day 10, when she fainted and had to be sedated and invasively ventilated. Inhalative isoflurane was chosen for sedation because of its potential organ-protective effects and because it provides deep sedation with reduced oxygen requirements, while enabling rapid neurological examination during the sedation windows as well as regular and calm spontaneous breathing. Posthypoxic encephalopathy was demonstrated clinically and electroencephalographically by seizure activity during the sedation windows. Anticonvulsive treatment was started. At a hemoglobin of 1.8 g/dl, she received 2 units of polymerized bovine hemoglobin (Hemopure®, Hemoglogin Oxygen Therapeutics LLC, Souderton, PA, USA), repeated several times on subsequent days because of its short half-life. Considerable methemoglobinemia was noted. After subtracting methemoglobin, the hemoglobin rose by 0.4-0.8 g/dl after each 2 units, initially increasing the oxygen binding capacity of the blood by 33%. After a full neurological recovery and weaning from the ventilator but still on hemodialysis, the patient was transferred to another hospital after 38 days.If allogeneic blood transfusion is not an option, administration of polymerized bovine hemoglobin can temporarily increase the oxygen transport capacity as a last resort treatment. Reduction of oxygen requirements by deep inhaled sedation with isoflurane also seems beneficial and provides advantages.

An uncertainty budget for trace analysis by isotope-dilution ICP-MS with proper consideration of correlation.

Isotope-dilution mass spectrometry (IDMS) is considered to be a method without significant correction factors. It is also believed that this method is well understood. But unfortunately a large number of different uncertainty budgets have been published that consider different correction factors. These differences lead to conflicting combined uncertainties especially in trace analysis. It is described how the known correction factors must be considered in the uncertainty budget of values determined by IDMS combined with ICP-MS (ICP-IDMS). The corrections applied are dead time, background, interference, mass discrimination, blank correction and air buoyancy.IDMS measurements consist always of a series of isotope abundance ratio measurements and can be done according to different measurement protocols. Because the measurement protocols of IDMS are often rather sophisticated, correlations of influence quantities are difficult to identify. Therefore the measurement protocol has to be carefully considered in the specification of the measurand and a strategy is presented to properly account for these correlations. This will be exemplified for the estimation of mass fractions of platinum group elements (PGEs) and Re in the geological reference material UB-N (from CRPG-CNRS, Nancy in France) with ICP-IDMS. The PGEs with more than one isotope and the element Re are measured with on-line cation-exchange chromatography coupled to a quadrupole ICP-MS. All contents are below 10 microg kg(-1). Only osmium is separated from the matrix by direct sparging of OsO(4) into the plasma. This leads to transient signals for all PGEs and Re. It is possible to estimate the combined uncertainties and keep them favourably small despite the low contents, the transient signals and the sophisticated correction model.

Recognizing heterogeneous distribution of platinum group elements (PGE) in geological materials by means of the Re-Os isotope system.

The identification of uncertainties caused by sample inhomogeneity, as distinct from those caused by sample preparation and measurement, is a challenging task. Use of chemometric methods to separate and estimate these contributions to the combined standard uncertainty of a measurement (uc) of an analytical result requires complex experiments. The difficulty of platinum group element measurement makes this task even more complex. But unless it can be demonstrated that sample inhomogeneity is the major contributor to the high variability of an analytical result one should be careful not to mistakenly attribute this to a nugget effect. In this contribution we are able to demonstrate in two special cases that irreproducible results (up to 90% RSD) for analysis of Os and Re in the pg g(-1) to ng g(-1) range are truly caused by a nugget effect and not by inadequacies of the analytical method.

Simplified method for the determination of Ru, Pd, Re, Os, Ir and Pt in chromitites and other geological materials by isotope dilution ICP-MS and acid digestion.

A method for the determination of low Ru, Pd, Re, Os, Ir and Pt abundances in geological reference materials by isotope dilution inductively coupled plasma mass spectrometry (ICP-MS) after acid digestion in a high pressure asher (HPA-S) is presented. The digestion technique is similar to that using Carius tubes but easier to handle and reaches higher temperatures. Osmium can be determined as OsO4 with ICP-MS directly after digestion through a sparging technique. The remaining elements are preconcentrated by means of anion column chromatography. The resin is digested directly without elution leading to high yields but this causes problems if Zr is present at higher levels in the silicate rich materials. The analytical results for international platinum group element (PGE) reference materials, chromitite CHR-Bkg, basalt TDB-1 and gabbro WGB-1, are presented and compared with literature data, demonstrating the validity of the described method. Although higher in concentration, PGEs determined for reference material WGB-1 were worse than for TDB-1 indicating a more inhomogeneous distribution of the platinum group mineral phases. The low PGE abundance chromitite standard, CHR-Bkg, is likely to be homogeneous for Ru, Re, Os and Ir and is recommended as a reference material for the study of chromitites. Detection limits (3s x total procedure blank) range from 0.012 ng (Re and Os) to 0.77 ng (Pt), which could be further improved by applying higher quality acids.

[A simple health control for the elderly. Screening for vitamin B12 deficiency and thyroid disease]. / Enkel hälsokontroll värdefull för ädre. Screening upptäcker B12-brist och tyreoideasjukdom.

Screening for vitamin B12 deficiency and thyroid disease is cheap and enables early diagnosis to be made and treatment to be started while it is still simple and can prevent the development of such serious conditions as dementia, depression, or irreversible tissue damage. In 1995-6, 83% (126/151) of all 75-year-olds in Härryda, a district (population 28,500) to the east of Gothenburg, agreed to undergo a health control designed to detect hypo- or hyper-thyroidism or vitamin B12 deficiency among elderly residents without symptoms (or with atypical symptoms not easily recognised). Of the 126 participants, four (3%) had low plasma cobalamin (vitamin B12) levels (a figure similar to or lower than those reported by others), and were treated with vitamin B12 after further examination; eight (6%) had serum thyroid stimulating hormone (TSH) levels below the lower normal limit, though further examination showed all eight to be euthyroid; and two (1.6%) were diagnosed as being hypothyroid (a lower prevalence than figures reported elsewhere), and were treated with laevothyroxine. The findings suggest that such screening might be useful in primary care. However, the clinical diagnosis of vitamin B12 deficiency, and of hypo- or hyperthyroidism, is often difficult, especially in the elderly; and although a low serum TSH level is also considered to be a reliable marker of hyperthyroidism, like others this study showed that it may occur even in the absence of disease. Thus, serum TSH and plasma B12 levels are useful screening variables, but need to be complemented by other tests before diagnosis is set.

Studies on the melts of alkali metal acetates.

The density, viscosity, and electrical conductivity of alkali metal acetates were measured over the temperature interval between melting and decomposition. The apparent activation energies of the equivalent conductivities and viscosities were calculated. It has been concluded from the results that alkali metal acetates, similarly to alkali metal benzenesulphonates studied earlier, exhibit properties quite unlike those of alkali metal halides. In the dependence of equivalent conductivity on the nature of the cation, the anomalous behaviour of lithium salts appears to be due to association prevailing in the melt phase.

Electron spin resonance analysis of the redox indicator variamine blue II.

The oxidation of the redox indicator Variamine Blue in an aqueous medium has been studied by the ESR method. The optimum conditions for the formation of the radical have been determined. The spectra have in some cases shown hyperfine splitting, from which conclusions could be drawn for the nature of the oxidation reaction and structure of the oxidized product. The coupling constants have also been determined for the radicals. The correctness of the assumptions for the structure of the radicals has been supported by the simulation of spectra and the investigation of deuterated derivatives.