Postoperative blood salvage in hip and knee arthroplasty. A prospective study on cost effectiveness in 161 patients.

We conducted a prospective controlled study on 161 patients who underwent primary or revision total hip or knee arthroplasty to assess the efficacy and limitations of postoperative blood salvage. The actual quantity of blood salvaged after washing, the theoretical increase in hemoglobin concentration caused by its reinfusion and the cost of this procedure were studied. The mean amount of packed red cells after washing was 117 g. The average increase in hemoglobin concentration, which theoretically would have been achieved by retransfusion, was 0.47 g/dL. One third of the devices used were discarded as not effective enough and, in order to obtain an increase of 1 g/dL in the hemoglobin concentration, an average of 3.4 postoperative Solcotrans Plus Orthopaedic devices were used. To obtain the same increase in hemoglobin concentration as that given by an allogeneic blood transfusion, the overall cost of materials alone was more than five times the price of a single blood unit transfusion.

Fluctuations in viremia, aminotransferases and IgM antibody to hepatitis B core antigen in chronic hepatitis B patients with disease exacerbations.

We studied the relationships between the serum levels of viremia, aminotransferases and IgM anti-HBc, measured by monthly quantitative assays, in 52 untreated chronic hepatitis B patients (41 anti-HBe+, 11 HBeAg+) followed up for 12-20 months. Forty hepatitis exacerbations were observed in 17/41 anti-HBe+ (41.5%) and in 6/11 HBeAg+ patients (54.5%) (p = NS); all but one were clinically asymptomatic. We analyzed the fluctuations in the serum levels of the three parameters before, during and after the hepatitis exacerbations and found this chronological sequence of events in 96.2% of them: HBV-DNA increase-->ALT flare-->IgM anti-HBc increase. These results suggest that both antiviral immune reactions and ALT flares were triggered by quantitative variations in viremia. HBV-DNA baseline levels before flares were lower in anti-HBe+ (3.9 +/- 1.2 pg/ml) than in HBeAg+ patients (35.3 +/- 5.4 pg/ml) (p < 0.0001) and there was an inverse correlation between basal values and viremia level increases at the time of disease exacerbations (p < 0.001). This suggests that for a hepatitis exacerbation to occur, low basal viremia needed to increase markedly, while moderate increases in HBV-DNA serum levels were sufficient to trigger ALT flares in patients with elevated basal viremia. In conclusion, asymptomatic hepatitis B exacerbations are frequent in the natural history of chronic HBV infection, and monthly monitoring of HBV-DNA, ALT and IgM anti-HBc appears to be a suitable method to evaluate their frequencies and entities. This method can be a helpful guide for clinical and therapeutic decision-making in the single patient with chronic hepatitis B.

Hepatitis C virus infection in patients with essential mixed cryoglobulinemia.

OBJECTIVE: To study the association between hepatitis C virus (HCV) infection and essential mixed cryoglobulinemia. SETTING: Wards and clinics of the Ospedali Riuniti di Bergamo and Ospedale di Treviglio e Caravaggio, Italy. PATIENTS: Fifty-one patients with essential mixed cryoglobulinemia associated with glomerulonephritis and 45 controls with noncryoglobulinemic glomerulopathies. MEASUREMENTS: Antibodies to hepatitis C virus (anti-HCV) in sera from patients with essential mixed cryoglobulinemia and from controls, using two enzyme-linked immunosorbent assays (c100 ELISA and c22/c200 ELISA) and a recombinant immunoblot assay (4-RIBA); cryoprecipitate anti-HCV before and after use of dithiothreitol, a substance able to destroy IgM antibodies with rheumatoid factor activity, in patients with essential mixed cryoglobulinemia; serum HCV RNA by polymerase chain reaction in patients with essential mixed cryoglobulinemia. RESULTS: In patients with essential mixed cryoglobulinemia, the c22/c200 ELISA detected anti-HCV in 98% of serum samples (95% CI, 90% to 100%), whereas the rate of reactivity remained at 2% (CI, 0% to 12%) in the control group (P less than 0.0001). These results were confirmed by the 4-RIBA in 66% of patients with essential mixed cryoglobulinemia. The study of cryoprecipitate by c100 ELISA showed anti-HCV in 41% (Cl, 28% to 56%) of patients. After dithiothreitol, the rate of reactivity increased to 94% (CI, 84% to 99%; P less than 0.0001 by the McNemar paired chi-square test), suggesting that the elimination of rheumatoid factor leads to unmasking of anti-HCV in cryoprecipitate. Polymerase chain reaction detected HCV RNA in 13 of 16 sera from patients with essential mixed cryoglobulinemia. CONCLUSIONS: The extremely high prevalence of anti-HCV in serum and cryoprecipitate along with the frequently associated serum HCV RNA suggests a close relation between essential mixed cryoglobulinemia and chronic HCV infection.

[Emerging pathologies and correlates of drug abuse in 2 therapeutic communities in Bergamo]. / Patologie emergenti e correlate alle droghe d'abuso in due comunità terapeutiche di Bergamo.

The authors monitored for 1 year 96 cases of ex-opiate addicts, belonging to two therapeutic Communities from Bergamo, a male and a female group, and a group of subjects living close to them (operators) or relatives and of laboratory technicians (51 cases on the whole). Protocols were set up with all the biochemical, hematological and serological parameters, to study the alterations connected with possible pathologies related to drug addiction, with repeated controls during the observation year. Only one LAS case was pointed out, at present markedly improved, a high incidence of hepatic involvement, due to previous hepatitis (type B or non A and non B), no alterations of kidney functions, while alterations of lymphocyte populations and subsets, thrombocytopenia, cross reactions with VDRL and negative TPHA, 45% of anti HTLV III antibody positive cases, were pointed out. Concerning the technicians and people living close to the examined subjects, no positivity for anti-HTLV III antibody, due to horizontal transmission of infection, was observed.