Comparison of plasma exchange performances between Spectra Optia and COBE Spectra apheresis systems in repeated procedures considering variability and using specific statistical models.

Repeated therapeutic plasma exchange (TPE) procedures using centrifugation techniques became a standard therapy in some diseases. As the new device Spectra Optia (SPO; Terumo BCT) was available, we studied its performances in repeated procedures in 20 patients in three apheresis units. First we analysed the performance results obtained by SPO. Second we compared the performances of the SPO device to a standard device, COBE Spectra (CSP; Terumo BCT) in the same patients using statistical method of mixed effects linear regression that considers variability between patients, centres and apheresis procedures. The performances analysed were classified according to plasma removal performances and their consequences on patients whose blood disturbances were assessed. Primary outcome was plasma removal efficiency (PRE) and PRE-anticoagulant corrected which was a more accurate parameter. Secondary outcomes corresponded to the volume of ACD-A consumed, platelets content in waste bag, procedure duration and status of coagulation system observed after TPE sessions. Before comparing the performances of both devices we compared the plasma volumes (PVs) processed in both techniques which showed that the PVs processed in SPO procedures were lower than in CSP procedures. In these conditions the statistical analysis revealed similar performances in both apheresis devices in PRE (p = ns) but better performances with SPO when considering higher PRE corrected by anticoagulant volume used (p < 0.05). Comparison of secondary outcomes showed no difference after SPO and CSP. After verifying that pre-apheresis patients' coagulation blood levels were identical before SPO and CSP, we showed identical haemostasis disturbances after SPO and CSP but lower platelet losses and higher fibrinogen post-apheresis blood levels after SPO (p < 0.05). No side effects or technical complications occurred during and after SPO and CSP. This study demonstrated that the Spectra Optia device is an alternative device to today's standard, the COBE Spectra device.

[Examination of the prepuce in 511 nursery school children. The role of retraction technics]. / Examen du prépuce chez 511 enfants en maternelle. Rôle des manoeuvres de décalottage.

The foreskin of 511 nursery school children was examined. Among the 500 unoperated children, 69.4% had a freely retractable foreskin. Adhesions were found in 28% of children and phimosis in 2.6% (total proportion of children with phimosis including the operated cases was 4.5%). A negative history for forcible retraction was found in 63.6% of children; among these subjects, 64% had a freely retractile foreskin and 31.1% had adhesions, which were usually extensive. Among children who had undergone forcible retraction, 77.5% had a freely retractile foreskin and 22% had adhesions, which were minor in most instances (p less than 0.001). The person who performed forcible retraction (the family physician in 54% of cases) and the age of the child at the time of forcible retraction were recorded. This retrospective study in a pediatric population of mean age 3 years 7 months provides data on the outcome after forcible retraction. Mean age at forcible retraction was 13 months in 36.4% of patients. Among the 500 unoperated children, 204 (40.8%) were spontaneously free of foreskin adhesions.