Use of coronary arteriography in the preoperative management of patients undergoing urgent repair of the thoracic aorta.

Noninvasive innovations have advanced the timing and precision of diagnosis of acute dissection or enlarging aortic aneurysm. However, the need to perform coronary arteriography prior to surgical repair in these patients remains a question for many clinicians. This retrospective 10-year (1978 to 1988) review examined data of 54 patients undergoing urgent surgical repair of thoracic aortic tear, aneurysm, or dissection in our institution. Results of coronary arteriography and clinical variables (history of coronary artery disease, electrocardiographic abnormalities, surgical procedures, and in-hospital mortality) were tabulated. Twenty-seven patients had type A aortic dissection and 27 patients had type B. Twenty-four patients had aortic dissection or tear (type A or B) due to motor vehicle trauma. In patients with type A, a history and/or electrocardiogram suggestive of coronary artery disease was present in 16, in whom cardiac catheterization was performed in five. None required coronary bypass surgery or died. In the 11 patients with no clinical history of coronary artery disease or electrocardiographic abnormalities, six had cardiac catheterization, none had coronary artery disease, two had coronary reimplantation, and six died. Only 1 of the 27 patients with type A dissection had a perioperative myocardial infarction (a patient with a clinical history of coronary artery disease who did not undergo cardiac catheterization). In patients undergoing type B aortic repair, 10 had a clinical history or electrocardiogram consistent with coronary artery disease but only one underwent cardiac catheterization and subsequent coronary artery bypass graft surgery for coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

'Spin, cool, and filter' red cells prepared in a regional blood center.

Red cells depleted of leukocytes by the "spin, cool, and filter" (SCF) method are effective in preventing most febrile, nonhemolytic transfusion reactions (FNHTR). To determine whether red cell concentrates may be centrifuged in a blood center and filtered subsequently at an outlying facility, the authors examined how leukocyte removal was affected by the transport and storage of centrifuged red cells before microaggregate filtration (MAF). One hundred fourteen red cell units were each divided into two aliquots. After centrifugation, one aliquot from each unit was retained in the blood center, and the other was transported on a truck for 2 to 12 hours. Aliquots were stored for variable periods, after which the residual leukocytes were counted. Neither transportation nor storage significantly affected leukocyte removal by MAF. However, an unacceptable proportion of all SCF units failed to meet American Red Cross standards for leukocyte-poor blood and studies of factors influencing leukocyte depletion were undertaken. A relative centrifugal force of 6700 X g was needed to produce consistently acceptable units when blood was 8 to 15 days old. These results show that making SCF red cells is a practical, inexpensive way for blood centers to provide hospitals with products that prevent most FNHTR; however, each facility that prepares these products must perform quality control carefully.

Application of an objective biological assay of human interferons to clinical specimens and a survey of a normal population.

A rapid, quantitative, and nonsubjective method of interferon assay is described, which can be readily applied to clinical specimens. Automated data acquisition and data reduction allowed a significant increase in volume per unit of time over existing methodologies. Plasma always yielded higher (usually 2:1) interferon values than did serum obtained simultaneously. Ranges of interferon levels in plasma in normal control populations are reported as well as ranges for clinical virology laboratory technicians and patients with terminal malignancies or collagen vascular diseases.

Selective IgA deficiency in blood donors.

The frequency of selective IgA deficiency was determined in a healthy population of 6,240 blood donors. Screening for IgA deficiency was performed by double-diffusion analysis in agarose gel. Confirmation testing was performed with the more sensitive passive hemagglutination inhibition assay. Prevalence of IgA deficiency, characterized by a serum level of below 50 mg/L, was 0.30% (1 in 328), which is the highest prevalence of selective IgA deficiency reported in a healthy population. Antibodies to IgA were detected in sera of 36.8% of the blood donors with selective IgA deficiency, which also is the highest prevalence of anti-IgA antibodies reported in any previous study. The literature on IgA deficiency in healthy populations is reviewed. Current concepts in treatment of IgA-deficient patients requiring blood products are described.