Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery.

Blood transfusion is absolutely indicated in acute anemia when the hemoglobin concentration falls below 6 g/dL. Sometimes it challenges the anesthesiologists if the blood intended for urgent transfusion is not readily or quickly available. In this case report, we describe an 81-year-old lady who accidentally sustained acute anemia after spinal surgery with the hemoglobin concentration falling to 1.4 g/dL. During the long wait for the process of cross-matching tests and delivery of blood from the blood bank in the city remote from the hospital, we could do nothing but administer crystalloid and colloid solutions to maintain the circulatory volume to prevent low cardiac output. Epinephrine was given when systolic blood pressure fell below 70 mmHg. Central venous pressure and arterial blood pressure were monitored to guide all the treatment. Fortunately, patient fully recovered on postoperative day 3 without any adverse events.

Effects of all-trans-retinoic acid on human esophageal carcinoma cells and their nuclear matrices.

Esophageal cancer is a common cancer among ethnic Chinese. The reported incidence of esophageal cancer has increased many fold in the past decades and is apparently still rising. Nuclear matrix forms the scaffold of the nucleus and participates in various nuclear functions. Cancer specific nuclear matrix proteins have been identified in several tumor systems. 2-D gel analysis shows the presence of novel nuclear matrix proteins in ATRA treated tumor cells and these proteins are cell line specific. Our preliminary study also shows ATRA altered the nuclear matrix density of tumor cells. The significance of these nuclear matrix proteins is discussed.

Clock-face drawing, reading and setting tests in the screening of dementia in Chinese elderly adults.

Comprehensive neuropsychological batteries focus on the subtle cognitive deficits in dementia, but a brief screening instrument is also of immense practical value. As the clock-drawing test encompasses a number of cognitive domains frequently disturbed by the dementing process, it is considered to be a suitable screening instrument for the disorder. We documented the usefulness of a new scoring method of the clock-drawing test for screening of dementia in the elderly Chinese in Hong Kong. Fifty-three demented individuals and 53 healthy elderly controls were assessed. At a cutoff score of 3/4, the sensitivity and specificity of the clock-drawing test in screening of dementia was 83% and 79%. With a composite test of clock reading and clock setting, the positive predictive value of the clock face test was 98%. This new scoring method of clock-drawing proved to be a valid measure for screening of dementia. It is applicable in non-English speaking populations and should be a useful adjunct for quick screening assessment of dementia.

The modified Fuld Verbal Fluency Test: a validation study in Hong Kong.

Recent studies in the West have found that verbal fluency tests are useful in the detection of dementia. In this study, the Fuld Verbal Fluency Test (FVFT) was modified and tested for its usefulness as a screening instrument for differentiating demented from normal elderly Chinese in Hong Kong. Fifty-three normal and 56 demented subjects were administered the FVFT, the Cantonese version of the Mini-Mental State Examination (CMMSE), and the Chinese version of the Hamilton Depression Rating Scale. In addition to bearing significant correlation with the CMMSE, the verbal fluency scores for all semantic categories (animals, fruits, vegetables) were found to produce significant differentiation between the normal and demented groups. However, test-retest reliability for the individual verbal fluency scores was shown to be unsatisfactory, and a composite measure was recommended for use in future screening on the grounds of its enhanced reliability.

Screening for dementia: a preliminary study on the validity of the Chinese version of the Blessed-Roth Dementia Scale.

Blessed-Roth Dementia Scale has been one of the most widely used rating scales in dementia. Previous studies indicated that this behavioral assessment scale is a useful tool for differentiating elderly subjects with no or minimal intellectual decline from those with cognitive deterioration. In the present study, the authors examined the validity of the Chinese version of the Blessed-Roth Dementia Scale (CDS) in Hong Kong. A total of 106 Chinese subjects were recruited from a social center, an old-age home, and psychogeriatric outpatient clinics. At a cutoff score of 3 of 4, the CDS achieved a sensitivity of 90.5% and specificity of 98.1% in differentiating demented from healthy control subjects. In the Chinese population studied, the scale was readily acceptable and considered to be an useful adjunct in screening of dementia.

Evaluation of the hemostatic clot formation of newborns by Sonoclot coagulation analyzer.

BACKGROUND: Sonoclot Analyzer has been widely used for more than five years in The United States to evaluate the platelet function and coagulation in adult. No clinical trial with the Analyzer has been reported in the field of pediatrics. The present study was aimed to evaluate the efficacy of the Sonoclot Analyzer for urgent determination of platelet function and coagulation in newborns. METHODS: Venous blood samples were drawn from the umbilical vein in 70 healthy newborns, and from the median cubital vein in 70 healthy adult volunteers, between 24 to 40 years of age, for control. DP2951 Sonoclot II Surgical Analyzer with graphic printer was used to evaluate the hemostatic clot formation. RESULTS: Results demonstrated that Sono ACT (activated coagulation time), peak time and retraction time increased by 36%, 66% and 70% respectively in newborns, while clot rate decreased by 69% in comparison with that of these adults. CONCLUSIONS: The results of using the Sonoclot Analyzer in this study confirmed other previous investigation that platelet function and coagulation are altered in newborns when compared with that of adults. The Sonoclot Analyzer is a simple device, easy to perform; It requires only small amounts of blood sampled (0.4 ml), and provides a rapid coagulation function for newborns.

Seizure after reversal of benzodiazepine treatment with flumazenil: a report of two cases.

Two patients developed seizure immediately after flumazenil administration that aimed to reverse the prolonged sedative effect of diazepam. The use of benzodiazepine for sedation in ICU may mask valuable information relevant to an ongoing pathological change. The seizure in our patients seemed most likely to result from septic encephalopathy which was unmasked by flumazenil. However, flumazenil has the potential to provoke seizure and should be used with caution.

Perceptual deficit in schizophrenia: a defect in redundancy utilization, filtering or scanning?

The perception by schizophrenic patients of stimuli with more than one feature (dimension) was investigated using psychiatric and non-psychiatric control groups. Indices of the ability (a) to make use of redundant stimulus cues, (b) to 'screen out' or filter irrelevant stimulus features, and (c) to scan the perceptual field for relevant stimulus features, indicated that only filtering was consistently poor in schizophrenia. It has been suggested that the schizophrenic patient may tend to perceive his environment in an undifferentiated holistic manner rather than in an analytic manner and the implication for the theory of left hemisphere pathology in schizophrenia is discussed. However, the performance of the schizophrenic subjects did not differ significantly from that of the group of depressed patients, which suggests that the selective attention deficits previously observed in schizophrenia are not specific to the disorder.