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Biomedical subjects

J Umlas

Publications and source records attributed to J Umlas.

At least 19 recordsLinked to original sources
PubMed1996

Orbital lesions in the blue rubber bleb nevus syndrome.

PURPOSE: To identify ophthalmologic manifestations of the blue rubber bleb nevus syndrome, a rare cutaneovisceral hemangiomatosis. METHODS: The authors report two patients with a diagnosis of blue rubber bleb nevus syndrome with orbital hemangiomas. RESULTS: In one patient, the orbital lesion presented with signs and symptoms similar to an orbital varix and in the other with lid ecchymosis from an eyelid lesion. CONCLUSION: Patients with the blue rubber bleb nevus syndrome may have vascular orbital lesions associated with intermittent proptosis. Ophthalmologists should be familiar with the syndrome and its life-threatening complication of gastrointestinal hemorrhage.

Adult↗
PubMed1994

Red cell loss following orthopedic surgery: the case against postoperative blood salvage.

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty. STUDY DESIGN AND METHODS: The volume of salvaged red cells was measured for the first 6 hours after operation. This volume was compared to total red cell loss during hospitalization and to the volume of allogeneic red cells transfused. RESULTS: Mean postoperative red cell loss in 31 patients following hip replacement was 55 +/- 29 mL and that in 20 patients following knee replacement was 121 +/- 50 mL. The 6-hour wound drainage represented 8.7 and 16.8 percent of overall red cell loss during hospitalization for hip and knee replacement, respectively. The transfusion of postoperatively salvaged red cells would have supplanted transfusion of less than one-third of a unit of allogenic blood after hip replacement and two-thirds of a unit after knee replacement. Only three patients (5.9%) lost red cell volume in the drainage equivalent to or in excess of 1 unit of red cells (180 mL). The volume of red cells salvaged postoperatively bore no relationship to perioperative red cell losses as a whole. CONCLUSION: The relatively small red cell loss in the postoperative period in most arthroplasty patients does not appear to justify the routine use of this technique for the recovery of autologous blood.

Aged↗
PubMed1993

Survival and half-life of red cells salvaged after hip and knee replacement surgery.

The survival of autologous red cells collected intraoperatively has been reported previously. This study measures the survival and half-life of red cells collected 3 hours after hip and knee arthroplasty. For six patients, four having knee replacements and two having hip replacements, the salvaged red cells were labeled with radioactive 51Cr. Peripheral blood was simultaneously labeled with nonradioactive 52Cr. There was no significant difference in the survival or half-life of the salvaged and the venous blood.

Chromium Radioisotopes↗
PubMed1993

Antibodies to hydrocortisone in reagent red cells causing positive antibody screening tests.

When a patient's serum contains a temperature-independent antibody reacting with all antibody screening and antibody identification panel cells but with few or no units of blood used for crossmatching, one should suspect an antibody against a constituent of the suspension medium of the reagent blood cells. This observation is confirmed by negative reactions with a) washed reagent cells or b) another manufacturer's cells that do not contain the same additives. Two patients are described with antibodies to hydrocortisone that are present in one manufacturer's antibody screening cells and identification panels. The hydrocortisone was added by the manufacturer to prevent hemolysis of the reagent red cells. The patient's antibodies were IgM, complement independent, and nonneutralizable by prior incubation with hydrocortisone. The addition of hydrocortisone to other manufacturers' reagents converted previously negative reactions to the same level of positivity as was seen with the reagent from the index manufacturer. Antibodies to reagent constituents can cause delays in finding compatible blood. It is suggested that manufacturers delete irrelevant additives or those of questionable necessity from their reagents.

Aged↗
PubMed1991

A cryoglobulin with cold agglutinin and erythroid stem cell suppressant properties.

A 93-year-old woman presented with profound anemia (hematocrit 23% [0.23]); there was clumping of her red cells in test tubes and on peripheral blood smears. There was also a marked decrease in erythroid precursors in the bone marrow and reticulocytopenia in the peripheral blood. An IgM kappa monoclonal gammopathy was found in low concentration (approximately 1%) in her serum, and the cold agglutinins had a titer of 2560. However, the cold agglutinin titer of the supernatant after cryoglobulin precipitation was 40. Redissolving the cryoglobulin in the supernatant resulted in a cold agglutinin titer of 1280. Moreover, the addition of the patient's whole serum inhibited erythroid colony formation in culture. The inhibition was removed by cryoprecipitation of the cryoglobulin. The patient was given steroid therapy, to which she responded with reticulocytosis and an elevation of hematocrit. By 3 months, the cold agglutinin titer had fallen to 10. She remained well 4 years later. Whereas reports of cryoprecipitable cold agglutinins are rare, this case is unique because there have been no previous reports that these cold active proteins also have erythroid stem cell-suppressant properties.

Aged↗
PubMed1991

Suitable survival and half-life of red cells after frozen storage in excess of 10 years.

To examine the appropriateness of the Food and Drug Administration's 10-year storage time for previously frozen red cells, 24-hour posttransfusion survival studies were performed, and the half-life of 3 units of autologous red cells that had been stored for 13.5, 14, and 17 years, respectively, was measured. The units had acceptable freeze-thaw-wash recovery (83.3-91.4%). When a 51Cr label was used for the previously frozen red cells and a simultaneous 52Cr label for freshly drawn autologous red cells was used as a comparison, it was seen that the previously frozen cells had normal 24-hour posttransfusion survival (75.1-88.4%) as well as normal half-life (23-33.7 days). These findings support further extension of the maximum allowable storage time for previously frozen red cells.

Blood Preservation↗
PubMed1991

Spindle cell pseudotumor due to Mycobacterium avium-intracellulare in patients with acquired immunodeficiency syndrome (AIDS). Positive staining of mycobacteria for cytoskeleton filaments.

A rare spindle-cell pseudotumor caused by Mycobacterium avium-intracellulare (MAI) that mimics a mesenchymal tumor, was recently reported (7,14). We report on three such pseudotumors in patients with the acquired immunodeficiency syndrome (AIDS), two involving lymph nodes and one involving the bone marrow. In the course of investigating the first-encountered example of this tumor for evidence of smooth-muscle origin of the spindle cells, it was noted that these cells stained positively for desmin by immunoperoxidase techniques (IPX), as did a variety of other cytoskeleton filaments of all sizes. Electron microscopic examination of one of these lesions revealed spindle cells containing lysosomes and large numbers of microorganisms compatible with MAI but no filaments or organelles suggestive of smooth-muscle cells. Further studies revealed that the typical lesions produced by MAI in patients with AIDS, namely aggregates of histiocytes or individual histiocytes laden with organisms, rather than the expansile spindle-cell pseudotumor, also strain strongly for cytoskeleton filaments, as do M. tuberculosis and Mycobacterium leprae. Awareness of the existence of this unusual manifestation of MAI infection in AIDS patients and its desmin positivity can avoid misdiagnosis of a primary or metastatic smooth-muscle neoplasm. The cell of origin appears to be the histiocyte.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Acquired immunodeficiency syndrome and directed blood donations. A dilemma for American medicine.

The devastating consequences of transfusion-associated acquired immunodeficiency syndrome have led some patients and physicians to propose recipient-orchestrated (directed) donations as a method of improving the safety of blood transfusions. This method is not safer than volunteer blood donation and introduces several legal, ethical, and administrative problems. Blood banks should discourage the use of directed blood donations, and physicians should work to educate the public about the lack of benefit of directed donations and their potential risks.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The ultrastructure of fiber cells in primate lenses: a model for studying membrane senescence.

We have compared the surface morphology of the youngest (cortical) fiber cells with that of the most senescent (nuclear) fiber cells in monkey and baboon crystalline lenses by stereo scanning electron microscopy (SEM) and thick-section stereo transmission electron microscopy (TEM). Both the broad and the narrow faces of the most senescent fiber cells featured distinctive, polygonal areas (domains) of furrowed cell membrane. The domains ranged in size from 2.42 to 8.78 microns2. Stereopair SEM and TEM micrographs demonstrated precisely oriented microvilli measuring approximately 0.14 micron in diameter and ranging in length from 1.27 to 4.65 microns overlying each ridge in the domains. Formation of microvilli on senescent cells has been noted in other types of aging cells but they are imprecisely arranged and their function is unknown. Since every fiber cell remains in a fixed location (relative to other fiber cells) throughout life, the lens provides a unique model to study structure-function relationships of senescent microvilli in situ. The discovery of an age-related elaboration of numerous microvilli on senescent fiber cells of noncataractous lenses invalidates the currently accepted theory that close, parallel apposition of the broad faces of lens fiber cells is necessary for the lens to be transparent.

Aging↗
PubMed1988

Warfarin-induced alopecia.

Earlier reports of the association between oral anticoagulation and alopecia describe a high incidence of this complication (42 to 78 percent). However, judged by its extreme rarity in a survey of eight experienced, busy academic dermatologists in Boston, this association is not common, nor is the assumption that the alopecia tends to occur soon after the administration of warfarin necessarily true. Nevertheless, alopecia persists in the face of continued warfarin administration; the time required for hair to regrow after discontinuation of the drug may be too long to be practical if continued anticoagulation is necessary; the effect of oral substitutes for warfarin is unknown; and alopecia may recur if the patient is rechallenged with warfarin.

Alopecia Areata↗
PubMed1984

Heparin monitoring and neutralization during cardiopulmonary bypass using a rapid plasma separator and a fluorometric assay.

Avoidance of over- or underheparinization during cardiopulmonary bypass (CPB) is crucial in preventing bleeding or clotting. Currently no completely satisfactory method is available for measuring heparin levels--a method that would be rapid, inexpensive, specific, and reproducible. We combined the use of two devices, a rapid plasma separator and a fluorometric heparin assay system, in an attempt to satisfy these requirements in 15 patients having CPB during cardiac surgical procedures. The first instrument separates plasma from whole blood using a pneumatic filtration principle, while the heparin assay system measures the effect of heparin on thrombin conversion of a synthetic fluorogenic substrate. Accurate plasma heparin levels can be generated in less than five minutes, and the assays are inexpensive and easy to perform. Performing heparin assays at critical intervals during CPB allowed desired heparin levels to be maintained and the protamine dose for heparin neutralization to be reduced to a minimum. In addition, studies for heparin rebound revealed negligible rebound up to six hours postoperatively despite the reduced doses of protamine. There were no hemorrhagic or clotting complications in the series.

Cardiopulmonary Bypass↗
PubMed1983

Transfusion of patients undergoing cardiopulmonary bypass.

Although certain hematologic changes that occur as a consequence of cardiopulmonary bypass are unique, their influence on the transfusion requirements of open-heart surgical patients is not different from that on other bleeding patients. While knowledge of the peculiarities of open-heart surgery is important for the blood bank medical director, this clinical situation can be managed using the basic principles of component therapy as they apply to other clinical situations.

Blood Transfusion↗
PubMed1983

A device for rapid plasma separation.

The STATSEP Plasma Separator (Instrumentation Laboratory, Inc, Lexington, MA), a device for rapidly separating plasma from whole blood, generates plasma at the rate of 0.5 ml/min by filtration rather than centrifugation. When plasma was separated by conventional centrifugation or by the plasma separator, there were no clinically significant differences in concentrations of a variety of important analytes in duplicate specimens. In addition, there were no clinically significant differences in measurements of prothrombin times (PT) and partial thromboplastin times (PTT) on plasmas generated by the 2 techniques. This device, therefore, reduces the analytic time of these frequent coagulation tests by 9 min. The above tests were performed on patients with leukemia and with benign and neoplastic elevations of platelet counts, with no differences seen between plasma specimens separated by either technique. Elevated hematocrits, however, require as much as 2 min to produce 0.5 ml of plasma. Both the machine and disposables are inexpensive and easy to operate.

Blood Chemical Analysis↗
PubMed1983

Anticoagulant monitoring and neutralization during open heart surgery--a rapid method for measuring heparin and calculating safe reduced protamine doses.

Confident monitoring of heparin during cardiopulmonary bypass and subsequent neutralization by protamine has been hampered by the absence of an accurate, reproducible, rapid, simple, and specific assay for heparin. By using two new instruments in tandem, one of which produced 0.5 ml of plasma in 1 min and one which specifically measures heparin in 3-4 min, heparin levels are available in approximately 5 min. By performing heparin assays at a variety of intervals, it was demonstrated that 76% of patients receiving common doses of heparin during cardiopulmonary bypass may have plasma levels that are potentially too low. Minimum neutralizing doses of protamine may be calculated using the formula: (estimated blood volume + pump prime volume) X (plasma heparin level/100) X 1.1 + 50. These doses were nearly two-thirds of previous doses and were unassociated with increased bleeding, clotting, or clinically significant heparin rebound.

Biological Assay↗