Biomedical subjects

J Wasman

Publications and source records attributed to J Wasman.

5 recordsLinked to original sources

PubMed1996

Mantle cell lymphoma. Morphologic findings in bone marrow involvement.

Although mantle cell lymphoma (MCL), has been well described in lymph nodes, involvement of blood and bone marrow has not been well defined. The authors reviewed involved blood and marrow specimens from 13 patients with MCL to determine patterns of infiltration. These findings were compared to marrow involvement by follicular small cleaved cell lymphoma (SCCL) and small lymphocytic lymphoma (SLL). Peripheral blood involvement by MCL was present in 5 patients (38%). The circulating lymphoma cells were small (7-10 mu) with slightly folded nuclei. Marrow involvement ranged from 5% to 90% of the marrow space and was predominantly intertrabecular, including nodules and interstitial infiltrates (9 cases each; 68%). Paratrabecular aggregates (6 cases; 46%) and diffuse replacement by lymphoma (3 cases; 23%) were also seen. In SCCL, paratrabecular involvement was seen as were interstitial nodules. Cases of SLL showed diffuse, interstitial or nodular involvement without paratrabecular localization. Cytologic comparison showed nuclei that were angulated in SCCL, round in SLL, and slightly irregular in MCL, with considerable overlap among the groups. The architectural and cytologic findings in marrow involved by MCL show features of both SCCL and SLL, and cannot be used to definitively diagnose MCL.

Adult↗

PubMed1995

Effects of tumor necrosis factor alpha and vascular permeability factor on neovascularization of the rabbit ear flap.

OBJECTIVE: The survival of compromised skin flaps depends on neovascularization for their nutrition and metabolic waste removal. Our study investigated the effectiveness of angiogenic factors in accelerating peripheral neovascularization and in increasing skin flap viability. DESIGN: We elevated pedicled dorsal skin flaps on the ears of 23 New Zealand white rabbits, and the vascular pedicle was ligated to achieve partial flap necrosis. Fifteen flaps were treated with 0.1 micrograms/mL vascular permeability factor, and eight flaps were treated with 1.0 micrograms/mL tumor necrosis factor alpha. The ear flaps that were not treated with growth factor functioned in each rabbit as a normal saline control. MAIN OUTCOME MEASURES: The viability of skin flaps was observed visually and was measured by Cartesian planimetry using templates. Neovascularization was documented by microangiography and by histologic analysis of the flaps. RESULTS: Although the angiogenic factors accelerated neovascularization, increased flap survival was demonstrated only in those animals treated with vascular permeability factor that was supplied by an absorbable gelatin sponge. CONCLUSION: This experimental model, despite different levels of controls, contains multiple variables, including the use of an absorbable gelatin sponge, seroma formation, bioactivity of the angiogenic factors, optimal dosages and dosimetry, the need for a "blinded" format, and the validity of the histologic analysis. Additional investigation must be done and the experimental model itself must be improved before these apparently positive results may be accepted as clinically useful.

Animals↗

PubMed1989

Limitations to donating adequate autologous blood prior to elective orthopedic surgery.

We reviewed 175 patients who predeposited autologous blood prior to elective orthopedic surgery to define potential limitations of procuring adequate autologous blood. These potential limitations include physician underordering, storage interval, and erythropoietic response. We found that a continuing medical education intervention increased the amount of autologous blood requested by physicians for storage: from 121 U for 50 patients (mean = 2.4) before CME to 195 U for 65 patients (mean = 3.0) afterward; eight (16%) of 50 patients had 4 U or more requested before CME vs 25 (38%) of 65 patients afterward. Continuing medical education had no impact on mean (+/- SD) effective storage interval, 22.6 +/- 9.0 vs 21.6 +/- 9.4 days. Thirty (17%) of 175 patients were deferred (hematocrit less than or equal to 0.34) and were unable to donate units of blood requested; of these, 13 (43%) received homologous blood compared with 19 (13%) of 145 not deferred. We conclude that a significant percentage of patients are deferred from autologous donation because of hematocrit limitations and receive homologous blood. This problem is not related to physician underordering or inappropriate physician transfusion behavior, but rather to the erythropoietic response to serial phlebotomy over a limited storage interval. Future studies should focus on mechanisms to maximize autologous blood procurement.

Blood Banks↗

PubMed1989

Effects of a CME program on physicians' transfusion practices.

A two-stage project was designed to assess physicians' transfusion practices and to evaluate the effectiveness of a continuing medical education (CME) lecture to change these practices. The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. The groups were matched for age and sex distribution and for procedure. The results suggested that the physicians accepted lower hematocrit levels for autologous-donor patients, did not request adequate amounts of autologous blood, overtransfused some patients with their own blood, and did not schedule the elective procedures far enough in advance to allow patients to deposit the requested amounts of autologous blood. A CME program developed to address the latter three problems was given to seven subspecialty groups in a grand rounds lecture format. Follow-up comparisons of the orthopedic surgeons' blood transfusion practices indicate that after the CME program they did significantly less underordering of autologous blood but still did not increase the time for patients to donate the requested amounts of blood.

Blood Transfusion↗

PubMed1987

Autologous blood donation for elective surgery. Effect on physician transfusion behavior.

The hospital records of 69 autologous blood donors undergoing elective surgical procedures and those of matched controls were reviewed in an effort to assess whether autologous blood donation altered physician transfusion behavior. Physicians tolerated significantly lower admission (0.372 vs 0.437 [37.2% vs 43.7%]), nadir (0.304 vs 0.334 [30.4% vs 33.4%]), and discharge (0.326 vs 0.358 [32.6% vs 35.8%]) hematocrits in patients with autologous blood predeposits compared with matched controls. Additionally, 44 patients undergoing orthopedic procedures stored insufficient blood to prevent homologous blood exposure; ten of 17 patients could have avoided homologous blood if 4 U of autologous blood had been stored. Twenty-five patients undergoing nonorthopedic procedures stored an insufficient volume of blood to satisfy an unexpected transfusion need but were given transfusions of more than needed amounts of their own blood when transfusion was not clinically indicated. Future studies designed to maximize procurement of autologous blood are needed; a salutary effect on physician transfusion behavior would then be coupled with an autologous blood inventory that could eliminate homologous blood exposure in these patients.

Adult↗