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Biomedical subjects

M Inman

Publications and source records attributed to M Inman.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Use of hydroxyethyl starch to improve granulocyte collection in the Latham blood processor.

This report describes a practical, relatively inexpensive system of leukapheresis and plateletpheresis, utilizing the Haemonetics blood processor. The results of 236 phereses of normal donors are reported, with particular attention to an evaluation of five different anticoagulant mixtures: ACD, 2 per cent citrate in saline, and three different combinations of citrate and hydroxyethyl starch (HES). These mixtures were compared with respect to their effectiveness in the harvesting of granylocytes and platelets, respectively. The best harvest of granulocytes (3.5 X 10(9) cells per liter of blood processed) was with 6 per cent HES anticoagulated with trisodium citrate. All solutions gave about the same platelet yields (a mean of 1.6 X 10(11) per liter of blood processed). Because of its higher citrate content, ACD caused three times as many donor reactions as the other solutions. The use of HES thus permits this widely available plateletpheresis system to be used for leukapheresis with only minimal procedural modification.

Anticoagulants↗
PubMedDate not supplied

Leukapheresis of patients with chronic granulocytic leukemia (CGL), using the Haemonetics blood processor.

By the use of citrated hydroxyethyl starch (HES) as anticoagulant, the Haemonetics blood processor can be used to obtain large numbers of granulocytes from patients with CGL. This report is of 67 leukaphereses on 11 different patients. A median of 1.14 x 10(11) granulocytes was obtained per 6-cycle pheresis (3.4 x 10(10) per liter of blood processed), or eight to ten times the number obtained from comparable leukaphereses of normal donors. High yields of platelets were also obtained, although not in proportion to granulocytes, since some of the patients used as donors have normal or even low platelet counts. The patients tolerated the procedure well, and no adverse reactions to HES were observed. The patients experienced a mean 35 per cent drop in the postleukapheresis WBC count, but in no case was this drop sustained for more than a few days, and no lasting effect on the disease process was observed.

Adolescent↗
PubMedDate not supplied

Renal cell carcinoma metastatic to the pituitary gland: clinical manifestations and successful treatment with transsphenoidal resection.

OBJECTIVE: To describe two cases of metastatic involvement of the pituitary gland by renal cell carcinoma (RCCA) and review the medical literature regarding this entity. METHODS: We present two case reports and discuss the published literature to illustrate the clinical findings, radiographic features, and recommended management of RCCA metastatic to the pituitary gland. RESULTS: During a 12-month period, we encountered two patients, one with visual deficits and both with anterior pituitary dysfunction, who had large sellar lesions that were histologically proved to be RCCA. Both patients were successfully treated with transsphenoidal surgical resection of the lesion, one of whom is alive and well more than 2 years later. A pituitary metastatic tumor is an uncommon complication of RCCA; it may be difficult to diagnose and potentially fatal. Anterior pituitary dysfunction and visual disturbances are more common initial features than is diabetes insipidus, in contrast to pituitary metastatic involvement from other tumors. CONCLUSION: Transsphenoidal resection is a safe and effective method of treatment of RCCA metastatic to the pituitary gland.

Journal Article↗
PubMedDate not supplied

The negative impact of MQSA (Mammography Quality Standards Act) on rural mammography programs.

Since Roentgen's discovery in 1895, physicians and scientists have found ways to use x-ray to evaluate and diagnose disease. In 1960, Dr. Richard Egan modified an x-ray machine to image the breast, for example. In 1982, one study found that deaths from breast cancer could be reduced 40 percent by using screening mammography. In 1991, Congress appropriated $90 million for breast cancer research, a figure that rose to $406 million several years later. The Mammography Quality Standards Act (MQSA), passed in 1992, requires all mammography facilities to meet minimum quality standards for equipment, radiologists, physicists and technologists. Regulations require extensive records of medical audit and outcome analysis, personnel qualification and medical reporting. Inspection and certification are now the responsibility of the Food and Drug Administration (FDA). Although they ensure compliance with the law, these inspections cost each facility $1,549 annually and the average cost to reach compliance with MQSA is $18,000. These fees are easily absorbed by high-volume centers but are burdensome for smaller, lower volume centers. Screening exams, to be useful, must be simple, accessible and cost-effective. MQSA's regulations have added significant costs and in most cases, the smaller centers will be forced to raise prices or discontinue offering mammography for a segment of the population with little or no other recourse for screening. The FDA should look for ways to perform more cost-effective inspections that still enforce regulations and monitor quality. Inspections should be unannounced and fines raised for violations. Implementation costs must be more realistic and the amount of paperwork reduced.

Ambulatory Care Facilities↗
PubMedDate not supplied

Mobile contract services: what you need to know.

With sufficient planning and ongoing attention to detail, the performance of a mobile imaging service provider can exceed expectations and requirements. The relationship can prove to be mutually agreeable and profitable for many years. But, when contracting mobile services, you cannot spend too much time on initial research and detail. Several scenarios present outsourcing or mobile services as an acceptable alternative to purchase or lease: outdated equipment, novel or under-utilized technologies, the need for incrementally added or temporary service. To find suitable providers, check with peer sources in your area for recommendations; look specifically for facilities that are comparable in size and volume to your facility. Expect that larger volume facilities will rate more favorable schedules or pricing. Obtain and check references. Require mobile service providers to adhere to the same state and federal laws, rules and regulations that govern your facility; receive the assurance of compliance in writing if it is not specifically addressed in the contract. JCAHO requires that any contract service provider be governed by the same requirements as the accredited facility. Several other rules or licensing requirements may also pertain to mobile services. A prevailing reason for outsourcing imaging services is high equipment costs that cannot be justified with current volume projections. However, equipment quality should not be compromised; it must meet your needs and be in good repair. The mobile service provider you choose should be an extension of your department; quality standards must exist unilaterally. The set rule for assessing mobile service fees is that there is no set rule. There are many ways to negotiate the fee schedule so that it meets the needs of both parties. An effective marketing campaign lets physicians and patients know what you have available. Work with the mobile service provider to plan an initial announcement or open house. The mobile provider should also have patient education materials for referring physicians and your hospital. Having the mobile technologist meet with the radiologists to discuss written protocols will eliminate misunderstandings concerning expectations of both parties; ongoing communication is vital.

Communication↗