[Cesarean section in a patient with acute myocardial infarction during pregnancy]

Maternal heart disease during pregnancy is the main cause of obstetric morbidity and mortality. We report the case of a 40-year-old woman with a history of myocardial infarction and percutaneous transluminal coronary angioplasty. The patient suffered a second heart attack and received pharmacologic treatment. After admission, she was seen to be 29 weeks pregnant. Delivery was by cesarean section under progressive epidural block without complications. We review the medical, obstetric, and anesthetic implications of myocardial infarction during pregnancy. The management of such patients should be multidisciplinary and decisions about delivery should be taken based on obstetric considerations.

[Tobacco use among young people in informal education settings: a survey of behaviors and opinions]

OBJECTIVES

To obtain information about the tobacco use of young people in an informal educational setting. To analyze the profile of the young smoker and the associated social and health factors, and to discover the opinion of tobacco held by smokers and non-smokers. POPULATION AND METHODS An anonymous, self-administered, personal questionnaire was completed by volunteers aged 14 to 26 years old taking part in the activities of 3 youth centers. The questionnaire included items about the subjects' smoking habits, their awareness of the harmful effects of cigarette smoking and knowledge of tobacco cessation techniques. The survey also covered the health and social profile of young smokers.

RESULTS

A total of 84 completed questionnaires were received (40 males and 44 females). The mean age of the sample was 18.3 years. Of the total, 15.4% had never smoked, 44% described themselves as smokers, and 16.6% as ex-smokers. Of the smokers, 40% smoked up to 10 cigarettes/day and 60% between 11 and 20. The age of initiation or experimentation was 13.1 years, and that of the onset of regular or daily use, 14.6 years. Only 23.5% of the smokers expressed a desire to stop smoking, and 50% had never tried to quit. Tobacco use was associated with weekend alcohol consumption in 59% of the smokers. None of the respondents were aware of the tobacco cessation aids and therapies available.

CONCLUSIONS

According to the data collected by way of these questionnaires, a high percentage of the young people who participate in these leisure activities are smokers. They report a very early age of initiation and an accurate understanding of the serious consequences of tobacco use. Their lack of awareness about the available aids for tobacco cessation is a cause for concern, and the number of smokers who expressed a desire to quit was minimal. A disturbing increase in the association between alcohol and tobacco consumption was observed.

Methodological considerations for implementation of lymphocyte subset analysis in a clinical reference laboratory

As the diagnostic utility of lymphocyte subset analysis has been recognized in the clinical research laboratory, a wide variety of reagents and cell preparation, staining and analysis methods have also been described. Methods that are perfectly suitable for analysis of smaller sample numbers in the biological or clinical research setting are not always appropriate and/or applicable in the setting of a high volume clinical reference laboratory. We describe here some of the specific considerations involved in choosing a method for flow cytometric analysis which minimizes sample preparation and data analysis time while maximizing sample stability, viability, and reproducibility. Monoclonal T- and B-cell reagents from three manufacturers were found to give equivalent results for a reference population of healthy individuals. This was true whether direct or indirect immunofluorescence staining was used and whether cells were prepared by Ficoll-Hypaque fractionation (FH) or by lysis of whole blood. When B cells were enumerated using a polyclonal anti-immunoglobulin reagent, less cytophilic immunoglobulin staining was present after lysis than after FH preparation. However, both preparation methods required additional incubation at 37 degrees C to obtain results concordant with monoclonal B-cell reagents. Standard reagents were chosen on the basis of maximum positive/negative separation and the availability of appropriate negative controls. The effects of collection medium and storage conditions on sample stability and reproducibility of subset analysis were also assessed. Specimens collected in heparin and stored at room temperature in buffered medium gave reproducible results for 3 days after specimen collection, using either FH or lysis as the preparation method. General strategies for instrument optimization, quality control, and biohazard containment are also discussed.

The effect of delayed refrigeration on red blood cells, platelet concentrates and cryoprecipitable AHF

The effect of delaying blood processing for six hours while maintaining it at ambient temperature was investigated. Blood drawn from volunteers on two occasions was processed immediately (I) or after a six-hour delay (D). The effects of the delay on the efficacy and safety of red blood cells, platelet concentrates and cryoprecipitable AHF were studied. There was a more rapid decrease in 2,3-DPG in the delayed group during 21 days of refrigerated storage. ATP levels declined at similar rates. 24-hour survival of 51CR-labeled autologous cells was slightly better (p = .05) in the (I) group but excellent for both. Total platelets, per cent recovery and pH at 72 hours were identical for both groups. All cultures were sterile. There was no difference in total AHF recovered or per cent recovery between the two groups. To increase the availability of blood components, a six-hour processing delay seems warranted.

Airborne contamination in orthopedic surgery. Evaluation of laminar air flow system and aspiration suit

The question arises whether, on the basis of our studies, the laminar flow system and aspiration suit should be considered as useful and effective components of the overall proctocol to prevent postoperative surgical infections. Our observations do not permit a definitive answer. This would obviously depend on the demonstration of a reduction of the incidence of postoperative infection by means of a large controlled study. The infection rate encountered in this study can not be used to draw any conclusion as to the efficacy of the laminar flow systems, since there are too many uncontrollable variables which may be influential in causing a post operative wound infection. Published reports and present data seem to indicate that the airborne route of transmission is of little significance in modern surgery and that the amount of wound contamination is not necessarily a reflection of airborne contamination. Thus, the use of the laminar air flow system and aspiration suits, which are clearly designed to prevent wound infection by the airborne route, does not seem to be justified on this basis at the present time. On the other hand, the use of laminar air flow system and/or aspiration suit by necessity imposes a strict discipline in those operating rooms, where multiple personnel are routinely involved; i.e., they reduced the number of personnel in contact with patient, reduce the traffic about the surgical patient, etc., which may have significant benefits towards the control of surgical wound infections. This enforced discipline may very well account for the significant decrease in the number of positive intraoperative wound cultures in this study when laminar air flow systems and/or aspiration suits were in use.

The effect of operating-room environment on the infection rate after Charnley low-friction total hip replacement

After 300 Charnley low-friction arthroplasties done in two hospitals by two surgical teams using clean-air enclosures but no preoperative, operative, or postoperative antibiotics, there were three deep wound infections, two caused by Staphylococcus albus, coagulase negative, and one by Klebsiella. Two of these infections occurred in hips previously operated on and one was in a hip with no previous surgery. These findings suggest that two operating-room environments using the same basic principles without antibiotics can achieve a 1 per cent rate of deep wound infection with no early deep wound infections after total hip replacement, a rate comparable to that reported in other series in which antibiotics were used. However, this study did not answer the questions: Is the environment the primary reason for the low infection rate or is it the discipline required by the environment? Will the rate of late (four to five years) wound infection after operations done in a clean-air enclosure be lower than that after procedures done in a "normal" operating-room environment using preoperative, operative, and postoperative antibiotics?