Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation

Six patients with pregnancies of 19-31 weeks'' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions.Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord.     

Demands for preserved blood and blood transfusions in planned operations

An analysis is described which deals with the relation existing between those amounts of stored blood which are demanded and used in serological cross tests on the one hand and that transfused stored blood used in operations which can be planned in selected clinics on the other hand by accounting for the demanding parameters of 3 stored blood items and less and 4 stored blood items and more.     

Imipenem in the treatment of patients with severe surgical infection]

The clinical efficacy and safety of intravenously administered imipenem/cilastatin in the treatment of 45 patients with severe bacterial septicemia due to intra-abdominal abscesses, respiratory and urinary tract as well as skin, soft tissue and bone infections was studied in the prospective and open trial. The in vitro antimicrobial activity of imipenem has been assessed on the basis of 909 bacterial strains isolated from patients treated and non-treated with imipenem/cilastatin. Among them were 526 Gram-negative, 370 Gram-positive aerobic bacteria and 13 Gram-negative anaerobic bacteria (Bacteroides sp.). Pathogen susceptibility to imipenem was determined with a disc-diffusion technique using Merck, Sharp Dohme sensitive discs containing 10 mcg of imipenem. Highly sensitive to imipenem were 96.8% of Gram-negative 82.7% of Gram-positive aerobic bacteria and 100% of Bacteroides sp. All patients, in whom evident foci of infection e.g. intra-abdominal abscesses were discovered, were operated on. The dosage of imipenem/cilastatin ranged from 1.5 to 2.0 g/24 h. Clinical cure and bacteriological elimination was achieved in 39 (86.7%) of patients while 6 (13.3%) showed marked clinical improvement. Before and during therapy, aerobic and anaerobic cultures were taken from accessible sites. All specimens were worked up using conventional bacteriological techniques. Before during and after therapy, samples for hematology, biochemistry and urinanalysis were obtained. Adverse clinical effects were noted in 2 (4.4%) patients. One had nausea and vomiting which were probably related to rapid infusion and disappeared after increasing the administration time, and one had transient diarrhea. In conclusion, imipenem/cilastatin was a well tolerated and effective drug in the treatment of life-threatening surgical infections.     

Sulperazone in the treatment of severe infections in patients with cancer]

For the evaluation of rational sulperazone position in oncological hospital and elaboration of its implementation criteria investigation was performed. The trial included 193 patients (88 patients with injuries, 66 with hospital pneumonia, 39 with urinary track infection). From different clinical material of the patients were isolated 136 straines of Gram-negative bacteria. Suseptibile to sulperazone were 67 per cent of P. aeruginosa, 78-86 per cent of P. vulgaris, Klebsiella and E. coli isolates, 66 [symbol: see text] 60 per cent of Enterobacter and Serratia isolates subsequently. Comparative results of treatment with sulperazone as monotherapy and for combination with aminoglycosides (gentamycin or amicacin) in the case of P. aeruginosa infection demonstrated high sulperazone efficacy not lower than imipenem/cilsatatin and cefepime efficacy in the case of hospital infections treatment at critical care units. Low price of the sulperazone treatment when compared to imipenem/cilastatine is emphasized. Another advantage of sulperazone when compared to cefepime is anaerobic infection treatment--cefepime is administered in combination with metronidazole while sulperazone is used in monotherapy.     

Anti-HLA immunization following transfusions of leukocyte-poor blood

We have followed the evolution of leucocyte antibodies in patients receiving multiple blood transfusions of leucocyte-poor blood. The number of leucocytes present in one unit of transfused blood was always less than 1 X 10(8). We observed that such preparations were able to re-stimulate antibodies which had disappeared, but especially they were able to provoke a first immunisation in some patients never immunized in the past. The specificities of these antibodies corresponded to one or several antigens present in the donor of the transfused unit. This study shows that leucocyte immunisation cannot always be avoided in spite of the selection of blood products containing very few white cells.     

Efficacy of meropenem in the treatment of severe complicated urinary tract infections]

The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.     

Cefepime (maxipime) in the treatment of severe urinary tract infection]

Comparative susceptibility of microflora isolates from patients with complicated urinary tract infections to cefepime, other cephalosporins, amikacin, ciprofloxacin and ofloxacin was studied. Isolates in the diagnostic titers (5 x 10(4)-5 x 10(8)) from the patients treated with cefepime as etiotropic monotherapy were identified. The treatment course was 7 to 14 days. The daily dose was 1 to 2 g. The clinical and bacteriological efficacies of the cefepime therapy equaled to 93.2 and 85.4% respectively.