Objective Acute promyelocytic leukemia (APL) is characterized by the proliferation of blasts with distinct morphology and promyelocytic leukemia-retinoic acid receptor alpha (PML-RARA) transcripts. Although the treatment outcome is dramatically improved by all-trans retinoic acid (ATRA), life-threatening bleeding from enhanced fibrinolytic-type disseminated intravascular coagulation (DIC) remains a serious clinical problem, and a standard treatment has not been established. However, recent reports indicate that recombinant human soluble thrombomodulin (rTM) is effective against DIC. Methods To elucidate the clinical characteristics and outcomes of DIC resulting from APL, we retrospectively analyzed 10 patients with DIC resulting from APL at our institution over a six year period. Of the 10 patients, four were treated with serine protease inhibitors (SPI) and six were treated with rTM. The diagnosis of DIC was based on the diagnostic criteria of the Japanese Ministry of Health and Welfare. In addition to treating APL with ATRA, rTM was administered for six consecutive days. Results The DIC was resolved within seven days after initiating treatment in 25.0% (1/4) of the patients in the SPI group and 66.6% (4/6) of the patients in the rTM group. Although the rTM group consisted of patients with life-threatening bleeding who required RCC transfusion, a prompt resolution rate and reduced DIC score without progression of bleeding was achieved in this group. All patients were alive after the 28-day observation period. Conclusion Based on the present findings, rTM administration may be an effective, safe, and feasible therapeutic modality, producing a rapid resolution without progression of hemorrahage.
The effects of intraocular irrigating solutions on electroretinography have been extensively studied in animal models, but effects on human electroretinography have not been reported. This study examined the effects of two commercially available irrigating solutions, S-MA2 (Opeguard MA) and DE-057 (BBS-Plus) on 30-Hz flicker electroretinography during closed vitrectomy in humans. Eight eyes of 8 patients were examined. All patients underwent a simple vitrectomy without treatment of proliferative membrane. For 30-Hz flicker electroretinography recording, a contact lens with a built-in light-emitting diode was sterilized and used as both a stimulus source and a recording electrode. Replacing S-MA2 with DE-057 decreased the electroretinography amplitude from 55.8 +/- 15.2 to 45.5 +/- 13.2 microV (mean +/- SEM). Changing the irrigation solution from DE-057 back to S-MA2 increased the amplitude from 45.5 +/- 13.2 to 59.9 +/- 17.3 microV. However, these changes were not statistically significant. Replacing S-MA2 with DE-057 significantly increased the peak time from 50.1 +/- 1.5 to 57.6 +/- 1.3 msec (p < 0.001). This change was reversible; after changing from DE-057 back to S-MA2, the peak time of flicker electroretinography significantly decreased from 57.6 +/- 1.3 to 49.0 +/- 2.1 msec (p < 0.01). Thus intraoperative 30-Hz electroretinography showed delayed peak time during irrigation with DE-057, as compared with S-MA2. The lower potassium concentration and higher glucose concentration of S-MA2, as compared with DE-057, may be the cause of such electroretinography changes.
The purpose of this study was to determine how changes in [HCO3-] alter the electrical properties of the retinal pigment epithelium (RPE). Experiments were conducted on the isolated chick retina-RPE-choroid preparation. The chamber holding the preparation allowed independent perfusion of the retinal and the choroidal surfaces. The light-evoked trans-tissue potential (TTP), the trans-epithelial potential (TEP), the trans-retinal potentials, and the intracellularly-recorded apical and basal membrane potentials were studied. Increasing the [HCO3-]0 in the choroidal bath from 25 to 40 mEq/1 led to an increase in the TTP and TEP. The same change in the retinal bath decreased the TTP because of a biphasic change of the RPE membrane potentials. There was also an increase in the amplitudes of the TEP, the c-wave and the slow PIII. The light-evoked subretinal K+ decrease was greater which is consistent with an increase in the photoreceptor light response. These observations indicated that the decrease of TTP resulted from a basal membrane hyperpolarization followed by an apical membrane depolarization induced by an increase in retinal [HCO3-]0. The relationship of these potential changes to the human bicarbonate responses is discussed.
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