Leukapheresis comes from Leuk+apheresis. Apheresis is the general term for separating out one particular constituent of blood and returning the remainder to the circulation. Leukapheresis is a laboratory procedure in which white blood cells are separated from a sample of blood.

Uses

• To decrease a very high white blood cell count [Hematological malignancies]
• Obtain patients white blood cells for later transplant back into the patient
• Obtain cells for research purposes.
• Obtain the patient’s own blood cells for later transplant.
• For removing white blood cells  for protection before high-dose chemotherapy[Cells are then transfused back into the patient after chemotherapy]
• For obtaining cells for processing them to stimulate a patient’s immune system to target prostate cancer cells.
• Removal of  granulocytes, macrophages and monocytes  as a treatment for autoimmune diseases such as ulcerative colitis and rheumatoid arthritis.

Overview of Procedure

Blood is drawn from one arm with the help of a catheter that is placed in one of the veins.

Following removal the blood is placed in the.

The centrifuge spins the blood and separates it into various components making. As a result, the blood can be separated into red blood cells, white blood cells, and platelets.

The white blood cells are removed and the rest of the cells and the rest is returned to the body through another catheter.

Leukapheresis usually takes about two to four hours.

A photgraph of nasal endoscopic examination.

Nasal Endoscopy Being Performed

The endoscopy was done for diagnostic purpose only.

A central venous catheter is a catheter placed into a large vein in the neck like internal jugular vein, external jugular vein or  chest (subclavian vein) or groin (femoral vein).

A central venous catheter is used to administer medication or fluids, to draw blood samples and to  directly obtain cardiovascular measurements such as the central venous pressure.

Central Venous catheter In Internal Jugular Vein

The above photograph shows a central venous catheter on right side of the neck. It was inserted in subclavian vein.

Hemophilia is a disease of inheritance. Therefore genetic counseling and prenatal diagnosis are important measures to help people.

Genetic counseling helps people with hemophilia, carriers, and their families make more informed choices about having children where there is a possibility of having a child with hemophilia. It includes a wide range of tests for diagnostic and carrier detection, as well as individual counseling.

Prenatal diagnosis is usually offered when termination of the pregnancy would be considered if an affected fetus was identified. However, it may also be done for helping the family to be prepared and for planning delivery. Assisted delivery is best avoided if the fetus has hemophilia.

Prenatal diagnosis is done by following tests

Chorionic villous sampling

Chorionic Villous Sampling or biopsy, is the main method of prenatal diagnosis and can be done earliest at 10-11 weeks of gestation. It is avoided before this period as it may cause with fetal limb abnormalities.

Amniocentesis is another procedure can be done at 12-15 of weeks of gestation and involves withdrawal of amniotic fluid.

All invasive methods used for prenatal diagnosis may cause feto-maternal hemorrhage, and anti-D immunoglobulin should be given if the mother is Rh D negative.

These procedures are carried out early in a pregnancy before the factor VIII level has risen significantly, hemostatic support may be required to prevent maternal bleeding, if the maternal levels are below 50%.

In a new study published in Archives Of Facial Plastic Surgery, the data suggests that  osseocartilaginous dorsal onlay rib grafts used for augmentation rhinoplasty is a stable and predictable technique for dorsal reconstruction.

In this study,  58 rib graft rhinoplasties were performed in the 10-year review period, 39 of which used dorsal onlay grafts. The patient were followed for 24 months and the  median duration of clinical follow-up was 16 months.

Osseocartilaginous onlay grafts showed 100%  viability at the last follow up. In contrast only 83% cartilaginous onlay grafts were viable, rigid, and had maintained dorsal projection at last follow-up.

None of the grafts warped.

The relief of nasal obstruction was almost same. It was 88% in osseocartilaginous flaps and 83% in cartilaginous onlay grafts had persisting relief of their nasal obstruction.

The authors concluded that osseocartilaginous onlay rib grafts provide an ideal scaffold for dorsal nasal augmentation and restoration of nasal airway in patients with collapse of the nasal framework due to a saddle deformity, history of trauma, or history of multiple septorhinoplasties.

The graft has excellent viability, lacks potential for long-term warping, achieves bony fusion to the nasal bones, and allows surgical molding of the cartilaginous tip.

J. Jared Christophel and Peter A. Hilger are the authors of study.

Surgery in hemophilia should be done with following considerations

• Surgical procedures should be performed in co-ordination with a team experienced in the management of hemophilia.
• The procedure should be done in a center with adequate laboratory support
• Pre-operative inhibitor screening should be done.
• It is preferable to perform the surgery early in the day so as maximum resources could be utilized
• Availability of sufficient quantities of clotting factor concentrates should be checked before procedure is started.

A recent meta analysis published in Pediatrics has recommended against investigating by ultrasound if undescended testis is not palpable in the child.

Ultrasound does not reliably localize nonpalpable testes.

Cryptorchidism or undescended testis affects 1% to 3% in term and 15% to 30% of premature male infants.

It is a usual practice to locate the testes if they are  not palpable.

The present authors argue that the  ultrasound lacks diagnostic power to  clearly locate the testes because it cannot differentiate with certainty, the testes from other tissues.

For their meta-analysis the authors included 591 testes in 12 studies.

Pediatrics published online December 13, 2010 (10.1542/peds.2010-1800)

Nao gastric tubing is used for many purposes which may be to provide the feed in patients who for any reasons could not be fed through the mouth or to aspirate the gastric content as in poisoning  or during neck surgery for better localization of the esophagus.

While the process needs to be individualzed in every patient, I thought it is good have a video explaining the basics in insertion of nasogastric tube.

See my note at the end after you finish your video.

Click here to view the embedded video.

Note

The position of the Ryle’s tube can also be confirmed by auscultating the stomach by placing the stethoscope over the area below xiphisternum.

A syringe would push air through the outer end of the tube and a loud audible air entry is heard by the stethoscpoe.

Songe bathing is a very effective means of bringing fever down. Dr Susan, in this video tells you how to have sponge bath

Click here to view the embedded video.

It is a rapid cultivation method for detection of mycobacteria. It is based on radiometric detection of C14 labelled CO2 released as a result of growth of mycobacteria in a special 12B liquid medium which contains c14 labelled palmitic acid. Palmitic acid is used for growth by these bacteria. This is both a sensitive and specific test.

The main advantage of this test is early results. It can detect the growth of mycobacteria in as early as 5 days, with an average duration of 1-12 days, as against the 6-8 weeks taken to grow AFB by culture on traditional media. In a smear positive individual, AFB culture and drug sensitivity testing can be done simultaneously results can be made available in 10-12 days.