During the last ten years the Hospital Information System (HIS) was developed at the Institute of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical side into the "Gabriele Monasterio Foundation" (FGM) by joint efforts of CNR, Tuscany Region and Universities. At G.Pasquinucci Heart Hospital (GPH), currently FGM's section in Massa, the HIS was adapted and extended to Cardiac Surgery and Pediatric Cardiology. Data archiving and middleware integration through HIS network, connecting GPH with head institution in Pisa, allowed to achieve full secure access to patient information from any workstation within hospital or outside. PACS was developed using Open Source DICOM utilities. Electronic Medical Record is daily used since 2005 on both inpatients and outpatients. Recently telediagnosis was set up between Balkan countries and GPH in Massa.

At "G. Pasquinucci" Hospital in Massa, a section of CNR Institute of Clinical Physiology, an information system for cardiac surgery has been in use during the last years. This system was integrated with the Hospital Information System, already set up at the head of our institute in Pisa. Anesthesia data are recorded in the Operating Room (OR) as well as materials used during cardiac surgery operations. From the OR, data are transferred into the central clinical database, creating surgery reports in the medical record and filling in standardized clinical registers. Since 2000 a total of 2185 adult and 956 pediatric cardiac surgery operations were recorded.

Abstract

The kinetics of G-CSF PBPC mobilization are well described. CD34+cells in peripheral blood rise four days after G-CSF administration, and decline after the eighth day. VP-16 is increasingly used with G-CSF as a mobilizing regimen; however, the kinetics of mobilization are sparsely described. We retrospectively reviewed 275 patients (pts) with NHL or HD who received VP-16 plus G-CSF as a primary PBPC mobilizing regimen. 214 (78%) had NHL; 31% received prior radiation therapy; 63% were male; 85% had responsive disease. Pts received VP-16 (2 gm/m2) followed by daily G-CSF (10 mcg/kg). All pts experienced a significant WBC nadir. Pts began pheresis when their WBC recovered to 5,000. Pts were pheresed for at least 2 days or until 7.0 x 106 CD34+ cells/kg were collected; pheresis continued until a minimum of 2.0 x 106 CD34+ cells were collected. WBC nadir occurred day +6 after VP-16 and WBC recovery to 5,000 occurred day +13 (median) after VP-16. Pts were pheresed for a median of 3 days which yielded a median of 9.7 x 106 CD34+ cells/kg (range, 2.0–100.1 x 106). 72% of pts began collection on day +12, day +13, or day +14. The average CD34+ cell collection was maximal on the first 3 days of pheresis, but reasonable yields continued to be obtained for approximately 10 days of pheresis, as shown below: Figure Figure 81% collected ≥ 5 x 106 CD34+ cells/kg, and 72% collected ≥ 7 x 106 CD34+ cells/kg. The platelet count on the first day of pheresis correlated with the ability to collect 5 and 7 x 106 CD34+ cells/kg (p<0.001). 50 of 275 (18%) pts did not begin pheresis until day +15 or longer after VP-16 administration. The variables that correlated with these problematic pts was the platelet count at day 1 of pheresis and refractory disease at the time of mobilization; of 24 pts with refractory disease, 11 (46%) had poor WBC recovery after VP-16 and initiated mobilization on a median of day +16 (p<0.001). We conclude that VP-16 + G-CSF is a very effective mobilizing regimen. The majority of pts mobilize large numbers of CD34+ cells requiring only 3 days of leukopheresis for excellent yields. Unlike the kinetics of G-CSF for PBPC mobilization in which yields of CD34+ cells are optimal for only 3–4 days, CD34+ cell collection continues for approximately 10 days from the initiation of pheresis. A minority of pts have poor WBC recovery after VP-16 administration, and these pts tend to be those with refractory disease.

Abstract