Administration of G-CSF in the posttransplant period accelerates the rate of neutrophil engraftment, shortens the duration of hospitalization, and reduces the number of days on nonprophylactic antibiotics in patients who receive autologous PBSC with or without autologous bone marrow following high-dose therapy.

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The activation of the coagulation system followed by secondary stimulation of the fibrinolytic system in patients on regular hemodialyis has been documented [ l]. Moreover, the activation of platelets collected by apheresis has also been identified [2][3][4]. These findings prompted us to look at the effect of therapeutic apheresis on coagulation parameters.We collected data on 19 consecutive patients admitted to Thomas Jefferson University Hospital for therapeutic plasmapheresis (TP). Patients were between 25 and 78 years of age, ten males, nine females, had neurologic/ autoimmune pathology, and received albumin replacement. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FIBR), anti-thrombin-I11 (AT-III), fibrin split products (FSP), and D-Dimer (DD) were measured by standard laboratory methods.The effect of TP on FIBR and AT-111 was a marked decrease in concentration within 1 hour after apheresis followed by an approximately 60-80% recovery within 24 hours. PT and alTT were increased within 1 hour following apheresis, but decreased to near baseline values within 24 hours.FSPs were increased following ten apheresis treatments (12.2%) in six patients. Data from the morning following apheresis are available for only four of these treatments, but in all cases FSP concentration decreased to < 10 mg/ ml. DD concentrations increased following 1 1/76 (14.5%) apheresis treatments in nine patients. Information from the following morning is available for eight of the 11 treatments following which an increase in DD concentration had occurred. In all eight, a decrease in DD was noted, and in six of these eight, the decrease was to <.5 mg/ml.Little correlation was seen between increases in FSP and DD concentration. Following the ten apheresis treatments in which FSPs increased, DD concentrations were unchanged in six, while following the 11 treatments in which DD was increased FSP concentration was unchanged in six.In this group of patients, admitted for plasmapheresis but without evidence of hematologic or hepatic disease, there were marked effects on several coagulation parameters, but these were unaccompanied by any clinical evidence of pathologic hemorrhage or thrombosis. The par-0 1994 Wiley-Liss, Inc. Parametersallel decrease in both FIBR (median decrease = 61%) and AT-I11 concentrations (median decrease = 58.5%) suggests that apheresis may decrease both pro and anticoagulant activities in such a manner as to prevent significant thrombohemorrhagic complications in the absence of pre-existing hematologic or hepatic pathology.Approximately 20% of apheresis treatments were accompanied by evidence of activation of the fibrin-(0gen)olytic system, i.e., an increase in FSP and or DD concentration which reverted toward normal in the postpheresis period. The increase in DD concentration would suggest secondary activation of the fibrinolytic system consequent to an initial activation of the coagulation system, but primary fibrinogenolysis may also occur since following six apheresis treatments a...

Patients with epilepsy refractory to medical therapy or who experience intolerable side effects from the medication may benefit from placement and activation of a vagus nerve stimulator (VNS) (Cyberonics, Houston, TX). We present our experience with the VNS implanted by a pediatric surgeon and its activation managed by a pediatric neurologist. Six patients (one male and five females) with average age 11 years, 10 months (range 7 years, 4 months to 18 years, 1 month) received VNS implants at a community-based teaching hospital. One patient developed a self-inflicted wound complication secondary to persistent trauma at the implant site that led to removal of the implant. Before VNS implantation the frequency of seizures among the remaining five patients averaged 73 per patient per month (range 20–165). Length of follow-up averaged 6.5 months (range 1.5–11 months). At most recent follow-up seizure frequency averaged 14 per month (range 1–42); this represents an average reduction of 78 per cent (range 30–99%). We conclude that a pediatric surgeon with pediatric neurologic support can safely and effectively perform the VNS implantation at a hospital equipped to administer anesthesia to pediatric patients.