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Objectives: This study aimed to assess the budget and organizational impact of progressively replacing the intraoperative cell salvage centrifugation-based systems currently installed in French hospitals with the SAME system, a new autotransfusion medical device. Methods: An Organizational and Budget Impact Model (OBIM) was developed based on two methodological guidelines issued by the French Health Authority (Haute Autorité de Santé, HAS). The OBIM was also developed based on a pragmatic literature review, hospital data and hospital pharmacists' expertise. Results: Considering an average hospital cohort of 600 cardio-thoracic surgery patients, with 57% experiencing mild hemorrhages, 23% moderate hemorrhages, and 20% massive hemorrhages, and a SAME market share of 33% in Year 1, the implementation of SAME resulted in significant savings. With an average allogeneic transfusion of 4.19 packed red blood cells (RBC) and 0.62 platelet concentrate per patient based on National Hemovigilance Report of the ANSM (French National Agency for the Safety of Medicines and Health Products) and when using SAME system a reduction of 45% of RBC transfusion associated with a reduction of 60% and 90% of platelet use for moderate and massive hemorrhages respectively, the first year annual saving amounted to €44,601 and the cumulated saving over 5 years to €535,206. Discussion: This model structure was developed based on overall hospitals' needs and acknowledged guidelines, with inputs based on French literatures and hospital data, so findings were specifics to a context. Among the inputs, the number of annual SAME procedure is not based on device capability but rather on hospital capability with the number of operating rooms used for cardio-thoracic surgery equipped with the device. Conclusions: The results of this OBIM demonstrated the economic and organizational benefits of SAME for hospitals. This benefit results mainly of a reduction in the use of allogeneic blood products (RBCs, platelets). [ABSTRACT FROM AUTHOR]

, , 237-244. α Three young patients with radiographic pulmonary emphysema predominantly in the lower zones are reported. The clinical and physiological features were those observed in severe pulmonary emphysema. Predominance of the main lesions in the lower zones was confirmed in two cases by selective pulmonary angiography. One of the patients died and extensive panlobular emphysema was found at necropsy. Although the similarities between our patients and those with emphysema and α-antitrypsin deficiency were remarkable, the latter condition was ruled out. [ABSTRACT FROM PUBLISHER]

, , 81-89. Pulmonary emphysema exists in two main pathological forms, centrilobular and panlobular (panacinar) emphysema, the lesions predominantly affecting the upper and lower zones of the lungs respectively. There is disagreement among authors as to the clinical and physiological differences between these two forms, and direct evidence of the pathological type is seldom available during life. Patients with emphysema can, however, be divided on radiological criteria into an `upper zone' and a `lower zone' group, and it can be argued that these groups relate respectively to the centrilobular and panlobular forms of the disease. The evidence is far from conclusive but it was thought that a comparison of the two radiological groups would be of value. Patients in whom there was no obvious zonal preponderance were not included in the study. Fifty patients with definite radiological evidence of pulmonary emphysema have been studied, those with α-antitrypsin deficiency being excluded. Thirty-one patients (62%) had emphysema which predominantly affected the upper zones of the lungs; the lower zones were the more severely affected in the remainder. Bullae were found in approximately equal proportions in each group. All the patients were, or had been, cigarette smokers. There was no significant difference between the mean ages of the two groups; only seven patients were free from exertional dyspnoea, all being in the upper zone group. Chronic bronchitis occurred with equal frequency in the two groups but started on average about 10 years earlier in those with lower zone disease; the latter patients had rather more severe airflow obstruction and more severe blood-gas abnormalities. The presence or absence of chronic bronchitis per se, however, did not appear to have any significant effect upon the common respiratory function tests. No data emerged from this study which suggested that there were differing aetiological factors in the two groups. [ABSTRACT FROM PUBLISHER]

Five patients with asthma and severe aspirin hypersensitivity were challenged on separate days with increasing doses of aspirin given by mouth, starting with 5 mg, until a reduction in FEV1 greater than 15% was obtained. Sodium cromoglycate in doses of 20-40 mg inhibited the bronchoconstrictive reaction not only when inhaled before the challenge but also after it, at a time when progressive reduction in FEV1 values was taking place. According to these results, it seems reasonable to postulate sequential mast cell degranulation and liberation of mediators of anaphylaxis as the mechanism through which aspirin induces bronchoconstriction in aspirin-sensitive asthmatics. The differences between bronchial provocation tests and oral challenge with aspirin are stressed. [ABSTRACT FROM PUBLISHER]

, , 584-587. Three methods of measuring the vital capacity have been compared in six normal subjects and in six with pulmonary emphysema, according to a randomized design. The methods were () the inspiratory vital capacity (IVC), () the expiratory vital capacity (EVC), and () the forced vital capacity (FVC). In normal subjects, there was a small but significant difference between the methods. The residual standard deviation derived from analysis of variance was 94 ml (coefficient of variation 1.7%). A slight but significant rise in vital capacity with repeated effort was observed. In emphysematous subjects, there was no significant difference between the IVC and EVC methods. The FVC gave values which were, on average, approximately 0.5 litre less than those obtained by the other methods. The standard deviation in all three methods was substantially greater than for the normal subjects. The FVC is not a suitable method for the measurement of vital capacity in patients with pulmonary emphysema. The EVC is satisfactory, provided it is used with caution, but in practice the IVC is the preferred method. [ABSTRACT FROM PUBLISHER]