3-Methoxytyramine as an indicator of impulse-induced dopamine release in rat brain in vivo

Autotransfusions were performed in 80 patients operated upon for thyroid diseases at the Department of Surgery, Institute of Haematology in Warsaw. For autotransfusions patients were selected in good general condition and with haematological indices in the range accepted for blood donors. Planning of autotransfusion is purposeful only in these cases of thyroid disease in which the necessity of blood transfusion can be predicted in advance (e.g. Graves-Basedov-disease, retrosternal goitre, mediastinal goitre). The transfused volume may cover completely or partly the intraoperative blood loss. Autotransfusion protects the patients against possible isoimmunization which may develop after transfusion of blood from donors. Protection of patients against possible immunization is a problem of considerable value. It is important particularly in young subjects, especially young women who may become mothers. Operations connected with blood loss up to 500 ml do not require supplementary transfusions. Intraoperative blood loss in the range from 500 to 1000 ml requires supplementation. The risk of posttransfusion complications is lowest when autotransfusion is done.     

Blood transfusion and non-Hodgkin lymphoma: lack of association

BACKGROUND: Non-Hodgkin lymphoma is the seventh most commonly diagnosed malignant condition worldwide, and its incidence has increased markedly in recent decades. Blood transfusions have been implicated as a possible risk factor for non-Hodgkin lymphoma. OBJECTIVE: To determine whether blood transfusions are associated with an elevated risk for non-Hodgkin lymphoma. DESIGN: Population-based, nested case-control study. SETTING: Nationwide cohort in Sweden. PATIENTS: 361 patients with non-Hodgkin lymphoma and 705 matched controls, nested within a population-based cohort of 96795 patients at risk for blood transfusion between 1970 and 1983. Prospectively collected information on exposure was retrieved from computerized transfusion registries. MEASUREMENTS: Odds ratios obtained from conditional logistic regression models were used as measures of relative risks. RESULTS: No association was found between blood transfusions and the risk for non-Hodgkin lymphoma when patients who had received transfusions were compared with patients who had not received transfusions (odds ratio, 0.93 [95% CI, 0.71 to 1.23]). A reduction in risk was seen among persons who received transfusion of blood without leukocyte depletion (odds ratio, 0.72 [CI, 0.53 to 0.97]). Risk was not related to number of transfusions, and no interaction was seen with latency after transfusion. CONCLUSION: The findings in this study do not support previous observations of an association between blood transfusions and the risk for non-Hodgkin lymphoma.     

Extent of blood transfusion and cancer-related mortality after cystectomy and urinary diversion for bladder cancer

OBJECTIVE: To assess the possible adverse effect of peri-operative blood transfusion on cancer-related survival after radical cystectomy for bladder cancer. PATIENTS AND METHODS: The hospital records of 130 patients treated with cystectomy and urinary diversion for bladder cancer between 1967 and 1986 were retrospectively reviewed. RESULTS: Standard proportional hazards estimation revealed tumour stage and radiation response after pre-operative irradiation to be significantly associated with cancer-related mortality, whereas age, tumour grade or the extent of peri-operative blood transfusion were not. In models which allowed time varying effects a significantly changed effect of blood transfusion (> or = 7 versus < or = 6 units) was observed, from an initially insignificantly increased relative hazard (RH) (RH = 1.44 at 6 months) to an insignificantly decreased effect after longer follow-up (RH = 0.53 after 2 years). CONCLUSION: Although no overall association between blood transfusion and cancer-related mortality was found, a tendency towards an increased risk early in the follow-up period was observed if more than 6 units were transfused. However, these results need confirmation in further studies before a restrictive attitude towards peri-operative blood transfusion is recommended.     

Perisurgical erythropoietin application in anemic patients with colorectal cancer: A double-blind randomized study

BACKGROUND: Blood transfusions are associated with higher postoperative morbidity and tumor recurrence rates in colorectal cancer surgery, To reduce the need for transfusions in patients with tumor-induced anemia who are not suitable for autologous blood donation, it was tested whether perisurgical erythropoietin application would be able to stimulate hematopoiesis adequately. METHODS: In a double-blind randomized study 150 IU/kg body weight erythropoietin was given subcutaneously every 2 days beginning 10 days before operation and continuing until postoperative day 2. Twenty patients were randomized into the erythropoietin group with three observed dropouts and 10 patients into the placebo group. RESULTS: In the erythropoietin group two episodes of hypertension and one deep venous thrombosis were observed. Preoperative hemoglobin response in the erythropoietin group (p = 0.069) was paralleled by a highly significant reticulocyte increase (p = 0.0004). However, frequency of blood transfusion was not different between both study groups (erythropoietin, 1.82 +/- 0.80 units/ patient; placebo, 1.80 +/- 0.97 units/patient). If iron availability was analyzed, a strong correlation between ferritin blood levels and transferrin iron saturation with hemoglobin response was observed in regression analysis (p < 0.001). CONCLUSIONS: These results indicate that hematopoiesis in anemic patients with colorectal cancer can be stimulated by erythropoietin; however, clinical efficacy is to be expected only in selected patients with high iron availability, which calls for further studies combining erythropoietin and parenteral iron application.     

Prostate specific antigen doubling time in prostate cancer before treatment and in refractory status]

Prostate-specific antigen(PSA) increases exponentially in prostate cancer patients before treatment and in refractory status. PSA increases in 68-86% of prostate cancer patients before treatment, and that of the remaining 14-32% of the patients is stable. Those patients with a higher pre-treatment PSA level are more likely to have a shorter PSA-doubling time(PSA-DT). The relationship between pre-treatment stage, grade and PSA-DT is controversial. PSA-DT in biochemical failure patients predicts the risk of clinical recurrence. PSA-DT was correlated well with time to clinical recurrence after biochemical failure. Distant recurrence was associated with short PSA-DT. Higher clinical stage and lower differentiation before treatment correlated with shorter PSA-DT in recurrent cancer patients. PSA-DT is an important parameter for judging malignant potential of each cancer.     

Influence of blood transfusions on surgery-induced immune changes in colorectal carcinoma

Perioperative blood transfusions have been shown to enhance recurrence rates in patients with operable solid tumors, perhaps by inducing immunosuppression through unknown mechanisms. Since the surgical treatment per se has been proven to induce immune alterations, the present study was carried out to evaluate the immune effect of blood transfusions on surgery-induced immune variations. The study included 27 patients with resectable colorectal carcinoma, 18 of whom received no transfusion, while the other 9 received blood transfusions in the perioperative period. Total lymphocytes, total T lymphocytes (CD3) and soluble IL-2 receptor serum levels (SIL-2R) were measured on venous blood samples collected from each patient either before or 7 days after surgery. Both in non transfused and in transfused patients, SIL-2R mean levels were significantly higher after than before surgery. Their increase was associated with a significant decrease in both lymphocytes and CD3 cells in non-transfused patients, while in the transfused ones lymphocytes and CD3 cells did not show significant changes with surgery. This study shows that blood transfusions modify the relation between changes in SIL-2R and those in lymphocyte number induced by major surgery. It remains to be understood which relation exist between these immune effects and the promoting action of blood transfusion on relapse frequency in cancer.     

Hemodilution in clinical surgery: state of the art 1996

Acute normovolemic hemodilution entails removal of blood from a patient either immediately before or shortly after induction of anesthesia and simultaneous replacement with cell-free fluid. Nowadays, because of their predictable volume effects, the synthetic colloids (6% dextran 60/70, 6% hydroxyethyl starch 200,000) are preferred as volume substitutes; albumin should be avoided because of its high cost. Hemodilution has experienced a renaissance in recent years, mainly due to the evolving discussion of legal aspects, immunologic changes, viral infections, and a potentially higher cancer recurrence rate associated with the transfusion of homologous blood. Hemodilution should be considered for elective surgical patients free of contraindications and presenting with an initial hemoglobin concentration >/= 12 g/dl and an anticipated blood loss of >/= 1500 ml. The efficacy of this method (judged by the need to give homologous blood transfusion) depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra- and postoperative transfusion trigger. In the past, data from clinical trials showed that in healthy subjects a target hematocrit of 20% to 25% (hemoglobin 7.0-8. 0 g/dl) is feasible and safe for the patient. The lower the target hematocrit accepted, the more extensive is the monitoring required: Intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by surgical patients without adverse effects. The safety and efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements has been demonstrated in various clinical studies. Hemodilution therefore is regarded an integral part of programs aimed at reducing the need for homologous blood and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage, and carefully adjusted surgical techniques. Hemodilution is feasible and relatively cost-effective, and it minimizes adverse effects associated with transfusion of homologous blood, particularly transmission of viral diseases, immunosuppression, and infectious complications.     

Local recurrence after low anterior resection of rectal cancer

Among 75 consecutive patients operated upon with anterior resection for rectal adenocarcinoma during a five year period, 29 (39%) developed local cancer recurrence. The total cumulative five-year survival was 49%, but only 17% in those with a local cancer recurrence. The most important risk factors for development of local recurrence were tumour fixation, intraoperative blood transfusion and surgical routine. Local recurrence was seen in 4/23 (17%) after operation performed by a consultant, 1/5 (20%) after a consultant-supervised operation and 24/47 (51%) after operation by a senior registrar (p < 0.02). As a consequence we recommend that operation for rectal cancer should only be performed or supervised by a few specialists in colorectal surgery.     

Perioperative blood transfusion does not prevent recurrence in Crohn's disease. A pooled analysis

The effect of perioperative blood transfusion on the recurrence of Crohn's disease is controversial. Various studies have suggested that perioperative blood transfusions reduce the risk of recurrence; others have failed to find a protective effect. Since all the studies are based on relatively small numbers, we performed a pooled analysis. We contacted the senior authors of seven previously published studies and asked for the original data. Four authors provided their data. The pooled database included 622 patients with a primary and complete resection of macroscopic disease. Recurrence was defined as the need for repeat surgery for disease control. Kaplan-Meier life table analysis was performed. Of the study sample, 366 cases (59%) were female. Disease distribution was as follows: small bowel (47%), small/large bowel (35%), and large bowel only (18%). Three hundred thirty-one patients (53%) received blood in the perioperative period. Mean follow-up was 72.8 months. For the overall sample, the 5-year recurrence rates were 26.9% for the transfused group and 25.2% for the nontransfused (p = 0.456). When the data were stratified by age, gender, disease location, and length of resection, no difference in 5-year recurrence rates between transfused and nontransfused cases could be detected. In this pooled analysis of four retrospective studies on the effect of blood transfusions on the risk of recurrence in Crohn's disease, we were unable to document a protective effect.     

Adverse effects due to unstable blood products

Most discussions of blood transfusion cover risks and side effects, while the daily benefits of donor systems and transfusion concepts for modern medicine are taken for granted. Even though in this report side effects are a major part of the content, we should be aware that today's component concept leads to a remarkable quality level of blood products. After a historical introduction we present a patient with transfusion transmitted anti-hepatitis A IgM antibodies and a delayed type hemolytic transfusion reaction induced by a boostered anti-Fyb alloantibody. This case demonstrates that the safety of transfusions depends on both the blood product and the patient's transfusion history. In the second part we summarize side effects from transfused blood products: (1) transmission of infectious diseases and the risk of blood products testing falsely negative, (2) immune mediated side effects, (3) immuno-modulations by blood transfusions, (4) side effects caused by human error. Minimizing transfusion risks is not only the task of the doctors specialized in transfusion medicine, but can only be achieved by close cooperation between all the persons associated with each step, from motivating unpaid blood donors, evaluation of donors, phlebotomy, viral testing, preparation of components, storage, and transportation conditions, to adequate indications and transfusions for the patients.     

Diagnosis and treatment of pulmonary tuberculosis complicated with chronic liver disease

Immunocompromised or malnutritional hosts are high risk group of pulmonary tuberculosis. Chronic liver disease especially decompensated cirrhosis of the liver is one of the risk group for this infection. When ascites or pleural effusion developed in patient with hepatic cirrhosis, complication of pulmonary tuberculosis must be considered. In such condition, drug metabolism was impaired so that anti-tuberculous drugs should be used carefully, but in almost cases except decompensated cirrhotic patients are tolerable for standard anti-tuberculous combination therapy and they could be cured. Hepatitis C virus infection is common in patients with old pulmonary tuberculosis because many of them were infected Hepatitis C virus at the time of blood transfusion for pulmonary resection or thoracoplasty. In such condition recurrence of pulmonary tuberculosis is rare but probability of recurrence must be considered when they developed decompensated cirrhosis.     

Blood reinfusion during nephrectomy in patients with kidney neoplasm'

Reinfusion of autologous blood in 22 patients with cancer of the kidney was used during nephrectomy. Intraoperative blood loss made up 1000-4000 ml (20-80% VCB). 800-3600 ml of blood was collected from the operation wound and reinfused. In spite of massive blood loss, 20 patients recovered. Lethal outcomes (2 patients) were not caused by blood reinfusion. In 19 patients of control group with renal cancer massive blood loss was compensated by preserved donor blood transfusion. It is shown that reinfusion of autologous blood promotes more stable hemodynamics during the operation, reduces the quantity of postoperative complications and lethal outcomes, provides qucker restoration of morphologic structure of the blood and results in less substantial changes in filtration of a single kidney. There were no statistically significant differences in 5-year survival rate of patients in the study (40.9%) and control (42.1%) groups, nor in the frequency of hematogenous metastasizing of cancer. Because blood reinfusion does not increase the risk of hematogenous metastases of cancer, it is not contraindicated in massive blood loss during nephrectomy in patients with renal cancer.     

Autologous blood transfusion: the benefits to the patient undergoing abdominal aortic aneurysm repair

The clinical benefits of using intraoperative autologous blood transfusion during abdominal aortic aneurysm bypass surgery become increasingly apparent when use of autologous and homologous blood transfusions is compared. That homologous blood transfusions carry some risk is widely recognized. When autologous blood is used as a sole source of blood transfusion, the risk of transmission of infectious agents and potential immunologic side effects are avoided. A prospective randomized pilot study comparing autologous and homologous blood transfusion in patients undergoing elective infrarenal abdominal aortic aneurysm bypass surgery was undertaken. The purpose of this study was to determine whether autologous blood salvaged intraoperatively may serve as an alternative to homologous blood by comparing the rate of postoperative infection and duration of hospital stay for patients receiving autologous versus homologous blood transfusions. Fifty patients undergoing abdominal aortic aneurysm bypass surgery were prospectively randomly assigned to receive either a homologous or an autologous blood transfusion, with 27 receiving a homologous blood transfusion and 23 receiving an autologous blood transfusion. The data from this study show that the length of hospital stay of patients receiving an autologous blood transfusion intraoperatively was reduced by a mean of 3 days and the risk of postoperative complications such as a systemic inflammatory response or sepsis, was reduced by more than 50%.     

Frontal sinus mucoceles causing proptosis--two case reports

BACKGROUND: Blood requirements for Head and Neck surgical procedures have not been studied carefully. In order to set up an autotransfusion program, the blood loss and transfusion requirements should be known precisely. METHODS: The blood bank database was used to determine which Head and Neck procedures required blood transfusion during the previous 5 years. A list of 10 transfusion-associated operations was established, the records of all patients who underwent these procedures during a 5-year period were reviewed, and average the blood loss and number of units transfused determined. RESULTS: All procedures were for cancer resection. The operations were classified in 3 groups according to their transfusion probability: high (> 80%), low (< 5%) and moderate. For the moderate transfusion group, age, preoperative hemoglobin, and past medical history of cardiac and pulmonary disease were associated with higher incidence of transfusion. An average delay of 3 weeks was found between the diagnosis and the actual surgery. CONCLUSION: The transfusion requirements of Head and Neck surgical procedures could be safely met by an autotransfusion protocol, given the average delay of 3 weeks between diagnosis and surgery.     

A rapid method for DNA extraction from fine-needle aspiration biopsies of thyroid tumors, and subsequent RET mutation analysis

In 22 consecutive patients with tetralogy of Fallot (TF), a total correction was attempted without the use of a homologous blood transfusion from September 1995 to March 1997. The 22 patients were divided into two groups according to their surgical procedures; namely, either a simple correction (group I: n = 14) or a complex correction including the relief of peripheral pulmonary stenosis and/or the division of a previous systemic-pulmonary shunt (group II: n = 8). In 77% of all patients, surgery was performed without a homologous blood transfusion. No differences were found in the non-transfusion rate and the hematocrit (Ht) values between the two groups and, as a result, we thus confirm that this additional procedure is not a risk factor for surgery without a homologous blood transfusion. According to the correlation of the red blood cell volume before and after surgery, the preoperative Ht value corresponding to the postoperative Ht of 30% could be accurately predicted. The calculated Ht values were 41.0% in the patient weighing 15 kg, 42.5% in those weighing 10 kg, and 46.9% in those weighing 5 kg. These data suggest that a surgical correction without a homologous blood transfusion can therefore be safely performed in almost all patients with TF.     

A clinical and economic evaluation of red blood cell transfusions in patients receiving cancer chemotherapy

A clinical and economic evaluation of red blood cell (RBC) utilization in cancer patients during chemotherapy is described. Using a randomized sampling process, 100 patients who had received chemotherapy with or without cisplatin were selected (50 in each group). Multiple logistic regression was then used to identify risks factors for transfusion requirements. Twenty-five percent of patients in the cisplatin and 12% in the noncisplatin group received at least one blood transfusion during chemotherapy (p = .09). Depressed hemoglobin levels and cisplatin dosage were identified as risk factors for transfusion requirements. Combining all transfused patients revealed an overall cost of Can $599 (95% CI: $513-$683) per transfusion. The results of the current study indicated that anemia is a common complication of cancer chemotherapy that can be costly to manage.     

Blood surface interactions in extravascular salvageable blood pools

Anticoagulation largely prevents clotting and defibrination in extravascular blood pools. Systemic or local heparin may be more effective than local citrate phosphate dextrose in preventing coagulation in extravascular blood, if there is to be a lag period greater than 60 minutes between blood loss and collection. Nonanticoagulated extravascular blood in the thorax or peritoneal cavity is completely defibrinated within 20 minutes and is a potential risk in large autotransfusions. Blood in the thorax is better preserved than peritoneal blood after local or systemic heparinization.     

Blood transfusion. An independent risk factor for postinjury multiple organ failure

OBJECTIVE: To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes. DESIGN: A 55-month inception cohort study ending on August 30, 1995. Data characterizing postinjury MOF were prospectively collected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blood pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. Additionally, the same multiple logistic regression analyses were performed with early MOF and late MOF as the outcome variables. SETTING: Denver General Hospital, Denver, Colo, is a regional level I trauma center. PATIENTS: Five hundred thirteen consecutive trauma patients admitted to the trauma intensive care unit with an Injury Severity Score greater than 15 who were older than 16 years and who survived longer than 48 hours. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The relationship of blood transfusions and other shock indexes with the outcome variable, MOF. RESULTS: A dose-response relationship between early blood transfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regression models tested; the odds ratios were high, especially in the early MOF models. CONCLUSIONS: Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.     

Analysis of surgical activity of residents in pediatric surgery

BACKGROUND: Allogeneic blood transfusion is associated with an increased risk of infection and higher cancer recurrence rates. Previous research has shown that blood transfusion results in multiple immune effects, including cytokine alterations. The purpose of this study was to measure the long term kinetics of splenocyte cytokine production in transfused mice. METHODS: Balb/c mice received either syngeneic transfusion (Syn-BT) or allogeneic transfusion (Allo-BT) from C3H-HeN mice. Splenocyte production of IL-2, IL-6, IL-10, and IFN-gamma was quantitated by ELISA on post-transfusion days 5, 10, 21, and 30. RESULTS: Both Allo-BT and Syn-BT produced significant alterations in cytokine production, but Allo-BT produced the most dramatic and enduring effects as summarized: IL-2: Production of IL-2 was suppressed at day 5, (p < 0.0001), but then rose, peaking at day 21, 30% greater than control values (p < 0.05). IL-6: Allo-BT mice showed suppression of IL-6 throughout the study period (p < 0.005 vs controls, each time point). IL-10: A 5-fold increase in IL-10 production was seen at day 5 after Allo-BT (p < 0.0001 vs control). Production of IL-10 was suppressed at days 10 and 21 (p < 0.001), but returned to control levels by day 30, gamma-IFN: At day 5 post Allo-BT, gamma-IFN was 4 x greater than controls (p < 0.0001). Gamma-IFN production was suppressed at day 10, but then rose at days 21 and 30 to nearly 3 x control levels (p < 0.0001). CONCLUSION: Allo-BT produced multiple cytokine alterations that were of prolonged duration. These results provide a theoretic explanation for the multiple, long-term immunomodulating effects seen in patients who have received transfusions.