The clinical advantages of autologous transfusion. A randomized, controlled study after knee replacement

We have carried out a randomised, controlled trial on 70 patients having unilateral total knee replacement in which transfusion was either with homologous bank blood or by reinfusion of unwashed blood salvaged after operation. No complications or adverse effects were observed from reinfusion. The need for bank blood was reduced by 86% in the reinfusion group but, more importantly, the number of infective episodes was significantly less when the use of bank blood was avoided. The mean length of stay in hospital was also reduced by more than two days.     

Major interventions in vascular surgery with and without autotransfusion. Comparison of coagulation and hemodynamic parameters

Twenty out of 32 patients undergoing major vascular surgery received autologous blood transfusion and hemostatic and hematological parameters were evaluated in both transfused and non-transfused groups. Blood and urine samples were also analysed. No acceleration of the hemostatic process was observed during either surgery or the postoperative period; free hemoglobin present in reinfusion sacks (?), even in high doses, was immediately restored to normal values in the patient's circulation. A slight effect was observed at the renal level alone. These findings confirm the good qualitative level of the procedures used to reinfuse blood lost during surgery.     

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.     

Parity as a risk factor for cancer cervix

PURPOSE: To analyze the likelihood of perioperative transfusion using the data of the abstracted patient discharge records. MATERIAL AND METHODS: It was studied the data of the records of the pediatric patients in whom were done surgical procedures for 1996. The abstracted patient discharge records are codified according the ICD-9-CM codes. RESULTS: 1,166 pediatric patients were operated, of whom were transfused 25 (2.1%). The transfusion rate was higher in patients less than 3 years old, who were operated with three o more surgical procedures simultaneously, who were admitted newly after the admittance here studied, and patients operated of spine, dorsolumbar spine, pharynx, thorax and mediastinum, central nervous system, colon, vessels and hip. CONCLUSIONS: Given the variability of the transfusion rate, to know it will allow a better planning of the surgical transfusions, the policy of the hospital blood bank and to increase the information to patient about the risk of the elective surgery.     

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.     

Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.     

An erythrocyte suspension in Modegel in the treatment of acute gastrointestinal hemorrhages

The effectiveness of a suspension of erythrocytes in the new colloid preservative "Modegel" (in 1:1 ratio) was studied in the complex treatment of 31 patients with severe gastroduodenal bleedings. It was established that the hemodynamic, antianemic action of the suspension was not inferior (and even excels) to the action of the whole preserved blood and the erythrocytic mass. The suspension transfusion has a favorable effect upon functions of the liver and kidneys, corrects the acidic-alkaline state of the recipients' blood, decreases the lipid peroxidation and has detoxicating properties. During transfusion of the suspension hypocoagulation of blood doesn't take place. The temperature reactions following the suspension transfusion are rare. The suspension of erythrocytes "Modegel" deserves wide introduction to clinical practice.     

Changes of upper gastrointestinal blood flow after hemorrhage in rabbits

The effect of hemorrhage and blood transfusion on the regional blood flow of the upper gastrointestinal tract was measured with radioactive microspheres in a rabbit shock model. Fifteen minutes after hemorrhage, mucosal blood flow in the esophagus, corpus, and antrum and total blood flow in the duodenum decreased drastically. The persistent reduction of mucosal blood flow continued until 60 minutes after hemorrhage. In spite of these distribution patterns of mucosal blood flow during hemorrhage, no macroscopic change was seen in any part of the gastrointestinal mucosa. One hour after blood reinfusion, the mucosal blood flow in the corpus was increased markedly, and innumerable hemorrhagic erosions appeared in this region. It may be that the striking increase of mucosal blood flow due to blood transfusion caused bleeding from the disrupted mucosa of the corpus. At this time the impaired flow in the esophagus, antrum, and duodenum tended to be improved already. Six hours after blood reinfusion, the bleeding from the mucosal foci in the corpus ceased and the mucosal blood flow returned to almost normal. Thus the higher susceptibility of the corpus to hemorrhagic shock may be due to the greater degree of rapid increase of mucosal blood flow occurring in this portion alone after blood transfusion as well as to its higher vulnerability to ischemia in the hemorrhagic period. The flow patterns in the muscular layer almost paralleled those in the mucosal layer during hemorrhage and blood transfusion.     

Reinfusion of whole blood following addition of tobramycin powder to the wound during total knee arthroplasty

This study prospectively examined nine human volunteers who underwent unilateral cementless total knee arthroplasty and had 600 mg of tobramycin powder added to their wound just prior to fascial closure. Serum levels of tobramycin were measured at 30 minutes, 4 hours, 8 hours, and 12 hours after surgery. Tobramycin levels in the reinfused whole blood were measured with each reinfusion. Patients were reinfused up to 12 hours after surgery and then the reservoir was left to suction drainage. All patients had significant levels of serum tobramycin 30 minutes after surgery. The average serum level was 5.5 micrograms/ml (range, 3.0-10.6 micrograms/ml). This level was achieved prior to any reinfusion and represented systemic absorption of tobramycin from the bleeding surfaces of the muscle and bone. All patients received at least one reinfusion of 400 ml of whole blood in the first 8 hours after surgery. Two thirds of the patients received a second reinfusion within the same time frame. Serum tobramycin levels measured post-reinfusion indicated that the risk of attaining potential toxic levels of aminoglycoside was not dependent on reinfusion, but on absorption from the wound. The dose of tobramycin in the drain was measured and found to be excessive and potentially toxic (range, 27-312 mg; average, 132 mg). Despite this fact, reinfusion was not as likely to produce toxic serum levels as was local uptake of the antibiotic. Although no patient in this series had any complaints relating to the high dose of tobramycin (deafness or renal failure), caution should be exercised when using antibiotics in a reinfusion system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of facial expression in "cooperative-avoidance conditioning" in monkeys.

This experiment was performed to determine whether a monkey would perform an avoidance response to affective expression in another monkey, 6 monkeys were individually trained to perform an instrumental avoidance response and were then tested in pairs in a "cooperative-conditioning" situation. The "stimulus animal" received the CS but lacked the response mechanism while the "responder" had the response lever but no CS. The responder could, however, observe the face of the stimulus monkey via television. The data revealed that emotional expressions of the stimulus monkey upon CS presentation elicited discriminated avoidance behavior by the responder. The results suggest that the cooperative-conditioning paradigm may permit identification of the specific facial expressions associated with various affects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autologous platelet-rich plasmapheresis: risk versus benefit in repeat cardiac operations

Preoperative platelet-rich plasmapheresis has been suggested as a means of reducing homologous blood transfusions in cardiac surgical patients. The current study evaluated this technique in patients undergoing repeat cardiac operations. Fifty-two patients undergoing repeat myocardial revascularization and/or valve replacement were evaluated in a prospective randomized controlled study design. Autologous platelet-rich plasma (PRP) was harvested after the induction of anesthesia in the experimental group. After reversal of heparin, each patient received his or her autologous plasma. Patients in the control group did not have plasmapheresis and received standard transfusion therapy if coagulation variables were abnormal and a coagulopathy was clinically evident. Routine coagulation tests, thromboelastography (TEG), perioperative bleeding, and transfusion requirements were compared in the two groups. Forty-four patients completed the study. A significantly larger volume of packed red blood cells (PRBCs) was transfused in the PRP group than in the control group (P = 0.03). Platelet and fresh frozen plasma (FFP) transfusions did not differ between the two groups. Mediastinal tube drainage did not differ between the two groups. During PRP infusion, 60% of the patients required treatment for moderate hypotension (mean arterial pressure [MAP] < 60 mm Hg). Only 16% of control patients required treatment for hypotension during the comparable time period (P < 0.05). No patient who completed the study returned to the operating room for postoperative bleeding. These data suggest that PRP did not reduce postbypass bleeding or transfusion requirements in repeat cardiac surgical patients. Moreover, the incidence of hypotension during PRP reinfusion introduces a potential risk to the procedure in the absence of any obvious benefit.     

Effect of peridural block on the adrenal cortex function after operations on the biliary tract

In patients operated upon with the use of peridural blockade the concentration of 11-OCS in blood plasma does not exceed the normal values both during surgery and in the immediate postoperative period. In patients operated upon under conditions of the routine combined narcosis an increased secretion of corticosteroids was observed.     

Follow-up results of a new colomyotomy in the treatment of diverticulosis

In the present study, we report upon the preliminary results of our technique of myotomy--combined colon-myotomy at L shaped or transversal T shaped--which includes a simultaneous incision of both longitudinal and circular muscle fibers, avoiding a large bloody area. Ten patients have been operated upon by this method, the results of follow-up examination of seven patients who were given roentgenologic and motility studies for a maximum of 24 months being reported upon. It appears that the technique is quite safe, with no mortality or morbidity being observed in the first ten patients operated upon. Even functional results are most satisfactory. On the basis of this preliminary study, the technique seems to offer better results than do other types of colomyotomies currently being used.     

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.     

The Nesbit-Kelami procedure for congenital curvature of the erect penis. Report on 20 patients

Twenty patients with a congenital deformity of the erect penis were operated upon using the Nesbit-Kelami technique. Excellent results were obtained in all patients.     

Plastic repair of the urinary bladder

Clinical observations of 76 patients in whom an artifical urinary bladder was constructed from the rectum are presented. 52 patients were operated upon for cancer of the urinary bladder, total papillomatosis, a metastasis of uterine cancer in the bladder, cancer of the sigmoid with the urinary bladder involvement, sarcoma and cancer of the prostate with the bladder involvement. 17 patients were operated upon for extrophy, 7 -- for cancer of the urethra. An isolation of the rectum is followed by ligation of the upper rectal and vein. Fifteen patients died postoperatively due to peritonitis (6), ascending infection of the urinary tract (4), postoperative shock (I), phlegmon of the minor pelvis (I). In late postoperative period an artificial urinary bladder provides for reservoir and excretory functions.     

Hearing impairment in Thais due to sport shooting: a preliminary report

Frequency of intracavernous invasion by a pituitary adenoma varies from 9% to 40% depending on the publications. Without putting off the possibility of true intracavernous invasion, it seems less frequent than evocated on CT-Scan and/or MRI data. We studied 153 files of pituitary adenomas operated upon recently: 72 prolactinomas (47.3%), 30 GH-secreting adenomas (19.7%), 7 corticotrop adenomas (4.6%), 44 non secreting adenomas (28.3%). 108 patients (70.4%) harboured a macroadenoma (diameter > 10 mm). A suprasellar expansion was seen 90 times on CT-Scan and/or MRI views. 19 times (17.7% of macroadenomas, 12.5% of the whole series) MRI evocated an infiltration of one or both cavernous sinuses (CS). Such data were found 3 times before 1991, 16 times since 1991, i.e. since MRI is systematically performed preoperatively. Except in two patients who respectively presented with a large intraorbital or temporal expansion, we have not been able to confirm the reality of the intracavernous invasion. We think that most of CT-Scan or MRI data of so-called intracavernous invasion correspond in fact to a compression or to a fingerglove invagination of the medial wall of the CS. In fact, anatomical studies by Harris & Rhoton (1976) and by Taptas (1990) demonstrated that such an invagination of the medial wall exists in almost one third of normal pituitary glands. These data must bring up to much carefulness when considering a possible pathological CS invasion by a macroadenoma. Therefore, it should be thoroughly assessed with anatomoradiological and radio-surgical correlations.     

Cholecystectomy with intraperitoneal drain. Presence and significance of conjugated bilirubin in the drainage fluid

The content of conjugated bilirubin in the drainage fluid of 85 patients, operated upon consecutively with cholecystectomy and intraperitoneal drain for nonacute gallbladder pathology was measured by the adapted method of Jendrassik and Grof. The measured amounts varied from 0 to 755 micromol. A weak correlation was found between the concentration of conjugated bilirubin and the total amount of drainage fluid (r = 0.37). In the majority of patients the evacuated amounts of conjugated bilirubin corresponded to the content of bilirubin in a few milliliters of hepatic bile. In 10% of the patients there were however greater amounts of conjugated bilirubin in the drainage fluid. Greater amounts of conjugated bilirubin were significantly more often evacuated from patients operated upon by surgeons with less than 3 years of surgical experience compared to patients operated upon by more experienced surgeons. The amount of conjugated bilirubin in the drainage fluid was not significantly correlated with operative blood loss, dryness of the operative field at the end of the operation or iatrogenic perforation of the gallbladder during operation. Higher (however not significant) temperatures and bilirubin levels in serum were observed in patients with greater amounts of conjugated bilirubin in the drainage fluid. Increased amounts of conjugated bilirubin in the drainage fluid were not significantly associated with increased postoperative morbidity. Two of the patients with large amounts of conjugated bilirubin in the drainage fluid were reoperated because of bile leakage/abscess but the remaining patients had no serious complication, which could be a result of efficiency of the intraperitoneal drain.     

The effects of perioperative blood salvage and autologous blood donation on transfusion requirements in scoliosis surgery

Fifty consecutive cases of surgical instrumentation and fusion for adolescent idiopathic scoliosis were prospectively studied to test the hypothesis that the use of predonated autologous blood combined with judicious perioperative blood salvage could decrease the amount of homologous blood needed. All cases had posterior instrumentation and fusion. Nineteen patients had their rib prominence resected with an average of 4.8 ribs per patient. Our protocol called for perioperative blood salvage with the cell saver and reinfusion of postoperative drained blood if more than 300 ml were drained in 4 hours. Two units of predonated autologous blood was made available. Hypotensive anesthesia and meticulous hemostasis kept the blood loss to a minimum. The average total blood loss was 1,055 ml. Blood loss per segment was 91 ml with an average of 11 segments fused per patient. Patients with rib resection had a blood loss of 1,105 ml, while those without had a blood loss of 955 ml. The cell saver blood returned per case was 391 ml with the hematocrit of the product averaging 46%. Twelve patients were reinfused an average of 300 ml of the postoperative drained blood. The predonated autologous blood was used as part of the intraoperative fluid management. In no patient was homologous blood needed. The average starting hematocrit was 35.6%, with the hematocrit at discharge (seventh day) being 32.4%. There were no complications or blood transfusion reactions. Our results suggest that judicious perioperative blood management may decrease the need for homologous blood transfusion in selected posterior idiopathic scoliosis surgery.     

Transcervical chorionic villus sampling beyond 12 weeks of gestation

While patients with esophageal cancer are operated, a large quantity of non-functional extracelluler fluid (ECF) are appeared. Mediastinum, intestines, visceral vessels, wound of thoracotomy and laparotomy, etc, become so called "third space", then much water, Na are shifted and restored there. Moreover, plenty of water are evaporated from operated fields and lymph issues are active. A long time ago, intraoperative fluid infusion was little, but recently more fluid (Hartmann solution) are infused (8 approximately 10/ml/kg/hr). Intraoperative blood transfusion is often done because blood tends to lose. But it sometimes had serious side effects, example for GVHD (graft-versus-host disease), infections. In order to prevent from thease, autotransfusion and irradiation to transfused blood are recommended.