THE ORDERING OF BLOOD FOR ELECTIVE GENERAL SURGICAL OPERATIONS

The current practice in ordering blood for common elective general surgical operations in the Prince of Wales Hospital has been studied. The numbers of patients having serum grouped and held and those having blood cross-matched were determined, together with the number of units cross-matched. The percentage of patients transfused and the number of units of blood given were then assessed for each procedure. The results demonstrated that blood was often ordered for patients who were most unlikely to require it. In addition, the amounts of blood ordered were frequently excessive, so that the cross-match-to-transfusion ratio (C/T ratio) for some procedures was high. We suggest that relatively simple changes in the current practice of ordering blood for operations should result in savings in costs, and most importantly, in a reduction in the wastage of blood.     

COMPLEX RELATIONS BETWEEN CORTICOSTEROIDS AND THE ADHESIVE STATE OF THE WHITE BLOOD CELLS IN THE PERIPHERAL BLOOD: FURTHER ANALYSIS OF THE STATE OF LEUKOCYTE/ADHESIVENESS AGGREGATION IN THE PERIPHERAL BLOOD AS A MARKER OF STRESS

Stress is associated with an increment in the concentration of cortisol, a leukocytotic response and increased state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood. We investigated the interrelationship between these three parameters in individuals under various conditions of stress. These included 123 emergency room patients with chest pain who were also classified in regard to the presence or absence of heart failure; 15 men in the fertility clinic donating semen and 16 women in the operating room before induction of anaesthesia for dilatation and curettage. A low (r=0.35) but significant (p<0.001) correlation was noted between cortisol level, leukocyte count, and per cent of aggregated leukocytes in the peripheral blood in the first group (ischaemic heart disease) but not the fertility clinic or operating room patients. A complementary study in dogs which received an intravenous hydrocortisone injection revealed neither an increased leukocyte number in the peripheral blood nor an increment in the adhesive state. In vitro studies confirmed the depressant effect of high concentrations of hydrocortisone on cell adhesiveness despite an increment in the expression of various adhesive proteins on the surface of the peripheral blood leukocytes. We concluded that the increased state of leukocyte adhesiveness noted by us in the past in patients under stress is not necessarily related to the presence of an increased cortisol concentration, and that factors other than corticosteroid level should be explored as possible triggers of the LAA response during stress. © 1997 by John Wiley & Sons, Ltd.     

双向引流在面部除皱术中的临床应用研究

面部除皱术,皮瓣分离范围广泛,血肿形成是常见的并发症,直接影响手术的成败。为了防止血肿形成,提高手术成功率。作者设计了双向引流管,在临床中应用双向引流41例。并设对照组,对单、双向引流进行了对比研究。结果表明,双向引流彻底,可有效地防止发生血肿。本文介绍了双向引流管的制备及方法,对双向引流的优点及在面部除皱术中的作用进行了讨论。     

INTRAOPERATIVE AND POSTOPERATIVE CHANGES IN PERIPHERAL WHITE BLOOD CELL COUNTS: THE CONTRIBUTION OF STRESS

The effect of major surgery, blood loss and psychological stress on the peripheral white blood cell (WBC) populations of human patients and healthy volunteers was examined. During, and in the hours immediately after, major surgery, there was a highly significant fall in the numbers of circulating lymphocytes (mean ? 30%-60%) and a highly significant decrease in polymorphs (mean ? 160%-350%). Blood loss and psychological stress are not major factors contributing to this fall in peripheral blood lymphocytes in the human, as blood donors and individuals under temporary stress (anxiety about an imminent dental procedure or an important examination) showed no change in their peripheral blood lymphocyte levels in the hours immediately after these experiences. Significant increases in circulating polymorph numbers, however, accompanied procedures involving even slight tissue trauma, e.g. following blood donation and tooth extraction, but did not occur after psychological stress alone, and were much smaller (? 20%-55%) than those occurring after major surgery. Thus, apart from the complex question of anaesthesia, the nature of the surgical procedure, probably, that is, the degree of tissue trauma involved, is the most important trigger determining changes in the circulating WBC counts after operation.     

肝海绵状血管瘤血供来源研究方法的讨论

目的 探讨肝海绵状血管瘤供血来源及研究方法的科学性。方法 对５例病人,经肝右动脉支结扎后,分别行门静脉连续造影和注入亚甲兰肝染色,观察门静脉与瘤体关系;对２２例肝动脉支插管造影;２例切除肝叶经静脉行血管铸型标本观察。结果 门静脉造影在门静脉期,门静脉支被瘤体稚移,造影剂不进入瘤内;肝实质期,瘤体区形成低密度区,亚甲兰染色,仅见肝实质染色,瘤区不被染色,界限分明,血管铸型标本见瘤体完全腐蚀脱落、无静     

两种术式治疗陈旧性下尺桡关节紊乱的远期效果比较

目的 评价尺骨头切除术和尺骨假关节成形术的远期效果,方法 将２３例陈旧性下尺桡关节紊乱患者分为两组,分别作有关节切除术（１１例）和尺骨假关节成形术（１２例）,腕背尺侧倒Ｌ形切口;（１）尺骨头切除术,骨膜上切除尺骨下端及尺骨头２ｃｍ,缝合骨膜,石膏托制动侧横断尺骨,造成１ｃｍ的尺骨缺损,去除下尺桡关节软骨,用一枚螺钉固定,下尺桡关节植骨融合,尺骨缺损用部分带蒂旋前方肌瓣填塞,石膏托制动３～４周,结果     

胆囊结石及胆囊癌病人ABO血型分布的研究

分析５２８例胆囊结石和６３例胆囊癌病人的ＡＢＯ血型分布情况,并与６００名健康献血员的血型分布做对比研究。结果表明：胆囊结石病人Ａ血型占３２．０％,Ｂ血型占２４．５％,Ｏ血型占３５．７％,ＡＢ血型占８．５％,与对照组引相比无显著尤其则胆囊多发性结石较多发生于Ａ血型病人;胆囊癌病人Ａ血型占４１．３％,Ｂ血占２７．０％,Ｏ血型占２３．８％,ＡＢ血型占７．９％,与对照组相比Ａ型血患胆囊癌的机会明显增加。提     

THE ROLE OF BONE SCANS IN THE ASSESSMENT OF PROGNOSIS OF SCAPHOID FRACTURES

Fifty patients with radiographic evidence of an acute scaphoid fracture were studied prospectively. Technetium bone scans were performed on all patients soon after injury in an attempt to detect fractures at risk of non-union or avascular necrosis. In three patients the scan showed a focal area of decreased radionuclide concentration in the region of the proximal pole of scaphoid implying avascularity, and each developed the radiographic signs of avascular necrosis. Two of these patients, each with a displaced fracture, developed non-union. Acute fractures of the scaphoid with evidence of avascularity on bone scan are at high risk of developing non-union.     

WHITE BLOOD CELL COUNTS IN PATIENTS UNDERGOING ABDOMINAL SURGERY

Background: The role of pre-operative white blood cell counts (WBCC) in patients with an acute abdomen is contentious. Methods: This study documents the association between pre-operative WBCC and the extent of intraperitoneal inflammation at the time of surgery in a heterogeneous group of 1166 patients undergoing abdominal surgery. Results: WBCC failed to adequately discriminate between groups of patients with varying degrees of intraperitoneal inflammation. For example, only 31% (37/118) of the patients with either free pus or an abscess within the peritoneal cavity had a WBCC > 15.0 × 10⁹/L. Conclusions: There is a need to replace the WBCC with more powerful predictors of inflammation within the peritoneal cavity.