Perioperative blood transfusions. Changed indications and new alternatives

The surgeon has to keep abreast of changing advantages and disadvantages as well as alternatives in the context of homologous blood transfusions. We ought to realise that normovolaemic anaemia is better tolerated than we used to assume in the past. It is no longer necessary to provide transfusions to patients with 10 g/% Hb. About 8 g/% should rather be considered the adequate threshold. Possible transmission of hepatitis and AIDS virus is a genuine risk associated with blood transfusion. No hard evidence has yet been produced to immunosuppression and effects on the prognosis of cancer patients. More attention will have to be given in the future to preoperative supply of blood for autohaemotherapy.     

Treatment of the infected pseudoarthrosis of the tibia by the Harmon method]

The principles of treatment of tibial pseudoarthroses complicated by skin and soft tissue loss with the use of cancellous bone grafts from posterolateral approach to the tibia by Harmon method were discussed. The detailed surgical technique was presented. Management of 3 patients that resulted in bone union was described.     

Monitoring and evaluation of the health-for-all strategy: experience in the Eastern Mediterranean region

This article is an account of the activities undertaken by the WHO Regional Office for the Eastern Mediterranean in relation to reporting on monitoring and evaluation of progress in the implementation of the strategy for health for all by the year 2000, and the resulting effect on improving coverage and the quality of data. Tables 1-3 compare the completeness of items in the Eastern Mediterranean Region's reports on the three cycles (1983, 1985 and 1988) to that for other regions and for the global level. The comparison is based on the respective global reports presented to the World Health Assembly.     

Human immunodeficiency virus cultured from bone. Implications for transplantation

This study demonstrates by a virologic culture method that human immunodeficiency virus (HIV) resides in bone. After freezing, some initially positive specimens no longer yielded virus, but those that continued to yield virus were not further altered by subsequent washing, which removed essentially all marrow, or by freeze-drying. The safeguards against potential transmission of HIV by a bone allograft are principally the screening and testing methods previously described, although there may be a further reduction of the remote residual risk by the freezing step in the usual technical sequence for tissue banking by sterile techniques.     

Treatment of facial spasm with botulin A toxin

The authors use injections of botulinum A toxin in treatment of facial spasms. 105 patients (70 patients with blepharospasm, 35 patients with hemispasm) were treated during 4 years. The toxin Wisconsin relieved spasms for an average of 10 weeks. Local complications such as ptosis and diplopia appeared in less than 1/5 of the cases. No general complications were observed. Repeated treatments are necessary. The authors noted a decrease of lacrimal secretion on the treated side in hemifacial spasm and concluded that botulinum A toxin injections could be used as a treatment of epiphora.     

Effect of ceruletide on microvibration in schizophrenics

Ceruletide, a potent analogue of cholecystokinin, was administered by injection to eight schizophrenics treated with neuroleptics. We examined the dose–response effect on microvibration (MV) recorded from the chin of these patients. After 15 min of bed rest, MV was recorded for 5 min as a control recording. Subsequently, saline or ceruletide, at a dose of either 0.4 m?g/kg or at 0.8 m?g/kg, was injected according to a Latin square design with an interval of 4 weeks for washing out the drug effect and MV was recorded for 30 min. MV data obtained were subjected to the fast Fourier transform and an average power spectrum was computed. A three-way analysis of variance for these data was performed upon dose-effect, time-effect after treatment, and band-effect of the average power spectrum. The present results were similar to previous findings which had revealed effects of ceruletide on tardive dyskinesia symptoms, namely, the effects of ceruletide on MV were different according to the subjects (three cases: facilitation followed by inhibition, three cases: inhibition, two cases: no effects). The dose-response curve of ceruletide appears to be linear in some cases and an inverted U-shape in other cases. Present findings showed small doses of systemically administered ceruletide would modify muscle tonus of schizophrenics under chronic treatment of neuroleptics, and provided further reason for the therapeutic drug of tardive dyskinesia.     

Preoperative Chemotherapy Alone and Combined with Preoperative Radiotherapy in Small-Size Breast Cancer

Abstract: Breast conservation surgery is an effective and safe treatment for many breast carcinomas. It may be possible to further limit the extent of resection (or expand the indication for breast conservation) by the application of preoperative chemotherapy and radiotherapy. We explored the feasibility of this in a pilot study.
Seventy-three patients (mean age 48, 63% premenopausal) with confirmed breast cancer, less than 2.5 cm, received chemotherapy (Group A) or chemotherapy plus radiotherapy (Group B) prior to limited resection (tumorectomy). Axillary dissection was always performed. Results: In 6/31 (19%) Group A and 17/42 (40%) Group B patients the tumor was not palpable after preoperative treatment, with complete pathological remission in 1 and 3 cases respectively. Histologic grading, mitosis, cellular alteration, and cellularity evaluations indicated a consistently greater therapeutic effect with chemoradiotherapy than with chemotherapy alone.
In conclusion, radiotherapy appears useful in the preoperative treatment of breast cancer and its use in association with various drug combinations should be further explored.