Zentralblatt für Chirurgie
-
For the period from 1985 to 1987 were analysed the blood transfusions, which were carried out in seven surgical wards, within the scope of a study for quality assurance. 7.6% of the patients, treated in surgical ward and 5.4% of the patients, treated in traumatological ward, were given blood transfusion. The average was 3.6 transfusional units per treated patient. The biggest differences were to be remarked at cases of breast cancer and at thyroid gland surgery. ⋯ At these operation groups the blood transfusion were usually given once. Transfusional reactions, costs and responsibility towards the donor demand a turning away from scientifically non-established transfusion habits. The components concept by Lundsgaard should serve as an orientation.
-
In 1973 the observation was published that in patients who had received non specific blood transfusions before kidney transplantation graft survival was improved. An immunosuppressive effect of blood transfusion was suggested. Indeed, modulation on the cellular and humoral immunologic system has been demonstrated during the last decade. ⋯ The survival rate for patients with blood transfusions was significantly worse in comparison to the non-transfused group (43% versus 73%, respectively). Even when we subdivided our patients into tumor stage, differentiation and localisation, the negative influence of transfused blood was confirmed. We conclude that beside the risk of transmitting hepatitis or HIV the immunosuppressive effect is a strong argument to restrict the indication for blood transfusion.
-
In some cases of blunt abdominal trauma lesions of gastrointestinal tract are occasionally found. The difficulty with these injuries lies in establishing the diagnosis. Clinical examination alone does not reliable evidence, particularly if the patient is unconscious and therefore unable to respond subjectively. ⋯ In the retrospective analysis of our patients we have encountered serious complications such as peritonitis and even cases resulting in death. On the other hand when peritoneal lavage was employed, no false negative results occurred. Consequently the value of this method in the diagnosis of blunt abdominal trauma and possible lesions of the gastrointestinal tract is indisputable.
-
In the following paper a review is given on the development of scoring-systems of severe intraabdominal infections till now. After a critical reflection on various systems a heuristic assessment is shown in the summing-up about their possible utility in the future. At present the APACHE II index, the sepsis score by Elebute and Stoner and the Mannheim peritonitis index meet practically requirements for good scores by different revising questions.
-
The change of target variables in palliative cancer treatment led to a new evaluation of quality of life. Its use as a target variable to discriminate different therapies is problematic. Investigations with a patient-questionnaire assessing quality of life showed that the validity of this term is difficult to judge. At present it should be used in clinical research as an accompanying variable only.