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Autotransfusion for surgery: A comeback?
ABSTRACTS
392
GENERAL CONSIDERATIONS The Poland Syndrome. J. Gaubert, P. Rochiccioli,
M. Bardier, P. Cassignol, G. Dutau, and H. Guitter. Chirurgie p6diatrique (Paris) 19:135-143, 1978. The authors discuss seven cases of Poland syndrome in attempting to precisely delineate symptoms, associated problems, and limitations of treatment. The characteristic finding is agenesis of the peetoralis major muscle that may be associated with costochondral anomalies, mammary aplasia with skin changes, and complex malformations of the hand. Occasional hemiatrophy is seen. The authors question whether one can call the syndrome Poland syndrome in the absence of agenesis of the pectoralis major.--J. Deevey The Hoteropagus Conjoined Twins of NDU Sule, Nigeria.
O. A. Mabogunje and J. H. Lawrie. Clin Pediatr 17:861863, (November), 1978. Heteropagus conjoined female twins were successfully separated at age 5 wk. The autosite twin experienced a benign postoperative course and is doing well with a residual ventral hernia. The parasite twin, connected at the lower sternum and epigastrium, lacked a head, vertebral column, shoulder girdle and thorax. The abdominal cavities communicated but there was no connection of the gastrointestinal tracts. The autosite liver appeared to have four lobes. The parasite abdominal cavity contained a single globoid kidney with two ureters draining into a bladder. Pancreatic tissue and small bowel, blind at both ends, were also present. A uterus with cervix and vagina were in the pelvis. A single vascular pedicle arising near the autosite's liver connected the two.--Randall W. Powell Total Body Opacification. N. T. Griscom. Am J Roentgenol
131:919-925, (November), 1978. First reported in 1962, total body opacification has been useful in the diagnosis of many pediatric conditions. Especially useful in the evaluation of neonatal abdominal masses due to the large size of the mass, the large number of avascular masses, and the lower filtration rate of the neonatal kidney, the method is being replaced by more sophisticated studies. Computed tomography depends on varying degrees of contrast density and takes the concept of total body opacifieation further with its advanced technology. The author points out the initial disbelief of the concept in contrast to the rapid developments in diagnostic radiology today.--Randall W. Powell Autotransfusion for Surgery: A Comeback? Medical News.
JAMA 25:2710-271 I, (December), 1978. This article mentions some technical improvements in autotransfusion, which is a relatively old idea. A technique is described that is acceptable to Jehovah's Witnesses in which blood is preoperatively drained from a vein and circulated through a blood bag and partly returned to the patient along with intravenous fluid which dilutes it. Surgery is then undertaken following which the bulk of the previously removed blood is returned to the patient. This means that most of the operative blood loss is relatively dilute blood and that normal blood can be restored to the patient at the end of
the procedure together with a diuretic to get rid of the excess intravenous fluid. Another technique described by Dr. Malcolm Orr, Department of Anesthesiology, University of Texas Health Science Center, San Antonio, Texas, described a mode of autotransfusion technology known commercially as the Haemonetics Cell Saver. Essentially this system aspirates blood from the surgical field, subjects it to centrifugation, and saline washing. The packed red cells are then returned to their owner intravenously after surgery. Doctor Orr says the Cell Saver has been applied in 250 procedures, 160 open heart, 50 spinal surgery and liver resections in surgery on Jehovah's Witnesses and resections for abdominal aneurysms. Only the blood, and not the entire patient, is anticoagulated. This system has been in use 10 years with no incidents of disseminated intravascular coagulation. The cost is $9000.--David L. Collins
Zinc and Immunocompotonce in Protein-Energy Malnutrition. M. H. N. Golden, Barbara Golden, P. S. E. G.
Harland, and A. A. Jackson. Lancet 1:1226-1227, (June), 1978. Zinc deficient children have atrophy of the thymolymphatic system, decreased cell-mediated immunity, and increased susceptibility to infection. Children with proteinenergy malnutrition have similar immunologic changes. In order to confirm that the decrease in cell-mediated immunity in children with protein-energy malnutrition was associated with zinc deficiency, the authors carried out skin tests using an intradermal injection of Candida antigen on both arms in 10 malnourished children. The intradermal injection site was covered on one side with zinc sulphate ointment, the other side being covered by a placebo ointment. Significantly larger reactions to the same antigen were elicited on the side covered by zinc sulphate and significant negative correlation was established between plasma zinc concentration and degree of enhancement of delayed hypersensitivity response by topical zinc sulphate. The authors conclude that in children with protein-energy malnutrition the associated zinc deficiency may have a substantial part to play in the cause of depressed cell-mediated immunity found in these children.-J. G. Harvey
Progress in the Use of Elemental Diets in Infants and Children. R. J. Andrassy and M. M. Woolley. Surg Gynecol
Obstet 147:701-704, (November), 1978. The indications and advantages of the use of elemental diet in'infants and children are reported. Due to the hyperosmolar nature of the elemental diets, they are better tolerated when given by continual drip rather than by bolus feeding. The use of elemental diets in the transitional period between total parenteral nutrition and more conventional feedings as well as in providing nutritional support when the intestine is totally or partially available provides a method of earlier discontinuance of parenteral nutrition. This results in decreased incidence of mechanical, metabolic, and septic complications associated with intravenously administered nutrition. Each patient should be considered individually and a decision made as to whether or not enteral alimentation can be used in place of or in conjunction with parenteral nutrition.--George Holcomb, Jr.
392
GENERAL CONSIDERATIONS The Poland Syndrome. J. Gaubert, P. Rochiccioli,
M. Bardier, P. Cassignol, G. Dutau, and H. Guitter. Chirurgie p6diatrique (Paris) 19:135-143, 1978. The authors discuss seven cases of Poland syndrome in attempting to precisely delineate symptoms, associated problems, and limitations of treatment. The characteristic finding is agenesis of the peetoralis major muscle that may be associated with costochondral anomalies, mammary aplasia with skin changes, and complex malformations of the hand. Occasional hemiatrophy is seen. The authors question whether one can call the syndrome Poland syndrome in the absence of agenesis of the pectoralis major.--J. Deevey The Hoteropagus Conjoined Twins of NDU Sule, Nigeria.
O. A. Mabogunje and J. H. Lawrie. Clin Pediatr 17:861863, (November), 1978. Heteropagus conjoined female twins were successfully separated at age 5 wk. The autosite twin experienced a benign postoperative course and is doing well with a residual ventral hernia. The parasite twin, connected at the lower sternum and epigastrium, lacked a head, vertebral column, shoulder girdle and thorax. The abdominal cavities communicated but there was no connection of the gastrointestinal tracts. The autosite liver appeared to have four lobes. The parasite abdominal cavity contained a single globoid kidney with two ureters draining into a bladder. Pancreatic tissue and small bowel, blind at both ends, were also present. A uterus with cervix and vagina were in the pelvis. A single vascular pedicle arising near the autosite's liver connected the two.--Randall W. Powell Total Body Opacification. N. T. Griscom. Am J Roentgenol
131:919-925, (November), 1978. First reported in 1962, total body opacification has been useful in the diagnosis of many pediatric conditions. Especially useful in the evaluation of neonatal abdominal masses due to the large size of the mass, the large number of avascular masses, and the lower filtration rate of the neonatal kidney, the method is being replaced by more sophisticated studies. Computed tomography depends on varying degrees of contrast density and takes the concept of total body opacifieation further with its advanced technology. The author points out the initial disbelief of the concept in contrast to the rapid developments in diagnostic radiology today.--Randall W. Powell Autotransfusion for Surgery: A Comeback? Medical News.
JAMA 25:2710-271 I, (December), 1978. This article mentions some technical improvements in autotransfusion, which is a relatively old idea. A technique is described that is acceptable to Jehovah's Witnesses in which blood is preoperatively drained from a vein and circulated through a blood bag and partly returned to the patient along with intravenous fluid which dilutes it. Surgery is then undertaken following which the bulk of the previously removed blood is returned to the patient. This means that most of the operative blood loss is relatively dilute blood and that normal blood can be restored to the patient at the end of
the procedure together with a diuretic to get rid of the excess intravenous fluid. Another technique described by Dr. Malcolm Orr, Department of Anesthesiology, University of Texas Health Science Center, San Antonio, Texas, described a mode of autotransfusion technology known commercially as the Haemonetics Cell Saver. Essentially this system aspirates blood from the surgical field, subjects it to centrifugation, and saline washing. The packed red cells are then returned to their owner intravenously after surgery. Doctor Orr says the Cell Saver has been applied in 250 procedures, 160 open heart, 50 spinal surgery and liver resections in surgery on Jehovah's Witnesses and resections for abdominal aneurysms. Only the blood, and not the entire patient, is anticoagulated. This system has been in use 10 years with no incidents of disseminated intravascular coagulation. The cost is $9000.--David L. Collins
Zinc and Immunocompotonce in Protein-Energy Malnutrition. M. H. N. Golden, Barbara Golden, P. S. E. G.
Harland, and A. A. Jackson. Lancet 1:1226-1227, (June), 1978. Zinc deficient children have atrophy of the thymolymphatic system, decreased cell-mediated immunity, and increased susceptibility to infection. Children with proteinenergy malnutrition have similar immunologic changes. In order to confirm that the decrease in cell-mediated immunity in children with protein-energy malnutrition was associated with zinc deficiency, the authors carried out skin tests using an intradermal injection of Candida antigen on both arms in 10 malnourished children. The intradermal injection site was covered on one side with zinc sulphate ointment, the other side being covered by a placebo ointment. Significantly larger reactions to the same antigen were elicited on the side covered by zinc sulphate and significant negative correlation was established between plasma zinc concentration and degree of enhancement of delayed hypersensitivity response by topical zinc sulphate. The authors conclude that in children with protein-energy malnutrition the associated zinc deficiency may have a substantial part to play in the cause of depressed cell-mediated immunity found in these children.-J. G. Harvey
Progress in the Use of Elemental Diets in Infants and Children. R. J. Andrassy and M. M. Woolley. Surg Gynecol
Obstet 147:701-704, (November), 1978. The indications and advantages of the use of elemental diet in'infants and children are reported. Due to the hyperosmolar nature of the elemental diets, they are better tolerated when given by continual drip rather than by bolus feeding. The use of elemental diets in the transitional period between total parenteral nutrition and more conventional feedings as well as in providing nutritional support when the intestine is totally or partially available provides a method of earlier discontinuance of parenteral nutrition. This results in decreased incidence of mechanical, metabolic, and septic complications associated with intravenously administered nutrition. Each patient should be considered individually and a decision made as to whether or not enteral alimentation can be used in place of or in conjunction with parenteral nutrition.--George Holcomb, Jr.