The effects of the concentration and function of hemoglobin on the survival of rats after hemorrhage

Hemodilutional techniques of resuscitation, which are becoming popular, add anemia to the acute increase in the affinity of hemoglobin for oxygen that occurs in massively transfused patients when old liquid stored blood is used. A model simulating these conditions was established in rats, using blood stored in citrate for different durations ("fresh" for 1 day, P50 of 34.5 torr, and "old" for 14 to 20 days, P50 of 23.5 torr). Animals were exchange transfused of 90% of the original red cell mass with fresh or old blood at one of three different hematocrits, then hemorrhaged and treated with the same blood used for exchange. There was little difference in survival throughout the range of hematocrits when fresh blood was used (10 of 17, 11 of 16, and 10 of 16 rats). Survival was significantly less in recipients of old blood at low hematocrits (five of 21), but not at higher hematocrits (nine of 19, eight of 14). Ability to salvage the most vulnerable subgroup was tested in rats exchange transfused with old blood at low hematocrits, hemorrhaged, and treated with fresh or old blood, each at low or high hematocrits. Again survival was comparable with fresh blood at low or high hematocrits and old blood at high hematocrits (15 of 20, 19 of 21, 18 of 25) but was lower with old blood at low hematocrits (12 of 24). These results indicate that the oxygen-delivering capacity of blood can become a limiting factor in promoting survival after hemorrhage in otherwise normal animals when it is reduced below half of normal by a combination of anemia and impaired function of hemoglobin. Above that level, fresh blood was more efficacious than old blood in this model.

The relationship between transfusion and hypoxemia in combat casualties

The relationship between transfusion and subsequent hypoxemia was examined retrospectively in the records of combat casualties studied by the first three U.S. Army Surgical Research Teams in Vietnam. There was no evident relationship in 425 casualties studied before anesthesia and operation. In 199 casualties studied preoperatively and on at least two of the first three postoperative days, there was no evident relationship in those with injuries not involving the chest or abdomen. Eighteen such casualties received over ten units of blood each (average 24.5) and exhibited subsequent changes in arterial oxygen tension (PaO2) which were indistinguishable from those transfused lesser amounts or not all. Similar observations were made in casualties with injuries to the abdomen, although there was a tendency to lower PaO2 two days after injury in those heavily transfused. In those with thoracic injury, there was statistically significantly lower PaO2 on the first two postoperative days in those heavily transfused. Two possible interpretations are considered, one that blood transfusion contributed to hypoxemia, and alternatively, that a greater magnitude of the injuries accounted for both the worsened hypoxemia and the need for more transfusions. The latter was thought more likely. The differences in PaO2 related to the type of injury exceeded the differences associated with transfusion.

Surgical management of carcinoma of the cervix

Three hundred and fifty-two cases of carcinoma of the cervix which required some surgical procedure are reviewed. In Group I (primary treated), the lymph nodes were positive in 9% with Stage I and 45% with Staqe II disease. This group had an 88% five-year survival rate; patients with positive lymph nodes had a 60% two-year survival rate. One or more surgical complications occurred in 16.5% of patients treated for recurrent disease. The five-year survival rate in patients treated for recurrent disease was 35%. The Schauta-Amreich procedure is being used more commonly for poor-risk patients with recurrent disease confined to the cervix or with superficial vaginal involvement.

Induction of midtrimester abortion with intra-amniotic urea and intravenous oxytocin

Midtrimester abortions were induced in 295 patients with a combination of intra-amniotic urea and intravenous oxytocin. The mean injection-abortion interval was 26.4 hours. Abortion occurred spontaneously within 50 hours of amnioinfusion in 257 patients. The macerating effect of the hypertonic urea on fetal tissues allowed easy termination of the remaining 38 pregnancies by suction curettage at 50 hours after injection. Decreased urinary output occurred during the oxytocin infusions, but water intoxication was prevented by close monitoring of urinary output and serum electrolytes, and by the use of a concentrated solution of oxytocin in normal saline, allowing the administration of small volumes.

Observations on the biochemical effects of transfusion of citrate-phosphate-dextrose stored blood in man

Preliminary data on the biochemical effects of the transfusion of three units of CPD blood in man is presented. Free (ionized) calcium was found to decrease approximately two minutes following initiation of the transfusion of CPD stored blood at a rate of 50 ml/min. Due to mixing problems, arterial and not venous specimens were found necessary to monitor accurately the severity of these decreases. Parathyroid hormone in the peripheral blood was found to increase two to four minutes after the initiation of transfusion. Decreases in blood pressure were observed during transfusion. The blood pressure recovered when the transfusion was stopped and did not decrease any further after restarting the transfusion, were found out not to increase or decrease consistently, and only modest changes in plasma potassium were observed.

Verrucous carcinoma of the vagina

Verrucous carcinoma of the vagina is a highly differentiated and rare variety of squamous-cell carcinoma. Two new cases are presented; a search for the literature revealed three other cases. This neoplasm is characterized by a warty verrucous pattern of growth of squamous epithelium. Histologically, this type of squamous-cell carcinoma is extremely well-differentiated, with minimal evidence of anaplasia of the cells. The neoplasm tends to grow slowly and to infiltrate, sometimes extensively, by pushing rather than by permeating the surrounding tissues. Surgical excision seems to provide the best cure at the present time as the tumor does not respond to irradiation or to podophyllin treatment. Lymph-node dissection is not usually necessary in view of the tendency of the tumor to spread locally rather than to metastasize. However, the value of resection of lymph nodes should be reassessed after enough cases have accumulated.

Efficacy of leucocyte-poor red blood cell suspensions prepared by sedimentation in hydroxyethyl starch

Hydroxyethyl starch (HES), which is licensed for human use as a plasma volume expander, has red blood cell sedimenting properties similar to high molecular weight dextran (HMWD). The present studies document the effectiveness of commercially available HES in preparing leukocyte-poor red blood cell suspensions (L-PRBCs) from donor whole blood and packed red blood cells stored in CPD up to 120 hours prior to processing. The effect of HES sedimentation on final white blood cell count, on erythrocyte p50 and 2,3-DPG concentration, and on short- and long-term in vivo survival of 72-hour stored donor red cells are described, along with favorable clinical experience with over 300 transfusions of HES-sedimented L-PRBCs. Since the method requires no special equipment, it is immediately available for widespread use.