randomized controlled study of the immunosuppressive versus of whole blood transfusion versus packed red blood cells transfusion in patients undergoing elective colorectal surgery

In a randomized study, the effect of whole blood transfusion versus packed RBCs transfusion on CD4+:CD8+ ratio, the levels of soluble interleukin 2 receptor [sIL-2R] and interleukin IL-6 as well as on the development of the postoperative wound infection and intra-abdominal abscess, was assessed in 45 patients undergoing elective colorectal surgery. The patients were subdivided into three groups: Group A included 13 patients who were randomly selected received whole blood transfusion when blood transfusion was indicated, group B included 13 patients who were randomly selected received packed RBCs when blood transfusion was indicated and group C included 19 patients who did not receive any blood transfusion. The samples were obtained prior operation and 3, 7 and 30 days postoperatively. The study demonstrated that transfusion with whole blood in elective colorectal surgery was followed by a significant depression in immunocompetence and this depression is attenuated by the use of packed RBCs transfusion

Sentinel-node biopsy is a good representative of axilla in breast cancer with clinically negative axillary lymph-nodes

The aim of this work was to evaluate the accuracy of sentinel node biopsy in relation to the axillary lymph nodes and to find out whether this node can be a good representative of the axillary node status in clinically palpable breast cancer with clinically negative axilla so as to reduce the need of complete axillary dissection with its morbidity in such patients. Fifty female patients [age range of 34-75 years with a mean of 56] with clinically palpable breast cancer and clinically negative axillary lymph node enlargement were included in this study. The tumor size was 2-4 cm by palpation [stage T1 and T2, N0, M0]. Sentinel lymph node was identified by injection of 5 ml of methylene blue adjacent to the tumor, then dissecting the first axillary lymph node receiving the bluish colored lymphatics. The accuracy of identifying the sentinel node was 94%. Taking the sentinel node as the representative of the axillary; lymph nodes had a sensitivity of 88.9%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 97.5% and an overall accuracy of 97.9%

Outcome of early surgical management of intrabdominal sepsis in critically ill patients

Gram negative bacteremia is one of the common events leading to the sepsis syndrome, which is associated with severe intrabdominal sepsis and is the most frequent reason for admission of a surgical patient to the intensive care unit. The aim of this study is to revise the cases of critically ill patients with sepsis syndrome due to intrabdominal sepsis admitted to the ICU, who were managed surgically as early as possible and to compare the results with the other studies as regards the outcome in relation to age and rapid diagnostic work up. This study included 28 patients, from January, 1996 to May, 1998 with confirmed diagnosis of intrabdominal sepsis, all the patients were critically ill with sepsis syndrome. These were 16 males and 12 females. The preoperative diagnostic work up and preoperative preparation and stabilization time [The time between admission and start of operation] ranged from 2 to 12 hours with a mean of [3.61 +/- 2.41] hours. All the patients were subjected to operations under general anesthesia. Overall 40 operations were done for 28 patients, 20 patients operated upon once, 4 patients operated upon twice and 4 patients operated upon 3 times. The patients improved after drainage of the sepsis and removal of the necrotic tissue within 24-48 hours from the operation, except 5 patients did not respond to treatment and deteriorated rapidly and finally died from multiple organ failure. The mortality rate was 17.85%. The range of age was 18 to 88 years with the mean age [46.75 +/- 16.8] years. The mean age in the survivors, 23 patients, was [41.69 +/- 13.23] years and in the 5 dead patients was [70 +/- 10.93], with a significant difference between the two groups, this means that the younger the age, the better will be the prognosis. The preoperative time was ranging between 2 and 12 hours with the mean time was [3.61 +/- 2.41] hours. If we compare the preoperative time in the survivors group and that in the dead patients, it was [2.69 +/- 0.76] hours and [7.8 +/- 3.033] hours respectively, with a significant difference between the two groups. This means that the shorter the preoperative time, the better will be the prognosis. Two from the 5 dead patients were subjected to multiple operations and 6 patients from the 23 survivors were subjected to multiple operations, there was no significant increase in the mortality rate by repetitive surgery. So, we can say that early surgical intervention even repeatedly after rapid diagnostic work up, preoperative stabilization and preparation, improve the results