Transfusion vs. alternative treatment modalities in acute bleeding: a systematic review.

BACKGROUND AND METHODS: The practice of transfusion varies a great deal between countries and hospitals. Therefore, a systematic literature review was performed to evaluate the evidence underlying practice of transfusion and alternative treatment modalities in acute bleeding. After a stepwise evaluation, 79 out of 2438 abstracts were approved as the evidence base. RESULTS: Albumin for volume therapy is not better than artificial colloids or crystalloids and may be detrimental in trauma patients. No outcome difference has been proved between artificial colloids and crystalloids. Use of hypertonic solutions remains controversial, as do the concepts of delayed and hypotensive resuscitation. Healthy individuals tolerate acute, normovolaemic anaemia at 5 g haemoglobin/dl, but pre-operative haemoglobin < 6 g/dl gives increased mortality from surgical interventions. Keeping haemoglobin higher than 8-9 g/dl has not been associated with any positive effect on mortality or morbidity, even in patients with cardiovascular disease. The changes induced in erythrocytes by storage may be clinically insignificant. No alternative to erythrocyte transfusion was established. Evidence underlying the practice of thrombocyte and plasma transfusion is scarce. Available evidence on recombinant coagulation factor VIIa is insufficient to define its future role in acute bleedings. Antifibrinolytic drugs in general seem to reduce the need for transfusion. CONCLUSIONS: Intravenous volume replacement and transfusion policies seem largely based on local tradition and expert opinions. As a result of the difficulties in performing controlled studies in patients with acute bleeding and the large number of patients needed to prove effects, other scientific evidence should be sought to better define best practice in this important field.

Inter- and intratester comparison of the Rolimeter knee tester: effect of tester's experience and the examination technique.

Clinical knee examination is imperative for the prognosis, follow-up, and scientific comparison of anterior cruciate ligament surgery results. A new device, the Rolimeter knee tester was studied in this study with respect to inter- and intratester reliability. We found no significant difference in the intratester evaluation, and data were reliable between repeated measurements and between different testers with the same examination technique. The tester's experience seems to play a role using use the Rolimeter knee tester, but even an inexperienced tester can use it and obtain data that are very close to the data obtained by an experienced tester when the same technique is used. Furthermore, it was found that the manual examination of anterior translation also provides a reliable measurement, at least in the hand of experienced testers. Further advantages are that the Rolimeter knee tester is cheap, can be sterilized, and is simple to use.

[Surgical treatment of lumbar disk prolapse. A 20-year material]. / Operativ behandling av lumbalt skiveprolaps. Et 20 års materiale.

Surgery for herniated lumbar discs was performed on approximately 700 patients during the period 1963-83. 500 patients with a median observation of 13.5 years (5-25 years) were included in a follow-up study by reviewing journals and using a questionnaire. 35 of these patients (7%) had an acute operation. 398 patients (79.6%) were satisfied with the operation. There was a high positive correlation between the radiologic and peroperative findings and few complications after operation. 59 patients (11.8%) were reoperated and 94 patients (18.8%) were later hospitalized without operation because of lumbar pain. We conclude that patients who are to have surgery must be carefully selected, and that patients should be informed about the degenerative process, and the marked possibility of residual or repeated herniation and continuing lumbar pain.

[Dorsal dislocation of the metacarpophalangeal joint of the index finger]. / Dorsal dislokasjon av pekefingerens metakarpofalangealledd.

Dorsal dislocation of the index metacarpophalangeal joint, although uncommon, is a serious injury. An open reduction is usually necessary. In the present case, an open reduction was performed by a dorsal approach. The pathological anatomy is described.

Serotonin--a possible transmitter for the gastric adaptive relaxation. Interaction with histamine and prostaglandin F2 alpha on pressure responses in the isolated stomach.

Serotonin, or 5-hydroxytryptamine (5-HT), relaxes upper guinea pig stomach, and its possible role as a transmitter in the vagally induced upper gastric adaptive relaxation has been discussed. Such a transmitter is expected to act via other mechanisms than crude muscle depression. To test whether the relaxation response to serotonin is compatible with a putative role as transmitter in gastric adaptive relaxation, we wanted to evaluate whether serotonin acts by crude muscle depression and whether it selectively inhibits histamine or prostaglandin F2 alpha (PGF2 alpha). The study shows that 5-HT, in addition to its relaxatory effect on fundic spontaneous activity, selectively inhibits histamine, whereas PGF2 alpha is not inhibited. It is then concluded that the relaxatory effect of 5-HT is provided through other mechanisms than crude muscle depression and that selective inhibition of intramural agonists, like histamine, is a possible effect mechanism.

Early loss of fixation of femoral neck fractures. Comparison of three devices in 244 cases.

In successive series of displaced subcapital femoral neck fractures in the elderly, we operated on 75 cases with three Gouffon screws, 94 with three Mecron screws, and 75 with two von Bahr screws. Redisplacement within 3 months occurred in 20 Gouffon cases, 11 Mecron cases, and 12 von Bahr cases. Poor reduction contributed to the failures in all the groups. Although the reduction results in the three groups were similar, the Mecron group had better fixation and better social recovery than the Gouffon group. We concluded that, in addition to good reduction of the fracture, solid screws also contributed to the stability of the bone-implant construct.