Cell saver efficacy for routine coronary artery bypass surgery.

A retrospective study was conducted to determine the effect of intraoperative Haemonetics Cell Saver (HCS) usage on postoperative homologous blood product requirements in CABG patients. From 1 January to 31 December 1993, 516 patients without renal disease or postoperative surgical or gastrointestinal haemorrhage had elective, first-time CABG surgery. The HCS was utilized in 435 of these patients (Group CS) and in 81 patients the HCS was excluded (Group NCS). Preoperative patient variables were similar in the group. We evaluated the HCS effect on blood product transfusion by comparing -x units of red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLTS) transfused per patient between groups CS and NCS. There were no differences in the -x units of RBC (1.9 +/- 2.7 CS vs. 1.8 +/- 1.5 NCS) or in the RBC transfusion rate (48% CS vs 50% NCS). There were also no significant differences between the groups in -x units of FFP (0.9 +/- 0.8 CS vs 0.4 +/- 0.9 NCS) or PLTS (0.7 +/- 3.1 CS vs 0.4 +/- 2.5 NCS), or in the percentage of patients receiving these products (12% CS vs 8% NCS). These data provide no evidence that the use of the HCS decreases the amount of homologous blood bank products required postoperatively in patients having routine first-time CABG surgery. The current era of aggressive blood conservation may have limited the role of the HCS in routine CABG surgery.

Projection systems and terminal localization of dorsal column afferents: an autoradiographic and horseradish peroxidase study in the rat.

Projection systems from the gracile nucleus and the cuneate nuclear complex to their terminal sites in the mesencephalon, diencephalon, and cerebellum were examined by means of anterograde autoradiography and retrograde horseradish peroxidase methods. Three projection systems emerge from the dorsal column nuclei, decussate via internal arcuate fibers, and form the contralateral medial lemniscus (ML). At the obex, some fibers split off the ML and course dorsolaterally, forming an ascending lateral system which fits the "lemniscal adjunct channel" (LAC) concept of Graybiel ('72). The ML continues rostrally as the "main lemniscal line channel" (MLLC). At the inferior colliculus, some LAC fibers terminate in the pontine nuclei, parabrachial, dorsal reticular nuclei, and the external and ventral medial part of the central nucleus of the inferior colliculus. More rostrally at the level of the superior colliculus, terminal fields are found in the medial nucleus of the medial geniculate body, the suprageniculate, pretectal, and mesencephalic reticular nuclei, marking the end of the LAC. In the diencephalon, gracile fibers leave the MLLC and form a crescentlike terminal field along the extreme lateral border of the ventral posterior lateral nucleus (VPL) of the thalamus. Cuneate MLLC fibers terminate in a bandlike formation in the VPL medial to the gracile termination. The third fiber system, the cuneocerebellar projection, emerges from the cuneate, the external cuneate nuclei, and the "cellular bridge" and immediately enters the ipsilateral inferior cerebellar peduncle. Upon entering the cerebellum, the major fiber component remains ipsilateral and terminates as vertical bands in vermal and paravermal lobules, and lobules I through IVa. The posterior cerebellar lobe contains terminal bands in lobules VII-IX, the copula pyramidis, and the paramedian lobule. It is concluded that the dorsolateral fiber system conforms to Graybiel's LAC. It is more divergent and probably less modality specific, whereas the medial lemniscal system conforms to the MLLC, which is said to be modality specific, less divergent, and locked to specific sensory-motor response characteristics. The topography of cerebellar terminal bands indicates that there is sensory-motor representation from all parts of the body to all parts of the cerebellum, at least in the rat.