Blood transfusion and survival following surgery for prostatic carcinoma.

Blood transfusion in the perioperative period has been reported to have a detrimental effect on survival in many types of cancer. Other studies have failed to confirm this. We have examined retrospectively the records of 246 patients with prostatic carcinoma who underwent transurethral resection of the prostate (TURP) in Aberdeen Royal Infirmary between 1977 and 1982. Bilateral orchiectomy (BLO) was performed in 193 patients. Of these patients, 71 of 246 (29 per cent) received perioperative blood transfusion. After controlling for differences due to a number of variables, transfusion of non-autologous blood was shown to be associated with a significant negative effect on survival. Perioperative transfusion of non-autologous blood should be avoided in patients with malignancy, unless there are clear overriding clinical indications. Prospective trials are needed urgently.

The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women.

To study the effects on the fetus of variations in maternal glucose tolerance, a 25 g rapid intravenous glucose tolerance test was performed at or about 32 weeks gestation in 917 randomly selected nondiabetic women with singleton pregnancies. The results were withheld from the patients and their obstetricians and paediatricians, and no treatment or advice was offered. Fasting plasma glucose and indices of glucose disposal (including a new index which we have termed "summed glucose") were distributed unimodally, with no evidence of a separate pathological group towards the diabetic end of the distributions. Significant associations were found between maternal glucose metabolism and various measures of neonatal nutrition and morbidity, including the incidence of congenital malformations and morbidity related to asphyxia, suggesting that variations within the normal range in maternal glucose metabolism can influence growth and development in the fetus. These relationships were continuous throughout the range of maternal glucose tolerance and were not of predictive value in individual cases.

Ethnic differences in incidence of very low birthweight and neonatal deaths among normally formed infants.

The incidence of very low birthweight babies (less than 1500 g) and neonatal mortalities in this group were analysed for the 15,608 births to mothers of various racial origins at this hospital during the years 1979-82 inclusive. Very low birth weight occurred less commonly in the European (9.1/1000) and Pakistani (10.1/1000) groups and most commonly in the West Indian group (23.2/1000). Neonatal survival in West Indians, however, was better than in any other group. Analysis of the stillbirths weighing less than 1500 g showed a lower rate in the West Indians compared with that of the European, Pakistani, and Indian groups. There was no evidence of a higher incidence of 'light for dates' in very low birthweight West Indian neonates.

Ethnic differences in incidence of very low birthweight and neonatal deaths among normally formed infants

The incidence of very low birthweight babies (less than 1500 g) and neonatal mortalities in this group were analysed for the 15,608 births to mothers of various racial origins at this hospital during the years 1979-82 inclusive. Very low birth weight occurred less commonly in the European (9.1/1000) and Pakistani (10.1/1000) groups and most commonly in the West Indian group (23.2/1000). Neonatal survival in West Indians, however, was better than in any other group. Analysis of the stillbirths weighing less than 1500 g showed a lower rate in the West Indians compared with that of the European, Pakistani, and Indian groups. There was no evidence of a higher incidence of `light for dates' in very low birthweight West Indian neonates.(AU)

Long-range implications for the mother. The Aberdeen experience.

One hundred twelve women with impaired glucose tolerance (IGT) diagnosed by intravenous glucose tolerance test (IVGTT) after pregnancy were followed up for a period of up to 22 yr (mean 12.9 yr). About one-third have been treated with chlorpropamide and the others by diet only. At the final assessment, approximately 35% had abnormal intravenous glucose tolerance and less than 7% overt diabetes. Chlorpropamide did not prove significantly more effective than diet only. Factors associated with deterioration in glucose tolerance were age at diagnosis and follow-up and the initial fasting plasma glucose (FPG) level (greater than or equal to 5.8 mM), but obesity was less important, although it was associated with an increased rate of vascular complications. Tests for islet cell antibodies (ICA) were weakly positive in 12.5% of 72 subjects and in only 0.5% of an unselected population; they did not correlate with the final state of glucose tolerance. Only three patients developed insulin-dependent diabetes (IDDM) and did so before the ICA study was started. A comparison is made between the results reported by O'Sullivan in patients diagnosed as having gestational diabetes, only 2% of whom still had abnormal oral glucose tolerance postpartum, and the results of our patients, all of whom had IGT after pregnancy. In spite of differences of technique and in the populations studied, the prevalence of IGT and overt diabetes at follow-up was significantly less in the Aberdeen series, who were initially a higher risk group. It seems probable that this is mainly attributable to dietary treatment in the follow-up period as O'Sullivan's cases were treated only during pregnancy.

Interrelations between ABO blood group, plasminogen, alpha1-antitrypsin, alpha2-macroglobulin and the platelet count in blood donors.

The level of plasminogen alpha1-antitrypsin, alpha2-macroglobulin and the platelet count were measured in 511 blood donors. The mean level of alpha1-antitrypsin was significantly lower in men of group B compared with that of group O. No other differences between the blood groups reached statistical significance. Woman had higher mean levels of alpha1-antitrypsin and alpha2-macroglobulin and a higher platelet count than men. The levels of plasminogen and alpha1-antitrypsin were significantly higher in women using oral contraceptive compared with those who were not. The level of alpha2-marcoglobulin fell with age until the 60-64 year age-group in men and the 40-49 year age-group in women. A positive correlation existed between the alpha1-antitrypsin and the alpha2-macroglobulin level and between the platelet count and the plasminogen level.

PIP: Interrelations between ABO blood group, plasminogen, alpha-1-antitrypsin, alpha-2-macroglobulin, and the platelet count in blood donors were studied in 511 donors, 272 male and 239 female. The mean level of alpha-1-antitrypsin was significantly lower in men of group B compared with that of group 0 (p less than .005). Mean levels of alpha-1-antitrypsin, alpha-2-macroglobulin, and platelets were higher in women than in men. Levels of plasminogen and alpha-1-antitrypsin were significantly higher (p less than .01 and p less than .001, respectively) in women using oral contraceptives compared with those who were not. Alpha-2-macroglobulin levels fell with age until the 60-64 year age-group in men and the 40-49 year age-group in women. A positive correlation existed both in men (p less than .001) and women (p less than .02) between alpha-1-antitrypsin level and alpha-2-macroglobulin level and in men (p less than .05) and women (p less than .05) between platelet count and plasminogen level.

The effeCt of vitamin c supplements on serum cholesterol, coagulation, fibrinolysis and platelet adhesiveness.

The administration of ascorbic acid (1g/day) to healthy adults did not significantly influence the levels of serum cholesterol, plasminogen activator activity, plasminogen, fibrinogen, FR-antigen, partial thromboplastin time, platelet adhesiveness, a-1-antitrypsin or a-2-macroglobulin over the 3-month period of study.

Aspirin and alcohol in gastrointestinal haemorrhage.

The intake of aspirin, of alcohol, and of a combination of both, among 817 patients admitted for gastrointestinal haemorrhage is reported. The incidence of ingestion in six diagnostic groups is compared with that in two control groups. Analysis confirms that there is a markedly significant association between overt haemorrhage and the ingestion of aspirin, but this was not shown for alcohol taken alone: the combination of aspirin and alcohol showed a highly significant synergistic effect.