The formation of aneurysms.

Arterial aneurysms account for a significant proportion of the various diseases treated by the vascular surgeon. Refinements of surgical technique have reduced the morbidity and mortality, yet, we have no effective medical therapy to prevent the growth of small aneurysms. Although the pathogenesis of aneurysmal disease has received attention, the complex nature of the process has not been fully elucidated. The emergence of new and refined techniques in the fields of immunology, biochemistry, cell biology, and genetics has advanced the understanding of the dynamic interactions within a diseased vessel. Although past work was descriptive, investigators are now studying the role of the local inflammatory infiltrates and the destructive proteolytic enzymes they produce and regulate. The clinical observations we make regarding the familial tendency of abdominal aortic aneurysms (AAA) underscores the importance of research directed at identifying an aneurysm-related gene. As new pieces are added to the puzzle and the picture of AAA pathogenesis becomes more clear, we can expect the development of new therapeutic measures directed at controlling the critical matrix changes, and thus the growth of small AAA, as well as screening methods searching for AAA-associated genes.

Hospital-wide educational program decreases red blood cell transfusions.

BACKGROUND: Because of the numerous risks associated with the use of packed red blood cells (RBCs), it is critical that they be transfused only when appropriate. A hospital-wide educational program was developed in an attempt to improve the transfusion practices and provide a framework for blood bank audit at a Veterans Affairs teaching hospital. MATERIALS AND METHODS: The program required physicians to fill out an information sheet that listed appropriate criteria for transfusion. Charts were reviewed to determine if the transfusion met these criteria. If the transfusion was deemed inappropriate by peer review, the staff physician was notified by letter. The information sheet was used on a voluntary basis without chart review in 1989 and on a mandatory basis beginning in 1990. Transfusion rates and mortality were adjusted to patient days of hospitalization and evaluated using chi 2 analysis. RESULTS: While voluntary use did not affect transfusion rate, mandatory implementation resulted in a 26% decline (P < 0.001) between 1989 and 1990 in the number of RBC units transfused per patient days of hospitalization. A diminished use of RBCs persisted in the subsequent years. There was no increase in mortality during this time to suggest a detrimental effect from the decrease in RBC transfusion. No apparent variation in the hospital population could account for the changes. CONCLUSION: Use of a unique and simple transfusion request sheet as an educational tool resulted in improved transfusion practices at a Veteran Affairs teaching hospital.