Autologous blood donation in total hip replacement.

The effectiveness of autologous blood donation in reducing the need for homologous transfusion was evaluated in a review of 529 consecutive total hip replacements (THR) from 1988 to 1992. The review was retrospective from 1988 to 1990 and prospective from 1991 to 1992. Since 1988 there have been 188 primary THR performed using autologous blood donation. In 1988-89, this represented 18% of all primary THR, in 1990 37% and in 1991-92 73%. This increase reflects a growing enthusiasm for the programme and a loosening of age restrictions. In 1991-92, 4% of autologous donors undergoing primary THR required homologous transfusions compared to 84% of non-autologous donors. Over the same period after revision THR, 36% of autologous donors required homologous transfusions compared to 100% of non-autologous donors. The participation rate of patients undergoing revision THR was 33%. The prospective part of the study in 1991-92 compared autologous and matched non-autologous patients. Blood loss, transfusion volumes and operating time were identical. The pre- and postoperative haemoglobin concentrations in the autologous group were lower by 15 and 10 g/L, respectively, after primary THR and by 10 g/L in both instances after revision THR. This was not reflected in a longer admission.

Perforation of the esophagus by a fish bone leading to cardiac tamponade.

A 32-year-old woman swallowed a fish bone and presented to the hospital 3 days later with chest pain and fever. While in the hospital, she became hypotensive. A computed tomographic scan showed a fish bone penetrating from the esophagus into the pericardium. The fish bone was removed at urgent thoracotomy with immediate relief of her circulatory compromise. At the time of the operation, the fish bone was noted to be abrading the surface of the left atrium. We report this case of cardiac tamponade secondary to a perforated esophagus after foreign body ingestion.