[Anticoagulation medication for proximal femoral fractures: prospective validation study of new institutional guidelines]. / Gerinnungshemmende Medikation bei proximaler Femurfraktur: Prospektive Validierungsstudie einer neuen institutionellen Leitlinie.

BACKGROUND: Under current guidelines surgical care of hip fractures has to be initiated within 48 h which is a challenge for the management of patients on medical anticoagulation. The aim of this study was to evaluate the in-house standard operation procedure (SOP) concerning these patients. METHODS: All geriatric hip fracture patients were included in this prospective study. Data concerning medical anticoagulation and hemoglobin levels on admission and at discharge, the start and duration of surgery, transfusion rates and postoperative complications were collected RESULTS: A total of 154 (62%) out of 247 patients were on anticoagulants. Patients on acetylsalicylic acid (ASA) demonstrated a significant increase in the rate of transfusion (62%, 95% CI, range 53%-72%, p<0.05) but lost significantly less hemoglobin during hospitalization (1.25 g/dl, 95% CI 0.62-1.88g/dl, p<0.05) in comparison to the control group (40% transfused, hemoglobin loss 3.00 g/dl). Patients on phenprocoumon were operated on later (26 h versus 20 h,95% CI 22-30, p<0.001). There were no significant differences concerning complications. CONCLUSION: Under this SOP anticoagulation has no impact on complication rates after hip fracture. The increased transfusion rates under ASS can be attributed to early blood transfusions. Antagonization of coumarin with vitamin K delays surgery but seems adequate. An analysis of more patients over a longer period of time should be conducted.

Perspectives of paid whole and plasma donation.

Although payment of blood donors is rejected by the WHO, the FDA, the EU, and the Red Cross (RC), in Germany, monetary compensation of expenses is permitted not only for plasmapheresis but also for whole blood donation. The structure and organisation of the institutions ensuring the blood supply in Germany and the pertaining aspects of blood safety will be discussed. Data reported to the health authorities show that the frequency of transfusion-transmitted infection markers in the German donor population is low and that only very few infections have been transmitted through blood. This is underlined by a detailed analysis of the paid donor population of a small university blood service (UBS). The analysis documents a very stable and reliable cohort of predominantly repeat donors. Unpaid RC donors of blood units transfused to patients at the university hospital of Marburg showed a sixteen-times higher sero-conversion rate than those of the UBS (p < 0.0001). However, in a survey, 77% of the paid donors denied continuation of blood donation in the event of payment being stopped. Therefore non-remuneration would result in acute blood supply shortages. Since increased blood shortages are to be expected anyway in the near future, all measures improving the supply of safe blood, including monetary compensation, should be objectively discussed without prejudice.

How to maintain blood supply during computer network breakdown: a manual backup system.

Electronic data management systems using computer network systems and client/server architecture are increasingly used in laboratories and transfusion services. Severe problems arise if there is no network access to the database server and critical functions are not available. We describe a manual backup system (MBS) developed to maintain the delivery of blood products to patients in a hospital transfusion service in case of a computer network breakdown. All data are kept on a central SQL database connected to peripheral workstations in a local area network (LAN). Request entry from wards is performed via machine-readable request forms containing self-adhesive specimen labels with barcodes for test tubes. Data entry occurs on-line by bidirectional automated systems or off-line manually. One of the workstations in the laboratory contains a second SQL database which is frequently and incrementally updated. This workstation is run as a stand-alone, read-only database if the central SQL database is not available. In case of a network breakdown, the time-graded MBS is launched. Patient data, requesting ward and ordered tests/requests, are photocopied through a template from the request forms on special MBS worksheets serving as laboratory journal for manual processing and result report (a copy is left in the laboratory). As soon as the network is running again the data from the off-line period are entered into the primary SQL server. The MBS was successfully used at several occasions. The documentation of a 90-min breakdown period is presented in detail. Additional work resulted from the copy work and the belated manual data entry after restoration of the system. There was no delay in issue of blood products or result reporting. The backup system described has been proven to be simple, quick and safe to maintain urgent blood supply and distribution of laboratory results in case of unexpected network breakdown.

[Can hysteroscopy reliably detect malignancy? Analysis of 1200 hysteroscopy findings]. / Muze hysteroskopující spolehlive odhadnout malignitu? (analýza 1200 hysteroskopických nálezu).

OBJECTIVE: The aim of this study was retrospective analysis of how accurate was per-operational visual evaluation of malign process in an uterus cavity during hysteroscopy. And to evaluate whether increasing experience of hysteroscopiers leads to significant accuracy considering the neoplasm of an uterus cavity. SETTING: Department of Gynaecology and Obstetrics, Havírov. METHOD: In Havírov Hospital, 1,200 hysteroscopies altogether were performed in the period from December 1995 to March 1999. In this group, there were 26 cases of histologically verified endometrial cancer. The authors retrospectively attempted to evaluate how accurately the suspected disorder was already stated during the per-operational hysteroscopy. The advantage of comparing the sub-group was taken in the first 690 hysteroscopies, of which the complex analysis was published in Cs. Gynekologie 5/98, and in the sub-group of 510 hysteroscopies performed in the following period, to state whether experience can more precisely define the per-operational malignity recognition. The statistical analysis was performed by means of the Fischer exact test of numerical charts. Among other things, the MEDLINE database was used during discussion. RESULTS: The endometrial cancer was encountered 26 times altogether, it means in 2.2% cases of hysteroscopies. Carcinoma in situ occurred three times, the stage IA three times, IB 17 times, IC three times. A hysteroscopier described the negative finding incorrectly 13 times altogether, it means 50% of all cases. The sensitivity and the specificity of hysteroscopy for endometrial cancer prediction was 50% and 99.5% (P < 0.01). The comparison of the first sub-group results (16 cases of endometrial cancer, sensitivity 75%, specificity 99.7%, (P < 0.01) and the second sub-group (10 cases of endometrial cancer, sensitivity 10%, specificity 99.2%, P = 0.09%) indicates that even increasing experience of a hysteroscopier does not more precisely define per-operation malign consideration. CONCLUSION: The authors have come to the conclusion that the pre-operation consideration of intrauteral pathology during hysteroscopy does not allow to assess precisely whether there is a neoprocess of an uterus cavity, or not. Even growing experience does not define with more precision verification of malign disorders especially at early stages of this illness. Hysteroscopy always has to be supplemented with endometrium biopsy.