Blood conservation in major orthopedic surgery.

During an eight-year period, intraoperative autotransfusion was performed in 1922 operations. There were 476 primary hip arthroplasties, 1017 revision hip arthroplasties, 339 spinal procedures, and 90 vascular cases. There were no known complications related to autotransfusion in any of the cases. With proper technique, red cell salvage is approximately 58% effective, and intraoperative blood loss can be reduced by that amount. The first four years' experience with the preoperative autogeneic blood program is as follows. Using a combined program of predonation and primary hip arthroplasty, 72% of the revision hip arthroplasties and 81% of the spinal instrumentations required only autologous blood. A combined program of autologous donation and intraoperative autotransfusion is an excellent alternative to allogeneic blood replacement and a means of eliminating transfusion-related disease.

Asymmetrical arrest of the proximal tibial physis and genu recurvatum deformity.

We are reporting six cases of premature asymmetrical closure of the proximal tibial physis and associated genu recurvatum deformity and have reviewed the fourteen cases reported in the English-language literature. No single etiological factor could be implicated as the cause of the physeal arrest. Trauma, prolonged immobilization, tibial wire traction, and a surgical procedure involving the proximal tibial physis were observed risk factors among our patients. In our patients, established genu recurvatum due to deformity of the proximal end of the tibia and associated tibial length discrepancy were managed successfully by an opening-wedge osteotomy through the proximal one-third of the tibia and bone-grafting. Epiphyseodesis in the contralateral extremity may be required in patients with significant shortening of the tibia.

Long-range air transmission of bacteria.

Bacterial spores from a sandstorm area north of the Black Sea were transmitted to Sweden by air, giving increased concentrations of viable bacterial spores at two air sampling stations in Sweden.

Three-year investigation of the natural airborne bacterial flora at four localities in sweden.

The concentration of airborne bacteria was recorded during a period of 3 years at four localities: (i) in an agricultural district with an average of 99 (range, 2 to 3,400) bacteria per m3; (ii) in a coastal area with an average of 63 (range, 0 to 560) bacteria per m3; (iii) in a city park with an average of 763 (range, 100 to 2,500) bacteria per m3; and (iv) in a city street with an average of 850 (range, 100 to 4,000) bacteria per m3. At all four localities the bacterial concentrations varied within broad limits, but an annual periodicity with high average counts found during summer and autumn could be seen. The influence of certain meteorological factors on the number of airborne bacteria is also reported. Rain or high relative humidity caused a decrease in the bacterial counts, while high temperature or high wind velocities increased the counts. The particle size distribution for the four localities showed that about 50% of the particles carrying bacteria were larger than 8 micrometer.

Surface-decontaminating action of glutaraldehyde in the gas-aerosol phase.

The surface disinfectant effect of glutaraldehyde in the gas-aerosol phase was investigated at different relative humidities and temperatures. At a gas-aerosol concentration of 15 to 20 mg/m3 and a relative humidity of about 80%, glutaraldehyde had a good disinfectant effect against both vegetative bacteria (decimal reduction time, less than 5 min) and bacterial spores (decimal reduction time, less than 45 min). In spite of its low volatility, glutaraldehyde was more effective than formaldehyde when the two substances were compared on an "added amount" basis.