[Survival after blood transfusion: a study at Rouen university hospital]. / Facteurs de survie à six mois des patients transfusés: étude au CHU de Rouen.

UNLABELLED: The aim of this study was to estimate short term survival rate after blood transfusion according to various criteria. PATIENTS AND METHODS: Patients admitted and transfused from January, 1 until June, 30 1996 at Rouen university hospital were retrospectively included, and their status (alive or dead) was determined. The characteristics of patients admitted and transfused were compared to the overall population of inpatients. Independent factors associated with mortality six months after blood transfusion were evaluated using Cox model. RESULTS: During the study period, 1887 patients were transfused. These patients were older, more often admitted in surgical or in intensive care units, and had a longer duration of stay, than the overall inpatients population. The survival rate at six months in transfused patients was 76.1%. Mortality rate at six months was independently higher in patients aged 75 and older, in men, in patients admitted in intensive care units, or transfused with homologous fresh-frozen plasma or packed platelet blood cells. Mortality rate was lower in patients who underwent a surgical procedure, in children under 16, and in patients whose stay was classified in "Circulatory system disorders", "Musculoskeletal system and connective tissues disorders or trauma", or "Injuries, allergy or poisoning". CONCLUSION: In this study implemented in a teaching hospital inpatients receiving blood transfusion, the survival was mainly associated with the severity and characteristics of the diseases requiring transfusion.

[Evaluation of spontaneous peri-transfusional screening for HVC and HIV at the Rouen University Hospital Center]. / Evaluation du dépistage spontané péri-transfusionnel des virus VHC et VIH au CHU de Rouen.

INTRODUCTION: Since October 1996, French hospitals have been instructed to introduce screening for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in all patients before and 3 months after each blood transfusion. The aim of this study was to assess the degree to which this recommendation had been taken into account in a university hospital via a pre- and post transfusion screening comparison. PATIENTS AND METHODS: A retrospective study on the use or non-use of screening tests for HCV and HIV was carried out in 2 groups of 150 randomly selected patients who had received blood transfusions in 1996 and in 1998. RESULTS: The coverage by pre-transfusion screening tests for HCV and HIV varied from 23% in 1996 to 20% in 1998 (not significant). The post-transfusion screening tests were performed by the hospital in 6% of the cases in 1996 and in 3% of the cases in 1998 involving blood transfusion. CONCLUSION: This study suggests that in the majority of patients, screening (particularly post-transfusion screening) for HCV and HIV was not carried out, and that over the 2-year period considered no noticeable improvement was observed. However, these results only concerned one hospital in which no specific screening program had been introduced. It is therefore possible that these findings are not representative of the situation in other hospitals; further studies would be useful in this regard.

Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol.

BACKGROUND: The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections. AIM OF THE STUDY: To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS. METHODS: Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated. RESULTS: The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor. CONCLUSION: Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.

Incidence of rectosigmoid adenomatous polyps in subjects without prior colorectal adenoma or cancer: a prospective cohort study.

BACKGROUND: Subjects without known colorectal adenomas or cancer constitute a large majority of the population where 85% of all cases of colorectal cancer are thought to occur. Consequently these people should be considered for screening to decrease mortality from colorectal cancer in the general population. AIMS: To estimate the incidence rate of rectosigmoid adenomas in these subjects. METHODS: Subjects without adenomas or cancer at a previous examination which had visualised the rectosigmoid underwent a fibre endoscopy every three years. Endoscopic data and population characteristics were collected prospectively. RESULTS: A total of 450 subjects fulfilled the selection criteria; 287 (64%) underwent at least two examinations, and 163 had three or more. At the second examination, with a mean delay of 39 months, the incidence rate of rectosigmoïd adenomas was 1.50% per patient year. The rate was 1.75% per patient year (95% CI 0.80-3.33) at the third endoscopy with an additional mean delay of 38 months. The cumulative incidence rate at six years was 7.3% (95% CI 4.3-10.3), representing a mean of 1.2% per patient year. This rate increased with age and was higher for men than for women after age adjustment (p< 0.03). CONCLUSIONS: The incidence rates are very low compared with those of patients with prior adenomas. These results should be considered in establishing rectosigmoid adenoma screening strategies.

Should the patella be resurfaced in total knee arthroplasty? Efficacy of patellar resurfacing.

To assess the long-term efficacy of patellar resurfacing, 100 knees were evaluated in 84 patients. The operations were performed between 1978 and 1982. The follow-up period ranged from 60 to 103 months. The diagnosis was degenerative joint disease (DJD) in 83%, rheumatoid arthritis in 12%, and miscellaneous in 5% of the knees. The implant (47 knees) and nonimplant (53 knees) groups were comparable with respect to age, body size, and length of follow-up period. The analysis revealed equivocal results. Considering all diagnostic categories combined, rest pain was marginally better in the resurfaced group (p = 0.04), but this difference resulted from an unequal distribution of subjects between mild and zero pain categories. Pain with walking, maximum walking distance, ability to climb stairs and rise from a chair, active arc of motion, extensor lag, and quadriceps strength were similar in the two groups. When the DJD group was considered separately, no significant difference emerged. There was little evidence to support a recommendation for routine patellar resurfacing in total knee arthroplasty.

Compression capability of cerclage fixation systems. A biomechanical study.

Cerclage wire or tension band techniques are frequently complicated by broken wires or inadequate bony stabilization. The fixation capabilities of various cerclage systems were defined in this study by measuring the maximum compression forces generated by the different methods as well as their ultimate strengths. Parham bands and swage-lock titanium cables were found to exhibit the greatest fixation potential and highest ultimate strengths. Cerclage fixation using stainless steel wire was found to be enhanced by using a modified square knot. Mersilene tape was found to have fixation capabilities of similar magnitude to 20 guage stainless wire secured with a twist knot. The polypropylene and nylon cable ties tested showed no advantage when compared to the other systems.