[Prognostic incidence of blood transfusion in 753 patients operated for colorectal adenocarcinoma]. / Incidence pronostique de la transfusion sanguine chez 753 malades opérés d'un adénocarcinome colorectal.

Do transfusions have a deleterious effect on the survival after surgery for colorectal carcinoma (CRC)? Among 1,221 patients operated on for a CRC between 1969 and 1988, 753 patients having undergone a curative surgical procedure with a follow-up of at least six months were evaluated retrospectively. 134 patients (17.2%) did not receive any transfusion; the others 619 (82.80%) received transfusions including 150 with packed red blood cells only. Transfused and non transfused patients were compared. Among the classical indicators for disease free survival, the only valuable parameter was the pathological classification, but it was not discriminant between transfused and non transfused patients. Prognostic value of transfusions were evaluated with regard of the components and the quantity of transfused items, the time of transfusions (either per- or perioperative), the surgical procedures and the tumor location on colon and rectum. The 5 years survival of transfused patients was less than for non transfused patients (56.3% versus 61.7%, p > 0.05 NS), but only the transfusions of more than 5 packed red blood cells worsened significantly the prognostic. (5 years chi 2 = 5.7; p < 0.02). Adjustments with pathologic analysis and time evolutive indications for transfusions did not alter those results. These results point the fact that transfusions could influence survival after surgery for CRC and stress us to limit reasonably transfusions.

[Indications and results of autotransfusion. Normovolemic hemodilution in gynecology-obstetrics]. / Indication et résultats de l'auto-transfusion. Hémodilution normovolémique en gynécologie-obstétrique.

Considering the importance of haemorrhagic complications in gynaecology-obstetrics and the increasing fear of accidents during blood transfusion, the authors propose, from the literature and the study of 13 cases, a reflection on the indications of deferred autotransfusion (DAT) and of normovolemic haemodilution (NVH). In obstetrics, even if DAT has undoubtedly certain advantages (besides viral contaminations, appearance of allo-antibodies...), it can be indicated at present only for pregnant women exposed to a predictable risk of haemorrhage or for women with a rare blood group. In gynaecology, the authors have not found any significant advantages in our study as regards NVH associated with DAT. However, as in obstetrics, the technique is harmless, and no thrombo-embolic complications have been observed, even in women at high thrombotic risk. These methods are expensive and require qualified personnel. Their exact modalities and indications, as well as their medico-legal aspects, are yet to be defined.

[Neonatal exchange transfusion with irradiated whole blood. Preliminary results]. / L'exsanguino-transfusion néonatale avec sang total irradié. Résultats préliminaires.

Some clinical manifestations following exchange transfusion (ET) could result from graft versus host disease secondary to the introduction of viable foreign T lymphocytes: skin rash, fever, acute and sometimes bloody diarrhea or enterocolitis. Between February 1985 and January 1989 the blood used for 31 ET was irradiated at 40 grays. We compared the manifestations occurring during the days following ET to those occurring after 44 previous ET with non irradiated blood during the period January 1981 to January 1985. From 1981 to 1985, 13 of 44 infants developed problems within 3 days following ET: an erythematous macular skin rash in 4; gastrointestinal manifestations (diarrhea, vomiting and rectal bleeding, necrotizing enterocolitis) in 7; both skin lesions and a gastrointestinal problem in 2. Since 1985, 27 infants had no problems whereas only 4 developed gastrointestinal or cutaneous manifestations: NEC in a preterm infant, abdominal distension with rectal bleeding, fever and petechial rash in 2 infected infants. These data show a dramatic decrease of complications since the irradiation of blood products has been started: 30% with non irradiated, 13% with irradiated blood.

[Results of a French retrospective study on autologous transfusion]. / Résultats d'une enquête rétrospective française concernant la transfusion autologue.

To determine organization of autotransfusion in France, two questionnaires were sent to blood centers, anesthetists in 2,100 public hospitals, 50 anesthetists in private clinics and members of the French Hemapheresis Society, requesting information on autotransfusion method, date of installation, applications and persons responsible for its use. Data collected showed wide use of autotransfusion in order to economise human products before any legislation and before pressure due to transfusion transmissible diseases (TTD). However, many groups began this activity in 1987, and others still hesitate because of practical difficulties (legislation, cost, liability) in spite of the request of their colleagues or patients motivated by the risk of TTD.

[Cholinergic crisis in a patient with myasthenia treated by plasma exchange and anticholinesterase agents]. / Crises cholinergiques chez un myasthénique traité par échanges plasmatiques et anticholinestérasiques.

A patient with myasthenia receiving treatment with anticholinesterase agents and plasma exchanges for an acute episode, developed three successive periods of neurological deterioration during which plasma cholinesterase levels were determined. The risk of onset of a cholinergic crisis under these circumstances has been reported in the literature but not documented. The accidents in the present case were related to cumulative overdose effects of anticholinesterase agents and depletion of cholinesterase, suggesting caution in the use of anticholinesterase agents when frequent plasma exchanges are being carried out in a patient with myasthenia.

[Therapeutic leukapheresis in a leukostasis syndrome complicating chronic lymphoid leukemia]. / Leucaphérèse thérapeutique au cours d'un syndrome de leucostase compliquant une leucémie lymphoïde chronique.

A 50 year old man with chronic lymphocytic leukemia (CLL) and extreme hyperleukocytosis (600 x 10(9)/liter) presented with a respiratory distress syndrome, congestive heart failure with cardiomegaly, endotoxic shock and anuria. Examination revealed nodes in all areas and hepatosplenomegaly; laboratory studies showed hypoxemia and a chest X-ray diffuse bilateral alveolar infiltrates. He was treated twice by leukapheresis using a cell separator. This procedure removed 10.1 x 10(10) white blood cells with marked clinical improvement and resolution of air-space diseases over the subsequent 48 hours. Despite this unusual indication for leukapheresis in CLL, this procedure may be of value in treating the leukemic phase of CLL with pulmonary leukostasis.

[Major hypertriglyceridemia, associated with severe acute pancreatitis, successfully treated with plasma exchange]. / Hypertriglycéridémie majeure, associée à une pancréatite aiguë grave, traitée avec succès par échanges plasmatiques.

A 27 year-old alcoholic patient with severe acute pancreatitis (4 Ranson's objective prognostic signs), complained of abdominal pain and vomiting and presented fever and rigors. The plasma was of milky turbidity and the concentration of triglycerides (TG) very high (26 Mmol/l, Normal: 3-1.6). Serum pancreatic amylase was elevated (262 U/l, Normal: 10-200). The electrocardiogram (ECG) showed S-T depression. The diagnosis was confirmed by computed tomography which showed a pancreatic phlegmon and a collection in the left pararenal space (Ranson's grade D). After PE on days 1 and 2: the amylase became normal, plasma clear, TG decreased (7.8 Mmol/l), the clinical picture improved and the ECG normal. Assisted ventilation was necessary over 10 days. Pancreatic morphology remained unchanged. The patient was discharged to intensive care on day 18. There was no indication for surgery. The fast drop in TG levels, the precursors of free fatty acids, may have limited their toxicity the pancreas, allowing a difficult stage to be over come and the course of the illness to interrupted. Normalization of the ECG requires emphasis. The association of HG, increased plasma amylase and abdominal pain justifies early iterative PE.