'Blind' transfusion of blood products in exsanguinating trauma patients.

BACKGROUND: In trauma, as interventions are carried out to stop bleeding, ongoing resuscitation with blood products is of vital importance. As transfusion policy in exsanguinating patients cannot be based on laboratory tests, transfusion of blood products is performed empirically or 'blindly'. The aim of this study was to delineate 'blind' transfusion practice in the hectic clinical situation of exsanguination. METHODS: Seventeen trauma patients were selected who died due to uncontrolled bleeding despite haemostatic interventions within 24h after admission and who received more than 12 U of RBC. Transfusion data were compared with a theoretically optimal transfusion model with a fixed ratio between units of RBC, FFP, and platelets. The difference between the observed and expected amounts of blood products was calculated. RESULTS: The patients (82%) received insufficient amounts of FFP and platelets when compared to the calculated amounts. The total numbers of transfused FFP and platelets were on average 50% lower than the calculated amounts. Regression models showed an increase of FFP and platelets with increasing amounts of RBC but not in sufficient quantities. CONCLUSION: Exsanguinating trauma patients receiving massive transfusions are subject to 'blind' transfusion. This is associated with insufficient transfusion of both FFP and platelets, which may aggravate bleeding. A 'blind' transfusion strategy consisting of a validated guideline with a predefined ratio of the different blood products, timing of laboratory tests as well as a sound logistic protocol facilitating this procedure, involving the blood bank and treating physicians, is needed urgently.

Recovery of acetic acid from waste streams by extractive distillation.

Wastes have been considered to be a serious worldwide environmental problem in recent years. Because of increasing pollution, these wastes should be treated. However, industrial wastes can contain a number of valuable organic components. Recovery of these components is important economically. Using conventional distillation techniques, the separation of acetic acid and water is both impractical and uneconomical, because it often requires large number of trays and a high reflux ratio. In practice special techniques are used depending on the concentration of acetic acid. Between 30 and 70% (w/w) acetic acid contents, extractive distillation was suggested. Extractive distillation is a multicomponent-rectification method similar in purpose to azeotropic distillation. In extractive distillation, to a binary mixture which is difficult or impossible to separate by ordinary means, a third component termed an entrainer is added which alters the relative volatility of the original constituents, thus permitting the separation. In our department acetic acid is used as a solvent during the obtaining of cobalt(III) acetate from cobalt(II) acetate by an electrochemical method. After the operation, the remaining waste contains acetic acid. In thiswork, acetic acid which has been found in this waste was recovered by extractive distillation. Adiponitrile and sulfolane were used as high boiling solvents and the effects of solvent feed rate/solution feed rate ratio and type were investigated. According to the experimental results, it was seem that the recovery of acetic acid from waste streams is possible by extractive distillation.

Patellar metastasis from a lung epidermoid carcinoma.

Patellar metastases are very rare. There have been approximately 20 cases reported in the literature. We have also noted two other reports of patellar metastasis from lung carcinoma as the first manifestation of lung cancer in our literature review. We present a case of patellar metastasis as the first manifestation of lung epidermoid carcinoma in a patient who was a smoker for 33 years.