Mean Number Of Blood Units Research Articles

New and Off-Label Uses of Tranexamic Acid.

New and Off-Label Uses of Tranexamic Acid.

Increased Use of Blood Transfusions to Manage Urological Conditions during the COVID-19 Pandemic

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to an extensive reorganization of the healthcare system in Italy, with significant deferment of the treatment of urology patients. We aimed to assess the impact of deferred treatment during the SARS-CoV-2 pandemic on the need for blood transfusions in 3 Italian urology departments. Methods: We reviewed hospital chart data on blood transfusions at the urology units of 3 academic centers in the north of Italy from March to April 2020. Data were compared with values from the same time frame in 2019 (March to April 2019). Results: We observed significant reductions of the number of patients admitted to the urology units from March to April 2020 (373 vs. 119) and the number of performed surgeries (242 vs. 938) compared to 2019. Though, the number of transfused blood units was comparable between the 2 years (182 vs. 252), we found a greater mean number of blood units transfused per admission in 2020 (0.49 vs. 0.22; p < 0.0001). As a whole, the transfusion rate for hematuria was higher in 2020 than in 2019 (36 vs. 7.9%; p < 0.0001). Discussion/Conclusion: The observed increased number of blood transfusions needed throughout the SARS-CoV-2 era could have had a negative impact on both patients and the healthcare system. It is possible to speculate that this is the consequence of a delayed diagnosis and deferred treatment of acute conditions.

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study.

In thecurrent literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs). The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs. Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6months and mortality at 1, 3 and 12months. Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8min vs. 97.7min), a lower mean number of blood units transfused perioperatively (1.4U vs. 1.9U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant. The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population. Level IV, retrospective cohort study.

Transfusion Challenges in Patients with Hematological Malignancies in Sub-Saharan Africa: A Prospective Observational Study from the Uganda Cancer Institute

Blood transfusion is fundamental in managing hematologic malignancies. We sought to evaluate the need and availability of blood products for patients with hematological malignancies at Uganda Cancer Institute. We prospectively studied the demand and supply of blood for patients with thrombocytopenia (platelet count ≤50 × 109/L), anemia (hemoglobin ≤10 g/dL), and bleeding (WHO grade ≥2). We used Poisson generalized estimating equation regression models for longitudinal binary outcomes. Among 91 patients, the median age was 26 years (IQR, 11–47). Thrombocytopenia occurred on ≥1 day in 58% of patients and on 49% of hospital days. Platelets were transfused to 39% of patients. The mean number of platelet units requested per day was 16.2 (range 0–30); 5.1 (range 0–15) were received. Anemia occurred on ≥1 day in 90% of patients; on 78% of days; and 68% received at least one blood transfusion. The mean number of blood units requested was 36.3 (range 8–57) units per day; 14 (range 0–30) were received. Bleeding occurred on ≥1 day in 19% of patients on 8% of hospital days. Thrombocytopenia and anemia were common, but product availability was substantially below that requested. We recommend increased blood collection and adherence to strict transfusion triggers as strategies to improve blood availability.

Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes.

To report on outcomes following the use of prophylactic internal iliac artery occlusion balloons in patients with abnormal placental implantation. A retrospective analysis was undertaken of patients with abnormal placental implantation who underwent prophylactic iliac balloon placement prior to delivery in a University Maternity Hospital. Various clinical and technical factors were analysed, including technical success of balloon placement, blood loss and number of blood units transfused, duration of surgery, length of stay, hysterectomy rates, complications related to the balloon insertion, foetal pH and infant Apgar scores. Twenty-two patients with placenta accreta or a variant thereof underwent caesarean section after first undergoing prophylactic placement of bilateral internal artery balloons. Average follow-up duration was 2.08years. The average gestational age was 37weeks 6days, and the mean gravidity was 2.8. The mean number of previous caesarean sections was 2.4, while the mean maternal age was 35years. The mean intraoperative blood loss was 1.4L, and the mean number of blood units transfused was 2. Mean duration of surgery was 90min, mean total length of hospital stay 7.5days, while the mean duration of ICU/HDU stay was 1.2days. The balloons were inflated in 60% of cases and two patients (2/22-9%) underwent subsequent hysterectomy. There were no major maternal complications due to the procedure. Prophylactic placement of arterial balloons prior to caesarean section in patients with placenta accreta is well tolerated and leads to satisfactory maternal and foetal outcomes with minimal complications.

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

BackgroundPerioperative tranexamic acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures. MethodsWe conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed. ResultsNinety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (P = 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (P = 0.06). TXA resulted in a significant decrease in intraoperative bleeding (P = 0.01) and total bleeding (P = 0.01) relative to placebo. The incidence of adverse events was similar in the two groups. ConclusionsTXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss in adults undergoing major spinal surgery. Clinical trial registrationNCT01136590.

Effect of Topical versus Parentral Tranexamic Acid on Blood Loss in Spinal Deformity Surgery. A Prospective Randomized Controlled Trial

Introduction Massive hemorrhage and massive blood transfusion are not uncommon in spinal deformity surgery. There are many factors which may affect the perioperative blood loss. Multiple studies showed the beneficial effects of parentral tranexamic acid (TXA) in decreasing intraoperative blood loss but there is a lack of knowledge about the effect of topical use of tranexamic acid. The aim of this study is to evaluate the effect of using tranexamic acid topically versus parentrally on the amount of intra operative blood loss. Material and Methods Between 2011 and 2014, eighty three patients (49 females/34 males, mean age 17 ± 4 ys, body weight 49 ± 6 kg) underwent correction (in the form of multiple Ponte osteotomies, PSO, PVCR) and posterior spinal fusion for spinal deformity (57 AIS, 14 congenital scoliosis, 12 syndromic). These patients were randomized into one of three groups. In group 1 ( n = 31 patients), TXA was used topically. TXA was sprayed directly in the wound and sponges soaked with it were used. In group 2 ( n = 29 patients), intravenous TXA was used intra-operatively. In group 3 ( n = 23 patients), TXA acid was used neither topically nor systemically. Intraoperative blood loss and the number of blood units transfused were recorded for all patients. The three groups were comparable in the mean age, body weight, operative time, type of deformity, type of osteotomy, number of fused segments, number of screws used. Results The mean operative time was (240 minute ± 50). The mean blood loss in group 1 was 1353 ± 273 cc, 1271 ±279 cc in group 2, and 1430 ± 311 cc in group 3. The mean number of blood units transfused in group 1 was 2.65 ± 0.587, 2.3 ± 0.571 in group 2, and 3.4 ± 0.5 in group 3. There were no significant differences in intraoperative blood loss and number of units of transfused blood between the first and second groups while there was a significant difference between them and the control group. One patient developed DVT in the intravenous TXA group. Conclusion Topical TXA is as effective as intravenous TXA and may be used safely to decrease the need for blood transfusion and intraoperative blood loss.

A 10-year age-related survival analysis on cytoreductive surgery in stage IIIC-IV ovarian cancer: Elderly versus younger women.

123 Background: Approximately half of women diagnosed with advanced ovarian cancer (AOC) is over 65 years old. According to WHO,65 years is the cut-off age for distinguishing elderly individuals from younger people. Aim of the study was to analyze, in a 10-year retrospective series, the age-related differences in perioperative outcome of cytoreductive surgery for stage IIIC-IV ovarian cancer, identifying in ≥ 65y and &lt; 65y patients(pts)the clinicopathological factors associated with poor prognosis. Methods: 167pts with primary epithelial AOC FIGO stage IIIC-IV underwent cytoreduction and platinum-based chemotherapy from 2005 to 2015 at “Sapienza” University of Rome. Pts ≥ 65 and &lt; 65 years were compared regarding surgical outcome, clinicopathological variables and prognosis. Results: Median age was 56 years(19-87);50 pts (29.9%) were ≥ 65y, whereas 117 pts(70.1%) were younger.42%(21/50) of pts in elderly group and 39%(46/117) in younger group received neoadjuvant chemotherapy followed by interval debulking surgery. No residual tumor was achieved in 82% of elderly pts and in 82.9% of younger pts (p &gt; 0.05).No differences between the two groups were found in terms of mean operative time, mean number of blood units transfused, mean postoperative stay and number of pts requiring intensive care unit stay. The perioperative complications rate was 16% in elderly group and 10.2% in younger pts(p &gt; 0.05).The 60-day postoperative mortality was 2%for elderly and 0.8%for younger pts(p &gt; 0.05).The 10y-PFS was 11.6% vs 15.2%(p = 0.84) and the 10y-OS was 16.9% vs 21.4%(p = 0.60) in elderly and younger pts, respectively. Multivariate analysis showed that age itself was not a prognostic factor for OS but in &lt; 65y pts BMI had an independent prognostic significance (HR:4.97;CI 95%:2.09-11.83),together with residual tumor, which was confirmed to be an independent prognostic factor also in elderly pts(HR = 7.33;CI 95% = 1.30-41.33). Conclusions: Elderly pts with AOC showed a similar perioperative outcome compared to younger pts. In ≥ 65y pts, residual tumor was the only variable impacting significantly survival, while in pts &lt; 65y, BMI was also found to be an independent prognostic factor for OS.

Could MSBOS contribute to patient blood management in the era of global financial crisis?

No Abstract

Blood transfusion trends in obstetrics at the Federal Teaching Hospital in Abakaliki, South-East Nigeria

BackgroundObstetric hemorrhage has been repeatedly implicated as a leading cause of maternal mortality in Nigeria, yet there are very few studies that evaluate the practice of blood transfusion in obstetrics as a life saving measure.ObjectivesThe aim of this study was to evaluate the practice of obstetric blood transfusion, the mean decision-transfusion interval, and the outcome in parturients who had blood transfusions.MethodsThis was a prospective descriptive study conducted at the Federal Teaching Hospital, Abakaliki, South-East Nigeria, between 1st January, 2012 and 31st December, 2012. Statistical analysis was done using SPSS version 15.0 for Windows.ResultsOut of 151 parturients who received blood transfusion, 141/151 (97.4%) were knowledgeable about blood transfusion, while only 10/151 (2.6%) had no knowledge of it. The hospital was the source of information for 120/151 (80.8%) of the participants. Blood transfusion rate was 7.04% of all parturients. The mean decision-transfusion interval was 12.0 ± 4.3 hours. All participants were transfused with either whole blood or sedimented cells. The mean number of blood units transfused was 1.77 ± 0.93 units. The indications for transfusion were: anemia, 109/151 (72.2%); shock, 13/151 (8.6%); postpartum hemorrhage, 23/151 (15.2%); antepartum hemorrhage, 6 (4%). Six (4%) women died; mortality was due to renal failure in 3/6 (50%) and disseminated intravascular coagulopathy in 3/6 (50%). These deaths were due to delays and difficulty in securing blood for transfusion, while those who got transfused on time were salvaged with minimal morbidity, 21/151 (14%), or with no morbidity, 130/151 (86%).ConclusionExcessive blood loss and anemia still complicate most pregnancies in our practice and the mean decision-transfusion interval is unacceptably long with debilitating maternal morbidity and mortality that can be improved with safe and effective blood transfusion with minimal or no risk.

Tranexamic acid for reducing blood transfusions in arthroplasty interventions: a cost-effective practice

Tranexamic acid (TXA) administered during arthroplasty intervention can prevent blood loss and blood transfusions. The purpose of the present study is to evaluate the benefit of TXA administration on blood transfusion rates in patients undergoing joint arthroplasty, and to perform cost-benefit analysis. The study population included 100 patients admitted for arthroplasty intervention between 1st June 2008 and 31st October 2008 who did not receive TXA, and 98 patients admitted between 1st June 2009 and 31st October 2009 receiving TXA during the intervention. Blood transfusion was the main outcome. Risk factors for transfusion were evaluated in logistic regression models. Costs of autologous blood donation, TXA administration, autotransfusion and homologous blood transfusion were used to perform a cost-benefit evaluation. In the multivariate adjusted analysis, high preoperative haemoglobin level and TXA administration were significantly associated with a reduced risk of transfusion. Seventy-five percent of patients not receiving TXA required at least one transfusion versus 40.8% of patients receiving TXA, with a reduction of 45.6%. The mean number of blood units transfused was reduced of 26%. The reduction in transfusions was higher in hip arthroplasty. Among patients receiving TXA, the reduction in Hb level was lower both at days 1 and 2 after the intervention. The mean saving related to TXA administration was of <euro>138 per patient. The administration of TXA during arthroplasty intervention reduces the need of transfusion among patients undertaking arthroplasty interventions and can be considered a cost-effective practice for the National Health System.

Release of ischaemia prior to wound closure in total knee arthroplasty: a better method?

We included 46 total knee arthroplasties (43 patients) in a prospective, randomised study, dividing them into two groups: group A (23 knees, 21 patients) in which the ischaemia was released prior to wound closure allowing control of bleeding and group B (23 knees, 22 patients) releasing the tourniquet after suturing and bandaging. We compared the haemoglobin before surgery and at 24 and 48 h postoperatively, the total blood loss and the transfusions that were needed. Student's t-test was used to analyse the data. The results we obtained were as follows: preoperative haemoglobin in group A was 14.21 g/dl and group B 14.28 g/dl; haemoglobin at 24/48 h for group A was 10.04/10.1 g/dl and group B 10.28/10.3 g/dl; total blood loss was 743.2 cc for group A and 692.5 cc for group B; the mean number of blood units transfused were 2 in group A and 1.8 in group B. No statistical differences were found in the data analysed, but one of the complications in group B was major blood loss right after surgery that needed reintervention. We assume that this could have been avoided if the tourniquet had been released beforehand. We conclude that releasing ischaemia prior to wound closure does not demonstrate a statistical difference, but like other authors, we found clinical advantages suggesting the need of further study of this situation.

Infections virales : VHC, VHB et VIH chez les hémodialyses, CHU Ibn-Rochd, Casablanca

The viral infections are frequent in haemodialysis patients, notably those due to the hepatitis C virus (HCV), the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). The objective of this study is to determine the prevalence of the hepatitis C, the hepatitis B, the HIV infection in haemodialysis patients and the main risk factors for hepatitis C in the chronic haemodialysis patients treated in haemodialysis unit of Ibn Rochd University Hospital in Casablanca. This retrospective study was performed in 186 chronic haemodialysis patients and showed a high prevalence of HVC infection (76%), the prevalence of HBV infection was at 2%, none of the patients had detectable antibodies of HIV. Among the patients infected by the HCV, the mean duration of dialysis was 8,7 years. The mean number of blood units transfused was 16,5. Seventeen patients (11%) had no history of blood transfusion. In conclusion, the blood transfusion is not considered to be a like a major risk factor of the HCV infection in haemodialysis patients and this since the systematic detection of the anti-HCV antibodies in the blood donors. The nosocomial transmission of HCV seems to be the main risk factor HCV infection in the haemodialysis units requiring a strict adherence to infection control procedures for prevention of HVC infection in haemodialysis patients.

Resection of the abdominal inferior vena cava for complicated renal cell carcinoma with tumour thrombus

To describe our experience of excising the inferior vena cava (IVC) without a graft; en bloc resection of a renal cell carcinoma (RCC) with the renal vein and vena cava tumour thrombus and a segment of the entire abdominal IVC is technically feasible, but traditionally, after resection, attempts are made to restore continuity with the use of synthetic or homologous venous grafts. Between May 1997 and September 2004, 60 patients (mean age 62 years) underwent surgical resection of a renal tumour with a thrombus extending into the IVC. To resect the entire evident tumour, excision of the affected portion of the IVC was required in three patients (5%); the IVC was not reconstructed. The three patients were aged 38, 39 and 74 years; the mean operative duration was 5.88 h, the mean (range) estimated blood loss was 833 (500-1000) mL, the mean number of blood units transfused was 3.3 (0-7) units, and the mean follow-up was 24 months. The course after surgery was uneventful; specifically, none of the patients had a venous thrombosis or a pulmonary embolus. RCC has a propensity to invade the renal vein and IVC. Occasionally the thrombus invades the wall of the IVC and complete removal requires excision of a circumferential portion of the IVC; this can be done safely without a graft.

Renal cell carcinoma with tumor thrombus extending above diaphragm: Avoiding cardiopulmonary bypass

Objectives Renal cell carcinoma with a tumor thrombus extending into the supradiaphragmatic inferior vena cava (IVC) and right atrium represents a challenge to the surgical team. We describe a technique that can be used to resect these tumors safely through a transabdominal approach without recourse to cardiopulmonary bypass (CPB) or entry into the thoracic cavity. Methods Between May 1997 and August 2004, 59 patients (mean age 61 years) underwent surgical resection of a renal tumor extending into the IVC by techniques developed with the intention to avoid sternotomy and CPB. In 7 patients (12%), the tumor thrombus extended into the supradiaphragmatic IVC and right atrium. Complete surgical resection was successful through a transabdominal approach without CPB in all 7 of these patients. Results In the 7 patients who underwent the described technique, the median age was 71 years (range 51 to 80). The mean operative time was 7 hours, 47 minutes. The mean estimated blood loss was 2514 mL (range 500 to 6000). The mean number of blood units transfused was 4.7 (range 0 to 11). One patient died in the immediate postoperative period of cardiac arrhythmia. The median follow-up was 11.1 months, and 5 patients were disease free. Conclusions In select cases, renal cell carcinoma extending into the supradiaphragmatic IVC and right atrium can be resected without the use of CPB. We describe our technique.

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement

The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and −) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A− 1017 ml, Group B+ 622 ml and Group B− 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time (P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement

The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and −) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A− 1017 ml, Group B+ 622 ml and Group B− 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss ( P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time ( P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis ( P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.

Abdominoperineal resection for rectal cancer at a specialty center.

Although sphincter-preservation procedures have replaced abdominoperineal resection as the treatment of choice for rectal cancer, a subset of patients with rectal cancer will still require abdominoperineal resection. The use of adjuvant radiotherapy has been shown to reduce local recurrence, and combined modality therapy (chemoradiation) improves survival. Sharp mesorectal excision compared with the classic teaching of blunt retrorectal dissection is also an important component of local control. The primary aim of the present study was to evaluate the postoperative complications associated with neoadjuvant therapy in patients requiring complete rectal excision. Oncologic outcomes for all patients with abdominoperineal resection are also provided. A prospective database of 5,634 patients who underwent surgery for colorectal cancer at Memorial Sloan-Kettering Cancer Center between the years 1987 and 1997 was reviewed. Patients with primary adenocarcinoma of the rectum who underwent abdominoperineal resection were identified. In 1,622 patients who were operated on for primary rectal cancer, 292 patients (18 percent) underwent abdominoperineal resection and the rest had a sphincter-preserving procedure. Ten patients were excluded from the study because of prior pelvic irradiation for other cancer (8 patients) and insufficient radiation dose (<4,000 cGy; 2 patients). Neoadjuvant radiotherapy was given to 123 patients and postoperative adjuvant radiotherapy to 65 patients, whereas 94 did not receive radiotherapy. Intraoperative radiotherapy combined with preoperative radiotherapy was administered to 23 of the 123 patients given neoadjuvant radiotherapy. The duration of the operation was significantly longer in both neoadjuvant radiotherapy and intraoperative radiotherapy groups compared with the nonradiotherapy group (P = 0.01 and P < 0.0001, respectively). Estimated blood loss, mean number of blood units transfused per patient, and the percentage of patients being transfused were similar among the groups. Early postoperative complications were significantly higher in the neoadjuvant radiotherapy groups compared with the nonradiotherapy group. Late complications, overall survival, disease-free survival, and local recurrence were not significantly different among the groups. In patients with cancer of the lower one-third of the rectum, sharp pelvic dissection can result in a low rate of local recurrence even without radiotherapy. The role of preoperative radiotherapy, although associated with higher perineal wound complications, is important in increasing resectability and sphincter-preservation rate. Randomized, prospective trials will be needed to establish the role of adjuvant radiotherapy in patients undergoing sharp mesorectal excision for rectal cancer.

Prognostic significance of bacterial infection in bleeding cirrhotic patients: A prospective study

Background/Aims: In cirrhotic patients, bacterial infection is frequently associated with gastrointestinal bleeding and seems to increase mortality. The aims of this study were to determine the incidence of bacterial infections in bleeding cirrhotic patients and the influence of infections on the risk of rebleeding and death. Methods: Cirrhotic patients admitted for gastrointestinal bleeding who had not received antimicrobial chemotherapy in the previous 7 days were included. Blood, urine, and ascitic fluid cultures were systematically performed 1, 2, 4, and 7 days after admission. Results: Sixty-four patients were enrolled. Forty-two bacterial infections were documented in 23 patients (36%) within 7 days of admission. In patients with bacterial infection, mean Child-Pugh score and mean number of blood units transfused were significantly higher, early rebleeding was more frequent (43.5% vs. 9.8%; P < 0.01), and 4-week mortality was higher (47.8% vs. 14.6%; P < 0.01). Multivariate analysis only identified bacterial infections as predictive of early rebleeding ( P < 0.02) and a high Child-Pugh score as predictive of death ( P < 0.001). Conclusions: In bleeding cirrhotic patients, bacterial infections only increase the risk of early rebleeding, and mortality is related to the severity of cirrhosis.