Eighteen patients undergoing total hip replacement (n = 13) or knee arthroplasty (n = 5) due to osteoarthritis or osteoarthrosis were prospectively studied in an investigation of complement ...activation and anaphylatoxin release in association with reinfusion of aspirated wound blood. Twelve of the patients needed blood transfusions and received an average of 390 +/- 75 ml (+/- SD) of autologous blood within 45 min. Plasma complement components, anaphylatoxins, and inhibitors were studied 1 min before and 15 min after the start of and 15 min after the completion of autologous transfusion. Samples also were taken from the collected blood, before and after passing it through a microporous filter. Blood gases and systemic complement samples were drawn simultaneously. There were no significant changes in systemic complement variables before, during, or after transfusion of autologous blood. However, in the aspirated blood, increased concentration of anaphylatoxins (C3a and C5a) and terminal complement complexes (TCC) were present (P less than 0.001). There were no differences observed between samples drawn before and after filtration of the blood. The concentration of C5 was less in the collected blood than in the systemic blood (P less than 0.05). No changes in blood gases were observed. This study demonstrated that postoperatively salvaged whole blood underwent anaphylatoxin formation and complement activation. However, after reinfusion of this blood, neither systemic complement activation nor clinical complications were observed.
BACKGROUND: Inflammatory mediators are released in association with intraoperative and postoperative salvage of blood. Whether these mediators (cytokines) participate in the modulation of ...erythropoiesis or not has been investigated.
STUDY DESIGN AND METHODS: Twenty‐seven patients who were to undergo total knee replacement surgery were randomly assigned to postoperative blood salvage with either filtered whole blood or washed red cells. Patients with postoperative blood loss <400 mL were considered a control group. The control group did not receive any transfusions. Plasma concentrations of the anaphylatoxin C3a, the C5b‐9 terminal complement complex, and the cytokines interleukins 6 and 8, hemoglobin, reticulocytes, and red cell volume fraction in the patients were repeatedly analyzed before and after surgery.
RESULTS: Significantly increased concentrations of interleukin 6 appeared in all three groups, which was interpreted as a response to the surgical trauma. The increase was significantly greater in the group that received filtered whole blood after return of shed blood. The recovery of hemoglobin levels did not differ in the groups.
CONCLUSION: The transfusion of filtered whole blood leads to the formation of interleukin 6 in the circulation, but postoperative hemoglobin recovery was similar in all groups.
The haulout patterns of five adult and two juvenile crabeater seals (Lobodon carcinophaga) were documented from February to December 1995 in three areas of the Antarctic. The longest haulout event ...was 19.2 h (mean=7.9, median=7.8); the longest in-water event was 85.8 h (mean=15.1, median=14.2). In no month were more than 76% of the adult seals in our sample hauled-out simultaneously. Multivariate repeated measures analysis of variance tests revealed no difference between males and females in the daily timing of haulout (P>0.05) between March and August (the only months with an adequate sample); in contrast, haulout timing differed between juvenile and adult seals (P<0.05) except in May. Juveniles spent about twice as much time hauled-out on the ice as adults (38% vs 20%, respectively; P<0.05). Predator avoidance by juveniles is hypothesized to be a possible cause for these differences. In light of these haulout patterns, population surveys of crabeater seals conducted in February, and as close as possible to local solar noon, can be expected to encounter the highest proportion of seals hauled-out on ice.
Background: Red blood cells may be destroyed by autotransfusion processing during intraoperative salvage. The aim of the present study was to evaluate the blood component recovery rate of techniques ...built on either continuous centrifugation and washing, or haemofiltration (HF).
Methods: Two different methods used in blood salvage - red cell salvage with continuous processing with centrifugation and saline washing (Continuous Auto Transfusion System, CATS) and whole blood recirculation through a 30000-Da filter, i.e., HF - were compared in a randomized laboratory study using donor whole blood activated by cobra venom factor. The recovery of red blood cells, haemoglobin, free haemoglobin, leucocytes, platelets, albumin, total protein and potassium was measured.
Results: The recovery of red cells was 86% with CATS and 76% with HF. HF had a significantly higher recovery of leucocytes (CATS 20%, HF 63%), platelets (CATS 4%, HF 37%), albumin (CATS 0.2%, HF 70%), total protein (CATS 1.3%, HF 71%) and potassium (CATS 2%, HF 17%). Less than 1% haemolysis was obtained in processed blood from both groups.
Conclusion: Both methods caused little destruction of the red blood cells during processing. There was a larger reinfusion of leucocytes, platelets, albumin, total protein and extracellular potassium when HF was used compared with the ‘CATS’ method.
This article focuses on judicial policy making and seeks to determine the extent of regional differences by examining the Environmental Protection Agency (EPA) enforcement actions in Resources ...Conservation and Recovery Act civil judicial cases. The research evaluates three competing models, the law school model, the political culture/regional model, and the economic model, that attempt to explain and predict penalty imposition and penalty severity. An integrated model with EPA regions and judicial circuits independently added is also evaluated. Findings suggest that the law school model appeared to be the best model to determine penalty imposition and that EPA administrators may be better predictors than judges. When a penalty is imposed, findings suggest that an integrated model best predicts penalty severity. Additional findings indicated that region or circuit does not add significantly more predictive value than the substantive theoretical variables in penalty severity.
Este artículo se enfoca en el diseño de políticas judiciales y busca determinar la extensión de las diferencias regionales por medio del examen de la aplicación de acciones de la Agencia de Protección Ambiental (APA) en los casos civiles judiciales de la Ley de Conservación y Rescate de Recursos. La investigación evalúa tres modelos, el modelo legal, el modelo cultural/regional político y el modelo económico, en el intento de explicar y predecir los resultados de los casos en relación a si un castigo es impuesto o no, así como la severidad del mismo. Un modelo integral es también evaluado, con las regiones APA y los circuitos judiciales entonces añadidos independientemente a este modelo. Las conclusiones sugieren que el modelo legal parece ser el mejor para determinar la imposición del castigo y que los administradores de la APA pueden ser mejores vaticinadores que jueces. Cuando un castigo es impuesto, los resultados sugieren que un modelo integrado predice mejor la severidad del castigo. Resultados adicionales indican que la región o el circuito no añaden un mayor valor significativo que las variables teóricas substantivas en la severidad del castigo.
To investigate ventilation and gas elimination during the emergence from inhalational anesthesia with controlled normoventilation with either sevoflurane/N2O or sevoflurane alone.
Twenty-four ASA ...I-II patients scheduled for abdominal hysterectomy were randomly allocated to receive either 1.3 MAC sevoflurane/N2O (n = 12) or equi-MAC sevoflurane (n = 12) in 30% oxygen (O2). Expired minute ventilation volumes (V(E)), end-tidal (ET) concentrations of O2, carbon dioxide (CO2), sevoflurane and N2O as well as pulse oximetry saturation (SpO2) and CO2 elimination rates (VCO2) were measured. The ET concentrations of sevoflurane and N2O were converted to total MAC values and gas elimination was expressed in terms of MAC reduction. Time to resumption of spontaneous breathing and extubation were recorded and arterial blood gas analysis was performed at the end of controlled normoventilation and at the beginning of spontaneous breathing.
Resumption of spontaneous breathing and extubation were 8 and 13 min less, respectively, in the sevoflurane/N2O than in the sevoflurane group. Spontaneous breathing was resumed in both groups when pH had decreased by 0.07-0.08 and PaCO2 increased by 1.3-1.5 kPa. Depression of V(E) and VCO2 were less, and MAC reduction more rapid in the sevoflurane/N2O than in the sevoflurane group.
Respiratory recovery was faster after sevoflurane/N2O than sevoflurane anesthesia. Changes in pH and PaCO2 rather than absolute values were important for resumption of spontaneous breathing after controlled normoventilation. In both groups, the tracheas were extubated at about 0.2 MAC.
To determine whether the method of the autotransfusion in association with knee arthroplasty leads to differences in anti-inflammatory cytokines in the patient's circulation.
Prospective study in a ...university hospital.
Twenty-one patients undergoing knee arthroplasty were randomized into two groups assigned to postoperative blood salvage. Seven patients received postoperatively filtered salvaged blood, and seven received centrifuged and washed salvaged blood. Patients with postoperative blood loss less than 400 ml (n=7) did not receive any transfusion.
Plasma levels of interleukin (IL) 1beta, IL-4, and IL-10 and of polymorphonuclear leukocyte elastase were measured by enzyme-linked immunosorbent assay. The plasma concentration of IL-10 was elevated after reinfusion of salvaged blood in all groups 1 day after surgery (p<0.05). Plasma IL-6, IL-10, and PMN elastase was higher (p<0.01) in all groups 1 day after surgery than preoperatively. There were significantly higher plasma levels 1 min after retransfusion of IL-6 (p<0.01) and IL-10 (p<0.05) in patients receiving filtered blood than in those receiving centrifuged and washed salvaged blood.
Total knee arthroplasty results in the release of interleukin-10. Transfusion of filtered salvaged blood leads to higher levels of cytokines IL-6 and IL-10 than after transfusion of washed and centrifuged salvaged blood.
Background: Perioperative blood salvage is associated with release of inflammatory mediators. Depending on type of processing, the complement system is activated to some extent in the final blood ...product. The aim of the present study was to evaluate a haemofiltration technique concerning complement system activation and whether the volume of added saline will have an influence on the elimination of activated complement during processing.
Methods: Sixteen patients undergoing total hip arthroplasty received wound blood salvaged intraoperatively with a haemofiltration technique. Saline was added to the reservoir for washing in a ratio of 1:1 or 5:1 of estimated blood volume. Samples for determination of the anaphylatoxins C3a and C5a, and the terminal SC5b–9 complement complex (TCC) were drawn from the patients, the collected blood, the ultrafiltrate and the processed blood.
Results: Increased concentrations of C3a, C5a and TCC were found in aspirated and processed blood. Haemofiltration did not reduce the concentrations of these factors, except that of C3a in the group where saline was added in a ratio of 5:1. There were no increased concentrations of C3a, C5a or TCC in the patient plasma after reinfusion. No differences in blood pressure, heart rate, pH, arterial oxygen tension, arterial carbon dioxide tension, or base excess were found in association with rein‐fusion of the blood.
Conclusion: Collected shed blood washed through haemofiltration contained moderately elevated concentrations of C3a, C5a and TCC. Reinfusion of the blood neither led to increased systemic concentrations of complement activation products, nor to disturbances in haemodynamic or biochemical parameters.
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