Background The improvement of renal allograft survival by pre-transplantation transfusions alerted the medical community to the potential detrimental effect of transfusions in patients being treated for cancer. Objectives The present meta-analysis aims to evaluate the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by validating the results of a previously published meta-analysis (Amato 1998); and by updating it to December 2004. Search strategy Published papers were retrieved using Medline, EMBASE, the Cochrane Library, controlled trials web-based registries, or the CCG Trial Database. The search strategy used was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The tendency not to publish negative trials was balanced by inspecting the proceedings of international congresses. Selection criteria Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received any amount of blood products within one month of surgery. Excluded were patients with distant metastases at surgery, and studies with short follow-up or with no data. Data collection and analysis A specific form was developed for data collection. Data extraction was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was ranked using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 4.2). When available, data were stratified for risk factors of cancer recurrence. Main results The findings of the 1998 meta-analysis were confirmed, with small variations in some estimates. Updating it through December 2004 led to the identification of 237 references. Two-hundred and one of them were excluded because they analyzed survival (n=22), were repetitive (n=26), letters/reviews (n=66) or had no data (n=87). Thirty-six studies on 12,127 patients were included: 23 showed a detrimental effect of PBT; 22 used also multivariable analyses, and 14 found PBT to be an independent prognostic factor. Pooled estimates of PBT effect on colorectal cancer recurrence yielded overall OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients in randomized controlled studies. Stratified meta-analyses confirmed these findings, also when stratifying patients by site and stage of disease. The PBT effect was observed regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis. Authors' conclusions This updated meta-analysis confirms the previous findings. All analyses support the hypothesis that PBT have a detrimental effect on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and conclusions on the effect of surgical technique could not be drawn, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.

Perioperative blood transfusions for the recurrence of colorectal cancer

Background
The improvement of renal allograft survival by pre-transplantation transfusions alerted to the potential detrimental effect of transfusions in cancer treatment.

Objectives
This meta-analysis evaluates the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by updating the results of a previously published meta-analysis (Amato 2006) to December 2009.

Search methods
Papers were retrieved using Medline, EMBASE, the Cochrane Library, trials web-based registries, or the CCG Database. The search strategy was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The publication bias was balanced by reviewing the proceedings of international congresses.

Selection criteria
Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received blood products within one month of surgery. Excluded were patients with distant metastases and studies with short follow-up or no data.

Data collection and analysis
A specific form was used for data collection. Data was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was evaluated using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 5). When available, data were stratified for risk factors of cancer recurrence.

Main results
Updating the previous review through December 2009 identified 41 additional papers, for a grand total of 278 references. Two-hundred and fourty-two of them were excluded because they analyzed survival (n=27), were repetitive (n=29), letters/reviews (n=71) or had no data (n=115). Thirty-six studies on 12,127 patients remained included: 23 showed a detrimental effect of PBT; 22 used multivariable analyses, and 14 found an independent PBT effect. Pooled estimates of PBT effect on recurrence in randomised studies yielded an OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients. Stratified meta-analyses confirmed these findings also by site and stage of disease, regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis.

Authors' conclusions
This updated meta-analysis confirms the previous findings and supports the association of PBT on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and the effect of surgical technique could not be assessed, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.

Perioperative blood transfusions and recurrence of colorectal cancer

OBJECTIVE To assess the putative impact of perioperative blood transfusions on overall and disease-free survival in patients undergoing curative resection of stage I-III rectal cancer by applying propensity-scoring methods. BACKGROUND Whether perioperative blood transfusions negatively impact survival remains a matter of great debate. METHODS In a single-center study, 401 patients undergoing open curative resection of stage I-III rectal cancer between 1996 and 2008 were assessed. The median follow-up was 34.2 months. Patients who did and did not receive perioperative blood transfusions were compared using Cox regression and propensity score analyses. RESULTS Overall, 217 patients (54.1%) received blood transfusions. Patients' characteristics were highly biased concerning transfusions (propensity score 0.77±0.23 vs. 0.28±0.25; P<0.001). In unadjusted analysis, blood transfusions were associated with a 119% increased risk of mortality [hazard ratio (HR): 2.19, 95% confidence interval (CI): 1.34-3.57, P=0.001]. In propensity score-adjusted Cox regression (HR: 1.02, 95% CI: 0.65-1.58, P=0.970), blood transfusions did not increase the risk of overall survival. Similarly, in propensity score-adjusted Cox regression (HR: 0.86, 95% CI: 0.60-1.23, P=0.672), blood transfusions were not associated with an increased risk of recurrence. CONCLUSIONS This is the first propensity score-based analysis providing compelling evidence that worse oncological outcomes after curative rectal cancer resection in patients receiving perioperative blood transfusions are caused by the clinical circumstances requiring transfusions, not due to the blood transfusions themselves. Therefore, concerns about overall and disease-free survival should be no issue in the decision-making regarding perioperative blood transfusions in patients undergoing curative rectal cancer resection.

Perioperative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection: a propensity score analysis.

Farmyard injuries in young adults and the elderly usually result from machinery accidents, whereas children tend to be injured by runovers and motor vehicle collisions. A variety of farmyard injuries secondary to environmental and human factors may cause permanent disability or even death. Common injuries include lacerations, hand injuries, amputations, farm animal bites, fractures and dislocations. Special considerations should be taken into account when treating these injuries, focusing on their noteworthy bacterial load in order to minimise the risk of chronic morbidity.

Prevalence and current concepts of management of farmyard injuries

Several recent reports have affirmed the feasibility of the laparoscopic approach for radical prostatectomy. In this review, we discuss the morbidities associated with this technique and compare outcomes and convalescence with standard open radical prostatectomy. We reviewed all currently published data on laparoscopic radical prostatectomy and our series of 45 robotic-assisted radical prostatectomies and compared them to several landmark series of open retropubic and perineal radical prostatectomies. Although the initial series reported long operating times, these times have been significantly reduced in more recent series. Data on blood loss, convalescence, impotence, and incontinence rates have also been promising. Although follow-up has been short thus far, laparoscopic radical prostatectomy has been shown to be similar to open radical prostatectomy in several areas.

Laparoscopic radical prostatectomy: review and assessment of an emerging technique

The total number of 542 patients with colorectal cancer surgery have been analyzed in order to estimate the effect of receiving transfusion local recurrences, and the disease free - survival. It should be examined whether there are changes in general immunity indicators which would be connected with perioperative transfusion. A significant connection has been found between local recurrences and blood transfusion (p<0.0001), the most noticeable being in Dukes A (p =0.045), localization on rectum (p=0.036). The receiving of blood transfusion is linked significantly with disease free - survival reduction (p =0.0068; log rank), the most significant being in Dukes A stage (p =0.0123; log rank) and with localization on rectum (p=0.0231). The analysis of general immunity indicators has shown significant immunocompromitation of patients just before the surgery and this could have effect on immunomodulation caused by transfusion and just as on the treatment prognosis of colorectal carcinoma.

/pdf/the-immunomodulation-effect-of-allogenic-blood-transfusion-9e2ahtpqiw.pdf

The Immunomodulation Effect of Allogenic Blood Transfusion in Colorectal Cancer – A New Approach

Agricultural injuries are a complex surgical problem, especially because of frequently extensive skin lesions prone to infection and delayed healing The aim of the study was to assess the local effect of pesticides, chemical substances widely used in agriculture, on wound healing, especially on wound contraction Local effects of the combined herbicide composed of atrazine and dual (Primextra) and insecticide alphametrin (Fastac 10% SC) on primary wound healing were assessed in a bioassay performed in 18 New Zealand white rabbits Relative size of the wound, measured on days 0, 1, 3, 6, 9 and 12 of wounding was analyzed by two-factor analysis of variance with repeat measurements The activity of the process of restoration was assessed on histopathologic preparations obtained after the last measurement Results of the study showed the final wound contraction to be smaller and the process of healing slower in the experimental groups of animals Histopathology revealed defects of epithelialization, phasic delay in healing, infiltration with eosinophilic granulocytes, and decreased density of newly formed collagen Pesticides were concluded to have adverse local effects on the wound, causing impairment of the mechanisms of healing

/pdf/effect-of-pesticides-on-wound-contraction-xyaamexyio.pdf

Effect of pesticides on wound contraction.

The paper analyses and compares the results of the treatment of acute cholecystitis with open and laparoscopic approach in a seven-year period. From 1994 to 2000, 311 patients with clinical picture of acute cholecystitis were operated. Open cholecystectomy was done in 162 (52.09%) patients, and laparoscopy in 149 (47.91%). In both patient groups the time from the onset of clinical symptoms to the surgery, and preoperative workup and preparation, were the same. In patients with open surgery the procedure lasted 93 (+/-SD) minutes, and in those with laparoscopic surgery 114 (+/-SD) minutes. Those operated with open method received 5.83 (+/-SD) ampules and 3.75 (+/-SD) tablets of analgesics, and those with laparoscopic surgery 3.2 (+/-SD) ampules and 2.1 (+/-SD) tablets per patient. Antibiotics were administered to 149 patients with open surgery for 4.9 (+/-SD) days and to 68 of those with laparoscopic surgery for 2.29 (+/-SD) days. Patients with open surgery stayed in the hospital 9.55 (+/-SD) days and were on sick leave 43 (+/-SD) days, and those with laparoscopy spent 4.35 (+/-SD) days in hospital and were 16 (+/-SD) days on sick leave. In conclusion, better clinical results and faster return to everyday activities point to the significant advantage of laparoscopic cholecystectomy. Analysis of the results shows that total costs of treatment of working patients are significantly lower than of those with laparoscopic surgery, due to shorter hospital stay, shorter sick leave, and faster recovery.

Comparison of open and laparoscopic cholecystectomy in the treatment of acute cholecystitis

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The Immunomodulation Effect of Allogenic Blood Transfusion in Colorectal Cancer – A New Approach

Effect of pesticides on wound contraction.

Comparison of open and laparoscopic cholecystectomy in the treatment of acute cholecystitis

Pouzdanost ginekološkog pregleda u diferencijalnoj dijagnostici upale crvuljka žena reproduktivne dobi