Unavailability of blood is a common cause of canceled operations but clinicians' blood ordering habits have been shown to waste hospital resources. A prospective audit was set up in a blood bank in a teaching hospital in Saudi Arabia. Data were separately logged on blood transfusion for all surgical operations between August 1991 and December 1992. Standard terminology was employed. During the 16 months, 565 consecutive operations were logged. Only two of eight departments met the criterion of efficient blood ordering, vis-a-vis a C:T ratio (units crossmatched divided by units transfused) of 2.5:1. Similarly, in the four most frequently performed operations, the transfusion index (Ti) was <0.25, indicating that blood would have been required for <25% of these cases. The study confirms others' experience of inefficiency in blood ordering for surgical operations, plus its attendant waste of resources. It is recommended that unless written and binding guidelines are published on a nationwide basis, clinicians' inefficient methods in ordering blood are unlikely to alter rapidly. Ann Saudi Med 1994;14(4):326-328. Resource. 1994; 14(4): 326-328 Since the introduction of blood transfusion into clinical practice, its appropriate use has been a subject for debate. Dodsworth and Dudley 1 reported that only 30% of the blood crossmatched for routine surgery was used and that many operations were being canceled, an event that the government of the United Kingdom now intends to use as an indicator of a hospital's performance. In a recent study from Saudi Arabia, Magbool et al. SA. Sowayan, Use of Blood in Elective Surgery: an Area of Wasted Hospital2 found that canceled operations were frequent and unavailability of blood was the third most common cause.However, surgeons' blood ordering habits are such that supplies, reagents, and technicians' time are committed and can be wasted. Thus, it has been shown from the United Kingdom, 1,3-6 the United States of America, [7][8][9][10] Australia, 11 Kuwait,12,13 and Saudi Arabia 14 that if clinicians' blood ordering habits were rationed, savings would accrue without patients being harmed. For example, Al-Momen et al.14 estimated that an annual savings of 312,000 Saudi Riyals (approximately US $83,000) would accrue in one hospital alone if its blood transfusion services were appropriately used. They concluded, "We are not making the most efficient use of blood bank facilities", and added, "it is most unlikely that we are alone in this regard and we urge . . . other hospitals to review their current blood ordering policies".The purpose of this audit was to determine the efficiency of our surgeons' use of blood transfusions with particular reference to common operations for which blood is routinely ordered. We intend to use the information as a basis for revising our policies on blood ordering for surgical procedures. We also have reason to believe that our findings will be of general interest. Patients and MethodsA prospective survey was conducted in the King Fahd Hospital of the Un...

Data on 130 women with invasive breast cancer, seen at our institution between April 1981 and November 1990, were retrospectively reviewed to assess the influence of age and menstrual status on the pattern and prognosis of their disease. Patients were mostly young (median age 40 years) and in 21 patients (16%) the diagnosis was established at the age of 30 years or younger. Eighty-six patients (66%) were under 50 and 82 patients (63%) were pre-menopausal. Pre-menopausal patients were more numerous than expected in stage III and less numerous in stage II. On the other hand, the differences between observed and expected values for both stage I and stage IV in the 2 menopausal groups were not significant. Compared with post-menopausal patients, pre-menopausal patients with 1-3 or greater than 3 positive lymph nodes were more numerous than expected. Differences between pre-menopausal and post-menopausal patients have persisted after categorizing patients into 2 age-groups with a cut-off point at 50 years. Comparable initial assessment and therapeutic modalities were offered to the 2 menopausal groups. At the time of analysis (January, 1991) all patients had a complete follow-up. Over a median follow-up of 46 months, the overall median survival (+/- SE) was 85.7 (+/- 4.4) months with a survival probability (+/- SE) at 5 years of 62% (+/- 5%). The proportional hazard model of Cox has identified advanced stage (stages III and IV) and involvement of lymph nodes as the only independent adverse predictors of survival with estimated hazard rates of 2.9 and 2.8, respectively. Unadjusted analysis, adjusted analysis and stratified survival functions failed to reveal any survival difference based on age or menstrual status. We conclude that, in a low-risk population and despite apparent baseline differences in demographic and disease characteristics between pre-menopausal and post-menopausal breast cancer patients, neither age nor menopausal status had a significant influence on survival. Our results should guide future cancer-care programs in Saudi Arabia.

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The large bowel is the most frequent primary site for metastases in inguinal hernial sacs. We report four cases, two due to carcinoid of unknown primary, and one each due to adenocarcinoma of colon, stomach and pancreas. We recommend that all hernial sacs, particularly in the elderly, be examined microscopically.