Blood transfusion and recurrent Crohn's disease

Abstract

We read with interest the review article by Komori et al. (Br J Surg 1991; 78: 1027-30). They emphasize the important role of the endothelium in modulating the underlying vascular smooth muscle by releasing endothelium-derived relaxing factor (EDRF), which is a potent vasodilator and inhibitor of platelet aggregation. In addition, they speculate on the possible relationship between decreased EDRF production by a functionally injured endothelium and the development of both vasospasm and intrinsic graft lesions.However, their article concentrates on reversed vein grafts where the effects of surgical preparation of the graft on EDRF production are well established', but they make no mention of the in situ technique. In femorodistal bypasses to below the knee this technique is the method of choice because it has the advantage of a better size-match between artery and vein graft at each anastomosis. Despite the fact that the vein is often fully mobilized' and a valvulotome is passed along its lumen to destroy the valves, it has been suggested that this technique leads to superior endothelial preservation when compared with the reversed method3.We have recently investigated endothelial and smooth muscle cell injury during preparation of both reversed and in situ vein grafts4. Whilst we agree that EDRF production is reduced after preparation of reversed vein grafts, it is absent after preparation of in situ grafts because of severe loss of endothelial cells and functional impairment of any remaining cells. In addition, preparation of reversed and in situ vein grafts also leads to injury to the smooth cells of the media.It is likely that cellular injury plays a role in the subsequent development of intrinsic lesions in infrainguinal vein grafts which are an important cause of failure in the first postoperative year. Recently a link has been established between endothelial and smooth muscle cell injury during preparation of reversed vein grafts and intimal hyperplasia in an organ culture system'. Therefore the importance of endothelial loss and absent EDRF production associated with the in situ technique warrants further study. . Surgical preparation impairs release of endothelium-derived relaxing factor from human saphenous vein. Ann Thorac Surg 1989; 48: 41 7-20. Beard JD. Wyatt M, Scott DJA, Baird RN, Horrocks M. The non-reversed vein femorodistal bypass graft: a modification of the standard in-situ technique. Eur J Vasc Sury 1989; 3: 55-60. Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in-situ autogenous vein grafts. Ann Surg 1985; 4. Sayers RD, Watt PAC, Muller S, Bell PRF, Thurston H. Structural and functional smooth muscle injury after surgical 2. 3. 202: 50-5. preparation of reversed and non-reversed (in situ) saphenous vein bypass grafts. Br J Surg 1991; 78: 1256-8. Angelini GD, Soyombo AA, Newby AC. Smooth muscle cell proliferation in response to injury in an organ culture of human saphenous vein. Eur J Vasc Surg 1991; 5 : 5-12. 5.

The impact of comorbidity on the overall survival and the cause of death in patients after colorectal cancer resection

“…However, patients with cancer of the rectum, especially cancer requiring an abdominoperineal resection [29], are at greater risk of receiving transfusions. This has been confirmed especially in advanced stages [16] by several authors [5,9,10,11,12,14,19,20,32,33]. Experience of the surgeon and mobilization of the tumor are of additional importance.…”

“…Hermanek et al [27] and Marsh et al [28] have pointed out that plasma proteins in full blood or fresh-frozen plasma, not erythrocytes, are responsible. This conclusion has been challenged by both Modin et al [14] and Nathanson et al [29]. Autologous blood was tolerated better than allogenic blood in the study by Heiss et al [30].…”

“…[7] and Amato and Pescatori [8] who evaluated 32 of 132 papers on this subject confirmed this suspicion and concluded that the deleterious effect depends on the number of blood units given. On the other hand, several recent studies deny or minimize a detrimental effect of blood transfusion [9,10,11,12,13,14,15,16,17,18,19,20].…”

The Impact of Homologous Packed Red Blood Cell Transfusion on Patients’ Survival after Radical Surgical Treatment of Colorectal Cancer

“…The transfusion was performed only in lifethreatening conditions according to commonly accepted criteria. Although at present there is no consensus as to the strict criteria for transfusion, the drop of haematocrit to below 25-30% and haemoglobin below 7-10 g/dl are the most often reported values in the literature when trans fusion is considered (2,9,12,23).…”

“…Patients who received blood during the peri-operative period present a greater risk of infective complications (2)(3)(4)(5). Some authors thought that blood transfusion was connected to poorer survival in cancer patients while others did not observe such a relationship (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Most publications and most controversies concerned studies of patients operated on for colorectal cancer.…”