The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 95 per cent confidence interval 13-32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 95 per cent confidence interval 0.05-11 per cent) and in two non-transfused patients (2 per cent, 95 per cent confidence interval 0.3-8 per cent) (P less than 0.01). Natural killer cell function was significantly (P less than 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.

No abstract

Human epidermal growth factor (EGF), a small polypeptide (6 kDa) with mitogenic properties, has been implicated in the protection of gastrointestinal mucosal integrity. The efficacy of EGF in the prevention and healing of sclerotherapy-induced esophageal lesions was investigated in 24 minipigs with surgically induced portal hypertension. In addition, the effect of EGF on intragastric acidity and pharmacokinetics was investigated as possible means to explain its protective mechanism of action. The animals underwent three weekly sessions of sclerotherapy with polidocanol 2% and were concomitantly and for an additional three weeks treated with either placebo or EGF administered paravenously in the esophagus and/or subcutaneously. The subcutaneous treatment with EGF significantly (P < 0.05) reduced esophageal stricture and scar formations associated with sclerotherapy. Gastric pH values were significantly (P < 0.01) elevated only in animals receiving subcutaneous injections of EGF. Furthermore, the subcutaneous administration of EGF was associated with unexpected prolonged plasma concentration of the peptide. These results suggest a possible clinical value of EGF as an adjunctive treatment with the sclerotherapy.

The properties of isolated small oesophageal and mesenteric veins were investigated in a rabbit model subjected to a 4-week period of portal vein stenosis. The animals developed oesophageal varices and these together with the small mesenteric veins were mounted on a myograph. Compared with sham-operated controls portal hypertension resulted in an increased normalized inner radius and media thickness of the oesophageal veins resulting in a non-significant increase in the media to lumen ratio, while the inner radius decreased as media thickness increased in mesenteric veins resulting in a significant (P less than 0.01) increase in the media to lumen ratio. When activated, the active wall tension of both the oesophageal and mesenteric veins was increased following portal hypertension, but the active media stress was unchanged. The EC50 for noradrenaline and angiotensin II did not change in portal hypertensive vessels compared with controls and was equal in oesophageal and mesenteric vessels. The ability of isoprenaline and serotonin to relax pre-contracted vessels of both types was reduced by the portal hypertension. The results of these studies suggest that the development of oesophageal varices is not only due to increased portal venous pressure.

Acute prehepatic portal hypertension was mechanically induced in Göttingen minipigs. A 125% increase in portal pressure resulted in a significant decrease in estimated hepatic blood flow. The decrease in blood flow was accompanied by a 25% reduction in the 'true' clearance of indocyanine green and an 18% decrease in splanchnic oxygen consumption. Judged from the splanchnic elimination rate of galactose, the functional liver cell mass was not altered by portal banding, and an unaltered lactate to pyruvate ratio in hepatic venous blood indicated that no functional parts of the liver became severely hypoxic.