Although aseptic necrosis of the femoral head secondary to alcoholism is a very frequent entity, its etiology remains unknown. The same pathogenic mechanism is thought to be shared both by aseptic necrosis secondary to alcoholism and steroid therapy. Since alcohol stimulates adrenal steroid secretion, we have studied serum cortisol and urinary free-cortisol levels in 8 patients with aseptic necrosis of the femoral head due to alcoholism and compared them with those found in 8 age-matched patients with aseptic necrosis of idiopathic origin. Serum cortisol levels and urinary free-cortisol levels were significantly higher in the alcoholic than in the idiopathic group: serum 227 +/- 21.7 vs 154 +/- 22.1 ng/ml, P less than 0.001; urine 0.20 +/- 0.002 vs 0.13 +/- 0.04 micrograms/mg Cr/day, P less than 0.001. The data indicate that alcohol-induced aseptic necrosis of the femoral head results, at least in part, from increased circulating cortisol.
SUMMARY
In order to identify opportunities to enhance blood‐sparing strategies, we studied blood‐transfusion practices in patients undergoing scheduled major surgery in Spain. This prospective, multicenter epidemiological study involved 20 Spanish hospitals. We recorded the pre‐ and postoperative hemoglobin concentrations, the estimated and calculated blood loss, the number of patients transfused and the blood‐sparing techniques used. A total of 359 patients from 18 centers were included in the analysis. Mean preoperative hemoglobin concentration was 13.7 ± 1.6 g/dL. In 29% of the patients, preoperative hemoglobin concentration was lower than 13 g/dL. All surgeries combined, mean estimated blood loss was 845 ± 659 mL and mean calculated blood loss 1722 ± 1021 mL. The percentage of patients transfused with allogeneic blood was 28.4% altogether and ranged from 47.2% in cardiac surgery patients to 4.5% in plastic‐maxillofacial surgery patients. Blood‐sparing techniques were used only in 70 patients (19.4%). For a large percentage patients who underwent scheduled major surgery, blood transfusion was needed and perioperative blood loss was underestimated. Blood‐sparing techniques were underused in non‐orthopedic surgery, despite the fact that sufficient time was available to plan appropriate blood‐sparing measures.
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