[More effective blood transfusion policies in elective surgery by objective transfusion guidelines]. / Efficiënter bloedtransfusiebeleid bij electieve operaties door objectieve transfusierichtlijnen.

The blood ordering practice in a general hospital was evaluated for 22 types of frequently scheduled elective surgical procedures. The following parameters were used: the C/T ratio (crossmatched/transfused ratio) for appraising the tendency to over-order in terms of frequency, the BOQ (blood ordering quotient) to establish whether the appropriate amount is ordered, and the transfusion probability to establish whether the risk accompanying the procedure warrants crossmatching blood. Using the results a list was compiled grouping the procedures as follows: 1. transfusion probability greater than 30%: type & screen and crossmatching of blood before the surgical procedure; 2. transfusion probability less than 30%: type & screen; 3. transfusion probability = 0%: no type & screen (remaining procedures). The number of units crossmatched for surgical procedures in the first group is in accordance with actual expected needs. Owing to the use of this list of expected haemotherapy requirements the number of patients for whom blood is crossmatched preoperatively has diminished from 76.5% to 29.8%. Furthermore, the C/T ratio has decreased from 3.33 to 1.45 with a practically unchanged transfusion probability (the mean for 22 types of surgical procedures). The number of crossmatches for these procedures has shown a 56% decrease. The use of the list of expected requirements has led to an annual saving of Dfl. 20,000-on laboratory expenses.

Mandibular ameloblastoma (resection with primary reconstruction). A case report with a concise review of the literature.

A case report of an ameloblastoma in the mandibula is given. The characteristics of this neoplasm are discussed. The tumor is histologically benign but clinically malignant. The therapy of choice is therefore radical surgery, preferably resection with primary reconstruction in one stage. Eight years after the operation in this case no signs of recurrence were found.

Long-term inversion stability of the ankle after rupture of the lateral ligaments.

The late results of surgical and nonsurgical treatment of recent ruptures of the lateral ligaments of the ankle are compared in two groups of 52 patients. By means of a questionnaire, physical examination and inversion stress roentgenography (at an average of three years after the injury), the functional and mechanical stability of the ankle were determined. After both surgical repair and treatment with plaster cast alone, more than 90% of patients achieved inversion stability of the ankle.

Rupture of small peripheral aneurysms: report of three cases, with review of the literature.

Three cases of rupture of a small peripheral aneurysm are presented and compared with reports in the literature. Such ruptures are rare but life-threatening events. Diagnosis is difficult since confusion with other diseases may occur. The therapy depends on the anatomical location: catheter-embolisation or operative. In the three cases presented operative management was necessary.

Reference values and analytical performance of the hydroxyproline/creatinine ratio in early morning urine samples.

The hydroxyproline/creatinine ratio for two groups of healthy individuals and two groups of patients with a history of mammary and prostatic carcinoma without metastases was measured and compared with literature values. The hydroxyproline/creatinine ratio for healthy adults appears to be 1.4 (range 0.7--2.3). Furthermore, the influence of diet and gelatin load of 30 g on the hydroxyproline creatinine ratio and the hydroxyproline excretion has been investigated. The analytical characteristics of the test used in the present study were evaluated using the method of standard additions. An intra-assay quality-control on the basis of the standard addition is proposed. The coefficient of variation of the hydroxyproline/creatinine ratio appears to be 22%. The intraindividual variability has also been established for the hydroxyproline/creatinine ratio and appears to be 25%.