Comparison of citrated and fresh whole blood for viscoelastic coagulation testing during elective neurosurgery.

BACKGROUND: Previous viscoelastic haemostatic tests studies have often indicated a hypercoagulative test signal with citrated blood, which could influence clinical decision makings. PURPOSE: The aim of this study was to compare fresh and citrated whole blood using two non-automated viscoelastic ROTEM and Sonoclot tests. Our hypothesis was that citrated blood would demonstrate a hypercoagulative response in this setting, not tested before. METHODS: Perioperative viscoelastic coagulation changes were evaluated with a ROTEM and Sonoclot in 38 patients undergoing elective brain tumor surgery. The citrated samples were recalcified with CaCl2. Wilcoxon nonparametric-paired tests and Bland-Altman plots were performed to compare the fresh and citrated blood analyses. RESULTS: The citrated blood showed a hypercoagulative response in ROTEM NATEM-clot formation time and α-angle, Sonoclot-clot rate and platelet function, as compared to fresh blood (p<0.0001). CONCLUSIONS: Fresh whole blood may theoretically reflect in vivo haemostasis more closely than citrated analyses, which indicated a hypercoagulative response as compared to the fresh whole blood analyses Bland-Altman plots also indicated that ROTEM reference ranges in patients undergoing brain surgery should be redefined. Future studies must establish the correlation between viscoelastic test results using fresh or citrate anticoagulated blood and clinical outcomes, such as bleeding, transfusion or reoperation for postoperative haematoma.

Survival experience in the Breast Cancer Detection Demonstration Project.

Very high survival rates have been observed in four through 11 years of follow-up in 4,240 women with a histologically confirmed diagnosis of breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP). The relative five, eight, and 10-year survival rates were 88, 83, and 79 percent, respectively. Allowances were made for lead-time bias among cancers detected through screening, and the validity of the findings was supported by internal analyses, which showed that length-time bias was of little, if any, importance, and that any possible "overdiagnosis" of cancer cases was also of small relevance. In view of current interest in the value of screening women before age 50, intensive analyses were made comparing the BCDDP data for women in their 40s with women in their 50s. In terms of kinds of breast cancers found, modality of finding them, and survival rates once they have been found, the parallel results for the two groups show that screening was virtually as effective in the younger as in the older women. Some authorities are of the opinion that the benefits of mammography after age 50 are well documented, but at younger ages the evidence is still inconclusive. The findings in this study show there is no doubt of the very successful results of screening for breast cancer with mammography in younger as well as older women. In comparing relative five-year and eight-year survival rates for women with invasive breast cancers detected through screening in the BCDDP, with those for cases diagnosed in the National Cancer Institute's Surveillance, Epidemiology and End Results (NCI SEER) program from 1977 to 1982, it is seen that for individual subcategories by tumor size and nodal class, the survival rates are about the same. However, for overall invasive cancers, the five-year and eight-year survival rates were 87 and 81 percent, respectively, for the BCDDP compared with 74 and 65 percent for SEER. Thus the substantial gains in survival followed the large shift toward a high proportion of cancers being diagnosed and treated in more favorable stages through the screening accomplishments. With respect to the relative case fatality rates, the complements of the relative survival rates, the eight-year rate of 19 percent for the BCDDP versus that of 35 percent for SEER connotes 46 percent fewer women dying in the BCDDP group.

Cancer incidence, survival, and mortality for children younger than age 15 years.

Incidence and survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program for the 10-year period 1973-1982 are presented. Childhood cancer incidence rates have remained relatively stable over the last decade. The overall incidence rate increased slightly from 124 to 127 per million children from 1973-1977 to 1978-1982 while rates for leukemias remained unchanged over this same time period at 38 per million for all races combined. Leukemias and lymphomas accounted for 44% of all cancers among white children and 33% among blacks. For all forms of cancer combined, the 5-year relative survival rate was 57% for both whites and blacks. The 5-year relative survival rate exceeded 80% for fibrosarcomas, retinoblastomas, Hodgkin's disease, and gonadal and germ cell tumors. Survival rates for children have shown improvement during the last decade, the most dramatic improvements occurring among patients with leukemia (15% 5-year relative survival in 1967-1973 versus 51% in 1973-1981), non-Hodgkin's lymphoma (24% versus 51%), and bone tumors (28% versus 48%).

Probabilities of eventually developing or dying of cancer--United States, 1985.

The usual measures of the magnitude of the cancer problem are annual incidence and mortality data. We present another measure of the magnitude of the cancer problem. We computed the probabilities at birth and at various ages of developing or dying of the disease within 10 years, 20 years, or total lifetime and show the trends that have occurred in these data since 1975. These probabilities were computed for males and females and among whites and blacks for 1975 and 1980, and projected to 1985. The data indicate a continuing, albeit modest, increase in the probabilities of eventually developing cancer in each of the four sex-race groups, both excluding and including carcinoma in situ. White males now show the highest probability at birth of eventually developing cancer, and black females, the lowest, with the figures for the other two groups being intermediate. Larger increases were seen for males between 1980 and 1985 (more than three percent) than for females (two percent or less). A child born in the US in 1985 has more than one in three chances of eventually developing invasive cancer (exclusive of epidermoid skin cancer). By site, for males the largest probabilities and the largest increases in the probabilities are for eventually developing lung and prostate cancer. For women, the largest eventual probabilities are for breast cancer, almost one in 10 for white females and one in 14 for black females. The largest increases are seen for lung cancer and cancer of the colon-rectum. The probability of eventually dying of cancer is increasing among the four sex-race groups and is now greater for males of both races than for their female counterparts. For males born in 1985, the chances of eventual death from cancer are almost one in four, and for females, almost one in five. With the long-term, downward trends in terms of other causes of death--most specifically, decreases in mortality from cardiovascular diseases--the effect on the population at large is greater longevity. This situation, in turn, leaves more people longer time to be exposed to cancer risks. Thus, while the probabilities of developing or dying of cancer are seen to increase, the increases should be viewed in light of the increasing numbers of people available for such an occurrence.(ABSTRACT TRUNCATED AT 400 WORDS)