The clinical significance of blood transfusion at the time of radical hysterectomy

Article Abstract:

Blood transfusions, which increase the safety of abdominal surgery, are also associated with the transmission of infections. In addition, there is some evidence that blood transfusions can suppress the immune response, according to studies of patients who had kidney transplants or cancer surgery. To see if blood transfusions during hysterectomy for the treatment of uterine cancer affect the immune response, 126 patients were studied. At least one unit of donated blood was given to 68 patients, while 58 patients received no blood during operations to remove the uterus and abdominal lymph nodes for stage IB cervical cancer. All of the patients had similar disease, evidenced by clear surgical margins, lymph nodes without cancer and no cancer detected in the blood vessels near the lymph nodes. None of the patients had radiation treatment and chemotherapy following surgery, which can suppress the immune response. The average blood loss was 1,104 milliliters for the patients who were transfused and 764 milliliters for the untransfused patients. The cancer returned in 10 patients (14.7 percent) who received blood products during surgery and only two patients (3.4 percent) who did not receive blood. Excluding any other clinical variables, the transfusion of blood during radical hysterectomy affected the recurrence and survival of women with cervical cancer managed by radical hysterectomy. On the basis of these results it may be useful to minimize blood loss and use transfused blood only when necessary. Transfusing with patient blood (autologous transfusion), if available, may reduce transfusion-induced immunosuppression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Prognosis, Cancer, Immune response, Blood transfusion

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Cefazolin for hysterectomy prophylaxis

Article Abstract:

One of the most common complications of surgery is infection, and antibiotics are often given at the time of surgery as a preventive measure (known as antibiotic prophylaxis). There is no consensus on the best antibiotic to use to prevent infection after hysterectomy. The safety and effectiveness of the cephalosporin cefazolin, given as a single dose just prior to hysterectomy, were evaluated. Of the patients who completed the study, 539 had abdominal hysterectomies and 207 had vaginal hysterectomies. The antibiotic was given intramuscularly (IM) or intravenously (IV) to roughly half of the women in each surgical group. Patients who received cefazolin IV and underwent vaginal hysterectomy had an infection of rate of 4.7 percent, while all others had an infection rate of 7.6 to 7.9 percent, regardless of the route of cefazolin administration. Women who developed infections tended to be younger, or have lower levels of hemoglobin (the oxygen-transporting protein). Several had developed a pelvic hematoma (clotted blood mass), which was probably related to the quality of the surgical technique. Six patients developed abscesses, which would probably respond better to antibiotics with bacterial specificity different from that of cefazolin. The findings suggest that cefazolin prophylaxis is generally effective in preventing infections subsequent to hysterectomy when given IM or IV. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Risk factors, Surgical wound infections, Cefazolin

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Incisional hernia of the vaginal apex following vaginal hysterectomy in a premenopausal, sexually inactive woman

Article Abstract:

A premenopausal, sexually inactive woman underwent a hysterectomy, the surgical removal of the uterus through a cut in the vagina. The hysterectomy was performed to cure uterine prolapse, a downward displacement of the uterus, due, in her case, to an abnormal placement of the urethra. As a result of the surgery, the patient developed a small-bowel hernia, the protrusion of a loop or knuckle of the small intestines through the scar of the cut at the top (apex) of the vagina. The vaginal scar had ruptured, causing the herniation, because the incision had been made on the apex, a place of tension in this patient because of her original condition, the displacement of the urethra. The rupture was surgically repaired.

Surgery, Vagina

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