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Blood transfusions are commonly viewed as life-saving interventions; however, current evidence shows that blood transfusions are associated with a significant increase of morbidity and mortality in a dose-dependent relationship. Not only explanatory models of basic research but also the results from randomized controlled trials suggest a causal relationship between blood transfusion and adverse outcome. Therefore, it can be claimed that the current state of science debunks the long held belief in the so-called life-saving blood transfusion by exposing the potential for promoting disease and death. Adherence to the precautionary principle and also the fact that blood transfusions are more costly than previously assumed require novel approaches in the treatment of anemia and bleeding. Patient Blood Management (PBM) allows transfusion rates to be dramatically reduced through correcting anemia by stimulating erythropoiesis, minimization of perioperative blood loss and harnessing and optimizing the physiological tolerance of anemia. A resolution of the World Health Assembly has endorsed PBM and therefore morbidity and mortality should be significantly reduced by lowering of the currently high blood utilization rate of allogeneic blood products in Austria, Germany and Switzerland.

Development of magnetic resonance imaging (MRI) device technology continues to increase the static magnetic flux densities applied and consequently leads to considerably increased occupational exposure. This has already made it necessary to review limits of occupational exposure and to postpone European legal regulations for occupational exposure to electromagnetic fields. This raises the question whether and if so which adverse health effects and health risks might be associated with occupational exposure to MRI ultra-high static magnetic fields. Based on a survey on interaction mechanisms recommendations and safety rules are presented to help minimize adverse health effects of emerging ultra-high field MRI.

We describe a 34-year-old male with pulmonary embolism. The patient had been admitted to a peripheral hospital for incision and drainage of a very large ischio-rectal abscess. Four days after successful surgical intervention and during a change of dressings he developed a massive pulmonary artery embolism. The patient was transferred to the Department of Cardiac Surgery in Graz; on arrival he had a cardiac arrest. Resuscitation was initiated and the patient was transferred to the operating theatre where emergency sternotomy and embolectomy revealed large thrombotic masses in the pulmonary circulation. Extracorporeal circulation was initiated, but despite aggressive medical measures (dopamine, dobutamine, isoproterenol, enoximone, and prostaglandin E1 in maximum therapeutic doses) and a long reperfusion time weaning was not possible. Despite the septic state, a right ventricular assist device (RVAD; ABIOMED BVS 5000) was installed. Weaning was finally accomplished with a pump flow of 2.2 l/min m2 and the patient transferred to the intensive care unit. On post-operative day 3 the pump flow was reduced to 2 l/min. The patient's condition remained stable, which made removal of the RVAD possible on postoperative day 5. The further course was uneventful, with secondary ischio-rectal wound closure. His initial psychomotor impairment had nearly disappeared and he was discharged 2 months later.

Since 1977, the Department of Anesthesiology of the University of Graz has had a preoperative clinic. Since August 1988 we have processed current data using a personal computer (PC). We have adapted an IBM-compatible PC and a commercial data-processing program (dBase III plus) for the special requirements of the preoperative clinic. The procedure is directed by menus and is also easy to learn for non-professionals. Important functions have been executed automatically by the current program, such as loading the software or securing the data on a floppy disk. No additional work is necessary for data input. Every test result can be supplied immediately by a printer, whereby important parameters are denoted as such. After 13 months of testing, we could see that the use of a PC offers an inexpensive possibility for processing medical data with the help of electronics. The installation was not destined to remain a short trial, but will become a permanent system at our clinic.

Unlabelled: As a result of their interpretation of the Bible, members of Jehovah's Witnesses do not accept blood transfusions under any circumstances. Consequently, they present moral and ethical problems to surgeons and anesthetists, especially in cardiac surgery. PATIENTS and METHODS. From November 1978 to November 1988, 66 members Jehovah's Witnesses were scheduled for cardiac surgery; 57 patients were operated upon (mean age 33.3 years, 14 days to 70.4 years; mean body weight 51 kg, 0.7 to 95.5 kg); 21 were younger than 14 years. Patients with hematocrit (Hct) less than 35%, expected high intra- and postoperative blood loss, compromised left ventricular function, ST-segment alterations, critical aortic stenosis, severe unstable angina pectoris, complex heart defects, especially in children, extreme body weight, severe diabetes, renal insufficiency, coagulopathies, severe pulmonary disease, and heavy smokers were excluded from operation. Whereas in nonbypass patients no special blood-saving techniques were used, in bypass patients a modified version of isovolemic hemodilution, with a hypothermic, bloodless priming technique of extracorporeal circulation (ECC) was performed after induction of anesthesia. At the end of the ECC all blood collected in the pericardial and pleural cavities was returned to the oxygenator and the entire content of the extracorporeal circuit was infused into the patient through the aortic cannula. All patients receiving ECC were ventilated for 24 h postoperatively and received dopamine (2-5 micrograms/kg) and antibiotics routinely., Results: Due to the above mentioned contraindications, 9 patients were not accepted for surgery, 10 were operated upon without cardiopulmonary bypass or blood-saving techniques. In 47 patients open heart surgery with ECC and moderate or deep hypothermia was performed. In the adult patients (n = 36) Hct values decreased from 44.4% (35-70%) preoperatively to 32.1% (21-46%) after hemodilution, reached their lowest levels during cardiopulmonary bypass at 17.9% (9.9-43%), and increased to 33.7% (22%-43%) at the end of the operation. Hct averaged 28.2% (20%-39%) on the 3rd and 33.2% (23%-46%) on the 12th postoperative day. In children (n = 11) Hct decreased from 47.2% (36.9%-70%) to 33.6% (27.2%-49.1%) after hemodilution, during bypass to 16.1% (10.5%-25.5%) and increased to 32.1% (24.4%-37.4%) at the end of the operation. On the 3rd postoperative day Hct was 25% (21.4%-39%) and increased to 29.4% (25.1%-40%) on the 12th postoperative day. No statistical differences in Hct values were found between both groups. (ABSTRACT TRUNCATED AT 400 WORDS)