bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of blood components in surgical transfusion therapy
Authors: Högman Claes F. , Bagge Lars , Thorén Lars 
Published: May 2005

AbstractBlood components can be prepared either by separation of ordinary whole blood units or, selectively, by apheresis techniques. In recent years, new methods for improvement of quality and length of storage have been developed. The additive solution approach is now being applied increasingly. Its advantages and the difference between some available systems are described. Blood component therapy must be integrated into the patients' water/electrolyte balance and nutrition schedule. An outline is given of the role of blood components in the treatment of shock. The question of excessive bleeding, the possibilities of making the diagnosis of its cause(s) in the individual case, and the use of blood components is described. Coronary pulmonary bypass is used as an example of a complicated situation that can be handled effectively by a limited number of diagnostic and therapeutic tools.
Acute limited normovolemic hemodilution: A method for avoiding homologous transfusion
Authors: Martin Eike , Hansen Ernil , Peter Klaus 
Published: May 2005

AbstractPreoperative normovolemic hemodilution was introduced for clinical application by Messmer and co‐workers. Preoperative blood withdrawal of 1,500–2,000 ml by an isovolemic exchange with colloids or crystalloids (3 times the volume of blood withdrawn), in order to maintain a constant circulating volume, is offset by an adequate increase of cardiac output and an unchanged systemic oxygen transport capacity despite a decreased oxygen content. Patients lose fewer red cells and more plasma intraoperatively. The retransfusion of autologous blood follows in the reverse order of collection after hemostasis is restored. The procedure is a safe and feasible method, which is not beset with the logistical problems of autologous blood predeposit and has the added advantage that fresh autologous blood is available at once for retransfusion. Provided that the contraindications are observed, the technique helps to reduce or even avoids the risks of homologous blood transfusion. The need for stored blood can be reduced by 20% to 90%, depending on the surgical procedure.
Intraoperative autotransfusion
Authors: Glover John L. , Broadie Thomas A. 
Published: May 2005

AbstractIntraoperative autotransfusion was done only sporadically until equipment, modified from cardiac surgery, became available in the 1970's. Use has increased because of the availability of cell‐washing techniques and the increased demand for blood associated with complex operations, such as liver transplantation and resection of thoracoabdominal aneurysms. There is a lack of agreement about the use of anticoagulation with autotransfusion, and there are several factors that limit widespread applicability. More studies are needed regarding infusion of activated clotting factors, and blood contaminated with bacteria or tumor cells. Although a significant administrative commitment is required, implementation of a program of autotransfusion is useful in trauma, vascular surgery, and any procedure that involves large amounts of blood loss.
The appropriate role of frozen‐stored red blood cells in transfusion practice
Authors: Chaplin Hugh 
Published: May 2005

AbstractFrozen‐stored red blood cells (FS‐RBC) held great promise when the product was introduced 35 years ago. They appeared to offer sufficient logistical and clinical advantages to predict wide application in component transfusion therapy in the years ahead. Yet, in 1986, FS‐RBC account for < 1% of RBC product usage. Quantitative, operational, and logistical characteristics of FS‐RBC are reviewed in order to explain their seemingly paradoxical “unpopularity.” The limited indications for FS‐RBC usage in contemporary transfusion practice are defined.
The use of plasma substitutes with special attention to their side effects
Authors: Messmer K. F. W. 
Published: May 2005

AbstractPlasma protein fraction and human serum albumin are suitable for plasma replacement; however, they are in short supply and extremely expensive. Fresh‐frozen plasma should not be used for volume replacement, but for documented coagulation protein deficiencies and for patients who require massive blood transfusions. Artificial colloids are free from the risk of transmitting diseases and easy to provide at low costs. The intravascular volume effect of colloid solutions based on dextran, gelatin, or hydroxyethyl starch depends on the physicochemical characteristics of the polymer solution. For the given colloid, the half‐life varies from 2 to 8 hours. In addition to the volume effect, dextran provides specific antithrombotic properties. None of the colloids are free from the risk of untoward effects, such as anaphylactoid/anaphylactic reactions. The low frequency of these reactions and the possibility to prevent and to treat them justifies the use of artificial colloids on a routine basis for shock treatment, volume support, and perioperative hemodilution.
Recent developments in the area of massive transfusion
Authors: Collins John A. 
Published: May 2005

AbstractIn 2 previous reviews of the subject of massive transfusion, this author noted that one of the most distressing complications of massive transfusion, pathological diffuse bleeding, was poorly understood, but was almost certainly not something induced by the transfusions themselves. Much better evidence is now available relating to the development of coagulopathies during transfusion, and these studies will be reviewed here. In both the prior reviews, the author also noted that one of the potentially most important aspects of massive transfusion was the effect on immunologic defenses, but that this was almost entirely ignored. This situation has now changed dramatically, and most of this review will deal with the rapidly emerging data on this aspect of transfusion. Most of the other aspects of massive transfusion have not changed substantially since the previous reviews.
Blood transfusion: Yesterday, today, and tomorrow
Authors: Rudowski Witold J. 
Published: May 2005

AbstractThe evolution of blood transfusion practice into modern transfusion medicine is reported. The impact of great wars on the technique of blood storage and organization of blood supply is discussed. The progress of immunotechnology and fractionation of plasma contributed greatly to contemporary transfusion medicine and the implementation of blood and plasma component therapy. Three basic indications for use of blood in surgery are summarized: restoration of acute loss of circulating blood volume, improvement of oxygen transport, and delivery and correction of coagulation disorders. Some factors arising from storage lesion of blood (citrate intoxication, 2,3‐DPG depletion, cellular aggregates) are described. The recent research in blood transfusion refers particularly to red cell substitutes. The oxygen‐carrying solutions, perfluorocarbons, stroma‐free hemoglobin, and current research on artificial red cells are discussed. The in vitro culturing, recombinant DNA technology, and the practical application of monoclonal antibodies in clinical practice are emphasized. The advent of great technological advances in transfusion medicine makes it possible to predict several future developments. Blood will be substituted by oxygen carriers, human protein and cells by biotechnological and genetic engineering. The education of tomorrow's surgeons must be adapted to the recent progress and advances of transfusion medicine.
Vagal regeneration after parietal cell vagotomy: An experimental study in dogs
Authors: Cuesta Valentin M. A. , Doblas Dominguez M. , Rodriguez Alonso M. , Bengoechea Gonzalez E. 
Published: May 2005

AbstractThe gradual increase with time of the insulin‐stimulated acid output, after a well‐performed parietal cell vagotomy (PCV), has been thought to be produced by regeneration of the vagus nerves. A genuine regeneration of the gastric branches of the vagus connected to the intramural plexus has yet to be confirmed. Experiments have been carried out in dogs to determine if this type of regeneration takes place after PCV.The animals were divided into 3 groups (A, B, and C) of 4 mongrel dogs each. In all dogs, a PCV was performed and the Grassi test was used intraoperatively to check the completeness of vagotomy. During the experiments, an insulin stimulation test and a macroscopic and microscopic study of the esophagus and stomach were obtained at several points in time (in group A, at operation and after 2 weeks; in group B, after 6 months; and in group C., after 2 1/2 years).We found, 2 weeks after PCV, a complete degeneration pattern of the vagal branches in the gastric serosa. After 6 months, and more completely after 2 1/2 years, many nerve fibers are seen, macroscopically, crossing from the vagus nerves and the branches of Latarjet to the esophagus and the lesser curvature through the old ligatures. This regeneration can be confirmed microscopically. These pathological changes in the nervous system of the stomach were found to correlate with recovery of gastric secretion. It is suggested that the recovery of acid secretion after a well‐performed PCV is accounted for by vagus nerves regeneration.
Comparison of selective and nonselective single‐dose antibiotic cover in biliary surgery
Authors: Ambrose N. S. , Morris D. L. , Burdon D. W. , Alexander‐Williams J. , Keighley M. R. B. 
Published: May 2005

AbstractA prospective randomized trial has compared 2 policies of single‐dose antibiotic prophylaxis in biliary surgery. Patients were randomly allocated to 1 of 2 regimens: in group A, all patients received a single dose (2 g) of mezlocillin; in group B, patients were only given a single dose (2 g) of mezlocillin if they could be identified as “high‐risk.” The high‐risk criteria used in group B patients were: emergency surgery, jaundice, age over 70, recent cholangitis, choledocholithiasis, or previous biliary surgery. Eighty‐five patients were randomized (random numbers) to group A and 84 patients to group B. Only 34 (40%) of the 84 patients in group B were high‐risk patients and these were the only patients who qualified for antibiotic cover. Septicemia occurred in 1 patient in each group. Wound sepsis occurred in 11 (13%) of the 84 patients in group B compared with only 2 (2.3%) of those in group A (p<0.02). These findings indicate that it is more advisable to provide single‐dose antibiotic prophylaxis to all patients having biliary tract surgery than to adopt a policy of “selective” antibiotic cover to high‐risk cases only.
Tuberculous mastitis: A continuing problem
Authors: Banerjee S. N. , Ananthakrishnan N. , Mehta R. B. , Parkash S. 
Published: May 2005

AbstractEighteen patients with tuberculosis of the breast are presented. The disease was prevalent in young female patients. The most common presentation was a lump, with or without sinuses, in the upper, outer quadrant of the breast, with matted axillary lymphadenopathy. One‐third of the patients were lactating at the time of presentation. In 1 patient the disease was associated with carcinoma of the breast. The majority were treated by excision biopsy of the mass or a biopsy from a sinus for histological confirmation of the diagnosis, followed by standard antituberculous chemotherapy. Two patients required a sector mastectomy and 1 patient required a radical mastectomy for associated malignancy.This article stresses the need for a high index of suspicion in making the diagnosis (especially in developing countries), in establishing the diagnostic criteria, and in the overlapping of clinical presentation with malignancy of the breast as well as the possibility of a coexisting carcinoma. The role of surgery is mentioned both in diagnosis and for treatment of residual masses.
The hyperfunctioning intrathyroidal parathyroid gland: A potential pitfall in parathyroid surgery
Authors: Wheeler M. H. , Williams E. D. , Wade J. S. H. 
Published: May 2005

AbstractThe details of 7 patients with hyperparathyroidism in whom 8 intrathyroid hyperfunctioning parathyroid glands were located are presented. Seven of the 8 glands were inferior parathyroids and this observation is discussed in the light of current embryological teaching. The intrathyroidal hyperfunctioning parathyroid is considered to be a potential cause of failed parathyroid surgery and, therefore, when an inferior parathyroid gland is missing, it is recommended that the lower pole of the thyroid be incised and, if necessary, a thyroid lobectomy performed.
Identification and antibiotic prophylaxis of high‐risk patients in elective colorectal surgery
Authors: Törnqvist A. , Forsgren A. , Leandoer L. , Ursing J. 
Published: May 2005

AbstractHigh‐risk patients undergoing elective colorectal surgery were identified by culturing irrigation fluid samples taken peroperatively, and the effect of supplementary antibiotics in this group was evaluated. All patients (n =267) got 600 mg doxycycline intravenously as a preoperative prophylaxis. The day after operation the high‐risk patients could be identified by a count of bacteria cultured from the irrigation fluid. They were randomly allocated either to group A (n=40), no further antibiotics, or to group B (n=45), combination of cefuroxime and metronidazole. The rate of postoperative septic complications was 20% in group A and 4.4% in group B (p<0.05). It is concluded that high‐risk patients undergoing elective colorectal surgery can be identified by culturing the irrigation fluid taken peroperatively. With supplementary antibiotic prophylaxis, the postoperative complication rate can be lowered significantly.
Duodenal carcinoid in neurofibromatosis: A calcitonin‐ and amyloid‐containing tumor
Authors: Posalaky Zoltan , Mulholland Michael , Kasperson Elmer , Posalaky Irene P. 
Published: May 2005

AbstractA patient with neurofibromatosis was found to have a malignant periampullary carcinoid tumor. Electron microscopic and immunohistochemical studies demonstrated calcitonin‐producing tumor cells and the presence of extracellular amyloid. The association of neurofibromatosis and duodenal carcinoids is rare. Cases found in the literature are reviewed and possible pathogenic implications are discussed.
Bacteria, toxins, and the peritoneum
Authors: Hau Toni 
Published: May 2005

AbstractIntraperitoneal infections are caused by members of the gastrointestinal flora, mainlyEscherichia coli, enterococci, Klebsiella, Enterobacter, Proteus, Bacteroides, anaerobic cocci, Clostridia, and Fusobacteria. The Gram‐negative aerobic bacteria exert their pathogenic potential mainly through endotoxin which acts by way of mediators, causing systemic septic response and, initially, the local response of the peritoneal cavity. The main virulence factors of anaerobic bacteria are exoenzymes and capsular polysaccharides. Peritoneal infections are truly synergistic infections. The most important synergistic mechanisms are protection against host defense and creation of a suitable environment by one member of the flora for another. Aside from bacteria, certain adjuvant substances, i.e., bile, gastric juice, blood, and necrotic tissue, play a role in the pathogenesis of peritonitis. The peritoneum deals with an infection in 3 ways: first, the direct absorption of bacteria into the lymphatics via the stomata of the diaphragmatic peritoneum; second, the local destruction of bacteria through phagocytosis by either resident macrophages or polymorphonuclear granulocytes attracted to the peritoneal cavity; and third, the localization of the infection in the form of an abscess.
Systemic and peritoneal host defense in peritonitis
Authors: Christou Nicolas V. 
Published: May 2005

AbstractMost of the work of host defense has been carried out in mixed patient populations. It is now clear that elective preoperative surgical patients have totally different host defense capabilities as compared to posttrauma patients or those suffering from peritonitis. Specific cell‐mediated immune studies need to be repeated in these 2 patient groups as well. What will contribute clinical relevance to these studies will be the means to correct the defects. If these defects or—more correctly termed—abnormalities of host defense are, indeed, important and contribute to an increased sepsis rate and mortality from sepsis in affected patients, then correcting them should reduce these complications. This hypothesis can only be tested when such means become available. The issues of most interest in the next few years will be the significance of serum albumin in host outcome, the role of immunomodulators, the involvement of cytokines in the overall process of host defense, and the use of specific nutritional support regimens targeted to the immune system.
Intraabdominal infections and gut origin sepsis
Authors: Offenbartl Karsten , Bengmark Stig 
Published: May 2005

AbstractIntraabdominal postoperative or posttraumatic infections remain a major threat to life in spite of generation after generation of increasingly effective antimicrobial drugs indicating the importance of immunological host defense failure following major trauma or surgical complications. The spectrum of infectious postoperative or posttraumatic complications can, in part, be explained by pathogenic factors inherent to the methodology of modern surgical intensive care and techniques. This report presents a survey of the historical background as well as current concepts of the multiple systems organ failure syndrome as related to postoperative or posttraumatic intraabdominal infectious complications. The pathophysiology of nosocomial infectious complications in the intensive care unit setting is analyzed. The concept of “gut origin sepsis” is presented and possible preventive and therapeutic actions discussed. A judicious use of antimicrobial drugs on strict indications is emphasized as is the importance of increased knowledge of the interactions between the gut flora, antibiotics, and absence of enteral nutrition.
Intraabdominal infection: Pulmonary failure
Authors: Runcie C. , Ramsay G. 
Published: May 2005

AbstractSince its first description in 1967, the mortality of the adult respiratory distress syndrome (ARDS) has remained unchanged despite the increasing sophistication of supportive techniques. Few patients now die of refractory hypoxemia, the majority succumbing to the multiple systems organ failure syndrome, commonly due to sepsis. Sepsis is both the most common cause of ARDS, usually involving the abdomen, and the most frequent complication, usually affecting the lungs. ARDS is, thus, increasingly seen as the pulmonary component of multiple systems organ failure, triggered by the systemic response to sepsis.In critically ill patients, impairment of hepatic function and of the barrier function of the gut mucosa allows translocation of endotoxin derived from the aerobic Gram‐negative bacteria within the gut. This releases mediators which are responsible for the activation of cellular and humoral cascades, resulting in the pathological changes seen in ARDS. This sequence of events underlines the importance of therapies directed at abnormal colonization of the gastrointestinal tract and elimination of the gut endotoxin pool. Selective decontamination of the digestive tract is attractive in that it attacks the problem from 2 sides: first, by eliminating colonization, it appears effective in preventing secondary infection and, second, it may also play a role in reducing the enteric endotoxin pool.Recent descriptions of pathological oxygen supply dependency in both ARDS and septic patients emphasize the similarity of pathophysiological abnormalities in the 2 conditions. Intensive supportive therapy to achieve adequate oxygen transport and aggressive investigation and surgical management of septic foci are the cornerstones of management of the established syndrome.
Imaging intraabdominal abscesses and nonoperative drainage procedures
Authors: Haaga John R. 
Published: May 2005

AbstractWith state‐of‐the‐art imaging and interventional techniques, the diagnosis and management of intraabdominal abscesses have improved. Radionuclide scanning, ultrasound, and computed tomography are very accurate for the diagnosis and staging of intraabdominal abscesses, permitting the use of percutaneous drainage methods. Percutaneous abscess drainage (PAD) has gained wide acceptance and applications now include not only curative drainages but also certain palliative ones. Although some controversy exists relative to results and palliative procedures, PAD is now accepted as an effective alternative to operative drainage.
Nonoperative antiinfective treatment of intraabdominal infections
Authors: Pollock Alan V. 
Published: May 2005

AbstractThere are many causes of peritonitis. Primary peritonitis is rare, but may complicate cirrhosis of the liver or may, in developing countries, be caused byMycobacterium tuberculosis.It is occasionally iatrogenic, particularly as a complication of continuous ambulatory peritoneal dialysis. It is, however, most frequently the result of perforation of a hollow viscus, caused by either trauma or disease. Its most lethal form follows breakdown of an intestinal anastomosis.Primary and iatrogenic peritonitis should be treated with antibiotics, and localized abscesses can sometimes be cured by percutaneous aspiration. Secondary peritonitis requires resuscitation, antibiotics, and operation. When there is gross microbial invasion, it is wise to avoid suture of the hollow viscus. If there is a strong chance of recurrence of intraabdominal abscesses, nonclosure of the abdomen is theoretically desirable and allows frequent reexploration. This is particularly applicable to pancreatic abscesses.
Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds?
Authors: Hugh Thomas B. , Nankivell Charles , Meagher Alan P. , Li Bei 
Published: May 2005

AbstractThis study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation—elective and emergency surgery—through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self‐administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single‐layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned.
Percutaneous control of a portacaval H‐graft: Description of a new device and its initial clinical application
Authors: Smith Ross C. , Brown Alastair R. , Spencer Peter C. , Gill Robert W. , Griffiths Kaye A. , Lane Rodney J. , Reeve Thomas S. 
Published: May 2005

AbstractA percutaneously‐controlled inflatable cuff which can change the diameter of a portacaval H‐graft has been developed and used in 10 patients. When inflated, the cuff narrows the H‐graft to increase portal pressure and reduce shunting. Use of the cuff has been of clinical significance in 3 of 7 long‐term surviving patients. Narrowing the shunt improved the clinical state in 2 patients with encephalopathy, and reopening a closed shunt improved ascites in the third patient. Duplex ultrasound and deep Doppler have demonstrated an alteration of hepatic portal blood flow following inflation of the cuff after 6 months. It is concluded that further development of this controlled portacaval H‐graft is warranted.