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https://www.readbyqxmd.com/read/28213059/multidisciplinary-team-learning-in-the-management-of-the-morbidly-adherent-placenta-outcome-improvements-over-time
#1
Alireza A Shamshirsaz, Karin A Fox, Hadi Erfani, Steven L Clark, Bahram Salmanian, B Wycke Baker, Michael Coburn, Amir A Shamshirsaz, Zhoobin H Bateni, Jimmy Espinoza, Ahmed A Nassr, Edwina J Popek, Shiu-Ki Hui, Jun Teruya, Celestine Shauching Tung, Jeffery A Jones, Martha Rac, Gary A Dildy, Michael A Belfort
BACKGROUND: Morbidly adherent placenta (MAP) is a serious obstetric complication causing mortality and morbidity. OBJECTIVE: To evaluate whether outcomes of patients with morbidly adherent placenta improve with increasing experience within a well-established multidisciplinary team at a single referral center. STUDY DESIGN: All singleton pregnancies with pathology-confirmed MAP (including placenta accreta, increta or percreta) managed by a multidisciplinary team between January 2011 and August 2016 were included in this retrospective study...
February 14, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28197273/clinical-and-surgical-strategies-for-avoiding-or-reducing-allogeneic-blood-transfusions
#2
Antonio Alceu Dos Santos, Jose Francisco Baumgratz, Jose Henrique Andrade Vila, Rodrigo Moreira Castro, Rodrigo Freire Bezerra
Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was successfully handled without using the standard therapy to treat anemia with hemotransfusions...
April 2016: Cardiology Research
https://www.readbyqxmd.com/read/28194493/oral-health-of-adult-patients-undergoing-hematopoietic-cell-transplantation-pre-transplant-assessment-and-care
#3
REVIEW
Agnieszka Bogusławska-Kapała, Kazimierz Hałaburda, Ewa Rusyan, Hubert Gołąbek, Izabela Strużycka
Hematopoietic cell transplantation (HCT) is now one of the frequent procedures used for treatment of malignant and non-malignant blood diseases, autoimmune disorders, and certain solid tumors. Despite improvements of therapeutic protocols, HCT still carries a high risk of non-relapse mortality due to early and late complications. Side effects of the therapy regimen frequently occur in the oral cavity and often significantly decrease the patients' quality of life. The complications may result from or may be exacerbated by improper oral preparation of the patient before transplantation...
February 13, 2017: Annals of Hematology
https://www.readbyqxmd.com/read/28194399/the-role-of-permissive-and-induced-hypotension-in-current-neuroanesthesia-practice
#4
Suren Soghomonyan, Nicoleta Stoicea, Gurneet S Sandhu, Jeffrey J Pasternak, Sergio D Bergese
BACKGROUND: Induced hypotension (IH) had been used for decades in neurosurgery to reduce the risk for intraoperative blood loss and decrease blood replacement. More recently, this method fell out of favor because of concerns for cerebral and other end-organ ischemia and worse treatment outcomes. Other contributing factors to the decline in its popularity include improvements in microsurgical technique, widespread use of endovascular procedures, and advances in blood conservation and transfusion protocols...
2017: Frontiers in Surgery
https://www.readbyqxmd.com/read/28188036/outcomes-of-an-accelerated-care-pathway-for-pediatric-blunt-solid-organ-injuries-in-a-public-healthcare-system
#5
Oluwatomilayo Daodu, Mary Brindle, Carlos R Alvarez-Allende, Lisette Lockyer, Bryce Weber, Steven R Lopushinsky
PURPOSE: An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed. METHODS: Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest...
January 29, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28166812/efficacy-of-high-intensity-focused-ultrasound-assisted-hepatic-resection-hifu-ar-on-blood-loss-reduction-in-patients-with-liver-metastases-requiring-hepatectomy-study-protocol-for-a-randomized-controlled-trial
#6
Aurélien Dupré, David Pérol, Ellen Blanc, Patrice Peyrat, Valéria Basso, Yao Chen, Jérémy Vincenot, Anthony Kocot, David Melodelima, Michel Rivoire
BACKGROUND: Liver resection is the only potentially curative treatment for colorectal liver metastases (LM). It is considered a safe procedure, but is often associated with blood loss during liver transection. Blood transfusions are frequently needed, but they are associated with increased morbidity and risk of recurrence. Many surgical devices have been developed to decrease blood loss. However, none of them has proven superior to the standard crushing technique. We developed a new, powerful intra-operative high-intensity focused ultrasound (HIFU) transducer which destroys tissue by coagulative necrosis...
February 6, 2017: Trials
https://www.readbyqxmd.com/read/28162984/eltrombopag-versus-placebo-for-low-risk-myelodysplastic-syndromes-with-thrombocytopenia-eqol-mds-phase-1-results-of-a-single-blind-randomised-controlled-phase-2-superiority-trial
#7
Esther N Oliva, Caterina Alati, Valeria Santini, Antonella Poloni, Alfredo Molteni, Pasquale Niscola, Flavia Salvi, Grazia Sanpaolo, Enrico Balleari, Ulrich Germing, Pierre Fenaux, Aspasia Stamatoullas, Giuseppe A Palumbo, Prassede Salutari, Stefana Impera, Paolo Avanzini, Agostino Cortelezzi, Anna Marina Liberati, Paola Carluccio, Francesco Buccisano, Maria Teresa Voso, Stefano Mancini, Austin Kulasekararaj, Fortunato Morabito, Monica Bocchia, Patrizia Cufari, Maria Antonietta Aloe Spiriti, Irene Santacaterina, Maria Grazia D'Errigo, Irene Bova, Gina Zini, Roberto Latagliata
BACKGROUND: In myelodysplastic syndromes, thrombocytopenia is associated with mortality, but treatments in this setting are scarce. We tested whether eltrombopag, a thrombopoietin receptor agonist, might be effective in improving thrombocytopenia in lower-risk myelodysplastic syndromes and severe thrombocytopenia. METHODS: EQoL-MDS was a single-blind, randomised, controlled, phase 2 superiority trial of adult patients with low-risk or International Prognostic Scoring System intermediate-1-risk myelodysplastic syndromes and severe thrombocytopenia...
February 2, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28161216/the-impact-of-perioperative-red-blood-cell-transfusions-in-patients-undergoing-liver-resection-a-systematic-review
#8
REVIEW
Sean Bennett, Laura K Baker, Guillaume Martel, Risa Shorr, Timothy M Pawlik, Alan Tinmouth, Daniel I McIsaac, Paul C Hébert, Paul J Karanicolas, Lauralyn McIntyre, Alexis F Turgeon, Jeffrey Barkun, Dean Fergusson
BACKGROUND: Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature. METHODS: The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion...
February 1, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28151829/haemotherapy-algorithm-for-the-management-of-trauma-induced-coagulopathy-an-australian-perspective
#9
James Winearls, Biswadev Mitra, Michael C Reade
PURPOSE OF REVIEW: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre...
February 1, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28149824/early-high-ratio-platelet-transfusion-in-trauma-resuscitation-and-its-outcomes
#10
Ruben Peralta, Adarsh Vijay, Ayman El-Menyar, Rafael Consunji, Ibrahim Afifi, Ismail Mahmood, Mohammed Asim, Rifat Latifi, Hassan Al-Thani
INTRODUCTION: The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP. METHODS: Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28139513/transfusion-of-plasma-collected-at-late-phase-after-preconditioning-reduces-myocardial-infarct-size-induced-by-ischemia-reperfusion-in-rats-in-vivo
#11
Yang Zhao, Zhi-Nan Zheng, Chi-Wai Cheung, Zhi-Yi Zuo, San-Qing Jin
BACKGROUND: Plasma transfusion is a common clinical practice. Remote ischemic preconditioning (RIPC) protects organs against ischemia-reperfusion (IR) injury. Whether preconditioned plasma (PP), collected at late phase after RIPC, could protect organs against IR injury in vivo is unknown. This study explored whether transfusion of PP could reduce myocardial infarct size (IS) after IR in rat in vivo. METHODS: Eighty Lewis rats were randomized to eight groups (n = 10 for each group)...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28131428/a-new-intraoperative-protocol-for-reducing%C3%A2-perioperative-transfusions-in%C3%A2-cardiac-surgery
#12
J Hunter Mehaffey, Sarah A Schubert, Michael G Gelvin, Eric J Charles, Robert B Hawkins, Lily E Johnston, Gorav Ailawadi, Irving L Kron, Leora T Yarboro
BACKGROUND: Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. METHODS: All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion...
January 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28131117/identification-and-management-of-obstetric-hemorrhage
#13
REVIEW
Emily J Baird
Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28129780/manubrium-limited-ministernotomy-versus-conventional-sternotomy-for-aortic-valve-replacement-mavric-study-protocol-for-a-randomised-controlled-trial
#14
Enoch Akowuah, Andrew T Goodwin, W Andrew Owens, Helen C Hancock, Rebecca Maier, Adetayo Kasim, Adrian Mellor, Khalid Khan, Gavin Murphy, James Mason
BACKGROUND: Aortic valve replacement is one of the most common cardiac surgical procedures performed worldwide. Conventional aortic valve replacement surgery is performed via a median sternotomy; the sternum is divided completely from the sternal notch to the xiphisternum. Minimally invasive aortic valve replacement, using a new technique called manubrium-limited ministernotomy, divides only the manubrium from the sternal notch to 1 cm below the manubrio-sternal junction. More than one third of patients undergoing conventional sternotomy develop clinically significant bleeding requiring post-operative red blood cell transfusion...
January 28, 2017: Trials
https://www.readbyqxmd.com/read/28115278/the-role-of-thromboelastography-teg-in-pediatric-patients-with-sinusoidal-obstructive-syndrome-receiving-defibrotide
#15
Joanna L Gendreau, Christine Knoll, Roberta H Adams, Leon L Su
Sinusoidal obstructive syndrome (SOS) is a potentially fatal form of hepatic injury following hematopoietic stem cell transplant (HSCT). Patients can develop liver dysfunction, portal hypertension, ascites, coagulopathies, and multi-system organ failure. The mortality rate of severe SOS has been reported as high as 98% by Day 100 post-transplant. Defibrotide, which is now approved for the treatment of SOS, has significantly decreased mortality. Defibrotide is a polynucleotide with pro-fibrinolytic, anti-ischemic, and anti-inflammatory activity...
January 20, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28111825/effect-of-red-blood-cell-preservation-by-droplet-freezing-with-non-permeable-cryoprotective-agents-in-blood-group-antigen-reactivity
#16
M A B Chagas, D G Chaves, S K Haddad, E M A Ubiali, L C Schmidt, M C F Silva-Malta
BACKGROUND: In the last few decades, various red blood cell (RBC) freezing techniques have been developed and improved to enable the preservation of erythrocytes for future use in pre-transfusion tests in reference immunohaematology laboratories. However, not all these techniques have been sufficiently evaluated for the preservation of blood group antigens. OBJECTIVES: In this study, we evaluated the antigenic pattern of RBCs preserved by droplet freezing in liquid nitrogen in a blood bank context...
January 22, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28108578/the-activated-clotting-time-in-cardiac-surgery-should-celite-or-kaolin-be-used
#17
Adrianus J De Vries, Annemieke Oude Lansink-Hartgring, Freek-Jan Fernhout, Rolf C G Huet, Edwin R van den Heuvel
OBJECTIVES: Both kaolin- and Celite-activated clotting times (ACT) are used to guide anticoagulation during cardiopulmonary bypass. It is unknown whether these methods lead to similar management procedures for anticoagulation in patients and are thus interchangeable in terms of bias, precision and variability. METHODS: We randomized 97 patients undergoing coronary artery bypass grafting or aortic valve replacement to either kaolin- or Celite-guided anticoagulation...
January 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28107785/blood-management-strategies-to-reduce-transfusions-after-elective-lower-extremity-joint-arthroplasty-surgeries
#18
Ankit Kansagra, Chester Andrzejewski, Robert Krushell, Andrew Lehman, Jordan Greenbaum, Paul Visintainer, Joan McGirr, Kathleen Mahoney, Darlene Cloutier, Alice Ehresman, Mihaela S Stefan
Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post...
January 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28102730/alloimmunisation-in-transfused-patients-serial-cross-matching-in-a-population-of-hospitalised-cats
#19
Layla Hourani, Christiane Weingart, Barbara Kohn
Objectives Cross-matching is currently recommended as part of pre-transfusion testing for repeat transfusions in cats 4 days after having received an initial transfusion. This prospective study determined when and if cats developed positive cross-match (CM) results after having been transfused with AB-compatible blood. Methods Donors were selected according to standard transfusion safety protocols. Twenty-one hospitalised anaemic recipients (blood type A: n = 20; blood type B: n = 1) received 1-4 (median 2) whole-blood transfusions (WBTs) over 1-6 days (median 2) in 33 transfusion instances...
January 1, 2017: Journal of Feline Medicine and Surgery
https://www.readbyqxmd.com/read/28098575/obstetric-anesthesia-liability-concerns
#20
Joanna M Davies, Linda S Stephens
Obstetric practice carries a high risk of medical liability and involves both obstetricians and anesthesiologists. Analysis of data from the Anesthesia Closed Claims Project database shows an increase in the proportion of anesthesia claims for maternal death and brain damage between the 1990s and 2000 and later, primarily due to hemorrhage. The proportion of claims for newborn brain damage remained unchanged while those for maternal nerve injury and minor injuries decreased. Use of massive transfusion protocols and clinical drills have been shown to improve outcomes from hemorrhage...
January 16, 2017: Clinical Obstetrics and Gynecology
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