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Marius Rehn, Anne Weaver, Karim Brohi, Sarah Eshelby, Laura Green, Jo Røislien, David J Lockey
BACKGROUND: Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. METHODS: Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients...
April 16, 2018: Shock
Timothy J Harris, William C Beck, Avi Bhavaraju, Benjamin Davis, Mary K Kimbrough, Joseph C Jensen, Anna Privratsky, John R Taylor, Kevin W Sexton
A 67-year-old male presented with acute pancreatitis secondary to gallstones, also known as acute biliary pancreatitis, and subsequently developed gastric outlet obstruction and was transferred to our hospital. A gastro-jejunal feeding tube was placed and an open cholecystectomy was performed. The patient had a pancreatic drain placed for interval increase in pancreatic necrosis and then nearly exsanguinated from gastroduodenal artery pseudoaneurysm bleed. This was managed by coiling the gastroduodenal artery...
March 2018: Journal of Surgical Case Reports
Joshua D Hasty, John A Henson, Gary R Acuff, Dennis E Burson, John B Luchansky, Nicholas J Sevart, Randall K Phebus, Anna C S Porto-Fett, Harshavardhan Thippareddi
Scalding of hide-on bob veal carcasses with or without standard scalding chemical agents typically used for hogs, followed by an 82.2°C hot water wash and lactic acid spray (applied at ambient temperature) before chilling, was evaluated to determine its effectiveness in reducing Shiga toxin-producing Escherichia coli surrogate populations. A five-strain cocktail of rifampin-resistant, nonpathogenic E. coli surrogates was used to inoculate hides of veal carcasses immediately after exsanguination (target inoculation level of 7...
April 5, 2018: Journal of Food Protection
Wongsakorn Chaochankit, Osaree Akaraborworn, Burapat Sangthong, Komet Thongkhao
PURPOSE: Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT...
March 3, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Yi-Chuan Chen, Cheng-Ting Hsiao, Leng-Chieh Lin, Kuang-Yu Hsiao, Ming-Szu Hung
BACKGROUND: The benefits of transfusion for acute upper gastrointestinal bleeding (UGIB) have not been well established; however, previous studies suggest that transfusion is associated with adverse outcomes. We performed an observational study using a 10-year database to analyze the association between red blood cell (RBC) transfusion and outcomes in patients with UGIB in the emergency department (ED). METHOD AND FINDINGS: All adult patients with UGIB were identified through diagnostic codes...
March 29, 2018: Clinical and Translational Gastroenterology
L G Schneider, Z R Stromberg, G L Lewis, R A Moxley, D R Smith
Cattle hides are an important source of enterohaemorrhagic Escherichia coli (EHEC) carcass contamination at slaughter. Seven EHEC serogroups are adulterants in raw, non-intact beef: EHEC O26, O45, O103, O111, O121, O145 and O157. The objective of this study was to estimate the probability for hide contamination with EHEC among US market beef cows at slaughter and to test the effects of season and geographic region on prevalence of hide contamination. Hides (n = 800) of market cows were swabbed at slaughter immediately after exsanguination, prior to hide removal...
March 25, 2018: Zoonoses and Public Health
Giancarlo Bozzo, Roberta Barrasso, Patrizia Marchetti, Rocco Roma, Giorgio Samoilis, Giuseppina Tantillo, Edmondo Ceci
Sixty Charolais male beef cattle of eight months of age were divided into two groups according to the slaughtering method, i.e., traditional or Kosher (religious Jewish rite). The aim of the study was to detect and compare the plasma concentrations of cortisol and catecholamines (dopamine, norepinephrine and epinephrine), by Elisa and HPLC test. These four stress indicators were evaluated during three different stages of each animal productive life: on the farm (step 1), after transportation (step 2) and during bleeding (step 3)...
March 21, 2018: Animals: An Open Access Journal From MDPI
Elisa Wirthgen, Sébastien Goumon, Martin Kunze, Christina Walz, Marion Spitschak, Armin Tuchscherer, Jennifer Brown, Christine Höflich, Luigi Faucitano, Andreas Hoeflich
In previous work using market-weight pigs, we had demonstrated that insulin-like growth factors (IGFs) and insulin-like growth factor binding proteins (IGFBPs) are regulated during shipment characterized by changing conditions of stress due to loading or unloading, transportation, lairage, and slaughter. In addition, we found in a previous study that IGFBP-2 concentrations were lower in pigs transported for longer periods of time. Therefore, we performed a more detailed study on the effects of transport duration and season on the plasma concentrations of IGFs and IGFBPs in adult pigs...
2018: Frontiers in Endocrinology
Charlotte Jouvène, Baptiste Fourmaux, Alain Géloën, Laurence Balas, Thierry Durand, Michel Lagarde, Marion Létisse, Michel Guichardant
Docosahexaenoic acid (DHA), a prominent long-chain fatty acid of the omega-3 family, is present at high amount in brain tissues, especially in membrane phospholipids. This polyunsaturated fatty acid is the precursor of various oxygenated lipid mediators involved in diverse physiological and pathophysiological processes. Characterization of DHA-oxygenated metabolites is therefore crucial for better understanding the biological roles of DHA. In this study, we identified and measured, by ultrahigh-performance liquid chromatography coupled with tandem mass spectrometry, a number of oxygenated products derived from DHA in exsanguinated and nonexsanguinated brains...
February 22, 2018: Lipids
Aaron Cunningham, Marc Auerbach, Mark Cicero, Mubeen Jafri
BACKGROUND: Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children. METHODS: Search terms "pediatric" and "tourniquet" were used to query the US National Library of Medicine National Institutes of Health for pertinent literature...
February 17, 2018: Journal of Trauma and Acute Care Surgery
Xiao Lu, Yimin Zhang, Libo Qin, Wenjian Ma, Lixian Zhu, Xin Luo
The objective of this study was to investigate the relationship between ultimate pH (pHu) and stress-related blood variables. Of 50 cattle in total, blood samples from 6 cattle which exhibited high (≥6.10) pHu (dark-cutting) were collected, along with the same number of low pHu and intermediate pHu cattle (5.40-5.80; 5.80-6.10, respectively) to determine the concentration of plasma cortisol, glucose, lactate, creatine kinase, lactate dehydrogenase, haptoglobin and serum amyloid A protein. Compared to cattle with low pHu, high pHu cattle showed higher plasma cortisol, glucose, lactate, creatine kinase and lactate dehydrogenase levels at exsanguination...
May 2018: Meat Science
Siobhan O'Donovan, Neil E I Langlois, Roger W Byard
"Defense" type wounds are sustained when a victim is attempting to ward off an attacker, or a weapon. A 39-year-old woman is reported who was found deceased with incised wounds to the dorsa of both hands that resembled defense wounds. Examination of the flexor surfaces of both wrists, however, revealed horizontal incised wounds typical of self-infliction. Perfusion of the subclavian arteries produced leakage of water from peripheral veins within wounds on both hands and the right wrist. Death was due to exsanguination from incised wounds of the hands and right wrist; manner suicide...
February 17, 2018: Forensic Science, Medicine, and Pathology
Peter Nissen Bjerring, Esben Jannik Bjerrum, Fin Stolze Larsen
BACKGROUND: Liver failure results in hyperammonaemia, impaired regulation of cerebral microcirculation, encephalopathy and death. However, the key mediator that alters cerebral microcirculation remains unidentified. In this study we show that topical ammonium significantly increases periarteriolar adenosine tone on the brain surface of healthy rats and is associated with a disturbed microcirculation. METHODS: Cranial windows were prepared in anaesthetized Wistar rats...
February 13, 2018: Journal of Hepatology
T Chan, M S Bleszynski, D S Youssef, M Segedi, S Chung, C H Scudamore, A K Buczkowski
INTRODUCTION: Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared to primary abdominal closure (PAC) at the index transplant operation. METHODS: Retrospective review of all adults undergoing deceased donor liver transplantation (2007-2011) at a single center tertiary care institution...
January 31, 2018: American Journal of Surgery
Rebecca D Powell, Donna A Goodenow, A Britton Christmas, Iain H Mckillop, Susan L Evans
Conditions of systemic stress can lead to increased reactive oxygen species production, mitochondrial dysfunction, systemic inflammation, and multiorgan dysfunction. Triphenylphosphonium (TPP+) is a lipophilic cation used to target therapeutics to mitochondria. We sought to determine the effects of TPP+ on mitochondrial integrity. Male rats were anesthetized and TPP+ (5 mg/kg) or vehicle (saline) was administered intravenously 30-minutes after anesthesia initiation and intraperitoneally (20 mg/kg) 60-minutes later...
January 1, 2018: American Surgeon
Alex Robertson, Tain-Yen Hsia
Neurologic deficit subsequent to cardiac surgery remains a cause of postoperative morbidity and mortality. Although myriad risk factors for postoperative cognitive decline have been identified, their individual influence remains undefined. Although less emphasis is now placed on the heart lung machine as the major source of postoperative cognitive decline, the conduct of cardiopulmonary bypass and, in particular, the management of the bypass circuit remain key to patient safety. We present a case of inadvertent intraoperative exsanguination of a patient following open heart surgery for implantation of a left ventricular assist device...
March 2018: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
Shogo Miura, Hiroyuki Kuroda, Ken Sato, Michiko Yamada, Ryo Itou, Michihiro Ono, Tomoyuki Abe, Shigeyuki Fujii, Masahiro Maeda, Masahiro Yoshida, Wataru Jomen, Masayoshi Kobune, Junji Kato, Miri Fujita
The gastrointestinal tract is a common site for the occurrence of non-Hodgkin's lymphoma (NHL). NHL with gastrointestinal lesions may lead to clinically relevant intestinal complications such as obstruction, perforation, and exsanguination during the course of the disease. Consequently, patients with NHL are often examined by means of upper and lower gastrointestinal endoscopy at the initial visit. There are no clear guidelines regarding which patients should undergo capsule endoscopy (CE) and balloon enteroscopy for detecting small intestinal lesions...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
S B Smith, T L Blackmon, J E Sawyer, R K Miller, J R Baber, J C Morrill, A R Cabral, T A Wickersham
We hypothesized that abomasal infusion of glucose would promote de novo fatty acid biosynthesis from glucose in vitro in bovine intramuscular (i.m.) and subcutaneous (s.c.) adipose tissues to a greater extent than ruminal infusion of acetate, propionate, or glucose. Angus crossbred steers (n = 24), 22 mo of age, were fitted with ruminal cannulas, and steers were adapted to another corn/sorghum finishing diet over a 2-wk period while recovering from the placement of the cannulas. After the adaptation period, the steers were fed the second finishing diet at 130% of their voluntary intake and were infused with isocaloric amounts (3...
February 2, 2018: Journal of Animal Science
Brian C Beldowicz
Damage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity...
January 2018: Clinics in Colon and Rectal Surgery
Petr Handlos, Klára Marecová, Margita Smatanová, Igor Dvořáček, Martin Dobiáš
In this study, we present two cases of sudden deaths of people with end-stage kidney with arteriovenous fistulas for long-term hemodialysis treatment. This procedure is associated with a number of known complications. While stenosis, thrombosis, and infection are well known, lethal hemorrhage from arteriovenous fistula is much less commonly encountered. Inspection of the bodies at the scene of the death by a medical examiner suggested that the deaths were due to exsanguination. Autopsies revealed visible defects on the front wall of the arteriovenous fistulas...
January 16, 2018: Journal of Forensic Sciences
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