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Massive Blood Loss

Thorsten Tjardes, Markus Luecking
Introduction: To achieve the aim of zero preventable deaths on the battlefield a deeper understanding of uncontrolled hemorrhage from junctional or proximal extremity sources is mandatory. While tourniquet application to the extremities has drastically reduced morbidity and mortality, there is still room for improvement regarding the timing of tourniquet placement as the available evidence clearly points out a tight correlation between timing of tourniquet application and outcome. To save as many lives as possible the "point of no return" regarding the circulatory breakdown due to hemorrhage, colloquially addressed as platinum 5 min, needs to be determined...
March 14, 2018: Military Medicine
Jiaze Tan, Haitao Yang, Jingchuan Fan, Yulan Fan, Fei Xiao
OBJECTIVES: Neutral lipid storage disease with myopathy (NLSDM) is a rare metabolic myopathy occurring owing to mutations in the patatin like phospholipase domain containing 2 (PNPLA2) gene. Till date, less than 50 patients with PNPLA2 mutations have been reported. In this study, we describe the clinical, pathological, and genetic findings, and muscle magnetic resonance imaging (MRI) changes in four Chinese patients with NLSDM. PATIENTS AND METHODS: Peripheral blood smears were stained using Wright's stain...
March 5, 2018: Clinical Neurology and Neurosurgery
Nikita Zaborovskii, Dmitrii Ptashnikov, Dmitrii Mikaylov, Sergei Masevnin, Oleg Smekalenkov
BACKGROUND: Intraoperative hemorrhage can sometimes be massive in patients with spinal metastasis of renal cell carcinoma (MRCC). Preoperative embolization and local hemostatic agents are routinely use in spinal tumor surgery, but there have been no comparisons between these methods. This report compares the efficiency of various methods of bleeding control and their influence on outcome and survival after decompression procedures for MRCC. MATERIALS AND METHODS: This was a retrospective case-control study of 54 patients with hypervascular extraosseous MRCC...
March 10, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Brant M Wagener, Parker J Hu, Joo-Yeun Oh, Cilina A Evans, Jillian R Richter, Jaideep Honavar, Angela P Brandon, Judy Creighton, Shannon W Stephens, Charity Morgan, Randal O Dull, Marisa B Marques, Jeffrey D Kerby, Jean-Francois Pittet, Rakesh P Patel
BACKGROUND: Trauma is the leading cause of death and disability in patients aged 1-46 y. Severely injured patients experience considerable blood loss and hemorrhagic shock requiring treatment with massive transfusion of red blood cells (RBCs). Preclinical and retrospective human studies in trauma patients have suggested that poorer therapeutic efficacy, increased severity of organ injury, and increased bacterial infection are associated with transfusion of large volumes of stored RBCs, although the mechanisms are not fully understood...
March 2018: PLoS Medicine
Filip Thieme, Jiri Fronek
INTRODUCTION: Polycystic liver disease is observed in 75-90% of patients with autosomal dominant polycystic kidney disease (ADPKD). ADPKD has a high prevalence of 1/1000. Hepatomegaly severely reduces quality of life and liver transplantation seems to be method of choice for many patients. Because of the rarity of this disease and the small number of symptomatic patients with massive hepatomegaly indicated for the transplantation, there is no standard approach for explantation of the liver...
January 8, 2018: International Journal of Surgery Case Reports
Georgios Karaolanis, Dimitrios Moris, C Cameron McCoy, Diamantis I Tsilimigras, Sotirios Georgopoulos, Chris Bakoyiannis
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary...
2018: Frontiers in Surgery
Hellen McKinnon Edwards
This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions...
March 2018: Danish Medical Journal
Natascha de Lange, Pim Schol, Marcus Lancé, Mallory Woiski, Josje Langenveld, Robbert Rijnders, Luc Smits, Martine Wassen, Yvonne Henskens, Hubertina Scheepers
BACKGROUND: Postpartum hemorrhage (PPH) is associated with maternal morbidity and mortality and has an increasing incidence in high-resource countries, despite dissemination of guidelines, introduction of skills training, and correction for risk factors. Current guidelines advise the administration, as fluid resuscitation, of almost twice the amount of blood lost. This advice is not evidence-based and could potentially harm patients. METHODS: All women attending the outpatient clinic who are eligible will be informed of the study; oral and written informed consent will be obtained...
March 6, 2018: Trials
Kenichiro Araki, Norio Kubo, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Hiroyuki Kuwano, Ken Shirabe
BACKGROUND: Massive bleeding during major hepatectomy is associated with greater mortality and morbidity.1 Our previous study shows that inferior vena cava (IVC) compression by tumor and an anterior approach without the liver-hanging maneuver (LHM) are risk factors for massive bleeding.2 The LHM is useful for controlling bleeding in deeper parenchymal transection planes.3 However, severe compression of the IVC by tumor makes it difficult to insert a hanging tape.4 The study shows a novel modified LHM strategy for severe IVC compression to minimize intraoperative bleeding...
February 14, 2018: Annals of Surgical Oncology
DaShawn A Hickman, Christa L Pawlowski, Andrew Shevitz, Norman F Luc, Ann Kim, Aditya Girish, Joyann Marks, Simi Ganjoo, Stephanie Huang, Edward Niedoba, Ujjal D S Sekhon, Michael Sun, Mitchell Dyer, Matthew D Neal, Vikram S Kashyap, Anirban Sen Gupta
Traumatic non-compressible hemorrhage is a leading cause of civilian and military mortality and its treatment requires massive transfusion of blood components, especially platelets. However, in austere civilian and battlefield locations, access to platelets is highly challenging due to limited supply and portability, high risk of bacterial contamination and short shelf-life. To resolve this, we have developed an I.V.-administrable 'synthetic platelet' nanoconstruct (SynthoPlate), that can mimic and amplify body's natural hemostatic mechanisms specifically at the bleeding site while maintaining systemic safety...
February 15, 2018: Scientific Reports
Burr Fong, Daniel Novak, Michael Dalley, Gregory Alfred
BACKGROUND: Deep vein thrombosis (DVT) is a common disease that is diagnosed in approximately 1 in 1000 adults annually. Extensive DVT can lead to life- or limb-threatening diagnoses such as phlegmasia cerulea dolens (PCD), phlegmasia alba dolens, and venous gangrene. PCD, also known as massive iliofemoral venous thrombosis, is rare, and a severe complication of DVT. CASE REPORT: We report a case of a 94-year-old bedridden woman with past medical history of dementia, hypertension, pulmonary embolism, DVT, and atrial fibrillation...
February 12, 2018: Journal of Emergency Medicine
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
Khai Luen Koh, Ali Zain
: Open cranial vault remodeling techniques require rigid fixation with hardware such as plates and screws; however, complications can occur. The purpose of this study was to assess the surgical outcome after open reconstruction for craniosynostosis with less rigid fixation using nonabsorbable suture. METHODS: Retrospective review of patients who underwent open craniofacial reconstruction for craniosynostosis at the Hospital Kuala Lumpur between January 2011 and December 2016 were performed...
February 12, 2018: Journal of Craniofacial Surgery
T Ohmori, T Kitamura, T Nishida, T Matsumoto, T Tokioka
AIM: There is not adequate evidence to establish whether external fixation (EF) of pelvic fractures leads to a reduced mortality. We used the Japan Trauma Data Bank database to identify isolated unstable pelvic ring fractures to exclude the possibility of blood loss from other injuries, and analyzed the effectiveness of EF on mortality in this group of patients. PATIENTS AND METHODS: This was a registry-based comparison of 1163 patients who had been treated for an isolated unstable pelvic ring fracture with (386 patients) or without (777 patients) EF...
February 2018: Bone & Joint Journal
Shun Huang, WenPing Peng, Ning Yang, Tao Yu, Hong Yuan Cui, Jing Yong Xu, Qi An, Hua Yang, Yan Nan Liu, Zhe Li, Ming Zhang Zuo
BACKGROUND: The development of sensitive myocardial-specific cardiac biomarkers allows for detection of very small amounts of myocardial injury or necrosis. Myocardial injury (MI) as a prelude of the serious perioperative complication myocardial infarction, should be paid more attention, especially in elderly susceptible patients. Myocardial injury after abdominal surgery in elderly patients has not been described yet. The objectives of this study were to identify the incidence, predictors, characteristics and the impact of MI on outcome in elderly patients underwent abdominal surgery...
February 12, 2018: Aging Clinical and Experimental Research
Meng Pan, Zonghao Tang, Jianbing Tu, Zhengchao Wang, Qinhui Chen, Rongdong Xiao, Haiqing Liu
Quick hemostats for non-lethal massive traumatic bleeding in battlefield and civilian accidents are important for reducing mortality and medical costs. Chitosan (CS) has been widely used as a clinic hemostat. To enhance its hemostatic efficiency, Zn2+ in the form of zinc alginate (ZnAlg) was introduced to CS to make porous CS@ZnAlg microspheres with ZnAlg component on the surface. Such microspheres were prepared by successive steps of micro-emulsion, polyelectrolyte adhesion, and thermally induced phase separation...
April 1, 2018: Materials Science & Engineering. C, Materials for Biological Applications
H Lier, M Bernhard, B Hossfeld
The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e...
February 5, 2018: Der Anaesthesist
Gildardo Cortés-Julián, Luis C Valencia, Silviano Ríos-Pascual, Marco A de la Rosa-Abarroa, Enrique Guzmán-de Alba
Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
Hao Xu, Linyou Zhang
OBJECTIVE:  Video-assisted thoracic surgery lobectomy is a minimally invasive procedure for major pulmonary resection. The purpose of this study was to present a novel approach with a thoracoscope in the right upper lobe and to compare different lobectomy methods at our institution. METHODS:  We reviewed the medical records of patients who underwent a thoracoscopic right upper lobectomy for lung cancer between September 2015 and September 2016. We performed 128 thoracoscopic right upper lobectomies: group A (n = 50) was treated with the bronchus-first and vessels simultaneously stapled method and group B (n = 78) was treated with the conventional isolation-ligation method...
January 30, 2018: Thoracic and Cardiovascular Surgeon
Hazem Mashaly, Zoe Zhang, Andrew Shaw, Patrick Youssef, Ehud Mendel
BACKGROUND AND IMPORTANCE: Hemangiopericytoma is a rare vascular tumor with central nervous system involvement representing only 1% of central nervous system tumors. They rarely affect the vertebral column. Complete surgical resection is the treatment of choice for hemangiopericytoma given their high rates of local recurrence. However, the high vascularity of such tumors with the risk of massive bleeding during surgery represents a significant challenge to surgeons. Therefore, preoperative endovascular embolization via the transarterial route has been advocated...
February 1, 2018: Operative Neurosurgery (Hagerstown, Md.)
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