Objective: This study sought to validate Surgical APGAR Score in predicting major postoperative complications 30 days after surgery in our hospital setting. Methods: All patients undergoing major general surgery in Chinese General Hospital and Medical Center from March to October 2009 were enrolled. Three intraoperative variables were measured: estimated blood loss (EBL), lowest mean arterial pressure (LMAP) and lowest heart rate (LHR). Base on these three variables, Surgical APGAR Scores were obtained. Resulting data were analyzed and the relationship between the scores and the incidence of major complications evaluated. Results: Eighty patients were enrolled in this study. There was a significant association of incidence of major complications decreased monotonically. The optimum cutoff point was <= 6. At this cutoff point, sensitivity was 80%, specificity was 78.57%, positive predictive value was low at 34.8%, while negative predictive value was high at 96.5%. Conclusion: Results showed that a simple surgical score can be derived from intraoperative data alone that are readily available. It validated that this 10-point scoring system based on estimated blood loss (EBL), lowest mean arterial pressure (LAMP) and lowest heart rate (LHR) can predict group of patients at higher risk of major complications within 30 days of surgery. This system can be a significant tool for prognostification and clinical guide for early intervention of postoperative care in surgery. Key words: estimated blood loss, lowest mean arterial pressure
BLOOD LOSS, SURGICAL

Background: The effective dose of Tranexamic Acid (TA) is unclear in reducing blood loss after cardiac surgery. In Vietnam, the doses of TA 10mg/kg for starting anaesthesia, 5mg/kg for transfusion into extracorporeal circulation solution, then using a maintained dose of 1mg/kg/gi\u1edd reduces blood loss and transfusion, but there is no statistical significant. Objectives: To evaluate blood loss and need for transfusion after cardiac surgery in patients receiving TA 20 mg/kg at induction + 10 mg/kg in extracorporeal circulation solution and 2 mg/kg/1h for maintenance; To evaluate coagulation profile after TA. Subject and methods: A double blind randomly controlled trial is conducted in 80 surgical cardiac patients equally divided into TA and control groups: Results: In the TA group, the post - operative blood loss is 393.50 \xb1 136.64 ml, Hematocrit (Hct) 35.31 \xb1 3.38 % with less individuals and smaller amount of blood and/or frozen fresh platelets needed than in control (p<0.001). Conclusions: An above dose of TA reduces approximately a half of blood loss and elevates Hct postoperatively, with significant lower requirements of transfusion than the control and higher amount of platelets, reduced D-dimers (p<0.05) and unchanged Fibrinogen, PT, INR and aPTT (p >0.05).
open heart surgery ; tranexamic acid ; blood loss

Erythrocyte transfusion is an important treatment for some operation. However, it may cause risks of infection, immunal changes, especially HIV and hepatitis C infection. There were some questions for this procedure including indications for intraoperative erythrocyte transfusion, (hematocrite or hemoglobine). Blood dilution, host-blood transfusion, quality of erythrocyte, recombined erythropoietin and substitution indication.
Erythrocyte Transfusion ; Surgery ; Blood Loss, Surgical ; adult

Idiopathic sudden sensorineural hearing loss (ISSNHL) in children is rare, accounting for less than 10% of all sudden deafness. The etiology of ISSNHL is uncertain, but viral infeqction and the distribution of blood circulation in the inner ear are suspected as the causes of the disease. Therefore, stellate ganglion block (SGB) and antiviral agent have been used for its treatment. Recently we experienced an effective series of 12 SGBs in pediatric patient with ISSNHL, with no severe complication.
Blood Circulation ; Child ; Ear, Inner ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Stellate Ganglion*

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.
Blood Glucose ; Dexamethasone ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Perilymph ; Prednisolone ; Steroids

OBJECTIVES: This study was conducted to investigate that the chronic noise exposure is associated with decreased serum magnesium concentrations and evaluate whether decreased serum magnesium is associated with noise induced hearing loss. METHODS: One hundred seventy-eight male workers exposed to noise were selected and classified three groups by the degree of hearing loss. Hearing threshold levels were less than 30 dB at 1,000 Hz or less than 40 dB at 4,000 Hz in group I, more than 30 dB at 1,000 Hz or more than 40 dB at 4,000 Hz and 15 dB and less of pure tone average(PTA: (500 Hz+1,000 Hz+2,000 Hz)/3) in group II, more than 30 dB at 1,000 Hz or more than 40 dB at 4, 000 Hz and over 15 dB of PTA in group III. RESULTS: Serum magnesium concentrations were 2. 42+/-0. 26 nc/dt in group I, 2. 35+/-0.23 mg(dl in group II, 2.26+/-0.24 ne/dl in group III, respectively and significantly different between group I and group III (p<0. 01). It was negatively correlated with duration of the noise exposure as correlation coefficient(r) of -0.194 (p<0.05). Analysis of the multiple regression on hearing threshold levels showed that serum magnesium, diastolic blood pressure, duration of the noise exposure were statistically significant at 4,000 Hz(p<0.05). While only age was statistically significant at 1,000 Hz(p<0.05). CONCLUSIONS: These results suggest that chronic noise exposure may induces decrease in serum magnesium concentrations and that its decreased concentration is related with noise induced hearing loss.
Blood Pressure ; Hearing Loss* ; Hearing* ; Humans ; Magnesium* ; Male* ; Noise*

OBJECTIVE: To analyze the conventional application of using comprehensive hemostatic methods during the perioperative period, and the effect of autologous blood transfusion (ABT) device compared with non-negative pressure drainage on preventing blood loss and allogenic blood transfusion after primary total knee arthroplasty (TKA). METHODS: A total of 131 patients (131 knees) with severe knee osteoarthritis who underwent unilateral primary TKA by the same surgeon in Peking University Third Hospital from June 2014 to June 2015 were enrolled in this study. The patients were divided into ABT group (64 patients) and control group (67 patients). ABT devices were used for drainage and blood transfusion in the ABT group while the control group used the non-negative pressure drainage only. The results of the drainage fluid volume, the decrease of hemoglobin, the total blood loss, the hidden blood loss and blood transfusion after TKA were compared between the two groups. RESULTS: The drainage fluid volume in ABT group was significantly higher than that in control group [515 mL (80-1 610 mL) vs. 260 mL (40-670 mL), P<0.001]. The autologous blood transfusion in ABT group was 245 mL (60-1 070 mL). There were no significant differences between the two groups in the value of hemoglobin decrease 1 day after surgery (P=0.340) and 3 days after surgery (P=0.524). There were no significant differences in the total blood loss (P=0.101) and the hidden blood loss (P=0.062) between the two groups either. There were 9 patients in the 131 patients who received allogeneic blood transfusion, of whom 5 in the ABT group (5/64, the blood transfusion rate was 7.8%) and 4 in the control group (4/67, the blood transfusion rate was 6.0%), and no significant differences in the blood transfusion rate between the two groups (P=0.943). CONCLUSION With the conventional application of using comprehensive hemostatic methods during perioperative period, the ABT device did not show the effective result of controlling postoperative blood loss and failed to reduce the rate of allogeneic blood transfusion in patients with unilateral primary TKA. However, the ABT device could increase the drainage fluid volume and improve the patient's hospitalization expenses. Therefore, there is no need for routine application of ABT device in unilateral primary TKA.
Arthroplasty, Replacement, Knee ; Blood Loss, Surgical/prevention & control* ; Blood Transfusion ; Blood Transfusion, Autologous/instrumentation* ; Hemostatics ; Humans

OBJECTIVETo investigate the application of tourniquet in burn patients during tangential excision on the extremities.

METHODSSeventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded.

RESULTSThe amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05).

CONCLUSIONContinuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.

Adult ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; Burns ; surgery ; Extremities ; surgery ; Humans ; Skin Transplantation ; Tourniquets

Altitude ; Animals ; Blood Glucose ; metabolism ; Cholesterol ; blood ; Hypoxia ; metabolism ; Mice ; Weight Loss

A new system of blood flow block for control of bleeding in abdominal operation is composed of an abdominal magnetic blocking unit, an abdominal external electromagnet unit and other non-magnetic operation instrument. The abdominal external electromagnetic unit is placed in advance in the operation bed. The abdominal magnetic blocking unit can be placed directly on the ventral of the large vessels when need to blocking the abdominal large vessels during the operation. According to the non-contact suction characteristics of magnetic materials, the two magnetic units will attract each other and compression the vessels. Using this system for vascular occlusion does not need clear exposure and without separating vessel. There is the advantage of rapid, accurate and reliable for the system.
Abdomen ; blood supply ; Blood Loss, Surgical ; prevention & control ; Electromagnetic Phenomena ; Equipment Design ; Surgical Equipment