BACKGROUND: To avoid the risks associated with transfusion of homologous blood products, artificial colloid solutions represent an alternative for intra-operative blood loss replacement. However, synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. We investigated the effect of Hydroxyethyl starch (HES) on blood coagulation in vitro under thromboelastography (TEG). METHODS: Whole blood was withdrawn from fifteen volunteers undergoing peripheral surgery who had no history of coagulation defect. Whole blood was diluted with HES to 25, 50 and 75 vol% concentrations, and the changes in coagulation status were analysed using TEG and were compared with those of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilution with HES solution at 50 vol% concentration decreased the MA and alpha angle values (P < 0.05), but the R and K values remained unchanged. In case of profound hemodilution at a 75 vol% concentration, the values of MA and alpha angle were severely decreased (P < 0.05) and the values of R and K were severely increased (P < 0.05). CONCLUSIONS:There were many reports that moderate hemodilution with crystalloids increased coagulability, but hemodilutions up to 50 vol% concentration with HES solution did not significantly change blood coagulability. Significant hypocoagulability occurred at a 75 vol% hemodilution with HES.
Blood Coagulation ; Colloids ; Hemodilution ; Humans ; Starch* ; Thrombelastography* ; Volunteers

BACKGROUND: The high incidence of deep vein thrombosis (DVT) of lower extremities and a subsequent pulmonary embolism (PE) makes it the most common cause of death following total hip replacement surgery. Therefore, the authors measured the perioperative changes in the blood coagulation activity with a thromboelastography (TEG) in the patients treated with fluid and packed red cells (PRC). METHODS: Hemodilution was estimated with a measurement of hemoglobin (Hb), hematocrit (Hct), and platelet count. The changes in the coagulation factor activities were measured with TEG. Samples were obtained before skin incision (step 1); at the period that Hb and Hct ranged from about 10 g/dl to 30% (step 2); in the postanesthetic care unit (step 3); and on the postoperative first and third day (step 4, 5). RESULTS: Although Hct and Hb decreased to 9.4% statistically at step 2 only, platelet counts were significantly decreased in step 2 (10.6%), 3 (34.5%), 4 (32.5%), and 5 (33.6%) compared with step 1 (P < 0.05). At step 2, there were no significant changes in TEG parameters except r time, which decreased (21.5%) (P < 0.05). At step 3, r time, alpha angle, and maximum amplitude (MA) decreased, and k time and lysis 60 increased (P < 0.05). CONCLUSIONS: In spite of consumption and dilution of coagulation factors after massive fluids and PRC therapy during total hip replacement surgery, the increased activities of procoagulants and decreased fibrinolytic activities predisposed the body to initiate and maintain the thrombus.
Arthroplasty, Replacement, Hip* ; Blood Coagulation ; Blood Coagulation Factors ; Cause of Death ; Hematocrit ; Hemodilution ; Humans ; Incidence ; Lower Extremity ; Platelet Count ; Pulmonary Embolism ; Skin ; Thrombelastography ; Thrombosis ; Venous Thrombosis

PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS: We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.
Abdomen ; Adenocarcinoma ; Cholecystectomy ; Diagnosis ; Digestive System ; Duodenum* ; Female ; Follow-Up Studies ; Gallbladder* ; Humans ; Incidence ; Liver ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Phenobarbital ; Recurrence ; Tomography, X-Ray Computed ; Biomarkers, Tumor