No abstract available.
Acute Kidney Injury* ; Edema* ; Hemofiltration*

No abstract available.
Acute Kidney Injury* ; Edema* ; Hemofiltration*

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 METHODS: Whole blood was withdrawn from fifteen volunteers undergoing peripheral surgery who had no history of coagulation defect.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: Aprotinin is a potent, nonspecific broad serine protease inhibitor. It's inhibitory effects on intrinsic pathway of coagulation cascade can augment anticoagulation by heparin. This study designed to demonstrate augmented anticoagulation of aprotinin to heparin contaminated blood on thromboelastography(TEG). METHODS: This study designed into two phases for 21 healthy volunteers undergoing elective opeation. The first phase study, it was for looking at TEG differences between blood treated with aprotinin 200 KIU and blood treated with heparin 0.05 unit and 0.1 unit per blood 1 ml. The second phase study was for looking at anticoagulation of aprotinin added by heparin 0.05 unit and 0.1 unit per blood 1 ml and their reversal added by optimal dose of protamine sulfate. RESULTS: The aprotinin treated blood showed only a prolonged reaction time. Blood treated with incremental dose of heparin showed longer reaction time and smaller alpha angle than TEGs of native blood. Aprotinin added to the heparin contaminated blood showed much longer reaction time and much less alpha angle when compared with TEGs of aprotinin or heparin treated blood. Depressed TEG pattern by the heparin and aprotinin mixture reversed back to the TEGs of blood treated with aprotinin when optimal dose of protamine added. CONCLUSIONS: Those results suggest that aprotinin administered in open cardiac surgery can augment the remained anticoagulation effect due to heparin even after first dose fo protamine after weaning of cardiopulmonary bypass. This is of clinically improtance to distinguish heparin related coagulopathy from heparin non related coagulopathy by thromboelastography.
Aprotinin* ; Cardiopulmonary Bypass ; Healthy Volunteers ; Heparin* ; Protamines ; Reaction Time ; Serine Proteases ; Thoracic Surgery ; Thrombelastography* ; Weaning

No abstract available.
Amebiasis* ; Diabetes Mellitus* ; Humans ; Kidney* ; Liver*

Of the case of malignant astrocytoma, spontaneous transdural extension is very rare. Only several cases of transdural extension of primary intracranial tumor are reported. However, these cases are through the foramina of the skull base. We have experienced a case of malignant astrocytoma which directly extended out through the dura and calvarium near the pterion of the left side.
Astrocytoma* ; Skull ; Skull Base

We have experienced 3 cases of localized cervical adhesive arachnoiditis. 2 of them had history of operation under spinal anesthesia. Paresthetic pain and weakness are the commonest presenting symptoms and signs in our cases. Myelographically, findings are simulating the intramedullary lesion in 2 cases. With surgical intervention, 2 cases have good results.
Adhesives* ; Anesthesia, Spinal ; Arachnoid* ; Arachnoiditis*

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

Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient’s platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.
Aorta ; Aorta, Abdominal* ; Blood Platelets ; Embolism ; Extremities ; Follow-Up Studies ; Humans ; Hydroxyurea ; Ischemia ; Myeloproliferative Disorders ; Platelet Count ; Recurrence ; Thrombocythemia, Essential ; Thrombocytosis ; Thromboembolism* ; Thrombosis

A 30 years old female patient was diagnosed valvular heart disease and double valve replacement was ndertaken. After operation, mediastinitis developed and we had done continuous mediastinal irrigation and had used IV antibiotics for 3 weeks. During outpatient follow-up, infection signs developed, so she readmitted and was reoperated because CT revealed mediastinal abscess. No infected material was observed at the operation. Infection signs continued for 3 weeks. Chest CT revealed giant pseudoaneurysm of ascending aorta. We resected the pseudoaneurysm and performed an aortoplasty with bovine pericardium under deep hypothermia and total circulatroy arrest. She recovered well and was discharged without any complication.
Abscess ; Adult ; Aneurysm, False ; Anti-Bacterial Agents ; Aorta* ; Female ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Hypothermia ; Mediastinitis* ; Outpatients ; Pericardium ; Thoracic Surgery* ; Tomography, X-Ray Computed