RESUMEN
A study was undertaken to evaluate the current use of autologous blood predonation within 3 weeks of reduction mammaplasty in our institution. A retrospective study of 153 consecutive patients undergoing reduction mammaplasty between April of 1987 and October of 1992 was analyzed. Nine patients were excluded because of inadequate data, leaving 81 patients in the autologous blood predonation study group and 63 patients in the control group. The two groups were similar with regard to age, preintervention hemoglobin levels, technique of reduction mammaplasty, average number of grams excised per side, estimated blood loss, and duration of hospital stay. Those in the study group, despite preoperative iron therapy initiated just prior to the time of autologous blood donation, had significantly lower preoperative hemoglobin levels (p < 0.001). Seventy-two percent of those patients who donated blood preoperatively received all their blood intraoperatively or within 1 day of surgery. Eleven percent received 1 of their 2 units donated, and the remaining 17 percent were not transfused. Despite 83 percent of the study group patients receiving all or some of their predonated blood, their postoperative hemoglobin levels were not significantly different from those of the control group. We concluded that under our current program, autologous blood predonation for reduction mammaplasty is not beneficial to the patient in the immediate perioperative period.
Asunto(s)
Transfusión de Sangre Autóloga , Mamoplastia/métodos , Adulto , Transfusión de Sangre Autóloga/estadística & datos numéricos , Femenino , Hemoglobinas/análisis , Humanos , Estudios RetrospectivosRESUMEN
Eighteen patients with major burns (mean total body surface area burned was 49% and mean total body surface area with full-thickness burns was 38%) had cultured epithelial autografts applied to 2% to 35% of the body surface area. In six patients successful "take" of greater than 65% occurred, and in 12 patients less than 40% "take" occurred. Most wounds underwent early excision to subcutaneous fat or fascia, and the wounds of 16 patients had been treated previously with homograft. Cultured epithelial autografts were covered with either single or multilayered dressings. Perioperative wound cultures showed that all patients had microorganisms, and appropriate perioperative antibiotic coverage of Staphylococcus epidermidis and Pseudomonas aeruginosa was noted less frequently in the poor take group, which may have influenced subsequent cultured epithelial allograft take. Adherence and stability of cultured epithelial allografts lag behind adherence and stability of meshed split-thickness autograft. The anterior trunk and thighs are the best recipient sites. The number of autograft harvests that were required to close wounds and the length of hospital stay were not significantly decreased by the use of cultured epithelial allografts as compared with comparable full-thickness burns that were treated previously without cultured epithelial allografts. Presently, grafting with cultured epithelial allografts is an adjunct but not an alternative to conventional burn-wound coverage with split-thickness autograft, because engraftment is inconsistent.
Asunto(s)
Quemaduras/cirugía , Trasplante de Piel/métodos , Adolescente , Adulto , Antibacterianos/uso terapéutico , Quemaduras/epidemiología , Células Epiteliales , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Trasplante de Piel/fisiología , Trasplante Autólogo , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/epidemiologíaRESUMEN
Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization by Staphylococcus aureus was less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization by Enterococcus faecalis, Pseudomonas aeruginosa, or Enterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization by S. aureus (35% versus 51%, p = 0.03) and P. aeruginosa (8% versus 16%, p = 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization by S. aureus.
Asunto(s)
Bacterias/crecimiento & desarrollo , Quemaduras/microbiología , Clorhexidina/análogos & derivados , Sulfadiazina de Plata/uso terapéutico , Administración Tópica , Adolescente , Adulto , Aerosoles , Análisis de Varianza , Bacterias/efectos de los fármacos , Niño , Clorhexidina/uso terapéutico , Recuento de Colonia Microbiana , Quimioterapia Combinada , Humanos , Persona de Mediana Edad , Nariz/microbiología , Faringe/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/crecimiento & desarrollo , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Four major burns (two flame, one scald, one electrical) were managed without administration of blood or plasma. Serial changes in hemoglobin, and serum albumin and total protein measurements were compared with those of controlled patients matched in age and total body surface area burned who were treated by standard methods. Hemoglobin values were lower but within one standard deviation, although serum protein and albumin measurements fell more than one standard deviation below mean values observed in control patients at comparable times after burn injury. Important treatment principles that were instrumental to recovery include a high-calorie, high-protein diet, iron supplementation, use of pediatric blood sampling techniques, and monitoring for and prophylaxis against infection while allowing eschar to separate spontaneously rather than performing early debridement. Amputation of mummified electrically burned limbs at more proximal levels, including marginally viable muscle, is recommended to minimize infection and decrease blood loss associated with customary conservative serial debridements.
Asunto(s)
Transfusión Sanguínea , Quemaduras/terapia , Adulto , Proteínas Sanguíneas/análisis , Quemaduras/sangre , Quemaduras/cirugía , Quemaduras por Electricidad/cirugía , Quemaduras por Electricidad/terapia , Desbridamiento , Hemoglobinas/análisis , Humanos , Lactante , Masculino , Cooperación del Paciente , Plasma , Albúmina Sérica/análisis , Infección de Heridas/terapiaRESUMEN
In acute myeloid leukaemia the peripheral leukocyte count is known to be a prognostic factor. The preserved capacity of leukaemic cells to mature has also been suggested to be one. In a series of 179 cases of adult acute myeloid leukaemia peripheral leukaemic cell count and degree of maturation were found to be inversely correlated. As the degree of maturation of leukaemic cells in peripheral blood was lower than that in bone marrow in the majority of cases, blast cells appear to be released more easily from the marrow than cells that have matured to some extent in the direction of the larger promyelocytic or promonocytic cell type. In a series of 35 cases we found peripheral blast cells to be smaller than those in bone marrow. Moreover, central blast cell diameter and peripheral leukaemic cell count were inversely correlated. Therefore, leukaemic cell size or some factor related to it may contribute to the preferential egress of small immature cells from the marrow. Differences in proliferative activity could not account for the inverse correlation between degree of maturation and leukaemic cell count.
Asunto(s)
Leucemia Mieloide Aguda/patología , Leucocitos/patología , Adulto , Médula Ósea/patología , Granulocitos , Humanos , Leucemia Mieloide Aguda/sangre , Recuento de Leucocitos , Mitosis , PronósticoRESUMEN
PIP: An updated definition of microsurgery includes the application of magnification techniques to basic surgical principles and the functional restoration of body structures by means of the direct union of parts or transfer of tissue using microsurgical techniques. Nylen performed the 1st surgery under magnification with the use of an operating microscope in Sweden in 1921. With the expanding scope of microsurgery, it becomes obvious that it is a surgical technique clinically applicable in every surgical specialty. The equipment for microscopy is microscopes, sutures, jeweler's forceps, needle holders, scissors, and coagulators. In microsurgery, all surgical movements have been reduced to a pinch mechanism between thumb and index. The instruments have been designed with this in mind and are characterized by small precision tips, light balanced proportions, pinch closure, and nonreflective surfaces. Long handled instruments are necessary for neurosurgery and gynecology due to the depth of the working field. The perfection of the microsurgery technique begins with extensive practice in the research laboratory. Clinical microsurgical reconstruction should be attempted only when competence has been achieved in the laboratory.^ieng