Asunto(s)
Fiebre de Origen Desconocido/etiología , Anciano , Regulación de la Temperatura Corporal/fisiología , Diagnóstico Diferencial , Fiebre de Origen Desconocido/fisiopatología , Anciano Frágil , Hogares para Ancianos , Humanos , Casas de Salud , Guías de Práctica Clínica como Asunto , Valores de ReferenciaAsunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Aortitis/diagnóstico , Vena Cava Inferior , Trombosis de la Vena/etiología , Anciano , Aneurisma de la Aorta Abdominal/complicaciones , Aortitis/complicaciones , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Factores de Riesgo , Trombosis de la Vena/diagnósticoRESUMEN
Conventional laboratory investigations of haemostasis like prothrombin time and activated partial thromboplastin time are not useful in predicting and managing intra-operative bleeding complications. In order to establish a possible "perioperative reference range" for thrombin generation prothrombin fragment F1+2 (F1+2) and fibrin degradation (D-dimer) markers, we measured F1+2 and D-dimer concentrations before surgery (but after induction of anaesthesia), 30 minutes into surgery, 10 minutes after the event expected to induce the maximal activation of the haemostatic systems, 90 minutes after surgery and on postoperative days 1 and 2 in 226 consecutive patients. Samples were collected from arterial lines. Twenty patients developed a clinically defined, intraoperative disorder of haemostasis, 206 did not. Patients with an intraoperative disorder of haemostasis had significantly higher preoperative F1+2 and D-dimer concentrations. Preoperative values for F1+2 and D-dimer concentrations above the 75th percentile of patients without an intraoperative disorder of haemostasis indicated a 2.70 to 2.88 fold risk of developing an intraoperative disorder of haemostasis (odds ratios were 3.04, 3.12 and 3.29 for D-dimer, ELISA, F1+2, and D-dimer latex tests, respectively with 95% confidence intervals from 1.20 to 8.46) with negative predictive values of 94%, but positive predictive values of only 16% to 26%. These data suggest that preoperative determination of molecular markers might be helpful in identifying a group of patients at high risk for intraoperative disorder of haemostasis by exclusion of low risk patients. Validation of such an approach requires a prospective trial.
Asunto(s)
Coagulación Sanguínea , Pérdida de Sangre Quirúrgica/prevención & control , Hemostasis , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/prevención & control , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Complicaciones Intraoperatorias/sangre , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/sangre , Protrombina/metabolismo , Factores de RiesgoRESUMEN
One hundred fifty thousand cells in a vaginal, ectocervical and endocervical smears from 25 patients with poorly to moderately differentiated squamous cancer of the uterine cervix were evaluated to determine the numerical composition of cellular clusters, the sizes of the clusters and the cellular types contained. The study is a baseline assessment for the design of automated cytology devices for which monocellular layers or individual cells are of importance. The evaluation indicates that the majority of cells appear in actual or facultative clusters, and that dispersement or breaking up of these clusters can yield improved machine-readable samples.