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Biomedical subjects

G C Caroli

Publications and source records attributed to G C Caroli.

At least 19 recordsLinked to original sources
PubMed1997

Autotransfusion in major orthopaedic surgery: experience with 1785 patients.

Using a prospective audit, we have evaluated the efficacy of an integrated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We examined prospectively the records of 1785 patients (1198 females, 5867 males, mean age 62 (range 16-90) yr, preoperative haemoglobin concentration 13.4 (SD 1.4) g dl-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD + THA, 18 patients), total knee arthroplasty (TKA, 263 patients), revision surgery of the hip (HR cup + stem revision, 197 patients; cup revision, 53 patients; stem revision, 16 patients) and total knee revision (TKR, nine patients). We estimated that the number of predonations (MSBOS = maximum surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with fixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions were carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, higher ASA rating and co-existing diseases such as coronary artery disease.

Adolescent↗
PubMed1994

Short-term cardiac adaptation to severe haemodilution: an echocardiographic study in normal and hypertensive subjects.

In order to avoid transfusion risks and optimize blood bank resources, in recent years many blood sparing techniques have been proposed, including severe haemodilution. The aim of this study is to assess the pattern of normal haemodynamic and cardiac adaptation to severe haemodilution in patients undergoing major orthopaedic surgery and refusing blood transfusions for religious reasons (the patients were Jehovah's Witnesses). Two-dimensionally guided M-mode echocardiograms were performed at baseline and 4 days after major orthopaedic surgery in 26 Jehovah's Witnesses (age 61 +/- 11 years), with normal regional and global baseline left ventricular function and no valvular disease. Left ventricular (LV) volumes were estimated by using the Teichholz formula. From the latter, we calculated ejection fraction and stroke volume, cardiac output (stroke volume x heart rate), and total peripheral resistance estimated as mean arterial pressure by cuff sphygmomanometer x 80/cardiac output. On the basis of LV mass (ASE-cube corrected by Devereux), two groups were identified: non-hypertrophic (LV mass index < 110 g.m-2 in women and < 130 g.m-2 in males) and hypertrophic. In the 19 patients without LV hypertrophy, haemoglobin decreased from 13.5 +/- 1.6 (mean +/- standard deviation) g.dl-1 (at baseline) to 8.7 +/- 1.3 post-operation (P < 0.01), and peripheral vascular resistances fell from 2131 +/- 450 to 1278 +/- 310 (dyne.s.cm-5) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Christianity↗
PubMed1994

[Consensus conference. Saving blood: which are still the doubts and the problems?].

The consensus conference on blood saving has allowed us to formulate some interesting guidelines. The autologous and homologous transfusion require the patient's consent. For volemic replacement crystalloid solutions are used for phlebotomies below 10-15%, and colloid solutions for those greater than 10-15% of the blood mass. Severe isovolemic hemodilution (Ht < 20%) necessitates the reduction of the dosage of some drugs. A limit of Hb around 9 g/dl after phlebotomy may be acceptable in the absence of cerebral and coronary vascular disease. Phlebotomies are therefore possible also when the Hb values are 10 g/dl (Ht 30%). Hb values around 7 g/dl in the late postoperative period (from day 3 to 6) may be accepted only if well tolerated. The blood salvaged during surgery and at the beginning of the postoperative phase must always be centrifugated, washed and microfiltered. Subsequently, in the first 8 hours it is possible to reinfuse red cells after sedimentation and microfiltration. The techniques of predeposit, hemodilution and recovery are valid especially if associated with careful control of postoperative bleeding by means of aspiration under controlled pressure (at minimum negative values and sometimes positive ones), monitoring of blood loss from drainage and application of elastic compression bandages.

Blood Loss, Surgical↗
PubMed1992

Prevention of deep vein thrombosis in orthopaedic surgery. Comparison of two different treatment protocols with low molecular weight heparin ('Fluxum').

The efficacy of two treatment protocols with a low molecular weight heparin used for the prevention of post-operative deep vein thrombosis was compared in 40 patients undergoing hip replacement surgery. The aim was to assess whether the different timing--2 hours before (Group A, 19 patients) or 2 hours after (Group B, 21 patients) the surgical operation--of the first dose administered (15,000 aXaU) of a therapeutic cycle of 7 days could affect the results, both with respect to the preventive efficacy and to the risk of haemorrhage often connected with antithrombotic therapy. The results showed that the incidence of deep vein thrombosis was very similar and extremely low in the two groups, only 1 patient in each group having a positive diagnosis on phlebography. The effectiveness of a single daily dose of 15,000 aXaU in orthopaedic surgery was also confirmed. This dose guaranteed effective prophylaxis against the onset of deep vein thrombosis and did not appear to have any local side-effects (such as burning or pain at the site of injection) which could diminish patient compliance.

Aged↗
PubMed1991

[Spinal trauma].

Explore the source record for details and available documents.

First Aid↗
PubMed1989

[Reduction and early surgical stabilization of fractures and fracture-luxations in cervical vertebral and spinal cord injuries].

A series of 21 patients with cervical spinal trauma, 12 patients with complete spinal lesion and 9 with incomplete spinal lesion, is reported. All these patients have been treated with surgical reduction and stabilization at average 9 hours after trauma. The authors point out pre- and intraoperative anesthesiological problems connected with early surgical operation and discuss the postoperative complications. At the follow-up of average 2 years the results were: among the 12 patients with complete spinal lesion, 2 died, 2 improved until the deambulation, 7 didn't change and 1 had no follow-up; among the 9 patients with incomplete spinal lesion, 7 improved until the deambulation, 1 didn't change and 1 worsened. Independently of the neurological recovery, the early surgical stabilization enables to reduce remarkably the incidence of the complications, to start precociously a rehabilitation, to improve the patient's expectation of life.

Adolescent↗
PubMed1984

Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection.

Local injection of radiopaque medium demonstrated the presence of intracystic fibrous septa in 13 patients with solitary bone cyst. Contrast examination was helpful in predicting the response of solitary bone cysts to treatment by injection of methylprednisolone-acetate (MPA). As the number of septa increased, an increased difficulty in obtaining an equal distribution of MPA inside the cyst and a higher incidence of incomplete healing of the cyst was encountered.

Adolescent↗