Clinical application of viscoelastic point-of-care tests of coagulation-shifting paradigms

Bleeding during cardiac surgery, liver transplant, trauma and post partum hemorrhage are often multifactorial and these factors are dynamic as new factors crop up during the course of management. Conventional tests of coagulation offer information of a part of the coagulation system and also is time consuming. Viscoelastic point of care tests (VE POCTs) like rotational thromboelastometry, thromboelastogram and Sonoclot, are based on analysis of the viscoelastic properties of clotting blood and provide information for the entire coagulation pathway. In this comprehensive review being presented here, we have examined the pros and cons of VE POCTs including clinical, cost and survival benefits. The recommendations of the various guidelines regarding use of VE POCTs in various scenarios have been discussed. The review also tried to offer suggestions as to their optimal role in management of bleeding during cardiac surgeries, extracorporeal membrane oxygenation, left ventricular assist devices, liver transplant and briefly in trauma and postpartum hemorrhage.

Fine needle aspiration biopsy in the management of tumours in superolateral quadrant of orbit.

Forty-two cases of orbital lesions in superolateral quadrant were evaluated in our study by fine needle aspiration biopsy. Cases were histologically proven wherever possible. In 92.85% cases the diseases were correctly diagnosed. Females were mainly affected. Lymphomatous tumours were diagnosed on the basis of atypical lymphoid proliferation, correlated with clinical features and findings of computed tomographic scan and managed by radiotherapy. Pseudotumours, dermoid and epithelial tumours of lacrimal gland were diagnosed accurately except in one case of malignant mixed tumour where the malignant component was aspirated. Pseudotumours were treated by steroid, dermoid by excision. In case of adenocarcinoma and adenocystic carcinoma, tumour masses were removed by lateral orbitotomy and radiotherapy was applied when bony erosion was present. One case of eosinophilic granuloma was treated by radiotherapy and curettage. The suspected case of intra-osseous cavernous haemangioma did not turn up for treatment.