ABSTRACT
Few guidelines exist for determining transfusion needs and strategies, namely, the appropriate use of autologous versus homologous blood for elective vascular surgery. To address this deficiency, we have developed and used an algorithm based on an analysis of the procedure, maximum surgical blood ordering schedule, patient status, and patient suitability for autologous alternatives. Data were derived from consecutive major vascular procedures done at our hospital from 1991 to 1992. The algorithm helps the surgeon assess transfusion need and patient suitability for autologous predonation and aids in selecting appropriate transfusion alternatives. Using this algorithm during the past year with 120 patients, we simplified transfusion decisions, reduced homologous blood use (to only 4.2%), and reduced wasting of autologous blood to less than 5% of the units predonated. We believe that the use of this algorithm will aid the vascular surgeon in choosing appropriate alternatives to allogeneic blood transfusion, thereby reducing the patient's exposure to risk. The algorithm should also reduce wasting of autologous blood.
Subject(s)
Algorithms , Blood Loss, Surgical/prevention & control , Blood Transfusion , Patient Care Planning , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Blood Transfusion, Autologous , Female , Humans , Male , Middle Aged , Preoperative CareABSTRACT
This technique of totally diverting loop colostomy may be performed as an independent procedure or with exploratory laparotomy and surgical treatment on the distal part of the colon. Either a transverse or sigmoid loop colostomy can be used for diversion without the risk of fecal contamination of the peritoneal cavity, particularly when working with unprepared intestine. When distal irrigation is desired to purge the intestine of fecal material, either intraoperatively or as part of a subsequent intestinal preparation, it can easily be accomplished by placing an irrigating catheter distal to the staple line. In addition, the use of a small rubber suspension bar facilitates application of standard colostomy appliances for the stoma.
Subject(s)
Colostomy/methods , Therapeutic Irrigation/methods , HumansABSTRACT
The vasoactive intestinal polypeptide was present in synaptosomal (nerve ending) preparations from cerebral cortex, hypothalamus, and striatum of rat brain in higher concentrations than in these tissues as a whole. The total content and relative specific activity of the peptide increased with progressive purification of the synaptosomal fractions and generally followed the distribution of known synaptosomal constituents--dopamine, norepinephrine, and lactate dehydrogenase (L-lactate:NAD+ oxidoreductase, EC 1.1.1.27). The peptide was also released from synaptosomal pellets with increased K+ concentration, and this release was Ca2+-dependent. The findings suggest a role for vasoactive intestinal polypeptide as a transmitter or modulator of synaptic function.
