A simple preparation of autologous fibrin glue for skin-graft fixation.

Numerous uses of fibrin glue as a sealant, hemostatic agent, and adhesive have been reported. We developed a simple method of preparing autologous fibrin glue for skin-graft fixation. Fifty patients have undergone the autologous fibrin glue technique for trauma, burns, and difficult wounds. The mean area grafted was 237 cm2 (range 50 to 700 cm2), and grafts were typically 0.012 to 0.016 inch thick (meshed 1.5:1). A standard gauze dressing was applied to all wounds, and no sutures or staples were used. At a mean follow-up of 3.4 months (range 1 to 9 months), 45 of 50 patients had over 95 percent take, and no patient had less than 90 percent take. There were no adverse reactions or infections noted, and no patient required additional grafting. This method offers a simple, cost-effective alternative for skin-graft fixation that leads to minimized postoperative care, subjectively cleaner wounds, and high patient satisfaction.

The role of various antithrombotic agents in microvascular surgery.

The ultimate goal in microvascular surgery is to achieve improved patency rates while reducing complications of systemic antithrombotic agents. Using a described model of microarterial thrombosis, the antithrombotic effects of oral aspirin (ASA) were assessed in rats. ASA-treated animals (30 mg/kg orally) exhibited significantly prolonged mean bleeding times 1 h and 24 h after dosing when compared to controls (p < 0.01). Platelet aggregation profiles also displayed an inhibition of platelet aggregation in the ASA group relative to controls. In the thrombosis model, however, patency rates were significantly improved at 20 min, but all vessels were thrombosed at 24 h.

Laparoscopic appendectomy: is it worth it?

Data on all laparoscopic appendectomies (LA) were collected prospectively from June 1990 through July 1992 and compared retrospectively with all open appendectomies (OA) done at the same hospital during the same time period. Laparoscopic appendectomies were performed in 29 patients (ages 15-47, mean 25.3 years) and OA in 77 patients (ages 18-71, mean 31.9 years, P < 0.01). Preoperative findings were similar in the two groups. Acute appendicitis was confirmed in 22 (76%) LA and in 57 (74%) OA; of these, 9/22 (41%) LA and 23/57 (40%) OA were gangrenous or perforated. A normal appendix was removed in seven (24%) LA and in 20 (26%) OA. Three patients (10%) required conversion of LA to an open procedure. Operative time was significantly longer for LA (mean 105 minutes) compared with OA (mean 69 minutes; P < 0.001). Postoperative complications requiring further intervention (wound infection or intraabdominal abscess) occurred in three LA (10%) and in 23 OA (30%, P < 0.05). Wound morbidity as measured by number of wounds left open at surgery or opened for infection was significantly less after LA (14% LA, 39% OA, P < 0.001). Hospital stay was significantly shorter after LA (mean 4.2 days) compared with OA (mean 6.3 days; P < 0.05). Hospital charges and professional fees were not significantly different between the two groups. In selected patients, LA is a safe, effective alternative to OA, with fewer complications and shorter hospital stay. In addition, hospital charges are similar, making an investment of more time in the operating yield an outcome equal or superior to OA.

Effects of ketorolac tromethamine (Toradol) on a functional model of microvascular thrombosis.

Ketorolac tromethamine (Toradol), a potent nonsteroidal anti-inflammatory drug used for postoperative pain, also strongly inhibits platelet aggregation. The anti-thrombotic effects of intramuscular ketorolac were assessed with a described rat model of microarterial thrombosis. After a single dose of ketorolac mean bleeding times were significantly prolonged (p < 0.01) and platelet aggregation was markedly reduced. Patency rates at 20 min were significantly higher in ketorolac groups compared to controls (p < 0.005). However, all vessels were thrombosed at 24 h. Scanning electron microscopy demonstrated decreased platelet aggregation and decreased thrombus formation in ketorolac treated animals at 20 min. The prolonged bleeding time and reduction in platelet aggregation add support to concerns of bleeding complications reported in patients treated with ketorolac perioperatively. Thus, ketorolac should probably not be used for pain relief in patients in whom postoperative haematoma formation is a particular concern. In addition, in this model, ketorolac as a single agent was ineffective for long-term prevention of microarterial thrombosis.

Determining conservation priorities.

One important component in achieving an optimal compromise between mineral development and environmental conservation is to rank different geographical areas according to their priorities for development and conservation respectively. The latter is considered here.There are three main steps in assigning conservation priorities: (i) acquisition and assessment of information on the existing baseline environment and on potential impacts; (ii) assignment of values to the environmental components concerned and integration of these to yield overall values for alternative possible conservation targets; and (iii) incorporation of logistic considerations to determine the practical priorities for conservation.One particularly critical aspect of this process is the relative significance of different conservation criteria, specifically including the presence of rare species, high diversity, pristine condition and representativeness. These criteria all reflect the same underlying conservation values, but their relative significance varies from case to case. Their integration is based on professional judgement rather than any formal algorithm and explicit guidelines for such judgement are needed to promote consensus in the determination of conservation priorities.