The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis.

BACKGROUND: Venous thromboembolism (VTE) is a major worldwide problem. OBJECTIVES: The primary objectives of this survey were to identify patients at risk for VTE, to define the rate of patients receiving appropriate VTE prophylaxis and to examine the frequency of the presence of guidelines and their application. PATIENTS AND METHODS: Ten countries, 101 hospitals and a total of 4983 patients were included in this multinational cross-sectional survey. Standardized case report forms were filled out by trained individuals on one predefined day. Risks were categorized according to the Caprini Risk Assessment Model. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. RESULTS: Of 4983 patients, 3368 (68%) and 1615 (32%) were surgical and medical, respectively. Seven hundred and seventy-two (15.5%) were considered to be at low risk, 1001 (20%) at moderate risk, 1289 (26%) at high risk and 1921 (38.5%) at very high risk for VTE. Of 3575 (72%) patients who were eligible to receive VTE prophylaxis, 2747 (77%) received any drug prophylaxis. Among these patients 720/1056 (68%) and 2027/2519 (80%) were medical and surgical patients, respectively. The overall compliance with ACCP guidelines was 38%, being 24% for medical patients and 44% for surgical patients. CONCLUSIONS: The results of this large multinational survey, although indicating overall improvement in VTE prophylaxis, identify a considerable number of patients who either did not receive any VTE prophylaxis or received it inappropriately. Although more medical patients were at risk for VTE, they were given prophylaxis less frequently than surgical patients. Concordance with VTE prophylaxis guidelines was higher in surgical patients, but overall application of these tools was unacceptably low.

Organ retrieval from brain-dead patients by a single organ procurement center in Iran.

INTRODUCTION: The majority of transplantations depend solely on cadaveric organs. In recent years, special focus has been directed toward brain-dead patients in Iran, but it seems that there is limited information regarding the characteristics of cadaveric organ donation in our country. MATERIALS AND METHODS: This is a retrospective analysis of data of our Organ Procurement Unit (OPU), which is one of the most active organ procurement units in Iran. We incorporated the data on all organ donations from brain-dead patients between 2004 and 2008 into the present study. Demographic characteristics of the patients along with data regarding brain death and organ donation were extracted from already registered data on patients. RESULTS: Among 93 brain-dead patients registered in the database of the OPU, organs were retrieved from 85% (n = 79). Out of the 14 patients from whom no organ was retrieved, the cause for this failure was death before donation in 85% (n = 12). The numbers of donated organs varied between zero and six (mean +/- standard deviation = 3.1 +/- 1.7). The most donated organs in terms of frequency and count were: right kidney (n = 68; 73.1%), left kidney (n = 67; 72%), liver (n = 63; 67.7%), heart (n = 40; 43%), pancreas (n = 5; 5.4%), and lung (n = 4; 4.3%). DISCUSSION: The overall organ retrieval rate from brain-dead patients by this OPU was comparable to that of developed countries; however, we still believe we can improve this rate/scale.

Modified sleeve anastomosis in large muscular arteries of sheep.

OBJECTIVE: The purpose of this investigation was to test a modified telescopic anastomosis in large muscular arteries. MATERIAL AND METHODS: The right carotid arteries in 30 sheep (average weight 57+/-5.7 kg) were transected and anastomosed end to end using two guided sutures and compared with a control group (10 sheeps) using two external sutures (Lauritzen method). RESULTS: The mean time to complete the anastomosis (4.5 min) and hemostasis (4.3 min) in the experimental group was less than the control group (17.3 min for anastomosis and 6.4 min for hemostasis) (P<0.05). In addition, the total amount of blood loss during the modified anastomosis was significantly lower than Lauritzen method (3.8 versus 8 ml). In both experimental and control groups the scanning electron microscopy (SEM) at 90th day post-operation revealed a continuous smooth layer of endothelial cells covering the anastomotic junction. CONCLUSIONS: Anastomosis with two guided sutures is easy and faster to perform and could be applicable to an acutely transected vessel.