Fibrin glue achieves hemostasis in patients with coagulation disorders.

Fibrin glue (FG), made with highly concentrated human fibrinogen and clotting factors, was used to achieve parenchymal organ hemostasis in patients with disordered coagulation secondary to massive transfusion, chronic disease, and disseminated intravascular coagulation; it was effective in controlling liver hemorrhage in seven patients and in the performance of a splenorrhaphy in one other patient. The coagulation profile was grossly abnormal in all patients, and the mean +/- SD intraoperative blood loss was 5.1 +/- 4.2 L; patients received 14 +/- 10 U of blood perioperatively. The amount of FG required to achieve hemostasis varied directly with the extent of injury and intraoperative blood loss (r = .84), and all patients with a blood loss greater than 4 L required at least 25 mL of FG to stop bleeding. Two patients died postoperatively secondary to cardiac arrest and adult respiratory distress syndrome. Because FG does not depend on adequate platelet or clotting factor levels to be effective, it is especially useful in patients with parenchymal organ hemorrhage and disordered coagulation.

Fibrin glue in renal and ureteral trauma.

Fibrin glue (FG) made with highly concentrated human fibrinogen and clotting factors was used to achieve hemostasis of fourteen renal injuries and to seal three ureteral anastomoses in 15 patients. The cause of injury included twelve gunshot wounds, four stab wounds, and one iatrogenic ureteral injury. The mean intraoperative blood loss was 1.6 +/- 1.1 L (SD), and patients received 4 +/- 5 units of blood perioperatively. Utilizing the described techniques, FG was effective in achieving hemostasis and sealing ureteral suture lines against leakage in all cases. There were no cases of renal infection, rebleeding, urinary fistulas, delayed rupture, stone formation, or urinary tract obstruction. Two patients underwent re-exploration for causes unrelated to their renal or ureteral injuries. The use of FG was associated with less reliance on suture redundancy to achieve parenchymal hemostasis and perform ureteral anastomoses. FG sealing of renal and ureteral injuries is a safe and effective technique for controlling hemorrhage and sealing anastomoses. It is effective in the management of both superficial and deep renal injuries.

Clinical use of nonautologous fibrin glue.

Nonautologous, highly concentrated human fibrinogen and clotting factors were used in the form of fibrin glue to treat three patients with varied surgical problems that were resistant to conventional treatment. Fibrin glue was used to occlude longstanding enterocutaneous fistulae, control liver hemorrhage in an alcoholic patient with coagulopathy, and perform a splenorrhaphy, following a gunshot wound to the spleen. Fibrin glue is effective in establishing hemostasis and sealing tissues; its use is a helpful adjunct in the care of surgical patients.

Multicomponent noninvasive physiologic monitoring of circulatory function.

A multicomponent noninvasive monitoring system for high-risk critically ill patients was developed and tested in a series of 58 high-risk surgical patients. The system was comprised of a thoracic electric bioimpedance (TEB) method for cardiac output estimation, laser-Doppler velocimeter for small vessel flow, transcutaneous oxygen (PtcO2) sensor for tissue oxygenation, pulse oximeter for arterial hemoglobin saturation (SaO2) and finger pressor sensor for arterial pressure. In a series of critically ill patients, this noninvasive system was compared with the widely used invasive monitoring system with systemic and pulmonary artery catheters. Despite theoretical limitations of TEB as a measure of cardiac output, there was a satisfactory correlation (r = .83) of cardiac output measured by thermodilution (TD) and TEB throughout a wide range of severe illnesses. Moreover, changes in TEB cardiac output satisfactorily tracked changes in TD cardiac output (r = .91). There was poor correlation between TD cardiac output and BP or heart rate. The incidence of abruptly changing physiologic patterns was observed with simultaneously monitored invasive and noninvasive systems. Descriptions were made of the central circulation, peripheral perfusion, and pulmonary function; common interactive responses of these circulations were also evaluated. Monitored events defined as abrupt reductions in these variables often occurred from reduced cardiac output, PtcO2 or PtcO2/PaO2 index, and infrequently from unanticipated reductions in SaO2. Recovery from the nadir of the monitored event was associated usually with improvements in flow, PtcO2, or both. Hemodynamic and oxygen transport patterns of a few commonly encountered patterns are described.

Stereotactic core needle biopsy of mammographic breast lesions as a viable alternative to surgical biopsy.

BACKGROUND: Stereotactic needle biopsy technique has received considerable attention as a possible alternative to surgical biopsy of nonpalpable breast lesions. The exact role of this procedure in the management of mammographic breast lesions has not yet been accurately defined. METHODS: Data have been collected prospectively on 416 patients over an 8-month period (January 1992 through August 1992). Of 416, 356 patients underwent only stereotactic breast biopsy with a 14-gauge needle. Sixty patients underwent stereotactic breast biopsy followed by surgical biopsy. Based on mammographic findings before biopsy, lesions were classified as benign (24%), likely benign (49%), malignant (2%), likely malignant (6%), and indeterminate (19%). The number of core biopsy specimens obtained from each patient ranged from one to six. RESULTS: The specimen was considered adequate in 98% of cases. Complications were minimal. The tissue diagnosis was benign in 92% and malignant in 8% of patients. In those patients undergoing surgical and stereotactic biopsy, 57 of 60 had matching histopathological results, representing an agreement rate of 95% (p < 0.001). The three patients whose histopathological results did not match had malignant diagnoses on stereotactic biopsy that were subsequently not identified in the modified radical mastectomy specimen because the entire focus of malignancy was removed by the several passes made by the core needle during biopsy. No patient had a negative stereotactic biopsy result in whom malignancy was later detected by surgical biopsy. CONCLUSIONS: This study indicates excellent agreement between surgical and stereotactic needle biopsy findings. Stereotactic biopsy with a 14-gauge needle could obviate the need for surgical biopsy in certain women with radiologically benign, likely benign, and indeterminate lesions.