Rapid correction of prothrombin time after low-dose recombinant factor VIIA in patients undergoing orthotopic liver transplantation.

Orthotopic liver transplantation (OLTx) is associated with a major risk of blood loss resulting from portal hypertension, collateral circulation, and clotting disturbances. Application of a recombinant factor VIIa (rFVIIa) has been reported to promptly correct clotting abnormalities reducing the risk of intraoperative bleeding. This study included 8 patients who underwent OLTx for end-stage liver cirrhosis, with protrombin times (PT) exceeding the upper limit of normal by more than 4 seconds before surgery. All subjects were administered a small single intravenous dose of rFVIIa [mean 68.37 microg/kg body mass (range, 32.88-71.64)] 10 minutes prior to the skin incision. The PT was then measured 15 minutes later, following graft reperfusion, and 12 hours since drug application. All patients showed rapid correction of PT within 15 minutes after injection (median PT before injection 20.25 seconds vs 11.5 seconds after injection, P <.0001). Following the reperfusion PT was found to be prolonged again. These values are not significantly differ from those before surgery and are comparable to PT values after reperfusion in patients who did not receive rFVIIa. None of the patients developed thromboembolic complications. In conclusion, lower than recommended dose of rFVIIa caused rapid improvement in the PT shortly after injection. After reperfusion PT became prolonged again, which may account for the lack of thromboembolic complications observed in this group of patients.

[Comparisons of laparoscopic and classical adrenalectomy from personal material]. / Porównanie adrenalektomii laparoskopowej i klasycznej w materiale wlasnym.

Postoperative course in 12 patients which had laparoscopic adrenalectomy performed was compared with 8 underwent classic one in terms of operating time, blood loss, blood pressure recordings, C-reactive protein blood concentration, postoperative pain and hospital stay. The advantages of the laparoscopic approach have been stressed.

[Surgery for inguinal hernia from the extraperitoneal approach using laparoscopy--two years of personal studies]. / Operacja przepukliny pachwinowej z dostepu zewnatrzotrzewnowego z uzyciem laparoskopu--dwuletnie doswiadczenia wlasne.

From May 1995 to January 1997, 237 laparoscopic extraperitoneal inguinal hernia repairs were performed in Department of General Surgery of District Hospital in Szczecin. 197 patient had uni- and 20 bilateral inguinal hernia. The mean age of patients was 51 years. The average time of procedure and hospitalization was 38 min and 1.7 days respectively. Seven (3.2%) recurrences were observed in postoperative observation. As a conclusion, according to authors' achieved experience, one can say that the laparoscopic extraperitoneal inguinal hernia repair is in benefit both for patient and for surgeon.

Anesthesia care in the outpatient setting.

Outpatient anesthesia is a rapidly growing and dynamic specialty. The anesthetist is challenged with brisk patient turnover without compromising safety and high-quality care. Current issues of patient selection, equipment and monitoring, drugs used in outpatient anesthesia, liposuction, recovery and discharge criteria, and legal aspects are addressed.