Subject(s)
Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/physiopathology , Aortic Aneurysm/diagnostic imaging , Aortic Dissection/diagnostic imaging , Cardiopulmonary Bypass , Aortic Dissection/diagnosis , Aortic Dissection/surgery , Aorta, Thoracic/surgery , Aortic Aneurysm/diagnosis , Aortic Aneurysm/surgery , Blood Flow Velocity/physiology , Cardiopulmonary Bypass/adverse effects , Diagnosis, Differential , Humans , Male , Middle Aged , UltrasonographySubject(s)
Appendectomy , Chest Pain/etiology , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/etiology , Neck Pain/etiology , Postoperative Complications/diagnostic imaging , Subcutaneous Emphysema/complications , Trachea/injuries , Adult , Chest Pain/diagnostic imaging , Female , Humans , Neck Pain/diagnostic imaging , Rupture , Temporomandibular Joint Disorders/etiology , Tomography, X-Ray ComputedSubject(s)
Aortic Valve/surgery , Extracorporeal Membrane Oxygenation , Heart Valve Prosthesis Implantation/adverse effects , Postoperative Complications/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Algorithms , Aortic Valve/diagnostic imaging , Echocardiography, Transesophageal , Humans , Male , Middle Aged , Positive-Pressure Respiration , Postoperative Complications/diagnostic imaging , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Respiratory Function Tests , RewarmingABSTRACT
OBJECTIVE: To determine the positive and negative predictive values of visual inspection of peritoneal lavage fluid and the threshold concentration of erythrocytes for diagnosing significant hemoperitoneum by this method. DESIGN: Nineteen residents in surgery and 21 staff surgeons were asked to inspect mock peritoneal lavage fluid and state whether they would proceed with urgent laparotomy. MAIN RESULTS: The overall positive and negative predictive values for visual inspection were 52.0% and 98.9%, respectively. The threshold for diagnosing significant hemoperitoneum by visual inspection was between 10,000 and 20,000 erythrocytes/mL for most subjects. There were no significant differences between residents and staff surgeons. CONCLUSIONS: Visual inspection of peritoneal lavage fluid has good negative but poor positive predictive value, and the threshold for diagnosing significant hemoperitoneum by visual inspection is less than 100,000 erythrocytes/mL. Therefore, patients whose condition is stable and for whom visual inspection of lavage fluid indicates apparently significant hemoperitoneum should not undergo laparotomy without confirmation by laboratory testing.
Subject(s)
Hemoperitoneum/diagnosis , Peritoneal Lavage , Abdominal Injuries/diagnosis , Abdominal Injuries/epidemiology , Ascitic Fluid/cytology , Erythrocytes , General Surgery/education , Hemoperitoneum/epidemiology , Humans , Internship and Residency , Laparotomy , Medical Staff, Hospital , Peritoneal Lavage/statistics & numerical data , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
The diagnosis of infection in the intensive care unit is confounded by the presence of non-infectious causes of leucocytosis. Unless such causes are recognised, time and effort will be spent on unnecessary investigations and treatments. In a prospective study we have shown that the transfusion of blood frequently (45/50 patients) causes an acute leucocytosis in such patients. This effect was not seen in 8 patients who received plasma. Blood transfusion should be added to the list of non-infectious causes of leucocytosis in the critically ill.
Subject(s)
Leukocytosis/etiology , Transfusion Reaction , Adult , Female , Humans , Intensive Care Units , Male , Middle Aged , Plasma , Prospective StudiesSubject(s)
Anemia/genetics , Hemoglobins, Abnormal/genetics , Adolescent , Adult , Canada , Female , Hematologic Tests , Hemolysis/drug effects , Humans , Male , Ukraine/ethnologyABSTRACT
We report our experience of 4 successful pregnancies (including a pair of twins) in 3 women who have essential thrombocythemia (ET). All of the patients had a significant fall in platelet count (> 20% of non-pregnant state) during the course of the pregnancy. A review of the literature and our own experience suggests that the degree of platelet count reduction may be correlated with pregnancy outcome. Close monitoring of the platelet count is useful in the management of these cases.
