The American surgeon
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Serum albumin and absolute hepatic albumin synthetic rates were measured in ten seriously ill injured and septic patients using the (14C) carbonate technique. Although it is commonly believed that serum albumin levels (SAL) reflect hepatic function and visceral protein status in hospitalized patients, no relationship was found between these two measured parameters in this patient population. ⋯ No significant mean SAL and albumin synthetic rate differences were noted between injured nonseptic and septic patient populations. Since albumin synthesis was elevated in most of these stressed patients these findings support the view that extravascular protein redistribution and/or increased peripheral catabolism are the major factors responsible for hypoalbuminemia in critically ill patients.
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This essay has been delivered as the William H. Harridge, Jr., M. D. ⋯ The most effective and accurate diagnostic method for disclosing an intra-abdominal abscess appears to be computed tomography (CT). The indications and anticipated success of percutaneous drainage by CT guidance has been presented. The field continues to evolve.
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The American surgeon · Jun 1985
Changes in antithrombin, antiplasmin, and plasminogen during and after cardiopulmonary bypass.
Platelet counts and several clotting parameters, especially antithrombin, alpha 2-antiplasmin, and plasminogen, were determined in 33 patients undergoing cardiopulmonary bypass surgery. Except for Factors VIII and XI, all activities measured fell significantly as the patients were placed on the pump. This initial drop paralleled the drop in hematocrit, i.e., the drop was most likely due to hemodilution. ⋯ Comparisons between activated clotting times (ACTs) and actual heparin levels revealed a good correlation (0.886). Good correlations were also noted when manual factor assays were compared with automated assays using an automated analyzer suggesting the potential use of automation and profiling for these patients. Possible reasons for some of the most commonly encountered postoperative bleeding problems are discussed.