American journal of therapeutics
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Randomized Controlled Trial Comparative Study
Does HBOC-201 (Hemopure) affect platelet function in orthopedic surgery: a single-site analysis from a multicenter study.
HBOC-201, Hemoglobin glutamer-250 (bovine), (Biopure Corp., Cambridge, MA) has been studied in an international, multicenter, pivotal Phase III trial. A subset analysis of use of blood products indicated that the HBOC-201 group required no more than the packed red blood cell (PRBC) group and was limited to less than 6% in both treatment groups. In a subset analysis from one site, platelet function using PFA-100 was assessed before and after transfusion, and compared those receiving HBOC-201 versus PRBC. ⋯ Our study shows that HBOC-201 causes mild platelet dysfunction. Although there were significant changes after HBOC infusion and cEPI and cADP mean values were above the upper normal limit, they did not reach the non-closure time. Further controlled studies are needed to establish definitively the effects that HBOC-201 has on platelet function in patients.
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Review Case Reports
Sevoflurane hepatotoxicity: a case report of sevoflurane hepatic necrosis and review of the literature.
Sevoflurane, a halogenated anesthetic, is associated with mild aminotransferase elevations but does not tend to cause clinically significant hepatotoxicity. We report a rare case of severe hepatic necrosis following exposure to sevoflurane during surgery. A 37-year-old man presented with nausea,vomiting, abdominal pain, and jaundice on the third postoperative day after an abdominal wall mass resection. ⋯ The patient was likely susceptible to toxicity due to an underlying EBV infection and a probable history of exposure to halogenated anesthetics. Sevoflurane is generally considered to be relatively safe for subjects with mild liver dysfunction, in comparison with other halogenated anesthetics. However, this case suggests that sevoflurane can lead to severe life-threatening hepatic necrosis in at-risk individuals.
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The discovery of the anesthetic properties of chloroform by Sir James Simpson is one of the therapeutic triumphs of the 19th century. Queen Victoria requested chloroform anesthesia for the birth of her second son, Prince Leopold, and from then until the end of century chloroform was the most popular general anesthetic for obstetrics and surgery. Chloroform was so pleasant to inhale that it became a drug of abuse and was involved in all sorts of criminal activity. ⋯ Whicher," the Detective Inspector assigned to the case by Scotland Yard. According to Ms Summerscale's records, Mr Whicher ignored the possibility that chloroform was involved in Saville's death. However, evidence supports the view that chloroform played a critical role in the crime and indicates that the guilty plea by Samuel Kent's daughter, Constance, for which she spent 20 years to the day in prison, was as inaccurate as it was incomplete.
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We report on an eighty five year old male who had presented with bradycardia and a prominent J wave on EKG. Initial attemps to treat bradycardia with atropine were unsuccessful and on further evaluation the patient was found to have hypothermia.