The Journal of surgical research
-
Comparative Study
Liquid plasma use during "super" massive transfusion protocol.
A massive transfusion protocol (MTP) presents a logistical challenge for most blood banks and trauma centers. We compare the ratio of packed red blood cells (PRBC) and plasma transfused over serial time points in those requiring MTP (10-30 U PRBC/24 h) to those requiring "super" MTP (S-MTP; >30 U PRBC/24 h) and test the hypothesis that changes in allocation of blood products with use of readily transfusable liquid plasma (LP) improves the ratio of PRBC and plasma during S-MTP. ⋯ Within the first hour of transfusion, units of PRBC transfused positively correlated with PRBC:plasma, and patients receiving S-MTP had higher PRBC:plasma than those receiving MTP. Changes in our institution's MTP protocol to include LP improved the early PRBC:plasma transfused in patients requiring S-MTP.
-
Pediatric patients who undergo liver transplantation are at higher risk of developing vascular complications when compared to adult liver transplant recipients. The consequences of hepatic artery thrombosis (HAT) or portal vein thrombosis (PVT) can cause significant morbidity and mortality. We examined pediatric liver transplant recipients who developed vascular thrombosis and the presence of thrombophilia. ⋯ All pediatric liver transplant recipients who developed any vascular thrombosis were also found to have thrombophilia. Recipients who were smaller in size were at significantly higher risk of developing vascular thrombosis. Lower weight recipients with thrombophilia may benefit from arterial reconstruction with a conduit to decrease the risk of vascular thrombosis.
-
Medical malpractice has become a rising concern for physicians, affecting the cost and delivery of health care. Colorectal procedures account for 24% of all general surgery cases, a high-risk specialty, with 15% of its physicians facing malpractice suit annually. ⋯ The most common cause of alleged malpractice was failure to recognize a complication in a timely manner, followed by damage to surrounding tissue. Plaintiff awards were significantly higher than settlement payments. It is important to understand the mechanism of malpractice allegations to better prevent litigation and improve patient care.
-
Three-dimensional printing (3DP) is gaining increasing recognition as a technique that will transform the landscape of surgical practice. It allows for the rapid conversion of anatomic images into physical objects, which are being used across a variety of surgical specialties. It has been unclear which groups are leading the way in coming up with novel ways of using the technology and what specifically the technology is being used for. The aim of this article was to review the current applications of 3DP in modern surgical practice. ⋯ Different specialties are at different stages in the use of the technology. The costs involved with implementing the technology and time taken for printing are important factors to consider before widespread use. For the foreseeable future, this is an exciting and interesting technology with the capacity to radically change health care and revolutionize modern surgery.