Mayo Clinic proceedings
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Mayo Clinic proceedings · Dec 1987
Comparative StudyThe effects of intraoperative blood salvage and induced hypotension on transfusion requirements during spinal surgical procedures.
Spinal surgical procedures, such as placement of Harrington rods for correction of scoliosis, are associated with considerable perioperative blood loss and, hence, with the risks associated with homologous blood transfusions. To test the hypothesis that intraoperative autologous blood transfusions could decrease the amount of homologous blood needed in such operations, we conducted a two-part study: (1) a retrospective review of 142 patients in whom blood salvage was not used and (2) a prospective review of 28 patients who received autologous transfusions. Intraoperative autologous transfusion reduced the amount of homologous blood required by more than 50% (5.1 versus 2.0 units; P less than 0.001). ⋯ Induced hypotension in 81 of the 142 patients who did not receive autologous transfusions did not decrease the homologous blood transfusion requirements from those needed by the normotensive patients. We conclude that intraoperative autologous transfusion significantly reduces the need for homologous blood products in patients who undergo spinal surgical procedures. Induced hypotension, which did not affect transfusion requirements in our study, should be further evaluated in a blinded, prospective study.
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Recently, balloon aortic valvuloplasty has been proposed for the treatment of severe aortic stenosis in elderly patients when aortic valve replacement has been declined or deferred. The natural history of these patients has not been clearly defined. Therefore, to develop a comparison cohort of patients with unoperated aortic stenosis, we reviewed the records of all Mayo Clinic patients in whom severe aortic stenosis had been diagnosed during the period 1978 through 1985 but no surgical procedure had been performed because the patient declined or the physician deferred this option. ⋯ At last follow-up, only 13 of the 50 patients (26%) were alive. A cardiac cause was cited for 36 of the 37 deaths. Because of the poor survival in this group of patients, evaluation of alternative nonsurgical therapeutic modalities such as balloon valvuloplasty is imperative when operative intervention is declined or deferred in elderly patients.
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The clinical, pathologic, and imaging characteristics of clival chordomas in 14 patients who underwent magnetic resonance examinations were evaluated. Magnetic resonance imaging (MRI) was compared with skull series, tomography, computed tomography (CT), and magnification angiography in the diagnosis of clival chordomas. ⋯ In all 14 cases, MRI revealed the neoplasms to be black on inversion-recovery, gray on partial-saturation, and white on T2-weighted pulse sequences. Three chordomas had a speckled signal void pattern, typical of tumor calcification.
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Mayo Clinic proceedings · Feb 1987
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy.
Although three effective topical treatments for allergic rhinitis are available, little information to assist the clinician in choosing among them has been reported. Therefore, we conducted a randomized clinical trial to compare beclomethasone nasal solution, flunisolide, and cromolyn with placebo in 120 patients with hay fever during the ragweed season of 1984. ⋯ Surprisingly, we also found that these intranasal treatments considerably reduced the symptoms of seasonal asthma. Further study of this therapeutic advantage is needed.
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Mayo Clinic proceedings · Jan 1987
Biography Historical ArticleMorton: pioneer in the use of ether.