Surgery
-
The heparin-induced thrombocytopenia and thrombosis (HITT) syndrome is associated with hemorrhage as well as development of systemic thrombosis. A case is presented in which a posthepatectomy patient had probable heparin-induced thrombocytopenia complicated by venous thrombosis and pulmonary emboli after receiving low doses of heparin as line flushes. HITT is reviewed and factors related to its successful management in this postoperative patient are analyzed in detail.
-
The effect of fluid resuscitation from hemorrhagic shock on cerebral edema, intracranial pressure (ICP), and blood brain barrier function was investigated in the presence of a simulated head injury. Beagle dogs were anesthetized and ICP was measured via a right subarachnoid bolt while a contralateral epidural balloon was inflated in the left hemicranium to mimic a closed head injury. Forty percent of the dogs' blood was shed and the shock state was maintained for 1 hour. ⋯ Coronal sections of fixed HS brains showed deep cortical Evans blue staining on the side of balloon injury. Therefore, in the presence of an intracranial mass lesion, resuscitation with hypertonic (3%) saline solution is accompanied by lower ICP values and less cerebral edema than is isotonic saline or colloid resuscitation. Blood brain barrier function is not restored by hypertonic saline solution resuscitation.