Zentralblatt für Chirurgie
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Review Comparative Study
[Haemostaseological aspects of perioperative blood management].
Recent studies in humans have shown that tissue factor on the surface of endothelial cells, monocytes, or subendothelial structures sparks plasmatic coagulation. In vivo, there is no functional separation of an "endogenous" and "exogenous" pathway of the coagulation cascade. However, global laboratory tests run along such pathways due to preincubation with specific activators and, hence, allow localization of inherited coagulation defects. ⋯ The quality of such plasma undergoing consecutive filtration steps has to be clinically studied. The application of a synthetic platelet substitute, the "plateletsome", containing platelet glycoproteins led to significantly improved haemostasis without generating systemic procoagulant activity. In a far future, procoagulant cell surface transformation may be influenced by topic application of inhaled thrombomodulin loaded liposomes or by sense or antisense oligonucleotides inducing thrombomodulin expression or suppressing tissue factor expression, respectively.
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Comparative Study
[Calcaneus fractures. Open reduction and internal fixation].
Critical analysis of the medium-term results of open reduction and internal fixation (ORIF) of displaced intra-articular calcaneus fractures with a standardized protocol in a greater patient cohort. ⋯ Management of intra-articular calcaneus fractures with a standardized protocol of ORIF and early mobilization leads to reproducible good or excellent clinical results in a majority of patients. New approaches like an interlocking calcaneus plate, the use of subtalar arthroscopy, early soft tissue coverage for complex open injuries and percutaneous screw fixation for selected fractures should further improve prognosis.
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The current study presents a new technique and results of minimal invasive screw osteosynthesis in the treatment of Bennett's fractures and discusses its advantages and disadvantages. ⋯ Good results can be achieved by minimal invasive screw osteosynthesis in the treatment of Bennett's fractures. Correct indications and minute operation technique are indispensable preconditions for this new kind of treatment.
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Current data demonstrate a lack of support for allogeneic transfusion as a reliable means of delivering oxygen. For the ICU patient tolerance of anemia along with aggressive erythropoitin plus iron therapies can restore hemoglobin levels to normal earlier and with fewer morbidities and possibly enhanced survival than by allogeneic transfusion. ⋯ In the past, anemia meant an almost mandatory transfusion. Now, evidence provides the clinician with sufficient alternatives to treat anemic patients without the use of bank blood products at lower costs with excellent survival and with evidence accumulating to suggest better outcomes.
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Since July, 1998 the transfusion act regulates obligatory the transfusion management in Germany. The act aims to achieve greater safety for blood products and transfusion practices. Consequently the transfusion act, too, requires that a quality assurance system regarding the use of blood products is set up in hospitals.