PubMed Health⌕ Search

Biomedical subjects

J A Caprini

Publications and source records attributed to J A Caprini.

At least 19 recordsLinked to original sources
PubMed1991

Iatrogenic biliary tract complications: radiologic features and clinical significance.

Thirteen intrahepatic and 22 extrahepatic biliary tract complications were detected radiologically in 35 adult patients who had undergone cholecystectomy and bile duct exploration. Intraoperative usage of Fogarty balloon catheters to extract biliary calculi without fluoroscopic guidance resulted in focal ectasia or rupture of intrahepatic radicles in two and seven cases, respectively. Metallic surgical instruments such as Bakes dilators and biliary forceps or clamps accounted for most of the common duct injuries; these were manifested as submucosal dissection (two cases), transmural laceration (four cases), or localized trauma with subsequent stricture (three cases). Technical mishaps during T-tube placement led to common duct perforation (four cases) and extraluminal malposition of T tubes (three cases). The remaining complications included choledochoduodenal fistula (three cases), biliovenous fistula (two cases), biloma (three cases), and retained intraductal fragments of biliary drainage catheters (two cases). Knowledge about radiologic features and causal factors of such iatrogenic processes can play a crucial role in their prevention, correct diagnosis, and management.

Adolescent↗
PubMed1991

Clinical assessment of venous thromboembolic risk in surgical patients.

Prophylaxis against postoperative venous thromboembolism should be tailored according to the patient's level of risk. However, risk assessment is not yet in widespread use in surgical practice. In this study, 538 general surgical patients were prospectively assessed based on a scoring system containing 20 risk factors. Depending on the total risk factor score, the patients were grouped into low (0 to 1, 34.5%), moderate (2 to 4, 48.5%), or high risk (more than 4, 17.2%) categories. Statistically significant (p less than 0.0001) correlation was found between our results and those of three existing risk assessment systems. Overall, of the 538 patients, 37.2% received prophylaxis; 10%, 42.1%, and 76% received prophylaxis in the low-, moderate-, and high-risk categories, respectively. Mechanical prophylactic modalities (graduated elastic compression and sequential intermittent compression) were preferred over pharmacologic modalities. These results suggest that implementation of prophylaxis remains underutilized despite published reports, including NIH guidelines. Our results indicate that the majority of surgical patients seen in this suburban hospital have two or more risk factors for developing venous thromboembolism.

Adult↗
PubMed1991

Venous thromboembolism prophylaxis and risk assessment in medical patients.

In summary we have developed a VTE risk assessment system for medical patients based on our prior experience in surgical patients. In this model we divide individuals into low, moderate, and high-risk categories. We realize that our system needs further validation with appropriate diagnostic endpoints to correlate the actual occurrence of venous thromboembolism with the predicted risk on the basis of our score system. Nevertheless, the proposed model reflects one approach to achieving a prophylaxis tailored to the patients' risk.

Causality↗
PubMed1989

Postoperative deep vein thrombosis: current clinical considerations.

The approach to thrombosis prophylaxis must be individualized according to the patient's risk factors, pathophysiology, planned surgical procedure, and specific medical problems. Based on an assessment of all these variables, the previously recommended modalities can be used alone or in combination, according to the particular needs of the patient. No one method will be completely effective in all patients or all situations. Only through deliberate evaluation and implementation of the appropriate available modalities will the greatest level of thrombosis prophylaxis be achieved.

Humans↗
PubMed1988

Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients.

We simultaneously evaluated platelet and fibrinolytic parameters to assess their individual and combined contributions to postoperative blood loss in cardiopulmonary (CP) bypass patients. Platelet count, platelet aggregability, hematocrit, plasminogen (PLG) concentration, alpha 2-antiplasmin (AP) concentration, free protease activity (fPA), and antithrombin-III (AT-III) were measured in nine patients undergoing surgery using cardiopulmonary bypass. Chest tube drainage was used as the measure of postoperative blood loss. Hematocrit, platelet count, PLG, AP, and AT-III all decreased during CP bypass, with PLG and AT-III decreasing much more than dilution. During CP bypass, platelet aggregability to ADP did not change significantly from pre-bypass, but aggregability to arachidonic acid (AA) decreased significantly. Following protamine administration there was a large increase (83%) in fPA, the platelet count showed a further drop (from 61% to 50% of pre-bypass levels), and platelet aggregability decreased significantly (from 95% to 34% of pre-bypass levels for ADP, and from 55% to 11.9% for AA). Chest tube drainage during the first four postoperative hours correlated positively (p less than 0.05) with the combination of increase in free protease activity and decrease in platelet count. The total chest tube drainage correlated significantly with the combination of decrease in platelet count and the decrease in platelet aggregability. These combinations of changes correlated significantly with postoperative blood loss whereas the individual changes did not.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III↗
PubMed1988

Role of compression modalities in a prophylactic program for deep vein thrombosis.

During the past decade, we have learned a great deal about the etiology, pathogenesis, diagnosis, and treatment of thromboembolic disease. Subcutaneous heparin has emerged as a major deterrent worldwide for thrombosis prevention but is associated with the potential risk of bleeding and cannot be used in certain patient situations. External compression modalities have emerged as major alternate forms of prophylaxis. We have learned that these devices stimulate the fibrinolytic system, prevent stasis and the endothelial injury that can accompany extreme venous distention. Since they are not associated with bleeding or other serious complications, they are attractive methods for most surgeons, including those performing delicate or complex surgical procedures. Independent studies worldwide have demonstrated their effectiveness in reducing deep vein thrombosis, as recognized by the NIH Consensus Development Panel, and the evidence is compelling that DVT efficacy is a valid marker for PE efficacy. Since these devices reduce the incidence of deep vein thrombosis, they almost certainly must prevent pulmonary emboli; however, a properly designed protocol should be conducted to validate these assumptions. Evidence suggests that full-leg sequential compression is superior to calf compression, but further study is necessary. We believe that a hospital-wide plan, including risk-factor assessment and application of clinical management guidelines, including all available modalities, is important to provide the maximum protection of patients with the lowest risk of side effects. Such a program has been very successful in our community.

Clothing↗
PubMed1988

Relationship between postsurgical fibrinolytic parameters and deep vein thrombosis in surgical patients treated with compression devices.

This study consisted of 52 patients admitted for orthopedic surgery and 28 patients admitted for general surgery, who were treated with Sequential Compression Devices (SCD) and Thromboembolic Deterrent Stockings (TEDS) and monitored for the development of deep vein thrombosis (DVT). Coagulation and fibrinolytic profiles were carried out on these patients preoperatively, and on days one, three, and six postoperatively. All patients were followed by I-125-Fibrinogen scanning, Venous Doppler, and Impedance Plethysmography studies for clot detection. In the orthopedic surgery group, six (11.5%) developed DVT, and in the general surgery group, one (3.6%) developed DVT. No patients developed pulmonary embolism. The combined incidence of DVT was 8.8 per cent. A variety of parameters was measured in order to determine whether compression devices prevent a fibrinolytic shut-down commonly seen in the postsurgical patient. A combination of three assays was found to be significant in demonstrating a fibrinolytic response. These parameters were a post-surgical decrease in the plasminogen level, an increase in the level of free protease activity postoperatively, and an increase in the level of tissue plasminogen activator after surgery. 56.3 per cent of all patients treated with SCD and TEDS showed a fibrinolytic response on postoperative day one by a combination of all three of these parameters. In the group of patients that developed DVT none showed an increase in free protease activity, and five of seven showed no significant decrease in plasminogen and no increase in tissue plasminogen activator. Patients who developed thrombosis had measurable differences in their fibrinolytic system compared to those without postoperative thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Clothing↗
PubMed1988

Biliary stone extraction.

This report summarizes a 14-year experience with 219 patients referred for sinus tract extraction of retained common duct stones. The patients ranged from 18 to 94 years of age and 60 per cent were women. Forty seven per cent of patients were seen within 6 weeks postoperatively and 79 per cent within 3 months of surgery. Sixty four per cent of patients had a single stone; the remainder had multiple stones, sludge or ductal debris. Sinus tract manipulation under fluoroscopic control was done using a variety of baskets, catheters and instruments, including endoscopy, along with pre- and post-manipulation intravenous antibiotics. Routine testing and cultures are done and useful when clinical biliary sepsis occurs (1%). Meticulous postextraction cholangiography has contributed to our success and is an important part of the procedure, usually done 24 hours after the last manipulation. Successful extraction occurred during a single session in 125 of 219 patients (57%); 60 of 219 patients required two extraction sessions. Four patients spontaneously passed stones. The remaining patients required three to seven sessions before the extraction was considered complete. Successful extraction of all stones and debris from patients' biliary ducts occurred in 210 of 219 cases (96%). Five of the nine failures occurred in the first one hundred patients (1974-1979) and all required reoperation. Failure occurred in four of the last one hundred patients (1979-1986) and all were successfully treated by ERCP extraction. Two deaths occurred very early in our series and were related to advanced biliary sepsis at the time of the initial presentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Thrombelastography of blood from subjects with chronic renal failure.

Blood samples from 23 subjects with chronic renal failure and 19 controls were tested using thrombelastography and other hematologic tests. The uremic subjects were divided into two groups, those who had not yet begun maintenance hemodialysis treatments (12 subjects) and those who had (11 subjects). Compared to those from control subjects, the thrombelastograms from the uremic subjects consistently indicate normal clotting times but significantly elevated amplitudes. The increased amplitudes correlate positively in the dialyzed uremic group with both platelet count and fibrinogen concentration and correlate negatively in both uremic groups with hematocrit. Thrombelastography demonstrates a hypercoagulability in these samples in vitro, despite the prolonged bleeding time that commonly occurs in uremic subjects.

Fibrinogen↗
PubMed1986

In vitro comparison of fibrinolytic activity of plasminogen activators using a thrombelastographic method: in vivo evaluation of the B-chain-streptokinase complex in the dog model using pre-titered doses.

Thrombelastography was used to quantitatively compare the clot-lysing efficiency of 6 different plasminogen activators, using human whole blood, pooled normal plasma, and platelet rich plasma. The activators compared were the B-chain-streptokinase complex, the plasmin-streptokinase complex, the mini-plasminogen-streptokinase complex, tissue plasminogen activator, streptokinase, and urokinase. The most efficient activator found was the B-chain-streptokinase complex. This complex was 4.0 times more effective than streptokinase, 3.0 times more effective than the plasmin-streptokinase complex, 1.3 times more effective than the mini-plasminogen-streptokinase complex, 2.3 times more effective than tissue plasminogen activator, and 16.0 times more effective than urokinase. Although there were differences in both the coagulation and fibrinolysis thrombelastographic patterns between plasma and whole blood, the comparative efficiencies of each activator were the same with either plasma or blood. The B-chain-streptokinase complex was evaluated as a thrombolytic agent in clot-lysis experiments in the jugular vein in the dog model, using a thrombelastographic method to determine the minimum dose of activator necessary for clot-lysis. With 6 dogs infused locally with 0.25 mg (8000 I.U.) of the plasmin-streptokinase complex, the cumulative clot-lysis was 18.0 +/- 3.0% with the first dose, 33.0 +/- 2.1% with the second dose, and 55.2 +/- 8.6% with the third dose. With 6 dogs infused locally with 0.03 mg (2000 I.U.) of the B-chain-streptokinase complex, the cumulative clot-lysis was 30.6 +/- 6.4% with the first dose, 54.4 +/- 9.6% with the second dose, and 80.2 +/- 9.0% with the third dose.

Animals↗
PubMed1985

Etiology, diagnosis, and treatment of recovery room bleeding/hemorrhage.

A successful outcome for the patient who hemorrhages after surgery is based on the recognition of bleeding, the specific diagnosis of bleeding sites and disorders, and the management of bleeding by control measures and replacement of blood lost (Table III). The best preventative measures include careful preoperative assessment of historical and physical findings along with appropriate laboratory tests.

Blood Coagulation Factors↗
PubMed1979

Symptomatology as an indicator of recurrent or metastatic breast cancer.

Eighty-seven patients with recurrent breast cancer after mastectomy were analyzed for patterns of recurrence and methods of detection. After an average disease-free interval of 30 months, 38% developed osseous metastases, 16% recurred locally, 10% had local plus systemic disease, 10% showed pulmonary metastases and the remainder were distributed among liver, brain, and remaining breast disease. In 79 patients recurrence was heralded by symptoms. Physical examination in five asymptomatic patients revealed local or supraclavicular recurrence. In only three asymptomatic patients was recurrence documented by "routine" chest x-rays (in two), or liver enzymes/liver scan (in one). No asymptomatic disease was found by bone scan. It is concluded that periodic history, physical examination, and chest x-rays are the most important components in the follow-up of breast cancer patients. Radioisotope scans and other radiographs are valuable in confirming symptomatic disease and detecting additional diseases, but cannot be recommended routinely in the asymptomatic patient because of low yield and cost.

Bone Neoplasms↗