Biomedical subjects
Publications and source records attributed to K T Schricker.
The survival rate after curative surgery of colorectal carcinoma was reduced by the application of fresh frozen plasma. This result was verified using multivariance analysis. In contrast, the transfusion of erythrocytes with and without buffy-coat was of no influence on postoperative morbidity.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In recent years in the literature several investigators described a negative effect of perioperative transfusion of blood and hemoderivatives on the prognosis of malignant tumors. Concerning the patients with colorectal carcinoma operated between 1979 and 1983 at Erlangen University Hospital these results could be proven. We observed a significantly worse 5-year survival rate for patients who received perioperative blood transfusion. However, multivariant analysis in Cox-regression model revealed other factors like tumor stage and localisation responsible for the poorer prognosis. Therefore blood transfusion seems not to have any influence on the prognosis itself. Furthermore we observed a significantly poorer prognosis concerning patients who perioperatively received fresh frozen plasma (FFP). Surprisingly multivariant analysis showed that FFP substitution in contrast to blood transfusion has an own prognostic influence. This difference in prognosis cannot be explained by selection criteria. The mechanism of the negative influence of FFP on the prognosis of colorectal carcinoma remains unclear and is investigated currently in prospective studies.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In a single-blind trial 25 patients with progressive scleroderma and Raynaud's phenomenon intravenous infusions of iloprost, a prostacyclin derivative (carbaprostacyclin), were given daily for five hours during a six-day hospital stay, after a comparable initial single placebo infusion. Duration, frequency and intensity of Raynaud symptoms improved in more than 75% of the patients. This improvement was objectified by telethermometry which demonstrated acral hyperthermia and significantly briefer rewarming after standardized cooling of the hands. In addition, there was more rapid healing of ulcerations and necroses of the digital pulp. A significant inhibition of ADP- and collagen-dependent platelet aggregation was demonstrated during the iloprost infusion. Side effects, such as headache, nausea and tiredness occurred only transitorily during the infusion, were individually highly variable, and then only at higher concentrations. A dosage of 2 ng/kg X min was tolerated by all patients.
Explore the source record for details and available documents.
A 62-year-old woman with stenosing coronary artery disease had the rare blood group Oh (Bombay phenotype). After prophylactic deep-freeze conservation of autologous blood, direct myocardial revascularization was successfully accomplished under extracorporeal circulation. Three deep-freeze units of erythrocyte concentrates were used. Both operation and postoperative wound healing progressed without complication.
The possibilities of reducing the number of transfusions of heterologous blood are haemodilution, intraoperative auto-transfusion using the Bentley pump, and the administration of autologous deep-frozen erythrocytes. Indications, contraindications as well as the pros and cons of the various methods are discussed. Today, the use of coagulation factors is mainly limited to the treatment of congenital coagulation disorders, and prothrombin concentrate to application in bleeding problems arising from coumarin application. For other indications these preparations have been replaced by the therapeutically more effective fresh frozen plasma. The problems of transfusion hepatitis are briefly mentioned. Only small amounts of whole blood are usually required for transfusion in neonates and infants. Freshly collected whole blood has the best therapeutic effect. The indications and risks of the transfusion of freshly drawn blood are examined. The collection of fresh blood from a donor pool comprised of physicians and nursing staff from our own clinic has proved effective. The selection and control of these blood donors is discussed.
Hemostatic changes in liver cirrhosis regularly have complex causes. In addition to a quantitative deficiency of hemostatic factors, also qualitative changes in coagulation factors, disturbances in coagulation factor metabolism and possible iatrogenic disturbances in plasmatic and thrombocytic hemostatic mechanism are to be considered. To diagnose a deficit of hemostatic factors is no problem, but to answer the question which of the numerous pathogenetic factors dominates in an individual case at this moment is very difficult and often impossible.
Explore the source record for details and available documents.
Cardiac operations were made possible by deep freezing of autologous blood in 187 out of 262 cardiac patients (71%) using only the patients' own blood. In only 75 patients (29%) was additional homologous blood transfusion necessary. It should be possible to lower further the requirements for donor blood by using an even stricter indication for the transfusion of homologous blood and by further improvements in techniques and organization. Autologous blood donation and transfusion of deep frozen conserved own blood were both tolerated very well by patients with cardiac disease. The advantages of deep frozen conservation of autologous blood in cardiac surgery are so convincing that they fully compensate for disadvantages of high cost and work required.
Case report of a 57-year old man, who had a severe congenital factor VII deficiency (factor VII 2%), and who was substituted with factor VII concentrate, before undergoing a subtotal gastrectomy. The patient was previously asymptomatic. The operation and wound-healing was without complication. That the patient, despite his factor VII deficiency, showed no clinical signs of a bleeding diathesis, raises the question, whether in such a case a factor VII substitution is necessary. 3 children of the patient (2 sons aged 25 and 23 years, and an 18 year old daughter) were examined and found to be heterozygote carriers to a degree of 32%, 42% and 60% factor VII; none showed sure signs of a bleeding tendency related to factor VII deficiency.
Explore the source record for details and available documents.
Reviewed are the causes of hemorrhagic shock, pathophysiology of blood loss as well as clinical signs and diagnostic measures. The problematic nature of determination and judgement of blood loss, especially at internal bleeding and during operations is pointed out. Measures for prevention and stanching of bleeding are touched. Blood, blood plasma and colloids (dextran, gelatine and hydroxyethyl starch) for volume replacement and their side effects are discussed briefly.
Explore the source record for details and available documents.
Explore the source record for details and available documents.