(OT)Re: [HSF] Reclacitrant sternal bleeding

prasannasimha prasannasimha at gmail.com
Sun Dec 10 09:01:12 EST 2006


Ani his native language is "American English". (I could not help 
laughing when I read your statement especially with the Mmmmm).
Ani I have a job for you - you need to put your VAD problems and 
expeiences and solutions in the Wiki. There is a link to it.

http://ctsurgcomplications.wikia.com/index.php?title=VENTRICULAR_ASSIST_DEVICES&action=edit
http://ctsurgcomplications.wikia.com/index.php?title=HEART_TRANSPLANTATION&action=edit
Please try to do some editing in your spare time. There is a place to 
log in / create account to enable your contributions to be acknowledged. 
(top right corner)
If you have problems editing , please go ahead and still edit and type 
matter in , I can do the spring cleaning afterwards.

Prasanna
Ani Anyanwu wrote:
> Native language???? Mmmm
>
> I thought recalcitrant was an English word Michael.....
>   ----- Original Message ----- 
>   From: Michael Firstenberg<mailto:msfirst at gmail.com> 
>   To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
>   Sent: Saturday, December 09, 2006 6:06 PM
>   Subject: Re: [HSF] Reclacitrant sternal bleeding
>
>
>   Prasanna,
>   For those of us who use American English vs the much more prim,  
>   proper, and sophisticated dialect, I must ask is "recalcitrant" the  
>   most appropriate word.  Although it probably described your  
>   experience (and clearly reflects you are more in command than I of my  
>   native language), I am wondering that it would not be the first word  
>   to pop into my mind if I wanted to search the topic?
>
>   -michael
>
>
>   Merriam-Webser online:
>   Main Entry: re·cal·ci·trant 
>   Pronunciation: -tr&nt
>   Function: adjective
>   Etymology: Late Latin recalcitrant-, recalcitrans, present participle  
>   of recalcitrare to be stubbornly disobedient, from Latin, to kick  
>   back, from re- + calcitrare to kick, from calc-, calx heel
>   1 : obstinately defiant of authority or restraint
>   2 a : difficult to manage or operate b : not responsive to treatment  
>   c : RESISTANT <this subject is recalcitrant both to observation and  
>   to experiment -- G. G. Simpson>
>
>
>
>
>
>   On Dec 9, 2006, at 8:39 AM, prasannasimha wrote:
>
>   >
>   > I have done a write up of management of recalcitrant sternal  
>   > bleeding on the Wiki (sarcastically  I would wonder about my  
>   > credentials to write it after losing the patient !!)
>   > This is hardly discussed in any text book and is a rarely occurring  
>   > event which we probably see (hopefully) once or twice in our careers.
>   > I request all of you to visit the Wiki and give it a read and  
>   > either edit it directly or add any other relevant points that I  
>   > have missed. I lost most of my emails recently and so I am doing  
>   > most of this based on memory of the discussion we had on our list  
>   > and from personal experience (for whatever it is worth)
>   >
>   > It is at
>   > http://ctsurgcomplications.wikia.com/wiki/<http://ctsurgcomplications.wikia.com/wiki/> 
>   > Recalcitrant_Sternal_Bleeding
>   > Prasanna
>   >
>   >
>   >
>   > prasannasimha wrote:
>   >> Jacob serendipity - I was trying to dig out the article for giving  
>   >> a reply to Hal's boiling blood !!
>   >> Prasanna
>   >> Jacob Lavee, MD wrote:
>   >>> Bob and Nasser,
>   >>> Old tricks never die, they unfortunately just fade away. Please  
>   >>> read my abstract from 1989 regarding the clear clinical and  
>   >>> electron-microscopy prooved benefit in using one unit of fresh  
>   >>> whole blood after cardiac surgery:
>   >>>
>   >>>  J Thorac Cardiovasc Surg. 1989 Feb;97(2):204-12.
>   >>> The effect of transfusion of fresh whole blood versus platelet  
>   >>> concentrates after cardiac operations. A scanning electron  
>   >>> microscope study of platelet aggregation on extracellular matrix.
>   >>> Lavee J, Martinowitz U, Mohr R, Goor DA, Golan M, Langsam J,  
>   >>> Malik Z, Savion N. Department of Cardiac Surgery, Maurice and  
>   >>> Gabriela Goldschleger Eye Research Institute, Sheba Medical  
>   >>> Center, Tel Hashomer, Israel.
>   >>>
>   >>> To evaluate the effect of fresh whole blood transfusion versus  
>   >>> platelet concentrates transfusion on platelet aggregation after  
>   >>> cardiac operations, 24 patients were randomized to receive either  
>   >>> one unit of fresh whole blood (12 patients) or 10 platelet units  
>   >>> (12 patients) after cardiopulmonary bypass. Platelet aggregation  
>   >>> on extracellular matrix, platelet count, and mean platelet volume  
>   >>> were studied preoperatively, at termination of cardiopulmonary  
>   >>> bypass, after protamine administration, and after the transfusion  
>   >>> of fresh whole blood or after transfusion of each two platelet  
>   >>> units. Extracellular matrix produced by cultured bovine corneal  
>   >>> cells closely resembles the vascular subendothelial basal lamina,  
>   >>> and is an ideal in vitro model in the study of platelet  
>   >>> interaction with the subendothelium. Platelet aggregation on  
>   >>> extracellular matrix, studied by a scanning electron microscope,  
>   >>> was graded from 1 to 4, wherein grade 1 represents nonactivated  
>   >>> platelets and grade 4 a mature platelet aggregate. With this  
>   >>> grading system, the two groups were similar in preoperative  
>   >>> values (3.3 +/- 0.9 versus 3.7 +/- 0.4) and values after  
>   >>> cardiopulmonary bypass (1.5 +/- 1.0 in both groups). One unit of  
>   >>> fresh whole blood restored platelet aggregation on extracellular  
>   >>> matrix to preoperative status (3.0 +/- 1.0), whereas eight  
>   >>> platelet units were needed for the same result (3.2 +/- 0.8). One  
>   >>> unit of fresh whole blood increased platelet count in a manner  
>   >>> similar to that achieved by six platelet units and increased mean  
>   >>> platelet volume to a level higher than that achieved by 10  
>   >>> platelet units. These results suggest that the effect of one unit  
>   >>> of fresh whole blood on platelet aggregation after  
>   >>> cardiopulmonary bypass is at least equal, if not superior, to the  
>   >>> effect of 8 to 10 platelet units.
>   >>>
>   >>>
>   >>> Jay  Lavee
>   >>>
>   >>> ----- Original Message ----- From: <Rwmfglycar at aol.com<mailto:Rwmfglycar at aol.com>>
>   >>> To: <OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>>
>   >>> Sent: Friday, December 08, 2006 3:42 PM
>   >>> Subject: Re: [HSF] Reclacitrant sternal bleeding
>   >>>
>   >>>
>   >>>
>   >>>> Dear Nasser, I saw the hot blood trick done by my father in  
>   >>>> 1944. I went with him  to do a prostatectomy in a country town,  
>   >>>> He did a Freyer prostatectomy and the  prostate bed bled.  
>   >>>> Multiple stitches, packs, local adrenaline did not stop the   
>   >>>> bleeding. His mask was not properly over his nose and sweat from  
>   >>>> his forehead  trickled down his nose and dropped into the  
>   >>>> bladder. He called for a blood  donor. Within half an hour a  
>   >>>> gentleman in his street clothes was wheeled  into  the operating  
>   >>>> theatre. A quick cross match was done on a glass slide.  The  
>   >>>> donor was brought close to the operating table. There were steel  
>   >>>> needles  in  patient and donor  arms, connected by tubing that  
>   >>>> met in  a threeway stopcock. With a big glass syringe blood was  
>   >>>> pulled from the donor  and then pushed into the patient. I can't  
>   >>>> remember how many syringe fulls were  delivered but by the time  
>   >>>> the transfer was completed the bleeding had stopped  and the  
>   >>>> operation could be completed. I was the fly on the wall watching  
>   >>>> this.  Later we drove home in his Hudson car. He told me later  
>   >>>> that the patient had  done well,
>   >>>> Bob
>   >>>> _______________________________________________
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>   >>>>
>   >>>>
>   >>> Jacob Lavee, MD
>   >>> Director, Heart Transplantation Unit
>   >>> Deputy Director, Department of Cardiac Surgery
>   >>> Sheba Medical Center
>   >>> Tel Hashomer 52621
>   >>> Israel
>   >>>
>   >>> Tel- 972-3-5302225
>   >>> Fax 972-3-5302410
>   >>> E mail  jaylavee at netvision.net.il<mailto:jaylavee at netvision.net.il>
>   >>> _______________________________________________
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>   >>
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