Robert M. Hardaway

Alterations in blood coagulation mechanism after incompatible blood transfusion: Clinical and experimental observations☆

Abstract 1. 1. The hemorrhagic diathasis following an incompatible blood transfusion reaction is associated with thrombocytopenia, prolongation of the coagulation time, prolongation of the prothrombin time, a decrease in the circulating white blood cells, the appearance of fibrinolytic activity and of a “heparinoid” anticoagulant. 2. (2) The reaction is somewhat different in dogs inasmuch as the fibrinogen level does not decrease as markedly as in the human case, nor does fibrinolytic activity appear. 3. 3. It is suggested that the management of these cases be a complete immediate estimate of all the major blood clotting factors with a subsequent replacement of fibrinogen or the use of an antiheparin agent wherever indicated.

Pathologic Study of Intravascular Coagulation Following Incompatible Blood Transfusion in Dogs I. INTRAVENOUS INJECTION OF INCOMPATIBLE BLOOD

Abstract 1.1. The injection of incompatible blood into the dog results in disseminated intravascular coagulation. 2.2. When blood is injected rapidly intravenously, the animals die instantly with numerous small thrombi predominantly in the small pulmonary vessels but also in the liver, pancreas and gastrointestinal mucosa. 3.3. When the blood is injected slowly intravenously, the animals survive unscathed or die hours later with a few residual thrombi in the lungs and gastrointestinal mucosa. 4.4. These observations offer an explanation for the alterations in the hemostatic mechanism, sudden death, shock, dyspnea and bloody diarrhea which occur following administration of incompatible blood.

Microcoagulation in shock

Abstract 1. 1. Disseminated intravascular coagulation (DIC) is a common occurrence and plays an important part in shock. 2. 2. Two prerequisites are necessary for its occurrence: (1) capillary stagnation and (2) a clotting stimulus. The prevention of either prevents DIC. 3. 3. Capillary stagnation can be prevented clinically by volume expansion and vasodilators.

Expansion of the intravascular space in severe shock

Abstract Hypovolemic shock, if untreated for a while or if severe, results in an increase in intravascular capacity due to the opening of all capillaries at once. This expansion of the vascular capacity in patients with severe or untreated shock requires much more intravenous fluids for adequate treatment than the volume of blood lost. Fluid volume requirements should be determined by results (normal blood pressure and urinary output) and by central venous pressure or pulmonary arterial pressure for maximum tolerable administration. Blood volume measurements are useless. The vascular space shrinks to normal after adequate resuscitation, creating relative hypervolemia.

Importance of capillary perfusion

Perfusion is more critical than oxygen in the maintenance of cell viability. A high hematocrit or high fibrinogen level increases blood viscosity and predisposes to disseminated intravascular coagulation. It is recommended that a hematocrit of about 30 be maintained in periods of circulatory stress such as shock or extracorporeal circulation.

Cystadenoma of the pancreas

Abstract A case of cystadenoma of the pancreas with surgical removal is described and a brief review of the literature is presented.

Steroids and Shock

This book consists primarily of fulllength research papers presented at a symposium held in Philadelphia in Jaunuary 1973, on the mechanism of action of steroids and their possible application to the treatment of various types of shock. These papers are by basic scientists and research clinicians. They document basic pharmacological and physiological action of the various steroids and define, in a scientific way, their effects on intracellular, extracellular, and circulatory processes, both in the normal and the shock state. These findings are discussed and interpreted by several international authorities in the field of shock. Although a tremendous amount of information is made available on the action and usefulness of steroids in shock, it is a measure of the objectivity of a summarizing author that he concludes regarding the use of corticosteroids as an adjunct to the treatment of shock states... neither malpractice to do so nor negligence if you elect

Burns, Shock, and Plasma Volume Regulation.

This volume by two professors of surgery is a clear and detailed summary of the outstanding research and clinical treatment of burns and burn shock being carried out at the laboratories and burn unit at Washington University in St. Louis. This organization is recognized as one of the two outstanding burn centers in the world and is the source of origin of one of the two currently prominent methods of treatment. The book presents the views of its authors and does not attempt to reflect the research and opinions of other major centers. Their study is presented in detail; in most cases the text represents an adoption of material previously published. It is an excellent summary of the authors work which is original and farreaching. One may have a few doubts about some rather authoritarian statements in the text; for instance, The risk of pulmonary edema is no greater with

The useful rotation flap.

Abstract The single or double rotation flap is a simple one-stage procedure which can be employed to give skin and subcutaneous coverage to wide areas in almost any location.

Modified Heller operation for achalasia

Abstract A case of severe achalasia is presented which was treated by the modified Heller operation. This resulted in complete alleviation of obstructive symptoms. To date no symptoms of esophagitis have appeared. It is thought that the Heller procedure results in a more physiologic cardia than other operations, and is more in line with similar operations for similar conditions at other sites. The resulting cardia is expansible and adequate both in passage of the bolus and in preventing regurgitation.