Robert S. Shaw

Optimal Conditions for Storage of Fresh Frozen Plasma

Small aliquots of plasma in 3.8 per cent trisodium citrate were stored at −15, −30 and −50 C. Lengthening of the recalcification time after 24 hours followed by progressive shortening for 10–14 days was observed at −15 and −50 C. At −30 C. no significant changes occurred until two months had elapsed. Assay of clotting factors VII and X, VIII and IX revealed essentially that the activity of each rose gradually over a span of 12–14 days after an initial decline at −15 C. and −50 C. At −30 C. factors VIII and IX were stable for at least two months. Factor V level declined gradually at −15 C. and −50 C. but no significant fall was observed at −30 C. The increase in the activity of factor VIII observed during storage at −15 and −50 C. was eliminated by prior adsorption with Celite which is believed to remove an activation product of Hageman factor and Plasma Thromboplastin Antecedent. There seemed to be somewhat greater instability of plasma stored in untreated glass containers than in cellulose nitrate or in siliconized glass. Storage temperatures below −40 C. and above −25 C. appear to be unfavorable for plasma coagulation factors.

Operative Treatment of Aortic Stenosis in the Adult

THE OPERATIVE TREATMENT of adult aortic stenosis is in a phase of transition. While there is general agreement that an open, visual approach is superior to closed, blind instrumentation of the valve, there can be real debate over the relative merits of debridement and incision versus artificial prosthesis. Indeed, the problems of autogenous reconstruction and homologous replacement are just appearing above the horizon, and the basic process of calcification of valvular structures is little understood. It seems worth while, therefore, to report our total experience to date with open repair of aortic stenosis in 103 adult patients. These patients represent a consecutive and, within certain limits, standardized experience. All operations were performed with the objective of restoring valvular function by deliberate, unhurried debridement and incision of accurately identified commissures, avoiding prosthetic cusp or valvular replacement wherever possible. Preliminary exploration in postmortem specimens demonstrated the feasibility of restoring function to deformed and calcified aortic valves and provided convincing evidence that this approach would be a reasonable one.1 The experience reported here, therefore, is a baseline against which the value of artificial valves can be measured and indications for their use defined. The overall clinical picture is presented in figure 1. An initial staggering mortality-10 hospital-deaths in the first 17 patients-was followed by an equally startling sequence of 23 cases without a hospital-death. Another disquieting period followed, finally leveling off so that in the last 50 cases the mortalitvI

The Use of ACD Bank Blood and Fresh Heparinized Blood in Open‐Heart Surgery:

A study was undertaken to establish whether the use of stored ACD blood, up to four days old and subsequently heparinized and recalcified, in the pump‐oxygenator for open‐heart surgery would have any detrimental effect upon postoperative coagulation and hemostasis. A comparison was made with cases in which fresh heparinized blood was used.

Oliguria following diagnostic translumbar aortography; report of a case.

TRANSLUMBAR aortography has assumed increasing importance in clinical medicine as a diagnostic aid for a variety of conditions. This technic has been of particular importance in elucidating the pat...

Reconstructive arterial surgery in upper-extremity injuries.

A plea is immade for primary restoration of arterial continuity in cases of upper-extremity traunma involving injury to major arteries. This is justified by the high incidence of limb loss in such injuries and is particularly important where there is conconmitant injury in the distal, relatively ischaemic portion of the extremity. Such efforts can be rewarding even in late and neglected cases. Excellent flow through the reconstructed vessel is essential to success. This requires scrupulous attention to the avoidance of stricture at the suture line and complete removal of distal thrombus in the artery. The latter can be accomplished by retrograde flushing or by the use of instruments from an unthrombosed point in the distal portion of the artery. Re-exploration in the event of postoperative thrombosis is urged since this frequently will convert failure to success if the reason for thrombosis is recognized and corrected. The free use of venous autografts is recommended. Extremes of heat and cold are to be avoided in the extremity with marginal circulation since both can cause serious tissue injury. The extremity should be warmed to a temperature of from 80 to 90 degrees Fahrenheit. Even severe degrees of ischaemic injury resulting from long periods of circulatory arrest will heal and allow salvage of a useful extremity if the circulation is restored. Conservatism is urged in the treatment of such cases.

A Method of Studying "Normal" Function in the Amputated Human Limb Using Perfusion

Reliable information concerning the physical parameters of functionimig mnuscle, such as tendon excursion and lemigth-tension relationships, are essemitial basic data for the intelligent planning of oi-thopaedic procedures such as tendon traiisplamitation and the like. Efforts have been made to obtain such basic information from comiscious subjects with conventional ergographic techniques. Subjective variables in discomfort, fatigue, arid motivation have made this information unreliable. The productiomi of muscle comitractiomi imi such subjects with percutaneous high-voltage stimulation 25 did not completely overcome the problem of voluntary or iiivoluntary interference with the measurement of the true potential of the muscle group under study.

Stimulation of Rh antibodies in an Rh-negative patient with hemophilia; report of a case developing after repeated transfusions of fresh frozen plasma prepared from Rh-positive bloods.

THE use of plasma units obtained from a single unit of whole blood is becoming more and more common for two reasons. An increasing number of hospitals prefer to use unpooled plasma because the prob...