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Peter J. Symbas

Bio: Peter J. Symbas is an academic researcher from Emory University. The author has contributed to research in topics: Autotransfusion & Fibrinolysis. The author has an hindex of 2, co-authored 2 publications receiving 70 citations.

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Journal ArticleDOI
TL;DR: Ascending aortic rupture should be considered in any patient with severe blunt trauma who has widened mediastinum or cardiac tamponade, as well as in patients with associated major thoracic injuries.

50 citations

Journal ArticleDOI
TL;DR: It was concluded that autotransfusion from a hemothorax of 25% the blood volume in dogs causes a mild loss of hemostatic components, but does not significantly compromise the clotting mechanism.
Abstract: The coagulation system was investigated in five dogs undergoing autotransfusion from experimental hemothorax. One fourth of the blood volume was bled into the pleural space, drained, and autotransfused. The hemothorax blood showed: very prolonged PT and PTT; very low platelets and fibrinogen; midly elevated FDP; very low coagulation factors VIII, and V; reduced XII, prothrombin, X, XI, and VII. Partial clotting, mild fibrinolysis, and fibrin deposition over the pulmonary pleura seemed to cause incoagulability of hemothorax blood. Post autotransfusion arterial blood showed: normal PT and PTT; 25% decrease in platelets, and 31% decrease in fibrinogen from baseline values. There was also an overall 20% reduction of fibrinogen from baseline values. There was also an overall 20% reduction of all clotting factors, but their levels remained above 50% activity. It was concluded that autotransfusion from a hemothorax of 25% the blood volume in dogs causes a mild loss of hemostatic components, but does not significantly compromise the clotting mechanism.

25 citations


Cited by
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Journal ArticleDOI
TL;DR: The historical and current status of imaging and therapy of acute traumatic aortic injuries will be reviewed, and percutaneous endovascular repair is becoming commonplace in many trauma centers.
Abstract: Despite recent advances in prehospital care, multidetector computed tomographic (CT) technology, and rapid definitive therapy, trauma to the aorta continues to be a substantial source of morbidity and mortality in patients with blunt trauma. The imaging evaluation of acute aortic injuries has undergone radical change over the past decade, mostly due to the advent of multidetector CT. Regardless of recent technologic advances, imaging of the aorta in the trauma setting remains a multimodality imaging practice, and thus broad knowledge by the radiologist is essential. Likewise, the therapy for acute aortic injuries has changed substantially. Though open surgical repair continues to be the mainstay of therapy, percutaneous endovascular repair is becoming commonplace in many trauma centers. Here, the historical and current status of imaging and therapy of acute traumatic aortic injuries will be reviewed.

134 citations

Journal ArticleDOI
TL;DR: The data and guidelines emphasize overarching clinical principles, including the need for a high clinical suspicion of acute regurgitation, timely use of echocardiography, and, in the majority of patients, rapid progression to surgery.
Abstract: Acute severe valvular regurgitation is a surgical emergency, but accurate and timely diagnosis can be difficult. Although cardiovascular collapse is a common presentation, examination findings to suggest acute regurgitation may be subtle, and the clinical presentation may be nonspecific. Consequently, the presentation of acute valvular regurgitation may be mistaken for other acute conditions, such as sepsis, pneumonia, or nonvalvular heart failure. Although acute regurgitation may affect any valve, acute regurgitation of the left-sided valves is more common and has greater clinical impact than acute regurgitation of right-sided valves. Data to guide appropriate management of patients with acute regurgitation are sparse; there are no randomized trials, and much of the literature describes either small series or the experiences of specific centers. Despite these limitations, the available data are sufficient to allow identification of general principles as well as development of applicable guidelines from both the American College of Cardiology/American Heart Association and European Society of Cardiology. The guidelines recommend valve surgery for symptomatic patients with aortic or mitral regurgitation, including those with acute regurgitation.1–3 The data and guidelines emphasize overarching clinical principles, including the need for a high clinical suspicion of acute regurgitation, timely use of echocardiography, and, in the majority of patients, rapid progression to surgery. Causes of acute regurgitation overlap with causes of chronic regurgitation and vary depending on the valve affected (Table 1). Endocarditis may affect either the aortic or mitral valve, whereas other causes are unique to the specific valve involved. The majority of causes of acute regurgitation present as an acute or subacute event. However, acute regurgitation can occur in patients with chronic regurgitation, when regurgitant severity is exacerbated by factors such as coronary ischemia, chordal rupture, or leaflet perforation from endocarditis. Acute regurgitation of either the aortic or mitral valve may result from procedural …

130 citations

Journal ArticleDOI
TL;DR: Filtration of unwashed SMB may confuse the interpretation of tests for disseminated intravascular coagulation or fibrinolysis, which could lead to unnecessary blood component use and is preventable by washing before infusion, and it is recommended that the routine infusion of unwASH SMB no longer be employed.

101 citations

Journal ArticleDOI
TL;DR: Whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival is investigated to determine.
Abstract: The traditional management of acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. The recommendation for this treatment is primarily based on the premise that as many as 90% of patients will die within the first 24 hours after their injury. 1,2 Immediate repair of the transected aorta has been associated with a surgical death rate of 0% to 54.2%. 3 This high death rate is often due to the other associated injuries that may be present in the major trauma patient. Delayed repair of the acute aortic tear, allowing the patient to recover from other major injuries, has been reported in the literature with increasing frequency. 4–9 This review was conducted to determine the safety of delayed repair of acute rupture of the thoracic aorta, and this strategy’s impact on the patient’s outcome.

101 citations

Journal ArticleDOI
TL;DR: No longer confined to a few pioneering surgical departments, IBS is now widely practiced and likely to continue to grow rapidly, and knowledge and research of the medical issues surrounding its use will become increasingly valuable in transfusion medicine.

62 citations