scholarly journals Is there a difference between two different skin disinfection methods in cardiac surgery in terms of isolated pathogens?

2020 ◽  
Vol 14 (06) ◽  
pp. 647-653
Author(s):  
Murat Günday ◽  
Atilla Orhan ◽  
Hale Turan ◽  
Muslu Kazım Körez
Keyword(s):  
Postoperative Complications ◽  
Povidone Iodine ◽  
Artery Bypass ◽  
Anaerobic Conditions ◽  
Skin Disinfection ◽  
Coronary Artery Bypass Operation ◽  
Microbiological Techniques ◽  
Group 2 ◽  
Aerobic And Anaerobic ◽  
Group 1

Introduction: In this study, our aim was to prospectively compare the different methods of patient disinfections with scrubbing + iodine + alcohol, and the povidone iodine disinfection method, which can be described as classical, in terms of the pathogens isolated on skin and during early postoperative complications. Methodology: Eighty patients undergoing a coronary artery bypass operation were included in the study. The patients were divided into two groups: group 1 (n = 48) patients who underwent scrub, iodine, followed by skin disinfection with alcohol, and group 2 (n = 32) who were treated with povidone iodine three times. The samples were immediately sent to the microbiology laboratory. Specimens from the wounds were incubated under aerobic and anaerobic conditions, and isolates were identified using standard microbiological techniques. Results: In samples taken after disinfection in group 1, significantly less reproduction was observed compared to group 2 (p = 0.001). There was no difference in postoperative complications between the two groups except for pleural effusion (p = 0.040). S. epidermidis was the most frequently isolated pathogen in both groups. Conclusion: We did not find a study which compares scrub + alcohol + iodine and povidone iodine in our literature review. We think that our study is original in this respect. We can conclude that skin disinfection with scrub + alcohol + iodine was superior to using only povidone iodine in terms of the pathogens isolated afterwards from the wound.

Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

2015 ◽  
Vol 18 (6) ◽  
pp. 255 ◽  
Author(s):  
Hüseyin Şaşkın ◽  
Çagrı Düzyol ◽  
Kazım Serhan Özcan ◽  
Rezan Aksoy ◽  
Mustafa Idiz
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Platelet To Lymphocyte Ratio ◽  
Artery Bypass Grafting ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

<strong>Objective:</strong> To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation.<br /><strong>Methods:</strong> We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142.<br /><strong>Results:</strong> The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality.<br /><strong>Conclusion:</strong> In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

scholarly journals A Genome-Scale Model of Shewanella piezotolerans Simulates Mechanisms of Metabolic Diversity and Energy Conservation

mSystems ◽  
2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Keith Dufault-Thompson ◽  
Huahua Jian ◽  
Ruixue Cheng ◽  
Jiefu Li ◽  
Fengping Wang ◽  
...  
Keyword(s):  
Energy Conservation ◽  
Deep Sea ◽  
Carbon Sources ◽  
Scale Model ◽  
Anaerobic Conditions ◽  
A Genome ◽  
Group 2 ◽  
Genome Scale ◽  
Genome Scale Model ◽  
Group 1

ABSTRACT The well-studied nature of the metabolic diversity of Shewanella bacteria makes species from this genus a promising platform for investigating the evolution of carbon metabolism and energy conservation. The Shewanella phylogeny is diverged into two major branches, referred to as group 1 and group 2. While the genotype-phenotype connections of group 2 species have been extensively studied with metabolic modeling, a genome-scale model has been missing for the group 1 species. The metabolic reconstruction of Shewanella piezotolerans strain WP3 represented the first model for Shewanella group 1 and the first model among piezotolerant and psychrotolerant deep-sea bacteria. The model brought insights into the mechanisms of energy conservation in WP3 under anaerobic conditions and highlighted its metabolic flexibility in using diverse carbon sources. Overall, the model opens up new opportunities for investigating energy conservation and metabolic adaptation, and it provides a prototype for systems-level modeling of other deep-sea microorganisms. Shewanella piezotolerans strain WP3 belongs to the group 1 branch of the Shewanella genus and is a piezotolerant and psychrotolerant species isolated from the deep sea. In this study, a genome-scale model was constructed for WP3 using a combination of genome annotation, ortholog mapping, and physiological verification. The metabolic reconstruction contained 806 genes, 653 metabolites, and 922 reactions, including central metabolic functions that represented nonhomologous replacements between the group 1 and group 2 Shewanella species. Metabolic simulations with the WP3 model demonstrated consistency with existing knowledge about the physiology of the organism. A comparison of model simulations with experimental measurements verified the predicted growth profiles under increasing concentrations of carbon sources. The WP3 model was applied to study mechanisms of anaerobic respiration through investigating energy conservation, redox balancing, and the generation of proton motive force. Despite being an obligate respiratory organism, WP3 was predicted to use substrate-level phosphorylation as the primary source of energy conservation under anaerobic conditions, a trait previously identified in other Shewanella species. Further investigation of the ATP synthase activity revealed a positive correlation between the availability of reducing equivalents in the cell and the directionality of the ATP synthase reaction flux. Comparison of the WP3 model with an existing model of a group 2 species, Shewanella oneidensis MR-1, revealed that the WP3 model demonstrated greater flexibility in ATP production under the anaerobic conditions. Such flexibility could be advantageous to WP3 for its adaptation to fluctuating availability of organic carbon sources in the deep sea. IMPORTANCE The well-studied nature of the metabolic diversity of Shewanella bacteria makes species from this genus a promising platform for investigating the evolution of carbon metabolism and energy conservation. The Shewanella phylogeny is diverged into two major branches, referred to as group 1 and group 2. While the genotype-phenotype connections of group 2 species have been extensively studied with metabolic modeling, a genome-scale model has been missing for the group 1 species. The metabolic reconstruction of Shewanella piezotolerans strain WP3 represented the first model for Shewanella group 1 and the first model among piezotolerant and psychrotolerant deep-sea bacteria. The model brought insights into the mechanisms of energy conservation in WP3 under anaerobic conditions and highlighted its metabolic flexibility in using diverse carbon sources. Overall, the model opens up new opportunities for investigating energy conservation and metabolic adaptation, and it provides a prototype for systems-level modeling of other deep-sea microorganisms.

scholarly journals LOW-VOLUME CARDIOPLEGIA BY «CUSTODIOL» SOLUTIONIN CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

2017 ◽  
Vol 9 (1) ◽  
pp. 59-67 ◽  
Author(s):  
T A Istomin ◽  
I S Kurapeev ◽  
Y B Mihaleva ◽  
E V Suborov ◽  
I A Domanskaya ◽  
...  
Keyword(s):  
Solution Method ◽  
Artery Bypass ◽  
Control Group ◽  
Transfusion Requirements ◽  
Low Volume ◽  
Group 2 ◽  
Volume Method ◽  
Pulmonary Bypass ◽  
Control Group Group ◽  
Group 1

The study presents the results of quality assessment of antiischemic myocardial protection by low- volume method of cardioplegia by «Custodiol» solution during operations with cardiopulmonary by- pass. The study involved 57 patients who underwent different cardiosurgery operations with cardio- pulmonary bypass. The patients were divided into two groups on the basis of the volume of cardioplegic solution. Research group (Group № 1) consists of 33 patients who were administered «Custodiol» in low volume limited by 1000 ml. The control group (Group № 2) consists of 24 patients who were ad- ministered standart volume of the solution corresponding to the manufacturer's instructions: 1 ml per 1 g of myocardial mass during 6-8 minutes. The results has indicated that the use of low volume of car- dioplegic «Custodiol» in a single administration manner provides a complete antiischemic protection of the myocardium during the correction of valvular heart disease, including combination with coronary artery bypass grafting. usage of low volume «Custodiol» solution method does not increase the need of inotropic and vasopressor usage and pacing time. The use of low volumes of «Custodiol» helps to reduce transfusion requirements of blood and its components.

scholarly journals Hypogammaglobulinemia as a Predictive Factor of Postoperative Complications in Pediatric Cardiac Surgery

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Heart Defects ◽  
Blood Stream ◽  
Neonatal Unit ◽  
Pediatric Cardiac Surgery ◽  
Impact On Survival ◽  
Group 2 ◽  
Attending Physician ◽  
Group 1

Hypogammaglobulinemia, developed as a result of cardiac surgery accompanied by cardiopulmonary bypass (CPB), may be caused by hemodilution, destruction of immunoglobulin, extravasation into the interstitial space related to systemic inflammation, and capillary leak syndrome. Therefore, to address this gap, we analyzed the characteristics of the infants who developed hypogammaglobulinemia after cardiac surgery and could benefit from Immunoglobulin supplementation. Methods: This is a retrospective study evaluating infants undergoing surgery for repair of congenital heart defects from October 1, 2019 to June 30th, 2020 in the neonatal unit of our institution. Due to its retrospective design, informed consent was not required. Patients were divided in two groups: Group 1 (IgG >= 340mg/dL) and Group 2 (IgG < 340mg/dL). The value cut point was defined taking into consideration p10 level of Immunoglobulin according to Fujimura. Results: From October 1, 2019 to June 30th, 2020, 62 children were born or admitted in our neonatal unit. Among them, 19 (30%) have their IgG dosed, according to attending physician decision. Among patients with hypogammaglobulinemia, Pseudomonas sp was present in 87.5% of blood stream and/or tracheal secretion cultures. Regarding survival analysis, mortality was not different between Group 1 and 2. Conclusion: Hypogammaglobulinemia has proved to be a predictor factor of postoperative complications in pediatric cardiac surgery. However, prospective trials are needed to determine the incidence of this problem, its real impact on survival, and the appropriate therapy.

scholarly journals Impact of Renal Function on the Surgical Outcomes of Displaced Femoral Neck Fracture in Elderly Patients

2019 ◽  
Vol 8 (8) ◽  
pp. 1149 ◽  
Author(s):  
Kwon ◽  
Lim ◽  
Yang ◽  
Lee ◽  
Jeon ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Femoral Neck ◽  
Renal Impairment ◽  
Femoral Neck Fracture ◽  
Bipolar Hemiarthroplasty ◽  
Neck Fracture ◽  
Group 3 ◽  
Group 2 ◽  
Complications And Mortality ◽  
Group 1

Background: The aim of this study was to investigate the relationship between estimated glomerular filtration rate (eGFR) and outcomes of bipolar hemiarthroplasty for femoral neck fracture in elderly patients, and to compare postoperative complications and mortality among groups according to eGFR. Methods: A total of 181 patients who underwent bipolar hemiarthroplasty for displaced femoral neck fracture were divided into three groups according to eGFR. Data were retrospectively analyzed. Group 1 had 96 patients with eGFR greater than or equal to 60 mL/min/1.73 m2; Group 2 had 54 patients with eGFR greater than or equal to 30 mL/min/1.73 m2 and lower than 60 mL/min/1.73 m2; and Group 3 had 31 patients with eGFR lower than 30 mL/min/1.73 m2. Postoperative complications and mortality were compared between groups at a minimum 2-year follow-up. Results: Patients in Group 3 had the longest hospital stay of the three groups (p = 0.001). The rates of medical complications did not differ significantly among groups. However, Group 2 and 3 had higher rates of surgical complications (p = 0.001) and mortality (p = 0.043) than Group 1. Severe renal impairment was associated with increased risk of postoperative complications compared to mild renal impairment (odds ratio (95% confidence interval) = 4.33 (1.32–13.19), p = 0.015). Conclusion: Patients with moderate or severe decreased eGFR associated with chronic kidney disease (CKD) could have higher postoperative complications and mortality after bipolar hemiarthroplasty compared to patients with CKD stage 1 or 2.

Assessment of myocardial remodeling in the perioperative period of coronary artery bypass grafting: effects of prehabilitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Argunova ◽  
A Korotkevich ◽  
E Moskin ◽  
S Pomeshkina ◽  
O Barbarash
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Control Group ◽  
Bypass Grafting ◽  
Myocardial Remodeling ◽  
Group 2 ◽  
Group 1

Abstract Purpose To assess serial changes in the morphological and functional parameters, and indicators of myocardial perfusion in the perioperative period of coronary artery bypass grafting (CABG), depending on the preoperative management strategy. Methods 60 male patients with stable coronary artery disease (CAD) were randomized into two groups before on-pump CABG. Group 1 patients (n=30, aged of 61.5 [56; 63] years) underwent treadmill training at 80% of VO2max for a 7-day period. Group 2 patients (n=30, aged of 62.0 [56; 64] years) underwent routine management without prehabilitation. Cardiac morphological and functional parameters were evaluated using echocardiography in the preoperative period and 5–7 days after CABG. Adenosine loading single-photon emission computed tomography (SPECT) was used to measure the parameters of myocardial perfusion before and after the indexed CABG. Data were processed using the QPS program (Cedars Sinai Medical Center (USA)) and the 17-segment polar mapping. Statistical analysis was performed using commercially available Statistica 10.0 software package (Statsoft, USA). Results Both groups demonstrated a decrease in LVEF in the postoperative period. However, an LVEF decline in Group 1 patients was less significant (p=0.00015) than in the control group (p=0.000003). LV end-systolic dimension increased by 8.5% and LV end-systolic volume by 18% in patients who underwent prehabilitation as compared to the baseline, whereas these changes were more pronounced in the control group (17% (p=0.00029) and 41% (p=0.00028), respectively). Group 1 patients demonstrated better myocardial perfusion parameters in the postoperative period. Patients in the prehabilitation group reported higher accumulation levels of radiopharmaceuticals in the basal (75.0 [72.5; 80] and 72.0 [70; 75]%, p=0.036), middle (87.0 [83; 91] and 81.0 [77; 84]%, p=0.012) and apical (86.0 [82; 89] and 82.0 [78; 86]%, p=0.037) myocardium as compared with those in the control group. The stress-induced ischemia (SDS) was less pronounced in Group 1 compared to Group 2 (p=0.025). Conclusion Optimized myocardial remodeling parameters and improved myocardial perfusion in the postoperative period have proved the effectiveness of high intensity physical trainings introduced in the prehabilitation program for CABG. Funding Acknowledgement Type of funding source: None

Dynamics of nasopharyngitis in children

2000 ◽  
Vol 122 (5) ◽  
pp. 696-700
Author(s):  
Itzhak Brook ◽  
Alan E. Gober
Keyword(s):  
Bacterial Growth ◽  
Anaerobic Bacteria ◽  
Purulent Discharge ◽  
Nasal Discharge ◽  
Bacterial Interaction ◽  
Prevotella Species ◽  
Group 2 ◽  
Aerobic And Anaerobic ◽  
Fusobacterium Species ◽  
Group 1

PURPOSE: Our goal was to characterize the dynamics and bacterial interaction of the aerobic and anaerobic flora of nasal discharge of children at different stages of uncomplicated nasopharyngitis. METHODS AND PATIENTS: Serial semiquantitative nasopharyngeal (NP) and quantitative nasal discharge (ND) cultures were taken every 3 to 5 days from 20 children in whom purulent discharge eventually developed (group 1), and a single culture was obtained from a group of 20 who had only clear discharge (group 2). RESULTS: Aerobic and anaerobic bacteria were isolated from all NP cultures. Bacterial growth was present in 8 (40%) NDs of group 2. Only 7 (35%) of the clear NDs of group 1 showed bacterial growth; the number increased to 14 (70%) at the mucoid stage and 20 (100%) at the purulent stage. It declined to 6 (30%) at the final clear stage. The number of species and total number of organisms increased in the NDs of group 1. Group 1 patients had higher recovery rates of Streptococcus pneumoniae and Haemophilus influenzae in their NP cultures than group 2 patients ( P < 0.05). During the purulent stage, Peptostreptococcus species were isolated in 15 (75%), Fusobacterium species in 10 (50%), Prevotella species in 9 (45%), H influenzae in 8 (40%), S pneumoniae in 6 (30%), and β-hemolytic streptococci in 5 (25%) of group 1 NDs. This was higher than their recovery in the clear stages of both groups and the mucoid stage of group 1. A total of 8 organisms capable of interfering with the growth of potential pathogens were isolated from the NPs of group 1, as compared with 35 from group 2 ( P < 0.001). CONCLUSIONS: The development of purulent nasopharyngitis is associated with the pre-existing presence of potential pathogens and the absence of interfering organisms.

The Usage of Endobiliary Stents with Antiseptic Coating in the Treatment of Choledocholithiasis

2020 ◽  
Vol 17 (9) ◽  
pp. 4751-4754
Author(s):  
Angela V. Gnashko ◽  
Vladimir F. Kulikovskiy ◽  
Andrey L. Yarosh ◽  
Aleksandr A. Karpachev ◽  
Aleksandr V. Soloshenko ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Plastic Stents ◽  
Biliary Stenting ◽  
Biliary Stents ◽  
Aged Patients ◽  
Actual Problem ◽  
Septic Complications ◽  
Group 2 ◽  
Group 1

Introduction: Choledocholithiasis is still an actual problem of treatment of complicated forms of cholelithiasis. The difficulties in treatment of this pathology are caused by the predominance of elderly and senile aged patients whom biliary stenting in most cases can be used as the only method of treatment. The purpose of the study is to justify the usage of endobiliary prostheses with antiseptic coating in the treatment of patients with choledocholithiasis. Material and methods: We analyzed the results of 95 patients’ treatment with “difficult” choledocholithiasis and in these casesbiliary endoprostheses were used at the first stage of curing. In 56 cases (group 1–58.4%), stenting was performed with “traditional” plastic prostheses without special coating, 39 stentings (group 2–41.6%) were performed with plastic stents, the surfaces of which were modified with 10% betadin solution. Results: The frequency of patient’s postoperative complications of the 1st group was 19.64% and 7.69% in the 2nd group. The decrease of specific complications such as early stent obturation and the development of purulent cholangitis was identified. The rate of complications in cases of endobiliary uncoated stenting using was 7.14% and 5.36% and these complications occurred in 2.56% and 2.56% in the group where Betadine coating was used. The term of serving of the biliary stents in the 2nd group (182.3±37.1 days) was significantly higher than the term of the uncoated stents (125.8±33.9 days). Conclusion: The usage of the antiseptic coating reduces the risk of developing of purulent-septic complications and increases the duration of functioning of biliary stents in patients with “difficult” choledocholithiasis.

Comparison of Antihypertensives after Coronary Artery Surgery

2005 ◽  
Vol 13 (4) ◽  
pp. 302-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Hasan Karabulut ◽  
Onur Goksel ◽  
Serdar Evrenkaya ◽  
Sumer Tarcan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sodium Nitroprusside ◽  
Artery Bypass ◽  
Effective Control ◽  
Hemodynamic Effects ◽  
Double Product ◽  
Myocardial Infraction ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Audrone Veikutiene ◽  
Pranas Grybauskas ◽  
Jurate Cimbolaityte ◽  
Ausra Mongirdiene ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Blood Loss ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

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