понедельник, 17 января 2011 г.

Письменное показание под присягой Стивена Джеффри Полларда, хирурга Университетской клиники Святого Иакова, г. Лидс, Англия.

В ГОЛОВИНСКОМ МЕЖМУНИЦИПАЛЬНОМ СУДЕ МОСКВЫ

Дело No 2-2208/98


МЕЖДУ:-  

ПРОКУРОРОМ СЕВЕРНОГО АДМИНИСТРАТИВНОГО ОКРУГА МОСКВЫ
Истец
- и 

СОБРАНИЕМ СВИДЕТЕЛЕЙ ИЕГОВЫ ГОРОДА МОСКВА
Ответчик


ПОКАЗАНИЯ ПОД ПРИСЯГОЙ СТЕФАНА ДЖЕФФРИ ПОЛЛАРДА

Я, СТЕФАН ДЖЕФФРИ ПОЛЛАРД, хирург-консультант больницы университета св.Иакова, Лидс LS9 7TF Англия, КЛЯНУСЬ и сообщаю следующее:-


1. В той степени, в которой данные под присягой показания находятся в пределах моей личной компетенции, они являются истинными. В той степени, в которой они представляют предмет моей осведомленности, они являются истинными с точки зрения моих знаний, информированности и убеждений.

2. Я обладаю следующими профессиональными квалификациями, должным образом заверенными и зарегистрированными Генеральным медицинским советом Великобритании и Королевским колледжем хирургов Англии и указанными в Медицинском справочнике:-

1978 Бакалавр естественных наук, Лондонский университет, Англия.

1981 Бакалавр медицины; бакалавр хирургии, Лондонский университет, Англия.

1983 Премия Халлетта.

1986 Член Королевского колледжа хирургов, Лондон, Англия.

1990 Стипендиат Риджент энд Этикон Трэвеллинг.

1990 Премия Прискеля за научную работу.

1993 Магистр гуманитарных наук, Кембриджский университет, Англия.

1994 Магистр хирургии, Лондонский университет, Англия.

3. Мой послужной список:-

Клинический лектор и старший регистратор хирургии в больнице Адденбрука, Кембридж.

Действительный член научного общества Ист Англиан

Регистратор, больница Адденбрука, Кембридж.

Приглашенный доцент хирургии, больница Индианаполисского университета, Соединенные Штаты Америки.

4. В настоящее время я занимаю должность хирурга-консультанта и возглавляю отделение заболеваний печени в больнице св.Иакова, Лидс. Это самая большая больница в Соединенном Королевстве и одно из самых больших отделений подобного рода в Европе.

5. Среди моих публикаций:-

1992 Оперативная хирургия (в соавторстве)

Кроме того, мною опубликованы материалы по (среди прочего) гастроинтестинальной хирургии; трансплантации.

6. Я занимаюсь клинической практикой с 1981 года и провожу широкий спектр хирургических процедур, многие из которых – для Свидетелей Иеговы. Выбор бескровного лечения стал обычным делом. Все хирурги признают риск, присущий переливанию гомологичной крови. Это риск возникновения гиперкалемии (высокий уровень содержания калия в крови за счет его утечки из запасных красных кровяных клеток) и гопокальцемии (низкий уровень кальция из-за токсичности, вызванной цитратным антикоагулянтом), сильные и необратимые реакции в связи с несовместимостью крови, реакции между имплантантом и «хозяином» (характеризующиеся 100% смертностью) в связи с использованием предположительно совместимой крови, инфекционные заражения, в том числе HIV, гепатиты А, В и С, цитомегаловирус, а также в настоящее время до конца не изученная и еще не имеющая решения проблема переливания термостойких прионовых частиц, приводящего к таким болезням, как болезнь Кройцфельда-Якоба. У реципиента крови могут развиться аллергические реакции – от умеренных до сильных – на медикаменты (например, пенициллин) и продукты питания (например, яйца), принятые донором до процедуры переливания. Центры почечного диализа всеми силами избегают переливания крови из-за риска развития пациентом антител, противоборствующих с протеинами белых клеток крови, что может затем помешать трансплантации почек. Несмотря на попытки служб переливания крови фильтровать кровь и подвергать ее термической обработке, а также устранить ошибки канцелярской работы, процедура переливания крови никогда не будет считаться безопасной на 100%; могут быть устранены только некоторые из вышеперечисленных осложнений. Эти риски хорошо документированы в стандартных учебниках, а также в равноценных журналах, таких как The Lancet и The British Medical Journal.

7. Как хирург я несу юридические и этические обязанности перед своим пациентом, и в случае Свидетелей Иеговы это признано в Практическом Кодексе хирургического лечения Свидетелей Иеговы Королевского колледжа хирургов Англии, опубликованном в 1996 году. Он был распространен среди всех членов Королевского колледжа, многие из которых практикуют не только в пределах Европы, но и далеко за ее пределами.

8. Многие мои коллеги в настоящее время в обычном порядке повсеместно производят хирургические процедуры без применения донорской крови. В медицинской литературе находится множество отчетов, показывающих, что большинство хирургических процедур, включая многие сложные ключевые операции, могут быть успешными, если производятся без использования переливания крови.

9. Я не являюсь одним из Свидетелей Иеговы, не разделяю их убеждений и не поддерживаю их ни материально, ни каким-либо другим образом. Однако я уважаю их права как пациентов на сознательный отказ от получения донорской крови и постоянно действую в их отношении в рамках ограничений, налагаемых бескровным лечением. Уровень заболеваемости и смертности среди них, на сколько мне известно, по крайней мере, не хуже, чем среди пациентов, получающих кровь, а во многих случаях, они ограждены от пост-операционных инфекций и осложнений, часто обусловленных кровью. В качестве вещественного доказательства SP1 прилагается библиография, полученная из международной частной базы данных мировой литературы, известной как Medline.

10. Все более обычным становится обращение пациентов, не являющихся Свидетелями Иеговы (особенно врачей), с просьбой воздерживаться от переливания крови, основанной исключительно на их знании о рисках, связанных с переливанием. По моему мнению и по мнению многих других медиков-практиков, медицинская профессия налагает профессиональное обязательство учитывать такую просьбу - исходит она от Свидетеля Иеговы или кого-то другого - как выбор пациента, точно так же, как в случае их выбора, подвергаться или нет любой другой потенциально рискованной процедуре. Я верю, что при условии, что пациенту дано разъяснение относительно соответствующих рисков и преимуществ воздержания от переливания крови, врач связан обязательством уважать подобную просьбу пациента.

КЛЯТВА дана и нотариально заверена в )

Лидсе, Англия, в этот )

день ноября 1998 года )

В МОЕМ ПРИСУТСТВИИ,

Нотариус.







 В ГОЛОВИНСКОМ МЕЖМУНИЦИПАЛЬНОМ СУДЕ МОСКВЫ

МЕЖДУ:-

ПРОКУРОРОМ СЕВЕРНОГО АДМИНИСТРАТИВНОГО ОКРУГА МОСКВЫ

- и

СОБРАНИЕМ СВИДЕТЕЛЕЙ ИЕГОВЫ ГОРОДА МОСКВА
               ________________________________________

ВЕЩЕСТВЕННОЕ ДОКАЗАТЕЛЬСТВО
               ________________________________________

Данное вещественное доказательство, обозначенное 'SP1', относится к показаниям, данным под присягой Стефаном Джеффри Поллардом и представлено мне.

Клятвенно заверено в этот 16 день Ноября 1998 г.

В моем присутствии,

(подпись)

Нотариус Гордон Вацон
Нотариус
Лидс
Англия

(Текст документа на англиском языке)



IN THE GOLOVINSKIY INTERMUNICIPAL COURT OF MOSCOW

BETWEEN: Case No 2-2208/98

THE PROSECUTOR OF THE NORTHERN ADMINISTRATIVE CIRCUIT OF MOSCOW

Complainant

-and

THE CONGREGATION OF JEHOVAH'S WITNESSES
OF THE CTTY OF MOSCOW

Respondent

EXHIBIT

This is the exhibit marked 'SP1' referred to in the Affidavit of Stephen Geoffrey Pollard and produced to me.
Sworn this














________________________________________

Pediatr. Cardiol. 1997 May- Jun; 18(3): 245-6

Open heart surgery in the pediatric Jehovah's Witness population: no longer "Russian roulette".

Rosengart TK, Lang S, Helm R, Friedman D

Publication Types:

• Letter

PMID: 9142725, UI: 97287931
________________________________________

Int. J. Pediatr Otorhinolaryngol 1997 Jan 3; 38(3): 197-205; discussion 207-13

The Jehovah's Witness family, transfusions, and pediatric day surgery.

Morrison JE Jr., Lane G, Kelly S, Stool S

Department of Anesthesiology, Children's Hospital, University of Colorado Health Science, Denver 80218, USA. morrison@essex.uchsc.edu

The pediatric otolaryngologist and anesthesiologist, when encountering a family of the Jehovah's Witness (JW) faith should be aware of the potential problems which may arise when deciding to proceed with surgery. Two case reports are presented which illustrate the difficult situations, which can occur when unanticipated complications (i.e. profound bleeding) arise perioperatively. An overview of the history and common tenets of the JW faith, previous legal perspectives, pertinent clinical information from the medical literature, and the protocol of The Children's Hospital, Denver, for dealing with this sensitive issue (drafted with the cooperation of the local JW Hospital Liaison Committee) are presented.

PMID: 9051425. UI: 97203853

________________________________________

Conn. Med. 1997 Apr; 61(4): 195-9

Coronary stent placement as a bridge to coronary artery bypass surgery in an unstable, anemic Jehovah's Witness patient: a case report and review of bloodless surgery techniques.

Dougherty JE, Gallagher RC, Hirst JA, Rinaldi MJ, Biskup JM, Chamberlain RD, Waters D

Department of Medicine, Hartford Hospital, CT 06102, USA

Bloodless cardiac surgery would be optimal for all patients undergoing major or complex heart surgery, however, for Jehovah's Witnesses it involves a religious law and is fundamentally mandated. In this context, we review a case of unstable angina with associated anemia requiring catheterization and definitive intervention in a Jehovah's Witness patient. Coronary stenting to stabilize the acute coronary syndrome is described with definitive total revascularization performed by coronary artery bypass graft surgery after utilizing erythropoietin and aggressive blood conservation techniques.

Publication Types:

• Review

• Review, tutorial

PMID: 9149480, UI: 97293514

________________________________________

Harefuah 1996 Apr 15; 130(8); 517-8, 584, 583

[Anterior resection for rectal carcinoma in an anemic Jehovah's Witness].

[Article in Hebrew] Haphtel L, Rephaeli Y, Zbida D, Rubin M

Dept. of Surgery B, Wolfson Medical Center, Holon.

Anterior resection is accepted treatment for tumors of the middle rectum, with mortality less than 5%. Since such surgery involves blood loss, blood transfusion is regarded as essential. We report a 69-year old anemic Jehovah's Witness who had a bleeding rectal tumor but who refused blood transfusion, despite a hemoglobin level of 4.8 g/dl. Anterior resection of the tumor was successfully performed without substantial blood loss. Her hemoglobin level was 5.8 g/dl on discharge. Jehovah's Witnesses do not oppose medical treatment nor do they practice faith healing. Instead, they seek good medical care but accept only proven medical alternatives to blood transfusions. Physicians, world-wide, are now successfully performing major surgery of all types on both adult and minor Witnesses, Due to their success in the use of alternatives, over 50 hospitals in North America, Europe and Australia have established "bloodless-surgery" centers to serve not only Jehovah's Witnesses but also a growing number of other patients who wish to avoid risks associated with blood transfusion.

PMID: 8765872, HI: 96316S30

________________________________________

CMAJ 1996 Feb 15; 154(4). 557-60

Jehovah's Witnesses leading education drive as hospitals adjust to no blood requests.

Robb N

Jehovah's Witness representatives have visited more than 10 Canadian medical schools and 200 hospitals in an attempt to educate future and practising physicians about nonblood medicine. The trend is becoming more popular since the advent of HIV, and there are now about 100 bloodless medicine and surgery centres around the world, including 52 in the US. However, a Jehovah's Witness spokesman says Canada is "conspicuously absent" from the list of countries that offer bloodless-medicine programs.

Comments:

• Comment in. Can. Med. Assoc. J 1996 Aug 1; 155(3): 275-6

PMID- 8630845, UI: 96229949

________________________________________

Lakartidningen 1991 Dec 4.88(49)-4245-6

[Erythropoietin made surgery for aortic coarctation possible in a Jehovah's witness patient].

[Article in Swedish]

Halden E, Birgegard G, Duvernoy 0, Henze A

Thoraxanestesi-sektionen, sarntliga vid Akademiska sjukhuset, Uppsala-

PMID: 1758229. UI: 92099709

________________________________________

Am J Surg. 1990 Mar, 159(3): 32-4

Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality.

Spence RK, Carson JA, Poses R, McCoy S, Pello M, Alexander J, Popovich J, Norcross E, Camishion RC

Department of Surgery, Cooper Hospital/University Medical Center. Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, Camden,

To clarify the widespread practice of preoperative transfusion to attain a 10 g/dL level of hemoglobin, the relationship between preoperative hemoglobin level, operative blood loss, and mortality was studied by analyzing the results of 113 operations in 107 consecutive Jehovah's Witness patients who underwent major elective surgery. Ninety-three patients had preoperative hemoglobin values greater than 10 g/dL, 20 had preoperative hemoglobin levels between 6 to 10 g/dL. Mortality for preoperative hemoglobin levels greater than 10 g/dL was 3 of 93 (3.2%); for preoperative hemoglobin levels between 6 to 10 g/dL, mortality was I of 20 (5%). Mortality was significantly increased with an estimated blood loss of greater than 500 mL, regardless of the preoperative hemoglobin level (p less than 0.025). More importantly, there was no mortality if estimated blood loss was less than 500 mL, regardless of the preoperative hemoglobin level. From these data, we conclude that: (1) Mortality in elective surgery appears to depend more on estimated blood loss than on preoperative hemoglobin levels; and (2) Elective surgery can be done safely in patients with a preoperative hemoglobin level as low as 6 g/dL if estimated blood loss is kept below 500 mL.

PMID: 2305940, UI: 90164873

________________________________________

J Clin. Ethics 1990 Spring; 1 (1): 65-71; discussion 71-4

The Jehovah's Witness and blood: new perspectives on an old dilemma.

Vinicky JK, Smith MI, Connors RB Jr., Kozachuk WE

PMID: 2131063, UI: 9203302S

________________________________________

Can. J. Anaesth. 1989 Sep; 36(5)-578-85

Surgery in Jehovah's Witnesses.

Wong DH, Jenkins LC

Department of Anaesthesia, Faculty of Medicine, University of British Columbia, Vancouver.

This is a retrospective study of the outcome of surgical procedures in patients who were Jehovah's Witnesses. Over a 75-month period, 58 Jehovah's Witness patients had 78 surgical procedures at the Vancouver General Hospital. Three patients had preexisting anaemia of less than l00 g. L-1 l haemoglobin. Postoperative haemoglobin concentration decreased below 50 g. L-1 in three patients. One patient had a postoperative haemoglobin of 34 g. L-1 (haematocrit 10.1 percent) and survived. One patient died from uncontrollable postoperative haemorrhage. Perioperative morbidity was not uncommon, including significant hypotension (eight cases), cardiac arrhythmias (six), myocardial ischaemia (three), excessive bleeding (four), postoperative nausea or syncope (four), and wound or urinary tract infection (four).

Comments:

* Comment in: Can. J. Anaesth. 1990 Apr; 37(3): 391-2

PMID: 2639668. UI: 90003550

________________________________________

Br J Hosp Med. 1996 Jul 10-Aug 20.56(2-3): 107-8

Elective surgery in an anaemic Jehovah's Witness.

Cooper R, Quincy N

Musgrove Park: Hospital, Taunton, England.

PMID 8963478. UI: 97100893
________________________________________
Br J Anaesth. 1996 May; 76(5): 740-3
Use of recombinant human erythropoietin to facilitate liver transplantation in a Jehovah's Witness.
Snook NJ, O'Beirne HA, Enright S, Young V, Bellamy MC Intensive Care Unit, St James's University Hospital, Leeds.
A 46-yr.-old woman with rapidly progressing primary biliary cirrhosis presented for liver transplantation. The use of preoperative recombinant human erythropoietin enabled this to be achieved without prohibited Hood products. Perioperative management of this patient and general principles of management of Jehovah's Witnesses undergoing major surgery are discussed.
PMID 8688281, UI: 96288397
________________________________________
Ann Surg 1993 Nov, 218(5): 610-4
Hepatic resection for cystic lesions of the liver.
Madariaga JR, Iwatsuki S, Sterzl TE, Todo S, Selby R, Zetti G
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
OBJECTIVE. The purpose of this study was to report the authors' experience with hepatic resection for cystic lesions of the liver. SUMMARY BACKGROUND DATA. Past experience with aspiration. sclerosing therapy, internal drainage, fenestration, and marsupialization are of limited value. Hepatic resection has evolved into a safe operation over the last two decades. METHODS. A retrospective study of 44 patients with various cystic lesions of the liver (polycystic disease, 2; solitary or multiple congenital cysts, 19, biliary cystadenoma. 6; cystadenocarcinoma, 3; squamous cell carcinoma, 3, Caroli's disease, 5, and hydatid cyst, 6) was performed. RESULTS. After 7 trisegmentectomies, 24 lobectomies, 6 left lateral segmentectomies, and 7 nonanatomical hepatic resections, only 1 operative death occurred in a Jehovah's Witness. Symptomatic relief was complete and permanent in all of the patients with benign congenital or parasitic hepatic cysts, except for the two patients with polycystic disease of the liver. One of the 3 patients with adenocarcinoma and 3 patients with squamous cell carcinoma of the cyst wall died of tumor recurrence between 3 and 14 months after hepatic resection. CONCLUSIONS. Hepatic resection is safe and effective for cystic lesions of the liver. Symptomatic relief is complete and permanent after hepatic resection, except in cases of diffuse polycystic disease of the liver. Liver transplantation should be considered for diffuse polycystic disease of the liver when the symptoms are extremely severe.
PMID- 8239774, UI 94058380
________________________________________
Arch Surg. 1993 Oct. 128(10): 1168-70
Use of erythropoietin and parenteral iron dextran in a severely anemic Jehovah's Witness with colon cancer.
Mudura JA
Department of Surgery, Indiana University School of Medicine, Indianapolis.
A Jehovah's Witness presented with colon cancer and profound anemia. On admission, her hemoglobin level was 30 g/L, (3.0 g/dL). She refused all transfusions and failed to respond to oral iron therapy. She was ultimately prepared for surgery using recombinant human erythropoietin, iron dextran, and total parenteral nutrition. It took nearly I month to increase her hemoglobin level to an acceptable preoperative level of 110 g/L (11.0 g/dL). During the postoperative period, erythropoietin and parenteral iron therapy were briefly continued and a follow-up hemoglobin level of greater than 120 g/L (12-0 g/dL) was observed. Recombinant human erythropoietin, along with parenteral iron and adequate nutrition, may be useful in patients who refuse transfusion or cannot be transfused because of difficult cross-reacting antibodies.
PMID. 8215878, UI: 94029533
________________________________________
Lakartidningen 1992 Sep 9,89(37): 295 5-7
[Autotransfusion of blood cells made surgery of a Jehovah's Witness possible].
[Article in Swedish] Bengtsson A, Johansson S, Hablin M, Crona N
Anestesidivisionen, Sahlgrenska sjukhuset, Goteborg.
PMID. H05899-UI: 93023041
________________________________________
Arch. Surg. 1992 Mar, 127(3): 3 49-5]
Pancreaticoduodenectomy without homologous blood transfusion in an anemic Jehovah's Witness.
Atabek U, Spence RK, Pello M, Alexander J, Carnishion R
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden.
Whipple pancreaticoduodenectomy is an accepted procedure for management of periarnpullary and pancreatic carcinomas and has modern mortality rates of less than 10%. The procedure is associated with significant operative blood loss. Therefore, blood transfusion is an important supportive measure. We report the case of a. bleeding ampullary carcinoma in a Jehovah's Witness who refused transfusion of all homologous blood products. Despite a preoperative hemoglobin level of 51 g/L. curative pancreaticoduodenectomy was successfully performed. The success of the procedure can be primarily attributed to careful surgical technique, intraoperative autotransfusion, avoidance of postoperative complications, minimization of perioperative phlebotomies, use of human recombinant erythropoietin, and, possibly, the use of the perfluorocarbon emulsion Fluosol DA-20%. The case illustrates several important principles for the surgical treatment of patients with severe anemia who refuse transfusion of homologous blood products.
PMID: 1347993, UI: 92198210
________________________________________
Clin. Transplant 1996 Oct; 10(5): 404-7
Liver transplantation for fulminant hepatic failure in a Jehovah's Witness.
Seu P, Neelankanta G, Csete M, Olthoff KM, Rudich S, Kinkhabwala M, Imagawa DK, Goldstein LI, Martin P, Shackleton CR, Busuttil RW
Department of Surgery, UCLA School of Medicine 90095, USA
Jehovah's Witness patients who refuse transfusions have generally not been fell to be candidates for liver transplantation owing to the frequent requirement for blood transfusions during liver transplantation. This is the first report to our knowledge of successful emergent liver transplantation without the use of blood or blood products in a Jehovah's Witness. The surgical and anesthetic strategies employed in achieving a successful outcome are discussed.
PMID: 8930452, UI: 97084108
________________________________________
J. Clin. Anesth. 1996 Aug 8(5). 386-91
Anemia and perioperative myocardial ischemia in a Jehovah's Witness patient.
Botero C, Smith CE, Morscher AH
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA-
We present a case in which an anemic patient with religious objections to blood transfusion experienced three episodes of severe myocardial ischemia during the perioperative period. The first episode of ischemia was successfully treated by discontinuing isoflurane and resolving the hypotension. The second and third episodes were successfully treated by heart rate control with esmolol and neostigmine.
PMID. 8832450, UI-96429349
________________________________________
Am Surg 1998 Nov; 64(11): 1074-6
Extended hemipelvectomy in a Jehovah's Witness with erythropoietin support.
Meyers MO, Heinrich S, Kline R, Levine EA
Section of Surgical Oncology, Louisiana State University Medical Center, New Orleans, USA. [Medline record in process]
The care of patients refusing blood transfusion who require major ablative surgery for malignancy is a continuing challenge. The use of recombinant human erythropoietin is clearly efficacious in patients with renal disease and may be useful in anemic patients who refuse transfusion. Herein, we report a successful extended hernipelvectomy in a Jehovah's Witness using recombinant human erythropoietin support.
PMID 9798772, UI: 99013116
________________________________________
Ann Fr Anesth Reanim 1998; 17(4): 310-4
[Hemorrhagic surgery in two Jehova's witness children refusing programmed autotransfusion: a place for erythropoietin].
[Article in French] Roure P, Hayem C, Daoud A
Service d'anesthesie-reanimation, hopital R-Poincare, Garches, France.
We report two cases of haemorrhagic surgery in a 6-year-old and 16-year-old girl, respectively, whose parents were Jehovah's witnesses and therefore opposed to preoperative blood donation, but accepting intraoperative blood salvage. Erythropoietin and intravenous iron were administered preoperatively to increase red cell mass. Intraoperative blood salvage, including nonnovolaemic haemodilution and intraoperative autologous transfusion, avoided homologous blood transfusion.
PMID:9750750, UI:98423324
________________________________________
Med KIin 1998 Aug 15,93(8): 457-62
[No title available].
[Article in German]
Schneider HT, Schell E, Wenzel F, Benninger J, Rabenstein T, Flugel H, Katalinic A, Hahn EG, EU C
Medizinische Klinik I mit Poliklnik, Friedrich-Alexander-Universitat Erlangen-Numberg-[Medline record in process]
BACKGROUND: The treatment of cholecystolithiasis has changed fundamentally in recent years due to the development of non-surgical techniques (extracotporeal shockwave lithotripsy [ESWL], oral litholysis) and the implementation of laparoscopic cholecystectomy. PATIENTS AND RESULTS. Retrospective analysis of 2270 patients (1649 women, 621 men; age- 47.2 +/- 14 years) presenting with gallstone disorders in a university medical outpatients department between 198B and 1992 in order to be instructed as to the most suitable therapy method bear witness to the rapid change in therapeutic procedure. Laparoscopic removal of the gallbladder has virtually supplanted conventional cholecystectomy, and within 5 years the proportionate role of ESWL has declined from 21 to 12%. Over the years, the proportion of patients requiring no therapeutic intervention remained constant (at about 20°'4); the therapeutic recommendations of the "experts" were implemented in almost 80% of cases. The majority of patients were satisfied with (he chosen therapeutic approach (surgery 93-0%, ESWL. 77.6%). although 44% of ESWL-patients and 36% of surgically managed patients reported complaints Which persisted even after completion of therapy. Despite unsuccessful ESWL (residual fragments or recurrent stones) 58/95 (61%) of interviewed patients would again give preference to this non-invasive modality in the event of a renewed therapeutic decision. CONCLUSION: Only a few years after its introduction, laparoscopic cholecystectomy has asserted itself as the predominant treatment option- But as far as acceptance and preference by the patient are concerned extracorporeal shockwave lithotripsy-as a non-invasive treatment modality-also enjoys high popularity and can be recommended as an alternative to surgery in suitable patients chosen according to the currently established stringent selection criteria.
PMID: 9747100. UI: 9B4I9237
________________________________________
Kyobu Geka 1998 Feb, 51(2): 89-94; discussion 94-7
Furuse A Jr., Kotsuka V, Kawauchi M, Tanaka 0, Hirata K
Department of Cardiothoracic Surgery, University of Tokyo, Japan.
Clinical experiences of 35 cardiothoracic operations in Jehovah's Witness patients were presented with special reference to a method of taking informed consent for surgery. Al first the surgeon explained the details of the proposed surgery including its risks and benefits. He should also express his confidence in accomplishing the operation without blood transfusion. Otherwise he should not dare to perform the operation. The surgeon asked the patient to talk about his or her religious belief in transfusion denial. Then the surgeon was allowed to talk about his professional duty and ethical belief in saving the patient at all costs. Finally, both the patient and the surgeon would sign the document of informed consent without fully determining whether or not the patient would undergo transfusion at an unexpected situation since the possibility of such unexpected necessity of blood transfusion was believed extremely tow by both the surgeon and the patient. The trust of the patient in the technique of the surgeon was the key to this agreement.
Publication Types:
• Review
• Review of reported cases
PMID. 9492454, in: 98) 53331
________________________________________
Wiad Lek 1997,50(4-6): 120-2
[Operation for ruptured abdominal aortic aneurysm without consent for blood transfusion-case report].
[Article in Polish] Gutowski P, Dybkowska K, Szumilowicz G
Kliniki Chiurgii Ogolnej i Naczyniowej. Pomorskiej Akademii Medycznej w Szczecinie.
Successful operation for ruptured abdominal aortic aneurysm (AAA.) in a Jehovah's Witness 66-year-old man was presented. The patient was urgently operated for symptomatic AAA. We found during surgery that that aneurysm was ruptured. Bifurcated PTFE aorto-bi-iliac prosthesis was implanted. The patient did not receive any blood or blood-origin products while staying in our Hospital.
PMID. 93B1714, UI- 97451949
________________________________________
Nippon Kyobu Geka Gakkai Zasshi 1997 Dec; 45(12): 2006-10
[Open heart surgery in a Jehovah's Witness boy-a case report of successful management of aortic regurgatation and aneurysm of sinus Valsalva due to infective endocarditis].
[Article in Japanese] Sawada Y, Asada K, Matsuyama N, Hasegawa S, Sasaki S
Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.
Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee, There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/d). Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively- We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.
PMID: 9455116, UI: 98116130
________________________________________
Nippon Kyobu Geka Gakkai Zasshi 1997 Aug; 45(8): 1165-8
[A case of Jehovah's Witness underwent double valves replacement in reoperation].
[Article in Japanese] Nishimoto M, Sawada Y, Asada K, Hasegawa S, Sasaki S
Department of Thoracic and Cardiovascular Surgery, Osaka Medical School, Japan.
The patient was a sixty five-year-old woman and Jehovah's Witness who refused either homologous or autologous blood transfusion on the ground of her faith. At the age of 47, she had closed commissurotomy for mitral valve stenosis. This time, because mitral valve restenosis and tricuspid valve regurgitation were found, double valve replacement, mitral and tricuspid, was performed on her, with an excellent result. It is expected that, in the near future, the indication for open heart surgery without blood transfusion will be increased by means of the following considerations as to blood loss preservation; 1. to shorten the time necessitating for an operation and reduce preoperative blood loss, 2, to improve cardio-pulmonary bypass system (Heparin coating etc), and 3. to augment the erythropoiesis (administration of EPO at the patient's own expense, etc.) and so on.
PMID: 9301249, UI: 97446774
________________________________________
J CIin. Anesth. 1997 Sep,9(6): 510-3
Management of Jehovah's Witness patients for scoliosis surgery: the use of platelet and plasmapheresis.
Safwat AM, Reitan JA, Benson D
Department of Anesthesiology, University of California, Davis Medical Center, Sacramento 95817, USA.
Four patients whose religious beliefs prohibited accepting blood during surgery for scoliosis were anesthetized and managed successfully using plateletpheresis and plasmapheresis. Blood losses were replaced with crystalloid and hetastarch solutions. In addition, a moderate hypotensive technique was used to minimize surgical blood loss. Postoperatively, the patients received iron therapy and/or erythropoietin. Three of these patients bad an uncomplicated postoperative course, however, the fourth patient had some postoperative bleeding with initial hemodynamic instability. We believe that patients who refuse to receive blood transfusion during surgery because of religious beliefs or health issues can be managed safely using other alternatives and techniques such as platetetpheresis and plasmapheresis, which conserve and minimize blood loss. Each case should be assessed on an individual basis.
PMID:9278843, UI:97424730
________________________________________
Surg. Endosc. 1997 Aug; 11(8):850-l
Laparoscopic splenectomy in a Jehovah's Witness with profound anemia.
Ferzli GS, Horwitz JB, Fiorillo MA, Hayek NE, Dysarz FA, Kiel T
Department of Laparoendoscopic Surgery, Staten Island University Hospital, NY 10304, USA.
Open surgery in a severely anemic patient may be complicated by a substantial blood loss from a large incision and subsequent poor wound healing secondary to the anemia. We report our success in preforming a splenectomy laparoscopically in a profoundly anemic patient, A 50-year-old white male Jehovah's Witness who was HTV positive was referred for splenectomy alter he developed profound, worsening anemia secondary to hypersplenism that was refractory to medical management. His preoperative hemoglobin and hematocrit levels were 2.7 g/dl and 8-8%, respectively, but his religious beliefs precluded transfusion. A laparoscopic splenectomy by the posterior gastric approach was performed. The patient tolerated the surgery well and experienced no additional morbidity. On postoperative day 7, his hemoglobin and hematocrit were 6.8 g/d! and 22%, respectively. We conclude that laparoscopic splenectomy is an attractive procedure in a severely anemic patient who requires splenectomy and refuses blood transfusion.
PMID:9266651, UI:97411716



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(Гаагская конвенция 5 октября 1961 г.)

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