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Stokes WA, Schubart J, Carr MM. Response to a Letter on Postoperative Bleeding Associated with Ibuprofen Use After Tonsillectomy. Otolaryngol Head Neck Surg 2020; 162:265-266. [PMID: 32009556 DOI: 10.1177/0194599819892656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zaroni FM, Cavalcante RC, João da Costa D, Kluppel LE, Scariot R, Rebellato NLB. Complications associated with orthognathic surgery: A retrospective study of 485 cases. J Craniomaxillofac Surg 2019; 47:1855-1860. [PMID: 31813754 DOI: 10.1016/j.jcms.2019.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors. METHODS This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05. RESULTS A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05). CONCLUSION Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.
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Yamada SI, Hasegawa T, Soutome S, Yoshimura H, Miyakoshi M, Ueda N, Okamoto K, Hishida S, Rokutanda S, Nakahara H, Fujita S, Akashi M, Kitagawa Y, Kirita T, Shibuya Y, Umeda M, Kurita H. Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on warfarin therapy: a multicenter retrospective study in Japan. Odontology 2019; 108:462-469. [PMID: 31705338 DOI: 10.1007/s10266-019-00474-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
Abstract
Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P < 0.001). The cutoff value for PT-INR was 2.11 based on a receiver-operating characteristic analysis. A multivariate analysis indicated that an elevated PT-INR value [hazard ratio (HR) 3.798, 95% confidence interval (CI) 1.400-10.467, P < 0.01], preoperative antibiotic administration (HR 4.434, 95% CI 1.591-14.775, P < 0.01), difficulties with intraoperative hemostasis (HR 16.298, 95% CI 2.986-110.677, P < 0.01), and higher serum creatinine levels (HR 7.465, 95% CI 1.616-39.576, P < 0.05) are significant predictors of postoperative hemorrhage after lower third molar extraction. Multivariate correlations were observed between risk factors including an elevated PT-INR value, preoperative antibiotic administration, and higher serum creatinine levels, and postoperative hemorrhage after lower third molar extraction in patients receiving warfarin therapy. Clinicians need to consider these risk factors for postoperative hemorrhage after the lower third molar extraction and monitor PT-INR in patients receiving warfarin therapy.
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Dobarganes-Barlow FG, López-Villers A, Trueba-Vasavilbaso C, Navarrete-Álvarez JM, Rebuelta-Cancio AA, Guevara-Álvarez A, Garcini-Munguia FA, Téllez-Hoyos S. [Use of tranexamic acid in primary total knee arthroplasty]. ACTA ORTOPEDICA MEXICANA 2019; 33:352-356. [PMID: 32767875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Reducing blood loss and transfusions in patients operated on primary TKR is associated with a better clinical and functional outcome. The use of Tranexamic Acid (ATX) is one of the methods used to decrease that bleeding. MATERIAL AND METHODS Results in Hb, Hto, rate of bleeding and transfusion, surgical time and pain between groups A (with ATX) and group B (without tranexamic acid) after TKR are compared. Results: Statistically significant differences were found during surgery and perisurgical bleeding, in the decrease of Hb at 24 hours, transfusion rate, surgical time and pain to wandering in favor of group A. DISCUSSION There are no published studies in Mexico on the use of ATX in patients operated on TKR. We consider its use to be increasingly common, the optimal dose and route of administration remains a controversial topic. CONCLUSION The use of ATX in the proposed scheme is safe and effective in reducing the rate of bleeding and transfusions in patients operated on ATR.
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Abstract
Gastrointestinal bleeding (GIB) can occur as a complicating issue in the postoperative course after visceral surgery. It can be of varying clinical extent ranging from mild anemia to fatal hemorrhagic shock. Symptomatic manifestations of a GIB are hematemesis, melena and hematochezia. The GIB are fundamentally differentiated into upper and lower GIB. While upper GIB is defined as the occurrence of endoluminal hemorrhage above the ligament of Treitz, correspondingly the definition of lower GIB is intraluminal bleeding distal to the duodenojejunal flexure. Knowledge of their procedure-related incidence during the postoperative course enables a better assessment of the necessary intervention.
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Yu JX, Oliver M, Lin J, Chang M, Limketkai BN, Soetikno R, Bhattacharya J, Kaltenbach T. Patients Prescribed Direct-Acting Oral Anticoagulants Have Low Risk of Postpolypectomy Complications. Clin Gastroenterol Hepatol 2019; 17:2000-2007.e3. [PMID: 30503964 PMCID: PMC6541555 DOI: 10.1016/j.cgh.2018.11.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs. METHODS We performed a retrospective analysis using Optum's de-identified Clinformatics Data Mart Database (2003-2016) (a de-identified administrative database from a large national insurance provider) to identify adults who underwent colonoscopy with polypectomy or endoscopic mucosal resection (EMR) from January 1, 2011, through December 31, 2015. We collected data from 11,504 patients prescribed antithrombotic agents (1590 DOAC, 3471 warfarin, and 6443 clopidogrel) and 599,983 patients not prescribed antithrombotics of interest (controls). We compared 30-day post-polypectomy complications, including gastrointestinal bleeding (GIB), cerebrovascular accident (CVA), myocardial infarction (MI), and hospital admissions, of patients prescribed DOACs, warfarin, or clopidogrel vs controls. RESULTS Post-polypectomy complications were uncommon but occurred in a significantly higher proportion of patients receiving any antithrombotic vs controls (P < .001). The percentage of patients in the DOAC group with GIB was 0.63% (95% CI, 0.3%-1.2%) vs 0.2% (95% CI, 0.2%-0.3%) in controls. The percentage of patients with CVA in the DOAC group was 0.06% (95% CI, 0.01%-0.35%) vs 0.04% (95% CI, 0.04%-0.05%) in controls. After we adjusted for bridge anticoagulation, EMR, Charlson comorbidity index (CCI), and CHADS2 (congestive heart failure, hypertension, age over 75, diabetes, stroke [double weight]) score, patients prescribed DOACs no longer had a statistically significant increase in the odds of GIB (odds ratio [OR], 0.90; 95% CI, 0.44-1.85), CVA (OR, 0.45; 95% CI, 0.06-3.28), MI (OR, 1.07; 95% CI, 0.14-7.72), or hospital admission (OR, 0.86; 95% CI, 0.64-1.16). Clopidogrel, warfarin, bridge anticoagulation, higher CHADS2, CCI, and EMR were associated with increased odds of complications. CONCLUSION In our retrospective analysis of a large national dataset, we found that patients prescribed DOACs did not have significantly increased adjusted odds of post-polypectomy GIB, MI, CVA, or hospital admission. Bridge anticoagulation, higher CHADS2 score, CCI, and EMR were risk factors for GIB, MI, CVA, and hospital admissions. Studies are needed to determine the optimal peri-procedural dose for high-risk patients.
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Zhang C, Guo F, Jing T, Wang F, Wang H, Ye C, Yang Y, Yang B. The margin strategy in laparoscopic partial nephrectomy with selective renal artery clamping: Anatomical basis, surgical technique and comparative outcomes. Asian J Surg 2019; 43:417-422. [PMID: 31253384 DOI: 10.1016/j.asjsur.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/14/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the possibility and efficiency of a modified margin strategy in laparoscopic partial nephrectomy with selective renal artery clamping. METHODS Seventy-six cases of laparoscopic partial nephrectomy with segmental renal artery clamping in Shanghai Changhai Hospital between July 2014 and September 2017 were retrospectively reviewed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (segmental artery mobilization time, operating time, warm ischemic time, estimated blood loss, complications, and so on). A comparative analysis between standard technique and margin strategy was performed. RESULTS In 38 cases, margin strategy to mobilize segmental artery was successfully performed. In the other 38 cases, the surgery was performed in traditional method. The use of new strategy led to a shortened segmental artery mobilization time (5 min vs 12 min, p < 0.001). There was no difference in terms of perioperative complications between the two techniques. CONCLUSIONS The margin strategy is a practical method in laparoscopic partial nephrectomy with selective renal artery clamping. It provides a simplified way of finding segmental arteries. Further studies are needed to confirm these preliminary findings.
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Matsushita M, Nishio A, Okazaki K. Meaningless comparison of resection depth between cold snare polypectomy and endoscopic mucosal resection. J Gastroenterol 2019; 54:471-472. [PMID: 30852669 DOI: 10.1007/s00535-019-01567-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
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Kaman L, Chakarbathi K, Gupta A, Dahiya D, Singh K, Ramavath K, Behera A, Kajal K. Impact of Enhanced Recovery after Surgery protocol on immediate surgical outcome in elderly patients undergoing pancreaticoduodenectomy. Updates Surg 2019; 71:653-657. [PMID: 30673978 DOI: 10.1007/s13304-019-00625-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
The numbers of patients undergoing pancreaticoduodenectomy are increasing and considerable percentage is elderly patients. Pancreaticoduodenectomy is a major and complicated surgery. The morbidity and mortality following pancreaticoduodenectomy have significantly reduced in recent times; it still remains unclear in elderly patients. Applications of Enhanced Recovery after Surgery protocol have contributed for this better outcome. In this retrospective study, patients who underwent pancreaticoduodenectomy with Enhanced Recovery after Surgery protocol were included and divided into two groups (< 60 years vs ≥ 60 years). The "elderly patients" (≥ 60 years) were defined based on the WHO definition for Indian subcontinent. Outcomes were analyzed in terms of postoperative morbidity, mortality and length of hospital stay. Total 103 patients underwent pancreaticoduodenectomy during the study period (January 2012-December 2017). The mean age was 56.6 ± 10.32 years. Fifty-six (54.37%) patients were aged < 60 years (young group) and 47 (45.63%) patients were aged ≥ 60 years (elderly group). There was no difference between the groups in terms of age, gender, co-morbidity, preoperative drainage and diagnosis. There was no significant difference in the morbidity and mortality (p > 0.05). Delayed gastric emptying was the most common complication which was 25.24% (21% vs 23.41%). Pancreatic fistula rate was 13.59% (8.9% vs 12.76%) and hemorrhage was 4.85% (5.4% vs 4.3%). Mortality was 4.85%. Postoperative hospital stay was comparable (14.7 days vs 15.3 days) (p = 0.164). Pancreaticoduodenectomy is a safe surgical procedure in elderly patients in comparison to young patients. Application of Enhanced Recovery after Surgery protocol can improve the outcome further.
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Hart R. Bleeding from lumbar ventral epidural venous plexus managed with hemostatic agent from oxidized non-regenerated cellulose. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2019; 98:245-247. [PMID: 31331180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Bleeding from epidural blood vessels may be an unpleasant complication during surgery of the lumbar spine, which is often difficult to manage with electrocoagulation. The use of local hemostatic agents is a possible solution. This paper presents the first experience with an agent of oxidized non-regenerated cellulose. METHODS The agent of oxidized non-regenerated cellulose was used in 21 patients (12 women and 9 men) to stop bleeding from the ventral epidural lumbar venous plexus. It was always removed before the end of the operation. RESULTS In all cases, bleeding was stopped within 2 minutes. Bleeding did not recur until the end of surgery (even after removal of the agent). No early or other complications were observed in the patients studied. CONCLUSION The agent of oxidized non-regenerated cellulose appears to be a rational and effective solution for bleeding from epidural veins in the lumbar spine.
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Bryniarski P, Rajwa P, Życzkowski M, Taborowski P, Kaletka Z, Paradysz A. A non-inferiority study to analyze the safety of totally tubeless percutaneous nephrolithotomy. ADV CLIN EXP MED 2018; 27:1411-1416. [PMID: 30058789 DOI: 10.17219/acem/71196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Totally tubeless percutaneous nephrolithotomy (ttPCNL) becomes increasingly frequently utilized in the treatment of kidney stones. This procedure emerged as an answer for patients' needs to minimize hospitalization time, pain intensity and discomfort due to nephrostomy tube. However, ttPCNL may be less safe for patients, as without nephrostomy tube bleeding from renal vessels is potentially more severe. OBJECTIVES The purpose of our study was to retrospectively evaluate the safety parameters of ttPCNL collected in a prospective manner. MATERIAL AND METHODS This was a single tertiary care center, non-inferiority study with 2 arms (55 patients in each arm). The 1st group consisted of patients who underwent ttPCNL with the application of TachoSil® (Takeda, Osaka, Japan) as sealing material, while in the 2nd group, conventional PCNL with nephrostomy tube (cPCNL) was utilized. The primary goal was to prove that hemoglobin drop after surgery, as equivalent of safety, was not inferior than 1 g/dL. The secondary endpoints comprised visual analogue scale (VAS) of pain, additional pain treatment and hospital stay. RESULTS The mean hemoglobin drop after ttPCNL was insignificantly lower in comparison with cPCNL group (mean: -0.35 g/dL; confidence interval (CI) = -0.8, 0.21). Visual analogue scale of pain and pain treatment were comparable between groups. Hospital stay was significantly shorter in the ttPCNL group. CONCLUSIONS Totally tubeless PCNL can be considered a safe option after uncomplicated lithotripsy - what is important, it is characterized by a shorter hospitalization time. Postoperatively, pain intensity is comparable between both groups.
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Wang WG, Lu WZ, Yang CM, Yu KQ, He HB. Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy. Medicine (Baltimore) 2018; 97:e11820. [PMID: 30095654 PMCID: PMC6133531 DOI: 10.1097/md.0000000000011820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy. METHODS A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain. RESULTS Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), -0.75; 95% confidence interval (CI), -1.14 to -0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), -17.19; 95% CI, -25.66 to -8.72; z = 3.98; P < .0001], and lower incidence of anal stricture (OR, 0.12; 95% CI, 0.03-0.53; z = 2.85; P = .004). However, the differences of urinary retention, bleeding and length of hospital stay were similar between the 2 methods. CONCLUSION Our meta-analysis suggests that LIS effectively relieves postoperative pain and reduces patient's postoperative analgesic requirements. LIS also reduces the incidence of anal stenosis but increases the incidence of fecal incontinence.
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Bartos A, Ionescu M, Iancu C, Stroescu C, Zaharie F, Brasoveanu V, Hajjar NA, Vasilescu C, Graur F, Hutanu I, Mocan L, David L, Bodea R, Cacovean D, Molnar G, Furcea L, Alexandrescu S, Matei E, Mitulescu G, Ungureanu C, Tonea A, Zamfir R, Popescu I, Dumitrascu T. An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment. Chirurgia (Bucur) 2018; 113:374-384. [PMID: 29981668 DOI: 10.21614/chirurgia.113.3.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
Introduction: National databases for pancreaticoduodenectomies (PD) have contributed to better postoperative outcomes after such complex surgical procedure because the multicentre collection of data allowed more reliable analyses with quality assessment and further improvement of technical issues and perioperative management. The current practice and outcomes after PD are poorly known in Romania because there was no national database for these patients. Thus, in 2016 a national-intent electronic registry for PD was proposed for all Romanian surgical centers. The study aims to present the preliminary results of this national-intent registry for PD after one-year enrollment. Patients Methods: The database was started on October 1st, 2016. Data were prospectively collected with an electronic online form including 102 items for each patient. The registry was opened to all the Departments of Surgery from Romania performing PD, with no restriction. Results: During the first year of enrollment were collected the data of 181 patients with PD performed by 24 surgeons from four surgical centers. The age of patients was 64 years (28 - 81 years), with slightly male predominance (61.3%). Computed tomography was the main preoperative imaging investigation (84.5%). All the PDs were performed by an open approach. The Whipple technique was used in 53% of patients, and a venous resection was required in 14.3% of cases. A posterior approach PD was considered in 16.6% of patients. The stomach was used to treat the distal remnant pancreas in 50.1% of patients. The operative time was 285 min (110 - 615 min), and the estimated blood loss was 400 ml (80 - 3000 ml). The overall morbidity rate was 55.8%, with severe (i.e., grade III-IV Dindo-Clavien) morbidity rate of 10%, and 3.9% in-hospital mortality rate. The overall pancreatic fistula, delayed gastric emptying and hemorrhage rates were 19.9%, 39.8% and 15.5%. Periampullary malignancies were the main indications for PD (78.9%), with pancreatic cancer on the top (48%). Conclusions: To build a prospective electronic online database for PD in Romania appears to be a feasible project and a useful tool to know the current practice and outcomes after PD in our country. However, improvements are still required to encourage a larger number of surgical centers to introduce the data of patients with PD.
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Brignardello-Petersen R. There seems to be a low risk of experiencing postoperative bleeding in patients undergoing dental extractions or minor oral surgery who continue using antiplatelet therapy. J Am Dent Assoc 2018; 149:e141. [PMID: 29907259 DOI: 10.1016/j.adaj.2018.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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115
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Sierra RJ, Smith HM. Low-Dose Epinephrine Infusions and Tranexamic Acid During Lower-Extremity Total Joint Arthroplasty: Commentary on an article by Wei-Nan Zeng, MD, et al.: "Low-Dose Epinephrine Plus Tranexamic Acid Reduces Early Postoperative Blood Loss and Inflammatory Response. A Randomized Controlled Trial". J Bone Joint Surg Am 2018; 100:e23. [PMID: 29462045 DOI: 10.2106/jbjs.17.01229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Mann DG. In Reference to: "Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis". Otolaryngol Head Neck Surg 2017; 157:1080. [PMID: 29192851 DOI: 10.1177/0194599817737251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhao YJ, Zhan PC, Chen Q, Cheng W, Ye FZ, Wang YS, Wang JJ, Li JH, Tang ZM. [A novel disposable circumcision device versus conventional surgery in the treatment of redundant prepuce and phimosis]. ZHONGHUA NAN KE XUE = NATIONAL JOURNAL OF ANDROLOGY 2017; 23:1007-1013. [PMID: 29738167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis. METHODS Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients. RESULTS All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time ([3.78 ± 0.42] vs [26.24 ± 3.99] min, P <0.05), less intraoperative blood loss ([2.39 ± 1.01] vs [10.80 ± 3.57] ml, P <0.05), lower pain scores intraoperatively (0.14 ± 0.36 vs 2.30 ± 1.46, P <0.05), 6 hours postoperatively (0.32 ± 0.78 vs 3.03 ± 1.56, P <0.05) and at the ring removal (3.35 ± 1.42 vs 2.78 ± 1.43, P <0.05), shorter wound healing time ([7.61 ± 1.60] vs [8.57 ± 1.37] d, P <0.05), higher satisfaction with postoperative penile appearance (97.8% [440/450] vs 86% [258/300], P <0.05), and lower incidence of postoperative bleeding or hematoma (0.89% [4/450] vs 3% [9/300], P <0.05). No statistically significant differences were observed between groups A and B in the nocturnal pain score before the ring removal (1.45±1.02 vs 1.38 ± 0.92, P >0.05) or the postoperative incidence rate of edema (0.89% [4/450] vs 2.33% [7/300], P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group. CONCLUSIONS Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.
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Murgier J, Cailliez J, Wargny M, Chiron P, Cavaignac E, Laffosse JM. Cryotherapy With Dynamic Intermittent Compression Improves Recovery From Revision Total Knee Arthroplasty. J Arthroplasty 2017; 32:2788-2791. [PMID: 28465126 DOI: 10.1016/j.arth.2017.03.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/09/2017] [Accepted: 03/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The goal of this study was to assess the efficacy of cryotherapy with dynamic intermittent compression (CDIC) in relieving postoperative pain, decreasing blood loss, and improving functional scores after revision total knee arthroplasty (rTKA). METHODS We conducted a prospective case-control study (level of evidence: I) to evaluate the efficacy of CDIC on postoperative bleeding, pain, and functional outcomes after rTKA. Forty-three cases were included at a single institution and divided in 2 groups: a control group without CDIC (n = 19) and an experimental group with CDIC (n = 24). Bleeding was evaluated by calculating total blood loss, pain at rest was evaluated with a visual analog scale on postoperative day 3, and function was assessed using the Oxford score at 6 months postoperatively. The comparative analysis was performed using the Fisher exact test. RESULTS The CDIC group had significantly lower total blood loss (260 vs 465 mL; P < .05), significantly less pain on day 3 (1 vs 3; P < .05), and a significantly higher functional score (42 vs 40; P < .05) than the control group. CONCLUSION This is the first report dealing with the use of CDIC after rTKA. According to our results, it improves the recovery of patients who underwent rTKA; thus, it should be integrated into our daily practice.
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Kiesewetter H. Measures for Bleeding Control. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:562. [PMID: 28855054 PMCID: PMC5596158 DOI: 10.3238/arztebl.2017.0562a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Jeon YL, Lee WI, Kang SY, Kim MH. Limitations of Preoperative PFA-200 as a Predictor of Postoperative Blood Loss in Total Knee Arthroplasty: According to Use of Tranexamic Acid. Clin Lab 2017; 63:1121-1128. [PMID: 28792707 DOI: 10.7754/clin.lab.2017.161218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recently, anti-fibrinolytic agents (tranexamic acid) have been used to reduce blood loss or and the need for transfusion. We evaluated the clinical utility of PFA-200 as a predictor of postoperative blood loss in a clinical setting, where hemostasis can be affected by variables such as existing comorbidities and medication use. METHODS We analyzed retrospectively 243 TKA patients having PFA-200 results between March 2014 and May 2016. We collected the medication history of anti-thrombotic agents, closure time measured by PFA-200, postoperative drainage volume, and perioperative change of hemoglobin values. Parameters associated with postoperative blood loss were compared to the prolongation of closure time and medication use. The influence of variables on postoperative blood loss was analyzed. RESULTS The closure times of PFA-200 were prolonged in 68 patients (295.8 ± 10.7) and were not prolonged in 175 patients (125.4 ± 35.8). The prolonged closure time did not affect any parameters associated with postoperative blood loss. A history of preoperative anti-platelet agents used was a factor that statistically significantly increased the amount of postoperative drainage and reduction of perioperative hemoglobin values. In addition, postoperative tranexamic acid treatment was the factor that decreased the postoperative hemoglobin levels (OR = 0.297 with p = 0.010) most. CONCLUSIONS The effectiveness of preoperative PFA-200 in assessments of postoperative bleeding risk is reduced with postoperative use of tranexamic acid.
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Muto S, Suzuki H. [Management of Chest Drain after Lung Resection]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2017; 70:683-687. [PMID: 28790289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aims of chest drainage after pulmonary resection are to evacuate fluid and air that accumulate in the pleural space and to obtain information on problems such as air leakage and postoperative bleeding. Although suction or water seal drainages are commonly used procedures, the use of digital monitoring system (Thopaz) is gaining popularity as an alternative of the procedures. We need to pay attention to postoperative hemorrhage, chylothorax, infection, and air leakage. Chest X-ray is essential to check the position of the drainage tube and lung expansion. After pneumonectomy, clamps are basically used for drain management to prevent mediastinal shift. It should be noted that postoperative drain management must be performed according to the operative procedure and residual lung condition.
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Hong Y, Guo Q, Pu Y, Lu D, Hu M. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy: A retrospective study. Medicine (Baltimore) 2017; 96:e7687. [PMID: 28746234 PMCID: PMC5627860 DOI: 10.1097/md.0000000000007687] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to compare the efficacy and safety between high-intensity focused ultrasound (HIFU) treatment and uterine artery embolization (UAE) treatment; we retrospectively analyzed 152 cases with cesarean scar pregnancy (CSP). Based on our inclusion and exclusion criteria, 152 patients (average age, 31.8 ± 4.6 years old) with CSP were eligible for the HIFU group (85 patients) or the UAE group (77 patients). All patients in 2 groups received the treatment with suction curettage under hysteroscopy prior to HIFU or UAE treatment and followed up for 12 months. The assessment criteria of treatment efficacy included the success rate, intraoperative blood loss, duration of vaginal bleeding, normal menstrual function recovery time, time for β-human chorionic gonadotrophin (β-HCG) back to normal level, duration of hospital stays, and other adverse effects. Following up for 12 months, the HIFU group was of less intraoperative blood loss (76.38 ± 22.89 vs 114.42 ± 30.34 mL, P = .02), shorter duration of postoperative vaginal bleeding (11.28 ± 3.65 vs 15.77 ± 7.24 days, P = .01) and lower adverse effects rate comparing to the UAE group. However, the HIFU group have longer time for the β-HCG recovery to the normal level (35.28 ± 9.86 vs 29.91 ± 7.29, P = .03). Additionally, there were no significantly statistic differences between the 2 groups in baseline characteristics, success rate, and average time of gestational sac disappeared and menstrual recovery and hospital stay. Thus, we concluded that the method of both HIFU and UAE combined with suction curettage under hysteroscopy is safe and effective in the management of CSP. Meanwhile, HIFU is a better therapy option than UAE for those women who are seeking complete relieve of symptom to gain fertility.
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Lucy AL, Gandhi RP, Gross L, McNair B. Pediatric Admissions After Dental Care Under General Anesthesia: A Retrospective Study at a Tertiary Care Center. JOURNAL OF DENTISTRY FOR CHILDREN (CHICAGO, ILL.) 2017; 84:65-71. [PMID: 28814365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to identify factors associated with planned and unplanned pediatric hospital admissions following dental treatment under general anesthesia (DGA) in a tertiary care center. METHODS Dental and medical records of 100 subjects one to 20 years of age, with a known history of admission after DGA, were reviewed retrospectively for patient-, procedure-, and anesthesia-related factors as well as adverse events following DGA. RESULTS During the review period (December 3, 2011 to June 30, 2015), 10,371 subjects underwent DGA, of which 100 subjects (less than one percent) required admission. A significant association was found between postoperative (PO) recovery time and unplanned admissions following DGA (P<0.001). Adverse post-operative events significantly associated with unplanned admissions included emesis (P=0.01) and hypoxia (P<0.001). CONCLUSIONS Patients who were classified as having American Anesthesiology Association (ASA) III status were more frequently admitted following DGA. Adverse events such as emesis and hypoxia were significantly associated with patients with an unplanned admission.
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Kikura M, Tobetto Y, Uehara H, Toyonaga Y, Kato M, Suzuki Y, Kojima Y, Go R. [Efficacy and Indication of Fibrinogen Replacement Therapy in Thoracic Aortic Surgery A Retrospective Cohort Study]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2017; 66:376-382. [PMID: 30382635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Fibrinogen replacement therapy con- tributes to effective hemostasis and saving blood trans- fusions in critical hemorrhage. We retrospectively studied the efficacy and indication for cryoprecipitate or fibrinogen concentrate in thoracic aortic surgery. METHODS In 169 patients undergoing thoracic aortic surgery, 92 (54.4%) patients received dryoprecipitate or fibrinogen concentrate and 77 (45.6%) patients did not We compared them with regard to postoperative bleeding and perioperative blood transfusion. We deter- mined the effective dose of the fibrinogen in cryopre- cipitate or fibrinogen concentrate for increasing the fibrinogen level. RESULTS The cutoff value of the fibrinogen level at the end of cardiopulmonary bypass between both groups was 100 mg · dl⁻¹. For a fibrinogen level less than 130 mg · dl⁻¹ during cardiopulmonary bypass, the patients who received cryoprecipitate or fibrinogen concentrate had less postoperative bleeding (P<0.01) and fewer transfusions of total blood, fresh frozen plasma, and platelet concentrates (P<0.05). The effec- tive dose 50 of fibrinogen amount was 0.031-0.051 g - kg⁻¹. CONCLUSIONS The fibrinogen amount of 2-3 g (per 50-70 kg in body weight) in cryoprecipitate or fibrino- gen concentrate effectively reduces postoperative bleeding and perioperative blood transfusions when a fibrinogen level is less than 100-130 mg · dl⁻¹ during cardiopulmonary bypass.
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Budak AB, McCusker K, Gunaydin S. A structured blood conservation program in pediatric cardiac surgery. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2017; 21:1074-1079. [PMID: 28338185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The limitation of alternative transfusion practices in infants increases the benefits of blood conservation. We analyzed the efficacy of a structured program to reduce transfusions and transfusion-associated complications in cardiac surgery PATIENTS AND METHODS: Our pediatric surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of an effective blood conservation program beginning in March 2014. A total of 214 infants (8.1±3.4 months) who underwent biventricular repair utilizing CPB (Group 1 - Blood conservation) were studied in a 12-month period (March 2014-February 2015) after the implementation of the new program, and compared with 250 infants (7.91±3.2 months) (Group 2 - Control-No blood conservation) of the previous 12-month period (March 2013-February 2014). RESULTS The proportion of patients transfused with red blood cells was 75.2% (N=188) in control group and reduced by 16.4% in the study group (58.8% - 126 patients, p <0.01). The mean number of transfusions was 1.25 ± 0.5 units per patient in control group and decreased to 0.7 ± 0.5 units per patient after the start of the program (p = 0.035). Cerebral oximetry demonstrated better follow-up during the operative period confirming less hemodilution in Group 1. Respiratory support, inotropic need and ICU stay were significantly better in the study group. CONCLUSIONS These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations. Circuit miniaturization, ultrafiltration, and reduced postoperative bleeding, presumably secondary to higher fibrinogen and other coagulation factor levels, contributed to this outcome.
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