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Urakov A, Urakova N, Nikolenko V, Belkharoeva R, Achkasov E, Kochurova E, Gavryushova L, Sinelnikov M. Current and emerging methods for treatment of hemoglobin related cutaneous discoloration: A literature review. Heliyon 2021; 7:e05954. [PMID: 33506129 PMCID: PMC7814147 DOI: 10.1016/j.heliyon.2021.e05954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/01/2020] [Accepted: 01/08/2021] [Indexed: 01/08/2023] Open
Abstract
Background Currently, there is no available medication for immediate correction of bruise discoloration. Instead, makeup, cosmetic powders, concealers, and various traditional herbal remedies are used to mask discoloration. These approaches have no influence on the pathology behind the discoloration. The purpose of this study was to explore existing methods and current trends in correction of hemoglobin related cutaneous discoloration. Methods This paper describes the treatment methodologies available for proposed correction of hemoglobin related cutaneous discoloration. A thorough literature review was conducted to assess current knowledge of available treatments for bruise discoloration. Results current cosmetics being marketed under the names "Bleacher bruises," "Bleaching agents" and "Blood bleachers" addressing bruise related discoloration do not offer targeted pathological treatment. Several methods for immediate discoloration of the skin and nail plate in the area of bruising and hematoma were found, yet no method offered sufficient clinical data in support of its efficacy and safety. The intricate mechanisms of discoloration associated with hemoglobin extravascular deterioration are not targeted by any treatment method. Only one paper outlining the clinical application of bleaching agents was found. Conclusion The primary blood pigments responsible for the discoloration in bruises include methemoglobin, oxyhemoglobin, carbohymoglobin, verdoglobin, biliverdin, and bilirubin. No existing method targets the degradation of hemoglobin in the area of ecchymosis. The efficacy of existing patented methods remains questionable and unsupported clinically. Future research should focus on developing a drug targeting hemoglobin derivatives, preventing discoloration at an early stage.
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Affiliation(s)
- Aleksandr Urakov
- Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences, Izhevsk, Russia
| | - Natalia Urakova
- Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences, Izhevsk, Russia
| | - Vladimir Nikolenko
- Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | | | - Evgeny Achkasov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Silveira D, Prieto-Garcia JM, Boylan F, Estrada O, Fonseca-Bazzo YM, Jamal CM, Magalhães PO, Pereira EO, Tomczyk M, Heinrich M. COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy? Front Pharmacol 2020; 11:581840. [PMID: 33071794 PMCID: PMC7542597 DOI: 10.3389/fphar.2020.581840] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. AIMS To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for "respiratory diseases" within the current frame of the COVID-19 pandemic as an adjuvant treatment. METHOD The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. RESULTS A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. CONCLUSIONS Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.
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Affiliation(s)
- Dâmaris Silveira
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Jose Maria Prieto-Garcia
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Fabio Boylan
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Omar Estrada
- Biophysics and Biochemistry Center, Venezuelan Institute of Scientific Research, Caracas, Venezuela
| | | | | | | | - Edson Oliveira Pereira
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Michal Tomczyk
- Faculty of Pharmacy, Medical University of Bialystok, Bialystok, Poland
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy, School of Pharmacy, University College of London, London, United Kingdom
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3
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Abstract
BACKGROUND There is increased emphasis on the importance of the gluteal region in the perception of beauty. Biodegradable fillers provide a nonsurgical method of augmenting and rejuvenating this area. OBJECTIVE To review pertinent aspects of anatomy, patient evaluation, injection technique, and complications for gluteal augmentation using injectable biodegradable fillers. METHODS The authors review the literature for poly-L-lactic acid-based gluteal augmentation. RESULTS Like many aesthetic procedures, there is a paucity of literature on this emerging treatment modality (Level 4, Centre for Evidence-Based Medicine, Oxford). However, the collective clinical experience is that poly-L-lactic acid fillers are an effective treatment for patients seeking noninvasive gluteal enhancement with minimal downtime. Physicians must understand gluteal anatomy and avoid injecting deeply in the danger triangle to prevent intravascular injection into the gluteal vessels or injury to the sciatic nerve. Other safety elements include the use of blunt cannulas, reduced pressures, smaller volumes, and retrograde delivery. CONCLUSION Gluteal augmentation with fillers can safely and effectively improve gluteal firmness, shape, proportion, and projection. Practitioners injecting fillers in the gluteal region must be aware of appropriate patient selection, regional anatomy, and safe injection techniques. Given the increasing demand for this procedure, further high-quality studies are needed.
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Understanding Delayed Bruising After Hyaluronic Acid Injections: Why the Molecule and Not Just the Injection Matters. Dermatol Surg 2019; 45:471-473. [DOI: 10.1097/dss.0000000000001817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Brown DG, Wilkerson EC, Love WE. A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons. J Am Acad Dermatol 2015; 72:524-34. [DOI: 10.1016/j.jaad.2014.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/29/2014] [Accepted: 10/16/2014] [Indexed: 12/22/2022]
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6
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Choi WY, Cho HW, Lee DW. Complications of Injectable Soft Tissue Filler. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2015. [DOI: 10.14730/aaps.2015.21.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Korea
| | | | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Korea
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7
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Abstract
Local flaps are a common reconstructive technique of the head and neck. Consequently, knowledge of fundamental concepts and pitfalls to avoid will reduce surgical complications. These complications result from tension-related, ischemic, hematologic, and infectious causes. This paper seeks to address each of these causes with pearls to accomplish a successful outcome.
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Affiliation(s)
- Charles R Woodard
- Division of Otolaryngology-Head & Neck Surgery, Facial Plastic and Reconstructive Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA.
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8
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Newer hemostatic agents used in the practice of dermatologic surgery. Dermatol Res Pract 2013; 2013:279289. [PMID: 23997764 PMCID: PMC3749606 DOI: 10.1155/2013/279289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022] Open
Abstract
Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes.
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9
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Kleydman K, Cohen JL, Marmur E. Nitroglycerin: a review of its use in the treatment of vascular occlusion after soft tissue augmentation. Dermatol Surg 2013. [PMID: 23205544 DOI: 10.1111/dsu.12001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin necrosis after soft tissue augmentation with dermal fillers is a rare but potentially severe complication. Nitroglycerin paste may be an important treatment option for dermal and epidermal ischemia in cosmetic surgery. OBJECTIVES To summarize the knowledge about nitroglycerin paste in cosmetic surgery and to understand its current use in the treatment of vascular compromise after soft tissue augmentation. To review the mechanism of action of nitroglycerin, examine its utility in the dermal vasculature in the setting of dermal filler-induced ischemia, and describe the facial anatomy danger zones in order to avoid vascular injury. METHODS A literature review was conducted to examine the mechanism of action of nitroglycerin, and a treatment algorithm was proposed from clinical observations to define strategies for impending facial necrosis after filler injection. RESULTS AND CONCLUSIONS Our experience with nitroglycerin paste and our review of the medical literature supports the use of nitroglycerin paste on the skin to help improve flow in the dermal vasculature because of its vasodilatory effect on small-caliber arterioles.
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Affiliation(s)
- Kate Kleydman
- Division of Dermatologic and Cosmetic Surgery, Department of Dermatology, Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA
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10
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Abstract
This article presents common and rare complications following blepharoplasty, with discussion of avoidance of these complications through presurgical planning and review. Management of the complications is provided, with surgical details supported by images and advice for the best approaches. The complications discussed include hemorrhage, infection, corneal abrasion, ptosis, lacrimal gland injury, and residual excess skin.
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11
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Fasinu PS, Bouic PJ, Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions. Front Pharmacol 2012; 3:69. [PMID: 22557968 PMCID: PMC3339338 DOI: 10.3389/fphar.2012.00069] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/05/2012] [Indexed: 12/22/2022] Open
Abstract
Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is globally popular. There is also an increasing interest in medicinal herbs as precursor for pharmacological actives. Of serious concern is the concurrent consumption of herbal products and conventional drugs. Herb-drug interaction (HDI) is the single most important clinical consequence of this practice. Using a structured assessment procedure, the evidence of HDI presents with varying degree of clinical significance. While the potential for HDI for a number of herbal products is inferred from non-human studies, certain HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic HDI have been identified and include the alteration in the gastrointestinal functions with consequent effects on drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and alteration of renal excretion of drugs and their metabolites. Due to the intrinsic pharmacologic properties of phytochemicals, pharmacodynamic HDIs are also known to occur. The effects could be synergistic, additive, and/or antagonistic. Poor reporting on the part of patients and the inability to promptly identify HDI by health providers are identified as major factors limiting the extensive compilation of clinically relevant HDIs. A general overview and the significance of pharmacokinetic and pharmacodynamic HDI are provided, detailing basic mechanism, and nature of evidence available. An increased level of awareness of HDI is necessary among health professionals and drug discovery scientists. With the increasing number of plant-sourced pharmacological actives, the potential for HDI should always be assessed in the non-clinical safety assessment phase of drug development process. More clinically relevant research is also required in this area as current information on HDI is insufficient for clinical applications.
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Affiliation(s)
- Pius S. Fasinu
- Division of Pharmacology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
| | - Patrick J. Bouic
- Division of Medical Microbiology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
- Synexa Life Sciences, Montague GardensCape Town, South Africa
| | - Bernd Rosenkranz
- Division of Pharmacology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
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12
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DELANEY AMY, DIAMANTIS STEPHANIE, MARKS VICTORJ. Complications of tissue ischemia in dermatologic surgery. Dermatol Ther 2012; 24:551-7. [DOI: 10.1111/j.1529-8019.2012.01459.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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14
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Pomerantz RG, Lee DA, Siegel DM. Risk assessment in surgical patients: balancing iatrogenic risks and benefits. Clin Dermatol 2011; 29:669-77. [DOI: 10.1016/j.clindermatol.2011.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Akyol AD, Yildirim Y, Toker E, Yavuz B. The use of complementary and alternative medicine among chronic renal failure patients. J Clin Nurs 2011; 20:1035-43. [PMID: 21320219 DOI: 10.1111/j.1365-2702.2010.03498.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to evaluate the factors affecting the use and frequency of use of complementary and alternative medicine among chronic renal failure patients. BACKGROUND The use of complementary and alternative medicine in the general population and patients with chronic renal failure has increased significantly. Despite this, there is limited information concerning the use of complementary and alternative medicine among chronic renal failure patients. DESIGN Cross-sectional survey. METHOD The research was carried out at the nephrology and internal medicine outpatient clinics. Two hundred and six chronic renal failure patients admitted to the outpatient clinics were included in the study. Mean outcomes measures were the frequency and type of complementary and alternative medicine use, demographic and disease-related characteristics affecting complementary and alternative medicine use and the reasons for using complementary and alternative medicine. The data were evaluated by Pearson's chi-square test and Fisher's exact test. RESULTS While 2·9% of the patients had been using complementary and alternative medicine before the renal disease occurred, 25·2% of the patients reported that they had at least once used complementary and alternative medicine methods after the renal disease occurred. A significant difference was found between complementary and alternative medicine usage and age, gender, place of living, occupational status and educational background (p < 0·05). While most of the patients using complementary and alternative medicine (78·3%) stated that they used such methods as a cure for their disease, 46·1% used body-mind techniques. CONCLUSIONS The results of our study showed that one-fourth of the chronic renal failure patients were using complementary and alternative medicine, mainly body-mind techniques. In addition, the study proved that most of the patients do not discuss their complementary and alternative medicine usage with their doctors and nurses. RELEVANCE TO CLINICAL PRACTICE It is essential that nephrology doctors and nurses should ask specific questions about complementary and alternative medicine usage while taking anamnesis on the patients' disease and nutritional status and that the nephrology team should expand their knowledge on complementary and alternative medicine methods to ensure patient and treatment safety.
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Affiliation(s)
- Asiye D Akyol
- Department of Internal Medicine Nursing, Ege University Nursing School, Bornova, Izmir, Turkey
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16
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Redbord KP, Busso M, Hanke CW. Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite fillers. Dermatol Ther 2011; 24:71-81. [DOI: 10.1111/j.1529-8019.2010.01380.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention, and treatment of dermal filler complications. Aesthet Surg J 2011; 31:110-21. [PMID: 21239678 DOI: 10.1177/1090820x10391083] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The availability of dermal fillers for multiple cosmetic indications has led to a dramatic increase in their application. Although fillers are generally regarded as safe tools for soft tissue augmentation, complications can occur. Therefore, to describe and review the complications associated with the currently-available dermal filling agents, the authors conducted a literature review in peer-reviewed journals and present the reported complication rates. They also describe current strategies to avoid, diagnose, and manage complications if they do occur.
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Affiliation(s)
- Steven H Bailey
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75038, USA
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18
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Elefteriades JA. "How I do it: utilization of high-pressure sealants in aortic reconstruction". J Cardiothorac Surg 2009; 4:27. [PMID: 19558685 PMCID: PMC2708158 DOI: 10.1186/1749-8090-4-27] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/26/2009] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Suture-line hemostasis, reinforcement of friable tissue, and adhesion prevention are key concerns for patients undergoing cardiac surgery for aortic reconstruction. Failure to secure hemostasis at anastomotic junctures and reinforce fragile tissue may lead to increased blood loss, additional blood product requirements, increased operative time, and, in extreme cases, reoperation. Patients with aortic pathology may also be at higher risk for reoperation, and adhesion formation from prior surgery is an added risk at resternotomy. The advent of high-pressure sealants has been of benefit in helping to alleviate these perioperative challenges. METHODS The author utilizes two high-pressure sealants for aortic reconstructive procedures. The first is made of two polymers of polyethylene glycol (PEG) [Coseal, Baxter Healthcare, Corporation], and is used to secure anastomotic suture-line hemostasis and for adhesion prevention. The second is a bovine serum albumin-glutaraldehyde (BSAG) glue [BioGlue, CryroLife, Inc.], used for the repair of dissected aortic tissue and in reinforcing ("tanning") fragile aortic tissues. The techniques for application in select aortic reconstruction procedures are described. RESULTS To substantiate the hemostatic clinical benefit observed by the author, 60 consecutive major thoracic aortic operations in 57 patients in whom PEG sealant was used were retrospectively reviewed. Although comparisons with other agents were not performed for this descriptive report, bleeding results were very favorable for these types of operations. The strong clinical impression is that topical hemostatic application of PEG sealant to anastomotic suture lines is helpful in preventing bleeding. CONCLUSION In major aortic reconstructive procedures the need for anastomotic sealing performance, reinforcement of friable tissues, and adhesion prevention should not be underrated. High-pressure surgical sealants represent an important surgical adjunct, and the author has found the use of both PEG sealant and BSAG glue advantageous in aortic reconstruction and repair.
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Affiliation(s)
- John A Elefteriades
- Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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19
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Hurst EA, Yu SS, Grekin RC, Neuhaus IM. Bleeding complications in dermatologic surgery. ACTA ACUST UNITED AC 2008; 26:189-95. [PMID: 18395666 DOI: 10.1016/j.sder.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.
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Affiliation(s)
- Eva A Hurst
- UCSF Dermatologic Surgery and Laser Center, San Francisco, CA, USA
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Kirkorian AY, Moore BL, Siskind J, Marmur ES. Perioperative Management of Anticoagulant Therapy during Cutaneous Surgery: 2005 Survey of Mohs Surgeons. Dermatol Surg 2007; 33:1189-97. [PMID: 17903151 DOI: 10.1111/j.1524-4725.2007.33253.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The perioperative management of anticoagulation and antiplatelet therapy is a controversial topic in the field of dermatologic surgery. Dermasurgeons must weigh the risk of bleeding against the risk of thrombotic complications when deciding how to manage perioperative anticoagulation. OBJECTIVE Our aim is to present a summary of current practice in anticoagulation management perioperatively during cutaneous surgery. We compare our results to those found in a similar survey in 2002. METHODS AND MATERIALS A questionnaire surveying current practice in perioperative management of anticoagulant therapy was mailed to 720 dermasurgeons. RESULTS Thirty-eight percent of dermasurgeons responded to the questionnaire. Of the responding physicians, 87% discontinue prophylactic aspirin therapy, 37% discontinue medically necessary aspirin, 44% discontinue warfarin, 77% discontinue nonsteroidal anti-inflammatory drugs (NSAIDs), and 77% discontinue vitamin E therapy perioperatively at least some of the time. Although clopidogrel was not surveyed, 78 physicians included comments about the management of this agent. CONCLUSION Dermasurgeons were more likely to continue medically necessary aspirin and warfarin in 2005 compared to 2002, with the most dramatic shift evident in the management of warfarin. They were more likely to discontinue prophylactic aspirin, NSAIDs, and vitamin E. Surgeons were concerned about bleeding with the antiplatelet agent clopidogrel. More evidence-based medicine is necessary to set guidelines for the management of anticoagulation and antiplatelet therapy perioperatively.
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Affiliation(s)
- A Yasmine Kirkorian
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
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21
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Perioperative Management of Anticoagulant Therapy during Cutaneous Surgery. Dermatol Surg 2007. [DOI: 10.1097/00042728-200710000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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White CP, Hirsch G, Patel S, Adams F, Peltekian KM. Complementary and alternative medicine use by patients chronically infected with hepatitis C virus. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:589-95. [PMID: 17853954 PMCID: PMC2657989 DOI: 10.1155/2007/231636] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 01/26/2007] [Indexed: 11/18/2022]
Abstract
Complementary and alternative medicine (CAM) is becoming increasingly popular in North America. The use of CAM is also popular in patients with chronic liver disease but is not well documented. The extent of use of CAM in chronic hepatitis C virus (HCV) infected patients was determined, and the demographic and clinical data between users and nonusers of CAM was compared. Seventy-six patients (30% female) with chronic HCV were interviewed. The mean age was 43+/-8 years. Current use of CAM for HCV was reported by 35 of 76 patients (46%). Eighteen of 76 patients within this group used herbal supplements (24%). The most commonly used herb was Silybum marianum (milk thistle), reported by 10 of 76 patients (13.2%). Commonly reported benefits of CAM use included reduction in fatigue, boost in the immune system and improved gastrointestinal function. No adverse effects of CAM use were reported. In the present study, four of 18 patients (22%) with chronic liver disease taking herbal therapies were on herbs that increased bleeding time. The use of CAM in chronic HCV patients is significant. Patients should be asked specifically about their use of CAM. CAM use may have implications affecting conventional treatment and management of HCV.
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Affiliation(s)
- Colin P White
- Hepatology Services, Division of Gastroenterology, Departments of Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia
| | - Gerilynn Hirsch
- Hepatology Services, Division of Gastroenterology, Departments of Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia
| | - Sunil Patel
- Hepatology Services, Division of Gastroenterology, Departments of Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia
| | - Fatin Adams
- Rockyview General Hospital, Calgary, Alberta
| | - Kevork M Peltekian
- Hepatology Services, Division of Gastroenterology, Departments of Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia
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Abstract
Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.
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Affiliation(s)
- Eva A Hurst
- UCSF Dermatologic Surgery and Laser Center, San Francisco, CA 94115, USA
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