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Rathod, Dr Rohit Narendra. "Hemostasis in the Surgical Field." EAS Journal of Medicine and Surgery 4, no. 10 (November 16, 2022): 211–14. http://dx.doi.org/10.36349/easjms.2022.v04i10.003.
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Hemostatic mechanisms are an integral a part of the human physiology. Traditionally divided into intrinsic and extrinsic arms, the coagulation cascade converges, through the interactions of the many various factors, at a standard element—thrombin. As a consequence, variety of various agents is developed to supplement this common, critical step to assist surgical hemostasis. Intraoperative interventions most ordinarily include sutures and heat-generating cautery devices; however, these methods are sometimes insufficient or inappropriate for a selected procedure or anatomic location, resulting in the event of other adjunctive therapies, including topical hemostats. Topical hemostatic agents generally act as active, passive, and combinations therapies, counting on their individual composition and mode of action. We offer a quick review of the traditional coagulation cascade, including critical points, followed by a discussion of surgical strategies and adjuctive therapies want to achieve surgical hemostasis and concluding with a discussion of topical thrombins.
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Zavhorodnii, S. M., O. V. Kapshytar, O. I. Kotenko, O. O. Kapshytar, and M. B. Danyliuk. "The results of endoscopic and surgical methods of hemostasis in persons of elderly and senile age with acute gastrointestinal bleeding caused by an ulcer." Zaporozhye Medical Journal 24, no. 4 (August 1, 2022): 402–7. http://dx.doi.org/10.14739/2310-1210.2022.4.245872.
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The aim of the study. To define the number of acute gastrointestinal bleeding cases due to ulcer and to analyze the results of endoscopic and surgical methods of hemostasis in elderly and senile patients. Materials and methods. In total, 463 patients with acute gastrointestinal bleeding (AGIB) due to ulcer were treated between 2019 and 2020. There were 323 persons over 60 years of age (69.8 %). A risk for bleeding was identify according to the Forrest Classification (2006). Local hemostasis was performed in 68 (21.1 %) patients over 60 years of age. Results. Group A (n = 32; 47.1 %) was represented by patients who underwent endoscopic hemostasis by diathermocoagulation, and local hemostasis was achieved. The indication was the bleeding activity: FIa in 4 (12.5 %) patients, FIb – in 14 (43.8 %), FIIa – in 1 (3.1 %), FIIb – in 6 (18.8 %) and FIIc – in 7 (21.9 %). Successful hemostasis was achieved in 24 (75 %) patients, and they were discharged. Recurrent massive AGIB was observed in 8 (25 %) patients for 2–6 days. We have identified the causes of recurrent bleeding: giant ulcers on the posterior wall of the duodenal bulb, lesser curvature and gastric cardia, active bleeding at the time of hemostasis, prehospital anticoagulants, decompensated concomitant pathology. Emergency laparotomy with variants of surgical hemostasis was performed in 6 (75 %) patients. After the operation, 5 (83.3 %) patients died (hemorrhagic shock – 2, multiple organ failure – 2, pulmonary embolism – 1). Repeated endoscopic hemostasis was performed for 2 (25 %) patients with a fatal outcome in both cases. Group B (n = 36; 52.9 %) was represented by patients with F1a stigma who failed to perform endoscopic hemostasis and underwent surgical hemostasis. 16 (44.4 %) patients died (hemorrhagic shock – 8, multiple organ failure – 5, polymorbid state – 2, pulmonary embolism – 1). Conclusions. Among patients with AGIB due to ulcer, persons over 60 years old accounted for 69.8 %, among whom local hemostasis was performed in 21.1 % with the prevalence of surgical hemostasis over endoscopic one, 52.9 % and 47.1 %, respectively. Surgical hemostasis options were traumatic, more reliable, but resulted in a high mortality rate – 44.4 %. Endoscopic hemostasis was low-traumatic, successful in 75 % of patients, non-effective in the form of massive rebleeding episodes – in 25 %, followed by surgical hemostasis, that led to the high mortality rate – 83.3 %.
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Gerlach, Rüdiger, Gerhard Marquardt, Heimo Wissing, Inge Scharrer, Andreas Raabe, and Volker Seifert. "Application of recombinant activated factor VII during surgery for a giant skull base hemangiopericytoma to achieve safe hemostasis." Journal of Neurosurgery 96, no. 5 (May 2002): 946–48. http://dx.doi.org/10.3171/jns.2002.96.5.0946.
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✓ The authors report on a 64-year-old woman with a huge recurrent skull base hemangiopericytoma, in whom they encountered severe difficulty in attaining intraoperative hemostasis. Standard surgical hemostatic methods and the administration of fresh-frozen plasma and prothrombin complex concentrates failed to stop diffuse bleeding from an inoperable tumor remnant. At a critical point during the operation, the intravenous administration of recombinant activated factor VII, combined with mechanical compression, finally led to satisfactory hemostasis. The rationale for using recombinant activated factor VII in situations of uncontrolled bleeding during neurosurgical procedures is discussed, along with the literature in which the use of recombinant activated factor VII as a maneuver of last resort is reported for hemostasis in other surgical fields.
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Semichev, Ye V., A. N. Baikov, P. S. Bushlanov, and G. Ts Dambayev. "COMPARATIVE ANALISYS OF HEMOSTASIS METHODS IN OPERATIONS ON SPLEEN." Bulletin of Siberian Medicine 14, no. 2 (April 28, 2015): 91–99. http://dx.doi.org/10.20538/1682-0363-2015-2-91-99.
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The paper provides statistics of spleen traumas, anatomy and characters of the organ damage. The most common methods of spleen hemostasis, currently used in surgical clinics of the Russian Federation, are presented. A small historical excursus about existed methods of hemostasis is given in the paper. A comparative analysis of currently used methods, their advantages and disadvantages is carried out. Some possible criteria for an ideal method of spleen hemostasis are listed as well.
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Malkov, I. S., M. N. Nasrullaev, G. R. Zakirova, and I. I. Khamzin. "Modern methods of diagnosis and treatment of acute gastrointestinal bleeding of various etiology." Kazan medical journal 97, no. 6 (December 15, 2016): 832–37. http://dx.doi.org/10.17750/kmj2016-832.
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Aim. Analysis of the treatment results in patients with gastrointestinal bleeding with the use of endoscopic and surgical methods of hemostasis.Methods. Analysis of the treatment results in 421 patients with acute gastrointestinal bleeding from the urgent surgical department of City Clinical Hospital №7 of Kazan was conducted.Results. Endoscopic methods of hemostasis in bleeding from the upper gastrointestinal tract (argon plasma coagulation, combined prolonged infiltration hemostasis with the use of 6% solution of polyglucin with mafusol, irrigation with the solution «Hemolab», ligation of the esophageal veins and Danis stent implantation) were applied to 404 patients. All patients simultaneously received conservative treatment. When using the methods of endoscopic hemostasis mentioned above in patients with bleeding from upper gastrointestinal tract the efficiency was achieved in 87.9% of cases. It was the highest when using combined endoscopic methods. Recurrent acute bleeding was diagnosed in 30 (7.1%) cases. Majority of the patients with recurrent bleeding suffered from gastric ulcer and/or duodenal ulcer (21 patients). In all 30 patients with recurrent bleeding surgical intervention with the author’s technique was performed.Conclusion. The efficacy of endoscopic methods of hemostasis in bleeding from the upper gastrointestinal tract, especially their combined use, was revealed; differentiated approach to the use of endoscopic and surgical techniques of hemostasis depending on the source of bleeding and its intensity is required.
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Tușaliu, Mihai, Raluca Băican, Tatiana Decuseară, C. Ioniţă, Andreea Nicoleta Costache, A. Coman, Loredana Ghiuzan, I. Bulescu, and Vlad Andrei Budu. "Methods of hemostasis in endoscopic sinus surgery." ORL.ro 2, no. 1 (May 9, 2016): 6–8. http://dx.doi.org/10.26416/orl.31.2.2016.127.
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Functional endoscopic sinus surgery gained increasing popularity among otolaryngologists in the last decades. During any endoscopic sinonasal surgery the major limiting factors are its complex anatomy and the high vascularity. Often, even a small hemorrage is sufficient to reduce visibility of the operating field. From the surgical perspective, there are novel technologies that reduce bleeding, thus, improving the visualization of the operating field. We present some methods of hemostasis used in endoscopic sinus surgery
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Alfieri, Ottavio. "Evaluation of BioFoam for Anastomotic Bleeding in Cardiovascular Surgery." AORTA 06, no. 02 (April 2018): 053–58. http://dx.doi.org/10.1055/s-0039-1678549.
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Background Hemostatic agents are increasingly used as an adjunct to standard methods of controlling anastomotic bleeding in surgical procedures. The purpose of this study was to investigate the safety and effectiveness of BioFoam Surgical Matrix used as an adjunct for anastomotic hemostasis following cardiovascular surgery. Methods A prospective, multicenter, single arm study was conducted with 75 subjects treated with BioFoam following a total of 105 elective cardiovascular surgical procedures. Time to hemostasis was recorded following a single application of BioFoam in 74 subjects. Safety evaluations included intraoperative administration of a blood product, requirement for alternative means to achieve hemostasis, and the incidence of reoperation for bleeding. Results Hemostasis within 3 minutes was achieved in 62 (84%) of the 74 subjects and within 10 minutes in 69 (93%) of these subjects. BioFoam was well tolerated. Twelve (16%) of the 75 enrolled subjects each experienced one adverse event, and 13 serious adverse events were reported in 10 (13.3%) of the subjects. None of the adverse events was considered by the Investigators to be related to BioFoam. Blood products were administered to 14 (18.6%) of the 75 subjects, banked autologous blood was given to 5 (6.6%) subjects, and 57 (75.7%) subjects required only a cell saver. Four (5.3%) of the 75 subjects required reoperation for bleeding within 24 hours of surgery. There were no observations of bleeding in any subject at discharge and no reoperation for bleeding following discharge. The mean operation time was 218.2 (±72.2) minutes. Conclusions This study demonstrates the effectiveness of BioFoam Surgical Matrix when used as an adjunct for anastomotic hemostasis following a broad range of cardiovascular surgical procedures. The safety outcomes were within the normal limits for the types of procedures performed.
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de Nucci, Germana, Raffaella Reati, Ilaria Arena, Cristina Bezzio, Massimo Devani, Cristina della Corte, Daniela Morganti, et al. "Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding." Endoscopy 52, no. 09 (April 21, 2020): 773–79. http://dx.doi.org/10.1055/a-1145-3412.
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Abstract Background Acute gastrointestinal bleeding (AGIB) results in significant morbidity and mortality. Topical hemostatic products have been developed for endoscopic use to help in the management of difficult bleeding. Our aim was to demonstrate the ease of use, safety, and efficacy of PuraStat, a novel hemostat, to control AGIB. Methods We describe 77 patients (41 men) who were treated for acute upper and lower AGIB in a 2-year period. In 50 patients, bleeding occurred as a complication of a previous endoscopic procedure, predominantly endoscopic mucosal resection (EMR) and endoscopic retrograde cholangiopancreatography (ERCP); however, in the other 27 patients, it derived from peptic ulcers, angiodysplasia, cancers, and surgical anastomoses. Bleeding was spurting in 13 of the 77 patients and oozing in 64. PuraStat was used after the failure of at least two conventional hemostatic methods. Results A mean of 2.6 conventional hemostatic methods had been attempted prior to the application of PuraStat. PuraStat achieved successful hemostasis in 90.9 % of patients. In 41 patients, once hemostasis was obtained with PuraStat, endoscopists further stabilized hemostasis by using at least one additional method. Recurrence of bleeding was observed in eight patients (10.4 %). In 16 patients with intraprocedural bleeding, it was possible to complete the procedures (14 EMR, 2 ERCP) after PuraStat hemostasis. No adverse events related to PuraStat were recorded. Conclusions PuraStat is feasible, safe, and effective in controlling different types of gastrointestinal hemorrhage after failure of conventional hemostatic methods. Its application also does not hinder continuing endotherapy.
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Reuthebuch, Oliver, Lachat, Vogt, Schurr, and Turina. "FloSeal®: Ein neuartiges Hämostyptikum in der peripheren Gefäßchirurgie." Vasa 29, no. 3 (August 1, 2000): 204–6. http://dx.doi.org/10.1024/0301-1526.29.3.204.
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Background: Bleeding is a common and often severe side-effect in vascular surgery. The use of glue is widely accepted to achieve a dry surgical field. The application of sealant is limited when the surface is covered with blood. Aim of this study was to evaluate a new sealant (FloSeal®) in patients undergoing vascular surgery. Patients and methods: Between June 1998 and July 1999 a total of 17 patients with peripheral vascular interventions was included in this investigation. Effectiveness was measured by bleeding severity prior and after application, time to hemostasis, amount of fusion matrix necessary for hemostasis, the potential need for additional hemostatic measures, or the need for reoperations to control the bleeding. Results: In 15 out of 17 patients bleeding was controlled with FloSeal® alone, two patients required further surgical or hemostatic treatment. There were no local or systemic complications after use of this product. Conclusion: FloSeal® is an advantageous hemostatic tool.
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Shutov, S. A., K. I. Danishyan, O. V. Shcherbakova, L. A. Gorgidze, P. A. Batrov, and O. S. Dimitrieva. "Transperitoneal hernioplasty in a patient with severe hemophilia A on preventive treatment with emicizumab." Pediatric Hematology/Oncology and Immunopathology 20, no. 3 (October 8, 2021): 116–24. http://dx.doi.org/10.24287/1726-1708-2021-20-3-116-124.
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Performance of surgical interventions in patients with severe hemophilia A on emicizumab requires the development of a protocol for the perioperative period management. Objective. To present the first experience of laparoscopic hernioplasty, hemostatic therapy and laboratory monitoring in a patient with severe hemophilia A on emicizumab. A transperitoneal hernioplasty was performed in a 31-year-old patient with severe hemophilia A on emicizumab. The patient received hemostatic therapy with recombinant FVIII for 5 days. Laboratory parameters (detection of FVIII via chromogenic and clotting methods, thromboelastography, determination of aPTT and FVII inhibitor titer) were monitored for 8 days. For a complete postoperative hemostasis, a significantly smaller amount of FVIII concentrate was required due to the lower frequency of administrations compared to similar surgical interventions in patients with severe hemophilia A who did not receive prophylactic therapy with emicizumab. According to thromboelastrography data, not a single episode of hypercoagulation was recorded. Emicizumab monotherapy can maintain adequate hemostasis during surgical procedures associated with a potentially low risk of perioperative bleeding in patients with hemophilia A. In other situations, the use of standard doses of FVIII concentrate concomitantly with emicizumab makes it possible to control hemostasis during postoperative period without the risk of thrombotic complications. The patient has signed a consent to the use of information, including photos, for research purposes and in publications.
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Kamamoto, Dai, Tokunori Kanazawa, Eriko Ishihara, Kaoru Yanagisawa, Hideyuki Tomita, Ryo Ueda, Masahiro Jinzaki, Kazunari Yoshida, and Masahiro Toda. "Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL®, in intracranial tumor resection." Surgical Neurology International 11 (February 7, 2020): 16. http://dx.doi.org/10.25259/sni_272_2019.
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Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.
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Polidoro, Daniel P., and Philip H. Kass. "Evaluation of a Gelatin Matrix as a Topical Hemostatic Agent for Hepatic Bleeding in the Dog." Journal of the American Animal Hospital Association 49, no. 5 (September 1, 2013): 308–17. http://dx.doi.org/10.5326/jaaha-ms-5927.
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New generation topical hemostatic agents containing thrombin have been developed for use in surgical procedures when control of bleeding by conventional methods is either ineffective or impractical. The authors compared the safety, hemostatic efficacy, and handling characteristics of a thrombin-containing topical surgical hemostatic agent (a gelatin matrix) to a hemostatic gelatin sponge for treatment of parenchymal bleeding after liver biopsy. Fourteen dogs were enrolled in this prospective clinical study. Paired 1.5 cm × 1.5 cm and 0.5 cm deep liver biopsies were obtained via laparotomy for each dog. One bleeding liver biopsy lesion was treated with the gelatin matrix and the other with a gelatin sponge. The treated liver biopsy sites were compared for bleeding severity, time to hemostasis, cumulative blood loss, and hemostatic agent handling characteristics. Median time to hemostasis was significantly shorter (P = 0.034) and median cumulative blood loss was significantly lower (P = 0.033) for the lesions treated with the gelatin matrix than the gelatin sponge. Adverse reactions were not observed within the first 24 hr postoperatively. When used to control parenchymal bleeding from liver biopsy sites in the dog, the evaluated gelatin matrix was safe and more effective than the gelatin sponge.
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Khajibayev, A. M., R. I. Rakhimov, A. A. Nabiev, and A. G. Mahamadaminov. "Results of surgical treatment of uclear bleed in patients with ischemic heart disease." Нospital-replacing technologies:Ambulatory surgery, no. 1-2 (June 8, 2020): 110–16. http://dx.doi.org/10.21518/1995-1477-2020-1-2-110-116.
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Introduction. This article is devoted to one of the urgent problems of modern emergency abdominal surgery – the result of surgical treatment of ulcer bleed in patients with ischemic heart disease.Undoubtedly intensive hemostatic conservative therapy and endoscopic hemostasis methods are the main treatment methods for this group of patients. However, in a certain number of patients with NGDK with various variants of IHD, such treatment is ineffective and there is a need to perform surgical hemostasis in an emergency and urgently.Surgical methods of hemostasis of NGDK patients with different variants of IHD are shown only in cases of inefficiency of conservative and endoscopic treatment methods. Among surgical interventions, radical surgeries are more preferable, which, if performed against the background of intensive resuscitation support, allow to achieve reliable hemostasis and thus avoid postoperative recurrent bleeding. Palliative surgery should be used when radical surgery is not possible due to the severity of the patient’s condition or lack of technical skill of surgeons. Finally, it is clear that in order to improve treatment results in patients in this category, correction of changes caused by the accompanying IHD is necessary.Materials and methods: In our research material, 89 out of 997 patients had such a need, which was 8.9%. It mainly corresponds to the modern literature data.Results: An analysis of the results of these patients’ palliative and radical surgical interventions clearly showed that the last ones were more preferable.The basis for this judgment was the high percentage of mortality after palliative care compared to radical care with approximately the same number of postoperative complications.In addition, it is noteworthy that postoperative complications typical of palliative care in the form of recurrent ulcerative bleeding are often fatal, because half of these patients in our observations have not experienced repeated radical interventions.Conclusion: At the same time, the necessary condition for performing radical operations is, firstly, appropriate technical skill of the surgeon, and secondly, providing the latter with intensive resuscitation support. In case of impossibility of performance of these conditions the method of a choice should serve palliative care.
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Kazhanov, I. V., A. Y. Demko, V. A. Manukovsky, S. I. Mikityuk, V. A. Reva, E. A. Kolchanov, and D. V. Pavlov. "Surgical Hemostasis for Severe Multisystem Pelvic Injuries." Russian Sklifosovsky Journal "Emergency Medical Care" 8, no. 4 (January 17, 2020): 396–408. http://dx.doi.org/10.23934/2223-9022-2019-8-4-396-40.
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For the treatment of patients with severe multysistem pelvic trauma accompanied by pelvic bleeding, many algorithms have been proposed that have different procedures for the use of various methods of surgical hemostasis, but none of them may guarantee the complete arrest of pelvic bleeding. The purpose of this study was to estimate clinical efficacy and developed algorithm, aimed at timely diagnosis of intrapelvic bleeding and its complete arrest with the help of different methods of surgical hemostasis in patients with severe concomitant injury of the pelvis. The article analyzes the results of treatment of 168 patients with unstable pelvic ring injuries and signs of intrapelvic bleeding, who were treated in two trauma centers of the first level in St. Petersburg: I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine and Military Surgery Clinic of S.M. Kirov Military Medical Academy in 2010-2018. The victims were divided into two statistically homogeneous groups. In the comparison group (75 people), the pelvic ring was mechanically stabilized with the Ganz C-clamp or the anterior part of the pelvis was fixed with an external fixation device (EFD), and the arrest of the ongoing pelvic bleeding was expected due to occur due to the effect of biological tamponade. In the main group (93 people), after mechanical stabilization of the pelvic ring, various methods of surgical hemostasis were used: balloon occlusion of the aorta, pelvic tamponade, angiography with embolization. The choice of method for surgical haemostasis after trauma depended on the severity of the affected condition of hemodynamic parameters, availability of life-threatening consequences of damage to other areas of the body and the efficacy of previously applied method for intrapelvic bleeding arrest. The introduction of modern diagnostic and treatment algorithm, aimed at complete hemostasis in patients with ongoing intrapelvic bleeding reduced the overall mortality rate by 1.7 times, mortality within 24 hours of admission by 2.3 times, as well as the duration and the volume of blood transfusion therapy by 3 and 1.8 times.Authors declare lack of the conflicts of interests.
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Neveleff, Deborah J., Larry W. Kraiss, and Christine S. Schulman. "Implementing Methods to Improve Perioperative Hemostasis in the Surgical and Trauma Settings." AORN Journal 92, no. 5 (November 2010): S1—S15. http://dx.doi.org/10.1016/j.aorn.2010.08.006.
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Severinov, Dmitriy Andreevich, Gennady Alekseevich Bondarev, Vyacheslav Alexandrovich Lipatov, and Araik Rubenovich Saakyan. "Intraoperative Tactics of Local Surgical Hemostasis in Injuries and Planned Operations on the Parenchymal Organs of the Abdominal Cavity." Journal of Experimental and Clinical Surgery 13, no. 3 (September 28, 2020): 268–78. http://dx.doi.org/10.18499/2070-478x-2020-13-3-268-278.
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Currently, mortality rate in the liver and spleen injuries remains high, despite the present-day level of advances in the diagnosis and treatment of surgical diseases. Damage to parenchymal organs leads to the development of intra-abdominal bleeding. The severity of bleeding depends on the anatomical features of the blood supply to the damaged organ and the massiveness of the lesion, the type of traumatic agent. Intraoperative provision of reliable hemostasis is a significant problem in liver and spleen injuries. This paper summarizes the experience of Russian and foreign experts on surgical treatment of various types of parenchymal organ injuries. Stitching, adhesive compositions, biological and synthetic films, non-contact methods are used to achieve the final intraoperative hemostasis for parenchymal organ injuries; electrocoagulation is also very popular. Currently, the issues of surgical treatment tactics of spleen and liver injuries are not fully resolved. The search for optimal options, as well as technical advancement of organ-preserving operation techniques involving parenchymal organs, remains relevant. This depends on the structural features of these organs, availability of the methods of local hemostasis listed in this paper and surgeon's knowledge and manual skills. Moreover, at present, hemostatic application agents are widely introduced into clinical practice, parenchymal bleeding caused by superficial planar injuries of parenchymal organs being the main indication for the use of these agents.
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Kazhanov, I. V., V. A. Manukovskii, I. M. Samokhvalov, G. M. Besaev, S. I. Mikityuk, and V. G. Bagdasariants. "PRACTICE OF USING THE PELVIC C-CLAMP IN PATIENTS WITH SEVERE CONCOMITANT PELVIC INJURY." VESTNIK KHIRURGII IMENI I.I.GREKOVA 177, no. 4 (September 8, 2018): 38–43. http://dx.doi.org/10.24884/0042-4625-2018-177-4-38-43.
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The OBJECTIVE the study is to rate the clinical efficacy of pelvic C-clamp in patients with unstable pelvic ring injuries and signs of intrapelvical ongoing bleeding. MATERIAL AND METHODS. We studied the results of treatment of 87 patients with unstable pelvic ring injuries signs of unstable hemodynamics. Pelvic C-clamp was used for mechanical stabilization of the posterior pelvic half-ring in order to stop the ongoing pelvic bleeding. Surgical methods of hemostasis in addition to the stabilization of the pelvis were used in 30 patients. Control of systolic blood pressure in the dynamics, volume and duration of blood transfusion therapy were carried out to assess the effectiveness of hemostasis. Additionally, spiral computed tomography with intravenous contrast enhancement and pelvic diagnostic angiography were performed. RESULTS. Surgical methods of hemostasis combined with mechanical stabilization of the damaged pelvic ring made allow to achieve the final stopping of the ongoing pelvic bleeding in ¾ patients. CONCLUSION. In severe concomitant pelvic injury, surgical methods of hemostasis in combination with mechanical stabilization of the damaged pelvic ring should be actively used in patients in critical condition.
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Popov, S. V., I. N. Orlov, I. S. Pazin, and M. A. Perfilyev. "Nephrostomy-free percutaneous nephrolithotripsy: intraoperative hemostasis methods of the percutaneous tract." Vestnik Urologii 9, no. 3 (October 5, 2021): 107–17. http://dx.doi.org/10.21886/2308-6424-2021-9-3-107-117.
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Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.
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Popov, S. V., I. N. Orlov, I. S. Pazin, and M. A. Perfilyev. "Nephrostomy-free percutaneous nephrolithotripsy: intraoperative hemostasis methods of the percutaneous tract." Vestnik Urologii 9, no. 3 (October 5, 2021): 107–17. http://dx.doi.org/10.21886/2308-6424-2021-9-3-107-117.
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Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.
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Usenko, O. Yu, O. N. Litvinenko, and O. P. Ternavskyi. "SURGICAL METHODS OF COAGULATIVE HEMOSTASIS OF LIVER PARENCHYMA (REVIEW OF LITERATURE)." Bukovinian Medical Herald 21, no. 2 (82) p.1 (November 13, 2017): 157–62. http://dx.doi.org/10.24061/2413-0737.xxi.2.82.1.2017.34.
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Orlov, V. M., and Y. V. Kovalyova. "Methods of reducing blood loss during reconstructive operations on the uterus." Journal of obstetrics and women's diseases 52, no. 3 (August 14, 2003): 85–94. http://dx.doi.org/10.17816/jowd88988.
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There can be no doubt about expediency of reconstructive operations on the uterus in young patients. These operations make it possible to preserve reproductive and menstrual function. However, such operations are accompanied by formation of extensive wound surfaces, considerable muscular tissue defects and characterized by high traumatism, quite often impossibility to ensure effective hemostasis and massive blood loss during operation. In this connection a number of complications during early postoperative period is higher than after hysterectomy. Taking into account the above, it is actual to use the surgical techniques which allow to reduce traumatism of operation and ensure effective hemostasis. In present review different methods used for ensuring hemostasis and reducing operative blood loss during reconstructive operations on the uterus are considered.
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Gupta, Gaurav, and Charles J. Prestigiacomo. "From sealing wax to bone wax: predecessors to Horsley's development." Neurosurgical Focus 23, no. 1 (July 2007): 1–4. http://dx.doi.org/10.3171/foc-07/07/e16.
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Object Writers of neurosurgical history have traditionally maintained that the initial use of cranial bone wax for hemostasis in humans was developed and promoted by Sir Victor Horsley, the father of British neurosurgery. A thorough literature review, however, suggests that the use of bone wax for cranial bone hemostasis had its roots more than 50 years before Dr. Horsley's description in 1892. In this study the authors review the sources addressing this issue and establish due credit to the surgeons using bone wax for cranial bone hemostasis before Horsley. Methods Primary and secondary general surgery and neurosurgery literature from 1850 to the present was comprehensively reviewed. The key words used in the literature searchers were “bone wax,” “sealing wax,” “cranial surgery,” “Victor Horsley,” “hemostasis,” and “bone hemostasis.” Results Although Dr. Horsley's description in 1892 clearly delineates the necessary formula for creating a soft, malleable, nonbrittle wax that would easily promote hemostasis, the literature suggests that sealing wax was commonly used as early as 1850 for hemostasis in cranial bones. Even though there is documentation that Magendie (1783–1855) used wax to occlude venous sinuses in animals, detailed documentation of the constituents are not available. Evidence reveals that surgeons like Henri Ferdinand Dolbeau (1840–1877), professor of external pathology and the surgical clinic (1868–1872) at the Paris hospitals, used bone wax in 1864 for the extirpation of a frontal osteoma/exostoses of the frontal sinus. Conclusions The use of bone wax in cranial surgery was described by Henri Ferdinand Dolbeau, 50 years prior to Sir Victor Horsley's report in 1892. Nonetheless, it was Horsley who advocated and popularized its use in neurological surgery as an additional tool in the hemostatic and surgical armamentarium.
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Pavlenko, O., M. Boiko, and S. Kabanchuk. "Evaluation of early healing of postoperative wounds oral mucosa depending on the method of hemostasis and connection of wound edges." SUCHASNA STOMATOLOHIYA 106, no. 2 (2021): 48–54. http://dx.doi.org/10.33295/1992-576x-2021-2-48.
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Actuality. The final and obligatory stage of each surgical intervention in the oral cavity is the tight connection of the wound edges and ensuring quality hemostasis, in order to prevent postoperative complications and the fastest recovery of tissues. The literature describes various techniques for joining soft tissues, using suture material, staples, fabric adhesive compositions, but due to the emergence of new methods, it is important to compare them. Goal. Compare and evaluate the early stage of healing of postoperative wounds in the oral cavity after open alveolectomy and the use of three methods for hemostasis and connection of wound edges (high-frequency electric welding, suturing nylon 5/0 and N-butyl-2-cyanoacrylate medical adhesive composition). Materials and methods. The study involved 42 patients aged 56 to 83 years, who were in the stage of surgical preparation for prosthetics with removable dentures and required open alveolectomy. Patients with cognitive impairment, cancer, systemic disease, recent acute or long-term chronic cardiovascular and musculoskeletal disorders did not participate in the study. All patients who participated in the study were randomly divided into 3 groups according to the methods of hemostasis and connection of the wound edges. After performing an open alveolectomy, hemostasis and joining of the wound edges were performed. In group 1 (electric welding) consisting of 14 patients, hemostasis and connection of wound edges were performed by welding soft tissues with the device «EKVZ-300M1». In group 2 (suturing) consisting of 14 patients, hemostasis of the wound was performed by connecting its edges with suture material nylon 5/0. In group 3 (adhesive composition) consisting of 14 patients, hemostasis of the wound was performed by joining its edges with a synthetic N-butyl-2-cyanoacrylate medical adhesive composition. Assessment of pain in patients of each group was performed according to the visual-analog scale (VAS). Determination of postoperative wound healing was performed on the basis of the wound healing index according to Landry, Turnbull and Howley. The average time to achieve intra-wound hemostasis and connection of wound edges in each of the groups were determined. The average values of the length of the trapezoidal section in each of the groups were also determined. Results. The analysis of the obtained results showed statistically significant differences (p ≤ 0.05) on the first day in terms of pain sensitivity between groups 2 (sutures) and 3 (glue). On the third day on both indicators (pain and wound healing) between groups 2 and 3 there were no statistically significant differences (p > 0.05). Group 1 (electric welding) has no statistically significant differences in pain sensitivity for the first day with other groups (p > 0.05). Statistically significant differences (p ≤ 0.01) appear on the third day both in terms of pain sensitivity and in terms of wound healing. Conclusions. The method of high-frequency electric welding can be used for intra-wound hemostasis with almost simultaneous connection of the wound edges after open alveolectomy. We found that electric welding has better hemostatic properties, faster connection of wound edges, reduced surgical time, postoperative pain and better results of wound healing compared to suture and adhesive methods. The method of high-frequency electric welding can be an alternative to suture and adhesive methods of hemostasis and joining the edges of the wound oral mucosa after open surgery on the jaws. Key words: oral cavity, mucous membrane, high-frequency electric welding, nylon sutures, adhesive composition, hemostasis, connection, index assessment, oral surgery.
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Zubkov, E. A., and M. E. Sitdykova. "Prevention of complications of transvesical adenomectomy with a blind suture of the urinary bladder." Kazan medical journal 93, no. 1 (February 15, 2012): 56–61. http://dx.doi.org/10.17816/kmj2146.
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Aim. To determine the frequency and develop methods for prevention of possible complications of transvesical adenomectomy. Methods. Conducted was an analysis of results of surgical treatment of 492 patients with prostate adenoma. One-stage suprapubic transvesical adenomectomy with a primary blind suture of the urinary bladder and hemostasis of the adenoma bed was performed in 347 patients. Results. In the postoperative period inflammatory complications of the urinary tract were observed in 5 (1.4%) out of 347 operated patients. It was established that the frequency and nature of both early and late pyo-inflammatory and obstructive postoperative complications of the suprapubic adenomectomy depend on the method of hemostasis of the bed of the adenoma and on the time of urination recovery. Conclusion. The main measures of prevention of complications during suprapubic adenomectomy are hemostasis of the bed of the adenoma by temporary retriganization with removable hemostatic ligatures, early recovery of urethral voiding (2-4 days) and application of antibiotics to the bed of the adenoma via the drainages of the deference ducts.
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Nosov, A. K., E. M. Mamizhev, N. A. Shchekuteev, D. P. Semeyko, P. A. Lushina, D. I. Rumyantseva, and M. V. Berkut. "Techniques of surgical hemostasis and sealing after laparoscopic partial nephrectomy." Cancer Urology 18, no. 3 (December 7, 2022): 27–34. http://dx.doi.org/10.17650/1726-9776-2022-18-3-27-34.
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Background. The kidney cancer treatment remains cornerstone problem in our country for healthcare. Survival results of partial nephrectomy as a radical nephrectomy are similar in groups of patients with the same morphological features and was confirmed by previously results: “indications for nephron-sparing treatment of kidney cancer is determined with the degree of resectability, assessed subjectively by surgeon and his experience, ambitions and technical capabilities. It does not depend on oncological prognostic factors”. This thesis is actual due to oncological preoperative factors and limited only by tumor size. Therefore, development of technical capabilities, techniques and skills expand our capabilities in organ-preserving treatment.Aim. To evaluate the effectiveness and safety of bipolar coagulation with fibrin glue in comparison with the standard technique of surgical suture to the area of non-ischemic partial nephrectomy.Materials and methods. This is prospective trial which had included the results of treatment of 121 patients who received partial-nephrectomy for localized kidney cancer from 2015 to 2017 at the N.N. Petrov National Medical Research Center of Oncology. Two variants of hemostasis were used in the work: standard surgical (surgical suture) and electrohemostasis with an additional hemostatic component (fibrin glue). Among the selected patients, there were no patients with a single kidney and a pronounced violation of the excretory function of the organ.Results. The groups were comparable in terms of tumor size (р = 0.09), morphometric characteristics according to the R.E.N.A.L. scale (p = 0.07), no differences were found in clinical and morphological staging. The use of electrohemostasis with a hemostatic glue component did not significantly affect at the excretory function of the kidney, assessed on the 3rd and 10th days after laparoscopic non-ischemic resection, which indirectly confirms the functional safety of the tested technique (р >0.05). The groups did not differ significantly in terms of the blood loss, hemotransfusions (р = 0.067), and none of delayed bleeding was found which indicates the reliability of electrohemostasis using an adhesive composition.Conclusion. We proposed a patent “Method of surgical hemostasis in laparoscopic partial nephrectomy” RU2654402C1 by combining bipolar coagulation in the 90 W-effect 7–8 mode and hemostatic fibrin glue (SURGIFLO, PERCLOT). Used adhesive compositions complement the achieved electrohemostasis, and also provide sealing of the area of the resected kidney tissue.
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Faraday, Nauder, Eliseo Guallar, Valerie A. Sera, Everlie D. Bolton, Robert B. Scharpf, Ann M. Cartarius, Kathryn Emery, Julia Concord, and Thomas S. Kickler. "Utility of Whole Blood Hemostatometry Using the Clot Signature Analyzer®for Assessment of Hemostasis in Cardiac Surgery." Anesthesiology 96, no. 5 (May 1, 2002): 1115–22. http://dx.doi.org/10.1097/00000542-200205000-00014.
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Background A hemostatic monitor capable of rapid, accurate detection of clinical coagulopathy within the operating room could improve management of bleeding after cardiopulmonary bypass (CPB). The Clot Signature Analyzer is a hemostatometer that measures global hemostasis in whole blood. The authors hypothesized that point-of-care hemostatometry could detect a clinical coagulopathic state in cardiac surgical patients. Methods Fifty-seven adult patients scheduled for a variety of elective cardiac surgical procedures were studied. Anesthesia, CPB, heparin anticoagulation, protamine reversal, and transfusion for post-CPB bleeding were all managed by standardized protocol. Clinical coagulopathy was defined by the need for platelet or fresh frozen plasma transfusion. The Clot Signature Analyzer collagen-induced thrombus formation (CITF) assay measured platelet-mediated hemostasis in vitro. The activated clotting time, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen concentration were also measured. Results The postprotamine CITF was greater in patients who required hemostatic transfusion than in those who did not (17.6 +/- 8.0 min vs. 10.5 +/- 5.7 min, respectively; P < 0.01). Postprotamine CITF values were highly correlated with platelet and fresh frozen plasma transfusion (Spearman r = 0.50, P < 0.001 and r = 0.40, P < 0.005, respectively). Receiver operator characteristic curves showed a highly significant relation between the postprotamine CITF and intraoperative platelet and fresh frozen plasma transfusion (area under the curve, 0.78-0.81, P < 0.005) with 60-80% sensitivity, specificity, positive and negative predictive values at cutoffs of 12-14 min. Logistic regression demonstrated that the CITF was independently predictive of post-CPB hemostatic transfusion, but standard hemostatic assays were not. Conclusions The Clot Signature Analyzer CITF detects a clinical coagulopathic state after CPB and is independently predictive of the need for hemostatic transfusion. Hemostatometry has potential utility for monitoring hemostasis in cardiac surgery.
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Hwang, Yeokgu, Yoo Jung Park, Dong-Woo Shim, Jin Woo Lee, and Seung Hwan Han. "Clinical Efficacy of a Kaolin-impregnated Dressing for Hemostatic Control in Diabetic Foot Ulcer Patients Receiving Anticoagulant Therapy in an Outpatient Clinic." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000213.
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Category: Diabetes Introduction/Purpose: Orthopedic physicians encounter many diabetes patients who receive anticoagulant treatment because vascular diseases are the chief causes of death and disability in these patients. In these patients, if surgery or other procedures are required, it is still unclear whether anticoagulation therapy administration should continue. After discontinuation of anticoagulation therapy, the risk of cardiovascular complications is increased, although complications of bleeding after surgery are decreased; this is a dilemma in the treatment of diabetic foot ulcer. The purpose of this study was to examine the effectiveness, safety, and hemostatic effect of kaolin-impregnated gauze on diabetic foot ulcer patients who continue to receive anticoagulants after surgical debridement. Methods: Twenty patients receiving anticoagulant medication with diabetic foot ulcers requiring surgical debridement were enrolled. Diabetic foot ulcers were treated using surgical debridement and a basic dressing protocol, which involved direct application of the dressing material to the wound bed. For the study group, a kaolin-impregnated dressing was used, and dry gauze was applied to patients in the control group. Patients were randomly assigned to either group, and we compared hemostatic efficacy and adverse effects between the two groups. The presence or absence of hemostasis was assessed 5 and 10 minutes after dressing application. Treatment was considered successful if bleeding ceased adequately and no extra hemostatic measures were required within 10 minutes. Results: In the 20 patients undergoing surgical debridement, there was no evidence of bleeding within 10 minutes of dressing application. Eight of the 10 patients treated with a kaolin-impregnated dressing achieved complete hemostasis within 5 minutes. Five of the 10 patients in the control group failed to achieve hemostasis within 10 minutes. No adverse effects were noted. Conclusion: The use of a kaolin-impregnated dressing appears to be a safe, feasible, and beneficial option for the management of diabetic foot ulcer patients with a high risk of bleeding.
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Tskhay, V. B., and A. A. Bakunina. "Comparative analysis of the effectiveness of different methods of surgical hemostasis in patients with placenta accreta spectrum disorders." Medical Herald of the South of Russia 13, no. 3 (July 11, 2022): 161–72. http://dx.doi.org/10.21886/2219-8075-2022-13-3-161-172.
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Currently, the medical community has accumulated significant experience in the use of endovascular methods in obstetric practice to achieve hemostasis and prevent massive hemorrhage, including in patients with placenta accreta spectrum (PAS) disorders. Objective — to evaluate the effectiveness of various methods of uterine devascularization in reducing blood loss during caesarean section in patients with PAS. In this review, we analyzed relevant literature and assessed the quality of clinical trials based on a systematic search in the Embase, PubMed, Web of Science, and Cochrane Library databases. The review presents an overview of modern methods of uterine devascularization aimed at reducing intraoperative blood loss in patients with PAS. A comparative analysis of the effectiveness of such methods of uterine devascularization as temporary balloon occlusion of the internal iliac arteries, common iliac arteries, abdominal aorta, as well as arterial compression using distal hemostasis was carried out. We evaluated effectiveness of the methods by such indicators as the mean amount of blood loss and the frequency of hysterectomy. The most effective methods of hemostasis in patients with PAS are temporary balloon occlusion of the abdominal aorta and the method of distal hemostasis. At the same time, there is still no ideal method for uterine devascularization in PAS, and clinical research in this direction should be continued.
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Keast, David, and Ashrafunissa Janmohammad. "The Hemostatic and Wound Healing Effect of Chitosan Following Debridement of Chronic Ulcers." Wounds : a compendium of clinical research and practice 33, no. 10 (October 10, 2021): 263–70. http://dx.doi.org/10.25270/wnds/082421.01.
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Introduction. Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting pathway, leading to thrombus formation. Objective. Based on the properties of chitosan as a rapidly acting hemostatic agent, the authors sought to determine if a chitosan gelling fiber wound dressing could control bleeding of freshly debrided wounds. The effect of the chitosan dressing on overall healing and patient and provider satisfaction was also evaluated. Materials and Methods. Wounds of any etiology requiring sharp debridement in patients older than 18 years who were capable of consent were eligible. Wounds were sharply debrided by curettage, scalpel, electrosurgery, or a combination of methods. A chitosan dressing was applied to the freshly debrided wound with gentle pressure. The time from application to hemostasis as assessed by non-progression of blood pattern was measured. Other outcome measures also included digital photography, wound surface area, numerical pain scores, and Photographic Wound Assessment Tool (PWAT) scores. Patient and provider satisfaction were measured. Results. Twenty patients with a variety of etiologies and ulcer types were evaluated. After debridement, wound bleeding was rated as mild (n=9), moderate (n=9), or severe (n=2). The mean time to hemostasis was 75 seconds ± 41 SD (range, 28–221 seconds). In 1 week, the mean wound area decreased from 6.9 cm2 ± 7.8 to 6.2 cm2 ± 7.9 and mean PWAT scores decreased from 17.7 ± 4.9 to 11.4 ± 5.0 (lower score indicates wound healing). Pain scores associated with wound debridement were reduced in all but 1 patient evaluated at week 1. Overall, the rating scores from the Patient Reported Acceptance Questionnaire (PRAQ) and Provider Acceptance Questionnaire (PAQ) developed by this research group were high. The mean total PRAQ score was 30.5 ± 3.9 out of 35 (35 being most satisfied). The PAQ score was 15 out of 15 for all but 1 patient (15 being most satisfied). Conclusions. The chitosan gelling fiber wound dressing was simple to use and rapidly promoted hemostasis in fresh sharply debrided wounds. It was safe and easy to use in an outpatient setting and was highly rated by the patients.
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Severgin, Vladisav, Sergei Prohoda, and Aleksey Prohoda. "MINIMALLY INVASIVE METHODS IN TREATMENT OF COMPLICATED FORMS OF CENTRAL LUNG CANCER." EUREKA: Health Sciences 3 (May 31, 2017): 44–48. http://dx.doi.org/10.21303/2504-5679.2017.00342.
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Despite certain achievements in lung cancer treatment, the essential number of patients is subjected to palliative and symptomatic treatment. Hemoptysis addition is the one of most heavy symptoms of unresectable lung cancer. No less heavy complication is an atelectasis and hypoventilation of a lobe or a whole lung, which clinical image is attended by respiratory failure phenomena or association of purulent-septic pneumonia. The combination of endoscopic hemostasis with roentgen endovascular embolization of bronchial arteries (REEBA) allows to increase patients’ live quality and to prolong it for some time. In the clinic REEBA has been done in 121 patients with unresectable forms of lung cancer. The causes of surgical treatment refusal were a widespread tumor process, age, and severity of associated pathology. Hemostasis was achieved in 112 patients. A relapse of pulmonary bleeding was observed in 11 patients, who underwent the repeated REEBA. Lethal outcome was observed in 5 cases. Hemostasis was ineffective in 9 patients. Thus, the experience of using REEBA and endoscopic hemostasis at complicated forms of unresectable lung cancer allows to increase the life quality and in further to realize chemoradial therapy that gives a possibility to prolong a patient’s life.
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Maskin, S. S., V. V. Aleksandrov, and V. V. Matyukhin. "Features of surgical tactics for injuries of abdominal and retroperitoneal major arteries (review of literature)." Grekov's Bulletin of Surgery 180, no. 1 (June 2, 2021): 111–17. http://dx.doi.org/10.24884/0042-4625-2021-180-1-111-117.
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Injuries of abdominal and retroperitoneal major blood vessels are the most severe injuries. Delayed diagnosis, irrational accesses and methods of temporary hemostasis aggravate the severity of the condition and lead to life-threatening complications. The objective was to summarize the data from Russian and foreign literature for improving the results of treatment of patients with injury of abdominal and retroperitoneal major vessels. The article discusses the etiology, clinic, diagnostic algorithm for abdominal vascular injury and treatment of patients with injury of abdominal arteries, describes the methods of temporary and final hemostasis. It is necessary for a general surgeon to know the therapeutic and diagnostic algorithm for vascular injury, rational accesses to them and methods of temporary and final hemostasis, as well as the principles of «damage control» tactics to save the life of the patient.
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Grishenko, O. V., and V. V. Bobrytska. "The efficacy of hemostasis in gynecological practice." HEALTH OF WOMAN, no. 10(116) (December 29, 2016): 94–97. http://dx.doi.org/10.15574/hw.2016.116.94.
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The objective: to study the clinical efficacy of Cyclokapron-Zdorovje and its impact on the parts of the system in cases of abnormal uterine bleeding (AUB), as well as a comparison of the effectiveness of the complex method of stop bleeding and hormonal hemostasis. Patients and methods. The study included 60 patients with AUB at the age 35-46 years with metrology. The patients were divided into three groups according to the therapy: group I (n=20) received the drug Cyclokapron-Zdorovje 10 ml (1 g tranexamic acid) for the purpose of hemostasis; group II (n=20) surgical hemostasis – separate curettage or hysteroscopy combined with intravenous Cyclokapron 10 ml (1 g); group III (n=20), in which hemostasis was achieved using a combined estrogen-progestin preparation (ethinyl estradiol 30 mg in combination with desogestrel 150 mg). Results. Treatment of abnormal uterine bleeding using intravenous infusions of Cyclokapron 1000mg was performed. The medicine was administered to patients before the curettage, as well as the hemostatic agent in patients with advanced endometrial histological result of the state. Intravenous dosage of 1000mg Cyclokapron in women with abnormal uterine bleeding achieves significant hemostatic effect, reduces total blood loss. Conclusion. The medicine is clinically effective and safe. The drug can be recommended for inclusion in the standard algorithm for emergency patients with AUB. In addition, the safety of the drug can be recommended for the whole spectrum of possible clinical situations in obstetrics and gynecology, complicated by hemorrhage. Key words: abnormal uterine bleeding, hemostasis, Cyclokapron-Zdorovje.
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Bochkova, T. V., and A. Kh Gainullin. "Autoplasma as a Hemostatic Agent for Endoscopic Surgery of Hollow Organs." Creative surgery and oncology 10, no. 3 (November 30, 2020): 212–16. http://dx.doi.org/10.24060/2076-3093-2020-10-3-212-216.
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Introduction. To maximize the effectiveness of hemostatic technologies, it is necessary to optimize local hemostasis through hybrid and controlled approaches, as well as to improve the conditions for tissue surgical dissection preventing perforation of hollow organs. This study is aimed at assessing the efficacy of stopping bleeding and the safety of resection of digestive hollow organs in experimental models of trauma to abdominal organs in laboratory animals.Materials and methods. Experiments were carried out in vivo on 20 rabbits. All animals were divided into 4 experimental groups (5 animals each): I — the control group, in which no methods for stopping bleeding were used; II — the group, in which infiltration of the wall of a hollow organ with saline solution was used; III — the group, in which physical hemostasis was applied using an electrosurgical unit and an argon plasma coagulation apparatus; IV — the group, animals in which underwent controlled local biological hemostasis using autoplasma. Prior to laparotomy, 2–3 ml of whole blood was taken from the rabbit’s ear for preliminary preparation of autoplasma. The prepared autoplasma was introduced into the area of resection or other operation of the mucous membrane of the rabbit’s digestive tract.Results and discussion. Although no statistical difference in the time of stopping bleeding was observed between the control (I) and saline (II) groups, one more episode of bleeding was noted in group II. Preventive local administration of autoplasma (group IV) was established to have a high hemostatic potential. As expected, electrocoagulation was more effective than saline; however, hemostasis achieved by means of argon plasma coagulation is characterized by rapid formation of a necrotic zone, which may lead to undesirable consequences in the long-term period.Conclusion. Preventive local administration of autoplasma and recombinant human protein has a high hemostatic potential in animals. In comparison, electrocoagulation is less effective due to the rapid filling of the pathological focus with blood.
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Guedes, Rogério Luizari, João Batista Poncio da Silva, and Peterson Triches Dornbusch. "Applying and Cutting Device for Tie-Wraps During Laparoscopic Ovariectomy in Standing Mares." Acta Scientiae Veterinariae 44, no. 1 (March 19, 2018): 5. http://dx.doi.org/10.22456/1679-9216.81079.
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Background: Laparoscopic ovariectomy it is used more than 20 years in veterinary medicine, however, information of this technique in Brazil are rare. Also, the cost for his execution are high, specially the ovarian hemostasis procedure, that depends on highly specialized surgical instruments. The goal of this study is show the results achieved during laparoscopic ovariectomy in mares using a device to apply and cut tie-wraps, developed by the authors and that is in a patent process.Materials, Methods & Results: Four mares with ovarian pathologies were selected for a standing unilateral ovariectomy procedure and access to cavity occurred through three laparoscopic portals. The vessels and ligament were dissected to allow positioning of a polyamide tie-wrap by the device for cutting and applying those seals. Occlusion was made by pushing, and cutting through a rotation on the tie latch. Then, the mesovarium was cut with laparoscopic scissors and ovary removed by a communication between two accesses. Total surgical time and the equipment handling were noted. The average duration of surgical procedures was 80 ± 12.35 min and device handling time since its external preparation, application and cutting the polyamide tie-wraps was 3.4 ± 2.63 min. Only in one of four animals it was necessary to apply more than one tie, since the first promoted incomplete vessels occlusion. Within 10 postoperative days none of the animals showed clinical signs consistent with bleeding and / or infection and the wound’s healing were complete.Discussion: Surgical time for dissection and hemostasis during laparoscopic ovariectomy in mares shows great variation in the literature and depend on hemostasis technique. The average time of 80 min for a one-sided procedure using the device for application and cutting tie-wraps was considered appropriate, with the possibility of significantly reduction, since this is an instrumental in testing and yet there is not a definition of the learning curve from its use. The main reason related to the tie-wraps use, even controversial, is due a significant reduction in cost, since the devices for hemostasis available are very expensive to brazilian veterinarians. Although considered a simple application and advantages over other hemostatic methods the authors of this study do not indicate the use of non-surgical polyamide ties when other materials are available, also, it is important to clarify that the main purpose of this study was to report the effectiveness of the device for application and cut these ties while performing these surgical procedure steps. The device for applying and cutting tie-wraps allows closing and resection of polyamide tie-wraps, producing safe hemostasis to ovarian vessels during laparoscopic ovariectomy in mares, with appropriate surgical time and without trans or postoperative complications.
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Fujita, Yasutaka, Kazuhisa Doi, Daisuke Harada, and Shuji Kamikawa. "Modulation of physiological hemostasis by irrigation solution: comparison of various irrigation solutions using a mouse brain surface bleeding model." Journal of Neurosurgery 112, no. 4 (April 2010): 824–28. http://dx.doi.org/10.3171/2009.7.jns09561.
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Object Intraoperative bleeding often obscures the surgical field and may cause neurological damage. The irrigation fluids used during surgery might affect physiological hemostasis because they modulate the extracellular fluid composition of the bleeding area directly. The authors therefore investigated the influence of irrigation fluid on hemostasis in a mouse brain surface bleeding model. Methods The cerebral cortices of ddY strain mice were exposed under irrigation with normal saline, lactated Ringer (LR) solution, or artificial CSF (ACF-95). To investigate the influence of electrolytes, calcium, potassium, or both were also added to the saline. After 10 minutes of irrigation at 100 ml/hour, sequential photographs of the surgical area were taken with a microscope, and the number of bleeding points was counted visually. Irrigation and counting were performed in a masked manner. Results There were significantly more bleeding points after irrigation with normal saline than with ACF-95; LR solution had a similar effect on physiological hemostasis as ACF-95. Saline augmented with calcium or potassium and calcium was superior to normal saline in terms of hemostasis. Conclusions The authors demonstrated that the irrigation fluid used in neurosurgery affects bleeding at the surgical site. To avoid surgical site bleeding, ACF-95 and LR solution should be used as irrigation fluids instead of normal saline. The calcium and potassium content of irrigation solutions seems to be important in hemostasis.
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Shabunin, A. V., N. M. Podzolkova, V. A. Alimov, D. N. Grekov, V. V. Bedin, S. S. Lebedev, N. Yu Sokolov, et al. "Recurrent cervical and vaginal hemorrhage in a patient with advanced cervical cancer." Voprosy ginekologii, akušerstva i perinatologii 21, no. 2 (2022): 140–45. http://dx.doi.org/10.20953/1726-1678-2022-2-140-145.
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Clinical observation of recurrent cervical and vaginal hemorrhage from a tumor in a 55-year-old patient with locally advanced cervical cancer is presented. The use of uterine artery embolization was ineffective. Subsequently, the following surgical interventions were performed: laparoscopy, clipping of internal iliac arteries on both sides, coagulation of gonadal arteries. Symptomatic radiation therapy to the pelvic region with hemostatic purpose based on vital indications was performed. Positive dynamics against the background of radiation therapy was noted: complete hemostasis was achieved. Conclusion. Symptomatic radiation therapy to the pelvic region can be applied with hemostatic purpose for vital indications in case of insufficient effectiveness of traditional methods to stop cervical and vaginal hemorrhage in patients with advanced cervical cancer. Key words: radiation therapy, cervical cancer, surgical treatment, cervical and vaginal hemorrhage, uterine artery embolization
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Ponomarova, Kateryna V., Dmytry V. Minukhin, Denis O.Yevtushenko, Andrey V. Tokarev, Oleksandr M. Kudrevych, and Vasiliy G. Hroma. "USING OF ENDOVASCULAR CATHETER METHODS IN SURGICAL TREATMENT PATIENTS WITH LUNG BLEEDING." Wiadomości Lekarskie 73, no. 6 (2020): 1149–53. http://dx.doi.org/10.36740/wlek202006113.
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The aim: Improve the results of the treatment of patients with pulmonary bleeding. Materials and methods: We examined 57patients with lung bleeding different etiology, who were hospitalized in the department of Thoraco-Abdominal Surgery. All patients were divided into two groups – of the main group 27patients and the comparison group 30 patients, depend of ages, sex, nosological form, level of lung bleeding. Patients aged from 27 to 78 years, including 34 men (62,5%) and 23 women (37,5%.). The test diseases includes: bronchiectasis disease – in 21 (37,1 %), pulmonary fibrosis with malformation BA – in 14 (24,7 %), abscess of the lung – in 9 (15,9 %), polycystic lung disease – in 6 (12,7 %), chronic obstructive pulmonary disease – in 5 (9,6 %). Results: As a result of complete physical examination of patients with LB, it has been established that hemorrhage was the result of obstructive bronchitis in 14 patients (42%), there was chronic obstructive pulmonary disease in 7 (21%) and bronchiectasis was diagnosed in 6 (18%) patients. In 2 (6%) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12%) patients. Conclusions: Bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases. Endovascular occlusion of bronchial arteries permits: to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumor; to perform effective endovascular hemostasis.
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Huec, J. C. Le, S. AlEissa, A. J. Bowey, B. Debono, A. El-Shawarbi, N. Fernández-Baillo, K. S. Han, et al. "Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations." Neurospine 19, no. 1 (March 31, 2022): 1–12. http://dx.doi.org/10.14245/ns.2143196.598.
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Bleeding in spine surgery is a common occurrence but when bleeding is uncontrolled the consequences can be severe due to the potential for spinal cord compression and damage to the central nervous system. There are many factors that influence bleeding during spine surgery including patient factors and those related to the type of surgery and the surgical approach to bleeding. There are a range of methods that can be employed to both reduce the risk of bleeding and achieve hemostasis, one of which is the adjunct use of hemostatic agents. Hemostatic agents are available in a variety of forms and materials and with considerable variation in cost, but specific evidence to support their use in spine surgery is sparse. A literature review was conducted to identify the pre-, peri-, and postsurgical considerations around bleeding in spine surgery. The review generated a set of recommendations that were discussed and ratified by a wider expert group of spine surgeons. The results are intended to provide a practical guide to the selection of hemostats for specific bleeding situations that may be encountered in spine surgery.
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Tkachenko, Aleksandr Nikolaevich, Dmitriy Svyatoslavovich Savitskiy, and Aleksandr Anatolievich Khromov. "Hemostasis in Liver Injuries: An Experimental Study." Journal of Experimental and Clinical Surgery 14, no. 1 (January 12, 2021): 47–52. http://dx.doi.org/10.18499/2070-478x-2021-14-1-47-52.
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Introduction. Bleeding in liver injuries is observed during natural disasters, massive injuries, in military field conditions and under other circumstances. The vital need for surgical treatment in these cases is obvious. As a rule, time for assistance is limited, and operations are performed by surgeons who do not have sufficient experience. Intraoperative hemostasis methods are not always effective. The search for intraoperative hemostasis methods has not stopped for many decades. Experimental study of the effect of new agents that allow for reliable hemostasis in liver damage is relevant for medical science and practice.Materials and methods. The experimental study included 116 white Wistar rats of both sexes weighed 230 25 g and 30 Chinchilla rabbits of both sexes weighed 2.5-3.5 kg. The following parameters were identified in experiments in vivo: the duration of bleeding in simulated liver injury without the use of hemostatics and with the use of alufer and viscostat preparations. A morphological study of the regenerative process in the liver was carried out on the 1st - 14th day after the injury. The biopsy material was fixed in 10% formalin solution. Staining of histological sections was carried out with hematoxylin and eosin, as well as Prussian blue (according to Max Perls) to detect iron compounds in tissues.Results. It was revealed that the implementation of hemostasis with the use of the alufer preparation is accompanied by a decrease in circulatory disorders (edema, hemorrhages); characterized by a more pronounced formation of the connective tissue in the area of drug application, which is partially retained (taking into account the time interval of the study) at the site of application.
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Ozolinya, Lyudmila A., and Angelina A. Anikeeva. "Hemostatic system in patients with endometrial hyperplasia and the risk of venous thrombosis: А literature review." V.F.Snegirev Archives of Obstetrics and Gynecology 9, no. 4 (December 24, 2022): 193–201. http://dx.doi.org/10.17816/2313-8726-2022-9-4-193-201.
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While treating patients with endometrial hyperplasia, the physician may face both bleeding and thrombotic complications, particularly, during hormonal or surgical treatment, which significantly increases the risk of these complications. In addition, thrombotic complications in gynecological patients may result from congenital or acquired thrombophilia, blood flow disorders (blood stasis), and vascular wall damage, that is, the classic Virchow triad.
This study aimed to review the recent scientific literature on the peculiarities of the blood coagulation system in patients with endometrial hyperplasia.
The review reflects the results of studies conducted by Russian and foreign authors on the status of the blood coagulation system in patients with endometrial hyperplasia. The features of vascular, thrombocytic, plasma (procoagulant and anticoagulant), and fibrinolytic elements of hemostasis in these patients are considered. The data from the literature on the state of hemostasis before treatment and following hormone therapy and surgical treatment are presented. Moreover, the data of some studies on the genetic features of the hemostatic system in patients with endometrial hyperplasia are summarized. An analysis of the literature indicates the need for a careful choice of drugs and methods of treatment of these patients to avoid venous thromboembolic complications.
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Sinenchenko, Georgiy I., Vladimir G. Verbitskiy, Andrey E. Demko, Aleksey N. Sekeyev, Sergey A. Alentyev, Maksim Kiselev, Anton O. Parfenov, and Pavel A. Alimov. "The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding." HERALD of North-Western State Medical University named after I.I. Mechnikov 13, no. 1 (June 8, 2021): 103–8. http://dx.doi.org/10.17816/mechnikov62306.
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This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.
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Birda, Chhagan L., Antriksh Kumar, and Jayanta Samanta. "Endotherapy for Nonvariceal Upper Gastrointestinal Hemorrhage." Journal of Digestive Endoscopy 12, no. 02 (June 2021): 078–92. http://dx.doi.org/10.1055/s-0041-1731962.
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AbstractNonvariceal upper gastrointestinal hemorrhage (NVUGIH) is a common GI emergency with significant morbidity and mortality. Triaging cases on the basis of patient-related factors, restrictive blood transfusion strategy, and hemodynamic stabilization are key initial steps for the management of patients with NVUGIH. Endoscopy remains a vital step for both diagnosis and definitive management. Multiple studies and guidelines have now defined the optimum timing for performing the endoscopy after hospitalization, to better the outcome. Conventional methods for achieving endoscopic hemostasis, such as injection therapy, contact, and noncontact thermal therapy, and mechanical therapy, such as through-the-scope clips, have reported to have 76 to 90% efficacy for primary hemostasis. Newer modalities to enhance hemostasis rates have come in vogue. Many of these modalities, such as cap-mounted clips, coagulation forceps, and hemostatic powders have proved to be efficacious in multiple studies. Thus, the newer modalities are recommended not only for management of persistent bleed and recurrent bleed after failed initial hemostasis, using conventional modalities but also now being advocated for primary hemostasis. Failure of endotherapy would warrant radiological or surgical intervention. Some newer tools to optimize endotherapy, such as endoscopic Doppler probes, for determining flow in visible or underlying vessels in ulcer bleed are now being evaluated. This review is focused on the technical aspects and efficacy of various endoscopic modalities, both conventional and new. A synopsis of the various studies describing and comparing the modalities have been outlined. Postendoscopic management including Helicobacter pylori therapy and starting of anticoagulants and antiplatelets have also been outlined.
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Shelekhov, Alexey V., V. V. Dvornichenko, A. V. Munkuev, R. I. Rasulov, S. I. Radostev, A. Yu Novopashin, N. I. Minakin, and D. V. Moskovskikh. "Results of X-ray endovascular hemostasis in the treatment of malignant neoplasms of the colon and rectum, complicated by bleeding." Russian Journal of Oncology 21, no. 4 (August 15, 2016): 186–89. http://dx.doi.org/10.18821/1028-9984-2016-21-4-186-189.
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There are present near results of X - ray endovascular hemostasis in patients suffering from malignant neoplasm of rectosigmoid colon and rectum complicated by bleeding. Patients were divided into basic group (n=16) where the X - ray-endovascular hemostasis was performed and control group (17 patients) where the conservative methods of hemostasis were used. For angiography there was used X-raysurgical complex “GE INNOVA 4100” (General Electric, USA) and ”SHIMADZU” (Shimadzu Corporation, Japan). After preformed hemostasis, the patients of the control and basic groups for rectal cancer were undergone to preoperative radiotherapy, then radical surgery, for rectosigmoid cancer - surgical treatment. The quantity, volume of donor blood products in the treatment ofpatients of the control group were used in a significantly greater extent (p
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Fatkullina, Irina B., Alfia G. Yashchuk, Yulia N. Fatkullina, and Anna Yu Lazareva. "Modern approaches to organ-conserving surgical hemostasis in obstetric bleeding." Journal of obstetrics and women's diseases 70, no. 3 (August 16, 2021): 115–20. http://dx.doi.org/10.17816/jowd41753.
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BACKGROUND: Obstetric hemorrhage is an urgent problem of global health care, since it occupies a leading position in the structure of maternal mortality.
AIM: The aim of this study was to analyze data on hemostasis in obstetric bleeding.
MATERIALS AND METHODS: The article presents a review of the world literature on modern approaches to hemostasis, which take into account new data on the anatomical structure of the female reproductive system.
RESULTS AND CONCLUSIONS: Based on the foreign and domestic literature data, a strict step-by-step implementation of all prescribed measures along with a differentiated approach to treatment that takes into account anatomical features is the key to success in the fight against obstetric bleeding as the main cause of maternal mortality in the world.
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Maskin, S. S., V. V. Aleksandrov, and V. V. Matyukhin Matyukhin. "Features of surgical tactics for injuries of abdominal and retroperitoneal major veins (review of literature)." Grekov's Bulletin of Surgery 180, no. 2 (August 20, 2021): 101–7. http://dx.doi.org/10.24884/0042-4625-2021-180-2-101-107.
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Injuries of abdominal and retroperitoneal major veins, especially in combination with pelvic fractures, are accompanied by high mortality and require further improvement of treatment tactics. The objective of the study was to analyze the data from Russian and foreign literature for improving the treatment of patients with injuries of the major abdominal veins, including pelvic bone fractures, by General surgeons. The article considers treatment options for patients with damage to major abdominal veins, describes the methods of temporary and final hemostasis, features of temporary prosthetics and vascular suture, and considers indications for endovascular interventions. CONCLUSION. Indications for endovascular methods of treatment of injuries of abdominal and retroperitoneal major veins are expanded. For general surgeons, knowledge of rational approaches and methods of temporary and final hemostasis is necessary to save the life of the sufferer.
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Simo, K. A., E. M. Hanna, D. K. Imagawa, and D. A. Iannitti. "Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil)." ISRN Surgery 2012 (September 13, 2012): 1–12. http://dx.doi.org/10.5402/2012/729086.
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Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.
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Kadyrov, D. M., F. D. Kodirov, Sh Sh Saidaliev, and Z. V. Tabarov. "Surgical treatment tactics of gastroduodenal ulcerous bleeding combined with pyloroduodenal stenosis." Health care of Tajikistan, no. 1 (April 29, 2022): 35–42. http://dx.doi.org/10.52888/0514-2515-2022-352-1-35-42.
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Aim. To improve the surgical treatment tactics of gastroduodenal ulcerous bleeding combined with pyloroduodenal stenosis.Material and methods. Results of diagnostics and surgical treatment of 105 patients with DUD, divided into two groups were analyzed: the first - 54 patients, in which individualized tactics with maximum use of modern endo- and pharmacological hemostasis was used, mainly planned operations were executed; the second - 51 patients, in which active surgical tactics without endohemostasis was used, mainly “traditional” variants of gastric resection were used.Results. In case of active surgical tactics the number of urgent operations made up 29,4%, delayed - 54,9%, planned operations - 15,7%. The use of resection (76,4%) and palliative (19,6%) operations was one of the causes of a high frequency of postoperative complications (37,2%) and lethality rate (13,7%). The use of modern endo- and pharmacological hemostasis techniques contributed to the efficacy of treatment, a decrease in urgent (11,0%) and delayed (9,2%) operations, and an increase in elective operations (79,8%), which promoted the decrease of postoperative complications (9,2%) and absence of lethality.Conclusion. In DUD the tactics based on endo- and pharmacological hemostasis contributes to a decrease of operation activity by urgent and delayed indications, transfer of the situation to the category of the planned operations that promotes the decrease in the frequency of postoperative complications and lethality.
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Seicean, Andreea, Nicholas K. Schiltz, Sinziana Seicean, Nima Alan, Duncan Neuhauser, and Robert J. Weil. "Use and utility of preoperative hemostatic screening and patient history in adult neurosurgical patients." Journal of Neurosurgery 116, no. 5 (May 2012): 1097–105. http://dx.doi.org/10.3171/2012.1.jns111760.
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Object The utility of preoperative hemostasis screening to predict complications is uncertain. The authors quantified the screening rate in US neurosurgery patients and evaluated the ability of abnormal test results as compared with history-based risk factors to predict hemostasis-related and general outcomes. Methods Eleven thousand eight hundred four adult neurosurgery patients were identified in the 2006–2009 American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression modeled the ability of hemostatic tests and patient history to predict outcomes, that is, intra- and postoperative red blood cell [RBC] transfusion, return to the operating room [OR], and 30-day mortality. Sensitivity analyses were conducted using patient subgroups by procedure. Results Most patients underwent all 3 hemostatic tests (platelet count, prothrombin time/international normalized ratio [INR], activated partial thromboplastin time), but few had any of the outcomes of interest. The number of screening tests undergone was significantly associated with intraoperative RBC transfusion, a return to the OR, and mortality; an abnormal INR was associated with postoperative RBC transfusion. However, all tests had low sensitivity (0.09–0.2) and platelet count had low specificity (0.04–0.05). The association between patient history and each outcome was approximately the same across all tests, with higher sensitivity but lower specificity. Combining abnormal tests with patient history accounted for 50% of the mortality and 33% of each of the other outcomes. Conclusions This is the first study focused on assessing preoperative hemostasis screening as compared with patient history in a large multicenter sample of adult neurosurgery patients to predict hemostasis-related outcomes. Patient history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Routine laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually.
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Kazakova, Rada T., Georgi T. Tomov, Christo K. Kissov, Angelina P. Vlahova, Stefan Ch Zlatev, and Svitlana Y. Bachurska. "Histological Gingival Assessment after Conventional and Laser Gingivectomy." Folia Medica 60, no. 4 (December 1, 2018): 610–16. http://dx.doi.org/10.2478/folmed-2018-0028.
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Abstract Background: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. Aim: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments – a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. Materials and methods: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types – as test groups. The following histological parameters were measured: coagulation layer thickness (in μm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. Results: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. Conclusions: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.
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Ermolaev, A. Yu, A. V. Yarikov, A. Ya Aleynik, A. O. Dubskikh, I. I. Smirnov, O. A. Perlmutter, A. G. Sosnin, A. M. Ermolaeva, and A. P. Fraerman. "Surgical methods in management of metastatic spinal cord lesions." Russian journal of neurosurgery 24, no. 2 (June 13, 2022): 78–93. http://dx.doi.org/10.17650/1683-3295-2022-24-2-78-93.
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Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.