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Hemostasis
Kinds of Hemostasis Selected AbstractsPulp capping with adhesive resin-based composite vs. calcium hydroxide: a reviewDENTAL TRAUMATOLOGY, Issue 6 2000A. H. B. Schuurs Abstract , The results of some short-term experiments suggest that direct capping of a vital pulp with the modern resin-based composite systems may be as effective as capping with calcium hydroxide. Total cavity etching with 10% phosphoric acid seems to be safe for the exposed pulp, but unless annulled by calcium hydroxide 35% phosphoric acid may be disastrous. For hemostasis and cleaning of the pulp wound both sodium hypochlorite and saline seem suitable, whereas the effectiveness of a 2% chlorhexidine solution is questionable. Although hard-setting calcium hydroxide cements may induce the formation of dentin bridges, they appear not to provide an effective long-term seal against bacterial factors. Within a few years, the majority of mechanically exposed and capped pulps show infection and necrosis due to microleakage of such capping materials and tunnel defects in the dentin bridges. It is unknown whether newer types of resin containing calcium-hydroxide-products will act as a permanent barrier. The cytotoxicity of the resin-based composites and the temperature rise during polymerisation may not be of concern, but microleakage, sensitisation and allergic reactions may pose problems. Based on available data, pulp capping with resin-based composites may be said to be promising, but more and long-term research is mandatory before the method can be recommended. [source] Hydrogen Peroxide and Wound Healing: A Theoretical and Practical Review for Hair Transplant SurgeonsDERMATOLOGIC SURGERY, Issue 6 2008SARA WASSERBAUER MD BACKGROUND In most hair restoration practices, hydrogen peroxide has been routinely used to remove blood during and after hair transplant surgery. In other specialties, hydrogen peroxide is also used in these ways: wound cleaning, prevention of infection, hemostasis, and removal of debris. Despite its widespread use, there are still concerns and controversy about the potential toxic effect of hydrogen peroxide. OBJECTIVE The objective was to review all available literature including in vivo and in vitro effects of hydrogen peroxide, as well as general wound healing research. MATERIAL AND METHODS Literature up to and including the past three decades was investigated. RESULTS Two pilot studies were found, and there are not enough data examining the real impact of using hydrogen peroxide in hair transplant surgery. In other specialties, H2O2 appears to have positive effects, such as stimulation of vascular endothelial growth factor, induction of fibroblast proliferation, and collagen, or negative effects, such as cytotoxicity, inhibition of keratinocyte migration, disruption of scarless fetal wound repair, and apoptosis. CONCLUSIONS There are not enough data in hair restoration surgery about the use of hydrogen peroxide, and it is unknown and unclear what the optimum dilution should be. Positive and negative effects were found in other specialties. Further studies are recommended. [source] Perioperative Management of Medications for Psoriasis and Psoriatic Arthritis: A Review for the DermasurgeonDERMATOLOGIC SURGERY, Issue 4 2008CLAUDIA HERNANDEZ MD BACKGROUND Psoriasis affects an estimated 3% of the world's population. Many are on chronic immunosuppressive therapy for the cutaneous and joint manifestations of this disorder. The management of these medications in the perioperative period is controversial. Psoriasis and psoriatic arthritis medications can affect wound healing, hemostasis, and infection risk during cutaneous surgery. OBJECTIVES The objective of this article is to provide a critical review of various medications used for care of the psoriatic patient and their potential effect on cutaneous surgical procedures. CONCLUSIONS This review summarizes current understanding of wound healing, hemostatic effects, and infectious risks regarding many psoriasis medications including nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, corticosteroids, various immunosuppressants, and biologic response modifiers. Recommendations vary depending on the agent in question, type of procedure, and comorbid conditions in the patient. Caution is advised when using many of the medications reviewed due to lack of human data of their effects in the perioperative period. [source] Hydrophilic Polymers with Potassium Salt and Microporous Polysaccharides for Use as Hemostatic AgentsDERMATOLOGIC SURGERY, Issue 12 2007JULIA HO MD BACKGROUND Postoperative bleeding can lead to complications such as hematoma, infection, dehiscence, and an unscheduled office visit. Topical hemostatic agents can be used to aid in hemostasis. OBJECTIVE The objective is to familiarize physicians with topical hemostatic agents,hydrophilic polymers with potassium salts (Urgent QR powder) and microporous polysaccharide hemispheres (Bleed-X). METHODS Two hemostatic agents, microporous polysaccharide hemospheres and hydrophilic polymers with potassium salt, are discussed. The literature is reviewed. RESULTS Numerous types of hemostatic agents exist. Topical hemostatic agents are safe, cost-effective, and efficient. CONCLUSION Microporous polysaccharide hemospheres and hydrophilic polymers with potassium salts can be an adjunct to hemostasis after cautery and ligation. Patients can apply hemostatic agents if they experience any bleeding leading to decreased office visits. Hemostatic agents used intraoperatively shorten bleeding time and enable the physician to use less cautery. Using hemostatic agents can lead to fewer hematomas, infections, and office visits. [source] Effectiveness of Microporous Polysaccharide Hemospheres for Achieving Hemostasis in Mohs Micrographic SurgeryDERMATOLOGIC SURGERY, Issue 6 2004FRCPC, Stephen R. Tan MD Background. Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. Objective. The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. Methods. Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). Results. Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). Conclusion. The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal. [source] CO2 Laser Treatment of Epidermal Nevi: Long-Term SuccessDERMATOLOGIC SURGERY, Issue 7 2002Sarah Boyce MD background. Epidermal nevi have been notoriously difficult to treat due to their large size and often conspicuous location. Variable results have been obtained with different laser treatments, and scarring and/or incomplete removal is typical after excisional or other destructive modalities. objective. To outline the successful use of a short-pulsed CO2 laser in the long-term eradication of epidermal nevi in three patients. methods. Three females (ages 15,19) presented with extensive grouped verrucous papules and plaques on the face, trunk, and extremities. A pulsed CO2 laser was used to vaporize the lesions using a 500 mJ pulse energy, 3 mm spotsize, and 7 watts of power. results. All lesions healed without incident. No lesional recurrence was observed 10 to 13 months after treatment except in one small area on the ankle in one patient. conclusions. Carbon dioxide laser vaporization of epidermal nevi provides good clinical effect and offers unique advantages for the treatment of these lesions, including effective intraoperative hemostasis with excellent lesional visualization. It is also possible to treat widespread areas in one laser treatment session. While the results of this series clearly show the benefit of CO2 laser treatment, epidermal nevi may not always respond so favorably, due in part to the variability in their depths of involvement. [source] A Liquid Adhesive Bandage for the Treatment of Minor Cuts and AbrasionsDERMATOLOGIC SURGERY, Issue 3 2002William H. Eaglstein MD Background. Octyl-2-cyanoacrylate is U.S. Food and Drug Administration (FDA) approved for the closure of incisions and lacerations. In animal studies, a more flexible formulation of octyl-2-cyanoacrylate suitable for cuts and abrasions produced faster healing of partial thickness wounds than traditional bandages. Objective. To evaluate the effectiveness of a more flexible octyl-2-cyanoacrylate liquid adhesive bandage for the treatment of minor cuts and abrasions. Methods. One hundred sixty-two volunteers with recent minor cuts or abrasions were recruited and randomized to treatment with either liquid adhesive bandage (LAB) or a control device (Band-Aid brand adhesive bandage, sheer, 2.5 cm). The primary efficacy criterion was complete healing at day 12. Secondary efficacy criteria were the ability of patients to properly apply LAB, and the ability of LAB to stop bleeding, to reduce pain, and to remain on the wound. Results. At day 12 there was no statistical difference between the number of completely healed wounds in the LAB and the bandage-treated patients (P = .493). The ability of patients, as rated by investigators, to effectively apply the LAB device and the bandage was not significantly different (P = .165). Only the LAB provided significant hemostasis (P = .0001) and pain relief (P = .002). conclusion. In this randomized, controlled trial, the LAB was as effective as the control at promoting healing as measured by complete healing at day 12. The LAB was easy to use and gave rapid control of bleeding and pain, forming a film that stayed on wounds well. [source] An Octyl-2-Cyanoacrylate Formulation Speeds Healing of Partial-Thickness WoundsDERMATOLOGIC SURGERY, Issue 9 2001Stephen C. Davis BS Background. Occlusive dressings have been known to accelerate the rate of healing. Every year new dressings are being introduced in the marketplace. Objective. The purpose of this study was to evaluate the effect of a new octyl-2-cyanoacrylate liquid dressing as compared to two over-the-counter bandages on partial-thickness wounds. Performance parameters were epithelialization, erythema, scab formation, material adherence, hemostasis, and infection. Method. Eight pigs with a total of 645 partial-thickness wounds were assigned to one of the following treatments: liquid dressing, standard bandage, hydrocolloid bandage, or untreated air exposed. Result. The liquid bandage enhanced the rate of epithelialization and was the only treatment to provide complete hemostasis, reduced scab formation, and did not induce an irritant response (erythema) or infection. Conclusion The liquid bandage is an easy to use material that stops bleeding (instantaneous hemostasis) while enhancing healing of partial-thickness wounds. [source] The Effects of Variable Pulse Width of Er:YAG Laser on Facial SkinDERMATOLOGIC SURGERY, Issue 4 2001Khalil A. Khatri MD Background. The use of CO2 and Er:YAG lasers for resurfacing has increased significantly in the past few years. Er:YAG laser causes pinpoint bleeding during and after treatment with a typical pulse width of 250 ,sec. A longer pulse of Er:YAG laser can potentially coagulate dermal blood vessels and increase the residual thermal damage (RTD). Objective. To evaluate the effects of various pulse durations of Er:YAG laser on the depth of RTD and bleeding. Methods. The preauricular skin of a volunteer was exposed to Er:YAG laser at 250-, 350-, and 700-,sec pulse durations, with a fluence of 5 J/cm2. The number of passes varied between 6 and 16. The treated skin was excised and a histologic evaluation was done. Results. The maximum depth of RTD was 50 ,m and there was decreased bleeding with a 700-,sec pulse duration. Conclusion. The increased pulse duration of Er:YAG laser of 700 ,s does not increase the maximum reported RTD and therefore would not change the recovery time and may have a beneficial effect on hemostasis. [source] Resurfacing of Pitted Facial Acne Scars with a Long-Pulsed Er:YAG LaserDERMATOLOGIC SURGERY, Issue 2 2001Jeung-Tae Jeong MD Background. Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. Objective. To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. Methods. Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III,V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0,7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. Results. The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. Conclusion. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars. [source] Donor Harvesting: A New Approach to Minimize Transection of Hair FolliclesDERMATOLOGIC SURGERY, Issue 4 2000Damkerng Pathomvanich MD Background. There are several methods for harvesting donor hairs, including punch excision, single-bladed knife excision, and multibladed knife excision. All of these procedures are blind and thus result in transection of hair follicles. Transection of hair follicles during harvesting results in fewer follicles being available for transplantation, detrimentally affecting the final cosmetic result. Objective. To explore a new method of donor hair harvesting called "donor dissecting." This new procedure is an open technique because hair follicles are directly visualized during the harvesting process. Methods. The technique of donor dissecting utilizes a #15 scalpel blade to excise the donor hair ellipse from the occiput while maintaining meticulous hemostasis. This enables individual hair follicles to be visualized and protected from transection during the harvesting process. Once the donor ellipse is harvested, it is then further divided into individual mini- and micrografts using direct visualization of individual follicles to again prevent transection. Results. The technique of donor dissecting was utilized in 50 consecutive hair transplant patients. Utilizing this new technique, only 1.9% of hair follicles in the donor ellipse were transected during the harvesting process. The dissection of the donor ellipse 1.2% follicles being transected in the graft cutting process. Combining the donor dissection technique with dissection of the individual grafts, we were able to transect 1.59% of hair follicles harvested for transplantation. Conclusion. The technique of donor dissection minimizes the transection of hair follicles in the donor hair harvesting phase of hair transplantation. This technique is superior to the blind methods of donor harvesting which have been plagued by the problem of hair follicle transection. [source] SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCERDIGESTIVE ENDOSCOPY, Issue 2010Nobutsugu Abe Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life-threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid-reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis. [source] MANAGEMENT OF ANTIPLATELET THERAPY FOR ENDOSCOPIC PROCEDURES: OPTIMAL CESSATION PERIOD OF ANTIPLATELET THERAPY FOR JAPANESEDIGESTIVE ENDOSCOPY, Issue 4 2007Yoshiko Tamai Although antiplatelet agents are widely used for the treatment and prevention of thrombotic diseases, only a few studies have reported the validity of the cessation period prior to endoscopic procedures. In 2002, the American Society for Gastrointestinal Endoscopy (ASGE) published a reference on the management of anticoagulation and antiplatelet therapy for endoscopic procedures, but it should be confirmed as appropriate for use in Asian patients. To evaluate the optimal cessation period of antiplatelet agents prior to endoscopic procedures for Japanese, we have studied: (i) the current clinically adopted cessation period of antiplatelet agents prior to invasive endoscopic procedures in Japan; (ii) the relationship between the cessation period of antiplatelet agents and complications around the invasive endoscopic procedures; (iii) colonic mucosal bleeding time after aspirin ingestion; and (iv) the time course of primary hemostasis after cessation of antiplatelet agents. We conclude that 3 days cessation period for aspirin, 5 days cessation for ticlopidine and 7 days cessation for aspirin + ticlopidine administration should be sufficient for Japanese. [source] A new type of hemoclip deviceDIGESTIVE ENDOSCOPY, Issue 2 2005Kenichi Watanabe Background: There are many endoscopic techniques for hemostasis of non-variceal upper GI bleeding. Endoscopic hemoclip placement is one of the most important techniques. A rotatable clip-fixing device developed by Olympus Co. (Tokyo, Japan) has come into widespread use in Japan. However, it involves a number of problems, such as requirement of skill for attachment and it is time-consuming. Materials: We developed a new type of hemoclip device with collaboration with Olympus Co. Results: We explain the new type of hemoclip device and how to use it. Finally, we examine the convenience of the new type of hemoclip compared with previous devices. Conclusion: Hemoclip placement for bleeding of GI tract seems to be very convenient now and may become common in the world in the future. [source] Pseudoxanthoma elasticum with recurrent gastric hemorrhage managed by endoscopic mechanical hemostasisDIGESTIVE ENDOSCOPY, Issue 2 2004Hitoshi Nishiyama A 24-year-old-woman was admitted to our hospital for further examination of recurrent upper gastrointestinal tract hemorrhage. The characteristic xanthomatous papular rash, retinal angioid streaks, and stenosis of cardiac coronary artery confirmed the diagnosis of pseudoxanthoma elasticum. Upper gastrointestinal endoscopy revealed vascular dilation in the gastric body to fornix. The vessel showing conspicuous dilation covered with the discolored mucosa was suspected as the source of the bleeding. The vessel was identified as a dilated vein located in the submucosa by endoscopic ultrasonography and pulsed-wave Doppler ultrasonography. Abdominal angiography demonstrated aneurysmal dilation in the splenic artery, but not in the gastric artery. Endoscopic band ligation was chosen as an initial treatment for the prevention of recurrent bleeding. The procedure seemed to be successful, but rebleeding occurred on the next day, which was again treated with hemostatic clipping. There have been no further episodes of gastrointestinal hemorrhage during the 15-month follow up. [source] Endoscopic band ligation for postpolypectomy gastric bleedingDIGESTIVE ENDOSCOPY, Issue 2 2003RYOSAKU TOMIYAMA We report a case of a patient in whom endoscopic band ligation was achieved for postpolypectomy gastric bleeding. A 76-year-old man visited our hospital because of anemia. Endoscopy revealed a gastric polyp, approximately 12 mm in diameter, on the lesser curvature in the distal gastric body. The polyp was considered to be the source of chronic anemia and was therefore removed by using standard careful snare-cautery polypectomy technique. Four days later, follow-up endoscopy was performed to evaluate the postpolypectomy site, and an active bleeding postpolypectomy ulcer was identified. Initial attempts to achieve hemostasis with ethanol injection were unsuccessful. Immediate hemostasis was obtained with a subsequent endoscopic band ligation device. There has been no recurrent bleeding. Endoscopic band ligation might be a good treatment modality for the treatment of a postpolypectomy gastric bleeding lesion. [source] Gastric bleeding due to Dieulafoy's ulcer successfully treated with an esophageal variceal ligation (EVL) kitDIGESTIVE ENDOSCOPY, Issue 3 2001Yoshihide Chino Dieulafoy's ulcer is a cause of life-threatening upper gastrointestinal hemorrhage. With advanced endoscopic procedures, Dieulafoy's ulcer is easily diagnosed and treated. However, a few patients still need surgery to stop bleeding or they will die of shock. Further improved procedures are therefore required to treat bleeding in Dieulafoy's ulcer. A 77-year-old man was admitted to our hospital with hematemesis and general malaise. He had moderate anemia and azotemia but no past history of gastric ulcer. He was diagnosed with Dieulafoy's ulcer endoscopically. Dieulafoy's ulcer was ligated with an endoscopic variceal ligation kit without surgery. Although an ulcer was found at the ligation point after 1 week, the ulcer changed to the scar on administration of Histamine H2 receptor blockers. The patient has suffered no recurrent ulcer and no bleeding for 24 months. Endoscopic variceal ligation may be an alternative new method for hemostasis of Dieulafoy's ulcer. [source] Successful Endoscopic Band Ligation for Treatment of Postpolypectomy HemorrhageDIGESTIVE ENDOSCOPY, Issue 4 2000Yohei Mizuta We describe a case of large pedunculated tubulovillous adenoma of the stomach associated with postpolypectomy hemorrhage, which was successfully treated by endoscopic band ligation. The case study involved a 60-year-old Japanese woman with a pedunculated polyp with a slightly lobular surface, measuring 25 mm in diameter. It was detected on the posterior wall of the middle body of the gastric remnant. The lesion was diagnosed as a tubulovillous adenoma by a biopsy specimen and treated by endoscopic polypectomy using the detachable snare to prevent postpolypectomy hemorrhage. There was no episode of immediate postpolypectomy hemorrhage, but hematemesis occured 18 h after the excision. Endoscopic examination of the stomach showed the mark left by bleeding on the cutting surface and the absence of the detachable snare. Endoscopic intervention by rubber band ligation was performed to prevent the recurrent bleeding. Complete hemostasis was obtained and no serious complications occured. [source] Recombinant clotting factor VIII concentrates: Heterogeneity and high-purity evaluationELECTROPHORESIS, Issue 16 2010Gian Maria D'Amici Abstract Factor VIII is an important glycoprotein involved in hemostasis. Insertion of expression vectors containing either the full-length cDNA sequence of human factor VIII (FLrFVIII) or B-domain deleted (BDDrFVIII) into mammalian cell lines results in the production of recombinant factor VIII (rFVIII) for therapeutic usage. Three commercially available rFVIII concentrates (Advate®, Helixate NexGen® and Refacto®), either FLrFVIII or BDDrFVIII, were investigated by 1- and 2-DE and MS. The objective of this study was to compare the heterogeneity and the high purity of both rFVIII preparations before and after thrombin digestion. In particular, the 2-D gel was optimized to better highlight the presence of contaminants and many unexpected proteins. Recombinant strategies consisting of insertion of expression vectors containing BDDrFVIII and FLrFVIII resulted in homogeneous and heterogeneous protein products, respectively, the latter consisting in a heterogeneous mixture of various B-domain-truncated forms of the molecule. Thrombin digestion of all the three rFVIII gave similar final products, plus one unexpected fragment of A2 domain missing 11 amino acids. Regarding the contaminants, Helixate NexGen® showed the presence of impurities, such as Hsp70,kDa, haptoglobin and proapolipoprotein; Refacto® showed glutathione S -transferase and ,-lactamase, whereas Advate® apparently did not contain any contaminants. The proteomic approach will contribute to improving the quality assurance and manufacturing processes of rFVIII concentrates. In this view, the 2-DE is mandatory for revealing the presence of contaminants. [source] Synthesis and Characterization of Thrombin Conjugated ,-Fe2O3 Magnetic Nanoparticles for HemostasisADVANCED ENGINEERING MATERIALS, Issue 12 2009Ofra Ziv Abstract Thrombin is the final protease produced in the clotting pathways. Thrombin has been used in the clinic more than six decades for topical hemostasis and wound management. In human plasma the half-life of thrombin is shorter than 15 seconds due to close control by inhibitors. In order to stabilize thrombin, this enzyme was conjugated covalently and physically to ,-Fe2O3 magnetic nanoparticles. The physical conjugation was accomplished through adsorption of thrombin to BSA coating on the nanoparticles. The coagulant activity of the covalently bound thrombin was significantly lower than that of the physically adsorbed thrombin. Leakage of the physically bound thrombin into PBS containing 4% HSA was negligible. The physical conjugation of thrombin onto the nanoparticles stabilized the thrombin against its major inhibitor antithrombin III and improved its storage stability. At optimal CaCl2 concentration, the clotting time by the bound thrombin is shorter than that of the free enzyme. This novel conjugated thrombin may be an efficient candidate for topical hemostasis and wound healing. [source] Evaluation of postoperative drainage with application of platelet-rich and platelet-poor plasma following hemithyroidectomy: A randomized controlled clinical trial,,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2008John Yoo MD Abstract Background. Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) have been used to improve hemostasis and wound healing after surgery; however, randomized controlled trials proving their efficacy are lacking. Methods. Hemithyroidectomy was performed on 52 patients. Autologous PRP and PPP were applied during wound closure in the treatment group, while saline was applied in the controls. Outcome measures were postoperative drainage, pain, analgesic use, and length of hospital stay. Results. The 24-hour cumulative drainage was reduced by 29.3% in the treatment group (44.9 mL vs 63.5 mL, p = .039). The treatment group required less analgesic medication despite similar pain scores; however, the difference was not significant. There was a trend toward decreased length of stay for thePRP/PPP group (p = .059). Conclusions. Hemithyroidectomy served as a stringent test to evaluate the wound-healing capacity of platelet-rich and platelet-poor plasma. This study provides evidence that PRP and PPP reduced postoperative drainage in soft-tissue surgery. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] CoagMDB: a database analysis of missense mutations within four conserved domains in five vitamin K,dependent coagulation serine proteases using a text-mining tool,HUMAN MUTATION, Issue 3 2008Rebecca E. Saunders Abstract Central repositories of mutations that combine structural, sequence, and phenotypic information in related proteins will facilitate the diagnosis and molecular understanding of diseases associated with them. Coagulation involves the sequential activation of serine proteases and regulators in order to yield stable blood clots while maintaining hemostasis. Five coagulation serine proteases,factor VII (F7), factor IX (F9), factor X (F10), protein C (PROC), and thrombin (F2),exhibit high sequence similarities and all require vitamin K. All five of these were incorporated into an interactive database of mutations named CoagMDB (http://www.coagMDB.org; last accessed: 9 August 2007). The large number of mutations involved (especially for factor IX) and the increasing problem of out-of-date databases required the development of new database management tools. A text mining tool automatically scans full-length references to identify and extract mutations. High recall rates between 96 and 99% and precision rates of 87 to 93% were achieved. Text mining significantly reduces the time and expertise required to maintain the databases and offers a solution to the problem of locus-specific database management and upkeep. A total of 875 mutations were extracted from 1,279 literature sources. Of these, 116 correspond to Gla domains, 86 to the N-terminal EGF domain, 73 to the C-terminal EGF domain, and 477 to the serine protease domain. The combination of text mining and consensus domain structures enables mutations to be correlated with experimentally-measurable phenotypes based on either low protein levels (Type I) or reduced functional activities (Type II), respectively. A tendency for the conservation of phenotype with structural location was identified. Hum Mutat 29(3), 333,344, 2008. © 2007 Wiley-Liss, Inc. [source] Identification of a novel human tissue factor splice variant that is upregulated in tumor cells,INTERNATIONAL JOURNAL OF CANCER, Issue 7 2006Hitendra S. Chand Abstract Tissue factor (TF) is a transmembrane glycoprotein that serves as the prime initiator of blood coagulation and plays a critical role in thrombosis and hemostasis. In addition, a variety of tumor cells overexpress cell-surface TF, which appears to be important for tumor angiogenesis and metastasis. To elucidate the mechanism involved in the upregulation of TF in human tumor cells, a comprehensive analysis of TF mRNA from various normal and tumor cells was performed. The results of these studies indicate that, in addition to possessing a normal full-length TF transcript and minor levels of an alternatively spliced transcript known as alternatively-spliced tissue factor (asTF) (Bogdanov et al., Nat Med 2003;9:458,62), human tumor cells express additional full-length TF transcripts that are also generated by alternative splicing. Reverse transcriptase-polymerase chain reaction (RT-PCR) and 5,-rapid amplification of cDNA ends- (5,-RACE) based analyses of cytoplasmic RNA from normal and tumor cells revealed that there is alternative splicing of the first intron between exon I and exon II resulting in 2 additional TF transcripts. One of the transcripts has an extended exon I with inclusion of most of the first TF intron (955 bp), while the second transcript is formed by the insertion of a 495 bp sequence, referred to as exon IA, derived from an internal sequence of the first intron. The full length TF transcript with alternatively spliced novel exon IA, referred to as alternative exon 1A-tissue factor (TF-A), represented ,1% of the total TF transcripts in normal cells, but constituted 7,10% of the total TF transcript in tumor cells. Quantitative real-time RT-PCR analysis indicated that cultured human tumor cells contain 10,25-fold more copy numbers of TF-A in comparison to normal, untransformed cells. We propose that high-level expression of the novel TF-A transcript, preferentially in tumor cells, may have utility in the diagnosis and staging of a variety of solid tumors. © 2005 Wiley-Liss, Inc. [source] The purse-string suture revisited: a useful technique for the closure of cutaneous surgical woundsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2007Philip R. Cohen MD The purse-string suture provides complete or partial closure of round postoperative skin defects. It is a rapid and simple procedure to perform. Tension placed on the suture uniformly advances the skin from the entire periphery of the wound, resulting in a significant reduction of the defect size and enhancement of hemostasis at the wound edge. The history, modifications of the technique, advantages, and potential complications of the purse-string suture are reviewed. It is not only useful following the removal of nonmelanoma skin cancer but also after the local excision of melanoma. In addition, this technique is especially suitable for the repair of round surgical wounds for patients who are unable to modify their active lifestyles during the week following surgery, individuals concurrently being treated with anticoagulants, antiplatelet agents or both, and people with extensive postoperative defects that would otherwise require either a skin graft or a large cutaneous flap. Typically, the site of the surgical wound following partial or complete closure with the purse-string suture demonstrates excellent long-term cosmetic and functional results. [source] The use of thrombelastography to determine coagulation status in severe anorexia nervosa: A case seriesINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2010Jennifer L. Gaudiani MD Abstract Objective: Hospitalized patients with severe anorexia nervosa (AN) frequently have a complex coagulation profile, with elements of hypocoagulability-thrombocytopenia and elevated international normalized ratio (INR) and elements of hypercoagulability-usually manifested as immobility, which is either due to their marked weakness or from enforced degrees of bed rest to minimize energy expenditure. Hospitalized medical patients have been shown to have appropriate prophylaxis for venous thromboembolic (VTE) disease in only 40% of cases. Method: A simple test that could evaluate the overall coagulation profile of these patients would help guide appropriate VTE prophylaxis. The thrombelastogram is a blood test that evaluates the full dynamic process of hemostasis. Results: The study of patients did not reveal evidence of being hypocoagulable and thus should be considered for VTE prophylaxis. Discussion: We report on three cases of young women with severe AN and weakness, hospitalized for closely monitored refeeding, in whom the thromboelastogram was used to evaluate the coagulation status of the patient and assist in guiding therapy. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] Complete robotic-assistance during laparoscopic living donor nephrectomies: An evaluation of 38 procedures at a single siteINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2007Jacques Hubert Objective: To evaluate our initial experience with entirely robot-assisted laparoscopic live donor (RALD) nephrectomies. Methods: From January 2002 to April 2006, we carried out 38 RALD nephrectomies at our institution, using four ports (three for the robotic arms and one for the assistant). The collateral veins were ligated, and the renal arteries and veins clipped, after completion of ureteral and renal dissection. The kidney was removed via a suprapubic Pfannenstiel incision. A complementary running suture was carried out on the arterial stump to secure the hemostasis. Results: Mean donor age was 43 years. All nephrectomies were carried out entirely laparoscopically, without complications and with minimal blood loss. Mean surgery time was 181 min. Average warm ischemia and cold ischemia times were 5.84 min and 180 min, respectively. Average donor hospital stay was 5.5 days. None of the transplant recipients had delayed graft function. Conclusions: Robot-assisted laparoscopic live donor nephrectomy can be safely carried out. Robotics enhances the laparoscopist's skills, enables the surgeon to dissect meticulously and to prevent problematic bleeding more easily. Donor morbidity and hospitalization are reduced by the laparoscopic approach and the use of robotics allows the surgeon to work under better ergonomic conditions. [source] Associated Replacement of Ascending Aorta, Aortic Valve, and Noncoronary Sinus of ValsalvaJOURNAL OF CARDIAC SURGERY, Issue 4 2007Francesco Santini M.D. It offers the advantage to secure stable hemostasis in an area where surgical exposure may be difficult to achieve off-pump. For its easy reproducibility, this procedure might contribute to a more radical resection of diseased tissue thus limiting risk of further dilatation, rupture, and need for reoperation. [source] Hemostatic Defect in Baboons Autotransfused Treated Plasma to Simulate Shed BloodJOURNAL OF CARDIAC SURGERY, Issue 6 2006C. Robert Valeri M.D. This study was done to determine how autotransfusion of nontreated plasma and plasma treated with urokinase with and without aprotinin affected hemostasis in healthy baboons. Methods: A 500-mL volume of blood was collected from the baboon, a 250-mL volume of plasma was isolated, and the RBCs were reinfused. Three baboons were autotransfused untreated plasma. Four baboons received plasma that had been treated with 3000 IU/mL urokinase at +37°C for 30 minutes. Eight baboons received plasma that had been treated first with urokinase 3000 IU/mL at +37°C for 30 minutes and then with aprotinin (1000 KIU/mL). Bleeding time, fibrinogen degradation products (FDP), D-dimer, and alpha-2 antiplasmin levels were measured. Results: During the 4-hour period following autotransfusion of the urokinase-aprotinin-treated plasma, the levels of D-dimer and FDP were significantly higher and fibrinogen and alpha-2 antiplasmin levels were significantly lower than those levels seen after the autotransfusion of nontreated plasma. FDP and D-dimer levels showed significant positive correlations with prothrombin time (PT) and activated partial thromboplastin time (aPTT). A significant negative correlation was observed between thrombin time (TT) and fibrinogen level. A significant positive correlation was observed between bleeding time and D-dimer level and a significant negative correlation between the bleeding time and the fibrinogen level. Conclusions: The infusion of a volume of urokinase or urokinase-aprotinin treated autologous plasma equivalent to 15% of the blood volume was not associated with a bleeding diathesis in healthy baboons. [source] Fibrin Sealants and GluesJOURNAL OF CARDIAC SURGERY, Issue 6 2003Thomas E. MacGillivray M.D. They have been used as an adjunct to hemostasis, wound healing, tissue adhesion, and drug delivery. In cardiac surgery, fibrin glues have emerged as valuable tools to improve hemostasis, decreased blood transfusions, improve tissue handling, and pretreat vascular grafts. Fibrin glues and sealants are now available commercially in the United States. This article will review the history, pharmacology, uses, and toxicity of fibrin sealants and fibrin glues. (J Card Surg 2003;18:480-485) [source] Antifibrinolytic agents reduce tissue plasminogen activator-mediated neuronal toxicity in vitroACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009H.-Y. SUN Introduction: Serine proteases and their inhibitors play an important role in physiological homeostasis including neuronal activity, hemostasis, and wound healing. Tissue plasminogen activator (tPA) is involved in normal neuronal plasticity and memory formation but can also be neurotoxic. We hypothesized that the serine protease inhibitor aprotinin confers neuronal protection by inhibiting tPA activity. Methods: Using cultured rat dopaminergic neuroblasts (N27 line), tPA-induced cytotoxicity was quantitated by an MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay and flow cytometry using propidium iodide DNA staining. The anti-apoptotic effects of aprotinin and other protease inhibitors were also evaluated using these systems. Results: Treatment of cultured neuroblasts with tPA (10,20 ,g/ml) caused a dose-dependent decrease in cell viability (71.3±2.4 at 10 ,g/ml down to 52.7±2.5% at 20 ,g/m tPA, 24-h treatment), which was potentiated in the absence of serum in the culture medium (59.5±6.3% at 10 ,g/ml down to 47.9±4.7% at 20 ,g/ml). Aprotinin was effective in ameliorating cell death when administered 30 min before tPA exposure as shown by increased cell viability (91.8±0.6% at tPA at 20 ,g/ml), but this protection was significantly reduced when aprotinin was administered after tPA. The efficacy of aprotinin as a neuroprotectant was equivalent or superior to other direct tPA antagonist peptides Glu-Gly-Arg-chlormethylketone (EGRck) and Phe-Pro-Arg-chlormethylketone (FPRck) in this setting. Conclusion: These data suggest that one of the mechanisms of neuroprotection afforded by aprotinin may be inhibition of tPA-mediated neurotoxicity. [source] | ||||||||||||||||||||||||||||||||||||||||