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2.
Medicine (Baltimore) ; 103(36): e39618, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39252307

RESUMO

To investigate the safety of pancreatic body suspension (PBS) technique in laparoscopic splenectomy combined with pericardial devascularization for patients. A retrospective study inclusive of 16 patients who underwent laparoscopic splenectomy combined with pericardial devascularization from 2017 to 2022 was performed. A total of 5 patients underwent PBS technique and 11 underwent the traditional technique. There was no significant difference in age, sex, body mass index (BMI), preoperative serum white cell count (WBC), platelets (PLT), hemoglobin (HB), albumin (ALB), prothrombin time (PT), total bilirubin (TBIL), or spleen size between the 2 groups (P > .05). In the PBS group, the operation time was 280 minutes. The estimated intraoperative blood loss (EBL) was 250 mL. The mean postoperative hospitalization length was 11.2 days. There was no conversion to an open procedure or postoperative bleeding. In the traditional method group, the mean operation time was 240.91 minutes. The EBL was 290.91 mL. There were 2 cases of conversion to open, 3 cases of postoperative bleeding, and 1 reoperation. The incidence of postoperative short-term complications (postoperative bleeding, reoperation) was significantly higher in the traditional method group than in the PBS group (36.36% vs 0%, P = .034). PBS technique improved the safety of laparoscopic splenectomy combined with pericardial dissection and is worthy of clinical promotion.


Assuntos
Laparoscopia , Duração da Cirurgia , Pericárdio , Esplenectomia , Humanos , Esplenectomia/métodos , Esplenectomia/efeitos adversos , Masculino , Feminino , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Pericárdio/transplante , Pericárdio/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pâncreas/cirurgia , Pâncreas/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Tempo de Internação/estatística & dados numéricos
3.
Sci Rep ; 14(1): 21037, 2024 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-39251616

RESUMO

Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. TRIAL REGISTRATION: www. CLINICALTRIALS: gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic. CLINICALTRIALS: gov/ct2/show/NCT04533698.


Assuntos
Ponte de Artéria Coronária , Hidratação , Reoperação , Humanos , Feminino , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Masculino , Hidratação/métodos , Idoso , Estudos Retrospectivos , Incidência , Pessoa de Meia-Idade , Ressuscitação/métodos , Ressuscitação/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Fatores de Risco
4.
Medicine (Baltimore) ; 103(36): e39597, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39252235

RESUMO

The risk factors for immediate post-polypectomy bleeding (IPPB) after cold snare polypectomy (CSP) are not well-known. We sought to define such risk factors and develop a predictive risk-scoring model. This prospective observational study included 161 polyps (4-9 mm in diameter) that were removed via CSP from 118 patients during the period from June to September 2019 in 2 tertiary hospitals. IPPB was defined as post-polypectomy bleeding within 24 hours or grade 3 or 4 intraprocedural bleeding requiring endoscopic hemostasis. IPPB incidences according to grade were 13.0% (21/161) (grade 3) and 0% (grade 4). Univariate analysis showed that the polyp size and morphology, as well as iatrogenic ulcer size and shape, were significantly associated with IPPB. Multivariate analysis showed that polyp size [6-9 mm vs 4-5 mm, odds ratio (OR) 3.72, 95% confidence interval (CI) 1.28-10.79], polyp morphology (polypoid vs non-polypoid, OR: 3.93, 95% CI: 1.22-12.64), and iatrogenic ulcer size (≥10 vs ≤ 9 mm, OR: 3.12, 95% CI: 1.04-9.38) were significantly associated with IPPB. We created a four-marker risk-scoring model to predict IPPB after CSP; we summed the points assigned for the 4 factors. At a cutoff of 2, the sensitivity was 85.7% and the specificity was 65.0%; at a cutoff of 3, the sensitivity was 65% and the specificity was 90.0%. Polyp size and morphology, as well as iatrogenic ulcer size and shape, were associated with IPPB after CSP. The four-marker risk-scoring model appears to effectively predict IPPB after CSP (Clinical Research Information Service: KCT0004375).


Assuntos
Pólipos do Colo , Hemorragia Pós-Operatória , Humanos , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Pólipos do Colo/cirurgia , Idoso , Fatores de Risco , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/epidemiologia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Medição de Risco/métodos
7.
Neurosurg Rev ; 47(1): 562, 2024 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-39242434

RESUMO

The recent study by Kaiwen Wang et al., titled "Early postoperative acetylsalicylic acid administration does not increase the risk of postoperative intracranial bleeding in patients with spontaneous intracerebral hemorrhage," explores the association between postoperative intracranial bleeding (PIB) and various risk factors, including smoking, pre-hemorrhagic antiplatelet therapy, and dyslipidemia. While the study highlights that smoker, particularly women, are at increased risk for subarachnoid hemorrhage and acknowledges the risks of pre-hemorrhagic antiplatelet use, it overlooks the potential risk of PIB associated with early postoperative aspirin administration. This critique underscores the need to approach the study's findings with caution, given the broader context of aspirin's risk profile. Specifically, aspirin has been associated with a 37% higher relative risk of any intracranial hemorrhage, as indicated by other randomized trials. Additionally, the study's implications regarding the benefits of aspirin in stroke prevention must be critically evaluated, as the increased risk of intracranial bleeding may outweigh the potential benefits. This abstract emphasizes the importance of careful consideration of aspirin's adverse effects in the context of postoperative care.


Assuntos
Aspirina , Hemorragia Cerebral , Inibidores da Agregação Plaquetária , Humanos , Aspirina/efeitos adversos , Aspirina/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/administração & dosagem , Fatores de Risco , Hemorragias Intracranianas , Feminino , Complicações Pós-Operatórias , Hemorragia Pós-Operatória , Masculino
8.
World J Surg Oncol ; 22(1): 234, 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39232775

RESUMO

BACKGROUND: This study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications. METHODS: Data from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics. RESULTS: In total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery. CONCLUSION: The risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients.


Assuntos
Neoplasias da Mama , Fibrinolíticos , Excisão de Linfonodo , Mastectomia Segmentar , Hemorragia Pós-Operatória , Humanos , Feminino , Estudos Retrospectivos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/tratamento farmacológico , Pessoa de Meia-Idade , Fibrinolíticos/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/induzido quimicamente , Idoso , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Excisão de Linfonodo/efeitos adversos , Seguimentos , Adulto , Prognóstico , Axila , Biópsia de Linfonodo Sentinela/efeitos adversos , Idoso de 80 Anos ou mais , Fatores de Risco
9.
Neurosurg Rev ; 47(1): 416, 2024 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-39122900

RESUMO

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48 h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.


Assuntos
Antifibrinolíticos , Perda Sanguínea Cirúrgica , Escoliose , Fusão Vertebral , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/uso terapêutico , Escoliose/cirurgia , Feminino , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Masculino , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Adolescente , Estudos Prospectivos , Adulto , Transfusão de Sangue/estatística & dados numéricos , Resultado do Tratamento , Período Pós-Operatório , Tempo de Internação , Adulto Jovem , Hemorragia Pós-Operatória/epidemiologia
10.
J Otolaryngol Head Neck Surg ; 53: 19160216241267719, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39109798

RESUMO

BACKGROUND: In the emergency department (ED), there are pre-assembled tonsillar hemorrhage trays for management of post-tonsillectomy hemorrhage and peritonsillar abscess. After use, the tray is sent to the medical device reprocessing (MDR) department for decontamination, sterilization, and re-organization, all at a significant cost to the hospital and environment. OBJECTIVE: The goal of this project was to reduce unnecessary instruments on the tonsil hemorrhage tray by 30% by 1 year and report on the associated cost and carbon dioxide (CO2) emissions savings. METHODS: This quality improvement project was framed according to the Institute for Healthcare Improvement's Model for Improvement. ED and Otolaryngology-Head & Neck Surgery staff and residents were surveyed to determine which instruments on the tonsil hemorrhage trays were used regularly. Based on results, a new tray was developed and compared to the old tray using MDR data and existing CO2 emissions calculations. RESULTS: Tray optimization resulted in a total cost reduction from $1092.63 to $330.21 per tray per year, decreased processing time from 12 to 6-8 minutes per tray, and decreased CO2 emissions from 6.11 to 2.85 kg per year for the old versus new tray, respectively. Overall, the new tray contains half the number of instruments, takes half the time to assemble, produces 50% less CO2 emissions, and will save the hospital approximately $100,000 over 10 years. CONCLUSION: Healthcare costs and environmental sustainability are collective responsibilities. Surgical and procedure tray optimization is a simple, effective, and scalable form of eco-action.


Assuntos
Melhoria de Qualidade , Instrumentos Cirúrgicos , Centros de Atenção Terciária , Tonsilectomia , Humanos , Instrumentos Cirúrgicos/economia , Hemorragia Pós-Operatória/terapia , Canadá , Serviço Hospitalar de Emergência , Abscesso Peritonsilar/terapia
11.
Scand Cardiovasc J ; 58(1): 2382477, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39087759

RESUMO

Background. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. Methods. Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005-2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative Bleeding. The primary outcome measure was early mortality and secondary outcome measures were perioperative stroke, mechanical ventilation more than 48 h, new-onset dialysis, and intensive care unit stay. Propensity score matching was performed to adjust for differences in covariates. Results. Nine hundred ninety-seven patients were included, of whom 403 (40.4%) had massive bleeding. In the propensity score-matched cohort (344 pairs), patients with massive bleeding had higher 30-day mortality (17.2 versus 7.6%, p < .001), mechanical ventilation more than 48 h (52.8 versus 22.6%, p < .001), perioperative stroke (24.3 versus 14.8%, p = .002), new-onset dialysis (22.5 versus 4.9%, p < .001), and longer intensive care unit stay (6 versus 3 days, p < .001), compared with patients without massive bleeding. Risk factors for massive bleeding were previous cardiac surgery, preoperative clopidogrel or ticagrelor therapy, DeBakey type I dissection, and localized or generalized malperfusion. Conclusions. Massive bleeding in surgery for acute type A aortic dissection is associated with a markedly increased risk for severe complications as well as early death. Further improvement of surgical technique and pharmacological optimization of coagulation is paramount to possibly improve outcomes in acute type A aortic dissection repair.


Assuntos
Aneurisma Aórtico , Dissecção Aórtica , Bases de Dados Factuais , Hemorragia Pós-Operatória , Respiração Artificial , Humanos , Dissecção Aórtica/cirurgia , Dissecção Aórtica/mortalidade , Dissecção Aórtica/complicações , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Resultado do Tratamento , Fatores de Tempo , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/complicações , Medição de Risco , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/etiologia , Doença Aguda , Países Escandinavos e Nórdicos/epidemiologia , Tempo de Internação , Diálise Renal , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
12.
Wiad Lek ; 77(6): 1127-1133, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39106370

RESUMO

OBJECTIVE: Aim: To improve the management of morbidly obese patients who undergo gastric bypass surgery to reduce the number of postoperative complications, in particular, bleeding. PATIENTS AND METHODS: Materials and Methods: From 2011 to 2022, a total of 348 patients with morbid obesity (MO) underwent laparoscopic gastric bypass treatment at the clinical base of the Department of General Surgery №2 of Bogomolets National Medical University. The retrospective group included 178 patients who received treatment between 2011 and 2019. 170 patients were enrolled in the prospective group for the period from 2019 to 2022. RESULTS: Results: Retrospective group had 8 episodes of postoperative bleeding, representing a rate of 4.49%, prospective group - 3 episodes of postoperative bleeding, representing a rate of 1.76% Four factor characteristics associated with the probability of bleeding were identified: "number of comorbid conditions", "arterial hypertension", "chronic liver diseases" and "chronic obstructive pulmonary disease". CONCLUSION: Conclusions: The factors responsible for the occurrence of postoperative bleeding in morbidly obese patients after laparoscopic gastric bypass surgery were the number of comorbid conditions, the presence of arterial hypertension, the presence of chronic liver diseases, and chronic obstructive pulmonary disease. A new strategy for the management of morbidly obese patients after laparoscopic gastric bypass was developed. This strategy involves changing cassettes to create gastroentero- and enteroenteroanastomoses, reducing the period of use of the nasogastric tube, drains, and urinary catheter from 3-4 days to 1 day, and resuming the drinking regimen 6 hours after extubation.


Assuntos
Derivação Gástrica , Obesidade Mórbida , Hemorragia Pós-Operatória , Humanos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Derivação Gástrica/efeitos adversos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Pessoa de Meia-Idade , Laparoscopia/efeitos adversos , Estudos Prospectivos
13.
Neurosurg Rev ; 47(1): 407, 2024 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-39107612

RESUMO

The complications anticipated in the postoperative period after surgical resection of lateral ventricular neoplasms (LVN) are hemorrhage, hydrocephalus. At the N.N. Burdenko Neurosurgery Center, 48 patients with LVN underwent surgical resection. We focused on the correlation between approaches to the ventricular system on one hand and the extent of resection and incidence of complications on the other based on anatomical and perfusion characteristics estimated via preoperative magnetic resonance imaging (MRI) with arterial spin labeling perfusion. By eliminating the surgical approach as a potential risk factor, we were able to demonstrate the correlation between the frequency of postoperative hemorrhage, the Evans index value, patient's gender, tumor blood flow (nTBF) and the location of the mass in the anterior horn of the lateral ventricle. The risk of hemorrhage depends on the patient's gender, presence of hydrocephalus, location of the mass and tumor blood flow values. The risk increases along with increase in Evance index and nTBF values.


Assuntos
Neoplasias do Ventrículo Cerebral , Hidrocefalia , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Neoplasias do Ventrículo Cerebral/cirurgia , Adulto , Idoso , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Ventrículos Laterais/cirurgia , Adolescente , Adulto Jovem , Estudos Retrospectivos , Criança , Hemorragia Pós-Operatória/epidemiologia
14.
Ther Adv Respir Dis ; 18: 17534666241273012, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39161257

RESUMO

BACKGROUND: Perioperative heparin-free anticoagulation extracorporeal membrane oxygenation (ECMO) for lung transplantation is rarely reported. OBJECTIVE: To evaluate the impact of a heparin-free strategy on bleeding and thrombotic events, blood transfusion, and coagulation function during the early perioperative period and on prognosis, and to observe its effect on different ECMO types. DESIGN: A retrospective cohort study. METHODS: Data were collected from 324 lung transplantation patients undergoing early perioperative heparin-free ECMO between August 2017 and July 2022. Clinical data including perioperative bleeding and thrombotic events, blood product transfusion, coagulation indicators and 1-year survival were analysed. RESULTS: Patients were divided in venovenous (VV; n = 251), venoarterial (VA; n = 40) and venovenous-arterial (VV-A; n = 33) groups. The VV group had the lowest intraoperative bleeding and thoracic drainage within 24 h postoperatively. Vein thrombosis occurred in 30.2% of patients within 10 days postoperatively or 1 week after ECMO withdrawal, and no significant difference was found among the three groups. Double lung transplantation, increased intraoperative bleeding, and increased postoperative drainage were associated with vein thrombosis. Except for acute myocardial infarction in one patient, no other serious thrombotic events occurred. The VV-ECMO group had the lowest demand for blood transfusion. The highest prothrombin time and the lowest fibrinogen levels were observed in the VA group during ECMO run, while the highest platelet counts were found in the VV group. Both intraoperative bleeding and thoracic drainage within 24 h postoperatively were independent predictors for 1-year survival, and no thrombosis-related deaths occurred. CONCLUSION: Short-term heparin-free anticoagulation, particularly VV-ECMO, did not result in serious thrombotic events or thrombosis-related deaths, indicating that it is a safe and feasible strategy for perioperative ECMO in lung transplantation.


Assuntos
Anticoagulantes , Coagulação Sanguínea , Oxigenação por Membrana Extracorpórea , Transplante de Pulmão , Trombose , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Estudos Retrospectivos , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Feminino , Masculino , Pessoa de Meia-Idade , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Adulto , Trombose/prevenção & controle , Trombose/etiologia , Fatores de Tempo , Coagulação Sanguínea/efeitos dos fármacos , Resultado do Tratamento , Fatores de Risco , Transfusão de Sangue , Heparina/administração & dosagem , Heparina/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Perda Sanguínea Cirúrgica/prevenção & controle
15.
Sci Adv ; 10(33): eado3919, 2024 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-39141742

RESUMO

Postoperative rehemorrhage following intracerebral hemorrhage surgery is intricately associated with a high mortality rate, yet there is now no effective clinical treatment. In this study, we developed a hemoglobin (Hb)-responsive in situ implantable DNA hydrogel comprising Hb aptamers cross-linked with two complementary chains and encapsulating deferoxamine mesylate (DFO). Functionally, the hydrogel generates signals upon postoperative rehemorrhage by capturing Hb, demonstrating a distinctive "self-diagnosis" capability. In addition, the ongoing capture of Hb mediates the gradual disintegration of the hydrogel, enabling the on-demand release of DFO without compromising physiological iron-dependent functions. This process achieves self-treatment by inhibiting the ferroptosis of neurocytes. In a collagenase and autologous blood injection model-induced mimic postoperative rehemorrhage model, the hydrogel exhibited a 5.58-fold increase in iron absorption efficiency, reducing hematoma size significantly (from 8.674 to 4.768 cubic millimeters). This innovative Hb-responsive DNA hydrogel not only offers a therapeutic intervention for postoperative rehemorrhage but also provides self-diagnosis feedback, holding notable promise for enhancing clinical outcomes.


Assuntos
Hemorragia Cerebral , Hemoglobinas , Hidrogéis , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/tratamento farmacológico , Hidrogéis/química , Hemoglobinas/metabolismo , Animais , Desferroxamina/farmacologia , Desferroxamina/uso terapêutico , Desferroxamina/química , DNA/metabolismo , Humanos , Masculino , Ratos , Modelos Animais de Doenças , Ferroptose/efeitos dos fármacos , Ferro/metabolismo , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/diagnóstico , Aptâmeros de Nucleotídeos/farmacologia , Aptâmeros de Nucleotídeos/química
16.
Neurosurg Rev ; 47(1): 452, 2024 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-39168945

RESUMO

Postoperative hemorrhage can severely affect the patients' neurological outcome after awake craniotomy. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. In this retrospective analysis, we included patients who underwent awake surgery at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 h. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. We included 48 patients with a median age of 39 years. 9 patients (19%) required further treatment due to postoperative hemorrhage, which was surgery in 2 cases and intensive blood pressure measurements in 7 cases. However, with early treatment, no significant difference in Performance scores at follow-up could be found. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p < 0.05) as well as intraoperatively throughout the procedure (p < 0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140mmHg during the early postoperative course could be shown. Postoperative hemorrhage is a rare but possible complication in awake surgery glioma patients. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140mmHg for the postoperative course.


Assuntos
Pressão Sanguínea , Neoplasias Encefálicas , Craniotomia , Glioma , Hemorragia Pós-Operatória , Vigília , Humanos , Craniotomia/efeitos adversos , Masculino , Glioma/cirurgia , Glioma/complicações , Feminino , Adulto , Pessoa de Meia-Idade , Pressão Sanguínea/fisiologia , Neoplasias Encefálicas/cirurgia , Vigília/fisiologia , Estudos Retrospectivos , Hemorragia Pós-Operatória/epidemiologia , Idoso , Adulto Jovem , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos
17.
Sci Rep ; 14(1): 18332, 2024 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-39112624

RESUMO

Postpancreatectomy hemorrhage (PPH) is an important risk factor for postoperative complications after laparoscopic pancreaticoduodenectomy (LPD). Recent studies have reported that the use of ligamentum teres hepatis (LTH) in LPD may reduce the risk of PPH. Therefore, this study aims to investigate whether wrapping the hepatic hilar artery with the LTH can reduce PPH after LPD. We reviewed the data of 131 patients who underwent LPD in our team from April 2018 to December 2023. The patients were divided into Groups A (60 patients) and B (71 patients) according to whether the hepatic portal artery was wrapped or not. The perioperative data of the two groups were compared to evaluate the effect of LTH wrapping the hepatic hilar artery on LPD. The platelet count of Group A was (225.25 ± 87.61) × 10^9/L, and that of Group B was (289.38 ± 127.35) × 10^9/L, with a statistically significant difference (p < 0.001). The operation time of group A [300.00 (270.00, 364.00)] minutes was shorter than that of group B [330.00 (300.00, 360.00)] minutes, p = 0.037. In addition, A set of postoperative hospital stay [12.00 (10.00, 15.00)] days shorter than group B [15.00 (12.00, 19.50)] days, p < 0.001. No PPH occurred in Group A, while 8 patients in Group B had PPH (7 cases of gastroduodenal artery hemorrhage and 1 case of proper hepatic artery hemorrhage), p = 0.019. The new technique of wrapping the hepatic hilar artery through the LTH can effectively reduce the occurrence of PPH after LPD.


Assuntos
Artéria Hepática , Laparoscopia , Pancreaticoduodenectomia , Hemorragia Pós-Operatória , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Artéria Hepática/cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Ligamentos/cirurgia , Estudos Retrospectivos , Duração da Cirurgia , Adulto , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Tempo de Internação
19.
Medicine (Baltimore) ; 103(35): e39279, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39213198

RESUMO

RATIONALE: Postoperative bleeding after lobectomy is relatively rare. By analyzing and discussing the case history and management of hemorrhagic shock caused by chest tube removal after lobectomy, we can achieve the purpose of preventing postoperative bleeding after thoracic surgery and reducing postoperative complications, which can help avoid the risk of second surgery, shorten the patient's hospital stay, reduce the cost of medical care, and improve the patient's quality of life. PATIENT CONCERNS: A case of bleeding from tube removal after lobectomy. The bleeding from chest drain removal on the 3rd day after thoracoscopic lobectomy resulted in hemorrhagic shock, which was stopped by thoracoscopic exploration again under active antishock, and there was no recurrence of bleeding after the operation, and the patient was discharged from the hospital after chest drain removal. DIAGNOSES: Enhanced computed tomography of the chest revealed a space-occupying lesion in the middle lobe of the right lung. INTERVENTIONS: Thoracoscopy was performed again on the condition of active anti-shock. OUTCOMES: On the third day after thoracoscopic lobectomy, the patient underwent removal of the chest drain and subsequently experienced hemorrhagic shock. Given the necessity of maintaining anti-shock measures, the patient was subjected to a second thoracoscopic exploration with the objective of halting the hemorrhage. Following this procedure, the patient did not present with any further episodes of bleeding. Subsequently, a new chest drain was placed, and once the drainage flow had diminished to an acceptable level, the chest drain was removed. The patient subsequently made a full recovery and was discharged from the hospital. LESSONS: Even if the safely inserted drain tube is removed, the thoracic surgeon must be aware of possible vascular bleeding.


Assuntos
Tubos Torácicos , Remoção de Dispositivo , Pneumonectomia , Hemorragia Pós-Operatória , Humanos , Tubos Torácicos/efeitos adversos , Remoção de Dispositivo/métodos , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Masculino , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Toracoscopia/métodos , Toracoscopia/efeitos adversos , Choque Hemorrágico/etiologia , Drenagem/métodos , Neoplasias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X
20.
Zhonghua Yi Xue Za Zhi ; 104(34): 3236-3241, 2024 Sep 03.
Artigo em Chinês | MEDLINE | ID: mdl-39193609

RESUMO

Objective: To evaluate the clinical efficacy of transoral robotic surgery (TORS) with the da Vinci robot system in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Methods: A mixed cohort study was conducted to collect and analyze the clinical data of OPSCC patients who underwent TORS at the Eye & ENT Hospital, Fudan University between July 2020 and February 2023 (TORS group). OPSCC patients who underwent conventional surgery between January 2016 and September 2020 were included as the control group. The baseline information, incidence of complications and follow-up data were compared between the two groups. Results: A total of 166 patients were included, with 102 cases (81 males and 21 females) in the TORS group [mean age: (59.1±9.8) years] and 64 cases (54 males and 10 females) in the control group [ mean age: (57.6±9.7) years]. Compared with the control group, the TORS group had lower postoperative bleeding rate [2.9% (3/102) vs 10.9% (7/64), P=0.035] and infection rate [1.0% (1/102) vs 18.8% (12/64), P<0.001]. No statistically significant differences were observed in tracheotomy rate [46.1% (47/102) vs 59.4% (38/64), P=0.070] and median length of hospital stay [8 (7, 10) d vs 10 (4, 12) d, P=0.088]. After propensity score matching, compared with the control group, the TORS group had lower postoperative infection rate [0 (0/31) vs 19.4% (6/31), P=0.032] and median length of hospital stay [7 (7, 10) d vs 10 (8, 12) d, P=0.031]. No statistically significant differences were found in postoperative bleeding rate [3.2% (1/31) vs 6.5% (2/31), P=1.000] and tracheotomy rate [22.6% (7/31) vs 45.2% (14/31), P=0.060] between the two groups. Moreover, 1-and 2-year disease-free survival rates were 96.3% and 94.6% in the TORS group, and 90.6% and 84.3% in the control group, respectively (P=0.233). The 1-and 2-year cancer-specific survival rates were both 100% in the TORS group, and 96.9% and 93.8% in the control group, respectively (P=0.539). Conclusion: TORS for OPSCC is associated with high clinical safety and favorable oncological outcomes.


Assuntos
Neoplasias Orofaríngeas , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias Orofaríngeas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Resultado do Tratamento , Estudos de Coortes , Complicações Pós-Operatórias , Tempo de Internação , Idoso , Hemorragia Pós-Operatória
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