Two Consecutive Invasive Surgeries Utilizing Zymogen Protein C (ZPC) That Enhanced Patient Safety and Reduced Costs.

This case report describes a major surgical procedure for a protein C-deficient, hypercoagulable patient who underwent two back-to-back invasive surgeries, hip replacement, and spinal stenosis correction. The patient, an 84-year-old male with a history of deep vein thromboses (DVT) and pulmonary emboli (PE), was treated pre-, peri-, and postoperatively with zymogen protein C (ZPC-Baxter, International) and recovered without clotting or increased bleeding. During the procedure, the patient was not administered any other anticoagulants. There have now been several case reports on different patients with unrelated teams in various locations worldwide using zymogen protein C during surgical procedures. Thus, this procedure is becoming a viable choice for patients with a high probability of clotting during and after invasive surgery. This case focuses on accomplishing safer surgery and reducing costs, by using less ZPC while accomplishing two surgeries in one procedure. As a result, this procedure might be useful for many medical situations where acquired protein C deficiency could be a problem (e.g., sepsis, pregnancy, etc.). This approach may have greater application to medical conditions other than protein C deficiency, where clotting and inflammation can become issues.

Measurement of vertebral cortical integrity during pedicle exploration for intrapedicular fixation.

STUDY DESIGN: This study determined the predictive ability of electrical impedance measurement in detecting cortical perforation in a porcine model of pedicular exploration. OBJECTIVE: This study tested the hypothesis that a large decrease in electrical impedance would occur as a result of perforation of the vertebral cortex by the pedicle probe. SUMMARY OF BACKGROUND DATA: The resistivity of cortical bone has been reported to be 25 to 100 times greater than that of soft tissues. METHODS: A total of 42 pedicles of the lumbar spines of six swine were explored using the instrumented pedicle probes. RESULTS: Using a 1 microAmp 30-Hz current source, measurement of electrical impedance predicted cortical rupture with a sensitivity, specificity, and accuracy of 95%. Maximum applied voltages of 2.8 mV did not result in myogenic stimulus. CONCLUSIONS: Electrical impedance measurement provides an accurate real-time measurement of cortical perforation. This technique is adapted readily for use with pedicular screws and screw tape. Further investigation to determine the clinical use of this technique is recommended.