[No clinical evidence for an enhanced bleeding tendency due to perioperative treatment with bromelain]. / Keine klinische Evidenz für ein erhöhtes Blutungsrisiko durch Bromelain bei perioperativem Einsatz.

BACKGROUND: Systemic enzyme therapy with bromelain resembles a sensible alternative to nonsteroidal antiinflammatory drugs for the treatment of sports injuries, with particular consideration of therapeutic benefits and possible risks. Beyond aftertreatment of sports injuries, bromelain is used postoperatively as well. Besides the desired effects remission of oedema and pain relief, however, the postoperative use of bromelain raises uncertainty in some patients and physicians since an enhanced bleeding tendency in case of concomitant therapy with anticoagulants was described as a possible interaction. Therefore, the goal of this study was to investigate the clinical relevance of this interaction. PATIENTS/METHODS: In two non-interventional studies, altogether 260 patients were peri- or postoperatively (cruciate ligament- or coxarthrosis surgery) treated with bromelain (n = 129, 1000 - 3000 F. I. P. units/day) or diclofenac (n = 131; 150 mg/day) under concomitant thrombosis prophylaxis with low molecular weight heparin. Parameters tested were prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen and tolerability of the medication. RESULTS AND CONCLUSION: Only marginal changes and a low variability of coagulation parameters were observed in both treatment groups (bromelain vs. diclofenac) in both studies. Elevated laboratory parameters were observed in both treatment groups for thrombin time which is very likely attributable to the therapy with low molecular weight heparin, due to the substantially parallel course of this parameter in both treatment groups. Therapy with bromelain was superior to the treatment with diclofenac concerning the number and the severity of undesirable effects, as was expected. The presented studies therefore support the previous clinical evidence that a perioperative treatment with bromelain is well tolerated and does not lead to an increased risk of haemorrhage when used concomitantly with low molecular weight heparin.

[Ruptures of the pectoralis major muscle - clinical results after operative and non-operative treatment]. / Rupturen des M. pectoralis major - Klinische Ergebnisse nach operativer und konservativer Behandlung.

AIM: Ruptures of the pectoralis major muscle should be treated operatively due to the expected loss of strength following conservative treatment. Minimal-invasive surgery technique using suture anchors can lead to perfect anatomical refixation of the muscle. We report mid-term clinical results. METHODS: We present clinical results of a comparative study concerning ruptures of the pectoralis major muscle. Between 2001 and 2006 a total number of 9 patients were treated operatively using suture anchors. The surgical procedure is described. A control group (n = 4) consisted of patients being treated conservatively in 1999 und 2000. For evaluation of results Bak's score was used. RESULTS: The mean follow-up-time was six months. We found 4 very good and 4 good results, only one patient showed a satisfying result. Among the patients who had followed the conservative treatment regime only one had a good outcome while three patients remained in a satisfying condition. All type-1-ruptures according to Roller showed postoperatively nearly equal strength conditions for both sides. CONCLUSION: The operative treatment of acute ruptures of the pectoralis major muscle in active people and athletes leads to better results concerning restoration of strength than conservative or delayed treatment. The surgical technique depends upon the type of rupture which has to be determined intraoperatively. The use of suture anchors aiming for intraosseous fixation helps to avoid intraoperative complications and leads to stable conditions with nearly full restoration of strength.