Comparison of Floseal® and Tranexamic Acid for Bleeding Control after Total Knee Arthroplasty: a Prospective Randomized Study.

OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.

Treatment of fibrinolytic alveolitis with rifamycin B diethylamide associated with Gelfoam: a histological study / Tratamento de alveoliti fibrinolítica com dietalamida rifamicina B dietamida associada com Gelfoam: estudo histológico

The most common complication in the healing of extraction wounds is fibrinolytic alveolitis, which may also be termed «dry socket¼. Reduction in the incidence of this condition after the application of topical antibiotics and the use of systemic antibiotics has been reported. A histological study of disturbed alveolar socket healing in rats was carried out to analyse the influence of application of rifamycin B diethylamide (Rifocin M) associated or not with Geolfman. Sixty-four male rats (Rattus norvegicus albinus, Wistar), weighing 120-150g, were divided into 4 groups of 16 animals each. In the second group of rats which received implants of Geolfam, there was an intense resorption of bone walls in the initial stage. The rats that received implants of Geolfam satured with Rifocin M (fourth group) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. The third group (only irrigation with rifamycin) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. Thus, these results showed that rifamycin irrigation is useful in the control of alveolar infections

Vocal cord injection in children with unilateral vocal cord paralysis.

Unilateral vocal cord paralysis (UVCP) in children is uncommon and rarely leads to serious sequelae. However, on rare occasions, it can present with severe aspiration and dysphonia. Several therapeutic techniques have been used in adults with UVCP, but the reported alternatives in children have been much more limited. Observation and speech therapy are the standard treatment. We describe three children with UVCP and severe aspiration who were treated with vocal cord injection. The treatment indications, clinical courses, and outcomes of the three cases are detailed. The injection of vocal cords in children is discussed, with an emphasis on those aspects unique to the management of UVCP in pediatric patients. Alternative surgical treatment modalities are also presented. Vocal cord injection is an effective and viable therapeutic option for the management of UVCP in certain pediatric patients with severe aspiration and dysphonia.

Tratamento imediato de comunicação buco-sinusal com esponja de gelatina / Immediate closures of oro-antral communications with gelatin sponge

Os autores descrevem um método simples, rápido e fácil para se obliterar alguma comunicação buco-sinusal que possa ocorrer no ato da exodontia. Empregam, no interior do alvéolo, 2 a 3 fragmentos de esponja de gelatina, objetivando manter o coágulo sangüíneo e permitir o reparo alveolar, sem a necessidade do profissional empregar técnicas cirúrgicas sofisticadas. Comentam os cuidados no trans e pós-operatórios e as recomendações ao paciente. Contra-indicam esse procedimento para obliterar fístulas buco-sinusais crônicas com ou sem infecção do seio maxilar. Consideram o emprego da esponja de gelatina um método prático para o clínico geral obliterar alguma comunicação buco-sinusal verificada no ato da exodontia e discutem a sua vantagem sobre outras técnicas empregadas