Effectiveness of a thrombin-gelatin flowable for treating severe liver bleeding: an experimental study.

BACKGROUND: Current scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model. METHODS: Twenty-four swine were prospectively randomized to receive either Flowable or standard packing technique. We used a novel severe liver injury model, in which the middle and left suprahepatic veins were selectively injured, causing an exsanguinating hemorrhage. The main outcome measure was the percentage of lost blood volume. RESULTS: The median total percentage of total blood volume per animal lost, from injury to minute 120, was significantly lower in the Flowable group (15.2%; interquartile range: 10.7-46.7%) than in the Packing group (64.9%; Interquartile range: 53.4-73.0%) (Hodges-Lehmann median difference: 41.1%; 95% CI: 18.9-58.0%, p = 0.0034). The 24-hour survival rate was significantly higher in the Flowable group (87.0%) than in the Packing group (0.0%) (Hazard ratio (HR) 0.08; 95% confidence interval 0.102 to 0.27; p < 0.0001). Mean-arterial pressure was significantly lower at minute 60 and 120 in the Flowable group than in the packing group (p = 0.0258 and p = 0.0272, respectively). At minute 120, hematocrit was higher in the Flowable than in the packing group (Hodges-Lehmann median difference: 5.5%; 95%CI: 1.0 to11.0, p = 0.0267). Finally, the overall-surgical-procedure was significantly shorter with Flowable than with Packing (Hodges-Lehmann median difference: 39.5 s, 95% CI: 25.0 to 54.0 s, p = 0.0004). CONCLUSIONS: The use of the Flowable was more effective in achieving hemostasis, reducing blood loss, and improving survival rates than standard packing in a severe porcine-liver bleeding model.

Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario / Relationship between parathormone concentration during surgery and the post-operative outcome of primary hyperparathyroidism

Introducción Se analiza la relación entre la concentración intraoperatoria de parathormona (IOPTH) y la evolución a largo plazo de pacientes intervenidos por hiperparatiroidismo primario (HPTP). Pacientes y métodos Estudio prospectivo observacional que incluye 120 pacientes. Se realizaron tres determinaciones de PTH en sangre: basal, en el momento de localizar la glándula patológica y a los 10 minutos tras su extirpación. Se determinaron las concentraciones de calcio, PTH y vitamina D (25-OH-D3) durante el seguimiento. Resultados En 96 (80%) pacientes se observó disminución de IOPTH > 50% y el valor postextirpación volvió al rango normal (Grupo I), en 18 (15%) disminución > 50% pero el valor final se mantuvo superior al nivel normal (Grupo II) y en 6 (5%) la disminución fue<50% (Grupo III). Durante el seguimiento se detectó HPTP persistente en 6 pacientes (5%): uno en el Grupo I (1%), 3 (16,7%) en el II y 2 (33,3%) en el III (p<0,001). El riesgo de HPTP persistente fue superior en el Grupo II (odds ratio: 19; IC95%: 1,85-194) y en el III (odds ratio: 47; IC95%: 3,53-639). No se observaron casos de HPTP recidivado. Se detectó calcemia normal con PTH elevada en 20 pacientes del el Grupo I (20,8%), 11 (61,1%) en el II y 3 (50%) en el III (p<0,001). Estos pacientes presentaron menor concentración de vitamina D postoperatoria (17 ng/ml, rango: 24; frente a 28 ng/ml, rango: 21) (p=0,008) y mayor frecuencia de hipovitaminosis D (70,6% frente a 26,2%) (p>0,001).Conclusion El riesgo de persistencia del HPTP es superior cuando la IOPTH disminuye más del 50% pero se mantiene en niveles elevados (AU)

Introduction: The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).Patients and methods: A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3)levels were measured during follow up. Results: A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the postextirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50%but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI:3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001).These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24;compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D(70.6% compared to 26.2%) (P>.001). Conclusion: The risk of persistent PHPT is higher when the IOPTH decreases more than 50%but still remains high (AU)

[Relationship between parathormone concentration during surgery and the post-operative outcome of primary hyperparathyroidism]. / Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario.

INTRODUCTION: The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT). PATIENTS AND METHODS: A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up. RESULTS: A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was<50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P<.001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P<.001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P=.008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001). CONCLUSION: The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.