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2.
J Stroke Cerebrovasc Dis ; 29(2): 104552, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839545

RESUMO

BACKGROUND AND AIM: Performance measures have been extensively studied for acute ischemic stroke, leading to guideline-established benchmarks. Factors influencing care efficiency for intracerebral hemorrhage (ICH) are not well delineated. We sought to identify factors associated with early recognition of ICH and to assess the association between early recognition and completion of emergency care tasks. METHODS: Consecutive patients with spontaneous ICH were enrolled in an observational cohort study conducted from 2009 to 2017 at an urban comprehensive stroke center, excluding patient transferred from other hospitals. We used stroke team activation as the indicator of early recognition and measured completion times for multiple ICH-relevant performance metrics including door to computed tomography (CT) acquisition and door to hemostatic medication initiation. RESULTS: We studied 204 cases. All stroke-related performance times were faster in patients managed with stroke team activation compared to no activation, including quicker door to CT acquisition (median 24 versus 48 minutes, P < .001) and door to hemostatic medication initiation (63 versus 99 minutes, P = .005). These associations were confirmed in adjusted models. Stroke codes were activated in 43% of cases and were more likely in patients with shorter onset-to-arrival times, higher National Institutes of Health Stroke Scale scores, and higher Glasgow Coma Scale scores. CONCLUSIONS: Stroke team activation was associated with more rapid diagnostic and therapeutic interventions for patients with ICH, but activation did not occur in the majority of cases, implying absence of early recognition. A stroke team activation process improves care performance, but leveraging the advantages of existing systems will require improved triage tools to identify ICH in the acute setting.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Serviço Hospitalar de Emergência/normas , Hemostáticos/administração & dosagem , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Tempo para o Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Procedimentos Clínicos/normas , Esquema de Medicação , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X/normas , Resultado do Tratamento
3.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 611-615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31625678

RESUMO

OBJECTIVE: To determine the effect of Yunnan Baiyao (YB) on hemostatic parameters measured by thromboelastography (TEG) in apparently healthy cats administered 1 capsule of YB orally twice daily for 1 week. DESIGN: Prospective study of client-owned cats at a small animal specialty hospital. SETTING: One private referral center. ANIMALS: Twenty client-owned adult cats were prospectively enrolled. INTERVENTIONS: All cats underwent echocardiographic examination by the same board-certified cardiologist to rule out occult cardiomyopathy. Blood samples were collected for analysis of baseline CBC, fibrinogen, and kaolin-activated TEG values. Cats were administered 1 capsule (250 mg/capsule) of YB twice daily orally for 1 week and the physical examination, CBC, fibrinogen, and TEG were re-evaluated. Any side effects attributed to YB were noted at this time. MEASUREMENTS AND MAIN RESULTS: Three cats were excluded as 2 cats were identified with underlying cardiomyopathy and another cat had a cystic mass in the cranial mediastinum identified via echocardiography. Seventeen cats were treated with YB; however, 1 cat could not complete the study due to severe vomiting associated with YB administration. The remaining 16 cats completed the study, although 2 additional cats experienced transient vomiting. Yunnan Baiyao administration was associated with a significant decrease in HCT and red blood cell count, although no cat became anemic. None of the TEG parameters significantly changed compared to baseline after 1 week of YB therapy. CONCLUSIONS: The results of this study suggest YB at a dose of 1 capsule orally twice daily in cats fails to produce any significant change in hemostatic parameters as measured by TEG, although it did significantly reduce HCT and red blood cell count. Yunnan Baiyao was tolerated for most of the cats, although 3 of 17 (17.6%) cats experienced vomiting. Clinicians should be aware of these effects before considering the use of YB in cats.


Assuntos
Gatos/sangue , Medicamentos de Ervas Chinesas/farmacologia , Hemostasia/efeitos dos fármacos , Hemostáticos/farmacologia , Tromboelastografia/veterinária , Administração Oral , Animais , Gatos/fisiologia , China , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Fibrinogênio , Hemostáticos/administração & dosagem , Masculino , Estudos Prospectivos , Tromboelastografia/efeitos dos fármacos
4.
Am J Case Rep ; 20: 1497-1499, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601777

RESUMO

BACKGROUND Radiofrequency ablation is a minimally invasive treatment for arrhythmias, including frequent ventricular premature. As a complication of radiofrequency ablation, pseudoaneurysm can be treated conservatively or by ultrasound-guided thrombin injection. CASE REPORT We report a case that a possible allergic reaction to thrombin injected into pseudoaneurysm after radiofrequency ablation. CONCLUSIONS We hope that the report of successful management of the allergic reaction in this case may be of help to other doctors; we also emphasize the importance of checking the patient's history of allergies to thrombin when considering treating pseudoaneurysm with thrombin injection.


Assuntos
Falso Aneurisma/terapia , Hipersensibilidade a Drogas/diagnóstico , Artéria Femoral , Hemostáticos/efeitos adversos , Trombina/efeitos adversos , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Hipersensibilidade a Drogas/etiologia , Eletrocardiografia , Feminino , Febre/etiologia , Fibrina/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemoglobinas/análise , Hemostáticos/administração & dosagem , Humanos , Hipotensão/etiologia , Injeções Intra-Arteriais , Leucopenia/etiologia , Náusea/etiologia , Ablação por Radiofrequência , Trombina/administração & dosagem , Trombocitopenia/etiologia , Complexos Ventriculares Prematuros/cirurgia
5.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 233-237, sept.-oct. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183877

RESUMO

Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement


Los hemangiomas vertebrales son relativamente comunes, pero los que causan la compresión de la médula espinal son raros. Un hombre de 19 años presentó dolor de espalda torácica. El examen neurológico fue normal y los exámenes radiológicos demostraron un hemangioma vertebral agresivo centrado en el cuerpo vertebral T11. Se observaron componentes óseos y vertebrales dañados de la masa en el espacio epidural. La cirugía se realizó utilizando una nueva técnica que incluía ablación por radiofrecuencia, inyección de un agente hemostático (FLOSEAL, Baxter, EE. UU.) Y colocación de autoinjerto de hueso en el cuerpo vertebral afectado. No hubo complicaciones intra y postoperatorias, y el dolor de espalda del paciente se resolvió completamente durante el período posquirúrgico. El sangrado es un problema grave en los casos de hemangioma vertebral agresivo. Esta nueva técnica proporciona un mejor control de la hemorragia y fortalece la vértebra afectada a través de la colocación del autoinjerto


Assuntos
Humanos , Masculino , Adulto Jovem , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Ablação por Radiofrequência/métodos , Hemostáticos/administração & dosagem , Transplante Autólogo/métodos , Medula Espinal/patologia , Dor nas Costas/etiologia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/cirurgia
6.
Gac Med Mex ; 155(4): 369-376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486789

RESUMO

Introduction: Few studies have assessed the economic impact of inhibitors in hemophilia A in Mexico, especially in the pediatric population. Objective: To determine the economic impact entailed by the development of inhibitors in pediatric patients with hemophilia A. Method: Patients with hemophilia A under the care of a pediatric hematology department between December 2015 and November 2017 were retrospectively assessed. Direct and indirect costs were determined based on the presence or absence of inhibitors. Results: The cost analysis of the study population (n = 24) showed that diagnosis, follow-up, prophylaxis, treatment and hospitalization of these patients had an annual cost of $ 6 883 187.4 per patient, out of which more than 95 % depended on the use of hemostatic factors. Annual cost per patient in the group with inhibitors was $ 5 548 765.0 in comparison with $ 1 334 422.4 in the group without inhibitors, 4.2 times higher. Conclusions: This is the first national study to show that the presence of inhibitors in pediatric patients with hemophilia A increases the cost of the disease more than four times.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hemofilia A/tratamento farmacológico , Hemostáticos/administração & dosagem , Hospitalização/economia , Adolescente , Criança , Pré-Escolar , Custos e Análise de Custo , Hemofilia A/diagnóstico , Hemofilia A/economia , Hemostáticos/economia , Humanos , Masculino , México , Estudos Retrospectivos
7.
Am J Disaster Med ; 14(1): 17-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441025

RESUMO

OBJECTIVE: Compare QuikClot Combat Gauze (QCG) and Celox Rapid (CR) for initial hemostasis and over a 1-hour period. DESIGN: Experimental study. SETTING: Approved animal laboratory. SUBJECTS: Twenty-one Yorkshire swine. INTERVENTIONS: Subjects were randomly assigned to either the QCG (n = 11) or CR (n = 10) group. An arteriotomy was made in the right femoral artery with a 6-mm vascular punch. Bleeding was allowed for 45 seconds. QCG or CR was applied followed by firm pressure for 3 minutes according to Committee on Tactical Combat Casualty Care guidelines. A 10-pound weight simulating a pressure dressing was applied, and the wound was observed for 1 hour. Dressing failure was bleeding > 2 percent of blood volume. MAIN OUTCOME MEASURES: Achievement and maintenance of hemostasis and amount of hemorrhage during observation. Odds of successful hemostasis. RESULTS: QCG was significantly better than CR in initial hemostasis (p = 0.049) and maintaining hemostasis over 1 hour (p = 0.020). One hundred percent of QCG subjects and 70 percent of CR subjects achieved initial hemostasis. During the 1-hour observation, one additional CR subject failed to maintain hemostasis. CR had significantly more hemorrhage than QCG during the 1-hour observation (p = 0.027). QCG had no bleeding compared to CR that had a mean of 162 ± 48 mL (standard error of mean) over 2 minutes. QCG had 15.9 times greater odds of success compared to CR over a period of 1 hour. Over the 1-hour observation time, 100 percent of QCG achieved hemostasis compared to 60 percent of CR.


Assuntos
Bandagens , Hemorragia/terapia , Hemostáticos/administração & dosagem , Ferimentos e Lesões/terapia , Animais , Biopolímeros , Modelos Animais de Doenças , Artéria Femoral/lesões , Hemostasia , Técnicas Hemostáticas/instrumentação , Distribuição Aleatória , Suínos , Fatores de Tempo , Resultado do Tratamento
8.
Eur Arch Otorhinolaryngol ; 276(10): 2819-2826, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332548

RESUMO

BACKGROUND: The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC). METHODS: Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa. RESULTS: There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound. CONCLUSION: HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.


Assuntos
Epistaxe/terapia , Formaldeído/administração & dosagem , Procedimentos Cirúrgicos Nasais/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Álcool de Polivinil/administração & dosagem , Hemorragia Pós-Operatória/terapia , Animais , Cães , Técnicas Hemostáticas , Hemostáticos/administração & dosagem , Humanos , Modelos Animais , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Aderências Teciduais , Resultado do Tratamento
10.
J Clin Neurosci ; 66: 33-37, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31160199

RESUMO

Antiplatelet therapy at the time of spontaneous intracerebral hemorrhage (sICH) may increase risk for hemorrhage expansion and mortality. Current guidelines recommend considering a single dose of desmopressin in sICH associated with cyclooxygenase-1 inhibitors or adenosine diphosphate receptor inhibitors. Adult subjects with sICH and concomitant antiplatelet therapy admitted to a large, tertiary care center were included. We sought to compare the risk of hematoma expansion in patients that received desmopressin for antiplatelet reversal in the setting of sICH to similar patients that did not receive desmopressin. The primary outcomes were the incidence of relative and absolute hematoma expansion. In total, 71 patients (29 received desmopressin, 42 did not receive desmopressin) were analyzed. All patients in the desmopressin group received a 0.3 mcg/kg intravenous dose prior to hematoma expansion assessment. Relative hematoma expansion occurred in 5/29 (17%) with desmopressin compared to 11/42 (26%) without desmopressin (OR 0.59 [95% CI 0.18-1.92]). Absolute hematoma expansion occurred in 9/29 (30%) with desmopressin compared to 12/42 (28%) without desmopressin (OR 1.13 [95% CI 0.40-3.16]). Multiple logistic regression controlling for significant covariates did not reveal a significant effect of desmopressin on relative or absolute hematoma expansion (OR 0.65 [95% CI 0.18-2.43] and OR 1.55 [0.48-4.99], respectively). We failed to find evidence that desmopressin administration for antiplatelet reversal in sICH reduces the incidence of hematoma expansion. Larger studies, focusing on the early phase of sICH, are needed to characterize the clinical efficacy and safety of desmopressin for antiplatelet reversal before widespread implementation.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/epidemiologia , Desamino Arginina Vasopressina/administração & dosagem , Hematoma/tratamento farmacológico , Hematoma/epidemiologia , Hemostáticos/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/induzido quimicamente , Estudos de Coortes , Feminino , Hematoma/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
11.
BMC Anesthesiol ; 19(1): 97, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185916

RESUMO

BACKGROUND: Most centres use fresh frozen plasma (FFP) based protocols to prevent or treat haemostatic disturbances during liver transplantation. In the present study, we used a rotational thrombelastometry (ROTEM™, TEM, Munich, Germany) guided haemostasis management with fibrinogen concentrates, prothrombin complex concentrates (PCC), platelet concentrates and tranexamic acid without FFP usage and determined the effect on 30 day mortality. METHODS: Retrospective data analysis with 372 consecutive adult liver transplant patients performed between 2007 and 2011. RESULTS: Thrombelastometry guided coagulation management resulted in a transfusion rate for fibrinogen concentrates in 50.2%, PCC in 18.8%, platelet concentrates in 21.2%, tranexamic acid in 4.5%, and red blood cell concentrates in 59.4%. 30 day mortality for the whole cohort was 14.2%. The univariate analyses indicated that nonsurvivors received significantly more fibrinogen concentrates, PCC, red blood cell concentrates, platelet concentrates, and infusion volume, and had a higher MELD score. However, association with mortality was weak as evidenced by receiver operating characteristic curve analyses. Further univariate analyses demonstrated, that up to 8 g of fibrinogen did not increase mortality compared to patients not receiving the coagulation factor. Multivariate analysis demonstrated that platelet concentrates (p = 0.0002, OR 1.87 per unit), infused volume (p = 0.0004, OR = 1.13 per litre), and MELD score (p = 0.024; OR 1.039) are independent predictors for mortality. Fibrinogen concentrates, PCC, and red blood cell concentrates were ruled out as independent risk factors. CONCLUSIONS: ROTEM™ guided substitution with fibrinogen concentrates and PCC does not negatively affect mortality after liver transplantation, while the well-known deleterious effect associated with platelet concentrates was confirmed.


Assuntos
Fatores de Coagulação Sanguínea/metabolismo , Coagulação Sanguínea/fisiologia , Hemostáticos/sangue , Transplante de Fígado/mortalidade , Transplante de Fígado/métodos , Rotação , Adolescente , Adulto , Idoso , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/sangue , Coagulação Sanguínea/efeitos dos fármacos , Fatores de Coagulação Sanguínea/administração & dosagem , Plaquetas/metabolismo , Criança , Feminino , Fibrinogênio/administração & dosagem , Fibrinogênio/metabolismo , Hemostasia/efeitos dos fármacos , Hemostasia/fisiologia , Hemostáticos/administração & dosagem , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Tromboelastografia/efeitos adversos , Tromboelastografia/métodos , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/sangue , Adulto Jovem
12.
Eur Arch Otorhinolaryngol ; 276(7): 1995-1999, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161361

RESUMO

BACKGROUND: Bleeding during functional endoscopic sinus surgery always been a challenge for the quality of surgical field for surgeons. This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in functional endoscopic sinus surgery. METHODS: This study was conducted on 90 patients with chronic rhinosinusitis who were candidate for endoscopic sinus surgery. They were randomly assigned to two study groups. One group received a single puff of local desmopressin (10 µg) in each side of nasal cavity 30 min before the surgery and the other received normal saline instead. Blood loss and the quality surgical field were determined in 15, 30, 60 and 90 min during the surgery (scoring by BOEZAART grading system). All data were analyzed. RESULTS: Blood loss was significantly lesser in the desmopressin group (mean ± SD, 16.289 ± 5.605 ml) than in the control group (24.289 ± 5.2722 ml, P < 0.001).Surgeons were more satisfied with the surgical field in the desmopressin group than control group in all cutoff points (15, 30, 60, and 90 min during the surgery, P < 0.001). No side effects were observed using local desmopressin. CONCLUSIONS: Premedication with local desmopressin can reduce bleeding effectively and clear the surgical field during functional endoscopic sinus surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Desamino Arginina Vasopressina/administração & dosagem , Endoscopia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Doença Crônica , Monitoramento de Medicamentos/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Hemostáticos/administração & dosagem , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Pré-Medicação/métodos , Resultado do Tratamento
13.
World J Gastroenterol ; 25(21): 2549-2564, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210709

RESUMO

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient's quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.


Assuntos
Anemia Ferropriva/terapia , Angiodisplasia/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etiologia , Angiodisplasia/complicações , Angiodisplasia/terapia , Transfusão de Sangue , Endoscopia por Cápsula , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemostáticos/administração & dosagem , Humanos , Intestino Delgado/irrigação sanguínea , Intestino Delgado/diagnóstico por imagem , Ferro/administração & dosagem , Fatores de Risco , Prevenção Secundária/métodos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(21): e15515, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124931

RESUMO

PURPOSE: To evaluate the efficacy and safety of orally administered grape seed proanthocyanidin extract (GSPE) in patients with non-proliferative diabetic retinopathy (NPDR). METHODS: In this randomized (1:2:2), multicentre, double-blind trial, patients (n = 124; age: 40-78 years) were administered placebo, calcium dobesilate (CD; 750 mg/d), or GSPE (150 mg/d) orally for up to 12 months. All patients had retinal thickening with hard exudates (HEs) that met predefined criteria; the median best-corrected visual acuity was 0.8, as assessed using the Snellen visual acuity card. The main outcome measure was an improvement in HEs by at least 1 grade on a 10-grade severity scale. This was evaluated using fundus photography over 1 year. RESULTS: The rate of improvement in the HE severity was higher in the GSPE group than in the CD group. No statistically significant difference existed among the study groups in optical coherence tomography parameters, such as central subfield macular thickness and total macular volume (TMV). However, in the GSPE group, TMV after 9 months of treatment was significantly decreased compared with that at baseline. The GSPE group showed a significantly greater improvement in HE severity than did the placebo or CD group. Four cases in the GSPE group and 2 in the CD group were determined to have developed potential treatment-related adverse reactions, which were all gastrointestinal in nature. CONCLUSIONS: Oral GSPE therapy for 1 year improved HEs in patients with NPDR. The efficacy of GSPE for HEs was higher than that of oral CD in the study patients.


Assuntos
Dobesilato de Cálcio/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Exsudatos e Transudatos/efeitos dos fármacos , Extrato de Sementes de Uva/administração & dosagem , Hemostáticos/administração & dosagem , Proantocianidinas/administração & dosagem , Administração Oral , Idoso , Retinopatia Diabética/patologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
15.
Cardiovasc Intervent Radiol ; 42(9): 1322-1328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31087146

RESUMO

PURPOSE: While transarterial chemoembolization (TACE) is a mainstay of treatment for unresectable hepatocellular carcinomas (HCCs), technical aspects have varied considerably in the literature. These variations lead to heterogeneity and make meaningful comparisons between articles difficult. The goal of this survey was to report international embolization practices for the treatment of HCC in an effort to understand current treatment strategies as a first step toward technique standardization. MATERIALS AND METHODS: An anonymous 18 question online survey, evaluating technical aspects of TACE, was distributed via e-mail to practicing members of the five largest interventional radiology societies in Chinese and English. A total of 1160 responses were obtained from 62 countries. RESULTS: Between regions, there were significant statistical differences in nearly all responses, including the amount of ethiodol oil used for cTACE (p = < 0.001). Practitioners most commonly used greater than 7.5 ml of ethiodol oil (240/506, 47.4%) and most did not utilize a specific mixing method (249/505, 49.3%). Particles utilized varied by geographical region (p = < 0.001), spherical embolic particles were slightly favored (363/757, 47.9%), followed closely by gelatin-based or sponge particles (279/680, 36.8%). Gelfoam was used almost exclusively in Japan and Korea (79/82 responses). LC/DC beads were the most commonly used drug-eluting bead (DEB) (450/742, 60.6%), with the most common size of DEB being 100-300 µm (354/690, 51.3%, p = 0.07). CONCLUSION: Technical aspects of transarterial embolization for HCC vary significantly by geographical location.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Pesquisas sobre Serviços de Saúde/métodos , Neoplasias Hepáticas/terapia , Radiologia Intervencionista/métodos , Antineoplásicos/administração & dosagem , Óleo Etiodado/administração & dosagem , Esponja de Gelatina Absorvível/administração & dosagem , Hemostáticos/administração & dosagem , Humanos , Internacionalidade , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(20): e15623, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096472

RESUMO

To investigate the usefulness of the oxidized regenerated cellulose patch (ORCP) for postbiopsy hemostasis, anxiety, and depression in patients undergoing transrectal ultrasound-guided prostate biopsy.This was a prospective-retrospective study of 300 patients who underwent systematic 12-core prostate biopsy from August 2016 through March 2018. The ORCP was inserted into the rectum immediately after prostate biopsy in the prospective group (n = 150), while the retrospective group (n = 150) underwent prostate biopsy alone. The frequency rate and duration of hematuria, rectal bleeding, and hematospermia were compared between the 2 groups. Anxiety and depression were assessed with the hospital anxiety and depression scale before and after prostate biopsy in the prospective group.The frequency rates of hematuria and hematospermia showed no significant differences between the prospective versus retrospective groups (64.7% vs 66.7%, P = .881; 18 vs 20%, P = .718; respectively). Frequency of rectal bleeding was significantly lower in the prospective group than in the retrospective group (26.7% vs 42.7%, P = .018). However, there were no significant differences in median duration of rectal bleeding, hematuria, or hematospermia between the 2 groups (2, 5, and 2 days vs 2, 7, and 1 day, P > .05, respectively, for the prospective vs retrospective group). Multivariate analysis found that ORCP insertion was a significant protective factor against postbiopsy rectal bleeding (P = .038, odds ratio 0.52). Only anxiety level in the prospective group before versus after prostate biopsy was significantly reduced (5 vs 4, P = .011).ORCP insertion after prostate biopsy is an effective and simple method for decreasing rectal bleeding. ORCP insertion may also alleviate anxiety in patients undergoing prostate biopsy.


Assuntos
Biópsia com Agulha de Grande Calibre/efeitos adversos , Celulose Oxidada/administração & dosagem , Hemorragia/etiologia , Hemorragia/prevenção & controle , Hemostáticos/administração & dosagem , Próstata/patologia , Idoso , Ansiedade/epidemiologia , Bandagens , Depressão/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reto , Ultrassonografia de Intervenção
17.
Br J Radiol ; 92(1098): 20180893, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30982331

RESUMO

OBJECTIVE: Evaluate the factors associated with pseudoaneurysm development and morphology. Measure ultrasound-guided thrombin injection (UGTI) and surgical treatment outcomes for pseudoaneurysms, and the necessity for post-primary intervention (reintervention). METHODS: Retrospective analysis of ultrasound scans and CT angiography of peripheral pseudoaneurysm interventions from February 2011 to April 2017. 99 patients (61.6% female) were identified; median age 72 years (range 12-89). Multivariate analysis of patient demographics, including pre-intervention anticoagulant and antiplatelet medication was performed. RESULTS: Primary intervention for peripheral pseudoaneurysms (62.6% common femoral artery) included 93 UGTI and 6 surgical repairs; with 12 reinterventions (9 UGTI and 3 surgical). Pseudoaneurysm incidence for vascular interventional radiology (VIR) was 0.48% (31/6451) and cardiology was 0.24% (60/25,229). Rates for primary success, immediate complications, 30-day mortality and reintervention were measured respectively for UGTI (98.9%, 3.0%, 2.0%, and 11.8%) and surgical repair (100%, 0.0%, 22.2% and 16.7%). Reintervention risk factors included pre-intervention thrombocytopaenia (<150 × 109/L) ( p = 0.025) and pseudoaneurysms following vascular surgery (p = 0.033). Other positive associations for reintervention (non-significant) included use of a sheath size > 6 Fr ( p = 0.108) or arterial closure device ( p = 0.111) during the pseudoaneurysm causative procedure. The pre-intervention warfarin subgroup developed a larger mean pseudoaneurysm sac size (4.21 cm, range 0.9-7.6), compared to no treatment (p = 0.003), aspirin (p = 0.005) and clopidogrel (p = 0.026) subgroups. UGTI dosage for thrombosis had a positive correlation with incremental sac size increase (p < 0.001). CONCLUSION: The main reintervention risk factor was pre-intervention thrombocytopaenia, with additional positive associations including pseudoaneurysms caused by surgery, increased sheath size and arterial closure devices. Warfarinized patients developed larger sac-sized pseudoaneurysms compared with other pre-intervention regimens, with positive correlation of higher UGTI dosage required for thrombosis. ADVANCES IN KNOWLEDGE: Patients with pre-intervention thrombocytopaenia and pseudoaneurysms attributed to vascular surgery are subgroups that may benefit from post-intervention imaging surveillance due to significant reintervention risk.


Assuntos
Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doença Arterial Periférica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Anticoagulantes/uso terapêutico , Criança , Angiografia por Tomografia Computadorizada , Feminino , Hemostáticos/administração & dosagem , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Trombina/administração & dosagem , Ultrassonografia , Ultrassonografia de Intervenção , Adulto Jovem
18.
World J Gastroenterol ; 25(13): 1592-1602, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30983819

RESUMO

BACKGROUND: Gastrointestinal (GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders (HP) represent "touch-free" agents. AIM: To analyze short term (ST-within 72 h-) and long-term (LT-within 30 d-) success for achieving hemostasis with HP and to directly compare the two agents Hemospray (HS) and Endoclot (EC). METHODS: HP was applied in 154 consecutive patients (mean age 67 years) with GI bleeding. Patients were followed up for 1 mo (mean follow-up: 3.2 mo). RESULTS: Majority of applications were in upper GI tract (89%) with following bleeding sources: peptic ulcer disease (35%), esophageal varices (7%), tumor bleeding (11.7%), reflux esophagitis (8.7%), diffuse bleeding and erosions (15.3%). Overall ST success was achieved in 125 patients (81%) and LT success in 81 patients (67%). Re-bleeding occurred in 27% of all patients. In 72 patients (47%), HP was applied as a salvage hemostatic therapy, here ST and LT success were 81% and 64%, with re-bleeding in 32%. As a primary hemostatic therapy, ST and LT success were 82% and 69%, with re-bleeding occurring in 22%. HS was more frequently applied for upper GI bleeding (P = 0.04). CONCLUSION: Both HP allow for effective hemostasis with no differences in ST, LT success and re-bleeding.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Hemostáticos/administração & dosagem , Minerais/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pós , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Surg Res ; 239: 269-277, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30884383

RESUMO

BACKGROUND: A novel injectable expanding foam based on hydrophobically modified chitosan (HM-CS) was developed to improve hemostasis during surgeries. HM-CS is an amphiphilic derivative of the natural biopolymer chitosan (CS); HM-CS has been shown to improve the natural hemostatic characteristics of CS, but its internal safety has not been systematically evaluated. The goal of this study was to compare the long-term in vivo safety of HM-CS relative to a commonly used fibrin sealant (FS), TISSEEL (Baxter). METHODS: Sixty-four Sprague-Dawley rats (275-325 g obtained from Charles River Laboratories) were randomly assigned to control (n = 16) or experimental (n = 48) groups. Samples of the test materials (HM-CS [n = 16], CS [n = 16], and FS [n = 16]) applied to a nonlethal liver excision (0.4 ± 0.3 g of the medial lobe) in rats were left inside the abdomen to degrade. Animals were observed daily for signs of morbidity and mortality. Surviving animals were sacrificed at 1 and 6 wk; the explanted injury sites were microscopically assessed. RESULTS: All animals (64/64) survived both the 1- and 6-wk time points without signs of morbidity. Histological examination showed a comparable pattern of degradation for the various test materials. FS remnants and significant adhesions to neighboring tissues were observed at 6 wk. Residual CS and HM-CS were observed at the 6 wk with fatty deposits at the site of injury. Minimal adhesions were observed for CS and HM-CS. CONCLUSIONS: The internal safety observed in the HM-CS test group after abdominal implantation indicates that injectable HM-CS expanding foam may be an appropriate internal use hemostatic candidate.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Quitosana/administração & dosagem , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Animais , Quitosana/efeitos adversos , Quitosana/química , Modelos Animais de Doenças , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostáticos/efeitos adversos , Hemostáticos/química , Humanos , Interações Hidrofóbicas e Hidrofílicas , Fígado/cirurgia , Masculino , Camundongos , Ratos , Ratos Sprague-Dawley
20.
Surg Infect (Larchmt) ; 20(5): 378-381, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30785856

RESUMO

Background: We describe the management and control of an outbreak of mediastinitis in a cardiac surgery department. Method: We performed a retrospective cohort study of 87 patients who underwent coronary artery bypass grafting (CABG), valve replacement, or both during a five-month period with a higher than normal number of cases of post-operative mediastinitis. In addition to medical records review, a survey was conducted among surgeons to estimate the frequency of cellulose-derived absorbable hemostatic (CDAH) use. Results: Eleven patients (12.5%) developed mediastinitis during the period. None of them died, and the course of the infections was benign. No differences were found between the infected and non-infected patients regarding clinical or demographic characteristics. The rate of infection by surgeon ranged from 0 to 21.4%. (p = 0.38). We found a significant linear relation between the frequency of CDAH use and the risk of infection, from 3.3% to 22.6% (p = 0.024). Cultures of unused CDAHs were negative. Cessation of product use led to no new cases for the following year and to a mediastinitis rate <1% for the following 24 months. Conclusion: We identified a cluster of undesired clinical outcomes compatible with mediastinitis that added morbidity and associated cost, but not deaths, related to the use of CDAH as a hemostatic. These data suggest keeping the use of CDAH in cardiothoracic surgery to a minimum.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Celulose/efeitos adversos , Surtos de Doenças , Hemostasia Cirúrgica/efeitos adversos , Hemostáticos/efeitos adversos , Mediastinite/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Celulose/administração & dosagem , Feminino , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
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