scholarly journals The use of tranexamic acid for the prevention of hemorrhagic complications in percutaneous nephrolithotripsy

2021 ◽  
Vol 14 (2) ◽  
pp. 52-57
Author(s):  
S.V. Popov ◽  
◽  
I.N. Orlov ◽  
A.Y. Kulikov ◽  
D.A. Sytnik ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Postoperative Period ◽  
Operation Time ◽  
Patient Treatment ◽  
Control Group ◽  
Irrigation Fluid ◽  
Hemorrhagic Complications ◽  
Percutaneous Nephrolithotripsy

Introduction. The problem of urolithiasis remains relevant throughout the world. The widespread prevalence of the disease is the reason for the search for new and effective methods of dealing with various complications of surgical treatment in order to improve the efficiency of patient treatment. Materials and methods. The material was searched in the following databases: PubMed, Google Scholar, Scopus by keywords such as  Tranexamic acid and percutaneous nephrolithotripsy . When searching in the above databases, 18 articles were found and analyzed. The results of preoperative, intra – and postoperative use of tranexamic acid (TA) in various dosages, and the frequency of the drug use, including the addition of TA to the irrigation fluid, are described. Indicators such as the average level of hemoglobin, the time of surgery, the need for blood transfusion, and the volume of irrigation fluid were evaluated. In all these cases, the control group consisted of patients for whom TA was not used either before the operation or in the postoperative period. Results. The article presents an analysis of the literature data on the correction of hemorrhagic complications by the use of TА. The data on intra- and postoperative hemorrhagic complications of percutaneous nephrolithotripsy (PNLT) and the effect of TА on them are presented. The results of preoperative, intra- and postoperative use of TА in various dosages, and the frequency of use of the drug, including the addition of TА to the irrigation fluid, are described. Indicators such as the average hemoglobin level, operation time, the need for blood transfusion, and the volume of irrigation fluid were assessed. In all the above cases, the control group consisted of patients in whom TА was not used either before the operation or in the postoperative period. Conclusions. The results obtained make it possible to judge the safety and appropriateness of the use of TА in order to reduce the degree of hemorrhagic complications both during the operation and in the postoperative period. Assessment of the hemostatic system and the effect of hemostatic drugs during the surgical treatment of urolithiasis on the upper urinary tract, in our opinion, is a key moment in improving the effectiveness of patient treatment.

scholarly journals Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

2020 ◽  
Vol 28 (2) ◽  
pp. 94-104
Author(s):  
Liang Sun ◽  
Rui Guo ◽  
Yi Feng
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Orthognathic Surgery ◽  
Operation Time ◽  
Controlled Trials ◽  
Allogenic Blood Transfusion ◽  
Intraoperative Blood Loss ◽  
Irrigation Fluid ◽  
Allogenic Blood

Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

2014 ◽  
Vol 21 (4) ◽  
pp. 648-652 ◽  
Author(s):  
Jianxiong Shen ◽  
Jinqian Liang ◽  
Haiquan Yu ◽  
Guixing Qiu ◽  
Xuhong Xue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Blood Transfusion ◽  
Spinal Fusion ◽  
Predictive Factors ◽  
Operation Time ◽  
Control Group ◽  
Allogenic Blood Transfusion ◽  
Allogenic Blood ◽  
Delayed Infection

Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.

scholarly journals ТREATMENT OF STENOSIS OF THE PYLORIC BULBAR ZONE OF ULCERATIVE GENESIS USING MINIMALLY INVASIVE SURGERY

2020 ◽  
pp. 167-175
Author(s):  
O. M. Babii ◽  
S. A. Tarabarov ◽  
N. V. Prolom ◽  
B. F. Shevchenko ◽  
A. A. Galinsky
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Postoperative Period ◽  
Clinical Signs ◽  
State Institution ◽  
Disease Recurrence ◽  
Control Group ◽  
Surgical Interventions ◽  
Remote Observation

Summary. Purpose: to improve the results of surgical treatment of stenosis of the pyloroduodenal zone of ulcerative origin through the use of minimally invasive laparoendoscopic interventions. Material and methods. In the Department of Surgery of the Digestive Organs of the State Institution “Institute of Gastroenterology of the NAMS of Ukraine” for 2014-2019, 114 patients with stenosis of the pyloroduodenal zone of ulcerative origin were examined. Of these, 35 — with compensated stenosis, 57 — with subcompensated, 22 — with decompensated stenosis. The average age (45.3±5.2) years. The control group consisted of 20 healthy individuals. All patients underwent surgical treatment using minimally invasive and traditional surgical interventions. Results and discussion. During the study, known indications were clarified and new indications for performing endoscopic balloon pyloroduodenoplasty and combined laparoendoscopic intervention were clarified. Complications in the immediate postoperative period occurred in 1 patient (1.04%) in the form of perforation of the dilated zone. In patients after the traditional laparotomy surgery, the average postoperative period was (15 ± 2) days. Complications in the immediate postoperative period occurred in 2 patients (11.1 %) in the form of bleeding and leaks in the pyloroplasty zone, which required repeated surgical treatment. Тhere were no fatal cases. The remote observation period was 7-22 months. Endoscopic, radiological and clinical signs of recurrence of peptic ulcer and stenosis were not detected. Conclusions. The method of minimally invasive endoscopic and combined laparoendoscopic interventions in the treatment of stenosis of the pyloroduodenal zone of ulcerative genesis is characterized by a minimal number of complications, has good efficacy indicators and the absence of disease recurrence in the long-term period.

scholarly journals The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

2017 ◽  
Vol 25 (4) ◽  
pp. 234-9 ◽  
Author(s):  
Aryo N. Triyudanto ◽  
Andri M.T. Lubis
Keyword(s):  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Transfusion Rate ◽  
Intraoperative Bleeding ◽  
Post Surgery ◽  
Drain Removal ◽  
Significant Difference ◽  
Total Knee

Background: Despite the advances in the design and fixation of implants in total knee replacement (TKR). the amount of postoperative bleeding is still an important issue that has not been resolved. This study aimed to measure the effectiveness of various tranexamic acid administration. Methods: This was a randomized controlled trial study, held from August 2014 to February 2016 at Cipto Mangunkusumo Hospital, Jakarta. Twenty two patients having TKR were divided into three groups: the control group, the tranexamic acid intra-articular-intraoperative group, and the intravenous preoperative group. Intraoperative bleeding, haemoglobin (Hb) level on preoperative to five-day-post-surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared. Numerical data were analyzed by using parametric and non-parametric test, depended on the normality of the data. Results: The amount of blood transfusion needed in both the intra-articular group (200±SD 100 mL) and the intravenous group (238±SD 53 mL) were significantly different compared to those in the control group (1,016±SD 308.2 mL) (p=0.001). Meanwhile, there was no significant difference between the amount of blood transfusion needed in the intra-articular group and the intravenous group. Total drain production in the intra-articular group (328±SD 193 mL) and intravenous group (391±SD 185 mL) was significantly different compared to the control group (652±SD 150 mL) (p=0.003). No significant difference between the levels of both preoperative and postoperative haemoglobin, the amount of intraoperative bleeding, and the duration of drain usage. Conclusion: Intravenous and intra-articular tranexamic acid effectively decreased transfusion volume and drain production in patients undergoing TKR.

scholarly journals Brachicefalinių arterijų chirurginės korekcijos rezultatai

2003 ◽  
Vol 1 (4) ◽  
pp. 0-0
Author(s):  
Ilona Bičkuvienė
Keyword(s):  
Health Status ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Neurological Symptoms ◽  
Surgical Correction ◽  
Control Group ◽  
Combined Lesions ◽  
Brachiocephalic Arteries

Ilona BičkuvienėVilniaus universiteto Neurologijos ir neurochirurgijos klinikaVilniaus greitosios pagalbos universitetinės ligoninėsNeuroangiochirurgijos centrasŠiltnamių g. 29, LT-2043 Vilnius Įvadas / tikslas Įvertinti vertebrobazilinės ligos klinikinę raišką ligoniams, kuriems yra įvairi brachicefalinių arterijų patologija, iki ir po šių arterijų rekonstrukcijos. Ligoniai ir metodai Ištirti 288 ligoniai, kuriems pasireiškė vertebrobazilinės ligos klinikiniai simptomai ir įvairi brachicefalinių arterijų patologija. Chirurgiškai gydyti 228 ligoniai, o konservatyviai – 60 ligonių, kurie sudarė kontrolinę grupę. Visi ligoniai ištirti neurologo, jiems atliktas brachicefalinių arterijų dvigubas skenavimas ir aortos lanko šakų angiografija. Operuotų arterijų neurologiniai klinikiniai pokyčiai ir kraujotaka buvo vertinama per 3 metų laikotarpį. Rezultatai Paroksizmai yra būdingi neurologiniai simptomai esant brachicefalinių arterijų patologijai. Šių arterijų chirurginė korekcija atliekama, jei konservatyvus gydymas buvo neveiksmingas, o neurologinė simptomatika progresavo. Chirurginiam gydymui įvertinti ligoniai tirti po operacijos praėjus ne daugiau kaip 2 savaitėms, iki 1 metų ir nuo 1 iki 3 metų. Pagrindinis dėmesys buvo sutelktas į neurologinių simptomų pokyčius trečiuoju pooperaciniu laikotarpiu. Teigiami klinikiniai pokyčiai (paroksizmai po operacijos visiškai nebesikartojo) nustatyti daugiausia tiems ligoniams, kuriems buvo brachicefalinių arterijų anomalijos (82,86%) ir deformacijos (72,54%). Chirurginis gydymas buvo neveiksmingas 30% ligonių, kuriems yra brachicefalinių arterijų ateroskleroze, ir 21% – mišri patologija. Papildomų simptomų, kurių iki operacijos nebuvo, atsirado mišrios patologijos grupės ligoniams (3,41%). Chirurginio gydymo veiksmingumui įrodyti ištirta 60 kontrolinės grupės ligonių. Teigiamų sveikatos būklės pokyčių nenustatyta. Ketvirtadalio ligonių sveikatos būklė nepakito, kitų – pablogėjo dėl naujų praeinančių smegenų išemijos priepuolių ir insultų. Išvados Teigiami pooperaciniai pokyčiai per trejų metų laikotarpį leidžia teigti, jog subjektyvūs ir objektyvūs neurologinai vertebrobazilinės ligos simptomai siejasi su įvairia brachicefalinių arterijų patologija. Tais atvejais, kai konservatyvus gydymas neveiksmingas, galima chirurginė brachicefalinių arterijų korekcija. Prasminai žodžiai: brachicefalinės arterijos, vertebrobazilinė liga, chirurginis gydymas, pooperaciniai rezultatai Vertebrobasilar disease. Results of surgical correction of brachiocephalic arteries Ilona Bičkuvienė Background / objective The aim of this study was to analyze preoperative and 3-year follow-up postoperative symptoms of vertebrobasilar disease due to the pathology of brachiocephalic arteries. Methods 288 patients with symptoms of vertebrobasilar disease due to the pathology of brachiocephalic arteries have been examined. 228 patients were operated on and 60 (control group) were treated conservatively. All the patients were examined by the neurologist, duplex scanner and angiographycally. Neurological clinical dynamics and blood flow in operated on arteries were evaluated in a 3-year period. Results Paroxysms are characteristic of the lesions of the brachiocephalic arteries. Surgical correction of the lesions was performed if the conservative treatment had no effect and the neurological symptoms were progressing. To evaluate the effectiveness of surgical treatment, the patients were examined in the early postoperative (2 weeks after operation) and late postoperative period: 1) until 1 year and 2) from 1 to 3 years. Attention was focused on the dynamics of the neurological symptoms in the third postoperative period (from 1 to 3 years). Positive clinical dynamics (paroxysms disappeared) was ascertained mostly in the groups with anomalies of the brachiocephalic arteries (82.86%) and deformations (72.54%). This surgical treatment was ineffective in 30% of cases in the group with atherosclerotic and in 21% with combined lesions of brachiocephalic arteries. New additional symptoms after operation were ascertained in the group with combined lesions (3,41%). To approve the effectiveness of surgical treatment, 60 patients (control group) were examined. They had been treated conservatively, without a positive dynamics of their health status. There were no changes in the health status for the quarter of the patients. In all the others the health status worsened – TIA and strokes appeared. Conclusions A 3-year positive postoperative dynamics allow us to conclude that the subjective and objective clinical symptoms are connected with various types of pathology of brachiocephalic arteries. In cases when conservative treatment is unsuccessful, surgical treatment of brachiocephalic arteries can be applied. Keywords: brachiocephalic arteries, vertebrobasilar disease, surgical treatment, postoperative results

scholarly journals Percutaneous nephrolithotripsy in children of the young age

2021 ◽  
Vol 14 (1) ◽  
pp. 144-150
Author(s):  
Yu.E. Rudin ◽  
◽  
D.S. Merinov ◽  
A.B. Vardak ◽  
L.D. Arustamov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Kidney Stones ◽  
Postoperative Period ◽  
Single Case ◽  
Problem Solution ◽  
Stone Size ◽  
Kidney Size ◽  
Extracorporeal Shock Wave ◽  
Percutaneous Nephrolithotripsy ◽  
Residual Stones

Introduction. Urolithiasis remains one of the most common diseases in the pediatric urology practice. A special category is made up of children weighing up to 15 kg with large and coral-like kidney stones, which require a smaller instrument to remove. Aim. The aim of the study was to evaluate the effectiveness of percutaneous nephrolithotripsy, used for urolithiasis treatment in children aged 1 to 3 years. Materials and methods. Between 2008 and 2019 in the pediatric uroandrology department of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation 93 children aged 1 to 3 years (69 (74.2%) boys and 24 (25.8%) girls) had nephrolithotripsy. The average patients age was 1 year and 9 months. Fifty-one (54.8%) patients had coral-like kidney stones, while the remaining 42 (45.2%) had kidney pelvic stones. The average stone size was 25.8mm. (15 – 56 mm). Nephrolithotripsy was performed according to the standard technique, all patients underwent cystoscopy and ureteral catheterization. In the prone position, under ultrasound and X-ray guidance, a puncture of the renal collecting system was performed. In 59 cases (63.5.1%) the puncture was performed through the lower calyx, in 31 cases (33.3%) – through the middle one, and in nine children two approaches were performed. In 93 children the intervention was performed using a mini-nephroscope with tubes of 12, 15 and 16.5 Ch. To disintegrate the stone, a pneumatic lithotripter and a holmium laser "Auriga" with a fiber of 365 and 600 μm in diameter were used. Only in 31 cases, when the kidney size allowed, a standard 24 Ch nephroscope and combined lithotripsy (ultrasound and pneumatic) were used. The duration of the procedure varied from 32 to 145 minutes, with an average of 43.5 minutes. In the postoperative period, all patients underwent infusion and antibiotic therapy based on the results of urine bacteriological examination. After the patients’ activation on days 1 – 3, a survey urography and antegrade pyeloureterography were performed. In the absence of residual stones and urinary passage disorders, nephrostomy drainage was removed. Results. The effectiveness of nephrolithotripsy in our cohort of patients was 87.1% (81 patients). Four children (4.3%) required second percutaneous intervention. The remaining 8 (8.6%) patients with residual stones underwent distance lithotripsy in the short postoperative period. Significant bleeding occurred in 2 patients who then required transfusion of blood products. Fever was noted in 5 (5.4%) patients. We have not observed a single case of septic and bacteriotoxic shock. Discussion. As a first-line surgical treatment in pediatric practice, it is recommended to use extracorporeal shock wave lithotripsy (ESWL). This treatment is ideal for stones ≤ 15 mm in size, with SFR of 68-95%. However, the need for repeated ESWL sessions occurs in 14-54% cases. Complications rate, frequency of retreatment, as well as a decrease in SFR, increase when a stone size is greater than 1.5 cm. Since all types of surgical treatment in children require anesthesia, and the treatment approach may not provide a complete problem solution, it is preferable to choose a procedure with the greatest possible success in one session. Primary SFR was significantly lower in children with stones ≥ 30 mm in size and multiple kidney stones. Mini– percutaneous nephrolithotripsy is an effective (87.1%) method for nephrolithiasis treatment in children aged 1 to 3 years. Conclusion. Mini-percutaneous nephrolithotripsy in children aged 1 to 3 years is an effective treatment for nephrolithiasis. However, in a small percentage of cases, it becomes necessary to combine the procedure with extracorporeal lithotripsy. Paying attention to the small size of the organ, to reduce the number of hemorrhagic complications, it is preferable to perform this intervention with one approach. The occurrence of even a small amount of bleeding during the operation is a formidable complication, given the small volume of circulating blood in children.

scholarly journals CHANGE IN THE QUALITY OF LIFE OF CHILDREN AFTER SURGICAL TREATMENT OF RETINAL DETACHMENT

2018 ◽  
Vol 25 (6) ◽  
pp. 149-153
Author(s):  
A. N. Sergienko ◽  
V. V. Dashina ◽  
A. V. Malyshev ◽  
O. I. Lysenko ◽  
S. V. Yanchenko
Keyword(s):  
Quality Of Life ◽  
Statistical Analysis ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Postoperative Period ◽  
Control Group ◽  
Russian Version ◽  
Group I ◽  
Group Ii

Aim.The study was designed for the evaluation of the quality of life of children with retinal detachment during vitrectomy.Materials and methods. 23 children with retinal detachment aged from 10 to 17 years were treated. Surgical treatment consisted of a three-port vitrectomy and a laser endocoagulation of the retina. 3 groups were formed with the help of a random sampling. During the surgical treatment of group I (n=8), only balanced non-oxidant solutions of salts (Balsed Salt Solution − BSS) were used. Tablets of antioxidant preparations were not assigned. Saline solutions with antioxidants (BSS plus) were used to carry out surgery for group II (n=8). Group III (n=7) was additionally taking antioxidant preparations peros for 3 months in the postoperative period . The quality of life was studied using the abridged Russian version of the VFQ-25 questionnaire. 10 children of the same age with no indications of surgical treatment of retinal detachment were selected for the control group. Statistical analysis of the obtained data was carried out using a set of programs for applied statistical analysis Analyst Soft, Bio Stat 2007.Results.A week after the surgical treatment, no increase in visometric data was observed. Six months later, a significant increase in visual acuity was revealed. The highest visometric data were observed in group II due to the minimal progression of lens opacities. Group I patients had the lowest values of this index.Conclusion.The positive effect of the surgical treatment of retinal detachment positively influenced the patients’ quality of life in the early and late postoperative period.

scholarly journals Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA 

2020 ◽  
Author(s):  
Huiping Wei ◽  
Qiuping Xiao ◽  
Jianfeng He ◽  
Tianji Huang ◽  
Wantang Xu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Elderly Patients ◽  
Tranexamic Acid ◽  
Topical Application ◽  
Control Group ◽  
Specific Method ◽  
Intertrochanteric Fractures ◽  
Perioperative Blood Loss ◽  
Perioperative Bleeding

Abstract Background: The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).Methods: A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the two groups.Results: The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between the two groups (P>0.05).Conclusion: Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

New Potentialities in Surgical Treatment of Proximal Humerus

2011 ◽  
Vol 18 (1) ◽  
pp. 21-27
Author(s):  
Eduard Ivanovich Solod ◽  
A F Lazarev ◽  
Ya G Gudushauri ◽  
M G Kakabadze ◽  
A S Roskidaylo ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Surgical Treatment ◽  
General Condition ◽  
Postoperative Period ◽  
Proximal Humerus ◽  
Original Method ◽  
Early Postoperative Period ◽  
Early Rehabilitation ◽  
Control Group ◽  
Stable Fixation

Original method of stressed osteosynthesis for the treatment of proximal humerus is proposed. Primary tension of Y-shaped pin fixative and secondary tension that is created at its intramedullar insertion and blocking enable to achieve stable fixation of fragments without inflicting additional intraoperative injury in patients of any age and independently of their general condition. Preservation of blood supple in fragments, low traumatic osteosynthesis, and possibility of patients' early rehabilitation define the prospective of this technique for the treatment of patients with fractures on the background of osteoporosis. The importance of drug therapy for osteoporosis in the early postoperative period is shown. Experience in treatment of 62 patients aged from 23 to 78 years is presented. Control group included 30 patients with similar fractures who were treated using osteosynthesis. In the main group good results were achieved in 82.3% of patients, satisfactory - in 17.7%, no poor results were observed. In control group good results made up 40%, satisfactory - 56.7%, poor 0 3.3%.

Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty

2017 ◽  
Vol 31 (03) ◽  
pp. 270-276 ◽  
Author(s):  
Hernan Prieto ◽  
Heather Vincent ◽  
Justin Deen ◽  
Dane Iams ◽  
Hari Parvataneni
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Flexion Extension ◽  
Total Knee

AbstractTranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. Of these, 20 patients received TXA and 30 patients did not receive TXA and served as the control group. Primary outcome measurements were intraoperative estimated blood loss, hemoglobin (Hb) and Hematocrit (Hct) levels on postoperative day (POD) 1 and POD2, and blood transfusion rates. Secondary outcomes included length of stay (LOS), knee flexion/extension range of motion (ROM), and postoperative complications. There was no difference between groups for preoperative Hb and Hct (all p > 0.05). The TXA group demonstrate higher Hb levels at POD1 (11.7 in TXA vs. 10.4 controls; p < 0.001) and POD2 (10.5 in TXA vs. 9.6 controls; p < 0.001), as well as higher Hct levels at POD1 (35.6 in TXA vs. 32.1 controls; p < 0.001) and POD2 (31.9 in TXA vs. 29.3 controls; p < 0.001). There was less percentage variation in Hb levels in the TXA group from preoperative to POD1 (17.7% in TXA vs. 25.7% controls; p < 0.0001) and POD2 (26.1% TXA vs. 31.8% controls; p = 0.019). Similarly, less percentage variation in Hct levels in the TXA group from presurgery to POD1 (17.0% TXA vs. 25.7% controls; p < 0.0001) and POD2 (25.0% TXA vs. 31.3% controls; p = 0.005). A total of 23.3% of patients in the control group required transfusions compared with no patients in the TXA (p = 0.044). There were no differences in LOS, knee ROM, or number of complications. No thromboembolic events occurred. TXA in bilateral simultaneous TKA effectively reduces blood loss, maintains postoperative Hb and Hct levels, and significantly decreases blood transfusion rates. The level of evidence is level III (therapeutic study).

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