scholarly journals Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy

2020 ◽  
Vol 25 (3) ◽  
pp. 298-304
Author(s):  
Chad A. Purnell ◽  
Rachel Skladman ◽  
Tord D. Alden ◽  
Julia F. Corcoran ◽  
Jeffrey C. Rastatter
Keyword(s):  
Blood Loss ◽  
Dermoid Cyst ◽  
Demographic Data ◽  
Nasal Bone ◽  
Direct Access ◽  
Intracranial Extension ◽  
Transfusion Rate ◽  
Cyst Excision ◽  
The Mean ◽  
Coronal Incision

OBJECTIVEUp to 10% of midline nasal dermoid cysts have intracranial extension. Previous techniques of excision include frontal and frontonasal craniotomies via a coronal approach, combined with a direct cutaneous excision of the dermoid cyst. While the coronal incision allows for wide visualization, it carries significant risks of transfusion, blood loss, and scarring. The authors present an alternative technique in which access is gained through a midline extension of the dermoid cyst excision that provides direct access for a keyhole frontal craniotomy.METHODSThe authors utilize a nasal bone osteotomy, pericranial flap, and keyhole-type craniotomy performed through a nasal midline incision for the treatment of nasal dermoid cysts with intracranial extension. They performed a retrospective chart review of all patients with nasal dermoid cysts treated at the Ann & Robert H. Lurie Children’s Hospital of Chicago from 2009 to 2017. Patient demographic data, operative data, and in- and outpatient complication data were collected.RESULTSIn 10 patients with cyst extension near or into the intracranial cavity (7 with true intracranial extension), the nasal osteotomy technique was performed. The mean blood loss was 13 ml, with a 0% transfusion rate. The mean length of inpatient stay was 1 day. A durotomy was made and repaired as part of the dermoid cyst dissection in 3 patients. One patient underwent intraoperative placement of a lumbar drain. The mean operative time was 228 minutes. There were no intraoperative or postoperative complications, including the need for a reoperation. No patients had any long-term complications, and no patients have had dermoid cyst recurrence. The appearance of the scar was acceptable in all cases.CONCLUSIONSThe midline approach to nasal dermoid cysts with intracranial extension is safe and results in limited blood loss, short operative times, and short lengths of inpatient hospital stay. This is a viable technique for the treatment of this challenging pathology.

scholarly journals Initial Canadian experience with robotic simple prostatectomy: Case series and literature review

2015 ◽  
Vol 9 (9-10) ◽  
pp. 626 ◽  
Author(s):  
Nathan Y. Hoy ◽  
Stephan Van Zyl ◽  
Blair A. St. Martin
Keyword(s):  
Blood Loss ◽  
Operating Time ◽  
Case Series ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Transfusion Requirements ◽  
Simple Prostatectomy ◽  
Significant Difference ◽  
The Mean

Introduction: Robotic-assisted simple prostatectomy (RASP) has been touted as an alternative to open simple prostatectomy (OSP) to treat large gland benign prostatic hyperplasia. Our study assesses our institution’s experience with RASP and reviews the literature.Methods: We performed a retrospective chart review from January 2011 to November 2013 of all patients undergoing RASP and OSP. Operative and 90-day outcomes, including operation time, intraoperative blood loss, length of hospital stay (LOS), transfusion requirements, and complication rates, were assessed.Results: Thirty-two patients were identified: 4 undergoing RASP and 28 undergoing OSP. There was no difference in mean age at surgery (69.3 vs. 75.2 years; p = 0.17), mean Charlson Comorbidity Index (2.5 vs. 3.5; p = 0.19), and mean prostate volume on TRUS (239 vs. 180 mL; p = 0.09) in the robotic and open groups, respectively. There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 vs. 79 min; p = 0.008). The mean intraoperative blood loss was significantly higher in the open group (835.7 vs. 218.8 mL; p = 0.0001). Mean LOS was shorter in the RASP group (2.3 vs. 5.5 days; p = 0.0001). No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP vs. 57.1% with OSP (p = 0.10).Conclusions: Our data suggest RASP has a shorter LOS and lower intraoperative volume of blood loss, with the disadvantage of a longer operating time, compared to OSP. It is a feasible technique and deserves further investigation and consideration at Canadian centres performing robotic prostatectomies.

scholarly journals Does Use of Oral Anticoagulants at the Time of Admission Affect Outcomes Following Hip Fracture

2018 ◽  
Vol 9 ◽  
pp. 215145931876415 ◽  
Author(s):  
Ariana Lott ◽  
Jack Haglin ◽  
Rebekah Belayneh ◽  
Sanjit R. Konda ◽  
Philipp Leucht ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Academic Medical Center ◽  
Cost Of Care ◽  
Transfusion Rate ◽  
Time To Surgery ◽  
Discharge Disposition ◽  
Increased Risk ◽  
The Mean

Purpose: The purpose of this study was to compare hospital quality outcomes in patients over the age of 60 undergoing fixation of hip fracture based on their anticoagulation status. Materials and Methods: Patients aged 60 and older with isolated hip fracture injuries treated operatively at 1 academic medical center between October 2014 and September 2016 were analyzed. Patients on the following medications were included in the anticoagulation cohort: warfarin, clopidogrel, aspirin 325 mg, rivaroxaban, apixaban, dabigatran, and dipyridamole/aspirin. We compared outcome measures including time to surgery, length of stay (LOS), transfusion rate, blood loss, procedure time, complication rate, need for intensive care unit (ICU)/step-down unit (SDU) care, discharge disposition, and cost of admission. Outcomes were controlled for age, Charlson comorbidity index (CCI), and anesthesia type. Results: A total of 479 hip fracture patients met the inclusion criteria, with 367 (76.6%) patients in the nonanticoagulated cohort and 112 (23.4%) patients in the anticoagulated cohort. The mean LOS and time to surgery were longer in the anticoagulated cohort (8.3 vs 7.3 days, P = .033 and 1.9 vs 1.6 days, P = .010); however, after controlling for age, CCI, and anesthesia type, these differences were no longer significant. Surgical outcomes were equivalent with similar procedure times, blood loss, and need for transfusion. The mean number of complications developed and inpatient mortality rate in the 2 cohorts were similar; however, more patients in the anticoagulated cohort required ICU/SDU-level care (odds ratio = 2.364, P = .001, controlled for age, CCI, and anesthesia). There was increased utilization of post-acute care in the anticoagulated cohort, with only 10.7% of patients discharged home compared to 19.9% of the nonanticoagulated group ( P = .026). Lastly, there was no difference in cost of care. Conclusion: This study highlights that anticoagulation status alone does not independently put patients at increased risk with respect to LOS, surgical outcomes, and cost of hospitalization.

scholarly journals Comparison of conservative and radical surgery in the management of placenta previa percreta

2021 ◽  
Vol 29 (1) ◽  
pp. 46-53
Author(s):  
Burak Sezgin ◽  
Burcu Kasap ◽  
Eda Adeviye Şahin ◽  
Aysun Camuzcuoğlu ◽  
Hakan Camuzcuoğlu
Keyword(s):  
Blood Loss ◽  
Radical Surgery ◽  
Placenta Previa ◽  
Transfusion Rate ◽  
Intraoperative Blood Loss ◽  
The Mean ◽  
Placental Invasion ◽  
Caesarean Hysterectomy ◽  
Hemoglobin Drop ◽  
Type Of Surgery

Objective We aimed to compare the uterine sparing (US) surgery and hysterectomy for placenta previa percreta (PPP) management. Methods Data from PPP patients with anterior invasion who underwent US surgery and caesarean hysterectomy were retrospectively analyzed. The clinical and surgical outcomes of patients with PPP were compared according to the type of surgery. Results The mean intraoperative blood loss was lower in US surgery group than in caesarean hysterectomy group (1227.78±204.80 ml vs 1442.22±125.68 ml; p=0.017). The hemoglobin drop was also significantly lower in the patients with US surgery (1.87±0.68 g/dl vs 2.88±1.04 g/dl; p=0.026). Moreover, the mean total transfusion rate was also significantly lower in the patients with US surgery (1.33±0.87 U vs 2.33±0.71 U; p=0.016). Conclusion Uterine sparing surgery reduces intraoperative blood loss and transfusion rate in PPP patients with anterior placental invasion compared to hysterectomy. The temporary blockage of bilateral uterine and uteroovarian arteries with Satinsky clamps may potentially contribute to the success of US surgery.

scholarly journals Tranexamic acid use is associated with lower transfusion rates in shoulder arthroplasty patients with preoperative anaemia

2019 ◽  
Vol 12 (1_suppl) ◽  
pp. 61-69
Author(s):  
T Bradly Clay ◽  
A Sayo Lawal ◽  
Thomas W Wright ◽  
Matthew Patrick ◽  
Aimee M Struk ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Shoulder Arthroplasty ◽  
Demographic Data ◽  
Acid Group ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
American Society ◽  
Preoperative Anaemia

Background We evaluate tranexamic acid use in high-risk shoulder arthroplasty patients, hypothesizing that tranexamic acid will decrease transfusion rates in patients with low preoperative haematocrit. Methods A retrospective review of shoulder arthroplasty patients with preoperative anaemia compared those treated with and without perioperative tranexamic acid. Inclusion criterion was any shoulder arthroplasty with a preoperative haematocrit (Hct) <38%. Tranexamic acid was given generally as 1 g intravenously before incision and 1 g during wound closure; topical tranexamic acid was used in cases of contraindication to IV tranexamic acid. Preoperative Hct, postoperative Hct, estimated blood loss, preoperative anticoagulation use, American Society of Anesthesiologist score, transfusion rate and demographic data were compared between groups with and without tranexamic acid. Results Of the 435 arthroplasties performed, 109 patients had preoperative Hct < 38% (haemoglobin of 12.7 g/dL); 69 had tranexamic acid perioperatively and 40 did not. Demographics, anticoagulation use, diagnosis, arthroplasty types, estimated blood loss and preoperative Hct were similar between groups. The tranexamic acid group had a higher postoperative Hct, significantly lower transfusion rate and significantly smaller drop in Hct. Hct levels, Hct change and transfusion rate for topical versus intravenous tranexamic acid were not significantly different. Discussion Perioperative tranexamic acid in high-risk shoulder arthroplasty patients with preoperative Hct <38% is associated with higher postoperative Hct and lower transfusion rates.

Bivalirudin anticoagulation during cardiac surgery: a single-center experience in 141 patients

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 7-11 ◽  
Author(s):  
A Koster ◽  
S Buz ◽  
T Krabatsch ◽  
R Yeter ◽  
R Hetzer
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Single Center ◽  
Off Pump ◽  
Single Center Experience ◽  
Number Of Patients ◽  
The Mean ◽  
Procedural Success

The feasibility of bivalirudin for anticoagulation during cardiac surgery has been confirmed in four multicenter clinical trials. Here, we report our single-center experience with bivalirudin anticoagulation in “on-pump” and “off-pump” cardiac surgery in a large number of patients with and without heparin antibodies. Data of patients who underwent cardiac surgery with bivalirudin anticoagulation between 06/2003 and 12/2007 at our institution were reviewed. Assessment included procedural success, blood loss, transfusion requirements, re-exploration rates and drug-related complications during the procedures. There were 141 patients treated with bivalirudin, of whom 40 had heparin antibodies. In 26 patients, “off-pump” coronary artery bypass grafting was performed and the remaining 115 patients had surgery with cardiopulmonary bypass (CPB). The procedural success rate after 7 days and after 30 days was 99.4%. The mean blood loss after “off-pump” surgery was 833 ± 310 ml, with a transfusion rate of 30%. The mean blood loss after “on-pump” surgery was 750 ± 494 ml, with a transfusion rate of 56%. Two patients needed re-exploration due to persistent hemorrhage. Overall transfusion rates were increased in patients with heparin antibodies. The current investigation demonstrates that, in experienced hands, bivalirudin anticoagulation can be performed with excellent procedural success and low complication rates during “on-pump” and “off-pump” cardiac surgery. Recent problems associated with the production of heparin have emphasized the urgent need for an alternative for use beyond the limited indication of heparin-induced thrombocytopenia.

scholarly journals Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study

2016 ◽  
Vol 54 (3) ◽  
pp. 239-246
Author(s):  
C. Langdon ◽  
P. Herman ◽  
B. Verillaud ◽  
R.L. Carrau ◽  
D. Prevedello ◽  
...  
Keyword(s):  
Blood Loss ◽  
Multicenter Study ◽  
Residual Disease ◽  
Long Term Results ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Advanced Stage ◽  
The Mean ◽  
Retrospective Multicenter Study

Objectives: Endoscopic resection has become an established surgical option for most juvenile nasopharyngeal angiofibromas (JNA). However, surgical management of JNA with intracranial extension remains challenging. This retrospective multicenter study reviews a series of patients with advanced stage JNA treated via endonasal/endoscopic approach. Methods: The experience of five academic tertiary or quaternary care ORL-HNS Departments were included. Medical records of all patients operated for JNA staged as Radkowski stage IIIA or IIIB were reviewed. Main outcome measures included intraoperative blood loss, length of hospital stay, complication rate, and rate of persistence or recurrence. Results: A total of 74 male patients with stages IIIA and IIIB were included. The mean age was 16.4 years and preoperative embolization was performed in 71 patients. The mean blood loss in 45 patients for whom the data was available was 1279.7 ml. The more anatomic subsites were involved, the higher the risk was of intraoperative bleeding. The mean follow-up for 54 out of 73 patients was 37.9 months. Patients with residual disease are significantly linked to involvement of combined (anterior-lateral and posterior) anatomic subsites and to a higher number of affected subsites. At last follow-up, all patients were asymptomatic and those with residual tissue displayed no imaging signs of growth. Conclusions: This retrospective multicenter study supports the notion that expanded endonasal endoscopic approaches for advance staged JNA are a feasible option associated with good long-term results.

scholarly journals Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

2019 ◽  
Vol 8 (4) ◽  
pp. 1588
Author(s):  
Neelam Manda ◽  
Oby Nagar ◽  
Lata Rajoria ◽  
C. P. Dadhich
Keyword(s):  
Blood Loss ◽  
Vaginal Hysterectomy ◽  
Demographic Data ◽  
Pelvic Sepsis ◽  
Control Group ◽  
Complication Rates ◽  
Index Group ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
The Mean

Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.

scholarly journals Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiaojian Wang ◽  
Ting Xu ◽  
Rui Wang ◽  
Penghe Wang ◽  
Shuaijie Jin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Platelet Count ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Transfusion Rate ◽  
Vein Thrombosis ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B

Objective. To investigate the efficacy and safety of performing primary unilateral total knee arthroplasty (TKA) in the “Si hour-period” meaning 09:00 a.m. to 11:00 a.m. (one of the 12 two-hour periods into which the day was traditionally divided, each being given the name of one of the 12 earthly branches), compared with the “Wei hour-period” (13:00–15:00). Methods. Patient documentations were studied for those who underwent a primary unilateral TKA performed by the same surgical team with a tourniquet between January 2018 and January 2021 at our medical center. Eighty-four patients were enrolled and assigned into group A (in Si hour-period) and group B (in Wei hour-period). The main outcomes were total blood cell loss (TBL), hidden blood loss (HBL), visible blood loss (VBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were length of hospital stay (LOS), postoperative femorotibial mechanical axis (FTMA), FTMA correction, platelet count, plasma D-dimer (D-D), prothrombin time (PT), international normalized ratio (INR), and the incidence of postoperative complications. Results. Group A showed statistical significance lower at the mean TBL, the mean HBL, and the maximum Hb drop (95% CI: −352.8 to −46.1, P = 0.011 , 95% CI: −348.0 to −40.1, P = 0.014 , and 95% CI: −9.5 to −0.7, P = 0.023 , respectively) after TKA than group B. The postoperative platelet count of group A was more significant than that of group B (95% CI:3.1 to 52.9, P = 0.028 ). The VBL, transfusion rate, the LOS, postoperative FTMA, FTMA correction, plasma D-D, PT, INR, and the incidence of postoperative complications (wound complications, calf muscular vein thrombosis, infection, pulmonary embolism, and deep vein thrombosis) were similar between the two groups ( P > 0.05 , respectively). Conclusion. Our study shows that blood loss can be reduced when TKA is performed in the “Si hour-period,” which may be due to increasing platelet count, and postoperative complications did not increase, compared with the Wei hour-period. We recommend that the selective operation, such as TKA, should be performed in the “Si hour-period” in clinical practice between the two hour-period.

Hemorrhagic complications of robot-assisted laparoscopic partial nephrectomy for renal masses.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 621-621
Author(s):  
Andrew Franklin ◽  
Jack Campbell ◽  
Naveen Pokala
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Average Length ◽  
Demographic Data ◽  
Operating Time ◽  
Renal Tumors ◽  
Transfusion Rate ◽  
Renal Masses ◽  
Postoperative Blood Transfusion ◽  
Hemorrhagic Complications

621 Background: Partial nephrectomy is the current standard of care for T1a tumors. With advances in laparoscopy and robotic-assisted surgery, RPNx is increasingly being performed for complex renal tumors. However, significant hemorrhagic complications can occur. We review hemorrhagic complications following RPNx. Methods: At our institution 111 RPNx were performed on 110 patients (2011-2015). Demographic data and Nephrometry scores were determined. Total operating time, intraoperative blood loss, postoperative blood transfusion rate, gross hematuria, need for further procedures and mortality were collected. Pathology, including histologic diagnosis, and margin status was recorded. Results: Of 111 RPNx, 110 were done for renal masses and 112 masses were removed. Of these, 77% were malignant and most common commonly Renal Cell Carcinoma, Clear Cell pT1a (51%). Mean operative time was 245 minutes (SD 68), mean blood loss was 297 mL (SD 68), and average length of stay was 2.8 days. Hemorrhagic complications occurred in 21 patients (19%). Five had hematuria and 16 received a transfusion. Four patients required interventional radiology (IR) for angioembolization. Two patients died, one from hemorrhagic complications, and the other from septic shock related to a bowel injury. The most common Nephrometery score was 4a followed by 5a. Of those with hemorrhagic complications the most common Nephrometery score was 8, with 60% being 7 or higher. Among patients needing IR, 75% were 6 or higher and the one patient who died had a score of 11a in the setting of bilateral renal masses. Patients with hemorrhagic complications had a change in hemoglobin and hematocrit from per- to post-operation of 3.06 g/dL and 9.07% respectively compared to 2.34 g/dL and 6.28% for patients with no hemorrhagic complications. Conclusions: RPNx is a safe and nephron-sparing surgery for patients with appropriate renal masses. Significant hemorrhagic complications can occur, commonly managed with blood transfusions or angioembolization. However, catastrophic bleeding can occur in patients with high Nephrometry scores and monitoring in the ICU setting is recommended in high-risk patients.

The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
Author(s):  
Marco Cattaneo ◽  
Alan S Harris ◽  
Ulf Strömberg ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Controlled Trials ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Transfusion Requirements ◽  
The Mean ◽  
Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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