1.
Paracentesis-induced circulatory dysfunction with modest-volume paracentesis is partly ameliorated by albumin infusion in ACLF
Arora V, Vijayaraghavan R, Maiwall R, Sahney A, Thomas SS, Ali R, Jain P, Kumar G, Sarin SK
Hepatology (Baltimore, Md.). 2019
Abstract
Paracentesis-induced circulatory dysfunction (PICD) is a serious complication of large-volume (>5 L) paracentesis in cirrhosis and is reduced with albumin infusion. There is a lack of data on PICD in acute-on-chronic liver failure (ACLF). Because ACLF patients have greater hemodynamic derangements than patients with decompensated cirrhosis, we investigated whether PICD could develop with modest-volume paracentesis (MVP) and the role of albumin infusion. A total of 80 ACLF patients undergoing <5 L paracentesis were randomized to receive albumin (8-10 g/L of ascitic fluid; n = 40) or no albumin (n = 40) and were serially followed to detect PICD. Baseline characteristics were comparable between groups, including volume of ascitic tap (4.16 +/- 0.23 vs. 4.14 +/- 0.27 L; P = 0.72) and plasma renin activity (PRA) (20.5 +/- 7.03 vs. 23.2 +/- 8.24 ng/mL/hour; P = 0.12). PICD was more frequent in the no-albumin group than the albumin group (70% vs. 30%; P = 0.001), with higher incidence of hepatic encephalopathy (50% vs. 27.5%; P = 0.04), hyponatremia (67.5% vs. 22.5%; P < 0.001), acute kidney injury (62.5% vs. 30%; P = 0.001), and in-house mortality (62.5% vs. 27.5%; P = 0.003). PRA of 25.15 ng/mL at day 3 had sensitivity and specificity of 71% and 68% for development of PICD at day 6. Albumin infusion decreased the incidence of PICD at day six (odds ratio, 0.068; 95% confidence interval, 0.011-0.43; P = 0.005). Conclusion: PICD is common and develops even with MVP in ACLF patients. Albumin infusion decreases the incidence of PICD and mortality in ACLF patients.
2.
A prospective randomized trial of the efficacy of marginal quilting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site
Dancey AL, Cheema M, Thomas SS
Plastic and Reconstructive Surgery. 2010;125((5):):1309-17.
Abstract
BACKGROUND The extended latissimus dorsi is a workhorse flap and plays an important role in breast reconstruction. Unfortunately, seromas at the flap donor site are a frustrating problem complicating many procedures. The purpose of this study was to evaluate the efficacy of a combination of fibrin sealant (Quixil; Johnson & Johnson, Langhorne, Pa. ) and limited quilting sutures at reducing seroma formation. METHODS This was a prospective, double-blinded, clinical trial under a single surgeon. Twenty-six patients were enrolled in the study, and all were followed up for a period of 6 months. The patients were randomized to receive either quilting sutures only (group 1) or a combination of Quixil sealant and marginal quilting sutures (group 2). RESULTS The incidence of seroma was 23. 1 percent in group 1 and 7. 7 percent in group 2 (odds ratio, 0. 28; relative risk, 0. 33). The mean total volume aspirated was significantly higher in group 1 (196. 7 ml compared with 30 ml, p = 0. 01). The average number of aspirations was 2. 7 in group 1 compared with one in group 2. There was a significant reduction in inpatient stay for group 2 by 2 days (p = 0. 01). Operative time was shortened by an average of 25 minutes. CONCLUSIONS The combination of fibrin sealant and marginal quilting sutures significantly reduces total drainage, hospital stay, and seroma formation. In the authors' opinion, the benefits of seroma prevention outweigh the extra costs associated with this product. The potential, albeit small, risk of virus transmission and allergic reaction, however, needs to be taken into consideration, as with any blood transfusion product.