Abstract

BACKGROUND : Endoscopic clip placement is technically challenging using a duodenoscope, limiting their application for treatment of bleeding after endoscopic papillectomy. This study evaluated the efficacy of newly designed clips to prevent bleeding after endoscopic papillectomy. METHODS : Patients (n = 80) with suspected benign adenomas on the major papilla who were scheduled for endoscopic papillectomy with or without clipping were randomized. A new duodenoscope-compatible clip capable of being rotated, reopened, and repeatedly repositioned was used. The primary end point was incidence of delayed bleeding. RESULTS : The clipping procedure was successful in all patients. The incidence of delayed bleeding was nonsignificantly higher in the no-clipping group than in the clipping group (31.6 % [95 % confidence interval (CI) 19.1-47.5] vs. 15.0 % [95 %CI 7.1-29.1]). The incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis did not differ significantly between the groups (clipping vs. no-clipping: 17.5 % [95 %CI 8.7-31.9] vs. 5.3 % [95 %CI 1.5-17.3]), and all cases were mild. CONCLUSIONS : Placement of the newly designed rotatable clip was technically feasible and tended to have a protective effect by preventing delayed bleeding after endoscopic papillectomy, although statistical significance was not reached.

Abstract

Preterm prelabor rupture of membranes (PPROM) is the main cause of preterm delivery, resulting in increased perinatal morbidity and mortality. Several techniques have been studied for the healing of ruptured membranes, with some success. Before new techniques using tissue/organ engineering are applied in clinical practice, these techniques must be validated in clinical trials. To address this issue, the objective of this study was to summarize the current literature on interventions to seal or heal the amniotic membranes after PPROM. An electronic search was conducted using the keywords "fetal membranes," "premature rupture," "amnion," "tissue engineering," "fibrin tissue adhesive," "regenerative medicine," "tissue adhesive," "wound healing," and "fetoscopy" through the MEDLINE, Embase, and Cochrane CENTRAL databases, with the limitation of English-language studies. Through a review of the identified studies, it was found that spontaneous healing of the fetal membrane has not been successful. Several efforts have been made to seal membranes before or after rupture using different methods, including amniopatches, collagen, tissue patches, fibrin sealant, mussel-mimetic sealant, engineered cell matrix, and immunological supplements. However, most studies have been conducted in ex vivo or in vivo settings, so the safety and applicability of these techniques to spontaneous rupture of membranes in clinical settings have not been sufficiently tested. Overall, the current evidence is limited regarding the safety and effectiveness of interventions against PPROM.

Abstract

BACKGROUND Bleeding control is critical after total knee arthroplasty (TKA). The purpose of this study was to evaluate the optimal time to release the clamped drain after TKA. METHODS We performed unilateral TKA in 120 patients using three methods of drainage. Group A (N = 40) had a 3-hour clamp applied, and group B (N = 40) had a 4-hour clamp applied. Group C (N = 40) underwent conventional negative drainage. We evaluated the drainage volume, as well as the hemodynamic markers, transfusion volume, visual analog scale (VAS) scores, and range of motion (ROM). RESULTS The drained blood volume in groups A and B was significantly less than that in group C. No significant difference was found between groups A and B. The level of hemoglobin in group A was significantly higher than that in group C at 2 days after surgery. The ROM of groups A and C was larger than that of group B at 5 days after surgery. Furthermore, the VAS scores of groups A and C were significantly lower than those of group B at both 2 and 5 days after surgery. CONCLUSIONS The temporary drain clamping method after TKA significantly reduced the volume of bleeding and blood transfusion. The 3-h clamping method reduced the drained volume as effectively as the 4-hour clamping method and resulted in less acute phase pain and more rapid recovery of ROM than the 4-hour clamping method. In conclusion, we recommend 3-h clamping after TKA as the optimal release time to reduce blood loss and acute phase pain.

Abstract

BACKGROUND/PURPOSE We performed a prospective, multicenter, randomized controlled study to investigate the clinical outcomes, including POPF, after using the TachoSil(R) patch in distal pancreatectomy (NCT01550406). METHODS Between June 2012 and September 2014, 101 patients at 5 centers were randomized into Control (n = 53) and TachoSil (n = 48) groups. In all patients, the pancreas was resected using a stapler with Endo-GIA staples. The TachoSil patch was wrapped around the pancreatic stump only in the TachoSil group, not in Control group. RESULTS The patient characteristics, including age and diagnosis, were comparable in both groups. The mean operation time (159.4 vs 172.3 min, P = 0.081) and postoperative hospital stay (10.0 vs 9.7 days, P = 0.279) were similar in the Control and TachoSil groups, respectively. The overall incidence of POPF was 62.4% (n = 63). The distribution of grades A, B, and C POPF was similar in the Control (14/14/1) and TachoSil (23/11/0) groups, as were the overall incidence (54.7% vs 70.8%, P = 0.095) and the incidence of grade B and C POPF (28.3% vs 22.9%, P = 0.536). CONCLUSION This study showed that the TachoSil patch did not reduce the incidence of POPF after distal pancreatectomy. This article is protected by copyright. All rights reserved.

Abstract

AIMS: The objective of the current study was to evaluate the efficacy and feasibility of fibrin sealant (Tisseel) in the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2 or 3). METHODS We designed a single-blind, prospective, randomized study in 40 consecutive women undergoing LEEP for CIN 2 or 3 at our institute. Two milliliters of fibrin sealant (Tisseel) was applied to the uterine cervix of 20 women immediately after LEEP surgery (treatment group). We evaluated abdominal pain, vaginal bleeding, vaginal discharge and impairment in daily living after 1 week using visual analogue scale questionnaires and compared the results with those of 20 women who did not receive fibrin sealant (control group). RESULTS Among 40 women who returned for a follow-up 1 week after LEEP, 25 women (62.5%) reported at least one moderate to severe postprocedural symptom. The mean duration of moderate to severe vaginal bleeding and impairment in daily living during postoperative week 1 for the treatment group and the control group was 0.3 +/- 0.80 versus 1.7 +/- 2.36 days (p = 0.015) and 0.9 +/- 1.37 versus 3.00 +/- 2.62 days (p = 0.060), respectively. CONCLUSION Intraoperative application of fibrin sealant (Tisseel) in LEEP can decrease postoperative vaginal bleeding and impairment in daily living. © 2015 S. Karger AG, Basel.

Abstract

BACKGROUND/AIMS: Desmopressin decreases bleeding time in uremic patients. Although bleeding time is the most frequently used measure of global platelet function, this test has important disadvantages. In vitro closure time (CT) is a relatively new and efficient test of primary hemostasis. We designed a prospective randomized study to evaluate the effect of desmopressin on platelet function, as measured by in vitro CT, in uremic patients. METHODS Forty-eight uremic patients, about to commence hemodialysis and with prolonged CT, were randomized to infusion with desmopressin (n = 24) or saline alone (n = 24). Complete blood count, prothrombin time, activated partial thrombin time, levels of plasma fibrinogen, von Willebrand factor (VWF), factor VIII (FVIII) and CT were measured before and 1 h after desmopressin or saline infusion. RESULTS Following desmopressin infusion, collagen/epinephrine and collagen/adenosine diphosphate CT were significantly shortened from 212 +/- 58 to 152 +/- 45 s (p = 0. 01) and from 189 +/- 78 to 147 +/- 58 s (p = 0. 012), respectively; levels of FVIII and VWF were significantly increased from 188 +/- 66 to 252 +/- 93% (p = 0. 017) and from 113 +/- 9 to 121 +/- 9% (p = 0. 043), respectively. There were no significant changes in the control group. CONCLUSIONS Desmopressin improved platelet dysfunction and increased the plasma concentrations of VWF and FVIII, suggesting that desmopressin may play a role in improving the bleeding tendency in uremic patients.

Abstract

This study was performed to investigate the interrelation between blood albumin level and D-dimer (a marker of intravascular coagulation) and von Willebrand factor (vWF; a marker of endothelial injury) levels or platelet aggregation. Blood levels of albumin, D-dimer, vWF, and C-reactive protein (CRP) and the threshold aggregating concentration (TAC) of ristocetin were measured in 64 continuous ambulatory peritoneal dialysis (CAPD) patients and compared with 36 healthy controls. Twenty-two CAPD patients with albumin levels less than 3.0 g/dL were divided into experimental and disease-control groups. In the experimental group, levels were measured before and after repeated infusions of 20% albumin, 100 mL/d for 7 days. The same parameters were measured in the disease-control group that did not receive the albumin infusion. CAPD patients had higher D-dimer and vWF levels than the healthy controls. There were inverse correlations between albumin and D-dimer (r = -0.48; P < 0.001), vWF (r = -0.29; P < 0.05), or logCRP (r = -0.44; P < 0.001) in CAPD patients. There were positive correlations between logCRP and D-dimer (r = 0.38; P < 0.01) and between logCRP and vWF (r = 0.32; P = 0.01) in CAPD patients. No change was seen in D-dimer, vWF, and CRP levels in either group. The TAC of ristocetin in the 18 CAPD patients was not different from that in the 11 healthy controls (0.55 +/- 0.09 v 0.65 +/- 0.07 mg/mL). There was a correlation between albumin level and TAC in the CAPD patients (r = 0.59; P < 0.01). TAC increased from 0.50 +/- 0.09 to 0.62 +/- 0.13 mg/mL (123% +/- 17%; P < 0.05; n = 6) at the end of the repeated albumin infusions in the experimental group, whereas it did not change in the control group. CRP level did not change in either group. The results of this study indicate that hypoalbuminemia increases platelet aggregability. The observation that the albumin infusion was not associated with changes in D-dimer and vWF despite the inverse correlations suggests that these relationships may be secondary to other factors, such as inflammation.

Abstract

BACKGROUND This study was performed to evaluate the relationship between serum albumin and plasma concentration of haemostatic factors and the effect of raising serum albumin on haemostatic factors synthesized in the liver in CAPD patients. METHODS We measured blood levels of albumin, fibrinogen, factor II, factor VII, protein C, free protein S, plasminogen, alpha2-antiplasmin and antithrombin III in 103 CAPD patients and 30 normal controls. Twenty-two patients with albumin < 3.5 g/dl were divided into two groups. In the experimental group (n = 11), haemostatic factors and albumin were measured before, after repeated infusion of 20% albumin 100 ml three times per week for 2 weeks, and 4 weeks after withdrawal of albumin infusion. The same parameters were measured in the control group (n = 11) which did not receive albumin infusion. C-reactive protein and haematocrit were followed in both groups as an indicator of acute phase reactant and an indirect measure of volume status. RESULTS CAPD patients as a whole had lower albumin and higher fibrinogen and factor VII than normal controls. A significant inverse correlation was present between fibrinogen and albumin (r = -0.27, P < 0.01). Albumin in the experimental group increased from 2.7 +/- 0.4 to 3.5 +/- 0.6 g/l at the end of its repeated infusion and haematocrit decreased from 26.6 +/- 4.4 to 24.9 +/- 5.2%. Fibrinogen and factor VII decreased significantly, even after correction for haematocrit (624 +/- 96 vs 556 +/- 91 mg/dl, 160 +/- 36 vs 121 +/- 44%, P < 0.05). Four weeks after withdrawal of albumin infusion, serum albumin decreased to 2.7 +/- 0.5 g/dl, whereas fibrinogen and factor VII increased to 619 +/- 78 mg/dl and 158 +/- 32%, respectively (P < 0.05). Albumin, haematocrit and haemostatic factors in the control group did not change. CRP was stable during the study period in both groups. CONCLUSION These findings indicate that hypoalbuminaemia is an important trigger factor in the elevation of fibrinogen, and possibly factor VII, in CAPD patients.