Average Bleeding Volume Research Articles

Early prognostic capacity of serum lactate for severe postpartum hemorrhage (SPPH)

Introduction25% of maternal deaths worldwide are due to postpartum hemorrhage (PPH)1. Tissue hypoperfusion causes anaerobic respiration and lactic acid production. Lactate measurement has shown prognostic utility in different clinical conditions as severe sepsis and polytrauma.ObjectiveTo Determine whether the concentration of serum lactate measured at the diagnosis of postpartum hemorrhage indicates the development of severe hemorrhage.Material and MethodologyA prognostic cohort study was carried out including 30 patients in vaginal labor and cesarean section who presented bleeding ≥ 500 ml measured by gravimetric method. A venous blood sample was taken for analysis of serum lactate. Those with a total loss of ≥ 1500 ml at the end of labor were classified with severe bleeding. The relationship between serum lactate elevation and development of severe hemorrhage (SPPH) was analyzed by chi‐square and odds ratio was calculated. The best cut point was determined by Curve‐ROC, and its prognostic capacity was compared with the cut‐off point of 2.2 mmol/l as used in ATLS.ResultsThirty patients were analyzed. General average volume of bleeding: 1260 + 691 ml; in severe group was 1700 + 690 ml and 1100 + 224 ml in non‐severe, p = 0.0004. General average serum lactate: 2.68 + 1.8 mmol/l; in severe group 3.24 + 3 mmol/l vs non‐severe 2.28 + 0.54 mmol/l, p = 0.0120. The cut point that best differentiates the groups was 2.6 mmol/l, OR of 12.50 (1.34–116.8), p = 0.017; sensitivity: 0.71 (0.29–0.96); specificity 0.83 (0.52–0.98) and AUC = 0.74 for severe hemorrhage.ATLS cut point of 2.2 mmol/l had RR of 3.65 (0.57,23.37), OR 6.55 (0.68, 63.33, 0.077 sensibility of 0.92 (0.64, 1.00), specificity of 0.35 (0.14, 0.62) positive predictive value of. 1.43 (0.97, 2.10)Support or Funding InformationConsejo Nacional de Ciencia y Tecnología (CONACYT) COMPARATIVE TABLE Cut points RR OR P VALOR Sensibilidad Especificidad PPV 2.2 3.65 (0.57, 23.37) 6.55 (0.68, 63.33) 0.077 0.92 (0.64, 1.00) 0.35 (0.14, 0.62) 1.43 (0.97, 2.10) 2.6 5.50 (1.46, 20.71) 17.88 (2.73, 116.88) <0.001*** 0.85 (0.55, 0.98) 0.76 (0.50, 0.93) 3.60 (1.48, 8.74) RR: RELATIVE RISK OR: ODDS RATIO PPV: POSITIVE PROGNOSTIC VALUE This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Quick blocking screw insertion in closed reduction and intramedullary nailing for distal tibial meta-physeal fractures

Objective To explore the technique and clinical efficacy of quick blocking screw insertion in closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures. Methods The data of 24 distal tibial metaphyseal fractures were retrospectively analyzed which had been treated with closed reduction and internal fixation with intramedullary nails from October 2013 to December 2014 at Department of Orthopaedics, Zhoukou Central Hospital. They were 17 males and 7 females, with an average age of 39.7 years (from 21 to 60 years). There were 2 open fractures of Gustilo type I. According to AO/OTA classification, 3 cases belonged to type 42-A2, 4 to type 42-A3, 6 to type 42-B1, 2 to type 42-B2, 3 to type 42-B3, 2 to type 42-C1, 3 to type 42-C2, and 1 to type 42-C3. In the internal fixation with in-tramedullary nails, the varus or valgus malalignment of the distal tibia was corrected by manual reduction. According to the fracture type, a 3.0 mm Schanz pin was placed in the concave or convex side of deformity first and then gradually replaced by a 4.5 mm blocking screw to maintain reduction. The operation time, bleeding volume, fracture healing time, and complications (including infection, hardware loosening or breakage, delayed union and nonunion) were recorded. The reduction quality and alignment were evaluated by postoperative X-ray and CT 3D reconstruction. The clinical efficacy was evaluated at the final follow-up based on the Johner-Wruhs criteria. Results The 22 patients were followed up for a mean time of 35.5 months (from 24 to 48 months). The average operation time was 68.3 minutes (from 50 to 85 minutes), and the average bleeding volume was 95 mL (from 60 to 150 mL). One case of delayed union was healed after dynamic treatment. The average healing time was 3.9 months (from 3 to 8.5 months). No infection, hardware loosening or breakage, or malunion was observed. According to the Johner-Wruhs evaluation at the final follow-up, 12 cases were excellent, 10 good and 2 fair, giving an excellent to good rate of 91.7%. Conclusion In the closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures, the varus or valgus malalignment of the distal fragment can be quickly corrected by manual reduction and quick insertion of a blocking screw to gradually replace a preceding Schanz pin. Key words: Tibia; Fracture fixation, internal; Bone nails; Distal tibial metaphyseal fractures

The Effect of Finasteride on Vascular Endothelial Growth Factor (VEGF) Expression in the Prostate Tissue and Bleeding Volume during Trans Urethral Resection of the Prostate (TURP)

This study was evaluated the efficacy of Finasteride as a neoadjuvant therapy in reducing bleeding volume in patients with Benign Prostatic Hyperplasia (BPH) and urinary retention with prostate volume 30–50 mL who underwent Trans Urethral Resection of the Prostate (TURP). The study respondent consisted 26 patients with BPH and urinary retention who planned to undergo TURP. The study sample was randomly split into 2 treatment groups, 13 patients received Finasteride 5 mg once daily for 2 to 4 weeks before the operation and 13 others defined as control group. The therapy efficacy is evaluated by comparing the Haemoglobin pre-post operation difference, bleeding volume, bleeding volume per gram prostate tissue resected and the Vascular Endothelial Growth Factor (VEGF) expression within the prostate tissue. The treatment group indicated difference Haemoglobin between pre and post operation and average bleeding volume has less significant than the control group. The treatment group showed less amount of bleeding volume per gram of prostate tissue resected compare to control group. The treatment group also found significant lower VEGF expression within prostate tissue than the control group. This study demonstrated Neoadjuvant therapy with finasteride 1 x 5 mg for 2 to 4 weeks can reduce the VEGF expression in prostate tissue and reduce bleeding volume due to TURP.

PS01.222: HAS A MEDIASTINOSCOPE-ASSISTED ESOPHAGECTOMY CONTRIBUTE TO CURABILITY AND MINIMAL INVASIVE SURGERY?

Abstract Background In a mediastinoscope-assisted esophagectomy, it is unknown whether it contributes to minimally invasive surgery or curability. We examined the outcome of treatment of a mediastinoscope-assisted esophagectomy performed in our hospital. Methods From June 2014 to October 2017, 31 patients underwent a mediastinoscope-assisted esophagectomy. The examined items were clinicopathological factors, preoperative complications, preoperative treatment, bleeding volume, operation time, postoperative complications, and recurrence. Results There were 29 males, 2 females, and the average age 66 years. As preoperative treatment, 12 nontreatment, 4 chemotherapies, and 15 chemoradiotherapy (CRT) were performed. Preoperative complications were found in 27 cases, among which 13 cases were respiratory complications. The percentage of double cancers was also high, 8 cases with synchronous cancer, and 6 cases with metachronous cancer. Gastric cancer accounted for half in synchronous cancer, and in metachronous lung cancer was 4 cases. The reconstructed organs were 29 cases of stomach tube and 2 cases of colon. The reconstruction route was 17 cases in front of the chest wall and the chest wall anterior route was selected for the case of preoperative CRT significantly. The average bleeding volume was 316 ml, and the average operation time was 560 minutes. Pathological tumor depth T0/1a/1b/2/3 were each 2/11/6/7/4 cases. In the postoperative complications, 12 cases of temporary recurrent nephropathy, 5 cases of anastomotic suture failure, 3 cases of pulmonary complications. There were 6 cases (19.3%) of recurrence. Postoperative recurrence was associated with significant pathological tumor depth. Conclusion A mediastinoscope-assisted esophagectomy decreased postoperative pulmonary complications and there were not many recurrences after surgery. It seemed to contribute to minimally invasive surgery and curability. Disclosure All authors have declared no conflicts of interest.

Robot-assisted transaxillary thyroidectomy: our early experience

Objective:To evaluate the feasibility, effectiveness and safety of robot-assisted transaxillary thyroidectomy (RATT).Method: The clinical data of 66 patients undergoing RATT from November 2016 to May 2018 were prospectively collected and analyzed. The average age was (38.61±11.72) years, 57 cases were female and 9 cases were male. Preoperative fine needle aspiration biopsy revealed papillary thyroid carcinoma in 58 cases and follicular thyroid tumor in 8 cases.Result:All the patients successfully completed RATT, and there was no open operation, in which 54 cases of ipsilateral lobetomy and isthmus resection and ipsilateral central lymph node dissection, 8 cases with ipsilateral lobectomy and contralateral near-total lobectomy, and total thyroidectomy with ipsilateral central lymph node dissection and selective neck dissection combined with retroauricular approach in 4 cases. The mean operative time was (124.30±23.41) min, and the average bleeding volume was (17.73±8.28) ml. The mean diameter of thyroid papillary carcinoma was (0.71±6.22) cm, and the postoperative drainage volume was (67.57±25.11) ml. The average postoperative hospitalization time was (3.24±0.81) days. 3 cases (4.5%) had temporary laryngeal nerve palsy after operation, and 1 case (1.5%) had temporary hypocalcemia after operation, all recovered after one month. No postoperative bleeding, subcutaneous emphysema, drinking water cough and permanent hypocalcemia were observed. The average numbers of lymph node dissection in PTC patients were (6.26±4.76), of which 21 cases (36.2%) had lymph node metastasis, postoperative stage T1 54 cases, T2 4 cases, N1a 17 cases, N1b 4 cases. The follow-up time were 1-18 months. The postoperative cosmetic VAS score in January was (9.66±0.54). Ultrasound showed no residual glands in the affected thyroid gland, and there was no recurrence in the local and regional regions.Conclusion:RATT is safe and feasible with good aesthetic effect and can be used as an option for the treatment of thyroid diseases..

Chitosan Pad, Cellulose Membrane, or Gelatin Sponge for Peridural Bleeding: An Efficacy Study on a Lumbar Laminectomized Rat Model.

Study DesignExperimental study in an animal model.PurposeThis study aims to evaluate the hemostatic properties of four common hemostatic materials including the chitosan clot pad, absorbable gelatin sponge, cellulose membrane, and gauze on peridural bleeding using a rat model.Overview of LiteratureIntraoperative bleeding during spinal surgery can lead to morbidities. Hemostatic materials have been developed, but the efficacy of these materials on peridural bleeding remains unclear.MethodsForty 8-week-old Sprague-Dawley rats were used in this study. Under adequate anesthesia, each rat was posteriorly dissected to their L5 and L6 spinous processes. Bleeding from muscles and soft tissue dissections was stopped before lumbar bone cutting. Immediately after the L5–L6 laminae were cut and removed, the rats were randomly allocated to receive one of the abovementioned hemostatic materials. All hemostatic materials were placed over the raw surface of cut bone and dura and changed every 60 seconds. The procedure was stopped when there was no further bleeding. Time to staunching and amount of bleeding were recorded for statistical analysis.ResultsThe respective mean±standard deviation hemorrhage volume and time for the cellulose membrane, gelatin sponge, chitosan pad, and gauze were 1.19±0.44, 1.03±0.72, 0.96±0.57, and 1.98±0.62 mL, respectively, and 2.9±0.6, 2.1±0.6, 1.7±0.5, and 2.9±1.0 minutes, respectively. The overall bleeding volumes for the cellulose membrane, gelatin sponge, and chitosan pad were significantly lower than the overall bleeding volume for gauze.ConclusionsChitosan clot pads, gelatin sponges, and cellulose membranes have better hemostatic properties than gauze. The chitosan pad had the lowest average bleeding volume, followed by gelatin sponge and cellulose membrane.

Effects of radiofrequency ablation assisted partial hepatectomy in the treatment of primary liver cancer

Objective: To investigate the effects of radiofrequency ablation assisted partial hepatectomy in the treatment of primary liver cancer. Methods: A total of 60 patients with primary liver cancer treated in our hospital from March 2013 to October 2015 were selected as study subjects and were divided into the control group and the study group by the random number table method, 30 cases in each group. The control group were treated with partial hepatectomy. On the basis, the study group were treated with radiofrequency ablation. The operation associated indexes (operation time, the average wound bleeding volume, postoperative length of hospital stay), preoperative and postoperative liver function indexes [alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST)], the incidence of complications and recurrence rates in the two groups were observed. Results: The operation time and postoperative length of hospital stay of the study group were significantly shorter than those of the control group, and the average bleeding volume was significantly less than that of the control group (P < 0.05). There was no significant difference in ALT, TBiL and AST between the two groups before operation(P>0.05). After operation, ALT, TBiL and AST in the two groups were significantly lower than those before operation, and the changes in the study group were greater than those in the control group (P < 0.05). The incidence of postoperative complications and the recurrence rate in 1 year after operation were significantly  lower than those in the control group (P < 0.05). Conclusion: Radiofrequency ablation has obvious positive effect in patients with primary liver cancer undergoing partial hepatectomy. It has advantages of little bleeding, short rehabilitation time, protecting liver function, few postoperative complications and low recurrence rate.

Evaluation of anticoagulant therapy after cerebral hemorrhage combined with deep vein thrombosis of lower extremity

Objective To evaluate the efficacy and safety of anticoagulant therapy with low-molecular-weight heparin after cerebral hemorrhage combined with deep vein thrombosis of lower extremity. Methods One hundred and fifty-three cases of deep vein thrombosis of lower extremity after intracerebral hemorrhage were collected of Beijing Tiantan Hospital, Capital Medical University from June 2014 to June 2016. According to whether accepted anticoagulant therapy with low-molecular-weight heparin, the patients were divided into treatment group (n=79) and control group(n=74). Compared the head CT images and the ultrasound of lower extremity venous in the day when admissed to hospital and in the 7th day after treatment. The measurement data was adopted by t test, Chi-square test was adopted in the count data. Results Before the low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.38±0.45) ml for the anticoagulant therapy group. After 7 days of low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.01±0.54) ml, there was no increasing cerebral hemorrhage, with a statistically significant difference(P=0.000). The bleeding volume in intracerebral was(1.47±0.47) ml of control group cases, and after 7 days it became (1.17±0.52) ml, with a statistically significant difference (P=0.000), all these showed that cerebral hemorrhage had significantly absorbed. There was no statistically significant difference between the treatment group and the control group (P=0.123). It explained that anticoagulation was not increased intracranial hemorrhage with low-molecular-weight heparin. ultrasound showed that the lower extremity venous thrombosis was stable or decreased before and after anticoagulant therapy, and the difference was statistically significant (P=0.000), indicating that the anticoagulant therapy was effective. Conclusions It is safe and effective in low-molecular-weight heparin anticoagulant therapy for deep vein thrombosis of lower extremity after intracerebral hemorrhage. But patients need strict screening, and follow the individualized treatment. Key words: Cerebral hemorrhage; Venous thrombosis; Heparin, low-molecular-weight; Anticoagulants

Minimally Invasive Cholecystolithotomy to Treat Cholecystolithiasis in Children: A Single-center Experience With 23 Cases.

Minimally invasive cholecystolithotomy is recently popularized treatment that may offer advantages over laparoscopic cholecystectomy, especially in China. However, there are few reports concerning the use of this technique in the pediatric population. This report describes our initial experience with minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy to treat cholecystolithiasis in children. A retrospective review of 23 pediatric patients with cholecystolithiasis who underwent minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy from January 2009 to December 2015 was performed. The operations were successful in all 23 cases. None required conversion to conventional laparoscopic cholecystectomy. The average operative time was 68 minutes (range, 45 to 97 min). The average bleeding volume during surgery was 30 mL (range, 10 to 55 mL). The average length of hospital stay was 5.2 days (range, 3 to 7 d). There were no perioperative complications. All patients were followed for 9 to 12 months without any obvious gastrointestinal symptoms. None had a recurrence of stones in the gall bladder. Minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy is a safe and viable technique that may be used successfully in pediatric surgery.

Temporary internal iliac artery balloon occlusion in cesarean section for patients with pernicious placenta previa

Clinical data of 12 patients with pernicious placenta previa admitted in our hospital from October 2015 to July 2016 were retrospectively reviewed. Bilateral internal ilia artery balloons were placed percutaneously before cesarean section. After cesarean delivery normal saline was applied to fill the balloon for temporary occlusion of bilateral iliac arteries, then placental separation and hysterorrhaphy were performed. The average volume of bleeding during cesarean section was 1 146 ml. There were no hysterectomy, pelvic organ necrosis, lower limb artery thromosis and other complications. The application of temporary internal iliac artery balloon occlusion can significantly reduce the intraoperative bleeding in cesarean section for patients with pernicious placenta previa. It provides a clear operational field for obstetricians to perform the placental separation and hysterorrhaphy, facilitating the uterine reservation. Key words: Placenta previa; Ultrasonography, interventional; Balloon occlusion; Iliac artery

Endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity

Objective To analyze the clinical efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity and summarize the experiencein order to achieve better results. Methods From January 2014 to June 2015, 45 patients (52 limbs, including 17 males and 28 females, aged 36 to 68 years) diagnosed as great saphenous varicosity received endovenous laser treatment combined with transilluminated powered phlebectomy. Thirty-eight cases was unilateral great saphenous varicose veins, 7 cases was bilateral large saphenous varicose veins. The clinical efficacy was analyzed. Results All cases were performed successfully. The mean operation time was (68.4±15.1) minutes, the average bleeding volume was (23.5±10.7) ml, the number of mean operative incision quantity was (5.8±1.9)and the average hospitalization time was (5.9±1.6) days. All patients had no serious complications. During a mean follow- up time of 22 months (12 to 30 months), only one patient recurred. Conclusions Endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective and safe. It also has the advantages of shorter operation time, less bleeding, shorter hospitalization time, small trauma and better cosmetic results. Key words: Varicose veins; Saphenous vein; Lasers; Transilluminated powered phlebectomy; Treatment outcome

Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities.

The risk of neurological injury during vertebral column resection is high. In this study, we investigated the incidence and risk factors for neurological complications when treating spinal deformities by thoracic posterior vertebral column resection (PVCR). Between 2008 and 2013, there were 62 consecutive patients (34 female patients and 28 male; the mean age: 16.3years, range 6-46years) treated with thoracic PVCR. We retrospectively reviewed the clinical records to obtain demographic and radiographic data, operative time, estimated blood loss (EBL, the ratio between circulating and lost blood), bleeding volume (the lost blood), number of vertebrae fused, number of vertebrae resected, usage of titanium mesh cage, and intraoperative neuromonitoring data. Multi-factor logistic regression was used to find the major risk factors for neurological complications. The average follow-up period was 46months (range 24-88months); no patients were lost to follow up. The average operative time was 524.8±156.8min (range 165.0-880.0min), the average bleeding volume was 2585±2210ml (100-9600ml), and the average estimated blood loss was 75.8% (9-278%). Ten patients (16.1%) developed post-operative neurological complications (nine transient and one permanent). Multi-factor logistic regression revealed that the risk factors for neurological complications were age ≥18years, pulmonary dysfunction, and EBL >50%. Thoracic PVCR can lead to satisfactory outcomes in the treatment of severe spinal deformities. Risk factors for neurological complications include the age over 18years, presence of pulmonary dysfunction, and EBL greater than 50%. The pulmonary dysfunction can be regarded as the most valuable indicator to measure the severity of the spine deformity.

Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma

BackgroundSpleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. MethodsAfter making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. ResultsThe mean operation times in control and interventional group were 21 and 12 min respectively (p < 0.05). The average volume of bleeding in control group during open splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p < 0.05) using the Ligasure system. Post-operative complications such as bleeding were non-existent in both groups. ConclusionThe application of Ligasure™ in blunt abdominal trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures.

Comparison of General and Spinal Anesthesia on Maternal Hemoglobin Changes After Caesarean Section

Introduction Obstetrical hemorrhage belongs to main global causes of morbidity and mortality (1). This is prominent in developing countries and WHO estimates 585,000 maternal deaths per year among which 25% is directed by partum hemorrhage (2). The average volume of bleeding is supposed to be aro

Clinical effect and perioperative nursing of holmium laser lithotripsy under ureteroscope in the treatment of isolated kidney stones

Objective To study the clinical effect and perioperative nursing of holmium laser lithotripsy under ureteroscope (PCUL) in the treatment of isolated kidney stones. Methods A total of 32 patients with isolated kidney stones were selected and their calculus were removed by using PCUL and meticulous perioperative nursing. Operation time, bleeding volume and stone clearance rate were observed; renal function changes before and 2 weeks after surgery were compared; anxiety and depression psychological state and pain before and after nursing were assessed; adverse events before and after nursing were recorded. Results The mean operative time was (89.7±2.18) min; average bleeding volume was (22.8±0.95) mL; totally 30 patients with stone clearance and the clearance rate was 93.75%; The levels of blood urea nitrogen (BUN) and serum creatinine (Scr) were significantly reduced 2 weeks after surgery (P<0.01); Creatinine (Ccr) rate was decreased slightly; The scores of anxiety, depression and pain were significantly reduced after nursing (P<0.01). The cases of hematuria, back pain, bladder irritation and infections were significantly reduced. Conclusions PCUL is safe and effective for the treatment of isolated kidney stones with high stone clearance rate, and combined with meticulous perioperative nursing can significantly improve patients′ anxiety and depression; reduce the incidence of postoperative complications and adverse events, and promote early recovery. It′s worthy of clinical use. Key words: Perioperative nursing; PCUL; Isolated kidney stones

Modern diagnostics and complex treatment of hemorrhagic disorders in children with “cyanotic” congenital heart disease

The aim. To study the frequency and volume of postoperative bleeding in children operated with “cyanotic” CHD and to estimate efficacy of modern methods of diagnosis hemorrhagic disorders in the perioperative period.Materials and Methods. It was studied a group of children with “cyanotic” CHD, which applied standard methods of diagnosis of hemostasis and a group of patients in whom correction of hemostasis was performed under the supervision low-frequency vibration of the piezoelectric thromboelastography (LVPT). Results. The study found that intraoperative period at the end of the studied groups were observed hypocoagulation phenomenon, as evidenced by a significant decrease prothrombin ratio and prothrombin time in the first group and a significant decrease ICT, TBC, ICD, ICP, TIC in the second group compared to a group of healthy children. The volume and speed of blood loss was not significantly different in both groups. The frequency of bleeding, which exceeded 3 ml/kg/hour the first group was 16.6%, in the second - 10%.Conclusions. Despite not what the average volume and rate of bleeding between the groups was not significantly different, tactics differentiated treatment that was used in the second group through modern methods of diagnosis, can reduce the volume and number of medications and to avoid possible drug polypharmacy.

Effects evaluation of rapid response first-aid case on bedside emergency endoscopic hemostasis therapy

Objective To explore the effects of rapid response first-aid case on bedside emergency gastroscopy hemostatic treatment. Methods A total of 52 patients with esophageal-fundal varices in liver cirrhosis from January 2014 to June 2015 were divided into control group (n=25) and experimental group (n=27). The patients of control group received the routine nursing; then we summarized the experience and mistakes of operation cooperation, optimized process; next we designed rapid response first-aid case and used in the experimental group. The blood transfusion time, goods preparation time, blood loss, blood transfusion volume were compared in two groups. Results The data of the experimental group in average bleeding to transfusion time (90.22±36.47)min, materials preparation time (14.66±3.48) min, the average amount of bleeding (369.62±158.90) ml, average blood transfusion amount (322.40±117.82) ml were lower than those of the control group [average bleeding to blood transfusion time (123.60±51.87) min, materials preparation time (22.44±2.59) min, average bleeding volume (660.20±181.82) ml, average blood transfusion amount (458.00±140.63)ml](P<0.05). Conclusions The implementation of rapid response first-aid case can effectively shorten the rescue time, reduce bleeding and blood transfusion time, the blood loss, the wastage of human resources and medical resources, improve the efficiency of nursing work in the department and the success rate of rescue. Key words: First aid; Endoscopy; Hemostasis; Rapid response first-aid case

Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement

ObjectiveTo evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Materials and methodsProspective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. ResultsNo drop-outs were recorded during follow-up. There were no significant differences between groups as regard the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48h postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. ConclusionsIntravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualised, its use justified in the patient medical records, and informed consent is mandatory.

Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla

ObjectiveTo evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Materials and methodsProspective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. ResultsNo drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. ConclusionsIntravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory.

Effectiveness comparison between cervical plate internal fixation and Zero profile interboby fixation system for the treatment of cervical spondylotic myelopathy

Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system(Zero-P) in the treatment of cervical spondylotic myelopathy. Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study. All patients were randomly divided into two groups, respectively using plate fixation(screw plate system group, 26 cases) and Zero-P(Zero-P group, 21 cases). Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing. Evaluated the Japanese Orthopaedic Association(JOA) score of nerve function and calculated improvement rate; measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications. Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups. The average bleeding volume was 78.1±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group; the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zero-P group, no significant difference was found. 5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group. Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91%±7.9%, and Zero-P group was 14.32±2.87, the improvement rate was 69.79%±11.2%, there were no significant difference; curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up; Zero-P group was 18.1°±7.9°, which with significant difference. Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period. Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion; Treatment outcome