Drop In Hemoglobin Level Research Articles

Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?

The use of tourniquet in total knee arthroplasty (TKA) has resulted in negligible intra-operative blood loss but notable post-operative blood loss, creating the ideal scenario for using topical haemostatic agents intra-operatively. Recently, medical adjuvants including tranexamic acid (TXA) and hydrogen peroxide (H2O2) have been introduced. The aim of this study was to evaluate the effectiveness of intra-articular TXA and H2O2 in reducing blood loss during TKA. Fifty patients, who underwent a primary TKA with 1,500 mg of intra-articular TXA between May 2011 and December 2011, were compared with two matching cohorts of 50 patients each who underwent TKA with 100 ml of 3 % H2O2 wash and TKA without any TXA or H2O2. All surgeries were performed by two senior surgeons. The total blood loss was calculated by the hemoglobin balance method. The pre-operative serum hemoglobin levels were 13.1 ± 1.3, 13.1 ± 1.3 and 13.0 ± 1.2 g/dl (p > 0.05); while the drop in serum hemoglobin levels post-operatively was 2.0 ± 0.7, 2.4 ± 0.9 and 2.7 ± 0.8 g/dl for the TXA, H2O2 and Control groups, respectively (p < 0.001). The total amount of blood loss was 596 ± 449, 710 ± 279 and 760 ± 228 ml, respectively (p = 0.046). There was no difference in the duration of surgery between the three groups (p > 0.05). This study showed that intra-articular TXA reduced blood loss during TKA without significantly increasing the duration of surgery. We cannot justify H2O2 wash as an alternative to intra-articular TXA to reduce blood loss during TKA.

Mastectomy Blood Loss: Can We Predict the Need for Blood Transfusion?

Background: Bleeding during total mastectomy and axillary clearance is inevitable, and blood transfusion is often required when bleeding is excessive. Objectives: To predict the probability of transfusion, we tested the hypothesis: “The blood loss during total mastectomy and axillary clearance in Accra is related to the stage of the disease and the size of the breast”. Design: Patients undergoing total mastectomy and axillary clearance were prospectively studied from June 2008 to June 2011. The breast and used swabs were weighed immediately after surgery, and patients’ full blood count was checked before and after surgery. Setting: Surgical wards and theatres of the Korle Bu Teaching Hospital, Accra. Results: There were 80 women, aged 31 to 85 (Mean 50, SD 3.4) years, with body mass index between 20 and 46 (mean 23.7, median 28). Fifty one (63.8%) had Stage 3 disease, and 47 (58.8%) required neoadjuvant chemotherapy. Pre-operative haemoglobin was 9.5 g/dl to 14.9g/dl (mean 11.6 g/dl, SD 1.1). Post-operative haemoglobin was 9.2 g/dl - 13.4 g/dl (mean 10.9, SD 0.97). The mean drop in haemoglobin level was 0.75 g/dl. None of the 80 patients received blood transfusion. There was a linear increase in breast weight with increasing BMI. Blood loss ranged from 95 g to 1185 g, with majority (59; 73.8%) losing between 100 and 400 gram blood. Only 2 patients (2.5%) lost more than 1000 g of blood. Less than 400 g of blood was lost with breast weights below 2 kg. Above that, blood loss increased to more significant volumes. Conclusions: Blood loss during total mastectomy and axillary clearance in Accra was directly related to the size of the breast. There was, however, inconclusive association between tumour stage and blood loss.

Bipolar versus monopolar transurethral prostate resection: Comparison of hemodynamic and biochemical changes

Background and aimTransurethral resection of the prostate (TURP) is the standard procedure for treatment of benign prostatic hyperplasia which is the most common non-malignant disorder of the prostate, affecting over 50% of the elderly male population. This randomized study was done to compare the effect of bipolar cautery using saline with monopolar cautery using glycine regarding hemodynamic and biochemical changes in TURP.MethodsAfter approval from the ethical committee in Kasr Al Ainy university hospital, fifty consenting ASA II and III male patients scheduled for TURP were randomly allocated into two equal groups. Monopolar group had TURP performed with monopolar cautery using 1.5% glycine and bipolar group had it done using bipolar cautery with 0.9% saline. Spinal anesthesia was used. Hemodynamic data (mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), and oxygen saturation (SPO2)) were recorded preoperatively and postoperatively. Hemoglobin (Hb) and biochemical laboratory findings (Na+, ABG) were recorded pre- and postoperatively. Volume of irrigant was recorded by the end of surgery.ResultsNo significant difference in patients’ age or size of the prostate was present. Duration of surgery in bipolar group was longer (p-value 0.003). Preoperatively there was no significant difference in the hemodynamic variables, SPO2, CVP, biochemical markers and hemoglobin. Postoperatively, the mean HR was significantly higher in bipolar group, p-value 0.006. Also, MAP in bipolar group was higher, and p-value was 0.001. Postoperatively, the mean serum Na+ level and mean Hb were significantly lower in monopolar group, p-value 0.002 and 0.013 respectively. Although there was no significant difference in both SPO2 and CVP of both groups postoperatively, the increase in CVP in monopolar group was significantly higher.ConclusionsBipolar TURP causes less drop in serum sodium and hemoglobin level and less fluid overload than monopolar TURP. However, it takes longer resection time.

Impact Of Prognostically Detrimental Mutations (ASXL1, EZH2, SRSF2, IDH1/2) On Outcomes In Patients With Myelofibrosis Treated With Ruxolitinib In COMFORT-II

Impact Of Prognostically Detrimental Mutations (ASXL1, EZH2, SRSF2, IDH1/2) On Outcomes In Patients With Myelofibrosis Treated With Ruxolitinib In COMFORT-II

Genetic Polymorphisms In Candidate Genes Predict Increased Toxicity With Methotrexate Therapy In Children With Acute Lymphoblastic Leukemia In Lebanon

BackgroundAcute Lymphoblastic Leukemia (ALL) is the most common cancer in childhood accounting for almost 30% of pediatric cancer cases in Lebanon. Polymorphisms in genes involved in methotrexate (MTX) metabolism have been associated with toxicity but with controversial results. The aim of this study was to analyze polymorphisms in genes involved in MTX metabolism including ABCB1 (or MDR1), ABCC2, SLC19-A (or RFC19),SLCO1B1; and MTX effect mainly MTHFR and TYMS; as well as measure the frequency of polymorphisms in TPMT involved in 6MP detoxification; and to assess whether these polymorphisms are predictors of treatment toxicity and/or MTX clearance. MethodsThis is a retrospective cohort study whereby all patients (pts) diagnosed with ALL and followed up and treated at the AUB CCCL as per the St. Jude TOTAL XV protocol between 2009 and 2012 were recruited. The study was approved by the IRB. Informed consents were obtained. Medical records were reviewed for baseline data at the time of diagnosis and treatment and toxicity details during the consolidation and continuation phase. Whole peripheral blood for DNA was collected after completion of the induction phase and documentation of remission.Genotyping was performed using real time PCR or RFLP. MTX levels were measured by a polarization fluorescence assay from Roche (Basel, Switzerland). MTX clearance was estimated based on all available MTX levels measured after HDMTX treatment during consolidation phase, using 2-compartmental linear pharmacokinetic model with 2 doses (10% of the total dose infused in the first hour and 90% infused in the next 23 hours) via WinNonlin software version 6.3 (Pharsight Corporation, St. Louis, USA). Data were analyzes using SPSS version 19. ResultsThis study included 127 ALL pts. Table 1 shows the genotype frequencies that were all in Hardy Weinberg Equilibrium and similar to Caucasian populations.During the consolidation phase, a statistically significant association was found among neutropenia (ANC<300) and variant allele carriers of ABCB1 rs1045642 (OR=5.174; 95% CI: 1.674-15.989) and ABCB1 rs1128503 (OR=3.364; 95% CI: 1.257-9.004) respectively. ABCC2 rs717620 variant allele carriers needed significantly more prolonged time to reach a MTX level below 0.1µM. (Beta=5.122; 95% CI: 1.412-8.831). In addition, a clinically significant association was shown between MTHFRrs1801133 variant allele carriers and drop in hemoglobin levels (OR=3.057; 95% CI: 1.217, 7.680). No statistically significant associations were found with MTX clearance estimates.During continuation phase, a statistically significant association was shown between ABCC2 rs717620 and TYMS 28 bp tandem repeats variant allele carriers with the need to decrease the weekly doses of methotrexate in order to maintain an ANC> 300 and be able to administer weekly chemotherapy (Beta=-5.770 95% CI: -10.138; -1.403 and Beta=-5.770; 95% CI: -10.138; -1.403) respectively. There was a close to significant association between ABCB1 rs1128503 variant allele carriers and development of febrile neutropenia P=0.046 but this was lost with regression analysis (OR=3.937; 95% CI: 0.847-18.309). The three pts with TPMT (*1/*3A) developed severe anemia and neutropenia necessitating a decrease in their chemotherapy doses. ConclusionsPolymorphisms in ABCB1, ABCC2, and MTHFR were associated with increased toxicity during consolidation phase whereas polymorphisms in ABCC2 and TYMSwere associated with increased toxicity during the continuation phase of ALL therapy in Lebanese children. Genotyping for these polymorphisms may be helpful in identifying pts at risk of increased MTX toxicity and the need for dose optimization before treatment initiation. Disclosures:Abboud:Novartis: Honoraria; Sangart: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Hemaquest: Research Funding.

Haemophilic arthropathy: Long-term outcomes in 107 primary total knee arthroplasties

BackgroundArthropathy of the knee is a frequent complication in patients with severe bleeding disorders leading to considerable pain and disability. Total knee arthroplasty (TKA) provides marked pain relief. However, a modest functional outcome and a high number of complications due to prosthetic infection and loosening are reported. Data on long-term outcomes are scarce, and most case series include few patients. We have studied clinical outcomes and complications of TKAs with special emphasis on prosthetic survival and periprosthetic infection. MethodsA consecutive series of 107 TKAs in 74 patients with haemophilic arthropathy were retrospectively reviewed. Follow-up was mean 11.2years (range 0.8–33.1years). ResultsFive- and 10-year survival rates, with component removal for any reason as the end point, were 92% and 88%, respectively. Twenty-eight TKAs were removed after median 10years (range 0.8–28years). The most common cause of failure was aseptic loosening (14 knees) and periprosthetic infection (seven knees). The overall infection rate was 6.5%. The mean postoperative drop in haemoglobin levels was 4.3g/dL (range 0.5–9.4) with a significant difference between haemophilia A patients with and without inhibitor (6.3g/dL (range 3.6–9.4) versus 3.7g/dL (range 0.5–8.1) (p<0.001). A painless knee was reported in 93% of the TKAs at the latest follow-up. ConclusionsThe medium and long-term results of primary TKA in a large haemophilic population show good prosthetic survival at five and 10years with an excellent relief of pain. Periprosthetic infection is still a major concern compared to the non-haemophilic population. Level of evidenceLevel IV.

Low vacuum re-infusion drains after total knee arthroplasty: is there a real benefit?

Low vacuum re-infusion drains after total knee arthroplasty: is there a real benefit?

A Randomized Trial Comparing Diode Laser Enucleation of the Prostate with Plasmakinetic Enucleation and Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia

We compared the safety and efficacy of diode laser enucleation of the prostate (DiLEP) with plasmakinetic enucleation and resection of the prostate (PKERP). A total of 80 patients with bladder outflow obstruction from benign prostatic hyperplasia (BPH) were randomly assigned to either DiLEP or PKERP prospectively. All patients were assessed preoperatively and followed up at 3, 6, and 12 months postoperatively. Baseline characteristics of the patients, perioperative data, and postoperative outcomes were compared. The operative data and perioperative and postoperative complications were also recorded. The preoperative data were comparable between the two groups. The DiLEP group had significantly shorter operative time, postoperative irrigation, time and catheterization time than the PKERP group (P=0.000, P=0.000 and P=0.000). The drop in hemoglobin level was statistically significantly less in the DiLEP group (P=0.002). There were no statistical differences in complications between the two groups except irritative symptoms (P=0.018). At the 3, 6, and 12-month follow-up, no statistically significant differences were observed between the two groups in International Prostate Symptom Score, maximum flow rate, quality of life, postvoid residual, prostate volume, and prostate-specific antigen level (P>0.05). The efficacy of DiLEP and PKERP were similar for relieving obstruction and low urinary tract symptoms. DiLEP provides less risk of hemorrhage, reduced bladder irrigation, and catheter times. The downward morcellation technique is more efficient than the resection technique. Future well designed randomized trials with extended follow-up and larger sample sizes may be needed to better verify the advantage of DiLEP in treating patients with symptomatic BPH.

Ruptured Cryptogenic Mycotic Abdominal Aortic Aneurysm by Salmonella enteritidis

The aim of this study is to describe a case of ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis (SE) and present a comprehensive review of the literature. A 66-year-old man with a past medical history of coronary artery bypass graft (CABG) and polymylagia rheumatica (PMR) presented with a 2-day history of right-flank-to-groin pain and fever. He was found to have tenderness on the right of the umbilical region and laboratory data showed leukocytosis, raised C-reactive protein, and a significant drop in hemoglobin level as compared with his first visit 17 days earlier, with no hemodynamic instability. An immediate computed tomography angiogram (CTA) was performed, which showed a 4-cm, fusiform, ruptured infrarenal aortic aneurysm. Exploratory laparatomy was performed and the aorta was isolated and excised from the infrarenal level to the common iliac bificuration. A straight silver Dacron graft soaked in rifampicin was placed with an end-to-end anastomosis. The excised aorta and the lymph nodes were sent for histologic and microbiologic assessment. Blood culture and specimen microbiology grew Salmonella enteritidis (SE). The histology exhibited atherosclerosis at the rupture point with decreasing neutrophil deposition from the intima to the adventitia layer, respectively. Infrarenal abdominal mycotic aneurysm (MA) by SE was observed and showed vague, nonspecific signs and symptoms. We recommend a high index of suspicion and low threshold for use of CT imaging in any infected patient of age >60 years with fever and abdominal pain on a background of diabetes and connective tissue disease. A comprehensive review of the literature was performed due to a lack of consensus on the best surgical treatment and limited information on the path of SE-induced aortitis or MA from presentation to final outcome.

Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial

Objective: Cesarean section is associated with more blood loss than vaginal delivery. This could increase the risk of morbidity and mortality especially among anemic women. The objective of the trial is to assess the possible effect of tranexamic acid on blood loss during and after elective cesarean section.Methods: We conducted a randomized controlled trial at Women's Health Hospital, Assiut University, Assiut, Egypt. All pregnant women with singleton fetus planned to have elective cesarean section at ≥37 wks gestation were randomized to receive 1 g tranexamic acid slowly intravenously over 10 min before elective cesarean section group or not. Blood loss was measured during and for two hours after operation. Any side effects, complications, medications, changes in vital signs and duration of hospital stay were recorded. This study is registered, number ACTRN12612000313831.Results: Seven hundred and forty women were randomized (373 in study group and 367 in control group). Mean total blood loss was 241.6 (SE 6.77) ml in the tranexamic acid group versus 510 (SE 7.72) ml in the control group. The mean drop in hematocrit and hemoglobin levels were statistically significantly lower in the tranexamic acid group than in the control group. There were no statistically or clinically significant differences in other outcomes.Conclusions: Pre-operative use of tranexamic acid is associated with reduced blood loss during and after elective cesarean section. This could be of benefit for anemic women or those who refuse blood transfusion.

Blood Loss and the Need for Transfusion after Shoulder Surface Replacement

Background Studies on stemmed primary shoulder arthroplasty have shown transfusion rates of up to 38%. The present study aimed to evaluate blood loss and the need for blood transfusion after primary humeral and total shoulder surface replacement. Materials and methods Patients undergoing both primary humeral head ( n = 20) and total shoulder ( n = 63) resurfacing were included. The mean drop in haemoglobin levels on the first postoperative day and the need for transfusion were recorded and analyzed against the patient's age, sex, body mass index, American Society of Anesthesiologists grade, type of surgery performed, pre-operative haemoglobin and the use of tranexamic acid. Results Only one patient in the entire series (1.2%) required blood transfusion postoperatively, following total shoulder resurfacing. There were statistically significant differences between the two groups with respect to estimated blood loss ( p = 0.005), duration of surgery ( p &lt; 0.0005) and haemoglobin drop ( p &lt; 0.0005), all in favour of the humeral head resurfacing group. The type of surgery was the only independent factor significantly affecting the reduction of haemoglobin levels postoperatively ( p &lt; 0.0005). Conclusions Surface replacement of the shoulder appears to be associated with reduced blood loss, leading to a very low need for blood transfusion.

Massive haemorrhage from the internal iliac artery following a low energy superior pubic ramus fracture in a 73-year-old man.

We report a case of a 73-year-old man with a background of aspirin use who fell and sustained a minimally displaced right superior pubic ramus fracture. He subsequently developed hypotension that necessitated fluid resuscitation, associated with a significant drop in blood haemoglobin levels that required a packed red blood cell transfusion. CT scans revealed the presence of two pelvic haematomas, with ongoing bleeding. An angiogram demonstrated bleeding from the superior vesical branch of the anterior division of the right internal iliac artery, which was successfully embolised with gelfoam slurry. The patient recovered uneventfully thereafter. This is a unique case involving an unexpected injury to the superior vesical branch of the anterior division of the internal iliac artery following low energy trauma to an elderly man. We recommend that patients who develop hypotension following a seemingly-benign isolated pubic ramus fracture be evaluated for concomitant arterial injuries with the relevant CT imaging and angiography.

A rare case of leaking thoracic aortic aneurysm in a patient with massive pulmonary embolism

AbstractThe aim of this study was to report a rare case of a leaking thoracic aorta aneurysm in a female patient with massive pulmonary embolism. A 70-year-old woman with hypertension who had suffered a cerebral vascular accident 2 years ago presented with urinary tract infection, dehydration, and anemia. While in hospital, she was diagnosed with pulmonary embolism, and anticoagulation therapy was started using heparin. As the tachycardia persisted with a further drop in hemoglobin levels, and because a new left-sided pleural effusion was revealed on chest radiograph, a chest CT with a CT angiography was performed. It revealed a large leaking aneurysm of the descending thoracic aorta. This was treated by inserting an endovascular stent. This rare case shows the importance of investigating for other serious coexistent causes of tachycardia in patients with pulmonary embolism during treatment.

Parenchymal Thickness: Does It Have an Impact on Outcomes of Percutaneous Nephrolithotomy?

Objective: To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). Methods: We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. Results: The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m². The mean stone burden was 293 ± 126 (150-800 mm²). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). Conclusion: The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.

Continuing Aspirin Causes Higher Drainage Even under Full Protection with Antifibrinolytics

The purpose of this study was to assess the impact of continuation of aspirin on bleeding complications following coronary artery bypass grafting (CABG) surgery operated by a single surgeon. A total of 109 patients underwent isolated, primary, on-pump surgery performed over a 17-month period. These patients were divided into two groups: group 1 (n = 51) received aspirin (81 mg daily) to within 7 days of surgery and group 2 (n = 58) in which aspirin was discontinued > 7 days before surgery. All patients received antifibrinolytic agents. Both groups had identical preoperative characteristics. The aspirin group had significant more drainage and consumed more blood products than the nonaspirin group during the first 12 postoperative hours. However, both groups were similar in terms of: (1) re-exploration rate, (2) requirements for blood transfusion, (3) drop in hemoglobin levels and platelet counts, and (4) length of intensive care unit and hospital stay. Continuing aspirin before CABG is associated with increased blood loss even when used in small doses and under full cover of antifibrinolytic agents. However, this blood loss is not harmful and does not negatively affect the patient's clinical progress.

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. women in the carbetocin group (group A) received a bolus of 100 μg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% Na-Cl solution IV (150 mL/hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

Sudden Onset Abdominal Wall Swellings in Patient of Liver Cirrhosis

Spontaneous hematomas in cirrhotic patients are uncommon. Severe coagulopathy in advanced hepatic disease is characterized by both coagulation factor deficiencies and accelerated fibrinolysis. Hyperfibrinolysis in cirrhosis is a result of excess fibrin breakdown leading to defective hemostasis. We present a case of spontaneous hematomas with an acute drop in hemoglobin level, in a patient with cirrhosis which was due to primary hyperfibrinolysis.

Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies

To evaluate hematological toxicity after robotic stereotactic body radiosurgery (SBRT) for treatment of women with metastatic abdominopelvic gynecologic malignancies. A total of 61 women with stage IV gynecologic malignancies treated with abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3 divided consecutive daily doses) delivered by a robotic-armed Cyberknife SBRT system. Abdominopelvic bone marrow was identified using computed tomography-guided contouring. Fatigue and hematologic toxicities were graded by retrospective assignment of common toxicity criteria for adverse events (version 4.0). Bone marrow volume receiving 1000 cGy (V10) was tested for association with post-therapy (median 32 days [25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin levels, and platelet counts as marrow toxicity surrogates. In all, 61 women undergoing abdominopelvic SBRT had a median bone marrow V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for metastatic disease. Bone marrow V10 did not associate with hematological adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue symptoms were self-reported among the 61 women within the first 10 days post-therapy, with fatigue resolved spontaneously in all 17 women by 30 days post-therapy. Neutropenia was not observed. Three (5%) women had a grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2, and 3 thrombocytopenias were documented in 3 women. Abdominopelvic SBRT provided ablative radiation dose to cancer targets without increased bone marrow toxicity. Abdominopelvic SBRT for metastatic gynecologic malignancies warrants further study.

Unicompartmental Knee Arthroplasties Revised to Total Knee Arthroplasties Compared With Primary Total Knee Arthroplasties

We studied the technical operative features and the subjective outcomes of 63 patients requiring a revision to a total knee arthroplasty (TKA) for failed Oxford medial unicompartmental knee arthroplasty. We compared this revision study group to a contemporary control cohort of 126 patients who underwent primary TKAs. The 2 groups from the same institution had a minimum follow-up of 2 years and were retrospectively matched 1:2 for age, sex, body mass index, and follow-up time. Length of stay and hemoglobin level drop were similar. Technically, the revision group required larger polyethylene inserts (P < .001) and longer tourniquet times (P < .001) with 15 of these patients needing augments, grafts, and/or stems. Subjectively, the revision group's mean total Western Ontario and McMaster Universities Arthritis Index score was 25.8 ± 20.2, thus less satisfactory compared with the control group (19.8 ± 15.3) at a mean follow-up of 3.1 years (P = .03). A revision unicompartmental knee arthroplasty to TKA is technically more difficult and functionally less satisfactory at last follow-up when compared with a primary TKA.

2022 DOES TOPICAL TRANEXAMIC ACID REDUCE POST TURP HEMATURIA; A DOUBLE BLIND RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122022 DOES TOPICAL TRANEXAMIC ACID REDUCE POST TURP HEMATURIA; A DOUBLE BLIND RANDOMIZED CONTROL TRIAL Aziz Abdullah and Atif Javed Aziz AbdullahAziz Abdullah Karachi, Pakistan More articles by this author and Atif JavedAtif Javed Karachi, Pakistan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of prostate (TURP) is considered to be the gold standard treatment of BPH. Bleeding after TURP is most common complication. To reduce post operative hematuria several different approaches have been tried. Tranexamic acid prevents bleeding by inhibiting TPA. Recent studies have proven the role of topical application of tranexamic acid in reducing the blood loss after orthopedic and dental surgeries. However role of topical application of tranexamic acid in decreasing hematuria after TURP through irrigation fluid has not been studied. OBJECTIVES: To evaluate the role of topical application of tranexamic acid through irrigation fluid in reducing post TURP hematuria. METHODS A double blind randoized control trial in which fifty two men who underwent TURP and met inclusion crieteria were randomised to receive irrigation fluid with 500 mg tranexamic acid in one litre normal saline and placebo. Weight of resected prostate, intra-operative blood loss and blood loss on 1st and 2nd post operative day were measured and difference between two groups were calculated. RESULTS Both groups (which received tranexamic acid vs placebo) were comparable in terms of mean prostatic weight (58.84gm vs 56.15gm), mean resected prostate (31.92gm vs 32.30gm) and mean duration of resection (36.53 vs 31.46). Patients who received tranexamic acid in irrigation fluid had slightly decreased drop in mean hemoglobin levels (0.87gm on 1st P.O.D and 0.31gm on 2nd P.O.D) as compared to the patients who received placebo in irrigation fluid (0.98gm on 1st P.O.D and 0.95gm on 2nd P.O.D). CONCLUSIONS Topical tranexamic acid through irrigation fluid decreases blood loss after TURP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e816 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aziz Abdullah Karachi, Pakistan More articles by this author Atif Javed Karachi, Pakistan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...