Occurrence Of Postoperative Hemorrhage Research Articles

Ventriculoperitoneal Shunt Placement Safety in Idiopathic Normal Pressure Hydrocephalus: Anticoagulated Versus Non–Anticoagulated Patients

Many patients with idiopathic normal pressure hydrocephalus (iNPH) have medical comorbidities requiring anticoagulation that could negatively impact outcomes. This study evaluated the safety of ventriculoperitoneal shunt (VPS) placement in iNPH patients on systemic anticoagulation versus those not on anticoagulation. Patients > 60 years of age with iNPH who underwent shunting between 2018 and 2022 were retrospectively reviewed. Baseline demographics, comorbidities (quantified by modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI)), anticoagulant/antiplatelet agent use (other than aspirin), operative details, and complications were collected. Outcomes of interest were the occurrence of postoperative hemorrhage and overdrainage. A total of 234 patients were included in the study (mean age 75.22 ± 6.04 years; 66.7% male); 36 were on anticoagulation/antiplatelet therapy (excluding aspirin). This included 6 on Warfarin, 19 on direct Xa inhibitors, 10 on Clopidogrel, and one on both Clopidogrel and Warfarin. Notably, 70% of patients (164/234) used aspirin alone or combined with anticoagulation or clopidogrel. Baseline mFI was similar between groups, but those on anticoagulant/antiplatelet therapy had a higher mean CCI (2.67±1.87 vs. 1.75±1.84; p=0.001). Patients on anticoagulants were more likely to experience tract hemorrhage (11.1 vs. 2.5%; p=0.03), with no significant difference in the rates of intraventricular hemorrhage or overdrainage related subdural fluid collection. Anticoagulant and antiplatelet agents are common in the iNPH population, and patients on these agents experienced higher rates of tract hemorrhage following VPS placement; however, overall hemorrhagic complication rates were similar.

In vivo Evaluation of the Hemostatic and Cicatrising Activities of a Gel Based on Vernonia Conferta Benth. On Post-extraction Wounds in Wistar Rats

Introduction: Despite the progress in oral surgical techniques, the occurrence of post operative haemorrhage can lead to delayed healing. It is with this in mind that we proposed to explore other therapeutic avenues to try to provide other solutions through traditional African medicine. The Aim of the Study: To evaluate the haemostatic and healing activity of a Vernonia conferta-based gel on postextractional wounds induced in Wistar rats. Methodology: An experimental study was conducted over a period of eight months during 2021 at the multidisciplinary laboratory of Galenic Pharmacy and Pharmaceutical Legislation of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé 1. A gel formulation test carried out in standard proportions for a 2% concentration such as the Elugel reference gel used as a positive control. To evaluate the haemostatic and healing activity, we made up three batches of five female wistar rats with a body mass of between 100 and 130 grams, acclimatised for three days before the experiment. This test consisted of performing an avulsion of the central incisor in the rat and then applying our active principle for 5 successive days on one of the batches and our reference gel on the other batch, while the last batch will be under observation receiving no treatment and considered as a negative control. The observation was carried out during 14 days while respecting the feeding conditions of the animals. The haemostatic activity was evaluated using a stopwatch or we took the bleeding time after tooth extraction in the constituted batches. The healing activity was evaluated by taking a tissue sample from the extraction site on days 3, 7 and 14 for histological analysis. Results: The aqueous extract-based gel, made in standard proportions at a 2% concentration like the reference gel used as a positive control, stopped bleeding almost instantly, and clot formation occurred within 1-3 minutes after application. As for the healing activity, the batch of rats that received our test gel showed a rapid re-epithelialization observed on day 14ème, testifying to the restitution of the tissue injured during avulsion. Conclusion: The adhesion of Vernonia conferta aqueous leaf gel to the post-extraction alveolar mucosa in vivo in wistar rats has a favourable profile, as it allows faster haemostasis and accelerated healing.

Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial

IntroductionFast-track protocols often include short-term thromboprophylaxis and short length of hospital stay. These treatment strategies may negatively affect the occurrence and diagnosis of postoperative haemorrhage. Over the years, the rates...

Risk factors of postoperative bleeding of endoscopic submucosal dissection for early gastrointestinal cancer

Objective To analysis the risk factors of postoperative bleeding of endoscopic submucosal dissection (ESD) for early gastrointestinal cancer. Methods A retrospective study was performed on the data of 430 patients (449 lesions) with early gastrointestinal cancer undergoing ESD in Fujian Provincial Hospital Digestive Endoscopic Center from June 2008 to February 2015 and in Fujian Provincial Hospital South Branch Digestive Endoscopic Center from May 2015 to April 2018. Patients with postoperative bleeding were compared with those without postoperative bleeding on the basis of general conditions, endoscopic performance, postoperative pathology and so on to analysis the risk factors for postoperative bleeding of ESD. Results Among the 430 cases (449 lesions)of early gastrointestinal cancer undergoing ESD, 16 cases (3.7%) had postoperative bleeding. According to whether the occurrence of postoperative hemorrhage, patients were divided into bleeding group (n=16) and not bleeding group (n=433). Univariate analysis suggested that whether had hypertension was statistically significant between the two groups (χ2=4.793, P=0.029), while patients age (t=0.465, P=0.642), gender (χ2=0.035, P=0.642), whether to have diabetes (χ2=0.647, P=0.421), whether to have coronary heart disease (P=1.000), lesion size (t=1.598, P=0.111), whether two or more lesions (P=1.000), lesion site (χ2=6.183, P=0.289), operation time (t=1.335, P=0.201), pathological grading (χ2=0.687, P=0.709), and lesion infiltration depth (χ2=0.134, P=0.714) were not statistically significant between the two groups. Logistic regression analysis showed that hypertension (OR=3.358, 95%CI: 1.227-9.186, P=0.018) was an independent risk factor of bleeding after ESD for early gastrointestinal cancer. Conclusion Hypertension is closely related to postoperative bleeding following ESD for early gastrointestinal cancer.Patients with hypertension are at a greater risk of bleeding after ESD. Key words: Risk factors; Early gastrointestinal cancer; Endoscopic submucosal dissection; Postoperative bleeding

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).

Іnnovation technologies in the gut organs surgery

Objective. To improve the surgical treatment results in patients, suffering the gut organs diseases, due to its sophistication and elaboration of modern innovation technologies.
 Маterials and methods. In the work the author’s concept and results of the modern innovative technologies while performing surgery on the gut organs for ulcerative hemorrhage, complicated postbulbar, parapapillary ulcers, gastric cancer and polyps, colorectal cancer, ulcerative colitis, Crohn’s disease of large bowel, familial adenomatous polyposis are adduced. Endoscopic operations, methods of atraumatic dissection of tissues, new restoration and reconstructive-restorative operations, using modern staplers for anastomoses formation, laparoscopic operations were applied. The innovative surgical technologies were applied in 2428 patients.
 Results. Using methods of endoscopic hemostasis a definitive arrest of ulcerative hemorrhage was achieved in 91.1% patients. Еndoscopic polypectomy for the large bowel polyps of significant size and for «spreading» polyps were performed in 90.5% patients. Occurrence of postoperative hemorrhage was reduced to 0.74%, а large bowel wall perforation was not observed. In patients with complicated postbulbar and parapapillary ulcers the postoperative morbidity was reduced tо 24.7%, postoperative lethality - tо 7.6%. More favorable functional results were obtained after gastroplastic operations. Postoperative complications have occurred in 15.8% patients, 1.7% patients died.
 Conclusion. Modern innovation surgical technologies, including endoscopic, staplers for anastomoses formation, methods of atraumatic dissection of tissues, reconstructive-restorative, laparoscopic surgical interventions are sufficiently effective in the treatment of patients, suffering diseases of the gut organs. Application of modern innovation technologies in the gut organs surgery makes possible to eliminate pathological process, its complications, to reduce significantly the surgical interventions traumaticity, time of their performance, quantity of postoperative complications, lethality, and to improve functional results and quality of life in the patients operated.

Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy.

BackgroundWith the wider application of nephron-sparing surgery, there has been an increase in the occurrence of postoperative hemorrhage. However, despite such an increase, there are only a limited number of reports regarding renal artery embolization (RAE) for the management of postoperative bleeding after nephron-sparing surgery, especially after robot-assisted laparoscopic partial nephrectomy (RALPN).PurposeTo evaluate the safety and clinical efficacy of transcatheter RAE for postoperative hemorrhage after open partial nephrectomy (OPN) and RALPN.Material and MethodsA total of 29 patients (17 men, 12 women; age range, 31–70 years) who were referred to our hospital for postoperative hemorrhage after partial nephrectomy, between December 2003 and December 2014, were selected. We retrospectively reviewed patients’ clinical data, angiographic findings, embolization details, and clinical outcomes.ResultsEmbolization was performed in patients who underwent OPN (25/29) and RALPN (4/29). The angiographic findings were as follows: renal artery pseudoaneurysm (n = 18), contrast extravasation (n = 8), and arteriovenous fistula (n = 3). Fiber-coated microcoil and n-butyl-2-cyanoacrylate (NBCA) was administered to the targeted bleeding renal arteries in 12 and 11 patients, respectively. In six patients, fiber-coated microcoil and NBCA were used concurrently. Technical and clinical successes were achieved in all patients (100%). Bleeding cessation was achieved in all patients, and no further relevant surgeries or interventions were required for hemorrhage control. There were no episodes of hemorrhagic recurrence during the follow-up period (median, 20 days; range, 7–108 days).ConclusionAngiography and RAE identified the origin of bleeding and could successfully preserve the residual renal function.

Hemorrhagic complications after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

ObjectiveTo evaluate clinical features and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after intravitreal ranibizumab injection. DesignRetrospective case series. ParticipantsThe charts of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg. MethodsThe study was conducted as a retrospective chart review of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg. Analysis of 2 groups was based on mean PCV lesion size: < 15mm2 (n = 24); or ≥ 15mm2 (n = 32). The occurrence of fresh postoperative subretinal hemorrhage, best corrected visual acuity, systemic disease, and medication history were documented and analyzed. ResultsThe mean injection number was 3.3 ± 0.7 (range, 1 to 6), with a mean follow-up of 7.4 ± 2.8 months (range, 4 to 14 months). During the follow-up period, postoperative subretinal hemorrhage was observed in 5 (8.9%) of 56 eyes. Occurrence of postoperative hemorrhage was significantly increased in the group with large PCV size (p = 0.01). Pars plana vitrectomy was performed for postoperative bleeding that resulted in vitreous hemorrhage in 1 eye (1.8%). Various systemic diseases and medication with an anticoagulant had no correlation with occurrence of hemorrhagic complications. ConclusionsSubretinal hemorrhage after ranibizumab injection can occur in patients with PCV. When considering ranibizumab injection for treatment of a large PCV lesion, the risk for hemorrhagic complications should be considered.

Long-term results of laser-tonsillotomy in obstructive tonsillar hyperplasia

Carbon-dioxide-laser-tonsillotomy is reconsidered as a procedure to relieve patients in early childhood from obstructive symptoms caused by tonsillar hyperplasia such as snoring or sleep apnea without influencing the immunological function. The protruding part of the tonsils was removed by a CO (2)-laser delivering 10 - 15 W. During 1993 to 2003, 83 children received laser-tonsillotomy, combined with adenoidectomy 51 children were available for follow-up with a standard questionnaire. The parents were surveyed in average 39 months postoperatively. 5 patients required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia. Histological investigations were done. 15 children were reevaluated by clinical examination. Most of the patients were relieved from obstructive symptoms. There was no occurrence of postoperative hemorrhage or peritonsillar abscesses. The histological investigations on the specimens from later performed tonsillectomy (n = 5) showed no evidence of scarring opened crypts. The clinical examination did not reveal any signs of chronic infections. The tonsillotomy by carbon-dioxide-laser appears as a suitable and safe technique for the treatment of tonsillar hyperplasia without severe throat infection in early childhood.

The Marfan syndrome: Report of two cases

A brief review of the literature on the Marfan syndrome is presented and two cases are described. The significance of the syndrome to the profession is discussed, and attention is drawn to the need of preventing subacute bacterial endocarditis, to the possible occurrence of postoperative hemorrhage, and the possibility of temporomandibular joint dysarthrosis. The problems of the conservation operator and the oral surgeon are mentioned. Finally, the association of this syndrome with cystic lesions of the jaws is postulated.