Reduction Of Intraoperative Bleeding Research Articles

La instilación preoperatoria de epinefrina y lidocaína puede reducir el tiempo quirúrgico del tratamiento endoscópico del SDTM

IntroductionGreater Trochanteric Pain Syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS. Hypothesis: An instillation of vasoconstrictors and local anesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time. Materials and methodsA prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups. ResultsOne hundred thirty-nine hips from 139 patients were included in the analysis. One hundred two patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70) minutes, respectively (P<.001). ConclusionThe instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols.

Preoperative Embolization of Intracranial Meningioma

Preoperative embolization(POE)of intracranial meningioma is performed worldwide. Although clear evidence of the effectiveness of POE has not been reported in the literature, the technique plays an important role in open surgery, especially for large or skull base meningiomas. The purposes of embolization include: 1)induction of tumor necrosis, resulting in a safer operation, 2)reduction in intraoperative bleeding, and 3)decrease in operative time. Knowledge of the functional vascular anatomy, embolic materials, and endovascular techniques is paramount to ensure safe embolization. Our standard procedure is as follows: 1)embolization is performed several days before open surgery; 2)in cases with strong peritumoral edema, steroid administration or embolization may be performed immediately prior to surgery; 3)patients undergo the procedure under local anesthesia; 4)the microcatheter is inserted as close as possible to the tumor; 5)particulate emboli are the first-line material; 6)embolization is occasionally performed with N-butyl cyanoacrylate(NBCA)glue; and 7)if possible, additional proximal feeder occlusion with coils is performed. The JR-NET study previous showed the situation regarding intracranial tumor embolization in Japan. Endovascular neurosurgeons should fully discuss the indications and strategies for POE with tumor neurosurgeons to ensure safe and effective procedures.

The Role of Tranexamic Acid (TXA) In Spine Surgery for Patients with Comorbidities in Basra/Iraq

Background: Blood loss occurs frequently and remains a challenge in spinal surgery. As significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma, and anemia. The need for allogenic blood transfusions can lead to potential transfusion reactions and infections, in addition to increasing long-term mortality rates. Although there are many randomized control trials and meta-analysis investigating the role of tranexamic acid (TXA), we could not find any study that investigated the role of TXA in patients with medical comorbidities. Therefore, tackling the role of TXA in patients with single or multiple comorbidities is of valuable outcome to our locality as most of the patients have indeed associated comorbidities. Objectives: to investigate the role of tranexamic acid in decreasing perioperative blood loss in patients with multiple comorbidities as compared to otherwise healthy individuals. Patients and methods: A single center randomized control trial. We included patients that were about to undergo simple decompressive surgeries for lumbar canal stenosis and fixation with decompression for spondylolisthesis. Patients were randomly categorized into cases (who received TXA) and controls who received NS. Patients then were subcategorized according to comorbidities and types of surgeries. Intraoperative blood loss was calculated using the suction drain and the gauze while the post operative bleeding was calculated using the drain output. Results: There was 441.84 ml (49.6 %) decrease in intraoperative bleeding for patients who received TXA as compared to controls regardless the type of surgery and regardless the presence or absence of comorbidities. Hypertensive patients had 52.7 % reduction in intraoperative bleeding when received TXA, Diabetic patients showed 44.4 % reduction in bleeding, Obese patients showed 51.1% reduction and patients with multiple comorbidities showed 51% reduction in intraoperative bleeding while healthy individuals showed 38.9% reduction in intraoperative bleeding. Conclusion: TXA was even more effective in decreasing intraoperative bleeding in patients with multiple comorbidities as compared to healthy individuals.

Effects of Tranexamic Acid on Intraoperative Bleeding and Surgical Field Visualization During Middle Ear Surgery: A Narrative Review.

Tranexamic acid is an antifibrinolytic agent widely used in several surgical procedures to reduce intraoperative bleeding. Intraoperative bleeding is a crucial problem for the ear surgeon, as it prevents good visualization of the surgical field. The aim of this work was to analyze the relevant literature about the use of tranexamic acid in ear surgery. A literature search was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, across 3 databases (Medline, Cochrane, and Google Scholar), with the terms "tranexamic acid," and "ear," and "surgery." Three prospective, randomized, and double-blind clinical trials met the inclusion criteria. Studies were not able to be pooled because of heterogeneity in material, methods of delivery and evaluation, and procedures used. Despite these limitations, all 3 papers found a significant reduction in intraoperative bleeding, allowing a better visualization of the operating field. Despite the scarcity of published trials, tranexamic acid is safe and seems to be useful in reducing intraoperative bleeding in ear surgery, thus improving operative field visualization.

Comparative Study Between the Efficacy of Oral Verapamil and Bisoprolol on Reduction of Intraoperative Bleeding during Endoscopic Sinus Surgery under General Anesthesia

Comparative Study Between the Efficacy of Oral Verapamil and Bisoprolol on Reduction of Intraoperative Bleeding during Endoscopic Sinus Surgery under General Anesthesia

Efficacy of pterygopalatine fossa injection with local anesthetic agent and adrenaline in reduction of intra-operative bleeding during endoscopic sinus surgery

BackgroundThis study aimed to assess the effect of pterygopalatine fossa injection via greater palatine canal with xylocaine and adrenaline on intra-operative surgical field bleeding and overall blood loss during FESS.MethodsWe are doing this randomized blinded study on 60 patients who underwent FESS. Infiltration with 2 ml of xylocaine 2% with 1:100,000 adrenaline was slowly injected on one side and the surgeon was asked to assess the surgical field using a Boezaart scale.ResultsOperative time is significantly less in injected cases than the other cases with a P value < 0.001. blood loss in injected side was significantly less than Non-injected side with a P value < 0.001.ConclusionThere was a significant decrease in blood loss, duration of surgery, and improvement in visual field using Boezaart score in injection group (cases) who underwent pterygopalatine fossa injection of xylocaine/adrenaline compared to the other non-injected group.

Comparison of the Effect of Injectable Tranexamic Acid and Inhaled Desmopressin in Controlling Bleeding and Ecchymosis in Open Rhinoplasty.

Bleeding during rhinoplasty surgery has a negative effect on the quality of surgery; so, it is important to reduce bleeding during rhinoplasty. We aimed to evaluate the effect of injectable tranexamic acid (TXA) and nasal spray of desmopressin (DDAVP) on reduction in intraoperative bleeding and ecchymosis after open rhinoplasty. In a Randomized Clinical Trial ( RCT) prepared since 2020 to 2021 in Razi Hospital and Imam Khomeini Hospital, Tehran, Iran on 42 patients who underwent open rhinoplasty were divided into three groups. In the first group, TXA was injected one hour before surgery at a dose of 10 mg / kg with a placebo inhalation spray. In the second group, DDAVP was administered as a nasal spray at a dose of 40 mcg with a placebo injection. The third group received a placebo spray and placebo injection. All required data were gathered and analyzed. In TXA group and DDAVP groups, the volume of bleeding during surgery significantly (P=0.022) decreased compared to placebo group, also, the quality of the surgical field and the surgeon's satisfaction significantly (P=0.007) improved compared to the placebo group but not with each other. Unlike placebo group, there were no reports of postoperative bleeding in the TXA and DDAVP groups. Duration of surgery, ecchymosis on the day after surgery and coagulation tests before and after surgery were not significantly different in three groups. Use of DDAVP and TXA can both reduce the amount of bleeding during surgery and postoperative bleeding in rhinoplasty and improve the quality of the surgical field and the surgeon 's satisfaction during surgery.

Internal fixation through rectus abdominis in the treatment of pelvic acetabular fractures and the reduction of intraoperative bleeding.

article: Observation on the effect of internal fixation through rectus abdominis approach in the treatment of pelvic acetabular fractures and the reduction of intraoperative bleeding - Panminerva Medica 2021 Oct 25 - Minerva Medica - Journals

Main advantages and drawbacks of different types of dental lasers in soft-tissue oral surgery

Introduction : Dental lasers are applied in all areas of oral surgery, including soft-tissue and bone surgery as well as in biostimulation of postoperative wounds for the induction of healing processes. The main types of lasers used for soft tissue oral surgery are CO 2 lasers, Nd:YAG lasers, diode lasers, erbium lasers Er:YAG and Er,Cr:YSGG. Aim: The purpose of the literature review presented in this paper is to summarize the most frequently discussed advantages and drawbacks of dental laser application in soft-tissue surgical manipulation and to provide an overview of the indications for use of different laser types. The paper also discusses the advantages of dental lasers over conventional surgical methods. Materials and Methods: The academic databases and search engines used as sources were: PubMed, Medline and Google Scholar from January 2010 to December 2020. A total of 175 publications relevant to the topic concerned were found. Thirty-six articles were then shortlisted as containing specific information on the practical application of lasers in oral surgery. The present study focuses on articles examining signs such as need for anesthesia, bleeding, coagulation ability, duration of surgery, need for sutures, fear of manipulation, presence of postoperative scars and recurrences. Results: Laser treatment provides possibility for surgery without infiltration anesthesia, along reduction of intraoperative bleeding, shortening of operative time, and eliminating the need for wound suturing. Erbium lasers (Er,Cr:YSGG, Er:YAG) prove to be the least invasive and thus contribute to faster healing with the possibility of histological evaluation, but appear to be inferior with regard to their hemostatic ability, where CO 2 and diode lasers show better results. Conclusion: Dental lasers are an effective alternative in performing soft-tissue surgery since operating with them offers a number of benefits both for the patient and the oral surgeon.

Virtual preoperative planning of acetabular fractures using patient-specific biomechanical simulation: A case-control study

IntroductionThe first patient-specific biomechanical model for planning the surgical reduction of acetabular fractures was developed in our institution and validated retrospectively. There are no prior studies showing its effectiveness in terms of reduction quality, operative duration and intraoperative bleeding. Therefore, we performed a case control study aiming to: 1) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the operating time and intraoperative bleeding; 2) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the quality of reduction. MethodAll patients operated on between January 2019 and June 2019 after planning by biomechanical simulation were included in this case-control study. Each patient included was matched to 2 controls from our database (2015–2018) according to age and fracture-type. DICOM data were extracted from the preoperative high-resolution scanners to build a three-dimensional model of the fracture by semi-automatic segmentation. A biomechanical model was built to virtually simulate the different stages of surgical reduction. Surgery was then performed according to simulation data. Surgical duration, blood loss, radiological findings and intraoperative complications were recorded, analysed and compared. ResultsThirty patients were included, 10 in the simulation group and 20 in the control group. The two groups were comparable in terms of age, time from accident to surgery, fracture-type and surgical approach. The mean operative time was significantly reduced in the simulation group: 113min±33 (60–180) versus 196min±32 (60–260) (p=0.01). Mean blood loss was significantly reduced in the simulation group: 505mL±189 (100–750) versus 745mL±130 (200–850) (p<0.01). However, no significant difference was found in the radiological results according to Matta's criteria, although an anatomical reduction was obtained for 9 patients in the simulation group (90%) versus 12 patients in the control group (60%) (p=0.26). A postoperative neurological complication was recorded in the control group (sensory deficit of the lateral cutaneous nerve of thigh). ConclusionThis study confirms the promising results of preoperative planning in acetabular trauma surgery based on patient-specific biomechanical simulation as well as its feasibility in routine clinical practice. By providing a better understanding of the fracture and its behavior, a reduction in intraoperative bleeding and in operative duration is achieved. Level of evidenceIII; case-control study.

The Use of Tranexamic Acid in Facial Cosmetic Surgery Procedures: A Technical Note

Tranexamic acid (TXA) has been widely used as an antifibrinolytic in dentoalveolar surgery and only recently has its effects been explored in facial procedures. Multiple studies have reported the use of TXA in facial cosmetic surgery; and to date, only a limited number of them utilized TXA as a local infiltrative technique for rhytidectomy procedures. We present a technical note to using lower concentrations of TXA in tumescent anesthesia for an array of facial cosmetic procedures. Our experience thus far has shown improved hemostasis, reduction of intraoperative bleeding and a more profound reduction in postoperative ecchymosis, edema and seroma formation.

Modified C1 lateral mass screw insertion using a threaded K-wire. A technical note

Instrumented fixation of the C1-C2 motion segment is a standard surgical technique to stabilise that spinal segment. Instability at C1-C2 can arise from a number of conditions. Fixation of the C1 lateral mass usually involves dissection and exposure of the C2 nerve root and the posterior wall of the C2 lateral mass which can result in significant bleeding from the venous plexus. Whilst image guidance is increasing in accessibility, there are few public hospitals in Australia that have access to this technology. The authors describe their technique for insertion of a C1 lateral mass screw over a threaded K-wire to avoid extensive dissection of the C2 nerve root, reducing the risk of significant haemorrhage from the epidural venous plexus during the procedure. A retrospective analysis was undertaken on 18 consecutive patients who underwent C1-C2 instrumented fixation using this technique. Indications for C1-C2 instrumented fixation included traumatic injury (10 patients), failure of non-operative management of odontoid fractures (5 patients), pathological fractures of C2 (2 patients) and inflammatory conditions (1 patient). All patients underwent successful C1-C2 stabilisation using this technique. Blood loss did not exceed 400mls in any patient. There were no vertebral artery injuries and no patient experienced a neurological deterioration. The authors propose that their technique for insertion of a C1 lateral mass screw over a threaded K-wire is safe and effective with a low risk of neurological or vertebral artery injury. The technique may be considered as a slight modification of the Harm’s procedure to reduce disturbance of the adjacent venous plexus and thereby reduction in intraoperative bleeding and operative time.

Risk factors for the fever after percutaneous nephrolithotomy: a retrospective analysis.

BackgroundIt’s very common to see the onset of fever after percutaneous nephrolithotomy (PCNL), it’s necessary to analyze the risk factors for the fever following PCNL, and to provide evidence for infection prevention after PCNL.MethodsA total of 546 adult PCNL patients were included as study subjects and retrospective studies were performed. We collected clinical data of patients using a prospectively designed database. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the fever after PCNL.ResultsOf the included 546 PCNL patients, there were 82 fever patients and 464 no-fever patients following PCNL. Escherichia coli and Proteus mirabilis are the two most common infectious bacteria. Preoperative urinary tract infection (OR =4.38, 95% CI: 1.15–9.53), multiple access (OR =5.31, 95% CI: 1.23–10.75), diabetes (OR =4.97, 95% CI: 1.37–9.86), length of operation ≥60 min (OR =5.67, 95% CI: 2.24–13.42), estimated blood loss in PCNL ≥500 mL (OR=2.78, 95% CI: 2.32–3.61) were the independent risk factors associated with postoperative infection.ConclusionsEffective control of urinary tract infection, reduction of access number, strict control of blood glucose, length of operation control, reduction of intraoperative bleeding should be considered as measures to prevent postoperative fever for patients with PCNL.

The Hemostatic Effect of Desmopressin on Bleeding as a Nasal Spray in Open Septorhinoplasty.

Rhinoplasty is associated with intraoperative bleeding which affects the quality of the operation and may increase the time of surgery. The aim of this study was to assess the role of nasal spray of desmopressin on reduction in intraoperative bleeding during elective open rhinoplasty. Conducting an interventional study in our hospital, all patient data including demographic information, medical history and laboratory tests before surgery were collected. Patients who were randomly divided into two study groups, received nasal desmopressin spray or placebo spray, 60min before starting open septorhinoplasty. The measured variables included: bleeding volume, the operative field quality in regard to bleeding (Boezaart score), the surgeons' satisfaction in regard to bleeding during surgery (Likert scale), postoperative bruising, postoperative bleeding and menstruation. Thirty cases were studied; 13 (46.3%) people received placebo and 17 (56.7%) received desmopressin. The Boezaart score, satisfaction scores, bleeding volume, upper eyelid ecchymosis in the group receiving desmopressin were significantly better than the control group. Postoperative bleeding was also less in the desmopressin group, but not significant as other variables. In women of each group, menstruation had no effect on the amount of bleeding, surgical field quality and surgeon satisfaction compared with non-menstruation women. Nasal desmopressin use is an effective method for reducing intraoperative and postoperative bleeding and diminished postoperative ecchymosis which improves surgeons' satisfaction. So using the nasal form of desmopressin could be considered as method of controlling bleeding and ecchymosis in open rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cirurgia híbrida na exérese de tumor glômico Shamblin II

Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping.

Use of intravenous dexmedetomidine in modified radical mastoidectomy under general anesthesia

Background: Modified radical mastoidectomy is a microscopic ENT procedure which when performed under general anesthesia (GA) required nitroglycerin for control of intraoperative bleeding at the surgical site. When dexmedetomidine used as an adjuvant to anesthetic drugs, nitroglycerin is rarely used. Objective: The aim of this study is to evaluate the efficacy of dexmedetomidine on the reduction of intraoperative bleeding in modified radical mastoidectomy under GA. Materials and Methods: This study was conducted on 100 adult ASA Grade I/II patients of either sex, scheduled for modified radical mastoidectomy under GA. Grading of bleeding at the surgical site, a number of patients required nitroglycerin for control of bleeding were recorded. Results: No patient in Group D required nitroglycerin for reduction of bleeding, but 40 patients in Group C required nitroglycerin for reduction of bleeding. The overall incidence of significant bleeding which required frequent suctioning in control group was 40 (80%) compared with 0 (0%) in the dexmedetomidine group. Conclusion: Infusion of dexmedetomidine in perioperative period significantly reduced the requirement of nitroglycerin for controlled hypotension.

Effectiveness of tranexamic acid for reducing intraoperative bleeding in palatoplasties: A randomized clinical trial

BackgroundFew data are available regarding blood loss during cleft palate surgery. This study assessed the effect of using tranexamic acid in the reduction of intraoperative bleeding. MethodsA double-blind, randomized clinical trial compared intraoperative bleeding and the incidence of oronasal fistulas after palatoplasties in a control group that was given placebo and an intervention group that was given 10 mg/kg tranexamic acid followed by a continuous infusion of 1 mg/kg/h of the same until the end of surgery. Patients who underwent primary palatoplasty with no known or suspected coagulation disorders at our institution during the study period were included in the study. Results70 patients were allocated, 66 received the intervention. Blood loss was reduced by 11.9%, without statistical significance. The incidence of fistulas in the intervention and control groups was 12.9% and 18.75%, respectively. The reduction of 5.8% (CI 95%: 12%–23.8%) was not significant. ConclusionsThe reduction of intraoperative blood loss was lower than expected and not statistically significant; a larger sample is needed to confirm the observed reduction. The drug did not seem to have negative effects on flap viability.

Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence.

Spine surgery has been growing rapidly as a neurosurgical operation, with an increase of 220% over a 15-year period. Intraoperative blood transfusion is a major outcome determinant of spine procedures. Various approaches, including pharmacologic and nonpharmacologic therapies, have been tested to decrease both intraoperative and postoperative blood loss. The aim of this systematic review is to report clinical evidence on the relationship between intraoperative blood loss (primary outcome) and on transfusion requirements and postoperative complications (secondary outcomes) in patients undergoing spine surgery. A literature search of PubMed database was performed using 5 key words: spine surgery and transfusion; spine surgery and blood loss; spine surgery and blood complications; spine surgery and deep vein thrombosis; and spine surgery and pulmonary embolism. Clinical reports (randomized controlled trials, prospective and retrospective studies, and case reports) were selected. A total of 473 articles were examined; 450 were excluded, and 24 were selected for this systematic review. Selected articles were categorized into 3 subchapters: (1) drugs active on coagulation (12 studies): tranexamic acid, aminocaproic acid, aprotinin, and recombinant activated factor VII; (2) drugs not active on coagulation (5 studies): ketorolac, epoetin alfa, magnesium sulfate, propofol/sevoflurane, and omega-3 and fish oil; (3) nonpharmacologic approaches (7 studies): surgical tips, patient positioning, and general or spinal anesthesia. Several studies have shown a significant reduction in intraoperative bleeding during spine surgery and in the requirement for blood transfusion.

Abstract P6-11-07: Perioperative administration of desmopressin (dDAVP) in breast cancer patients: A phase II dose-escalation study

Abstract Background: dDAVP is a well known peptide analog of the antidiuretic hormone vasopressin, that has been used to prevent bleeding during surgical procedures in patients with hemostatic disorders. It induces a rapid increase of hemostatic mediators by stimulating their release from microvascular endothelial cells. In preclinical studies, dDAVP inhibited lymph node and early blood-borne metastasis from aggressive mouse mammary tumors. Besides, perioperative administration of dDAVP significantly prolonged disease-free and overall survival in a veterinary clinical trial enrolling dogs with locally advanced mammary cancer. The compound is a selective agonist of V2 vasopressin receptors present on both endothelial and breast cancer cells. Recent evidence indicated that dDAVP promotes tumor-mediated production of angiostatin and also activates endothelial release of von Willebrand factor (vWF), which may cause apoptosis of micrometastatic cells. Considering its hemostatic and antimetastatic properties, a phase II dose-escalation trial was performed in patients with breast cancer, administering a lyophilized formulation of dDAVP by IV infusion in saline, before and after surgical resection of primary tumor. Methods: Eligibility included otherwise healthy female patients between 18 and 65 years of age, histological/cytological diagnosis of breast carcinoma (Stage 0, I, II), and mastectomy or lumpectomy with sentinel node biopsy, either requiring or not further axillary dissection. dDAVP was administered in two IV infusions, the first 30-60 minutes before surgery and the second 24 hours later. Five groups of at least 4 patients each received increasing total dDAVP doses of 0.5, 1.0, 1.25, 1.5 and 2.0 μg/kg. Primary endopoints were safety and tolerability in breast cancer patients undergoing surgery as first treatment, as well as selection of the best dose for clinical use. Secondary endpoints included surgical bleeding, plasma levels of vWF, and circulating tumor cells (CTC) as measured by quantitative PCR detection of cytokeratin 19 (CK-19) mRNA in whole blood. Results: The trial accrued 21 patients from April 2012 to February 2014. Adverse events were reversible and observed from the third dose level (1.25 μg/kg), including nausea, hot flushing, skin rash, dyspnea and palpitations. Reactions were adequately managed by slowing the infusion rate of dDAVP (over 30 minutes). A reduced intraoperative bleeding of up to 50% was noted with increasing doses of dDAVP. Both vWF antigen and activity showed a rise after each dDAVP infusion, and maximum plasma levels were obtained at the higher dose level of 2 μg/kg. Interestingly, a preliminary analysis indicated a drop in CTC counts 24-48 hours after dDAVP treatment in patients with detectable CK-19 mRNA preoperative levels. Conclusions: At the highest dose level evaluated (2 μg/kg) perioperative dDAVP appeared safe when administered in two slow IV infusions of 1 μg/kg, before and after the surgical procedure. The available data suggest that treatment is associated with reduction of intraoperative bleeding, higher circulating vWF levels and postoperative drop in CTC counts. Final results will be available at the time of the meeting. Clinical trial number: NCT01606072. Citation Format: Ruth S Weinberg, Marcelo O Grecco, Gimena S Ferro, Debora Seigelshifer, Nancy V Perroni, Francisco J Terrier, Analia Sanchez Luceros, Enzo Domenichini, Marcelo D Guthmann, Daniela Di Leo, Eduardo Spitzer, Graciela N Ciccia, Ana V Torbidoni, Juan Garona, Marina Pifano, Giselle V Ripoll, Roberto E Gomez, Daniel F Alonso. Perioperative administration of desmopressin (dDAVP) in breast cancer patients: A phase II dose-escalation study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-11-07.

Minimizing bleeding complications in spinal tumor surgery with preoperative Onyx embolization via dual-lumen balloon catheter

BackgroundIntraoperative bleeding is a significant risk in surgery for highly vascular spinal tumors, but preoperative embolization can safely decrease intraoperative blood loss in extrinsic spine tumors. Onyx, widely used for...