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[PMID]:29390496
[Au] Autor:Lu K; Xu M; Li W; Wang K; Wang D
[Ad] Endereço:Department of Joint Surgery, Liaocheng Clinical College of Taishan Medical University.
[Ti] Título:A study on dynamic monitoring, components, and risk factors of embolism during total knee arthroplasty.
[So] Source:Medicine (Baltimore);96(51):e9303, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Fat embolism is a common complication of orthopedic surgery. However, the exact component and risk factor responsible for this complication remains unelucidated. This study aimed to detect the origin of the pulmonary embolus and identify relevant risk factors of pulmonary embolism in total knee replacement. METHODS: A total of 40 osteoarthritis patients who underwent primary unilateral TKA were recruited into this study. Transesophageal echocardiography (TEE) was utilized to dynamically monitor the embolism. Pulmonary arterial pressure was recorded and biopsies were obtained from the medullary cavity during surgery. RESULTS: After tourniquet release, the arterial embolism was observed by TEE to have a peak signal at 30 seconds when pulmonary arterial pressure was increased by 25% to 40% (P = .002). The pathology study of the embolism revealed its bone marrow origin. Total embolus quantity was positively correlated with age (P = .021), body mass index (BMI, P = .041), and fat content of the bone marrow (P = .003). Logistic regression analysis revealed that the fat content of the marrow (OR: 1.432, 95% CI: 1.335-1.592), age (OR: 1.632, 95% CI: 1.445-1.832), and BMI (OR: 1.231, 95% CI: 1.032-1.381) were risk factors for pulmonary hypertension. CONCLUSION: This study revealed that the embolus detected in the right atrium was derived from bone marrow tissues, and this led to pulmonary arterial pressure fluctuations after tourniquet release. Therefore, elderly patients who have high BMI or bone marrow fat content are at high-risk for pulmonary fat embolism during TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/efeitos adversos
Embolia Gordurosa/diagnóstico por imagem
Átrios do Coração/diagnóstico por imagem
Monitorização Intraoperatória
[Mh] Termos MeSH secundário: Tecido Adiposo/patologia
Fatores Etários
Pressão Sanguínea
Índice de Massa Corporal
Medula Óssea/patologia
Ecocardiografia Transesofagiana
Embolia Gordurosa/etiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Osteoartrite do Joelho/cirurgia
Complicações Pós-Operatórias
Fatores de Risco
Torniquetes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009303


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[PMID]:29189453
[Au] Autor:Quail MT
[Ad] Endereço:M. Thomas Quail is the clinical coordinator for the Massachusetts Department of Public Health, Bureau of Environmental Health, in Boston, Mass. This article is Mr. Quail's own work and doesn't represent the opinions of the Massachusetts Department of Public Health or the Commonwealth of Massachusetts.
[Ti] Título:What's the Stop the Bleed Campaign?
[So] Source:Nursing;47(12):15-16, 2017 Dec.
[Is] ISSN:1538-8689
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Promoção da Saúde
Hemorragia/prevenção & controle
Incidentes com Feridos em Massa
Torniquetes/utilização
[Mh] Termos MeSH secundário: Serviços Médicos de Emergência
Serviço Hospitalar de Emergência
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/01.NURSE.0000526884.10306.68


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[PMID]:29369184
[Au] Autor:Ozkunt O; Sariyilmaz K; Gemalmaz HC; Dikici F
[Ti] Título:The effect of tourniquet usage on cement penetration in total knee arthroplasty: A prospective randomized study of 3 methods.
[So] Source:Medicine (Baltimore);97(4):e9668, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is a randomized study to compare cement penetration on x-rays after total knee arthroplasty (TKA) among 3 different ways to use tourniquets; application during the surgery, application only with implantation prosthesis and with no tourniquet use. METHODS: A total 69 knees of 59 patients were included in the study in a quasirandom manner. Each patient had physical exams and standard radiographic evaluations at 6 weeks after the TKA procedure. Outcome evaluations included visual analog scale (VAS) scores, Knee Society Scores (KSS), blood transfusion, and drainage status after surgery for all groups. For radiographic review, the tibial plateau was divided into zones in the anterior-posterior and lateral views, according to the Knee Society Scoring System. RESULTS: The average age of the patients who were eligible for the study was 65.05 (range 46-81) years. All 59 patients included in the study were female patients. Group 1 consisted of 24 patients who had TKA with use of a tourniquet during the entire operation. Group 2 consisted of 20 patients who had TKA with use of tourniquet only at the time of cementing and group 3 consisted of 25 patients with no use tourniquet. There is no significant difference in early cement penetration among the groups (group 1 2.50 mm, group 2 2.28 mm, group 3 2.27 mm; group 1 vs 2 P = .083, group 1 vs 3 P = .091, group 2 vs 3 P = .073). There is no significant difference for postoperative drainage among the 3 groups (group 1 245 mL, group 2 258.76 mL, group 3 175.88 mL; group 1 vs 2 P = .081, group 1 vs 3 P = .072, group 2 vs 3 P = .054). There was no need to transfuse more than 1 unit in any patient. The VAS score was significantly higher (group 1 3.58, group 2 1.55, group 3 1.52; group 1 vs 2 P = .022, group 1 vs 3 P = .018, group 2 vs 3 P = .062) and KSS was significantly lower in the tourniquet group (group 1 63, group 2 79, group 3 82; group 1 vs 2 P = .017, group 1 vs 3 P = .02, group 2 vs 3 P = .082). CONCLUSION: We do not suggest long-duration tourniquet use, which can lead higher pain scores and reduce functional recovery after total knee arthroplasty.
[Mh] Termos MeSH primário: Artroplastia do Joelho/instrumentação
Cimentos para Ossos/uso terapêutico
Dor Pós-Operatória/etiologia
Torniquetes/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia do Joelho/métodos
Feminino
Seres Humanos
Período Intraoperatório
Joelho/fisiopatologia
Joelho/cirurgia
Masculino
Meia-Idade
Dor Pós-Operatória/fisiopatologia
Estudos Prospectivos
Recuperação de Função Fisiológica
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Bone Cements)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009668


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[PMID]:29257010
[Au] Autor:Huang Z; Xie X; Li L; Huang Q; Ma J; Shen B; Kraus VB; Pei F
[Ad] Endereço:Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, ChengDu, Sichuan Province, People's Republic of China.
[Ti] Título:Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial.
[So] Source:J Bone Joint Surg Am;99(24):2053-2061, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tourniquet use during primary total knee arthroplasty is thought to reduce intraoperative blood loss and improve visibility. Our goal was to investigate whether tourniquet use is necessary for controlling intraoperative blood loss when alternatives such as tranexamic acid (TXA) are available. METHODS: One hundred and fifty patients were equally randomized to 3 groups. Group A was treated with a tourniquet as well as multiple doses of intravenous TXA (20 mg/kg 5 to 10 minutes before the skin incision and 10 mg/kg 3, 6, 12, and 24 hours later) along with 1 g of topical TXA, Group B was treated the same as Group A but without the tourniquet, and Group C was treated with the tourniquet only. RESULTS: The amount of intraoperative blood loss was similar for the 3 groups. Group B had significantly less hidden blood loss than Group A (p = 0.018) and Group C (p < 0.001). No significant differences (p > 0.05) were observed between Group A and Group B with regard to total blood loss, drainage volume, intraoperative blood loss, transfusion rate, or maximum change in the hemoglobin (Hb) level. We also found significantly more benefits for Group B compared with Groups A and C with regard to postoperative swelling ratio, levels of inflammatory biomarkers, visual analog scale (VAS) pain scores, range of motion at discharge, Hospital for Special Surgery (HSS) score, and patient satisfaction. There were no significant differences (p > 0.05) in the deep venous thrombosis or pulmonary embolus rates among the 3 groups. More wound secretion was observed in the groups in which a tourniquet was used. CONCLUSIONS: Patients treated with multiple doses of intravenous and topical TXA without a tourniquet had less hidden blood loss, a lower ratio of postoperative knee swelling, less postoperative knee pain, lower levels of inflammatory biomarkers, better early knee function, and even better early satisfaction than those treated with a tourniquet. Long-term follow-up should be performed to evaluate the effects on prosthetic fixation and long-term survival of total knee arthroplasty performed without a tourniquet. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Artroplastia do Joelho/métodos
Perda Sanguínea Cirúrgica/prevenção & controle
Medição da Dor
Torniquetes/utilização
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Administração Tópica
Idoso
Artroplastia do Joelho/efeitos adversos
Perda Sanguínea Cirúrgica/fisiopatologia
China
Terapia Combinada
Feminino
Seguimentos
Seres Humanos
Injeções Intravenosas
Masculino
Meia-Idade
Dor Pós-Operatória/fisiopatologia
Dor Pós-Operatória/prevenção & controle
Estudos Prospectivos
Medição de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01525


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[PMID]:29245293
[Au] Autor:Li Z; Liu D; Long G; Ke G; Xiao A; Tang P; Dong J
[Ad] Endereço:aDepartment of Orthopedics, Chinese PLA General Hospital, BeijingbDepartment of Orthopedics, Chinese PLA General Hospital and Hainan Branch, SanyacDepartment of Orthopaedics, the 309th hospital of PLA, BeijingdDepartment of Orthopedics, 252 Hospital of Chinese PLA, Baoding, Hebei, China.
[Ti] Título:Association of tourniquet utilization with blood loss, rehabilitation, and complications in Chinese obese patients undergoing total knee arthroplasty: A retrospective study.
[So] Source:Medicine (Baltimore);96(49):e9030, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Obesity not only gives rise to more blood loss volume but also correlates with postoperative rehabilitation and complications in surgical patients. It is not clear at present whether tourniquet utilization is associated with blood loss, rehabilitation, and complications, and it is imperative to ascertain the tactics of utilizing tourniquet in obese patients undergoing total knee arthroplasty (TKA). The present study was designed to explore the association of tourniquet utilization with blood loss, rehabilitation, and complications, and ascertain the tactics of utilizing tourniquet in obese patients undergoing TKA.A total of 130 patients from January 2014 to December 2014 were categorized into tourniquet group (n = 94) and non-tourniquet group (n = 36) based on whether the tourniquet was utilized or not during operation. Recorded data were as follows: total blood loss volume, intraoperative blood loss volume, hidden blood loss volume, blood transfusion volume, drainage volume, difference between hemoglobin value before operation and that on the fifth day after operation (5d Hb D-value), thigh swelling rate and visual analogue scale (VAS) score of motion pain, and Knee Society Score (KSS) score.Mean age was 65.27 ±â€Š7.43 (49-82) years, and 15 patients (11.5%) were men. No significant difference in total blood loss volume, drainage volume, blood transfusion volume, and 5d Hb D-value was noted between the 2 groups (P > .05 for all). Tourniquet group had significantly less intraoperative blood loss volume and significantly more hidden blood loss volume than the non-tourniquet group (P < .05 for all). Tourniquet group had significantly higher thigh swelling rate and VAS score of motion pain on the third day after operation, and significantly lower KSS function score in the third week after operation than non-tourniquet group (P < .05). No significant difference in KSS function score in the first year after operation was found between the 2 groups (P > .05). No difference in postoperative complications was observed between the groups (P > .05).The current study demonstrated that the tourniquet is not associated with reduced blood loss and increased postoperative complications in obese patients undergoing TKA. Step-down postoperative rehabilitation related to tourniquet is short-term rather than long-term in obese patients undergoing TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/instrumentação
Perda Sanguínea Cirúrgica/estatística & dados numéricos
Obesidade/complicações
Osteoartrite do Joelho/cirurgia
Complicações Pós-Operatórias/etiologia
Torniquetes/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia do Joelho/efeitos adversos
Artroplastia do Joelho/reabilitação
Transfusão de Sangue/estatística & dados numéricos
China
Drenagem/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Osteoartrite do Joelho/etiologia
Osteoartrite do Joelho/reabilitação
Período Pós-Operatório
Estudos Retrospectivos
Coxa da Perna/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009030


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[PMID]:27776904
[Au] Autor:Bin Abd Razak HR; Binte Abd Razak NF; Tan HA
[Ad] Endereço:Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: hamidrazak@gmail.com.
[Ti] Título:Prevalence of Venous Thromboembolic Events Is Low in Asians After Total Knee Arthroplasty Without Chemoprophylaxis.
[So] Source:J Arthroplasty;32(3):974-979, 2017 03.
[Is] ISSN:1532-8406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This retrospective cohort study was designed to establish the prevalence of clinically significant venous thromboembolic events (VTE) in our patients undergoing total knee arthroplasty (TKA) without chemoprophylaxis. METHODS: A single-surgeon cohort of patients who underwent TKA from 2006 to 2014 were included. All patients had a pneumatic tourniquet applied and a drain inserted postoperatively. Tranexamic acid was not used perioperatively. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. All patients ambulated on the second postoperative day. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort. RESULTS: A total of 966 patients were reviewed. Mean age was 66.1 ± 7.8 years. Mean body mass index was 28.2 ± 4.7 kg/m . Mean tourniquet time was 53 ± 23 minutes. Patients stayed in hospital for a mean of 5.4 ± 3.1 days. There was 100% compliance to mechanical prophylaxis. And 11.1% of our patients were on concomitant antiplatelet or anticoagulant use. There were 8 patients with clinically significant VTE. This translates to a prevalence of 0.82%. Seven patients developed deep vein thrombosis and 1 patient died from massive pulmonary embolism. CONCLUSION: The prevalence of clinically significant VTE in our patients who underwent TKA without routine chemoprophylaxis is 0.82%. With proper patient selection, risk stratification, and stringent perioperative protocols, routine chemoprophylaxis may not be necessary in Asians undergoing TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/efeitos adversos
Tromboembolia Venosa/epidemiologia
Tromboembolia Venosa/etiologia
[Mh] Termos MeSH secundário: Idoso
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos
Quimioprevenção
Feminino
Seres Humanos
Masculino
Meia-Idade
Período Pós-Operatório
Prevalência
Embolia Pulmonar/epidemiologia
Estudos Retrospectivos
Torniquetes
Ácido Tranexâmico
Trombose Venosa/epidemiologia
Trombose Venosa/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29190257
[Au] Autor:Scerbo MH; Holcomb JB; Taub E; Gates K; Love JD; Wade CE; Cotton BA
[Ad] Endereço:From the Center for Translational Injury Research (CeTIR) (M.H.S., J.B.H., C.E.W., B.A.C.), Department of Surgery (M.H.S., J.B.H., E.T., J.D.L., C.E.W., B.A.C.), and Department of Emergency Medicine (K.G.), The University of Texas Health Science Center, Houston, Texas; and Life Flight, Memorial Hermann Hospital, Houston, Texas (J.D.L.).
[Ti] Título:The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock.
[So] Source:J Trauma Acute Care Surg;83(6):1165-1172, 2017 Dec.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement. METHODS: All patients arriving to a Level 1, urban TC between October 2008 and January 2016 with a tourniquet placed before (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated (absolute indication [vascular injury requiring repair/ligation, operation within 2 hours for extremity injury, or traumatic amputation] or relative indication [major musculoskeletal/soft tissue injury requiring operation 2-8 hours after arrival, documented large blood loss]) or non-indicated. Outcomes were death from hemorrhagic shock, physiology upon arrival to the TC, and massive transfusion requirements. After univariate analysis, logistic regression was carried out to assess independent predictors of death from hemorrhagic shock. RESULTS: A total of 306 patients received 326 tourniquets for injuries to 157 upper and 147 lower extremities. Two hundred eighty-one (92%) had an indication for placement. Seventy percent of patients had a blunt mechanism of injury. T-TC patients arrived with a lower systolic blood pressure (SBP, 101 [86, 123] vs. 125 [100, 145] mm Hg, p < 0.001), received more transfusions in the first hour of arrival (55% vs. 34%, p = 0.02), and had a greater mortality from hemorrhagic shock (14% vs. 3.0%, p = 0.01). When controlling for year of admission, mechanism of injury and shock upon arrival (SBP ≤90 mm Hg or HR ≥120 bpm or base deficit ≤ 4) indicated T-TC had a 4.5-fold increased odds of death compared to T-PH (OR 4.5, 95% CI 1.23-16.4, p = 0.02). CONCLUSIONS: Waiting until TC arrival to control hemorrhage with a tourniquet was associated with worsened blood pressure and increased transfusion within the first hour of arrival. In routine civilian trauma patients, delaying to T-TC was associated with 4.5-fold increased odds of mortality from hemorrhagic shock. LEVEL OF EVIDENCE: Level IV.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/métodos
Hemorragia/complicações
Técnicas Hemostáticas/instrumentação
Choque Hemorrágico/mortalidade
Tempo para o Tratamento/tendências
Torniquetes/utilização
[Mh] Termos MeSH secundário: Adulto
Traumatismos do Braço/complicações
Feminino
Seguimentos
Hemorragia/mortalidade
Hemorragia/terapia
Seres Humanos
Traumatismos da Perna/complicações
Masculino
Meia-Idade
Estudos Retrospectivos
Choque Hemorrágico/etiologia
Choque Hemorrágico/terapia
Taxa de Sobrevida/tendências
Texas/epidemiologia
Centros de Traumatologia
População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001666


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[PMID]:29145985
[Au] Autor:Steiner MM; Calandruccio JH
[Ad] Endereço:Department of Hand Surgery, Bienville Orthopaedic Specialists, 6300 East Lake Boulevard, Gautier, MS 39565, USA. Electronic address: murphysteiner@gmail.com.
[Ti] Título:Use of Wide-awake Local Anesthesia No Tourniquet in Hand and Wrist Surgery.
[So] Source:Orthop Clin North Am;49(1):63-68, 2018 Jan.
[Is] ISSN:1558-1373
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:WALANT (wide-awake local anesthesia no tourniquet) appears to be a safe and effective anesthesia technique for many hand and wrist surgeries. Patient satisfaction is high because of the avoidance of preoperative testing and hospital admission. Postoperative recovery is rapid, and procedures can be done in outpatient settings, resulting in substantial savings in time and money.
[Mh] Termos MeSH primário: Anestesia Local
Mãos/cirurgia
Procedimentos Ortopédicos
[Mh] Termos MeSH secundário: Protocolos Clínicos
Seres Humanos
Torniquetes
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171118
[St] Status:MEDLINE


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[PMID]:28460426
[Au] Autor:Schoonover MJ; Moser DK; Young JM; Payton ME; Holbrook TC
[Ad] Endereço:Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma.
[Ti] Título:Effects of tourniquet number and exsanguination on amikacin concentrations in the radiocarpal and distal interphalangeal joints after low volume intravenous regional limb perfusion in horses.
[So] Source:Vet Surg;46(5):675-682, 2017 Jul.
[Is] ISSN:1532-950X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the influence of a dual tourniquet technique and limb exsanguination on amikacin concentrations in the synovial fluid of the radiocarpal joint (RCJ) and distal interphalangeal joint (DIPJ) after low volume, cephalic intravenous regional limb perfusion (IVRLP). STUDY DESIGN: Randomized cross-over design. ANIMALS: Six healthy adult horses. METHODS: One gram of amikacin in 6 mL of 0.9% NaCl was infused via cephalic IVRLP in 6 standing, sedated horses using 4 techniques: proximal pneumatic tourniquet (P), proximal pneumatic tourniquet with exsanguination (PE), proximal pneumatic and distal Esmarch tourniquet (PD), and proximal pneumatic with distal Esmarch tourniquet and exsanguination (PDE). Amikacin concentrations were measured in RCJ and DIPJ synovial fluid samples, collected just before perfusion (time 0), and at 15 and 30 minutes (before tourniquet release) after perfusion. RESULTS: Synovial fluid amikacin concentrations achieved in the RCJ were higher with techniques PD and PDE than those achieved with techniques P and PE 15 and 30 minutes after perfusion (P < .0001). Synovial fluid amikacin concentrations in the DIPJ were higher with techniques P and PE than those achieved with techniques PD and PDE at 15 minutes (P = .0002) and were higher than technique PDE at 30 minutes after perfusion (P < .0001). CONCLUSION: Low volume (10 mL) cephalic IVRLP should be combined with the placement of 2 tourniquets (proximal and distal to the carpus) to achieve therapeutic amikacin concentrations in the RCJ. Exsanguination prior to low volume IVRLP does not alter synovial fluid amikacin concentrations.
[Mh] Termos MeSH primário: Amicacina/química
Amicacina/farmacocinética
Antibacterianos/farmacocinética
Cavalos
Líquido Sinovial/química
Torniquetes/veterinária
[Mh] Termos MeSH secundário: Amicacina/administração & dosagem
Animais
Antibacterianos/administração & dosagem
Estudos Cross-Over
Membro Anterior
Perfusão
Procedimentos Cirúrgicos Vasculares
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 84319SGC3C (Amikacin)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1111/vsu.12662


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Texto completo
[PMID]:29069032
[Au] Autor:Xu J; Lu X; Zhang Y; Yang H; Yu X
[Ad] Endereço:The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China.
[Ti] Título:Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy: A case report.
[So] Source:Medicine (Baltimore);96(43):e8378, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Staged hepatectomy is an important surgical method for large hepatocellular carcinoma (HCC). However, the insufficient future liver remnant (FLR) is still the major barrier in stage II hepatectomy. We herein reported a case of laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization (TAE) for staged hepatectomy. PATIENT CONCERNS: Laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) was performed for cirrhotic HCC in stage I. To stimulate the growth of FLR, a "rescue" TAE was initiated before stage II. DIAGNOSE: HCC with hepatitis B cirrhosis. OUTCOMES: Two weeks later after TAE, the FLR achieved sufficient hypertrophy and stage II surgery was successfully performed. The patient was discharged 7 days after the second stage without serious complication. During the follow-up at postoperative 6 months, the patient underwent radiofrequency ablation, because contrast-enhanced ultrasonography showed 1 cm tumor recurrence in the remnant liver. LESSONS: Rescue TAE plays an important role to stimulate the increasing of FLR after ALTPS.
[Mh] Termos MeSH primário: Embolização Terapêutica/instrumentação
Hepatectomia/métodos
Laparoscopia/métodos
Ligadura/instrumentação
Torniquetes
[Mh] Termos MeSH secundário: Carcinoma Hepatocelular/complicações
Carcinoma Hepatocelular/cirurgia
Embolização Terapêutica/métodos
Hepatectomia/instrumentação
Seres Humanos
Laparoscopia/instrumentação
Ligadura/métodos
Cirrose Hepática/etiologia
Cirrose Hepática/cirurgia
Neoplasias Hepáticas/complicações
Neoplasias Hepáticas/cirurgia
Masculino
Meia-Idade
Recidiva Local de Neoplasia
Veia Porta/cirurgia
Período Pós-Operatório
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008378



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