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Sample records for hemostasis

  1. Kelainan Hemostasis pada Leukemia

    Zelly Dia Rofinda

    2012-09-01

    Full Text Available AbstrakLatar belakang: Leukemia adalah penyakit keganasan pada jaringan hematopoietik yang ditandai denganpenggantian elemen sumsum tulang normal oleh sel darah abnormal atau sel leukemik. Salah satu manifestasi klinisdari leukemia adalah perdarahan yang disebabkan oleh berbagai kelainan hemostasis.Kelainan hemostasis yang dapat terjadi pada leukemia berupa trombositopenia, disfungsi trombosit,koagulasi intravaskuler diseminata, defek protein koagulasi, fibrinolisis primer dan trombosis. Patogenesis danpatofosiologi kelainan hemostasis pada leukemia tersebut terjadi dengan berbagai mekanisme.Kata kunci: leukemia, kelainan hemostasisAbstractBackground: AbstractLeukemia is a malignancy of hematopoietic tissue which is characterized bysubstituted of bone marrow element with abnormal blood cell or leukemic cell. One of clinical manifestation ofleukemia is bleeding that is caused by several hemostasis disorders.Hemostasis disorders in leukemia such asthrombocytopenia, platelet dysfunction, disseminated intravascular coagulation, coagulation protein defect, primaryfibrinolysis and thrombosis. Pathogenesis and pathophysiology of thus hemostasis disorders in leukemia occur withdifferent mechanism.Keywords: leukemia, hemostasis disorder

  2. Hemostasis and ageing

    Mari, D.; Ogliari, G.; Castaldi, D.; Vitale, G.; Bollini, E.M.; Lio, D.

    2008-01-01

    Abstract On March 19, 2008 a Symposium on Pathophysiology of Ageing and Age-Related Diseases was held in Palermo, Italy. The lecture of D. Mari on Hemostasis and ageing is summarized herein. Physiological ageing is associated with increased plasma levels of many proteins of blood coagulation together with fibrinolysis impairment. This may be of great concern in view of the known association between vascular and thromboembolic diseases and ageing. On the other hand, centenarians are characteri...

  3. New models of hemostasis.

    McMichael, Maureen

    2012-05-01

    Hemostasis is an essential protective mechanism that depends on a delicate balance of procoagulant and anticoagulant processes. The waterfall/cascade models of coagulation are useful for understanding several essential steps of coagulation in vitro. These have resulted in the creation of the plasma-based tests used commonly and the ability to identify deficiencies in the extrinsic, intrinsic, and common pathways of coagulation. The model was also essential in elucidating the role of several of the inhibitors of coagulation and is currently used to demonstrate coagulation as it occurs in plasma in a static environment that is devoid of endothelial interactions. The intrinsic pathway originally described by these models does not appear to be essential for in vivo hemostasis but may play a role in pathologic thrombosis. The waterfall/cascade models' lack of cellular elements sets the stage for the cell-based model of coagulation. The cell-based model of blood coagulation, which includes the varied, complicated network of factors necessary for appropriate in vivo coagulation to occur, was the next step in the evolution of our understanding of coagulation. Recently, researchers have focused on real-time, in vivo models of hemostasis and this research reveals unexpected phenomena. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Study of hemostasis procedures for posterior epistaxis.

    Iimura, Jiro; Hatano, Atsushi; Ando, Yuji; Arai, Chiaki; Arai, Satoshi; Shigeta, Yasushi; Kojima, Hiromi; Otori, Nobuyoshi; Wada, Kota

    2016-06-01

    Hemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbach's area. The subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis. The bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures. We propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Gender related issues in thrombosis and hemostasis

    Hvas, Anne-Mette; Favaloro, Emmanuel J

    2017-01-01

    Introduction: Many aspects of hemostasis, both primary and secondary, as well as fibrinolysis display sex differences. From a clinical viewpoint, certain differential phenotypic presentations clearly arise within various disorders of thrombosis and hemostasis. Areas covered: The present mini......-review summarizes selected clinical entities where sex differences are reflected in both frequency and clinical presentation of hemostasis disorders. Sex differences are discussed within the settings of cardiovascular disease, including coronary artery disease and ischemic stroke, venous thromboembolism...... and inherited bleeding disorders. Moreover, pregnancy and labor present particular challenges in terms of increased thromboembolic and bleeding risk, and this is also summarized. Expert commentary: Available knowledge on sex differences in risk factors and clinical presentation of disorders within thrombosis...

  6. Critical laboratory values in hemostasis: toward consensus.

    Lippi, Giuseppe; Adcock, Dorothy; Simundic, Ana-Maria; Tripodi, Armando; Favaloro, Emmanuel J

    2017-09-01

    The term "critical values" can be defined to entail laboratory test results that significantly lie outside the normal (reference) range and necessitate immediate reporting to safeguard patient health, as well as those displaying a highly and clinically significant variation compared to previous data. The identification and effective communication of "highly pathological" values has engaged the minds of many clinicians, health care and laboratory professionals for decades, since these activities are vital to good laboratory practice. This is especially true in hemostasis, where a timely and efficient communication of critical values strongly impacts patient management. Due to the heterogeneity of available data, this paper is hence aimed to analyze the state of the art and provide an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis, thus providing a basic document for future consultation that assists laboratory professionals and clinicians alike. KEY MESSAGES Critical values are laboratory test results significantly lying outside the normal (reference) range and necessitating immediate reporting to safeguard patient health. A broad heterogeneity exists about critical values in hemostasis worldwide. We provide here an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis.

  7. Technological advances in the hemostasis laboratory.

    Lippi, Giuseppe; Plebani, Mario; Favaloro, Emmanuel J

    2014-03-01

    Automation is conventionally defined as the use of machines, control systems, and information technologies to optimize productivity. Although automation is now commonplace in several areas of diagnostic testing, especially in clinical chemistry and immunochemistry, the concept of extending this process to hemostasis testing has only recently been advanced. The leading drawbacks are still represented by the almost unique biological matrix because citrated plasma can only be used for clotting assays and few other notable exceptions, and by the highly specific pretreatment of samples, which is particularly distinct to other test systems. Despite these important limitations, a certain degree of automation is also now embracing hemostasis testing. The more relevant developments include the growing integration of routine hemostasis analyzers with track line systems and workcells, the development of specific instrumentation tools to enhance reliability of testing (i.e., signal detection with different technologies to increase test panels, plasma indices for preanalytical check of interfering substances, failure patterns sensors for identifying insufficient volume, clots or bubbles, cap-piercing for enhancing operator safety, automatic reflex testing, automatic redilution of samples, and laser barcode readers), preanalytical features (e.g., positive identification, automatic systems for tube(s) labeling, transillumination devices), and postphlebotomy tools (pneumatic tube systems for reducing turnaround time, sample transport boxes for ensuring stability of specimens, monitoring systems for identifying unsuitable conditions of transport). Regardless of these important innovations, coagulation/hemostasis testing still requires specific technical and clinical expertise, not only in terms of measurement procedures but also for interpreting and then appropriately utilizing the derived information. Thus, additional and special caution has to be used when designing projects of

  8. Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders

    Ordookhani, Arash; Burman, Kenneth D.

    2017-01-01

    Context There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. Evidence Acquisition A comprehensive literature search was conducted employing MEDLINE database. T...

  9. Hemostasis in Overt and Subclinical Hyperthyroidism

    Ordookhani, Arash; Burman, Kenneth D.

    2017-01-01

    Context There are contradictory results on the effect of hyperthyroidism on hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). The present review focuses on hemostatic changes in overt and subclinical hyperthyroidism. Methods A systematic literature search was conducted employing MEDLINE database. The following words were used for the search: Hyperthyroidism; thyrotoxicosis; Graves disease; goiter, nodular; ...

  10. Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders.

    Ordookhani, Arash; Burman, Kenneth D

    2017-04-01

    There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. A comprehensive literature search was conducted employing MEDLINE database. The following words were used for the search: Hypothyroidism; thyroiditis, autoimmune; blood coagulation factors; blood coagulation tests; hemostasis, blood coagulation disorders; thyroid hormones; myxedema; venous thromboembolism; fibrinolysis, receptors thyroid hormone. The papers that were related to hypothyroidism and autoimmune thyroid disorder and hemostasis are used in this review. Overt hypothyroidism is more associated with a hypocoagulable state. Decreased platelet count, aggregation and agglutination, von Willebrand factor antigen and activity, several coagulation factors such as factor VIII, IX, XI, VII, and plasminogen activator-1 are detected in overt hypothyrodism. Increased fibrinogen has been detected in subclinical hypothyroidism and autoimmune thyroid disease rendering a tendency towards a hypercoagulability state. Increased factor VII and its activity, and plasminogen activator inhibitor-1 are among several findings contributing to a prothrombotic state in subclinical hypothyroidism. Overt hypothyroidism is associated with a hypocoagulable state and subclinical hypothyroidism and autoimmune thyroid disorders may induce a prothrombotic state. However, there are contradictory findings for the abovementioned thyroid disorders. Prospective studies on the risk of VTE in various levels of hypofunctioning of the thyroid and autoimmune thyroid disorders are warranted.

  11. Hemostasis in Overt and Subclinical Hyperthyroidism

    Ordookhani, Arash; Burman, Kenneth D.

    2017-01-01

    Context There are contradictory results on the effect of hyperthyroidism on hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). The present review focuses on hemostatic changes in overt and subclinical hyperthyroidism. Methods A systematic literature search was conducted employing MEDLINE database. The following words were used for the search: Hyperthyroidism; thyrotoxicosis; Graves disease; goiter, nodular; hemostasis; blood coagulation factors; blood coagulation disorders; venous thromboembolism; bleeding; fibrinolysis. The articles that were related to hyperthyroidism and hemostasis are used in this manuscript. Results Hyperthyroidism, either overt or subclinical, renders a hypercoagulable state, although there are several studies with contradictory findings in the literature. Hypercoagulability may be caused by an increase in the level of various coagulation factors such as factor (F) VIII, FX, FIX, von Willebrand F (vWF), and fibrinogen, while hypofibrinolysis by changes in coagulation parameters such as a decrease in plasmin and plasmin activator or an increase in α2-antiplasmin, plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor Conclusions Although many reports are in favor of a hypercoagulable state in overt hyperthyroidism but this finding at the biochemical level and its clinical implication, on the occurrence of VTE, has yet to be confirmed. PMID:29201071

  12. Toward a computational model of hemostasis

    Leiderman, Karin; Danes, Nicholas; Schoeman, Rogier; Neeves, Keith

    2017-11-01

    Hemostasis is the process by which a blood clot forms to prevent bleeding at a site of injury. The formation time, size and structure of a clot depends on the local hemodynamics and the nature of the injury. Our group has previously developed computational models to study intravascular clot formation, a process confined to the interior of a single vessel. Here we present the first stage of an experimentally-validated, computational model of extravascular clot formation (hemostasis) in which blood through a single vessel initially escapes through a hole in the vessel wall and out a separate injury channel. This stage of the model consists of a system of partial differential equations that describe platelet aggregation and hemodynamics, solved via the finite element method. We also present results from the analogous, in vitro, microfluidic model. In both models, formation of a blood clot occludes the injury channel and stops flow from escaping while blood in the main vessel retains its fluidity. We discuss the different biochemical and hemodynamic effects on clot formation using distinct geometries representing intra- and extravascular injuries.

  13. Laboratory hemostasis: milestones in Clinical Chemistry and Laboratory Medicine.

    Lippi, Giuseppe; Favaloro, Emmanuel J

    2013-01-01

    Hemostasis is a delicate, dynamic and intricate system, in which pro- and anti-coagulant forces cooperate for either maintaining blood fluidity under normal conditions, or else will prompt blood clot generation to limit the bleeding when the integrity of blood vessels is jeopardized. Excessive prevalence of anticoagulant forces leads to hemorrhage, whereas excessive activation of procoagulant forces triggers excessive coagulation and thrombosis. The hemostasis laboratory performs a variety of first, second and third line tests, and plays a pivotal role in diagnostic and monitoring of most hemostasis disturbances. Since the leading targets of Clinical Chemistry and Laboratory Medicine include promotion of progress in fundamental and applied research, along with publication of guidelines and recommendations in laboratory diagnostics, this journal is an ideal source of information on current developments in the laboratory technology of hemostasis, and this article is aimed to celebrate some of the most important and popular articles ever published by the journal in the filed of laboratory hemostasis.

  14. Hemostasis and endothelial damage during sepsis.

    Johansen, Maria Egede

    2015-08-01

    The sepsis syndrome represents a disease continuum, including severe sepsis and septic shock associated with high mortality. One of the main problems in severe sepsis and septic shock, resulting in organ failure and death, are disturbances in the hemostasis due to sepsis-related coagulopathy. Sepsis-related coagulopathy affects not only traditional coagulation factors, but also the platelets and endothelium. Functional testing of the hemostatic system has found application in critical illness. Thrombelastography (TEG) provides an overview of the hemostatic system allowing for an evaluation of interactions between coagulation factors and platelets. Additionally, the role of the endothelium during sepsis can be explored through testing of biomarkers of endothelial damage. The three studies comprising this PhD thesis all investigate important aspects of the disturbed hemostasis during sepsis, including endothelial damage. Together, the specific findings from the three studies improve the existing understanding of sepsis-related coagulopathy, and the possible influences of some of the treatments offered these patients. The first study investigates the occurrence of antimicrobial-induced thrombocytopenia among critically ill patients. In sepsis, thrombocytopenia is a predictor of poor outcome, and reports, of mainly casuistic nature, have previously hypothesized that specific antimicrobial agents could induce in sepsis-related thrombocytopenia. This hypothesis was tested using a randomized designed set-up, encompassing 1147 critically ill patients, and no significant difference in risk of thrombocytopenia was observed among patients receiving large amounts of antimicrobials vs. patients receiving standard-of-care. As a consequence, the risk of antimicrobial-induced thrombocytopenia in the general population of critically ill patients seemingly does not represent a substantial problem and thrombocytopenia during critical illness is most likely due to other factors such

  15. Hemostasis in tubeless PNL: point of technique.

    Aron, Monish; Goel, Rajiv; Kesarwani, Pawan K; Gupta, Narmada P

    2004-01-01

    Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL. copyright 2004 S. Karger AG, Basel

  16. Lonomia obliqua Walker (Lepidoptera: Saturniidae: hemostasis implications

    Silviane Maggi

    2015-06-01

    Full Text Available Summary In southern Brazil, since 1989, several cases of accidents produced by unwilling contact with the body of poisonous caterpillars of the moth species Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae, were described. L. obliqua caterpillars have gregarious behavior and feed on leaves of host trees during the night, staying grouped in the trunk during the day, which favors the occurrence of accidents with the species. This caterpillar has the body covered with bristles that on contact with the skin of individuals, breaks and release their contents, inoculating the venom into the victim. The basic constitution of the venom is protein and its components produce physiological changes in the victim, which include disturbances in hemostasis. Hemorrhagic syndrome associated with consumption coagulopathy, intravascular hemolysis and acute renal failure are some of the possible clinical manifestations related to poisoning by L. obliqua. Specific laboratory tests for diagnosis of poisoning have not been described previously. The diagnosis of poisoning is made based on the patient's medical history, clinical manifestations, erythrocyte levels, and, primarily, parameters that evaluate blood coagulation. Treatment is performed with the use of supportive care and the administration of specific hyperimmune antivenom. Poisoning can be serious and even fatal.

  17. The state of hemostasis in pregnant women with hydramnion

    I. A. Lyoshenko

    2016-05-01

    Abstract Purpose. To determine the state of various stages of hemostasis in pregnant women with hydramnion as a risk factor for premature detachment of the placenta. Results. There was investigated the state of hemostasis in pregnant women with hydramnion by low piezoelectric thromboelastography (LPTEG and standard coagulogram. According to the LPTEG results this group of women was found to have increased plasma coagulation potential manifested in elevated constant thrombin activity (TAC by 76.8%, the intensity of coagulation drive (ICD by 74.9%, maximum clot density (MA by 16.8%, shortening of coagulation time (T3 by 7.8% and inhibition of fibrinolysis manifested by decrease in retraction intensity and clot lysis (RICL by 67.7% (p<0.05. Conclusions. The state of hemostasis in pregnant women with hydramnion is characterized by increased plasma coagulation and inhibition of fibrinolysis potential that are factors of preparing the woman’s body for the upcoming birth to control and minimize blood loss.   Keywords: pregnancy, hydramnion, hemostasis, thromboelastography.

  18. ENDOVASCULAR HEMOSTASIS IN UTERINE BLEEDING IN PATIENTS WITH UTERINE LEIOMYOMA

    M. M. Damirov

    2017-01-01

    Full Text Available We report results of treatment for 72 patients with uterine leiomyoma (LM of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE. We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

  19. Molecular aspects in clinical hemostasis research at Karolinska Institutet.

    Blombäck, Margareta

    2010-05-21

    The development of hemostasis research at Karolinska Institutet is described, focusing first on the initial findings of the fibrinogen structure and the hereditary bleeding disorders, hemophilia A and von Willebrand's disease. Basic research has focused on new biomarkers for cardiovascular/thromboembolic disorders, such as myocardial infarction and stroke, including preeclampsia and diabetes, with studies on the importance of decreased fibrinolysis in these disorders. Since long, the structure of the fibrin network has been evaluated, and recently the influence of aspirin and new thrombin and factor Xa inhibitors has been investigated. Research on the contact pathway of coagulation has also started at the Unit. 2010 Elsevier Inc. All rights reserved.

  20. Microparticle Analysis in Disorders of Hemostasis and Thrombosis

    Mooberry, Micah J.; Key, Nigel S.

    2015-01-01

    Microparticles (MPs) are submicron vesicles released from the plasma membrane of eukaryotic cells in response to activation or apoptosis. MPs are known to be involved in numerous biologic processes, including inflammation, the immune response, cancer metastasis, and angiogenesis. Their earliest recognized and most widely accepted role, however, is the ability to promote and support the process of blood coagulation. Consequently, there is ongoing interest in studying MPs in disorders of hemostasis and thrombosis. Both phosphatidylserine (PS) exposure and the presence of tissue factor (TF) in the MP membrane may account for their procoagulant properties, and elevated numbers of MPs in plasma have been reported in numerous prothrombotic conditions. To date, however, there are few data on true causality linking MPs to the genesis of thrombosis. A variety of methodologies have been employed to characterize and quantify MPs, although detection is challenging due to their submicron size. Flow cytometry (FCM) remains the most frequently utilized strategy for MP detection; however, it is associated with significant technological limitations. Additionally, pre-analytical and analytical variables can influence the detection of MPs by FCM, rendering data interpretation difficult. Lack of methodologic standardization in MP analysis by FCM confounds the issue further, although efforts are currently underway to address this limitation. Moving forward, it will be important to address these technical challenges as a scientific community if we are to better understand the role that MPs play in disorders of hemostasis and thrombosis. PMID:25704723

  1. A refined model of the genomic basis for phenotypic variation in vertebrate hemostasis

    Ribeiro, Ângela M.; Zepeda Mendoza, Marie Lisandra; Bertelsen, Mads Frost

    2015-01-01

    BACKGROUND: Hemostasis is a defense mechanism that enhances an organism's survival by minimizing blood loss upon vascular injury. In vertebrates, hemostasis has been evolving with the cardio-vascular and hemodynamic systems over the last 450 million years. Birds and mammals have very similar vasc...

  2. Changes in hemostasis in foals naturally infected with Strongylus vulgaris

    Pihl, Tina Holberg; Krarup Nielsen, Martin; Jacobsen, Stine

    2017-01-01

    Strongylus vulgaris has been found endemic in equine populations subject to parasite control by targeted selective anthelmintic therapy. This study investigated hemostasis in foals naturally infected with S. vulgaris and monitored this response over the course of progressing infection stages...... 4. Strongylus vulgaris antibody levels were statistically associated with D-dimer (P = .0076) and fibrinogen (P = .0004) concentrations. Naturally acquired infection with S. vulgaris was associated with changes suggestive of mild activation of coagulation, fibrinolysis, and inflammation. The results....... The hemostatic indices D-dimer, antithrombin III (ATIII), fibrinogen, prothrombin time (PT), and activated partial thromboplastin time were evaluated in weekly blood samples for up to 50 weeks in 12 foals born into a herd with high prevalence of S. vulgaris. Results were compared with weekly S. vulgaris antibody...

  3. Platelets in thrombosis and hemostasis: old topic with new mechanisms.

    Wang, Yiming; Andrews, Marc; Yang, Yan; Lang, Sean; Jin, Joseph W; Cameron-Vendrig, Alison; Zhu, Guangheng; Reheman, Adili; Ni, Heyu

    2012-12-01

    Platelets are small anucleate cells generated from megakaryocytes in the bone marrow. After being released into the circulation, platelets play key roles in the surveillance of vascular injury, and can quickly adhere and aggregate at the site of injury, which are critical events for vascular repair and hemostasis. However, the same biological processes of platelet adhesion and aggregation may also cause thrombotic disorders. The formation of a platelet plug at sites of atherosclerotic lesion rupture is the most common mechanism leading to myocardial or cerebral infarction. Platelet-related deep vein thrombosis is also one of the leading causes of mortality worldwide. The contribution of several platelet receptors and their ligands has been highlighted in these processes. In platelet adhesion, particularly at high shear stress, GPIbα-von Willebrand factor (VWF) interaction may initiate this event, which is followed by GPVI signalling and firm platelet adhesion mediated by members of the integrin family, such as β3 (αIIbβ3) and β1 (α2β1, α5β1) integrins. In platelet aggregation, although GPIbα-VWF, P selectin-sulfatides, and other molecules, may be involved, the process is mainly mediated by β3 (αIIbβ3) integrin and its ligands, such as fibrinogen and VWF. It is intriguing that platelet adhesion and aggregation still occur in mice lacking both fibrinogen and VWF, suggesting that other unforeseen molecule(s) may also be important in these processes. Identification and characterization of these molecules will enrich our knowledge in the basic science of hemostasis and thrombosis, and may lead to the development of new therapies against bleeding disorders and thrombotic diseases.

  4. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage.

    Liotta, Eric M; Prabhakaran, Shyam; Sangha, Rajbeer S; Bush, Robin A; Long, Alan E; Trevick, Stephen A; Potts, Matthew B; Jahromi, Babak S; Kim, Minjee; Manno, Edward M; Sorond, Farzaneh A; Naidech, Andrew M; Maas, Matthew B

    2017-08-22

    We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate ( p = 0.02), parsimoniously adjusted ( p = 0.002), and fully adjusted models ( p = 0.006), as well as greater hematoma growth ( p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes ( p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH. © 2017 American Academy of Neurology.

  5. A refined model of the genomic basis for phenotypic variation in vertebrate hemostasis.

    Ribeiro, Ângela M; Zepeda-Mendoza, M Lisandra; Bertelsen, Mads F; Kristensen, Annemarie T; Jarvis, Erich D; Gilbert, M Thomas P; da Fonseca, Rute R

    2015-06-30

    Hemostasis is a defense mechanism that enhances an organism's survival by minimizing blood loss upon vascular injury. In vertebrates, hemostasis has been evolving with the cardio-vascular and hemodynamic systems over the last 450 million years. Birds and mammals have very similar vascular and hemodynamic systems, thus the mechanism that blocks ruptures in the vasculature is expected to be the same. However, the speed of the process varies across vertebrates, and is particularly slow for birds. Understanding the differences in the hemostasis pathway between birds and mammals, and placing them in perspective to other vertebrates may provide clues to the genetic contribution to variation in blood clotting phenotype in vertebrates. We compiled genomic data corresponding to key elements involved in hemostasis across vertebrates to investigate its genetic basis and understand how it affects fitness. We found that: i) fewer genes are involved in hemostasis in birds compared to mammals; and ii) the largest differences concern platelet membrane receptors and components from the kallikrein-kinin system. We propose that lack of the cytoplasmic domain of the GPIb receptor subunit alpha could be a strong contributor to the prolonged bleeding phenotype in birds. Combined analysis of laboratory assessments of avian hemostasis with the first avian phylogeny based on genomic-scale data revealed that differences in hemostasis within birds are not explained by phylogenetic relationships, but more so by genetic variation underlying components of the hemostatic process, suggestive of natural selection. This work adds to our understanding of the evolution of hemostasis in vertebrates. The overlap with the inflammation, complement and renin-angiotensin (blood pressure regulation) pathways is a potential driver of rapid molecular evolution in the hemostasis network. Comparisons between avian species and mammals allowed us to hypothesize that the observed mammalian innovations might have

  6. Alterations in hemostasis associated with pregnancy in patients with glycemic disorders

    Irina Arkad'evna Bondar'

    2013-06-01

    Full Text Available In this review we present a comparative analysis of alterations in hemostasis and blood coagulation during normal pregnancy with those in pregnant women with glycemic disorders (diabetes mellitus type 1 and 2, gestational diabetes.

  7. Networks of enzymatically oxidized membrane lipids support calcium-dependent coagulation factor binding to maintain hemostasis

    Lauder, S.N.; Allen-Redpath, K.; Slatter, D.A.; Aldrovandi, M.; O'Connor, A.; Farewell, D.; Percy, C.L.; Molhoek, J.E.; Rannikko, S.; Tyrrell, V.J.; Ferla, S.; Milne, G.L.; Poole, A.W.; Thomas, C.P.; Obaji, S.; Taylor, P.R.; Jones, S.A.; Groot, P.G. de; Urbanus, R.T.; Horkko, S.; Uderhardt, S.; Ackermann, J.; Jenkins, P.V.; Brancale, A.; Kronke, G.; Collins, P.W.; O'Donnell, V.B.

    2017-01-01

    Blood coagulation functions as part of the innate immune system by preventing bacterial invasion, and it is critical to stopping blood loss (hemostasis). Coagulation involves the external membrane surface of activated platelets and leukocytes. Using lipidomic, genetic, biochemical, and mathematical

  8. El mecanismo de la hemostasis en neurocirugía

    Alejandro Jiménez Arango

    1949-05-01

    Full Text Available Desde los primeros tiempos de la cirugía, la hemorragia ha sido uno de los principales problemas que ha tenido que afrontar el cirujano, y uno de los mayores riesgos para la vida del paciente. Al paso que la anestesia y la antisepsia son adquisiciones relativamente recientes, la hemostasis ha tenido una evolución de muchos siglos y los principios generales que hoy en día se aplican no difieren de los que usaban los cirujanos de la antigüedad. Así, vemos que los egipcios, los chinos y los hindúes usaban la compresión y los estípticos, los griegos introdujeron la ligadura y el cauterio, que posteriormente se usó como hemostático. Finalmente, Ambrosio Paré ideó la primera pinza hemostática a la que llamó "bec de corbin", y de allí en adelante se siguieron perfeccionando los métodos instrumentales.

  9. Effect of intraosseous anesthesia on control of hemostasis in pigs.

    Baker, Tyler F; Torabinejad, Mahmoud; Schwartz, Stephen F; Wolf, David

    2009-11-01

    Intraosseous anesthesia is used to deliver anesthetic into cancellous bone adjacent to the root apices. No study has assessed the effect of this anesthetic technique on hemostasis. The purpose of this study was to compare the amount of bleeding from soft tissue and bone in pig jaws after preoperative intraosseous or infiltration anesthesia with 2% lidocaine containing 1:50,000 epinephrine. Twelve pigs were divided into 3 groups. The first group received infiltration anesthesia on one half of the jaw and no anesthesia on the other half. The second group received intraosseous anesthesia on one half of the jaw and no anesthesia on the other half. The third group received infiltration anesthesia on one half of the jaw and intraosseous anesthesia on the second half. Blood was collected during flap reflection to measure the volume of soft tissue bleeding. Osteotomies were then prepared with blood collected from the surgical site to measure the volume of osseous bleeding. The median soft tissue blood loss observed in animals receiving infiltration anesthesia (1.14 mL) was significantly less as compared with animals that received no anesthesia (4.49 mL) or intraosseous anesthesia (2.45 mL). Compared with median hard tissue blood loss observed in animals without anesthesia (1.51 mL), significantly less blood loss was observed in animals receiving either infiltration anesthesia (0.67 mL) or intraosseous anesthesia (0.76 mL). Infiltration anesthesia resulted in significantly less soft tissue bleeding (p = .004) as compared with no anesthesia. Infiltration and intraosseous anesthesia resulted in significantly less osseous bleeding than the use of no anesthetic (p < .001). The volume of blood loss for each animal was shown to be below the maximum safe volume of blood loss for a single procedure.

  10. Hemostasis biomarkers and incident cognitive impairment: the REGARDS study.

    Gillett, S R; McClure, L A; Callas, P W; Thacker, E L; Unverzagt, F W; Wadley, V G; Letter, A J; Cushman, M

    2018-05-07

    Vascular risk factors are associated with cognitive impairment, a condition with substantial public health burden. We hypothesized that hemostasis biomarkers related to vascular disease would be associated with risk of incident cognitive impairment. We performed a nested case control study including 1,082 participants with 3.5 years of follow-up in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a longitudinal cohort study of 30,239 black and white Americans ≥45 years old. Participants were free of stroke or cognitive impairment at baseline. Baseline D-dimer, fibrinogen, factor VIII, and protein C were measured in 495 cases who developed cognitive impairment during follow-up (based on abnormal scores on ≥2 of 3 cognitive tests) and 587 controls. Unadjusted ORs for incident cognitive impairment were 1.32 (95% CI 1.02, 1.70) for D-dimer >0.50 μg/mL, 1.83 (CI 1.24, 2.71) for fibrinogen >90 th percentile, 1.63 (CI 1.11, 2.38) for factor VIII >90 th percentile and 1.10 (CI 0.73, 1.65) for protein C impairment, with an adjusted OR 1.73 (CI 1.10, 2.69). Elevated D-dimer, fibrinogen, and factor VIII were not associated with occurrence of cognitive impairment after multivariable adjustment; however, having at least 2 abnormal biomarkers was associated, suggesting the burden of these biomarkers is relevant. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  11. Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

    Duan, Ya-Qi; Liang, Ping

    2013-05-01

    Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

  12. Acute Management of Hemostasis in Patients With Neurological Injury.

    Baharoglu, M Irem; Brand, Anneke; Koopman, Maria M; Vermeulen, Marinus; Roos, Yvo B W E M

    2017-10-01

    Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults. Review of articles fulfilling inclusion criteria and relevant references revealed that, in patients with ischemic stroke, intravenous thrombolytic therapy with recombinant tissue plasminogen activator within 4.5-5 hours after onset of symptoms improves clinical outcome. In contrast, there are no hemostatic therapies that are proven to improve clinical outcome of patients with hemorrhagic stroke or TBI. In patients with hemorrhagic stroke who use vitamin K antagonist or direct oral anticoagulants, there is evidence that specific reversal therapies improve hemostatic laboratory parameters but without an effect on clinical recovery. In patients with hemorrhagic stroke or TBI who use concomitant antiplatelet therapy, there is evidence for harm of platelet transfusion. In patients with aneurysmal subarachnoid hemorrhage, tranexamic acid was shown to reduce rebleeding rate without improving clinical outcome. The effects of tranexamic acid in patients with TBI are still under investigation. We conclude that, in patients with ischemic stroke, thrombolytic therapy improves outcome when given within 4.5-5 hours. In hemorrhagic stroke and TBI, most hemostatic therapies improved or corrected laboratory parameters but not clinical outcome. Currently, in several trials, the effects of tranexamic acid are

  13. Comparative efficiency of endoscopic hemostasis methods in bleeding undercomplicated peptic ulcer in children

    Сергій Олександрович Сокольник

    2015-05-01

    Full Text Available Aim. To compare the effectiveness of endoscopic hemostasis in complex treatment of gastrointestinal bleeding in children of Chernovtsy region with peptic ulcer disease.Methods. 43 cases of bleeding in peptic ulcer disease in children are analyzed. Argon plasma coagulation is undergone in order to stop the bleeding for 11 patients, for others – aminocaproic acid irrigation.Results. Using argon plasma coagulation, in contrast to the aminocaproic acid irrigation reduces the risk of rebleeding 0.59 times when the number of patients who must be treated – 2.99.Conclusions. The most effective method of endoscopic hemostasis of bleeding in peptic ulcer disease in children is argon plasma coagulation, which allows you to achieve a stable hemostasis and reduce the risk of rebleeding

  14. Enzymatic lipid oxidation by eosinophils propagates coagulation, hemostasis, and thrombotic disease

    Uderhardt, Stefan; Ackermann, Jochen A.; Fillep, Tobias; Hammond, Victoria J.; Willeit, Johann; Stark, Konstantin; Rossaint, Jan; Schubert, Irene; Mielenz, Dirk; Dietel, Barbara; Raaz-Schrauder, Dorette; Ay, Cihan; Thaler, Johannes; Heim, Christian; Collins, Peter W.; Schabbauer, Gernot; Mackman, Nigel; Voehringer, David; Nadler, Jerry L.; Lee, James J.; Massberg, Steffen; Rauh, Manfred; O’Donnell, Valerie B.

    2017-01-01

    Blood coagulation is essential for physiological hemostasis but simultaneously contributes to thrombotic disease. However, molecular and cellular events controlling initiation and propagation of coagulation are still incompletely understood. In this study, we demonstrate an unexpected role of eosinophils during plasmatic coagulation, hemostasis, and thrombosis. Using a large-scale epidemiological approach, we identified eosinophil cationic protein as an independent and predictive risk factor for thrombotic events in humans. Concurrent experiments showed that eosinophils contributed to intravascular thrombosis by exhibiting a strong endogenous thrombin-generation capacity that relied on the enzymatic generation and active provision of a procoagulant phospholipid surface enriched in 12/15-lipoxygenase–derived hydroxyeicosatetraenoic acid–phosphatidylethanolamines. Our findings reveal a previously unrecognized role of eosinophils and enzymatic lipid oxidation as regulatory elements that facilitate both hemostasis and thrombosis in response to vascular injury, thus identifying promising new targets for the treatment of thrombotic disease. PMID:28566277

  15. Rediscovering the wound hematoma as a site of hemostasis during major arterial hemorrhage.

    White, N J; Mehic, E; Wang, X; Chien, D; Lim, E; St John, A E; Stern, S A; Mourad, P D; Rieger, M; Fries, D; Martinowitz, U

    2015-12-01

    Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels. Yet, little is known regarding major internal arterial hemostasis, or how these commonly used treatments might influence hemostasis. (i) To use a swine model of femoral artery bleeding to understand the perivascular hemostatic response to contained arterial hemorrhage. (ii) To directly confirm the association between hemodynamics and bleeding velocity. (iii) To observe the feasibility of delivering an activated clotting factor directly to internal sites of bleeding using a simplified angiographic approach. Ultrasound was used to measure bleeding velocity and in vivo clot formation by elastography in a swine model of contained femoral artery bleeding with fluid resuscitation. A swine model of internal pelvic and axillary artery hemorrhage was also used to demonstrate the feasibility of local delivery of an activated clotting factor. In this model, clots formed slowly within the peri-wound hematoma, but eventually contained the bleeding. Central hemodynamics correlated positively with bleeding velocity. Infusion of recombinant human activated factor VII into the injured artery near the site of major internal hemorrhage in the pelvis and axillae was feasible. We rediscovered that clot formation within the peri-wound hematoma is an integral component of hemostasis and a feasible target for the treatment of major internal bleeding using activated clotting factors delivered using a simplified angiographic approach. © 2015 International Society on Thrombosis and Haemostasis.

  16. Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

    Kohei Kobatake

    2015-04-01

    Full Text Available Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants and to the non-insertion group (group B: 130 participants. In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0% vs. 11 (8.5%, P=0.029. The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort.

  17. Giving blood: Donor stress and hemostasis : Don't let your blood run cold

    Hoogerwerf, M.D.

    2017-01-01

    Does a donation induce stress in blood donors, and does this affect the donor’s hemostasis? Donation-induced psychological, hormonal and physiological stress response patterns during a blood donation procedure were examined, and the effects of donation-induced stress response on immediate changes in

  18. TAM receptors, Gas6, and protein S: roles in inflammation and hemostasis.

    van der Meer, Jonathan H M; van der Poll, Tom; van 't Veer, Cornelis

    2014-04-17

    TAM receptors (Tyro3, Axl, and Mer) belong to a family of receptor tyrosine kinases that have important effects on hemostasis and inflammation. Also, they affect cell proliferation, survival, adhesion, and migration. TAM receptors can be activated by the vitamin K-dependent proteins Gas6 and protein S. Protein S is more commonly known as an important cofactor for protein C as well as a direct inhibitor of multiple coagulation factors. To our knowledge, the functions of Gas6 are limited to TAM receptor activation. When activated, the TAM receptors have effects on primary hemostasis and coagulation and display an anti-inflammatory or a proinflammatory effect, depending on cell type. To comprehend the effects that the TAM receptors and their ligands have on hemostasis and inflammation, we compare studies that report the different phenotypes displayed by mice with deficiencies in the genes of this receptor family and its ligands (protein S(+/-), Gas6(-/-), TAM(-/-), and variations of these). In this manner, we aim to display which features are attributable to the different ligands. Because of the effects TAM receptors have on hemostasis, inflammation, and cancer growth, their modulation could make interesting therapeutic targets in thromboembolic disease, atherosclerosis, sepsis, autoimmune disease, and cancer.

  19. TAM receptors, Gas6, and protein S: roles in inflammation and hemostasis

    van der Meer, Jonathan H. M.; van der Poll, Tom; van 't Veer, Cornelis

    2014-01-01

    TAM receptors (Tyro3, Axl, andMer) belong to a family of receptor tyrosine kinases that have important effects on hemostasis and inflammation. Also, they affect cell proliferation, survival, adhesion, and migration. TAM receptors can be activated by the vitamin K-dependent proteins Gas6 and protein

  20. International Society on Thrombosis and Haemostasis core curriculum project: core competencies in clinical thrombosis and hemostasis

    McLintock, C.; Pabinger, I.; Bauer, K. A.; Laffan, M.; Angchaisuksiri, P.; Rezende, S. M.; Middeldorp, S.; Ross, M.

    2016-01-01

    Essentials The priority of ISTH was to establish a global core curriculum in thrombosis and hemostasis. International survey to determine competencies required for clinical specialists was carried out in the field. Competency framework provides a reference point for mapping and developing regional

  1. Infusion of DDAVP does not improve primary hemostasis in patients with cirrhosis

    F. Arshad (Freeha); S.C.M. Stoof (Carina); F.W.G. Leebeek (Frank); K. Ruitenbeek (Karin); J. Adelmeijer (Jelle); Blokzijl, H. (Hans); A.P. van den Berg (Arie P.); R.J. Porte (Robert); M.J.H.A. Kruip (Marieke); Lisman, T. (Ton)

    2015-01-01

    textabstractBackground & Aims: Cirrhosis frequently affects multiple components of hemostasis. Reversal of the coagulopathy of these patients is frequently required in case of bleeding episodes, or as prophylaxis before invasive procedures. Although 1-deamino-8-D-arginine vasopressin (DDAVP) is

  2. Immediate arterial hemostasis after cardiac catheterization: initial experience with a new puncture closure device.

    Aker, U T; Kensey, K R; Heuser, R R; Sandza, J G; Kussmaul, W G

    1994-03-01

    A novel device for obtaining arterial hemostasis after invasive procedures was tested in 30 patients undergoing diagnostic catheterization (26 patients) or coronary angioplasty (4 patients). The device is deployed through an arterial sheath and forms a positive mechanical seal both inside and outside the defect in the arterial wall. The components are all bioabsorbable. Thirteen patients received a heparin bolus during the catheterization procedure. The activated clotting time recorded in 15 patients just prior to device deployment averaged 264 sec. 29 of 32 attempted device deployments were successful (91%); and the remaining 3 devices pulled completely out as called for by design in the event of incomplete deployment. Twenty-nine patients ultimately achieved successful hemostasis using the device, with the other patient receiving manual hemostasis. Of these 29, hemostasis was immediate and complete in 19 patients. Light digital pressure was required in another 8 patients for less than 5 min. There was minor delayed bleeding requiring supplemental light pressure in several cases. A total of 11 patients required supplemental pressure in addition to the hemostasis device. The use of bolus heparin was significantly (P = 0.05, Fisher's exact test) related to the requirement for supplemental pressure. Three patients developed hematomas, one of which was present prior to device deployment. The other two patients had received bolus heparin. No patient required transfusion or surgical repair. There was no change in the ankle/brachial systolic blood pressure index after device deployment or at late (30-60 day) follow-up. Ultrasound studies revealed no significant pathology relative to the device.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Secure hemostasis in transhiatal esophagectomy for esophageal cancer with gauze packing

    Hirahara Noriyuki

    2012-12-01

    Full Text Available Abstract Background Transhiatal esophagectomy for esophageal cancer implies blind manipulation of the intrathoracic esophagus. We report a secure hemostatic method with gauze packing in transhiatal esophagectomy. Methods The gauze-packing technique is utilized for hemostasis just after removal of the thoracic esophagus during transhiatal esophagectomy. After confirming cancer-free margins, the abdominal esophagus and cervical esophagus are transected. A vein stripper is inserted into the oral-side stump of the esophagus and led to exit from the abdominal-side stump of the esophagus. The vein stripper and the oral stump of the esophagus are affixed by silk thread. A polyester tape is then affixed to the vein stripper, as the polyester tape is left in the posterior mediastinum after removal of the esophagus toward the abdominal side. The polyester tape on the cervical side is ligated with gauze and the polyester tape is removed toward the abdominal side. The oral stump of gauze and new additional gauze are affixed. As the first gauze is pulled out from the abdominal side, the second gauze gets drawn from the cervical wound into the mediastinum. The posterior mediastinum is finally packed with gauze and possible bleeding at this site undergoes a complete astriction. The status of hemostasis with the gauze packing is checked by an observation of color and bloodstain on the gauze. Results Between January 2005 and February 2012, 13 consecutive patients with esophageal cancer underwent a transhiatal esophagectomy with the gauze-packing hemostatic technique. Hemostasis at the posterior mediastinum was performed successfully and quickly in all cases with this method, requiring up to four pieces of gauze for a complete hemostasis. Median required time for hemostasis was 1219 (range 1896 to 1293 seconds and estimated blood loss was 20.4 (range 15 to 25 ml during gauze packing. Conclusions Our technique could minimize bleeding after the removal of the

  4. A case of advanced gastric cancer resected for rebleeding after palliative radiotherapy for hemostasis

    Muneoka, Yusuke; Ichikawa, Hiroshi; Ishikawa, Takashi

    2016-01-01

    We report a case of advanced gastric cancer (AGC) that was resected for rebleeding after palliative radiotherapy for hemostasis. A 74-year-old man with Stage IV gastric cancer received chemotherapy and achieved stable disease. After 23 months, he experienced continuous bleeding from the tumor due to regrowth. Palliative radiotherapy was conducted to control the bleeding, and the tumor successfully achieved hemostasis. However, 6 weeks later, the patient experienced rebleeding and developed hemostatic shock. We then performed a successful emergency gastrectomy. Bleeding negatively affects quality of life in patients with AGC and is potentially lethal. Although palliative radiotherapy for bleeding of gastric cancer is a safe and useful treatment within a short time frame in cases of rebleeding, emergency gastrectomy may be necessary. Therefore, when we select this treatment, the possibility of subsequent surgical treatment must be considered. (author)

  5. [Pharmacological study on hemostasis, analgesic and anti inflammation effects of the alcohol extract of Hibiscus tiliaceus].

    Qiu, Fen; Tian, Hui; Zhang, Zhi; Yuan, Xian-Ling; Tan, Yuan-Feng; Ning, Xiao-Qing

    2013-10-01

    To study the effects of hemostasis, analgesic and anti inflammation of the alcohol extract of Hibiscus tiliaceus and offer pharmacological and experimental basis for its safe and effective use in clinic. The effects of hemostasist were observed with tail breaking method, capillary tube method and slide method; Hot board and body distortion induced by acetic acid methods were applied in mice analgesia experiment, the mice model of acute auricle swelling induced by dmi ethylbenzene and capillary permeability induced by acetic acid were applied to observe the anti inflammatory effects. The alcohol extract of Hibiscus tiliaceus could significantly reduce the bleeding time and the clotting time, delay the plant reaction time and reduce the writhing times of the mice, and it also had effect on inhibiting swelling of mice ear and the permeability of the capillary. These results suggest that the alcohol extract of Hibiscus tiliaceus has the effects of hemostasis, analgesic and anti inflammation.

  6. Hemostasis system in patients with pulmonary cancer during multimodality treatment with the use of artificial hyperglycemia

    Demidchik, Yu.E.; Zharkov, V.V.; Antipova, L.I.; Kurchin, V.P.; Moiseev, P.I.

    1990-01-01

    The main hemostasis indices at all stages of combined treatment of 105 patients with pulmonary cancer, involving radiotherapy artificial hyperglycemia and surgical intervention, are estimated. The functional status of the hemostasis system was estimated on the basis of a complex of hemocoagulation tests. All patients were subjected to preoperative remote large-fractioned irradiation with 20 Gy total absorbed dose in 5 fractions of 4 Gy in a week. It is established that at the irradiation stage of combined treatment hyperglycemia leads to hyper coagulation and increases the risk of thromboembolic complications. For prophylaxis of the complications it is reasonable to combine low doses of heparin and preparations, improving blood rheology either before or after surgical intervention. 7 refs.; 2 tabs

  7. The Use of a Hemostasis Introducer for Percutaneous Extraction of Bile Duct Stones.

    Feisthammel, Juergen; Moche, Micheal; Mossner, Joachim; Hoffmeister, Albrecht

    2012-02-01

    Choledocholithiasis is defined as presence of at least one gallstone in the bile duct. Those bile duct stones (BDS) usually are extracted by ERCP. In case the bile duct is not accessible endoscopically (e.g. after major abdominal surgery), PTCD has to be performed. Extraction of the stones via PTCD has several risks as are hemorrhage, pancreatitis and injuries of the liver tissue. We here report about our experience with a significant modification of this technique by use of a 13-french hemostasis introducer as a sheath to track the transhepatic access to the bile ducts in order to reduce time and risk. Three patients were treated by use of the reported modification. In all cases, the stones were successfully removable without complications. We demonstrate that the use of a hemostasis introducer for percutaneous extraction of common bile duct stones seems to be promising in terms of shortening hospital stay and increasing patient safety.

  8. Impaired platelet aggregation and rebalanced hemostasis in patients with chronic hepatitis C virus infection

    Nielsen, Nick S.; Jespersen, Sofie; Gaardbo, Julie C.

    2017-01-01

    Increased risk of both cardiovascular disease (CVD) and bleeding has been found in patients with chronic hepatitis C (CHC) infection, and a re-balanced hemostasis has been proposed. The aim of this study was to investigate functional whole blood coagulation and platelet function in CHC infection....... The prospective study included 82 patients with CHC infection (39 with advanced liver fibrosis and 43 with no or mild liver fibrosis) and 39 healthy controls. A total of 33 patients were treated for CHC infection and achieved sustained virological response (SVR). Baseline and post-treatment blood samples were...... collected. Hemostasis was assessed by both standard coagulation tests and functional whole blood hemostatic assays (thromboelastograhy (TEG), and platelet aggregation (Multiplate). Patients with CHC and advanced fibrosis had impaired platelet aggregation both compared to patients with no or mild fibrosis...

  9. Impaired Platelet Aggregation and Rebalanced Hemostasis in Patients with Chronic Hepatitis C Virus Infection

    Nick S. Nielsen

    2017-05-01

    Full Text Available Increased risk of both cardiovascular disease (CVD and bleeding has been found in patients with chronic hepatitis C (CHC infection, and a re-balanced hemostasis has been proposed. The aim of this study was to investigate functional whole blood coagulation and platelet function in CHC infection. The prospective study included 82 patients with CHC infection (39 with advanced liver fibrosis and 43 with no or mild liver fibrosis and 39 healthy controls. A total of 33 patients were treated for CHC infection and achieved sustained virological response (SVR. Baseline and post-treatment blood samples were collected. Hemostasis was assessed by both standard coagulation tests and functional whole blood hemostatic assays (thromboelastograhy (TEG, and platelet aggregation (Multiplate. Patients with CHC and advanced fibrosis had impaired platelet aggregation both compared to patients with no or mild fibrosis and to healthy controls. Patients with CHC and advanced fibrosis also had lower antithrombin, platelet count, and coagulation factors II-VII-X compared to healthy controls. In contrast, TEG did not differ between groups. In treated patients achieving SVR, post-treatment platelet count was higher than pre-treatment counts (p = 0.033 and ADPtest, ASPItest, and RISTOhightest all increased post treatment (all p < 0.05. All Multiplate tests values, however, remained below those in the healthy controls. CHC-infected patients displayed evidence of rebalanced hemostasis with only partly hemostatic normalization in patients achieving SVR. The implications of rebalanced hemostasis and especially the impact on risk of CVD and bleeding warrants further studies.

  10. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography

    Roghani, Farshad; Tajik, Mohammad Nasim; Khosravi, Alireza

    2017-01-01

    Background: Coronary artery disease (CAD) is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. Materials and Methods: In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including tradi...

  11. ebb® Complete Tamponade System: effective hemostasis for postpartum hemorrhage

    McQuivey,Ross W; Block,Jon E; Massaro,Robert A

    2018-01-01

    Ross W McQuivey,1 Jon E Block,2 Robert A Massaro3 1Clinical Innovations, Salt Lake City, UT, USA; 2Independent Clinical Consultant, San Francisco, CA, USA; 3Monmouth Medical Center, Long Branch, NJ, USA Abstract: As a leading cause of maternal death, postpartum hemorrhage (PPH) remains a worldwide obstetrical problem. However, in most cases, mortality and morbidity can be averted if efforts are immediately undertaken to achieve hemostasis. Uterine balloon tamponade has been shown to provide e...

  12. Hemostasis in acquired hemophilia--role of intracavitary instillation of EACA.

    Sahu S

    1996-07-01

    Full Text Available An 82 year old man developed antibodies against coagulation factor VIII:C without any apparent cause. Bleeding from the soft tissue cavity could not be controlled by factor VIII:C concentrates, immunosuppression with steroids and intravenous immunoglobulin therapy in the standard dosages. However, a single injection of Epsilon Aminocaproic Acid (EACA instilled into the cavity under aseptic precautions achieved lasting hemostasis with resultant wound healing.

  13. The academic challenge of teaching psychomotor skills for hemostasis of solid organ injury.

    Lucas, Charles E; Ledgerwood, Anna M

    2009-03-01

    This study highlights the inherent challenges of achieving psychomotor skills in an era of nonoperative therapy for solid organ injuries. Technical procedures on the liver, the most frequent intra-abdominal solid organ injured, were assessed in five decades. Guided by prospective assessment and registry data, all patients with liver injury seen during 24 months in five consecutive decades were reviewed. Initially (1960s), all injuries were explored; currently (2000s), most injuries are observed. The number of patients was 235 (1960s), 228 (1970s), 79 (1980s), 116 (1990s), and 64 (2000s). The greater number in the 1990s reflects the diagnosis of minor, clinically insignificant, blunt injuries after abdominal CAT scan became available. Each injury was categorized by cause, severity (Abbreviated Injury Scale), associated shock, and primary therapy (observe [OBS], operation alone [OR], hepatorrhaphy [SUT], tractotomy [TRACT] with intraparenchymal hemostasis, hepatic dearterialization [HAL], and resection [RESECT]). Packing, used in each decade, was placed in one of the above primary treatment groups. The primary techniques for hemostasis are shown in the text table.Shock and Abbreviated Injury Scale correlated with mortality averaged 16%; 40 of 116 deaths (34%) exsanguinated from hepatic injury. During training, a resident performed an average of 12.0, 12.0, 2.4, 4.0, and 1.3 procedures for hemostasis. Reduced incidence and decreased therapeutic laparotomies for liver injury have created a training vacuum for future trauma surgeons. Surgical residents will need to supplement their clinical experience with solid organ hemostasis by practice on appropriate animal models of injury and cadaver dissections.

  14. ebb® Complete Tamponade System: effective hemostasis for postpartum hemorrhage

    McQuivey RW

    2018-03-01

    Full Text Available Ross W McQuivey,1 Jon E Block,2 Robert A Massaro3 1Clinical Innovations, Salt Lake City, UT, USA; 2Independent Clinical Consultant, San Francisco, CA, USA; 3Monmouth Medical Center, Long Branch, NJ, USA Abstract: As a leading cause of maternal death, postpartum hemorrhage (PPH remains a worldwide obstetrical problem. However, in most cases, mortality and morbidity can be averted if efforts are immediately undertaken to achieve hemostasis. Uterine balloon tamponade has been shown to provide effective control of PPH and avoid more invasive surgical procedures and even the emergency peripartum hysterectomy. Recent clinical recommendation suggests that balloon tamponade should be considered earlier in the treatment cascade in conjunction with uterotonic agents to ensure hemostasis in the most timely fashion and maximize clinical outcomes. This paper profiles the ebb® Complete Tamponade System, a unique dual-balloon single-use device that was developed specifically for hemostatic management of PPH. The ebb system combines a uterine conforming balloon that can be rapidly deployed with a vaginal balloon that eliminates the need for vaginal packing. The description, indications for use, procedural steps, and clinical characterization of this device are presented. Keywords: postpartum hemorrhage, balloon tamponade, hemostasis, maternal bleeding

  15. Low-cost 420nm blue laser diode for tissue cutting and hemostasis

    Linden, Kurt J.

    2016-03-01

    This paper describes the use of a 420 nm blue laser diode for possible surgery and hemostasis. The optical absorption of blood-containing tissue is strongly determined by the absorption characteristics of blood. Blood is primarily comprised of plasma (yellowish extracellular fluid that is approximately 95% water by volume) and formed elements: red blood cells (RBCs), white blood cells (WBCs) and platelets. The RBCs (hemoglobin) are the most numerous, and due to the spectral absorption characteristics of hemoglobin, the optical absorption of blood has a strong relative maximum value in the 420 nm blue region of the optical spectrum. Small, low-cost laser diodes emitting at 420 nm with tens of watts of continuous wave (CW) optical power are becoming commercially available. Experiments on the use of such laser diodes for tissue cutting with simultaneous hemostasis were carried out and are here described. It was found that 1 mm deep x 1 mm wide cuts can be achieved in red meat at a focused laser power level of 3 W moving at a velocity of ~ 1 mm/s. The peripheral necrosis and thermal damage zone extended over a width of approximately 0.5 mm adjacent to the cuts. Preliminary hemostasis experiments were carried out with fresh equine blood in Tygon tubing, where it was demonstrated that cauterization can occur in regions of intentional partial tubing puncture.

  16. Clinical use of femoral artery hemostasis sticking after interventional procedure via femoral artery access

    Zhu Zhongsheng; Chen Shaoliang; Ye Fei; Zhang Junjie; Zhou Jie; Tian Nailiang; Lin Song; Liu Zhizhong; Xiao Pingxi; Qu Hong

    2010-01-01

    Objective: To observe the clinical effect of the use of femoral artery hemostasis sticking V+PAD after the interventional procedure via femoral artery access. Methods: By using random permutation list 80 patients, who decided to receive coronary angiography and percutaneous transluminal coronary angioplasty, were randomly selected. Of the 80 patients, hemostasis sticking V + PAD was employed in 40 patients with even numbers (trial group), only manual compression was adopted to stop bleeding in another 40 patients with odd numbers (control group). All the patients were informed about this trial and had to sign a consent letter. The pressure time, the treatment method of access site after hemostasis, the posture in bed, the immobilization time, the comfort degree of patients, the complications of access site prior to discharge, etc. were observed and the results were compared between two groups. Results: There was no significant difference between two groups as respect to age, gender ratios,activated clotting time (ACT) value and blood pressure. However, significantly difference in the compression time and bed rest time existed between the two groups. The compression time in trial group and control group was (7.9 ± 0.5) min and (19.8 ± 5.1) min respectively (P<0.01), while the bed rest time in trial group and control group was (6.1 ± 5.0) hours and (23.9 ± 0.2) hours respectively (P<0.01). All patients in trial group was supine in bed with the head side of the bed raised at 30 degree immediately after the procedure, and the head side of the bed was further raised to 90 degree one hour later. The puncture site was bandaged with conventional compression and immobilization was not employed. Patients could lie in bed with free posture and the patient's comfort degree was greatly improved. During hospitalization no complications related to puncture site occurred in all patients except one obese woman in trial group who developed pseudoaneurysm. Conclusion: Femoral

  17. Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy.

    Paweł Woźniak

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30-240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers.Twelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT, prothrombin time (PT, and thrombin time (TT of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups.No difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL.Oxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates

  18. Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy.

    Woźniak, Paweł; Kontek, Bogdan; Różański, Waldemar; Olas, Beata

    2017-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30-240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers. Twelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups. No difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL. Oxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates hemostasis. By

  19. Prognostic Performance Evaluation of the International Society on Thrombosis and Hemostasis and the Korean Society on Thrombosis and Hemostasis Scores in the Early Phase of Trauma.

    Kim, Hong Sug; Lee, Dong Hun; Lee, Byung Kook; Cho, Yong Soo

    2018-01-15

    Disseminated intravascular coagulation (DIC) contributes to poor outcome in the early phase of trauma. We aimed to analyze and compare the prognostic performances of the International Society on Thrombosis and Hemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH) scores in the early phase of trauma. Receiver operating characteristics analysis was used to examine the prognostic performance of both scores, and multivariate analysis was used to estimate the prognostic impact of the ISTH and KSTH scores in the early phase of trauma. The primary outcome was 24-hour mortality and the secondary outcome was massive transfusion. Of 1,229 patients included in the study, the 24-hour mortality rate was 7.6% (n = 93), and 8.1% (n = 99) of patients who received massive transfusions. The area under the curves (AUCs) of the KSTH and ISTH scores for 24-hour mortality were 0.784 (95% confidence interval [CI], 0.760-0.807) and 0.744 (95% CI, 0.718-0.768), respectively. The AUC of KSTH and ISTH scores for massive transfusion were 0.758 (95% CI, 0.734-0.782) and 0.646 (95% CI, 0.619-0.673), respectively. The AUCs of the KSTH score was significantly different from those of the ISTH score. Overt DIC according to KSTH criteria only, was independently associated with 24-hour mortality (odds ratio [OR], 2.630; 95% CI, 1.456-4.752). Only the KSTH score was independently associated with massive transfusion (OR, 1.563; 95% CI, 1.182-2.068). The KSTH score demonstrates a better prognostic performance for outcomes than the ISTH score in the early phase of trauma. © 2018 The Korean Academy of Medical Sciences.

  20. The role of platelets in hemostasis and the effects of snake venom toxins on platelet function.

    de Queiroz, Mayara Ribeiro; de Sousa, Bruna Barbosa; da Cunha Pereira, Déborah Fernanda; Mamede, Carla Cristine Neves; Matias, Mariana Santos; de Morais, Nadia Cristina Gomes; de Oliveira Costa, Júnia; de Oliveira, Fábio

    2017-07-01

    The human body has a set of physiological processes, known as hemostasis, which keeps the blood fluid and free of clots in normal vessels; in the case of vascular injury, this process induces the local formation of a hemostatic plug, preventing hemorrhage. The hemostatic system in humans presents complex physiological interactions that involve platelets, plasma proteins, endothelial and subendothelial structures. Disequilibrium in the regulatory mechanisms that control the growth and the size of the thrombus is one of the factors that favors the development of diseases related to vascular disorders such as myocardial infarction and stroke, which are among the leading causes of death in the western world. Interfering with platelet function is a strategy for the treatment of thrombotic diseases. Antiplatelet drugs are used mainly in cases related to arterial thrombosis and interfere in the formation of the platelet plug by different mechanisms. Aspirin (acetylsalicylic acid) is the oldest and most widely used antithrombotic drug. Although highly effective in most cases, aspirin has limitations compared to other drugs used in the treatment of homeostatic disorders. For this reason, research related to molecules that interfere with platelet aggregation are of great relevance. In this regard, snake venoms are known to contain a number of molecules that interfere with hemostasis, including platelet function. The mechanisms by which snake venom components inhibit or activate platelet aggregation are varied and can be used as tools for the diagnosis and the treatment of several hemostatic disorders. The aim of this review is to present the role of platelets in hemostasis and the mechanisms by which snake venom toxins interfere with platelet function. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Hemorrhages and hemostasis in guinea-pigs exposed to irradiation at high altitude

    Tartakovskij, V.N.; Daniyarov, S.B.

    1988-01-01

    Hemorrhagic intensity, hemostasis and blood vessel wall resistance to mechanical effects were studied in guinea-pigs exposed to whole-body irradiation (3.0 Gy). The animals were irradiated at low altitude (760 m above sea level) and at high altitude (3200 m above sea level) after 1 and 31 days of adaptation. It was demonstrated that hemorrhagic intensity in both groups of guinea-pigs irradiated at high altitude was significantly reduced in comparison with that at low altitude. The decrease of radiation-induced hemorrhages at high altitude is associated with less severe changes in thrombopoiesis, blood vessel wall and blood coagulation

  2. AN EXPERIMENTAL STUDY OF THE EFFICACY AND SAFETY OF VARIOUS ENDOSCOPIC HEMOSTASIS TECHNIQUES

    A. I. Cherepanin

    2014-01-01

    Full Text Available ABSTRACT. The treatment of bleeding peptic ulcers remains one of the pressing challenges in urgent surgery. Currently available endoscopic hemostasis modalities only partially meet the requirements of safety, efficiency and reliability, and therefore total and postoperative mortality rates are still high, both in our country, and around the world. The aim of the study was to identify the benefits and shortcomings of endoscopic radiofrequency energy exposure compared to standard hemostatic techniques used in the world practice to treat bleeding peptic ulcers. 

  3. The changing face of hemostasis testing in modern laboratories: consolidation, automation, and beyond.

    Lippi, Giuseppe; Plebani, Mario; Favaloro, Emmanuel J

    2015-04-01

    The reality of laboratory diagnostics as a whole, and hemostasis testing in particular, is evolving under new paradigms of efficiency. The driving forces of health care and laboratory diagnostics in the third millennium are mainly represented by macro- and microeconomics. In a world with limited resources, shattered by an unprecedented economic crisis, laboratory diagnostics is undergoing a substantial reorganization, with emergence of new models under the imperative of terms, such as bedside testing, consolidation, and networking. The paradigms under which these changes are being developed include a variety of environment, preanalytical, technological, professional, and health-care aspects. The maintenance of continued quality is indeed the major challenge to be faced in the foreseeable future. In fact, some challenges prepotently emerge during a consolidation process, which basically involve delayed testing, centrifugation, transportation, and stability of the specimens, as well as the potential mismatch of sample matrix. This article is aimed to provide an overview of the current economic scenario of laboratory diagnostics and discuss the changing face of hemostasis testing in modern laboratories, providing a synthetic overview about potential drawbacks of actualized solutions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. The Design and Testing of a Dual Fiber Textile Matrix for Accelerating Surface Hemostasis

    Fischer, Thomas H.; Vournakis, John N.; Manning, James E.; McCurdy, Shane L.; Rich, Preston B.; Nichols, Timothy C.; Scull, Christopher M.; McCord, Marian G.; Decorta, Joseph A.; Johnson, Peter C.; Smith, Carr J.

    2011-01-01

    The standard treatment for severe traumatic injury is frequently compression and application of gauze dressing to the site of hemorrhage. However, while able to rapidly absorb pools of shed blood, gauze fails to provide strong surface (topical) hemostasis. The result can be excess hemorrhage-related morbidity and mortality. We hypothesized that cost-effective materials (based on widespread availability of bulk fibers for other commercial uses) could be designed based on fundamental hemostatic principles to partially emulate the wicking properties of gauze while concurrently stimulating superior hemostasis. A panel of readily available textile fibers was screened for the ability to activate platelets and the intrinsic coagulation cascade in vitro. Type E continuous filament glass and a specialty rayon fiber were identified from the material panel as accelerators of hemostatic reactions and were custom woven to produce a dual fiber textile bandage. The glass component strongly activated platelets while the specialty rayon agglutinated red blood cells. In comparison with gauze in vitro, the dual fiber textile significantly enhanced the rate of thrombin generation, clot generation as measured by thromboelastography, adhesive protein adsorption and cellular attachment and activation. These results indicate that hemostatic textiles can be designed that mimic gauze in form but surpass gauze in ability to accelerate hemostatic reactions. PMID:19489008

  5. The effects of nanomaterials on blood coagulation in hemostasis and thrombosis.

    Simak, Jan; De Paoli, Silvia

    2017-09-01

    The blood coagulation balance in the organism is achieved by the interaction of the blood platelets (PLTs) with the plasma coagulation system (PCS) and the vascular endothelial cells. In healthy organism, these systems prevent thrombosis and, in events of vascular damage, enable blood clotting to stop bleeding. The dysregulation of hemostasis may cause serious thrombotic and/or hemorrhagic pathologies. Numerous engineered nanomaterials are being investigated for biomedical purposes and are unavoidably exposed to the blood. Also, nanomaterials may access vascular system after occupational, environmental, or other types of exposure. Thus, it is essential to evaluate the effects of engineered nanomaterials on hemostasis. This review focuses on investigations of nanomaterial interactions with the blood components involved in blood coagulation: the PCS and PLTs. Particular emphases include the pathophysiology of effects of nanomaterials on the PCS, including the kallikrein-kinin system, and on PLTs. Methods for investigating these interactions are briefly described, and a review of the most important studies on the interactions of nanomaterials with plasma coagulation and platelets is provided. WIREs Nanomed Nanobiotechnol 2017, 9:e1448. doi: 10.1002/wnan.1448 For further resources related to this article, please visit the WIREs website. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  6. The Hemostasis Apparatus in Pancreatic Cancer and Its Importance beyond Thrombosis

    Echrish, Hussein; Madden, Leigh A.; Greenman, John; Maraveyas, Anthony

    2011-01-01

    Laboratory evidence of aberrant coagulation is found in the majority of patients with advanced pancreatic cancer and a clinical consequence of this is the high incidence and prevalence of vascular thromboembolic events. Other sequelae are hypothesized to be the facilitation and acceleration of mechanisms that define the malignant phenotype, such as invasion, trafficking and anchoring, establishing the metastatic niche and inducing angiogenesis. We review the in vitro and preclinical evidence that supports the role of the coagulation apparatus in the metastatic process of pancreatic cancer, with a particular emphasis on interaction of this pathway with clinically-targeted growth factor receptor pathways. Links between hemostasis, angiogenesis and epidermal growth factor pathways and their significance as therapeutic targets are considered

  7. Features state of hemostasis and immunopathological reactions in epstein-barr virus infection in children

    S. A. Hmilevskaya

    2015-01-01

    Full Text Available The results of clinical laboratory analysis conducted in 64 children with Epstein-Barr virus mononucleosis during the acute period and in different time follow-up observations are presents. It is shown that EBV-mononucleosis in children is accompanied by distinct changes of hemostasis, the Genesis of which play some role virusinduced autoimmune mechanisms, developing on the background of hyperactively immune system. The revealed correlation of data breaches with the severity of the infectious process. It was found that the criterion prolongation hemostatic changes are persistent viral activity. Interferon therapy in complex treatment of children, the sick EBV-mononucleosis, contributed to a more rapid regression of a number of clinical symptoms of disease and normalization gemostaziologicheskikh of indicators. Recommended expansion of the research program of follow-up of persons with EBV infection. 

  8. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography.

    Roghani, Farshad; Tajik, Mohammad Nasim; Khosravi, Alireza

    2017-01-01

    Coronary artery disease (CAD) is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including traditional group (60 patients; 24 females, 36 males; mean age: 64.35 ± 10.56 years) and patent group (60 patients; 28 females, 32 males; mean age: 60.15 ± 8.92 years). All demographic data including age, gender, body mass index, and CAD-related risk factors (smoking, diabetes, hypertension) and technical data including the number of catheters, procedure duration, and hemostatic compression time and clinical outcomes (radial artery occlusion [RAO], hematoma, bleeding) were collected. Data were analyzed by SPSS version 16. Our findings revealed that the incidence of RAO was significantly lower in patent groups compared with traditional group ( P = 0.041). Furthermore, the difference incidence of RAO was higher in early occlusion compare with late one ( P = 0.041). Moreover, there were significant relationship between some factors in patients of traditional group with occlusion (gender [ P = 0.038], age [ P = 0.031], diabetes mellitus [ P = 0.043], hemostatic compression time [ P = 0.036]) as well as in patent group (age [ P = 0.009], hypertension [ P = 0.035]). Our findings showed that RAO, especially type early is significantly lower in patent method compared classic method; and patent hemostasis is the safest method and good alternative for classical method.

  9. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography

    Farshad Roghani

    2017-01-01

    Full Text Available Background: Coronary artery disease (CAD is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. Materials and Methods: In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including traditional group (60 patients; 24 females, 36 males; mean age: 64.35 ± 10.56 years and patent group (60 patients; 28 females, 32 males; mean age: 60.15 ± 8.92 years. All demographic data including age, gender, body mass index, and CAD-related risk factors (smoking, diabetes, hypertension and technical data including the number of catheters, procedure duration, and hemostatic compression time and clinical outcomes (radial artery occlusion [RAO], hematoma, bleeding were collected. Data were analyzed by SPSS version 16. Results: Our findings revealed that the incidence of RAO was significantly lower in patent groups compared with traditional group (P = 0.041. Furthermore, the difference incidence of RAO was higher in early occlusion compare with late one (P = 0.041. Moreover, there were significant relationship between some factors in patients of traditional group with occlusion (gender [P = 0.038], age [P = 0.031], diabetes mellitus [P = 0.043], hemostatic compression time [P = 0.036] as well as in patent group (age [P = 0.009], hypertension [P = 0.035]. Conclusion: Our findings showed that RAO, especially type early is significantly lower in patent method compared classic method; and patent hemostasis is the safest method and good alternative for classical method.

  10. The Effect of Severe Birth Asphyxia on the Hemostasis System in Newborns During the First Hour of Life

    I. E. Golub

    2017-01-01

    Full Text Available In newborns with severe intranatal asphyxia, the hemostasis system adaptation is impaired, thus increasing the risk of bleeding during the first day of life.The purpose of the work was to evaluate the effect of severe birth asphyxia and metabolic acidosis on the newborns' hemostasis system, based on the thromboelastography (TEG findings.Materials and methods. A retrospective analysis of medical records of 40 severely asphyxiated newborns (group 1 and 20 healthy newborns (group 2 was performed. The study was carried out during the first hour of life of the newborns.Results. Infants in group 1 demonstrated a reduced activity of platelets and enzymatic components of the coagulation. The enzymatic phase of the coagulation hemostasis (P<0.001 and the kinetics of clot strength growth significantly decreased in group 1 newborns, as compared to the second group (P<0.001 and P<0.01, respectively. The fibrin network growth rate and its structurization in group 1 newborns was lower than that in group 2 newborns (P<0.05. The platelet activity in group 1 infants was reduced as compared to group 2 (P< 0.05.Fibrinolysis in newborns did not differ at the 30th minute of the study. The correlation analysis demonstrated that decreased pH and Be values and hyperlactacidemia correlated; platelet and coagulation hemostasis parameters were altered with a shift to hypocoagulation. Conclusion. Thromboelastographic study of whole blood samples demonstrated a shift of the hemostatic system to hypocoagulation for both platelet and enzymatic components of hemostasis, without any changes in the clot lysis in severely asphyxiated newborns.

  11. Comparison of Hemostasis Times With a Kaolin-Based Hemostatic Pad (QuikClot Radial) vs Mechanical Compression (TR Band) Following Transradial Access: A Pilot Prospective Study.

    Roberts, Jonathan S; Niu, Jianli; Pastor-Cervantes, Juan A

    2017-10-01

    Hemostasis following transradial access (TRA) is usually achieved by mechanical compression. We investigated use of the QuikClot Radial hemostasis pad (Z-Medica) compared with the TR Band (Terumo Medical) to shorten hemostasis after TRA. Thirty patients undergoing TRA coronary angiography and/or percutaneous coronary intervention were randomized into three cohorts post TRA: 10 patients received mechanical compression with the TR Band, 10 patients received 30 min of compression with the QuikClot Radial pad, and 10 patients received 60 min of compression with the QuikClot Radial pad. Times to hemostasis and access-site complications were recorded. Radial artery patency was evaluated 1 hour after hemostasis by the reverse Barbeau's test. There were no differences in patient characteristics, mean dose of heparin (7117 ± 1054 IU), or mean activated clotting time value (210 ± 50 sec) at the end of procedure among the three groups. Successful hemostasis was achieved in 100% of patients with both the 30-min and 60-min compression groups using the QuikClot pad. Hemostasis failure occurred in 50% of patients when the TR Band was initially weaned at the protocol-driven time (40 min after sheath removal). Mean compression time for hemostasis with the TR Band was 149.4 min compared with 30.7 min and 60.9 min for the 30-min and 60-min QuikClot groups, respectively. No radial artery occlusion occurred in any subject at the end of the study. Use of the QuikClot Radial pad following TRA in this pilot trial significantly shortened hemostasis times when compared with the TR Band, with no increased complications noted.

  12. Peculiarities of coagulation hemostasis disorders in patients with chronic obstructive pulmonary disease

    Yakovlieva V.H.

    2015-09-01

    Full Text Available The violation of blood coagulation properties is observed in many diseases of the respiratory system, including chronic obstructive pulmonary disease (COPD. It is known that in a stable COPD phase release of proinflammatory cytokines in blood is observed, it leads to disturbance of hemostasis parameters toward hypercoagulation. The aim of our study was to determine possibility of coagulation disorders formation in patients with COPD in a stable phase of pathological process at different stages of disease course and identify relationship between coagulation parameters levels and degree of violation of ventilation lung function. Materials and methods. We examined 30 patients with COPD in a stable disease phase, included in the main group (FEV1 =49,5±15,5% of the due, there were 27 men (90.0%, 3 (30.0% women, mean age was 61,8±7,9 years, level of pack /years index - 34,2±15,3. The control group consisted of 10 healthy subjects matched with the patients of the main group by age and sex. All patients were divided into 2 subgroups. Subgroup 1 included 16 patients with moderate COPD, that is the level of FEV1>50% (61,8±7,4% of predicted, and subgroup 2 - 14 COPD patients with severe COPD, that is the level of FEV1 <50% (35,3±8,2% of predicted. Patients received standard treatment according to the disease stage. Main indicators of coagulation levels: prothrombin index (PI, prothrombin ratio (PR, international normalized ratio (INR, activated partial thromboplastin time (APTT, thrombin time (TT and antithrombin III (AT III were identified in all patients. Results. The levels of PI, PR and INR in the subgroup 1 differed significantly from those of in the subgroup 2, control group (p<0,05 and pointed at hypercoagulation, whereas in the subgroup 2 all indicators were absolutely identical with control group. Correlation link between the level of INR levels and FEV1 (r=-0,73; p<0.01 in patients of the main group was determined. Levels of APTT, TT and AT

  13. Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

    Merih Cibis

    2017-12-01

    Full Text Available Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored.Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1 and 4 weeks (Time-2 following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed.Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01; Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009; The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002 and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04 decreased; Thrombin-antithrombin complex (TAT decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008. A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001 at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04 at Time-2.Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation

  14. Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

    Cibis, Merih; Lindahl, Tomas L.; Ebbers, Tino; Karlsson, Lars O.; Carlhäll, Carl-Johan

    2017-01-01

    Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009); The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002) and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001) at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related

  15. Hormonal, electrolyte disturbances and features of hemostasis in term newborn infants of mothers with gestational diabetes mellitus.

    Evgeny Viktorovich Mikhalev

    2015-03-01

    Full Text Available The article reviews the available data on investigations in the field of electrolyte (calcium, magnesium, hormonal (insulin, leptin and hemostasis disturbances in term newborns from women with gestational diabetes; possible mechanisms of their development are also highlighted. The review describes changes in blood glucose concentration in term newborns from women with gestational diabetes, and their impact on the child's condition. In addition to already known factors causing macrosomia and other metabolic disorders in term neonates, the role of leptin (peptide hormone that regulates energy metabolism is quite discussable. Low leptin levels lead to the development of obesity. It is also confirmed, that leptin influences brain development of the newborn, leading to later cognitive deficits in children from women with GDM. The aim of the review is to summarize the available data on investigations in the field of electrolyte (calcium, magnesium, hormonal (insulin, leptin and hemostasis disturbances in term newborns from women with gestational diabetes.

  16. Effects of inhaled nitric oxide on hemostasis in healthy adults treated with heparin: a randomized, controlled, blinded crossover study

    Goldstein Brahm

    2012-01-01

    Full Text Available Abstract Background Effects of nitric oxide (NO on hemostasis have been studied in various investigational settings, but data regarding inhaled NO on bleeding and platelet function are conflicting. It is not known if inhaled NO has an effect when administered with drugs that influence hemostasis. This trial evaluated effects of inhaled NO on hemostasis in the presence of heparin using aspirin as a positive control. Patients/Methods Twelve healthy adult males were enrolled in a single-center, randomized, single-blind, four-way crossover trial. Subjects received 80 ppm NO or medical air (placebo inhalation for 30 min with simultaneous injection of placebo or heparin. Aspirin capsules were used as a positive control. Parameters of hemostasis were measured before treatment and at post-treatment intervals. Results Activated clotting time (ACT, prothrombin time (PT and activated partial thromboplastin time (aPTT increased only in groups that received heparin. Areas under the curve for ACT in heparin groups receiving inhaled NO were judged to be equivalent to those receiving medical air for both 0- to 4-h (ratio: 1.00; 90% CI, 0.90-1.11 and 0- to 24-h time intervals (ratio: 1.01; 90% CI, 0.92-1.12. Changes in bleeding time and platelet aggregation were observed only in aspirin groups. No clinically significant changes in hemoglobin, red blood cell counts or haematocrit were observed in any group. Conclusions Inhaled NO, when administered with heparin, exhibited no significant additive effects on ACT, PT, aPTT, bleeding time or platelet aggregation.

  17. Successful Endoscopic Hemostasis Is a Protective Factor for Rebleeding and Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding.

    Han, Yong Jae; Cha, Jae Myung; Park, Jae Hyun; Jeon, Jung Won; Shin, Hyun Phil; Joo, Kwang Ro; Lee, Joung Il

    2016-07-01

    Rebleeding and mortality rates remain high in patients with nonvariceal upper gastrointestinal bleeding. To identify clinical and endoscopic risk factors for rebleeding and mortality in patients with nonvariceal upper gastrointestinal bleeding. This study was performed in patients with nonvariceal upper gastrointestinal bleeding who underwent upper endoscopic procedures between July 2006 and February 2013. Clinical and endoscopic characteristics were compared among patients with and without rebleeding and mortality. Logistic regression analysis was performed to determine independent risk factors for rebleeding and mortality. After excluding 64 patients, data for 689 patients with nonvariceal upper gastrointestinal bleeding were analyzed. Peptic ulcer (62.6 %) was by far the most common source of bleeding. Endoscopic intervention was performed within 24 h in 99.0 % of patients, and successful endoscopic hemostasis was possible in 80.7 % of patients. The 30-day rebleeding rate was 13.1 % (n = 93). Unsuccessful endoscopic hemostasis was found to be the only independent risk factor for rebleeding (odds ratio 79.6; 95 % confidence interval 37.8-167.6; p = 0.000). The overall 30-day mortality rate was 3.2 % (n = 23). Unsuccessful endoscopic hemostasis (odds ratio 4.9; 95 % confidence interval 1.7-13.9; p = 0.003) was also associated with increased 30-day mortality in patients with nonvariceal upper gastrointestinal bleeding. Successful endoscopic hemostasis is an independent protective factor for both rebleeding and mortality in patients with nonvariceal upper gastrointestinal bleeding.

  18. REGENERATIVE PECULIARITIES OF LIVER TISSUE AFTER HEMOSTASIS BY NONEQUILIBRIUM PLASMA ON 90TH AND 180TH DAY (EXPERIMENTAL STUDY

    Ye. V. Semichev

    2014-01-01

    Full Text Available Liver damages occur to 17.8% of blunt abdominal trauma cases. Postoperative mortality in liver damage is a high. It amounts to 4–10% in case of stab wounds, to 30.4–35,2% in case of closed injury, to 39.3% in case of concomitant injury. Complete hemostasis without damage to organ parenchyma is needed for liver surgical operation.The aim of research is to evaluate the regenerative characteristics of liver tissue after hemostasis by nonequilibrium plasma in a long-term period.Material and methods. Research was performed on 20 laboratory rats, 3 experimental groups. 10 intact animals and 5 animals in groups on 90th and 180th day. Surgery is resection of liver left lobe and coagulation with cold plasma coagulator. The biochemical control (glucose, ALT, AST, total bilirubin, direct, alkaline phosphatase, total protein, urea, α-amylase, CRP, fibrinogen, aPTT, PTT, INR, morphological study of rat liver were performed.Results. After surgery with cold plasma hemostasis animals are active, early begin to eat. Fatal cases are not. Analysis of biochemical markers doesn't reveal statistically significant differences from the norm for the majority of indicators. Decrease of glucose concentration in the blood serum is observed in a long-term period. Histological analysis reveals an increase of the central and interlobular veins and moderate signs of edema on the 90th day. Hepatocytes with pronounced signs of protein and fatty degeneration are identified. Liver histology corresponds to the usual structure and is represented by liver lobules, separated by a small layer of connective tissue on the 180th day.Conclusion. Cold plasma coagulation in liver surgery showed effective hemostasis, minimal trauma of organ parenchyma, the lack of systemic effect and the subsequent complete regeneration of liver tissue in the treatment area.

  19. Comparison of a priori versus provisional heparin therapy on radial artery occlusion after transradial coronary angiography and patent hemostasis (from the PHARAOH Study).

    Pancholy, Samir B; Bertrand, Olivier F; Patel, Tejas

    2012-07-15

    Systemic anticoagulation decreases the risk of radial artery occlusion (RAO) after transradial catheterization and standard occlusive hemostasis. We compared the efficacy and safety of provisional heparin use only when the technique of patent hemostasis was not achievable to standard a priori heparin administration after radial sheath introduction. Patients referred for coronary angiography were randomized in 2 groups. In the a priori group, 200 patients received intravenous heparin (50 IU/kg) immediately after sheath insertion. In the provisional group, 200 patients did not receive heparin during the procedure. After sheath removal, hemostasis was obtained using a TR band (Terumo corporation, Tokyo, Japan) with a plethysmography-guided patent hemostasis technique. In the provisional group, no heparin was given if radial artery patency could be obtained and maintained. If radial patency was not achieved, a bolus of heparin (50 IU/kg) was given. Radial artery patency was evaluated at 24 hours (early RAO) and 30 days after the procedure (late RAO) by plethysmography. Patent hemostasis was obtained in 67% in the a priori group and 74% in the provisional group (p = 0.10). Incidence of RAO remained similar in the 2 groups at the early (7.5% vs 7.0%, p = 0.84) and late (4.5% vs 5.0%, p = 0.83) evaluations. Women, patients with diabetes, patients having not received heparin, and patients without radial artery patency during hemostasis had more RAO. By multivariate analysis, patent radial artery during hemostasis (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.004 to 0.28, p = 0.002) and diabetes (OR 11, 95% CI 3 to 38,p patent hemostasis is maintained. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    Rimon, Uri, E-mail: rimonu@sheba.health.gov.il; Khaitovich, Boris, E-mail: borislena@012.net.il [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Yakubovich, Dmitry, E-mail: Dmitry.Yakubovitch@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Bensaid, Paul, E-mail: paulbensaid@hotmail.com; Golan, Gil, E-mail: gilgolan201@gmail.com [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Silverberg, Daniel, E-mail: Daniel.Silverberg@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel)

    2015-06-15

    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  1. Thromboelastography as a Surrogate Marker of Perisurgical Hemostasis in Gaucher Disease.

    Ioscovich, Alexander; Fadeev, Dmitri; Kenet, Gili; Naamad, Mira; Schtrechman, Gal; Zimran, Ari; Elstein, Deborah

    2016-10-01

    Thromboelastography (TEG) has long been available for routine monitoring of perisurgical and postpartum hemostasis, especially at point of care. The purpose of this study is to retrospectively compare TEG parameters to concomitant standard clotting test results in an unselected cohort of patients with Gaucher disease to ascertain whether TEG values are specific and sensitive enough to substitute for classic coagulation tests for decision making. This remains a cogent concern because of high incidence of thrombocytopenia in patients with Gaucher disease. Thromboelastography values were compared to concomitant platelet counts, partial thromboplastin time, international normalization ratio, and plasma fibrinogen. Demographic characteristics were collected from patients' files. There were 22 patients with Gaucher disease (2 children; 12.5%) for whom there were 24 TEG results at the same time as classic coagulation test results and 30% performed platelet function tests. The current study shows linear and/or monotonic relationships between platelet counts and several TEG values that were significant over a range of platelet counts including severe thrombocytopenia. The fibrinogen component, correlating only with the rate of clot lysis, played a lesser role. Based on these preliminary results albeit in a small cohort with only 1 case of hemorrhage, there is putative support for the intention to treat patients with Gaucher disease based on TEG results using the same TEG protocol as for other patients undergoing comparable procedures in our institution. © The Author(s) 2015.

  2. Direct Fibrinolytic Snake Venom Metalloproteinases Affecting Hemostasis: Structural, Biochemical Features and Therapeutic Potential.

    Sanchez, Eladio F; Flores-Ortiz, Renzo J; Alvarenga, Valeria G; Eble, Johannes A

    2017-12-05

    Snake venom metalloproteinases (SVMPs) are predominant in viperid venoms, which provoke hemorrhage and affect hemostasis and thrombosis. P-I class enzymes consist only of a single metalloproteinase domain. Despite sharing high sequence homology, only some of them induce hemorrhage. They have direct fibrin(ogen)olytic activity. Their main biological substrate is fibrin(ogen), whose Aα-chain is degraded rapidly and independently of activation of plasminogen. It is important to understand their biochemical and physiological mechanisms, as well as their applications, to study the etiology of some human diseases and to identify sites of potential intervention. As compared to all current antiplatelet therapies to treat cardiovascular events, the SVMPs have outstanding biochemical attributes: (a) they are insensitive to plasma serine proteinase inhibitors; (b) they have the potential to avoid bleeding risk; (c) mechanistically, they are inactivated/cleared by α2-macroglobulin that limits their range of action in circulation; and (d) few of them also impair platelet aggregation that represent an important target for therapeutic intervention. This review will briefly highlight the structure-function relationships of these few direct-acting fibrinolytic agents, including, barnettlysin-I, isolated from Bothrops barnetti venom, that could be considered as potential agent to treat major thrombotic disorders. Some of their pharmacological advantages are compared with plasmin.

  3. Outcomes in Patients Treated with a Novel, Simple Method for Hemostasis of Dermal Avulsion Injuries.

    Dowling, Sean Taylor; Lin, Brian Wai

    2017-10-01

    A recently described technique proposes a simple method to achieve permanent hemostasis of distal fingertip dermal avulsion injuries. It is simple to learn and easy to perform with readily available materials found in most emergency departments. However, long-term outcomes for patients treated with this technique have not yet been evaluated. A primary objective of the current article is to provide safety data for the technique using an off-label product indication. Emergency department of Kaiser Permanente Medical Center, San Francisco, California. Six patients were treated in the emergency department for fingertip dermal avulsion injuries using a tourniquet and tissue adhesive glue (Dermabond by Ethicon, Somerville, New Jersey). Patients were subsequently contacted to assess healing and satisfaction with cosmetic outcome through interview and photographs of their wounds at 9 months following the date of injury. All 6 patients were satisfied with the cosmetic outcome of treatment, and none received a diagnosis of serious complications. This series demonstrates cosmetic outcomes for injuries treated with the technique, highlights potential problems that may be perceived by patients during their clinical course, and creates the groundwork for a larger clinical study examining the use of the technique.

  4. Decidualized Human Endometrial Stromal Cells Mediate Hemostasis, Angiogenesis, and Abnormal Uterine Bleeding

    Lockwood, Charles J.; Krikun, Graciela; Hickey, Martha; Huang, S. Joseph; Schatz, Frederick

    2011-01-01

    Factor VII binds trans-membrane tissue factor to initiate hemostasis by forming thrombin. Tissue factor expression is enhanced in decidualized human endometrial stromal cells during the luteal phase. Long-term progestin only contraceptives elicit: 1) abnormal uterine bleeding from fragile vessels at focal bleeding sites, 2) paradoxically high tissue factor expression at bleeding sites; 3) reduced endometrial blood flow promoting local hypoxia and enhancing reactive oxygen species levels; and 4) aberrant angiogenesis reflecting increased stromal cell-expressed vascular endothelial growth factor, decreased Angiopoietin-1 and increased endothelial cell-expressed Angiopoietin-2. Aberrantly high local vascular permeability enhances circulating factor VII to decidualized stromal cell-expressed tissue factor to generate excess thrombin. Hypoxia-thrombin interactions augment expression of vascular endothelial growth factor and interleukin-8 by stromal cells. Thrombin, vascular endothelial growth factor and interlerukin-8 synergis-tically augment angiogenesis in a milieu of reactive oxygen species-induced endothelial cell activation. The resulting enhanced vessel fragility promotes abnormal uterine bleeding. PMID:19208784

  5. Direct Injection of Blood Products Versus Gelatin Sponge as a Technique for Local Hemostasis

    Haaga, John [University Hospitals Case Medical Center, Department of Radiology (United States); Rahim, Shiraz, E-mail: Shiraz.rahim@uhhospitals.org

    2017-02-15

    PurposeTo provide a method of reducing risk of minimally invasive procedures on patients with abnormal hemostasis and evaluate efficacy of direct fresh frozen plasma injection through a procedure needle tract compared to Gelfoam (gelatin sponge) administration.Materials and MethodsEighty patients with elevated international standardized ratio (INR) undergoing minimally invasive procedures using imaging guidance were selected retrospectively. Forty patients had received Gelfoam as a means of tract embolization during the procedure. The other 40 received local fresh frozen plasma (FFP) through the needle tract. The number of complications and clinically significant bleeding events were recorded. A threshold of 30 cc of blood loss after a procedure was used to identify excess bleeding.ResultsNo patients experienced clinically significant bleeding after administration of FFP. Five patients experienced postoperative drops in hemoglobin or hematomas after administration of Gelfoam.ConclusionLocal injection of blood products can reduce postprocedure bleeding in patients undergoing minimally invasive procedures and provides a safe alternative to the use of synthetic fibrin plugs.

  6. Direct Fibrinolytic Snake Venom Metalloproteinases Affecting Hemostasis: Structural, Biochemical Features and Therapeutic Potential

    Eladio F. Sanchez

    2017-12-01

    Full Text Available Snake venom metalloproteinases (SVMPs are predominant in viperid venoms, which provoke hemorrhage and affect hemostasis and thrombosis. P-I class enzymes consist only of a single metalloproteinase domain. Despite sharing high sequence homology, only some of them induce hemorrhage. They have direct fibrin(ogenolytic activity. Their main biological substrate is fibrin(ogen, whose Aα-chain is degraded rapidly and independently of activation of plasminogen. It is important to understand their biochemical and physiological mechanisms, as well as their applications, to study the etiology of some human diseases and to identify sites of potential intervention. As compared to all current antiplatelet therapies to treat cardiovascular events, the SVMPs have outstanding biochemical attributes: (a they are insensitive to plasma serine proteinase inhibitors; (b they have the potential to avoid bleeding risk; (c mechanistically, they are inactivated/cleared by α2-macroglobulin that limits their range of action in circulation; and (d few of them also impair platelet aggregation that represent an important target for therapeutic intervention. This review will briefly highlight the structure–function relationships of these few direct-acting fibrinolytic agents, including, barnettlysin-I, isolated from Bothrops barnetti venom, that could be considered as potential agent to treat major thrombotic disorders. Some of their pharmacological advantages are compared with plasmin.

  7. Comparative evaluation of two techniques of hemostasis in neonatal circumcision using the Plastibell device.

    Kazem, Moslemi Mohammad; Mehdi, Abedin Zadeh; Golrasteh, Kholaseh Zadeh; Behzad, Feis Zadeh

    2010-06-01

    To evaluate the safety of the Plastibell neonatal circumcision technique and the incidence of complications in Iranian neonates. In this study, 7510 term neonates born between 2001 and 2006 in Rafsanjan medical centers, with age range of 3-36h, were randomized into two groups. In group A (3760 cases), an incision was made in the dorsal surface of the prepuce and then 3min frenular manual compression was performed with a sponge. In group B (3750 cases), frenular hemostasis was achieved using ophthalmologic thermal cautery. The two groups were compared in terms of complications of hemorrhage, wound infection, urine retention and delayed wound healing. In group A, bleeding occurred in 15 cases (0.4%), and in group B in two cases (0.05%). The bleeding rate in group A was significantly higher (P=0.002). In group A, urinary retention was seen in 12 cases (0.03%), in comparison to 35 cases (0.9%) in group B. This complication rate was significantly higher in group B (P=0.001). Local or systemic infection was not seen in either group. Although using thermal cautery we have less bleeding, the total complication rate is increased significantly. Copyright (c) 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  8. Alteraciones de la hemostasia en la diabetes mellitus Alterations of hemostasis in the diabetes mellitus

    Patricia Caunedo Almagro

    2005-04-01

    Full Text Available La diabetes mellitus (DM se clasifica en 2 tipos de acuerdo con su patogénesis: la tipo 1 representa menos del 10 % del total de pacientes, la DM tipo 2 es más común dentro de la población de pacientes diabéticos. Se han encontrado múltiples alteraciones de la hemostasia en los pacientes con este padecimiento. Estudios realizados en plaquetas, coagulación sanguínea y fibrinólisis han permitido asegurar que estos trastornos son posiblemente un factor importante en el estado pretrombótico que presentan estos enfermos. Las investigaciones en las plaquetas han demostrado una hiperreactividad plaquetaria, un aumento de la actividad procoagulante de las plaquetas. Por otra parte, la mayoría de los autores coinciden en la actualidad en que la DM es un estado de hipercoagulabilidad,lo cual se basa en numerosas investigaciones sobre la enfermedad y el mecanismo de la coagulación que demuestran el aumento del fibrinógeno, factor VII y factor von Willebrand, así como de los marcadores de activación de este sistema. Además, se han demostrado alteraciones en el sistema fibrinolítico, como el aumento del inhibidor del activador del plasminógeno y del inhibidor de la fibrinólisis activado por trombina. En este trabajo se presentan algunos mecanismos que pudieran explicar las alteraciones en la hemostasia que posiblemente contribuyan al desarrollo de complicaciones trombóticas que se presentan en estos pacientes.Diabetes mellitus is classified into 2 types according to its pathogenesis: type 1 accounts for less than 10 % of the total of patients, whereas type 2 is the most common in the population of diabetic patients. Multiple alterations of hemostasis have been found among the patients suffering from this disease. The studies conducted in platelets, blood coagulation and fibrinolysis have allowed to assert that these disorders are probably an important factor in the prethrombotic state of these patients. The investigations carried out with

  9. A review of three stand-alone topical thrombins for surgical hemostasis.

    Cheng, Christine M; Meyer-Massetti, Carla; Kayser, Steven R

    2009-01-01

    bovine thrombin, the percentages of patients who achieved hemostasis within 10 minutes of topical thrombin application were 95.4% and 95.1%, respectively (95% CI, -3.7 to 5.0). The incidence of hemostasis within 10 minutes was also similar in a Phase III comparison of human plasma-derived thrombin and bovine thrombin (both, 97.4% [95% CI, 0.96 to 1.05]). In the study that compared human recombinant and bovine thrombin, the incidence of antiproduct antibody formation was 21.5% (43/200) in the bovine thrombin group and 1.5% (3/198) in the human recombinant thrombin group (P vial basis. The average wholesale prices (US $, 2008) for 5000-IU vials of bovine thrombin and human recombinant thrombin were $87.85 and $103.20, respectively; the average wholesale price for a 4000- to 6000-IU vial of human plasma-derived thrombin was $96.00. Topical thrombins vary in the ways in which they are manufactured and their safety profiles, storage requirements, and costs. Human recombinant thrombin and human plasma-derived thrombin have each been shown to have hemostatic efficacy comparable to that of bovine thrombin. Bovine thrombin carries the risk of formation of cross-reactive antibodies to bovine thrombin, factor V, and other impurities that may be present in these formulations. Immunogenicity data for the currently marketed, highly purified bovine thrombin relative to older formulations of bovine thrombin could not be found. Whether the potential safety advantage justifies the added cost of the human products remains to be established.

  10. The role of platelet and endothelial GARP in thrombosis and hemostasis.

    Vermeersch, Elien; Denorme, Frederik; Maes, Wim; De Meyer, Simon F; Vanhoorelbeke, Karen; Edwards, Justin; Shevach, Ethan M; Unutmaz, Derya; Fujii, Hodaka; Deckmyn, Hans; Tersteeg, Claudia

    2017-01-01

    Glycoprotein-A Repetitions Predominant protein (GARP or LRRC32) is present on among others human platelets and endothelial cells. Evidence for its involvement in thrombus formation was suggested by full knockout of GARP in zebrafish. To evaluate the role of GARP in platelet physiology and in thrombus formation using platelet and endothelial conditional GARP knock out mice. Platelet and endothelial specific GARP knockout mice were generated using the Cre-loxP recombination system. The function of platelets without GARP was measured by flow cytometry, spreading analysis and aggregometry using PAR4-activating peptide and collagen related peptide. Additionally, clot retraction and collagen-induced platelet adhesion and aggregation under flow were analyzed. Finally, in vivo tail bleeding time, occlusion time of the mesenteric and carotid artery after FeCl3-induced thrombosis were determined in platelet and endothelial specific GARP knock out mice. Platelet specific GARP knockout mice had normal surface GPIb, GPVI and integrin αIIb glycoprotein expression. Although GARP expression was increased upon platelet activation, platelets without GARP displayed normal agonist induced activation, spreading on fibrinogen and aggregation responses. Furthermore, absence of GARP on platelets did not influence clot retraction and had no impact on thrombus formation on collagen-coated surfaces under flow. In line with this, neither the tail bleeding time nor the occlusion time in the carotid- and mesenteric artery after FeCl3-induced thrombus formation in platelet or endothelial specific GARP knock out mice were affected. Evidence is provided that platelet and endothelial GARP are not important in hemostasis and thrombosis in mice.

  11. Comparison of polyurethane with cyanoacrylate in hemostasis of vascular injury in guinea pigs.

    Kubrusly, Luiz Fernando; Formighieri, Marina Simões; Lago, José Vitor Martins; Graça, Yorgos Luiz Santos de Salles; Sobral, Ana Cristina Lira; Lago, Marianna Martins

    2015-01-01

    To evaluate the behavior of castor oil-derived polyurethane as a hemostatic agent and tissue response after abdominal aortic injury and to compare it with 2-octyl-cyanoacrylate. Twenty-four Guinea Pigs were randomly divided into three groups of eight animals (I, II, and III). The infrarenal abdominal aorta was dissected, clamped proximally and distally to the vascular puncture site. In group I (control), hemostasis was achieved with digital pressure; in group II (polyurethane) castor oil-derived polyurethane was applied, and in group III (cyanoacrylate), 2-octyl-cyanoacrylate was used. Group II was subdivided into IIA and IIB according to the time of preparation of the hemostatic agent. Mean blood loss in groups IIA, IIB and III was 0.002 grams (g), 0.008 g, and 0.170 g, with standard deviation of 0.005 g, 0.005 g, and 0.424 g, respectively (P=0.069). The drying time for cyanoacrylate averaged 81.5 seconds (s) (standard deviation: 51.5 seconds) and 126.1 s (standard deviation: 23.0 s) for polyurethane B (P=0.046). However, there was a trend (P=0.069) for cyanoacrylate to dry more slowly than polyurethane A (mean: 40.5 s; SD: 8.6 s). Furthermore, polyurethane A had a shorter drying time than polyurethane B (P=0.003), mean IIA of 40.5 s (standard deviation: 8.6 s). In group III, 100% of the animals had mild/severe fibrosis, while in group II only 12.5% showed this degree of fibrosis (P=0.001). Polyurethane derived from castor oil showed similar hemostatic behavior to octyl-2-cyanoacrylate. There was less perivascular tissue response with polyurethane when compared with cyanoacrylate.

  12. Identification of extant vertebrate Myxine glutinosa VWF: evolutionary conservation of primary hemostasis.

    Grant, Marianne A; Beeler, David L; Spokes, Katherine C; Chen, Junmei; Dharaneeswaran, Harita; Sciuto, Tracey E; Dvorak, Ann M; Interlandi, Gianluca; Lopez, José A; Aird, William C

    2017-12-07

    Hemostasis in vertebrates involves both a cellular and a protein component. Previous studies in jawless vertebrates (cyclostomes) suggest that the protein response, which involves thrombin-catalyzed conversion of a soluble plasma protein, fibrinogen, into a polymeric fibrin clot, is conserved in all vertebrates. However, similar data are lacking for the cellular response, which in gnathostomes is regulated by von Willebrand factor (VWF), a glycoprotein that mediates the adhesion of platelets to the subendothelial matrix of injured blood vessels. To gain evolutionary insights into the cellular phase of coagulation, we asked whether a functional vwf gene is present in the Atlantic hagfish, Myxine glutinosa We found a single vwf transcript that encodes a simpler protein compared with higher vertebrates, the most striking difference being the absence of an A3 domain, which otherwise binds collagen under high-flow conditions. Immunohistochemical analyses of hagfish tissues and blood revealed Vwf expression in endothelial cells and thrombocytes. Electron microscopic studies of hagfish tissues demonstrated the presence of Weibel-Palade bodies in the endothelium. Hagfish Vwf formed high-molecular-weight multimers in hagfish plasma and in stably transfected CHO cells. In functional assays, botrocetin promoted VWF-dependent thrombocyte aggregation. A search for vwf sequences in the genome of sea squirts, the closest invertebrate relatives of hagfish, failed to reveal evidence of an intact vwf gene. Together, our findings suggest that VWF evolved in the ancestral vertebrate following the divergence of the urochordates some 500 million years ago and that it acquired increasing complexity though sequential insertion of functional modules. © 2017 by The American Society of Hematology.

  13. Endoscopic hemostasis for peptic ulcer bleeding: systematic review and meta-analyses of randomized controlled trials.

    Baracat, Felipe; Moura, Eduardo; Bernardo, Wanderley; Pu, Leonardo Zorron; Mendonça, Ernesto; Moura, Diogo; Baracat, Renato; Ide, Edson

    2016-06-01

    Peptic ulcer represents the most common cause of upper gastrointestinal bleeding. Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this review is to compare the different modalities of endoscopic therapy. Studies were identified by searching electronic databases MEDLINE, Embase, Cochrane, LILACS, DARE, and CINAHL. We selected randomized clinical trials that assessed contemporary endoscopic hemostatic techniques. The outcomes evaluated were: initial hemostasis, rebleeding rate, need for surgery, and mortality. The possibility of publication bias was evaluated by funnel plots. An additional analysis was made, including only the higher-quality trials. Twenty-eight trials involving 2988 patients were evaluated. Injection therapy alone was inferior to injection therapy with hemoclip and with thermal coagulation when evaluating rebleeding and the need for emergency surgery. Hemoclip was superior to injection therapy in terms of rebleeding; there were no statistically significant differences between hemoclip alone and hemoclip with injection therapy. There was considerable heterogeneity in the comparisons between hemoclip and thermal coagulation. There were no statistically significant differences between thermal coagulation and injection therapy, though their combination was superior, in terms of rebleeding, to thermal coagulation alone. Injection therapy should not be used alone. Hemoclip is superior to injection therapy, and combining hemoclip with an injectate does not improve hemostatic efficacy above hemoclip alone. Thermal coagulation has similar efficacy as injection therapy; combining these appears to be superior to thermal coagulation alone. Therefore, we recommend the application of hemoclips or the combined use of injection therapy with thermal coagulation for the treatment of peptic ulcer bleeding.

  14. Lack of grading agreement among international hemostasis external quality assessment programs.

    Olson, John D; Jennings, Ian; Meijer, Piet; Bon, Chantal; Bonar, Roslyn; Favaloro, Emmanuel J; Higgins, Russell A; Keeney, Michael; Mammen, Joy; Marlar, Richard A; Meley, Roland; Nair, Sukesh C; Nichols, William L; Raby, Anne; Reverter, Joan C; Srivastava, Alok; Walker, Isobel

    2018-01-01

    : Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of 'pass' or 'fail' is made. EQA provider members of the international organization, external quality assurance in thrombosis and hemostasis, took part in a study to compare outcome of performance analysis using the same data set of laboratory results. Eleven EQA organizations using eight different analytical approaches participated. Data for a normal and prolonged activated partial thromboplastin time (aPTT) and a normal and reduced factor VIII (FVIII) from 218 laboratories were sent to the EQA providers who analyzed the data set using their method of evaluation for aPTT and FVIII, determining the performance for each laboratory record in the data set. Providers also summarized their statistical approach to assignment of target values and laboratory performance. Each laboratory record in the data set was graded pass/fail by all EQA providers for each of the four analytes. There was a lack of agreement of pass/fail grading among EQA programs. Discordance in the grading was 17.9 and 11% of normal and prolonged aPTT results, respectively, and 20.2 and 17.4% of normal and reduced FVIII results, respectively. All EQA programs in this study employed statistical methods compliant with the International Standardization Organization (ISO), ISO 13528, yet the evaluation of laboratory results for all four analytes showed remarkable grading discordance.

  15. Lack of grading agreement among international hemostasis external quality assessment programs

    Olson, John D.; Jennings, Ian; Meijer, Piet; Bon, Chantal; Bonar, Roslyn; Favaloro, Emmanuel J.; Higgins, Russell A.; Keeney, Michael; Mammen, Joy; Marlar, Richard A.; Meley, Roland; Nair, Sukesh C.; Nichols, William L.; Raby, Anne; Reverter, Joan C.; Srivastava, Alok; Walker, Isobel

    2018-01-01

    Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of ‘pass’ or ‘fail’ is made. EQA provider members of the international organization, external quality assurance in thrombosis and hemostasis, took part in a study to compare outcome of performance analysis using the same data set of laboratory results. Eleven EQA organizations using eight different analytical approaches participated. Data for a normal and prolonged activated partial thromboplastin time (aPTT) and a normal and reduced factor VIII (FVIII) from 218 laboratories were sent to the EQA providers who analyzed the data set using their method of evaluation for aPTT and FVIII, determining the performance for each laboratory record in the data set. Providers also summarized their statistical approach to assignment of target values and laboratory performance. Each laboratory record in the data set was graded pass/fail by all EQA providers for each of the four analytes. There was a lack of agreement of pass/fail grading among EQA programs. Discordance in the grading was 17.9 and 11% of normal and prolonged aPTT results, respectively, and 20.2 and 17.4% of normal and reduced FVIII results, respectively. All EQA programs in this study employed statistical methods compliant with the International Standardization Organization (ISO), ISO 13528, yet the evaluation of laboratory results for all four analytes showed remarkable grading discordance. PMID:29232255

  16. Comparison of polyurethane with cyanoacrylate in hemostasis of vascular injury in guinea pigs

    Luiz Fernando Kubrusly

    2015-02-01

    Full Text Available Objective: To evaluate the behavior of castor oil-derived polyurethane as a hemostatic agent and tissue response after abdominal aortic injury and to compare it with 2-octyl-cyanoacrylate. Methods: Twenty-four Guinea Pigs were randomly divided into three groups of eight animals (I, II, and III. The infrarenal abdominal aorta was dissected, clamped proximally and distally to the vascular puncture site. In group I (control, hemostasis was achieved with digital pressure; in group II (polyurethane castor oil-derived polyurethane was applied, and in group III (cyanoacrylate, 2-octyl-cyanoacrylate was used. Group II was subdivided into IIA and IIB according to the time of preparation of the hemostatic agent. Results: Mean blood loss in groups IIA, IIB and III was 0.002 grams (g, 0.008 g, and 0.170 g, with standard deviation of 0.005 g, 0.005 g, and 0.424 g, respectively (P=0.069. The drying time for cyanoacrylate averaged 81.5 seconds (s (standard deviation: 51.5 seconds and 126.1 s (standard deviation: 23.0 s for polyurethane B (P=0.046. However, there was a trend (P=0.069 for cyanoacrylate to dry more slowly than polyurethane A (mean: 40.5 s; SD: 8.6 s. Furthermore, polyurethane A had a shorter drying time than polyurethane B (P=0.003, mean IIA of 40.5 s (standard deviation: 8.6 s. In group III, 100% of the animals had mild/severe fibrosis, while in group II only 12.5% showed this degree of fibrosis (P=0.001. Conclusion: Polyurethane derived from castor oil showed similar hemostatic behavior to octyl-2-cyanoacrylate. There was less perivascular tissue response with polyurethane when compared with cyanoacrylate.

  17. Normal levels of anticoagulant heparan sulfate are not essential for normal hemostasis

    HajMohammadi, Sassan; Enjyoji, Keiichi; Princivalle, Marc; Christi, Patricia; Lech, Miroslav; Beeler, David; Rayburn, Helen; Schwartz, John J.; Barzegar, Samad; de Agostini, Ariane I.; Post, Mark J.; Rosenberg, Robert D.; Shworak, Nicholas W.

    2003-01-01

    Endothelial cell production of anticoagulant heparan sulfate (HSact) is controlled by the Hs3st1 gene, which encodes the rate-limiting enzyme heparan sulfate 3-O-sulfotransferase-1 (3-OST-1). In vitro, HSact dramatically enhances the neutralization of coagulation proteases by antithrombin. The in vivo role of HSact was evaluated by generating Hs3st1–/– knockout mice. Hs3st1–/– animals were devoid of 3-OST-1 enzyme activity in plasma and tissue extracts. Nulls showed dramatic reductions in tissue levels of HSact but maintained wild-type levels of tissue fibrin accumulation under both normoxic and hypoxic conditions. Given that vascular HSact predominantly occurs in the subendothelial matrix, mice were subjected to a carotid artery injury assay in which ferric chloride administration induces de-endothelialization and occlusive thrombosis. Hs3st1–/– and Hs3st1+/+ mice yielded indistinguishable occlusion times and comparable levels of thrombin•antithrombin complexes. Thus, Hs3st1–/– mice did not show an obvious procoagulant phenotype. Instead, Hs3st1–/– mice exhibited genetic background–specific lethality and intrauterine growth retardation, without evidence of a gross coagulopathy. Our results demonstrate that the 3-OST-1 enzyme produces the majority of tissue HSact. Surprisingly, this bulk of HSact is not essential for normal hemostasis in mice. Instead, 3-OST-1–deficient mice exhibited unanticipated phenotypes suggesting that HSact or additional 3-OST-1–derived structures may serve alternate biologic roles. PMID:12671048

  18. The role of platelet and endothelial GARP in thrombosis and hemostasis.

    Elien Vermeersch

    Full Text Available Glycoprotein-A Repetitions Predominant protein (GARP or LRRC32 is present on among others human platelets and endothelial cells. Evidence for its involvement in thrombus formation was suggested by full knockout of GARP in zebrafish.To evaluate the role of GARP in platelet physiology and in thrombus formation using platelet and endothelial conditional GARP knock out mice.Platelet and endothelial specific GARP knockout mice were generated using the Cre-loxP recombination system. The function of platelets without GARP was measured by flow cytometry, spreading analysis and aggregometry using PAR4-activating peptide and collagen related peptide. Additionally, clot retraction and collagen-induced platelet adhesion and aggregation under flow were analyzed. Finally, in vivo tail bleeding time, occlusion time of the mesenteric and carotid artery after FeCl3-induced thrombosis were determined in platelet and endothelial specific GARP knock out mice.Platelet specific GARP knockout mice had normal surface GPIb, GPVI and integrin αIIb glycoprotein expression. Although GARP expression was increased upon platelet activation, platelets without GARP displayed normal agonist induced activation, spreading on fibrinogen and aggregation responses. Furthermore, absence of GARP on platelets did not influence clot retraction and had no impact on thrombus formation on collagen-coated surfaces under flow. In line with this, neither the tail bleeding time nor the occlusion time in the carotid- and mesenteric artery after FeCl3-induced thrombus formation in platelet or endothelial specific GARP knock out mice were affected.Evidence is provided that platelet and endothelial GARP are not important in hemostasis and thrombosis in mice.

  19. Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients.

    Spiliopoulos, Stavros; Kitrou, Panagiotis; Christeas, Nikolaos; Karnabatidis, Dimitris

    2016-01-01

    Direct superficial femoral artery (SFA) antegrade puncture is a valid alternative to common femoral artery (CFA) access for peripheral vascular interventions. Data investigating vascular closure device (VCD) hemostasis of distant SFA 6F access are limited. We aimed to investigate the safety and effectiveness of the Starclose SE® VCD for hemostasis, following direct 6F antegrade SFA access distal to the femoral head. This prospective, single-center study included patients who were not suitable for CFA puncture and were scheduled to undergo peripheral endovascular interventions using direct antegrade SFA 6F access, at least 2 cm below the inferior edge of femoral head. Hemostasis was obtained with the Starclose SE® VCD (Abbott Laboratories). Primary endpoints were successful hemostasis rate and periprocedural (30-day) major complication rate. Secondary endpoint was the rate of minor complications. Clinical and Doppler ultrasound follow-up was performed at discharge and at one month. Between September 2014 and August 2015, a total of 30 patients (21 male; 70.0%) with a mean body mass index of 41.2 kg/m2 were enrolled. Mean age was 72±9 years (range, 67-88 years). Most patients suffered from critical limb ischemia (87.1%) and diabetes (61.3%). Calcifications were present in eight cases (26.6%). Reason for direct SFA puncture was obesity (100%). Successful hemostasis was achieved in 100% of the cases. No major complications were noted after one-month follow-up. Minor complications included two <5 cm hematomas (6.6%) not necessitating treatment. In this prospective study, Starclose SE® VCD was safe and effective for hemostasis of antegrade direct SFA puncture. Uncomplicated hemostasis was achieved even in cases of puncturing 2 to 7 cm below the inferior edge of the femoral head.

  20. Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

    Minko, Peter, E-mail: peterminko@yahoo.com; Katoh, Marcus [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany); Graeber, Stefan [University Hospital Saarland, Institute of Medical Biometry, Epidemiology and Medical Informatics (Germany); Buecker, Arno [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany)

    2012-08-15

    Purpose: This study was designed to investigate the efficacy of the AngioSeal vascular closure device after antegrade puncture of the femoral artery. Methods: In a prospective study, 120 consecutive patients underwent lower limb vascular intervention by an antegrade access to the common femoral artery (CFA). After intervention, a 6F (n = 88) or an 8F (n = 32) AngioSeal vascular closure device was used to achieve hemostasis. The technical success or the cause of failure was documented. In addition, the coagulation status (platelets, INR, prothrombin time, atrial thromboplastin time (PTT)), hypertonus, locoregional habitus of the groin, body mass index (BMI), presence of calcifications, and history of previous surgical interventions of the CFA were evaluated. Results: Hemostasis was achieved in 97 patients (81%). In 12 patients (10%), persistent bleeding of the puncture site required manual compression. In another nine patients (8%) a kink of the sheath obviated the passage of the collagen plug toward the vessel, and in two patients the anchor dislodged out of the vessel, requiring manual compression. There were no significant differences between the groups of successful and unsuccessful sealing regarding the mean platelets (241 vs. 254 * 10{sup 9}/l; P = 0.86), INR (1.06 vs. 1.02; P = 0.52), prothrombin time (90% vs. 90%; P = 0.86), and PTT (30 vs. 31 s; P = 0.82). However, unsuccessful sealing was more likely in obese patients with an increased BMI (26.6 vs. 28.8 kg/m{sup 2}; P = 0.04). Conclusions: Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.

  1. Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy.

    Lamberts, Regina; Koch, Anna; Binner, Christian; Zachäus, Marcus; Knigge, Ingrid; Bernhardt, Mark; Halm, Ulrich

    2017-05-01

    Background and study aims  In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods  Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results  Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions  Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

  2. Benefits of applying low-temperature plasma treatment to wound care and hemostasis from the viewpoints of physics and pathology

    Shimizu, Tetsuji; Ikehara, Yuzuru

    2017-12-01

    Over the last decade, low-temperature plasma (LTP) technology has reached the life sciences and introduced the benefits of using such technology at atmospheric pressure for medical applications. The active elements from LTP, such as reactive molecular species, charged particles and photons, appear to react with biomolecules on wounds and at bleeding points. This action by LTP might be analogous with semiconductor fabrication techniques such as etching and surface modification. From this perspective, we discuss the general aspects and principles of LTP devices used at atmospheric pressure in wound care and hemostasis as an interdisciplinary fusion of applied physics and pathology.

  3. Thrombin generation by activated factor VII on platelet activated by different agonists. Extending the cell-based model of hemostasis

    Herrera Maria

    2006-04-01

    Full Text Available Abstract Background Platelet activation is crucial in normal hemostasis. Using a clotting system free of external tissue factor, we investigated whether activated Factor VII in combination with platelet agonists increased thrombin generation (TG in vitro. Methods and results TG was quantified by time parameters: lag time (LT and time to peak (TTP, and by amount of TG: peak of TG (PTG and area under thrombin formation curve after 35 minutes (AUC→35min in plasma from 29 healthy volunteers using the calibrated automated thrombography (CAT technique. TG parameters were measured at basal conditions and after platelet stimulation by sodium arachidonate (AA, ADP, and collagen (Col. In addition, the effects of recombinant activated FVII (rFVIIa alone or combined with the other platelet agonists on TG parameters were investigated. We found that LT and TTP were significantly decreased (p 35min were significantly increased (p 35min (but not PTG when compared to platelet rich plasma activated with agonists in the absence of rFVIIa. Conclusion Platelets activated by AA, ADP, Col or rFVIIa triggered TG. This effect was increased by combining rFVIIa with other agonists. Our intrinsic coagulation system produced a burst in TG independent of external tissue factor activity an apparent hemostatic effect with little thrombotic capacity. Thus we suggest a modification in the cell-based model of hemostasis.

  4. Technical evaluation of the novel preanalytical module on instrumentation laboratory ACL TOP: advancing automation in hemostasis testing.

    Lippi, Giuseppe; Ippolito, Luigi; Favaloro, Emmanuel J

    2013-10-01

    Automation in hemostasis testing is entering an exciting and unprecedented phase. This study was planned to assess the performance of the new preanalytical module on the hemostasis testing system Instrumentation Laboratory ACL TOP. The evaluation included interference studies to define reliable thresholds for rejecting samples with significant concentrations of interfering substances; within-run imprecision studies of plasma indices on four different interference degrees for each index; comparison studies with reference measures of hemolysis index, bilirubin, and triglycerides on clinical chemistry analyzers; and calculation of turnaround time with and without automatic performance of preanalytical check. The upper limits for sample rejection according to our interference studies were 3.6 g/L for hemoglobin, 13.6 mg/dL for bilirubin, and 1454 mg/dL for triglycerides. We found optimal precision for all indices (0.6% to 3.1% at clinically relevant thresholds) and highly significant correlations with reference measures on clinical chemistry analyzers (from 0.985 to 0.998). The limited increase of turnaround time (i.e., +3% and +5% with or without cap-piercing), coupled with no adjunctive costs over performance of normal coagulation assays, contribute to make the automatic check of plasma indices on ACL TOP a reliable and practical approach for improving testing quality and safeguarding patient safety.

  5. CLINICAL SIGNIFICANCE OF ANTIPHOSPHOLIPID ANTIBODIES AND GENE MUTATIONS IN HEMOSTASIS OF CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND JUVENILE DERMATOMYOSITIS

    O.A. Solntseva

    2006-01-01

    Full Text Available Thrombophilia in children with diffuse connective tissue disorders as systemic lupus erythematosus (SLE and juvenile dermatomyositis (JDM could arise from various causes including peripherial blood circulation of antiphospholipid antibodies (APH and genetic mutations in the system of hemostasis. Thrombosis is a serious and prognostically unfavorable complication that has negative impact on the underlying disease course. The study included 96 children, 65 of them had diagnosed SLE and the other 31 had JDM. The Elisa method was used to detect antiphospholipid antibodies, coagulation method was used to detect lupus anticoagulant (LAC and antibodies to cardiolipins (anticl, ?2:glycoprotein 1 (anti ? 2 gp 1 and prothrombin (APT. The PCR method (DNA diagnostics was used to detect DNA mutations as factor resistance to of activated protein c (Leiden 5,10 methylen tetrahydrofolate reductase (MTHFR gene polymorphism. The incidence of APL antibodies was registered in 61.5% patients with SLE and in 32.2% of patients with JDM. Ac ligg, anti ?2 gp 1 Igg were clinically significant in thrombotic events in patients with SLE and JDM, and so was LAC in patients with SLE. The prevalence of the hemostasis system mutations is concordant with reported data. Conclusion thrombophilia is frequently associated with APH antibodies or combination of APH antibodies with genetic abnormalities. Sole genetic mutations are salient in patients with JDM.Key words: thrombophilia, systemic lupus erythematosus, juvenile dermatomyositis, antiphospholipid antibodies, lupus anticoagulant, leiden, prothrombin, methylentet rahydrofolate reductase.

  6. Trauma hemostasis and oxygenation research position paper on remote damage control resuscitation: definitions, current practice, and knowledge gaps.

    Jenkins, Donald H; Rappold, Joseph F; Badloe, John F; Berséus, Olle; Blackbourne, Lorne; Brohi, Karim H; Butler, Frank K; Cap, Andrew P; Cohen, Mitchell Jay; Davenport, Ross; DePasquale, Marc; Doughty, Heidi; Glassberg, Elon; Hervig, Tor; Hooper, Timothy J; Kozar, Rosemary; Maegele, Marc; Moore, Ernest E; Murdock, Alan; Ness, Paul M; Pati, Shibani; Rasmussen, Todd; Sailliol, Anne; Schreiber, Martin A; Sunde, Geir Arne; van de Watering, Leo M G; Ward, Kevin R; Weiskopf, Richard B; White, Nathan J; Strandenes, Geir; Spinella, Philip C

    2014-05-01

    The Trauma Hemostasis and Oxygenation Research Network held its third annual Remote Damage Control Resuscitation Symposium in June 2013 in Bergen, Norway. The Trauma Hemostasis and Oxygenation Research Network is a multidisciplinary group of investigators with a common interest in improving outcomes and safety in patients with severe traumatic injury. The network's mission is to reduce the risk of morbidity and mortality from traumatic hemorrhagic shock, in the prehospital phase of resuscitation through research, education, and training. The concept of remote damage control resuscitation is in its infancy, and there is a significant amount of work that needs to be done to improve outcomes for patients with life-threatening bleeding secondary to injury. The prehospital phase of resuscitation is critical in these patients. If shock and coagulopathy can be rapidly identified and minimized before hospital admission, this will very likely reduce morbidity and mortality. This position statement begins to standardize the terms used, provides an acceptable range of therapeutic options, and identifies the major knowledge gaps in the field.

  7. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding.

    Schatz, Frederick; Guzeloglu-Kayisli, Ozlem; Arlier, Sefa; Kayisli, Umit A; Lockwood, Charles J

    2016-06-01

    Human pregnancy requires robust hemostasis to prevent hemorrhage during extravillous trophoblast (EVT) invasion of the decidualized endometrium, modification of spiral arteries and post-partum processes. However, decidual hemorrhage (abruption) can occur throughout pregnancy from poorly transformed spiral arteries, causing fetal death or spontaneous preterm birth (PTB), or it can promote the aberrant placentation observed in intrauterine growth restriction (IUGR) and pre-eclampsia; all leading causes of perinatal or maternal morbidity and mortality. In non-fertile cycles, the decidua undergoes controlled menstrual bleeding. Abnormal uterine bleeding (AUB) accompanying progestin-only, long-acting, reversible contraception (pLARC) accounts for most discontinuations of these safe and highly effective agents, thereby contributing to unwanted pregnancies and abortion. The aim of this study was to investigate the role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. We conducted a critical review of the literature arising from PubMed searches up to December 2015, regarding in situ and in vitro expression and regulation of several specific proteins involved in uterine hemostasis in decidua and cycling endometrium. In addition, we discussed clinical and molecular mechanisms associated with pLARC-induced AUB and pregnancy complications with abruptions, chorioamnionitis or pre-eclampsia. Progestin-induced decidualization of estradiol-primed human endometrial stromal cells (HESCs) increases in vivo and in vitro expression of tissue factor (TF) and type-1 plasminogen activator inhibitor (PAI-1) while inhibiting plasminogen activators (PAs), matrix metalloproteinases (MMPs), and the vasoconstrictor, endothelin-1 (ET-1). These changes in decidual cell-derived regulators of hemostasis, fibrinolysis, extracellular matrix (ECM) turnover, and vascular tone prevent hemorrhage during EVT invasion and

  8. Anti-Mullerian hormone trend evaluation after laparoscopic surgery of monolateral endometrioma using a new dual wavelengths laser system (DWLS) for hemostasis.

    Nappi, Luigi; Angioni, Stefano; Sorrentino, Felice; Cinnella, Gilda; Lombardi, Michela; Greco, Pantaleo

    2016-01-01

    Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to assess the impact on ovarian reserve of the use of dual wavelengths laser system (DWLS) hemostasis after stripping technique of monolateral endometrioma, by dosing the anti-Mullerian hormone (AMH). This prospective study was conducted at the Institute of Obstetrics and Gynecology, University of Foggia, from December 2013 to January 2015. Forty-five women underwent excision of monolateral endometriotic ovarian cyst by stripping without using a bipolar coagulation and performing hemostasis with a DWLS. The AMH serum levels were estimated before the surgery (T0), 4-6 weeks (T1) and 6-9 months (T2) after surgery. Our results suggest that an appropriate surgical technique with the use of laser hemostasis does not determine a significant reduction of ovarian reserve. Laser hemostasis could prevent follicular reserve loss after ovarian endometrioma surgery.

  9. The impact of selective and non-selective non-steroid anti-inflammatory drugs on secondary hemostasis in healthy volunteers

    Schjerning, Ole; Larsen, Torben B; Damkier, Per

    2009-01-01

    BACKGROUND: Clinical and epidemiological studies have associated selective COX-2 inhibitors with an increased risk of cardiovascular events. There are no clinical studies on the possible effects of these drugs on secondary hemostasis. The hypothesis for this study is that the use of selective COX-2...

  10. COGNITIVE FUNCTIONS IN PATIENTS WITH ARTERIAL HYPERTENSION DEPENDING ON THE STATE OF HEMOSTASIS AND RENAL FUNCTION

    Oleh Shmanko

    2015-09-01

      Summary. In 58 patients with arterial hypertension cognitive functions were examined depending on the state of hemostasis and renal function. The evaluation was conducted using short scale assessment of mental status (MMSE, Montreal scale (MOCA for studying attention and concentration, executive functions, memory, language performance, constructive visual performance, abstract thinking, mental calculation, spatial and temporal orientation. The sustainability of attentional focus and speed of sensorimotor reactions were investigated using the tables of Schulte. The quality of life of patients was assessed for physical and mental components employing a questionnaire SF-12. It was found that such indicators of hemostasis system as international normalized ratio, prothrombin index, level of fibrinogen are diagnostic predictors of the risk of cognitive impairment development in patients with arterial hypertension, considering the results of neuropsychological assessment and evaluation of quality of life. No significant dependence was found between the glomerular filtration rate and the development of cognitive impairment in patients with arterial hypertension.   Keywords: arterial hypertension, cognitive impairment, international normalized ratio, prothrombin index, fibrinogen, glomerular filtration rate.       Резюме У 58 пацієнтів з артеріальною гіпертензією досліджено когнітивні функції в залежності від стану згортальної системи крові та функції нирок.  Оцінку когнітивного статусу проводили за допомогою короткої шкали оцінки психічного статусу (MMSE, Монреальської шкали (MOCA для вивчення уваги та концентрації, виконавчих функцій, пам’яті, мови, конструкти

  11. Parameters of metabolism and hemostasis in patients with type 1 diabetes mellitus and microgiopathy of different severity

    Galina Georgievna Petrik

    2010-06-01

    Full Text Available Aim. To identify risk factors of macro-microvascular lesions at different stages of pathological process in patients with type 1 diabetes mellitus andmicrogiopathy of different severity. Materials and methods. Comprehensive analysis of parameters of metabolism, hemogram, platelet and plasma hemostasis in 121 patients (67 menand 54 women of mean age 28.2?10.7 years with type 1 diabetes mellitus and angiopathy of different severity. Results. All patients had hyperglycemia along with dysproteinemia and altered lipid spectrum. Mean platelet volume and aggregation activity increasedwhile activated partial thromboplastic time decreased compared with control subjects regardless of the presence and severity of microangiopathy. Conclusion. Morphological and functional characteristics of platelets and activated partial throm-boplastic time are differently related to metabolicchanges.

  12. Pitfalls in hemostasis exploration, a case report of a girl with Henoch-Schönlein type vasculitis

    Arghirescu Smaranda

    2017-07-01

    Full Text Available The adequate performance and correct interpretation of assays for coagulation factor inhibitors play a critical role for the hemostasis laboratory. Both, false positive and false negative inhibitor assays may be reported, leading to erroneous patient’s management. Therefore, we decided to present a case with a spurious image of an exceptionally rare acquired combined haemophilia A, B and C, with severe factor ( F VIII, IX and XI deficiency, associated with high titre anti - F VIII, IX and XI inhibitors in a 4 years old girl with Henoch-Schönlein type vasculitis. Finally, performing, beside coagulometric methods also antigenic ELISA assays, we had to invalidate the diagnosis. The performance of antiphospholipd antibodies clarified the diagnosis , finally concluding as definite diagnosis Transient Lupus Anticoagulant Syndrome, with decisive impact on therapy and follow-up.

  13. A comparison between tourniquet application and epinephrine injection for hemostasis during hypospadias surgery: The effect on bleeding and postoperative outcome.

    Alizadeh, F; Fakoor, A; Haghdani, S

    2016-06-01

    To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications. Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines. The patients' ages, urethral defect lengths, pre-operative, intraoperative and postoperative variables were compared between the two groups. A total of 70 patients (35 in each group) were enrolled into the study. The mean ages and preoperative variables were not significantly different. Average blood loss was 23.51 ± 15.36 cc in the tourniquet group and 15.99 ± 10.00 cc in the epinephrine group, and was significantly higher in tourniquet group (P = 0.022); however, the mean operative time was not significantly different. Postoperative complications, described as Clavian classification, were reported in eight patients (23%) in the T group and 10 patients (30%) in the DE group, which was not significantly different. Epinephrine injections minimize operative bleeding without significant harmful effects on postoperative outcomes; therefore, it could be considered to be a safe and effective method for preparation of a bloodless field during hypospadias surgery. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  14. EVALUATION OF DISORDERS OF HEMOSTASIS, FUNCTIONAL STATE OF THE KIDNEYS AND RENAL HEMODYNAMICS IN CHILDREN WITH NEPHROTIC SYNDROME OF ACUTE GLOMERULONEPHRITIS

    Elena Genadievna Makhova

    2016-04-01

    Full Text Available Was made analysis of status single links in haemostatic system at children with sharp glomerulonephritis, changes in haemostatic links and changes of intrarenal subcapsular bloodstream during anticoagulant therapy. Among 44 children was made a standard medical checkup and survey of hemostasis system and duplex scaning of kidneys vessels. Was evaluated the dynamics changes of hemostasis and at intrarenal subcapsular bloodstream during anticoagulant therapy. It found that the debut is accompanied by signs of hypercoagulability at the mark of homeostasis and irregularities in duplex scanning of kidneys vessels with deterioration signs of subcapsular bloodstream. At sharp glomerulonephritis the risk of blood clots will grow up, and that can worsen disease and be the reason of process chronicis.

  15. ASVCP quality assurance guidelines: control of preanalytical and analytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching in veterinary laboratories.

    Vap, Linda M; Harr, Kendal E; Arnold, Jill E; Freeman, Kathleen P; Getzy, Karen; Lester, Sally; Friedrichs, Kristen R

    2012-03-01

    In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and provides recommendations for control of preanalytical and analytical factors related to hematology for mammalian and nonmammalian species, hemostasis testing, and crossmatching and is adapted from sections 1.1 and 2.3 (mammalian hematology), 1.2 and 2.4 (nonmammalian hematology), 1.5 and 2.7 (hemostasis testing), and 1.6 and 2.8 (crossmatching) of the complete guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts. © 2012 American Society for Veterinary Clinical Pathology.

  16. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count (ρ > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE

  17. An essential primer for understanding the role of topical hemostats, surgical sealants, and adhesives for maintaining hemostasis.

    Gabay, Michael; Boucher, Bradley A

    2013-09-01

    A wide variety of topical hemostats are approved as adjunctive therapies in the maintenance of hemostasis during surgical procedures in which conventional methods are insufficient or not practical. A multidisciplinary approach to the selection and application of these agents requires input from all members of the surgical team including surgeons, perioperative nurses, blood bank specialists, and pharmacists. However, pharmacist knowledge regarding topical hemostats may be limited based on lack of formal education within college of pharmacy curricula as well as their use being predominantly in the operating room setting. Furthermore, some of these agents might be procured through central supply rather than the hospital pharmacy. Topical hemostats include agents that act as a mechanical barrier to bleeding and provide a physical matrix for clotting, biologically active agents that catalyze coagulation, combination therapies, and synthetic sealants and adhesives. Although many of the topical hemostats were approved for use before the requirement for clinical trials, this review provides an overview of the available clinical evidence regarding the appropriate uses and safety considerations associated with these agents. Proper use of these agents is vital to achieving the best clinical outcomes. Specifically, knowledge of the contraindications and potential adverse events associated with topical hemostats can help prevent unwanted outcomes. Therefore, an understanding of the benefits and potential risks associated with these agents will allow hospital pharmacists to assist in the development and implementation of institutional policies regarding the safe and effective use of hemostatic agents commonly used in the surgical suite. © 2013 Pharmacotherapy Publications, Inc.

  18. Characteristics of hemostasis system and hemorrhagic syndrome in infants with congenital heart disease in operations with cardiopulmonary bypass

    Н. П. Леонов

    2016-01-01

    Full Text Available 97 neonates were included in this prospective observational study. While using the exclusion criteria, two groups without demographic differences were formed: the first group included 35 patients with blood loss greater than 10 ml/kg in the first 4 hours postoperatively, the second one consisted of 46 patients who did not have such blood loss. Hemostatic standard tests and thromboelastography were performed before surgery, immediately after surgery and 24 hours after it. As a result, a detailed description of the changes of hemostasis in the perioperative period in newborns with CHD was developed. It was found out that significant postoperative bleeding increases the incidence of coagulopathy, resuscitation after surgery, duration of mechanical ventilation, length of stay at ICU and 30-day mortality. It is confirmed that the main pathogenetic mechanisms of increased bleeding in the first hours after the operation are due to cardiopulmonary bypass coagulopathy, the dynamics and implications of which are documented in our study. Also established are prognostic clinical and laboratory predictors of coagulopathy associated with severe multiple organ failure.

  19. The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways.

    Sato, Akihiro; Yamada, Takayuki; Takase, Kei; Matsuhashi, Toshio; Higano, Shuichi; Kaneda, Tomohiro; Egawa, Shinichi; Takeda, Kazunori; Ishibashi, Tadashi; Takahashi, Shoki

    2011-03-01

    To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy. Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used. Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure (n = 8) and abscess (n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur (P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals (P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant (P > .61). HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  20. Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths.

    Yende, Sachin; D'Angelo, Gina; Mayr, Florian; Kellum, John A; Weissfeld, Lisa; Kaynar, A Murat; Young, Tammy; Irani, Kaikobad; Angus, Derek C

    2011-01-01

    Acceleration of chronic diseases, particularly cardiovascular disease, may increase long-term mortality after community-acquired pneumonia (CAP), but underlying mechanisms are unknown. Persistence of the prothrombotic state that occurs during an acute infection may increase risk of subsequent atherothrombosis in patients with pre-existing cardiovascular disease and increase subsequent risk of death. We hypothesized that circulating hemostasis markers activated during CAP persist at hospital discharge, when patients appear to have recovered clinically, and are associated with higher mortality, particularly due to cardiovascular causes. In a cohort of survivors of CAP hospitalization from 28 US sites, we measured D-Dimer, thrombin-antithrombin complexes [TAT], Factor IX, antithrombin, and plasminogen activator inhibitor-1 at hospital discharge, and determined 1-year all-cause and cardiovascular mortality. Of 893 subjects, most did not have severe pneumonia (70.6% never developed severe sepsis) and only 13.4% required intensive care unit admission. At discharge, 88.4% of subjects had normal vital signs and appeared to have clinically recovered. D-dimer and TAT levels were elevated at discharge in 78.8% and 30.1% of all subjects, and in 51.3% and 25.3% of those without severe sepsis. Higher D-dimer and TAT levels were associated with higher risk of all-cause mortality (range of hazard ratios were 1.66-1.17, p = 0.0001 and 1.46-1.04, p = 0.001 after adjusting for demographics and comorbid illnesses) and cardiovascular mortality (p = 0.009 and 0.003 in competing risk analyses). Elevations of TAT and D-dimer levels are common at hospital discharge in patients who appeared to have recovered clinically from pneumonia and are associated with higher risk of subsequent deaths, particularly due to cardiovascular disease.

  1. Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths.

    Sachin Yende

    Full Text Available Acceleration of chronic diseases, particularly cardiovascular disease, may increase long-term mortality after community-acquired pneumonia (CAP, but underlying mechanisms are unknown. Persistence of the prothrombotic state that occurs during an acute infection may increase risk of subsequent atherothrombosis in patients with pre-existing cardiovascular disease and increase subsequent risk of death. We hypothesized that circulating hemostasis markers activated during CAP persist at hospital discharge, when patients appear to have recovered clinically, and are associated with higher mortality, particularly due to cardiovascular causes.In a cohort of survivors of CAP hospitalization from 28 US sites, we measured D-Dimer, thrombin-antithrombin complexes [TAT], Factor IX, antithrombin, and plasminogen activator inhibitor-1 at hospital discharge, and determined 1-year all-cause and cardiovascular mortality.Of 893 subjects, most did not have severe pneumonia (70.6% never developed severe sepsis and only 13.4% required intensive care unit admission. At discharge, 88.4% of subjects had normal vital signs and appeared to have clinically recovered. D-dimer and TAT levels were elevated at discharge in 78.8% and 30.1% of all subjects, and in 51.3% and 25.3% of those without severe sepsis. Higher D-dimer and TAT levels were associated with higher risk of all-cause mortality (range of hazard ratios were 1.66-1.17, p = 0.0001 and 1.46-1.04, p = 0.001 after adjusting for demographics and comorbid illnesses and cardiovascular mortality (p = 0.009 and 0.003 in competing risk analyses.Elevations of TAT and D-dimer levels are common at hospital discharge in patients who appeared to have recovered clinically from pneumonia and are associated with higher risk of subsequent deaths, particularly due to cardiovascular disease.

  2. Assessment of effects of phenolic fractions from leaves and petals of dandelion in selected components of hemostasis.

    Lis, Bernadetta; Jędrejek, Dariusz; Stochmal, Anna; Olas, Beata

    2018-05-01

    Aerial parts and roots of Taraxacum officinale (dandelion) have been found to be rich sources of polyphenols, including cinnamic acid derivatives, flavonoids and triterpenoids, which exert different biological activities, such as anti-inflammatory, anticancer and antimicrobial. Additionally, the whole plant is recognized as safe and well tolerated by humans, with no reported adverse effects. Nowadays, dandelion is a commonly available dietary supplement and a component of pharmaceutical preparations used for the treatment of bladder, liver, and spleen. Nevertheless, the effect of dandelion on blood platelets and plasma - components of hemostasis involved in the functioning of a cardiovascular system and linked with various cardiovascular diseases, has not been studied yet. Thus, the main objective of our in vitro experiments was to examine the anti-platelet and antioxidant properties of four standardized dandelion phenolic fractions, i.e. leaves 50% and 85% methanol fractions, and petals 50% and 85% methanol fractions, in blood platelets. Additionally, aforementioned plant preparations were investigated for hemostatic activity in plasma, using three selected hemostatic parameters: the activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT). None of the studied dandelion fractions, caused the damage of human blood platelets, at the whole tested range. The inhibition of lipid peroxidation in platelets treated with H 2 O 2 /Fe (the donor of OH) was observed for two fractions: leaves and petals 50% fractions, both at the dose 50 μg/mL. Analysis of the effect on the coagulation activity of human plasma demonstrated that three fractions: petals 50% fraction, and leaves and petals 85% fractions, significantly prolonged the thrombin time, at the whole tested range. On the contrary, none of the fractions changed the APTT and the PT. The obtained results demonstrate that dandelion preparations, based on aerial parts, especially rich in

  3. Cardiopulmonary bypass and hemostasis

    Eijsman, Leon

    1992-01-01

    In chapter 1, we recalled that intracardiac defects can only be corrected when cardiopulmonary circulation is maintained by extracorporeal criculation and ventilation. To prevent clot formation in this artificial circuit, the socalled cardiopulmonary bypass (CPB), we completely depend on the

  4. Changes in hemostasis caused by different replacement fluids and outcome in therapeutic plasma exchange in pediatric patients in a retrospective single center study.

    Witt, Volker; Pichler, Herbert; Beiglboeck, Elisabeth; Kursten, Friedrich; Weidner, Lisa

    2017-02-01

    Therapeutic plasma exchange (TPE) is a generally accepted and frequently performed procedure for numerous therapeutic indications in adults. Slowly, TPE is also becoming more and more popular in the treatment of pediatric patients. Although, we know that TPE is safe in pediatric patients, the outcome of children treated with TPE is rarely reported. Furthermore, there are only general recommendations regarding the plasma replacement fluid for children and these are adopted from adults. Data concerning outcome and the influence of different types of replacement fluids on hemostasis in children are scarce. We retrospectively evaluated 324 TPE treatments performed in 35 patients between 2008 and 2013 in our level 4 institution for pediatric hematology and oncology. The plasmapheresis procedures were categorized into three groups based on the replacement fluid used. The first group received solvent/detergent-treated (S/D) plasma (70.0% of patients), the second group was administered 5% human albumin (7.7% of patients) and the third group was treated with a combination of human albumin 5% and S/D plasma (22.3% of patients). To assess hemostasis, data on INR, aPTT, fibrinogen and ATIII were collected before and after plasmapheresis from the patients' charts. A modified Multi Organ Dysfunction Syndrome (MODS) Index was used to classify organ failure. Patient outcome, survival rate and adverse events were evaluated. We found a significant increase in the INR by 35.83% and of the aPTT by 18.53% within the human albumin group. The INR and aPTT of patients allocated to the S/D plasma group decreased by 1.58% and 15.77% on average, respectively. The combination group revealed a mild increase of the INR (9.47%), accompanied by a reduction of aPTT (5.97%). Furthermore we found that the survival rate was significantly associated with a MODS Index of <2 (p<0.001). Overall, the number of adverse events was low (1.2%) and none of these were considered life-threatening. Hemostasis

  5. The role of factors of the hemostasis system and fibrinolysis in the development of gastroesophageal reflux in patients with chronic obstructive pulmonary disease

    Інна Володимирівна Дудка

    2015-11-01

    Full Text Available Gastroesophageal reflux disease (GERD and chronic obstructive pulmonary disease (COPD belong to common pathological conditions comorbid in 25–60 % of cases.Objective: to find probable mechanisms of GERD progressing against the ground of COPD by means of learning various links of the blood clotting system, anticoagulative blood activity and fibrinolysis for further improvement of the ways to correct the disorders found.Methods. 124 patients with COPD were examined including 90 with comorbid GERD. The control group included 24 practically healthy individuals of an appropriate age and sex. Clinical, biochemical, instrumental and statistical methods of examination were applied.Results. The patients were divided into the following groups: the 1st group – 34 patients with COPD, the 2nd group – 30 patients with COPD with endoscopically negative GERD, the 3rd group – 30 patients with COPD and endoscopically positive non-erosive GERD, the 4th group – 30 patients with COPD and endoscopically positive erosive GERD. The following results were found: while examining coagulation hemostasis – decrease of prothrombin time, fibrinogen content; while examining anticoagulation blood potential – decrease of thrombin time, activity of antithrombin III; while examining fibrinolytic blood activity – inhibition of the total fibrinolytic activity (at the expense of enzymatic activity decrease and compensatory increase of non-enzymatic fibrinolytic activity, decrease of Hageman-dependent fibrinolysis activity.Conclusions. Disorders of coagulation hemostasis, anti-coagulation potential and fibrinolytic blood activity are intensified with the increase of severity of bronchial obstructive syndrome and promote the development of endoscopically positive erosive GERD

  6. Comparative analysis of changes in protein and lipid metabolism, lipid peroxidation, and hemostasis under the effects of polychlorinated dibenzo-p-dioxins and radiation

    Kuntsevich, A.D.; Baulin, S.I.; Golovkov, V.F.; Rembovskii, V.R.; Smirnova, L.A.; Troshkin, N.M.

    1994-01-01

    Polychlorinated dibenzo-p-dioxins (PCDD) and ionizing radiation are among the most hazardous environmental factors causing ecological catastrophes and mass afflications in various accidents involving nuclear power plants and chemical industrial enterprises. The authors previously established that the simultaneous action of a toxic dose of PCDD and ionizing radiation increases the combined toxic effect. The effects of these chemical and physical factors were superadditive (the biological potentiation effect). Here, the authors compare the effects of PCDD and irradiation on protein and lipid metabolism, lipid peroxidation, and hemostasis in order to learn more about biochemical mechanisms mediating the potentiation effect. The experimental evidence suggests that PCDD can modify the biological effects of ionizing radiation through the generation of free radicals and activation of the chain reactions of free-radical lipid peroxidation, such as the formation of peroxides or malonic dialdehyde. The toxic effects of PCDD and ionizing radiation are based on free-radical reactions and chemical pathology. In other words, the chemical and physical factors directly and selectively hit the same biological target, thereby increasing their combined toxic effects. The results can partially explain the observed potentiating effect of the combined action of ionizing radiation and PCDD on the body. This phenomenon is based on biochemical processes generating an abundance of products of lipid peroxidation and the decrease in the body's defenses caused by disorders in protein and lipid metabolism and blood coagulation

  7. High-Dose Barium Impaction Therapy Is Useful for the Initial Hemostasis and for Preventing the Recurrence of Colonic Diverticular Bleeding Unresponsive to Endoscopic Clipping

    Ryota Niikura

    2013-01-01

    Full Text Available Most cases of colonic diverticular bleeding stop spontaneously, but some patients experience massive bleeding that requires emergency treatment. Endoscopy can be useful when the bleeding source is identified. However, bleeding sometimes recurs within a short period despite the successful endoscopic treatment. Under such conditions, more invasive therapy such as interventional angiography or surgery is required and can prolong hospitalization and involve frequent blood transfusions. We report the case of a 68-year-old woman who presented with massive hematochezia. The patient was in hemorrhagic shock and required 16 units of blood transfusion to recover to general condition. We performed multidetector row computed tomography, but it showed no sites of bleeding. We conducted colonoscopy and identified the source of bleeding as colonic diverticula. We treated the bleeding with endoscopic hemoclips and achieved hemostasis, but bleeding recurred the next day. Four units of blood transfusion were required. We tried high-dose barium impaction therapy to avoid further blood transfusion and surgery. No complications or recurrent bleeding was observed for an 18-month period. Therapeutic barium enema is an option for colonic diverticular bleeding unresponsive to endoscopic clipping and may be effective for preventing recurrent bleeding.

  8. Safety and effectiveness of a circumferential clip-based vascular closure device for hemostasis in off-label applications: Comparison with standard applications

    Lee, Seung Chan; Kim, Chang Won [Dept. of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan (Korea, Republic of); Jeon, Ung Bae [Dept. of Radiology, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan (Korea, Republic of)

    2016-09-15

    We investigated the efficacy and safety of a circumferential nitinol clip based arterial closure device following arteriotomy, especially in off-label applications. Consecutive patients who underwent the procedure with arteriotomy from January 2011 to February 2014 were included in this study. We defined standard use as the use of StarClose for retrograde puncture of the common femoral artery (CFA) and off-label use as the use of StarClose for retrograde puncture of the superficial femoral artery (SFA), antegrade puncture of the CFA or SFA, puncture of the brachial artery or puncture of the vascular graft. The procedures performed included percutaneous transluminal angioplasty and thrombolysis. Technical success was defined as complete hemostasis achieved within 3 minute after the closure. Complications, and laboratory findings associated with coagulation function, were also investigated. There were 146 cases of standard applications and 111 cases of off-label applications. Technical success was achieved in all cases. The off-label group comprised the use of StarClose for retrograde puncture of the SFA (n = 19), antegrade puncture of the CFA or SFA (n = 74), brachial artery puncture (n = 5), larger sheath than 6 Fr (n = 7) and vascular graft puncture (n = 6). Minor complications were noted in both groups (standard group: 7.5%, off-label group: 2.7%). Off-label use of StarClose is safe and feasible.

  9. Safety and effectiveness of a circumferential clip-based vascular closure device for hemostasis in off-label applications: Comparison with standard applications

    Lee, Seung Chan; Kim, Chang Won; Jeon, Ung Bae

    2016-01-01

    We investigated the efficacy and safety of a circumferential nitinol clip based arterial closure device following arteriotomy, especially in off-label applications. Consecutive patients who underwent the procedure with arteriotomy from January 2011 to February 2014 were included in this study. We defined standard use as the use of StarClose for retrograde puncture of the common femoral artery (CFA) and off-label use as the use of StarClose for retrograde puncture of the superficial femoral artery (SFA), antegrade puncture of the CFA or SFA, puncture of the brachial artery or puncture of the vascular graft. The procedures performed included percutaneous transluminal angioplasty and thrombolysis. Technical success was defined as complete hemostasis achieved within 3 minute after the closure. Complications, and laboratory findings associated with coagulation function, were also investigated. There were 146 cases of standard applications and 111 cases of off-label applications. Technical success was achieved in all cases. The off-label group comprised the use of StarClose for retrograde puncture of the SFA (n = 19), antegrade puncture of the CFA or SFA (n = 74), brachial artery puncture (n = 5), larger sheath than 6 Fr (n = 7) and vascular graft puncture (n = 6). Minor complications were noted in both groups (standard group: 7.5%, off-label group: 2.7%). Off-label use of StarClose is safe and feasible

  10. Alterações hemostáticas em pacientes com doença falciforme Changes in hemostasis in sickle cell disease patients

    Jaíne B. Stypulkowski

    2010-02-01

    Full Text Available A doença falciforme (DF é uma doença hereditária que tem uma fisiopatologia complexa e diversificada. Além da falcização dos eritrócitos, responsável pelos fenômenos de vaso-oclusão e hemólise, alterações no sistema de coagulação parecem ter papel importante nas várias manifestações clínicas desta doença. Aproximadamente todos os componentes da hemostasia, incluindo função plaquetária, mecanismos procoagulantes, anticoagulantes e sistema fibrinolítico, estão alterados nesta patologia, mesmo em pacientes clinicamente estáveis. A presença da fosfatidilserina (FS na superfície externa da membrana do eritrócito e o aumento dos anticorpos antifosfolipídeos e do fator tecidual (FT marcam o início da ativação da coagulação nestes pacientes. Também a destruição dos eritrócitos diminui a biodisponibilidade do óxido nítrico (NO e, como consequência, modifica a hemostasia vascular, aumentando a ativação plaquetária e a adesão de moléculas ao endotélio. Assim, o objetivo deste trabalho foi abordar as diferentes alterações hemostáticas que ocorrem nos pacientes com doença falciforme, a fim de melhor compreender o estado "hipercoagulável" como é descrito nesta doença.Sickle cell disease is an inherited disease characterized by a complex and varied physiopathology. Apart from the sickle red blood cells, responsible for vascular occlusion and hemolytic anemia, changes in the coagulation system seem to play an important role in the clinical manifestations of this disorder. Nearly every component of hemostasis, including platelet function and the procoagulant, anticoagulant, and fibrinolytic systems, are altered in sickle Cell Disease even in non-crisis steady-state patients. The presence of phosphatidylserine on the external membrane of the red blood cell and the increase in antiphosphatidylserine antibodies and tissue factor mark the beginning of coagulation activation in these patients. Moreover, red

  11. Gene Delivery of Activated Factor VII Using Alternative Adeno-Associated Virus Serotype Improves Hemostasis in Hemophiliac Mice with FVIII Inhibitors and Adeno-Associated Virus Neutralizing Antibodies.

    Sun, Junjiang; Hua, Baolai; Chen, Xiaojing; Samulski, Richard J; Li, Chengwen

    2017-08-01

    While therapeutic expression of coagulation factors from adeno-associated virus (AAV) vectors has been successfully achieved in patients with hemophilia, neutralizing antibodies to the vector and inhibitory antibodies to the transgene severely limit efficacy. Indeed, approximately 40% of mice transduced with human factor VIII using the AAV8 serotype developed inhibitory antibodies to factor VIII (FVIII inhibitor), as well as extremely high titers (≥1:500) of neutralizing antibodies to AAV8. To correct hemophilia in these mice, AAV9, a serotype with low in vitro cross-reactivity (≤1:5) to anti-AAV8, was used to deliver mouse-activated factor VII (mFVIIa). It was found that within 6 weeks of systemic administration of 2 × 10 13 particles/kg of AAV9/mFVIIa, hemophiliac mice with FVIII inhibitors and neutralizing antibodies (NAb) to AAV8 achieved hemostasis comparable to that in wild-type mice, as measured by rotational thromboelastometry. A level of 737 ng/mL mFVIIa was achieved after AAV9/mFVIIa adminstration compared to around 150 ng/mL without vector treatment, and concomitantly prothrombin time was shortened. Tissues collected after intra-articular hemorrhage from FVIII-deficient mice and mice with FVIII inhibitors were scored 4.7 and 5.5, respectively, on a scale of 0-10, indicating significant pathological damage. However, transduction with AAV9/mFVIIa decreased pathology scores to 3.6 and eliminated hemosiderin iron deposition in the synovium in most mice. Collectively, these results suggest that application of alternative serotypes of AAV vector to deliver bypassing reagents has the potential to correct hemophilia and prevent hemoarthrosis, even in the presence of FVIII inhibitor and neutralizing antibodies to AAV.

  12. RNA-Seq Analysis of Abdominal Fat in Genetically Fat and Lean Chickens Highlights a Divergence in Expression of Genes Controlling Adiposity, Hemostasis, and Lipid Metabolism

    Resnyk, Christopher W.; Chen, Chuming; Huang, Hongzhan; Wu, Cathy H.; Simon, Jean; Le Bihan-Duval, Elisabeth; Duclos, Michel J.; Cogburn, Larry A.

    2015-01-01

    Genetic selection for enhanced growth rate in meat-type chickens (Gallus domesticus) is usually accompanied by excessive adiposity, which has negative impacts on both feed efficiency and carcass quality. Enhanced visceral fatness and several unique features of avian metabolism (i.e., fasting hyperglycemia and insulin insensitivity) mimic overt symptoms of obesity and related metabolic disorders in humans. Elucidation of the genetic and endocrine factors that contribute to excessive visceral fatness in chickens could also advance our understanding of human metabolic diseases. Here, RNA sequencing was used to examine differential gene expression in abdominal fat of genetically fat and lean chickens, which exhibit a 2.8-fold divergence in visceral fatness at 7 wk. Ingenuity Pathway Analysis revealed that many of 1687 differentially expressed genes are associated with hemostasis, endocrine function and metabolic syndrome in mammals. Among the highest expressed genes in abdominal fat, across both genotypes, were 25 differentially expressed genes associated with de novo synthesis and metabolism of lipids. Over-expression of numerous adipogenic and lipogenic genes in the FL chickens suggests that in situ lipogenesis in chickens could make a more substantial contribution to expansion of visceral fat mass than previously recognized. Distinguishing features of the abdominal fat transcriptome in lean chickens were high abundance of multiple hemostatic and vasoactive factors, transporters, and ectopic expression of several hormones/receptors, which could control local vasomotor tone and proteolytic processing of adipokines, hemostatic factors and novel endocrine factors. Over-expression of several thrombogenic genes in abdominal fat of lean chickens is quite opposite to the pro-thrombotic state found in obese humans. Clearly, divergent genetic selection for an extreme (2.5–2.8-fold) difference in visceral fatness provokes a number of novel regulatory responses that govern

  13. Assembly and activation of alternative complement components on endothelial cell-anchored ultra-large von Willebrand factor links complement and hemostasis-thrombosis.

    Nancy A Turner

    Full Text Available Vascular endothelial cells (ECs express and release protein components of the complement pathways, as well as secreting and anchoring ultra-large von Willebrand factor (ULVWF multimers in long string-like structures that initiate platelet adhesion during hemostasis and thrombosis. The alternative complement pathway (AP is an important non-antibody-requiring host defense system. Thrombotic microangiopathies can be associated with defective regulation of the AP (atypical hemolytic-uremic syndrome or with inadequate cleavage by ADAMTS-13 of ULVWF multimeric strings secreted by/anchored to ECs (thrombotic thrombocytopenic purpura. Our goal was to determine if EC-anchored ULVWF strings caused the assembly and activation of AP components, thereby linking two essential defense mechanisms.We quantified gene expression of these complement components in cultured human umbilical vein endothelial cells (HUVECs by real-time PCR: C3 and C5; complement factor (CF B, CFD, CFP, CFH and CFI of the AP; and C4 of the classical and lectin (but not alternative complement pathways. We used fluorescent microscopy, monospecific antibodies against complement components, fluorescent secondary antibodies, and the analysis of >150 images to quantify the attachment of HUVEC-released complement proteins to ULVWF strings secreted by, and anchored to, the HUVECs (under conditions of ADAMTS-13 inhibition. We found that HUVEC-released C4 did not attach to ULVWF strings, ruling out activation of the classical and lectin pathways by the strings. In contrast, C3, FB, FD, FP and C5, FH and FI attached to ULVWF strings in quantitative patterns consistent with assembly of the AP components into active complexes. This was verified when non-functional FB blocked the formation of AP C3 convertase complexes (C3bBb on ULVWF strings.AP components are assembled and activated on EC-secreted/anchored ULVWF multimeric strings. Our findings provide one possible molecular mechanism for clinical

  14. A novel virtual reality simulation for hemostasis in a brain surgical cavity: perceived utility for visuomotor skills in current and aspiring neurosurgery residents.

    Gasco, Jaime; Patel, Achal; Luciano, Cristian; Holbrook, Thomas; Ortega-Barnett, Juan; Kuo, Yong-Fang; Rizzi, Silvio; Kania, Patrick; Banerjee, Pat; Roitberg, Ben Z

    2013-12-01

    To understand the perceived utility of a novel simulator to improve operative skill, eye-hand coordination, and depth perception. We used the ImmersiveTouch simulation platform (ImmersiveTouch, Inc., Chicago, Illinois, USA) in two U.S. Accreditation Council for Graduate Medical Education-accredited neurosurgical training programs: the University of Chicago and the University of Texas Medical Branch. A total of 54 trainees participated in the study, which consisted of 14 residents (group A), 20 senior medical students who were neurosurgery candidates (group B), and 20 junior medical students (group C). The participants performed a simulation task that established bipolar hemostasis in a virtual brain cavity and provided qualitative feedback regarding perceived benefits in eye-hand coordination, depth perception, and potential to assist in improving operating skills. The perceived ability of the simulator to positively influence skills judged by the three groups: group A, residents; group B, senior medical students; and group C, junior medical students was, respectively, 86%, 100%, and 100% for eye-hand coordination; 86%, 100%, and 95% for depth perception; and 79%, 100%, and 100% for surgical skills in the operating room. From all groups, 96.2% found the simulation somewhat or very useful to improve eye-hand coordination, and 94% considered it beneficial to improve depth perception and operating room skills. This simulation module may be suitable for resident training, as well as for the development of career interest and skill acquisition; however, validation for this type of simulation needs to be further developed. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Hemostasis in pre-eclampsia.

    Ismail, Siti Khadijah

    2012-01-31

    Pre-eclampsia (P-EC) is a multisystem disorder exclusive to pregnancy. It complicates ~2 to 8% of all pregnancies and remains a major cause of maternal mortality. P-EC is characterized by a profound hypercoagulable state. The delicate hemostatic balance that must be maintained in the uteroplacental circulation during pregnancy makes this system vulnerable to perturbation. An abnormal hemostatic pattern occurs within the uteroplacental circulation in P-EC compared with normal pregnancy. Much recent research has focused on the epidemiological link between inherited thrombophilia and P-EC. The data suggest a weak statistical association, indicating an improbable primary role in the pathogenesis. Without clear evidence, low molecular weight heparins have been widely used to reduce recurrence of P-EC in thrombophilia-positive women. This practice now should be reviewed. Future research needs to focus on improving our basic scientific understanding of the role of the hemostatic system in human placentation.

  16. Hemostasis in pre-eclampsia.

    Ismail, Siti Khadijah

    2011-03-01

    Pre-eclampsia (P-EC) is a multisystem disorder exclusive to pregnancy. It complicates ~2 to 8% of all pregnancies and remains a major cause of maternal mortality. P-EC is characterized by a profound hypercoagulable state. The delicate hemostatic balance that must be maintained in the uteroplacental circulation during pregnancy makes this system vulnerable to perturbation. An abnormal hemostatic pattern occurs within the uteroplacental circulation in P-EC compared with normal pregnancy. Much recent research has focused on the epidemiological link between inherited thrombophilia and P-EC. The data suggest a weak statistical association, indicating an improbable primary role in the pathogenesis. Without clear evidence, low molecular weight heparins have been widely used to reduce recurrence of P-EC in thrombophilia-positive women. This practice now should be reviewed. Future research needs to focus on improving our basic scientific understanding of the role of the hemostatic system in human placentation.

  17. Thrombosis and Hemostasis in Surgery

    Hvas, Anne-Mette; Larsen, Julie Brogaard; Pasalic, Leonardo

    2017-01-01

    .g., bleeding disorders, cancer, or developmental hemostatic changes in pediatric patients), to anticoagulant medication or complications such as heparin-induced thrombocytopenia (HIT), or to inherent risks of a particular surgical procedure or affected organ (e.g., hepatobiliary surgery or renal...... transplantation). All of these factors can have a profound effect on expected outcomes....

  18. Inventive activity of the Department of Protein Structure and Function of the Palladin Institute of Biochemistry of NAS of Ukraine. Part I. Development of the diagnostic methods for detection of hemostasis disorders and characterization of certain blood coagulation factors

    V. M. Danilova

    2016-04-01

    Full Text Available The practical aspects of inventive activity of the Department of Protein Structure and Function of the Palladin Institute of Biochemistry, NAS of Ukraine are highlighted in this article. Through years of fundamental and applied researches of blood coagulation system proteins, initiated by luminaries of the world biochemistry O. V. Palladin and V. O. Belitser, the Department staff have developed a considerable number of methods, techniques and tests for the assessment of the state of the hemostasis system, which were approved in many clinics. In the first part of this work the authors describe the development of the diagnostic methods for identifying the homeostasis system disorders in detail, as well as characterize certain coagulation factors.

  19. The compact Erlangen Active Simulator for Interventional Endoscopy: a prospective comparison in structured team-training courses on "endoscopic hemostasis" for doctors and nurses to the "Endo-Trainer" model.

    Hochberger, J; Euler, K; Naegel, A; Hahn, E G; Maiss, J

    2004-09-01

    In 1997 Hochberger and Neumann presented the "Erlangen Biosimulation Model" (commercialized as the "Erlangen Endo-Trainer") at various national and international meetings. The new compactEASIE is a simplified version of the original "Biosimulation Model" (Endo-Trainer) and is specially designed for easy handling. CompactEASIE is reduced in its features, focusing exclusively on flexible endoscopy training. The acceptance of training in endoscopic hemostasis is accepted by workshop participants, as evaluated by a questionnaire on both models. Eleven structured courses on endoscopic hemostasis for doctors and nurses organized by the same endoscopists from 3/1998 to 5/1999 were evaluated using one of both models. The questionnaires were filled in by 207/291 trainees (71%). The Endo-Trainer was used in 4 (n = 103) and the compactEASIE in 7 courses (n = 104). Both simulators were equipped with identical types of specially prepared pig-organ packages consisting of esophagus, stomach and duodenum, including artificial sewn-in vessels, polyps and varices. Blood perfusion was done with a roller pump connected to the sewn-in vessels and blood surrogate. All workshops were identical concerning the course structure: a 30-min theoretical introduction on ulcer bleeding was followed by 2 h of practical training in injection techniques and hemoclip application. The second part of variceal therapy consisted of a 30-min theoretical introduction prior to 2 h of practical training on sclerotherapy, band ligation and cyanoacrylate application. Finally, a questionnaire on the trainees' pre-experience and their rating of the different workshop sections was handed out to each participant. Previous endoscopic experience was comparable in both groups. The training in both simulators was highly accepted by the trainees (compactEASIE 95% excellent and good versus EASIE (Endo-Trainer) 97%) and did not show any significant difference (P = 0.493). Even in the assessment of the single techniques

  20. Вплив гелю «Лізостом» на судинно-тромбоцитарний гемостаз = Influtnce of gels «Lizostom» on the vascular-platelet hemostasis

    N. S. Kavushevska

    2016-10-01

    ** V. N. Karazin Kharkiv National University   Summary During experimental studies have shown the impact of dental gel "Lizostom" to reduce the duration of the microvascular bleeding, increased platelet aggregation and their capacity; increase blood clot retraction. Keywords: gel "Lizostom" vascular-platelet hemostasis, lysozyme hydrochloride.

  1. Technologies for Hemostasis and Stabilization of the Acute Traumatic Wound

    2015-10-01

    the resulting foams became more noodle -like in consistency in the same order. Both smaller volume and more noodle -like nature of the foam could be...in direction of yellow arrow. Only capsule exposed at this particular instant . Dashed circle: site of biopsy to illustrate PCL-capsule interface

  2. Technologies for Hemostasis and Stabilization of the Acute Traumatic Wound

    2014-10-01

    Thomas D. Morris Institute TEG thromboelastography UMM University of Maryland Medical Center UNL University of Nebraska—Lincoln UNMC University of...two subjects, and see what happens. VII. PLAN On the next three consecutive Tuesdays (Mar 25, Apr 1, Apr 8), we will be...Stabilization of the Acute Traumatic Wound" Jessica, Drs. Velander, Larsen, and I have decided to cancel our subcontract with the Thomas D. Morris Institute

  3. Esophageal variceal ligation for hemostasis of acute variceal bleeding

    Introduction: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of ...

  4. Chinese herbal remedies affecting thrombosis and hemostasis: A review

    Quan Li

    2015-04-01

    Full Text Available Acute coronary syndrome, stroke and other ischemic events continue to be the most common causes of mortality and morbidity in the world, and their incidence is rapidly increasing in the developing nations. These cardiovascular disorders clinically manifest as acute atherothrombotic events. Application of oral antiplatelet drugs is a milestone in the therapy of cardiovascular diseases. However, the limited efficacy of these drugs in the setting of arterial thrombosis, their unfavorable side effects, cost-to-benefit issues and the drug resistance phenomenon substantiate the need for the development of new and more efficacious antithrombotic drugs. In recent years, with the progress in the study of the Chinese medicine pharmacology, many Chinese herbs and formulas, as well as active constituents have been reported to possess not only effects on platelet aggregation and activation but also beneficial roles in vascular functions. Compared with currently used antithrombotic agents, herb remedies exert antithrombotic effects in a multi-pathway and multi-target manner. This paper will cover the progress in research on the ameliorating effects of herbal remedies on thrombosis, with focusing on their protection of vascular endothelial cells and inhibition of platelet activation.

  5. Herpes viruses, cytokines, and altered hemostasis in vital exhaustion.

    Ven, A.J.A.M. van der; Diest, R. van; Hamulyak, K.; Maes, M.; Bruggeman, C.A.; Appels, A.

    2003-01-01

    OBJECTIVE: Infections with herpes viruses have been implicated in the pathogenesis of atherosclerosis. We tested the hypothesis that vital exhaustion (VE) is associated with multiple herpesvirus infections, such as herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and

  6. [Medical hemostasis. II. Systemic hemostatics, a critical evaluation].

    van den Bogaard, A E

    1989-02-01

    The control of spontaneous and traumatic haemorrhage is a matter of constant concern to veterinary practitioners. In some instances, the control of bleeding may be relatively simple using some topical therapeutic procedure, but when haemostatic defects are present, treatment with topical agents alone might not be sufficient, and more radical and life-saving procedures are indicated: replacement therapy with blood or blood products. As this is not easy to perform in most veterinary clinical situations, any therapeutic agent, which facilitates control of haemorrhage is a welcome addition to the therapeutic armament. Besides vitamin K, blood products and agents for topical use, there are only a few agents having a well-defined action on the mechanism of haemostasis. On the other hand several drugs are propagated in the Netherlands as systemic haemostatics in the treatment of bleeding disorders and prevention of haemorrhage during operation. None of these is of proven clinical value in veterinary practice. The only agent, which possibly showed some clinical effect: ethamsylate, has recently been withdrawn from the Dutch market by the manufacturers. Double-blind prospective trials with quantitation of loss of blood showed that antifibrinolytic agents such as tranexamic acid are clinically effective in certain conditions in humans. Because of their mode of action, it might reasonably be expected that these drugs might have positive results in veterinary medicine. Therefore, clinical trials with antifibrinolytic agents are urgently indicated to evaluate the effectiveness and side-effects of these drugs in animals showing severe bleeding or in the prevention of peroperative haemorrhage.

  7. THE HEMOSTASIS SYSTEM STATUS IN CHILDREN WITH METABOLIC SYNDROME

    N. A. Tsaregorodtsev

    2015-01-01

    Full Text Available The aim of the research was to study the characteristic properties of hemostasia system of children suffer-ing from metabolic syndrome (MS and exogenous obesity.Material and methods, A total of 58 children and adolescents aged from 9 to 16 with different stages of obesity. The examined were divided into two groups – the main group including children with MS (n = 33 and the control group including patients with exogenous obesity but without any indications of (n = 25. The presence of obesity was stated according to the criteria described by L.V. Kozlova and her co-authors (2008. All the examined patients had a biochemical blood analysis that included component determination of hemostasia system. The component determination was to reflect all the links of blood coagulation, so the following indices were analysed – activated partial thromboplastin time (A-PPT, prothrombin time (PTT, prothrombin ratio, level of fibrinogen, thrombin time, international normalized ratio (INR and thrombocyte aggregation with ristomycin.Results. The children suffering from MS compared with the children without this syndrome had signifi-cantly higher level of prothrombin time, thrombocyte aggregation with ristomycin as well as INR. The index of thrombocyte aggregation with ristomycin in the main group was not only higher than in the con-trol group but also exceeded the reference value. The boys with MS had a notably higher index of throm-bocyte aggregation with ristomycin than the boys suffering fron obesity. The girls with MS had a higher INR factor than the group of girls with obesity.Conclusions. The research showed that with children suffering from MS their hemostatic system gets involved in the pathological process. The discovered peculiarities show inclination to hyper-coagulation 

  8. Technologies for Hemostasis and Stabilization of the Acute Traumatic Wound

    2012-10-01

    purified fibrinogen from USARMY donated plasma. 6. Generation of purified recombinant activated Factor XIII (rFXIIIA2-a) made from yeast fermentation ...Figure 5. SDS-PAGE of purified recombinant activated Factor XIII, from fermentation of Pichia pastoris. Lane 1: molecular weight marker...fibrinogen (FI) and activated Factor XIII (FXIIIa) were generated in the milk of transgenic cows and in yeast , respectively; human r- thrombin (FIIa

  9. Hemostasis of Left Atrial Appendage Bleed With Lariat Device

    Amena Hussain, MD

    2014-09-01

    Full Text Available New devices designed for minimally invasive closure of the left atrial appendage (LAA may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA, which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion.

  10. GAS6/TAM Pathway Signaling in Hemostasis and Thrombosis.

    Law, Luke A; Graham, Douglas K; Di Paola, Jorge; Branchford, Brian R

    2018-01-01

    The GAS6/TYRO3-AXL-MERTK (TAM) signaling pathway is essential for full and sustained platelet activation, as well as thrombus stabilization. Inhibition of this pathway decreases platelet aggregation, shape change, clot retraction, aggregate formation under flow conditions, and surface expression of activation markers. Transgenic mice deficient in GAS6, or any of the TAM family of receptors that engage this ligand, exhibit in vivo protection against arterial and venous thrombosis but do not demonstrate either spontaneous or prolonged bleeding compared to their wild-type counterparts. Comparable results are observed in wild-type mice treated with pharmacological inhibitors of the GAS6-TAM pathway. Thus, GAS6/TAM inhibition offers an attractive novel therapeutic option that may allow for a moderate reduction in platelet activation and decreased thrombosis while still permitting the primary hemostatic function of platelet plug formation.

  11. Technologies for Hemostasis and Stabilization of the Acute Traumatic Wound

    2013-10-01

    bacteriophage derived artificial chromosome (PAC) in Escherichia coli cells from Genome Systems, Inc. (St. Louis, MO). All three transgenes were...sequencer. N-terminal sequencing was performed by the University of Nebraska Medical Center’s Protein Structure Core Facility. The disappearance of...and N = 3 for the pdFI and rFI treatment groups. analysis indicated that the rates of disappearance of the γ-chain were similar for pdFI and rFI

  12. Homocysteine and coronary heart disease : the role of polymorphic genes and hemostasis

    Klerk, M.

    2002-01-01

    Background Homocysteine is a sulfur-containing amino acid formed during catabolism of the essential amino acid methionine. Defects in genes encoding enzymes or sub-optimal intake of B-vitamins (e.g. folate) involved in homocysteine

  13. Massive hematemesis after radiofrequency ablation of metastatic liver tumor with successful hemostasis achieved through transarterial embolization.

    Liu, Chien-An; Chiu, Nai-Chi; Chiou, Yi-You

    2018-03-03

    Hemorrhagic complications are the most common major complications that occur after radiofrequency ablation, but hematemesis as a complication after radiofrequency ablation for hepatic tumor has not been mentioned before. A hepatogastric fistula as a delayed complication is also rare. We present the case of a 77-year-old man with severe hematemesis that occurred 2 months after radiofrequency ablation of a liver metastasis of gastric cancer. A ruptured hepatic artery pseudoaneurysm and a hepatogastric fistula were confirmed through serial imaging examinations. The current case is reported in combination with 2 rare major complications after radiofrequency ablation of a liver tumor. Copyright © 2018. Published by Elsevier Inc.

  14. Aortic Hemostasis and Resuscitation Advanced REBOA for NCTH and Reversal of HiTCA

    2017-06-01

    animal model by effectively achieving ROSC, providing hemodynamic support, and increase pre- hospital transport and long-term survival. Non-compressible...other Internet site(s)  Technologies or techniques American Heart Association Resuscitation Conference Abstract submission June 12, 2017. Draft...swine NCTH and HiTCA in a series of experiments in which each animal underwent a liver laceration and allowed to free bleed for five minutes through

  15. Synthetic Platelets: Intravenous Infusible Nanoparticles to Promote Hemostasis and Survival Following Liver Injury in Swine

    2014-08-12

    measurements confirm the hydrodynamic diameter of the pru·ticles to be closer to 450 nm and the zeta potential to be -30 mY. The NME confirms the...ional studies. Brie Oy, the lefi lobe of the liver is iso lated and hemisected followed by c losure o f’the cavit y and quantification of blood loss

  16. Functionalization of single-walled carbon nanotubes regulates their effect on hemostasis

    Sokolov, A V; Aseychev, A V; Kostevich, V A; Gusev, A A; Gusev, S A; Vlasova, I I

    2011-01-01

    Applications of single-walled carbon nanotubes (SWNTs) in medical field imply the use of drug-coupled carbon nanotubes as well as carbon nanotubes functionalized with different chemical groups that change nanotube surface properties and interactions between nanotubes and cells. Covalent attachment of polyethylene glycol (PEG) to carboxylated single-walled carbon nanotubes (c-SWNT) is known to prevent the nanotubes from interaction with macrophages. Here we characterized nanotube's ability to stimulate coagulation processes in platelet-poor plasma (PPP), and evaluated the effect of SWNTs on platelet aggregation in platelet-rich plasma (PRP). Our study showed that PEG-SWNT did not affect the rate of clotting in PPP, while c-SWNT shortened the clot formation time five times compared to the control PPP. Since c-SWNT failed to accelerate coagulation in plasma lacking coagulation factor XI, it may be suggested that c-SWNT affects the contact activation pathway. In PRP, platelets responded to both SWNT types with irreversible aggregation, as evidenced by changes in the aggregate mean radius. However, the rate of aggregation induced by c-SWNT was two times higher than it was with PEG-SWNT. Cytological analysis also showed that c-SWNT was two times more efficient when compared to PEG-SWNT in aggregating platelets in PRP. Taken together, our results show that functionalization of nanoparticles can diminish their negative influence on blood cells. As seen from our data, modification of c-SWNT with PEG, when only a one percent of carbon atoms is bound to polymer (70 wt %), decreased the nanotube-induced coagulation in PRP and repelled the accelerating effect on the coagulation in PPP. Thus, when functionalized SWNTs are used for administration into bloodstream of laboratory animals, their possible pro-coagulant and pro-aggregating properties must be taken into account.

  17. Functionalization of single-walled carbon nanotubes regulates their effect on hemostasis

    Sokolov, A V; Aseychev, A V; Kostevich, V A; Gusev, A A; Gusev, S A; Vlasova, I I, E-mail: irina.vlasova@yahoo.com [Research Institute for Physico-Chemical Medicine, FMBA, M. Pirogovskaya Str. 1a, Moscow (Russian Federation)

    2011-04-01

    Applications of single-walled carbon nanotubes (SWNTs) in medical field imply the use of drug-coupled carbon nanotubes as well as carbon nanotubes functionalized with different chemical groups that change nanotube surface properties and interactions between nanotubes and cells. Covalent attachment of polyethylene glycol (PEG) to carboxylated single-walled carbon nanotubes (c-SWNT) is known to prevent the nanotubes from interaction with macrophages. Here we characterized nanotube's ability to stimulate coagulation processes in platelet-poor plasma (PPP), and evaluated the effect of SWNTs on platelet aggregation in platelet-rich plasma (PRP). Our study showed that PEG-SWNT did not affect the rate of clotting in PPP, while c-SWNT shortened the clot formation time five times compared to the control PPP. Since c-SWNT failed to accelerate coagulation in plasma lacking coagulation factor XI, it may be suggested that c-SWNT affects the contact activation pathway. In PRP, platelets responded to both SWNT types with irreversible aggregation, as evidenced by changes in the aggregate mean radius. However, the rate of aggregation induced by c-SWNT was two times higher than it was with PEG-SWNT. Cytological analysis also showed that c-SWNT was two times more efficient when compared to PEG-SWNT in aggregating platelets in PRP. Taken together, our results show that functionalization of nanoparticles can diminish their negative influence on blood cells. As seen from our data, modification of c-SWNT with PEG, when only a one percent of carbon atoms is bound to polymer (70 wt %), decreased the nanotube-induced coagulation in PRP and repelled the accelerating effect on the coagulation in PPP. Thus, when functionalized SWNTs are used for administration into bloodstream of laboratory animals, their possible pro-coagulant and pro-aggregating properties must be taken into account.

  18. The influence of carvedilol vs. metoprolol on sympathetic activity and hemostasis in patients with heart failure

    De Peuter, O.R.; Kok, W. E.; Verberne, H.J.; Van Den Bogaard, B.; Truijen, J.; Schaap, M.C.; Nieuwland, R.; Meijers, J.C.; Verheul, J.A.; De Groot, C.A.; Bakx, A.D.; Somsen, G.A.; Brewster, L.M.; Buller, H.R.; Kamphuisen, P.W.

    2011-01-01

    Background: Carvedilol, a non-selective beta-blocker, may be more effective in reducing the risk of thromboembolic events in heart failure, compared to metoprolol, a selective beta-blocker (De Peuter et al., Eur J Heart Fail, in press/ISTH 2009). We hypothesized that carvedilol lowers this risk

  19. Lack of grading agreement among international hemostasis external quality assessment programs

    Olson, John D.; Jennings, Ian; Meijer, Piet; Bon, Chantal; Bonar, Roslyn; Favaloro, Emmanuel J.; Higgins, Russell A.; Keeney, Michael; Mammen, Joy; Marlar, Richard A.; Meley, Roland; Nair, Sukesh C.; Nichols, William L.; Raby, Anne; Reverter, Joan C.

    2018-01-01

    Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of ‘pass’ or ‘fail’ is made. EQA provider members of the international organization, external quality assurance in thrombosis and h...

  20. Platelets as Contractile Nanomachines for Targeting Drug Delivery in Hemostasis and Thrombosis

    2015-12-01

    capsules were suspended in platelet - rich plasma, which was subsequently exposed to 1 U/mL of thrombin, the capsules successfully targeted target...thrombotic sites via integration into the forming fibrin networks and binding to activated platelets . The delivery vehicles successfully adhere to platelet ...rupture has successfully been achieved in static fibrin gels comprised of a high concentration of platelets (Figure 3). Only capsules incorporated into

  1. Influence of Acute Normobaric Hypoxia on Hemostasis in Volunteers with and without Acute Mountain Sickness

    Marc Schaber

    2015-01-01

    Full Text Available Introduction. The aim of the present study was to investigate whether a 12-hour exposure in a normobaric hypoxic chamber would induce changes in the hemostatic system and a procoagulant state in volunteers suffering from acute mountain sickness (AMS and healthy controls. Materials and Methods. 37 healthy participants were passively exposed to 12.6% FiO2 (simulated altitude hypoxia of 4,500 m. AMS development was investigated by the Lake Louise Score (LLS. Prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count were measured and specific methods (i.e., thromboelastometry and a thrombin generation test were used. Results. AMS prevalence was 62.2% (LLS cut off of 3. For the whole group, paired sample t-tests showed significant increase in the maximal concentration of generated thrombin. ROTEM measurements revealed a significant shortening of coagulation time and an increase of maximal clot firmness (InTEM test. A significant increase in maximum clot firmness could be shown (FibTEM test. Conclusions. All significant changes in coagulation parameters after exposure remained within normal reference ranges. No differences with regard to measured parameters of the hemostatic system between AMS-positive and -negative subjects were observed. Therefore, the hypothesis of the acute activation of coagulation by hypoxia can be rejected.

  2. Comparison of hemostatic matrix and standard hemostasis in patients undergoing primary TKA.

    Comadoll, James L; Comadoll, Shea; Hutchcraft, Audrey; Krishnan, Sangeeta; Farrell, Kelly; Kreuwel, Huub T C; Bechter, Mark

    2012-06-01

    Bleeding after total knee arthroplasty increases the risk of pain, delayed rehabilitation, blood transfusion, and transfusion-associated complications. The authors compared pre- and postoperative decreases in hemoglobin as a surrogate for blood loss in consecutive patients treated at a single institution by the same surgeon (J.L.C.) using conventional hemostatic methods (electrocautery, suturing, or manual compression) or a gelatin and thrombin-based hemostatic matrix during total knee arthroplasty. Data were collected retrospectively by chart review. The population comprised 165 controls and 184 patients treated with hemostatic matrix. Median age was 66 years (range, 28-89 years); 66% were women. The arithmetic mean ± SD for the maximal postoperative decrease in hemoglobin was 3.18 ± 0.94 g/dL for controls and 2.19 ± 0.83 g/dL for the hemostatic matrix group. Least squares means estimates of the group difference (controls-hemostatic matrix) in the maximal decrease in hemoglobin was 0.96 g/dL (95% confidence interval, 0.77-1.14 mg/dL; Pmatrix, 84%). In both groups, overall mean tourniquet time was approximately 1 hour, and the most common length of stay was 3 to 5 days. No serious complications related to the hemostatic agent were observed. These data demonstrate that the use of a flowable hemostatic matrix results in less reduction in hemoglobin than the use of conventional hemostatic methods in patient undergoing total knee arthroplasty. Copyright 2012, SLACK Incorporated.

  3. Cost evaluation of two methods of post tooth extraction hemostasis in patients on anticoagulant therapy.

    Zusman, S P; Lustig, J P; Bin Nun, G

    1993-06-01

    The classical management of patients on oral anticoagulant therapy included hospitalisation, cessation of the anticoagulant agent, and extraction of teeth when the prothrombine levels rise. This method was substituted in the High Risk Dental Clinic at Barzilai Medical Center in Ashkelon by use of a tissue sealant (Tisseel) which does not need hospitalisation nor cessation of the anticoagulant therapy. In comparing the last 23 sessions employing the former method to the first 23 sessions using the new method there were significant differences in the cost effectiveness for the health system, provider, insurer and patient. Despite the fact that from the health system point of view the new method is much more cost effective, there is no financial incentive for the provider (hospital) nor awareness on the part of the insurer (General Sick Fund) to embrace it and 'market' it.

  4. CORRELATION BETWEEN PARAMETERS OF HEMOSTASIS AND COURSE OF TUBERCULOSIS IN PULMONARY TUBERCULOSIS

    A. A. Yatsenko

    2016-01-01

    Full Text Available The homeostasis state in the peri-operative period was studied in 31 pulmonary tuberculosis patients. It was found out that the volume of peri-operative blood loss was not related to the presence of increased fractional thromboplastin time and hyperfibrinolysis. The following factors were found to be related to intra-operative blood loss: pulmonary surgery in the past; combination of signs – 2A or 2B group of dispensary follow-up, MDR/XDR TB, bacillary excretion, presence of fibrous cavernous pulmonary tuberculosis in the infiltration state, lesions in 10 segments and more. The formulas of linear regression were o`ered allowing predicting the volume of blood loss and duration of the stay in the intesive care department.

  5. Diagnosis, prevention, and management of bleeding episodes in Philadelphia-negative myeloproliferative neoplasms: recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society of Thrombosis and Hemostasis Research (GTH).

    Appelmann, Iris; Kreher, Stephan; Parmentier, Stefani; Wolf, Hans-Heinrich; Bisping, Guido; Kirschner, Martin; Bergmann, Frauke; Schilling, Kristina; Brümmendorf, Tim H; Petrides, Petro E; Tiede, Andreas; Matzdorff, Axel; Griesshammer, Martin; Riess, Hanno; Koschmieder, Steffen

    2016-04-01

    Philadelphia-negative myeloproliferative neoplasms (Ph-negative MPN) comprise a heterogeneous group of chronic hematologic malignancies. The quality of life, morbidity, and mortality of patients with MPN are primarily affected by disease-related symptoms, thromboembolic and hemorrhagic complications, and progression to myelofibrosis and acute leukemia. Major bleeding represents a common and important complication in MPN, and the incidence of such bleeding events will become even more relevant in the future due to the increasing disease prevalence and survival of MPN patients. This review discusses the causes, differential diagnoses, prevention, and management of bleeding episodes in patients with MPN, aiming at defining updated standards of care in these often challenging situations.

  6. Pressure ulcer: an unreported complication of the Safeguard® hemostasis device. No need to crack under pressure

    Moretti, Claudio; Quadri, Giorgio; Gaita, Fiorenzo; Sheiban, Imad

    2011-01-01

    Diagnostic cardiac catheterizations are predominantly performed using the femoral artery access. Several devices have been developed to aid in the closure of femoral arteriotomy. Safeguard® is a new pneumatic compression device that has been developed for compression of the femoral artery after brief manual compression. We hereby report the case of an elderly patient who underwent a percutaneous coronary intervention via the femoral artery in whom a Safeguard™ device, left overnight because of persistent oozing, provoked an extensive pressure ulcer. Knowledge of this potential complication is important to minimize its occurance and provide appropriate treatment. PMID:21977303

  7. Pressure ulcer: an unreported complication of the Safeguard® hemostasis device. No need to crack under pressure.

    Moretti, Claudio; Quadri, Giorgio; Gaita, Fiorenzo; Sheiban, Imad

    2011-01-01

    Diagnostic cardiac catheterizations are predominantly performed using the femoral artery access. Several devices have been developed to aid in the closure of femoral arteriotomy.Safeguard® is a new pneumatic compression device that has been developed for compression of the femoral artery after brief manual compression. We hereby report the case of an elderly patient who underwent a percutaneous coronary intervention via the femoral artery in whom a Safeguard™ device, left overnight because of persistent oozing, provoked an extensive pressure ulcer. Knowledge of this potential complication is important to minimize its occurance and provide appropriate treatment.

  8. Purification and characterization of novel fibrin(ogen)olytic protease from Curcuma aromatica Salisb.: Role in hemostasis.

    Shivalingu, B R; Vivek, H K; Priya, B S; Soujanya, K N; Swamy, S Nanjunda

    2016-12-01

    The proteases from turmeric species have procoagulant and fibrinogenolytic activity. This provides a scientific basis for traditional use of turmeric to stop bleeding and promote wound healing processes. Our previous studies revealed that fibrinogenolytic action of crude enzyme fraction of Curcuma aromatica Salisb., was found to be more influential than those of Curcuma longa L., Curcuma caesia Roxb., Curcuma amada Roxb. and Curcuma zedoria (Christm.) Roscoe. Hence, the purpose of this study is to purify and characterize protease from C. aromatica and to explore its role in wound healing process. The protease was purified by Sephadex G-50 gel permeation chromatography. Peak with potent proteolytic activity was subjected to rechromatography and then checked for homogeneity by SDS-PAGE and native PAGE. Furthermore purity of the peak was assessed by RP-HPLC and MALDI-TOF. The biochemical properties, type of protease, kinetic studies, fibrinogenolytic, coagulant and fibrinolytic activities were carried out. The two proteolytic peaks were fractionated in gel permeation chromatography. Among these, the peak-II showed potent proteolytic activity with specific activity of 10units/mg/min and named as C. aromatica protease-II (CAP-II). This protein resolved into a single sharp band both in SDS-PAGE (reducing and non-reducing) as well as in native (acidic) PAGE. It is a monomeric protein, showing sharp peak in RP-HPLC and its relative molecular mass was found to be 12.378kDa. The caseinolytic and fibrinolytic activity of CAP-II was completely inhibited by phenylmethylsulfonylfluoride (PMSF). The CAP-II exhibited optimum temperature of 45°C and optimum pH of 7.5. The Km and Vmax of CAP-II was found to be 1.616µg and 1.62units/mg/min respectively. The CAP-II showed hydrolysis of all three subunits of fibrinogen in the order Aα>Bß>γ. The CAP-II exhibited strong procoagulant activity by reducing the human plasma clotting time. It also showed fibrinolytic activity by complete hydrolysis of α-polymer and γ-γ dimer present in fibrin. The CAP-II is a novel serine protease from C. aromatica, which has been demonstrated to stop bleeding and initiate wound healing through its procoagulant and fibrin(ogen)olytic activities. Our study demonstrates the possible role of CAP-II, as therapeutic enzyme to stop bleeding at the time of wounding. Copyright © 2016 Elsevier GmbH. All rights reserved.

  9. Effect of X-ray contrast agents on hemostasis and its role in the genesis of adverse reactions

    Sviridov, N.K.; Napolov, Yu.K.

    2001-01-01

    Based on available data, the effect of X-ray contrast agents (XCA) on homeostasis and its role in side reactions genesis are discussed. It is shown that the contrast agent type used can essentially affect the thrombocytes. Nonionic XCA are able to increase the thrombocytes degranulation in case of coronarography and percutaneous transluminal coronary angioplastics with release of procoagulants in vessel gap. This effect can to lead to acute thromboses and be the start of restenosis [ru

  10. Impact of hemostasis methods, electrocoagulation versus suture, in laparoscopic endometriotic cystectomy on the ovarian reserve: a randomized controlled trial.

    Tanprasertkul, Chamnan; Ekarattanawong, Sophapun; Sreshthaputra, Opas; Vutyavanich, Teraporn

    2014-08-01

    To evaluate the impact on ovarian reserve between two different methods ofhemostasis after laparoscopic ovarian endometrioma excision. A randomized controlled study was conducted from January to December 2013 in Thammasat University Hospital, Thailand. Reproductive women, age 18-45years who underwent laparoscopic ovarian cystectomy were randomized in electrocoagulation and suture groups. Clinical baseline data and ovarian reserve outcome (anti-Mullerian hormone (AMH)) were evaluated. Fifty participants were recruited and randomized in two groups. Electrocoagulation and suture groups consisted of 25 participants. Baseline characteristics between 2 groups (age, weight, BMI, height, cyst diameter, duration and estimated blood loss) were not statistically different. There were no significant difference of AMIH between electrocoagulation and suture group atpre-operative (2.90±2.26 vs. 2.52±2.37 ng/ml), 1 week (1.78±1.51 vs. 1.99±1.71 ng/ml), 1 month (1.76±1.50 vs. 2.09±1.62 ng/ml), 3 months (2.09±1.66 vs. 1.96±1.68 ng/ml) and 6 months (2.11±1.84 vs 1.72±1.68 ng/ml), respectively. However mean AMH ofboth groups significantly decreased since the first week of operation. Effect oflaparoscopic ovarian surgery had significantly declined and sustained AMH level until 6 months. Laparoscopic cystectomy of ovarian endometrioma has negative impact to ovarian reserve. Either electroco- agulation or suture method had no different effects.

  11. Purification and Characterization of a New Serine Protease (VLCII) Isolated from Vipera lebetina Venom: Its Role in Hemostasis.

    Amel, Kadi-Saci; Fatima, Laraba-Djebari

    2015-08-01

    Snake venom serine proteinases (SVSPs) affect various physiological functions including blood coagulation, fibrinolysis, and platelet aggregation. Coagulant serine proteinase (VLCII) was purified from Vipera lebetina venom using three chromatographic steps: gel filtration on SephadexG-75, DEAE-Sephadex A-50, and reversed-phase high-performance liquid chromatography (RP-HPLC) on C8 column. VLCII appeared homogenous (60 kDa) when tested on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). VLCII as a thrombin-like enzyme was able to hydrolyze Nα-CBZ L-arginine-p-nitroanilide hydrochloride and could be a serine protease because it is inhibited by phenylmethylsulfonyl fluoride. The proteolytic activity of VLCII was not affected by ethylenediaminetetraacetic acid and 1.10-phenanthroline. It showed high coagulant activity against human plasma and cleaved both Aα chain and Bβ chain of bovine fibrinogen. The isolated VLCII displayed proaggregating effect on human platelet in a concentration-dependent manner with an absence of lag time. Clopidogrel P2Y12 adenosine diphosphate (ADP) receptor inhibitor reduced markedly the aggregating effect induced by VLCII than aspirin, indicating the involvement of ADP signaling pathway. © 2015 Wiley Periodicals, Inc.

  12. Hemostasia normal y coagulación intravascular diseminada en obstetricia Normal hemostasis and disseminated intravascular clotting in Obstetrics

    Danilo Nápoles Méndez

    2012-03-01

    Full Text Available En el período gravido - puerperal, la coagulación sanguínea sufre cambios que se impone conocer para interpretar correctamente esos trastornos cuando se presentan en esta etapa, teniendo en cuenta las posibles complicaciones y el peligro para la vida que pueden presentarse. El objetivo del presente artículo es proporcionar a los obstetras una revisión bibliográfica que les permita actualizarse acerca del tema y facilite su modo de actuación ante pacientes con coagulación intravascular diseminada. Se concluye que es preciso diagnosticar tempranamente el proceso en la fase bioquímica de bajo grado y aplicar en las féminas el tratamiento expedito de la enfermedad de base para eliminar las complicaciones o disminuir su ocurrenciaIn the period from pregnancy to puerperium, blood clotting suffers changes which are important to be known in order to interpret correctly those dysfunctions when they appear in this stage, keeping in mind the possible complications and the danger for life which can take place. The objective of the present work is to provide the obstetricians a literature review that allows them to be updated about the topic and facilitate their performance in case of patients with disseminated intravascular clotting. It is concluded that it is necessary to have an early diagnosis on the process during the low grade biochemical phase and to apply in these women the expedite treatment of the base disease to eliminate complications or to decrease their occurrence.

  13. Pharmacokinetics and hemostasis following administration of a new, injectable oxacephem (6315-S, flomoxef) in volunteers and in patients with renal insufficiency.

    Andrassy, K; Koderisch, J; Gorges, K; Sonntag, H; Hirauchi, K

    1991-01-01

    Flomoxef is a new oxacephem of broad antibacterial activity. The compound is mainly excreted through the kidneys. Two dose finding studies in patients with various degrees of renal insufficiency revealed that the dosage of flomoxef has to be reduced exactly according to the renal function. Although the N-methylthiotetrazole group has been replaced by a hydroxyethyl group, an inhibitory effect of flomoxef on vitamin K metabolism persisted. This effect was, however, less pronounced than with latamoxef. Only patients with low vitamin K stores are endangered. For those in whom low vitamin K stores are suspected repeated controls of prothrombin time are advised during the treatment. In contrast to latamoxef the platelet system was not affected by flomoxef. With the exception of loose stools in some patients no other clinical side effects during treatment were observed.

  14. Biosynthesis, Characterization, and Hemostasis Potential of Tailor-Made Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) Produced by Haloferax mediterranei

    Han, Jing; Wu, Linping; Hou, Jing

    2015-01-01

    . Consistently, two Tg were observed in the DSC curves of O-PHBV. The "blocky" feature of O-PHBV enhanced crystallinity percentages and improved Young's modulus. Notably, the film of one O-PHBV copolymer, O-PHBV-1, showed unique foveolar cluster-like surface morphology with high hydrophobicity and roughness...

  15. Plasmodium falciparum Infection Induces Expression of a Mosquito Salivary Protein (Agaphelin) That Targets Neutrophil Function and Inhibits Thrombosis without Impairing Hemostasis

    Waisberg, M.; Molina-Cruz, A.; Mizurini, D.M.; Gera, N.; Sousa, B.C.; Ma, D.; Leal, A.C.; Gomes, T.; Kotsyfakis, Michalis; Ribeiro, J.M.C.; Lukszo, J.; Reiter, K.; Porcella, S.F.; Oliveira, C. J.; Monteiro, R.Q.; Barillas-Mury, C.; Pierce, S.K.; Francischetti, I.M.B.

    2014-01-01

    Roč. 10, č. 9 (2014), e1004338 E-ISSN 1553-7374 R&D Projects: GA ČR GAP502/12/2409 Institutional support: RVO:60077344 Keywords : factor pathway inhibitor * platelet aggregation * in vivo * serine proteases * arterial thrombosis * gene expression * structure prediction Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 7.562, year: 2014

  16. Dangers in the practice of defensive medicine in hemostasis testing for investigation of bleeding or thrombosis: part I--routine coagulation testing.

    Lippi, Giuseppe; Favaloro, Emmanuel J; Franchini, Massimo

    2014-10-01

    Defensive medicine is a term conventionally used for defining the medical (mal)practice of ordering medically questionable diagnostic testing, procedures, or visits, or to avoid high-risk patients or procedures. The practice of defensive medicine may primarily be aimed to reduce exposure to malpractice liability, to avoid patient criticism regarding "medical inaction," or to avoid "missing" some otherwise potential identifiable defect(s). Although the precise impact of defensive medicine in the field of laboratory testing is difficult to estimate from the current literature, the overuse or inappropriate use of laboratory resources ranges from 23 to 67%, and a large part of this can be attributed to medical liability concerns, with apparently little clinical awareness of the adverse consequences that may be associated with this practice. Essentially, performing inappropriate testing remarkably increases the risk of obtaining false-positive results due to statistical, preanalytical, and analytical reasons, thus triggering further and potentially even more invasive follow-up testing, inappropriate patient management, along with incremental increases of expenditure due to misuse of health care resources. As routine coagulation testing is commonly performed for the screening of patients with bleeding or thrombotic disorders, either a false-negative or a false-positive result may significantly impact on clinical outcomes and health care resources. The aim of this article is to describe the leading causes of physiological, pathological, therapeutic, and spurious variations of the prothrombin time, activated partial thromboplastin time, and D-dimer, as well as the potential clinical consequences emerging from the generation of false-negative and false-positive results with these tests. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study)

    Larsen, Ellen Nyholm; Hansen, Charlotte Bak; Thayssen, Per

    2014-01-01

    Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI......). METHODS: Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma MOBS I cohort (100 patients were...... mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161...

  18. Acute Effects of Nitrate-Rich Beetroot Juice on Blood Pressure, Hemostasis and Vascular Inflammation Markers in Healthy Older Adults: A Randomized, Placebo-Controlled Crossover Study

    Kyle Raubenheimer

    2017-11-01

    Full Text Available Aging is associated with a vasoconstrictive, pro-coagulant, and pro-inflammatory profile of arteries and a decline in the bioavailability of the endothelium-derived molecule nitric oxide. Dietary nitrate elicits vasodilatory, anti-coagulant and anti-inflammatory effects in younger individuals, but little is known about whether these benefits are evident in older adults. We investigated the effects of 140 mL of nitrate-rich (HI-NI; containing 12.9 mmol nitrate versus nitrate-depleted beetroot juice (LO-NI; containing ≤0.04 mmol nitrate on blood pressure, blood coagulation, vascular inflammation markers, plasma nitrate and nitrite before, and 3 h and 6 h after ingestion in healthy older adults (five males, seven females, mean age: 64 years, age range: 57–71 years in a randomized, placebo-controlled, crossover study. Plasma nitrate and nitrite increased 3 and 6 h after HI-NI ingestion (p < 0.05. Systolic, diastolic and mean arterial blood pressure decreased 3 h relative to baseline after HI-NI ingestion only (p < 0.05. The number of blood monocyte-platelet aggregates decreased 3 h after HI-NI intake (p < 0.05, indicating reduced platelet activation. The number of blood CD11b-expressing granulocytes decreased 3 h following HI-NI beetroot juice intake (p < 0.05, suggesting a shift toward an anti-adhesive granulocyte phenotype. Numbers of blood CD14++CD16+ intermediate monocyte subtypes slightly increased 6 h after HI-NI beetroot juice ingestion (p < 0.05, but the clinical implications of this response are currently unclear. These findings provide new evidence for the acute effects of nitrate-rich beetroot juice on circulating immune cells and platelets. Further long-term research is warranted to determine if these effects reduce the risk of developing hypertension and vascular inflammation with aging.

  19. Transcriptional analysis of abdominal fat in genetically fat and lean chickens reveals adipokines, lipogenic genes and a link between hemostasis and leanness

    2013-01-01

    Background This descriptive study of the abdominal fat transcriptome takes advantage of two experimental lines of meat-type chickens (Gallus domesticus), which were selected over seven generations for a large difference in abdominal (visceral) fatness. At the age of selection (9 wk), the fat line (FL) and lean line (LL) chickens exhibit a 2.5-fold difference in abdominal fat weight, while their feed intake and body weight are similar. These unique avian models were originally created to unravel genetic and endocrine regulation of adiposity and lipogenesis in meat-type chickens. The Del-Mar 14K Chicken Integrated Systems microarray was used for a time-course analysis of gene expression in abdominal fat of FL and LL chickens during juvenile development (1–11 weeks of age). Results Microarray analysis of abdominal fat in FL and LL chickens revealed 131 differentially expressed (DE) genes (FDR≤0.05) as the main effect of genotype, 254 DE genes as an interaction of age and genotype and 3,195 DE genes (FDR≤0.01) as the main effect of age. The most notable discoveries in the abdominal fat transcriptome were higher expression of many genes involved in blood coagulation in the LL and up-regulation of numerous adipogenic and lipogenic genes in FL chickens. Many of these DE genes belong to pathways controlling the synthesis, metabolism and transport of lipids or endocrine signaling pathways activated by adipokines, retinoid and thyroid hormones. Conclusions The present study provides a dynamic view of differential gene transcription in abdominal fat of chickens genetically selected for fatness (FL) or leanness (LL). Remarkably, the LL chickens over-express a large number of hemostatic genes that could be involved in proteolytic processing of adipokines and endocrine factors, which contribute to their higher lipolysis and export of stored lipids. Some of these changes are already present at 1 week of age before the divergence in fatness. In contrast, the FL chickens have enhanced expression of numerous lipogenic genes mainly after onset of divergence, presumably directed by multiple transcription factors. This transcriptional analysis shows that abdominal fat of the chicken serves a dual function as both an endocrine organ and an active metabolic tissue, which could play a more significant role in lipogenesis than previously thought. PMID:23947536

  20. The FINISH-3 Trial : A Phase 3, International, Randomized, Single-Blind, Controlled Trial of Topical Fibrocaps in Intraoperative Surgical Hemostasis

    Bochicchio, Grant V.; Gupta, Navyash; Porte, Robert J.; Renkens, Kenneth L.; Pattyn, Piet; Topal, Baki; Troisi, Roberto Ivan; Muir, William; Chetter, Ian; Gillen, Daniel L.; Zuckerman, Linda A.; Frohna, Paul A.

    BACKGROUND: This Phase 3, international, randomized, single-blind, controlled trial (FINISH-3) compared the efficacy and safety of Fibrocaps, a ready-to-use, dry-powder fibrin sealant containing human plasma-derived thrombin and fibrinogen, vs gelatin sponge alone for use as a hemostat for surgical

  1. Acido tranexâmico e hemostasia em cirurgia de revascularização do miocárdio com circulação extracorpórea Tranexamic acid and hemostasis in myocardial revascularization with extracorporeal circulation

    Guilherme F Vargas

    1992-12-01

    Full Text Available O antífibrinolítico sintético ácido tranexâmico (Transamin ® foi avaliado em seus efeitos hemostáticos e poupadores de transfusões homólogas, em pacientes submetidos a revascularização do miocárdio com circulação extracorpórea (CEC. Quarenta pacientes receberam placebo e 55 pacientes foram operados sob o efeito do ácido tranexâmico na dose de 10 g endovenosa no trans-operatório (2 g administrados na indução anestésica e os restantes 8 g nas 4 horas seguintes de cirurgia, de modo contínuo. O ácido tranexâmico, na dosagem utilizada, demonstrou possuir efeito hemostático impressionante, promovendo uma redução no débito pelos drenos torácicos da ordem de 47% nas 12 horas de P.O., 42,5% nas 24 horas de P. O. e 40,5% até a retirada dos drenos, em relação ao grupo-controle (pThe synthetic antif ibrinolytic drug tranexamic acid was evaluated in its hemostatic and blood saving effects, in patients submitted to myocardial revascularization with extracorporeal circulation. To 40 patients were administered placebo and to 55 tranexamic acid I.V. in a dosage of 10 g in the operative period (2 g in the anesthetic induction and the remaining 8 g in a continuous way during the operative procedure. Tranexamic acid, in this dosage, has proved to have a very impressive hemostatic effect, leadir g to a reduction in post operative bleeding of 47% in 12 h, 42,5% in 24 h and 40,5% when drains were taken off, related to the control group (p < 0.05. Tranexamic acid have led to less utilization for homologous paked red cells per patient, but statistical significance was found only in the 24 h of post operative period, with 1,025 units/patient in control group and 0,333 units/ patient in treated group. Concerning post operative complications, there have been more neurological alterations without sequelae (2.5% against 12.7% and creatinin alterations (5% against 10.9% in the tranexamic acid group. Such alterations were attributed to the high dosage used. As a conclusion, we do not recommend routine use of tranexamic acid to patients submitted to myocardial revascularization in the dosage of 10 g I.V., but, owing to the evident hemostatic effect of the drug, we recommend more investigations concerning the ideal dosage and way of administration.

  2. [Inventive activity of the Departments of Protein Structure and Function, and Molecular Immunology of the Palladin Institute of Biochemistry of NAS of Ukraine. Part II. National breakthrough in the study and diagnostics of human hemostasis system].

    Lugovska, N E

    2016-01-01

    The scientists of Protein Structure and Function, and Molecular Immunology Departments of the Palladin Institute of Biochemistry (NAS of Ukraine) under the supervision of member of NASU and NAMSU, prof. S. V. Komisarenko and corresponding member of NASU prof. E. V. Lugovskoy have made the real breakthrough in the field of research of the mechanisms of fibrin polymerization and formation of fibrin framework of thrombi. The immunodiagnostic test-systems for the evaluation of the risk of thrombus formation were developed for the first time. Researches have obtained the monoclonal antibodies to fibrinogen, fibrin, D-dimer and their fragments. These monoclonal antibodies were used as molecular probes for the localization of newly detected fibrin polymerization sites. Obtained antibodies with high affinity interact with fibrinogen, D-dimer and soluble fibrin – main markers of the risk of thrombus formation. They were used for the development of the immunodiagnostic test-systems to quantify these markers in human blood plasma for the evaluation of the state of haemostasis system, detection of prethrombotic states, disseminated intravascular coagulation, detection of thrombosis and monitoring of antithrombotic and fibrinolytic therapy. The successful trial of developed test-systems was carried out in clinics of Ukraine, and the State registration was obtained for the implementation of them into the clinical practice. Presented works were awarded State prize of Ukraine in Science and technology.

  3. Laboratory heterogeneity of the lupus anticoagulant: a multicentre study using different clotting assays on a panel of 78 samples. Hemostasis Committee of the "Société Française de Biologie Clinique".

    1992-05-15

    The laboratory heterogeneity of the lupus anticoagulant (LA) was investigated in a multicentre study using a panel of 78 plasma samples diagnosed as containing a LA. Consecutive samples were collected by 12 participants using various screening tests, and sent to 7 laboratories which performed one or more clotting assays among the following: activated partial thromboplastin time (APTT), dilute Russell viper venom time, kaolin clotting time (KCT), dilute tissue thromboplastin time (dTTI) and a platelet neutralization test. For APTT and dTTI, 10 versions of these tests including standard and mixing procedures were carried out. They varied by reagents, phospholipid concentration or methodology. Cut-off times were determined for each test by comparing the results of the panel to those of a control population. When the data of all clotting assays were pooled, 70 of the 78 selected plasmas were considered to contain LA, 15 of them having a low-titer inhibitor. Sensitivity, defined as the proportion of positive results among LA-containing plasmas, varied from 62 to 100% and was positively related to responsiveness (defined as the mean ratio of clotting time to cut-off time). Laboratory heterogeneity of LA-containing plasma was illustrated by a star symbol plot analysis. Different populations of samples, with LA preferentially recognized by one assay (or group of assays) irrespective of the overall sensitivity of this assay, were identified. Multiple component analysis demonstrated the heterogeneity of low-titer inhibitors, which complicates their recognition in routine laboratory investigation.

  4. Comparison of a standardized procedure with current laboratory practices for the detection of lupus anticoagulant in France. Working Group on Hemostasis of the Société Française de Biologie Clinique.

    1993-11-15

    A multicenter study involving 13 laboratories was designed to compare a common procedure for screening lupus anticoagulants (LA) to the different practices currently in use in these laboratories. The common procedure combined 3 phospholipid-dependent assays, including mixing studies and a phospholipid neutralizing test. Due to the heterogeneity of LA expression, an abnormal result in at least one of the tests was sufficient to classify a sample as positive for LA. Consecutive samples referred for LA diagnosis were evaluated in parallel by each participant and the data found using the common procedure were analyzed independently according to mutually agreed cut-offs and criteria for sample classification. Within a period of 3 months, 535 samples were included, of which 147 were judged LA positive, 29 undetermined and 359 negative by the respective laboratories using their current practice. When using the common procedure, 149 plasmas were said to be positive, 38 undetermined and 348 negative. Absolute concordance occurred for 81% of the specimen population and absolute discordance (positive versus negative) for 7%. The level of agreement between the common procedure and the current practices, assessed by kappa indexes, indicated noticeable variations in the rates of detection from laboratory to laboratory. Among the different tests used in the common procedure, regular APTT was the least sensitive (about 50% detection) but none of the other tests alone recognized more than 73% of specimens from the LA positive population. This yield increased to about 90% with any combination of 2 sensitive tests.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution.

    Haas, Thorsten; Fries, Dietmar; Holz, Carmen; Innerhofer, Petra; Streif, Werner; Klingler, Anton; Hanke, Alexander; Velik-Salchner, Corinna

    2008-04-01

    Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All i.v. fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation. Using thrombelastometry (ROTEM), we studied 30 pigs (weighing 35-45 kg) after withdrawal of 60% of blood volume [1484 mL (1369-1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, alpha angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured. Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures. Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.

  6. Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina.

    Tajer, Carlos; Ceresetto, José; Bottaro, Federico Jorge; Martí, Alejandra; Casey, Marcelo

    2017-07-01

    Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR). In our country, there are no data available about the quality of anticoagulation in patients with AF. The primary goal of our study was to assess the level of effective anticoagulation in a multicenter network of anticoagulation clinics in Argentina, which included patients with nonvalvular AF (NVAF) treated with VKA oral anticoagulants. The TERRA trial is a multicenter, cross-sectional study involving 14 anticoagulation clinics that were invited to participate and recruit 100 consecutive patients with NVAF treated with VKA for more than 1 year. The international normalized ratio (INR) values were retrospectively obtained from patient charts, and TTR was calculated using the Rosendaal method. A total of 1190 patients were included in the analysis. Mean age was 74.9 ± 9.9 years, and 52.5% of the patients were male. Median TTR was 67.5% (interquartile interval 54-80). During 55% of the TTR, INR was >3. Interinstitution variability was substantial, with a range of 57.7% ± 17% to 87.7% ± 17%, P < .001. The 10th percentile of TTR was 41%, the 20th percentile was 50%, the 30th was 58%, and the 35th percentile was 60%. In 40% of patients, TTR was <70%. In this multicenter study, mean TTR values in patients with AF under VKA were similar to those in international therapeutic clinical trials (55%-65%). Marked variations among institutions were observed and, although average results obtained were high, one third of the patients exhibited a TTR below 60%. This cutoff value is conservative according to current recommendations, and guidelines suggest that when management with VKA cannot be improved, patients should be switched to direct oral anticoagulants. The addition of TTR calculation to clinical practice may help improve the quality of oral anticoagulation in patients with AF, thus improving anticoagulation outcomes.

  7. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: An open, randomized, prospective, multicenter, parallel-group trial

    Fischer, Lars; Seiler, Christoph M.; Broelsch, Christoph E.

    2011-01-01

    surgical trial with 2 parallel groups. Patients were eligible for intra-operative randomization after elective resection of ≥1 liver segment and primary hemostasis. The primary end point was the time to hemostasis after starting the randomized intervention to obtain secondaty hemostasis. Secondary end...

  8. Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding.

    Kim, Su Sun; Kim, Kyung Up; Kim, Sung Jun; Seo, Seung In; Kim, Hyoung Su; Jang, Myoung Kuk; Kim, Hak Yang; Shin, Woon Geon

    2017-12-15

    Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding. The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients' medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment. A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p upper gastrointestinal bleeding.

  9. Investigation of the Genetics of Hematologic Diseases

    2017-10-17

    Bone Marrow Failure Syndromes; Erythrocyte Disorder; Leukocyte Disorder; Hemostasis; Blood Coagulation Disorder; Sickle Cell Disease; Dyskeratosis Congenita; Diamond-Blackfan Anemia; Congenital Thrombocytopenia; Severe Congenital Neutropenia; Fanconi Anemia

  10. Evaluation of sensitivity and specificity of a standardized procedure using different reagents for the detection of lupus anticoagulants. The Working Group on Hemostasis of the Société Française de Biologie Clinique and for the Groupe d'Etudes sur I'Hémostase et la Thrombose.

    Goudemand, J; Caron, C; De Prost, D; Derlon, A; Borg, J Y; Sampol, J; Sié, P

    1997-02-01

    This study was designed to test the sensitivity and specificity of a combination of 3 phospholipid-dependent assays performed with various reagents, for the detection of lupus anticoagulant (LA). Plasmas containing an LA (n = 56) or displaying various confounding pathologies [58 intrinsic pathway factor deficiencies, 9 factor VIII inhibitors, 28 plasmas from patients treated with an oral anticoagulant (OAC)] were selected. In a first step, the efficiency of each assay and reagent was assessed using the Receiving Operating Characteristic (ROC) method. Optimal cut-offs providing both sensitivity and specificity > or = 80% were determined. The APTT assay and most of the phospholipid neutralization assays failed to discriminate factor VIII inhibitors from LA. In a second step, using the optimal cut-offs determined above, the results of all the possible combinations of the 3 assays performed with 4 different reagents were analyzed. Thirteen combinations of reagents allowed > or = 80% of plasmas of each category (LA, factor deficiency or OAC) to be correctly classified (3/3 positive test results in LA-containing plasmas and 0/3 positive results in LA-negative samples).

  11. Platelet function testing in pediatric patients

    Hvas, Anne-Mette; Favaloro, Emmanuel J

    2017-01-01

    Introduction: Platelets play a key role in primary hemostasis and are also intricately linked to secondary hemostasis. Investigation of platelet function in children, especially in neonates, is seriously challenged by the volumes required to perform the majority of platelet function tests and due...

  12. Pathophysiology and management of hemostatic alterations in cirrhosis and liver transplantation

    Arshad, Freeha

    2016-01-01

    In this thesis the results of several studies on the hemostasis prior to, during, and after OLT are discussed. Our studies show that various drugs and test work differently in patients with cirrhosis as compared to control groups. DDAVP has no effect on indices of hemostasis in contrast to patients

  13. Comparison of Combat Gauze with Fibrin Sealant Patch in Hemorrhage Control after Vascular or Hepatic Trauma

    2017-05-15

    Thromboelastography was measured at baseline and immediately prior to euthanasia . 3.3 Statistical Analysis SigmaPlot version 11.0 was utilized for...and hemostasis in the liver injury model may demonstrate a potential benefit of the FP. If initially placed and hemostasis is obtained, can it be left

  14. PREVENTION OF BLOOD ACTIVATION DURING AND COMPLICATIONS AFTER CARDIOPULMONARY BYPASS

    VANOEVEREN, W; WILDEVUUR, CRH

    1991-01-01

    The cardiopulmonary bypass (CPB) circuit for open heart surgery initiates a whole body inflammatory reaction (WBIR) resulting in impaired hemostasis and organ dysfunction. Impaired hemostasis appeared to be related to the activation of the contact system (factor XII), which can be inhibited by

  15. The routine use of fresh frozen plasma in operations with cardiopulmonary bypass is not justified

    Consten, E. C.; Henny, C. P.; Eijsman, L.; Dongelmans, D. A.; van Oers, M. H.

    1996-01-01

    BACKGROUND: The negative influence of cardiopulmonary bypass on hemostasis has been documented. Although abnormalities in platelet function are reported as the major cause of postoperative blood loss related to this hemostasis defect, fresh frozen plasma is often used in operations with

  16. The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy.

    Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Catani, Marco; Cozzi, Denis A

    2017-08-01

    The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT™ system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150 min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy.

  17. Effects of contraceptive steroids on cardiovascular risk factors in women with insulin-dependent diabetes mellitus

    Petersen, K R; Skouby, S O; Sidelmann, Johannes Jakobsen

    1994-01-01

    OBJECTIVE: We evaluated established cardiovascular risk factors within lipoprotein metabolism, hemostasis, and endothelial function in women with insulin-dependent diabetes mellitus who were using oral contraceptives. STUDY DESIGN: Twenty-five women with uncomplicated insulin-dependent diabetes m...

  18. Is there a tendency for thrombosis in gestational diabetes mellitus?

    Suheyla Gorar

    2016-01-01

    Conclusions: Our findings indicate tendency to develop thrombosis in GDM similar to diabetes mellitus; but more comprehensive studies with larger sample size are needed to determine the relationship between GDM and hemostasis.

  19. Early sheath removal after percutaneous coronary intervention using Assiut Femoral Compression Device is feasible and safe. Results of a randomized controlled trial

    Ayman K.M. Hassan

    2015-03-01

    Conclusion: Our results indicate that AFCD2 is a simple and effective alternative to MC for hemostasis following PCI. Early sheath removal 2 h post PCI is feasible, safe, and improves the patient’s comfort.

  20. Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

    Mara Clapp

    2013-01-01

    Full Text Available Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue. Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG confirmed tubal patency. The patient subsequently had an intrauterine pregnancy. Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

  1. Hemoglobinopathy Evaluation

    ... in Previous Reviews Harmening D. Clinical Hematology and Fundamentals of Hemostasis , Fifth Edition. F.A. Davis Company, Philadelphia, 2009, Chapters 11 and 12. Henry's Clinical Diagnosis and Management by Laboratory Methods . 21st ed. McPherson R, Pincus ...

  2. Iron Test

    ... 793, 826-827. Harmening D, Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, ... htm. Accessed June 2009. Henry's Clinical Diagnosis and Management by Laboratory Methods . 21st ed. McPherson RA and ...

  3. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations

    Frith, Christopher Donald; Goslings, J C; Gaarder, C

    2010-01-01

    Acute traumatic coagulopathy (ATC) is an impairment of hemostasis that occurs early after injury and is associated with a 4-fold higher mortality, increased transfusion requirements and organ failure....

  4. Prevention and treatment of emergencies in thyroid patients

    Anatoliy Filippovich Romanchishen

    2015-03-01

    Thyroid Surgery needs precise knowledge of skull base, neck and mediastinum anatomy, safety resection of thyroid, parathyroid, under RLN visual control, thorough hemostasis and closely postoperative watching for patients.

  5. Percutaneous microcrystalline chitosan application for sealing arterial puncture sites

    Hoekstra, A; Struszczyk, H; Kivekas, O

    Arterial catheterization is one of the most frequently performed inpatient diagnostic and therapeutic procedures in the development countries. Complications may occur after any catheterization from inadequate hemostasis, particularly in the setting of aggressive anticoagulation. This study suggests

  6. TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND FIBRIN MONOMERS SYNERGISTICALLY CAUSE PLATELET DYSFUNCTION DURING RETRANSFUSION OF SHED BLOOD AFTER CARDIOPULMONARY BYPASS

    DEHAAN, J; SCHONBERGER, J; HAAN, J; VANOEVEREN, W; EIJGELAAR, A

    1993-01-01

    Reduced hemostasis and bleeding tendency after cardiopulmonary bypass results from platelet dysfunction induced by the bypass procedure. The causes of this acquired platelet dysfunction are still subject to discussion, although, recently, greater emphasis has been placed on an overstimulated

  7. THE RISK FACTORS FOR INITIAL REPRODUCTIVE LOSS

    Екатерина Игоревна Лебедева

    2017-09-01

    Conclusion. Mixed somatic and gynecological pathology, abnormalities in hemostasis, combination of inherited and acquired thrombogenic risk factors dominates in women with initial reproductive loss, though only 37,3 % such pregnancies have favorable outcome.

  8. Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

    Davide Maggio

    2013-01-01

    Full Text Available BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB exhibiting high-risk stigmata (HRS having undergone endoscopic hemostasis are lacking.

  9. Mechanistic overview of reactive species-induced degradation of the endothelial glycocalyx during hepatic ischemia/reperfusion injury

    van Golen, Rowan F.; van Gulik, Thomas M.; Heger, Michal

    2012-01-01

    Endothelial cells are covered by a delicate meshwork of glycoproteins known as the glycocalyx. Under normophysiological conditions the glycocalyx plays an active role in maintaining vascular homeostasis by deterring primary and secondary hemostasis and leukocyte adhesion and by regulating vascular

  10. Experience with the Cardiva Boomerang Catalyst system in pediatric cardiac catheterization.

    Seltzer, Sharon; Alejos, Juan Carlos; Levi, Daniel S

    2009-09-01

    We studied the safety and efficacy of the Cardiva Boomerang Catalyst vascular closure system in pediatric patients after cardiac catheterization with access in femoral and internal jugular vessels. Recurrent catheterization and advances in pediatric interventions increase the need for easy hemostasis without a residual foreign body that may prevent re-accessing the vessel. The Boomerang can be deployed in sheaths as small as 4Fr without residual foreign body, with minimal orientation needed, and few complications reported. In a two-month period, all patients between 18 months and 21 years old catheterized with 4-8Fr sheaths less than 15 cm long were eligible for Boomerang placement. These were compared retrospectively with control patients with manual hemostasis. Anthropomorphic measurements, procedure type, activated clotting time, and sheath size as well as total times of cases, intubation, hemostasis, and extubation were compared between the two groups. Forty-six Boomerangs were deployed in 31 patients and compared with 40 patients with manual hemostasis. Boomerangs were deployed in femoral vessels and the internal jugular vein. Device success with hemostasis was achieved in 39 patients (85%). There were no significant differences in time to hemostasis or extubation between the two groups. No major complications or operator error occurred, including hematoma, transfusion, retroperitoneal bleed, infection, vessel occlusion, or need for surgery. The Boomerang is a safe and easy means of achieving hemostasis in the pediatric population, in femoral vessels as well as internal jugular veins. Its times to hemostasis and extubation were not significantly different from manual hold. 2009 Wiley-Liss, Inc.

  11. [Three methods for controlling presacral massive bleeding during pelvic operations].

    Wang, Xiaoxue; Liu, Zhimin; Xie, Shangkui; Ren, Donglin; Wu, Yin'ai

    2017-12-25

    To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the

  12. Simplified swift and safe vascular closure device deployment without a local arteriogram: Single center experience in 2074 consecutive patients

    Antonis S. Manolis

    2016-07-01

    Conclusion: Deployment of Angio-Seal without use of local angiography was efficacious and safe, characterized by a high success rate of deployment and hemostasis with few correctable complications in a large patient cohort undergoing transfemoral catheterization for PCI and non-PCI procedures under anticoagulation and antiplatelet drug therapy. VCD reduced the time-to-hemostasis and time-to-mobilization and minimized the incidence of complications.

  13. Hypercoagulability in response to elevated body temperature and central hypovolemia

    Meyer, Martin; Ostrowski, Sisse R; Overgaard, Flemming Anders

    2013-01-01

    Coagulation abnormalities contribute to poor outcomes in critically ill patients. In trauma patients exposed to a hot environment, a systemic inflammatory response syndrome, elevated body temperature, and reduced central blood volume occur in parallel with changes in hemostasis and endothelial...... damage. The objective of this study was to evaluate whether experimentally elevated body temperature and reduced central blood volume (CBV) per se affects hemostasis and endothelial activation....

  14. Prospective Nonrandomized Trial of Manual Compression and Angio-Seal and Starclose Arterial Closure Devices in Common Femoral Punctures

    Ratnam, Lakshmi A.; Raja, Jowad; Munneke, Graham J.; Morgan, Robert A.; Belli, Anna-Maria

    2007-01-01

    We compared the use of manual compression and Angio-Seal and Starclose arterial closure devices to achieve hemostasis following common femoral artery (CFA) punctures in order to evaluate safety and efficacy. A prospective nonrandomized, single-center study was carried out on all patients undergoing CFA punctures over 1 year. Hemostasis was achieved using manual compression in 108 cases, Angio-Seal in 167 cases, and Starclose in 151 cases. Device-failure rates were low and not significantly different in the two groups (manual compression and closure devices; p = 0.8). There were significantly more Starclose (11.9%) patients compared to Angio-Seal (2.4%), with successful initial deployment subsequently requiring additional manual compression to achieve hemostasis (p < 0.0001). A significant number of very thin patients failed to achieve hemostasis (p = 0.014). Major complications were seen in 2.9% of Angio-Seal, 1.9% of Starclose, and 3.7% of manual compression patients, with no significant difference demonstrated; 4.7% of the major complications were seen in female patients compared to 1.3% in males (p = 0.0415). All three methods showed comparable safety and efficacy. Very thin patients are more likely to have failed hemostasis with the Starclose device, although this did not translate into an increased complication rate. There is a significant increased risk of major puncture-site complications in women with peripheral vascular disease

  15. Experimental and clinical application of laser doppler flowmetry in gastric and duodenal ulcerative bleedings

    Afanasieva G.A.

    2011-12-01

    Full Text Available The research goal is to develop a new objective diagnostic method of prerecurrence syndrome that will prognose bleeding recurrence from gastroduodenal ulcers. Materials and methods. Method of laser Doppler flowmetry (LDF of the regional perfusion of tissue has been used. The experimental part has been done on 30 white laboratory rats. Characteristics of regional tissue perfusion in the simulation and laser hemostasis of bleeding have been studied. Gastroduodenal endoscopy has been performed with laser Doppler flowmetry (ELDF in clinical conditions to predict the recurrence of ulcerative bleeding. The prognostic method of gastroduodenal ulcerative bleeding was used in 58 patients hospitalized with such pathology and activity of bleeding Forrest II. Results. The study of microcirculation parameters and experimental hemostasis has showed the possibility of using LDF to measure its performance. Effective hemostasis has been accompanied by a significant decrease in perfusion. On the basis of microcirculation parameters in ulcerative bleeding, medical adrenaline test has been proposed for an objective verification pre-recurrence syndrome. To evaluate the effectiveness of endoscopic hemostasis perfusion has been measured before and after its implementation. Conclusion. ELDF has objectified the prognosis of ulcerative bleeding recurrence, verified pre-recurrence syndrome and evaluated the efficacy of endoscopic hemostasis

  16. Hemospray application in nonvariceal upper gastrointestinal bleeding

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J

    2013-01-01

    BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday...... in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB...... pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight...

  17. Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

    Lee, J H; Kim, B K; Seol, D C; Byun, S J; Park, K H; Sung, I K; Park, H S; Shim, C S

    2013-06-01

    Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    Kim, Young-Il

    2015-01-01

    Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

  19. A Retrospective Analysis of Hemostatic Techniques in Primary Total Knee Arthroplasty: Traditional Electrocautery, Bipolar Sealer, and Argon Beam Coagulation.

    Rosenthal, Brett D; Haughom, Bryan D; Levine, Brett R

    2016-01-01

    In this retrospective cohort study of 280 primary total knee arthroplasties, clinical outcomes relevant to hemostasis were compared by electrocautery type: traditional electrocautery (TE), bipolar sealer (BS), and argon beam coagulation (ABC). Age, sex, and preoperative diagnosis were not significantly different among the TE, BS, and ABC cohorts. The 3 hemostasis systems were statistically equivalent with respect to estimated blood loss. Wound drainage during the first 48 hours after surgery was equivalent between the BS and ABC cohorts but less for the TE cohort. Transfusion requirements were not significantly different among the cohorts. The 3 hemostasis systems were statistically equivalent with respect to mean change in hemoglobin level during the early postoperative period (levels were measured on postoperative day 1 and on discharge). As BS and ABC are clinically equivalent to TE, their increased cost may not be justified.

  20. Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients With Severe Nonvariceal Upper Gastrointestinal Hemorrhage.

    Jensen, Dennis M; Kovacs, Thomas O G; Ohning, Gordon V; Ghassemi, Kevin; Machicado, Gustavo A; Dulai, Gareth S; Sedarat, Alireza; Jutabha, Rome; Gornbein, Jeffrey

    2017-05-01

    For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F). Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  1. Studies on radiocalcium metabolism in pigs which suffer from a hereditary form of rickets (pseudo-vitamin D deficiency rickets)

    Grabe, C. von; Harmeyer, J.; Schmitt, R. (Veterinary School Hannover (Germany, F.R.). Inst. of Physiology; Veterinary School, Hannover (Germany, F.R.). Dept. of Medical Physics)

    1983-05-01

    Intestinal calcium absorption and calcium kinetics of plasma have been studied in pigs which suffer from pseudovitamin D deficiency rickets using /sup 45/Ca. On two consecutive days 200-250 ..mu..Ci of /sup 45/CaCl/sub 2/ was administered either orally or intravenously. The experiments were carried out in order to find out: (1) if kinetic measurements can provide suitable information on possible changes in calcium hemostasis during the development of the rachitic symptoms; (2) whether kinetic parameters of calcium metabolism can be used as indices to characterize the metabolic disturbance of calcium hemostasis.

  2. Studies on radiocalcium metabolism in pigs which suffer from a hereditary form of rickets (pseudo-vitamin D deficiency rickets)

    Grabe, C. von; Harmeyer, J.; Schmitt, R.; Veterinary School, Hannover

    1983-01-01

    Intestinal calcium absorption and calcium kinetics of plasma have been studied in pigs which suffer from pseudovitamin D deficiency rickets using 45 Ca. 200-250 μCi of 45 CaCl 2 administered either orally or intravenously on two consecutive days. The experiments were carried out in order to find out: (1) if kinetic measurements can provide suitable information on possible changes in calcium hemostasis during the development of the rachitic symptoms; (2) whether kinetic parameters of calcium metabolism can be used as indices to characterize the metabolic disturbance of calcium hemostasis. (author)

  3. Hemostatic homeostasis in liquidators of the aftereffects of the Chernobyl power plant accident

    Chekalina, S.I.; Lyasko, L.I.; Sushkevich, G.N.; Pashkov, E.I.; Savina, H.P.

    1995-01-01

    The function of the hemostasis system was examined in 128 participants in the liquidation of the aftereffects of the Chernobyl power plant accident 4 years, on an average, after their work in the radioactive zone of the 4th energy block. Signs of functional disorganization in the hemostasis system wer revealed: hemocoagulation and platelet aggregation activation in the presence of reduced fibrinolysis activity and antithrombogenic properties of vascular walls. The said trends were best of all detected by functional loading (local circulatory hypoxia) of the vascular wall. 11 refs

  4. Growth hormone used to control intractable bleeding caused by radiation-induced gastritis.

    Zhang, Liang; Xia, Wen-Jie; Zhang, Zheng-Sen; Lu, Xin-Liang

    2015-08-21

    Intractable bleeding caused by radiation-induced gastritis is rare. We describe a 69-year-old man with intractable hemorrhagic gastritis induced by postoperative radiotherapy for the treatment of esophageal carcinoma. Although anti-secretory therapy with or without octreotide was initiated for hemostasis over three months, melena still occurred off and on, and the patient required blood transfusions to maintain stable hemoglobin. Finally growth hormone was used in the treatment of hemorrhage for two weeks, and hemostasis was successfully achieved. This is the first report that growth hormone has been used to control intractable bleeding caused by radiation-induced gastritis.

  5. Regulation of non-classical immune parameters in immune thrombocytopenic purpura mice by a spleen-invigorating, qi-replenishing and blood-containing formula

    Tiantian Li

    2015-04-01

    Conclusions: The SQBF had a similar effect to prednisone with regards to enhancing peripheral blood platelet counts in ITP mice. Furthermore, it decreased β-EP levels and increased VIP and SIgA, and protected the thymus. This shows that, on base of the brain-gut axis functions, some non-classical immune vascular active factors or neurotransmitters are also involved in immune responses, and also have relationship with the onset of ITP and bleeding and/or hemostasis. It needs further study to determine whether a change in these active factors is related to immediate hemostasis.

  6. Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective

    Hui-Tzung Luh

    2018-01-01

    Conclusion: This study shows that local application of FloSeal Hemostatic Matrix is safe and effective for hemostasis during MIE evacuation of ICH. In our experience, this shortens the operation time, especially in cases with intraoperative bleeding. A large, prospective, randomized trial is needed to confirm the findings.

  7. Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens

    2016-01-01

    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study. METHOD: Retrospective...

  8. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience

    2015-10-01

    15. SUBJECT TERMS Spinal cord injury, pressure ulcer prevention, biomarkers, personalized healthcare 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...pressure ulcer prevention, biomarkers, personalized healthcare 3. Accomplishments Major Project Goals Task 1: Subject Recruitment and Data...months (Co-Investigator) Clinically translatable nanotechnology : hemostasis and neuroprotection New studies 09/30/14 -09/30/15 Started 01/01/15

  9. Early career professionals: the mission of a task force

    Barnes, G. D.; Lauw, M. N.

    2016-01-01

    Early career researchers and clinicians face unique challenges in comparison with more senior colleagues, for instance connecting with expert leaders outside of their own institution to enhance their expertise. As the largest international thrombosis and hemostasis professional society, the ISTH can

  10. Moderate alcohol consumption and changes in postprandial lipoproteins of premenopausal and postmenopausal women : a diet-controlled, randomized intervention study

    Gaag, van der M.S.; Sierksma, A.; Schaafsma, G.; Bakker, M.; Hendriks, J.F.J.

    2000-01-01

    Moderate alcohol consumption is associated with a reduced risk of coronary heart disease. Earlier studies in men have shown that moderate alcohol consumption affects lipoprotein metabolism and hemostasis. In this diet-controlled, randomized, crossover trial, we investigated the effect on lipoprotein

  11. Maternal and Fetal Effect of Misgav Ladach Cesarean Section in ...

    forefinger of the opposite hand as an elevator. Delivery of placenta. Manual removal. Controlled cord traction. Repair of the uterus. Uterus is exteriorized and repaired in one layer with continuous locked with chromic catgut # 1 taken big bites from both edges to secure hemostasis. The uterus is repaired within the peritoneal ...

  12. Ayurgenomics: Understanding human individuality through ...

    mitali

    Knowledge. VATA. PITTA. KAPHA. Stratification of Healthy based on prakriti. Axes of variation in Prakriti. EGLN1-HIF axis in. HAA/HAPE/asthma. Hypoxia responsiveness. (EGLN1 –HIF1-vWF). Hypoxia axis differentially regulated in VADU cohort. Hypoxia and Hemostasis axes linked through Prakriti. VWF levels also differ.

  13. Off-pump versus On-pump Coronary Artery Surgery - Identification of Fibrinolysis using Rotation Thromboelastography. A Preliminary, Prospective, Randomized Study

    Jareš, M.; Vaněk, T.; Bednář, F.; Malý, Marek; Šnircová, J.; Straka, Z.

    2007-01-01

    Roč. 48, č. 1 (2007), s. 57-67 ISSN 1349-2365 Source of funding: V - iné verejné zdroje Keywords : cardiopulmonary bypass * hemostasis * beating heart surgery * D-dimers * cardiac surgical procedures Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.929, year: 2007

  14. Fibrinolytic Inhibitors in Off-pump Coronary Surgery: A Prospective, Randomized, Double-Blind TAP Study (Tranexamic Acid, Aprotinin, Placebo)

    Vaněk, T.; Jareš, M.; Fajt, R.; Straka, Z.; Jirásek, K.; Kolesár, M.; Brůček, P.; Malý, Marek

    2005-01-01

    Roč. 28, č. 4 (2005), s. 563-568 ISSN 1010-7940 Source of funding: V - iné verejné zdroje Keywords : tranexamic acid * protinin * off-pump coronary artery bypass * hemostasis Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 1.802, year: 2005

  15. Case report

    ebutamanya

    2015-12-03

    Dec 3, 2015 ... surgical correction by high way by the Huntington technique or. Haultain or vaginally with the technique of Spinelli [1] - hysterectomy hemostasis remains the gold standard in case of persistent bleeding but is exceptionnel [6]. More recently the use of balloons such as Rusch or Bakri have been described in ...

  16. Pleiotropic role of growth arrest-specific gene 6 in atherosclerosis

    Tjwa, Marc; Moons, Lieve; Lutgens, Esther

    2009-01-01

    Growth arrest-specific gene 6 (Gas6) belongs to the family of vitamin K-dependent coagulation proteins, but in contrast to its other members, has only a limited role in hemostasis. Instead, Gas6 plays a prominent role in conditions of injury, inflammation and repair. Gas6 amplifies the activation of

  17. Effects of Thermal Status on Markers of Blood Coagulation During Simulated Hemorrhage

    2016-04-01

    Keywords Hemorrhage Hyperthermia Dehydration Hemostasis Exercise Heat stress Environment Pre- hospital Triage 3. Overall Project...Perspectives and significance The present study suggests that individuals performing physical work (e.g. exercise) in a hot environment will be likely to...3 6. Publications, Abstracts and Presentations ................................................. 4 7. Inventions, Patents and Licenses

  18. Management of prostate enlargement with acute urinary retention: Diode laser vaporization in combination with bipolar transurethral resection of the prostate

    Kai-Yi Tzou

    2016-03-01

    Conclusion: DV + bTURP is comparable with monopolar TURP for relieving acute urinary retention in men with BPE in terms of complications and functional outcomes. The combined technique can provide better intraoperative hemostasis and shorter catheterization time, with no significant postoperative irritative symptoms.

  19. Site-SpecificCu Labeling of the Serine Protease, Active Site Inhibited Factor Seven Azide (FVIIai-N), Using Copper Free Click Chemistry

    Jeppesen, Troels E; Kristensen, Lotte K; Nielsen, Carsten H

    2018-01-01

    A method for site-specific radiolabeling of the serine protease active site inhibited factor seven (FVIIai) with64Cu has been applied using a biorthogonal click reaction. FVIIai binds to tissue factor (TF), a trans-membrane protein involved in hemostasis, angiogenesis, proliferation, cell migrati...

  20. Endoscopic management of bleeding peptic ulcers

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  1. Live-cell Imaging of Platelet Degranulation and Secretion Under Flow

    Barendrecht, Arjan D; Verhoef, Johan J F; Pignatelli, Silvia; Pasterkamp, Gerard; Heijnen, Harry F G; Maas, Coen

    2017-01-01

    Blood platelets are essential players in hemostasis, the formation of thrombi to seal vascular breaches. They are also involved in thrombosis, the formation of thrombi that occlude the vasculature and injure organs, with life-threatening consequences. This motivates scientific research on platelet

  2. Poly(2-hydroxyethyl methacrylate) emboli with increased haemostatic effect for correction of haemorrhage of complex origin in endovascular surgery of children

    Horák, Daniel; Galibin, I. E.; Adamyan, A.; Sitnikov, A. V.; Dan, V. N.; Titova, M. I.; Shafranov, V. V.; Isakov, Y. F.; Gumargalieva, K. Z.; Vinokurova, T. I.

    2008-01-01

    Roč. 19, č. 3 (2008), s. 1265-1274 ISSN 0957-4530 R&D Projects: GA MŠk 1M0538; GA AV ČR KAN201110651 Institutional research plan: CEZ:AV0Z40500505 Keywords : 2-hydroxyethyl methacrylate * embolization * hemostasis Subject RIV: CE - Biochemistry Impact factor: 1.508, year: 2008

  3. White Blood Cell Count

    ... Pp 1003-1008. Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Pp 305-328. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus ...

  4. WBC (White Blood Cell) Differential Count

    ... Pp 1003-1008. Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Pp 305-328. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus ...

  5. Bone Marrow Aspiration and Biopsy

    ... Pp 10-16. Harmening D. Clinical Hematology and Fundamentals of Hemostasis., Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Pp 47-52, 54-57. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus ...

  6. Zero ischemia laparoscopic partial thulium laser nephrectomy.

    Thomas, Arun Z

    2013-11-01

    Laser technology presents a promising alternative to achieve tumor excision and renal hemostasis with or without hilar occlusion, yet its use in partial nephrectomy has not been significantly evaluated. We prospectively evaluated the thulium:yttrium-aluminum-garnet laser in laparoscopic partial nephrectomy (LPN) in our institution over a 1-year period.

  7. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations

    Frith, D.; Goslings, J. C.; Gaarder, C.; Maegele, M.; Cohen, M. J.; Allard, S.; Johansson, P. I.; Stanworth, S.; Thiemermann, C.; Brohi, K.

    2010-01-01

    Background: Acute traumatic coagulopathy (ATC) is an impairment of hemostasis that occurs early after injury and is associated with a 4-fold higher mortality, increased transfusion requirements and organ failure. Objectives: The purpose of the present study was to develop a clinically relevant

  8. Binding of von Willebrand factor to collagen type III: role of specific amino acids in the collagen binding domain of vWF and effects of neighboring domains

    van der Plas, R. M.; Gomes, L.; Marquart, J. A.; Vink, T.; Meijers, J. C.; de Groot, P. G.; Sixma, J. J.; Huizinga, E. G.

    2000-01-01

    Binding of von Willebrand Factor (vWF) to sites of vascular injury is the first step of hemostasis. Collagen types I and III are important binding sites for vWF. We have previously determined the three-dimensional structure of the collagen binding A3 domain of vWF (Huizinga et al., Structure 1997;

  9. Experience of Using Domestic High-Frequency Electric Welding Technology in Surgical Treatment of Patients with Abdominal Pathology

    A.M. Babiy

    2014-04-01

    Full Text Available The article presents the experience of using electric welding technology of biological tissues with domestic high-frequency electrical generator EC 300 M1 in 176 patients at open and laparoscopic surgery for abdominal pathology. The analysis of findings showed that electric welding of living tissue provides reliable hemostasis, promotes tissue repair after their separation.

  10. Blood levels of histone-complexed DNA fragments are associated with coagulopathy, inflammation and endothelial damage early after trauma

    Johansson, Pär I; Windeløv, Nis A; Rasmussen, Lars S

    2013-01-01

    Tissue injury increases blood levels of extracellular histones and nucleic acids, and these may influence hemostasis, promote inflammation and damage the endothelium. Trauma-induced coagulopathy (TIC) may result from an endogenous response to the injury that involves the neurohumoral, inflammatory...

  11. Chitosan pads vs. manual compression to control bleeding sites after transbrachial arterial catheterization in a randomized trial

    Poretti, F.; Rosen, T.; Koerner, B.; Vorwerk, D.

    2005-01-01

    Purpose: until now, no mechanical closure devices were available to achieve fast and secure hemostasis for vessel closure after catheterization of small arterial vessels. Material and methods: eighty patients were randomized to evaluate the effect on hemostasis by use of a chitosan pad (Chito-Seal, Abbott Vascular Devices, Galway/Ireland) in comparison to manual compression after diagnostic transbrachial arterial catheterization. Hemostasis after three minutes and one hour as well as local development of a hematoma after one and twenty-four hours were assessed. Results: the use of chitosan pads significantly decreased the bleeding time in the first three minutes after manual compression time (p < 0.01). Significant decrease in bleeding risk at three minutes by use of the chitosan closure pads was also found in subgroups of patients with hypertension (p < 0.001) or diabetes (p < 0.01) and also in patients under anticoagulation therapy (p < 0.01). In addition, long-term protection from bleeding complications such as the risk of hematoma was decreased by the use of chitosan closure pads one hour (p < 0.01) or twenty-four hours (p < 0.001) after catheter removal. Conclusion: the use of an intravascular anchor or suture system is not safely applicable in these vessels due to the small diameter of the brachial artery. Our results document a significant improvement in hemostasis by using chitosan pads in these cases. (orig.)

  12. Chitosan pads vs. manual compression to control bleeding sites after transbrachial arterial catheterization in a randomized trial; Randomisierte Untersuchung zur Anwendung eines Chitosan-Gerinnungspads zur Blutstillung bei transbrachialen Angiographien

    Poretti, F.; Rosen, T.; Koerner, B.; Vorwerk, D. [Inst. fuer diagnostische und interventionelle Radiologie, Klinikum Ingolstadt (Germany)

    2005-09-01

    Purpose: until now, no mechanical closure devices were available to achieve fast and secure hemostasis for vessel closure after catheterization of small arterial vessels. Material and methods: eighty patients were randomized to evaluate the effect on hemostasis by use of a chitosan pad (Chito-Seal, Abbott Vascular Devices, Galway/Ireland) in comparison to manual compression after diagnostic transbrachial arterial catheterization. Hemostasis after three minutes and one hour as well as local development of a hematoma after one and twenty-four hours were assessed. Results: the use of chitosan pads significantly decreased the bleeding time in the first three minutes after manual compression time (p < 0.01). Significant decrease in bleeding risk at three minutes by use of the chitosan closure pads was also found in subgroups of patients with hypertension (p < 0.001) or diabetes (p < 0.01) and also in patients under anticoagulation therapy (p < 0.01). In addition, long-term protection from bleeding complications such as the risk of hematoma was decreased by the use of chitosan closure pads one hour (p < 0.01) or twenty-four hours (p < 0.001) after catheter removal. Conclusion: the use of an intravascular anchor or suture system is not safely applicable in these vessels due to the small diameter of the brachial artery. Our results document a significant improvement in hemostasis by using chitosan pads in these cases. (orig.)

  13. LIM kinase-1 selectively promotes glycoprotein Ib-IX–mediated TXA2 synthesis, platelet activation, and thrombosis

    Estevez, Brian; Stojanovic-Terpo, Aleksandra; Delaney, M. Keegan; O’Brien, Kelly A.; Berndt, Michael C.; Ruan, Changgeng; Du, Xiaoping

    2013-01-01

    Role for LIMK1 in GPIb-IX–dependent cPLA2 activation, TXA2 synthesis, and platelet activation independent of its role in actin polymerization.LIMK1 is important in arterial thrombosis in vivo but appears to be dispensable for hemostasis, suggesting a new antithrombotic target.

  14. Case report

    abp

    &Corresponding author: Eylem Kuday Kaykısız, Bitlis State Hospital, Department of Emergency Medicine, 13000 Bitlis/Turkey. Key words: Abdominal pain, ... Received: 04/04/2017 - Accepted: 28/04/2017 - Published: 08/05/2017. Abstract ... Surgical evacuation and hemostasis is necessary if the hematoma fails to resolve.

  15. Identification of polymorphisms in the 5'-untranslated region of the TAFI gene: relationship with plasma TAFI levels and risk of venous thrombosis

    Franco, R. F.; Fagundes, M. G.; Meijers, J. C.; Reitsma, P. H.; Lourenço, D.; Morelli, V.; Maffei, F. H.; Ferrari, I. C.; Piccinato, C. E.; Silva, W. A.; Zago, M. A.

    2001-01-01

    BACKGROUND AND OBJECTIVES: Thrombin activatable fibrinolysis inhibitor (TAFI) plays an important role in hemostasis, functioning as a potent fibrinolysis inhibitor. TAFI gene variations may contribute to plasma TAFI levels and thrombotic risk. DESIGN AND METHODS: We sequenced a 2083-bp region of the

  16. Pathogenetic Substantiation of the Usability of the Natural Anticoagulant Sulodexide in a Combine Treatment of Pregnant Women with Premature Delivery

    T. A. Mielikova

    2017-05-01

    Full Text Available Clinical effectiveness of the Natural Anticoagulant Sulodexide at violations in system of a hemostasis at pregnant women with threat of premature births is studied. 57 pregnant women with threat of premature births are examined. At 31 women in a combine of treatment applied Sulodexide, at 26 – a heparin, at 20 the physiological current of a gestation is noted. Conducted all-clinical examination of pregnant women, estimated a condition of system of a hemostasis before combine treatment. At patients at threat of premature births essential have significant changes in the hemostatic system, manifested in thrombocyte hyper-aggregation and hyper-coagulation in the plasma link of hemostasis, as well as appearance of markers of activating the intravascular blood coagulation. Use of the natural anticoagulant sulodexide for pregnant women provided the high antithrombotic potential  and moderate anti-coagulative activity, contributed to normalization of rheological behavior of blood by influence on all links of a hemostasis, to improvement of the course of the gestational period and the functional state of the fetus.

  17. Second Chance for a Totally Thoracoscopic Video-Assisted Pulmonary Vein Isolation for Atrial Fibrillation

    Driessen, Antoine H. G.; Krul, Sébastien P. J.; de Mol, Bas A. J. M.; de Groot, Joris R.

    2012-01-01

    Thoracoscopic surgery for atrial fibrillation (AF) is an attractive and emerging treatment modality. However, when a bleeding occurs access for hemostasis is limited. Therefore, a sternotomy might be necessary to stop the bleeding and continue the operation. We report 2 patients with a

  18. BLOOD ACTIVATION DURING NEONATAL EXTRACORPOREAL LIFE-SUPPORT

    PLOTZ, FB; VANOEVEREN, W; BARTLETT, RH; WILDEVUUR, CRH

    Cardiopulmonary bypass for heart operations is associated with a whole body inflammatory reaction. The main factors involved in this reaction are the contact system and the complement system. The activation of the contact system is considered mainly responsible for impaired hemostasis because it

  19. Evaluation of the hemostatic state, carbohydrate and lipid metabolism in young women with abdominal obesity and hypertension

    Veronika Andreevna Sumerkina

    2015-09-01

    Full Text Available Aim of this study was to determine the characteristics of the laboratory parameters of hemostasis, carbohydrate and lipid metabolism in women with metabolic syndrome, isolated abdominal obesity or with hypertension. Materials and methods. The study included 71 women aged 30 – 44 years and was conducted at laboratory study of hemostasis system, carbohydrate and lipid metabolism. Results. In women with abdominal obesity and arterial hypertension we found an increased levels of glucose, total cholesterol, LDL-C and triglycerides and a decrease in a concentration of HDL-C compared to healthy women. The study of hemostasis revealed prothrombotic changes in the form of activation of coagulation hemostasis and fibrinolysis system activity. Conclusions. The disorders of carbohydrate and lipid metabolism are very prevalent in young women with abdominal obesity and hypertension with every second woman meeting the criteria for the metabolic syndrome. The most pronounced signs of activation of blood coagulation markes was seen in women with abdominal obesity and hypertension. In women with the individual components of the metabolic syndrome there were no significant changes in carbohydrate and lipid metabolism, although we saw an early signs of activation of hemocoagulation.

  20. Evaluating the efficacy of citrate anticoagulation during CRRT in cardiac patients

    А. М. Караськов

    2015-10-01

    Full Text Available Systemic anticoagulation during renal replacement therapy in cardiac patients increases the risk of postoperative complications. Citrate anticoagulation is a promising alternative. The objective of our study was to evaluate the efficacy of citrate anticoagulation and its influence on the parameters of hemostasis and complications.

  1. Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study

    Mahesh Kumar Goenka

    2017-01-01

    Full Text Available Background/Aims The over-the-scope clip (OTSC is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC. Methods Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip. Results All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10. Antiplatelet therapy was continued in patients with GI bleeding. Conclusions In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

  2. Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy

    Laursen, Stig Borbjerg; Jakobsen, Mark; Nielsen, Michael Milek

    2015-01-01

    Abstract Objective. In 5-10% of patients with peptic ulcer bleeding (PUB) it is impossible to achieve endoscopic hemostasis because of severe bleeding. These patients have traditionally been treated surgically. Transcatheter arterial embolization (TAE) may, however, be associated with a better ou...

  3. Effect of Puumala hantavirus infection on Human Umbilical Vein Endothelial Cell hemostatic function: platelet interactions, increased tissue factor expression and fibrinolysis regulator release

    Marco Goeijenbier

    2015-03-01

    Full Text Available Puumala virus (PUUV infection causes over 5000 cases of hemorrhagic fever in Europe annually and can influence the hemostatic balance extensively. Infection might lead to hemorrhage, while a recent study showed an increased risk of myocardial infarction during or shortly after PUUV infection. The mechanism by which this hantavirus influences the coagulation system remains unknown. Therefore we aimed to elucidate mechanisms explaining alterations seen in primary and secondary hemostasis during PUUV infection. By using low passage PUUV isolates to infect primary human umbilical vein endothelial cells (HUVECs we were able to show alterations in the regulation of primary- and secondary hemostasis and in the release of fibrinolysis regulators. Our main finding was an activation of secondary hemostasis due to increased tissue factor expression leading to increased thrombin generation in a functional assay. Furthermore, we showed that during infection platelets adhered to HUVECs and subsequently specifically to PUUV virus particles. Infection of HUVECs with PUUV did not result in increased von Willebrand factor while they produced more plasminogen activator inhibitor type-1 (PAI-1 compared to controls. The PAI-1 produced in this model formed complexes with vitronectin. This is the first report that reveals a potential mechanism behind the pro-coagulant changes in PUUV patients, which could be the result of increased thrombin generation due to an increased tissue factor expression on endothelial cells during infection. Furthermore, we provide insight into the contribution of endothelial cell responses regarding hemostasis in PUUV pathogenesis.

  4. New mechanisms of the TCM spleen-based treatment of immune thrombocytopenia purpura from the perspective of blood neurotransmitters

    Ke Chen

    2017-04-01

    Conclusions: The JYS prescription may regulate the expression levels of blood neurotransmitters via the brain-gut axis in patients with “spleen deficiency” ITP and thus activate hemostatic mechanisms to promote hemostasis. β-EP and VIP are key neurotransmitters of the JYS-induced functional regulation.

  5. Protein C and antithrombin levels in patients with sickle cell anemia ...

    Background: Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady ...

  6. The effect of moderate alcohol consumption on biomarkers of inflammation and hemostatic factors in postmenopausal women

    Inflammation and hemostasis contribute to the etiology of cardiovascular disease. We previously demonstrated that moderate alcohol consumption (1-2 drinks/day) may decrease risk for cardiovascular disease due to an improved the lipid profile. In addition to these beneficial changes, the alcohol medi...

  7. Hemothorax Caused by Primary Pulmonary Angiosarcoma

    Kristensen, Katrine Lawaetz; Olsen, Karen Ege; Eckardt, Jens

    2014-01-01

    A previously healthy 57-year-old woman was admitted to the Emergency Department with hemothorax. She had continuously blood loss during the next 24 hours accordingly she went to the OR in order to achieve hemostasis.Intraoperative findings were multiple lesions in the lung parenchyma and diffuse ...

  8. INTRAOPERATIVE PREDONATION CONTRIBUTES TO BLOOD SAVING

    SCHONBERGER, JPAM; BREDEE, JJ; TJIAN, D; EVERTS, PAM; WILDEVUUR, CRH

    1993-01-01

    The merits of reinfusing prebypass-removed autologous blood (intraoperative predonation) to salvage blood and improve postoperative hemostasis are still debated, specifically for patients at a higher risk for bleeding. To evaluate the effect of intraoperative predonation on the platelet count, blood

  9. The Role of Platelets in Liver Inflammation and Regeneration

    Lisman, Ton; Porte, Robert J.

    Platelets play a pivotal role in thrombosis and hemostasis, but an increasing variety of extra-hemostatic functions of platelets are being recognized. This review summarizes recent advances in the understanding of the role of platelets in various pathologies involving the liver. In

  10. Economic and outcomes consequences of TachoSil®: a systematic review.

    Colombo, Giorgio L; Bettoni, Daria; Di Matteo, Sergio; Grumi, Camilla; Molon, Cinzia; Spinelli, Daniela; Mauro, Gaetano; Tarozzo, Alessia; Bruno, Giacomo M

    2014-01-01

    TachoSil(®) is a medicated sponge coated with human fibrinogen and human thrombin. It is indicated as a support treatment in adult surgery to improve hemostasis, promote tissue sealing, and support sutures when standard surgical techniques are insufficient. This review systematically analyses the international scientific literature relating to the use of TachoSil in hemostasis and as a surgical sealant, from the point of view of its economic impact. We carried out a systematic review of the PubMed literature up to November 2013. Based on the selection criteria, papers were grouped according to the following outcomes: reduction of time to hemostasis; decrease in length of hospital stay; and decrease in postoperative complications. Twenty-four scientific papers were screened, 13 (54%) of which were randomized controlled trials and included a total of 2,116 patients, 1,055 of whom were treated with TachoSil. In the clinical studies carried out in patients undergoing hepatic, cardiac, or renal surgery, the time to hemostasis obtained with TachoSil was lower (1-4 minutes) than the time measured with other techniques and hemostatic drugs, with statistically significant differences. Moreover, in 13 of 15 studies, TachoSil showed a statistically significant reduction in postoperative complications in comparison with the standard surgical procedure. The range of the observed decrease in the length of hospital stay for TachoSil patients was 2.01-3.58 days versus standard techniques, with a statistically significant difference in favor of TachoSil in eight of 15 studies. This analysis shows that TachoSil has a role as a supportive treatment in surgery to improve hemostasis and promote tissue sealing when standard techniques are insufficient, with a consequent decrease in postoperative complications and hospital costs.

  11. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  12. Evaluation of a hemostatic device with percutaneous collagen application (VasoSeal trademark) compared to a mechanical compression system (Compressar trademark -) after transfemoral catheterization of patients suffering from arterial occlusive disease

    Neudecker, A.; Lenhart, M.; Zorger, N.; Paetzel, C.; Feuerbach, S.; Link, J.; Manke, C.

    2003-01-01

    Purpose: Comparison of the efficacy of VasoSeal trademark and a mechanical compression system (Compressar trademark ) for percutaneous hemostasis after femoral arterial catheterization of patients with arterial occlusive disease. Materials and Methods: 60 patients underwent either diagnostic angiography or interventional procedures. The level of anticoagulation, blood pressure, and activation clotting time were recorded, and the time to hemostasis after sheath removal was measured. VasoSeal trademark application was considered ''successful'' if the compression time was less than two minutes. On the subsequent day as well as 4 months later, color coded Doppler ultrasound was performed to register treatment success and potential (late) complications. Results: 57 patients qualified for inclusion in this study. In 21 of the 26 patients who underwent the procedure with the VasoSeal trademark , immediate hemostasis was achieved within 1.75 minutes. In all 31 patients who had the Compressar trademark applied, hemostasis was successful with a mean compression time of 17.4 minutes. Thus, VasoSeal trademark significantly reduced hemostasis time irrespective of anticoagulation status, but it had a much higher incidence of minor local complications (bleeding, hematoma) compared to the control group (34.6% vs. 5.8%). The technical success was lower with VasoSeal trademark than with Compressar trademark (81% vs. 100%). Both groups had no severe or late complications. Conclusion: According to our results, VasoSeal trademark does not provide a suitable alternative compared to the effective, safe and cheap application of Compressar trademark as a hemostatic device. (orig.) [de

  13. Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding - a single center experience.

    Cahyadi, Oscar; Bauder, Markus; Meier, Benjamin; Caca, Karel; Schmidt, Arthur

    2017-11-01

     TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB.  Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods.  Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs.  TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an "add-on" therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a

  14. Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

    Cahyadi, Oscar; Bauder, Markus; Meier, Benjamin; Caca, Karel; Schmidt, Arthur

    2017-01-01

    Background and study aims  TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods  Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results  Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions  TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent

  15. [Ligation of the retrobulbar vascular-nervous bunch during performance of evisceration and enucleation using titanic clips in ophthalmic surgery].

    Rykov, S A; Torchinskaia, N V; Bakbardina, I I; Simchuk, I V

    2011-10-01

    The efficacy of hemostasis achievement during conduction of a retrobulbar vascular-nervous bunch ligation (RVNBL), using titanic clips while evisceroenucleation performance, was studied up. A comparative analysis of clinical and functional results of surgical treatment of 36 patients, suffering terminal dolorous glaucoma and disaster of a sympathetic ophthalmia complication after an eye penetrating wounding occurrence. In 16 patients (the first group) a standard method of a hemostasis achievement was used while doing evisceroenucleation - a deep orbital tamponade for 5 minutes. In 20 patients (the second group) a procedure of RVNBL was conducted, using titanic clips before the bunch transsection doing. There was established, that while doing a RVNPL using titanic clips, a hemorrhage never occurs, a retrobulbar hematoma do not formated, the soft tissues reaction in the early postoperative period is less pronounced, and the patients postoperative rehabilitation period shortens.

  16. [Venous thromboembolism triggered by spinning in a young woman with thrombophilia].

    Elikowski, Waldemar; Małek, Małgorzata; Montewska, Dominika; Kurosz, Jolanta; Wróblewski, Dariusz; Zawilska, Krystyna

    2011-01-01

    Although regular sports activities decrease the risk of venous thromboembolism (VTE), VTE cases have been observed among professional and amateur athletes practicing various disciplines. The authors describe a case of a 25-year-old-woman in whom calf pain, as popliteal vein thrombosis manifestation--preceding pulmonary embolism, occurred after she took up spinning, a popular form of indoor cycling. There was no history of leg injury. In hemostasis work up, factor V Leiden mutation and acquired low antithrombin activity-related to oral contraceptives use, were found. Strenuous exercise in an untrained woman might augment prothrombotic hemostasis profile. Vigorous cycling in standing position in the last phase of spinning, seems to be most unfavorable for patients with high VTE risk.

  17. Acute coagulopathy of trauma

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  18. Did dinosaurs have megakaryocytes? New ideas about platelets and their progenitors.

    Brass, Lawrence F

    2005-12-01

    Biological evolution has struggled to produce mechanisms that can limit blood loss following injury. In humans and other mammals, control of blood loss (hemostasis) is achieved through a combination of plasma proteins, most of which are made in the liver, and platelets, anucleate blood cells that are produced in the bone marrow by megakaryocytes. Much has been learned about the underlying mechanisms, but much remains to be determined. The articles in this series review current ideas about the production of megakaryocytes from undifferentiated hematopoietic precursors, the steps by which megakaryocytes produce platelets, and the molecular mechanisms within platelets that make hemostasis possible. The underlying theme that connects the articles is the intense investigation of a complex system that keeps humans from bleeding to death, but at the same time exposes us to increased risk of thrombosis and vascular disease.

  19. Percutaneous artherial embolization in the treatment of liver trauma

    Flores, G.S.; Uflacker, R.

    1989-01-01

    Percutaneous arterial embolization in the treatment of liver trauma. Liver trauma requires emergency therapy. Because it is highly vascular and because of its location, the hemostasis is difficult to achieve. The main causes of death associated to liver trauma are due to prolonged hipovolemia. The current forms of surgical treatment of liver wounds are associated with a high morbidity rate. In some hepatic injuries, hemorrage is so massive that operative control of bleeding is necessary, bu t in most cases, particularly in blunt trauma, an angiographic approach with diagnosis and embolotherapy is preferable. Six patients with blunt or perforating hepatic trauma were managed with percutaneous arterial embolization. Hemostasis was achieved immediately in all of them withoyt recurrence. Surgical intervention with additional trauma was thus avoided, decreasing the morbidity rate. The percutaneous arterial embolization presents an efficient alternative in the management of hemorrage due to liver trauma, being particularly useful in the poor risk patient. (author) [pt

  20. Efficacy of chitosan dressing on endoscopic sinus surgery: a systematic review and meta-analysis.

    Zhou, Jing-Chun; Zhang, Jing-Jing; Zhang, Wei; Ke, Zhao-Yang; Zhang, Bo

    2017-09-01

    Chitosan dressing might be promising to promote the recovery following endoscopic sinus surgery (ESS). However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the influence of chitosan dressing on ESS. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of chitosan dressing on endoscopic sinus surgery were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were synechia and hemostasis. Meta-analysis was performed using random-effect model. Four RCTs involving 268 patients were included in the meta-analysis. Overall following ESS, compared with control intervention, chitosan dressing significantly reduced synechia (RR = 0.25; 95% CI 0.13-0.49; P chitosan dressing could significantly decrease edema and improve hemostasis, but had no effect on granulations, mucosal edema, crusting and infection.

  1. Endothelial dysfunction in rectal cancer patients chronically exposed to ionizing radiation

    Rakhypbekov, Tolebay; Pak, Laura; Chaizhunusova, Nailya; Manambayeva, Zukhra; Tokanova, Sholpan; Madiyeva, Madina [Semey State Medical University, Semey (Kazakhstan); Inoue, Ken [Kochi University, Health Service Center, Kochi (Japan); Kawano, Noriyuki; Hoshi, Masaharu [Hiroshima University, Hiroshima (Japan); Takeichi, Nobuo [Takeichi Clinic, Hiroshima (Japan); Noso, Yoshihiro [Shimane University, Department of General Surgery, Faculty of Medicine, Shimane (Japan); Khozhayev, Arman; Molgazhdarov, Maulen [The Kazakh National Medical University of S.D.Asfendiyarov, Department of Oncology, Almaty (Kazakhstan); Olzhaev, Sayakhat [Almaty Regional Oncologic Hospital, Department of Oncology, Almaty (Kazakhstan)

    2017-08-15

    We sought to identify the features of endothelial function in rectal cancer patients who were exposed to chronic ionizing radiation from a nuclear test site in Kazakhstan. We examined 146 individuals, 76 of whom were rectal cancer patients. The existence of a complex of disturbances of the endothelium and hemostasis systems in patients vs non-patients was revealed. Endothelial dysfunction was expressed as an increase of nitric oxide (NO) production along with decreases in vasodilatation function, and increased levels of von Willebrand factor in blood, along with an increase in the number of circulating endotheliocytes. Significant correlations between indicators of endothelial function and vascular-platelet hemostasis were observed. These changes and their interrelations were expressed more strongly in the patients who lived in the contaminated area around the nuclear test site. Such patients could have an increased risk of thrombosis and other complications after the treatment of a malignant neoplasm. (orig.)

  2. Prothrombin Complex Concentrate for Intracerebral Hemorrhage Secondary to Vitamin K Deficiency Bleeding in a 6-Week-Old Child.

    Rech, Megan A; Wittekindt, Lindsay; Friedman, Samantha D; Kling, Kendall; Ubogy, David

    2015-12-01

    Four-factor prothrombin complex concentrate is approved for use of life-threatening bleeding secondary to vitamin K antagonism in adults. We describe the use of four-factor prothrombin complex concentrate for hemostasis in a 6-week-old child with life-threatening vitamin K dependent-bleeding who never received vitamin K prophylaxis at birth. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Pharmacodynamics of recombinant activated factor VII and plasma-derived factor VII in a cohort of severe FVII deficient patients.

    van Geffen, Mark; Mathijssen, Natascha C J; Holme, Pål A; Laros-van Gorkom, Britta A P; van Kraaij, Marian G J; Masereeuw, Roselinde; Peyvandi, Flora; van Heerde, Waander L

    2013-07-01

    Recombinant activated factor VII (rFVIIa) and plasma-derived factor VII (pdFVII) are used to prevent bleedings in severe FVII deficient patients, despite their short half-lifes. It is suggested that FVII levels of 15-20 IU/dL are sufficient to maintain hemostasis. We analyzed the pharmacodynamic effects of FVII substitution therapy in the Nijmegen Hemostasis Assay (NHA) that simultaneously measures thrombin and plasmin generation. Ten severe FVII deficient patients were treated with 20 μg/kg rFVIIa or 25 IU/kg pdFVII in a cross-over design. Thrombin generation lag-time (TG-LT) was identified as an effect-response parameter. Pharmacodynamic analysis using a maximum effect model showed 50% reduction of the TG-LT effect at ~2 IU/dL FVII activity for both rFVIIa and pdFVII. The FVII activity to obtain TG-LT comparable to the upper limit of normal range in healthy controls (4 min) was given by the effective concentration (ECnormal), showing sufficient hemostasis at 3-4 IU/dL FVII activity. No association was seen between FVII activity and other thrombin or plasmin generation parameters as measured by NHA. In conclusion, 3-4 IU/dL FVII activity seems sufficient to maintain hemostasis in patients with severe FVII deficiency during prophylaxis. These data may suggest a potential value for measurement of TG-LT in the monitoring of FVII(a) therapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Transarterial embolization for management of severe postcoital bleeding

    Armen Eskandari

    2016-08-01

    Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

  5. Pseudoaneurysm of the superior gluteal artery following polytrauma

    Lee, Dennis [Vancouver General Hospital, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Legiehn, Gerald M. [Vancouver General Hospital, Interventional Radiology, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Munk, Peter L. [Vancouver General Hospital, MSK Section, University of British Columbia and Department of Radiology, Vancouver, BC (Canada)

    2007-09-15

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  6. Pseudoaneurysm of the superior gluteal artery following polytrauma

    Lee, Dennis; Legiehn, Gerald M.; Munk, Peter L.

    2007-01-01

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  7. Multi-parameter assessment of thrombus formation on microspotted arrays of thrombogenic surfaces

    sprotocols

    2014-01-01

    Authors: Susanne de Witt, Frauke Swieringa, Judith Cosemans & Johan Heemskerk ### Abstract Thrombus formation by adhering and aggregating blood platelets is fundamental to hemostasis and is a prerequisite for vascular occlusion in pathological thrombosis. The parallel-plate flow chamber technique has been extensively used to measure platelet adhesion and activation in vitro at arterial or venous flow conditions. Here, we describe the use of brightfield and confocal fluorescence micros...

  8. Contribution to the study of plasmatic fibrinogen and serum albumin: effects of irradiation

    Suscillon, M.

    1967-01-01

    The author studies the modifications of properties and structure of serum albumin and fibrinogen solution when subjected to radiation of low energy (X rays). On the other hand, two original techniques are exposed: 1. Amperometric determination of fibrin stabilizing factor or factor XIII of hemostasis. 2. Spectrophotometric study of fibrin formation kinetics. Then showing off and quantitative determination of platelets fibrinogen is exposed. (author) [fr

  9. Tick salivary secretion as a source of antihemostatics

    Chmelař, Jindřich; Calvo, E.; Pedra, J. H. F.; Francischetti, I.M.B.; Kotsyfakis, Michalis

    2012-01-01

    Roč. 75, č. 13 (2012), s. 3842-3854 ISSN 1874-3919 R&D Projects: GA ČR GAP502/12/2409 Institutional research plan: CEZ:AV0Z60220518 Keywords : Tick * Salivary gland * Hemostasis * Coagulation * Platelet aggregation * Thrombin Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 4.088, year: 2012 http://www.sciencedirect.com/science/article/pii/S187439191200245X

  10. An effective and safe gastric endoscopic submucosal dissection in the right lateral position using an inverted overtube

    Mori, Hirohito; Rafiq, Kazi; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Yachida, Tatsuo; Ayagi, Maki; Tani, Joji; Miyoshi, Hisaaki; Masaki, Tsutomu

    2014-01-01

    Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection (ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position...

  11. Rôle inflammatoire des plaquettes sanguines : application en transfusion

    Nguyen , Thi Kim Anh

    2013-01-01

    Blood platelets are non-nucleated cells and play a major role in primary hemostasis and a key role in inflammation, innate and adaptive immunity. They secrete a large variety of soluble factors including cytokines/chemokines (CK/CH) and immunomodulator factors. The emergence of their inflammatory role has raised numerous questions based on the ability of platelets to respond to complex stimuli. Our investigations to answer these questions were realized in the context of platelet component tra...

  12. Effect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of intracranial meningioma.

    Hooda, Bhavna; Chouhan, Rajendra Singh; Rath, Girija Prasad; Bithal, Parmod Kumar; Suri, Ashish; Lamsal, Ritesh

    2017-07-01

    Surgical excision of meningioma is often complicated by significant blood loss requiring blood transfusion with its attendant risks. Although tranexamic acid is used to reduce perioperative blood loss, its blood conservation effect is uncertain in neurosurgery. Sixty adults undergoing elective craniotomy for meningioma excision were randomized to receive either tranexamic acid or placebo, initiated prior to skin incision. Patients in the tranexamic acid group received intravenous bolus of 20mg/kg over 20min followed by an infusion of 1mg/kg/h till the conclusion of surgery. Intraoperative blood loss, transfusion requirements and estimation of surgical hemostasis using a 5-grade scale were noted. Postoperatively, the extent of tumor excision on CT scan and complications were observed. Demographics, tumor characteristics, amount of fluid infusion, and duration of surgery and anesthesia were comparable between the two groups. The amount of blood loss was significantly less in tranexamic acid group compared to placebo (830mlvs 1124ml; p=0.03). The transfusion requirement was less in tranexamic acid group (p>0.05). The patients in tranexamic acid group fared better on a 5-grade surgical hemostasis scale with more patients showing good hemostasis (p=0.007). There were no significant differences between the groups with regards to extent of tumor removal, perioperative complications, hospital stay or neurologic outcome. To conclude, administration of tranexamic acid significantly reduced blood loss in patients undergoing excision of meningioma. Fewer patients in the tranexamic acid group received blood transfusions. Surgical field hemostasis was better achieved in patients who received tranexamic acid. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. On the role of soft interfaces for the understanding of blood clotting

    Westerhausen, Christoph

    2013-01-01

    "How can the events in space and time which take place within the spatial boundary of a living organism be accounted for by physics and chemistry?" was the question brought up by Erwin Schrödinger 1944 in his book "What is Life?". A question that claims an interdisciplinary ansatz and cannot be solved without research between biology, chemistry, medical science and physics on an equal level. Motivated by this question, the present thesis treats biophysical aspects of primary hemostasis, mainl...

  14. Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer: An Asian population study.

    Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

    2016-12-01

    Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD).This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated.The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group.Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD.

  15. Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer

    Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

    2016-01-01

    Abstract Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD). This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated. The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group. Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD. PMID:27977613

  16. The use of snake venom derived fibrin glue in hysterorrhaphy of ovine caesarean surgery

    CHALHOUB, M.; PRESTES, N. C.; LOPES, M. D.; ROCHA, N. S.; THOMAZINI-SANTOS, I. A.; MENDES-GIANNINI, M.J.

    2000-01-01

    Fibrin glue has been used on its own or in conjunction with suturing materials to promote hemostasis, reduce adherence, strengthen the wound site, and improve healing. Snake venom derived fibrin glue was evaluated as an alternative to conventional uterine suturing after ovine caesarean surgery. Twenty-eight pregnant ewes of known mating date were used. The animals submitted to conventional caesarean sections showed a better wound healing process. As expected, all the operated animals had reta...

  17. Fibrin Clots Are Equilibrium Polymers That Can Be Remodeled Without Proteolytic Digestion

    Chernysh, Irina N.; Nagaswami, Chandrasekaran; Purohit, Prashant K.; Weisel, John W.

    2012-01-01

    Fibrin polymerization is a necessary part of hemostasis but clots can obstruct blood vessels and cause heart attacks and strokes. The polymerization reactions are specific and controlled, involving strong knob-into-hole interactions to convert soluble fibrinogen into insoluble fibrin. It has long been assumed that clots and thrombi are stable structures until proteolytic digestion. On the contrary, using the technique of fluorescence recovery after photobleaching, we demonstrate here that the...

  18. Prednison provokes serum and vasoactive substances in a mice model of immune thrombocytopenia

    Ling Zhang

    2016-09-01

    Conclusion: In this study, the β-EP, VIP, 5-HT and NE contents in ITP mice injected with GP-APS were changed by prednison. It shows that prednison as the first-line therapy for ITP with effective hemostasis function is likely to increasing the contents of VIP and 5-HT. These results suggest the therapeutic value of prednison for the treatment of ITP.

  19. Resuscitation and Transfusion Principles for Traumatic Hemorrhagic Shock

    2009-11-01

    with each of these in addition to bacterial contamination, deep venous thromboembolism (DVT), and febrile reactions.101 The risks of these adverse events...by Cannon in 1918 can be summarized as allowing the blood pressure to be slightly less than normal to promote thrombus formation while still providing...a forming thrombus will not be able to achieve hemostasis, and re-bleeding occurs. This has been called “popping the clot”.34 This concept is

  20. Roxicam pharmacological modulation of the prostacyclin-thromboxane system in heart failure-complicated acute myocardial infarction

    Shushlyapin, O.I.; Shelest, A.N.; Khossejn Shakhavat, A.F.M.

    1991-01-01

    The prostaglandin-thromboxane system, platelet hemostasis and central hemodynamics were evaluated in 51 patients with heart failure-complicated acute myocardial infarction. The concentration of active metabolites of thromboxane-prostacyclin system was determined by means of radioimmunoassay. The new non-steroidal antiinflammatory agent roxicam was shown to selectively inhibit thromboxane, without affecting prostacyclin levels. The agent may be use in therapy in patients with myocardial infarction concurrent with heart failure

  1. Factors Affecting Wound Healing

    Guo, S.; DiPietro, L.A.

    2010-01-01

    Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutane...

  2. Did dinosaurs have megakaryocytes? New ideas about platelets and their progenitors

    Brass, Lawrence F.

    2005-01-01

    Biological evolution has struggled to produce mechanisms that can limit blood loss following injury. In humans and other mammals, control of blood loss (hemostasis) is achieved through a combination of plasma proteins, most of which are made in the liver, and platelets, anucleate blood cells that are produced in the bone marrow by megakaryocytes. Much has been learned about the underlying mechanisms, but much remains to be determined. The articles in this series review current ideas about the...

  3. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won [Seoul Natioonal University College of Medicine, Seoul (Korea, Republic of); Choi, Guk Myung [Cheju National University College of Medicine, Jeju (Korea, Republic of)

    2003-06-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.

  4. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won; Choi, Guk Myung

    2003-01-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs

  5. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy

    Davenport, Ross; Brohi, Karim

    2013-01-01

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen con...

  6. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.

    Davenport, Ross; Brohi, Karim

    2013-09-24

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.

  7. [Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery].

    Wang, Gang-cheng; Han, Guang-sen; Ren, Ying-kun; Xu, Yong-chao; Zhang, Jian; Lu, Chao-min; Zhao, Yu-zhou; Li, Jian; Gu, Yan-hui

    2013-10-01

    To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery. We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed. In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml. Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.

  8. Effect of Cold Storage on Shear-induced Platelet Aggregation and Clot Strength

    2014-09-01

    hemostasis and are lifesavingwhen transfused to treat thrombocytopenia. In response to vascular injury, platelets adhere, aggregate, and along with fibrin ...Handling Platelet - rich plasma (PRP) was obtained from phlebot- omized blood or AP collection. Blood was drawn in acid cit- rate dextroseYcontaining...aging and senes- cence during storage.35,38 Platelet activation and aggregation lead to clot formation, beginning with the linear polymerization of fibrin

  9. Platelet Concentrates: Past, Present and Future

    Prakash, Shobha; Thakur, Aditi

    2011-01-01

    Platelets play a crucial role in hemostasis and wound healing, platelet growth factors are well known source of healing cytokines. Numerous techniques of autologous platelet concentrates have been developed and applied in oral and maxillofacial surgery. This review describes the evolution of the first and second generation of platelet concentrates (platelet rich plasma and platelet rich fibrin respectively) from their fore runner-fibrin sealants.

  10. Early fibrinogen degradation coagulopathy: a predictive factor of parenchymal hematomas in cerebral rt-PA thrombolysis.

    Sun, Xuhong; Berthiller, Julien; Trouillas, Paul; Derex, Laurent; Diallo, Laho; Hanss, Michel

    2015-04-15

    The purpose of this study was to systematically determine the correlations between the post-thrombolytic changes of hemostasis parameters and the occurrence of early intracerebral hemorrhage (ICH). In 72 consecutive patients with cerebral infarcts treated with rt-PA, plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, factor XIII, fibrin(ogen) degradation products (FDPs) and d-Dimers were measured at baseline, 2 and 24h after thrombolysis. Correlations were studied between the hemostasis events and early (less than 24h) hemorrhagic infarcts (HIs) or parenchymatous hematomas (PH). Of 72 patients, 6 patients (8.3%) had early PHs, 11 (15.3%) had early HIs, and 55 (76.4%) had no bleeding. Early HIs were not linked to any hemostasis parameter at any time. Univariate comparison of patients having early PHs with non-bleeding patients showed hemostasis abnormalities at 2h: high FDP (p=0.01), high Log FDP (p=0.01), low fibrinogen (p=0.01), and low Log fibrinogen (p=0.01). Logistic regression adjusted for age, NIHSS and diabetes confirmed these 2hour predictors: Log FDP (OR: 7.50; CI: 1.26 to 44.61, p=0.03), and Log fibrinogen (OR: 19.32; CI: 1.81 to 205.98, p=0.01). The decrease in fibrinogen less than 2g/L multiplies the odds of early PH by a factor 12.82. An early fibrinogen degradation coagulopathy involving an increase of FDP and a massive consumption of circulating fibrinogen is predictive of early parenchymal hematomas, indicating the occurrence of a particularly intense lysis of circulating fibrinogen. These results, if confirmed by future studies, suggest that early assays of fibrinogen and FDP may be useful in predicting the risk of post-thrombolytic intracerebral hematoma. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Platelet-rich fibrin matrix for facial plastic surgery.

    Sclafani, Anthony P; Saman, Masoud

    2012-05-01

    Platelets are known primarily for their role in hemostasis, but there is increasing interest in the effect of platelets on wound healing. Platelet isolates such as platelet-rich plasma have been advocated to enhance and accelerate wound healing. This article describes the use of a novel preparation, platelet-rich fibrin matrix (PRFM), for facial plastic surgery applications such as volume augmentation, fat transfer supplementation, and as an adjunct to open surgical procedures. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Hemothorax due to Ruptured Mycotic Aneurysm of Intercostal Arteries Associated with Infective Endocarditis

    Eddie Y. Liu

    2017-01-01

    Full Text Available We present a case of hemothorax due to ruptured mycotic aneurysm in three intercostal arteries in a 40-year-old male with methicillin-resistant Staphylococcus aureus infective endocarditis (IE due to intravenous drug use. Microcoil embolization and thoracotomy successfully achieved hemostasis. Mycotic aneurysm is a rare complication of IE and is usually found in the intracranial vessels. Ruptured mycotic aneurysm in the intercostal arteries can be associated with IE and can present as acute hemothorax.

  13. EXPOSURE TO ACROLEIN BY INHALATION CAUSES PLATELET ACTIVATION

    Sithu, Srinivas D; Srivastava, Sanjay; Siddiqui, Maqsood A; Vladykovskaya, Elena; Riggs, Daniel W; Conklin, Daniel J; Haberzettl, Petra; O’Toole, Timothy E; Bhatnagar, Aruni; D’Souza, Stanley E

    2010-01-01

    Acrolein is a common air pollutant that is present in high concentrations in wood, cotton, and tobacco smoke, automobile exhaust and industrial waste and emissions. Exposure to acrolein containing environmental pollutants such as tobacco smoke and automobile exhaust has been linked to the activation of the coagulation and hemostasis pathways and thereby to the predisposition of thrombotic events in human. To examine the effects of acrolein on platelets, adult male C57Bl/6 mice were subjected ...

  14. Влияние суппозиториев вагинальных на гемостаз железа на фоне экспериментального вагинита, отягощенного Escherichia coli

    Dolzhykova, O. V.; Maloshtan, L. M.; Yeriomenko, R. F.

    2017-01-01

    Currently, disorders of the vaginal flora are observed in 38 % of women, 11 % of them have aerobic vaginitis. Streptococcus agalactiae and Escherichia coli, which capture iron of the human body during bacterial infections, are isolated most frequently in cases of vaginitis.Aim. To study the effect of vaginal pessaries “Klimedeks” and “Melanizol” on iron hemostasis in female rats against the experimental positive Escherichia coli vaginitis.Materials and methods. The experiment was conducted on...

  15. TachoSil use in abdominal surgery: a review

    Giulio Reale

    2011-03-01

    Full Text Available Adriana Toro, Maurizio Mannino, Giulio Reale, Isidoro Di CarloDepartment of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, ItalyAbstract: The success of any surgical procedure is based on adequate hemostasis. Many different biomaterial products can be used to achieve that aim. The products that can be used during surgery may be classified as topical hemostats, sealants, and adhesives. Hemostats can clot blood. Sealants can create sealing barriers. Adhesives bond tissue together. Collagen, gelatin, and cellulose are hemostat agents. TachoSil® is a development of TachoComb® and TachoComb® H. TachoComb is made with equine collagen, bovine thrombin, bovine aprotinin, and human fibrinogen. The clinical efficacy of TachoSil was shown firstly by a clinical study of hepatic surgery. In the study, TachoSil proved to be superior to argon beamer in obtaining effective and fast intraoperative hemostasis. Following the study, many applications in different fields of surgery have been reported in the literature. The use of TachoSil in open abdominal surgery and its relevant results have encouraged the use of TachoSil in laparoscopic surgery. Unfortunately, its use in laparoscopy has not become as popular as it is in open surgery, due to a lack of efficacious techniques. Immunologic reactions to compounds of TachoSil and the transmission of infectious diseases are two major risks concerning topical hemostasis. Even though the risk of severe immunologic reactions to bovine material is low, TachoSil has gradually replaced all bovine material with material of human origin and has therefore eliminated the associated risks of bovine material. TachoSil has a good satisfaction rate among surgeons and reduces both the operating time for patients and the time spent in intensive care units.Keywords: TachoSil, abdominal surgery, hemostasis

  16. Comparison of microporous polysaccharide hemospheres and Ankaferd Blood Stopper in a rabbit epistaxis model.

    Yurttas, Veysel; Sereflican, Murat; Terzi, Elçin Hakan; Ozyalvaçlı, Gulzade; Kazaz, Hasan

    2016-04-01

    The aim of this study was to evaluate the histopathological impact, effectiveness, and safety of two hemostatic agents, Ankaferd Blood Stopper (ABS) and microporous polysaccharide hemospheres (MPH), in an experimental rabbit epistaxis model. Rabbits were randomly assigned, using a computerized random number generator, to the following three groups of six animals: group 1 (control, irrigated with saline); group 2 (ABS-treated); and group 3 (MPH-treated). In all groups, a standardized rabbit epistaxis model was used. Hemostasis time and extent of nasal bleeding were measured to compare the hemostatic effect of ABS and MPH among groups. Septums were removed for histopathological analysis, 7 days after the procedure. ABS reduced hemostasis time to 104.2 s and amount of bleeding to 20.5 mg. MPH reduced hemostasis time to 71.7 s and amount of bleeding to 11.5 mg. Mean bleeding time in wounds administered ABS and MPH was significantly shorter compared with wounds administered isotonic saline solution (p = 0.004). ABS and MPH application decreased bleeding significantly compared with the control group (p = 0.004). Bleeding time and amount in the MPH group was significantly reduced compared with the ABS group (p = 0.013 and p = 0.004, respectively). There was no significant difference in the histopathological evaluation results between the ABS, MPH, and control groups. Our data indicate that both ABS and MPH represent safe, effective, and fast-acting hemostatic agents in the management of epistaxis. MPH was more effective than ABS in terms of hemostasis time and amount of bleeding.

  17. Circumventing furin enhances factor VIII biological activity and ameliorates bleeding phenotypes in hemophilia models

    Siner, Joshua I.; Samelson-Jones, Benjamin J.; Crudele, Julie M.; French, Robert A.; Lee, Benjamin J.; Zhou, Shanzhen; Merricks, Elizabeth; Raymer, Robin; Nichols, Timothy C.; Camire, Rodney M.; Arruda, Valder R.

    2016-01-01

    Processing by the proprotein convertase furin is believed to be critical for the biological activity of multiple proteins involved in hemostasis, including coagulation factor VIII (FVIII). This belief prompted the retention of the furin recognition motif (amino acids 1645–1648) in the design of B-domain–deleted FVIII (FVIII-BDD) products in current clinical use and in the drug development pipeline, as well as in experimental FVIII gene therapy strategies. Here, we report that processing by fu...

  18. A French National Survey on Clotting Disorders in Mastocytosis.

    Carvalhosa, Ana B; Aouba, Achille; Damaj, Gandhi; Canioni, Danielle; Brouzes, Chantal; Gyan, Emmanuel; Durupt, Stéphane; Durieu, Isabelle; Cathebras, Pascal; Costédoat-Chalumeau, Nathalie; Launay, David; Pilmis, Benoit; Barete, Stephane; Frenzel, Laurent; Lortholary, Olivier; Hermine, Olivier; Hermans, Cedric; Chandesris, Marie-Olivia

    2015-10-01

    Mastocytosis is characterized by a clonal mast cell proliferation with organ infiltration and uncontrolled degranulation. Although not characteristic and poorly explained, some patients develop clotting abnormalities. We retrospectively identified patients with established diagnosis of mastocytosis and related clotting abnormalities (clinical and/or biological) using the national French Reference Centre for Mastocytosis database. From our cohort of 14 adult patients with clotting abnormalities (median age 46 years [range 26-75]), 4 had a presentation suggestive of a primary hemostasis disorder alone (by their symptoms and/or abnormal clotting tests [PFA, von Willebrand's disease [vWD] screening]) and 10 had a laboratory impairment of secondary hemostasis. Among these, 7 had bleeds characteristic of a coagulation cascade disorder (severe/life-threatening in 5 and mild in 2 patients). Clotting abnormalities were of variable severity, typically related to intense crisis of degranulation, such as anaphylactic reactions, and/or to severe organ infiltration by mast cells. Importantly, classical hemostatic management with platelet transfusion, fresh frozen plasma, or vitamin K infusions was unsuccessful, as opposed to the use of agents inhibiting mast cell activity, particularly steroids. This illustrates the crucial role of mast cell mediators such as tryptase and heparin, which interfere both with primary (mainly via inhibition of von Willebrand factor) and secondary hemostasis. There was interestingly an unusually high number of aggressive mastocytosis (particularly mast cell leukemia) and increased mortality in the group with secondary hemostasis disorders (n = 5, 36% of the whole cohort). Mast cell degranulation and/or high tumoral burden induce both specific biologic antiaggregant and anticoagulant states with a wide clinical spectrum ranging from asymptomatic to life-threatening bleeds. Hemostatic control is achieved by mast cell inhibitors such as steroids.

  19. National consensus on management of peptic ulcer bleeding in Denmark 2014.

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2014-11-01

    The Danish Society of Gastroenterology and Hepatology have compiled a national guideline for the management of peptic ulcer bleeding. Sources of data included published studies up to June 2014. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the Danish Society of Gastroenterology and Hepatology September 4, 2011. The current version is revised June 2014. RECOMMENDATIONS emphasize the importance of early and efficient resuscitation. Use of a restrictive blood transfusion policy is recommended in haemodynamically stable patients without serious ischaemic disease. Endoscopy should generally be performed within 24 hours, reducing operation rate, rebleeding rate and duration of in-patient stay. When serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Hemoclips, thermocoagulation, and epinephrine injection are effective in achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended even though the evidence is questionable. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least three days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) within 24 hours from primary endoscopy. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75 mg ASA and PPI should be preferred to monotherapy with clopidogrel in patients needing anti-platelet therapy on the basis of indications other

  20. Comparison of Radiofrequency and Electrocautery With Conventional Scalpel Incisions.

    Hasar, Zafer Burak; Ozmeric, Nurdan; Ozdemir, Burcu; Gökmenoğlu, Ceren; Baris, Emre; Altan, Gökçen; Kahraman, Sevil

    2016-11-01

    The disadvantages of conventional scalpels, including insufficient control of bleeding, prompted us to search for new alternative methods such as electrosurgery and radiosurgery. In this study, the conventional scalpel was compared with radiosurgery and electrosurgery for wound healing with assessment of lateral heat production, inflammation, and instrument performance. Incisions were made in the palatal mucosa of 42 Wistar rats using a scalpel, electrocautery instrument, or radiofrequency instrument. Postoperative hemostasis, tissue coagulation, and tissue sticking were measured, and pain evaluation through weight loss was recorded. Gingival biopsy specimens from the surgical area were obtained at the time of surgery and 2, 4, 7, and 14 days postoperatively and were evaluated immunohistochemically for inducible nitric oxide synthase and heat shock protein 70. Kruskal-Wallis, 1-way analysis of variance, and Mann-Whitney U tests were used for statistical evaluation. The rats in the electrosurgery and radiosurgery groups had aggressively greater weight loss when compared with the scalpel group in the first 7 days. Hemostasis was better in the electrocautery group, tissue coagulation was greater in the radiofrequency group (P < .001), and tissue sticking was lesser in the scalpel group (P < .001) compared with the other groups. Inducible nitric oxide synthase expression and heat shock protein 70 expression were similar in all 3 groups. Electrosurgery performed better regarding hemostasis, whereas a scalpel was superior in terms of tissue sticking and tissue coagulation. Radiosurgery was superior regarding hemostasis when compared with a conventional scalpel, but it was not as successful as electrosurgery. Copyright © 2016. Published by Elsevier Inc.

  1. Thromboelastography in Selected Avian Species

    Andersen, Sophie Susanna Strindberg; Nielsen, Tenna W; Ribeiro, Ângela M

    2015-01-01

    Currently available assay methods and reagents are not optimized for evaluating avian hemostasis; therefore, assessing avian coagulopathies is challenging. Recently, thromboelastography (TEG), which measures the viscoelastic properties of blood, has been used clinically in mammalian species...... to diagnose and characterize hemostatic disorders. To evaluate TEG in healthy individuals of 6 avian species, we modified existing mammalian TEG protocols to allow analysis of citrated, avian whole-blood samples collected from scarlet ibis (Eudocimus ruber) (n = 13), American flamingos ( Phoenicopterus ruber...

  2. Grey Turner's and Cullen's signs induced by spontaneous hemorrhage of the abdominal wall after coughing.

    Fan, Zhe; Zhang, Yingyi

    2017-08-01

    Grey Turner's and Cullen's signs are rare clinical signs, which most appear in patients with severe acute pancreatitis. The present patient complained of abdominal pain after coughing. However, contrast-enhanced CT revealed a hemorrhage of the abdominal wall. Therefore, spontaneous hemorrhage of the abdominal wall was diagnosed. The patient recovered through immobilization and hemostasis therapy. This case report and literature review aims to remind clinicians of manifestations and treatment of spontaneous hemorrhage.

  3. Promoting Autoimmune Diabetes in Non-Human Primates

    2014-04-01

    the mediastinum. After the completion of total thymectomy, hemostasis is obtained by electrocautery. If necessary, one or 2 small drains ( Jackson ...obtained by pressure. Small drains ( Jackson -pratt or equivalent) were not considered necessary for checking post-operative bleeding since no fluid...the second monkey ( Percy , #150-11), in contrast to the 70% removal in the first one (Leo, #149-11). The close to complete removal of the thymus enable

  4. Surgical sponges in small animal surgery.

    Zeltzman, Phil; Downs, Myron

    2011-06-01

    Sponges are commonly used in veterinary practice. Uses for sponges in the operative arena include hemostasis, retraction, protection, dissection, and general wound management. Blood loss can be quantitated by counting blood-soaked sponges. Complications may arise when sponges are retained in the patient. Sponge retention is a risk whenever sponges are used during surgery, regardless of surgical procedure. This article reviews physical characteristics and proper uses of sponges, complications of sponge retention, and techniques to avoid retained sponges.

  5. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

    2012-01-01

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  6. Hemostatic System in Chronic Viral Hepatitis

    Natalia Borisova

    2018-06-01

    Full Text Available Hemostasis is balanced by pro- and anticoagulant and pro- and antifibrinolytic factors, most of these being synthesized by the liver. Advanced liver disease is associated with perturbations in the level of these factors due to secretory deficiencies. Thrombocytopenia, reduced levels of factor II-VII-X, and anti-fibrinolytic factors are all features of CHC infection, suggesting hypocoagulability. However, higher concentrations of VWF and factor VIII, as well as lower concentrations of anticoagulant factors including protein C and S, have also been reported in CHC infections, suggesting hypercoagulability. Thus, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients with chronic viral hepatitis. In patients with chronic liver disease (CLD, in whom extremely complex alterations of hemostasis occur, one cannot rely on levels of individual coagulation factors, or on simplified tests of hemostasis such as the PT or APTT to predict the hemostatic status. To determine the hemostatic status in these patients, more complex tests and a more comprehensive overview of the hemostatic changes are required. In connection with the latest studies, a revision of the methods for correction of hemostatic system disorders in patients with acute and chronic liver diseases becomes urgent.

  7. Factor XI and XII as antithrombotic targets.

    Müller, Felicitas; Gailani, David; Renné, Thomas

    2011-09-01

    Arterial and venous thrombosis are major causes of morbidity and mortality, and the incidence of thromboembolic diseases increases as a population ages. Thrombi are formed by activated platelets and fibrin. The latter is a product of the plasma coagulation system. Currently available anticoagulants such as heparins, vitamin K antagonists and inhibitors of thrombin or factor Xa target enzymes of the coagulation cascade that are critical for fibrin formation. However, fibrin is also necessary for terminating blood loss at sites of vascular injury. As a result, anticoagulants currently in clinical use increase the risk of bleeding, partially offsetting the benefits of reduced thrombosis. This review focuses on new targets for anticoagulation that are associated with minimal or no therapy-associated increased bleeding. Data from experimental models using mice and clinical studies of patients with hereditary deficiencies of coagulation factors XI or XII have shown that both of these clotting factors are important for thrombosis, while having minor or no apparent roles in processes that terminate blood loss (hemostasis). Hereditary deficiency of factor XII (Hageman factor) or factor XI, plasma proteases that initiate the intrinsic pathway of coagulation, impairs thrombus formation and provides protection from vascular occlusive events, while having a minimal impact on hemostasis. As the factor XII-factor XI pathway contributes to thrombus formation to a greater extent than to normal hemostasis, pharmacological inhibition of these coagulation factors may offer the exciting possibility of anticoagulation therapies with minimal or no bleeding risk.

  8. Initial experience with the Cardiva Boomerang vascular closure device in diagnostic catheterization.

    Doyle, Brendan J; Godfrey, Michael J; Lennon, Ryan J; Ryan, James L; Bresnahan, John F; Rihal, Charanjit S; Ting, Henry H

    2007-02-01

    The authors studied the safety and efficacy of the Cardiva Boomerang vascular closure device in patients undergoing diagnostic cardiac catheterization. Conventional vascular closure devices (sutures, collagen plugs, or metal clips) have been associated with catastrophic complications including arterial occlusion and foreign body infections; furthermore, they cannot be utilized in patients with peripheral vascular disease or vascular access site in a vessel other than the common femoral artery. The Cardiva Boomerang device facilitates vascular hemostasis without leaving any foreign body behind at the access site, can be used in peripheral vascular disease, and can be used in vessels other than the common femoral artery A total of 96 patients undergoing transfemoral diagnostic cardiac catheterization were included in this study, including 25 (26%) patients with contraindications to conventional closure devices. Femoral angiography was performed prior to deployment of the Cardiva Boomerang closure device. Patients were ambulated at 1 hr after hemostasis was achieved. The device was successfully deployed and hemostasis achieved with the device alone in 95 (99%) patients. The device failed to deploy in 1 (1%) patient and required conversion to standard manual compression. Minor complications were observed in 5 (5%) patients. No patients experienced major complications including femoral hematoma > 4 cm, red blood cell transfusion, retroperitoneal bleed, arteriovenous fistula, pseudoaneurysm, infection, arterial occlusion, or vascular surgery. The Cardiva Boomerang device is safe and effective in patients undergoing diagnostic cardiac catheterization using the transfemoral approach, facilitating early ambulation with low rates of vascular complications. (c) 2006 Wiley-Liss, Inc.

  9. Autologous fibrin sealant (Vivostat®) in the neurosurgical practice: Part I: Intracranial surgical procedure

    Graziano, Francesca; Certo, Francesco; Basile, Luigi; Maugeri, Rosario; Grasso, Giovanni; Meccio, Flavia; Ganau, Mario; Iacopino, Domenico G.

    2015-01-01

    Background: Hemorrhages, cerebrospinal fluid (CSF) fistula and infections are the most challenging postoperative complications in Neurosurgery. In this study, we report our preliminary results using a fully autologous fibrin sealant agent, the Vivostat® system, in achieving hemostasis and CSF leakage repair during cranio-cerebral procedures. Methods: From January 2012 to March 2014, 77 patients were studied prospectively and data were collected and analyzed. Autologous fibrin sealant, taken from patient's blood, was prepared with the Vivostat® system and applied on the resection bed or above the dura mater to achieve hemostasis and dural sealing. The surgical technique, time to bleeding control and associated complications were recorded. Results: A total of 79 neurosurgical procedures have been performed on 77 patients. In the majority of cases (98%) the same autologous fibrin glue provided rapid hemostasis and dural sealing. No patient developed allergic reactions or systemic complications in association with its application. There were no cases of cerebral hematoma, swelling, infection, or epileptic seizures after surgery whether in the immediate or in late period follow-up. Conclusions: In this preliminary study, the easy and direct application of autologous fibrin sealant agent helped in controlling cerebral bleeding and in providing prompt and efficient dural sealing with resolution of CSF leaks. Although the use of autologous fibrin glue seems to be safe, easy, and effective, further investigations are strongly recommended to quantify real advantages and potential limitations. PMID:25984391

  10. Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

    Yoshinobu Yamamoto

    2017-01-01

    Full Text Available Background. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD for early gastric neoplasm (EGN. The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods. A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results. Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%. All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P<0.01. Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s than at nonperforated points (3.5 s in five patients. Conclusions. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

  11. Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts.

    Özgönen, Hakan; Erdemoglu, Evrim; Günyeli, Ilker; Güney, Mehmet; Mungan, Tamer

    2013-04-01

    Aim of the present study is to determine the effects of bipolar electrocoagulation and intracorporeal suture on the ovarian reserve after ovarian cystectomy. Sixty patients aged 18-42 years old and with a persistent adnexal mass were recruited to the study. Patients were randomized into suture hemostasis group or bipolar hemostasis group. Laparoscopic ovarian cystectomy was performed to all patients. Hemostasis was obtained by bipolar coagulation in 30 patients and by intracorporeal sutures in 30 patients. Serum levels of FSH, LH, estradiol, inhibin B and ultrasonographic measurements (antral follicle count and ovarian volume) were analyzed and recorded at day 3 of menstrual cycle, 1 and 3 months after the surgery. Basal FSH level measurement at the postoperative third month was significantly increased to 6.96 ± 1.86 mIU/ml (p electrocoagulation group. However, the decreased ovarian volume and antral follicle count was restored at the postoperative third month in the bipolar electrocoagulation group. Preoperative and postoperative FSH, LH, estradiol and inhibin B levels and ultrasonographic measurements were similar in the intracorporeal suture group. The unwanted effect of bipolar electrocoagulation on ovarian reserve is probably transient and causes minimal damage to ovary. FSH levels may be slightly elevated. Gentle use of bipolar electrocoagulation or intracorporeal are not found to effect ovarian reserve.

  12. Wound healing and degradation of the fibrin sealant Beriplast P following partial liver resection in rabbits.

    Kroez, Monika; Lang, Wiegand; Dickneite, Gerhard

    2005-01-01

    The objective of this study was to investigate the degradation kinetics of the fibrin sealant (FS) Beriplast P in an experimental liver surgery model in rabbits. A partial liver resection was performed in 21 rabbits, and the wound area covered with Beriplast P to ensure hemostasis. Wound healing of the resection sites was evaluated morphologically over 11 weeks. Degradation of the FS was evaluated by measuring the thickness of the remaining fibrin layer. Plasma samples were analyzed for antibodies against fibrinogen, albumin, thrombin, fibrin, and factor XIII. No postoperative hemorrhage was observed, indicating successful hemostasis throughout. The FS was degraded with a half-life of about 25 days postapplication and was completely replaced by granulation tissue within 9 weeks. The FS degradation and tissue development followed the general stages of wound healing: inflammation and resorption, proliferation, organization and production of collagen, maturation, and scarring. An immune reaction was elicited against the main four human proteins of the FS. The antibody titers peaked on day 14, with a gradual decrease thereafter. We conclude that the FS accomplished hemostasis, facilitated healing in accordance with natural processes, and was completely degraded over time. In humans, the reduced immunogenicity of the FS would potentially increase its degradation half-life.

  13. Flavanols and Platelet Reactivity

    Debra A. Pearson

    2005-01-01

    Full Text Available Platelet activity and platelet-endothelial cell interactions are important in the acute development of thrombosis, as well as in the pathogenesis of cardiovascular disease. An increasing number of foods have been reported to have platelet-inhibitory actions, and research with a number of flavanol-rich foods, including, grape juice, cocoa and chocolate, suggests that these foods may provide some protection against thrombosis. In the present report, we review a series of in vivo studies on the effects of flavanol-rich cocoa and chocolate on platelet activation and platelet-dependent primary hemostasis. Consumption of flavanol-rich cocoa inhibited several measures of platelet activity including, epinephrine- and ADP-induced glycoprotein (GP IIb/IIIa and P-Selectin expression, platelet microparticle formation, and epinephrine-collagen and ADP-collagen induced primary hemostasis. The epinephrine-induced inhibitory effects on GP IIb/IIIa and primary hemostasis were similar to, though less robust than those associated with the use of low dose (81 mg aspirin. These data, coupled with information from other studies, support the concept that flavanols present in cocoa and chocolate can modulate platelet function through a multitude of pathways.

  14. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.

  15. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  16. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  17. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat

    Lewis KM

    2015-12-01

    Full Text Available Kevin Michael Lewis,1 Carl Erik Kuntze,2 Heinz Gulle3 1Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA; 2Medical Affairs, Baxter Healthcare SA, Zurich, Switzerland; 3Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria Abstract: The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG. NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. Keywords: HEMOPATCH, hemostasis, surgical hemostasis, sealing, surgical sealant

  18. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: Using propensity score matching.

    Park, Jun Chul; Kim, Yeong Jin; Kim, Eun Hye; Lee, Jinae; Yang, Hyun Su; Kim, Eun Hwa; Hahn, Kyu Yeon; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2018-02-07

    Recently, the application of hemostatic powder to the bleeding site has been used to treat active upper gastrointestinal bleeding (UGIB). We aimed to assess the effectiveness of the polysaccharide hemostatic powder (PHP) in patients with non-variceal UGIB. We reviewed prospectively collected 40 patients with UGIB treated with PHP therapy between April 2016 and January 2017 (PHP group) and 303 patients with UGIB treated with conventional therapy between April 2012 and October 2014 (conventional therapy group). We compared the rate of successful hemostasis and the rebleeding between the two groups after as well as before propensity score matching using the Glasgow-Blatchford score and Forrest classification. Thirty patients treated with the PHP and 60 patients treated with conventional therapy were included in the matched groups. Baseline patient characteristics including comorbidities, vital signs, and bleeding scores were similar in the matched groups. The rate of immediate hemostasis and 7-day and 30-day rebleeding were also similar in the two groups before and after matching. In the subgroup analysis, no significant differences in immediate hemostasis or rebleeding rate were noted between PHP in monotherapy and PHP combined with a conventional hemostatic method. At 30 days after the therapy, there were no significant PHP-related complications or mortality. Given its safety, the PHP proved feasible for endoscopic treatment of UGIB, having similar effectiveness as that of conventional therapy. The PHP may become a promising hemostatic method for non-variceal UGIB. © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  19. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  20. Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

    Wei-Chen Lin

    Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

  1. Strategy and clinical significance of interventional management before surgical therapy for massive hemorrhage of gastrointestinal tract

    Hu Tingyang; Yu Wenqiang; Mao Yingmin; Yuan Jianhua; CChen Fanghong; Luo Zuyan; Ding Xiaonan; Zhou Bing; Ding Zhongxiang

    2009-01-01

    Objective: To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage, and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group. Methods: During the period of June 1998-Apr. 2009, 31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment. According to DSA manifestations, the patients underwent transarterial hypophysin infusion or transcatheter embolization as interventional management. The clinical efficacy of interventional procedures and its influence on the surgery were evaluated, and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements. The numeration data were analyzed with Fisher's exact test, and the SPSS 11.0 was used as statistical software. Results: The interventional managements were successfully performed in all the 31 patients, with a total hemostasis rate of 83.9% (26/31) and a total re-bleeding rate 30.7% (8/26). The hemostasis rate and re-bleeding rate of hypophysin infusion group and embolization group were 69.2% (9/ 13), 94.4% (17/18) and 44.4% (4/9), 23.7% (4/17), respectively. All the 31 patients received surgery after interventional therapy, of which selective operation was carried out in 20. Neither surgery-related or intervention-related serious complications nor death occurred. Conclusion: Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery, enable the physician to take a selective operation to replace an emergency one,as a result, the surgical risk will be greatly reduced. Therefore, it is worth popularizing the preoperative interventional managements in clinical practice. (authors)

  2. Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.

    Hieb, Robert A; Neisen, Melissa J; Hohenwalter, Eric J; Molnar, Jim A; Rilling, William S

    2008-12-01

    To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy. A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions. Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%. The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.

  3. The application of radiosterilised bovine bone xenograft as a dental haemostatic agent in adult merino sheep

    Samsudin, A.R.; Meor Kamal, M. Z.; Afifi Abu Bakar

    1999-01-01

    The aim of this study is to look at the efficacy of radiosterilised demineralised freeze dried bovine bone xenograft as a dental haemostatic agent in tooth socket wound following tooth extraction. Six adult Merino sheep underwent extraction of two central incisor teeth under general anaesthesia. In one tooth extraction socket (socket side A) a standard gelatin dental haemostatic agent was inserted while a radiosterilised cancellous bovine bone cube was inserted into the second tooth extraction socket (socket side B). The time taken for the bleeding from the both socket to stop was noted and the sheep were kept asleep under general anesthesia till complete hemostasis was achieved. The feeding habits and wound healing were observed till the tenth postoperative day. Results showed that in socket A, complete hemostasis was achieved in a mean time of 135 seconds (range 110 seconds to 145 seconds) and in socket B, complete hemostasis was achieved in a mean time of 97 seconds (range 8 8 seconds to 112 seconds). Observation regarding feeding habits demonstrate that all the sheep showed preference to chew food on the side of socket 'side B' till the fifth postoperative day and by the seventh day, all sheep chew on both sides of the jaw. The standard gelatin dental hemostatic agent was found to be dislodged from all socket side B on the first postoperative day while the bovine bone cube remained in socked side A till the seventh postoperative day. In conclusion, radiosterilised cancellous bovine bone cube may be applied as an effective dental hemostatic agent following tooth extraction

  4. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate.

    Grassia, Roberto; Capone, Pietro; Iiritano, Elena; Vjero, Katerina; Cereatti, Fabrizio; Martinotti, Mario; Rozzi, Gabriele; Buffoli, Federico

    2016-12-28

    To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB). In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding. Of the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded. Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.

  5. Infrared laser sealing of porcine vascular tissues using a 1,470 nm diode laser: Preliminary in vivo studies.

    Cilip, Christopher M; Kerr, Duane; Latimer, Cassandra A; Rosenbury, Sarah B; Giglio, Nicholas C; Hutchens, Thomas C; Nau, William H; Fried, Nathaniel M

    2017-04-01

    Infrared (IR) lasers are being explored as an alternative to radiofrequency (RF) and ultrasonic (US) devices for rapid hemostasis with minimal collateral zones of thermal damage and tissue necrosis. Previously, a 1,470 nm IR laser sealed and cut ex vivo porcine renal arteries of 1-8 mm diameter in 2 seconds, yielding burst pressures greater than 1,200 mmHg and thermal coagulation zones less than 3 mm. This preliminary study describes in vivo testing of a handheld laser probe in a porcine model. A handheld prototype with vessel/tissue clasping mechanism was tested on 73 blood vessels less than 6 mm diameter using 1,470 nm laser power of 35 W for 1-5 seconds. Device power settings, irradiation time, tissue type, vessel diameter, and histology sample number were recorded for each procedure. The probe was evaluated for hemostasis after sealing isolated and bundled arteriole/venous (A/V) vasculature of porcine abdomen and hind leg. Sealed vessel samples were collected for histological analysis of lateral thermal damage. Hemostasis was achieved in 57 of 73 seals (78%). The probe consistently sealed vasculature in small bowel mesentery, mesometrium, and gastrosplenic and epiploic regions. Seal performance was less consistent on hind leg vasculature including saphenous arteries/bundles and femoral and iliac arteries. Collagen denaturation averaged 1.6 ± 0.9 mm in eight samples excised for histologic examination. A handheld laser probe sealed porcine vessels, in vivo. Further probe development and laser parameter optimization is necessary before infrared lasers may be evaluated as an alternative to RF and US vessel sealing devices. Lasers Surg. Med. 49:366-371, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective.

    Luh, Hui-Tzung; Huang, Abel Po-Hao; Yang, Shih-Hung; Chen, Chien-Ming; Cho, Der-Yang; Chen, Chun-Chung; Kuo, Lu-Ting; Li, Chieh-Hsun; Wang, Kuo-Chuan; Tseng, Wei-Lung; Hsing, Ming-Tai; Yang, Bing-Shiang; Lai, Dar-Ming; Tsai, Jui-Chang

    2018-01-01

    Minimally invasive endoscope-assisted (MIE) evacuation of spontaneous intracerebral hemorrhage (ICH) is simple and effective, but the limited working space may hinder meticulous hemostasis and might lead to rebleeding. Management of intraoperative hemorrhage is therefore a critical issue of this study. This study presents experience in the treatment of patients with various types of ICH by MIE evacuation followed by direct local injection of FloSeal Hemostatic Matrix (Baxter Healthcare Corp, Fremont, CA, USA) for hemostasis. The retrospective nonrandomized clinical and radiology-based analysis enrolled 42 patients treated with MIE evacuation of ICH followed by direct local injection of FloSeal Hemostatic Matrix. Rebleeding, morbidity, and mortality were the primary endpoints. The percentage of hematoma evacuated was calculated from the pre- and postoperative brain computed tomography (CT) scans. Extended Glasgow Outcome Scale (GOSE) was evaluated at 6 months postoperatively. Forty-two ICH patients were included in this study, among these, 23 patients were putaminal hemorrhage, 16 were thalamic ICH, and the other three were subcortical type. Surgery-related mortality was 2.4%. The average percentage of hematoma evacuated was 80.8%, and the rebleeding rate was 4.8%. The mean operative time was 102.7 minutes and the average blood loss was 84.9 mL. The mean postoperative GOSE score was 4.55 at 6-months' follow-up. This study shows that local application of FloSeal Hemostatic Matrix is safe and effective for hemostasis during MIE evacuation of ICH. In our experience, this shortens the operation time, especially in cases with intraoperative bleeding. A large, prospective, randomized trial is needed to confirm the findings. Copyright © 2017. Published by Elsevier B.V.

  7. Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial.

    Burdette, Todd E; Kerrigan, Carolyn L; Homa, Karen; Homa, Karen A

    2011-10-01

    The authors hypothesized that the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) might outperform electrocautery in bilateral breast reduction surgery, possibly resulting in (1) shorter operative times, (2) lower postoperative fluid drainage rates, and (3) reduced postoperative pain scores. Thirty-one patients were evaluated in a matched-pair design, with random (blinded) assignment of one side to the Harmonic Scalpel, with the other side defaulting to electrocautery. Main outcome measures were: (1) resection/hemostasis time, (2) drainage volume, and (3) postoperative pain. The authors also compared the learning curves, operative time versus specimen weights, complications, and costs for the devices. There was a statistically significant (but not clinically significant) difference between the median times for the Harmonic Scalpel (33 minutes) and electrocautery (31 minutes) (p=0.02). There was no statistical difference in drainage scores, and pain scores were equivalent. The analysis of specimen weight versus resection/hemostasis time showed no correlation. There were more complications on the breasts reduced with the Harmonic device, but due to the small sample size, the complication results were not statistically significant. Start-up costs for the devices were comparable, but the per-procedure cost for the Harmonic device was considerably higher. The Harmonic Scalpel is roughly equivalent to electrocautery in breast reduction surgery in terms of resection/hemostasis time, serous drainage, and postoperative pain. Though the Harmonic device may be excellent for other surgical procedures, its high cost suggests that surgeons and institutions can confidently forgo its use in breast reduction surgery. Therapeutic, II.

  8. Possibility of application of low-frequency piezothromboelastografy method for the evaluation of haemostatic potential of blood in coronary bypass surgery on the background of long aspirinotherapy

    Elena V. Fanaskova

    2017-01-01

    Full Text Available Aim. To assess the hemostatic system on the aspirin therapy background using the VerifyNow Aspirin test, as well as examining platelet aggregation and low-frequency piezothromboelastography in patients with coronary artery disease during coronary artery bypass grafting.Materials and methods. 100 people with coronary artery disease who were taking aspirin (75–100 mg daily for more than 1 year were examined. The study was performed in the perioperative period of coronary bypass surgery without aspirin withdrawal. Evaluation of hemostasis was performed by the VerifyNow Aspirin тest (USA, platelet aggregation (Нelena Laboratories AggRAMTM, Britain and the low-frequency piezothromboelastography (ARP-01M “Mednord”, Russia.Results. Patients included in the study were sensitive to aspirin when under long-term administration of a drug: indicator test was VerifyNow ARU 496,9 ± 21,3%, the platelet aggregation to ADP and adrenaline was reduced by 46% and 52%, respectively. In the early postoperative period platelet aggregation of ADP decreased by 73,2%, collagen – 75,9%, and adrenaline – 82,64% in comparison with the control group.Perioperative hemorrhagic complications in the study group were not observed. Reduction of platelet aggregation after aspirin therapy was accompanied by an increase in thrombin activity of the blood, which allows for evaluation of the method of low-frequency piezothromboelastography (LPTEG. In the early postoperative period, the results of LPTEG, thrombin potential, and anticoagulant and fibrinolytic activity of blood were partially normalized without reaching the level of the control group.Conclusion. For the evaluation of hemostasis under aspirin therapy it is advisable to apply the low-frequency piezothromboelastography, which in contrast to the VerifyNow test and traditional platelet aggregation, allows one to reveal a degree of impairment in thrombin blood activity and to conduct an integrative assessment on all

  9. [Mucosal changes in the periulcer zone and endocrine system in patients with gastroduodenal ulcer, complicated by hemorrhage].

    Trofimov, M V

    2014-07-01

    Examination of patients, suffering gastroduodenal ulcer, complicated by hemorrhage, was conducted, using clinical, microbiological, immunohistochemical methods and chromatomassspectrography. Enhanced activity of inducible NO-synthase, contamination of periulcer zone with microorganisms Klebsiella pneumoniae, Streptococcus beta-haemoliticus, enhancement of contents of catecholamines and serotonin in the blood serum were revealed. These changes are most expressed in severe blood loss, unstable local endoscopic hemostasis, high risk of a recurrent hemorrhage occurrence. The data obtained permit to prognosticate severity of a pathologic process course and to improve the treatment programe.

  10. Acupuncture for radiation or combined treatment induced edema in arms and legs of breast and cervical cancer patients

    Bardychev, M.S.; Guseva, L.I.; Zubova, N.D.

    1988-01-01

    Acupuncture was carried out in 141 sufferers from delayed radiation injuries to skin and soft tissues. 122 patients (86%) revealed clinical manifestations of edema of varying gravity in arms and legs, while 19 (14%) suffered radiation-induced neufritis or plexitis unaccompanied by edema. Radionuclide and rheographic studies as well as evaluation of hemostatic function showed acupuncture to be an effective treatment for edema and pain. it also improved lymph flow, rheovasographic indexes and normalized hemostasis. The best results were obtained in cases of stage 1-2 edema

  11. Radiofrequency ablation in dermatology

    Sachdeva Silonie

    2007-01-01

    Full Text Available Radiofreqeuency ablation is a versatile dermatosurgical procedure used for surgical management of skin lesions by using various forms of alternating current at an ultra high frequency. The major modalities in radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation in dermatosurgical practice has gained importance in recent years as it can be used to treat most of the skin lesions with ease in less time with clean surgical field due to adequate hemostasis and with minimal side effects and complications. This article focuses on the major tissue effects and factors influencing radiofrequency ablation and its application for various dermatological conditions.

  12. Plasma factor VII-activating protease is increased by oral contraceptives and induces factor VII activation in-vivo

    Sidelmann, Johannes J; Skouby, Sven O; Kluft, Cornelis

    2011-01-01

    Oral contraceptive (OC) use influences the hemostatic system significantly and is a risk factor for development of cardiovascular disease. Factor VII-activating protease (FSAP) has potential effects on hemostasis. The 1601GA genotype of the 1601G/A polymorphism in the FSAP gene expresses a FSAP...... progestins. FSAP genotypes, FSAP and factor VII (FVII) plasma measures were assessed at baseline and after 6 cycles of OC. The 1601GA genotype was present in 49 (8.3%) of the women and was associated with significantly reduced levels of FSAP (P=0.001). OC use increased FSAP antigen by 25% and FSAP activity...

  13. Theories of blood coagulation.

    Riddel, James P; Aouizerat, Bradley E; Miaskowski, Christine; Lillicrap, David P

    2007-01-01

    Although the concept of the coagulation cascade represented a significant advance in the understanding of coagulation and served for many years as a useful model, more recent clinical and experimental observations demonstrate that the cascade/waterfall hypothesis does not fully and completely reflect the events of hemostasis in vivo. The goal of this article is to review the evolution of the theories of coagulation and their proposed models to serve as a tool when reviewing the research and practice literature that was published in the context of these different theories over time.

  14. Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

    Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

    2008-01-01

    Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

  15. Association between biomarkers of endothelial injury and hypocoagulability in patients with severe sepsis

    Ostrowski, Sisse Rye; Haase, Nicolai; Müller, Rasmus Beier

    2015-01-01

    -, 28- and 90-day mortality rates being 21%, 39% and 53%, respectively. Pre-intervention (before treatment with different fluids), TEG reaction (R)-time, angle and maximum amplitude (MA) and FF MA all correlated with syndecan-1, thrombomodulin and PC levels. By multivariate linear regression analyses......INTRODUCTION: Patients with severe sepsis often present with concurrent coagulopathy, microcirculatory failure and evidence of vascular endothelial activation and damage. Given the critical role of the endothelium in balancing hemostasis, we investigated single-point associations between whole...

  16. Supratentorial hematoma during infratentorial surgery: A short series of three cases

    Sandeep Mohindra

    2012-01-01

    Full Text Available Distant site hematoma formation may complicate an otherwise uneventful surgery. The authors describe three cases of such unexpected complications, while operating upon infratentorial lesions in prone position. Pathophysiology behind such complications and changes in intraoperative monitoring is discussed, along with all the previously reported cases. Of the three cases, there was one death, while rest of the two cases made eventless recovery. Meticulous hemostasis, isolation of operative site, avoidance of cerebrospinal fluid over-drainage during surgery may prevent such a complication. Careful interpretation of vital-monitoring may indicate the occurrence of such a complication.

  17. Pathogenic Mechanisms Involved in the Hematological Alterations of Arenavirus-induced Hemorrhagic Fevers

    Roberto G. Pozner

    2013-01-01

    Full Text Available Viral hemorrhagic fevers (VHFs caused by arenaviruses are acute diseases characterized by fever, headache, general malaise, impaired cellular immunity, eventual neurologic involvement, and hemostatic alterations that may ultimately lead to shock and death. The causes of the bleeding are still poorly understood. However, it is generally accepted that these causes are associated to some degree with impaired hemostasis, endothelial cell dysfunction and low platelet counts or function. In this article, we present the current knowledge about the hematological alterations present in VHF induced by arenaviruses, including new aspects on the underlying pathogenic mechanisms.

  18. Factors contributing to the disturbance of coagulation and fibrinolysis in dengue virus infection

    Yung-Chun Chuang

    2013-01-01

    Full Text Available Hemorrhage is one of the hallmarks of dengue hemorrhagic fever. However, the mechanisms that cause hemorrhage are unclear. In this review we focus on the possible factors that may be involved in the disturbance of coagulation and fibrinolysis during dengue virus (DENV infection. Factors such as autoantibodies and cytokines induced by DENV infection as well as hemostatic molecules expressed on DENV-infected cells, and DENV viral proteins may all contribute to the defect of hemostasis during DENV infection. It is the combination of these viral and host factors that may tilt the balance of coagulation and fibrinolysis toward bleeding in dengue patients.

  19. An effective and safe gastric endoscopic submucosal dissection in the right lateral position using an inverted overtube.

    Mori, Hirohito; Rafiq, Kazi; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Yachida, Tatsuo; Ayagi, Maki; Tani, Joji; Miyoshi, Hisaaki; Masaki, Tsutomu

    2014-02-14

    Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection (ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.

  20. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    Turan Calhan

    2015-01-01

    Full Text Available Duodenal intramural hematoma (DIH usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

  1. [Thromboelastography and its use in cardiac surgery].

    Ak, Koray; Atalan, Nazan; Tekeli, Atike; Işbir, Selim; Civelek, Ali; Emekli, Nesrin; Arsan, Sinan

    2008-04-01

    Thromboelastography is an alternative method to conventional coagulation tests for the general evaluation of hemostatic system. Cardiac surgery with cardiopulmonary bypass is accomplished by complex alterations of hemostasis, including acquired dysfunction of platelets, consumption coagulopathy and increased fibrinolysis. Despite major advances in blood conservation methods and perioperative care of the patients, transfusion rates in cardiac surgery remain high. Thromboelastography has an ability to assess almost all components of haemostatic system globally. Currently, thromboelastography is used with standard coagulation tests to decrease the microvascular bleeding and homologous blood transfusion in cardiac surgery with cardiopulmonary bypass. In this review, we aimed to discuss thromboelastography technology and its usage in cardiac surgery.

  2. Interventional radiological treatment in complications of pancreatitis

    Memis, Ahmet E-mail: ahmemis@yahoo.com; Parildar, Mustafa

    2002-09-01

    Percutaneous interventional therapy plays an important role in treating complications of acute and chronic pancreatitis. With the development of cross-sectional imaging and advanced interventional techniques, percutaneous drainage has become the preferred treatment for pancreatic fluid collections such as acute collections, pseudocysts and abscesses. Abscess and pancreatic hemorrhage are the most life threatening complications of pancreatitis. Massive hemorrhage is rare but frequently lethal. As a rule, bleeding complications of pancreatitis require prompt diagnosis and an aggressive surgical approach. In unstable patients with a severely bleeding pseudoaneurysm, hemostasis can be obtained by occlusion with mechanical devices.

  3. Interventional radiological treatment in complications of pancreatitis

    Memis, Ahmet; Parildar, Mustafa

    2002-01-01

    Percutaneous interventional therapy plays an important role in treating complications of acute and chronic pancreatitis. With the development of cross-sectional imaging and advanced interventional techniques, percutaneous drainage has become the preferred treatment for pancreatic fluid collections such as acute collections, pseudocysts and abscesses. Abscess and pancreatic hemorrhage are the most life threatening complications of pancreatitis. Massive hemorrhage is rare but frequently lethal. As a rule, bleeding complications of pancreatitis require prompt diagnosis and an aggressive surgical approach. In unstable patients with a severely bleeding pseudoaneurysm, hemostasis can be obtained by occlusion with mechanical devices

  4. Hemobilia into a metallic biliary stent due to pseudoaneurysm. A case report

    Morishita, Naoki; Nishida, Tsutomu; Hayashi, Yoshito

    2013-01-01

    A 48-year-old man with locally advanced pancreatic cancer underwent combined treatment with gemcitabine and proton radiation therapy. Because of subsequent obstruction of the common bile duct, a metallic biliary stent was placed and he received further gemcitabine chemotherapy. During chemotherapy, he developed an acute abdomen with a sudden-onset of tarry stool and jaundice. Gastroduodenoscopy revealed hemobilia from the biliary metallic stent. Contrast-enhanced abdominal computed tomography revealed the presence of a pseudoaneurysm arising from the right hepatic artery adjacent to the top of the stent. Hemostasis of the right hepatic artery pseudoaneurysm was achieved via transcatheter arterial embolization using cyanoacrylate. (author)

  5. Thrombin binding to human brain and spinal cord

    McKinney, M.; Snider, R.M.; Richelson, E.

    1983-01-01

    Thrombin, a serine protease that regulates hemostasis, has been shown to stimulate the formation of cGMP in murine neuroblastoma cells. The nervous system in vivo thus may be postulated to respond to this blood-borne factor after it breaches the blood-brain barrier, as in trauma. Human alpha-thrombin was radiolabeled with 125I and shown to bind rapidly, reversibly, and with high affinity to human brain and spinal cord. These findings indicate the presence of specific thrombin-binding sites in nervous tissue and may have important clinical implications

  6. Haematophagous arthropod saliva and host defense system: a tale of tear and blood

    Andrade Bruno B.

    2005-01-01

    Full Text Available The saliva from blood-feeding arthropod vectors is enriched with molecules that display diverse functions that mediate a successful blood meal. They function not only as weapons against host's haemostatic, inflammatory and immune responses but also as important tools to pathogen establishment. Parasites, virus and bacteria taking advantage of vectors' armament have adapted to facilitate their entry in the host. Today, many salivary molecules have been identified and characterized as new targets to the development of future vaccines. Here we focus on current information on vector's saliva and the molecules responsible to modify host's hemostasis and immune response, also regarding their role in disease transmission.

  7. An Incidental Finding of AL-associated Amyloidosis Presenting as Gastric Ulcers

    Nadia Huq

    2018-01-01

    Full Text Available Gastrointestinal tract amyloidosis has been reported in rare instances and related symptoms are usually nonspecific to the disease process. We present a patient who initially had melena on anticoagulation and endoscopy revealed a bleeding gastric ulcer. Hemostasis was achieved. The patient had a recurrence of symptoms despite being off anticoagulation months later and at that time repeat endoscopy showed multiple gastric ulcers with surrounding friable mucosa. Biopsy results were significant for light chain associated-amyloidosis. This case represents a rare cause of gastric ulcer.

  8. [The pathogenetic and clinical significance of disorders in hemostatic homeostasis in diabetics].

    Lapchyns'ka, I I; Bielits'ka, H O; Kovalenko, S O

    1997-01-01

    DM patients who do not present with clinical manifestations of nephropathy exhibited significant reduction of urine fibrinolytic activity which is regarded as suggesting a preclinical stage of renal lesion in DM as well as hyperaggregation of platelets, enhanced activity of coagulative link of hemostasis and changes of different directions in the system of fibrinolysis. Among coagulologic methods, of most informative value is the turbidimetric method. In DM and low tolerability to glucosa, there is an increased incidence of gastroduodenal abnormalities, ulcer disease included, which fact warrants a gastroenterologic evaluation to be done in this patient population prior to prescribing anticoagulants.

  9. RENAL ALLOGENEIC TRANSPLANTATION IN PATIENT WITH HAEMOPHILIA B

    N. V. Purlo

    2014-01-01

    Full Text Available We report the case of successful renal allogeneic transplantation and treatment in a 56-year-old patient with haemophilia B at Hematology Research Center. He has received replacement therapy by factor IX since 2010. The transplant is marked with good renal function during 13 post-transplant months without episodes of rejection or bleeding complications. The complicated surgical interventions are possible in patients with haemophilia В аnd end-stage chronic renal failure in the presence of replacement therapy of IX factor for the purpose of achievement of optimum hemostasis.

  10. Percutaneous access versus surgical cut down for TAVR: Where do we go from here?

    Ates, Ismail; Cilingiroglu, Mehmet

    2018-06-01

    Transcatheter aortic valve replacement is now the standard of care for severe symptomatic aortic stenosis patients who are at high-surgical risk. Percutaneous approach without a surgical cut down has been increasingly adapted by some centers in USA. Percutaneous approach seems to be associated with shorter hospital stay, similar short and late vascular complications, less disabling stroke, similar mortality as well as significantly less hospital cost. However, this technique also requires operators to be able to manage any vascular complications using advanced endovascular interventions to achieve complete hemostasis. © 2018 Wiley Periodicals, Inc.

  11. Antithrombotic Protective Effects of Arg-Pro-Gly-Pro Peptide during Emotional Stress Provoked by Forced Swimming Test in Rats.

    Grigor'eva, M E; Lyapina, L A

    2017-01-01

    Blood coagulation was enhanced and all factors (total, enzyme, and non-enzyme) of the fibrinolytic system were suppressed in rats in 60 min after forced swimming test. Argininecontaining tetrapeptide glyproline Arg-Pro-Gly-Pro administered prior to this test activated fibrinolysis and prevented hypercoagulation. Administration of this peptide in 5 min after swimming test also enhanced anticoagulant, fibrinolytic, and antithrombotic activity of the blood. Therefore, glyproline Arg-Pro-Gly-Pro exerted both preventive and curative effects on the hemostasis system and prevented enhancement of blood coagulation provoked by emotional stress modeled by forced swimming test.

  12. Like a slippery fish, a little slime is a good thing: the glycocalyx revealed.

    Biddle, Chuck

    2013-12-01

    The glycocalyx is a dynamic network of multiple membrane-bound complexes lining the vascular endothelium. Its role in maintaining vascular homeostasis includes regulating vascular permeability as well as a range of vital functions, such as mechanotransduction, hemostasis, modulation of inflammatory processes, and serving as an antiatherogenic. Revisionist thinking about the Starling principle is discussed in terms of the major influence of the glycocalyx on capillary and tissue fluid homeostasis. The clinical and pathophysiologic threats to the glycocalyx are reviewed as well as strategies to maintain its integrity.

  13. Nasopharyngeal angiofibroma treated with radiotherapy

    Janaki M

    2007-01-01

    Full Text Available Nasopharyngeal angiofibroma is a rare, highly vascular, benign, locally aggressive tumor, affecting boys of adolescent age. The aggressiveness and high vascularity makes surgery and even a biopsy difficult in majority of cases. Although surgery is the treatment of choice in early cases, considerable debate exists regarding the treatment of advanced disease with intracranial extension. Radiotherapy provides a good response and also avoids surgery-associated morbidity. We are herewith reporting a case of nasopharyngeal angiofibroma who showed complete hemostasis and improvement in vision to radiotherapy

  14. Neuroimaging differential diagnoses to abusive head trauma

    Girard, Nadine; Brunel, Herve; Dory-Lautrec, Philippe; Chabrol, Brigitte

    2016-01-01

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  15. Successful Large-volume Leukapheresis for Hematopoietic Stem Cell Collection in a Very-low-weight Brain Tumor Infant with Coagulopathy

    Yu-Mei Liao

    2013-06-01

    Full Text Available Peripheral apheresis has become a safe procedure to collect hematopoietic stem cells, even in pediatric patients and donors. However, the apheresis procedure for small and sick children is more complicated due to difficult venous access, relatively large extracorporeal volume, toxicity of citrate, and unstable hemostasis. We report a small and sick child with refractory medulloblastoma, impaired liver function, and coagulopathy after several major cycles of cisplatin-based chemotherapy. She successfully received large-volume leukapheresis for hematopoietic stem cell collection, although the patient experienced severe coagulopathy during the procedures. Health care providers should be alert to this potential risk.

  16. ASSESSMENT OF ERYTHROCYTE PERIPHERAL BLOOD AND ACTIVITY OF HEMOST ASIS IN PATIENTS WITH CER VICAL CANCER

    N. I. Stuklov

    2016-01-01

    Full Text Available Despite the availability and informative value of methods that facilitate the diagnosis, cervical cancer (CC does not lose its leading position as one of the most common cancers of the reproductive system in women worldwide. High prevalence of anemia and thrombotic complications in this group determines not only the quality of life of patients, but the outcome of the underlying disease. The purpose of the study was to determine the patterns of change in erythrocyte of peripheral blood and the state of vascular-platelet and coagulation hemostasis in patients with cervical cancer depending on the stage of disease and histological variant of the tumor.Materials and methods. We investigated the performance of erythron, thrombocytic and coagulation hemostasis in 74 patients with cervical cancer (mean age 46,49 ± 11,78 years. Blood analysis was performed in the initial evaluation of patients in the prehospital phase.Results. It is proved that the spread of the tumor outside the cervix exerts a systemic influence on hematopoiesis, hemostasis, significantly increasing the risk of venous thromboembolism and hematogenous dissemination of the disease (metastasis. In the case of adenocarcinoma and dimorphic (glandular-squamous cervical cancer we proved the significant increase in soluble fibrin-monomer complexes, fibrinogen, and with glandular-squamous-cell cervical cancer and hypercoagulability (decrease thrombin time, which requires mandatory and differentiated prevention of venous thromboembolism even in the early stages of these morphological variants of the disease.Conclusions. Cervical cancer has a systemic effect on the blood and hemostasis. A statistically significant decrease in the concentration of hemoglobin and increased erythrocyte sedimentation rate is determined in the second stage of the disease. The increase in the prevalence of cervical cancer and the presence of glandular component in the morphological

  17. Platelet aggregation following trauma

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...... aggregation response and ISS. Higher TRAP values were associated with death due to cerebral injuries (P 

  18. Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome

    Rawat SKS

    2010-01-01

    Full Text Available Antiphospholipid antibody syndrome (APLAS characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS.

  19. Neuroimaging differential diagnoses to abusive head trauma

    Girard, Nadine [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Aix Marseille University, UMR CNRS 7339, Marseille (France); Brunel, Herve; Dory-Lautrec, Philippe [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Chabrol, Brigitte [AP-HM Timone, Department of Pediatric Neurology, Marseille (France)

    2016-05-15

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  20. A case report of pancreatic transection by blunt abdominal trauma.

    Braşoveanu, V; Bălescu, I; Anghel, C; Barbu, I; Ionescu, M; Bacalbaşa, N

    2014-01-01

    Posttraumatic pancreatic rupture is associated with high morbidity and mortality. Various management strategies are described, but due to the relative rarity of this pathology no standards exist. We reported a 21 years old male with post traumatic complete rupture of the pancreatic isthmus,devascularization lesion of descending duodenum, right renal artery posttraumatic thrombosis and left lobe of the liver laceration. Laparotomy for hemostasis was initially performed in a different hospital and the patient was then referred to us.Pancreaticoduodenectomy and right nephrectomy were performed. Postoperatively the patient had a pancreaticojejunal anastomosis fistula spontaneously resolved at 45 days.Pancreaticoduodenectomy can in selected cases be a solution in pancreatic trauma. Celsius.

  1. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Cincu Rafael

    2009-01-01

    Full Text Available Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia and later on can manifest as rebleeding and neurological deterioration.

  2. Second chance for a totally thoracoscopic video-assisted pulmonary vein isolation for atrial fibrillation.

    Driessen, Antoine H G; Krul, Sébastien P J; de Mol, Bas A J M; de Groot, Joris R

    2012-06-01

    Thoracoscopic surgery for atrial fibrillation (AF) is an attractive and emerging treatment modality. However, when a bleeding occurs access for hemostasis is limited. Therefore, a sternotomy might be necessary to stop the bleeding and continue the operation. We report 2 patients with a periprocedural bleeding in whom sternotomy could be prevented by tamponading the bleeding, interrupting the operation and resuming 3 weeks later. Our cases show that sternotomies can be prevented and that there is a second chance for thoracoscopic surgery for AF. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Platelets as autonomous drones for hemostatic and immune surveillance.

    Li, Jackson LiangYao; Zarbock, Alexander; Hidalgo, Andrés

    2017-07-18

    Platelets participate in many important physiological processes, including hemostasis and immunity. However, despite their broad participation in these evolutionarily critical roles, the anucleate platelet is uniquely mammalian. In contrast with the large nucleated equivalents in lower vertebrates, we find that the design template for the evolutionary specialization of platelets shares remarkable similarities with human-engineered unmanned aerial vehicles in terms of overall autonomy, maneuverability, and expendability. Here, we review evidence illustrating how platelets are uniquely suited for surveillance and the manner in which they consequently provide various types of support to other cell types. © 2017 Li et al.

  4. Von-Willebrand Disease Presenting as Intractable Epistaxis after Nasal Polypectomy

    Jeong Jin Park

    2014-01-01

    Full Text Available Von-Willebrand disease (VWD is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. VWD patients typically have normal laboratory results on screening for bleeding disorders. To suspect and diagnose VWD, a careful review of past medical history and laboratory tests is critical. A 59-year-old male patient presented with intractable nasal bleeding after nasal polypectomy. The bleeding was controlled by platelet transfusion, and he was later diagnosed with VWD.

  5. TREATMENT OF ULCER GASTRODUODENAL BLEEDINGS: CURRENT STATE OF THE PROBLEM (A LITERATURE REVIEW

    O. N. Antonov

    2014-01-01

    Full Text Available ABSTRACT. The problem of ulcer gastro-duodenal bleeding therapy is one of the most essential in urgent surgery. The bleeding is the most serious complication of peptic ulcer desease. It is observed in 15– 20% cases when patients have peptic ulcer diagnosis determined. In general the issues of bleeding therapy in gastroduodenal sphere are surveyed imperfectly. Some patulous endoscopic hemostasis methods don’t fully meet safety and confidence reqirements that preserves high level of general and post-operational lethality in our country and in the rest of the world. 

  6. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  7. [Risk assessment of thrombotic events in patients with schizophrenia and schizoaffective disorder in the acute state: the 'fibrinodynamics' technology].

    Brusov, O S; Matveev, I A; Kirillov, P S; Faktor, M I; Karpova, N S; Vasilyeva, E F; Katasonov, A B; Zozulya, S A; Klushnik, T P

    To assess the risk of thrombotic events in patients with schizophrenia and schizoaffective disorder based on 'fibrinodynamics' technology. A group of 76 women, including 38 with paranoid schizophrenia (F20.0), 18 with schizoaffective disorder (F25.1) in the acute stage, and 20 healthy controls, participated in the study. The technology includes the study of coagulation and fibrinolysis, Karmin author software, and calculation of peak time and hemostasis potential of spontaneous clots. Growth and lysis of fibrin clots were studied in plasma purified from platelets. All preanalytic procedures were conducted within 30 minutes after blood sampling. Blood serum was studied separately using the neuroimmunological test. Dynamic of brightness profiles of the clots was determined and a number of parameters (peak time and hemostasis potential of spontaneous clots) were calculated using the Karmin software. In patients with schizophrenia, the dynamic brightness profile of the clots has two peaks: the first peak is formed as a result of the growth and lysis of the clot initiated by the activator, the second peak is due to the growth and lysis of spontaneous clots in the volume of the measuring cuvette far from the activator. In healthy donors, the second peak under experimental conditions is absent. In the group of schizophrenic patients, a strong negative correlation is observed between the peak time of the second peak and the activity of leukocyte elastase (Spearman R = -0.75, p<0.0001), i.e. the greater the activity of elastase, the earlier the maximum of the second peak is formed and vice versa. In the control group, there is no such correlation. Evaluation of the potential of hemostasis of spontaneous clots showed that in 42% of schizophrenic patients this parameter is shifted above the norm, which indicates an increased risk of thrombosis of small brain arteries in these patients. The developed technology of 'fibrinodynamics' has a good potential for introduction into

  8. Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature.

    Lehmann, Pierre; Saliou, Guillaume; Page, Cyril; Balut, Antonia; Le Gars, Daniel; Vallée, Jean Noel

    2009-05-01

    True carotid aneurysms with sphenoid extension and revealed by epistaxis are rare. A review of the literature shows the mortality risk of this pathology and the different therapeutic options. A 41-year-old female presented with a cavernous carotid aneurysm with sphenoid extension revealed by massive epistaxis. We propose a combined treatment of the affected vessel using coils and an uncovered stent. The first stage to stop the hemorrhages and occlude the aneurysm using the coil and the second stage several days later after anticoagulation using the stent to prevent revascularization. This treatment has been shown to be effective in producing immediate hemostasis and stable long-term occlusion.

  9. [Acute severe colitis with recto-vaginal fistula during treatment with non-steroidal anti-inflammatory agents].

    Tissot, B; Lamy, A; Perraudeau, F; Manouvrier, J L; Imbert, Y

    2002-07-13

    We report the case of severe colitis occurring during treatment with non-steroid anti-inflammatories (NSAI). A 57 year-old woman was hospitalized for lumbar pain that had not been relieved by AINS, tramadol and then morphine. The patient presented with septic shock and peritonitis by rectal perforation, followed by acute rectorrhagia. The endoscopic aspect evoked Crohn's disease with a recto-vaginal fistula. Progression was further complicated by two episodes of collapse because of acute rectorrhagia, requiring hemostasis colectomy and abdominal-perineal amputation. The diagnosis retained was AINS-induced colitis complicated by acute colectasia on a fecaloma with recto-vaginal fistula.

  10. Acupuncture for radiation or combined treatment induced edema in arms and legs of breast and cervical cancer patients

    Bardychev, M S; Guseva, L I; Zubova, N D

    1988-01-01

    Acupuncture was carried out in 141 sufferers from delayed radiation injuries to skin and soft tissues. 122 patients (86%) revealed clinical manifestations of edema of varying gravity in arms and legs, while 19 (14%) suffered radiation-induced neufritis or plexitis unaccompanied by edema. Radionuclide and rheographic studies as well as evaluation of hemostatic function showed acupuncture to be an effective treatment for edema and pain. it also improved lymph flow, rheovasographic indexes and normalized hemostasis. The best results were obtained in cases of stage 1-2 edema.

  11. Current use of factor concentrates in pediatric cardiac anesthesia.

    Guzzetta, Nina A; Williams, Glyn D

    2017-07-01

    Excessive bleeding following pediatric cardiopulmonary bypass is associated with increased morbidity and mortality, both from the effects of hemorrhage and the therapies employed to achieve hemostasis. Neonates and infants are especially at risk because their coagulation systems are immature, surgeries are often complex, and cardiopulmonary bypass technologies are inappropriately matched to patient size and physiology. Consequently, these young children receive substantial amounts of adult-derived blood products to restore adequate hemostasis. Adult and pediatric data demonstrate associations between blood product transfusions and adverse patient outcomes. Thus, efforts to limit bleeding after pediatric cardiopulmonary bypass and minimize allogeneic blood product exposure are warranted. The off-label use of factor concentrates, such as fibrinogen concentrate, recombinant activated factor VII, and prothrombin complex concentrates, is increasing as these hemostatic agents appear to offer several advantages over conventional blood products. However, recognizing that these agents have the potential for both benefit and harm, well-designed studies are needed to enhance our knowledge and to determine the optimal use of these agents. In this review, our primary objective was to examine the evidence regarding the use of factor concentrates to treat bleeding after pediatric CPB and identify where further research is required. PubMed, MEDLINE/OVID, The Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched to identify existing studies. © 2017 John Wiley & Sons Ltd.

  12. The effective control of a bleeding injury using a medical adhesive containing batroxobin

    You, Kyung Eun; Koo, Min-Ah; Lee, Dae-Hyung; Kwon, Byeong-Ju; Lee, Mi Hee; Park, Jong-Chul; Hyon, Suong-Hyu; Seomun, Young; Kim, Jong-Tak

    2014-01-01

    Many types of hemostatic agents have been studied for the effective control of bleeding. In this study, a powdery medical adhesive composed of aldehyded dextran and ε-poly (L-lysine) was used with the recombinant batroxobin. Batroxobin is a venomous component from the snake Bothrops atrox moojeni and catalyzes fibrinogen conversion to form soluble fibrin clots. This research aims to examine the performance of the batroxobin-containing adhesive for hemostasis, and evaluate its potential as a novel hemostatic adhesive. The fibrinogen conversion ability of batroxobin was evaluated by a fibrinogen clotting assay and a whole blood clotting assay. Both experiments demonstrated the effectiveness of the batroxobin-containing adhesive for blood clot formation. Animal experiments were also conducted. After a pricking wound was made in an ICR (imprinting control region) mouse liver, the adhesive and various concentrations of batroxobin were applied. The total amount of blood loss was reduced with increasing concentrations of batroxobin. For excessive bleeding conditions, the femoral artery wound model of SD (Sprague-Dawley) rats was adopted. With higher concentrations of batroxobin, hemostasis was more rapidly achieved. Histological analysis of the liver model also supports the hemostatic effects through fibrin clot formation. In conclusion, batroxobin and medical adhesive effectively facilitate blood coagulation, and could be developed for clinical use. (paper)

  13. Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome

    Ruess, L. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Sivit, C.J. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States)]|[Dept. of Pediatrics, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Eichelberger, M.R. [Dept. of Pediatrics, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States)]|[Dept. of Surgery, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences Washington, DC (United States); Taylor, G.A. [Dept. of Diagnostic Imaging and Radiology, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences, Washington, DC (United States); Bond, S.J. [Dept. of Surgery, Children`s National Medical Center, and George Washington Univ. School of Medicine and Health Sciences Washington, DC (United States)

    1995-07-01

    The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by {chi}{sup 2}-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by {chi}{sup 2}-test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury. (orig.)

  14. Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome

    Ruess, L.; Sivit, C.J.; Eichelberger, M.R.; Taylor, G.A.; Bond, S.J.

    1995-01-01

    The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by χ 2 -test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by χ 2 -test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury. (orig.)

  15. Evidence supporting the use of recombinant activated factor VII in congenital bleeding disorders

    Pär I Johansson

    2010-06-01

    Full Text Available Pär I Johansson, Sisse R OstrowskiCapital Region Blood Bank, Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Recombinant activated factor VII (rFVIIa, NovoSeven® was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX.Objective: To review the evidence supporting the use of rFVIIa for the treatment of patients with congenital bleeding disorders.Patients and methods: English-language databases were searched in September 2009 for reports of randomized controlled trials (RCTs evaluating the ability of rFVIIa to restore hemostasis in patients with congenital bleeding disorders.Results: Eight RCTs involving 256 hemophilic patients with antibodies against coagulation factors, also known as inhibitors, were identified. The evidence supporting the use of rFVIIa in these patients was weak with regard to dose, clinical setting, mode of administration, efficacy, and adverse events, given the limited sample size of each RCT and the heterogeneity of the studies.Conclusion: The authors suggest that rFVIIa therapy in hemophilic patients with inhibitors should be based on the individual’s ability to generate thrombin and form a clot, and not on the patient’s weight alone. Therefore, assays for thrombin generation, such as whole-blood thromboelastography, have the potential to significantly improve the treatment of these patients.Keywords: hemophilia, inhibitors, coagulation factor VIII, coagulation factor IX, rFVIIa, NovoSeven, FEIBA, hemostasis, RCT

  16. A hypothesis: factor VII governs clot formation, tissue repair and apoptosis.

    Coleman, Lewis S

    2007-01-01

    A hypothesis: thrombin is a "Universal Enzyme of Energy Transduction" that employs ATP energy in flowing blood to activate biochemical reactions and cell effects in both hemostasis and tissue repair. All cells possess PAR-1 (thrombin) receptors and are affected by thrombin elevations, and thrombin effects on individual cell types are determined by their unique complement of PAR-1 receptors. Disruption of the vascular endothelium (VE) activates a tissue repair mechanism (TRM) consisting of the VE, tissue factor (TF), and circulating Factors VII, IX and X that governs localized thrombin elevations to activate clot formation and cellular effects that repair tissue damage. The culmination of the repair process occurs with the restoration of the VE followed by declines in thrombin production that causes Apoptosis ("programmed cell death") in wound-healing fibroblasts, which functions as a mechanism to draw wound edges together. The location and magnitude of TRM activity governs the location and magnitude of Factor VIII activity and clot formation, but the large size of Factor VIII prevents it from penetrating the clot formed by its activity, so that its effects are self-limiting. Factors VII, IX and X function primarily as tissue repair enzymes, while Factor VIII and Factor XIII are the only serine protease enzymes in the "Coagulation Cascade" that are exclusively associated with hemostasis.

  17. Effect of uterine arterial embolization on the ovarian function in puerpera with postpartum hemorrhage

    Yan-Xian Deng

    2017-06-01

    Full Text Available Objective: To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function. Methods: A total of 45 patients with postpartum hemorrhage who were admitted in the Department of Obstetrics of our hospital from January, 2014 to June, 2016 for uterine arterial embolization were included in the study and served as the treatment group. The postoperative menstruation recovery was recorded. The hormone levels, ovarian function, and pelvic floor function before and after treatment were recorded. A total of 42 normal puerpera were served as the control group. The menstrual status of the two groups after menstruation was compared. Results: Rapid and effective hemostasis could be obtained from patients in the treatment group after treatment with hemostasis success rate of 100%. The comparison of menstruation cycle and menstruation days after treatment between the two groups was not statistically significant. The levels of E2, P, FSH, LH and PRL, ovarian function index RI and PI, pelvic floor muscle fatigue and vaginal dynamic pressure before and after 3 and 6 months had no significant difference, and there was no significant difference between the 2 groups. Conclusions: Uterine arterial embolization in the treatment of postpartum hemorrhage is effective, and has no influence on the patient's menstrual conditions, sex hormone levels, ovarian and pelvic floor functions; therefore, it is worthy of clinical application.

  18. Orofacial manifestations of hematological disorders: Anemia and hemostatic disorders

    Titilope A Adeyemo

    2011-01-01

    Full Text Available The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of hemostasis. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases, with emphasis on anemia. Mesh phrases used in the search were: oral diseases AND anaemia; orofacial diseases AND anaemia; orofacial lesions AND anaemia; orofacial manifestations AND disorders of haemostasis. The Boolean operator "AND" was used to combine and narrow the searches. Anemic disorders associated with orofacial signs and symptoms include iron deficiency anemia, Plummer-Vinson syndrome, megaloblastic anemia, sickle cell anemia, thalassaemia and aplastic anemia. The manifestations include conjunctiva and facial pallor, atrophic glossitis, angular stomatitis, dysphagia, magenta tongue, midfacial overgrowth, osteoclerosis, osteomyelitis and paraesthesia/anesthesia of the mental nerve. Orofacial petechiae, conjunctivae hemorrhage, nose-bleeding, spontaneous and post-traumatic gingival hemorrhage and prolonged post-extraction bleeding are common orofacial manifestations of inherited hemostatic disorders such as von Willebrand′s disease and hemophilia. A wide array of anemic and hemostatic disorders encountered in internal medicine has manifestations in the oral cavity and the facial region. Most of these manifestations are non-specific, but should alert the hematologist and the dental surgeon to the possibilities of a concurrent disease of hemopoiesis or hemostasis or a latent one that may subsequently manifest itself.

  19. Introduction of argon beam coagulation functionality to robotic procedures using the ABC D-Flex probe: equivalency to an existing laparoscopic instrument

    Merchel, Renée. A.; Barnes, Kelli S.; Taylor, Kenneth D.

    2015-03-01

    INTRODUCTION: The ABC® D-Flex Probe utilizes argon beam coagulation (ABC) technology to achieve hemostasis during minimally invasive surgery. A handle on the probe allows for integration with robotic surgical systems and introduces ABC to the robotic toolbox. To better understand the utility of D-Flex, this study compares the performance of the D-Flex probe to an existing ABC laparoscopic probe through ex vivo tissue analysis. METHODS: Comparisons were performed to determine the effect of four parameters: ABC device, tissue type, activation duration, and distance from tissue. Ten ABC D-Flex probes were used to create 30 burn samples for each comparison. Ex vivo bovine liver and porcine muscle were used as tissue models. The area and depth of each burn was measured using a light microscope. The resulting dimensional data was used to correlate tissue effect with each variable. RESULTS: D-Flex created burns which were smaller in surface area than the laparoscopic probe at all power levels. Additionally, D-Flex achieved thermal penetration levels equivalent to the laparoscopic probe. CONCLUSION: D-Flex implements a small 7F geometry which creates a more focused beam. When used with robotic precision, quick localized superficial hemostasis can be achieved with minimal collateral damage. Additionally, D-Flex achieved equivalent thermal penetration levels at lower power and argon flow-rate settings than the laparoscopic probe.

  20. Traumatic injuries: radiological hemostatic intervention at admission

    Dondelinger, R.F.; Trotteur, G.; Ghaye, B.; Szapiro, D. [Department of Medical Imaging, University Hospital Sart Tilman, Liege (Belgium)

    2002-05-01

    Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. Trauma-dedicated interventional radiologists should be on call for optimal patient management. Posttraumatic retroperitoneal and pelvic bleeding is a primary indication for angiographic hemostasis, together with orthopedic fixation of pelvic bone fractures. Angiography should be carried out rapidly, before the patient decompensates for considerable blood loss. In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae. (orig.)

  1. Traumatic injuries: radiological hemostatic intervention at admission

    Dondelinger, R.F.; Trotteur, G.; Ghaye, B.; Szapiro, D.

    2002-01-01

    Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. Trauma-dedicated interventional radiologists should be on call for optimal patient management. Posttraumatic retroperitoneal and pelvic bleeding is a primary indication for angiographic hemostasis, together with orthopedic fixation of pelvic bone fractures. Angiography should be carried out rapidly, before the patient decompensates for considerable blood loss. In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae. (orig.)

  2. Platelet-Derived Microvesicles in Cardiovascular Diseases

    Maria T. K. Zaldivia

    2017-11-01

    Full Text Available Microvesicles (MVs circulating in the blood are small vesicles (100–1,000 nm in diameter derived from membrane blebs of cells such as activated platelets, endothelial cells, and leukocytes. A growing body of evidence now supports the concept that platelet-derived microvesicles (PMVs, the most abundant MVs in the circulation, are important regulators of hemostasis, inflammation, and angiogenesis. Compared with healthy individuals, a large increase of circulating PMVs has been observed, particularly in patients with cardiovascular diseases. As observed in MVs from other parent cells, PMVs exert their biological effects in multiple ways, such as triggering various intercellular signaling cascades and by participating in transcellular communication by the transfer of their “cargo” of cytoplasmic components and surface receptors to other cell types. This review describes our current understanding of the potential role of PMVs in mediating hemostasis, inflammation, and angiogenesis and their consequences on the pathogenesis of cardiovascular diseases, such as atherosclerosis, myocardial infarction, and venous thrombosis. Furthermore, new developments of the therapeutic potential of PMVs for the treatment of cardiovascular diseases will be discussed.

  3. Short-Term Safety and Efficacy of Femoral Vascular Closure after Percutaneous Coronary Intervention with Combination of the Boomerang(TM) Device and Intravenous Protamine Sulfate.

    Chen, Ching-Pei; Huang, Huang-Kai; Hsia, Chien-Hsun; Chang, Yung-Ming; Lin, Lee-Shin; Lee, Cheng-Liang

    2013-11-01

    The Cardiva Boomerang(TM) is a device used to perform femoral vascular closure. It facilitates passive hemostasis at the arteriotomy site, leaving no residual foreign body. We performed a controlled, randomized study of 60 patients undergoing percutaneous coronary intervention. Patients were randomized into two groups (30 per group) to undergo vascular closure with the Boomerang(TM) or the Perclose(TM) suture-based device after the intravenous administration of protamine sulfate. We compared overall success rates, patient-reported pain, length of time to achieve hemostasis and mobilization of the patient, and the frequency of complications in the two groups. Overall success rates using the Boomerang(TM) and Perclose(TM) devices were similarly high, at 93% and 97%, respectively. The Boomerang(TM) was significantly quicker to deploy than the PercloseTM, device deployment time, median (Q1-Q3), [2.00 (1.33-2.75) vs. 3.84 (2.75-4.38) mins, p Boomerang(TM) group (1.1 ± 1.7 vs. 6.4 ± 2.9, p Boomerang(TM) (p Boomerang(TM) device is as safe and effective as the Perclose(TM) device for femoral vascular closure, but quicker to deploy and less painful to patients. Boomerang; Percutaneous intervention; Vascular closure device.

  4. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding.

    Hickman, DaShawn A; Pawlowski, Christa L; Sekhon, Ujjal D S; Marks, Joyann; Gupta, Anirban Sen

    2018-01-01

    Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Thermodynamic, Anticoagulant, and Antiproliferative Properties of Thrombin Binding Aptamer Containing Novel UNA Derivative

    Kotkowiak, Weronika; Lisowiec-Wachnicka, Jolanta; Grynda, Jakub

    2018-01-01

    Thrombin is a serine protease that plays a crucial role in hemostasis, fibrinolysis, cell proliferation, and migration. Thrombin binding aptamer (TBA) is able to inhibit the activity of thrombin molecule via binding to its exosite I. This 15-nt DNA oligonucleotide forms an intramolecular, antipar......Thrombin is a serine protease that plays a crucial role in hemostasis, fibrinolysis, cell proliferation, and migration. Thrombin binding aptamer (TBA) is able to inhibit the activity of thrombin molecule via binding to its exosite I. This 15-nt DNA oligonucleotide forms an intramolecular......, antiparallel G-quadruplex structure with a chair-like conformation. In this paper, we report on our investigations on the influence of certain modified nucleotide residues on thermodynamic stability, folding topology, and biological properties of TBA variants. In particular, the effect of single incorporation......-quadruplex thermodynamic and biological stability, and that the effect is strongly position dependent. Interestingly, TBA variants containing the modified nucleotide residues are characterized by unchanged folding topology. Thrombin time assay revealed that incorporation of certain UNA residues may improve G...

  6. Maternal malaria induces a procoagulant and antifibrinolytic state that is embryotoxic but responsive to anticoagulant therapy.

    John W Avery

    Full Text Available Low birth weight and fetal loss are commonly attributed to malaria in endemic areas, but the cellular and molecular mechanisms that underlie these poor birth outcomes are incompletely understood. Increasing evidence suggests that dysregulated hemostasis is important in malaria pathogenesis, but its role in placental malaria (PM, characterized by intervillous sequestration of Plasmodium falciparum, proinflammatory responses, and excessive fibrin deposition is not known. To address this question, markers of coagulation and fibrinolysis were assessed in placentae from malaria-exposed primigravid women. PM was associated with significantly elevated placental monocyte and proinflammatory marker levels, enhanced perivillous fibrin deposition, and increased markers of activated coagulation and suppressed fibrinolysis in placental plasma. Submicroscopic PM was not proinflammatory but tended to be procoagulant and antifibrinolytic. Birth weight trended downward in association with placental parasitemia and high fibrin score. To directly assess the importance of coagulation in malaria-induced compromise of pregnancy, Plasmodium chabaudi AS-infected pregnant C57BL/6 mice were treated with the anticoagulant, low molecular weight heparin. Treatment rescued pregnancy at midgestation, with substantially decreased rates of active abortion and reduced placental and embryonic hemorrhage and necrosis relative to untreated animals. Together, the results suggest that dysregulated hemostasis may represent a novel therapeutic target in malaria-compromised pregnancies.

  7. Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

    Ari Garber

    2016-09-01

    Full Text Available Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical, EndoClot (EndoClot Plus Inc., and Ankaferd Blood Stopper (Ankaferd Health Products, in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

  8. Early career professionals: the mission of a task force.

    Barnes, G D; Lauw, M N

    2016-07-01

    Early career researchers and clinicians face unique challenges in comparison with more senior colleagues, for instance connecting with expert leaders outside of their own institution to enhance their expertise. As the largest international thrombosis and hemostasis professional society, the ISTH can play a central role in supporting the development of early career professionals. The ISTH Early Career Task Force was formed to improve support for, and encourage collaboration between early career thrombosis and hemostasis researchers and clinicians. These activities include (1) maintaining an online forum for early career ISTH members to connect, promote clinical, research, funding and educational activities, and to generate a sense of community; (2) broaden ISTH's reach with early career professionals in the developing world through promotion of the Reach-the-World fellowships and translating ISTH websites into six languages; (3) encourage early career engagement with ISTH activities, such as guidelines and guidance document processing and online webinar series; and (4) establishing this early career forum series in this journal. The JTH Forum series will highlight the early career perspective on a wide range of issues relevant to this group, and all ISTH early career members are encouraged to contribute. © 2016 International Society on Thrombosis and Haemostasis.

  9. The Effectiveness of a New Hemostatic Agent (Ankaferd Blood Stopper for the Control of Bleeding following Tooth Extraction in Hemophilia: A Controlled Clinical Trial

    Hakkı Oğuz Kazancıoğlu

    2013-03-01

    Full Text Available Objective: To assess the hemostatic efficacy of a new local hemostatic agent, Ankaferd Blood Stopper (ABS, for the control of bleeding following tooth extraction in hemophiliacs. Materials and Methods: Simple tooth extractions were performed in 27 hemophilia A patients. In the treatment group (n=17 local hemostasis was achieved via application of ABS to the extraction sockets, whereas in the control group (n=10 local hemostasis was achieved via direct packing with gauze. Results: In all, 57 (21 primary and 36 permanent teeth extractions were performed in 27 hemophilia A patients. There were no significant differences in age or factor VIII level distribution between the 2 groups (p>0.05. The most significant clinical difference between the groups was associated with the use of ABS; those in the treatment group had significantly shorter duration of bleeding (p=0.002. Conclusion: This is the first study to evaluate the efficacy of ABS for the control of bleeding following tooth extraction in hemophiliacs. ABS can be considered an alternative local hemostatic agent for reducing clotting factor concentrates in hemophilia patients.

  10. [Inventive activity of the Departments of Chemistry and Biochemistry of Enzymes, and Protein Structure and Function of the Palladin Institute of Biochemistry of NAS of Ukraine. Part III. Diagnostic test-systems for analysis of fibrinolysis blood system and novel approaches to thrombosis treatment].

    Danilova, V M; Vynogradova, R P; Chernysh, I Yu

    2016-01-01

    This article continues analysis of scientific achievements of the Institute of Biochemistry in the study of hemostasis system. Two previous articles were focused on the studies of blood coagulation proteins and development of the immune-enzyme test-systems for evaluation of the risk of thrombosis upon various pathologies. This article highlights the research on the blood fibrinolysis system and new approaches to thrombosis treatment, which were developed (and are under development) in the Palladin Institute of Biochemistry of the NAS of Ukraine, in particular, in the Department of Chemistry and Biochemistry of Enzymes headed previously by Dr.Sci.(Biol.) S. O. Kudinov and now by Dr.Sci.(Biol.) T .V. Grinenko, and also in the Department of Protein Structure and Function headed by Dr.Biol.Sci. E. M. Makogonenko. The fundamental knowledge of protein molecule functions and mechanisms of regulation of blood coagulation and fibrinolysis opens up new opportunities to diagnose hemostasis disorders and control the effectiveness of the cardiovascular disease treatment and also contributes to development of new techniques for isolation of new proteins – promising therapeutic agents.

  11. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.

    Loor, Gabriel; Vivacqua, Alessandro; Sabik, Joseph F; Li, Liang; Hixson, Eric D; Blackstone, Eugene H; Koch, Colleen G

    2013-11-01

    High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding. From January 1, 2011, through June 30, 2012, 5812 cardiac surgical procedures were performed at Cleveland Clinic (Cleveland, OH). A multidisciplinary team developed a simple, easy-to-perform hemostasis checklist based on the most common sites of bleeding. An extensive educational in-service was performed before limited, then universal, checklist implementation. Geometric charts were used to track the number of cases between consecutive reoperations for bleeding. We compared these before (phase 0) and after the first limited implementation phase (phase 1) and the universal implementation phase (phase 2) of the checklist. The average number of cases between consecutive reoperations for bleeding increased from 32 in phase 0 to 53 in both phase 1 (P = .002) and phase 2 (P = .01). A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  12. Diode Laser Excision of Oral Benign Lesions.

    Mathur, Ena; Sareen, Mohit; Dhaka, Payal; Baghla, Pallavi

    2015-01-01

    Lasers have made tremendous progress in the field of dentistry and have turned out to be crucial in oral surgery as collateral approach for soft tissue surgery. This rapid progress can be attributed to the fact that lasers allow efficient execution of soft tissue procedures with excellent hemostasis and field visibility. When matched to scalpel, electrocautery or high frequency devices, lasers offer maximum postoperative patient comfort. Four patients agreed to undergo surgical removal of benign lesions of the oral cavity. 810 nm diode lasers were used in continuous wave mode for excisional biopsy. The specimens were sent for histopathological examination and patients were assessed on intraoperative and postoperative complications. Diode laser surgery was rapid, bloodless and well accepted by patients and led to complete resolution of the lesions. The excised specimen proved adequate for histopathological examination. Hemostasis was achieved immediately after the procedure with minimal postoperative problems, discomfort and scarring. We conclude that diode lasers are rapidly becoming the standard of care in contemporary dental practice and can be employed in procedures requiring excisional biopsy of oral soft tissue lesions with minimal problems in histopathological diagnosis.

  13. [Analysis and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome in children using plasma-mediated radio-frequency ablation at low temperature].

    Wang, Jun; Chen, Jie; Yang, Jun

    2013-09-01

    To analyze retrospectively cause, prevention and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome (OSAHS) in children using plasma-mediated radio-frequency (pmRF) ablation at low temperature. Tonsil and adenoid ablation were carried out in 4028 cases diagnosed with OSAHS, using ENTColator lI plasma system of Arthocare company under general anesthesia. Postoperative hemorrhage occurred in 37 cases of 4028 cases, among which 1 case occurred after tonsil ablation and other 36 cases occurred after adenoid ablation. Primary hemorrhage was in 7 cases, while secondary hemorrhage in other 30 cases. Cessation of bleeding was achieved by using different methods of hemostasis in all cases. Tonsil and adenoid ablation were performed by pmRF at low temperature with advantages of less trauma, less bleeding. However, postoperative hemorrhage might occur in a few cases (accounting for 0.92%). Postoperative hemorrhage in these patients was related with preoperatively incomplete control of inflammation of tonsil or adenoid, surgeon's experience, intraoperatively incomplete hemostasis, postoperative crying and restlessness, eating improperly in two weeks after surgery, coagulation factor deficiency. In case of postoperative hemorrhage, good outcome could be achieved by management of compression, pmRF at low temperature, bipolar coagulation.

  14. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    Choi, Young Ho; Koh, Young Hwan; Han, Dae Hee; Kim, Ji Hoon; Cha, Joo Hee; Lee, Eun Hye; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2008-05-15

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding.

  15. Factor Xa stimulates fibroblast procollagen production, proliferation, and calcium signaling via PAR1 activation

    Blanc-Brude, Olivier P.; Archer, Fabienne; Leoni, Patricia; Derian, Claudia; Bolsover, Steven; Laurent, Geoffrey J.; Chambers, Rachel C.

    2005-01-01

    Fibroblast proliferation and procollagen production are central features of tissue repair and fibrosis. In addition to its role in blood clotting, the coagulation cascade proteinase thrombin can contribute to tissue repair by stimulating fibroblasts via proteolytic activation of proteinase-activated receptor-1 (PAR 1 ). During hemostasis, the coagulation cascade proteinase factor X is converted into factor Xa. We have previously shown that factor Xa upregulates fibroblast proliferation via production of autocrine PDGF. In this study, we further examined the effects of factor Xa on fibroblast function and aimed to identify its signaling receptor. We showed that factor Xa stimulates procollagen promoter activity and protein production by human and mouse fibroblasts. This effect was independent of PDGF and thrombin production, but dependent on factor Xa proteolytic activity. We also showed that PAR 1 -deficient mouse fibroblasts did not upregulate procollagen production, mobilize cytosolic calcium, or proliferate in response to factor Xa. Desensitization techniques and PAR 1 -specific agonists and inhibitors were used to demonstrate that PAR 1 mediates factor Xa signaling in human fibroblasts. This is the first report that factor Xa stimulates extracellular matrix production. In contrast with endothelial cells and vascular smooth muscle cells, fibroblasts appear to be the only cell type in which the effects of factor Xa are mediated mainly via PAR 1 and not PAR 2 . These findings are critical for our understanding of tissue repair and fibrotic mechanisms, and for the design of novel approaches to inhibit the profibrotic effects of the coagulation cascade without compromising blood hemostasis

  16. The DSA diagnosis, artery embolization combined with low dose of vasopressin infusion treatment for lower digestive tract hemorrhage

    Huang Guoxin; Dou Yongchong; Zhang Yanfang; Shen Xinying; Xu Jianmin

    2005-01-01

    Objective: To evaluate the clinical value of digital subtraction angiography (DSA) diagnosis and interventional treatment for lower digestive tract hemorrhage of unknown reasons. Methods: DSA was performed in 32 patients with unknown etiologic lower digestive tract hemorrhage. The locations and causes of hemorrhage were determined by angiography according to the demonstration of contrast medium extravasation, abnormal vasculature and tumor staining. Superselective arterial embolization was performed with retaining catheter of low dose vasopressin infusion for 12 hours of hemostasis. Results: Seventy-five percent of the lesions were identified by DSA with 2 cases of intestinal typhoid, 1 intestinal tuberculosis, 14 cases of vascular malformation and 7 cases of tumor. Hemostasis was succeeded in 20 of 24 patients. The rate of success was 83.3%. Conclusions: DSA and interventional therapy are of great value in diagnosing and treating patients with lower digestive tract hemorrhage of unknown reasons and even those undergone unsuccessful conservative treatment. Low dose vasopressin infusion through retained catheter is safe and efficient after superselective arterial embolization. (authors)

  17. Microcautery based on zinc metallic nanoparticles photodeposited on the core of an optical fiber

    Zaca-Morán, P., E-mail: zmoran_placido@icloud.com [Departemento de Fisicoquímica de Materiales, Instituto de Ciencias, Universidad Autónoma de Puebla, 17 Nte 3417, Puebla 72050 (Mexico); Pastelín, C.F., E-mail: c_pastelin@yahoo.com.mx [Departemento de Biología y Toxicologia de la Reproducción, Instituto de Ciencias, Universidad Autónoma de Puebla, 14 Sur 6301, Puebla 72570 (Mexico); Morán, C., E-mail: carolina.moran@correo.buap.mx [Departemento de Biología y Toxicologia de la Reproducción, Instituto de Ciencias, Universidad Autónoma de Puebla, 14 Sur 6301, Puebla 72570 (Mexico); Pérez-Sánchez, G.F., E-mail: f_perez_s@hotmail.com [Departemento de Fisicoquímica de Materiales, Instituto de Ciencias, Universidad Autónoma de Puebla, 17 Nte 3417, Puebla 72050 (Mexico); Chávez, F., E-mail: fchr172@hotmail.com [Departemento de Fisicoquímica de Materiales, Instituto de Ciencias, Universidad Autónoma de Puebla, 17 Nte 3417, Puebla 72050 (Mexico)

    2017-01-15

    Highlights: • We demonstrate a microcautery implemented by an optical fiber with zinc nanoparticles photodeposited on its core. • We achieved a controllable heat “tip” via radiation intensity of a laser source. • We carried out cauterization and coagulation processes to induce hemostasis in blood vessels using rats. • The system is ideal to carry out micro cauterization processes. - Abstract: The experimental arrangement of a microcautery implemented by an optical fiber with zinc nanoparticles (ZnNPs) photodeposited on its core for the cauterization and coagulation in blood vessels hemostasis processes is presented. The interaction between a laser radiation source and the ZnNPS on the fiber core produces a controllable punctual heat source through the radiation intensity, which is capable of reaching a temperature up to 200 °C covering an area of approximately ten micrometers. By using three-to-four-month-old rats of CIIZ-V strain, we made several microcauterization experimental tests to stop blood flow. The findings show that the microcautery obliterates the smooth muscle of the blood vessels concatenating mutually to tissue in an average time of three seconds, at the same time, the blood elements responsible for the coagulation are thermally activated and thus the bleeding is stopped.

  18. Use of fibrin sealants in cardiovascular surgery: a systematic review.

    Rousou, John A

    2013-05-01

    Fibrin sealants are used for hemostasis and tissue adherence. This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries. © 2013 Wiley Periodicals, Inc.

  19. Reference intervals of citrated-native whole blood thromboelastography in premature neonates.

    Motta, Mario; Guaragni, Brunetta; Pezzotti, Elena; Rodriguez-Perez, Carmen; Chirico, Gaetano

    2017-12-01

    Bleeding due to acquired coagulation disorders is a common complication in premature neonates. In this clinical setting, standard coagulation laboratory tests might be unsuitable to investigate the hemostatic function as they reflect the concentration of pro-coagulant proteins but not of anti-coagulant proteins. Thromboelastography (TEG), providing a more complete assessment of hemostasis, may be able to overcome some of these limitations. Unfortunately, experience on the use of TEG in premature neonates is very limited and, in particular in this population, reference ranges of TEG parameters have not been yet evaluated. To evaluate TEG in preterm neonates, and to assess their reference ranges. One hundred and eighteen preterm neonates were analyzed for TEG in a retrospective cohort study. Double-sided 95% reference intervals were calculated using a bootstrap method after Box-Cox transformation. TEG parameters were compared between early-preterm and moderate-/late-preterm neonates and between bleeding and non-bleeding preterm neonates. Comparing early-preterm with moderate-/late-preterm neonates, TEG parameters were not statistically different, except for fibrinolysis which was significantly higher in early preterm neonates. Platelet count significantly correlated with α angle and MA parameters. Bleeding and non-bleeding neonates had similar TEG values. These results reinforce the concept that in stable preterm neonates, in spite of lower concentration of pro- and anti-coagulants proteins, the hemostasis is normally balanced and well functioning. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Evaluation of thromboelastography in two factor XII-deficient cats.

    Blois, Shauna L; Holowaychuk, Marie K; Wood, R Darren

    2015-01-01

    The current report describes thromboelastography (TEG) findings in two cats with factor XII (FXII) deficiency. The first cat was diagnosed with bilateral perinephric pseudocysts; hemostatic testing was performed prior to performing renal aspirates. The second cat was healthy; hemostatic testing was performed prior to inclusion into a research project. Both cats had markedly prolonged partial thromboplastin times and hypocoagulable TEG tracings when samples were activated with kaolin. However, when tissue factor (TF) was used to activate the sample, both cats had normal-to-hypercoagulable TEG tracings. The cats each had a subnormal FXII level. TEG is becoming widely used to investigate hemostasis in veterinary patients, and TEG results in cats with FXII deficiency have not been previously reported. FXII deficiency is the most common hereditary hemostatic defect in cats. While FXII deficiency does not lead to in vivo hemorrhagic tendencies, it can lead to marked prolongation in activated partial thromboplastin and activated clotting times, and cannot be differentiated from true hemorrhagic diatheses without measuring individual factor activity. With the increased use of TEG to evaluate hemostasis in veterinary patients, it is important to recognize the effects of FXII deficiency on this testing modality. The finding of a hypocoagulable kaolin-activated TEG tracing and a concurrent normal TF-activated TEG tracing in samples should prompt clinicians to consider ruling out FXII deficiency.

  1. Evaluation of thromboelastography in two factor XII-deficient cats

    Shauna L Blois

    2015-05-01

    Full Text Available Case summary The current report describes thromboelastography (TEG findings in two cats with factor XII (FXII deficiency. The first cat was diagnosed with bilateral perinephric pseudocysts; hemostatic testing was performed prior to performing renal aspirates. The second cat was healthy; hemostatic testing was performed prior to inclusion into a research project. Both cats had markedly prolonged partial thromboplastin times and hypocoagulable TEG tracings when samples were activated with kaolin. However, when tissue factor (TF was used to activate the sample, both cats had normal-to-hypercoagulable TEG tracings. The cats each had a subnormal FXII level. Relevance and novel information TEG is becoming widely used to investigate hemostasis in veterinary patients, and TEG results in cats with FXII deficiency have not been previously reported. FXII deficiency is the most common hereditary hemostatic defect in cats. While FXII deficiency does not lead to in vivo hemorrhagic tendencies, it can lead to marked prolongation in activated partial thromboplastin and activated clotting times, and cannot be differentiated from true hemorrhagic diatheses without measuring individual factor activity. With the increased use of TEG to evaluate hemostasis in veterinary patients, it is important to recognize the effects of FXII deficiency on this testing modality. The finding of a hypocoagulable kaolin-activated TEG tracing and a concurrent normal TF-activated TEG tracing in samples should prompt clinicians to consider ruling out FXII deficiency.

  2. Preparation and evaluation of squid ink polysaccharide-chitosan as a wound-healing sponge.

    Huang, Na; Lin, Jiali; Li, Sidong; Deng, Yifeng; Kong, Songzhi; Hong, Pengzhi; Yang, Ping; Liao, Mingneng; Hu, Zhang

    2018-01-01

    A new type of wound healing agent was developed using two marine biomaterials (squid ink polysaccharide and chitosan) as carriers and calcium chloride as an initiator for coagulation. Based on central composite design-response surface methodology, comprehensive evaluation of appearance quality for composite sponges and water absorbency were used as evaluation indices to identify the optimized preparation conditions and further evaluate the performance of the squid ink polysaccharide-chitosan sponge (SIP-CS). The optimized formulation of SIP-CS was as follows: chitosan concentration, 2.29%; squid ink polysaccharide concentration, 0.55%; and calcium chloride concentration, 2.82%, at a volume ratio of 15:5:2. SIP-CS was conducive to sticking on the wound, characterized by the spongy property, strong absorptivity, and tackiness. Rabbit ear arterial, hepatic, and femoral artery hemorrhage experiments indicated that, compared with chitosan dressings and absorbable gelatin, the hemostatic times were shorter and the bleeding volume was smaller. Furthermore, SIP-CS absorbed a large amount of hemocytes, leading to rapid hemostasis. The healing areas and wound pathological sections in scalded New Zealand rabbits indicated that SIP-CS promoted wound healing more rapidly than chitosan and better than commercially available burn cream. Thus, SIP-CS is a good wound healing agent for rapid hemostasis, promoting burn/scalded skin healing, and protecting from wound infection. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. HOMOLOGY BETWEEN SEGMENTS OF HUMAN HEMOSTATIC PROTEINS AND PROTEINS OF VIRUSES WHICH CAUSE ACUTE RESPIRATORY INFECTIONS OR DISEASES WITH SIMILAR SYMPTOMS

    I. N. Zhilinskaya

    2017-01-01

    Full Text Available Objectives: To identify homologous segments of human hemostatic and viral proteins and to assess the role of human hemostatic proteins in viral replication. Materials and Methods: The following viruses were chosen for comparison: influenza B (B/Astrakhan/2/2017, coronaviruses (Hcov229E and SARS-Co, type 1 adenovirus (adenoid 71, measles (ICHINOSE-BA and rubella (Therien. The primary structures of viral proteins and 41 human hemostatic proteins were obtained from open–access www.ncbi.nlm.nih. gov and www.nextprot.org databases, respectively. Sequence homology was determined by comparing 12-amino-acid segments. Those sequences identical in ≥ 8 positions were considered homologous. Results: The analysis shows that viral proteins contain segments which mimic a number of human hemostatic proteins. Most of these segments, except those of adenovirus proteins, are homologous with coagulation factors. The increase in viral virulence, as in case of SARS-Co, correlates with an increased number of segments homologous with hemostatic proteins. Conclusion: Hemostasis plays an important role in viral replication and pathogenesis. The conclusion is consistent with the literature data about the relationship of hemostasis and inflammatory response to viral infections.

  4. Clinical, general, hemocoagulation and pathologicanatomical features of patients with moderate and severe community acquired pneumonia by the data of retrospective analysis

    Pertseva T.A.

    2017-10-01

    Full Text Available According to literature data, patients with community acquired pneumonia (CAP fall into several groups of unfavorable prognostic factors. Development of thrombotic complications is one of causes of mortality of hospitalized patients. In this case systemic inflammation, which is always present in moderate and severe CAP, is the starting mechanism of formation of disorders in the hemostasis system. The aim of our work was to determine anamnestic, clinical, laboratory and pathologic anatomical features in patients with CAP, taking into account markers of systemic inflammation and coagulogram indices, as well as predicting the occurrence of complications. In the course of the work, a retrospective analysis of 151 medical histories of hospitalized patients with CAP was made. We analyzed anthropometric indicators, complaints at the time of hospitalization, results of physical examination, results of the chest X-ray, clinical and laboratory indicators, microbiological sputum analysis and to assess the possibility of thrombotic complications a RAM scale was used. It was found that late asking for medical help, the presence of mixed infection, underestimation of the severity of condition and severe systemic inflammation increase the risk of lethal outcome in patients with CAP. Considering a high risk of thrombosis in patients with CAP, it is necessary to assess the risk of thrombotic complications with the help of special scales, as well as timely detection and correction of disorders from the hemostasis system.

  5. [Clinical efficacy of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal pulmonary hemorrhage].

    Lin, Xin-Zhu; Lai, Ji-Dong; Lv, Mei; Zhu, Yao; Wang, Lian; Chen, Chao

    2015-04-01

    To explore the clinical efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH). A total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratified by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups. After 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO2, PaCO2, O/I, and P/F values compared with the control group (P0.05). HFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.

  6. Microcautery based on zinc metallic nanoparticles photodeposited on the core of an optical fiber

    Zaca-Morán, P.; Pastelín, C.F.; Morán, C.; Pérez-Sánchez, G.F.; Chávez, F.

    2017-01-01

    Highlights: • We demonstrate a microcautery implemented by an optical fiber with zinc nanoparticles photodeposited on its core. • We achieved a controllable heat “tip” via radiation intensity of a laser source. • We carried out cauterization and coagulation processes to induce hemostasis in blood vessels using rats. • The system is ideal to carry out micro cauterization processes. - Abstract: The experimental arrangement of a microcautery implemented by an optical fiber with zinc nanoparticles (ZnNPs) photodeposited on its core for the cauterization and coagulation in blood vessels hemostasis processes is presented. The interaction between a laser radiation source and the ZnNPS on the fiber core produces a controllable punctual heat source through the radiation intensity, which is capable of reaching a temperature up to 200 °C covering an area of approximately ten micrometers. By using three-to-four-month-old rats of CIIZ-V strain, we made several microcauterization experimental tests to stop blood flow. The findings show that the microcautery obliterates the smooth muscle of the blood vessels concatenating mutually to tissue in an average time of three seconds, at the same time, the blood elements responsible for the coagulation are thermally activated and thus the bleeding is stopped.

  7. Parameters of platelet activity in patients with thyrotoxicosis in the presence of chronic hyperglycemia and atrial fibrillation

    G G Petrik

    2011-06-01

    Full Text Available Object. The study of platelet hemostasis in patients with thyrotoxicosis in the presence of chronic hyperglycemia and atrial fibrillation to prevent coagulation disorders. Material and methods. A comprehensive analysis of the parameters of platelet and coagulation hemostasis in 91 patients (67 women and 24 men with uncomplicated thyrotoxicosis, as well as with the atrial fibrillation or a combination of hyperthyroidism with diabetes has been completed. Results. The aggregation activity of platelets in uncomplicated thyrotoxicosis comparable with that of healthy people. atrial fibrillation, as well as chronic hyperglycemia, modify platelet activity by increasing the average volume of platelets, their ability to aggregate intensification of the release reaction and along with the decrease of disaggregation properties. Regardless of the presence of diabetes or atrial fibrillation, hyperthyroidism is accompanied by the activation of coagulation. Conclusion. The presence of transforming effects of chronic hyperglycemia and atrial fibrillation on the platelet activity determines the feasibility of differentiated approach to the prevent of coagulation disorders in patients with thyrotoxicosis.

  8. Treatment countermeasures for common problems in dacryocystorhinostomy under nasal endoscope

    Zhong-Ling Luo

    2014-04-01

    Full Text Available AIM: To discuss the common problems and treatment countermeasures in dacryocystorhinostomy under nasal endoscope.METHODS: The clinical data of 37 cases(43 eyesof postoperative dacryocystorhinostomy under nasal endoscope, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods were reviewed in our hospital from Mar. 2011 to June. 2013. The effects of surgery were observed, and the intraoperative common questions and the treatments were discussed.RESULTS: In the 37 cases(43 eyes, 42 eyes(97.7%were cured, and 1 eye was improved, and the total efficiency was 100%. All operations were successfully completed without any serious complications during surgery.CONCLUSION: The common complication in dacryocystorhinostomy under nasal endoscope are effectively treated and the success rates of surgery are improved, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods. These methods are worthy of application and promotion.

  9. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

    Atsushi Kimura

    Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

  10. The Application of Hemospray in Gastrointestinal Bleeding during Emergency Endoscopy

    Alexander F. Hagel

    2017-01-01

    Full Text Available Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE. Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies. Hemospray was applied during 35 examinations in 27 patients (19 males, 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60% and in 14 (40% as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%, while long-term success occurred in 23 applications (65.7%. Similar long-term results were found after primary application (64,3% or salvage therapy (66,7%. Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8% occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions.

  11. Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

    Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

    2016-05-01

    This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

  12. Characteristics of patients with non-variceal upper gastrointestinal bleeding taking antithrombotic agents.

    Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

    2015-01-01

    The present study aimed to clarify the features and management of non-variceal upper gastrointestinal bleeding (UGIB) in Japanese patients taking antithrombotic agents. We retrospectively investigated the medical records of 560 patients who underwent emergency endoscopy for UGIB from 2002 to 2013. The patients were divided into two groups: group A, antithrombotic agent use; and group NA, no antithrombotic agent use. We compared clinical characteristics, comorbidities, and causes of UGIB between the groups. We also investigated management with antithrombotics. Of 560 patients with UGIB, 27.5% were taking antithrombotics, and this proportion gradually increased during the study period. Mean hemoglobin levels on admission were significantly lower in group A (8.0 ± 1.7 g/dL) than in group NA (8.9 ± 2.9 g/dL) (P bleeding was lower in group A than in group NA (P < 0.001), and the rate of endoscopic hemostasis was significantly higher in group A (98.7%) than in group NA (94.3%) (P = 0.022). After the release of the 2012 Japan Gastroenterological Endoscopy Society guidelines, the antithrombotic agent cessation periods were significantly shortened (P < 0.001). Among patients with UGIB, those taking antithrombotics exhibited more severe clinical signs. However spurting hemorrhage was rare. Antithrombotics may be resumed early after endoscopic hemostasis. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  13. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution.

    Chen, Yen-I; Barkun, Alan; Nolan, Sabrina

    2015-02-01

    TC-325 is a novel endoscopic hemostatic powder. Our aim was to describe a single-center experience with the use of TC-325 in the upper and lower gastrointestinal tract, while for the first time attempting to determine how long the powder remains on a lesion. The charts of consecutive patients receiving TC-325 therapy between July 2011 and July 2013 were reviewed retrospectively. Primary endpoints included immediate hemostasis and early rebleeding (≤ 72 hours). Overall, 60 patients received 67 treatments with TC-325: 21 for nonmalignant nonvariceal upper gastrointestinal bleeding, 19 for malignant upper gastrointestinal bleeding, 11 for lower gastrointestinal bleeding, and 16 for intra-procedural bleeding. Immediate hemostasis was achieved in 66 cases (98.5 %), with 6 cases (9.5 %) of early rebleeding. No serious adverse events were noted. No TC-325 powder was identified in the 11 patients who underwent second-look endoscopy, performed within 24 hours in 4 patients. TC-325 appears safe and effective for managing bleeding in the upper and lower gastrointestinal tract with a variety of causes. The time during which the powder remains in the gastrointestinal tract is short, with complete elimination from the gastrointestinal tract as early as within 24 hours after use. © Georg Thieme Verlag KG Stuttgart · New York.

  14. [Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].

    Lee, Su Hyun; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Youn Sun; Jeon, Seong Woo

    2015-08-01

    Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p bleeding associated mortality and total mortality) were not different among groups. Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

  15. Video-Assisted Minithoracotomy for Pulmonary Laceration with a Massive Hemothorax

    Hideki Ota

    2014-01-01

    Full Text Available Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy. The safety and efficacy of video-assisted thoracoscopic surgery (VATS techniques for this life-threatening condition have not been fully evaluated yet. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy. A 22-year-old man was transferred to our department after a falling accident. A diagnosis of right-sided pneumothorax was made on physical examination and urgent chest decompression was performed with a tube thoracostomy. Chest computed tomographic scan revealed pulmonary laceration with hematoma in the right lung. The pulmonary hematoma extending along segmental pulmonary artery in the helium of the middle lobe ruptured suddenly into the thoracic cavity, resulting in hemorrhagic shock on the fourth day after admission. Emergency right middle lobectomy was performed through video-assisted minithoracotomy. We used two cotton dissectors as a chopstick for achieving compression hemostasis during surgery. The patient recovered satisfactorily. Video-assisted minithoracotomy can be an alternative approach for the treatment of pulmonary lacerations with a massive hemothorax in hemodynamically unstable patients.

  16. The Carmat Bioprosthetic Total Artificial Heart Is Associated With Early Hemostatic Recovery and no Acquired von Willebrand Syndrome in Calves.

    Smadja, David M; Susen, Sophie; Rauch, Antoine; Cholley, Bernard; Latrémouille, Christian; Duveau, Daniel; Zilberstein, Luca; Méléard, Denis; Boughenou, Marie-Fazia; Belle, Eric Van; Gaussem, Pascale; Capel, Antoine; Jansen, Piet; Carpentier, Alain

    2017-10-01

    To determine hemostasis perturbations, including von Willebrand factor (VWF) multimers, after implantation of a new bioprosthetic and pulsatile total artificial heart (TAH). Preclinical study SETTING: Single-center biosurgical research laboratory. Female Charolais calves, 2-to-6 months old, weighing 102-to-122 kg. Surgical implantation of TAH through a mid-sternotomy approach. Four of 12 calves had a support duration of several days (4, 4, 8, and 10 days), allowing for the exploration of early steps of hemostasis parameters, including prothrombin time; coagulation factor levels (II, V, VII+X, and fibrinogen); and platelet count. Multimeric analysis of VWF was performed to detect a potential loss of high-molecular weight (HMW) multimers, as previously described for continuous flow rotary blood pumps. Despite the absence of anticoagulant treatment administered in the postoperative phase, no signs of coagulation activation were detected. Indeed, after an immediate postsurgery decrease of prothrombin time, platelet count, and coagulation factor levels, most parameters returned to baseline values. HMW multimers of VWF remained stable either after initiation or during days of support. Coagulation parameters and platelet count recovery in the postoperative phase of the Carmat TAH (Camat SA, Velizy Villacoublay Cedex, France) implantation in calves, in the absence of anticoagulant treatment and associated with the absence of decrease in HMW multimers of VWF, is in line with early hemocompatibility that is currently being validated in human clinical studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. LigaSure Impact™ versus conventional dissection technique in pylorus-preserving pancreatoduodenectomy in clinical suspicion of cancerous tumours on the head of the pancreas: study protocol for a randomised controlled trial

    Müller-Stich Beat P

    2011-06-01

    Full Text Available Abstract Background The pp-Whipple procedure requires extensive preparation. The conventional preparation technique is done with scissors for dissection and ligatures, and with clips and sutures for hemostasis. This procedure is very time-consuming and requires numerous changes of instruments. The LigaSure™ device allows dissection and hemostasis for preparation with one instrument. Up to now there has been no comparison of the two techniques with regard to operating time and the patients' outcome. It is still unclear which technique has the optimal benefit/risk ratio for the patient. Methods/Design A single-center, randomized, single-blinded, controlled superiority trial to compare two different techniques for dissection in a pp-Whipple procedure. 102 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective pp-Whipple procedure who signed the informed consent will be included. The primary endpoint is the operating time of the randomized technique. Control Intervention: Conventional dissection technique; experimental intervention: LigaSureTM dissection technique. Duration of study: Approximately 15 months; follow up time: 3 years. The trial is registered at German ClinicalTrials Register (DRKS00000166.

  18. Residents' response to bleeding during a simulated robotic surgery task.

    Walker, Jessica L; Nathwani, Jay N; Mohamadipanah, Hossein; Laufer, Shlomi; Jocewicz, Frank F; Gwillim, Eran; Pugh, Carla M

    2017-12-01

    The aim of this study was to assess performance measurement validity of our newly developed robotic surgery task trainer. We hypothesized that residents would exhibit wide variations in their intercohort performance as well as a measurable difference compared to surgeons in fellowship training. Our laboratory synthesized a model of a pelvic tumor that simulates unexpected bleeding. Surgical residents and fellows of varying specialties completed a demographic survey and were allowed 20 minutes to resect the tumor using the da Vinci robot and achieve hemostasis. At a standardized event in the simulation, venous bleeding began, and participants attempted hemostasis using suture ligation. A motion tracking system, using electromagnetic sensors, recorded participants' hand movements. A postparticipation Likert scale survey evaluated participants' assessment of the model's realism and usefulness. Three of the seven residents (postgraduate year 2-5), and the fellow successfully resected the tumor in the allotted time. Residents showed high variability in performance and blood loss (125-700 mL) both within their cohort and compared to the fellow (150 mL blood). All participants rated the model as having high realism and utility for trainees. The results support that our bleeding pelvic tumor simulator has the ability to discriminate resident performance in robotic surgery. The combination of motion, decision-making, and blood loss metrics offers a multilevel performance assessment, analyzing both technical and decision-making abilities. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Comparison between electrocautery and fibrin selant after hepatectomy in rats.

    Coutinho, Tâmara Rúbia Cavalcante Guimarães; Malafaia, Osvaldo; Torres, Orlando Jorge Martins; Ribas Filho, Jurandir Marcondes; Kaminski, Alvaro Fonseca; Cella, Igor Furlan; Jurkonis, Leandro Bressianini

    2014-01-01

    To compare between electrocautery and fibrin sealant hemostasis in rats after partial hepatectomy. we used 24 Wistar rats, which were submitted to 30% hepatic resection, divided into two groups of 12 animals each: Group Electrocautery and Group Tachosil(r). These animals were evaluated after three and 14 days. We assessed the presence of complications, laboratory tests and histological exam of the recovered liver. the presence of abscess was more prevalent in the electrocautery group. The observed adhesions were more pronounced in the electrocautery group, both in frequency and in intensity, after three and 14 days. There were no deaths in either group. As for laboratory analysis, after three days the hematocrit was lower in the TachoSil(r) Group. The elevation of AST and ALT were more pronounced in the electrocautery group (p = 0.002 and p = 0.004) in three days. Histological analysis of specimens collected on the third day after surgery showed similar results in both groups for the presence of polymorphonuclear cells, whereas mononuclear was more evident in the TachoSil(r) group. We also observed that angiogenesis, although present in both groups, was more pronounced in the TachoSil(r) group (p = 0.030). However, on the 14th day angiogenesis was more pronounced in the electrocautery group, but without statistical significance. hemostasis achieved by the groups was similar; however, the use of electrocautery was associated with infections, adhesions at higher grades and elevated liver enzymes.

  20. Reducing Postoperative Pain from Tonsillectomy Using Monopolar Electrocautery by Cooling the Oropharynx

    Vieira, Lucas

    2014-01-01

    Full Text Available Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05. There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.

  1. Effect of twenty minutes of aerobic exercise on in vivo platelet release in moderately trained females: radioimmunoassay of platelet factor 4 and beta-thromboglobulin

    Rudmann, S.V.

    1986-01-01

    Circulating blood platelets serve an important role in the physiological process of hemostasis. Physical exercise has been documented to result in alterations in many hemostatic parameters including platelet size, number and function. Most published research data support the hypotheses that both hemostasis and fibrinolysis become activated as a consequence of various levels of physical exercise. The purpose of this study was to determine the effect of twenty minutes aerobic exercise on platelet activation in vivo. Platelet activation in vivo is associated with the release of platelet granular contents. Platelet alpha granules contain two platelet specific proteins: platelet factor 4 (PF4) and beta-thromboglobulin (BTG). Elevated plasma levels of these proteins are a specific marker of in vivo platelet activation. Subjects were moderately trained female volunteers between the ages of 22 and 40 years. Subjects were exercised or twenty minutes on a bicycle ergometer at workloads that represented 65 to 75% of their functional capacity. Blood specimens were drawn within five minutes of exercise. Plasma samples from exercise and control subjects were assayed for PF4 and BTG using a sensitive competitive-binding radioimmunoassay procedure. The mean plasma levels of both proteins were significantly greater in the exercising subjects when compared with the non-exercising controls. Data from this study support the following research hypotheses: BTG plasma levels will be significantly higher in exercising subjects than in non-exercising controls, and PF4 plasma levels will be significantly higher in exercising subjects than in non-exercising controls

  2. Antibacterial hemostatic dressings with nanoporous bioglass containing silver

    Hu G

    2012-05-01

    Full Text Available Gangfeng Hu,1 Luwei Xiao,2 Peijian Tong,2 Dawei Bi,1 Hui Wang,1 Haitao Ma,1 Gang Zhu,1 Hui Liu21The First People’s Hospital of Xiaoshan, Hangzhou, China; 2Zhejiang Traditional Chinese Medical University, Hangzhou, ChinaAbstract: Nanoporous bioglass containing silver (n-BGS was fabricated using the sol-gel method, with cetyltrimethyl ammonium bromide as template. The results showed that n-BGS with nanoporous structure had a surface area of 467 m2/g and a pore size of around 6 nm, and exhibited a significantly higher water absorption rate compared with BGS without nanopores. The n-BGS containing small amounts of silver (Ag had a slight effect on its surface area. The n-BGS containing 0.02 wt% Ag, without cytotoxicity, had a good antibacterial effect on Escherichia coli, and its antibacterial rate reached 99% in 12 hours. The n-BGS’s clotting ability significantly decreased prothrombin time (PT and activated partial thromboplastin time (APTT, indicating n-BGS with a higher surface area could significantly promote blood clotting (by decreasing clotting time compared with BGS without nanopores. Effective hemostasis was achieved in skin injury models, and bleeding time was reduced. It is suggested that n-BGS could be a good dressing, with antibacterial and hemostatic properties, which might shorten wound bleeding time and control hemorrhage.Keywords: antibacterial, bioglass, cytotoxicity, dressing, hemostasis, nanopore, silver

  3. Clinical use of a 15-W diode laser in small animal surgery: results in 30 varied procedures

    Crowe, Dennis T.; Swalander, David; Hittenmiller, Donald; Newton, Jenifer

    1999-06-01

    The use of a 15-watt diode laser (CeramOptec)in 30 surgical procedures in dogs and cats was reviewed. Ease of use, operator safety, hemostasis control, wound healing, surgical time, complication rate, and pain control were observed and recorded. Procedures performed were partial pancreatectomy, nasal carcinoma ablation, medial meniscus channeling, perianal and anorectal mass removal (5), hemangioma and hemangiopericytoma removal from two legs, benign skin mass removal (7), liver lobectomy, partial prostatectomy, soft palate resection, partial arytenoidectomy, partial ablation of a thyroid carcinoma, photo-vaporization of the tumor bed following malignant tumor resection (4), neurosheath tumor removal from the tongue, tail sebaceous cyst resection, malignant mammary tumor and mast cell tumor removal. The laser was found to be very simple and safe to use. Hemostasis was excellent in all but the liver and prostate surgeries. The laser was particularly effective in preventing hemorrhage during perianal, anal, and tongue mass removal. It is estimated that a time and blood loss savings of 50% over that of conventional surgery occurred with the use of the laser. All external wounds made by laser appeared to heal faster and with less inflammation than those made with a conventional or electrosurgical scalpel.

  4. HEMOSTATIC DISORDERS IN LIVER DISEASES

    A. F. Minov

    2010-01-01

    Full Text Available The liver is an essential player in the pathway of coagulation in both primary and secondary hemostasis as it is the site of synthesis of all coagulation factors and their inhibitors. Liver diseases are associated with complex changes in coagulation and the delicate balance between pro and antithrombotic factors is preserved but reset to a lower level. There is growing evidence that portal and hepatic vein thrombosis is cause of disease progression in cirrhotic patients and worsens hemostatic abnormalities. These hemostatic abnormalities do not always lead to spontaneous bleeding, which may be triggered only by additional factors, such as infections. Usually therapy for coagulation disorders in liver disease is needed only during bleeding or before invasive procedures. In patients with end stage liver disease liver transplantation is the only treatment available, which can restore normal hemostasis, and correct genetic clotting defects. During liver transplantation hemorrhage may occur due to the pre-existing hypocoagulable state, the collateral circulation caused by portal hypertension and increased fibrinolysis. 

  5. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    Choi, Young Ho; Koh, Young Hwan; Han, Dae Hee; Kim, Ji Hoon; Cha, Joo Hee; Lee, Eun Hye; Song, Chi Sung

    2008-01-01

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding

  6. Validity of microporous polysaccharide hemispheres as a hemostatic agent in hepatic injuries: an experimental study in rats Validade de hemosferas microporosas de polissacarídeos como agente hemostático em ferimentos hepáticos: estudo experimental em ratos

    Maria de Lourdes Pessole Biondo-Simões

    2007-01-01

    Full Text Available INTRODUCTION: In the treatment of hepatic injuries, there is not always adequate and secure hemostasis. A hepatic biopsy is indispensable in the evolution of focal or diffuse liver cell disease, being necessary for candidates for liver transplant and post-transplant treatment. Many patients suffer blood clotting that increases the risk of bleeding. For this reason, it is necessary to seek for substances capable of bringing about hemostasis quickly and effectively. PURPOSE: The aim of this study was to recognize the validity of the use of microporous polysaccharide hemispheres (MPH as a hemostatic agent for hepatic injuries. METHODS: Thirty Wistar rats were used, split into three groups. Under anaesthetic, a laparoptomy was done and resulted in a standard liver injury that was treated in Group A with MPH, in Group B with n-butyl-2-cyanoacrylate and in Group C with fibrin adhesive. Immediate hemostasis, delayed bleeding and histological evolution were timed. RESULTS: The MPH took on average six minutes to promote hemostasis and also resulted in re-bleeding, which required reapplication; the n-butyl-2-cyanoacrylate took twenty seconds and the fibrin adhesive took one minute. The cyanoacrylate resulted in more intense adherence. The three adhesives mainly showed a chronic inflammatory reaction. The injuries treated with cyanoacrylate showed a larger area of injury (p=0,0164. The density of the collagen was similar in all groups. CONCLUSION: The MPH, despite achieving hemostasis, proved to be no more favorable than n-butyl-cyanoacrylate and the fibrin adhesive, the latter resulting in the lowest tissue reaction.INTRODUÇÃO: No tratamento de lesões hepáticas nem sempre se tem hemostasia adequada e segura. Biópsia hepática é indispensável na evolução de doença hepato-celular difusa ou focal sendo necessária para candidatos à transplante hepático e para acompanhamento pós-transplante. Muitos doentes apresentam coagulopatias que aumentam os

  7. Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

    V. V. Izbitsky

    2013-06-01

    Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

  8. Tromboelastógrafo em cirurgia cardíaca: estado atual Tromboelastógrafo en cirugía cardíaca: estado actual Thromboelastograph in cardiac surgery: state of the art

    Plínio Vasconcelos Maia

    2006-02-01

    la función plaquetaria están siendo incorporados en la práctica perioperatoria. La naturaleza multi-factorial de los disturbios de la hemostasia causados por la CEC exige conocimiento de la fisiopatología causal y correcta evaluación de la hemostasia para obtener una anti-coagulación eficaz durante la CEC y una coagulación normal con hemostasia adecuada luego de la cirugía. Tiempo de coagulación activado (TCA y coagulograma no son suficientes en este manejo. Es necesaria la evaluación amplia, con monitores capaces de medir la función de las plaquetas y la dinámica del proceso hemostático en su totalidad. CONTENIDO: La hemostasia resulta del equilibrio entre los sistemas de coagulación, anti-coagulación y fibrinólisis. Este equilibrio se rompe durante la CEC, tornando al paciente susceptible a sangrados microvasculares. La CEC por varios caminos altera el crecimiento de la fuerza plaquetaria y de las propiedades elásticas del coágulo. El uso e hemoderivados es frecuente y por eso es necesario desarrollar protocolos para orientar la terapia transfusional. Es importante monitorizar la función de las plaquetas con monitores que evalúen las propiedades del coágulo, como el tromboelastógrafo (TEG y el Sonoclot. CONCLUSIONES: El TEG es un monitor importante para evaluar la hemostasia de pacientes en CEC. Ha sido incorporado con buenos resultados para orientar la evaluación de disturbios de la hemostasis y de la terapia transfusional.BACKGROUND AND OBJECTIVES: Management of hemostasis of cardiopulmonary bypass (CPB patients is still a major challenge. New monitoring methods, new hemostatic drugs and new platelet function inhibitors are being added to the pre, intra and postoperative periods. The multifactorial nature of CBP-induced hemostasis disorders requires the understanding of their pathophysiology and the accurate hemostasis evaluation for effective coagulation during CPB, in addition to the maintenance of adequate postoperative hemostasis

  9. Identification of hemostatic genes expressed in human and rat leg muscles and a novel gene (LPP1/PAP2A suppressed during prolonged physical inactivity (sitting

    Zderic Theodore W

    2012-10-01

    Full Text Available Abstract Background Partly because of functional genomics, there has been a major paradigm shift from solely thinking of skeletal muscle as contractile machinery to an understanding that it can have roles in paracrine and endocrine functions. Physical inactivity is an established risk factor for some blood clotting disorders. The effects of inactivity during sitting are most alarming when a person develops the enigmatic condition in the legs called deep venous thrombosis (DVT or “coach syndrome,” caused in part by muscular inactivity. The goal of this study was to determine if skeletal muscle expresses genes with roles in hemostasis and if their expression level was responsive to muscular inactivity such as occurs in prolonged sitting. Methods Microarray analyses were performed on skeletal muscle samples from rats and humans to identify genes associated with hemostatic function that were significantly expressed above background based on multiple probe sets with perfect and mismatch sequences. Furthermore, we determined if any of these genes were responsive to models of physical inactivity. Multiple criteria were used to determine differential expression including significant expression above background, fold change, and non-parametric statistical tests. Results These studies demonstrate skeletal muscle tissue expresses at least 17 genes involved in hemostasis. These include the fibrinolytic factors tetranectin, annexin A2, and tPA; the anti-coagulant factors TFPI, protein C receptor, PAF acetylhydrolase; coagulation factors, and genes necessary for the posttranslational modification of these coagulation factors such as vitamin K epoxide reductase. Of special interest, lipid phosphate phosphatase-1 (LPP1/PAP2A, a key gene for degrading prothrombotic and proinflammatory lysophospholipids, was suppressed locally in muscle tissue within hours after sitting in humans; this was also observed after acute and chronic physical inactivity conditions

  10. Fibrinogen and fibrin.

    Weisel, John W

    2005-01-01

    Fibrinogen is a large, complex, fibrous glycoprotein with three pairs of polypeptide chains linked together by 29 disulfide bonds. It is 45 nm in length, with globular domains at each end and in the middle connected by alpha-helical coiled-coil rods. Both strongly and weakly bound calcium ions are important for maintenance of fibrinogen's structure and functions. The fibrinopeptides, which are in the central region, are cleaved by thrombin to convert soluble fibrinogen to insoluble fibrin polymer, via intermolecular interactions of the "knobs" exposed by fibrinopeptide removal with "holes" always exposed at the ends of the molecules. Fibrin monomers polymerize via these specific and tightly controlled binding interactions to make half-staggered oligomers that lengthen into protofibrils. The protofibrils aggregate laterally to make fibers, which then branch to yield a three-dimensional network-the fibrin clot-essential for hemostasis. X-ray crystallographic structures of portions of fibrinogen have provided some details on how these interactions occur. Finally, the transglutaminase, Factor XIIIa, covalently binds specific glutamine residues in one fibrin molecule to lysine residues in another via isopeptide bonds, stabilizing the clot against mechanical, chemical, and proteolytic insults. The gene regulation of fibrinogen synthesis and its assembly into multichain complexes proceed via a series of well-defined steps. Alternate splicing of two of the chains yields common variant molecular isoforms. The mechanical properties of clots, which can be quite variable, are essential to fibrin's functions in hemostasis and wound healing. The fibrinolytic system, with the zymogen plasminogen binding to fibrin together with tissue-type plasminogen activator to promote activation to the active enzyme plasmin, results in digestion of fibrin at specific lysine residues. Fibrin(ogen) also specifically binds a variety of other proteins, including fibronectin, albumin

  11. Endovascular treatment of radiation-induced carotid blowout syndrome. Report of two cases

    Adachi, Akihiko; Kobayashi, Eiichi; Watanabe, Yoshiyuki; Yoneyama, Tomoko S.; Hayasaka, Michihiro; Suzuki, Homare; Okamoto, Yoshitaka; Saeki, Naokatsu

    2011-01-01

    Carotid Blowout Syndrome (CBS), or Carotid Artery Rupture (CAR), is a delayed complication with potentially fatal consequences occurring after the implementation of radiotherapy on head and neck tumors. In this report we describe two patients received endovascular treatment for severe hemorrhagic CBS developing 36 and 2 years, respectively, after radiotherapy. Both patients survived and responded positively to treatment. Case 1 was an 80-year-old woman found with minor hemorrhage near the bifurcation of the common carotid artery, 36 years after neck irradiation. She experienced frequent hemorrhagic events during the following years. Six years after the initial discovery of bleeding, she experienced massive hemorrhage, lapsed into shock, and was admitted to an Emergency Room. Connective tissue around the carotid artery was largely exposed due to neck skin defect. After hemorrhage was halted by manual compression, transient hemostasis was achieved with coil embolization of the aneurysm presumed to be the source of bleeding. Recurrent hemorrhage developed two weeks later with unraveled coil mass extrusion. Parent artery occlusion was performed by endovascular trapping, achieving permanent hemostasis. Case 2 presented massive nasal bleeding originating from the petrous segment of the internal carotid artery, 2 years after having been treated with heavy particle irradiation for olfactory neuroblastoma. Ischemic tolerance was confirmed by balloon occlusion test. Based on previous experiences, the bleeding was immediately halted by endovascular trapping. Both patients were subsequently discharged, free of new neurological symptoms. Emergent hemostatic treatment is required in CBS developing severe hemorrhage. However, within irradiation fields, temporal embolization devices hardly lead to complete resolution. This is due to the deteriorated condition of the vascular wall incapable to enduring the expansion power of coils, stents or balloons. Bypass grafting is also

  12. Association of Vagotomy and Decreased Risk of Subsequent Ischemic Stroke in Complicated Peptic Ulcer Patients: an Asian Population Study.

    Fang, Chu-Wen; Tseng, Chun-Hung; Wu, Shih-Chi; Chen, William Tzu-Liang; Muo, Chih-Hsin

    2017-12-01

    The primary management of peptic ulcers is medical treatment. Persistent exacerbation of a peptic ulcer may lead to complications (perforation and/or bleeding). There has been a trend toward the use of a less invasive surgical simple suture, simple local suture or non-operative (endoscopic/angiography) hemostasis rather than acid-reducing vagotomy (i.e., vagus nerve severance) for treating complicated peptic ulcers. Other studies have shown the relationship between high vagus nerve activity and survival in cancer patients via reduced levels of inflammation, indicating the essential role of the vagus nerve. We were interested in the role of the vagus nerve and attempted to assess the long-term systemic effects after vagus nerve severance. Complicated peptic ulcer patients who underwent truncal vagotomy may represent an appropriate study population for investigating the association between vagus nerve severance and long-term effects. Therefore, we assessed the risks of subsequent ischemic stroke using different treatment methods in complicated peptic ulcer patients who underwent simple suture/hemostasis or truncal vagotomy/pyloroplasty. We selected 299,742 peptic ulcer patients without a history of stroke and Helicobacter pylori infection and an additional 299,742 matched controls without ulcer, stroke, and Helicobacter pylori infection from the National Health Insurance database. The controls were frequency matched for age, gender, Charlson comorbidity index (CCI) score, hypertension, hyperlipidemia history, and index year. Then, we measured the incidence of overall ischemic stroke in the two cohorts. The hazard ratio (HR) and the 95% confidence intervals (CIs) were estimated by Cox proportional hazard regression. Compared to the controls, peptic ulcer patients had a 1.86-fold higher risk of ischemic stroke. There were similar results in gender, age, CCI, hypertension, and hyperlipidemia stratified analyses. In complicated peptic ulcer patients, those who received

  13. Clinical characteristics of Helicobacter pylori-negative drug-negative peptic ulcer bleeding.

    Chung, Woo Chul; Jeon, Eun Jung; Kim, Dae Bum; Sung, Hea Jung; Kim, Yeon-Ji; Lim, Eun Sun; Kim, Min-Ah; Oh, Jung Hwan

    2015-07-28

    To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori (H. pylori)-negative and drug-negative] peptic ulcer bleeding (PUB). A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed. A total of 232 patients were enrolled in this study. The patients were divided into four groups according to the etiologies of PUB: idiopathic, H. pylori-associated, drug-induced and combined (H. pylori-associated and drug-induced) types. We compared the clinical characteristics and outcomes between the groups. When the silver stain or rapid urease tests were H. pylori-negative, we obtained an additional biopsy specimen by endoscopic re-examination and performed an H. pylori antibody test 6-8 wk after the initial endoscopic examination. For a diagnosis of idiopathic PUB, a negative result of an H. pylori antibody test was confirmed. In all cases, re-bleeding was confirmed by endoscopic examination. For the risk assessment, the Blatchford and the Rockall scores were calculated for all patients. For PUB, the frequency of H. pylori infection was 59.5% (138/232), whereas the frequency of idiopathic cases was 8.6% (20/232). When idiopathic PUB was compared to H. pylori-associated PUB, the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis during the hospital stay (30% vs 7.4%, P = 0.02). When idiopathic PUB was compared to drug-induced PUB, the patients in the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis upon admission (30% vs 2.7%, P ulcer (77% vs 49%, P < 0.01). However, the Blatchford and the Rockall scores were not significantly different between the two groups. Among the patients who experienced drug-induced PUB, no significant differences were found with respect to clinical characteristics, irrespective of H. pylori infection. Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission

  14. Monitoring the effectiveness of the natural anticoagulant sulodexide in pregnant women with autoimmune hyperthyroidism on the background of hyperhomocysteinemia

    A.Yu. Scherbakov

    2017-04-01

    Full Text Available According to modern concepts, the occurrence of complications in utero-placental pool during pregnancy is a common cause of primary placental insufficiency, severe forms of late gestosis, recurrent miscarriage. It is obvious that the study of the nature of violations in the hemostatic system during pregnancy and the development of methods for timely correction will be the prevention of many obstetric diseases. Among the factors that affect hemostasis, thyroid hormones occupy a special place, they are able to influence not only the functional activity of platelets, but also adjust the intensity of the plasma and tissue fibrinolysis. Oppression of fibrinolytic activity is one of the pathogenetic factors of thrombosis development. The aim – to study the efficacy of natural anticoagulant sulodexide in pregnant women with autoimmune hyperthyroidism on the background of hyperhomocysteinemia. Materials and methods. The study involved 34 pregnant women with autoimmune hyperthyroidism complicated by hyperhomocysteinemia. A control group comprised 29 somatically healthy pregnant women. General clinical examination was carried out, the main indicators of all the links of the hemostatic system and the level of homocysteine were determined. Results. We determined that the main group of pregnant is characterized with chronometric and structural hypercoagulation, which manifests itself in the form of subclinical syndrome of disseminated intravascular coagulation, leading to complications of pregnancy, childbirth and the pathological condition of the fetus. Addition of anticoagulant sulodexide to the standard treatment led to the significant change in indices of all the components of hemostasis in pregnant women of the main group, in particular normalization of the total capacity of the coagulation and fibrinolytic systems. Decrease in activity of intravascular coagulation and platelet aggregation, the level of homocysteine was marked. Clinical indicators of

  15. Identification of hemostatic genes expressed in human and rat leg muscles and a novel gene (LPP1/PAP2A) suppressed during prolonged physical inactivity (sitting)

    2012-01-01

    Background Partly because of functional genomics, there has been a major paradigm shift from solely thinking of skeletal muscle as contractile machinery to an understanding that it can have roles in paracrine and endocrine functions. Physical inactivity is an established risk factor for some blood clotting disorders. The effects of inactivity during sitting are most alarming when a person develops the enigmatic condition in the legs called deep venous thrombosis (DVT) or “coach syndrome,” caused in part by muscular inactivity. The goal of this study was to determine if skeletal muscle expresses genes with roles in hemostasis and if their expression level was responsive to muscular inactivity such as occurs in prolonged sitting. Methods Microarray analyses were performed on skeletal muscle samples from rats and humans to identify genes associated with hemostatic function that were significantly expressed above background based on multiple probe sets with perfect and mismatch sequences. Furthermore, we determined if any of these genes were responsive to models of physical inactivity. Multiple criteria were used to determine differential expression including significant expression above background, fold change, and non-parametric statistical tests. Results These studies demonstrate skeletal muscle tissue expresses at least 17 genes involved in hemostasis. These include the fibrinolytic factors tetranectin, annexin A2, and tPA; the anti-coagulant factors TFPI, protein C receptor, PAF acetylhydrolase; coagulation factors, and genes necessary for the posttranslational modification of these coagulation factors such as vitamin K epoxide reductase. Of special interest, lipid phosphate phosphatase-1 (LPP1/PAP2A), a key gene for degrading prothrombotic and proinflammatory lysophospholipids, was suppressed locally in muscle tissue within hours after sitting in humans; this was also observed after acute and chronic physical inactivity conditions in rats, and exercise was

  16. Neonatal Platelet Transfusions and Future Areas of Research.

    Sola-Visner, Martha; Bercovitz, Rachel S

    2016-10-01

    Thrombocytopenia affects approximately one fourth of neonates admitted to neonatal intensive care units, and prophylactic platelet transfusions are commonly administered to reduce bleeding risk. However, there are few evidence-based guidelines to inform clinicians' decision-making process. Developmental differences in hemostasis and differences in underlying disease processes make it difficult to apply platelet transfusion practices from other patient populations to neonates. Thrombocytopenia is a risk factor for common preterm complications such as intraventricular hemorrhage; however, a causal link has not been established, and platelet transfusions have not been shown to reduce risk of developing intraventricular hemorrhage. Platelet count frequently drives the decision of whether to transfuse platelets, although there is little evidence to demonstrate what a safe platelet nadir is in preterm neonates. Current clinical assays of platelet function often require large sample volumes and are not valid in the setting of thrombocytopenia; however, evaluation of platelet function and/or global hemostasis may aid in the identification of neonates who are at the highest risk of bleeding. Although platelets' primary role is in establishing hemostasis, platelets also carry pro- and antiangiogenic factors in their granules. Aberrant angiogenesis underpins common complications of prematurity including intraventricular hemorrhage and retinopathy of prematurity. In addition, platelets play an important role in host immune defenses. Infectious and inflammatory conditions such as sepsis and necrotizing enterocolitis are commonly associated with late-onset thrombocytopenia in neonates. Severity of thrombocytopenia is correlated with mortality risk. The nature of this association is unclear, but preclinical data suggest that thrombocytopenia contributes to mortality rather than simply being a proxy for disease severity. Neonates are a distinct patient population in whom

  17. Hemostatic properties of the free-electron laser

    Cram, G.P. Jr.; Copeland, M.L. [Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN 37235 (United States)

    1998-09-02

    We have investigated the hemostatic properties of the free-electron laser (FEL) and compared these properties to the most commonly used commercial lasers in neurosurgery, CO{sub 2} and Nd:YAG, using an acute canine model. Arterial and venous vessels, of varying diameters from 0.1 to 1.0 mm, were divided with all three lasers. Analysis of five wavelengths of the FEL (3.0, 4.5, 6.1, 6.45, and 7.7 microns) resulted in bleeding without evidence of significant coagulation, regardless of whether the vessel was an artery or vein. Hemorrhage from vessels less than 0.4 mm diameter was subsequently easily controlled with Gelfoam registered (topical hemostatic agent) alone, whereas larger vessels required bipolar electrocautery. No significant charring, or contraction of the surrounding parenchyma was noted with any of the wavelengths chosen from FEL source. The CO{sub 2} laser, in continuous mode, easily coagulated vessels with diameters of 4 mm and less, while larger vessels displayed significant bleeding requiring bipolar electrocautery for control. Tissue charring was noted with application of the CO{sub 2} laser. In super pulse mode, the CO{sub 2} laser exhibited similar properties, including significant charring of the surrounding parenchyma. The Nd:YAG coagulated all vessels tested up to 1.4 mm, which was the largest diameter cortical artery found, however this laser displayed significant and extensive contraction and retraction of the surrounding parenchyma. In conclusion, the FEL appears to be a poor hemostatic agent. Our results did not show any benefit of the FEL over current conventional means of achieving hemostasis. However, control of hemorrhage was easily achieved with currently used methods of hemostasis, namely Gelfoam registered or bipolar electrocuatery. Although only cortical vessels in dogs were tested, we feel this data can be applied to all animals, including humans, and the peripheral, as well as central, vasculature, as our data on the CO{sub 2} and

  18. Hemostatic properties of the free-electron laser

    Cram, G.P. Jr.; Copeland, M.L.

    1998-01-01

    We have investigated the hemostatic properties of the free-electron laser (FEL) and compared these properties to the most commonly used commercial lasers in neurosurgery, CO 2 and Nd:YAG, using an acute canine model. Arterial and venous vessels, of varying diameters from 0.1 to 1.0 mm, were divided with all three lasers. Analysis of five wavelengths of the FEL (3.0, 4.5, 6.1, 6.45, and 7.7 microns) resulted in bleeding without evidence of significant coagulation, regardless of whether the vessel was an artery or vein. Hemorrhage from vessels less than 0.4 mm diameter was subsequently easily controlled with Gelfoam registered (topical hemostatic agent) alone, whereas larger vessels required bipolar electrocautery. No significant charring, or contraction of the surrounding parenchyma was noted with any of the wavelengths chosen from FEL source. The CO 2 laser, in continuous mode, easily coagulated vessels with diameters of 4 mm and less, while larger vessels displayed significant bleeding requiring bipolar electrocautery for control. Tissue charring was noted with application of the CO 2 laser. In super pulse mode, the CO 2 laser exhibited similar properties, including significant charring of the surrounding parenchyma. The Nd:YAG coagulated all vessels tested up to 1.4 mm, which was the largest diameter cortical artery found, however this laser displayed significant and extensive contraction and retraction of the surrounding parenchyma. In conclusion, the FEL appears to be a poor hemostatic agent. Our results did not show any benefit of the FEL over current conventional means of achieving hemostasis. However, control of hemorrhage was easily achieved with currently used methods of hemostasis, namely Gelfoam registered or bipolar electrocuatery. Although only cortical vessels in dogs were tested, we feel this data can be applied to all animals, including humans, and the peripheral, as well as central, vasculature, as our data on the CO 2 and Nd:YAG appear to closely

  19. Avaliação da perda sanguínea na artroplastia total do joelho com e sem soltura do torniquete Blood loss in total knee arthroplasty with and without tourniquet release

    José Wanderley Vasconcelos

    2011-01-01

    Full Text Available OBJETIVO: Avaliar a perda sanguínea em pacientes submetidos à artroplastia total cimentada do joelho com e sem soltura trans-operatória do torniquete pneumático para a hemostasia. MÉTODOS: Foram estudados 72 pacientes submetidos à artroplastia total, num total de 80 joelhos, divididos em dois grupos: Grupo 1 onde se manteve o torniquete pneumático até a sutura e curativo da ferida operatória, e Grupo 2 onde foi realizada a soltura do torniquete pneumático após a cimentação da prótese, com realização de hemostasia direta, antes da sutura e curativo. Os pacientes foram avaliados quanto ao sangramento pelo dreno de sucção e à contagem de hemoglobina e hematócrito, considerando os intervalos de duas, 24 e 48 horas de pós-operatório. RESULTADOS: Não houve diferença significante entre os dois grupos quanto ao sangramento pós-operatório e decréscimo dos parâmetros hematimétricos. Somente um paciente do Grupo 2 necessitou transfusão de concentrado de hemáceas no pós-operatório. CONCLUSÃO: O sangramento pós-operatório na ATJ mostrou-se igual com e sem a soltura do torniquete pneumático para a realização da hemostasia.OBJECTIVE: To evaluate blood loss in patients submitted to cemented total knee arthroplasty with and without perioperative tourniquet release for hemostasis. METHODS: Seventy-two patients (eighty knees were submitted to total knee arthroplasty, allocated into two groups: in Group 1, in which the pneumatic tourniquet was maintained until suture and dressing of the operated wound, and Group 2, in which the pneumatic tourniquet was released intraoperatively after cementing the prosthesis, with direct hemostasis, before the suture and dressing. The patients were evaluated for blood loss by the suction drain, and hemoglobin and hematocrit counts, at intervals of 2, 24 and 48 hours in the postoperative period tube. RESULTS: There was no significant difference between the groups in terms of postoperative blood

  20. Sertraline-induced periorbital purpura: a case report.

    Kayhan, Fatih; Eken, Zahide Eriş; Uguz, Faruk

    2015-08-01

    The incidence of mild to severe levels of spontaneous bleeding due to the usage of selective serotonin reuptake inhibitors (SSRIs) is relatively low. Although the exact mechanism is not known, it is thought that inhibition of the serotonin transporter together with a decrease in platelet serotonin could be responsible for the bleeding. Therefore, the use of SSRIs in conjunction with anti-aggregants may predispose to or exacerbate the risk of bleeding. In this case report, we describe a 44-year-old female patient with a diagnosis of anxiety disorder who spontaneously developed periorbital purpura during treatment with sertraline. Abnormal bleeding after treatment with an SSRI should be kept in mind, and alternative non-SSRI drugs of choice in such cases would be more appropriate. More extensive and comprehensive studies focusing on hemostasis and bleeding disorders are needed for SSRIs such as sertraline. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  1. Monitoring of gastric secretion and early diagnostics of gastroduodenal ulcerative bleeding recurrences

    Belikov A.V.

    2011-12-01

    Full Text Available The research goal is to develop a universal method of monitoring of intragastric medium dynamics. It allows diagnosing of bleeding recurrences and monitoring the effectiveness of gastric secretion suppression. In Saratov clinic of General Surgery use of probe-detector, dynamic endoscopy, laser Doppler flowmetry and methods of endoscopic hemostasis has reduced mortality: postoperative mortality has been decreased from 7,4 to 1,6%, while the general mortality — from 3,5 to 1,5%. The proposed devices can be used separately, and do not allow parallel assessment of pH of gastric juice, the microcirculation in the stomach wall and bleeding recurrences. 47 patients have been under the study. The changes in electroconductivity of intragastric medium have been proved in the suppression of intragastric secretion and the appearance of blood in gastric lumen. The received data have considered impedancemetry as the method of monitoring of intragastric medium in gastroduodenal bleedings

  2. Mechanobiology of Platelets: Techniques to Study the Role of Fluid Flow and Platelet Retraction Forces at the Micro- and Nano-Scale

    Nathan J. Sniadecki

    2011-12-01

    Full Text Available Coagulation involves a complex set of events that are important in maintaining hemostasis. Biochemical interactions are classically known to regulate the hemostatic process, but recent evidence has revealed that mechanical interactions between platelets and their surroundings can also play a substantial role. Investigations into platelet mechanobiology have been challenging however, due to the small dimensions of platelets and their glycoprotein receptors. Platelet researchers have recently turned to microfabricated devices to control these physical, nanometer-scale interactions with a higher degree of precision. These approaches have enabled exciting, new insights into the molecular and biomechanical factors that affect platelets in clot formation. In this review, we highlight the new tools used to understand platelet mechanobiology and the roles of adhesion, shear flow, and retraction forces in clot formation.

  3. Supplementary arteriel embolization an option in high-risk ulcer bleeding--a randomized study

    Laursen, Stig Borbjerg; Hansen, Jane Møller; Andersen, Poul Erik

    2014-01-01

    OBJECTIVE: One of the major challenges in peptic ulcer bleeding (PUB) is rebleeding which is associated with up to a fivefold increase in mortality. We examined if supplementary transcatheter arterial embolization (STAE) performed after achieved endoscopic hemostasis improves outcome in patients...... with high-risk ulcers. MATERIAL AND METHODS: The study was designed as a non-blinded, parallel group, randomized-controlled trial and performed in a university hospital setting. Patients admitted with PUB from Forrest Ia - IIb ulcers controlled by endoscopic therapy were randomized (1:1 ratio) to STAE...... of rebleeding, need of hemostatic intervention and mortality. Secondary outcomes were rebleeding, number of blood transfusions received, duration of admission and mortality. RESULTS: Totally 105 patients were included. Of the 49 patients allocated to STAE 31 underwent successful STAE. There was no difference...

  4. Tissue factor-factor VIIa-specific up-regulation of IL-8 expression in MDA-MB-231 cells is mediated by PAR-2 and results in increased cell migration

    Hjortoe, Gertrud M; Petersen, Lars C; Albrektsen, Tatjana

    2004-01-01

    Tissue factor (TF), the cellular receptor for factor VIIa (FVIIa), besides initiating blood coagulation, is believed to play an important role in tissue repair, inflammation, angiogenesis, and tumor metastasis. Like TF, the chemokine interleukin-8 (IL-8) is shown to play a critical role...... in these processes. To elucidate the potential mechanisms by which TF contributes to tumor invasion and metastasis, we investigated the effect of FVIIa on IL-8 expression and cell migration in a breast carcinoma cell line, MDA-MB-231, a cell line that constitutively expresses abundant TF. Expression of IL-8 m......RNA in MDA-MB-231 cells was markedly up-regulated by plasma concentrations of FVII or an equivalent concentration of FVIIa (10 nM). Neither thrombin nor other proteases involved in hemostasis were effective in stimulating IL-8 in these cells. Increased transcriptional activation of the IL-8 gene...

  5. Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst.

    Koh, Peng Soon; Yoong, Boon Koon; Vijayananthan, Anushya; Nawawi, Ouzreiah; Mahadeva, Sanjiv

    2013-08-01

    Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management. © 2013 The Authors. Journal of Digestive Diseases © 2013 Wiley Publishing Asia Pty Ltd and Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.

  6. LAPAROSCOPIC NEPHRECTOMY USING RADIOFREQUENCY THERMAL ABLATION

    B. Ya. Alekseev

    2012-01-01

    Full Text Available The wide use of current diagnostic techniques, such as ultrasound study, computed tomography, and magnetic resonance imaging, has led to significantly increased detection rates for disease in its early stages. This gave rise to a change in the standards for the treatment of locally advanced renal cell carcinoma (RCC. Laparoscopic nephrectomy (LN has recently become the standard treatment of locally advanced RCC in the clinics having much experience with laparoscopic surgery. The chief drawback of LN is difficulties in maintaining intraoperative hemostasis and a need for creating renal tissue ischemia. The paper gives the intermediate results of application of the new procedure of LN using radiofrequency thermal ablation in patients with non-ischemic early-stage RCC.

  7. CT findings in children with blunt trauma in the spleen

    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori; Watanabe, Shinsuke.

    1991-01-01

    We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author)

  8. CT findings in children with blunt trauma in the spleen

    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori (Kyoto Second Red Cross Hospital (Japan)); Watanabe, Shinsuke

    1991-09-01

    We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author).

  9. Splenic trauma in a patient with portal hypertension and splenomegaly: A case report

    Ahmet Topçu

    2017-08-01

    Full Text Available The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Currently, 50-80% of adults with blunt splenic injuries are treated nonoperatively. In this report, we present a blunt abdominal trauma patient having a history of portal hypertension and splenomegaly. In grade 3 and even grade 4 splenic injuries non-operative treatment is recommended in current literature. Management of splenic trauma with a patient with history of splenomegaly and portal hypertension is insufficiently discussed in literature. In presented case, hypersplenism and portal hypertension were burden on hemostasis. Even with massive resuscitation, thrombocyte level decreased to 40.000/mm³ after five hours. But, insistence on non-operative treatment in this situation could be fatal.

  10. Regulation of plasma von Willebrand factor [version 1; referees: 3 approved

    Karl C Desch

    2018-01-01

    Full Text Available Von Willebrand factor (VWF is a multimeric plasma glycoprotein that plays a central role in the initiation of blood coagulation. Through interactions between its specific functional domains, the vascular wall, coagulation factor VIII, and platelet receptors, VWF maintains hemostasis by binding to platelets and delivering factor VIII to the sites of vascular injury. In the healthy human population, plasma VWF levels vary widely. The important role of VWF is illustrated by individuals at the extremes of the normal distribution of plasma VWF concentrations where individuals with low VWF levels are more likely to present with mucocutaneous bleeding. Conversely, people with high VWF levels are at higher risk for venous thromboembolic disease, stroke, and coronary artery disease. This report will summarize recent advances in our understanding of environmental influences and the genetic control of VWF plasma variation in healthy and symptomatic populations and will also highlight the unanswered questions that are currently driving this field of study.

  11. Life-threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia.

    Ikegami, Yukihiro; Yoshida, Keisuke; Imaizumi, Tsuyoshi; Isosu, Tsuyoshi; Kurosawa, Shin; Murakawa, Masahiro

    2016-10-01

    A 77-year-old man with severe septic disseminated intravascular coagulation following urinary infection was transported to our hospital. He had developed urinary retention induced by untreated prostatic hyperplasia. Immediate drainage with a Foley catheter was successfully carried out, but the hematuria progressed to life-threatening hemorrhage. Complete hemostasis was impossible by surgical treatment because the tissue around the prostatic urethra was very fragile and hemorrhagic. Organized treatments (continuous hemodiafiltration combined with polymyxin-B immobilized fiber column hemoperfusion and systemic treatment with antibiotics and coagulation factors) were commenced soon after the operation. The patient eventually recovered from the septic disseminated intravascular coagulation. This case report illustrates the risk of placement of Foley catheters in patients with severe septic disseminated intravascular coagulation.

  12. Critical off-target effects of the widely used Rac1 inhibitors NSC23766 and EHT1864 in mouse platelets

    Dütting, Sebastian; Heidenreich, Julius; Cherpokova, Deya

    2015-01-01

    BACKGROUND: Platelet aggregation at sites of vascular injury is essential for normal hemostasis, but may also cause pathological vessel occlusion. Rho GTPases are molecular switches that regulate essential cellular processes and they have pivotal functions in the cardiovascular system. Rac1......, have been characterized in different cell types, demonstrating high specificity for Rac1 or Rac, respectively. OBJECTIVES: We sought to analyze the specificity of NSC23766 and EHT1864. METHODS: Platelet function was assessed in mouse wild-type and Rac1-deficient platelets by using flow cytometric...... function tests. Both inhibitors induced a Rac1-specific inhibition of platelet spreading, but also markedly impaired agonist-induced activation of Rac1(-/-) platelets. Furthermore, GPIb-mediated signaling was dramatically inhibited by NSC23766 in both wild-type and Rac1-deficient platelets. Importantly...

  13. Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases.

    Son, Hee-Won; Park, Se-Hun; Cho, Hyun-Oh; Shin, Yong-Joon; Son, Jang-Ho

    2016-10-01

    Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

  14. [Results of the use of pumpan preparation in the treatment of severe forms of angina pectoris].

    Parshina, S S; Golovacheva, T V; Afanas'eva, T N; Panchenko, O V; Baldina, A A; Starostina, N V; Lial'chenko, I F; Egorova, L P

    2000-01-01

    To assess validity of adjuvant use of pumpan, a homeopathic compound, in patients with unstable angina pectoris and angina of effort (functional class III-IV) receiving conventional treatment. A direct open controlled trial for 15 months performed initially in hospital, then outpatiently, covered 49 patients with severe angina. Examination of the patients included evaluation of clinical condition and the disease course, lipid metabolism, hemostasis, blood plasma electrolytes, aminotransferases, echo-CG, bicycle exercise, rheoencephalography, ultrasonic dopplerography of head and neck vessels. Pumpan produced a positive effect total nonspecific systemic resistance improved, number of hospitalizations reduced, intracardiac hemodynamics improved in some cases with severe angina. Homeopathic compound pumpan can be recommended in the treatment of severe angina to reinforce antianginal effect, improve the disease clinical course, to obtain a hypocoagulative and hypocholesterolemic effect, to normalize intracardiac hemodynamics, to raise myocardial performance and intracoronary reserve as well as nonspecific resistance of the body.

  15. Delayed Development of Brain Abscesses Following Stent-Graft Placement in a Head and Neck Cancer Patient Presenting with Carotid Blowout Syndrome

    Oweis, Yaseen; Gemmete, Joseph J.; Chaudhary, Neeraj; Pandey, Aditya; Ansari, Sameer

    2011-01-01

    We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.

  16. [Spontaneous tension hemothorax due to rupture of a solitary fibrous tumor of the posterior mediastinum].

    Morita, Yohei; Ichimura, Hideo; Kikuchi, Shinji; Ozawa, Yuichiro; Inoue, Kazunari; Uchida, Atsushi; Kikuchi, Kazunori; Shiigai, Masanari; Shiotani, Seiji

    2013-10-01

    A 37-year-old man was transported by ambulance to our hospital due to abrupt chest pain. The pain began when he was practicing a combative-type sport. He denied any impact or blunt trauma. A chest radiograph revealed massive left pleural effusion with a mediastinal shift. Thoracentesis revealed a hemothorax;therefore, we performed an emergency thoracotomy. The intraoperative findings revealed a rupture of a posterior mediastinal tumor itself located between the descending aorta and the thoracic vertebra. After we identified the artery of Adamkiewicz that originates away from the tumor and evaluated the degree of tumor extension into the inter-vertebral foramen, we safely performed an elective tumor resection 1 month after the initial emergency operation. In patients with a hemothorax caused by rupture of the tumor itself, an elective tumor resection after detailed investigation should be considered if hemostasis can be achieved in the emergency thoracotomy.

  17. [Diagnosis of gastric ulcer in the elderly].

    Ashida, Kiyoshi; Fukuchi, Takumi; Yamashita, Hiroshi

    2010-11-01

    It is well known that gastric ulcers are most often found at anglus and upper corpus in the elderly. The number of gastric ulcer found at upper corpus hold half of all cases in the elderly patients with bleeding ulcer. Sixty percent of the elderly patients with bleeding ulcer took NSAIDs including low-dose aspirin in authors' hospital. Now it is easy to treat and cure bleeding ulcers due to development of endoscopic hemostasis and antiulcer drugs such as proton pump inhibitor(PPI). However, the elderly patients sometimes result in fatal outcome on bleeding from gastric ulcer. Therefore, it is important to prevent ulcer complications by PPI for the high-risk group such as elderly patients taking NSAIDs.

  18. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Miettinen Simo

    2012-09-01

    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  19. Progress Toward the Clinical Translation of Bioinspired Peptide and Protein Assemblies.

    Hainline, Kelly M; Fries, Chelsea N; Collier, Joel H

    2018-03-01

    Supramolecular materials composed of proteins and peptides have been receiving considerable attention toward a range of diseases and conditions from vaccines to drug delivery. Owing to the relative newness of this class of materials, the bulk of work to date has been preclinical. However, examples of approved treatments particularly in vaccines, dentistry, and hemostasis demonstrate the translational potential of supramolecular polypeptides. Critical milestones in the clinical development of this class of materials and currently approved supramolecular polypeptide therapies are described in this study. Additional examples of not-yet-approved materials that are steadily advancing toward clinical use are also featured. Spherical assemblies such as virus-like particles, designed protein nanoparticles, and spherical peptide amphiphiles are highlighted, followed by fiber-forming systems such as fibrillizing peptides, fiber-forming peptide-amphiphiles, and filamentous bacteriophages. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. [Gastrointestinal bleeding--concepts of surgical therapy in the upper gastrointestinal tract].

    Knoefel, W T; Rehders, A

    2006-02-01

    Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.

  1. An Arteriovenous Fistula Between the Internal Mammary Artery and the Pulmonary Vein Following Blunt Chest Trauma

    Ito, T.; Sakamoto, Toshihisa; Norio, Hirofumi; Kaji, Tatsumi; Okada, Yoshiaki

    2005-01-01

    A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization

  2. Olfactory groove meningiomas: approaches and complications.

    Aguiar, Paulo Henrique Pires de; Tahara, Adriana; Almeida, Antonio Nogueira; Simm, Renata; Silva, Arnaldo Neves da; Maldaun, Marcos Vinicius Calfatt; Panagopoulos, Alexandros Theodoros; Zicarelli, Carlos Alexandre; Silva, Pedro Gabriel

    2009-09-01

    Olfactory groove meningiomas (OGM) account for 4.5% of all intracranial meningiomas. We report 21 patients with OGMs. Tumors were operated on using three surgical approaches: bifrontal (7 patients), fronto-pterional (11 patients) and fronto-orbital (3 patients). Total tumor removal (Simpson Grade 1) was achieved in 13 patients and Simpson II in 8 patients. Perioperative mortality was 4.76%. The average size of the OGM was 4.3+/-1.1cm. The overall recurrence rate was 19%. We preferred to use the pterional approach, which provides quick access to the tumor with less brain exposure. It also allows complete drainage of cisternal cerebrospinal fluid, providing a good level of brain relaxation during surgery. However, for long, thin tumors, hemostasis can be difficult using this approach.

  3. The use of QuikClot combat gauze in cervical and vaginal hemorrhage

    Nicole Vilardo

    2017-08-01

    Full Text Available QuikClot combat gauze is a synthetic hemostatic dressing used for hemorrhage control. There is a paucity of data describing the clinical use and hemostatic results of combat gauze in the obstetric and gynecologic setting. This case series demonstrates the use of combat gauze as an effective hemostatic agent when used as vaginal packing in cervical and vaginal hemorrhage. Hemostasis was achieved rapidly in all cases and further interventions were avoided. The combat gauze remained in place for a mean time of 15 h with no adverse side effects observed. The use of combat gauze as vaginal packing may provide an alternative option in the treatment of cervical and vaginal hemorrhage when other traditional conservative and surgical interventions fail or are unavailable.

  4. Prosthetic valve sparing aortic root replacement: an improved technique.

    Leacche, Marzia; Balaguer, Jorge M; Umakanthan, Ramanan; Byrne, John G

    2008-10-01

    We describe a modified surgical technique to treat patients with a previous history of isolated aortic valve replacement who now require aortic root replacement for an aneurysmal or dissected aorta. This technique consists of replacing the aortic root with a Dacron conduit, leaving intact the previously implanted prosthesis, and re-implanting the coronary arteries in the Dacron graft. Our technique differs from other techniques in that we do not leave behind any aortic tissue remnant and also in that we use a felt strip to obliterate any gap between the old sewing ring and the newly implanted graft. In our opinion, this promotes better hemostasis. We demonstrate that this technique is safe, feasible, and results in acceptable outcomes.

  5. Effects of Aglumin on the rectal bleeding following radiotherapy

    Yamashita, Michitaka; Tanaka, Motoshi; Yoshimura, Osamu; Matsubayashi, Shigeru

    1978-01-01

    Aglumin was administered to 20 cases which had rectal bleeding following radiotherapy. The results were as follows. Rectal bleeding decreased in 16 of 20 cases (80%): remarkably effective, 15%; effective, 25%; slightly effective, 40%. Bleeding time decreased in 11 cases (55%). Rumpel-Leede test gave remarkable improvement in 10 of 14 cases which had been abnormal (71.4%). Platelet increased in 18 of 20 cases (90%). Liver function test and peripheral blood findings showed no remarkable changes. No side effects such as intestinal disturbance etc were noted. In the series of symptomatic treatment for rectal disturbance resulting from radiotherapy, this drug had considerable effect of hemostasis. It was concluded that this drug is useful in combined use with other antiphlogistics, analgesic, and hematinic etc. (Ueda, J.)

  6. Arthroscopic anatomy of the subdeltoid space

    Michael J. Salata

    2013-09-01

    Full Text Available From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears.

  7. Surgical excision of Infantile Haemangiomas: a technical refinement to prevent bleeding complications

    F. Leone

    2014-06-01

    Full Text Available Purpose: The aim of the study is to improve operative speed and precision of haemangiomas excision. Methods: Case-report: haemangioma is a common affection of the 8% of the population during the neonatal period. In complicated cases and involution sequelae surgical treatment is the first choice. The Authors propose a surgical refinement to prevent intraoperative bleeding. Methods: several suture stitches were placed around the hemangioma. The edges of the lesion became more defined, thus allowing accurate excision. Results and Conclusions: Haemangiomas are characterized by rich blood supply. Surgery is often hindered by massive bleeding and Temporary placement of full-thickness sutures, surrounding the hemangioma, allowed a noticeable improvement in hemostasis precision and greater definition of the margins of the hemangioma.

  8. Salivary gland extracts of Culicoides sonorensis inhibit murine lymphocyte proliferation and no production by macrophages.

    Bishop, Jeanette V; Mejia, J Santiago; Pérez de León, Adalberto A; Tabachnick, Walter J; Titus, Richard G

    2006-09-01

    Culicoides biting midges serve as vectors of pathogens affecting humans and domestic animals. Culicoides sonorensis is a vector of several arboviruses in North American that cause substantial economic losses to the US livestock industry. Previous studies showed that C. sonorensis saliva, like the saliva of many hematophagous arthropods, contains numerous pharmacological agents that affect hemostasis and early events in the inflammatory response, which may enhance the infectivity of Culicoides-borne pathogens. This paper reports on the immunomodulatory properties of C. sonorensis salivary gland extracts on murine immune cells and discusses the possible immunomodulatory role of C. sonorensis saliva in vesicular stomatitis virus infection of vertebrate hosts. Splenocytes treated with C. sonorensis mitogens were significantly affected in their proliferative response, and peritoneal macrophages secreted significantly less NO. A 66-kDa glycoprotein was purified from C. sonorensis salivary gland extract, which may be in part responsible for these observations and may be considered as a vaccine candidate.

  9. Tranexamic Acid: From Trauma to Routine Perioperative Use

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  10. Clinical Application of Diode Laser (980 nm) in Maxillofacial Surgical Procedures.

    Aldelaimi, Tahrir N; Khalil, Afrah A

    2015-06-01

    For many procedures, lasers are now becoming the treatment of choice by both clinicians and patients, and in some cases, the standard of care. This clinical study was carried out at Department of Maxillofacial Surgery, Ramadi Teaching Hospital, Rashid Private Hospital and Razi Private Hospital, Anbar Health Directorate, Anbar Province, Iraq. A total of 32 patients including 22 (≈ 70%) male and 10 (≈ 30%) female with age range from 5 months to 34 years old. Chirolas 20 W diode laser emitting at 980 nm was used. Our preliminary clinical findings include sufficient hemostasis, coagulation properties, precise incision margin, lack of swelling, bleeding, pain, scar tissue formation and overall satisfaction were observed in the clinical application. The clinical application of the diode (980 nm) laser in maxillofacial surgery proved to be of beneficial effect for daily practice and considered practical, effective, easy to used, offers a safe, acceptable, and impressive alternative for conventional surgical techniques.

  11. Surgical effects on soft tissue produced by a 405-nm violet diode laser in vivo

    Miyazaki, H.; Kato, J.; Kawai, S.; Hatayama, H.; Uchida, K.; Otsuki, M.; Tagami, J.; Yokoo, S.

    2011-12-01

    This study evaluated the surgical performance of a 405-nm diode laser in vivo, using living rat liver tissue. Tissue was incised by irradiation with the laser at low output power ranging from 1 W (722 W/cm2) to 3 W (2165 W/cm2) on a manual control at a rate of 1 mm/s. As a control, incisions using a stainless scalpel were compared. Immediately after operation, the surface of the incisions was macroscopically observed and histopathologically evaluated by microscopy. Laser-ablated liver tissue was smooth with observable signs of remnant carbonization and easily acquired hemostasis. The thickness of the denatured layer increased in proportion to the output power; the coagulation layer did not thicken accordingly. Bleeding could not be stopped for tissues incised with the stainless scalpel. The 405-nm diode laser thus proved to be effective for ablating soft tissue with high hemostatic ability at low power.

  12. Effectiveness of soft tissue diode laser in treatment of oral mucosal lesions

    Amanpreet Kaur

    2017-01-01

    Full Text Available Soft tissue diode lasers are becoming popular among clinicians due to their potential value in surgical procedures providing surface sterilization, dry surgical field, and increased patient acceptance. Two patients with different soft tissue lesions were selected, and soft tissue diode laser was used for excision and wound healing was assessed by visual method with photographs. No discomfort to the patient during and after the laser procedure was observed. Inspite of using minimal local anesthesia, avoiding placement of sutures, and not prescribing any antibiotics, minimal bleeding, no edema, and good wound healing was observed. We conclude that lasers treatments can be superior to conventional approaches with regards to easy ablation, decontamination, and hemostasis, and are less painful during and after the procedure.

  13. Management of tooth extraction in a patient with a rare bleeding disorder associated with Hermansky-Pudlak syndrome: a case report.

    Minkin, Patton; Bertetti, Richard; Lindsey, Sean; Bovino, Brian

    2015-02-01

    This report describes the case of a 27-year-old man who had been diagnosed with Hermansky-Pudlak syndrome shortly after birth. Because the patient had a major bleeding disorder associated with his syndrome, local and systemic hemostatic protection recommendations had to be considered before tooth extraction. Synthetic vasopressin (1-deamino-8-d-arginine vasopressin [DDAVP]) was transfused intravenously before surgery. During surgery the patient was transfused with 1 U of human leukocyte antigen (HLA)-matched apheresis platelets. A hemostatic packing of Avitene and Gelfoam was adapted to the extraction site. Treatment with DDAVP, HLA-matched platelets, and local application of a packing with Avitene and Gelfoam resulted in sustained hemostasis and an excellent healing response. Surgical and routine extractions appear to be safe procedures in patients with Hermansky-Pudlak syndrome when appropriate local and systemic hemostatic measures are used. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Blood-loss Management in Spine Surgery.

    Bible, Jesse E; Mirza, Muhammad; Knaub, Mark A

    2018-01-15

    Substantial blood loss during spine surgery can result in increased patient morbidity and mortality. Proper preoperative planning and communication with the patient, anesthesia team, and operating room staff can lessen perioperative blood loss. Advances in intraoperative antifibrinolytic agents and modified anesthesia techniques have shown promising results in safely reducing blood loss. The surgeon's attention to intraoperative hemostasis and the concurrent use of local hemostatic agents also can lessen intraoperative bleeding. Conversely, the use of intraoperative blood salvage has come into question, both for its potential inability to reduce the need for allogeneic transfusions as well as its cost-effectiveness. Allogeneic blood transfusion is associated with elevated risks, including surgical site infection. Thus, desirable transfusion thresholds should remain restrictive.

  15. A case of radiation hemorrhagic gastritis successfully treated by endoscopic argon plasma coagulation

    Furukawa, Koichi; Ho, Nichyau; Kuroda, Ken; Ikarashi, Kentarou; Hata, Koujirou; Tukioka, Satosi

    2003-01-01

    A 72-year-old woman underwent irradiation of 46 Grey in total dose, for lumbago of the advanced pancreatic cancer in August 2000. She was admitted to our hospital due to severe anemia in February 2001 with occasionally positive fecal occult blood. Endoscopy revealed erosive gastric mucosa diffuse in the lower body of the stomach, which resulted from radiation. We applied argon plasma coagulation (APC) in March 2001 and succeeded in hemostasis of the widely spreading radiation hemorrhagic gastritis. The progress of the severe anemia improved without cicatricial stenosis. As the coagulation of the APC is limited in the surface mucosa, APC is an easy and effective treatment for radiation hemorrhagic gastritis. (author)

  16. Nanotechnology in gastrointestinal endoscopy: A primer

    Ashish Kumar Jha

    2012-01-01

    Full Text Available Nanotechnology is the understanding, control of matter and development of engineered devices in nanometer range (1-100 nm. Nanoparticles have different physicochemical properties (small size, large surface area to volume ratio, and high reactivity in comparison to bulk materials of the same composition. The nanotechnology has proved its usefulness in early diagnosis, proteonomics, imaging diagnostics and multifunctional therapeutics. Recent studies have shown its role in early diagnosis and targeted therapy of various gastrointestinal disorders such as hepatitis B virus and hepatitis C virus related liver disease, inflammatory bowel disease, gastric ulcer, and malignancy. Application of this technology appears promising in diagnostic and therapeutic endoscopy such as the endoscopic hemostasis of peptic ulcer bleeding, prevention of clogging of plastic stent and advance capsule endoscopy. This article will highlight the basic concepts of nanotechnology and its potential application in gastrointestinal endoscopy.

  17. National consensus on management of peptic ulcer bleeding in Denmark 2014

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2014-01-01

    DESCRIPTION: The Danish Society of Gastroenterology and Hepatology have compiled a national guideline for the management of peptic ulcer bleeding. Sources of data included published studies up to June 2014. Quality of evidence and strength of recommendations have been graded. The guideline...... endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) within 24 hours from primary endoscopy. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put...... on prophylactic treatment with PPI at standard dosage. The combination of 75 mg ASA and PPI should be preferred to monotherapy with clopidogrel in patients needing anti-platelet therapy on the basis of indications other than coronary stents. Low-risk patients without clinical suspicion of peptic ulcer bleeding...

  18. Endoscopic Injection Therapy in Bleeding Peptic Ulcers. Low Mortality in a High Risk Population

    Joaqulm Balanzó

    1992-01-01

    Full Text Available Endoscoric injection therapy was performed in 341 patients consecutively admitted with a bleeding peptic ulcer at high risk of further hemorrhage, assessed by the presence of active arterial bleeding or a nonbleeding visible vessel at emergency endoscopy. Initial hemostasis was achieved in 111 of 119 actively bleeding patients (93%. Rebleeding ocurred in 75 cases (23%, at a mean interval of 53±52 h. A second emergency injection was a ttempted in 36 therapeutic failures, and was successful in 20 (55%. Emergency surgery was finally required in 52 patients (15%. Overall mortality was 4.9%. Major complications occurred in four patients (1.2% (two perforations and two aspiration pneumonia; therefore, injection therapy is an effective and simple method for treating bleeding ulcers, achieving the initial control of hemorrhage in a majority of cases although the rate of further hemorrhage is not negligible and complications are not irrelevant.

  19. Hypoalbuminemia is a predictor of mortality and rebleeding in peptic ulcer bleeding under proton pump inhibitor use.

    Cheng, Hsiu-Chi; Yang, Er-Hsiang; Wu, Chung-Tai; Wang, Wen-Lun; Chen, Po-Jun; Lin, Meng-Ying; Sheu, Bor-Shyang

    2018-04-01

    Peptic ulcer bleeding remains a deadly disease, and a simple indicator of long-term outcomes is crucial. This study validated whether hypoalbuminemia and its related factors in patients with peptic ulcer bleeding can indicate long-term mortality and rebleeding under proton pump inhibitor use. The prospective cohort study enrolled 426 patients with peptic ulcer bleeding who had high risk stigmata at endoscopy and had received endoscopic hemostasis. They were divided into 79 patients in the hypoalbuminemia group (Hypo-AG, serum albumin ulcer size ≥1.0 cm independently (p peptic ulcer bleeding can be an alarm indicator of all-cause mortality and recurrent bleeding in a long-term follow-up situation under proton pump inhibitor use (NCT01591083). Copyright © 2017. Published by Elsevier B.V.

  20. Role of angiography in diagnosis of endovasal treatment of gastrointestinal hemorrhages

    Prokubovskij, V.I.; Ovchininskij, M.N.; Cherkasov, V.A.; Kapranov, S.A. (Vtoroj Moskovskij Gosudarstvennyj Meditsinskij Inst. (USSR))

    Potentialities of angiography in the diagnosis of the nature and site of gastrointestinal hemorrhages have been defined; indications to its application have been specified. The results of angiographic studies and endovascular interventions in 106 patients with gastrointestinal hemorrhages are presented. The authors describe angiographic manifestations of deseases that most frequently are complicated by hemorrhages to the gastrointestinal tract, peptic ulcer in the gastroduodenal zone, gastric cancer, hepatocirrhosis and colonic cancer. The paper is concerned with the data on the frequency of the angiographic signs of these deseases. A necessity to use X-ray contrast examination of the vessels for endovasal catheter hemostasis is shown with reference to 52 patients; the peculiarities of its performance are described.