PURPOSE OF THE STUDY: Our aim was to compare the effects of intraarticular and intravenous (IV) tranexemic acid (TXA) application on bleeding and complication rates in patients who underwent total knee arthroplasty (TKA). MATERIAL AND METHODS: Between 2017 and 2021, 406 patients who underwent TKA with 2 g of IV TXA and retrograde 1.5 g of TXA applied through the drain were included in the study. Of the patients, 206 were in the IV TXA group. Preoperative and postoperative hemoglobin levels, drain output, BMI, ASA score, blood loss, and the number of transfused patients were recorded. Complications such as symptomatic venous thromboembolism were also recorded. RESULTS: There was no significant difference between the two groups in terms of age, sex, American Society of Anesthesiologists (ASA) score, or BMI (p = 0.68, 0.54, 0.28, 0.45). Total drain output and blood loss were significantly higher in the IV TXA group than in the intraarticular TXA group (p < 0.0001, p < 0.0001). Eighteen patients in the IV TXA group and 1 patient in the intraarticular TXA group received a blood transfusion (p < 0.0001). There was no difference between the two groups in terms of preoperative hemoglobin or platelet count (p = 0.24). However, postoperative hemoglobin level was higher in the patients who received intraarticular TXA (p=0.0005). More thromboembolism events were seen in the IV TXA group (p < 0.0001). CONCLUSIONS: Intraarticular TXA application reduces blood loss more than IV application, reduces the blood transfusion rate, and causes fewer complications. KEY WORDS: tranexemic acid, total knee arthroplasty, intraarticular injection, blood loss, blood transfusion.
- MeSH
- Antifibrinolytic Agents * administration & dosage MeSH
- Injections, Intra-Articular MeSH
- Administration, Intravenous MeSH
- Constriction MeSH
- Blood Transfusion statistics & numerical data MeSH
- Blood Loss, Surgical * prevention & control MeSH
- Tranexamic Acid * administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Hemorrhage prevention & control etiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Arthroplasty, Replacement, Knee * methods adverse effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
BACKGROUND: An indication for selective shunting during carotid endarterectomy (CEA) is based on monitoring during a procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) may be a simple technique, but its relevance during CEA, especially with respect to cutoff values indicating shunt implantation, still needs to be elucidated. METHODS: One hundred twenty five patients underwent CEA under local anesthesia (LA) and were monitored clinically throughout the whole procedure. The patients were also monitored using bilateral NIRS probes during surgery. The NIRS values were recorded and evaluated before and after selective cross-clamping, firstly by the external carotid artery (ECA), followed by the internal carotid artery (ICA). The decrease in the ipsilateral CO values, with respect to the indication of shunting, was only analyzed after selective cross-clamping of the ICA. The decision to use an intraluminal shunt was solely based on the neurological status evaluation after ICA cross-clamping. RESULTS: One hundred five patients (85%) were stable throughout the CEA, while 20 patients (15%) clinically deteriorated during surgery. The mean drop in the CO after selective ICA clamping in clinically stable patients was 6%, while in patients with clinical deterioration, the NIRS decreased by 14.5% (p < 0.05). When the cutoff value for selective shunting was set as a 10% decrease of the ipsilateral CO after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83.0%. CONCLUSIONS: Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cutoff value for selective shunting during CEA. Despite the availability of a variety of monitoring tools, the NIRS may be an easy, reliable option, especially in the scenario of acute CEA in general anesthesia.
- MeSH
- Carotid Artery, External diagnostic imaging surgery MeSH
- Carotid Artery, Internal diagnostic imaging surgery MeSH
- Spectroscopy, Near-Infrared MeSH
- Surgical Instruments * MeSH
- Diffusion Magnetic Resonance Imaging MeSH
- Endarterectomy, Carotid * MeSH
- Constriction MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain diagnostic imaging physiopathology surgery MeSH
- Neurosurgical Procedures * MeSH
- Oximetry * MeSH
- Prospective Studies MeSH
- ROC Curve MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Chronic constriction injury (CCI) is widely used as an animal neuropathic pain model. Neuropathic pain is considered to exist when withdrawal latency to thermal stimulation is decreased after inducing a CCI to the sciatic nerve. However, it is known that CCI leads to changes in skin temperature and that skin temperature can affect withdrawal latency. Aim of this study was to compare withdrawal latencies of constricted and contralateral hind limbs, to thermal stimulation, at the same artificially-induced skin temperatures. METHODS: Neuropathic pain was induced by four ligatures on the left sciatic nerve in adult male Wistar rats. Withdrawal latencies were measured from the 11th to 14th day after ligation, in different ambient temperatures, using the plantar test (Hargreaves method). By changing ambient we produced different hind limb skin temperatures. RESULTS: Our results show that (1) CCI cause an increase in skin temperature; (2) the withdrawal latency was inversely related to ambient and skin temperature in the same manner for both the ligated and contralateral hind limbs; and (3) withdrawal latencies did not differ significantly for the ligated and contralateral hind limbs when the temperature of the hind limbs was artificially made the same (i.e., by changing the ambient temperature). CONCLUSIONS: Withdrawal latencies to thermal stimulation did not differ on ligated and contralateral hind limb after CCI to the sciatic nerve if the temperature of the hind limbs was artificially or mathematically made the same. This finding may have significant impact on the interpretation results of neuropathic pain research.
- MeSH
- Hyperalgesia etiology MeSH
- Constriction MeSH
- Rats MeSH
- Sciatic Nerve MeSH
- Neuralgia * MeSH
- Rats, Wistar MeSH
- Skin Temperature * MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Chronic constriction injury to the sciatic nerve was used as an animal model of neuropathic pain. Instead of frequently used reflex-based tests we used an operant thermal place preference test to evaluate signs of neuropathic pain and the effect of baclofen administration in rats with neuropathy. Chronic constriction injury was induced by four loose ligations of the sciatic nerve. Thermal place preference (45 °C vs. 22 °C and 45 °C vs. 11 °C) was measured after the ligation and after the administration of baclofen in sham and experimental rats. Rats with the chronic constriction injury spent significantly less time on the colder plate compared to sham operated animals at the combination 45 °C vs. 11 °C. After administration of baclofen (10 mg/kg s.c.), the aversion to the colder plate in rats with chronic constriction injury disappeared. At the combination 45 °C vs. 22 °C, no difference in time spent on colder and/or warmer plate was found between sham and experimental animals. These findings show the importance of cold allodynia evaluation in rats with chronic constriction injury and the effectiveness of baclofen in this neuropathic pain model.
- MeSH
- Baclofen pharmacology therapeutic use MeSH
- Muscle Relaxants, Central pharmacology therapeutic use MeSH
- Constriction MeSH
- Rats MeSH
- Pain Measurement methods psychology MeSH
- Peripheral Nervous System Diseases drug therapy psychology MeSH
- Sciatic Neuropathy drug therapy psychology MeSH
- Cold Temperature * MeSH
- Conditioning, Operant drug effects physiology MeSH
- Rats, Wistar MeSH
- Hot Temperature * MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Úvod: Záchovné výkony na ledvině (resekce ledviny) jsou v současné době doporučovány u všech nádorů klasifikace T1 a T2. Miniinvazivní operační přístupy k výkonům na ledvinách jsou spojeny s menší morbiditou bez zhoršení onkologických výsledků. Moderní robotický systém da Vinci s možností fluorescenčního zobrazení při použití indocyaninové zeleně (ICG) usnadňuje identifikaci segmentární renální tepny a zajišťuje bezpečný selektivní klamping. Robotická asistence dnes umožňuje nabídnout miniinvazivní výkon všem kandidátům otevřené resekce ledviny. Popis klinického případu: Od ledna 2014 jsme provedli 52 roboticky asistovaných resekcí ledvin s využitím ICG. Při operaci jsme používali robotický systém da Vinci Si. Výkony provádíme v lumbotomické poloze. Kamerový port zavádíme v pupku, u pacientů s vyšším BMI v pararektální linii. Dva 8mm robotické porty zavádíme v medioklavikulární linii. Jeden 12mm port pro asistenta kraniálně, případně kaudálně od optického portu v závislosti na lokalizaci tumoru v ledvině. Výkon zahajujeme identifikací renální arterie a preparací segmentárních větví. Po naložení cévních svorek intravenózně aplikujeme ICG. Začínáme dávkou 1,5 ml při koncentraci ICG 2,5 mg/ml. Po 5 až 10 vteřinách ve fluorescenčním zobrazení detekujeme jednotlivé neprokrvené oblasti ledviny. Resekci ledviny následně provádíme v zobrazeném ischemickém segmentu. Po dokončení sutury ledviny a odstranění cévních svorek opětovnou aplikací ICG kontrolujeme kvalitu prokrvení ledviny a rozsah ischemické oblasti daný suturou defektu. Závěr: Roboticky asistovaná resekce ledviny je bezpečná metoda léčby renálního karcinomu. Selektivní klamping s fluorescenční kontrolou snižuje riziko ischemického poškození ledviny.
Introduction: Currently, kidney-sparing interventions (partial nephrectomies) are recommended for all patients with T1 or T2 tumors. Minimally invasive surgical approaches for interventions on the kidneys are associated with a lower morbidity without the deterioration of oncological results. The modern robotic system da Vinci with the possibility of fluorescent imaging using indocyanine green (ICG) facilitates the identification of segmental renal arteries and ensures safe selective clamping. Nowadays, robotic assistance offers minimally invasive surgery for all candidates of open partial nephrectomy. Description of the clinical case: Since January 2014, we performed 52 robot-assisted partial nephrectomies using ICG using the Da Vinci robotic system type Si. Operations are performed in the lumbotomy position. Camera port is introduced through the umbilicus, for patients with higher BMI in the pararectal line. Two 8 mm robotic ports are located in the medioclavicular line. One 12 mm port for the assistant is located cranial or caudal to the camera port depending on the tumor location in the kidney. The identification of the renal artery and the preparation of the segmental branches are the first steps. After loading the vascular clamps ICG is applied intravenously. The starting dose is 1.5 ml with the concentration of 2.5 mg/ml ICG. After 5 to 10 seconds we are able to identify with fluorescent imaging the individual parts of the kidney without blood flow. The partial nephrectomy is then performed in the displayed ischemic segment. Upon finishing the suture and removal of vascular clamps, ICG is reapplyed to check the quality of blood flow of the kidney and the range of the ischemic area given the suture of the defect. Conclusion: Robot-assisted partial nephrectomy is a safe method for the treatment of renal cell carcinoma. Selective clamping with fluorescence control reduces the risk of ischemic renal damage.
- MeSH
- Carotid Arteries physiology MeSH
- Baroreflex physiology MeSH
- Chronobiology Phenomena physiology MeSH
- Circadian Rhythm physiology MeSH
- Adult MeSH
- Financing, Organized MeSH
- Hypertension etiology physiopathology MeSH
- Constriction MeSH
- Blood Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies methods instrumentation statistics & numerical data MeSH
- Blood Pressure Determination methods MeSH
- Blood Flow Velocity physiology MeSH
- Heart Rate physiology MeSH
- Thigh blood supply MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
OBJECTIVES: To assess the feasibility of partial nephrectomy (PN) without renal hilar clamping using the 80-W GreenLight (532 nm) laser with opening of the collecting system followed by its suture in a porcine model.
- MeSH
- Financing, Organized MeSH
- Hemostatic Techniques MeSH
- Risk Assessment MeSH
- Immunohistochemistry MeSH
- Biopsy, Needle MeSH
- Constriction MeSH
- Blood Loss, Surgical prevention & control MeSH
- Laser Therapy methods MeSH
- Lasers MeSH
- Kidney Pelvis physiology surgery MeSH
- Disease Models, Animal MeSH
- Nephrectomy methods instrumentation MeSH
- Recovery of Function MeSH
- Swine MeSH
- Kidney Tubules, Collecting surgery pathology MeSH
- Sensitivity and Specificity MeSH
- Suture Techniques MeSH
- Feasibility Studies MeSH
- Sus scrofa MeSH
- Kidney Function Tests MeSH
- Treatment Outcome MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
Epidemiologické studie poukazují na možnou souvislost schizofrenie a intrauterinní nebo perinatální infekce. U schizofrenických pacientů bývá narušeno vnímání bolesti, což bylo potvrzeno také u experimentálních modelù. V této studii jsme se zamìøili na sledování r ozvoje neuropa- tické bolesti u dospìlých potkanù, jimž byl neonatálnì aplikován lipopolysacharid (LPS). Aplikace LPS se považuje za model infe kce. Jako model neuropatické bolesti jsme zvolili chronickou konstrikci sedacího nervu, mìøili jsme termický a mechanický práh bolesti deset dn í po operaci. Zjistili jsme, že u LPS potkanù se neuropatická bolest vyvíjí podobnì jako u kontrolních a intaktních zvíøat. Tyto výsledky pot vrzují, že vliv LPS je zprostøedkovaný imunitní odpovìdí, která u mláïat není dostateènì vyvinutá.
Increased incidence of schizophrenia has been observed following maternal infections during pregnancy. Pain sensation is impair ed in schizo- phrenia patients, similar results were observed in animal models of psychosis like behavior. In the presented study, developmen t of neuropathic pain was studied in adult rats after neonatal administration of lipopolysaccharide (LPS). Systemic administration of LPS is a w idely accepted model of infection. In order to evoke neuropathic pain, chronic constriction of sciatic nerve was used. Thermal and mechanical hyperlagesia was evaluated ten days after the surgery. It was found out, that neuropathic pain in LPS treated animals develops in similar wa y as in controls as well as intact animals. Since the immune system is not completely matured in neonatal rats, the results suggest that effect of LPS is rather mediated by immune response than by direct action of LPS.
- Keywords
- neonatální infekce, neuropatická bolest,
- MeSH
- Pain * etiology MeSH
- Pregnancy Complications, Infectious chemically induced immunology MeSH
- Constriction MeSH
- Humans MeSH
- Lipopolysaccharides * administration & dosage adverse effects toxicity MeSH
- Pain Measurement MeSH
- Sciatic Nerve physiopathology MeSH
- Rats, Wistar growth & development MeSH
- Pain Threshold physiology MeSH
- Schizophrenia * etiology chemically induced physiopathology MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Pain etiology MeSH
- Immunochemistry MeSH
- Constriction MeSH
- Spinal Cord chemistry MeSH
- Disease Models, Animal MeSH
- Sciatic Nerve MeSH
- Rats, Wistar MeSH
- Proto-Oncogene Proteins c-fos chemistry MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- GABA-B Receptor Agonists MeSH
- Baclofen administration & dosage pharmacology MeSH
- Research Support as Topic MeSH
- Physical Stimulation methods MeSH
- Constriction MeSH
- Rats MeSH
- Models, Animal MeSH
- Sciatic Nerve surgery MeSH
- Pain Threshold drug effects MeSH
- Receptors, GABA-B MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
