BACKGROUNDTourniquets used during total knee arthroplasty may lead to many complications. The aim of this study was to determine perioperative blood loss and its clinical relevance in total knee replacement surgery after applying a tourniquet.

METHODSFrom June 2009 to October 2009, 60 consecutive patients who underwent routine total knee arthroplasty were randomly divided into two groups and were treated with or without a tourniquet (30 patients/group). There were no significant differences in patient baseline characteristics between the two groups. We compared the two groups of patients in terms of intra- and postoperative bleeding, invisible or visible bleeding, and total blood loss.

RESULTSNone of the patients showed poor wound healing, lower extremity deep venous thrombosis or other complications. The amount of blood loss during surgery was lower in the tourniquet group than in the control group (P < 0.01). However, postoperative visible bleeding (P < 0.05) and occult bleeding (P < 0.05) were significantly greater in the tourniquet group than in the control group. There was no significant difference in the total amount of blood loss between the two groups (P > 0.05).

CONCLUSIONSTourniquet can reduce bleeding during total knee replacement surgery, but is associated with greater visible and invisible blood loss.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Blood Loss, Surgical ; prevention & control ; Female ; Humans ; Male ; Postoperative Hemorrhage ; Tourniquets

OBJECTIVETo prospectively compare of no drain or with drain after unilateral total knee arthroplasty (TKA).

METHODSA randomized prospective study was conducted between February 2006 and February 2007. The study included 100 patients who were divided into 2 groups: group A (n = 50), which included patients without drain release, and group B (n = 50), which included patients who had a drain release. The true total blood loss was calculated depending on the height, body mass and pre-and post-operative Hct, and hidden blood loss was gotten by subtracting the visible blood loss from total loss. The recovery after surgery, the correlative complications and transfusion amounts were compared and analyzed.

RESULTSAll 100 patients undergoing TKA were involved in the result analysis. In patients without a drain, the total blood loss was (535 +/- 295) ml and the hidden blood loss was (513 +/- 290) ml, in patients with a drain, the total blood loss was (853 +/- 331) ml and the hidden blood loss (689 +/- 324) ml. The total and hidden blood loss, blood transfusion amount between drain-group and without drain-group was significantly different (P < 0.05). The difference in the incidence of infection and post-op recovery and correlative complications did not reach statistical significance.

CONCLUSIONSIn patients having primary TKA, using a drain, compared with no use of a drain, does not show us a clear advantage that make us accept it. Without a drain release could present an effective and economic method for reducing blood loss and preventing blood transfusion in patients undergoing unilateral TKA.

Aged ; Arthroplasty, Replacement, Knee ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; prevention & control ; Prospective Studies

OBJECTIVETo investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).

METHODSClinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.

RESULTSGastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.

CONCLUSIONSGastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Hemorrhage ; prevention & control ; Retrospective Studies ; Young Adult

No abstract available.
Dissection/*adverse effects ; Female ; Gastric Mucosa/*surgery ; *Gastroscopy ; Humans ; Male ; Postoperative Hemorrhage/*prevention & control ; *Second-Look Surgery ; Stomach Neoplasms/*surgery

Objective: To investigate the safety and efficacy of embedding the stump of gastroduodenal artery between the left lateral lobe of the liver and the left caudate lobe to prevent bleeding after laparoscopic pancreaticoduodenectomy. Methods: The clinical data of 41 patients who underwent laparoscopic pancreaticoduodenectomy at the second Hospital of Hebei Medical University from October 2021 to April 2022 were analyzed retrospectively.There were 27 males and 14 females, aged (63.0±9.2)years (range: 48 to 78 years), and the body mass index was (24.1±3.2)kg/m² (range: 15.4 to 31.6 kg/m²). After routine laparoscopic pancreaticoduodenectomy, the stump of gastroduodenal artery was embedded between the left lateral lobe and the left caudate lobe of the liver, and the hepatic parenchyma of the left lateral lobe and the left caudate lobe were sutured with absorbable sutures.The occurrence and recovery of postoperative complications (pancreatic fistula, biliary fistula, postoperative abdominal bleeding, abdominal infection, liver abscess) were observed. Results: All the operations of 41 patients were completed successfully.The operation time was (277.5±52.0) minutes (range: 192 to 360 minutes). The entrapment time of gastroduodenal artery stump was (3.1±0.6) minutes (range: 2.3 to 4.2 minutes), and the intraoperative blood loss (M(IQR)) was 300 (200) ml (range: 50 to 800 ml).The results of ultrasound examination of hepatic artery on the first day after operation showed that the blood flows of hepatic artery were unobstructed.Postoperative pancreatic fistula occurred in 3 cases, including grade B pancreatic fistula in 2 cases (1 case with abdominal infection) and biochemical leakage in 1 case. Three patients with pancreatic fistula were discharged successfully after continuous abdominal drainage. There was no biliary fistula, abdominal bleeding, abdominal infection, liver abscess or postoperative liver dysfunction. Conclusion: The encasement of the gastroduodenal artery stump by the left outer and left caudate lobes of the liver may be an effective way to prevent bleeding from the rupture of the gastroduodenal artery stump after laparoscopic pancreatoduodenectomy, which is easy and safe to perform.
Female ; Male ; Humans ; Hepatic Artery ; Pancreaticoduodenectomy ; Pancreatic Fistula ; Retrospective Studies ; Laparoscopy ; Liver Abscess ; Intraabdominal Infections ; Postoperative Hemorrhage/prevention & control*

With the development of laparoscopic techniques and equipments, laparoscopic-assisted, even total laparoscopic radical surgery for gastric cancer can be performed successfully. However, the incidence of postoperative complications is higher in the laparoscopy group as compared to the open-surgery group, which is still the barrier for the total laparoscopic radical gastrectomy. Similar to open surgery, the major complications of digestive tract reconstruction after laparoscopic radical gastrectomy are anastomotic leakage, anastomotic bleeding, anastomotic stricture and stenosis of input or output loop. Moreover, due to the lack of tactile feedback and a narrow field of vision, the laparoscopic operation may be associated with complications due to technical reasons. In clinic, we tried to reduce the incidence of these complications by improving surgical skills and strengthening the perioperative treatment of patients. According to our experience, the complications mainly occur in the early stage, and with the cumulative experience, the complications can be effectively reduced.
Anastomotic Leak ; prevention & control ; therapy ; Constriction, Pathologic ; prevention & control ; therapy ; Education, Medical, Continuing ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; prevention & control ; therapy ; Humans ; Laparoscopy ; adverse effects ; Perioperative Care ; Postoperative Complications ; prevention & control ; therapy ; Postoperative Hemorrhage ; prevention & control ; therapy ; Reconstructive Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery

Endoscopic submucosal dissection (ESD) has been reported to have a higher bleeding rate than conventional methods. However, there are few reports on whether a proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric adenoma or adenocarcinoma were randomly assigned to pantoprazole or famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the pantoprazole group and 79 in the famotidine group were included for analysis. Primary outcome measure was the delayed bleeding rate. Clinical characteristics were not different between the two groups. The delayed bleeding rate was significantly lower in the pantoprazole group compared with the famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (> or =34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion, pantoprazole is more effective than famotidine for the prevention of delayed bleeding after ESD.
2-Pyridinylmethylsulfinylbenzimidazoles/*therapeutic use ; Aged ; Anti-Ulcer Agents/*therapeutic use ; Dissection ; Famotidine/*therapeutic use ; Female ; Gastric Mucosa/*surgery ; Gastrointestinal Hemorrhage/*prevention & control ; *Gastroscopy ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage/*prevention & control ; Prospective Studies ; Single-Blind Method ; Stomach Neoplasms/*surgery

OBJECTIVE: To observe the self-developed horn type of titanium clamp used for inferior turbinate resection from filling effect. METHOD: Choose the cases of inferior turbinate resection of 152 cases randomly selected 92 cases (group) in 2-4 angle type titanium clip head-tail closed wound middle turbinate, and therefore more than nasal passages in the surgical wound, just as in the nasal passages above micro tamponade, bare breathing zone, keep the ventilation, 1- 3 days to take out the angle titanium clamp; 60 cases (control group) with vaseline oil gauze or postoperative Merocel hemostatic sponge tamponade nasal bleeding. Observation of 1-3 days after nasal ventilation, headache, nasal bleeding, dry mouth, tolerance is painful, aural fullness tinnitus, a total of 7 indicators of sleep. RESULT: The team outside the there was no difference in blood loss and the control group, the rest of the indicators is better than the control group. CONCLUSION The angle of titanium clamp used in inferior turbinate resection from stuffing, patients get better comfort, avoid drawn yarn of pain, improve the quality of perioperative patients with life.
Bandages ; Blood Loss, Surgical ; prevention & control ; Epistaxis ; prevention & control ; Female ; Formaldehyde ; administration & dosage ; Hemostatics ; administration & dosage ; Humans ; Male ; Microsurgery ; Nasal Cavity ; Polyvinyl Alcohol ; administration & dosage ; Postoperative Hemorrhage ; prevention & control ; Surgical Instruments ; Titanium ; Turbinates ; surgery

OBJECTIVETo compare postoperative blood loss under different negative pressures of drainage after total hip arthroplasty for the treatment of femoral neck fractures.

METHODSFrom January 1st to December 30th 2013, 74 patients with femoral neck fractures treated with total hip arthroplasty were randomly divided into two groups: high negative pressure drainage group and low negative pressure drainage group. In high negative pressure drainage group, there were 34 cases including 10 males and 24 females, with a mean age of (75.94 ± 9.02) years old, and the patients were treated with 60 kPa negative pressure of drainage. In the low negative pressure drainage group, there were 40 cases including 13 males and 27 females, with an average age of (74.93 ± 8.90) years old, and the patients were treated with 30 kPa negative pressure of drainage. The amount of total drainage, total blood loss, and hemoglobin change were compared between these two groups.

RESULTSAll the patients got primary healing without infections. In high negative pressure drainage group,the change of hemoglobin was (41.74 ± 15.69) g/L, total blood loss was (1,217.73 ± 459.50) ml and the drainage volume was (312.94 ± 103.44) ml; while in low negative pressure drainage group,the results were (34.90 ± 12.90) g/L, (904.01 ± 381.58) ml and (129.25 ± 44.25) ml separately. All the results in high negative pressure drainage group were higher than those in the other group. Three days after operation, the change of hemoglobin was (46.00 ± 13.29) g/L and total blood loss was (1,304.72 ± 421.75) ml; while in low negative pressure drainage group, the changes of hemoglobin was (43.87 ± 11.39) g/L and total blood loss was (1,196.78 ± 344.20) ml; there were no statistically significant differences between two groups.

CONCLUSIONWhen placing drainage devices after total hip arthroplasty for the treatment of femoral neck fractures, the level of negative pressure should be chosen according to preoperative level of hemoglobin and HCT in patients. For old patients with femoral neck fracture, low negative pressure is more suitable.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Case-Control Studies ; Female ; Femoral Neck Fractures ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Postoperative Hemorrhage ; prevention & control

OBJECTIVETo compare the effects of elastic bandage compression with the specific hemostasis devices in patients undergoing transradial coronary intervention.

METHODSA total of 3000 consecutive patients were randomized to 3 groups and 2910 patients completed the study, 963 patients in elastic bandage group (ER), 976 in T band group (TB) and 971 in balloon group (TR). In-hospital vascular related complication was the primary study endpoint. The secondary endpoints included: risk factors of complications, compression time, fibroplasia conditions and the comfort feeling of patients.

RESULTSThe overall incidence of vascular related complication in 3 groups was similar (P = 0.262). Female, low body weight, prolongation of procedure and multi-punctures were identified as the independent risk factors for complications. Moreover, the compression time and the fibroplasia condition in TB and TR group were superior to those in the ER group. Comfortable feeling of the patients was better in TR and TB group than in ER group (P < 0.001).

CONCLUSIONSBoth conventional bandage device and specific radial device are feasible and associated with low incidence of vascular complication. However, the specific radial device has significant advantage over bandage strategy in compression time and quality of life.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Bandages ; Female ; Hemostatic Techniques ; instrumentation ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; prevention & control ; Radial Artery ; Treatment Outcome