scholarly journals Salvaging Digital Replantation and Revascularisation: Efficiency of Heparin Solution Subcutaneous Injection

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Haz Alfeky ◽  
Paul McArthur ◽  
Yasser Helmy
Keyword(s):  
Side Effects ◽  
Venous Drainage ◽  
Senior Author ◽  
Venous Congestion ◽  
Venous Anastomosis ◽  
Subcutaneous Heparin ◽  
Systemic Side Effects ◽  
Calcium Heparin ◽  
Heparin Solution ◽  
Digital Replantation

Background. Distal digital replantation and revascularisation remains one of the demanding microsurgical procedures due to the difficulty of vascular anastomosis. Venous congestion is the most commonly encountered problem after replantation due to the difficulty of venous anastomosis in traumatic injuries. Heparin, among other drugs, is commonly used to facilitate venous drainage and prevent thrombosis. However, systemic heparin can be contraindicated in some patients. The senior author has experience of subcutaneous heparin injection for venous congestion in thirteen patients. Methods. An amount of 1 ml of calcium heparin (25,000 U) was mixed in 2.4 ml of normal saline making a solution that has 1000 U per 0.1 ml. 1000 U (0.1 ml) of the solution was injected directly into the congested replanted digits. This was repeated twice daily until venous congestion improved. Results. All the congested replanted digits survived without systemic side effects. There were no local side effects of the treatment. The PT and APTT have shown slight increase but they remained within the normal range. Haemoglobin levels have dropped slightly but no patients were at any risk of developing anaemia or needed blood transfusion. Conclusions. Subcutaneous heparin injections can salvage the replanted digits when venous congestion is a warning flag for replantation failure. It is safe and very efficient in patients where systemic heparin cannot be administered. However, this article shows the results in only thirteen patients which is a small number to show the efficacy, safety, and side effects.

External bleeding versus dermal pocketing for distal digital replantation without venous anastomosis

2018 ◽  
Vol 44 (2) ◽  
pp. 181-186 ◽  
Author(s):  
Rebecca Lim ◽  
Ellen Lee ◽  
Joel Lim ◽  
Alphonsus K. S. Chong ◽  
Sandeep J. Sebastin ◽  
...  
Keyword(s):  
Venous Congestion ◽  
The Other ◽  
Small Study ◽  
Level Of Evidence ◽  
Venous Anastomosis ◽  
Digital Replantation ◽  
Better Than

Venous congestion in distal digital replantations is a common problem as suitable veins are not always available. We compared two methods of venous decongestion, external bleeding ( n = 15) and dermal pocketing ( n = 28) carried out when venous anastomosis was not possible. The findings of this small study suggest that neither method of venous decongestion is clearly better than the other. Level of evidence: IV

PREVENTING POSTOPERATIVE CONGESTION IN REVERSE PEDICLE DIGITAL ISLAND FLAPS WHEN RECONSTRUCTING COMPOSITE TISSUE DEFECTS IN THE FINGERTIP: A PATIENT SERIES

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 77-82 ◽  
Author(s):  
Hironori Matsuzaki ◽  
Hisao Kouda ◽  
Haruyoshi Yamashita
Keyword(s):  
Venous Drainage ◽  
Venous Congestion ◽  
Island Flap ◽  
Vascular Pedicle ◽  
Digital Artery ◽  
Flap Necrosis ◽  
Venous Anastomosis ◽  
Composite Tissue ◽  
Patient Series ◽  
Tissue Defects

For reconstructing an injured fingertip, a reverse pedicle digital island flap can restore excellent function and appearance. However, postoperative flap congestion may lead to flap necrosis. We tested a method for dissecting the vascular pedicle to prevent congestion and to provide more reliable results. Between August 2002 and December 2010, we reconstructed 14 fingertips in 13 patients (average age, 43 years; range, 24 to 68 years; 9 men). Through a small zigzag incision, the digital artery and a 4-mm-wide subcutaneous venous network were elevated in retrograde fashion to facilitate venous drainage. All flaps healed completely without severe congestion or necrosis. Slight flexion contractures remained in the PIP (mean, 12°) and DIP (mean, 14°) joints. Our procedure is simpler and more reliable than other techniques, such as adding a narrow skin bridge to the pedicle or a venous anastomosis to prevent venous congestion, and it assures the survival of the flap.

scholarly journals Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

2020 ◽  
Author(s):  
Marco Pignatti ◽  
Valentina Pinto ◽  
Federico A. Giorgini ◽  
Maria Elisa Lozano Miralles ◽  
Salvatore D'Arpa ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Preventive Measure ◽  
Venous Drainage ◽  
Venous Congestion ◽  
Cochrane Library ◽  
Diep Flap ◽  
Related Complication ◽  
Venous Anastomosis ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery

Abstract Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. Methods We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. Results Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. Conclusion Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

scholarly journals Recent advances in understanding NRF2 as a druggable target: development of pro-electrophilic and non-covalent NRF2 activators to overcome systemic side effects of electrophilic drugs like dimethyl fumarate

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2138 ◽  
Author(s):  
Takumi Satoh ◽  
Stuart Lipton
Keyword(s):  
Side Effects ◽  
Specific Interaction ◽  
Dimethyl Fumarate ◽  
Carnosic Acid ◽  
European Medicines Agency ◽  
Related Factor ◽  
Inflammatory Phase ◽  
First Case ◽  
Systemic Side Effects ◽  
Transcriptional Pathway

Dimethyl fumarate (DMF) is an electrophilic compound previously called BG-12 and marketed under the name Tecfidera®. It was approved in 2013 by the US Food and Drug Administration and the European Medicines Agency for the treatment of relapsing multiple sclerosis. One mechanism of action of DMF is stimulation of the nuclear factor erythroid 2-related factor 2 (NRF2) transcriptional pathway that induces anti-oxidant and anti-inflammatory phase II enzymes to prevent chronic neurodegeneration. However, electrophiles such as DMF also produce severe systemic side effects, in part due to non-specific S-alkylation of cysteine thiols and resulting depletion of glutathione. This mini-review presents the present status and future strategy for NRF2 activators designed to avoid these side effects. Two modes of chemical reaction leading to NRF2 activation are considered here. The first mode is S-alkylation (covalent reaction) of thiols in Kelch-like ECH-associated protein 1 (KEAP1), which interacts with NRF2. The second mechanism involves non-covalent pharmacological inhibition of protein-protein interactions, in particular domain-specific interaction between NRF2 and KEAP1 or other repressor proteins involved in this transcriptional pathway. There have been significant advances in drug development using both of these mechanisms that can potentially avoid the systemic side effects of electrophilic compounds. In the first case concerning covalent reaction with KEAP1, monomethyl fumarate and monoethyl fumarate appear to represent safer derivatives of DMF. In a second approach, pro-electrophilic drugs, such as carnosic acid from the herb Rosmarinus officinalis, can be used as a safe pro-drug of an electrophilic compound. Concerning non-covalent activation of NRF2, drugs are being developed that interfere with the direct interaction of KEAP1-NRF2 or inhibit BTB domain and CNC homolog 1 (BACH1), which is a transcriptional repressor of the promoter where NRF2 binds.

Efficacy of ultra-low-dose (0.1 mg) ranibizumab intravitreal injection for treatment of prethreshold type 1 retinopathy of prematurity: A case series

2018 ◽  
Vol 30 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Islam SH Ahmed ◽  
Ahmed MA Hadi ◽  
Hassan H Hassan
Keyword(s):  
Side Effects ◽  
Intravitreal Injection ◽  
Retinopathy Of Prematurity ◽  
Large Scale ◽  
Low Dose ◽  
Case Series ◽  
Results Of Treatment ◽  
Case Series Study ◽  
Systemic Side Effects

Aim: To report the results of treatment of type 1 prethreshold retinopathy of prematurity using intravitreal injection of ultra-low dose of ranibizumab (0.1 mg in 0.01 mL). Design: A retrospective observational case series study. Methods: Review of files of eligible infants who received this form of treatment to determine the outcome of treatment and any associated ocular or systemic side effects. Results: The study included 24 eyes of 12 preterm infants with mean gestational age of 29.75 ± 1.54 weeks and mean birth weight of 1074.58 ± 320.59 g. A total of 22 eyes (91.67%) had zone II disease while 2 eyes of one infant (8.33%) had zone I disease. All cases showed regression of the signs of the active retinopathy of prematurity with complete retinal vascularization. None of the cases required retreatment. Three eyes developed ocular complications. Apart from mild feeding intolerance that lasted for 24 h after injection in one infant, none of the cases developed systemic side effects. Conclusion: Intravitreal injection of ultra-low-dose ranibizumab showed promising efficacy and good ocular safety. However, further large-scale studies are required to give stronger evidence about the efficacy and safety of ultra-low-dose ranibizumab.

Unintended Side Effects of Electronic Cigarettes in Otolaryngology: A Scoping Review

2022 ◽  
pp. 019459982110695
Author(s):  
Ameen Amanian ◽  
Jobanjit Phulka ◽  
Amanda C. Hu
Keyword(s):  
Side Effects ◽  
Electronic Cigarettes ◽  
Meta Analysis ◽  
Senior Author ◽  
Significant Heterogeneity ◽  
Recent Emergence ◽  
Scoping Reviews ◽  
Long Term Impact ◽  
Meta Analyses

Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity. The US Food and Drug Administration defines side effects as unwanted or unexpected events or reactions. Our objective was to examine the unintended otolaryngology-related side effects associated with E-cigs. Data Sources Medline, EMBASE, CINAHL, Web of Science, and CENTRAL databases. Review Methods Study selection was independently performed by 2 authors in accordance with the PRISMA-ScR statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews); discrepancies were resolved by the senior author. English studies from database inception to May 1, 2020, with a sample size >5 were included. In vitro, animal, and lower respiratory tract studies were excluded. The main outcome was defined as otolaryngology-related side effects following E-cig use. Levels of evidence per the Oxford Centre for Evidence-Based Medicine were used to determine study quality. Results From 1788 articles, 32 studies were included. The most common unintended side effects were throat irritation (n = 16), cough (n = 16), mouth irritation (n = 11), and oral mucosal lesions (n = 8). A large proportion of participants also reported conventional tobacco use in addition to E-cigs. Eight studies investigated the effectiveness of vaping on smoking cessation. The quality of the literature was level 2 to 4. Given the significant heterogeneity in the studies, meta-analysis was not performed. Conclusion The most reported side effects were throat and mouth irritation, followed by cough. The long-term impact of E-cigs is not known given the recent emergence of this technology. Future studies are warranted.

Immunoengineering approaches for cytokine therapy

2021 ◽  
Author(s):  
Aslan Mansurov ◽  
Abigail Lauterbach ◽  
Erica Budina ◽  
Aaron T. Alpar ◽  
Jeffrey A. Hubbell ◽  
...  
Keyword(s):  
Side Effects ◽  
Protein Engineering ◽  
Autoimmune Diseases ◽  
Inflammatory Cytokines ◽  
Therapeutic Efficacy ◽  
Cytokine Therapy ◽  
Toxicity Profile ◽  
Wild Type ◽  
Systemic Side Effects ◽  
Secondary Lymphoid Organs

Since the discovery of cytokines, much effort has been put forth to achieve therapeutic translation for treatment of various diseases, including cancer and autoimmune diseases. Despite these efforts, very few cytokines have cleared regulatory approval, and those that were approved are not commonly used due to their challenging toxicity profile and/or limited therapeutic efficacy. The main limitation in translation has been that wild-type cytokines have unfavorable pharmacokinetic and pharmacodynamic profiles, either eliciting unwanted systemic side effects or insufficient residence in secondary lymphoid organs. In this review, we address protein engineering approaches that have been applied to both pro- and anti-inflammatory cytokines to enhance their therapeutic indices, and we highlight diseases in which administration of engineered cytokines is especially relevant.

The Use and Abuse of Topical Corticosteroids

1977 ◽  
Vol 63 (1) ◽  
pp. 18-25
Author(s):  
M. D. Catterall
Keyword(s):  
Side Effects ◽  
Topical Corticosteroid ◽  
Corticosteroid Therapy ◽  
Rank Order ◽  
Topical Corticosteroids ◽  
Systemic Side Effects

AbstractA rationalised approach to topical corticosteroid therapy is presented. Factors which influence the choice of preparation are considered, based upon the concept of ’rank order ’, for both halogenated and non-halogenated steroids. Practical considerations, including choice of base, polythene occlusion and tachyphylaxis are discussed and local and systemic side effects considered in detail.

"Topical Steroid Holiday"

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 455-456
Author(s):  
David Hepburn ◽  
Joseph Morelli ◽  
William L. Weston
Keyword(s):  
Side Effects ◽  
Plasma Cortisol ◽  
Topical Steroid ◽  
Topical Steroids ◽  
Prescribing Pattern ◽  
Biphasic Pattern ◽  
Systemic Side Effects ◽  
Continued Use ◽  
Cortisol Levels ◽  
Pediatric Prescribing

Daily use of low-potency topical steroids is a frequently observed pediatric prescribing pattern.1 Many clinicians believe such a strategy is safe because low-potency topical steroids usually do not suppress levels of plasma cortisol or produce systemic side effects. However, daily use of low-potency steroids may result in suppression of plasma cortisol levels.1-4 Suppression of plasma cortisol levels after use of topical steroids has been observed in a biphasic pattern. There is suppression within 2 weeks of starting daily therapy, then recovery to normal despite continued use, then suppression again after 4 to 6 weeks of daily therapy.2,3

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