Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?

2015 ◽  
Vol 96 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Seyed Mohammad Kazem Aghamir ◽  
Reza Elmimehr ◽  
Seyed Saeed Modaresi ◽  
Alborz Salavati
Keyword(s):  
Blood Transfusion ◽  
Renal Stones ◽  
Bleeding Complications ◽  
Transfusion Rate ◽  
Average Hospital ◽  
Single Access ◽  
Group A ◽  
Group B ◽  
Hemoglobin Drop ◽  
Tubeless Pcnl

Purpose: To assess bleeding complications in totally tubeless double-access percutaneous nephrolithotomy (PCNL) and compare it with the single-access method. Methods: One hundred and seven patients with large or scattered renal stones were enrolled in this cohort study. Totally tubeless PCNL with one access (group A, 70 cases) or two accesses (group B, 37 cases) was done and bleeding was assessed by measuring the hemoglobin drop of the patients, blood transfusion rate and need for performing angioembolization. Results: The mean (SD) hemoglobin drops in groups A and B were 1.97 (1.24) and 2.31 (1.24), respectively; p = 0.176. Blood transfusion rates in two groups were 7.1 and 10.8% (p = 0.716), respectively. None of our patients required angioembolization. The average hemoglobin drop and blood transfusion rate with double tracts were approximately near to those in single tract group and in acceptable ranges. The average hospital stay in groups A and B were 3.1 and 3.2 days (p = 0.074), respectively. There was no leakage from puncture site/s and stone free rates in the two groups were 85.7 and 97.3% (p = 0.093). Conclusion: Totally tubeless double-access PCNL is feasible and bleeding complications are comparable to single access totally tubeless PCNL making it an effective strategy to achieve more stone free rates.

scholarly journals Are Nephrostomy and Ureteral Stent Necessary after Multi-Access Percutaneous Nephrolithotomy?

2019 ◽  
Vol 13 (3) ◽  
pp. 141-144 ◽  
Author(s):  
Seyed Mohammad Kazem Aghamir ◽  
Reza Heidari ◽  
Seyedehsara Bayesh ◽  
Alborz Salavati ◽  
Reza Elmimehr
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Renal Stones ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Single Access ◽  
Group A ◽  
Group B ◽  
Multi Access ◽  
Tubeless Pcnl

Introduction: Totally tubeless percutaneous nephrolithotomy (PCNL) is a well-established technique used in single -access procedure nevertheless these results challenge the multi-access PCNL as a contra-indication to application of this technique. Aims: To compare complication rates and safety of use of this technique after multi-access PCNL. Methods: A Total of 130 patients with renal stones were enrolled in this cohort study. Totally tubeless PCNL with single access (Group A, n = 70) and multi-access (Group B, n = 60) were done and bleedings were assessed by measuring hemoglobin (Hb) drop, blood transfusion rate and need for angioembolization besides leakage rates which were also recorded. Results: In the 130 patients who underwent totally tubeless PCNL, no leakage from puncture site nor angioembolization cases were identified. There was no significant statistical differences between 2 groups regarding Hb drop (1.91 in single access versus 2.20 in multi-access), transfusion rate and length of hospital stay (p > 0.05). Stone-free rate was increased from 91% in single access to 97% in multi access by adding percutaneous access sites (from 91% in single access to 97% in multi-access). Conclusions: Multi-access totally tubeless PCNL seems feasible and has comparable complication rates including Hb drop besides providing the advantage of higher stone-free rates using multi-access tracts.

scholarly journals Perioperative protocol to reduce blood transfusions in ankylosing spondylitis patients undergoing total hip arthroplasty

2021 ◽  
Author(s):  
Yu Huang ◽  
Xiao Huang ◽  
Fulin Li ◽  
Wenwen Huang ◽  
Dong Yin
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Transfusion Rate ◽  
Blood Management ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Introduction: Although tranexamic acid (TXA) can reduce bleeding during total hip arthroplasty (THA), the amount of perioperative bleeding is greater in patients with ankylosing spondylitis (AS); So blood management is more challenging. Patient Blood Management (PBM) program can improve AS patients care and reduce health costs in THA. The purpose of this study is to assess the effects of PMB program on allogeneic transfusion rate, length of hospital stay(LOS), hospitalization expenses and adverse events. Methods : We conducted a retrospective observational study of patients with AS who underwent THA. All patients were treated with tranexamic acid before and after operation. Our PBM program included preoperative evaluation, preoperative acute normovolemic hemodilution and intraoperative recovery autotransfusion. We compared results between the group of patients before and the one after the PBM program implementation. Result: We included 68 as patients who underwent total hip arthroplasty before PBM program from January 2013 to December 2015 (group A) and 84 as patients who underwent total hip arthroplasty after PBM program from January 2016 to December 2019 (group B). In the comparison of intraoperative blood transfusion volume, intraoperative blood transfusion rate and total blood transfusion rate between the two groups, the group B was significantly lower than the group A (P ≤ 0.05); The length of stay and hospitalization expenses of the group B were lower than the group A (P ≤ 0.05). No adverse events were recorded. Conclunsions: Our PMB program can reduce allogeneic blood transfusion, hospital stay and hospitalization expenses, without risking patients to higher number of com- plications in AS patients undergoing THA.

scholarly journals Comparison of tubeless versus tubed percutaneous nephrolithotomy

2018 ◽  
Vol 8 (1) ◽  
pp. 24-31
Author(s):  
Rajiv Shah ◽  
Nirmal Lamichhane ◽  
Sudeep Raj K.C.
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Calculi ◽  
P Value ◽  
Transfusion Rate ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Tubeless Pcnl ◽  
Post Operative Complications

Percutaneous nephrolithotomy (PCNL) is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of procedure to avoid post operative complications. This is to compare the outcome of tubeless PCNL versus tubed PCNL. In a randomized prospective study of sixty-four consecutive patients were enrolled and divided into two groups; A being tubeless group and B being nephrostomy group with 32 patients in each arm divided by quota sampling restricted block method with allocation ratio of 1:1. The mean age in group A was 36.69 ± 13.65 years and in group B was 38.09 ± 13.18 years with no significant p value (p = 0.501). Duration of hospital stay in group A was 3.63 ± 1.04 days and in group B was 6.34 ± 1.71 days with a significant p value (p = 0.001). In group A 31 (96.9%) and in group B 24 (75%) cases were not transfused with blood while 1 (3.1%) and 8 (25%) cases were transfused with blood with a significant p value (p = 0.026). The post operative complications were comparable in between two groups. Therefore tubeless PCNL reduces the hospital stay and blood transfusion rate with no obvious post operative complications.

Use of Amplatz Sheath in Percutaneous Nephrolithotomy and effect of its various sizes: Randomized Controlled Trial

2020 ◽  
Author(s):  
Adnan Siddiq
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Controlled Trial ◽  
Renal Stones ◽  
P Value ◽  
Common Source ◽  
Stone Size ◽  
Group A ◽  
Group B ◽  
Hemoglobin Drop

Background: Nephrostomy tract itself is the most common source of hemorrhage during percutaneous nephrolithotomy, which can be avoided by puncturing through the calyx with minimal angulation between calyceal system and the nephroscope shaft. Smaller the sheath diameter, lesser would be the bleeding. Our objective was to compare mean change in hemoglobin (HB) level in patients undergoing percutaneous nephrolithotomy (PCNL) with 24 versus 30 French Amplatz sheath. Methods: In this study, 142 patients were randomly divided into Group A undergoing procedure with 24 French Amplatz sheath; and Group B with 30 French sheath. At the end of procedure in both groups, nephrostomy tube was kept for 24 hours. On first post-operative day, patients’ HB was checked and compared with pre-operative data, along with blood transfusion rates. SPSS 20 was used for data analysis and p-value < 0.05 was considered significant. Results: Median age and interquartile range of Group-A and Group-B patients was (40; 18) and (41; 21) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000]. Conclusion: It was observed that use of 24 French Amplatz sheath lead to less renal hemorrhage and less hemoglobin drop compared to standard 30 French Amplatz sheath. Thus, small size Amplatz sheath in percutaneous nephrolithotomy may be considered effective and safe option for treatment of renal stones.

Abstract TMP2: Is Eptifibatide a Viable and Safe Option as Stand-alone Therapy for Acute Ischemic Stroke Patients?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniel Korya ◽  
Mohammad Moussavi ◽  
Siddhart Mehta ◽  
Jaskiran Brar ◽  
Harina Chahal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
T Test ◽  
Bleeding Complications ◽  
Stroke Severity ◽  
Paired Samples ◽  
Group A ◽  
Group B ◽  
Iv Tpa

Introduction: The list of contraindications for IV tPA in acute ischemic stroke (AIS) is often too long and may lead to physicians opting to offer no treatment for certain strokes. An alternative treatment is proposed in cases where IV tPA is not an option due to time-window restrictions or contraindications. We compared the stroke severity, outcomes and safety of IV eptifibatide when compared with IV tPA. Methods: Patients who presented to a community based university affiliated comprehensive stroke center from 2012-15 with AIS over a two-year period were included in the study. Those who qualified for IV tPA, and were treated, were compared with patients who only received IV eptifibatide. The initial NIH Stroke Score (NIHSS), 24-hour NIHSS, discharge NIHSS (DCNIHSS), discharge mRS (DCmRS) and symptomatic ICH rates were compared with a paired samples t-test to determine significance of difference between the means. SPSS Version 22 was used for all data analysis. Results: A total of 864 patients presented with AIS in the evaluated time period and of those 166 met study criteria. There were 119 patients who received IV tPA alone (group A) and 47 patients received eptifibatide (group B). The mean initial NIHSS, 24-NIHSS, DCNIHSS, DCmRS and percent bleeding complications for group A were: 11.2, 10.8, 8.6, 3.1 and 6%. For group B the figures were: 6.7, 4.8, 4.3, 1.7 and 0%, respectively. Group A was compared with group B in a paired samples T-test and yielded -4.3, -6.2, -6, -1.5 (p=.0001 to .04) for initial, 24-hour, discharge NIHSS and discharge mRS, respectively. The difference between initial and discharge NIHSS between the two groups was -2.7 (p=.009), favoring IV tPA. Conclusion: In patients who are either outside the time-window or with contraindications to IV tPA, eptifibatide may be a safe alternative and appears to be efficacious. None of the patients who were started on eptifibatide had bleeding complications and they had a statistically significant improvement in their level of disability and stroke severity at discharge. A limitation of this study is that patients in group A had significantly worse initial NIHSS compared with group B. To better evaluate the efficacy of eptifibatide, a larger, prospective study should be initiated.

scholarly journals Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3601-3606 ◽  
Author(s):  
Hannes Wandt ◽  
Markus Frank ◽  
Gerhard Ehninger ◽  
Christiane Schneider ◽  
Norbert Brack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Bleeding Complications ◽  
Group A ◽  
Red Blood Cell Transfusions ◽  
Group B ◽  
Acute Myeloid

Abstract In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

Telemedicine in the blood transfusion laboratory – remote interpretation of pre-transfusion tests

2007 ◽  
Vol 13 (7) ◽  
pp. 357-362 ◽  
Author(s):  
Marko Meža ◽  
Marko Breskvar ◽  
Andrej Košir ◽  
Irena Bricl ◽  
Jurij Tasič ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Expert Opinion ◽  
Reference Laboratory ◽  
Local Hospital ◽  
Telemedicine System ◽  
Visual Method ◽  
Routine Work ◽  
Group A ◽  
Group B ◽  
Remote Inspection

We have developed a telemedicine system for blood transfusion work, to supply the local hospital laboratory with an expert opinion from the central reference laboratory. The telemedicine system allows remote inspection and interpretation of pre-transfusion tests, which are performed by ID-cards (micro-tube gel technology). The system was installed at three blood transfusion laboratories in Slovenia, approximately 70 km apart. Validation of the telemedicine system was performed using 99 clinical cases selected randomly from routine work. Two groups of immunohaematology specialists participated. Group A ( n = 8) performed the read-out of the pre-transfusion tests on ID-cards by using the telemedicine system. Group B ( n = 2) then read the ID-cards independently using the standard visual method. All 98 final interpretations which were recorded using the telemedicine system were correct. We recorded 591 micro-tube read-outs of agglutination strength using the telemedicine system, of which 582 were correct. For comparison, we recorded 591 micro-tube read-outs using the standard visual method, of which 582 were correct. The validation proved that the telemedicine system was suitable for operational use.

Arthroscopic Ankle Arthrodesis

2007 ◽  
Vol 28 (6) ◽  
pp. 695-706 ◽  
Author(s):  
Nikolaos E. Gougoulias ◽  
Filon G. Agathangelidis ◽  
Stephen W. Parsons
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Frontal Plane ◽  
Ankle Arthrodesis ◽  
Valgus Deformity ◽  
Postoperative Treatment ◽  
Average Hospital ◽  
Superficial Wound ◽  
Group A ◽  
Group B

Background: Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity. Methods: The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles had minor deformity (group A), whereas 30 ankles had a varus or valgus deformity of more than 15 degrees (maximum 45 degrees) (group B). The average hospital stay was 3.8 and 3.4 days in groups A and B, respectively ( p = 0.74). Postoperative treatment included ankle immobilization for 3 months. Progressive weightbearing was initiated at 2 weeks. Mean followup was 21.1 months. Results: Fusion occurred in 47 of 48 (97.9%) ankles in group A at an average time of 13.1 ± 5.8 weeks and in 29 of 30 (96.7%) ankles at 11.6 ± 2.4 weeks in group B ( p = 0.19). Unplanned operative procedures were required in 11 ankles (14.1%). One superficial wound infection occurred. Symptomatic arthritis from the adjacent joints developed in six ankles (7.7%). Postoperative ankle alignment in the frontal plane averaged 0.7 and 0.4 degrees of valgus ( p = 0.41), whereas the sagittal plane angle averaged 106 ± 4 degrees and 104.5 ± 7 degrees in groups A and B, respectively ( p = 0.22). The outcome was graded as very good in 79.2% (38 feet) in group A and 80% (24 feet) in group B, fair in 18.8% (9 feet) in group A and 16.7% (5 feet) in group B and poor in one ankle in each group ( p = 0.68). Conclusions: The arthroscopic technique offered high fusion rates and low morbidity. Deformity correction was achieved with good results.

Acute normovolemic hemodilution in total knee arthroplasty, a prospective study

2016 ◽  
Author(s):  
Jin Kyu Lee ◽  
Mi Ae Cheong ◽  
Choong Hyeok Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Allogeneic Blood ◽  
Acute Normovolemic Hemodilution ◽  
Allogeneic Transfusion ◽  
Group A ◽  
Total Knee ◽  
Normovolemic Hemodilution ◽  
Group B

Abstract Objective: In this prospective, randomized, controlled trial we sought to evaluate the effectiveness of acute normovolemic hemodilution (ANH) in terms of decreasing the need for allogeneic transfusion after conventional unilateral total knee arthroplasty (TKA). Summary of Background Data: TKA is often performed with an occlusive tourniquet, and thus, it could be considered ideally suited for ANH, because the chief benefit of ANH is red blood cell loss reduction and the shedding of whole blood perioperatively at lower hematocrit levels. Methods: Between January 2012 and May 2012, 40 consecutive patients scheduled to undergo elective, primary, cemented, unilateral TKA for knee osteoarthritis were enrolled. Patients were randomized to either a study (ANH) group (n=20) (Group A) or a control group (n=20) (Group B). Unit of allogeneic blood transfused was considered the primary outcomes. Results : In the ANH group, less allogeneic blood transfusion (6 units in Group A vs 15 units in Group B) was required after operation. Six patients, who required a transfusion in Group A received 1 unit of allogeneic blood. In contrast, 6 of 9 patients, who required transfusion in Group B, received at least 2 units of allogeneic blood (p&lt;0.05). There was no complication related to the methods of the protocol. Conclusions: ANH is likely to reduce postoperative allogeneic transfusion requirement in patients undergoing unilateral TKA. However, adjunctive strategies are required to further reduce allogeneic blood transfusion requirements.

scholarly journals The relationship between thyroidectomy complications and body mass index

2020 ◽  
Vol 66 (11) ◽  
pp. 1573-1576
Author(s):  
Mehmet Üstün ◽  
Avni Can Karaca ◽  
Ihsan Birol ◽  
Gülberk Uslu ◽  
Semra Demirli Atici ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Nerve Palsy ◽  
Operative Time ◽  
Bleeding Complications ◽  
Recurrent Nerve ◽  
Recurrent Nerve Palsy ◽  
Group A ◽  
Group B ◽  
The Relationship

SUMMARY INTRODUCTION: Obesity is a growing public health problem associated with many comorbid diseases. The aim of this study was to evaluate the relationship between body mass index and complications of thyroidectomy. METHODS: Patients who underwent total thyroidectomy between January 2015 and December 2018 were enrolled. Patients were divided into two groups, i.e., BMI <25 (group A) and BMI≥ 25 (group B). Demographics, operative time, and complications were retrospectively reviewed. RESULTS: The study included 145 patients (66 in Group A and 79 in Group B). There was no significant difference between the two groups in terms of age (p=0.330) and gender (p=0.055). No surgical site infection and bleeding complications were observed in any patients. The mean operative time was 148.4 minutes (90-235) in Group A and 153.4 minutes (85-285) in Group B (p=0.399). Transient hypocalcemia was observed in 25 (37.9%) patients in group A, and 23 (29.1%) patients in Group B (p = 0.291). Permanent hypocalcemia was not observed in any patient in group A, and in 2 patients in Group B (2.5%) (p = 0.501). Transient recurrent nerve palsy was observed in 1 (1.5%) patient in Group A and in 3 (3.8%) patients in Group B (p=0.626). None of the patients had permanent recurrent nerve palsy. Parathyroid autotransplantation was performed on 1 patient (1.5%) in group A and on 7 (8.9%) patients in Group B (p=0.055). CONCLUSION: We think there is no relationship between a high BMI and thyroidectomy complications, and surgery can also be performed safely in this patient group.

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