chondroitin-sulfates and Postoperative-Complications

The indications for ophthalmic viscosurgical devices have expanded with the introduction of newly developed ophthalmic viscosurgical devices. The characteristics of different ophthalmic viscosurgical devices and their specific uses in anterior segment surgery and possible problems are discussed.. Ophthalmic viscosurgical devices were first introduced to maintain space in the eye during the implantation of intraocular lenses. With the development of different types of ophthalmic viscosurgical devices, additional indications have been discussed. To protect the corneal endothelium, the ability of ophthalmic viscosurgical devices to be retained during phacoemulsification was compared. To enlarge and stabilize the size of the pupil, specific ophthalmic viscosurgical devices are used in patients with small pupils or intraoperative floppy iris syndrome. On the other hand, complications associated with the use of ophthalmic viscosurgical devices and their prevention have been discussed. Postoperative elevations of intraocular pressure have been reported and complete removal of the ophthalmic viscosurgical device at the end of surgery is the key factor to avoiding these elevations. Wound burns during phacoemulsification may occur and creating a fluid space around the phacoemulsification tip is necessary to avoid them.. The rheologic characteristics of the different types of ophthalmic viscosurgical device should be considered, and the appropriate use of ophthalmic viscosurgical devices in specific cases would improve the surgical outcomes.

Topics: Animals; Chondroitin; Chondroitin Sulfates; Drug Combinations; Humans; Hyaluronic Acid; Lens Implantation, Intraocular; Phacoemulsification; Postoperative Complications; Prosthesis Design; Viscosity

Heparin induced thrombocytopenia (HIT) in addition to bleeding complications are the most serious and dangerous side effects of heparin treatment. HIT remains the most common antibody-mediated, drug-induced thrombocytopenic disorder and a leading cause of morbidity and mortality. Two types of HIT are described: Type I is a transitory, slight and asymptomatic reduction of platelet count occurring during 1-2 days of therapy. HIT type II, which has an immunologic origin, is characterized by a thrombocytopenia that generally onset after the fifth day of therapy. Despite thrombocytopenia, haemorrhagic complications are very rare and HIT type II is characterized by thromboembolic complications consisting in venous and arterial thrombosis. The aim of this paper is to review new aspects of epidemiology, pathophysiology, clinical features, diagnosis and therapy of HIT type II. There is increasing evidence that platelet factor 4 (PF4) displaced from endothelial cells, heparan sulphate or directly from the platelets, binds to heparin molecule to form an immunogenic complex. The anti-heparin/PF4 IgG immune-complexes activates platelets through binding with the Fcgamma RIIa (CD32) receptor inducing endothelial lesions with thrombocytopenia and thrombosis. Cytokines are generated during this process and inflammation could play an additional role in the pathogenesis of thromboembolic manifestations. The onset of HIT type II is independent from dosage, schedule, and route of administration of heparin. A platelet count must be carried out prior to heparin therapy. Starting from the fourth day, platelet count must be carried out daily or every two days for at least 20 days of any heparin therapy regardless of the route of the drug administration. Patients undergoing orthopaedic or cardiac surgery are at higher risk for HIT type II. The diagnosis of HIT type II should be formulated on basis of clinical criteria and confirmed by in vitro demonstration of heparin-dependent antibodies detected by functional and antigen methods. However, the introduction of sensitive ELISA tests to measure anti-heparin/PF4 antibodies has showed the immuno-conversion in an higher number of patients treated with heparin such as the incidence of anti-heparin/PF4 exceeds the incidence of the disease. If HIT type II is likely, heparin must be immediately discontinued, even in absence of certain diagnosis of HIT type II, and an alternative anticoagulant therapy must be started followed by oral dicuma

Topics: Animals; Anticoagulants; Arginine; Chondroitin Sulfates; Dermatan Sulfate; Heparin; Heparitin Sulfate; Hirudins; Humans; Peptide Fragments; Pipecolic Acids; Postoperative Complications; Recombinant Proteins; Sulfonamides; Thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is an antibody-mediated syndrome associated with heparin exposure, a falling platelet count and a high risk of thrombosis. Cardiovascular patients are at increased risk of HIT due to wide use of heparin in this population. Should HIT be suspected, heparin must be avoided in most situations, and anticoagulation with an alternative anticoagulant should be instituted. Preferred agents include the direct thrombin inhibitors argatroban and lepirudin, whilst bivalirudin or desirudin (other direct thrombin inhibitors) can be used in some situations. The indirect thrombin inhibitors, danaparoid and fondaparinux, can also be considered at times. These agents and their use in cardiac patients, including patients with acute coronary syndrome, percutaneous coronary interventions, acute ST elevation myocardial infarction or cardiac surgery, will be reviewed.

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Arginine; Cardiovascular Diseases; Chondroitin Sulfates; Dermatan Sulfate; Drug Administration Schedule; Factor Xa Inhibitors; Fondaparinux; Heparin; Heparitin Sulfate; Hirudins; Humans; Pipecolic Acids; Polysaccharides; Postoperative Complications; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Recombinant Proteins; Sulfonamides; Thrombin; Thrombocytopenia

All patients with neurologic diseases should receive perioperative VTE prophylaxis. The choice of mechanical, pharmacologic, or combined modalities of prophylaxis depends on both the underlying risk factors and surgical VTE risks. Prophylaxis and treatment options must be individualized to the patient. Prevention of VTE will help minimize the need for therapeutic treatment. Options for treatment include both inpatient and outpatient regimens using UFH or LMWH. In patients with an absolute or relative contraindication to anticoagulation, an IVC filter is an appropriate management strategy. Perioperative bridging therapy should be considered in patients with high or moderate risks for recurrent VTE.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Brain Diseases; Chondroitin Sulfates; Dermatan Sulfate; Dose-Response Relationship, Drug; Drug Combinations; Fibrinolytic Agents; Heparin; Heparitin Sulfate; Humans; Postoperative Complications; Venous Thrombosis; Warfarin

In the absence of prophylaxis, elective orthopedic surgery is associated with a high risk of venous thromboembolic events that are responsible for substantial morbidity and mortality. Despite the publication of articles questioning the significance of fatal pulmonary embolism (PE) following elective hip replacement, recent reports support the need for effective thromboprophylaxis in this indication. These reports also provide evidence of a significant reduction in fatal PE and overall mortality provided by treatment with low-molecular-weight heparin (LMWH), compared with unfractionated heparin. Even with the most effective prophylaxis currently available, however, deep vein thrombosis still develops in a minority of high-risk patients, indicating a need for improved therapies. Desirudin, a novel recombinant hirudin and direct thrombin inhibitor, has been shown to provide more effective prophylaxis than the most widely used LMWH, enoxaparin, in orthopedic surgery patients with multiple thromboembolic risk factors. This benefit was not associated with any increase in bleeding. Regional anesthesia and use of graduated compression stockings may provide additional independent reductions in thromboembolic risk in elective orthopedic surgery.

Topics: Anesthesia, Conduction; Anticoagulants; Bandages; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Heparin, Low-Molecular-Weight; Heparitin Sulfate; Hirudin Therapy; Hirudins; Humans; Logistic Models; Postoperative Complications; Pulmonary Embolism; Recombinant Proteins; Risk Factors; Venous Thrombosis

Besides low molecular weight heparins (LMWHs) a number of new antithrombotic agents have been evaluated mainly in the prevention of deep vein thrombosis (DVT) and, to a lesser extent, in the treatment of established DVT. They include the Pentasaccharide, a synthetic ultra LMWH, Dermatan Sulphate, a glycosaminoglycan which activates heparin cofactor II, Orgaran, a mixture of Heparan and of Dermatan Sulphate, Hirulog and Hirudin, two direct thrombin inhibitors. The efficacy and safety of these compounds have been studied in comparison with a placebo or with unfractionated heparin but not with LMWH which is considered as a gold standard for these clinical indications. It is thus difficult at present to appreciate the advantages of these new antithrombotic agents over conventional LMWH therapy.

Topics: Anticoagulants; Antithrombin III; Binding Sites; Chondroitin Sulfates; Clinical Trials as Topic; Dermatan Sulfate; Drug Evaluation, Preclinical; Factor Xa Inhibitors; Fibrinolytic Agents; Heparin; Heparin, Low-Molecular-Weight; Heparitin Sulfate; Humans; Multicenter Studies as Topic; Oligosaccharides; Postoperative Complications; Pulmonary Embolism; Recurrence; Thrombin; Thrombophlebitis

On the basis of the results of the 11 studies reviewed, thromboprophylaxis with unfractionated heparin, low molecular weight (LMW) heparin or a heparinoid (danaparoid sodium; Org 10172) in patients undergoing total hip replacement did not show any important clinical differences with respect to the tolerability profiles of the different compounds. However, as a result of the great variability in the presentation and evaluation of blood losses and bleeding complications in these studies, it is mandatory to perform a direct comparison of the different compounds in question in a double-blind, prospective clinical study.

Topics: Chondroitin Sulfates; Dermatan Sulfate; Fibrinolytic Agents; Hemorrhage; Heparin; Heparinoids; Heparitin Sulfate; Hip Prosthesis; Humans; Molecular Weight; Postoperative Complications; Thrombocytopenia; Thrombosis; Wound Infection

Topics: Animals; Anticoagulants; Blood Coagulation; Cerebrovascular Disorders; Chondroitin Sulfates; Dermatan Sulfate; Drug Evaluation, Preclinical; Fibrinolytic Agents; Glycosaminoglycans; Hemorrhage; Heparin; Heparitin Sulfate; Humans; Incidence; Mammals; Molecular Weight; Platelet Aggregation; Postoperative Complications; Rabbits; Renal Dialysis; Thrombocytopenia; Thrombophlebitis; Thrombosis

Topics: Animals; Cardiopulmonary Bypass; Chondroitin Sulfates; Clinical Trials as Topic; Dermatan Sulfate; Factor X; Factor Xa; Fibrinolytic Agents; Glycosaminoglycans; Heparin; Heparinoids; Heparitin Sulfate; Humans; Kinetics; Molecular Weight; Postoperative Complications; Rats; Renal Dialysis; Thrombocytopenia; Thrombosis; Uremia

To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound.. Prospective, randomized clinical trial based on a tertiary eye hospital.. The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively.. The Shapiro-Wilks test was used to assess the normality of the data. Mann-Whitney U-test with the P value set at 0.05 was used to compare the two groups.. Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks.. No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon's preference, as both high and low flow parameters were found to have comparable postoperative outcomes.

Topics: Cataract; Cell Count; Chondroitin Sulfates; Corneal Pachymetry; Drug Combinations; Endothelium, Corneal; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Iris; Macula Lutea; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Prospective Studies; Therapeutic Irrigation; Tomography, Optical Coherence; Treatment Outcome; Ultrasonic Therapy; Visual Acuity

Decreased antithrombin III (ATIII) activity and large splenic vein diameter (SVD) are risk factors for portal vein thrombosis (PVT) after splenectomy in liver cirrhosis with portal hypertension. Antithrombin III concentrates can prevent PVT. This study was designed to stratify risks for PVT after splenectomy in cirrhotic patients and to develop prophylactic protocols for PVT.. In 53 patients (testing cohort), the cutoff level of preoperative ATIII activity (≤60%) was evaluated for administration of ATIII concentrates. Antithrombin III activity and SVD were re-evaluated as criteria for prophylaxis of PVT. In 57 patients (validation cohort), the risk stratification of PVT and prophylactic protocols were validated.. In the testing cohort, 10 (19%) of 53 patients had PVT. Risk level of PVT was stratified and prophylactic protocols were developed. Patients at low risk (ATIII activity ≥70% and SVD <10 mm) were not treated; those at high risk (ATIII activity <70% or SVD ≥10 mm) received ATIII concentrates (1,500 U/day) for 3 days; and those at highest risk (SVD ≥15 mm) received ATIII concentrates for 3 days, followed by danaparoid sodium (2,500 U/day) for 14 days and warfarin. In the validation cohort, 0 of 14 low-risk and 2 of 32 high-risk patients had PVT. Although 8 of 11 patients at highest risk had temporary PVT, it disappeared within 3 months postoperatively. Finally, only 2 (3.5%) of 57 patients had PVT.. Risk stratification of PVT after splenectomy and prophylaxis with ATIII concentrates and danaparoid sodium dramatically reduced the incidence of PVT.

Topics: Adult; Aged; Anticoagulants; Antithrombin III; Chondroitin Sulfates; Clinical Protocols; Decision Support Techniques; Dermatan Sulfate; Drug Therapy, Combination; Female; Fibrinolytic Agents; Heparitin Sulfate; Humans; Hypertension, Portal; Laparoscopy; Liver Cirrhosis; Male; Middle Aged; Portal Vein; Postoperative Complications; Prospective Studies; Risk Assessment; Risk Factors; ROC Curve; Splenectomy; Venous Thrombosis; Warfarin

To compare the effectiveness of brinzolamide 1%, brimonidine 0.2%, acetazolamide 250 mg, intracameral acetylcholine, and timolol 0.5% in preventing intraocular pressure (IOP) peaks during the early period after phacoemulsification in which sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) was used as the ophthalmic viscosurgical device (OVD).. Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey.. This prospective randomized study comprised 185 eyes of 185 patients with uncomplicated cataract scheduled for phacoemulsification using Viscoat as the OVD. Patients were randomly assigned to 1 of 6 groups: postoperative application of topical brinzolamide 1%, brimonidine 0.2%, oral acetazolamide 250 mg, intracameral acetylcholine, timolol 0.5%, or no ocular hypotensive agent (control group). The IOP was measured at baseline (preoperatively) as well as 6 hours, 20 to 24 hours, and 1 week after surgery.. The mean preoperative IOP values were not significantly different between the groups. Six hours and 20 to 24 hours postoperatively, the mean IOP was significantly lower in all groups receiving an ocular hypotensive agent than in the control group (P<.01). Six hours after surgery, the mean IOP significantly increased in all groups but was higher in the control group. At 20 to 24 hours, the mean IOP decreased significantly in all ocular hypotensive agent groups but remained significantly high in the control group. One week after surgery, there were no significant differences between the groups.. Brinzolamide, brimonidine, acetazolamide, intracameral acetylcholine, and timolol had similar effects in reducing IOP increases after phacoemulsification performed using Viscoat.

Topics: Acetazolamide; Acetylcholine; Administration, Topical; Aged; Aged, 80 and over; Antihypertensive Agents; Brimonidine Tartrate; Chondroitin; Chondroitin Sulfates; Double-Blind Method; Drug Combinations; Female; Humans; Hyaluronic Acid; Intraocular Pressure; Lens Implantation, Intraocular; Male; Middle Aged; Ocular Hypertension; Phacoemulsification; Postoperative Complications; Prospective Studies; Quinoxalines; Sulfonamides; Thiazines; Timolol; Tonometry, Ocular

To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%-sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery.. This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Ocucoat or Viscoat during cataract surgery of the first eye. The second eye was operated later and received the other viscoelastic agent. Cataract surgery was performed with a temporal 3.2 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively as well as 6 hours, 20-24 hours, and 1 week postoperatively.. At 6 hours after surgery the mean IOP increased by 4.6 (SD 5.1) mm Hg in the Ocucoat group (p<0.001) and by 8.6 (8.1) mm Hg in the Viscoat group (p<0.001). The increase was significantly higher in the Viscoat group than in the Ocucoat group (p=0.004). Intraocular pressure spikes of 30 mm Hg or more occurred in two eyes in the Ocucoat and in nine eyes in the Viscoat group (p=0.023); 20-24 hours and 1 week postoperatively the mean IOP was not statistically different.. These findings indicate that Viscoat causes a significantly higher IOP increase and significantly more IOP spikes than Ocucoat in the early period after small incision cataract surgery.

Topics: Aged; Aged, 80 and over; Chondroitin; Chondroitin Sulfates; Double-Blind Method; Drug Combinations; Female; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraoperative Care; Male; Methylcellulose; Middle Aged; Ocular Hypertension; Phacoemulsification; Postoperative Complications; Postoperative Period; Prospective Studies; Viscosity

Orgaran (danaparoid sodium injection) is a novel antithrombotic agent. Early studies suggest that this compound may be beneficial in preventing deep vein thrombosis in predisposed patients. This multicenter, randomized, assessor blinded, clinical trial compared subcutaneous danaparoid with warfarin for the prevention of deep vein thrombosis in patients undergoing hip replacement surgery. Bilateral venography was used to detect thrombi. Patients also underwent follow-up examinations 1, 2, and 3 months after discontinuation of the study to determine the after effects of treatment. Nearly 27% of patients who received warfarin and 14.6% of patients who received danaparoid developed deep vein thrombosis, a risk reduction of 46%. The absolute difference in the incidence of deep vein thrombosis was 12.3% in favor of danaparoid. The incidence of venographically documented proximal deep vein thrombosis was 1.5% for danaparoid and 4.1% for warfarin. These results demonstrate that danaparoid is more effective than warfarin in preventing deep vein thrombosis following hip replacement surgery. The preoperative administration of danaparoid does not increase surgical blood loss compared with warfarin.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Female; Heparitin Sulfate; Humans; Male; Middle Aged; Postoperative Complications; Single-Blind Method; Treatment Outcome; Venous Thrombosis; Warfarin

The study objective was to determine the relative efficacy and safety of a low-molecular-weight heparinoid (Orgaran) compared with aspirin for the prevention of postoperative venous thromboembolism in patients undergoing surgery for fractured hips. A double-blind, randomized, controlled trial was used to study 251 consecutive eligible and consenting patients undergoing surgery for hip fracture in seven participating hospitals.. Patients received either fixed-dose Orgaran by subcutaneous injection every 12 hours in a dose of 750 anti-Factor Xa units or aspirin 100 mg orally twice daily; both regimens were started 12 to 24 hours after surgery and continued for 14 days or until discharge, if sooner. All patients had postoperative 125I-fibrinogen leg scanning and impedance plethysmography. If the results of one or both tests were positive, then venography was performed. Otherwise, venography was done at day 14, or sooner if the patient was ready for discharge. Pulmonary embolism in symptomatic patients was diagnosed on the basis of a high probability perfusion/ventilation lung scan, a positive angiogram, or a clinically significant embolism detected at autopsy. Evaluable venograms were obtained in 90 of the 125 patients randomly assigned to receive Orgaran and in 87 of the 126 patients assigned to receive aspirin. Venous thromboembolism was detected in 25 (27.8%) patients in the Orgaran group and in 39 (44.3%) patients in the aspirin group. Thus, there was a relative risk reduction of 37% with Orgaran (P=.028; 95% confidence interval, 3.7% to 59.7%). Six (6.8%) of 88 patients in the Orgaran group and 12 (14.3%) of 84 patients in the aspirin group developed proximal deep vein thrombosis or pulmonary embolism, a relative risk reduction of 52% with Orgaran (P=.137; 95% confidence interval, -30.7% to 84.6%). Hemorrhagic complications occurred in 2 (1.6%) patients given Orgaran and 8 (6.4%) patients given aspirin (P=.10). There was one major bleed in the Orgaran group compared with four in the aspirin group.. This study demonstrates that Orgaran is significantly more efficacious than aspirin in preventing postoperative venous thromboembolism in patients undergoing surgery for fractured hips, with no evidence of any increase in hemorrhagic complications.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Chondroitin Sulfates; Dermatan Sulfate; Double-Blind Method; Female; Heparitin Sulfate; Hip Fractures; Humans; Injections, Subcutaneous; Male; Middle Aged; Postoperative Complications; Thromboembolism

The ability of DexSol medium, supplemented with two growth factors, human epidermal growth factor (hEGF) and human insulin, to improve long-term endothelial survival after penetrating keratoplasty was evaluated in a multi-center, randomized, prospective, double-masked clinical trial.. Donor cornea pairs, one stored in DexSol and the other in DexSol with hEGF (10 ng/ml) and human insulin (10 micrograms/ml) (ProCell), were transplanted into 105 pairs of recipients matched by diagnosis and procedure and followed postoperatively for graft and endothelial survival.. No primary donor failures occurred in either group. Graft clarity did not differ between the ProCell and DexSol groups at all postoperative periods: 3 months (98% versus 99%), 6 months (94% versus 98%), and 1 year (95% versus 97%), respectively. Postoperative complications (e.g., glaucoma, rejection) occurred with comparable frequencies in both groups. Mean endothelial cell loss did not significantly differ between the ProCell and DexSol groups at 3 months (5.7% versus 5.1%), 6 months (8.1% versus 10.1%), and 1 year (12.3% versus 15.6%), respectively. Similarly, there were no clinically and statistically significant differences in other endothelial morphometric parameters.. The use of corneas stored in DexSol medium with added hEGF and insulin in corneal transplantation resulted in a safety and efficacy profile comparable with that observed in patients receiving DexSol-stored corneas; however, there were no clinically and statistically significant differences in postoperative endothelial morphometric parameters.

Topics: Adult; Aged; Cell Count; Cell Survival; Chondroitin Sulfates; Cornea; Cryopreservation; Culture Media, Serum-Free; Double-Blind Method; Endothelium, Corneal; Epidermal Growth Factor; Female; Follow-Up Studies; Glycoside Hydrolases; Graft Survival; HEPES; Humans; Insulin; Keratoplasty, Penetrating; Male; Organ Preservation; Organic Chemicals; Postoperative Complications; Prospective Studies

This double-blind, randomised, multicentre trial in 513 patients having elective surgery for intra-abdominal or intrathoracic malignancy compared the efficacy and safety of venous thrombosis (VT) prophylaxis using 750 anti-factor Xa units of Orgaran (a mixture of low molecular weight heparinoids) given subcutaneously (sc) twice-daily with that of twice-daily injections of 5,000 units standard heparin. The main study endpoints were the development of postoperative VT detected by 125I-fibrinogen leg scanning, and the onset of clinically significant venous thromboembolism or bleeding. "Intent to treat" analysis showed a statistically non-significant trend towards less VT during Orgaran prophylaxis (10.4%) than after heparin (14.9%) and there was no difference in bleeding complications between the two study groups. Results remained similar if only patients who completed the intended course of therapy ("compliant patients") were analysed. Other trials have shown that Orgaran prevents VT after hip surgery and stroke. We now show it is also safe and effective in patients having major surgery for cancer.

Topics: Aged; Anticoagulants; Chondroitin Sulfates; Dermatan Sulfate; Double-Blind Method; Elective Surgical Procedures; Female; Gastrointestinal Neoplasms; Glycosaminoglycans; Hematologic Tests; Hemorrhage; Heparinoids; Heparitin Sulfate; Humans; Lung Neoplasms; Male; Middle Aged; Postoperative Complications; Pulmonary Embolism; Thrombophlebitis

Two studies evaluating the effect of Orgaran prophylaxis on the incidence of postoperative thrombosis in hip fracture surgery are reported. In one Scandinavian study, dextran was used in the comparative group, and in the US study, warfarin was used. In both, Orgaran was significantly more effective in reducing the frequency of deep vein thrombosis without producing an increase in bleeding complications or other side effects.

Topics: Aged; Aged, 80 and over; Chondroitin Sulfates; Dermatan Sulfate; Dextrans; Female; Glycosaminoglycans; Hemorrhage; Heparinoids; Heparitin Sulfate; Hip Fractures; Humans; Incidence; Male; Postoperative Complications; Pulmonary Embolism; Scandinavian and Nordic Countries; Single-Blind Method; Thrombophlebitis; United States; Warfarin

Patients who develop heparin-induced thrombocytopenia (HIT) frequently need further anticoagulation to treat an ongoing thromboembolic problem or to prevent one. Orgaran (Org 10172), a low-molecular-weight (LMW) glycosaminoglycuronan, has shown a low frequency (10%) of cross-reactivity in vitro with sera containing the HIT antibody, in contrast to the much higher frequency of cross-reactivity (approximately 80%) shown by the LMW heparins. This paper summarises the results of intravenous or subcutaneous Orgaran treatment in 57 of 67 Australian patients, in whom the diagnosis of HIT was reasonably confirmed by exclusion of other causes of thrombocytopenia and by objective tests. The presenting indications for Orgaran were: continuous venovenous haemofiltration and haemodialysis (n = 21), thrombo-embolism treatment (n = 23), thrombo-embolism prophylaxis (n = 10), and anticoagulation for coronary artery by-pass graft (n = 4), peripheral by-pass graft surgery and plasmapheresis (n = 1 each). The results showed Orgaran to be a safe, well-tolerated, effective (successful treatment in over 90% of patients) anticoagulant in patients with a high thrombotic and/or bleeding risk even if critically ill and requiring haemofiltration. The complete results of the world-wide study in 161 patients confirmed not only these clinical findings in the subgroup of 57 Australian patients, but also the low cross-reactivity (12%) of Orgaran with the HIT serum factor.

Topics: Antibody Specificity; Autoantibodies; Autoimmune Diseases; Chondroitin Sulfates; Cross Reactions; Dermatan Sulfate; Drug Evaluation; Glycosaminoglycans; Hemofiltration; Heparin; Heparinoids; Heparitin Sulfate; Humans; Postoperative Complications; Thrombocytopenia; Thromboembolism

In a randomized, prospective trial, a low-molecular-weight heparinoid (Org 10172 [Lomoparan]) was compared with warfarin for efficacy and safety in preventing deep-vein thrombosis in 263 patients who had an operatively treated fracture of the hip. One group of patients received Org 10172 in a dose of 750 units subcutaneously every twelve hours until the ninth postoperative day; on the seventh postoperative day, warfarin was added to the regimen. The other group received only warfarin. Both drugs were begun preoperatively, immediately after the admission evaluation. In the patients who received warfarin, the desired prothrombin time was one and one-half times the control level. Deep-vein thrombosis was detected by 125I-fibrinogen scanning and impedance plethysmography and was confirmed by phlebography and compression ultrasonography. Deep-vein thrombosis was found in nine (7 per cent) of the 132 patients who received Org 10172 and in twenty-eight (21 per cent) of the 131 patients who received warfarin (p less than 0.001). Adverse reactions were not significantly different in the two groups. Major bleeding complications occurred in eight patients in the Org-10172 group, only four of whom were receiving the drug at the time of bleeding, and in five patients who were receiving warfarin (not significant). There was no difference in intraoperative loss of blood or in requirements for transfusion. We concluded that the low-molecular-weight heparinoid Org 10172 is a safe, convenient, effective antithrombotic agent for the prevention of venous thrombosis after an operation for fracture of the hip.

Topics: Aged; Aged, 80 and over; Blood Loss, Surgical; Chondroitin Sulfates; Dermatan Sulfate; Female; Glycosaminoglycans; Heparinoids; Heparitin Sulfate; Hip Fractures; Humans; Iodine Radioisotopes; Male; Middle Aged; Molecular Weight; Plethysmography; Postoperative Complications; Prevalence; Prospective Studies; Risk Factors; Thrombophlebitis; Warfarin

A prospective randomized study was performed involving 200 patients divided into four groups: (1) Healon aspirated, (2) Amvisc aspirated, (3) Viscoat aspirated, and (4) Viscoat not aspirated. Postoperative intraocular pressures were measured at 4, 8, and 24 hours, two to three days, and one month. Significant differences between the groups were noted at four and eight hours; however, by 24 hours there were no significant differences. There were also no significant differences at two to three days and one month postoperatively. In this study, the Viscoat-not-aspirated group had the highest intraocular pressures followed, in decreasing order, by the Viscoat aspirated group, the Amvisc aspirated group, and the Healon aspirated group. From this study, I have concluded that Viscoat should be aspirated at the end of surgery to avoid postoperative intraocular pressure rises. Healon appears to be associated with lower intraocular pressures than the other two agents at four and eight hours postoperatively.

Topics: Cataract Extraction; Chondroitin; Chondroitin Sulfates; Humans; Hyaluronic Acid; Intraocular Pressure; Lenses, Intraocular; Postoperative Complications; Prospective Studies; Random Allocation; Time Factors; Tonometry, Ocular

Topics: Animals; Cardiopulmonary Bypass; Chondroitin Sulfates; Clinical Trials as Topic; Dermatan Sulfate; Factor X; Factor Xa; Fibrinolytic Agents; Glycosaminoglycans; Heparin; Heparinoids; Heparitin Sulfate; Humans; Kinetics; Molecular Weight; Postoperative Complications; Rats; Renal Dialysis; Thrombocytopenia; Thrombosis; Uremia

The prophylactic effect of a semisynthetic heparin analogue (SSHA) on deep vein thrombosis was investigated in a prospective double-blind multicentre trial. 440 major general surgical and gynaecological patients were randomized to one of three treatment groups: 50 mg SSHA, 37.5 mg SSHA and 5000 units sodium heparin subcutaneously 12-hourly. Deep venous thrombosis (DVT) was diagnosed with the fibrinogen uptake test and verified with phlebography. Bleeding complications and other side-effects were carefully monitored. There were no significant differences between the three treatment groups of patients in age, sex, type of operation or risk factors. A DVT was diagnosed in 16 patients (12 per cent) in the SSHA 50 mg group, in 21 patients (15 per cent) in the SSHA 37.5 mg group and 21 patients (14 per cent) in the heparin-treated group. No significant differences were found in the number of patients who bled unexpectedly in the postoperative period, required transfusion or developed wound haematomas. Blood loss at operation was similar in all three groups. Three pulmonary emboli were diagnosed by pulmonary scintigraphy, one in each group.

Topics: Adult; Aged; Anticoagulants; Chondroitin; Chondroitin Sulfates; Double-Blind Method; Female; Hemorrhage; Heparin; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; Risk; Surgical Procedures, Operative; Thrombophlebitis

Platelet aggregation, lipoprotein lipase activity, coagulation parameters and routine blood chemistry were measured in a randomised study of 21 surgical patients before, immediately after and 3 months after operation. Sodium heparin 5000 IU was given subcutaneously to 11 patients every 12 hours for 7 days, the first injection 2 hours preoperatively; 10 patients received a semi-synthetic heparin analogue (SSHA 75 mg) in the same manner. The groups were sex and age matched. No conclusive changes were found in platelet aggregation. The increase in lipoprotein lipase activity in SSHA patients 2 hours after injection was significantly greater than in heparin patients. Neither of the two drugs induced significant changes in coagulation parameters or routine blood chemistry. The results indicate a difference in the effect on lipoprotein lipase release between heparin and SSHA at the used dosage schedules.

Topics: Aged; Anticoagulants; Blood Coagulation Tests; Chondroitin; Chondroitin Sulfates; Female; Heparin; Humans; Lipoprotein Lipase; Male; Platelet Aggregation; Postoperative Complications; Thrombophlebitis

To describe the intraoperative and early postoperative complications using preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts with intraocular injection of the graft in Optisol-GS and omission of trypan blue restaining.. This is a retrospective case series of 132 consecutive eyes with Fuchs endothelial dystrophy or endothelial failure who underwent DMEK using preloaded donor tissue prepared as previously described. The graft was not restained with trypan blue by the surgeon, and Optisol-GS was injected with the graft into the eye instead of being rinsed from the injector. Early postoperative complications (0-8 wk) including intraoperative fibrin formation, intraocular inflammation, elevated intraocular pressure, partial graft detachment requiring rebubble, and early graft failure were recorded.. No eyes developed intraoperative fibrin formation or postoperative inflammation (such as toxic anterior segment syndrome) or elevated intraocular pressure. For eyes with Fuchs corneal dystrophy, our rebubble rate was 21% (22/106 eyes). Early graft failure was noted in 2% (3/132 eyes), which is similar to previous reports.. Our results suggest that injection of Optisol-GS into the anterior chamber during DMEK graft injection does not lead to increases in intraoperative or early postoperative complications. Trypan blue restaining is not necessary for intraoperative visualization. This simplification can reduce graft manipulation and save time and resources for this procedure.

Topics: Aged; Chondroitin Sulfates; Coloring Agents; Complex Mixtures; Corneal Endothelial Cell Loss; Culture Media, Serum-Free; Descemet Stripping Endothelial Keratoplasty; Dextrans; Endothelium, Corneal; Female; Follow-Up Studies; Gentamicins; Graft Survival; Humans; Male; Postoperative Complications; Retrospective Studies; Time Factors; Tissue Donors; Trypan Blue; Visual Acuity

The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.

Topics: Adolescent; Adult; Burns; Chondroitin Sulfates; Cicatrix; Collagen; Contracture; Elastin; Female; Guided Tissue Regeneration; Humans; Longitudinal Studies; Male; Middle Aged; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Postoperative Complications; Skin; Skin Transplantation; Transplantation, Autologous; Young Adult

Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative.. The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering.. From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted.. A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix.. The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.

Topics: Adolescent; Child; Child, Preschool; Chondroitin Sulfates; Collagen; Cutaneous Fistula; Follow-Up Studies; Foreskin; Humans; Hypospadias; Male; Postoperative Complications; Prospective Studies; Recurrence; Regeneration; Reoperation; Skin, Artificial; Urethra; Urinary Fistula; Urologic Surgical Procedures, Male

To compare corneal wetting performances of different dispersive ophthalmic viscosurgical devices.. Three different types of dispersive ophthalmic viscosurgical devices, hydroxypropyl methylcellulose %2 (HPMC), sodium hyaluronate %3-sodium chondroitin sulphate %4 (HACS), and sodium hyaluronate %3 (HA), were applied on corneal surfaces of 10 healthy volunteer subjects repeatedly at 3 different time points. Corneal wetting properties of the ophthalmic viscosurgical devices were compared qualitatively and quantitatively by anterior segment optical coherence tomography for 30 minutes.. Sodium hyaluronate 3% and HACS applications had a higher mean precorneal ophthalmic viscosurgical device thickness than HPMC application at all time points (seventh minute HPMC: 105.2 ± 25.3 μm, HA: 561.4 ± 115.8 μm, HACS: 481.2 ± 55 μm, P < 0.001). All HPMC applications were terminated by the 12th minute because of insufficient corneal wetting. Mean survival estimate time was significantly shortest for HPMC (11.5 ± 0.5 minutes, P < 0.001) and longest for HA (29.7 ± 0.28 minutes). It was slightly shorter for HACS (26.9 ± 0.87 minutes, P = 0.007) than the HA application.. Sodium hyaluronate 3% and HACS provide superior corneal covering compared with HPMC with an effect that can be maintained up to 30 minutes. They may be an effective option for corneal wetting during long vitreoretinal surgeries with longer duration of effect and fever number of applications.

Topics: Adolescent; Adult; Chondroitin Sulfates; Cornea; Drug Combinations; Female; Humans; Hyaluronic Acid; Hypromellose Derivatives; Male; Middle Aged; Ophthalmic Solutions; Phacoemulsification; Postoperative Complications; Surface Properties; Tomography, Optical Coherence; Viscosupplements; Young Adult

Extensive degloving injuries of the upper extremity are rare and pose unique reconstructive challenges. Circumferential loss of soft tissue coverage over the elbow treated by skin grafting is often complicated by elbow contracture and decreased range of motion, requiring secondary contracture release and free-flap reconstruction to restore function. As an alternative approach, we report a good outcome after the use of a dermal regenerative template and subsequent split-thickness skin grafting. A 38-year-old right hand dominant man presented with circumferential degloving injury of the entire right upper extremity to the level of the chest wall after an industrial accident. An immediate right transradial amputation was performed and serial debridement was required to remove all devitalized tissue. A dermal regenerative template with subsequent split-thickness skin grafting was used to cover the circumferential elbow soft tissue defect. Occupational therapy and splinting were used preoperatively and postoperatively to prevent contracture. However, axillary scar contracture release was required 4 months after injury. Six months after skin grafting, the patient had stable soft tissue coverage of the upper extremity. Shoulder motion measured 120-degree abduction and 140-degree forward flexion and elbow range of motion was 15 to 150 degrees. In this case, an excellent clinical outcome was obtained with a dermal regenerative template, aggressive wound care, and a multidisciplinary team approach.

Topics: Adult; Chondroitin Sulfates; Collagen; Contracture; Degloving Injuries; Humans; Male; Postoperative Complications; Skin Transplantation; Skin, Artificial; Upper Extremity

To present our initial experience using a dermal regeneration sheet as an urethral cover in the repair of recurrent urethrocutaneous fistulae in pediatric patients.. Since May 2016 to March a total of 8 fistulaes were repaired using this new technique. We performed the ddissection of the fistulous tract and posterior closure of the urethral defect. A dermal regeneration sheet was used to cover the urethral suture. Finally a rotational flap was performed to avoid overlap sutures.. During the follow-up (average 6 months), one patient presented in the immediate postoperative period infection of the surgical wound. This patient presented recurrence of the fistula. 88% of the patients included presented a good evolution with no other complications.. In our initial experience the new technique seems easy, safe and effective in the management of the recurrent urethrocutaneous fistulae in pediatric patients. More studies are needed to prove these results.. Describir nuestra experiencia inicial en la reparación de la fístula uretrocutánea recurrente en la población pediátrica, mediante el uso de una lámina de regeneración dérmica como cobertura uretral.. Desde mayo del 2016 hasta marzo del 2017 se repararon 8 fístulas uretrocutáneas mediante esta técnica. Se realizó la disección del trayecto fistuloso, la sección del mismo y el posterior cierre del defecto uretral. Una lámina de regeneración dérmica monocapa se utilizó como cobertura sobre la sutura uretral. Finalmente se realizó un colgajo cutáneo de rotación evitando la superposición de las suturas. Los pacientes fueron seguidos mensualmente en consulta mediante exploración física.. Durante un seguimiento medio de 6 meses (R: 2-10), únicamente 1 paciente (12%), que sufrió una infección de la herida quirúrgica durante el postoperatorio inmediato, sufrió una recidiva de la fístula uretrocutánea. El resto de los pacientes (88%) no desarrollaron ninguna complicación durante su evolución.. En nuestra experiencia inicial, la técnica descrita parece sencilla, segura y eficaz en el manejo de los pacientes con fístulas uretrocutáneas recurrentes. No obstante, estudios a largo plazo son necesarios para corroborar estos resultados.

Topics: Adolescent; Child; Child, Preschool; Chondroitin Sulfates; Collagen; Cutaneous Fistula; Follow-Up Studies; Humans; Hypospadias; Male; Postoperative Complications; Prospective Studies; Recurrence; Surgical Flaps; Surgical Wound Infection; Treatment Outcome; Urethra; Urinary Fistula

INTEGRA. We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann-Whitney (α = 0.05).. No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327-15,571) for the INTEGRA group and €7259 (IQR 1852-24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm. Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors. www.springer.com/00266 .

Topics: Aged; Aged, 80 and over; Chondroitin Sulfates; Cohort Studies; Collagen; Cost-Benefit Analysis; Female; Follow-Up Studies; Free Tissue Flaps; Hospital Costs; Humans; Injury Severity Score; Male; Middle Aged; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Risk Assessment; Scalp; Skin Transplantation; Skull; Treatment Outcome; Wound Healing

Head and neck wounds can present a reconstructive challenge for the plastic surgeon. Whether from skin cancer, trauma, or burns, there are many different treatment modalities used to dress and manage complex head and neck wounds. Vacuum-assisted closure (VAC) therapy has been used on wounds of nearly every aspect of the body but not routinely in the head and neck area. This study was conducted to demonstrate our results using the VAC in the treatment of complex head and neck wounds.. This is an IRB-approved, retrospective review of 69 patients with 73 head and neck wounds that were managed using the VAC between 1999 and 2008. The wound mechanism, location, and size, length of VAC therapy, patient comorbidities, use of radiation, complications, and ultimate outcome were assessed. In this patient population, the VAC was utilized because the standard reconstructive ladder was not a good option or had previously failed.. Sixty-nine patients with complex head and neck wounds were treated with the wound VAC. The mean age of the patients was 66 years, with a range of 5-96 years. Males outnumbered females in this study nearly 2:1. Eighty-six percent of patients had wounds secondary to cancer, 8% secondary to trauma, 3% secondary to infection, and 3% secondary to burns. The VAC was used as a dressing over skin grafts in 50%, over Integra in 21%, and over open debrided wounds in 29%. Wounds healed without complication in 44% of the skin grafts, 67% of Integra-covered wounds, and 71% of debrided wounds. Minor complications included failure of complete graft take, failure of granulation tissue formation in open debrided wounds, infection, and hematoma formation under skin grafts. Major complications included positive cancer margins requiring reexcision and death secondary to pulmonary embolism, sepsis, and metastatic cancer. Most complications resolved with dressing changes, repeat grafting, or the administration of antibiotics.. Our results demonstrate that the wound VAC provides a reliable, effective, and durable dressing for a multitude of complex head and neck wounds. Additionally, it is a valuable tool when traditional surgical procedures are not a viable option.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns; Child; Child, Preschool; Chondroitin Sulfates; Collagen; Craniocerebral Trauma; Debridement; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck Injuries; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Skin Transplantation; Skin, Artificial; Treatment Outcome; Wound Healing; Young Adult

Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening prothrombotic complication following heparin administration. We describe a patient, known with idiopathic dilating cardiomyopathy, presenting nine days after a biventricular ICD implantation with dyspnoea and thrombocytopenia. Thirteen days after administration of a single heparin flush during ICD implantation, the patient developed venous thrombosis in two extremities and pulmonary embolism caused by HIT. HIT is the development of thrombocytopenia, caused by IgG antibodies against complexes of platelet factor 4 and heparin, leading to platelet aggregation. HIT may be accompanied by thrombosis in 20-50% of patients and untreated mortality rates are high. Once HIT is suspected, heparin should be replaced by an alternative anti-factor Xa or anti-factor II therapy. Regardless of the low incidence of HIT, because of the widespread use of heparin and the potentially life-threatening course of HIT, all physicians should be aware of it.

Topics: Antibodies; Anticoagulants; Cardiomyopathy, Dilated; Chondroitin Sulfates; Defibrillators, Implantable; Dermatan Sulfate; Female; Follow-Up Studies; Heparin; Heparitin Sulfate; Humans; Immunoglobulin G; Middle Aged; Platelet Aggregation; Platelet Factor 4; Postoperative Complications; Pulmonary Embolism; Thrombocytopenia; Treatment Outcome; Venous Thromboembolism

Soft tissue deficits associated with exposed tendon and absent paratenon pose difficult reconstructive problems due to tendon adhesions, poor range of motion, poor cosmesis, and donor site morbidity. Integra Bilayer Matrix Wound Dressing (Integra Lifesciences Corp Plainsboro, NJ) is a skin substitute widely used in reconstructive surgery, including the incidental coverage of tendons. However, Integra's post-operative functionality of the tendons has not been well documented. We report the results of using Integra for soft tissue reconstruction overlying tendons with loss of paratenon in upper and lower extremity soft tissue defects.. Forty-two patients (35 men and 7 women) with exposed tendons due to trauma (37), cancer excision (2) or chronic wounds (3) were reconstructed using Integra. Results were compiled in a prospective manner, including age, gender, wound location, wound size, time to final closure, operative time, follow-up length, split-thickness skin graft percentage take and active post-operative range of motion. Likewise using Medline, a literature search of current surgical techniques for the treatment of exposed tendons and the results from the literature were compared with these study results.. All patients healed with an average split-thickness skin graft take rate of 92.5% ± 6.1 (range, 80-100%). The thirty-two patients not lost to follow-up achieved an average range of motion of 91.2% ± 6.5 (range, 80-100%).. Integra offers a convenient, efficient operative procedure with minimal morbidity, demonstrating good cosmesis and tendon function. Thus, Integra may offer an alternative option for immediate tendon coverage in both the upper and lower extremities.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Chondroitin Sulfates; Collagen; Debridement; Electrocoagulation; Female; Humans; Length of Stay; Male; Middle Aged; Neoplasms; Plastic Surgery Procedures; Postoperative Complications; Range of Motion, Articular; Retrospective Studies; Soft Tissue Injuries; Tendons; Treatment Outcome

In 2010 excellent aesthetic results after basal cell carcinoma excision and one-stage coverage with Integra without split thickness skin graft (STSG) were published in a series of 10 Asian patients. Our aim in this study was to verify these results in a series of Caucasian patients and evaluate this procedure as a possible new standard.. 6 patients with facial basal cell carcinoma were treated by regular excision with 3 mm safety margins and one-stage coverage with Integra without STSG, followed by a clinical evaluation and fotodocumentation.. In 3 patients local infection occurred with a complete loss of the Integra. 2 out of these 3 patients showed an unaesthetic scar and are considering another surgical approach for correction. The other 3 patients had an uneventful course, unfortunately 2 out of these patients (67%) developed an unaesthetic scar as well and are also considering surgical correction.. Because of aesthetically unsatisfactory results and high infection rates we abandoned this procedure after 6 patients only. Our standard remains excision with 3 mm safety margins, histological analysis and one-stage repair with local facial flaps.

Topics: Adult; Aged; Carcinoma, Basal Cell; Chondroitin Sulfates; Cicatrix; Collagen; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Microsurgery; Middle Aged; Plastic Surgery Procedures; Postoperative Complications; Skin Neoplasms; Skin Transplantation; Surgical Wound Infection

We present our experience with an experimental urinary bladder auto augmentation model using SURGISIS and INTEGRA (collagen layer) in comparison with seromuscular enterocystoplasty. The aim of the study was to evaluate the change in compliance and elasticity of the urinary bladder.. Eighteen lambs were divided into three different groups. Auto augmentation was performed using the seromuscular layer of small bowel, SURGISIS or the collagen layer of INTEGRA. After 3 months of the initial procedure, the lambs were re-operated, the bladder compliance was measured and the urinary bladder was submitted for histological examination and assessment of elasticity. The lambs were euthanized.. The postoperative period was uneventful in 17 lambs except for intestinal obstruction in one lamb from the seromuscular enterocystoplasty group. A statistically significant difference in compliance was observed with SURGISIS and the INTEGRA. Histologically, there was neovascularization in all the specimens from the SURGISIS and INTEGRA groups with the presence of fibrosis in the SURGISIS group. The INTEGRA group showed better elastic properties than the SURGISIS.. Urinary bladder auto augmentation using the collagen layer of INTEGRA showed better functional and histological results when compared with SURGISIS and demucosalized enterocystoplasty in the present model.

Topics: Absorbable Implants; Animals; Chondroitin Sulfates; Collagen; Elasticity; Female; Intestine, Small; Models, Animal; Omentum; Plastic Surgery Procedures; Postoperative Complications; Sheep; Statistics, Nonparametric; Tissue Extracts; Urinary Bladder

Reduction mammaplasty is a common procedure performed by plastic and reconstructive surgeons to relieve chronic back and neck pain associated with macromastia, with the added benefit of an improvement in the aesthetic contour of the ptotic breast. Complications related to this procedure are fortunately uncommon, but include hematoma, infection, and wound breakdown. The authors report an interesting case of reduction mammaplasty complicated postoperatively by pyoderma gangrenosum (PG), which is a rare inflammatory disorder leading to progressive skin necrosis. The destructive process, which involved both breast incisions, was managed successfully with immunosuppressive therapy and intensive wound care, followed by a novel method of coverage with a dermal regeneration template and subsequent epidermal autograft that led to stable coverage of the open wounds. PG is frequently misdiagnosed as a necrotizing infection, leading to improper debridement with exacerbation of the disease process. The mainstay of therapy for PG is still nonoperative and focuses on immunosuppressive medications and local wound care, which allows healing in most cases. However, there are a few indications for surgical intervention, including significantly large wounds that are refractory to medical management. It is important for plastic surgeons and other clinicians to be cognizant of this entity, as a delay in diagnosis and management of PG can lead to serious consequences, with considerable soft tissue loss and disfigurement of the breast.

Topics: Bandages; Chondroitin Sulfates; Collagen; Debridement; Female; Humans; Immunosuppressive Agents; Mammaplasty; Middle Aged; Pain, Postoperative; Postoperative Complications; Pyoderma Gangrenosum; Skin Transplantation

Itching erythematous or eczematous plaques around injection sites are quite frequent side effects of heparin treatment and are clinical symptoms of a delayed-type hypersensitivity to heparins. In most cases, changing the subcutaneous therapy from unfractionated to low molecular weight heparin or treatment with heparinoids does not provide improvement, due to extensive cross-reactivity. Interestingly, it has been demonstrated that patients with delayed-type hypersensitivity to subcutaneously injected heparins tolerate intravenous application of heparin in controlled challenge tests. A patient with known delayed-type hypersensitivity to heparins received the heparinoid, danaparoid, subcutaneously for thrombosis prophylaxis after orthopedic surgery. After the first few injections, eczematous plaques developed; administration of the anticoagulant was continued and gradually resulted in generalized eczema despite treatment with topical and oral glucocorticoids. However, the patient required further anticoagulation. After discontinuation of subcutaneous injections and a switch to intravenous heparin, rapid improvement and clearing of skin lesions occurred. Therefore, in cases of delayed-type hypersensitivity to subcutaneously injected heparins, the switch from subcutaneous to intravenous heparin administration may be justified.

Topics: Aged; Anticoagulants; Chondroitin Sulfates; Dermatan Sulfate; Dermatitis, Allergic Contact; Eczema; Female; Heparin; Heparitin Sulfate; Humans; Immobilization; Infusions, Intravenous; Injections, Subcutaneous; Postoperative Care; Postoperative Complications; Thrombophilia; Venous Thrombosis

To describe and identify unknown opaque material between the optic of an AR40 intraocular lens (IOL) injected with the Emerald Series implantation system (both AMO, Inc.) and the posterior capsule at the conclusion of routine phacoemulsification to prevent an outbreak of toxic anterior segment syndrome (TASS).. Ambulatory care center operating room, University of North Carolina Hospitals and Department of Ophthalmology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina, USA.. After coaxial phacoemulsification in multiple patients, opaque material was present between the optic of a posterior chamber IOL and the posterior capsule. Although there was no TASS, the material was removed from 2 eyes and analyzed with scanning electron microscopy (SEM) and x-ray microanalysis (XRM). Similarly, crystalline lens, Klenzyme (Steris Corp.), Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%), and Provisc (sodium hyaluronate 1.0%) were analyzed.. On SEM, the material had an irregular undulating surface similar to that of Provisc. Viscoat and the crystalline lens had smoother surfaces. On XRM, the material contained sodium, chlorine, and calcium, like Viscoat and Provisc, and phosphorous and sulfur, like Viscoat. The material also contained silicone, magnesium, aluminum, titanium, iron, and zinc. Klenzyme had smaller peaks of sodium, chlorine, and calcium and a higher carbon background than the unknown material.. The material was likely ophthalmic viscosurgical device that was chemically and structurally altered by the cleaning and sterilization process. The silicone and metallic elements were probably from the Emerald Series implantation system as the disposable cartridge is coated with silicone and the reusable injector is metal.

Topics: Anterior Eye Segment; Chondroitin; Chondroitin Sulfates; Drug Combinations; Electron Probe Microanalysis; Foreign-Body Reaction; Humans; Hyaluronic Acid; Lens Capsule, Crystalline; Lens Implantation, Intraocular; Microscopy, Electron, Scanning; Phacoemulsification; Postoperative Complications; Syndrome; Uveitis, Anterior

Heparin-induced thrombocytopenia (HIT) represents a serious side effect caused by an atypical immune response to platelet factor 4 leading to platelet activation and thrombin formation. These patients are at high risk of thromboembolism, with a rapid drop in platelet count between days 5 and 14 after the initiation of heparin treatment. In single cases, especially after major surgery, platelet count reduction might be absent or hidden by preceding thrombocytosis. Different clinical manifestations of HIT include unspecific skin reactions with potential necrosis at the site of heparin injection, mostly after the application of unfractionated heparin but also with low molecular weight heparin. In heparin-induced skin necrosis, administration of unfractionated or low molecular weight heparin is contraindicated and heparin therapy should be stopped immediately. Instead, an alternative anticoagulant in the form of a direct thrombin inhibitor such as argatroban, and respectively lepirudin, or danaparoid sodium must be administered. Due to frequent misinterpretations of heparin-induced unspecific skin reactions, especially in the absence of thrombocytopenia, we present two case reports which should increase the awareness of HIT's various clinical pictures.

Topics: Adult; Anticoagulants; Arginine; Chondroitin Sulfates; Dermatan Sulfate; Drug Eruptions; Female; Heparin; Heparin, Low-Molecular-Weight; Heparitin Sulfate; Hirudins; Humans; Male; Pipecolic Acids; Platelet Count; Platelet Factor 4; Postoperative Complications; Recombinant Proteins; Sulfonamides; Thrombocytopenia; Thrombosis; Time Factors

Topics: Adult; Anti-Bacterial Agents; Bone Cements; Calcium Phosphates; Chondroitin Sulfates; Femoral Fractures; Femur; Fracture Fixation, Intramedullary; Humans; Hydroxyapatites; Male; Methicillin Resistance; Osteomyelitis; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Succinates; Vancomycin

Type 2 heparin-induced thrombocytopenia is an uncommon but often fatal complication of heparin, frequently difficult to diagnose after cardiac surgery. In this series, we record the clinical presentation, temporal relationship, and treatment outcome of patients diagnosed with heparin-induced thrombocytopenia postoperatively.. Thirty-three consecutive patients (1.1%) with a diagnosis of heparin-induced thrombocytopenia established by a greater than 50% drop in platelet count with or without a thrombotic event and a positive platelet factor-4 assay were reviewed. We recorded the clinical presentation, the time to presentation, treatment, and outcome (thrombosis, mortality). Univariate analysis was performed on 13 preoperative, operative, and postoperative variables.. The cohort was at increased mortality risk as a result of age (69.4 years), reduced cardiac function (46.8%), nonbypass operations (57.6%), emergency surgery (21.2%), and implantation of three assist devices. The mean time to suspect heparin-induced thrombocytopenia postoperatively was 5.4 days, with 22 cases (66.6%) occurring within 5 days. All patients had previous (within 3 months) exposure to heparin, and 66.6% had ongoing treatment with heparin before surgery. Overall mortality was 33%; thrombotic complications occurred in 15 patients (45.5%), with a mortality of 7 (46.6%) despite immediate cessation of heparin and treatment with a nonheparin analog. Thrombocytopenia without thrombosis occurred in 18 patients (54.5%), but a subgroup of 5 patients with nonthrombotic complications accounted for the 4 (22.2%) deaths.. Heparin-induced thrombocytopenia after cardiac surgery is uncommon but may occur within 5 days of surgery, further complicating diagnosis and treatment. Thrombotic complications result in a high mortality despite treatment with a nonheparin analog, and a subgroup of patients with thrombocytopenia fared poorly.

Topics: Aged; Aged, 80 and over; Anticoagulants; Autoantibodies; Cardiac Surgical Procedures; Chondroitin Sulfates; Cohort Studies; Dermatan Sulfate; Diabetes Complications; Female; Gangrene; Heparin; Heparitin Sulfate; Hospital Mortality; Humans; Ischemia; Male; Middle Aged; Platelet Factor 4; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Factors; Thrombocytopenia; Thrombosis; Time Factors; Treatment Outcome

Topics: Anticoagulants; Cardiac Surgical Procedures; Chondroitin Sulfates; Contraindications; Dermatan Sulfate; Heparin; Heparitin Sulfate; Humans; Platelet Count; Platelet Factor 4; Postoperative Complications; Postoperative Period; Serotonin; Thrombocytopenia; Time Factors; Treatment Outcome

We report the case of 64-year-old female patient with pulmonary embolism and bilateral femoropopliteal deep vein thrombosis caused by heparin-induced thrombocytopenia type II (HIT II) resistant to danaparoid sodium and subsequently administered lepirudin in whom a single late plasmapheresis performed on day 6 of the initiation of treatment of HIT reversed the course of the disease, preventing its highly potential fatal outcome. Primarily administered lepirudin was not only ineffective but even led to further aggravation of the patient's clinical state and platelet count drop in the first stage of the HIT treatment. The improvement of the patient's clinical state was not achieved before therapeutic plasma exchange (TPE) had removed the greatest part of pathogenetic circulating substrate. Only after TPE, lepirudin, introduced again, led to the platelet count recovery. In the subsequent course of the treatment, lepirudin was combined with an overlapping oral anticoagulant. Previously positive heparin aggregation test and fast particle gel heparin-platelet factor 4 immunoassay were normalized as well as the patient's clinical status. Early plasmapheresis, administered within 4 days of the onset of thrombocytopenia in HIT, as a beneficial therapeutic measure in certain individual cases, is indisputable. However, our results do not concur with previously reported findings of the so far most comprehensive study on plasmapheresis performed in the management of HIT with thrombosis, discrediting late plasmapheresis administered 4 days after the onset of the disease not only as ineffective, but even as an aggravating factor. Our results suggest the possible beneficial impact of late plasmapheresis as a method that may reverse a prothrombotic process and lead to a fast improvement in the patient's platelet count, especially in cases initially resistant to thrombin inhibitors.

Topics: Arthroplasty, Replacement, Hip; Autoantibodies; Chondroitin Sulfates; Dermatan Sulfate; Drug Resistance; Female; Fibrinolytic Agents; Heparin; Heparitin Sulfate; Hip Fractures; Hirudins; Humans; Middle Aged; Partial Thromboplastin Time; Plasma; Plasmapheresis; Postoperative Complications; Pulmonary Embolism; Purpura, Thrombocytopenic, Idiopathic; Recombinant Proteins; Salvage Therapy; Thrombophilia; Time Factors

Patients with heparin-induced thrombocytopenia urgently requiring surgery with cardiopulmonary bypass (CPB) present a unique management challenge that must be addressed by the use of alternative anticoagulants. Although clinical success with the direct thrombin inhibitor hirudin has been reported, there is sparse information in the literature supporting the efficacy of this drug as an anti-thrombotic to prevent fibrin formation during CPB. In this report, we describe the efficacy of this drug to prevent thrombin-mediated fibrin formation during CPB.

Topics: Adult; Anticoagulants; Cardiopulmonary Bypass; Chondroitin Sulfates; Contraindications; Dermatan Sulfate; Endarterectomy; Fibrinolytic Agents; Fibrinopeptide A; Heparin; Heparitin Sulfate; Hirudins; Humans; Hypertension, Pulmonary; Hypothermia, Induced; Male; Peptide Fragments; Postoperative Complications; Prothrombin; Pulmonary Embolism; Purpura, Thrombocytopenic, Idiopathic; Recombinant Proteins; Thrombectomy; Thrombin; Thrombosis

This prospective study compares the effect of two viscoelastic agents (Viscoat and Provisc) on an early postoperative intraocular pressure after phacoemulsification and intraocular lens implantation. The study compares 36 patients with senile cataract. Intraocular pressure (IOP) was measured by standard Goldmann aplanation tonometry preoperatively as well as on the first postoperative day, after 24 hours and 1 week postoperatively. The mean postoperative IOP at first postoperative day in the Viscoat group was 24.2 mmHg and in the Provisc group was 21.2 mmHg. The increase was significantly higher in the Viscoat group than in the Provisc group but after 24 hours and 1 week postoperatively the mean IOP was not statisticaly different. The two viscoelastic agents cause equivalent pressure elevation postoperatively.

Topics: Chondroitin Sulfates; Drug Combinations; Humans; Hyaluronic Acid; Ocular Hypertension; Phacoemulsification; Postoperative Complications; Prospective Studies; Statistics, Nonparametric

To investigate the natural course of intraocular pressure (IOP) and its peak after small-incision cataract surgery with chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat, Alcon Laboratories, Inc., Fort Worth, TX).. Observational case series.. This prospective study comprised 40 eyes of 40 consecutive cataract patients scheduled for small-incision cataract surgery.. Cataract surgery was performed with sodium chondroitin sulfate 4%-sodium hyaluronate 3% as the ophthalmic viscosurgical device, which was removed as completely as possible from the eye at the end of surgery. The IOP was measured preoperatively and 30 minutes; 1, 2, 3, 4, 6, 8, and 20 to 24 hours; and 1 week postoperatively.. Postoperative IOP increase.. The mean IOP increased significantly at all observation times during the first 20 to 24 hours, with a peak increase of 13.4+/-9.4 mmHg after 1 hour (P<0.05). In all, 28 eyes (70%) had an IOP spike to 30 mmHg or higher. Sixty-eight percent of these spikes occurred at 30 minutes as well as at 1 hour and 2 hours postoperatively. At 20 to 24 hours, no eye had an IOP spike to 30 mmHg or higher.. Significant IOP increases were found during the first 24 hours, peaking at 1 hour after surgery. With a single postoperative IOP measurement, between 30 minutes and 2 hours after surgery, two thirds of these IOP spikes could be detected. To detect all IOP spikes, a second measurement between 4 and 6 hours after surgery would be necessary.

Topics: Aged; Chondroitin; Chondroitin Sulfates; Drug Combinations; Female; Humans; Hyaluronic Acid; Intraocular Pressure; Lens Implantation, Intraocular; Male; Ocular Hypertension; Phacoemulsification; Postoperative Complications; Postoperative Period; Prospective Studies; Time Factors; Tonometry, Ocular

In the past 10 years numerous reports of cases referring to complications and their outcome with heparin-induced thrombocytopenia type II (HIT II) have been published. Clinically these symptoms are manifested as a combination of arterial and venous thromboembolisms. Mostly affected are the vessels of the limbs, the abdomen, kidneys and coronary arteries. We present the most rare initial manifestations of cerebral symptoms with headache, nausea, change of character and generalised convulsion, which have found their origin in sinus vein thrombosis and the treatment with the heparinoid danaparoid.

Topics: Aged; Anticoagulants; Anticonvulsants; Blood Cell Count; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Heparin; Heparitin Sulfate; Humans; Male; Mental Disorders; Postoperative Complications; Seizures; Sinus Thrombosis, Intracranial; Thrombocytopenia; Tomography, X-Ray Computed

To investigate the removal times of ophthalmic viscosurgical devices (OVDs) with different intraocular lens (IOL) designs and materials.. Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA, and Heidelberg IOL & Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.. In a standardized laboratory setup, the Miyake-Apple posterior view video technique was used to evaluate OVD removal from capsular bags in human autopsy eyes implanted with poly(methyl methacrylate) (PMMA), silicone, and acrylic IOLs. The cohesive OVD ProVisc (sodium hyaluronate 1.0%) and the dispersive OVD Viscoat (sodium hyaluronate 3.0% and chondroitin sulfate 4.0%) were stained with fluorescein for better visualization. The open-sky preparation and an Alcon Series 20000 Legacy phaco machine with a flow rate of 25 mL/min and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration) were used. The time needed for complete removal of the cohesive and dispersive OVDs with each IOL type was measured and analyzed statistically.. The mean removal times for both OVDs were as follows: Alcon MZ60BD PMMA IOL-25.0 seconds +/- 3.7 (SD) (Viscoat), 15.9 +/- 6.9 seconds (ProVisc); Alcon AcrySof MA60BM IOL-35.5 +/- 10.0 seconds (Viscoat), 25.6 +/- 4.7 seconds (ProVisc); Chiron/Bausch & Lomb C1043 silicone IOL-46.5 +/- 10.5 seconds (Viscoat), 17.3 +/- 2.1 seconds (ProVisc); AMO SI-30 silicone IOL-33.5 +/- 3.1 seconds (Viscoat), 15.3 +/- 6.3 seconds (ProVisc); and Pharmacia 912 silicone IOL-18.3 +/- 5.8 seconds (Viscoat), 19.8 +/- 4.3 seconds (ProVisc).. Differences in OVD removal times were detected. The removal time for the cohesive OVD correlated with the IOL material. Overall, the time needed for complete removal was significantly longer for the dispersive OVD than for the cohesive OVD.

Topics: Acrylic Resins; Biocompatible Materials; Chondroitin; Chondroitin Sulfates; Drainage; Drug Combinations; Humans; Hyaluronic Acid; Intraoperative Complications; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Polymethyl Methacrylate; Postoperative Complications; Silicone Elastomers; Time Factors

Thrombosis prophylaxis using heparins is mandatory in most trauma patients. However, heparins can induce heparin-induced thrombocytopenia (HIT), the most common and clinically important immune-mediated drug-dependent thrombocytopenia. Affected patients are at risk of developing new thromboembolic complications. HIT has to be considered if platelet counts decrease >50% between day 5-10 of heparin therapy that cannot be explained alternatively or if new thromboses occur in a sufficiently heparinised patient. Immediately changing the anticoagulant to danaparoid or lepirudin is most important. Proof of anti-platelet-factor-4/heparin antibodies secures the diagnosis, usually retrospectively. Diagnosis and therapy are demonstrated in a typical HIT patient. HIT usually occurs in the second week of heparin administration. Heparin-reexposure within 100 days can lead to HIT before day 5. For early recognition of HIT, platelet counts should be monitored regularly. Because of earlier discharge of patients to rehabilitation or outpatient care, the problem of HIT-diagnosis and therapy gains increasing relevance in these sectors.

Topics: Adult; Anticoagulants; Autoantibodies; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Fractures, Bone; Heparin; Heparitin Sulfate; Hirudins; Humans; Male; Multiple Trauma; Platelet Count; Platelet Factor 4; Postoperative Complications; Recombinant Proteins; Thrombocytopenia; Thromboembolism

The goal of this study was to determine the efficacy of a single intraperitoneal administration of a chondroitin sulfate solution in preventing postoperative adhesion formation. METHODS. Twenty-five Sprague-Dawley rats had a 1-cm(2) area of cecal serosa abraded. Controls (CON, n = 5) received no treatment, the chondroitin sulfate group (CS, n = 10) received chondroitin sulfate (0.013 g/kg) in 0.9% NaCl intraperitoneally (ip), and vehicle controls (VC, n = 10) received an equal volume of 0.9% NaCl solution ip before the abdomen was closed. All animals were sacrificed on postoperative day 10. The extent of adhesion was quantified according to Mazuji's adhesion grade (0 to 4: 0 = no adhesion and 4 = very dense adhesion) and quantitated after H&E, trichome, and immunohistochemical staining for fibrin and collagen type I and type III using digital image analysis.. The mean Mazuji's adhesion grade in the CON was 4.0 +/- 0.0, in the VC 2.60 +/- 0.37, and in the CS 1.3 +/- 0.42 (P < 0.01 for CS vs CON and P < 0.05 for CS vs VC comparisons). The mean gray-scale intensity (0-255: 0 = dense amount and 255 = none) of adhesion density in the CON was 105. 5 +/- 5.5, in the VC 125 +/- 15.0, and in the CS 178.3 +/- 21.0 (P < 0.01 for CS vs CON and P < 0.05 for CS vs VC comparisons). The mean adjusted intensity stain indices (AISI) for fibrin and collagen type I in the CON were 59 +/- 17 and 53 +/- 19, in the VC 27 +/- 3 and 25 +/- 7, and in the CS 16 +/- 5 and 6 +/- 3, respectively (P < 0.05 between CS and CON comparisons). The AISI of collagen type III was not significant among all the groups (P > 0.1).. The extent of early postoperative intra-abdominal adhesion formation as determined by gross assessment and from quantitation of fibrin and collagen type I deposition was significantly reduced by a single intraperitoneal administration of a chondroitin sulfate solution.

Topics: Animals; Chondroitin Sulfates; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Sprague-Dawley; Solutions; Tissue Adhesions

To report the pathological and ultrastructural features and interval surgical management of an atypical case of opacification between piggyback intraocular lenses (IOLs).. Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, and Nature Coast EyeCare Institute and Surgery Center, Perry, Florida, USA.. Opacification between 2 acrylic piggyback lenses was observed 16 months after implantation, with decreased best corrected visual acuity and a hyperopic shift. Elschnig pearls were observed in the peripheral interface between the lenses, and the central interface was occupied by an amorphous material. The pearls were surgically aspirated, but attempts to remove the central material were unsuccessful. The lenses were explanted and sent to the laboratory. Staining with hematoxylin and eosin (H&E), examination under a light microscope, and scanning electron microscopic analysis were performed.. The surfaces of the anterior IOL were relatively clear. The amorphous material, mostly attached to the center of the anterior surface of the posterior IOL, was homogeneously stained with H&E. No cell nucleus was observed in this region. Scanning electron microscopy showed that the IOL edge presented a smooth, regular surface relatively free of deposits. The most central region was covered by an irregular layer of an amorphous compact material with some cracks, fissures, or both on its surface.. Although the exact composition of the material between the lenses could not be established, hypotheses were advanced to understand the pathological mechanism associated with this condition. This case is different from those in previous reports of opacification composed of cortex and cells between piggyback IOLs.

Topics: Acrylates; Adhesiveness; Biocompatible Materials; Chondroitin; Chondroitin Sulfates; Device Removal; Drug Combinations; Female; Humans; Hyaluronic Acid; Lenses, Intraocular; Microscopy, Electron, Scanning; Middle Aged; Postoperative Complications; Prosthesis Failure; Reoperation

Heparin-induced thrombocytopenia (HIT) has become more prevalent in today's cardiac setting and has resulted in the need for alternative anticoagulant therapies. Danaparoid sodium, one alternative to heparin, has been used in six cardiopulmonary bypass procedures in this hospital. This clinical experience has resulted in the progressive refinement of a protocol for the 'safe' clinical use of danaparoid sodium. Although there were six positive outcomes with the use of danaparoid sodium, alternatives must be explored in order to find the optimal anticoagulant for the treatment of HIT.

Topics: Adult; Aged; Anticoagulants; Cardiopulmonary Bypass; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Female; Hemorrhage; Heparin; Heparitin Sulfate; Humans; Male; Middle Aged; Postoperative Complications; Thrombocytopenia

Osteoarthritis (OA) influences the levels of free intraarticular glucosaminoglycans (GAG). Little is known about the direction--decrease/increase--of these changes, and information on the correlation between GAG levels and the degree of OA is sparse. Objectives of this study were to investigate the correlation between intraarticular levels of sulphated and unsulphated GAG and the degree of experimental OA, the time course of these changes and whether GAG might be useful as a marker for OA. Twenty-one sheep were randomly assigned to three groups: (1) transsection of the posterolateral bundle of the anterior cruciate ligament, ACL (TD), (2) medial meniscectomy (ME), and (3) meniscectomy and resection of the ACL (MV). During follow-up clinical and radiological examinations were done. After screening for intraarticular effusions, a joint tab was performed and the levels of hyaluronic acid and chondroitin sulphate were measured. The radiological scores differ significantly between group TD and groups ME and MV (P < 0.01). Hyaluronic acid levels in ME and MV are significantly higher than in the controls. Significantly increased levels (P < 0.01) of chondroitin sulphate are found 6 months after ME and 1 year following TD. Clinical consequences: Hyaluronic acid levels--at least in the experimental setting--correspond to a certain degree with osteoarthrotic changes: increasing levels were found along with increasing postoperative interval and increasing grade of OA. Chondroitin sulphate, on the other hand seems, to lend itself as a marker for chondromalacia, in other words for prearthrotic deformities and early stages of OA.

Topics: Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomarkers; Chondroitin Sulfates; Female; Glycosaminoglycans; Hyaluronic Acid; Knee Injuries; Knee Joint; Menisci, Tibial; Osteoarthritis; Postoperative Complications; Sensitivity and Specificity; Sheep; Tibial Meniscus Injuries

Heparin-induced thrombocytopenia type II (HIT-II) is a serious complication in heparin treatment. Because of arterial and/or venous thromboembolism, HIT-II quite often takes a life-threatening course. This article describes the clinical course of seven trauma patients, who developed HIT-II during thromboembolism prophylaxis with unfractionated heparin (UFH, Heparin-Natrium-Nattermann, 250,000 I.E., Rhone-Poulenc Rorer GmbH), given subcutaneously. Thromboembolic complications occurred in 5 out of 7 cases (71.4%). One case took a fatal course (14.3%). UFH was replaced by Orgaran when HIT-II was suspected or diagnosed. There were no more complications. Thrombocyte count increased to normal values within 3 to 9 days. The importance of HIT-II in heparin therapy during in- and outpatient therapy is discussed with reference to the current literature.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Chondroitin Sulfates; Dermatan Sulfate; Female; Femoral Neck Fractures; Heparin; Heparitin Sulfate; Hip Fractures; Humans; Male; Middle Aged; Multiple Trauma; Osteoarthritis, Hip; Platelet Count; Postoperative Complications; Thrombocytopenia; Thromboembolism

The records of 39 patients undergoing 40 consecutive penetrating keratoplasties were reviewed to identify donor factors that might correlate with the presence of an epithelial defect on the first postoperative day. Of the 40 transplanted corneas, 13 (32.5%) had no epithelial defect, 18 (45%) had some epithelial defect, and nine (22.5%) had a total epithelial defect 1 day postoperatively. The status of the epithelium was correlated with several donor factors. The only factor that had a statistically significant association with the degree of epithelial defect was the time interval from preservation to surgery (p = .001). Based on a logistic regression model, the probability of having an epithelial defect 1 day after penetrating keratoplasty increased with respect to longer storage times. These results may aid the surgeon in the selection of donor tissue, particularly when performing penetrating keratoplasty on patients with ocular surface disorders.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chondroitin Sulfates; Complex Mixtures; Cornea; Corneal Diseases; Culture Media, Serum-Free; Dextrans; Epithelium; Female; Gentamicins; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Organ Preservation; Postoperative Complications; Risk Factors; Time Factors; Tissue Donors

To evaluate the usefulness of four viscoelastic agents during phacoemulsification: 2% hydroxypropylmethylcellulose (HPMC) (Methocel), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat), 1% sodium hyaluronate (Healon), 1.4% sodium hyaluronate (Healon GV).. Eye Clinic, Kreiskrankenhaus Bad Hersfeld, Germany.. Two hundred patients, divided into four groups of 50 patients, received one of the viscoelastic substances during phacoemulsification and posterior chamber intraocular lens implantation. Patients were followed for 1 month. Visual acuity and intraocular pressure (IOP) were measured. The following were subjectively evaluated for each viscoelastic: corneal findings, anterior chamber reaction, visibility of intraocular structures and retention time during phacoemulsification, space maintaining ability, and removability and ease of injection.. Postoperative IOP and visual acuity were comparable among the four groups. Viscoat tended to trap nuclear fragments and air bubbles during the phacoemulsification procedure, which decreased visibility during surgery. Space maintenance and injection ease were significantly better with Healon and Healon GV.. The high molecular weight viscoelastics (Healon and Healon GV) performed better as viscosurgical tool during cataract surgery using phacoemulsification.

Topics: Chondroitin Sulfates; Follow-Up Studies; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Phacoemulsification; Postoperative Complications; Visual Acuity

The 29-year-old, heroin-addicted patient received an aortic valve prosthesis (SJM) 10 years ago because of aortic valve stenosis III. One year after surgical treatment he refused to take Phenprocoumon and thus received no anticoagulation for 9 years. The patient was hospitalized due to cardial decompensation and thrombosis of the aortic valve prosthesis was diagnosed. Under heparinization, he developed heparin-induced thrombocytopenia type II, which disappeared after changing the medication to Danaparoid-Sodium. In order to avoid any further heparin exposure, we also carried out the surgical replacement of the aortic valve prosthesis under anticoagulation with Danaparoid-Sodium.

Topics: Adult; Aortic Valve Stenosis; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Heart Valve Prosthesis; Heparin; Heparitin Sulfate; Heroin Dependence; Humans; Male; Platelet Count; Postoperative Complications; Prosthesis Failure; Reoperation; Thrombocytopenia; Thrombosis

Topics: Cataract Extraction; Chondroitin; Chondroitin Sulfates; Drug Combinations; Humans; Hyaluronic Acid; Intraocular Pressure; Ocular Hypertension; Postoperative Complications

The endothelial cell count and several morphologic characteristics of the cells were examined before and after surgery in 56 consecutive patients (60 eyes) who underwent phacoemulsification and implantation of a posterior chamber intraocular lens with either Healon (30 eyes) or Viscoat (30 eyes) as the viscoelastic material. In all cases the technique was the same, including removal of the viscoelastic from the anterior chamber at the end of the operation. The mean cell loss was greater in the Viscoat group than in the Healon group (9.27% +/- 2.52% vs. 2.71% +/- 2.53%), but not significantly so. There was a significantly greater reduction in polymegathism in the Healon group than in the Viscoat group (p less than 0.05). Although the results suggest that Healon has a greater protective effect on the corneal endothelium than Viscoat, the greater effort needed to remove Viscoat from the anterior chamber may have adversely affected the endothelium. Further studies in which Viscoat is left in the eye are warranted.

Topics: Aged; Cataract Extraction; Cell Count; Chondroitin; Chondroitin Sulfates; Drug Combinations; Endothelium, Corneal; Female; Humans; Hyaluronic Acid; Lenses, Intraocular; Male; Postoperative Complications

This retrospective study of 549 corneo-scleral rim cultures shows that gentamicin, used in MK and K-Sol medium storage at 4 degrees C, has decreased donor contamination from 43% in whole-globe storage to 13%, but failed to eliminate coagulase negative staphylococci (37%), streptococci (28%) and fungi (28%). Donor-to-host transmitted staphylococcal and streptococcal endophthalmitis have been reported previously. We present the first documented case of donor-to-recipient transmitted fungal endophthalmitis following corneal transplantation using corneas stored in MK or K-Sol solution at 4 degrees C; Candida albicans was isolated. Recommendations are made to assess critically the true incidence of donor fungal contamination and the necessity of adding anti-mycotic agents to preservation medium for 4 degrees C storage. In the absence of ideal antimicrobial cover for corneal preservation solutions, stringent prophylactic measures to reduce contamination and continued monitoring of corneo-scleral rim cultures are warranted, if the poor visual consequences of donor-to-host transmitted endophthalmitis are to be avoided.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Candidiasis; Child; Child, Preschool; Chondroitin Sulfates; Corneal Transplantation; Endophthalmitis; Gentamicins; HEPES; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mycoses; Organ Preservation; Postoperative Complications; Retrospective Studies; Staphylococcal Infections; Streptococcal Infections

A study was designed to test chondroitin sulphate and other high-molecular-weight solutions, using the rabbit uterus as the surgical model, in the prevention of postoperative adhesions. Eighty-five mature white female New Zealand rabbits underwent surgical injury of each uterine horn, with surgical repair of the left horn only in all animals using 9-0 nylon. The rabbits were randomly divided into five groups: groups A, B and C received 25 mL of chondroitin sulphate, sodium carboxymethylcellulose or 32% dextran 70, respectively. The remaining two groups received either 50 mL of normal saline (D) or no solution (E). Postoperatively the animals were killed, and the adhesions were carefully scored. The results clearly demonstrated the superiority of chondroitin sulphate as an intraperitoneal treatment for the prevention of postoperative adhesions (P less than .001 vs. carboxymethyl cellulose, dextran, saline and control).

Topics: Animals; Carboxymethylcellulose Sodium; Chondroitin; Chondroitin Sulfates; Dextrans; Female; Injections, Intraperitoneal; Methylcellulose; Peritoneum; Postoperative Complications; Rabbits; Tissue Adhesions; Uterine Diseases

Topics: Chondroitin; Chondroitin Sulfates; Drug Combinations; Humans; Hyaluronic Acid; Intraocular Pressure; Postoperative Complications

Postoperative hemorrhage remains a serious complication in cardiopulmonary bypass (CPB) surgery. In our study, alternative anticoagulation with a new low molecular weight (LMW) heparinoid (Org 10172) was compared with a standardized heparin regimen. A preliminary dose-finding study indicated the minimal effective heparinoid dose to be 260 anti-Xa U/kg body weight, which was comparable to the standardized heparin regime, as revealed by similar plasma anti-Xa values. The following randomized open pilot study in 12 mongrel dogs undergoing CPB showed the heparinoid to be as effective as heparin, with an additional advantageous decrease in postoperative blood loss in the Org 10172 group. Our randomized blind study in 16 mongrel dogs undergoing CPB was performed to confirm previous results. Both antithrombotic agents were effective in the prevention of clot formation within the extracorporeal circuit. Hematocrit values and erythrocyte and platelet counts showed no significant intergroup differences. Post-CPB leukocyte counts revealed a significantly more rapid increase in the group given heparinoid (P less than 0.05). In the group given heparin, the expected prolongations of both the thrombin time (TT) and activated partial thromboplastin time (APTT) were noted, whereas in the group given heparinoid, only a transient peak prolongation of the TT after dose administration was revealed, and no significant prolongation of the APTT. Mean anti-Xa plasma levels were similar during CPB, showing a rapid decrease in the group given heparin on protamine administration, as did the APTT. Assessment of the operating field indicated an elevated intraoperative blood loss in the group given heparin. Postoperative blood loss measured over a period of 2.5 hours after closure of the thorax was significantly lower in the group given heparinoid than in the heparinized animals (625 +/- 100.0 ml, mean +/- SD, and 806 +/- 178.2 ml, respectively; P less than 0.05). Our observations suggest that the LMW heparinoid Org 10172 has an increased benefit/risk ratio over standard heparin and is effective in CPB in dogs. Additional investigations in humans should verify the possibility of use of this substance as an alternative means of anticoagulation during CPB in patients in whom heparin is relatively contraindicated.

Topics: Animals; Antithrombins; Blood Coagulation Tests; Blood Volume; Cardiopulmonary Bypass; Chondroitin Sulfates; Dermatan Sulfate; Dogs; Drug Evaluation, Preclinical; Fibrinolytic Agents; Glycosaminoglycans; Hematocrit; Hemorrhage; Heparin; Heparitin Sulfate; Leukocyte Count; Molecular Weight; Platelet Count; Postoperative Complications; Random Allocation

A bilayer artificial skin composed of a temporary Silastic epidermis and a porous collagen-chondroitn 6-sulfate fibrillar dermis, which is not removed, has been used to physiologically close up to 60% of the body surface following prompt excision of burn wounds in ten patients whose total burn size covered 50--95% body surface area (BSA). Following grafting, the dermal portion is populated with fibroblasts and vessels from the wound bed. The anatomic structure of the artificial dermis resembles normal dermis and serves as a template for the synthesis of new connective tissue and the formation of a "neodermis," while it is slowly biodegraded. This artificial skin has physiologically closed excised burn wounds for periods of time up to 46 days before the Silastic epidermis was removed. At the time of election when donor sites are ready for reharvesting, the Silastic epidermis is removed from the vascularized artificial dermis and replaced with 0.004 autoepidermal graft in sheet or meshed form. Clinical and histologic experience in a relatively short follow-up period (2--16 months) indicates that "neodermis" retains some of the anatomic characteristics and behavior of normal dermis, thus promising improvement in the functional and cosmetic results, as well as providing physiologic function as a skin substitute. The artificial skin is easily sterilized and stored at room temperature, capable of large scale production, and immediately available for grafting, indicating its potential for easy and relatively economic use in the burn patient.

Topics: Adolescent; Adult; Artificial Organs; Burns; Child; Child, Preschool; Chondroitin Sulfates; Collagen; Humans; Middle Aged; Postoperative Complications; Silicone Elastomers; Skin; Wound Healing

Pretreatment of the lung graft with concanavalin A (Con A) or chondroitin sulfate (CIS) was used to modify the lung allograft response after transplantation into moderately immunosuppressed (low doses of azathioprine and prednisone) recipients. Significant (p less than 0.05) prolongation of survival was observed after graft pretreatment. Pneumonia and rejection were the most frequent causes of death for all groups of dogs. However, only 3 out of 6 animals from each of the groups with pretreated grafts died of pneumonia or rejection, whereas 5 of the 6 animals in the control group died of these causes. Furthermore, when rejection occurred in the dogs with lung grafts pretreated with Con A or CIS, it was considerably delayed compared with the controls. Partial pressure of arterial oxygen, chest roentgenograms, and lung histology were good indicators of lung viability after transplantation.

Topics: Animals; Chondroitin; Chondroitin Sulfates; Concanavalin A; Dogs; Female; Graft Rejection; Lung; Lung Transplantation; Male; Pneumonia; Postoperative Complications; Radiography; Transplantation, Homologous