fibrin and Postoperative-Complications

Pelvic adhesions can form secondary to inflammation, endometriosis, or surgical trauma. Strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene, and fibrin or collagen sheets between pelvic structures.. To evaluate the effects of barrier agents used during pelvic surgery on rates of pain, live birth, and postoperative adhesions in women of reproductive age.. We searched the following databases in August 2019: the Cochrane Gynaecology and Fertility (CGF) Specialised Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, and trial registries. We searched reference lists of relevant papers, conference proceedings, and grey literature sources. We contacted pharmaceutical companies for information and handsearched relevant journals and conference abstracts.. Randomised controlled trials (RCTs) on the use of barrier agents compared with other barrier agents, placebo, or no treatment for prevention of adhesions in women undergoing gynaecological surgery.. Three review authors independently assessed trials for eligibility and risk of bias and extracted data. We calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) using a fixed-effect model. We assessed the overall quality of the evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.. We included 19 RCTs (1316 women). Seven RCTs randomised women; the remainder randomised pelvic organs. Laparoscopy (eight RCTs) and laparotomy (11 RCTs) were the primary surgical techniques. Indications for surgery included myomectomy (seven RCTs), ovarian surgery (five RCTs), pelvic adhesions (five RCTs), endometriosis (one RCT), and mixed gynaecological surgery (one RCT). The sole indication for surgery in three of the RCTs was infertility. Thirteen RCTs reported commercial funding; the rest did not state their source of funding. No studies reported our primary outcomes of pelvic pain and live birth rate. Oxidised regenerated cellulose versus no treatment at laparoscopy or laparotomy (13 RCTs) At second-look laparoscopy, we are uncertain whether oxidised regenerated cellulose at laparoscopy reduced the incidence of de novo adhesions (OR 0.50, 95% CI 0.30 to 0.83, 3 RCTs, 360 participants; I² = 75%; very low-quality evidence) or of re-formed adhesions (OR 0.17, 95% CI 0.07 to 0.41, 3 RCTs, 100 participants; I² = 36%; very low-quality evidence). At second-look laparoscopy, we are uncertain whether oxidised regenerated cellulose affected the incidence of de novo adhesions after laparotomy (OR 0.72, 95% CI 0.42 to 1.25, 1 RCT, 271 participants; very low-quality evidence). However, the incidence of re-formed adhesions may have been reduced in the intervention group (OR 0.38, 95% CI 0.27 to 0.55, 6 RCTs, 554 participants; I² = 41%; low-quality evidence). No studies reported results on pelvic pain, live birth rate, adhesion score, or clinical pregnancy rate. Expanded polytetrafluoroethylene versus oxidised regenerated cellulose at gynaecological surgery (two RCTs) We are uncertain whether expanded polytetrafluoroethylene reduced the incidence of de novo adhesions at second-look laparoscopy (OR 0.93, 95% CI 0.26 to 3.41, 38 participants; very low-quality evidence). We are also uncertain whether expanded polytetrafluoroethylene resulted in a lower adhesion score (out of 11) (MD -3.79, 95% CI -5.12 to -2.46, 62 participants; very low-quality evidence) or a lower risk of re-formed adhesions (OR 0.13, 95% CI 0.02 to 0.80, 23 participants; very low-quality evidence) when compared with oxidised regenerated cellulose. No studies reported results regarding pelvic pain, live birth rate, or clinical pregnancy rate. Collagen membrane with polyethylene glycol and glycerol versus no treatment at gynaecological surgery (one RCT) Evidence suggests that collagen membrane with. We found no evidence on the effects of barrier agents used during pelvic surgery on pelvic pain or live birth rate in women of reproductive age because no trial reported these outcomes. It is difficult to draw credible conclusions due to lack of evidence and the low quality of included studies. Given this caveat, low-quality evidence suggests that collagen membrane with polyethylene glycol plus glycerol may be more effective than no treatment in reducing the incidence of adhesion formation following pelvic surgery. Low-quality evidence also shows that oxidised regenerated cellulose may reduce the incidence of re-formation of adhesions when compared with no treatment at laparotomy. It is not possible to draw conclusions on the relative effectiveness of these interventions due to lack of evidence. No adverse events directly attributed to the adhesion agents were reported. The quality of the evidence ranged from very low to moderate. Common limitations were imprecision and poor reporting of study methods. Most studies were commercially funded, and publication bias could not be ruled out.

Topics: Cellulose, Oxidized; Cervix Uteri; Collagen; Female; Fibrin; Glycerol; Humans; Hyaluronic Acid; Incidence; Infertility, Female; Laparoscopy; Laparotomy; Membranes, Artificial; Pain, Postoperative; Pelvis; Polyethylene Glycols; Polytetrafluoroethylene; Postoperative Complications; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Second-Look Surgery; Tissue Adhesions; Viscosupplements

Pelvic adhesions can form as a result of inflammation, endometriosis or surgical trauma. During pelvic surgery, strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene or fibrin sheets between the pelvic structures.. To evaluate the effects of barrier agents used during pelvic surgery on rates of pain, live birth and postoperative adhesions in women of reproductive age.. We searched the following databases in February 2015: the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL) and trial registries. We handsearched relevant journals, conference proceedings and grey literature sources and we contacted pharmaceutical companies for information.. Randomised controlled trials (RCTs) of the use of barrier agents compared with other barrier agents, placebo or no treatment for the prevention of adhesions in women undergoing gynaecological surgery.. Two review authors independently assessed trials for eligibility and risk of bias and extracted the data. We calculated odds ratios (ORs) or mean differences (MD) with 95% confidence intervals (CIs) using a fixed effect model. The overall quality of the evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.. Eighteen RCTs (1262 women) were included. Six RCTs randomised women; the remainder randomised pelvic organs. Laparoscopy (eight RCTs) and laparotomy (10 RCTs) were the primary surgical techniques. Indications for surgery included myomectomy (six RCTs), ovarian surgery (five RCTs), pelvic adhesions (five RCTs), endometriosis (one RCT) and mixed (one RCT). The sole indication for surgery in three of the RCTs was infertility. Twelve RCTs reported commercial funding; the rest did not state their source of funding.No studies reported either of our primary outcomes of pelvic pain and live birth. Oxidised regenerated cellulose (Interceed) versus no treatment at laparoscopy or laparotomy (13 RCTs)At second-look laparoscopy oxidised regenerated cellulose at laparoscopy was associated with reduced incidence of de novo adhesions (OR 0.50, 95% CI 0.30 to 0.83, three RCTs, 360 participants, I(2) = 75%, very low-quality evidence) and of re-formed adhesions (OR 0.17, 95% CI 0.07 to 0.41, three RCTs, 100 participants, I(2) = 36%, low quality evidence).At second-look laparoscopy no evidence was found of any difference between the groups in the incidence of de novo adhesions after laparotomy (OR 0.72, 95% CI 0.42 to 1.25, one RCT, 271 participants, I(2) = 41%, low-quality evidence). However, the incidence of re-formed adhesions was lower in the intervention group (OR 0.38, 95% CI 0.27 to 0.55, six RCTs, 554 participants, moderate-quality evidence). Expanded polytetrafluoroethylene (Gore-Tex) versus no treatment at gynaecological surgery (one RCT) The evidence suggested that at second-look laparoscopy expanded polytetrafluoroethylene was associated with a reduction in new adhesion formation (OR 0.17, 95% CI 0.03 to 0.94, one RCT, 42 participants, low-quality evidence). Expanded polytetrafluoroethylene (Gore-Tex) versus oxidised regenerated cellulose (Interceed) at gynaecological surgery (two RCTs)One RCT found no difference between the groups at second-look laparoscopy in the incidence of de novo adhesions (OR 0.93, 95% CI 0.26 to 3.41, 38 participants, very low-quality evidence). A second RCT suggested that the expanded polytetrafluoroethylene group had a lower adhesion score (out of 11) (MD -3.79, 95% CI -5.12 to -2.46, 62 participants, very low-quality evidence) and a lower risk of re-formed adhesions (OR 0.13, 95% CI 0.02 to 0.80, 23 participants, very low-quality evidence). This last finding was sensitive to choice of effect estimate and no longer suggested a differenc. We found no evidence on the effects of barrier agents used during pelvic surgery on either pain or fertility outcomes in women of reproductive age.Low quality evidence suggests that oxidised regenerated cellulose (Interceed), expanded polytetrafluoroethylene (Gore-Tex) and sodium hyaluronate with carboxymethylcellulose (Seprafilm) may all be more effective than no treatment in reducing the incidence of adhesion formation following pelvic surgery. There is no conclusive evidence on the relative effectiveness of these interventions. There is no evidence to suggest that fibrin sheet is more effective than no treatment. No adverse events directly attributed to the adhesion agents were reported. The quality of the evidence ranged from very low to moderate. The most common limitations were imprecision and poor reporting of study methods. Most studies were commercially funded, and publication bias could not be ruled out.

Topics: Cellulose, Oxidized; Cervix Uteri; Female; Fibrin; Humans; Hyaluronic Acid; Infertility, Female; Pain, Postoperative; Pelvis; Polytetrafluoroethylene; Postoperative Complications; Randomized Controlled Trials as Topic; Second-Look Surgery; Tissue Adhesions; Viscosupplements

Numerous studies have demonstrated that platelet-rich preparations applied to surgical sites, injuries, or wounds are a safe and effective way to promote soft tissue healing and bone growth. Various protocols have been developed for preparing platelet-rich preparations, with subtle but important differences between them. Unfortunately, only a minority of clinicians use platelet-rich preparations, such as platelet-rich plasma and platelet-rich fibrin, in their practice, possibly due to confusion about the different methods and their advantages and disadvantages. Therefore, the different types of preparations are described to help guide the selection of the best method for any size practice. Classic methods generally require large volumes of blood and can be expensive, complicated, and time-intensive. Simpler protocols have been developed recently, which require relatively inexpensive equipment and small blood volumes and, thus, may be more applicable for small clinical practices. Platelet-rich preparations accelerate healing at earlier time points to reduce discomfort and the potential for adverse outcomes, including infection, poor wound closure, and delays in forming strong bone for subsequent procedures (such as implants). However, platelet-rich preparations may also improve long-term outcomes in patients expected to have impaired healing, such as with lifestyle choices (eg, smoking), medications (eg, steroids), diseases (eg, diabetes, osteoporosis, atherosclerosis), and aging, by supplementing the deficient wound environment to restore proper healing. Therefore, both large and small clinical practices would benefit from utilizing platelet-rich preparations to enhance healing in their patients.

Topics: Blood Platelets; Fibrin; Humans; Intercellular Signaling Peptides and Proteins; Platelet-Rich Plasma; Plateletpheresis; Postoperative Complications; Wound Healing

Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that may cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. An increasing number of adhesion reduction agents, in the form of site-specific and broad-coverage barriers and solutions, are becoming available to surgical teams. The most widely studied strategies include placing synthetic barrier agents between the pelvic structures. Most of the adhesions in the barrier-treated patients develop in uncovered areas in the abdomen. This fact suggests that the application of liquid or gel anti-adhesive agents to cover all potential peritoneal lesions, together with the use of barrier agents, may reduce the formation of postoperative adhesions. This article introduces the topical choices available for adhesion prevention mentioned in preliminary clinical applications and animal models. To date there is no substantial evidence that their use reduces the incidence of postoperative adhesions. In combination with good surgical techniques, these non-barrier agents may play an important role in adhesion reduction.

Topics: Acetamides; Antioxidants; Collagen Type I; Female; Fibrin; Glucans; Glucose; Honey; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Icodextrin; Inflammation; Linezolid; Melatonin; Oxazolidinones; Pain, Postoperative; Pelvic Pain; Pelvis; Peritoneal Diseases; Phosphatidylcholines; Postoperative Complications; Tissue Adhesions; Treatment Outcome

The peritoneum is a serous membrane, which has a protective function for the contents of the abdominal cavity. It maintains homeostasis by allowing exchange of molecules and production of peritoneal fluid, thus providing an environment in which intra-abdominal organs can function properly. When traumatized, whether by surgery or due to inflammatory processes, a series of responses come into action to regenerate the injured part of the peritoneum. The inflammatory reaction causes influx of inflammatory cells but also activates resident mesothelial cells, ultimately leading to a fibrinous exudate. Depending on the severity of the trauma this exudate is transient due to fibrinolysis, or becomes more dense as a result of fibroblasts persisting, leading to fibrinous adhesions. A pivotal role is taken by the enzyme plasmin and its promotors and inhibitors; it is mainly the tissue-type plasminogen activator/plasminogen activator inhibitor ratio which determines the rate of fibrinolysis and therefore the rate of adhesion formation. The rate of injury determines the rate and extent of the inflammatory response to that injury; in its turn the inflammatory reaction determines the extent of adhesion formation. One should realize this when performing intra-abdominal surgery, which is in fact operating inside the peritoneal organ.

Topics: Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Homeostasis; Humans; Inflammation; Ischemia; Peritoneum; Postoperative Complications; Tissue Adhesions; Tissue Plasminogen Activator

Peritoneum is a serous membrane with a significant fibrinolytic potential, playing an important role in the abdominal response to trauma. Peritoneum takes part in the formation and degradation of postoperative adhesions. The sequence of changes during the adhesion formation is indispensable in the healing of peritoneal trauma. Presented paper describes the short historical update of mesothelial research and review of contemporary knowledge over the peritoneal function with special regard to its fibrinolytic activity. The factors influencing the fibrinolytic capacity of peritoneum were discussed, as well as present pathways of research on the prevention of postoperative adhesion formation.

Topics: Animals; Ascitic Fluid; Epithelium; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Humans; Peritoneum; Plasminogen Activator Inhibitor 1; Postoperative Complications; Rats; Tissue Adhesions; Tissue Plasminogen Activator; Wound Healing

Intra-abdominal adhesion formation is a major complication of serosal repair following surgery, ischaemia or infection, leading to conditions such as intestinal obstruction and infertility. It has been proposed that the persistence of fibrin, due to impaired plasminogen activator activity, results in the formation of adhesions between damaged serosal surfaces. This study aimed to assess the role of fibrinolysis in adhesion formation using mice deficient in either of the plasminogen activator proteases, tissue-type plasminogen activator (tPA) or urokinase-type plasminogen activator (uPA). We hypothesize that, following serosal injury, mice with decreased peritoneal fibrinolytic activity will be more susceptible to adhesion formation. Adhesion formation was induced in tPA- and uPA-deficient and wild-type mice following either surgical trauma to the serosa with haemorrhage and acute or chronic intraperitoneal inflammation. Adhesion formation was assessed from 1 to 4 weeks post-injury. Mice deficient in tPA were more susceptible to adhesion formation following both a surgical insult and a chronic inflammatory episode compared with uPA-deficient and wild-type mice. In addition, the time of maximal adhesion formation varied depending on the nature of the initial insult. It is proposed that the persistence of fibrin due to decreased tPA activity following surgery or chronic inflammation plays a major role in peritoneal adhesion formation.

Topics: Animals; Fibrin; Humans; Mice; Mice, Knockout; Models, Biological; Peritoneal Diseases; Plasminogen Activators; Postoperative Complications; Tissue Adhesions

to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane.. Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae.. Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred.. Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.

Topics: Adolescent; Adult; Aged; Child; Eye Injuries; Female; Fibrin; Fibrinolytic Agents; Humans; Hyphema; Inflammation; Male; Middle Aged; Ophthalmologic Surgical Procedures; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

The increased incidence of postoperative adhesions and their complications have refocused attention on our understanding of adhesions, their clinical consequences and prevention. Postsurgical adhesions have four major negative impacts on health care outcomes. First, adhesions cause significant morbidity, including intestinal obstruction, infertility and pelvic pain. Second, adhesions are associated with multiple surgical complications. Third, these complications lead to greater surgical workload and utilization of hospital and other health care resources. Fourth, all these negative impacts result in significant economic burden to society. The complexities of adhesion formation and limitations in their understanding and research have hampered the development of satisfactory preventive treatments. Adhesions are highly differentiated, formed through an intricate process and associated with a complex organ, the peritoneum. The surface lining of the peritoneum is the key site in adhesion formation and prevention. Two unique properties of the peritoneal surface play key roles in these processes: its delicacy and its uniform, relatively rapid rate of re-epithelialization, irrespective of the size of injury. A suitable barrier that separates damaged peritoneal surfaces for the entire five to seven days of re-epithelialization is likely to prove effective in reducing adhesion formation. Postsurgical peritoneal repair begins with coagulation, which releases a variety of chemical messengers that bring about a cascade of events. Some of the principal cellular elements in this cascade are leukocytes, including polymorphonuclear neutrophils and macrophages, mesothelial cells, and fibrin. Following surgical injury, macrophages exhibit increased phagocytic, respiratory burst and secretory activity, and after day 5, are the major component of the leukocyte population. Macrophages also recruit new mesothelial cells onto the surface of the injury. These cells form small islands throughout the injured area which proliferate into sheets of mesothelial cells and accomplish re-epithelialization, usually five to seven days after surgical injury. The progenitor to adhesions is the fibrin gel matrix which develops in several steps. These include the formation and insolubilization of fibrin polymer and its interaction with fibronectin and a series of amino acids. Protective fibrinolytic enzyme systems of the peritoneal mesothelium, such as the tissue plasminogen activator (tPA) sys

Topics: Animals; Fibrin; Fibrinolysis; Humans; Pelvic Pain; Peritoneum; Postoperative Complications; Tissue Adhesions; Tissue Plasminogen Activator; Wound Healing

Postsurgical abdominal adhesions and their sequelae continue to present major clinical and medicoeconomic problems. A complex network of mediators and responses affecting at least five interrelated biological systems, including the fibrinolytic system, are involved in the pathogenesis of postsurgical adhesions. The fibrinolytic system degrades fibrin through the action of the enzyme plasmin, which is stored as the inactive substrate plasminogen. Fibrinolysis, by mediating fibrin degradation, appears to play a pivotal role in adhesiogenesis. Tissue-type plasminogen activator (tPA) is the chief plasminogen activator in the blood, but its activity is restricted by plasminogen activating inhibitors type 1 (PAI-1) and type 2 (PAI-2). Inadequate peritoneal fibrinolysis may result from decreased tPA, increased PAI-1 and PAI-2, or both. The causal relationship between a reduction in fibrinolytic capacity and the formation of adhesions has been demonstrated in animals. In human studies, plasminogen activator activity (PAA) was significantly reduced in peritoneal biopsies from patients with peritonitis compared with those from normal patients. During surgery, PAA declined significantly in both normal and inflamed peritoneum. tPA was responsible for about 95% of PAA. Reduced fibrinolysis in human peritoneum associated with peritonitis and abdominal surgery correlates with increased adhesion formation and may thus be an important early biochemical event leading to adhesion formation. The regulation of plasmin-mediated fibrin degradation in the peritoneal cavity is poorly understood. However, new insights in the cellular distribution of fibrinolytic components in peritoneal tissue suggest that the mesothelium appears to have a principal role in fibrin regulation in the peritoneal cavity and in the early formation of adhesions.

Topics: Animals; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Humans; Inflammation; Peritoneum; Postoperative Complications; Tissue Adhesions; Tissue Plasminogen Activator

Topics: Adult; Aged; Animals; Anticoagulants; Blood Coagulation; Dogs; Fibrin; Heparin; Humans; Injections, Intravenous; Injections, Subcutaneous; Middle Aged; Monitoring, Physiologic; Postoperative Complications; Reference Standards; Thrombelastography

Inflammatory reactions following IOL-implantation are being caused by different factors. A recent finding refers to the fact that bacteria of usually low pathogenity (i.e. Probionibacterium acnes, Staph. epidermidis, Staph. aureus haemolyticus) can enter the eye during implantation into the capsular bag and can cause an initially localized endophthalmitis. Previously this clinical appearance had frequently been mistaken as a "Toxic Lens Syndrome". Clinically, a persisting or increasing fibrin reaction with or without hypopyon, a typical whitish appearance of the capsule and a more or less marked vitreous infiltration up to a generalized endophthalmitis may be observed. For diagnostic purposes an isolation of germs from the fibrin network in the pupillary area or from the excised fragments of the capsular bag can be successful. Therapy of choice are locally applied antibiotics (i.e. the combination of Cephalosporin with Tobramycin) or eventually an operative intervention. If this is performed in the early course, the IOL can be saved in the majority of cases, although the visual acuity is usually reduced. Postoperative inflammatory reactions can also be caused by individual disposition (pseudoexfoliation, glaucoma, uveitis). No importance is being attributed furthermore to diagnoses like "Toxic Lens Syndrome" or "Pseudo-phako-anaphylactic Endophthalmitis'. Postoperative inflammatory reactions can be divided into five different clinical courses. In cases of bacterial contamination the prognosis is worsened by mono-steroid therapy.

Topics: Endophthalmitis; Fibrin; Foreign-Body Reaction; Humans; Lenses, Intraocular; Postoperative Complications

Topics: Animals; Blood Platelets; Blood Preservation; Blood Transfusion; Cell Aggregation; Disease Models, Animal; Dogs; Fibrin; Humans; Leukocytes; Micropore Filters; Papio; Platelet Aggregation; Postoperative Complications; Pulmonary Embolism; Respiratory Distress Syndrome; Transfusion Reaction

Topics: Angina Pectoris; Coronary Artery Bypass; Coronary Circulation; Coronary Vessels; Fibrin; Humans; Myocardium; Necrosis; Postoperative Complications; Saphenous Vein; Thrombosis; Transplantation, Autologous

Topics: Antigens; Body Weight; Fibrin; Humans; Postoperative Complications; Prognosis; Risk; Serum Globulins; Thrombophlebitis; Time Factors; Varicose Veins

Topics: Autoimmune Diseases; Biomechanical Phenomena; Fibrin; Fibrinolysis; Humans; Peritoneal Diseases; Peritoneum; Postoperative Complications; Posture; Serous Membrane; Surgical Procedures, Operative; Tissue Adhesions

Defibrination is a fairly common clinical entity seen in a wide variety of clinical disorders. With an awareness of the likely clinical settings, a high degree of suspicion, and widely available sensitive laboratory tests, the diagnosis is ordinarily easily made. The best therapy is usually that which is directed at the underlying disease rather than at the defibrination syndrome itself. In certain symptomatic cases, heparin and/or replacement therapy is indicated, especially if the underlying disorder cannot be immediately successfully treated. On occasion, antifibrinolytic therapy will be useful, always with due regard to the danger of renal cortical necrosis. Depending on the clinical setting, it may be advisable to give heparin with the antifibrinolytic therapy to minimize that danger.

Topics: Adult; Aged; Antifibrinolytic Agents; Blood Cell Count; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Female; Fetal Death; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Heparin; Humans; Male; Postoperative Complications; Pregnancy; Prostatic Neoplasms; Sepsis; Syndrome

Topics: Adrenal Cortex Hormones; Adrenal Glands; Adult; Afibrinogenemia; Age Factors; Aged; Anticoagulants; Antineoplastic Agents; Blood Proteins; Child; Cicatrix; Fibrin; Growth Hormone; Hemophilia A; Humans; Insulin; Mineralocorticoids; Pancreas; Postoperative Complications; Vitamins; Wound Healing

This literature review attempts to enumerate possible etiologies of postoperative peritoneal adhesions as well as to suggest preventitive measures. The theory that the cause of adhesions was development of fibrous tissue resulting from the destruction of serosa at surgery is discussed, but the author points out that numerous experimental and clinical experiences point to a more complicated etiology. Serosal defects do heal, and not necessarily through adhesion formation, as shown in experimental animals; therefore a new notion of the process of peritoneal repair was advanced which, simply stated, sees free-floating macrophages as the principal source of new serosa. So other areas and tissue types are probably the source of adhesions. The discussion of these other etiological factors include ischemic tissue as a source of adhesions and foreign body causes of granuloma and adhesions (primarily surgical glove powder). In terms of adhesion prevention, many approaches have been tried from using prophylactic agents to inhibit the formation of fibrin in peritoneal exudate (agents such as sodium citrate, heparin, and anticoagulants), use of enzymes and fibrinolytic agents, such as streptokinase and hyaluronidase, to introduction of inert polysiloxanes for prevention at the time of surgery. The use of cortisone, which has been reported to have good results, is also discussed. Finally, the control of distribution of adhesions by plicative techniques is enumerated. With the up-to-date knowledge that adhesions which develop after abdominal operations represent a vascular response by surrounding structures to the stimulus of ischemic tissue or foreign material within the peritoneal cavity, rather than a healing mechanism for serosal defects, a rational approach toward operating on adhesions is presented; this technique requires scrupulous surgical procedure, freedom from foreign body intrusion, the leaving open of serosal defects (rather than pulling together under tension), and, frequently, attempts to surgically ensure that the inevitable adhesion formation occurs in areas which are innocuous to adjacent structures.

Topics: Abdomen; Enzyme Therapy; Exudates and Transudates; Fibrin; Fibrinolytic Agents; Histamine H1 Antagonists; Humans; Hyaluronoglucosaminidase; Intestinal Obstruction; Ischemia; Peritoneal Diseases; Peritoneum; Postoperative Complications; Tissue Adhesions; Wound Healing

Topics: Angiography; Animals; Anuria; Cadaver; Diuresis; Dogs; Fibrin; Glomerular Filtration Rate; Graft Rejection; Humans; Hypertension, Renal; Kidney; Kidney Glomerulus; Kidney Transplantation; Kidney Tubules; Postoperative Complications; Proteinuria; Thrombosis; Time Factors; Tissue Preservation; Transplantation Immunology; Transplantation, Autologous; Transplantation, Homologous

Topics: Alpha-Globulins; Animals; Basal Metabolism; Blood Proteins; Burns; Carbon Isotopes; Dogs; Environmental Exposure; Fibrin; Fibrinogen; Fractures, Bone; gamma-Globulins; Humans; Iodine Isotopes; Nitrogen; Nitrogen Isotopes; Paralysis; Postoperative Complications; Proteins; Rats; Serum Albumin; Serum Albumin, Radio-Iodinated; Temperature; Wounds and Injuries

Topics: Achilles Tendon; Animals; Choroid; Dogs; Fibrin; Humans; Light Coagulation; Polymers; Postoperative Complications; Retinal Detachment; Sclera; Silicones; Transplantation, Autologous

Topics: Fibrin; Hip Fractures; Humans; Postoperative Complications; Prospective Studies; Risk Factors; Thrombin; Tissue Plasminogen Activator

Blood products have been widely used in soft tissue and bone regeneration in oral and maxillofacial surgery. The purpose of this study is to evaluate the effects of leukocyte-platelet rich fibrin (L-PRF) following direct sinus lifting procedure.. Twenty-eight patients were included in the study. Direct sinus lifting was performed via lateral window approach under conscious sedation and local anesthesia. Bony window and sinus floor elevation were performed using piezosurgery device. Two groups were formed. In the first group an allogenous bone graft and L-PRF mixture was used as grafting material. The L-PRF membrane was used to close the lateral window. In the second group, only allogenous bone was used for grafting and resorbable collagen membrane was used to close the lateral window. Pain, swelling, sleeping, eating, phonetics, activities of daily living, missed work days and soft tissue healing were evaluated postoperatively.. Data of 24 patients were evaluated. Improvements were seen in the studied parameters in the L-PRF group; however, the difference was not significant between the two groups (P>0.05).. The use of L-PRF and allogenous bone graft in combination with L-PRF membrane does not significantly improve postoperative complications following direct sinus lifting.

Topics: Activities of Daily Living; Adult; Aged; Articulation Disorders; Blood Platelets; Edema; Female; Fibrin; Humans; Intercellular Signaling Peptides and Proteins; Leukocytes; Male; Middle Aged; Postoperative Complications; Sinus Floor Augmentation; Wound Healing; Young Adult

To assess the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing on the distal aspect of the second molar, and progress of bone regeneration in mandibular third molar extraction sockets.. Over a 2-year period, 31 patients (mean age, 26.1 yr) who required surgical extraction of a single impacted third molar and met the inclusion criteria were recruited. After surgical extraction of the third molar, only primary closure was performed in the control group, whereas PRF was placed in the socket followed by primary closure in the case group (16 patients). The outcome variables were pain, swelling, maximum mouth opening, periodontal pocket depth, and bone formation, with a follow-up period of 3 months. Quantitative data are presented as mean. Statistical significance was inferred at a P value less than .05.. Pain (P = .017), swelling (P = .022), and interincisal distance (P = .040) were less in the case group compared with the control group on the first postoperative day. Periodontal pocket depth decreased at 3 months postoperatively in the case (P < .001) and control (P = .014) groups, and this decrease was statistically significant. Bone density scores at 3 months postoperatively were higher in the case group than in the control group, but this difference was not statistically important.. The application of PRF lessens the severity of immediate postoperative sequelae, decreases preoperative pocket depth, and hastens bone formation.

Topics: Adult; Autografts; Blood Platelets; Bone Density; Bone Regeneration; Edema; Female; Fibrin; Follow-Up Studies; Humans; Male; Mandible; Molar; Molar, Third; Osteogenesis; Pain, Postoperative; Periodontal Pocket; Postoperative Complications; Tooth Extraction; Tooth Socket; Tooth, Impacted; Treatment Outcome; Trismus

Lymphoceles are a common complication after pelvic lymphadenectomy in women with gynecologic malignancies. Although typically asymptomatic, lymphoceles can superinfect requiring medical or surgical intervention. A single center randomized controlled trial provided first evidence, that a collagen-fibrin patch (Tachosil®) is effective in the prevention of symptomatic lymphoceles after pelvic lymphadenectomy.. We will perform a multicentre, blinded, randomized, controlled trial comprising 140 women with gynecologic malignancies undergoing pelvic lymphadenectomy. Women will be randomly allocated to Tachosil® application or no application. Primary outcome is efficacy, defined as lymphocele CTCAE 4.03 grade ≥2 within four weeks after surgery. Secondary outcomes are asymptomatic lymphocele verified by ultrasound, medical or surgical intervention. Assuming a two-sided 5% significance level, a power of 80%, and a drop out rate of 10%, a sample size of 68 patients per group was calculated to detect a 66% absolute decrease in symptomatic lymphoceles.. We aim to provide further evidence for the efficacy of a collagen-fibrin patch in the prevention of symptomatic lymphoceles in women with gynecological malignancies undergoing pelvic lymphadenectomy.. This study is registered at ClinicalTrials.gov (NCT01470677, protocol ID: TACHO-1). This study is registered at the EudraCT database (EudraCT number: 2011-003115-34).

Topics: Adolescent; Adult; Aged; Drug Combinations; Female; Fibrin; Fibrinogen; Humans; Intraoperative Care; Lymph Node Excision; Lymphocele; Middle Aged; Pelvis; Postoperative Complications; Thrombin; Treatment Outcome; Uterine Neoplasms; Young Adult

The aim of this study was to evaluate the success and complications following inferior alveolar nerve (IAN) transposition/reposition for dental implant placement in edentulous or partially edentulous mandibles. This was a multicenter retrospective study; patients who had undergone IAN transposition/reposition at four surgical clinics were retrospectively evaluated. Adverse effects, especially neural disturbances, were recorded and followed. Overall, 68 IAN reposition and 11 nerve transposition procedures were performed in 57 patients (only three patients reported on smoking). The residual bone above the IAN was an average 3.88±1.98mm. A total of 232 dental implants were inserted in the area after transposition/reposition of the nerve. The average follow-up time was 20.62±9.79 months, ranging from 12 to 45 months. One implant loss was observed during the follow-up period. Four patients reported prolonged transient neural disturbances immediately following surgery (5% of the operations). The duration of neural disturbances after the surgery ranged from 1 to 6 months. No permanent neural damage was reported. Thus, within this study's limitations, it can be concluded that IAN transposition and reposition are useful adjunct techniques for managing severely atrophic edentulous or partially edentulous mandibles with dental implants. The risk of neural dysfunction appears to be low.

Topics: Blood Platelets; Cohort Studies; Collagen; Cranial Nerve Diseases; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Restoration Failure; Female; Fibrin; Follow-Up Studies; Humans; Jaw, Edentulous; Jaw, Edentulous, Partially; Male; Mandible; Mandibular Nerve; Microdissection; Middle Aged; Osteotomy; Piezosurgery; Postoperative Complications; Retrospective Studies; Smoking; Time Factors; Touch; Treatment Outcome

Haemostasis after liver resection may be difficult to achieve as a result of the presence of challenging bleeding, the anatomic landscape of the liver and the quality of tissue making up the hepatic parenchyma. The fibrin pad (FP) is a topical absorbable haemostat designed to be effective in a variety of tissues and across multiple bleeding intensities. This is the first clinical trial to evaluate the hemostat's safety and effectiveness in controlling bleeding during elective hepatic resection.. This prospective, randomized, controlled superiority trial enrolled 104 subjects undergoing elective hepatectomy in 5 countries. After parenchymal transection, subjects with an appropriately defined target bleeding site (TBS) were stratified according to the type of hepatic parenchyma and immediately randomized 1:1: FP versus Standard of Care (SoC). SoC comprised manual compression with the use of an approved topical absorbable haemostat. The primary endpoint was haemostasis at 4 min from identification of the TBS, with no re-bleeding requiring re-treatment prior to abdominal closure. Results were stratified for both normal and abnormal (steatosis or cirrhosis) hepatic parenchyma. All subjects were followed for 60 days post-operatively.. The intent-to-treat (ITT) analysis showed an overall treatment difference of 53.0% (P < 0.001), 82.5% (33/40 FP) versus 29.5% (13/44 SoC) in achieving haemostasis at 4 min with no re-bleeding requiring treatment up to wound closure. The per protocol analysis showed an overall treatment difference of 65.7% (P < 0.001), with 33/35 successes (94.3%) in the FP group and 12/42 in the SoC group (28.6%). The stratification results showed treatment differences between the normal parenchyma group, 63.6% (95.8% FP versus 32.3% SoC P < 0.001) and a larger difference of 72.7% in the abnormal parenchyma group (90.9% FP versus 18.2% SoC P = 0.0003). Post-operative intra-abdominal fluid collections were less frequent in the FP group (3.4% FP versus 13.3% SoC P = 0.059). There was no difference in the safety profile between the FP or SoC groups.. The FP is safe and effective when used as an adjunct to achieve haemostasis during hepatic surgery. The success rate of achieving haemostasis with a FP remained high compared with the SOC group, especially in steatotic or cirrhotic liver tissue where the control success rates diminish. In addition, FP treatment of hepatic parenchymal surfaces may reduce the risk of post-operative biliary and fluid collections.

Topics: Adolescent; Adult; Aged; Australia; Blood Loss, Surgical; Blood Transfusion; Elective Surgical Procedures; Europe; Female; Fibrin; Hemostatic Techniques; Hemostatics; Hepatectomy; Humans; Male; Middle Aged; New Zealand; Postoperative Complications; Pressure; Prospective Studies; Time Factors; Treatment Outcome; Young Adult

We evaluated hemostatic markers in patients who underwent major orthopedic surgery, including total hip and total knee arthroplasty, and were treated for the prophylaxis of deep vein thrombosis (DVT) with or without fondaparinux (anti-Xa group, n = 98 and without anti-Xa group, n = 20). The frequency of DVT was significantly higher in the without anti-Xa group than in the anti-Xa group, but the reduction of hemoglobin and fibrinolytic marker levels was significantly lower in the without anti-Xa group than in the anti-Xa group. Eighteen patients in the anti-Xa group showed a reduction in hemoglobin of more than 2 g/dl, and those individuals were considered to be the increased bleeding (IB) group. The concentration of fibrinolytic markers in the anti-Xa group was significantly higher in the IB group than in the non-IB group. There were also no significant differences in the levels of anti-Xa activity, plasminogen activator inhibitor-I, soluble fibrin and antithrombin between the IB and non-IB groups. In conclusion, elevated fibrinolysis induced by increased bleeding may lead to further increases in bleeding in patients receiving thromboprophylaxis with fondaparinux following major orthopedic surgery.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Factor Xa Inhibitors; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Fondaparinux; Hemorrhage; Humans; Male; Middle Aged; Polysaccharides; Postoperative Complications; Venous Thrombosis

This 6-month randomized controlled clinical study primarily aimed to compare the results achieved by the use of a platelet-rich fibrin (PRF) membrane or connective tissue graft (CTG) in the treatment of gingival recession and to evaluate the clinical impact of PRF on early wound healing and subjective patient discomfort. Use of a PRF membrane in gingival recession treatment provided acceptable clinical results, followed by enhanced wound healing and decreased subjective patient discomfort compared to CTG-treated gingival recessions. No difference could be found between PRF and CTG procedures in gingival recession therapy, except for a greater gain in keratinized tissue width obtained in the CTG group and enhanced wound healing associated with the PRF group.

Topics: Adult; Blood Platelets; Connective Tissue; Epithelium; Female; Fibrin; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Gingival Recession; Granulation Tissue; Humans; Male; Membranes, Artificial; Middle Aged; Pain Measurement; Pain, Postoperative; Periodontal Attachment Loss; Periodontal Pocket; Pilot Projects; Postoperative Complications; Surgical Flaps; Wound Healing; Young Adult

To report the intra-and postoperative complications and visual acuity outcomes in pars plana vitrectomy (PPV), phacoemulsification and intraocular lens (IOL) implantation in patients with cataract and proliferative diabetic retinopathy (PDR). A comparison of the combined versus two-step surgical approach is given.. Retrospective uncontrolled interventional clinical trial. Forty-eight eyes of 48 consecutive patients with PDR were included. Twenty-eight (58.3%) eyes with combined surgery and 20 (41.7%) eyes with sequential surgery were analyzed.. Postoperative follow-up time was between 6 and 63 months (mean: 18 months). 1) Combined surgery: Preoperative best-corrected visual acuity (BCVA) ranged from 20/200 to hand motions, and postoperative BCVA ranged from 20/30 to hand motions. BCVA improved in 17 eyes (60.7%), while in 7 (25%) eyes there was no change (> or =2 ETDRS lines) in VA, and in 4 (14.3%) eyes BCVA decreased. Postoperative complications included vitreous hemorrhage (VH) in 10 (35.7%) eyes, and fibrinous exudation in 9 (32.1%) eyes. 2) Two-step surgery: Preoperative BCVA ranged from 10/200 to light perception, and from 20/40 to light perception in the postoperative period. Best-corrected visual acuity improved in 15 (75%) eyes, remained the same in 4 (20%) eyes, and decreased in 1 (5%) eye. Postoperative complications included fibrinous exudation in 6 (30%) eyes, and VH in 3 (15%) eyes.. Combined PPV, phacoemulsification and IOL implantation as well as the two-step procedure are safe and effective for the management of cataract in PDR. Sequential surgery could be advantageous to BCVA outcomes by minimizing postoperative VH, which is significantly more frequent after combined surgery.

Topics: Adult; Aged; Aged, 80 and over; Cataract; Diabetic Retinopathy; Exudates and Transudates; Female; Fibrin; Follow-Up Studies; Humans; Intraoperative Complications; Ischemia; Lens Implantation, Intraocular; Macula Lutea; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Retinal Detachment; Retrospective Studies; Time Factors; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Hemorrhage

To evaluate the efficacy of hyaluronic acid to improve the healing of surgical incisions in the oral cavity.. Six Italian private practices participated in this trial, each centre provided 12 patients. After suturing, patients were randomised to receive either a single application of 0.8% hyaluronic acid or a placebo (the carrier). Outcome measures were: assessment of wound healing 10 days post-operatively on a Likert scale by the blind operators and by an independent and blinded outcome assessor on the photographs, adverse events and post-operative complications. Reproducibility was assessed by evaluating agreement between operators and the independent outcome assessor using the weighted Kappa statistic.. Thirty-six patients were evaluated in each group, at ten days none had dropped-out. No post-operative complications or adverse events occurred. There were no statistically significant differences for wound healing, assessed clinically by the blinded operators or on photographs evaluated by a blinded and independent outcomes assessor. There was a substantial agreement between operators and the independent outcome assessor in the wound scoring.. Hyaluronic acid placed over surgical incisions in the oral cavity does not appear to improve wound healing. Further trials are needed to better understand the potential role of hyalulonic acid in dental applications.

Topics: Adult; Aged; Female; Fibrin; Follow-Up Studies; Humans; Hyaluronic Acid; Male; Middle Aged; Mouth Mucosa; Necrosis; Periodontium; Photography, Dental; Pilot Projects; Placebos; Postoperative Complications; Single-Blind Method; Surgical Wound Dehiscence; Surgical Wound Infection; Suture Techniques; Treatment Outcome; Wound Healing

To evaluate the effect of intraocular infusion of dalteparin, a low-molecular-weight heparin (LMWH) administered in the infusion fluid to prevent early postoperative fibrin formation in combined phacoemulsification-trabeculectomy surgery (phacotrabeculectomy).. Farabi Eye Hospital, Tehran, Iran.. Standard combined phacotrabeculectomy was performed prospectively in a masked fashion in 60 eyes; 35 eyes received 5 IU/mL LMWH in the infusate and 25 eyes served as controls. Masked postoperative examinations assessed visual acuity, intraocular pressure (IOP), anterior chamber cell and flare, and fibrin formation with slitlamp examinations 1, 3, 7, 30, and 90 days after surgery.. The rate of intraocular fibrin/membrane formation was significantly lower in the LMWH group than in the control group at each follow-up (P<.001, Student t test) . The amount of IOP was lower in LMWH group at each follow up (P<.01, Student t test). Final visual acuity was better in LMWH group (P = .03, Student t test). The frequency of synechia formation was lower in the LMWH group on day 90 (P = .002, chi-square test).. Infusion of dalteparin, a LMWH, may be an effective inhibitor of postoperative fibrin formation in phacotrabeculectomy surgery. It may reduce the frequency of synechia formation and improve visual acuity. It may not be associated with increased risk for intraoperative or postoperative complications at the tested dose. This drug may be a useful adjunct in combined surgery.

Topics: Aged; Cataract; Dalteparin; Double-Blind Method; Female; Fibrin; Fibrinolytic Agents; Glaucoma; Humans; Infusions, Parenteral; Intraocular Pressure; Lens Implantation, Intraocular; Male; Phacoemulsification; Postoperative Complications; Prospective Studies; Trabeculectomy; Visual Acuity

To evaluate the efficacy of low molecular weight heparin (LMWH) in prevention of postoperative fibrin formation following vitreoretinal surgery with proliferative vitreoretinopathy (PVR).. Thirty consecutive patients of retinal detachment with advanced PVR were enrolled in the study. They were randomised to study and control groups (n = 15 each). Study group patients received vitreoretinal surgery with 5 IU/cc of LMWH in vitrectomy infusion fluid. The control group patients received vitroretinal surgery without heparin in the infusion fluid. Patients were followed up at 1 week, 1 month and 3 months after surgery. Postoperative bleeding, media clarity, best-corrected visual acuity and success of the surgery at the end of 3 months were compared between the two groups.. At each follow-up visit, the study group showed a better media clarity, which was statistically significant (P = 0.0042). The study group had a 50% better chance of retinal reattachment compared to the control group. Five patients had intraoperative bleeding in the study group (33%) compared to 3 patients in the control group (20%).. Use of intravitreal LMWH prevents postoperative fibrin formation and is beneficial in repair of retinal detachments with PVR.

Topics: Adult; Aged; Female; Fibrin; Fibrinolytic Agents; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative

to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane.. Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae.. Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred.. Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.

Topics: Adolescent; Adult; Aged; Child; Eye Injuries; Female; Fibrin; Fibrinolytic Agents; Humans; Hyphema; Inflammation; Male; Middle Aged; Ophthalmologic Surgical Procedures; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

To evaluate the efficacy and safety of intracameral recombinant tissue plasminogen activator (rt-PA) application for fibrinolysis of fibrin formation after cataract surgery in children.. Johann Wolfgang Goethe-University, Department of Ophthalmology, Frankfurt am Main, Germany.. This study comprised 11 eyes of 10 patients aged 3 to 13 years (mean 7.2 +/- 3.68 [SD]) who developed severe fibrin formation after cataract surgery and IOL implantation despite intensive topical steroid therapy. Under general anesthesia, fibrinolysis was performed with 10 micrograms of rt-PA 7.18 +/- 2.04 days after intraocular surgery. Follow-up included slitlamp examination, tonometry, visual acuity testing, and-ophthalmoscopy. Anterior chamber flare measurements could be performed in 6 eyes.. Complete resolution of fibrin formations occurred in 90% of the patients in these cases, no recurrent fibrinous reaction or adverse effects were noted. In 2 eyes of the same patient with a history of juvenile rheumatoid arthritis and chronic uveitis, fibrin clot dissolution was incomplete. A recurrent fibrinous formation could be observed after 2 and 4 weeks, respectively. A beginning band keratopathy excluding the central and limbal cornea was noted after 6 and 8 weeks, respectively.. Intraocular application of rt-PA appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous reactions after pediatric cataract surgery.

Topics: Adolescent; Anterior Chamber; Cataract Extraction; Child; Child, Preschool; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Follow-Up Studies; Humans; Lens Implantation, Intraocular; Male; Pilot Projects; Postoperative Complications; Recombinant Proteins; Safety; Tissue Plasminogen Activator; Treatment Outcome; Visual Acuity

Despite the efficacy of antifibrinolytic drugs in reducing bleeding after cardiac surgery, concerns remain regarding their potential to promote thrombosis. We examined the effect of the antifibrinolytic drug, epsilon-aminocaproic acid (EACA) on fibrinolysis and thrombin generation during cardiac surgery. Forty-one adults undergoing primary coronary artery bypass graft surgery requiring cardiopulmonary bypass (CPB) were prospectively randomized in a double-blind trial to receive either saline or EACA. A loading dose of 150 mg/kg EACA was given before anesthetic induction, followed by a 15 mg x kg(-1) x h(-1) infusion, which continued until 3 h after CPB. Plasma samples for the measurement of D-dimer, thrombin-antithrombin III, and soluble fibrin were obtained before surgery, 1 h on CPB, and 3 and 20 h after CPB. In the EACA group, fibrinolytic activity, as measured by D-dimer, was significantly decreased 3 h after CPB, (0.51 +/- 0.15 mg/L vs 1.13 +/- 0.14 mg/L, P < 0.005). Decreased fibrinolytic activity was accompanied by decreased bleeding in the EACA group (660 +/- 127 mL vs 931 +/- 113 mL, P < 0.05). No differences in the generation of thrombin or soluble fibrin were apparent between the two groups. Suppression of fibrinolytic activity in the absence of concomitant reductions in thrombin generation suggests that EACA could potentiate a hypercoagulable prethrombotic state in the perioperative setting.. In a randomized, prospective trial of primary cardiac surgery, we demonstrated that the synthetic antifibrinolytic drug epsilon-aminocaproic acid suppresses fibrinolysis with no effects on thrombin generation. These results suggest the potential for synthetic antifibrinolytic drugs to induce a hypercoagulable prethrombotic state in the perioperative setting.

Topics: Aminocaproic Acid; Antifibrinolytic Agents; Antithrombin III; Cardiopulmonary Bypass; Coronary Artery Bypass; Double-Blind Method; Female; Fibrin; Fibrinolysis; Hemorrhage; Humans; Male; Middle Aged; Peptide Hydrolases; Postoperative Complications; Prospective Studies; Thrombin

Occlusion of chest drainage tubes by thrombus is not uncommon after open heart operations. It has been suggested that by coating the tube with phosphatidylcholine (PC), the most prominent phospholipid in the erythrocytes outer membrane, it may be possible to overcome the blood-material interaction responsible for thrombus formation. To test this hypothesis 102 patients (75 males; mean age, 57 +/- 10 years) were randomly allocated to receive either PC-coated or noncoated 32F chest drainage tubes. Preoperative status, type and length of operation, and duration of drainage were similar in the two groups as was postoperative blood loss. Patients receiving PC-coated tubes, however, had less residual blood clot in the tube after removal (0.7 +/- 0.1 versus 3.1 +/- 0.3 g; p < 0.001), a reduced incidence of pericardial effusions (17.6% versus 41.2%; p < 0.01), fewer postoperative supraventricular arrhythmias (2 of 51 versus 10 of 51; p < 0.002), and a shorter hospital stay (8.4 +/- 0.3 versus 9.7 +/- 0.5 days; p < 0.05). Late cardiac tamponade developed in 2 patients in the noncoated group 6 and 10 days postoperatively, which required reexploration. The data show that PC-coated chest drainage tubes are less susceptible to occlusion by thrombus and their use is associated with a significant reduction in postoperative morbidity.

Topics: Aged; Arrhythmias, Cardiac; Biocompatible Materials; Blood Platelets; Chest Tubes; Drainage; Erythrocytes; Female; Fibrin; Heart Diseases; Humans; Incidence; Length of Stay; Male; Microscopy, Electron, Scanning; Middle Aged; Pericardial Effusion; Phosphatidylcholines; Postoperative Care; Postoperative Complications; Prospective Studies; Surface Properties

In a preliminary clinical study, recombinant tissue plasminogen activator (rt-PA) was injected into the anterior chamber of 18 eyes and into the vitreous cavity of 2 eyes in a total of 20 patients. The clinical indications were severe fibrin formation after filtering operations for glaucoma (8 eyes), diabetic neovascular glaucoma (3), fibrin and hemorrhage after vitrectomy (3), keratoplasty (3), posterior chamber lens implantation (1), trauma (1), and endophthalmitis (1). Complete fibrinolysis within a minimum of 2 h was achieved in 81% of 26 injections. Although doses of about 12 micrograms rt-PA were generally given, in our observations, 6 micrograms proved to be sufficient for rapid fibrinolysis in selected cases. Injections of rt-PA should not be considered before the 3rd postoperative day so as to avoid rebleeding and recurrent fibrin formation. No toxic intraocular side effect was observed after the use of rt-PA in this study.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Eye Diseases; Female; Fibrin; Fibrinolysis; Humans; Injections; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Thrombolytic Therapy; Tissue Plasminogen Activator; Vitreous Body

In two double-blind controlled trials the anti-inflammatory effects of dexamethasone were examined in post-cataract extraction eyes after lens implantation in 321 patients. In the first trial, 103 patients were included. 49 eyes received eye-drops with 0.1% dexamethasone and antibiotics, the control-group of 54 eyes received the same antibiotics without any steroids. The follow-up was 2 months. In the case of unexpected complications, the patients dropped out. This was the case in 48% of the steroid-group and in 79% of the control-group. The main reason for this statistically significant difference were inflammatory complications in the control-group, which are difficult to quantify. The incidence of fibrinous reactions was not significantly different in the two groups, probably because of small numbers. In the second trial, we looked for fibrinous reactions. The follow-up was 3 weeks, 218 patients participated. They were divided into three groups: 71 patients received eyedrops with 0.1% dexamethasone 4x daily, 77 patients received the same drops 4x daily up to the fifth postoperative day, from then on 1x daily. 70 patients received the same drops 1x daily. A mild fibrinous reaction was seen in 10% of the high-dose-group, in 6% of the medium-dose-group and in 21% of the low-dose-group. Only the difference between the last two groups is statistically significant. We conclude that the therapy with corticosteroids after cataract extraction and lens implantation may be reduced early in the postoperative course.

Topics: Adult; Aged; Aged, 80 and over; Cataract Extraction; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Female; Fibrin; Foreign-Body Reaction; Humans; Hydrocortisone; Lenses, Intraocular; Male; Middle Aged; Neomycin; Polymyxin B; Postoperative Complications; Prospective Studies; Sulfonamides

Postoperative fibrinoid reactions are regarded as a localized form of endophthalmitis caused by microbial contamination of the capsular bag during intraocular lens implantation. The incidence of early fibrinoid reactions within the first 6 postoperative days following extracapsular cataract extraction was examined after intraocular administration of antibiotics vs placebo. In a double-blind randomized trial, 2 mg cefamandol or a placebo was administered in a 0.4-ml volume at the end of the operation. A group of 28 patients received the antibiotic (mean age 74.6 years; 15 f, 13 m), while 33 patients received the placebo (mean age 72,1 years; 21 f, 12 m). Fibrinoid reactions were observed in 8 out of 61 patients during the first 6 postoperative days. There was no significant difference between the antibiotic group and the placebo group (P = 0.31). We were unable to reduce the incidence of fibrinoid reactions although we had selected a broad-spectrum cephalosporin for antibiotic treatment. The results give rise to the suspicion that most of the early postoperative fibrinoid reactions we observed were not caused by contamination with bacteria of low pathogenicity.

Topics: Cefamandole; Double-Blind Method; Endophthalmitis; Fibrin; Humans; Injections; Lenses, Intraocular; Postoperative Complications

A prospective study of the peroperative behaviour of eyes with pseudoexfoliation syndrome (PEX) in cataract surgery was carried out between June 1989 and July 1990, including 164 eyes with PEX and 164 eyes in the control group. All eyes underwent either phakoemulsifikation or extracapsular extraction with implantation of a posterior chamber lens. Intraoperative the eyes with PEX fairly often failed to reach adequate mydriases (23%) compared with the control group (5.5%). The rate of postoperative fibrinoid reactions was almost the same in both groups (7.9% in eyes with PEX, 7.5% in the control group). Even though the cataract extraction and implantation of the IOL sometimes is slightly more difficult due to inadequate mydriasis, there is no evidence for an increased rate of severe intraoperative complications. The incidence of ruptures of the posterior capsule and vitreous loss was 1.2% and 0.6% respectively in eyes with PEX, the former is within our results of cataract surgery, delivered from a study of 6000 consecutive cases from 1982 to 1985 (0.73%).

Topics: Aged; Female; Fibrin; Foreign-Body Reaction; Glaucoma; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Male; Postoperative Complications; Prospective Studies; Risk Factors

The authors undertook a study to investigate the ability of systemic or heparin supplementation of the vitrectomy infusion solution to prevent formation of postoperative intraocular fibrin membranes. A total of 73 eyes were randomized; 26 served as the control group, 23 received 10,000 IU of intravenous bolus of heparin, and 12 eyes each underwent the vitrectomy with an infusion solution containing 10 or 5 IU/cc of heparin. Intraoperative bleeding, postoperative bleeding, and postoperative fibrin formation were graded. A 10-IU/cc heparin infusion resulted in a statistically significant reduction in postoperative fibrin formation (P = 0.04) but increased intraoperative bleeding (P = 0.02). A trend toward reduced postoperative fibrin formation was noted in the intravenous heparin and 5 IU/cc infusion groups.

Topics: Fibrin; Heparin; Humans; Infusions, Intravenous; Injections, Intravenous; Intraoperative Complications; Postoperative Complications; Prospective Studies; Random Allocation; Thrombosis; Vitrectomy; Vitreous Hemorrhage

A method for instilling a two-component fibrin adhesive into the prostatic cavity after transurethral resection of the prostate is described. In a prospective, controlled study, 30 consecutive patients undergoing transurethral prostatectomy (TURP) were randomised either to receive treatment with the local instillation of fibrin adhesive into the prostatic cavity or to a control group that received no special treatment post-operatively. There were no complications either during application of the fibrin adhesive or in the follow-up period. Post-operative blood loss was significantly reduced in the fibrin group (P less than 0.01).

Topics: Fibrin; Hemorrhage; Hemostasis, Surgical; Humans; Male; Postoperative Complications; Prostatectomy; Time Factors; Tissue Adhesives

A prospective study of the incidence of post-operative hepatitis was carried out in 417 patients following open-heart surgery. During the observation period 16 (3.8%) patients contracted hepatitis (15 non-A, non-B hepatitis; 1 hepatitis B). Fibrin seal was used intraoperatively in 19 patients; post-operatively there was no evidence of hepatitis in any of these cases. Thus fibrin seal should not be grouped with "high hepatitis-risk" preparations.

Topics: Adhesives; Cardiac Surgical Procedures; Fibrin; Hepatitis; Humans; Postoperative Complications; Prospective Studies

A clinical trial was undertaken to study endotoxemia in 14 patients with obstructive jaundice given the antiendotoxin polymyxin B, 13 patients with obstructive jaundice who were not given the antiendotoxin , and 13 nonjaundiced control patients undergoing comparable surgery. Endotoxins were detected by the limulus assay. Endotoxemia did not occur in the nonjaundiced patients but was common before (68 percent), during (70 percent), and after (81 percent) surgery in the jaundice patients. Thirty-six percent of the jaundiced patients had postoperative oliguria. Endotoxemia before surgery was associated with death after surgery, all deaths occurring in patients who were endotoxemic before operation (p less than 0.05). Polymyxin B infusion had no effect on endotoxemia or outcome. Measurement of indicators of fibrinolysis, soluble fibrin, and fibrin degradation products showed no prognostic significance. We conclude that preoperative endotoxemia is an important predictor of outcome in patients who undergo surgery for jaundice.

Topics: Bilirubin; Cholestasis; Clinical Trials as Topic; Endotoxins; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Kidney Diseases; Middle Aged; Polymyxin B; Polymyxins; Postoperative Complications

1. The purpose of fluid administration is not only the restoration of blood volume but also the normalization of impaired nutritive flow. 2. Plasma oncotic (colloid osmotic) pressure is the only force which can draw water into the circulation. In shock the infusion of colloid solutions is able to normalize nutritive flow and peripheral resistance almost at once. 3. Five per cent solutions of pasteurized plasma protein or albumin and 6 per cent dextran 70 yield a volume expansion corresponding to the amount infused. 4. The decrease in hematocrit produced by the infusion of these three colloidal solutions is accompanied by a decrease in whole blood viscosity resulting in a rise in cardiac output as well as in nutritional tissue flow. 5. Hemodilution improves oxygen supply as long as the hematocrit does not fall below 30 per cent, although normovolemia is the critical requirement. 6. Transmission of viral hepatitis is still the greatest danger of blood transfusion. 7. The use of large amounts of Ringer's lactate is not advised, as this solution does not reduce the total number of units of blood which need to be given. Pulmonary edema may become a problem. 8. Dextrans are best suited to initial volume replacement in shock. They increase plasma volume, improve blood flow, have antithrombotic properties, and are easily available and relatively cheap. Anaphylactoid reactions are rare. 9. Every third patient undergoing general surgery and every other patient having hip surgery develops a deep venous thrombosis. Widespread prophylaxis to prevent thromboembolic complications is mandatory. 10. The antithrombotic properties of dextran are due to a reduction in platelet adhesiveness, a change in fibrin clot structure, and the increased lysability of thrombi and the improvement of blood flow. 11. In a personal controlled, prospective, randomezed trial comparing subcutaneous heparin and intravenous dextran 40, 35.8 per cent of the controls (n=95), 13.2 per cent of the 83 patients in the heparin group, and 20.5 per cent in the dextran group (n=83) developed deep venous thrombosis. The difference between dextran and heparin is not significant; however, both treatment groups show a statistically significant effect compared to the controls.

Topics: Blood Coagulation Tests; Blood Transfusion; Bone and Bones; Coumarins; Dextrans; Female; Fibrin; Genital Diseases, Female; Heparin; Humans; Microscopy, Electron, Scanning; Molecular Weight; Phlebography; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Thromboembolism

The effect of a low-dosage regimen of ancrod in the prevention of postoperative deep vein thrombosis was assessed in 24 patients having surgical repair of fractured neck femur and compared with 25 control patients who did not receive therapy. The objective of the therapy was to lower the preoperative fibrinogen level and produce a low concentration of fibrin degradation products yet avoid the haemorrhagic complications of total defibrination. Ancrod therapy proved feasible to carry out, was not associated with haemorrhagic complications, and produced sustained, predictable reductions in fibrinogen concentration. There were seven thromboembolic complications in the control patients compared to one such complication in the ancrod-treated patients. Five deaths occurred in the control group and one in the treated group. Though the incidence of deep vein thrombosis was not apparently affected by ancrod it appeared on venography that the thrombi in the treated patients were less extensive than those in the control patients. Finally, some discrepancies in the diagnosis of deep vein thrombosis by the three techniques of clinical examination, (125)I-fibrinogen scanning, and ascending venography were identified.

Topics: Aged; Anticoagulants; Clinical Trials as Topic; Female; Femoral Neck Fractures; Fibrin; Fibrinogen; Hemagglutination Inhibition Tests; Humans; Injections, Intravenous; Iodine Radioisotopes; Peptide Hydrolases; Phlebography; Postoperative Complications; Radionuclide Imaging; Thromboembolism; Thrombophlebitis; Venoms

Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries.. A case series.. Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients.. This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.

Topics: Anterior Eye Segment; Conjunctiva; Eye Diseases; Fibrin; Formaldehyde; Humans; Hyaluronic Acid; Moxifloxacin; Phacoemulsification; Postoperative Complications; Prednisolone; Pterygium; Syndrome

Various surgical methods to prevent postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal surgery have been reported. However, comparative studies are scarce. We aimed to compare the efficacy of a fibrin-coated collagen fleece (TachoSil) versus a dural sealant (DuraSeal) to prevent postoperative CSF leakage. We perform a retrospective study comparing two methods of sellar closure during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma resection: TachoSil patching versus DuraSeal packing. Data concerning diagnosis, reconstruction technique, and surgical outcomes were analyzed. The primary endpoint was postoperative CSF leak rate. We reviewed 198 consecutive patients who underwent 219 EETS for pituitary adenoma from February 2007 and July 2018. Intraoperative CSF leak occurred in 47 cases (21.5%). A total of 33 postoperative CSF leaks were observed (15.1%). A reduction of postoperative CSF leaks in the TachoSil application group compared to the conventional technique using Duraseal was observed (7.7% and 18.2%, respectively; p = 0.062; Pearson exact test) although non-statistically significant. Two patients required lumbar drainage, and no revision repair was necessary to treat postoperative CSF rhinorrhea in Tachosil group. Fibrin-coated collagen fleece patching may be a valuable method to prevent postoperative cerebrospinal fluid (CSF) leaks during EETS for pituitary adenoma resection.

Topics: Adenoma; Cerebrospinal Fluid Leak; Collagen; Fibrin; Humans; Pituitary Diseases; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies

Topics: Ankle Brachial Index; Blood Platelets; Coronary Artery Disease; Female; Fibrin; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Peripheral Arterial Disease; Postoperative Complications; Prevalence; Republic of Korea; Risk Assessment; Severity of Illness Index; Thrombelastography; Thrombosis

We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function.. Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function.. Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups.. Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

Topics: Aged; Female; Fibrin; Follow-Up Studies; Gels; Humans; Ischemia; Kidney Function Tests; Kidney Neoplasms; Laparoscopy; Length of Stay; Male; Middle Aged; Nephrectomy; Operative Time; Organ Sparing Treatments; Postoperative Complications; Retrospective Studies; Sutureless Surgical Procedures; Warm Ischemia

To describe an intravascular fibrin sheath associated with a hemodialysis catheter in a dog.. A 4-year-old dog presented for hemodialysis to treat acute kidney injury. Hemodialysis catheter dysfunction during the course of treatment was temporarily alleviated using a tissue plasminogen activator. A thrombus composed of fibrin and granulation tissue creating a sheath around the catheter and focally adherent to the vessel wall was identified on postmortem evaluation.. Fibrin sheath formation is a commonly recognized problem of central venous catheters used for hemodialysis in people and is likely a common problem in veterinary patients undergoing dialysis as well. This report provides a description of the clinical features of the catheter dysfunction, response to treatment, postmortem radiographic and direct imaging, and histology of the fibrin sheath, and also provides a brief review of potential management techniques that have been described in people.

Topics: Acute Kidney Injury; Animals; Catheterization, Central Venous; Catheters, Indwelling; Diagnosis, Differential; Dog Diseases; Dogs; Equipment Design; Fibrin; Male; Osteotomy; Postoperative Complications; Recombinant Proteins; Renal Dialysis; Thrombosis; Tissue Plasminogen Activator

Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery.. A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries.. L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair.. L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery.

Topics: Adult; Aged; Cerebrospinal Fluid Leak; Dura Mater; Feasibility Studies; Female; Fibrin; Humans; Male; Membranes, Artificial; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Skull Base; Spine

Topics: Female; Fibrin; Fibrinolytic Agents; Humans; Intravitreal Injections; Middle Aged; Postoperative Complications; Tissue Plasminogen Activator; Vitrectomy

Various surgical methods to prevent intraoperative and postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal approach (TSA) surgeries have been reported, but surgical techniques to address large dural defects have been less thoroughly investigated in the literature. The authors retrospectively evaluated the usefulness of the sandwich technique using fibrin-coated collagen fleece (TachoSil) to prevent intraoperative CSF leakage from large dural defects in TSA surgery.. In total, 101 cases of intraoperative CSF leaks were observed among 465 patients who underwent TSA surgery at a single university hospital between 2002 and 2014. Among them, cases with Grade 3 intraoperative CSF leakages and large diaphragmatic/dural defects were reconstructed via the sandwich technique using TachoSil or via the conventional technique using simple intrasellar packing with fat or synthetic materials, and these cases were enrolled in this study.. A total of 28 cases with Grade 3 intraoperative CSF leakages were identified and analyzed. The sandwich technique using TachoSil was applied in 13 cases, and the conventional technique was applied in 15 cases. The postoperative CSF leakage was significantly decreased by the sandwich technique as compared to the conventional technique (retrospectively, 0 cases vs. 4 cases (30.8%); P=0.044).. The sandwich technique using TachoSil can effectively prevent CSF leakage in cases with large dural defects during TSA surgery.

Topics: Adult; Cerebrospinal Fluid Leak; Collagen; Drug Combinations; Dura Mater; Female; Fibrin; Fibrinogen; Humans; Intraoperative Complications; Male; Middle Aged; Neurosurgical Procedures; Pituitary Neoplasms; Plastic Surgery Procedures; Postoperative Complications; Sella Turcica; Sphenoid Sinus; Thrombin

The large orthopedic operations are associated with high risk of development of thrombosis of deep veins of lower extremities. Nowadays, new oral anticoagulants are widely applied for anti-thrombotic prevention. The coagulation alterations against the background of effect of Dabigatran, a direct inhibitor of thrombin were examined in 30 patients underwent endoprosthesis replacement of knee joint. The routine clotting indices, fibrinopeptid A, soluble fibrin-monomeric complexes, D-dimer. The samples of blood were selected before operation, after 30 minutes, and at 1st, 3d, 7th and 14th day after endoprosthesis replacement of knee joint. It is demonstrated that routine clotting tests and also detection of D-dimer and soluble fibrin-monomeric complexes provide no adequate evaluation of coagulation activity in patients underwent large orthopedic operation. The concentration of specific marker of fibrin formation of fibrinopeptid A continues to be increased no less than two weeks after endoprosthesis replacement of knee joint that testifies keeping hyper-coagulation and risk of thrombosis. The intake of Dabigatran etexilate in fixed dosage does not exclude development of thrombosis of deep veins of lower extremities that substantiates point of view concerning usefulness of individualization of anti-thrombotic prevention in case of application of new oral anti-coagulants.

Topics: Anticoagulants; Arthroplasty, Replacement, Knee; Blood Coagulation; Blood Coagulation Tests; Dabigatran; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Humans; Knee Joint; Male; Middle Aged; Postoperative Complications; Thrombin; Venous Thrombosis

Bone tunnel enlargement is a feared complication after ACL reconstruction. The aim of this study was to evaluate whether adding a fibrin clot to the allograft for anatomic single-bundle ACL reconstruction would reduce tunnel widening.. Fifty patients who underwent anatomic single-bundle ACL reconstruction were included. Twenty-five patients received an allograft alone, and 25 patients received an allograft with fibrin clot. All patients underwent standard plain anteroposterior and lateral radiographs of the operated knee immediately after surgery and at 1-year follow-up. The size of the tunnels was measured at both time points to calculate tunnel widening. Tunnel widening at 1 year was compared between the allograft and the allograft + fibrin clot group.. There was significantly less tunnel widening in the allograft + fibrin clot group for the femoral tunnel width in the middle and distal portion of the tunnel and for the tibial tunnel width in the proximal and distal portions, as compared to the allograft only group.. Adding a fibrin clot to the allograft in anatomic single-bundle ACL reconstruction reduces the amount of tunnel widening at 1-year follow-up. Reducing tunnel widening may positively affect outcomes after ACL surgery and may prevent inadequate bone stock during ACL revision procedures.. Case-control study, Level III.

Topics: Adolescent; Adult; Allografts; Anterior Cruciate Ligament; Anterior Cruciate Ligament Reconstruction; Case-Control Studies; Female; Femur; Fibrin; Humans; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Tibia; Transplantation, Homologous; Young Adult

Anosmia is not a rare complication of surgeries that employ the anterior interhemispheric approach. Here, we present a fibrin-gelatin fixation method that provides reinforcement and moisture to help preserve the olfactory nerve when using the anterior interhemispheric approach and describe the results and outcomes of this technique. We analyze the outcomes with this technique in 45 patients who undergo surgery for aneurysms, brain tumors, or other pathologies via the anterior interhemispheric approach. Anosmia occurred in 4 patients (8.8%); it was transient in 2 (4.4%) and permanent in the remaining 2 (4.4%). Brain tumors clearly attached to the olfactory nerve were resected in the patients with permanent anosmia. We found a significant difference in the presence of anosmia between patients with or without lesions that were attaching the olfactory nerve (p = 0.011). Our results suggested that fibrin-gelatin fixation method can reduce the reported risk of anosmia. However, the possibility of olfactory nerve damage is relatively high when operating on brain tumors attaching olfactory nerve.

Topics: Adult; Aged; Craniopharyngioma; Craniotomy; Female; Fibrin; Gelatin; Humans; Intracranial Aneurysm; Male; Meningioma; Middle Aged; Neurosurgical Procedures; Olfaction Disorders; Olfactory Nerve Injuries; Postoperative Complications; Skull Base; Skull Base Neoplasms; Smell; Young Adult

Fibrin sealants are widely used in neurosurgery to seal the suture line, provide watertight closure, and prevent cerebrospinal fluid leaks. The aim of this systematic review is to summarize the current efficacy and safety literature of fibrin sealants in dura sealing and the prevention/treatment of cerebrospinal fluid leaks.. A comprehensive electronic literature search was run in the following databases: Cochrane Database of Systematic Reviews, Cochrane Central Resister of Controlled Trials, clinicaltrials.gov, MEDLINE/PubMed, and EMBASE. Titles and abstracts of potential articles of interest were reviewed independently by 3 of the authors.. A total of 1006 database records and additional records were identified. After screening for duplicates and relevance, a total of 78 articles were assessed by the investigators for eligibility. Thirty-eight were excluded and the full-text of 40 articles were included in the qualitative synthesis. Seven of these included only safety data and were included in the safety assessment. The remaining 33 articles included findings from 32 studies that enrolled a total of 2935 patients who were exposed to fibrin sealant. Among these 33 studies there were only 3 randomized controlled trials, with the remaining being prospective cohort analysis, case controlled studies, prospective or retrospective case series. One randomized controlled trial, with 89 patients exposed to fibrin sealant, found a greater rate of intraoperative watertight dura closure in the fibrin sealant group than the control group (92.1% versus 38.0%, p<0.001); however, post-operative cerebrospinal fluid leakage occurred in more fibrin sealant than control patients (6.7% versus 2.0%, p>0.05). Other clinical trials evaluated the effect of fibrin sealant in the postoperative prevention of cerebrospinal fluid leaks. These were generally lower level evidence studies (ie, not prospective, randomized, controlled trials) that were not designed or powered to demonstrate a significant advantage to fibrin sealant use. Two small case series studies evaluated the effect of fibrin sealants in persistent cerebrospinal fluid leak treatment, but did not establish firm efficacy conclusions. Specific adverse reports where fibrin sealants were used for dura sealing were limited, with only 8 cases reported in neurosurgical procedures since 1987 and most reporting only a speculative relationship/association with fibrin sealant exposure.. A major finding of this systematic literature review is that there is a paucity of randomized studies that have evaluated the effectiveness and safety of fibrin sealants in providing intraoperative watertight dura closure and post-operative cerebrospinal fluid leakage. Among the limited studies available, evidence from a single randomized, controlled trial indicates that fibrin sealants provide a higher rate of intraoperative watertight closure of the dura suture line than control, albeit with a higher rate of postoperative cerebrospinal fluid leakage. Evidence from non-randomized, controlled trials suggests that fibrin sealants may be effective in preventing cerebrospinal fluid leaks with an acceptable safety profile. There is a substantial need for randomized, controlled clinical trials or well-designed prospective observational trials where the conduct of a randomized trial is not feasible to fully assess the impact of fibrin sealant utilization on the rates of intraoperative dura closure, postoperative cerebrospinal leakage, and safety.

Topics: Cerebrospinal Fluid Leak; Dura Mater; Fibrin; Fibrin Tissue Adhesive; Humans; Neurosurgical Procedures; Postoperative Complications; Postoperative Period; Prospective Studies; Resins, Synthetic; Retrospective Studies; Tissue Adhesives

Topics: Diabetes Mellitus, Type 2; Diabetic Retinopathy; Eye Diseases; Fibrin; Humans; Laser Coagulation; Macular Edema; Male; Middle Aged; Postoperative Complications; Tomography, Optical Coherence; Vitrectomy; Vitreous Body; Vitreous Hemorrhage

To report the clinical and histopathological results of a novel autologous scaffold grafting, platelet-rich fibrin (PRF) membrane, in cases with descemetocele.. Three patients with severe corneal stromal melting and central descemetocele caused by neurotrophic keratopathy and infective keratitis underwent PRF membrane grafting on the central cornea for the prevention of imminent corneal perforation. After a quiescent 3-month period, penetrating keratoplasty and cataract extraction were performed for visual rehabilitation in 1 patient and host corneal tissue was examined histopathologically.. Pain was significantly relieved, conjunctival inflammation was markedly resolved, and the central descemetocele area became thicker with scar formation in all patients. Histopathological examination revealed fibrosis formation over the descemetocele area without any tissue gap. Newly formed tissue containing irregular corneal lamellae covered the fibrosis formation and accounted for the prevention of perforation.. Temporary PRF membrane grafting may be an alternative intervention to avoid impending corneal perforation in cases with severe descemetocele.

Topics: Aged; Corneal Perforation; Descemet Membrane; Fibrin; Humans; Male; Membranes, Artificial; Middle Aged; Platelet-Rich Plasma; Postoperative Complications; Retrospective Studies; Tissue Scaffolds; Visual Acuity

Tendon injuries are an increasing problem in orthopedics as we are faced with a growing demand in sports and recreation and an aging population. Tendons have poor spontaneous regenerative capacity, and often, complete recovery after injury is not achieved. Once injured, tendons do not completely re-acquire the biological and biomechanical properties of normal tendons due to the formation of adhesions and scarring, and often these abnormalities in the arrangement and structure are risk factors for re-injury. These problems associated with the healing of tendon injuries are a challenge for clinicians and surgeons. This study examined 9 cases of subcutaneous injuries including quadriceps tendon (2 cases), patellar tendon (1 case), and Achilles tendon (6 cases), incomplete and complete, treated consecutively. The surgical technique has provided, as appropriate, the termino-terminal tenorraphy, techniques of plastics of rotation flap, reinsertion with suture anchors, and in one case tendon augmentation with cadaver tissue. In cases where we needed mechanical support to the suture, we used preloaded growth factors on porcine collagen scaffold; in cases where we needed only one biological support, we used fibrin scaffold.

Topics: Adult; Aged; Animals; Cohort Studies; Collagen; Female; Fibrin; Humans; Intercellular Signaling Peptides and Proteins; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Swine; Tendon Injuries; Tendons; Tissue Scaffolds

To analyze the cause of fibrinous inflammation in eyes with capsular tension rings (CTRs) after cataract surgery.. Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.. Retrospective case series.. High-performance liquid chromatography was implemented to eliminate impurities. One CTR was explanted for microbiologic examination. The pH values of the CTR and the storage solution were analyzed, Seldi and Maldi tests were performed, as well as toxicity tests with immortal cell lines. Material batches were analyzed. The organic carbon content of CTRs, detergents, and storage solutions was checked. The presence of endotoxins was excluded with the limulus amoebocyte lysate test. Gas chromatography with mass selective detector excluded the presence of extractable organic substances. An inductively coupled plasma analysis scanned for inorganic substances. The microbial count in operating rooms, smear tests, and microbiologic examinations of technical devices were initiated.. Analyses found no pathological findings. After intensive systemic and topical treatment with antibiotics and steroids, clinical findings improved. The implantation of CTRs was stopped immediately. No further cases occurred.. Fibrinous inflammations after implantation of CTRs were unknown until now. Contamination and/or irritation by detergents or the material CTR itself were excluded, indicating mechanical or toxic irritation by the CTR.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Aged; Aged, 80 and over; Device Removal; Endophthalmitis; Female; Fibrin; Humans; Lens Implantation, Intraocular; Male; Methacrylates; Methylmethacrylate; Middle Aged; Phacoemulsification; Postoperative Complications; Prostheses and Implants; Prosthesis Implantation; Retrospective Studies

Topics: Diabetic Retinopathy; Endophthalmitis; Female; Fibrin; Humans; Male; Postoperative Complications; Vitrectomy; Vitreous Body

Topics: Diabetic Retinopathy; Endophthalmitis; Female; Fibrin; Humans; Male; Postoperative Complications; Vitrectomy; Vitreous Body

There are many reports concerning the fondaparinux prophylaxis of deep vein thrombosis (DVT) after surgery, but little is known about the usefulness of diagnosing DVT by the thrombotic markers such as soluble fibrin (SF) and D-dimer in patients treated with fondaparinux. The main purpose of this study was to evaluate the accuracy of SF and D-dimer tests for DVT screening in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) treated with fondaparinux.. A total of 519 patients who underwent THA or TKA were evaluated. SF and D-dimer levels were evaluated on postoperative days 1, 4, 7, 14 and 21. DVT was confirmed by ultrasonography 4 days after surgery.. The incidence of DVT in patients treated with fondaparinux was significantly lower than in patients without fondaparinux. The SF test on postoperative day 1, and the D-dimer test on postoperative days 1, 4, and 7 were useful in untreated patients. However, in the patients treated with fondaparinux, the D-dimer test on postoperative day 7 only was useful for DVT screening.. The accuracy of SF and D-dimer test for the diagnosis of DVT was decreased by administration of fondaparinux. A new strategy for diagnosing DVT might be required for patients receiving fondaparinux.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fondaparinux; Humans; Male; Middle Aged; Polysaccharides; Postoperative Complications; Prospective Studies; Ultrasonography; Venous Thrombosis

To measure the inflammatory reaction in the anterior chamber after lens extraction in a rabbit model and to evaluate the effect of nonsteroidal antiinflammatory drugs (NSAIDs) or steroids on the amount of inflammation as measured by fibrinogen levels in the aqueous humor.. Animal laboratory, Goldschleger Research Institute, Tel Aviv University, Sheba Medical Center, Ramat Gan, Israel.. Experimental study.. Twenty-six eyes of New Zealand white rabbits had lens extraction surgery. One day later, aqueous humor (∼0.1 mL) was withdrawn from the anterior chamber and examined for fibrinogen concentration. Control rabbits received no treatment (9 eyes) or artificial tear eyedrops (5 eyes). One study group received NSAID drops (diclofenac) (6 eyes), and another study group received steroid drops (dexamethasone-neomycin) (6 eyes). All rabbits were treated hourly for 9 applications. Aqueous humor (∼0.1 mL) was withdrawn from the anterior chamber and examined for fibrinogen concentration 1 day later. Fibrinogen levels were also measured in the aqueous in 8 unoperated eyes.. Steroid-treated eyes achieved the lowest inflammatory score, followed by NSAID eyes, artificial tears eyes, and untreated eyes. The mean fibrinogen concentrations in the aqueous humor were 69.1 mg% untreated, 52.0 mg% artificial tears, 18.5 mg% NSAIDs, and 2.8 mg% steroids (P=.002).. Measurement of aqueous fibrinogen after lens extraction surgery in a rabbit animal model was simple and provided a useful parameter for precise evaluation of postoperative intraocular reaction. Steroids and NSAIDs were effective in reducing postoperative inflammation. Steroids reduced inflammation to almost undetectable values.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Acute-Phase Reaction; Animals; Anti-Inflammatory Agents, Non-Steroidal; Aqueous Humor; Cataract Extraction; Dexamethasone; Diclofenac; Fibrin; Fibrinogen; Glucocorticoids; Inflammation; Male; Postoperative Complications; Rabbits

Ischemia and infection of the distal part of the tracheobronchial anastomosis are the leading causes of bronchial anastomotic leakage with a high morbidity and mortality. To improve interpretation of healing of the anastomosis and the consequences, we have developed a classification scheme that allows quality control and defines early and standardized treatment of complications.. We conducted a retrospective analysis of the records of 202 patients treated in our institution between January 1, 2006 and December 31, 2010 after sleeve lobectomy. All patients received prophylactic inhalation with tobramycin 80 mg twice a day. Neoadjuvant treatment was given in 21% of the patients. Routine bronchoscopy on day 7 was performed with classification of the anastomosis as follows: X, unknown; 1, healing well with no fibrin deposits; 2, focal fibrin deposits and superficial (mucosal) necrosis; 3, circular fibrin deposits, superficial (mucosal) necrosis, and/or ischemia of the distal mucosa; 4, transmural necrosis with instability of the anastomosis; and 5, perforation, necrosis of the anastomosis, and insufficiency.. The anastomosis was graded as satisfactory (1 and 2) in 86% of the patients. In 14%, it was regarded as critical (≥3-5) leading to systemic antibiotic treatment and control bronchoscopy. The overall 30-day mortality was 1%.. Quality control of the tracheobronchial anastomosis comprised bronchoscopy performed before patients were dismissed. Inasmuch as postoperative bronchoscopy is not always performed by the operating surgeon, this classification is an aid to improve the description of endobronchial healing and to commence treatment of critical bronchial healing.

Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Bronchi; Bronchoscopy; Female; Fibrin; Germany; Humans; Male; Middle Aged; Necrosis; Pneumonectomy; Postoperative Complications; Quality Indicators, Health Care; Retrospective Studies; Time Factors; Trachea; Treatment Outcome; Wound Healing

Recently, efforts to control the propagation of the fibrin gel matrix (FGM) are under investigation as a means of limiting the formation of post-surgical adhesions (PSAs). A series of polymeric biomaterials based on block co-polymers of methacrylic acid (MA) and methoxypolyethylene glycol methacrylate (PEGMA) have been synthesized and characterized in order to study the impact of molecular architecture on the performance of these materials in suppressing FGM development. A robust synthetic strategy has been developed to facilitate the well controlled variation of numerous structural properties, including the relative size of each polymer block, the total polymer length, and the length of poly(ethylene glycol) (PEG) chain length, and to incorporate the fibrin-targeting pentapeptide cysteine-arginine-glutamic acid-lysine-alanine (CREKA). Preliminary investigations, based on quartz crystal microgravimetry (QCM), indicate the importance of molecular architecture in modulating the FGM propagation from model surfaces.

Topics: Chromatography, High Pressure Liquid; Fibrin; Fibrosis; Gels; Hydrolysis; Molecular Structure; Oligopeptides; Polymers; Postoperative Complications; Proton Magnetic Resonance Spectroscopy; Quartz Crystal Microbalance Techniques

Cardiac surgery performed on cardio-pulmonary bypass (CPB) may be complicated by coagulopathy and bleeding. This prospective observational study investigated the CPB-induced changes in thrombin generation, fibrin formation, and in the platelet component of the whole blood clot elasticity. The effects of haemostatic therapy with fresh frozen plasma (FFP) and platelet concentrate on these parameters were also evaluated.. In 90 cardiac surgery patients, thrombin generation was measured using the calibrated automated thrombogram, fibrin formation was assessed as the maximum clot elasticity of the fibrin-based clot in the thromboelastometry FIBTEM test (MCE(FIBTEM)), and the platelet component was defined as the difference in maximum elasticity between the whole blood clot obtained through extrinsic activation and the fibrin-based clot (MCE(EXTEM)-MCE(FIBTEM)). Blood samples were collected before surgery, immediately after CPB, and after administration of FFP or FFP and platelet concentrate.. Following CPB, the endogenous thrombin potential decreased to 93%, from median 1485 (interquartile range 1207, 1777) to 1382 (1190, 1533) nM*min (P>0.05), MCE(FIBTEM) decreased to 62%, from 21 (19, 29) to 14 (12, 19) (P<0.001), and the platelet component to 73%, from 139 (119, 174) to 101 (87, 121) (P<0.001). Administration of 11 (10, 13) ml per kg of bodyweight (ml/kgbw) FFP (40 patients), or of 13 (10, 18) ml/kgbw FFP and 7 (5, 9) ml/kgbw platelet concentrate (18 patients) brought no statistically significant changes in these parameters.. Fibrin formation is more impaired than thrombin generation and the platelet component of the whole blood clot immediately after cardiopulmonary bypass.

Topics: Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Female; Fibrin; Humans; Male; Middle Aged; Platelet Count; Postoperative Complications; Prospective Studies; Thrombin

Despite advances in surgical methods, postsurgical adhesions (PSA) remain a significant clinical challenge affecting millions of patients each year. These permanent fibrous connections between tissues result from the bridging of wounded internal surfaces by an extended fibrin gel matrix (FGM). Adhesion formation is a result of a systems level convergence of wound healing pathways, complicating the design of materials that could inhibit their occurrence. In this study, a systematic approach that identifies key material properties required for functional performance optimization was used to design a new fibrin-targeted PSA prevention material. A series of multifunctional polymers with varied molecular architectures was synthesized to investigate the effect of changing polymer structural parameters on the ability to disrupt the formation of an extended FGM. Initial studies in a murine adhesion model demonstrated a statistically significant reduction in the degree of PSA formation, demonstrating the potential value of this systematic approach.

Topics: Animals; Biocompatible Materials; Cell Adhesion; Cell Line; Female; Fibrin; Humans; Materials Testing; Mice; Mice, Inbred BALB C; Polymers; Postoperative Complications; Tissue Adhesions; Tissue Culture Techniques

Soluble fibrin (SF) and D-dimer are useful for making the diagnosis of deep vein thrombosis (DVT). However, the evidence for using such markers and optimal timing to diagnose postoperative DVT are unclear. We evaluate the usefulness of SF and D-dimer testing for the diagnosis of postoperative DVT. A total of 207 patients who had total hip arthroplasty or knee arthroplasty were evaluated. SF and D-dimer were tested on postoperative days 1 and 7. DVT was confirmed with ultrasonography. SF level on postoperative day 1 was the most useful, although D-dimer evaluation on postoperative days 1 and 7 was also useful. Using a SF cut-off of more than 4.00 microg ml(-1), the sensitivity was 90%, the specificity was 33%. Although the SF and D-dimer tests cannot be used as stand-alone tests, SF and D-dimer are valuable screening tools. We recommend two-stage screening including first with the SF or D-dimer test, followed by ultrasonography or venography.

Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Postoperative Complications; Sensitivity and Specificity; Solubility; Ultrasonography; Venous Thrombosis

The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP 21 mmHg with maximum tolerated medications) including 21 eyes. All of the patients had at least one quadrant without peripheral anterior synechia in gonioscopy. After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. Success was defined as IOP

Topics: Aged; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Chronic Disease; Female; Fibrin; Follow-Up Studies; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Macular Edema; Male; Middle Aged; Ophthalmologic Surgical Procedures; Phacoemulsification; Postoperative Complications; Prospective Studies; Tomography, Optical Coherence; Treatment Outcome; Viscoelastic Substances

Soluble fibrin (SF) and D-dimer are considered to be useful for the diagnosis of thrombosis; however, the efficacy of the diagnosis of deep vein thrombosis (DVT) after orthopaedic surgery by SF and D-dimer is still not well established. The present study was designed to evaluate the efficacy of SF and D-dimer in the diagnosis of DVT after orthopaedic surgery. The plasma concentrations of SF and D-dimer were measured in 99 patients following orthopaedic surgery. The plasma concentrations of D-dimer and SF in patients undergoing orthopaedic surgery were markedly high in comparison to healthy volunteers, and these markers were increased after surgery. The plasma concentrations of D-dimer were significantly higher in patients with DVT than in those without DVT at days 4, 7, 10 and 14, and those of SF were significantly higher in patients with DVT than in those without DVT at days 1, 4 and 14. A receiver operating characteristic (ROC) analysis of SF and D-dimer for diagnosis of DVT after surgery generated an ROC curve that showed SF to be better than D-dimer at day 1, while D-dimer was better than SF at day 4. In addition, less than 7.2 microg/ml of D-dimer or 3.6 microg/ml of SF at day 1 after surgery, or less than 7.0 microg/ml of D-dimer at day 4 excluded DVT. These findings suggest that the D-dimer and SF are useful for the diagnosis and exclusion of DVT after orthopaedic surgery.

Topics: Aged; Case-Control Studies; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; ROC Curve; Venous Thrombosis

Filamentous fibrin strands (FSs) attached to valve prostheses have been well described in patients undergoing transesophageal echocardiography, but the frequency and clinical significance of these strands remain poorly defined. The aims of this study were to determine the frequency of prosthetic valve strands and to assess their significance in relation to clinical cerebral ischemic events (CIEs) and anticoagulant status.. Three hundred consecutive patients with 421 prosthetic heart valves were evaluated for the presence of FSs (highly mobile, filamentous masses<1 mm thick).. FSs were found in 139 patients (49%) and 147 prostheses (38%) in patients with left-sided prostheses, with a significant association between FSs, CIEs, and anticoagulant status (P<.001). A lower international normalized ratio (<2.5) had a positive association with the occurrence of CIEs.. There is a significant association between FSs, CIEs, and patient's anticoagulant status; therefore, aggressive anticoagulation and close follow-up are recommended for these patients.

Topics: Adolescent; Adult; Comorbidity; Female; Fibrin; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Incidence; Iran; Male; Middle Aged; Postoperative Complications; Risk Assessment; Risk Factors; Thrombosis; Ultrasonography; Young Adult

Postoperative fibrin pupillary-block glaucoma, an uncommon complication of intraocular surgery, develops when an inflammatory fibrin membrane occludes the pupil, resulting in peripheral angle closure. We present a series of 4 patients with this condition and describe the role of anterior segment optical coherence tomography and ultrasound biomicroscopy in distinguishing fibrin pupillary-block glaucoma from other forms of postoperative acute glaucoma. Specific to this condition is the presence of a fibrin membrane across the pupil and accumulation of aqueous in the posterior chamber, as would be expected in pupil block, but with a clear separation between the intraocular lens and the iris. The possible risk factors are discussed and various treatment modalities reviewed.

Topics: Aged; Anterior Eye Segment; Female; Fibrin; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Lasers, Solid-State; Lens Implantation, Intraocular; Male; Microscopy, Acoustic; Middle Aged; Phacoemulsification; Postoperative Complications; Pupil Disorders; Tomography, Optical Coherence

Topics: Adolescent; Adult; Comorbidity; Female; Fibrin; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Incidence; Iran; Male; Middle Aged; Postoperative Complications; Risk Assessment; Risk Factors; Thrombosis; Ultrasonography; Young Adult

We report the early failure of two tissue valves within hours of surgery due to the accumulation of cellular debris in two different institutions in the United Kingdom. The valves were both found at explant to be covered in a cellular material - possibly fibrin. From clinical experience and careful review of the literature we have found no other reports of such early valve failure due to the build up of material on the structure of the valve. This rare occurrence needs to be reported in the literature to forewarn clinicians of an early complication that may not be recognized yet.

Topics: Aged; Aortic Valve Stenosis; Bioprosthesis; Device Removal; Fatal Outcome; Female; Fibrin; Heart Valve Prosthesis; Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Thrombosis; Ventricular Dysfunction, Left

Prosthetic heart valve obstruction is a severe and potentially fatal complication. We present a patient with a Bjork-Shiley prosthetic mitral and aortic valve implantation and recurrent pulmonary edema. Echocardiogram showed a rate-dependent "obstruction alternans" of the prosthetic mitral valve due to pannus formation.

Topics: Aged; Aortic Valve; Echocardiography, Doppler; Electrocardiography; Female; Fibrin; Heart Failure; Heart Rate; Heart Valve Prosthesis; Humans; Mitral Valve; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Pulmonary Edema; Reoperation; Thrombosis

To evaluate the interest of fibrin PRF clots, a concentrate of platelets and immune factors, for the optimization of the adipocyte graft according to the technique of facial lipostructure described by S. Coleman.. Between May 2005 and June 2006, 32 patients (7 men and 25 women) benefited from a Coleman lipostructure with the use of PRF. The average age was 59 years (39 to 72 years). Lipostructure was used alone in 22 patients and associated with a face lift and/or a blepharoplasty in 10 patients. Before the adipocyte graft, a mixture of PRF and greasy supernatant (resulting from the purification of the sample of adipocytes) is deposited on the zones to be grafted in the same way as for lipostructure. For 2 patients, the pretreatment of the site to be grafted with PRF was unilateral. Patients were followed-up for one year.. In this series, all the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. In the 2 patients treated with unilateral use of PRF, one notes a light asymmetry, the hemi-face treated with PRF appearing more stable than the side without PRF. No important residual oedema or echymosis were seen on the 3rd post-operative week.. By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft. Further studies are necessary to validate the interest of the PRF during aesthetic lipostructures. The potential uses in plastic surgery of such a biomaterial, easy and fast to produce, without any overcost and with no risk, are very numerous and require from now on to be tested and validated methodically.

Topics: Adipocytes; Adult; Aged; Blepharoplasty; Blood Platelets; Esthetics; Face; Female; Fibrin; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Rhytidoplasty; Treatment Outcome

To compare median patency times after treatment of malfunctioning tunneled hemodialysis catheters by one of three techniques: over-the-wire catheter exchange (CE), fibrin sheath stripping (FSS) from a femoral vein approach, and over-the-wire catheter removal with balloon dilation of fibrin sheath (DFS) followed by catheter replacement with use of the same tract.. Retrospective study was conducted of 66 consecutive procedures performed over a period of 47 months for poor flow through tunneled hemodialysis catheters despite tissue plasminogen activator infusion trials (CE, n=33; FSS, n=18; DFS, n=15). Baseline parameters (time since initial catheter placement, number of previous catheter interventions, catheter access site, and patient age and sex) were recorded to identify possible pretreatment differences among groups. Outcome comparison was based on duration of adequate catheter function on dialysis during follow-up.. No significant differences in baseline parameters were identified among the three groups (P>.05). Mean follow-up duration (67+/-89 days; range, 0-398 d) was similar among the three groups. The immediate technical success rate was 100%, and there were no complications. Cumulative catheter patency rates were 73% (CE), 72% (FSS), and 65% (DFS) at 1 month; 43% (CE), 60% (FSS), and 39% (DFS) at 3 months; and 28% (CE), 45% (FSS), and 39% (DFS) at 6 months. Median duration of patency was similar among groups (P=.60).. All three therapies were equivalent in terms of immediate technical success, complication rates, and durability of catheter function during later follow-up. Hence, when one technique is chosen over another, factors other than the period of secondary patency should be considered, such as cost and patient and physician preference.

Topics: Adult; Aged; Aged, 80 and over; Catheterization; Catheterization, Central Venous; Catheters, Indwelling; Equipment Failure; Female; Femoral Vein; Fibrin; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Postoperative Complications; Radiography, Interventional; Renal Dialysis; Retrospective Studies; Tissue Plasminogen Activator; Treatment Outcome; Vascular Patency

Cardiopulmonary bypass and coronary artery bypass grafting (CABG) result in significant thrombin generation and activation of fibrinolysis. Thrombin contributes to myocardial ischemia-reperfusion injury in animal studies, but the role of thrombin in myocardial damage after CABG is unknown.. We measured thrombin generation and fibrin turnover during reperfusion after CABG to evaluate their associations with postoperative hemodynamic changes and myocardial damage.. One hundred patients undergoing primary, elective, on-pump CABG were prospectively enrolled. Plasma prothrombin fragment F(1+2) and D-dimer were measured preoperatively and at seven time points thereafter. Mass of the Mb fraction of creatine kinase (Ck-Mbm) and troponin T (TnT) were measured on the first postoperative day.. Reperfusion induced an escalation of thrombin generation and fibrin turnover despite full heparinization. F(1+2) during early reperfusion associated with postoperative pulmonary vascular resistance index. F(1+2) at 6 h after protamine administration correlated with Ck-Mbm (r = 0.40, P < 0.001) and TnT (r = 0.44, P < 0.001) at 18 h postoperatively. Patients with evidence of myocardial damage (highest quintiles of plasma Ck-Mbm and TnT) had significantly higher F(1+2) during reperfusion than others (P < 0.002). Logistic regression models identified F(1+2) during reperfusion to independently associate with postoperative myocardial damage (odds ratios 2.5-4.4, 95% confidence intervals 1.04-15.7).. Reperfusion caused a burst in thrombin generation and fibrin turnover despite generous heparinization. Thrombin generation during reperfusion after CABG associated with pulmonary vascular resistance and postoperative myocardial damage.

Topics: Adult; Aged; Aged, 80 and over; Coronary Artery Bypass; Female; Fibrin; Heparin; Humans; Male; Middle Aged; Myocardial Ischemia; Postoperative Complications; Prospective Studies; Reperfusion Injury; Thrombin

To evaluate the efficacy and safety of tissue plasminogen activator in management of postoperative fibrinous uveitis.. Prospective study, interventional case series including 13 patients who developed fibrinous membrane in anterior chamber; patients were operated for cataract (4 cases), for cataract and glaucoma (7 cases) and for corneoscleral lacerations (2 cases). Initial treatment consisted of corticosteroid administration (topically, subconjunctival +/- systemic) and mydriatic-cycloplegic drugs. Inadequate response imposed intracavitary administration of tissue plasminogen activator (25 microg/ml, 0.2 ml). The main outcomes were: complete resolution of fibrinous membrane, presence of adverse events and visual rehabilitation.. Fibrinous membrane resorption starts in the next hours and complete resolution was proved in all cases after a mean time 53.55 +/- 37.65 (24-146) hours. In 12 patients we used only one administration of tissue plasminogen activator, but in one case we repeated it. It was not signaled any adverse event drug related. It was an important increase of visual acuity in all cases.. Intracavitary administration of tissue plasminogen activator is a safe and efficient alternative in the management of postoperative fibrinous membrane.

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Algorithms; Cataract Extraction; Drug Therapy, Combination; Eye Diseases; Female; Fibrin; Fibrinolytic Agents; Humans; Injections, Intralesional; Male; Middle Aged; Postoperative Complications; Prospective Studies; Tissue Plasminogen Activator; Uveitis; Visual Acuity

The Baylor Gyro BVAD is under development with the final goal of establishing a totally implantable biventricular assist system (BVAD). The aim of this study was to evaluate the safety, reliability, and effectiveness of the device in a long-term in vivo model.. The BVAD was implanted into eight calves for longer than 4 weeks in a biventricular bypass fashion, with the native heart remaining. Pump performance was assessed with the system's digital data acquisition unit. Postoperatively, anticoagulation was maintained with i.v. heparin perfusion (ACT< or = 250 sec) gradually replaced by coumadin. Treadmill exercise tests were performed daily following a 10-day reconvalescence period after surgery.. The animals were kept alive for 37-90 days. The pumps yielded average flows of 5.3 +/- 1.1 l/min and 4.9 +/- 0.7 l/min for the LVAD and RVAD, respectively. Power consumption was 8.2 +/- 2.7 W and 9.6 +/- 4.7 W at 1935 +/- 123 rpm and 2015 +/- 365 rpm, respectively. All cases exhibited low hemolysis; renal and liver function were kept normal throughout the experiments. The animals demonstrated no thromboembolic neurological symptoms and tolerated moderate treadmill exercise.. The Baylor Gyro BVAD demonstrated effective and reliable in vivo performance with acceptable biocompatibility. Based on these studies, we conclude that the system will be suitable as a long-term totally implantable BVAD for uses intended for longer than two years.

Topics: Animals; Biomarkers; Cardiac Output; Cattle; Creatinine; Equipment Design; Equipment Safety; Exercise Test; Fibrin; Heart Rate; Heart Ventricles; Heart-Assist Devices; Implants, Experimental; Models, Animal; Models, Cardiovascular; Myocardial Contraction; Postoperative Complications; Prosthesis Implantation; Reference Values; Regional Blood Flow; Treatment Outcome; Ventricular Function

To observe effects of ACOL on fibrinogen (FIB), fibrin degrading products (FDP) and changes of FIB and FDP concentration in rabbits with intro-abdominal exudates during 7 d after major abdominal surgery.. Sixty New Zealand rabbits were randomly divided into 4 groups: ACOL group, the control group, DCT group and the normal group. After being modeled, except the normal group, the other 3 groups were treated with different ways for a week; the intro-abdominal exudates of rabbits in the 4 groups were drawn for FIB and FDP measurement once daily during 7 d after major abdominal surgery.. FIB and FDP in the intro-abdominal exudates altered in a regular way and ACOL could change the concentration of FIB and FDP in the intra-abdominal exudates after major abdominal surgery.. ACOL can prevent intestinal adhesion by reducing the concentration of FIB and raising that of FDP in the intro-abdominal exudates after major abdominal surgery.

Topics: Abdomen; Animals; Ascitic Fluid; Drugs, Chinese Herbal; Exudates and Transudates; Female; Fibrin; Fibrinogen; Male; Postoperative Complications; Rabbits; Tissue Adhesions

Topics: Anterior Chamber; Cataract; Fibrin; Fibrinolysis; Glaucoma; Humans; Plasminogen Activators; Postoperative Complications; Tissue Plasminogen Activator

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gram-negative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.

Topics: Aorta, Abdominal; Aortic Diseases; Bacteriological Techniques; Biofilms; Blood Vessel Prosthesis; Coated Materials, Biocompatible; Collagen; Fibrin; Gram-Positive Cocci; Gram-Positive Rods; Granulation Tissue; Humans; Intestinal Fistula; Ischemia; Leg; Leriche Syndrome; Male; Microscopy, Electron; Middle Aged; Polyesters; Postoperative Complications; Prosthesis-Related Infections

To investigate the efficacy of tissue plasminogen activator (tPA) in the treatment of severe fibrinous anterior chamber reactions after intraocular surgery.. Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece.. The study comprised routine surgical and postoperative cases selected in a nonrandomized fashion. Low-dose tPA infusion (0.2 mL of 125 microg/mL) was administered through a side-port in the anterior chamber in 25 patients with recent or long-standing fibrin formation after cataract extraction (n = 13), trabeculectomy (n = 5), combined procedure (n = 5), or penetrating keratoplasty (n = 2). Patients were treated 4 to 25 days postoperatively (mean 7 days).. Fibrin lysis was observed 2 to 12 hours after tPA infusion. No hemorrhage or other complications occurred, and no further treatment was necessary in any patient. Three cases of delayed partial fibrin lysis resolved with intense topical steroid treatment. There were no recurrences over the 3-month follow-up.. Low-dose tPA was an effective and safe method for the management of anterior chamber fibrin formation. Treatment was well tolerated and gave excellent results with no complications.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Cataract; Female; Fibrin; Fibrinolysis; Glaucoma; Humans; Male; Middle Aged; Phacoemulsification; Plasminogen Activators; Postoperative Complications; Safety; Thrombolytic Therapy; Tissue Plasminogen Activator; Trabeculectomy

Topics: Aged; Anticoagulants; Aortic Valve; Bioprosthesis; Device Removal; Fibrin; Heart Valve Prosthesis; Humans; Male; Microscopy, Electron, Scanning; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Surface Properties; Thrombolytic Therapy; Thrombosis; Treatment Failure

Topics: Anterior Chamber; Cataract Extraction; Child; Child, Preschool; Fibrin; Fibrinolytic Agents; Fibrosis; Heparin, Low-Molecular-Weight; Humans; Lens Capsule, Crystalline; Postoperative Complications; Risk Factors; Vitrectomy

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Drug Synergism; Drug Therapy, Combination; Exudates and Transudates; Female; Fibrin; Flurbiprofen; Lens Implantation, Intraocular; Male; Ophthalmic Solutions; Postoperative Complications; Rabbits

Topics: Anterior Chamber; Fibrin; Fibrinolysis; Humans; Phacoemulsification; Plasminogen Activators; Postoperative Complications; Secondary Prevention; Tissue Plasminogen Activator

In a prospective study, coagulation test results were compared in 137 patients with colorectal cancer (CRC) and 39 subjects with benign colorectal diseases. Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and soluble fibrin (SF) were measured in plasma before and after surgery. CRC patients presented with significantly higher values of F1+2 and TAT than controls. Patients with localised CRC had elevated values of F1+2 and TAT, whereas patients with advanced CRC also had elevated SF values. TAT and SF levels correlated with tumour spread, and normal values virtually excluded advanced cancer. Postoperative deep venous thrombosis (DVT) was diagnosed by phlebography in 20% of the CRC patients. Preoperative values of the markers did not predict postoperative DVT, but postoperative values did.

Topics: Adult; Aged; Aged, 80 and over; Antithrombin III; Biomarkers; Biomarkers, Tumor; Blood Coagulation Tests; Case-Control Studies; Colorectal Neoplasms; Female; Fibrin; Humans; Male; Middle Aged; Peptide Fragments; Peptide Hydrolases; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Prothrombin; Severity of Illness Index; Venous Thrombosis

The effects of diclofenac sodium(DFNa) combined with dionine in cases with fibrin exudation membrane on intraocular lens (IOL) were studied.. Thirty-two eyes, derived from sixteen adult pure bred New Zealand rabbits, were divided at random into two groups after extracapsular lens extraction with posterior chamber IOL implantation: (1) rabbits received DFNa eyedrops combined with dionine eyedrops; (2) rabbits received Pred forte eyedrops. The sum of fibrinous exudation membrane on IOL was observed on 1, 3, 5, 7, 14, 21, 30d postoperation.. The fibrin exudations in the DFNa combined with dionine group is less than the pred forte group (P > 0.05).. DFNa combined with dionine is effective in treating fibrin exudation membrane after extracapsular lens extraction and IOL implantation, and it is more effective than the pred forte.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Drug Synergism; Drug Therapy, Combination; Ethylmorphine; Exudates and Transudates; Fibrin; Lens Implantation, Intraocular; Male; Membranes; Ophthalmic Solutions; Postoperative Complications; Rabbits; Random Allocation

To find a reasonable method for treating and preventing fibrinous membrane after intraocular lens (IOL) implantation by using diclofenac sodium or dionine topically.. Forty-eight eyes of twenty-four adult pure bred New Zealand rabbits were divided into three groups randomly. Group A: rabits received diclofenac sodium eyedrops; Group B: rabbits received dionine eyedrops; Group C: controlled. All the eyes received lens extraction combined with posterior chamber intraocular lens implantation. The fibrinous membrane was observed after 1, 3, 5, 7, 14, 21 and 30 days postoperatively.. The fibrinous membran in Group A was less than that of Group B and Group C, (P < 0.05); the difference between group B and group C on fibrinous membrance was also statistically significant (P < 0.05).. The study suggests that both diclofenac sodium and the dionine eyedrops can treat fibrinous membrane after IOL implantation. The effect of diclofenac sodium is better than that of dionine.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Drug Synergism; Ethylmorphine; Exudates and Transudates; Female; Fibrin; Lens Implantation, Intraocular; Male; Membranes; Ophthalmic Solutions; Postoperative Complications; Rabbits; Random Allocation

Topics: Aged; Anterior Chamber; Anti-Bacterial Agents; Cataract Extraction; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Humans; Injections; Lens Implantation, Intraocular; Male; Postoperative Complications; Staphylococcal Infections; Staphylococcus; Tissue Plasminogen Activator; Vitreous Body

Transplant coronary artery disease is the leading cause of long-term morbidity and mortality in cardiac transplantation. We developed a model for early identification of patients who subsequently develop coronary artery disease and graft failure. Serial biopsies obtained from 141 cardiac allografts (5.5 +/- 0.1 biopsies/patient) during the first 3 months post-transplant were evaluated immunohistochemically for deposition of myocardial fibrin, depletion of arteriolar tissue plasminogen activator, presence of arterial/arteriolar endothelial activation markers, and changes in vascular antithrombin. An immunohistochemical risk score was developed with a minimum value of 0 (normal) and a maximum value of 4 (most abnormal). Scores of 0 (low risk), 0.5-3.0 (moderate risk), and 3.5-4.0 (high risk) were analyzed for association with graft failure and development, severity, and progression of coronary artery disease detected using serial coronary angiograms (3.9 +/- 0.2/patient). Allografts with high immunohistochemical risk scores in the first 3months post-transplant developed more coronary artery disease (p<0.001), developed coronary artery disease earlier (p<0.001), developed more severe disease (p<0.001), and showed more disease progression (p<0.001) than allografts with moderate or low scores. Allografts with high immunohistochemical risk scores in the first 3 months post-transplant failed more (p<0.001) and failed earlier (p<0.001) than allografts with moderate or low scores. The present study demonstrates that early changes in the microvasculature are associated with impending coronary artery disease and graft failure in cardiac allograft recipients and suggests that treatment needs to be instituted early after transplantation in order to improve outcome.

Topics: Actins; Adult; Antibodies, Monoclonal; Biopsy; Cardiomyopathy, Dilated; Coronary Disease; Fibrin; Heart Transplantation; HLA-DR Antigens; Humans; Immunohistochemistry; Middle Aged; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Tissue Plasminogen Activator; Transplantation, Homologous

Topics: Cataract Extraction; Fibrin; Fibrinolysis; Fibrinolytic Agents; Humans; Membranes; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

Topics: Cataract Extraction; Child; Coated Materials, Biocompatible; Fibrin; Fibrinolysis; Fibrinolytic Agents; Heparin; Humans; Lenses, Intraocular; Membranes; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

The use of recombinant tissue plasminogen activator (r-TPA) has been advocated in the treatment of postsurgical fibrinous membrane formation following cataract surgery in adults. Its use in paediatric cases is not well documented.. A retrospective review of paediatric cataract extractions performed at Moorfields Eye Hospital between 1 January 1997 and 4 April 1999 was carried out.. Cataract extractions were performed in 37 patients, 22 in males 15 in females. Four (9.2%) underwent intracameral injection of 25 microg r-TPA. They were all females of Afro-Caribbean origin. The time to injection varied from 4-14 days, mean 7.2 days. Complete resolution of the fibrinous membrane was seen in all cases. There were no complications by the 3 month follow up.. r-TPA may be used safely and effectively at a dose of 25 microg for the treatment of severe fibrinous membranes following paediatric cataract extraction. It aided the visual recovery of the children and also allowed a reduced regimen of topical steroid therapy to be used postoperatively.

Topics: Anterior Chamber; Cataract Extraction; Child; Child, Preschool; Female; Fibrin; Fibrinolytic Agents; Fibrosis; Humans; Infant; Male; Postoperative Complications; Serine Endopeptidases; Tissue Plasminogen Activator; Visual Acuity

To examine whether the specific thrombin inhibitor argatroban can prevent anterior chamber, pupillary area, and anterior vitreous fibrin formation after vitrectomy and lensectomy in rabbits.. Argatroban was infused into the vitreous cavities of Japanese albino rabbits for 5 minutes after pars plana vitrectomy and lensectomy. Slitlamp microscopy and indirect ophthalmoscopy were performed at postoperative hours 0.5, 1, 2, 3, and 6, and at postoperative days 1, 2, 3, and 7, and the amounts of fibrin formation in the anterior chamber, pupillary area, and anterior vitreous were scored from grade 0 to 4.. Argatroban prevented fibrin formation from 0.5 hours postoperatively in a dose-dependent manner. In the eyes treated with 0.01% argatroban, the median score for postoperative fibrin formation was significantly less than that in control eyes between hours 1 and 3 (hour 1, P =.02; hour 2, P =.005; and hour 3, P =.003); the eyes treated with 0.003% argatroban also had significantly less fibrin than control eyes between 1 and 2 hours (hour 1, P =.005; hour 2, P =.03).. These results indicate that argatroban inhibits intraocular fibrin formation in an experimental rabbit model.. Argatroban may be useful clinically in cases that often produce fibrin postoperatively, such as proliferative vitreoretinopathy and proliferative diabetic retinopathy.

Topics: Animals; Anterior Chamber; Antithrombins; Arginine; Dose-Response Relationship, Drug; Fibrin; Lens, Crystalline; Ophthalmic Solutions; Pipecolic Acids; Postoperative Complications; Rabbits; Sulfonamides; Time Factors; Vitrectomy; Vitreous Body

The aim of the present study was to study whether patients developing anastomotic leakage after colorectal resections for colorectal cancer have laboratory signs of an altered hemostatic balance in the systemic circulation, preoperatively and postoperatively, causing an impaired healing process.. Patients operated on for colorectal cancer were studied. Seventeen consecutive patients with anastomotic leakage and 17 patients without anastomotic leakage were matched according to age, gender, tumor stage, and localization of tumor. Hemostatic balance was estimated preoperatively and at one, two, and seven days and at three months after surgery by plasma levels of sensitive markers of coagulation activation and fibrinolysis, i.e., prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, tissue-type plasminogen activator activity, and plasminogen activator inhibitor Type 1.. Preoperatively, the hemostatic balance was comparable in patients with and without anastomotic leakage. In the early postoperative period, patients developing anastomotic leakage exhibited signs of systemic coagulation activation, i.e., elevated plasma levels of prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, and plasminogen activator inhibitor Type 1. The observed coagulation activation appeared before the anastomotic leakage became clinically evident. More patients with anastomotic leakage received perioperative blood transfusions than patients without leakage, despite the fact that duration of surgery and intraoperative blood loss were comparable in the two groups.. Enhanced coagulation activity was observed postoperatively in patients developing anastomotic leakage after colorectal resections for colorectal cancer. Such a hypercoagulable state may contribute to the development of anastomotic leakage by facilitating formation of microthromboses in the perianastomotic area.

Topics: Age Factors; Anastomosis, Surgical; Blood Coagulation; Colorectal Neoplasms; Female; Fibrin; Fibrinolysis; Humans; Male; Middle Aged; Neoplasm Staging; Plasminogen Activator Inhibitor 1; Postoperative Complications; Prothrombin; Sex Factors; Surgical Wound Dehiscence; Thrombin

Plasma fibronectin (Fn) can both enhance phagocytic clearance of microparticulate debris by macrophages as well as incorporate it into the lung extracellular matrix (ECM). The goal of this study was to document that N-ethylmaleimide (NEM)-treated human plasma Fn (HFn) would lose its ability to incorporate into the lung ECM in vivo even though it would retain its ability to stimulate test particle phagocytosis and bind to fibrin. Using dual-label immunofluorescence, we compared the lung deposition of purified normal HFn and NEM-alkylated HFn (NEM-HFn) after their intravenous injection into postoperative nonbacteremic and bacteremic sheep in relationship to the localization of endogenous sheep Fn. Two days after a sterile surgical thoracotomy, sheep were infused with either 5 x 10(8) Pseudomonas aeruginosa (postsurgical bacteremic model) or the diluent (nonbacteremic model). They also received a bolus 100-mg injection (5 min) of either HFn or NEM-HFn. Analysis of serial lung biopsies harvested at 2-h intervals demonstrated little deposition of NEM-HFn compared with HFn in the lung interstitial matrix of postoperative nonbacteremic sheep. In contrast, enhanced deposition of both HFn and NEM-HFn was observed in the lungs of postoperative bacteremic sheep. However, in the lungs of bacteremic sheep, HFn displayed a diffuse fibrillar deposition pattern in the lung characteristic of ECM incorporation, whereas the enhanced NEM-HFn deposition, especially in the interstitial ECM region of the lung, was primarily focal and punctate, with very little fibrillar incorporation. Immunofluorescent analysis with antibodies specific to fibrinogen, Fn, and lung macrophage surface antigens coupled with immunoperoxidase staining for HFn antigen revealed that the punctate fluorescence pattern was due to both the binding of HFn to fibrin and its colocalization with inflammatory cells. Thus treatment of plasma Fn with low concentrations of NEM will limit its normal in vivo fibrillar incorporation into the interstitial ECM region of the lung.

Topics: Alkylation; Animals; Ethylmaleimide; Extracellular Matrix; Fibrin; Fibronectins; Hemodynamics; Humans; Immunoenzyme Techniques; Lung; Postoperative Complications; Sepsis; Sheep

Topics: Anterior Chamber; Aphakia; Fibrin; Foreign-Body Migration; Humans; Iris; Membranes; Postoperative Complications; Pseudophakia; Silicone Oils

To determine the efficacy of topical tissue plasminogen activator (tPA) for the resolution of postoperative or inflammatory intraocular fibrinous exudates.. Each treatment consisted of drops of 1 mg/ml tPA given 9 times 5 minutes apart. Records were reviewed and the results at 24 and 48 hours were recorded. Sixty-two patients had a total of 94 treatments.. Fibrin exudates following intraocular surgery in 34 patients were treated 44 times. In 6 patients there was a positive result. Fibrin associated with intraocular infection was treated in 9 patients. None showed clear improvement. Nineteen patients had a total of 34 treatments for poorly controlled intraocular pressure (IOP) after glaucoma surgery. Five patients showed adequate control of the IOP, 12 did not change, and 2 had a questionable improvement. Eleven patients had adequate IOP control after additional treatment. Seven required suture lysis, 2 ab interno bleb revision, and 2 YAG capsulotomy or iridotomy to reduce the IOP to an acceptable level.. Within the limits of this retrospective study and taking into account that fibrin may resolve spontaneously, it appears that topical tPA drops are not effective for the liquefaction of intraocular fibrin after surgery or in association with intraocular inflammation. They did not improve IOP control after glaucoma surgery.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Eye Diseases; Female; Fibrin; Fibrinolysis; Follow-Up Studies; Humans; Intraocular Pressure; Male; Middle Aged; Ophthalmologic Surgical Procedures; Plasminogen Activators; Postoperative Complications; Retrospective Studies; Tissue Plasminogen Activator; Treatment Outcome

To evaluate the efficacy of intraocular infusion of troxerutin in the inhibition of fibrin formation after vitrectomy in a rabbit model.. Lensectomies and vitrectomies were performed in a masked fashion on seven eyes treated with a 10-mM infusion of troxerutin and on seven control eyes that received only a balanced salt solution infusion. Masked grading of intraocular fibrin formation and intravitreal hemorrhage was performed for 1 week.. On postoperative days 1 and 2, the control group exhibited a greater mean fibrin index (MFI) percentage than the troxerutin-treated group (day 1, 27.7% versus 19.5% MFI; day 2, 14.5% versus 6.1% MFI, respectively). On postoperative day 3, both groups showed an MFI of 1.8%. On postoperative days 5 and 7, both groups showed only minimal presence of fibrin. Neither of the two groups had an increased rate of intraocular hemorrhage.. Infusion of 10 mM troxerutin resulted in a relative decrease in the amount of fibrin produced without an increased risk of intraocular hemorrhage in treated eyes compared with controls, but the difference was not statistically significant. Further studies may be warranted to evaluate the optimal dose of troxerutin alone or a possible role for its use in conjunction with other drugs employing a different mechanism of action in the prevention of fibrin formation.

Topics: Animals; Anticoagulants; Fibrin; Fibrinolysis; Follow-Up Studies; Hydroxyethylrutoside; Injections; Postoperative Complications; Rabbits; Treatment Outcome; Vitrectomy

We report the first case in which a fluid-blood interface was identified at autopsy in a patient with acute intracerebral hematoma on anticoagulant therapy. Anticoagulation may be one of the major factors contributing to the production of an intracerebral blood sedimentation level.

Topics: Aged; Anticoagulants; Blood Sedimentation; Blood-Brain Barrier; Brain; Cerebral Hemorrhage; Fibrin; Heart Valve Prosthesis Implantation; Hematoma; Humans; Male; Mitral Valve Stenosis; Postoperative Complications; Warfarin

Postsurgical adhesions represent a common complication following a variety of surgical procedures. We sought to develop and evaluate a water-soluble polymer that could self-assemble onto tissue surfaces, forming a barrier on the surface. A copolymer was synthesized so as to contain two components: one component adsorbed to the tissue surface, and the other created a steric barrier, thereby preventing cell interactions with the tissue surface, and perhaps altering the wound-healing response that leads to the formation of fibrous adhesions. The component selected for tissue binding was a water-soluble polycation, poly-L-lysine, which can bind to negative sites on glycoproteins, proteoglycans, and cells; and the component selected for steric stabilization was polyethylene glycol, a nonionic polymer that interacts poorly with proteins. Efficacy of lavage with an aqueous solution of the copolymer for the prevention of postsurgical abdominopelvic adhesions was assessed following a standard electrocautery injury of the uterine horns of rats. The copolymer resulted in an 88% reduction in the extent of adhesions that formed. In vitro studies designed to investigate the mechanism of this efficacy indicated that the copolymer may both hinder cell-tissue adhesive interactions and alter the process of fibrin formation.

Topics: Abdomen; Animals; Anions; Biocompatible Materials; Cell Line; Disease Models, Animal; Female; Fibrin; Hydrolysis; In Vitro Techniques; Macrophages; Pelvis; Polyethylene Glycols; Polylysine; Postoperative Complications; Rats; Tissue Adhesions

Topics: Aged; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Glaucoma; Humans; Injections; Postoperative Complications; Thrombolytic Therapy; Tissue Plasminogen Activator; Trabeculectomy

To investigate the method of treatment of intraocular fibrinous membrane by tissue plasminogen activator (t-PA) after intraocular lens (IOL) implantation and evaluate its clinical results.. 58 eyes of 43 patients after cataract surgery were divided into three groups, and received t-PA anterior chamber (AC) injection or combined with YAG laser therapy at different times after the operation. Group 1 included 26 eyes which received 4 microg t-PA AC injection at the end of operation. In group 2, 22 eyes whose fibrinous membrane was formed 5 - 7 days after the operation were injected with 4 microg t-PA at that time. In group 3, 10 eyes with thicker membrane were given YAG laser treatment at postoperative 5 - 9 days and then 4 microg t-PA was injected into the AC.. In group 1, hyphema occurred in 4 eyes, in 8 eyes at the pupillary region the fibrinous membrane was formed which was completely lysed after t-PA AC injection at postoperative 3 - 5 days. In group 2, the membrane was lysed within 24 hours in 20 of 22 eyes and no hyphema was found. In group 3, the membrane was lysed within 4 - 24 hours after t-PA injection in all cases, and no hyphema occurred.. It is very effective to treat fibrinous membrane formation after IOL implantation by t-PA AC injection at postoperative 1 week when the AC inflammation is well controlled. The combined use of YAG laser with t-PA AC injection is much more effective for the treatment of such a membrane.

Topics: Adolescent; Adult; Aged; Anterior Chamber; Child; Child, Preschool; Female; Fibrin; Humans; Injections; Lens Implantation, Intraocular; Male; Middle Aged; Postoperative Complications; Tissue Plasminogen Activator

The authors studied the effect of a direct acting antithrombin agent, desulfatohirudin variant 1 (Revasc, Ciba-Geigy, Ltd., Basel, Switzerland), on postoperative fibrin formation after cataract surgery in rabbits.. Phacoemulsification was performed in a masked fashion on 28 eyes of 28 New Zealand white rabbits. Ten control group eyes had lactated Ringer's solution in the infusion and an intracameral injection (approximately 1.5 ml) at the end of the case. Ten group 1 eyes received hirudin 100 micrograms/ml in the infusion and intracameral injection. Eight group 2 eyes had 100 micrograms/ml hirudin in the intracameral injection only. Using slit-lamp examination, all eyes were graded for the amount of fibrin and intraocular hemorrhage in a masked fashion on postoperative day 1.. Comparison of the mean postoperative fibrin grade (0-4) in group 1 (mean = 0.3), group 2 (mean = 0.25) and the control group (mean = 3.4) revealed a statistically significant difference between hirudin-treated and control eyes (P = 0.0002 for group 1, P = 0.0005 for group 2). No intraocular hemorrhage was noted in any group.. Recombinant hirudin significantly decreases postoperative fibrin formation in a rabbit cataract extraction model. Intracameral injection of hirudin alone appears to be at least as effective as infusion of hirudin throughout the case. With further study, this agent has potential for use in cataract surgery on patients known to be at high risk for postoperative fibrin formation.

Topics: Animals; Antithrombins; Fibrin; Fibrinolytic Agents; Hirudins; Humans; Injections; Phacoemulsification; Postoperative Complications; Rabbits; Recombinant Proteins; Thrombolytic Therapy

Having changed our cataract operation technique from ECCE to phacoemulsification (PE) we had the impression of less fibrinous membranes postoperatively.. To ascertain whether our impression was correct, we examined the last 2056 IOL implanted cataract patients retrospectively.. In the 2056 cataract cases we found 152 fibrinous reactions (7.4%). We observed after ECCE (n = 586) a 12.8% rate of fibrinous membranes, after phacoemulsification (PE) with sutured 6.5-mm corneoscleral incision (n = 546) 7.0%, and after PE with clear corneal self-sealing 4.1-mm incision (n = 924) only 3.9%. In 56% of these patients we found diabetes, in 13% former uveitis with posterior synechiae, in 11% glaucoma with rigid pupil, and in 10% pseudoexfoliation syndrome. In those cases with no diabetic retinopathy but known diabetes (n = 198), we found a 27% rate of fibrin reactions following ECCE (12 mm), 12% following PE (6.5 mm) and 8% following PE (4.1 mm). In non-proliferative diabetic retinopathy (n = 80) a 32% rate of fibrinous changes was observed after ECCE, 18% after PE (6.5 mm), and 9% after PE (4.1 mm). In cases of uncomplicated ECCE (n = 341) the rate of fibrinous reactions amounted to 22.4% following prolonged procedures (> 50 min) by residents, while it was as low as 9.5% following operations of short duration (< 30 min) by experienced surgeons. Intraocular injection of tPA (25 micrograms) was the most effective treatment.. The self-sealing corneal small incision cataract technique guarantees a short duration of the surgical procedure and the last fibrinous reactions.

Topics: Cataract Extraction; Endophthalmitis; Fibrin; Humans; Lenses, Intraocular; Phacoemulsification; Postoperative Complications; Retrospective Studies

Recombinant tissue plasminogen activator (rTPA) is commonly used in patients with myocardial infarction. Recently, it has also been applied intraocularly to dissolve postoperative fibrin with no serious complications being reported so far. In this study we describe our own experience with rTPA in 25 patients with persisting fibrinous membranes in the anterior segment. rTPA (Actilyse, Dr. Karl Thomae GmbH) was given in a single dose of 25 micrograms and injected into the anterior chamber via a paracentesis. We did not encounter any complications during the injection of rTPA. In 21 eyes fibrin could be reduced significantly, albeit sometimes only slowly. In 13 patients, the membrane had dissolved almost completely by the following day. In contrast, no success was observed after glaucoma surgery (2 eyes) and in chronic iritis (1 eye), or when fibrin mixed with blood was treated (1 eye). There were two (controllable) post-operative hemorrhages (rTPA after vitrectomy, and for fibrin/blood after cataract surgery). In addition, we noted 2 cases of irreversible superficial corneal clouding (rTPA after cataract surgery). We conclude that injection of rTPA can be a useful addition to steroid treatment in selective cases of persisting fibrin in the anterior segment. Long-standing membranes, however, are unlikely to be dissolved. Care should also be taken and rTPA be avoided when there is evidence of recent bleeding. Most worrying to us were the corneal complications that we cannot explain to date. With regard to the definite time correlation we feel that rTPA or one of the solution components might be the cause of this unusual feature.

Topics: Anterior Eye Segment; Eye Diseases; Fibrin; Humans; Injections; Paracentesis; Postoperative Complications; Thrombolytic Therapy; Tissue Plasminogen Activator; Visual Acuity

A template was devised for rapid analysis of the intervals, slopes and peak amplitude of the Sonoclot Signature.

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Platelets; Blood Viscosity; Cardiopulmonary Bypass; Elasticity; Equipment Design; Fibrin; Fibrinogen; Humans; Intraoperative Complications; Liver Transplantation; Monitoring, Intraoperative; Platelet Count; Postoperative Complications; Signal Processing, Computer-Assisted; Time Factors; Ultrasonics

To test the efficacy of a single intraocular injection of various doses of recombinant desulphatohirudin variant 1 (Revasc) in a rabbit model after lensectomy-vitrectomy surgery.. Standard fragmatome lensectomies and core vitrectomies were performed on Dutch Belted rabbits. In a masked fashion, 17 control eyes received single intraocular injections of lactated Ringer's solution, and the treated eyes, with eight eyes per treatment group, received single intraocular injections of hirudin at doses of 0.02 microgram, 2 micrograms, 10 micrograms, 50 micrograms, or 200 micrograms.. Intraocular injections of hirudin were effective in preventing postoperative fibrin formation at doses of 2 micrograms. There was no notable intraoperative bleeding. With an injection of 2.0 micrograms hirudin there was no hemorrhage at any time after surgery; with an injection of 200 micrograms hirudin, however, there was notable bleeding.. Hirudin is effective in the prevention of postoperative fibrin formation with a single intraocular injection of 2.0 micrograms after lensectomy-vitrectomy surgery in the rabbit model. There was no bleeding at the effective dose of 2.0 micrograms; at 100 times the effective dose, however, there was significant postoperative bleeding.

Topics: Animals; Fibrin; Fibrinolysis; Fibrinolytic Agents; Hirudins; Injections; Lens, Crystalline; Postoperative Complications; Rabbits; Recombinant Proteins; Thrombolytic Therapy; Vitrectomy; Vitreous Body

Topics: Female; Fibrin; Humans; Iris Diseases; Laser Therapy; Membranes; Plasminogen Activators; Postoperative Complications; Pupil; Thrombolytic Therapy; Tissue Plasminogen Activator

Since increased intraoperative iris irritation can lead to increased postoperative inflammation, we are interested in postoperative reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy.. From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphincterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early postoperative phase (up to 5 days postoperative) as well as 4 weeks after surgery. Fibrin reaction was classified according to 3 grades, (1) faint fibrinous threads, (II) fibrinous net, and (III) membranous fibrin exsudation.. In the group without additional surgery there was a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphincterectomy in four cases. While the intensity of fibrinous reaction was comparable in the first two groups, the fibrinous reaction after sphincterectomy was more intensive in one eye (grade III). However, response to intensive local antiphlogistic therapy was good. Frequency of fibrinous reaction in the three groups was statistically not significant. It should be pointed out that there was a partial restoration of pupil movements through sphincterectomy: mean pupil diameter was 4 mm, and 2.5 mm under exposure to light. Three patients had no pupillary reaction at all.. Partial sphincterectomy facilities intraoperative manipulations of cataract surgery. Postoperative inflammatory reaction is rare and was very responsive to medical treatment. The reconstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.

Topics: Aged; Aged, 80 and over; Cataract Extraction; Female; Fibrin; Humans; Iris; Lenses, Intraocular; Male; Postoperative Complications; Pupil Disorders; Risk Factors; Surgical Instruments

To determine the efficacy of a specific antithrombin agent (recombinant desulphatohirudin variant 1 [Revasc, Ciba-Geigy, Ltd., Basel, Switzerland]) administered in the infusion fluid to prevent early postoperative fibrin formation in a rabbit lensectomy and vitrectomy model.. Standard fragmatome lensectomies and core vitrectomies were performed prospectively in a masked fashion on ten control eyes with lactated Ringer's infusion and on ten eyes treated with 10 microgram of recombinant hirudin/ml in the infusate. The amounts of fibrin and hemorrhage were graded in a masked fashion by using slit-lamp examination and indirect ophthalmoscopy on postoperative days 1 through 5 and on day 7.. The difference in the mean grade of fibrin formed on the first postoperative day in the eyes treated with recombinant hirudin (mean, 0.9) in relation to the mean grade of fibrin in the control eyes (mean, 3.5) was statistically significant (P = .004). This difference was also significant on the second postoperative day (P = .01). None of the treated eyes developed intraoperative or postoperative hemorrhage.. Recombinant desulphatohirudin variant 1 is an effective inhibitor of postoperative fibrin formation in a rabbit model and is not associated with an increased risk of intraoperative or postoperative bleeding at the tested dose. This drug may be a useful adjunct in vitreous surgery for both proliferative vitreoretinopathy and the complications of proliferative diabetic retinopathy.

Topics: Animals; Antithrombins; Disease Models, Animal; Eye Hemorrhage; Fibrin; Fibrinolysis; Fibrinolytic Agents; Hirudin Therapy; Lens, Crystalline; Postoperative Complications; Prospective Studies; Rabbits; Recombinant Proteins; Thrombolytic Therapy; Vitrectomy

The aim of the present study was to correlate the preoperative plasma levels of TDP in patients with colorectal cancer to tumor stage, metastasis, and postoperative thromboembolic complications.. Ninety-one patients with colorectal cancer, 20 patients with colorectal adenoma, and 71 patients without neoplastic lesions in the colon or rectum were included in this prospective study. Before surgery, total fibrin and fibrinogen degradation products (TDP) were measured in plasma of all patients with a specific enzyme-linked immunosorbent assay test. Phlebography was performed postoperatively in 82 of 91 patients with colorectal cancer.. Median TDP in plasma of patients with colorectal cancer (805 (range, 339-5,024) ng fibrinogen equivalents (ngFE)) was significantly higher than TDP in patients with colorectal adenoma (591 (range, 417-1386) ngFE/ml) and TDP in patients without neoplastic lesions in the colon (632.8 (range, 180-2622) ngFE/ml; P < or = 0.003). In patients with colorectal cancer and liver metastasis, TDP in plasma (1085.5 (range, 468-5024) ngFE/ml) was significantly higher than in patients with localized tumor growth (753 (range, (339-2,780) ngFE/ml; P < or = 0.02). Twenty of 82 patients (24 percent) with cancer developed thromboembolic complications. TDP was preoperatively significantly higher in this group of patients (1,101 (range, 468-2,167) ngFE/ml) compared with patients without thromboembolic complications (753 (range, 339-5024) ngFE/ml; P < or = 0.04).. Preoperative plasma levels of TDP were elevated in patients with colorectal cancer, especially in patients with liver metastasis and in patients developing postoperative deep venous thrombosis.

Topics: Adenocarcinoma; Adult; Aged; Case-Control Studies; Colorectal Neoplasms; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Prospective Studies; Thromboembolism

In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, postoperative fibrin reaction in the anterior chamber. So far no serious side effects of this treatment have been reported.. Altogether, 32 patients received 0.2 ml solution with 20 micrograms TPA intracamerally. In 2 cases a dense corneal opacity was observed 12-24 hours after the injection of TPA which was resistant to treatment with local dexamethasone and lubricants. Therefore it was removed by superficial keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy.. In the keratectomy specimen a selective, fine-granular calcification of Bowman's membrane could be demonstrated.. The intracameral TPA treatment for postoperative fibrin reaction can cause a rapid band keratopathy. Therefore the application of TPA should be restricted to severe therapy-resistant cases of intracameral fibrin reaction. In cases with the development of a band keratopathy EDTA-treatment is recommended.

Topics: Aged; Aged, 80 and over; Anterior Chamber; Cornea; Corneal Opacity; Female; Fibrin; Humans; Injections; Male; Postoperative Complications; Tissue Plasminogen Activator

The fibrinolytic drug rt-PA, which has been successfully used systemically to treat arterial and venous occlusions, is now available for local, intraocular injection. rt-PA converts plasminogen to plasmin, which in turn is able to lyse fibrin and fibrin clots. Intraocular surgery, trauma and inflammation may lead to intraocular accumulation of fibrin. Treatment of this type of complication with high-dose corticosteroids is protracted and often unsuccessful.. Eight patients (age 59-75 years) with fibrin formation following phacoemulsification and IOL implantation combined with trabeculectomy were treated by intraocular injection of 10 micrograms rt-PA. The intraocular status following the local fibrinolytic therapy was documented by biomicroscopy, photography and laser-flare Tyndallometry on days 1, 2 and 8.. In all patients the fibrin clots dissolved completely. Neither relapses nor adverse affects were noted.. The intraocular application of rt-PA results in an efficient fibrinolytic effect, which prohibits potential complications of combined glaucoma and cataract surgery due to fibrin formation.

Topics: Aged; Combined Modality Therapy; Female; Fibrin; Fibrinolytic Agents; Humans; Injections; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator; Trabeculectomy; Treatment Outcome

Intraocular fibrinolysis with recombinant tissue-plasminogen activator (rt-PA) in patients with severe fibrin reactions following anterior segment surgery is widely accepted because of the low complication rate.. We present two eyes of two patients developing acute bandkeratopathy within the first week after intraocular rt-PA fibrinolysis (10 mg/100 ml). In the first patient, calcium deposition occurred inferiorly of the optic axis without visual impairment. In the second patient, a dense bandkeratopathy reaching from limbus to limbus developed, with a severe decrease of vision. A corneal abrasion together with the chelating agent disodium ethylene diamine tetra-acetate (EDTA) 0.5% in neutral solution led only to an incomplete resolution of the depositions.. Acute development of a bandkeratopathy is very rare. Several risk factors are identified so far, e.g. the use of phosphate containing eye drops. Their interactions and the possible pathomechanism are discussed in detail. The close coincidence of intraocular rt-PA fibrinolysis and acute band-keratopathy in our two patients is in favor of an at least additive causative role of rt-PA fibrinolysis. Therefore, the indication should be limited to severe fibrin reactions and local application of phosphate containing drugs should be avoided.

Topics: Aged; Aged, 80 and over; Corneal Opacity; Female; Fibrin; Humans; Lenses, Intraocular; Postoperative Complications; Recombinant Proteins; Thrombolytic Therapy; Tissue Plasminogen Activator

To assess whether annexin V-coated poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) prevent postoperative inflammation in rabbit eyes.. Department of Ophthalmology, Hôpital Purpan, Toulouse, France.. Thirteen IOLs coated with annexin V were implanted in 13 rabbit eyes; the contralateral eyes received uncoated IOLs. Postoperative fibrin was quantitated by daily slitlamp examination until the anterior chamber was completely clear. Results were analyzed using a Wilcoxon test. Ocular toxicity was evaluated by light and electron microscopy.. Eyes with the annexin V-coated IOLs had less severe inflammation on the first postoperative day, and the inflammation resolved more quickly than in eyes with uncoated IOLs (P < .05). No annexin V was released postoperatively, nor were there signs of ocular toxicity.. Annexin V-coated lenses effectively reduced postoperative inflammation in rabbit eyes.

Topics: Animals; Annexin A5; Cataract Extraction; Endophthalmitis; Enzyme-Linked Immunosorbent Assay; Fibrin; Follow-Up Studies; Foreign-Body Reaction; Lenses, Intraocular; Methylmethacrylates; Postoperative Complications; Rabbits

In a prospective study, plasma levels of soluble fibrin (SF) were assessed in 97 patients with colorectal cancer immediately before and 1, 2, 7, and 90 days after surgery, 18 patients undergoing surgery for benign colorectal disease serving as controls. Age distribution, routine blood analysis, duration of surgery, perioperative blood loss and anaesthesia was similar in the two groups. SF was quantitated using a commercial enzyme-linked immunosorbent assay. The preoperative plasma level of SF was normal in cancer patients as a whole. However, patients with disseminated colorectal cancer had higher levels of SF preoperatively compared to patients with localized colorectal cancer (p < 0.01) and controls (p < 0.005). On days 1, 2, and 7 days postoperatively, a rather pronounced increase in plasma SF was observed in cancer patients as well as in the controls. Three months after surgery, plasma SF had normalized in controls and in patients undergoing curative cancer treatment. Postoperative deep venous thrombosis (DVT) was detected in 23% of the cancer patients by means of phlebography. The preoperative values of SF in these patients were higher compared to patients not developing DVT (p < 0.05). Patients with colon cancer displayed higher SF in plasma than patients with rectal cancer (p < 0.05).

Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Case-Control Studies; Colonic Diseases; Colorectal Neoplasms; Female; Fibrin; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Rectal Diseases; Solubility; Thrombophlebitis

We investigated the anti-inflammatory effects of 0.1% diclofenac sodium on anterior inflammation after cataract surgery. Fibrin precipitation after surgery in patients without systemic or ocular disease was markedly less when diclofenac sodium ophthalmic solution was used in combination with topical corticosteroids. There was also a reduction in fibrin precipitation in other patients, especially in those with diabetes mellitus, primary angle-closure glaucoma, and exfoliation syndrome. In conclusion, diclofenac sodium was shown to be clinically useful as a topical preparation to suppress inflammation after cataract surgery.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anterior Eye Segment; Betamethasone; Cataract Extraction; Diclofenac; Drug Therapy, Combination; Endophthalmitis; Female; Fibrin; Fibrinolysis; Humans; Lenses, Intraocular; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Retrospective Studies

Tissue plasminogen activator (tPA) has been used to treat severe postcataract and vitrectomy fibrinous membranes, but intraocular bleeding has occurred with doses of 25 micrograms or higher. We report three patients, one with nonclearing total hyphema and uncontrollable intraocular pressure and two with severe fibrinous membrane formation, who had treatment with low-dose (4 micrograms to 6 micrograms) intraocular tPA. Although the fibrinous membranes or hyphema resolved in all three patients, they recurred and bleeding that required additional treatment occurred in one patient. Intraocular low-dose tPA may minimize the risk of corneal and retinal toxicity and may be considered an alternative treatment in intractable cases. However, secondary intraocular hemorrhage can occur, and the timing between the initial vascular injury, treatment with tPA, and subsequent bleeding may reduce the risk of further hemorrhaging.

Topics: Adult; Aged; Anterior Chamber; Cataract Extraction; Child; Cornea; Corneal Injuries; Eye Diseases; Eye Injuries, Penetrating; Fibrin; Humans; Hyphema; Injections; Keratoplasty, Penetrating; Male; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

We report on our first two patients treated by intracameral application of tissue plasminogen activator (tPA) for dissolving fibrinous exsudates. Both patients had developed fibrin membranes in the pupillary plane and in the anterior chamber several days after cataract surgery. Injection of 25 micrograms tPA into the anterior chamber resulted in complete dissolution of the fibrin within 1 h of its application.

Topics: Aged; Anterior Chamber; Cataract Extraction; Exudates and Transudates; Eye Diseases; Female; Fibrin; Fibrinolysis; Humans; Injections; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

Twenty two eyes of 22 cases with severe intraocular fibrin formation after vitrectomy who had been all unresponsive to conventional therapy were treated with tissue plasminogen activator (t-PA), including complicated retinal detachment (14 eyes), intraocular foreign body (3 eyes), vitreous hemorrhage (2 eyes), traumatic cataract (2 eyes) and endophthalmitis (1 eye). The fibrin formation appeared 1-5 days with a mean of 2 days after operation. Of these 22 eyes, fibrin was seen in the pupillary area in 11, in the anterior chamber in 10 eyes and in the vitreous cavity in 1 eye. The initial injection of t-PA was given between the 5th and 15th (mean, 8.6 days) postoperative days after vitrectomy. The t-PA (5-30 micrograms) was injected into the anterior chamber in 21 cases and into the vitreous cavity in 1 case (25 micrograms). Once injection resulted in complete fibrinolysis in 19 of 22 eyes and partial fibrinolysis in 3 eyes, and the complete dissolution with one injection was achieved within 0.5-2.5 hours with a mean of 1 hour. 1 eye required repeated t-PA injection for recurrent fibrin formation and the repeated injection resulted in complete fibrinolysis in this case. The follow-up periods ranged from 1 to 20 months (mean period, 10 months). At the final follow-up examination, the retina was totally attached in 16 of 22 eyes and partially attached and detached in 6. Visual acuity improved in 13 eyes. Complications of t-PA injection included hyphema, elevated intraocular pressure (IOP) and hyphema with elevated IOP in 1 case respectively. Factors affecting the therapeutic effect of t-PA and methods preventing the complications of t-PA injection were discussed.

Topics: Adolescent; Adult; Child; Female; Fibrin; Follow-Up Studies; Humans; Male; Middle Aged; Plasminogen Activators; Postoperative Complications; Retinal Detachment; Time Factors; Tissue Plasminogen Activator; Vitrectomy

To determine the effects of Nd: YAG laser to disrupt the fibrinous membrane and remnant substance on the anterior surface of intraocular lens.. Nd: YAG laser was applied on 23 cases of fibrinous membrane formation and 8 cases of remnant substance on the anterior surface of intraocular lenses (IOL) which had not responded well to steroid therapy. Eighteen cases were male and 13 female. The mean age was 49.7 years (range, 5 approximately 78 years). The interval between IOL implantation and laser therapy was 0.5 approximately 30 months in the fibrinous membrane cases and 3 approximately 10 days in the remnant substance cases. The energy applied was 0.8 approximately 3.0 mJ/exp. with 2 approximately 112 exposures. Mean follow-up period was 3.6 months.. Complications during therapy included only 2 cases of slight iris bleeding. Visual acuity after therapy was improved 1 line in 16 cases, 2 lines in 11 cases, 3 lines in 1 case, 4 lines in 1 case and 5 lines in 2 cases. No post-therapy complication was found.. Nd: YAG laser lysis is an effective alternative to remove the fibrinous membrane and remnant substances on the anterior surface of IOL.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Fibrin; Fibrinolysis; Follow-Up Studies; Foreign-Body Reaction; Humans; Laser Therapy; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Time Factors; Visual Acuity

One of the complications after implantation of posterior chamber intraocular lenses is fibrin reaction. The authors analyse group of 653 patients--659 eyes after the operation of cataract with implantation of posterior chamber IOL operated in 1991-1992 at Postgraduate School of Medicine, Ophthalmology Department in Bratislava. The fibrin reaction was found out in 33 cases (5%). This reaction started between the first and third day after the operation. From this group of 33 patients, 14 (43%) were treated for glaucoma, 11 (33%) had diabetes mellitus and 3 (9%) overcome uveitis in past years. In all cases after the treatment came to the complete loss of fibrin. Finally visual acuity was 5/5 to 5/10.

Topics: Aged; Aged, 80 and over; Cataract Extraction; Female; Fibrin; Humans; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications

Endopatch E-F is a new product elaborated with natural human and animal proteins. Its synthesis originates in a covalent link between elastin and fibrin monomers. Numerous experimental studies carried out in animal have previously shown its ability to reinforce healing process of digestive wall. The results reported herein have been obtained in very selected patients in whom a digestive anastomosis had to be done in spite of unfavorable circumstances, such as intra-abdominal infection, radiated bowel or ascitis. From October 1990 to October 1992, 21 digestive anastomosis have been performed in 18 patients. All were reinforced by Endopatch E-F. Two deaths have been observed (mortality: 11.1%), which do not look like a consequence of the use of the product (One myocardial infarction and one cirrhotic failure). There were 2 post-operative fistulas (9.5% of the whole anastomosis). No patients had any reaction of intolerance. These preliminary results confirm experimental data, and suggest that Endopatch EF can be used in order to reinforce digestive sutures when performed under unfavorable circumstances.

Topics: Adult; Aged; Aged, 80 and over; Biocompatible Materials; Elastin; Female; Fibrin; Humans; Male; Middle Aged; Postoperative Complications; Sepsis; Sutures; Wound Healing

The aim of the study was to improve the detection of small hemorrhages with minimal symptoms and of unruptured aneurysms after a subdural and subarachnoid bleeding by the control of the intravascular hemostatic system.. Prospective, open study.. Neurosurgical intensive care unit of a university hospital.. 44 patients undergoing a cranial trepanation. Patients of group 1 (control n = 11) had an intrasellar hypophysoma, patients of group 2 (n = 12) a chronic subdural hematoma without a previous traumatic incident and patients of group 3 (n = 15) a subarachnoid hemorrhage caused by an intracranial aneurysm.. After cranial trepanation changes of plasmatic hemostasis have been assessed by means of immunologically determined parameters of coagulation. The investigation included blood parameters (hemoglobin, hematocrit, thrombocytes), clotting status (prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, plasminogen, antithrombin III [AT III] activity and proteinase inhibitors), as well as immunological methods such as fibrinopeptide A (FPA), thrombin-antithrombin III (TAT), protein C and factor XIII activity (F XIII activity).. In comparison to group 1 (control) a significant difference (p < 0.001) was seen in groups 2 and 3 for thrombin-antithrombin III (TAT), fibrinopeptide A (FPA), protein C, and the antithrombin III activity. Intra- and postoperatively increased TAT levels in groups 2 (16.9 ng/ml) and 3 (21.1 ng/ml) and decreased protein C levels (group 2: 61% and group 3: 58%) demonstrated an intravascular thrombin generation. On account of the elevated FPA levels in groups 2 (6.5 ng/ml) and 3 (5.7 ng/ml) and decreased AT III activity in groups 2 (58%) and 3 (62%), this thrombin generation was only incompletely compensated. Caused by proteolytic thrombin effects, another sign for a thrombin-induced turnover of clotting factors is the significant reduction (p < 0.001) of F XIII activity in groups 2 (40%) and 3 (44%). In comparison to group 1 this significantly reduced F XIII activity in groups 2 and 3 was correlated (r = 0.99) to changes in FPA and TAT plasma levels, an indication of latent chronic clotting activity. No significant difference was found concerning total amount of infusion, intra- and postoperative blood loss and blood parameters. Eight patients (group 2: 5 patients, group 3: 3 patients) showed a rebleeding episode without operative interventions. In these patients increased clotting activity (TAT, FPA, protein C) caused by proteolytic thrombin effects was combined with a factor XIII activity smaller than 40%.. The results of the recent study indicated that immunologically determined TAT, FPA, protein C, factor XIII and AT III activities might serve to improve management in patients with intracranial bleeding events. In view of these parameters the evaluation of risks for a rebleeding is improved. A decrease of the plasma factor XIII activity under 40% associated with a latent clotting activity induced by a thrombin generation caused a higher risk of rebleeding after an initial intracranial bleeding event. The necessity of substituting factor XIII in such cases should be elucidated to minimize risks of rebleeding.

Topics: Aneurysm, Ruptured; Antithrombin III; Blood Coagulation Factors; Blood Coagulation Tests; Cerebral Hemorrhage; Factor XIII; Fibrin; Fibrinogen; Fibrinopeptide A; Hematoma, Subdural; Hemostasis, Surgical; Humans; Intracranial Aneurysm; Peptide Hydrolases; Plasminogen; Postoperative Complications; Protein C; Recurrence; Reference Values; Trephining

To determine whether postvitrectomy fibrin formation was associated with visual outcome, a prospective study of patients undergoing pars plana vitrectomy was performed.. In 121 patients undergoing vitrectomy at the Medical College of Wisconsin between July 1986 and April 1989, the association of fibrin formation and other perioperative factors with visual outcome was evaluated by univariate and multivariate regression analysis. Poor visual outcome was defined as visual acuity worse than 5/200.. After a median follow-up period of 23 months (range 6 to 51 months), patients with severe fibrin formation experienced a higher rate of poor visual outcome (19 of 26 patients, 73%) than patients with little or no fibrin formation (23 of 95 patients, 24%; P < 0.0001, univariate analysis). After adjusting for a variety of factors with multivariate regression analysis, fibrin formation was not significantly predictive of final visual outcome.. Factors associated with postvitrectomy fibrin formation may affect visual outcome more than fibrin formation itself.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Eye Diseases; Fibrin; Follow-Up Studies; Humans; Middle Aged; Postoperative Complications; Prognosis; Tissue Plasminogen Activator; Visual Acuity; Vitrectomy

We report the use of intracameral tissue plasminogen activator to dissolve a fibrin clot occluding a Molteno tube in the immediate postoperative period. This technique is an effective alternative to awaiting clot lysis or reoperation with minimal risk. The only complication was a small, layering hyphema.

Topics: Aged; Blood Coagulation; Cataract Extraction; Female; Fibrin; Fibrinolysis; Glaucoma, Open-Angle; Humans; Lens Subluxation; Ocular Hypertension; Postoperative Complications; Prostheses and Implants; Recombinant Proteins; Silicone Elastomers; Tissue Plasminogen Activator

I report the use of tissue plasminogen activator to open blocked silicone tubes of Baerveldt glaucoma implants in two cases. A dose of 25 micrograms was used in both cases; lysis of fibrin clots occurred within 15 to 45 minutes.

Topics: Aged; Aged, 80 and over; Anterior Chamber; Blood Coagulation; Female; Fibrin; Fibrinolysis; Glaucoma; Humans; Male; Postoperative Complications; Prostheses and Implants; Recombinant Proteins; Silicone Elastomers; Tissue Plasminogen Activator

Topics: Cellulitis; Fibrin; Hernia, Inguinal; Humans; Male; Middle Aged; Peritonitis; Postoperative Complications; Rupture, Spontaneous

The study concerns 17 eyes which, following vitrectomy, were given an injection of 25 micrograms of tissue plasminogen activator (tPA). Of these 17 cases, ten showed a severe fibrin formation in the anterior chamber, 3 cases showed vitreous hemorrhage (one of them with hyphema), 2 had fibrin formation and cellular proliferation, while in one case tPA was injected at the end of the vitrectomy because of perisilicone proliferation and in one case because of fibrin depositions on the intraocular lens. The tPA was injected into the anterior chamber (10 eyes) or into the vitreous cavity (7 eyes). The follow-up period ranged from 4 to 15 months (mean period 9 1/2 months). Fibrinolysis was noted in the 10 cases with fibrin formation in the anterior chamber. Fibrin dissolution was achieved within 3-4 hours. None of these cases presented a recurrence throughout the follow-up period. Positive results were observed also in the case with perisilicone proliferation. On the contrary in 3 cases with postvitrectomy hemorrhage the hemorrhage persisted unchanged. Also in 2 cases with fibrin formation and cellular proliferation on the anterior and posterior surface of the iris the tPA injection proved ineffective. Both cases developed traction retinal detachment (TRD) due to anterior proliferative vitreoretinopathy (PVR). In the case with fibrin depositions on the intraocular lens the situation remained unchanged. Any complications observed in our case proved to be mild and transitory.

Topics: Adolescent; Adult; Aged; Anterior Chamber; Female; Fibrin; Fibrinolysis; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Postoperative Complications; Thrombosis; Tissue Plasminogen Activator; Vitrectomy; Vitreous Hemorrhage

Three patients who developed anterior chamber fibrinous exudates after cataract surgery were treated with tissue plasminogen activator injected into the anterior chamber. There was prompt dissolution of the fibrinous exudates and no observed complications. When fibrinous exudates occur in high-risk patients after cataract surgery, tissue plasminogen activator provides an excellent means of clearing the fibrin.

Topics: Adult; Aged; Anterior Chamber; Cataract Extraction; Exudates and Transudates; Eye Diseases; Female; Fibrin; Humans; Lenses, Intraocular; Male; Postoperative Complications; Recombinant Proteins; Tissue Plasminogen Activator

Annexin V is a member of the calcium- and phospholipid-binding proteins, known to have an antithrombotic effect. For the first time, we have tested its ability to prevent intraocular postoperative fibrin formation in a standardised rabbit model and compared its effect with that of heparin. Annexin V, 20 micrograms and 60 micrograms, injected in the anterior chamber post-operatively, significantly reduced the area of the fibrin clot and its time to clearing. Annexin V appeared to be as efficient as heparin. It probably acts by preventing phospholipids from playing their role in the coagulation cascade which leads to fibrin formation. Furthermore, annexin V has an anti-inflammatory effect by protecting phospholipids from phospholipase A2 activity. Therefore, annexin V might be considered as a new therapeutic agent acting both on fibrin formation and inflammatory processes.

Topics: Animals; Annexin A5; Anterior Chamber; Eye; Fibrin; Heparin; Models, Biological; Ophthalmologic Surgical Procedures; Postoperative Complications; Rabbits

Tissue plasminogen activator (tPA) has been shown to be effective at a dose of 25 micrograms in the treatment of severe postvitrectomy fibrin. However, a recent report based on an animal model indicates that retinal toxicity may occur at doses as low as 25 micrograms. This study uses a low dose (1.5 micrograms to 3 micrograms) of tPA for 34 injections in 26 eyes, and determines the lowest effective dose to be between 1.5 and 3 micrograms. Complete fibrinolysis was achieved in all 28 eyes in which 3 micrograms of tPA was administered within 10 days of vitrectomy, whereas partial fibrinolysis was achieved in eyes treated with 3 micrograms of tPA 27 days and 82 days after vitrectomy. Complete fibrinolysis occurred in only 1 of 4 eyes that receive 1.5 micrograms of tPA. A dose of 3 micrograms of tPA is recommended for treatment of severe fibrin after vitrectomy, as it has a wider margin of safety than do higher doses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Fibrin; Fibrinolysis; Humans; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Retinal Detachment; Retrospective Studies; Tissue Plasminogen Activator; Vitrectomy

Previous ocular diseases (e.g. herpetic keratouveitis), glaucoma, previous ocular surgery and surgery longer than normal turned out to be the main risk factors for a fibrinoid reaction after an extracapsular cataract extraction with posterior chamber lens implantation in patients of the Universitäts-Augenklinik Düsseldorf between June 1989 and March 1990. This result was obtained from a retrospective study of the medical records. No special risks could be concluded neither from the presence of general diseases (e.g. diabetes mellitus, consumptive basic diseases), immuno-suppressive treatment, constitutional factors, nor from age, sex, operative method nor from the surgeon. Preoperative antiexsudative prophylactic treatment is suggested for patients with one or more risk factor.

Topics: Adult; Aged; Aged, 80 and over; Female; Fibrin; Foreign-Body Reaction; Humans; Lenses, Intraocular; Male; Methylmethacrylates; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors

Levels of plasma crosslinked fibrin derivatives, a sensitive and direct marker of the lysis of intravascular crosslinked fibrin, were measured serially in 135 patients undergoing major abdominal surgery to determine their behavior and their use as a screening test for postoperative venous thrombosis. Preoperative levels and levels on the first postoperative day were significantly higher by both enzyme immunoassay and latex assay in 31 patients who developed venous thrombosis (positive venography) than in 104 patients who did not (negative 125I fibrinogen leg scan). Preoperative XLFDP levels 400 ng/ml (enzyme immunoassay) had a sensitivity to the diagnosis of postoperative venous thrombosis of 58%, specificity 74%, positive predictive value 41% and negative predictive value of 85%. The sensitivity of XLFDP levels over 1200 ng/ml on the first postoperative day was 65%, specificity 73%, positive predictive value 38% and negative predictive value 89%. These cutoff values were chosen (high negative predictive value) to allow identification of patients who were unlikely to have venous thrombosis. Measurement of plasma XLFDP, a simple inexpensive test, could be used as a screen to select patients for surveillance procedures (IPG or duplex ultrasonography). A substantial increase in XLFDP levels (greater than 500 ng/ml) occurred in virtually all patients, suggesting that fibrinolysis is not 'shutdown' postoperatively and that these assays reflect lytic activity at the fibrin surface more accurately than do measurements of plasminogen activators and their inhibitors.

Topics: Abdomen; Adult; Female; Fibrin; Heparin; Humans; Macromolecular Substances; Male; Mass Screening; Postoperative Complications; Predictive Value of Tests; Sensitivity and Specificity; Sex Characteristics; Thrombophlebitis

Topics: Aged; Aged, 80 and over; Blood Coagulation; Female; Fibrin; Filtration; Glaucoma; Humans; Postoperative Complications; Tissue Plasminogen Activator

Topics: Female; Fibrin; Humans; Middle Aged; Postoperative Complications; Recurrence; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy

The success rate of replantation of amputated digits and limbs appears to be improved by local continuous intra-arterial infusion of urokinases, heparin and PGE1 at a daily dose of 240,000 I.U., 10,000 U, and 40 micrograms, respectively, for ten days, in comparison to intravenous infusion of the drugs. The purpose of this study was to investigate the difference between the haematological effects of intra-arterial and intravenous infusion. Accordingly coagulation and fibrinolytic enzyme levels were examined before, and at 4 and 12 hours after the start of infusion and on the 3rd and 10th postoperative days. Intra-arterial infusion was advantageous over intravenous infusion probably because the effect of general metabolism on drug levels was small, drugs exhibited immediate action and efficacy was localised. No particular side effects were demonstrated.

Topics: Blood Coagulation Factors; Fibrin; Fibrinolytic Agents; Fingers; Hand; Humans; Infusions, Intra-Arterial; Infusions, Intravenous; Platelet Aggregation; Postoperative Complications; Replantation; Toes

Human recombinant tissue plasminogen activator (25 micrograms) was injected into seven eyes of six patients who had developed massive fibrin deposition after vitrectomy surgery for diabetes. Six eyes had developed pupillary membranes and recurrence of tractional retinal detachment from fibrin membranes, and one eye had developed only a pupillary membrane. All pupillary membranes resolved within one hour of administration of tissue plasminogen activator, and five tractional retinal detachments resolved within 24 hours. All eyes developed evidence of intraocular bleeding after tissue plasminogen activator injection. Subsequently, six of seven eyes developed recurrence of fibrin accumulation and tractional retinal detachment.

Topics: Adult; Diabetic Retinopathy; Eye Diseases; Female; Fibrin; Hemorrhage; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy

We studied collagen shield heparin delivery to the rabbit eye utilizing radiolabeled heparin as well as a fibrin inhibition assay. Radiolabeled heparin studies revealed significant tritium delivery to the cornea, aqueous, and iris, with only trace levels detectable for the lens, vitreous, and sclera. An aqueous fibrin inhibition assay revealed that a single collagen shield soaked in heparin achieved anterior chamber anticoagulant levels that paralleled the time course of the radiolabeled heparin delivery and resulted in fibrin inhibition during the 6-hour study period. Subconjunctival heparin injection did not alter baseline aqueous anticoagulant activity. No complications related to collagen shield heparin delivery were encountered. These studies suggest that a heparin-hydrated collagen shield may prevent postoperative fibrin formation in eyes at risk for this complication, including eyes undergoing surgery for the complications of proliferative diabetic retinopathy proliferative vitreoretinopathy, and glaucoma filtration surgery.

Topics: Animals; Bandages; Biological Dressings; Collagen; Cornea; Eye; Female; Fibrin; Heparin; Male; Ophthalmologic Surgical Procedures; Postoperative Complications; Rabbits; Tissue Distribution

Thrombosis is the end result of two closely interrelated processes: the coagulation cascade and the platelet aggregation process. To determine their relative contribution, we used pharmacologic agents that selectively block each process. The specific effect of each pharmacologic agent on either fibrin deposition or platelet activity was confirmed morphologically by scanning electron microscopy and was substantiated with ADP-induced platelet aggregation and blood clotting time determinations. Forty-two rats had both femoral arteries subjected to a standardized crush-avulsion injury. A total of 84 femoral microvascular anastomoses were subsequently performed. None of the 24 control anastomoses treated with saline remained patent, whereas 6 of 24 of the anastomoses treated with dazmagrel (a selective thromboxane synthetase and platelet aggregation inhibitor), 2.5 mg/kg IV, remained patent and 18 of 24 of those treated with a single dose of heparin, 200 U/kg IV, remained patent. All 12 anastomoses treated with both drugs remained patent but developed a 33 percent hematoma rate. We conclude that in this microvascular model, fibrin mesh deposition is a more significant factor than platelet aggregation in the pathogenesis of occlusional thrombosis within traumatized arteries. Its temporary inhibition with a single dose of heparin yielded a 75 percent improvement in patency rate.

Topics: Anastomosis, Surgical; Animals; Femoral Artery; Fibrin; Heparin; Imidazoles; Microscopy, Electron, Scanning; Platelet Aggregation; Postoperative Complications; Rats; Rats, Inbred Strains; Surgical Flaps; Thrombosis; Thromboxane-A Synthase

In a retrospective review of 30 cases of complex retinal detachment, which had been managed by pars plana vitrectomy techniques together with silicone oil injection, we found that two patients developed marked postoperative anterior chamber fibrin and hypopyon. In all 30 cases, the same silicone oil was used: purified and heat-sterilized trimethylsiloxy-terminated, polydimethylsiloxane of 1000-centistoke viscosity. Although the silicone oil itself remained clear and without emulsification, the differential diagnosis of this postoperative inflammation included microbial endophthalmitis. These two cases were treated with frequent topical steroids and antibiotics while we closely monitored the retraction of the anterior chamber fibrin. In both cases, clinical improvement and long-term retinal reattachment with satisfactory visual function were achieved. The use of intense scatter laser endophotocoagulation and the presence of impurities in the silicone oil may have contributed to the excessive postoperative inflammation in these cases.

Topics: Anterior Chamber; Endophthalmitis; Fibrin; Humans; Injections; Middle Aged; Postoperative Complications; Retrospective Studies; Silicone Oils; Suppuration; Time Factors; Vitrectomy

To evaluate potential clinical applications of nonautologous fibrin glue (FG) as a hemostatic agent in vascular surgery, we compared its efficacy to oxidized regenerated cellulose (OC) in hemostatically sealing polytetrafluoroethylene (PTFE) vascular graft anastomoses. PTFE grafts (4 mm wide and 4 to 6 cm in length) were placed to each femoral artery in a heparinized canine model, in end-to-end fashion in half of the dogs and in end-to-side fashion in the remaining dogs. Each set of graft-arterial anastomoses was then sealed with either FG or OC, determined randomly, followed by simultaneous measurement of blood loss through the graft anastomoses and needle holes. There was significantly less bleeding from anastomoses sealed with FG compared with those sealed with OC, regardless of whether the anastomoses sealed with FG compared with those sealed with OC, regardless of whether the anastomosis was constructed in end-to-end (p less than 0.03) or end-to-side (p less than 0.004) fashion; overall, the operative blood loss for grafts sealed with FG was 14 +/- 6 (mean +/- standard error of the mean) vs 99 +/- 27 ml/min for those sealed with OC (p less than 0.001). In the early postoperative period, significant groin hematomas occurred more frequently in grafts sealed with OC compared with those sealed with FG. Microscopic examination of graft-arterial specimens harvested at postoperative intervals ranging from 1 day to 3 months revealed no significant inflammatory reaction with either hemostatic agent; after 2 to 3 weeks, paired specimens appeared histologically similar despite previous treatment with either FG or OC.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anastomosis, Surgical; Animals; Aprotinin; Biocompatible Materials; Blood Vessel Prosthesis; Cellulose; Cellulose, Oxidized; Dogs; Drug Combinations; Factor XIII; Femoral Artery; Fibrin; Fibrin Tissue Adhesive; Fibrinogen; Hemorrhage; Polytetrafluoroethylene; Postoperative Complications; Random Allocation; Thrombin; Tissue Adhesives; Vascular Patency; Wound Healing

Topics: Aprotinin; Cardiac Surgical Procedures; Drainage; Drug Combinations; Factor XIII; Female; Fibrin; Fibrin Tissue Adhesive; Fibrinogen; Hemorrhage; Humans; Male; Mediastinum; Middle Aged; Postoperative Complications; Thrombin; Tissue Adhesives

Topics: Epithelium; Fibrin; Foreign-Body Reaction; Histiocytes; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Postoperative Complications

Twenty-five micrograms of human recombinant tissue plasminogen activator (tPA) was injected intracamerally into the eyes of three aphakic patients who developed severe intraocular fibrin formation within 24 hours after vitrectomy surgery. Fluid obtained from gas-fluid exchange specimens taken 24 hours after tPA injection was analyzed for tPA by an enzyme-linked immunosorbent assay and a spectrophotometric solid-phase fibrin assay. In each of the three patients, complete fibrin resolution occurred within four hours after the tPA injection. There were no complications associated with the intraocular tPA injections. There was measurable tPA activity 24 hours after the initial injection ranging from 0.23 to 1.4 micrograms. In contrast, tPA was undetectable in gas-fluid exchange specimens obtained from seven patients who did not receive intraocular tPA injections. Intraocular tPA is an effective means of treating postvitrectomy fibrin formation in selected aphakic patients.

Topics: Adolescent; Adult; Anterior Chamber; Eye Diseases; Female; Fibrin; Fibrinolysis; Humans; Injections; Male; Middle Aged; Postoperative Complications; Tissue Plasminogen Activator; Vitrectomy

Intraocular recombinant tissue-type plasminogen activator was used for treatment of postoperative intraocular fibrin clots. Using a rabbit vitrectomy and cyclocryotherapy model of postoperative fibrin, rabbits were randomized on the first postoperative day to receive either an anterior chamber injection of lactated Ringer's solution or 25,000, 50,000, or 100,000 IU tissue plasminogen activator (tPA). An intraocular dose of 25,000 IU of tPA produced marked resolution of the fibrin clot 24 hours later. A 50,000 and 100,000 IU dose produced slightly more resolution of the fibrin. No ophthalmoscopic or histologic evidence of intraocular toxicity was seen.

Topics: Animals; Anterior Chamber; Blood Coagulation; Ciliary Body; Cryosurgery; Fibrin; Postoperative Complications; Postoperative Period; Rabbits; Tissue Plasminogen Activator; Vitrectomy

Local ocular hypothermia was evaluated in experimental open sky vitrectomy, closed vitrectomy, and anterior chamber irrigation and aspiration in 40 albino rabbits (80 eyes). The irrigating balanced salt solution was used at room temperature in control eyes and was cooled to 7 degrees C in experimental eyes. Experimental eyes demonstrated less intraocular bleeding volume, less fibrin production, and less postoperative inflammation. No detectable tissue intolerance to hypothermia was observed on short- or long-term follow-up.

Topics: Animals; Anterior Chamber; Eye Hemorrhage; Fibrin; Hypothermia, Induced; Inflammation; Postoperative Complications; Rabbits; Retinal Diseases; Retinal Hemorrhage; Vitrectomy

I observed transient membrane formation consisting primarily of fibrin on the anterior surface of the IOL in 45 (7.6%) of the 596 eyes that received posterior chamber lens implantation during the past year. The onset of the condition was generally five to six days after surgery. This membrane characteristically developed between the margins of the anterior capsule, and therefore might be the result of lens-induced uveitis from the proliferation of lens epithelial cells under the anterior capsule.

Topics: Adult; Aged; Cataract; Cornea; Diabetes Complications; Female; Fibrin; Humans; Lenses, Intraocular; Male; Membranes; Postoperative Complications; Steroids

Topics: Aged; Cholecystitis; Cholestasis; Chronic Disease; Embolism; Fibrin; Hepatic Duct, Common; Humans; Male; Postoperative Complications

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Cataract Extraction; Exudates and Transudates; Female; Fibrin; Glaucoma; Humans; Male; Middle Aged; Postoperative Complications; Trabeculectomy

Topics: Breast; Female; Fibrin; Humans; Middle Aged; Nipples; Postoperative Complications; Prostheses and Implants; Silicones; Tissue Adhesives

Topics: Animals; Collagen; Fibrin; Hemostatic Techniques; Liver Transplantation; Postoperative Complications; Swine

Examination with a specular microscope facilitates diagnostic evaluation of cells on the surface of intraocular lenses. Similarly, slit-lamp examination makes specular microscopic studies possible. However, image resolution and magnification are not achieved by using this method, though the amount of time and instrumental effort is minimal. Various types of cells can be differentiated. Fibroblast-like cells can only be demonstrated readily in the specular areas, whereas multinucleate giant cells can usually also be seen by using focal illumination. It is difficult to differentiate the smaller, mononucleated cells.

Topics: Fibrin; Fibroblasts; Foreign-Body Reaction; Histiocytes; Humans; Lenses, Intraocular; Microscopy; Postoperative Complications

The authors have evaluated the use of heparin as a method to prevent postoperative intraocular fibrin clot formation in the rabbit after vitrectomy and cyclocryotherapy. In addition, they have studied the effect of a heparin infusion on intraocular bleeding after sectioning of retinal vessels. Heparin was administered by several different routes. The extent of the postoperative fibrin clot, as well as the number of days until its clearing, were recorded. A single anterior chamber injection, heparin supplementation of the infusion solution, or a single intravenous (IV) injection, all resulted in a statistically significant reduction of postoperative intraocular fibrin. Once daily subcutaneous injections alone did not produce a reduction in postoperative fibrin. No ocular bleeding complications developed postoperatively. A constant heparin intraocular infusion of 10 IU/cc did not change the bleeding time after sectioning of a retinal vessel.

Topics: Animals; Blood Coagulation; Eye; Fibrin; Heparin; Postoperative Complications; Rabbits; Time Factors; Vitrectomy

Strabismus surgery sometimes fails because of the mechanical restriction caused by the development of fibrous adhesions between the operated muscle and the surrounding tissues. Reoperation increases the frequency and severity of mechanical restriction significantly because of additional scar formation. Attempts to isolate the muscle from other tissues using gelatin sponges or Supramid plastic sleeves have been unsuccessful because of the body's reaction to these permanent foreign bodies. We used an ultra-pure fraction of sodium hyaluronate to study whether this nonantigenic, noninflammatory, viscoelastic substance could function as a temporary sleeve to prevent or reduce scarring and mechanical restriction following strabismus surgery. We resected the superior rectus muscle of 14 eyes from seven 5- to 7-pound white rabbits. In one eye, we instilled sodium hyaluronate 1% around the muscle. The other eye served as a control. The rabbits were killed at five, seven, ten, 14, 21, 28, and 42 days. Ante mortem length-tension measurements and post mortem histologic examinations of the operated muscles were performed in a blinded fashion. The results suggested, but did not definitely demonstrate, that sodium hyaluronate may reduce postoperative adhesions.

Topics: Animals; Cicatrix; Collagen; Fibrin; Hyaluronic Acid; Oculomotor Muscles; Postoperative Complications; Rabbits; Strabismus; Tissue Adhesions

Topics: Abscess; Combined Modality Therapy; Debridement; Fibrin; Humans; Middle Aged; Peritoneal Lavage; Peritonitis; Postoperative Complications

Two lens models, one all silicone with J-loop haptics, the second with PMMA optics and angled polypropylene C-loop haptics, were implanted in the capsular bag of 36 rabbit eyes following extracapsular lens extraction. Technical ease of implantation, inflammatory response, lens position, and fibrin exudation as well as precipitate formation were examined. Biomicroscopy, light and phase-contrast microscopy were used. Differences in haptic vulnerability, lens position, and fibrin clot formation were found between the two lens types. Lens-specific differences in precipitate formation could not be substantiated.

Topics: Animals; Cornea; Fibrin; Intraocular Pressure; Iris; Lenses, Intraocular; Methylmethacrylates; Postoperative Complications; Prosthesis Design; Rabbits; Silicones

In a canine model small-diameter vascular grafts of knitted Dacron were seeded with autologous endothelial cells. Four weeks after surgery the grafts were removed. Seeded grafts showed a pseudo-intima covered by a monolayer, whereas control grafts showed a cellular lining only at the anastomoses. Graft pretreatment with either fibrin glue or autologous blood in combination with endothelial cell seeding promoted the neointima formation.

Topics: Animals; Blood; Blood Vessel Prosthesis; Dogs; Endothelium; Femoral Artery; Femoral Vein; Fibrin; Models, Biological; Polyethylene Terephthalates; Postoperative Complications; Thrombosis

A primate model was used to compare a silicone intraocular lens (Elastic Lens, STAAR Surgical) and a conventional polymethylmethacrylate/polypropylene lens. Tolerance and stability of silicone lenses within the eye were tested.

Topics: Animals; Anterior Chamber; Cataract; Cornea; Endothelium; Fibrin; Lens Capsule, Crystalline; Lenses, Intraocular; Macaca fascicularis; Melanins; Methylmethacrylates; Polypropylenes; Postoperative Complications; Prosthesis Design; Silicones

Topics: Adult; Aged; Aortic Valve; Bioprosthesis; Endocarditis, Bacterial; Female; Fibrin; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Mitral Valve; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Thrombosis

The bronchial stump insufficiency after lung resection specially after pneumonectomy is known as a dangerous complication. The occlusion of an experimentally produced bronchial stump fistula after pneumonectomy on the left succeeded in all cases (n = 7) by means of a fibrin adhesive. The adhesive was applied in the endoscopic way by a plastic catheter. This method appeared to us as the treatment of choice for the so-called early fistulas. This method was applied successfully in one clinical case.

Topics: Adhesives; Animals; Disease Models, Animal; Fibrin; Fistula; Lung; Pneumonectomy; Postoperative Complications; Swine

Fibrinaemia following total hip replacement was evaluated in eighteen patients, grouped according to a negative and a positive fibrinogen uptake test (FUT), after having excluded two patients due to a false negative test, using phlebography as reference. The ethanol gelation test (EGT) was employed for detection of circulating soluble fibrin, and the conversion of fibrinogen to fibrin was evaluated by the level of fibrinopeptide A (FPA). Eight patients were cleared with respect to thrombosis, whereas ten had a positive FUT. All patients developed a positive EGT, irrespective of thrombosis, coinciding with the postoperative increase in fibrinogen. FPA increased to approximately twice its preoperative level in both groups of patients, but reached its maximum earlier in patients with thrombosis. However, this parameter had no discriminative value in this type of postoperative thrombosis, possibly due to massive thromboplastin release in both groups.

Topics: Aged; Aprotinin; Female; Fibrin; Fibrinogen; Fibrinopeptide A; Heparin; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Reference Values; Thrombophlebitis; Time Factors; Warfarin

Topics: Fibrin; Humans; Intraocular Pressure; Lens Capsule, Crystalline; Lens, Crystalline; Lenses, Intraocular; Methods; Postoperative Complications; Time Factors; Visual Acuity

We have found glomerular capillary thrombi or afferent arteriolar thrombosis in eight renal biopsy specimens from seven renal allograft recipients. All patients were receiving cyclosporin and prednisolone. Biopsies were performed either routinely one and four weeks after transplantation or during periods of renal dysfunction. None of the patients whose biopsy material contained glomerular thrombi was considered, in retrospect, to have been undergoing rejection at the time of biopsy. Thrombi consisted of finely granular material partially obstructing glomerular capillaries. By light microscopy the staining characteristics of the thrombi were compatible with platelet-fibrin aggregates, and this was confirmed by immunoperoxidase examination. Such thrombi have not previously been seen in biopsy material from patients treated with prednisolone and azathioprine, except rarely associated with acute vascular injection. In none of these patients was there haematological evidence of the haemolytic uraemic syndrome as has been reported in bone marrow recipients treated with cyclosporin.

Topics: Adult; Blood Platelets; Cyclosporins; Female; Fibrin; Humans; Kidney Glomerulus; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prednisolone; Thrombosis

Topics: Adult; Crohn Disease; Female; Fibrin; Fistula; Humans; Perineum; Postoperative Complications; Tissue Adhesives

Alterations characteristic of the hypercoagulation syndrome such as changes in fibrinogen content, in FDP concentration and platelet counts as well as the presence of fibrinogen complexes were demonstrated by laboratory findings in 175 patients with severe diseases and disturbances of haemostasis. Twenty per cent of the patients showed no clinical signs of disturbances of haemostasis, in 32.5 per cent pronounced venous thrombosis occurred, bleeding complications arised in 28 per cent and microthrombosis developed in 20 per cent. The different findings in the individual groups are assumed to be due not only to haemostatic factors but also to other ones.

Topics: Blood Coagulation Tests; Cardiovascular Diseases; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Humans; Neoplasms; Partial Thromboplastin Time; Platelet Count; Postoperative Complications; Pregnancy; Pregnancy Complications, Hematologic; Thrombosis

Topics: Disseminated Intravascular Coagulation; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysin; Fibrinolysis; Glomerulonephritis; Hemostasis; Humans; Liver Cirrhosis; Postoperative Complications; Pulmonary Embolism; Thrombin; Thromboembolism; Thrombophlebitis

A simple, effective and safe method is proposed to liquidate a persistent residual pleural cavity by a biological filling prepared ex tempore from a solution of fibrinogen with antibacterial drugs. The method was used in 24 patients after pleura empyema. The method of filling is described as well as the conditions for a successful use of the new means of liquidation of the residual pleural cavity and prevention of recurrent pleura empyemas.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bronchial Fistula; Combined Modality Therapy; Empyema; Fibrin; Fistula; Humans; Lung Diseases; Male; Pleural Diseases; Postoperative Complications; Prostheses and Implants; Skin Diseases

Fibrin glue was used for sealing a total of 45 anastomoses in colonic and rectal surgery. ILS, SPTU and EEA staplers were used performing anterior resection (low 26, high 15). The incidence of dehiscence of anastomoses after anterior resection of the sigmoid colon and rectum was studied by radiological examination after a Peritrast-enema about 2 weeks after surgery. Suture dehiscence was roentgenologically detected in 2 patients, no clinical insufficiency. Only 1 patient, aged 80, died from haemorrhage. The rate of postoperative complications was very low.

Topics: Adult; Aged; Colon; Female; Fibrin; Humans; Intraoperative Period; Male; Middle Aged; Postoperative Complications; Rectum; Tissue Adhesives

The preventive effect of rat and human fibrin sealing on intra-abdominal adhesion formation was investigated in 40 rats. Intraperitoneal adhesion formation was induced by excision of 1 X 3 cm of the peritoneal parietalmuscular layer, subsequently closed by interrupted 3-0 silk sutures. A total of 80 defects were allocated to one of four treatments: 1) the defect was covered with human fibrin sealant with the aid of a syringe. 2) the defect was covered with rat fibrin sealant with the aid of a syringe. 3) the defect was covered with human fibrin sealant with the aid of a spray. 4) the defect was not covered (control group). Assessment of the adhesion formation one week postoperatively showed that the median length of adhesions in defects covered with fibrin sealant applied by a syringe (10.5 mm) or by spray (14 mm) was less than that of the control group (25 mm) to a significantly high degree (P less than 0.001). It is concluded that fibrin sealant prevents intraperitoneal adhesion formation in the present rat model.

Topics: Animals; Antifibrinolytic Agents; Drug Combinations; Factor XIII; Female; Fibrin; Fibrin Tissue Adhesive; Fibrinogen; Fibronectins; Humans; Peritoneal Dialysis; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Inbred Strains; Thrombin; Tissue Adhesions; Tissue Adhesives

The effects of locally deposited fibrin and of tranexamic acid-induced antifibrinolysis on forming granulation tissue were studied in the light of a recently developed method for treatment of postoperative fistulas by occlusion with a fibrin clot. Perforated teflon cylinders, either empty or fibrin-filled, were implanted subcutaneously in rats and extracted after 2 weeks. Fibrin deposition was found to stimulate granulation tissue ingrowth into the cylinders but it did not change the fibrinolytic activity in the granulation tissue. A significantly higher fibrinolytic activity was, however, found in the tissue fluid collected from the space between the granulation tissue and the implanted fibrin clot compared to tissue fluid from cylinders implanted empty. Tranexamic acid significantly reduced the fibrinolytic activity on the granulation tissue and delayed lysis of the implanted fibrin clot. It also reduced granulation tissue ingrowth but it did not abolish the positive effects of the clot on granulation tissue formation.

Topics: Animals; Cyclohexanecarboxylic Acids; Drug Evaluation, Preclinical; Drug Implants; Fibrin; Fibrinolysis; Fistula; Granulation Tissue; Histocytochemistry; Male; Postoperative Complications; Rats; Rats, Inbred Strains; Tranexamic Acid

Postoperative abdominal adhesion formation can undo the reconstructive work of the infertility surgeon. Adhesions can form in as little as three hours after surgery. Most adhesions are transient and lyse spontaneously within 72 hours of surgery. Such factors as tissue trauma, anoxia and ischemia cause a reduction in plasminogen activator activity that is strongly correlated with the persistence and progression of postoperative adhesions. Adhesions can be prevented by a proper and meticulous surgical technique emphasizing preservation of tissue without abrasion, anoxia or ischemia. Dextran, antiprostaglandins, antibiotics, steroids, antihistamines, anticoagulants and enzymes have various roles. Our current regimen involves Hyskon, Motrin and deoxycycline.

Topics: Combined Modality Therapy; Fallopian Tube Diseases; Female; Fibrin; Humans; Infertility, Female; Postoperative Complications; Pregnancy; Tissue Adhesions; Wound Healing

The treatment of postsurgical chylothorax with fibrin glue is reported. Chylothorax developed in a 3 1/2-month-old infant 2 days after extrapleural ligation of a patent ductus arteriosus. At rethoracotomy the chyle leak could not be located. To stop chyle effusion, the region of the presumed leakage was sealed with fibrin glue and a pleural flap. It is suggested that early reoperation and closure of the chyle leak with fibrin adhesive should be considered in cases of postsurgical chylothorax in infants.

Topics: Chylothorax; Drainage; Ductus Arteriosus, Patent; Fibrin; Humans; Infant; Male; Postoperative Complications; Radiography; Tissue Adhesives

The importance of the study of the subcellular structure of cardiac valve bioprostheses by means of scanning and transmission electron microscopy and x-ray microanalysis lies in the data it may provide for morphology, physiology, biochemistry, and pathology, as well as in clinical and surgical application.

Topics: Bioprosthesis; Calcinosis; Connective Tissue; Electron Probe Microanalysis; Endocardium; Fibrin; Heart Valve Prosthesis; Humans; Microscopy, Electron; Microscopy, Electron, Scanning; Postoperative Complications

A 73-year-old female was found to have prolonged thrombin and reptilase times in the immediate post-operative period. These abnormalities were not corrected by the addition of normal plasma. They were subsequently shown to be due to an IgG immunoglobulin which inhibited fibrin monomer polymerization. The IgG immunoglobulin activity could be neutralized completely by prior incubation with either patient or normal fibrinogen, uncrosslinked fibrin monomers or IgG antisera. No inhibitory effect on thrombin activity, fibrinopeptide A release or on the fibrin cross-linking reaction of factor XIIIa could be detected. Purified patient fibrinogen was functionally normal as demonstrated by normal fibrinogen-fibrin polymerization and fibrinopeptide A release. No underlying cause for this phenomenon was found. The presence of the inhibitor was associated with excessive blood loss during the post-operative period.

Topics: Aged; Autoantibodies; Biopolymers; Blood Coagulation Disorders; Female; Fibrin; Fibrinogen; Hip Prosthesis; Humans; Immunoglobulin G; Postoperative Complications; Thrombin Time

Topics: Adult; Aged; Female; Fibrin; Fistula; Humans; Ileal Diseases; Intestinal Fistula; Jejunal Diseases; Male; Middle Aged; Perineum; Postoperative Complications; Rectal Fistula; Sigmoid Diseases; Urinary Bladder Fistula; Vesicovaginal Fistula

Topics: Adhesives; Adult; Aged; Female; Fibrin; Fistula; Gastrointestinal Diseases; Humans; Male; Middle Aged; Postoperative Complications; Radiography

Two hundred eighty consecutive vitrectomies in diabetic patients were studied retrospectively. In 15 eyes, interlacing fibrin-like strands appeared on the surface of the retina and behind the iris plane from two to 14 days postoperatively. One or two days later, a gelatinous mass formed in the center of the vitreous activity, leading to the development of tractional retinal detachment and rubeosis iridis with neovascular glaucoma. Large doses of systemic and topical corticosteroids reversed the fulminating course of this complication in six of 15 eyes. The combination of lens surgery or scleral buckling procedure with vitrectomy, and the presence of retinal detachment preoperatively seemed to predispose to this complication. It is possible that multiple surgical procedures performed during the same operation cause an increase in vascular permeability resulting in the formation of a gelatinous, fibrin-like material in the diabetic eye.

Topics: Adult; Aged; Diabetic Retinopathy; Eye Diseases; Female; Fibrin; Glaucoma; Humans; Intraocular Pressure; Iris Diseases; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Retrospective Studies; Syndrome; Vitreous Body

Cardiac surgery is often associated with hemostatic abnormalities leading to severe bleeding. Special problems are to be expected, if prosthetic material has to be implanted. Preclotting of Dacron prostheses with blood is well established but failures are sometimes encountered. Several years ago a new hemostatic sealing system (fibrin glue) was introduced into therapy. Since 1978 fibrin glue has been applied in 176 patients. The indications were: 1. sealing of woven Dacron prostheses, 2. bleeding from suture-holes (Gore-Tex), 3. diffuse myocardial bleeding and 4. prevention of kinking of coronary artery grafts. In 32 patients with an aortoventriculoplasty operation using Dacron the "blood preclotting" and "fibrin sealing" methods were compared. In the fibrin glue group there was a significant reduction in postoperative blood loss as well as a shortening of the operation time (period of protamin administration to skin closure). No fibrinolytic dissolution of the fibrin layer on the prostheses was observed.

Topics: Cardiac Surgical Procedures; Fibrin; Humans; Intraoperative Complications; Polyethylene Terephthalates; Postoperative Complications; Prostheses and Implants; Tissue Adhesives

In 20 patients with recurrent perforations of the tympanic membrane after tympanoplasties the membrane defect was closed by using cialit-conserved temporal fascia and human fibrin tissue adhesive. The defects differed in size from 2 mm up to a subtotal defect. In 19 cases there was increasing vascularisation from the perforation margins towards the transplant centre after 4 weeks. After 8 weeks the connection between the transplant and the surrounding tissue was so tight that tympanometry could be performed using pressures up to 300 mmWS without any damage. Only in 1 case there was an infection. We had to remove the transplant. In comparison with the method of using only human fibrin tissue adhesive to close recurrent perforations, this method has the advantage that even bigger perforations of the tympanic membrane can be closed. The number of recurrencies of perforation also is lessened.

Topics: Fascia; Fibrin; Humans; Postoperative Complications; Recurrence; Tissue Adhesives; Transplantation, Autologous; Tympanoplasty

Le Veen shunts successfully alleviated ascites in 19 of 24 patients (79 percent). Clinical clotting typical of disseminated intravenous coagulation occurred in nine of these patients (37 percent) and was fatal in seven (78 percent). Laboratory findings suggesting disseminated intravenous clotting were present in five other patients (21 percent) but were not associated with troublesome bleeding. Coagulopathy was reversed in 7 of 14 patients (50 percent), if the shunt was ligated and supportive measures were taken early in the postoperative course. Failure to recognize or take immediate action resulted in progressive disseminated intravenous clotting associated with a mortality of 50 percent (7 of 14 patients).

Topics: Adult; Aged; Blood Coagulation Disorders; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Peritoneovenous Shunt; Postoperative Complications; Vascular Surgical Procedures

A Bjork-Shiley mitral valve prosthesis had to be replaced 4 years after implantation because of disc entrapment by an over-grown fibrous tissue on its sewing cuff. This abnormal fibrous tissue was found out to be an organizing platelet-fibrin deposit, of which luminal surface was only incompletely endothelialized. It is indicated that the heart valve prosthesis generally remains non-endothelialized for a prolonged period of time after implantation in man. Anticoagulation therapy should thus be given throughout the postoperative period for patients with the heart valve prosthesis.

Topics: Adult; Blood Platelets; Endothelium; Female; Fibrin; Heart Valve Prosthesis; Humans; Mitral Valve; Postoperative Complications; Thrombosis

Women who were to be operated upon for prolapse of the uterus were treated preoperatively with estrogens for atrophic vaginal mucosa and examined postoperatively by the 125I-fibrinogen uptake test and phlebography. Among 11 women who received 50 micrograms of ethinyl estradiol daily for three weeks, fibrin deposits were found in six. Of eight women receiving 200 micrograms daily for 12 days, such deposits developed in four. Corresponding figures for the control group were 18 of 157, p < 0.001. Estrogens, therefore, should not be given preoperatively, and those patients treated with preparations containing estrogens should have such therapy discontinued preoperatively.. This study determines whether or not fibrin deposits occur more frequently in patients who had gynecologic surgical procedures for prolapse of uterus and treated with estrogens than in those in a control group. 11 women were given 50 ug of ethinyl estradiol daily for 3 weeks while 8 women were given 200 ug ethinyl estradiol daily for 12 days. The remaining 157 women who received no hormonal treatment served as controls. The women were examined postoperatively by the Iodine fibrinogen uptake test and phlebography according to the method of Nylander. The chi-square test with Yate's correction was used for data analysis. Fibrin deposits were found in 6 of the 11 women who received 50 ug ethinyl estradiol for 3 weeks and in 4 of 8 women receiving 200 ug for 12 days. Corresponding figures for the control group were 18 of 157, p 0.001. Estrogens should not prescribed to patients preoperatively. Estrogen therapy should be discontinued in patients who are about to be operated.

Topics: Estradiol; Ethinyl Estradiol; Female; Fibrin; Humans; Iodine Radioisotopes; Middle Aged; Phlebography; Postoperative Complications; Thrombophlebitis; Uterine Prolapse

This study confirms preliminary indications that dry-pack sterilized lenses cause a more marked anterior chamber reaction than wet-pack sterilized lenses during the immediate post-op period. After the first two weeks, this difference is not evident.

Topics: Aged; Anterior Chamber; Corneal Diseases; Edema; Ethylene Oxide; Eye Diseases; Female; Fibrin; Humans; Intraocular Pressure; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Sodium Hydroxide; Sterilization; Time Factors; Visual Acuity

Topics: Adult; Female; Fibrin; Humans; Pleural Effusion; Postoperative Complications; Radiography; Thoracic Surgery; Tuberculosis, Pulmonary

A prospective study was carried out to confirm the validity of a predictive index for patients at risk of developing deep vein thrombosis. The index, which correctly identified nine out of 10 patients and incorrectly identified seven out of 52 patients as being at risk, is based on five variable--namely, the euglobulin lysis time, serum concentration of fibrin-related antigen, age, percentage overweight for height, and presence of varicose veins. Thus a population of patients at particularly high risk of developing postoperative deep vein thrombosis may be identified preoperatively by means of this index, so that prophylaxis may be used more rationally.

Topics: Adult; Aged; Antigens; Blood Coagulation Tests; Body Weight; Female; Fibrin; Humans; Postoperative Complications; Risk; Serum Globulins; Thrombophlebitis; Varicose Veins

Administration of prophylactic low-dose subcutaneous heparin to prevent postoperative deep vein thrombosis is expensive, entails treating many patients unnecessarily, and causes some side effects. By using a predictive index a population of patients who are at particularly high risk of developing postoperative deep vein thrombosis may be identified preoperatively. Prophylaxis was given only to these patients, resulting in an incidence of deep vein thrombosis of 3.8% compared with 16.1% in previous studies in which no specific prophylaxis was given. By limiting prophylaxis to the group of patients identified by the predictive index as being at high risk of developing postoperative deep vein thrombosis results may be obtained that are as good as those expected from treating the whole population. Thus many patients are saved from exposure to low-dose subcutaneous heparin.

Topics: Aged; Antigens; Blood Coagulation Tests; Body Weight; Drug Administration Schedule; Female; Fibrin; Heparin; Humans; Middle Aged; Postoperative Complications; Risk; Serum Globulins; Thrombophlebitis; Time Factors

Coronary artery bypass graft surgery has been available and widely successful for the symptomatic treatment of ischemic heart disease. Despite its widespread use, there is little information available on the pathological consequences of this procedure on the human heart. In this article, morphological consequences of coronary artery bypass graft surgery is reviewed. Intimal changes occurring within the vein graft itself consist predominately of fibrous initimal proliferation, which in some patients may progress to from an occlusive plaque. Most occlusions, however, occur at the coronary artery bypass graft anastomosis site and the mechanisms of occlusion include compression of the vascular lumen, thrombosis, and dissection of the coronary artery. Most graft failure occurs in the setting of too small a native coronary artery lumen. The myocardium is also at risk for alterations as a result of the bypass operation. Contraction band or reperfusion necrosis is the type of injury most commonly seen, and it appears to occur most often in the distribution of patent grafts. Accelerated atherosclerosis in vein grafts and the myocardial injury associated with revascularization require further detailed morphological studies, but these are important areas for pathological exploration since they bear on important and yet unanswered questions about coronary bypass surgery: can it in the long run perserve myocardium and prolong life?

Topics: Adult; Aged; Coronary Artery Bypass; Coronary Vessels; Female; Fibrin; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Necrosis; Postoperative Complications; Saphenous Vein; Thrombosis; Time Factors; Transplantation, Autologous

In animal experiments the additional sealing of colonic anastomoses using fibrin glue resulted in especially fast healing with formation of a delicate scar. Between April 1, 1976 and March 31, 1977, this method was used in 118 out of 355 patients undergoing extensive abdominal procedures. Suture line leakage was seven times less frequent than in the control group. This resulted in a considerable decrease of postoperative mortality.

Topics: Animals; Cicatrix; Colon; Dogs; Esophagus; Fibrin; Postoperative Complications; Stomach; Suture Techniques; Tissue Adhesives; Wound Healing

Soluble fibrin complexes, fibrin degradation products, and anti-thrombin III levels were determined in the plasma of 20 patients undergoing elective total hip replacement. The presence of deep venous thrombophlebitis was determined by venography at the end of the first postoperative week. Patients who developed thrombosis exhibited impairment of fibrinolysis as de-Patients who developed thrombosis exhibited impairment of fibrinolysis as detected levels of anti-thrombin III and soluble fibrin complexes were not useful in indicating the presence of deep venous thrombosis. However, the preoperative level of soluble fibrin complexes closely correlated with the subsequent development of thrombosis. Elevated soluble fibrin complexes appear to identify a group of patients with activated coagulation systems who are prone to develop thrombosis during total hip replacement.

Topics: Antithrombin III; Blood Coagulation Tests; Fibrin; Fibrin Fibrinogen Degradation Products; Hip Joint; Humans; Joint Prosthesis; Phlebography; Postoperative Complications; Thrombophlebitis

Fibrin clots may form in the biliary tract from hemobilia or in inflammatory disease. There is a wide variation in the clinical course of such clots which is exemplified by 9 patients. They may either dissolve through fibrinolysis, get ejected into the intestine, remain and obstruct the biliary tract, or may even transform into gallstones. In order to elucidate the mechanisms involved, the behavior of blood clots in bile was studied in vitro. A model was constructed of the biliary tract and, drained by a T-tube, where human bile circulated with a flow rate resembling that in vivo. When a small amount of human blood was injected, it flowed immiscibly to the lowest level, displaced the bile, and formed a clot of pure blood. Even a minor bleeding may thus form a coagulum. This is different from the mixed clot of blood and bile that forms in experiments simulating major hemorrhage. These findings are related to clinical experience and especially to the disappearance of "retained stones" with or without the use of dissolving agents.

Topics: Biliary Tract; Biliary Tract Diseases; Blood Coagulation; Cholangiography; Cholecystectomy; Cholelithiasis; Cholestasis; Diagnostic Errors; Female; Fibrin; Fibrinolysis; Gallstones; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Male; Models, Biological; Postoperative Complications

An experimental study was performed in rhesus monkeys (M. mulatta) to examine the contribution of Bunnell tendon suture to the production of postoperative tendon adhesions. It was found that Bunnell suture used with atraumatic technique caused a significant depression of in vitro tendon surface plasminogen activator activity, allowing the in vivo persistence and fibrous organization of fibrinous postoperative adhesions to sutured areas. Bunnell suture also produced coagulation necrosis of the sutured area of tendon. Collagen, which replaced the destroyed areas, was oriented randomly and frequently was continuous with surface tendon adhesions to surrounding connective tissues. Bunnell suture appears to be a cause of tendon adhesions in subhuman primates. The importance of fibrin and depressed local fibrinolysis in the relationship of tendon ischemia and adhesion formation is discussed.

Topics: Animals; Collagen; Fibrin; Haplorhini; Macaca mulatta; Plasminogen Activators; Postoperative Complications; Suture Techniques; Tendons; Tissue Adhesions

When injury of a major vessel can be ruled out as the cause of bleeding after tonsillectomy, a discrete disturbance of hemostasis must be considered. These are mainly slight thrombopathies or a pathologically increased fibrinolysis, which were not detected by routine tests and the past history. In former times severe bleeding disorders were a strict contra-indication for tonsillectomy. Under the supposition of an exact coagulogram and the substitution of highly purified factor concentrates the risk of severe post-tonsillectomy hemorrhages in such patients today is nearly the same as in patients with a normal hemostase.

Topics: Antifibrinolytic Agents; Blood Coagulation Factors; Blood Platelet Disorders; Fibrin; Hemorrhage; Hemorrhagic Disorders; Humans; Postoperative Complications; Tissue Adhesives; Tonsillectomy

In 21 patients with macular hole and retinal detachment a macular buckling procedure was performed including diathermic or cryogenic coagulation. An absorbable fibrin sponge (Fibrospum) was used as a new buckling material, which needs not to be sutured to the sclera at the posterior pole. In comparison to other procedures the use of fibrin sponge seems to be more simple and at least of the same results.

Topics: Cryosurgery; Electrocoagulation; Fibrin; Humans; Postoperative Complications; Refraction, Ocular; Retinal Detachment; Surgical Equipment; Visual Acuity

The development of postoperative peritoneal adhesions was studied in rats and rabbits, the frequency of adhesions in the experimental model used being very high. In the development of an adhesion, fibrin seems to be an important contributor to the bridge between different tissues. Dextran, which modifies the fibrin network and makes it more susceptible to lysis, was used as a possible prophylactic agent, but we found no difference between treated and control groups. It is concluded that the stimulus for fibrin formation in the peritoneal adhesions using this atraumatic model was too strong to be overcome by the normal fibrinolytic system. The anti-inflammatory reaction of hyaluronic acid did not diminish the frequency or degree of adhesions.

Topics: Animals; Dextrans; Fibrin; Hyaluronic Acid; Models, Biological; Peritoneal Diseases; Postoperative Complications; Rabbits; Rats; Tissue Adhesions

The implantation and one hour post-transplant renal biopsies from three types of allograft recipients were compared with a blind grading system: (1) 25 cadaver kidneys preserved by pulsatile perfusion, (2) seven cadaver kidneys preserved by simple hypothermia following electrolyte solution flush, (3) 18 kidneys from living-related donors. Significant lesions were found only in cadaver kidneys which had received pulsatile preservation. Microscopic findings were correlated with perfusing agent, length of perfusion and its characteristics, and subsequent clinical course of the patient. Perfusion-related injury was found to be morphologically identical to hyperacute rejection, although the lesion is produced by quite different mechanisms. Pulsatile preservation appears to be associated with a spectrum of mechanical endothelial injury ranging from minute breaks visible only ultrastructurally to areas of complete denudation baring the basement membrane. The exposed collagen activates the clotting sequence resulting in platelet and fibrin deposition, whereas in classical hyperacute rejection the triggering mechanism is cytotoxic recipient antibody. The extent of perfusion-related injury correlates well with length of preservation, quantity of fibrin deposited, and, most importantly, with both the immediate and long-term post-transplant failure rate. In some patients the injury appears to be produced by cytotoxic antibodies in the plasma perfusate, which combine with antigens in the kidney ex vivo. The Ag-Ab complex activates complement and coagulation sequences in vivo after reimplantation. Early results with albumin or purified plasma fraction perfusates suggest this portion of perfusion-related injury can be eliminated. Comparison of pre- and postimplantation biopsies of the kidneys preserved by simple hypothermia or by pulsatile preservation suggests that perfusion-related injury is much more common than is true hyperacute rejection mediated by recipient cytotoxic antibodies. We suggest that the term "hyperacute rejection" be reserved for situations where significant endothelial drainage has been excluded by preimplantation biopsy and where recipient cytotoxic antibodies can be proved.

Topics: Cadaver; Fibrin; Fluorescent Antibody Technique; Humans; Kidney Diseases; Kidney Glomerulus; Kidney Transplantation; Organ Preservation; Perfusion; Postoperative Complications; Tissue Survival; Transplantation, Homologous

Histological changes of ligated blood vessels were studied on 30 women of 41 to 57 years who had been selected according to certain criteria. For this purpose we usually resected the ligg. suspensoria ovarii, parts of the mesosalpinx, lig. latum and rotundum, the vasa uterina, segments of the basale parametrium the plexus vesico-vaginalis and others after 15 to 25 minutes. The abdominal hysterectomy was in most cases indicated due to uterus myomatosus. The histological examinations showed that, in spite of the ligation of the vessels the organism protects itself by forming a closing thrombus preventing a hemorrhage threatening life as well as a secondary hemorrhage at a later stage due to demarcation of the distal stump end. The occlusion consist of merged thrombocytes, coagulated fibrin and other blood elements; the lesion of the endothelial cells isvery important. Proximal, to the centre, the intravasal mutations decrease rapidly, the lumen is in most of the cases empty. Only in 16% of the lumina of arteries or arterioles and in 20% of the veins there were no hemostatic plugs found. The problem of hemostasis during the gynecological operation is only being touched upon, possible complications due to circulation and perfusion lesions are mentioned. A pathological extent of the coagulation in small pelvis is likely to be the reason for an embolism.

Topics: Adnexa Uteri; Adult; Blood Platelets; Female; Fibrin; Humans; Hysterectomy; Ligation; Middle Aged; Platelet Aggregation; Postoperative Complications

In 23 high risk patients the change in plasminogen activator activity in response to surgical operation was studied by euglobulin lysis time (ELT) and fibrin plate lysis before, during and for up to 6 days following a major surgical procedure. Fibrin degradation products (FDP) were also measured. The aim was to relate any changes to postoperative deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test. Peroperative increase and postoperative inhibition of fibrinolytic activity were seen in all the patients. Changes in fibrinolytic activity as measured by the ELT and during the first 24 hours by the fibrin plate technique were similar. This suggests that during this period the response was independent of plasma fibrinogen changes. There was no significant difference in these parameters between patients who developed DVT and those who did not. The relationship between venous thrombo-embolism and elevation of serum FDP was confirmed.

Topics: Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Humans; Male; Postoperative Complications; Serum Globulins; Thrombophlebitis; Time Factors

A range of clinical data was obtained from 124 patients about to undergo operation and several coagulation tests were performed. No patient received prophylaxis for deep vein thrombosis, and isotopic scanning after operation showed that 20 patients had developed thrombosis. a simiple prognostic index for predicting which patients would develop postoperative deep vein thrombosis was constructed using the clinical and coagulation data obtained before operation. The five variables with the best predictive power-euglobulin lysis time, age, presence of varicose veins, fibrin related antigen, and percentage overweight-produced an equation that identfied 95% of those who developed deep vein thrombosis and misallocated only 28% of those who did not develop thrombosis. In view of the complications that low-dose heparin and dextran can cause, giving prophylaxis to under a third of the patients who will not develop deep vein thrombosis is clearly better than giving it to all.

Topics: Adult; Age Factors; Antigens; Body Weight; Fibrin; Humans; Middle Aged; Postoperative Complications; Prognosis; Serum Globulins; Thrombophlebitis; Varicose Veins

A prospective study was performed on 32 consecutive patients undergoing elective operations on the abdominal aorta. Dacron prosthetic grafts were used to replace resected abdominal aortic aneurysms or to bypass aorta-iliac occlusive disease. Complete coagulation studies were performed preoperatively, immediately postoperatively and 24 hours postoperatively. Twenty to 30 per cent of the patients had significant postoperative alterations in prothrombin time, partial thromboplastin time and platelet count. Fibrin monomer, fibrin split products and plasminogen were abnormal in 40 to 80 per cent of the patients postoperatively. Results of preoperative studies showed no significant abnormalities. One of the 32 patients had mild clinical evidence of disseminated intravascular coagulation postoperatively, which was treated with 5 units of heparin per kilogram per hour. Results of the study indicate that aortic grafting procedures frequently produce intravascular coagulation, either local or disseminated. In most patients, this is offset by activation of the fibrinolytic system. However, clinically significant sequelae may result, requiring prompt recognition and treatment.

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm; Aortic Diseases; Arterial Occlusive Diseases; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Vessel Prosthesis; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prothrombin Time; Thromboplastin

An arterial line filter can become a grave source of platelet and fibrin destruction, with widespread deposition on the filter to form a membrane across the mesh, as proved by careful scanning electron microscopy. The same filter, when subjected to the low flows of the cardiotomy line, was well tolerated and served a very useful function. There was a 260% improvement in platelet counts and a 170% reduction in chest drainage when the arterial line filter was not used, perhaps through elimination of a degree of consumptive coagulopathy. Neurological changes did not occur in the absence of the arterial line filter, and operative mortality was 4.8% (5 of 103 patients).

Topics: Blood Platelets; Evaluation Studies as Topic; Fibrin; Filtration; Heart-Lung Machine; Humans; Postoperative Complications; Thrombosis

Levels of fibrin(ogen) degradation products (F.D.P.) have been measured by radioimmunoassay for degradation product E (FgE) and by tanned-red-cell haemagglutination-inhibition immunoassay (T.R.C.H.I.I.) in the serum of thirty-three patients undergoing total hip replacement. Levels of F.D.P. did not correlate with thermographic evidence of deep-venous thrombosis. However, in 34 patients with pulmonary embolism, levels of F.D.P. measured by the T.R.C.H.I.I. were transiently raised at the time of embolus, and FgE concentrations were increased for up to 5 days preceding the embolus. Since the measurments of FgE is simple, convenient, and cheap, this estimation might constitute a valuable screening test for major thromboembolic episodes in the postoperative period.

Topics: Aged; Fibrin; Fibrinogen; Fibrinolysis; Hemagglutination Inhibition Tests; Hip; Humans; Middle Aged; Phlebography; Postoperative Complications; Pulmonary Embolism; Radioimmunoassay; Thermography; Thrombophlebitis

Ninety-three postoperative patients 1 day to 13 years of age had blood cultures, limulus lysate assay, determination of fibrin degradation products, white blood cell and platelet counts. Seven groups were studied. The limulus lysate assay was often positive (64%) in the presence of gram negative septicemia but there were false positives and negatives. The tests for fibrin degradation products were inconsistent. The white blood cell count was low in babies with gram negative septicemia. One hundred per cent of the infants with gram negative septicemia had a platelet count below 150,000; 71% below 100,000 (average 67,000 septic babies, 257,000 non-septic babies). The drop in platelet count with gram negative septicemia was abrupt---as much as 222,000 in 24 hours. Platelets increased when therapy was effective. Two children with gram negative septicemia had platelet counts of 50,000 and 20,000. The platelet count for patients with gram positive septicemia was 299,000, and above 150,000 in all children with ruptured and non-ruptured appendicitis and major surgery without gram negative septicemia. It was concluded that serial measurements of platelet count in the postoperative infant and child was a rapid and reliable method for early detection of gram negative septicemia and changes in platelet count in response to treatment was an indicator of the effectiveness of therapy.

Topics: Abdominal Muscles; Adolescent; Appendicitis; Bacteria; Bacterial Infections; Blood Cell Count; Blood Platelets; Child; Child, Preschool; Enterocolitis, Pseudomembranous; Escherichia coli Infections; Fibrin; Gangrene; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Klebsiella Infections; Leukocyte Count; Liver Neoplasms; Platelet Aggregation; Postoperative Complications; Pseudomonas Infections; Sepsis; Time Factors

A case report of a patient with primary fibrinolysis resulting in hemorrhage after an oral surgical procedure has been presented. A comparison was made between DIC and primary fibrinolysis in patients with carcinoma of the prostate gland; etiology, clinical findings, diagnosis, and treatment were discussed.

Topics: Aged; Alveoloplasty; Aminocaproates; Blood Cell Count; Blood Coagulation Disorders; Blood Platelets; Blood Transfusion; Chlorothiazide; Diethylstilbestrol; Estrogens, Conjugated (USP); Fibrin; Fibrinolysis; Hematocrit; Hemoglobins; Humans; Male; Methyldopa; Oral Hemorrhage; Postoperative Complications; Prothrombin Time; Thromboplastin; Tooth Extraction

Topics: Blood Transfusion; Blood Vessels; Capillaries; Disseminated Intravascular Coagulation; Fibrin; Humans; Lung; Pancreas; Postoperative Complications; Shock; Thrombosis

We wished to know if excision of artificially produced intravitreal vessels would cause bleeding and if the hemorrhage could be controlled by increasing the intraocular pressure. In 17 rabbit eyes, the distal end of several intravitreal blood vessels was excised and removed by the Peyman vitrophage. No significant bleeding occurred from the vessels in 13 eyes, and in the remaining four bleeding stopped after 30 seconds or less of increased intraocular pressure. In one month of observation after surgery, there was no evidence of delayed hemorrhage. Electron microscopy of several transected intravitreal vessels revealed that vessel constriction, platelets and fibrin strands contributed to the prevention of immediate and delayed hemorrhage.

Topics: Ammonium Chloride; Animals; Disease Models, Animal; Endothelium; Erythrocytes; Eye Diseases; Fibrin; Hemorrhage; Hemostasis; Intraocular Pressure; Microscopy, Electron; Postoperative Complications; Rabbits; Retinal Diseases; Retinal Vessels; Time Factors; Vitreous Body

The wall of lover-limb arteries affected with severe atherosclerosis contains a Complex of substances with pro- and anticoagulative activities. The arterial wall, traumatized in endarterectomy by separation of the individual coats, releases procoagulative substances into blood circulation. The most conspicuous local manifestations of hypercoagulation and hypofibrinolysis appear on the day of surgery. The artery operated upon releases the thromboplastic factor for nine days; substances shortening the thrombin time (antiheparin substance, thrombin accelerator), for five days; and inhibitors of fibrinolysis, for four days after operation. A correlation was found between the regenerative process in the endarterectomized artery and the dynamics of the release of tissue factors influencing the haemocoagulation.

Topics: Animals; Arteriosclerosis Obliterans; Blood Coagulation; Catheterization; Dogs; Endarterectomy; Fibrin; Fibrinolysis; Humans; Iliac Artery; Perfusion; Postoperative Complications; Thrombin; Thromboplastin; Time Factors

In a prospective study of 13 patients undergoing open-heart surgery with extracorporeal circulation, marked qualitative platelet function defects were observed in addition to the usually occurring drop of the thrombocyte count. At the end of bypass, the following test results were significantly abnormal: concentration of fibrinogen and of circulating fibrin degradation products, platelet count, platelet adhesiveness to glass beads, and platelet aggregation induced by low and high doses of ADP. One to 2 hours after neutralization of heparin with protamine sulfate all abnormal test results improved, but the template bleeding time was markedly prolonged in 10 patients. There was no correlation between length of bypass and platelet fall and between concentration of circulating fibrin degradation products and extent of platelet dysfunction. An apparent correlation was found between the length of the postoperative bleeding time and the number of units of blood transfued during surgery. The results of this study suggest that dilution of the patient's own platelets by nonviable platelets contained in 3-day-old transfused ACD blood and the production of a refractory state of the patient's circulating platelets to ADP induced aggregation played a significant role in the development of platelet function abnormalities during extracorporeal circulation.

Topics: Adenosine Diphosphate; Blood Cell Count; Blood Platelet Disorders; Blood Platelets; Blood Proteins; Cardiac Surgical Procedures; Collagen; Epinephrine; Extracorporeal Circulation; Fibrin; Fibrinogen; Hemorrhage; Humans; Platelet Adhesiveness; Platelet Aggregation; Platelet Factor 3; Postoperative Complications; Prospective Studies; Protamines; Time Factors

The effects of various combinations of streptokinase-induced hyperfibrinolysis, electric shock, myocardial ischemia, and ventricular fibrillation on cat pericardial and epcardial fibrinolytic activity were studied. Streptokinase alone or electric shock alone slightly increased the periepicardial fibrinolytic activity but epicardial rebleeding did not occur. However, streptokinase infusions followed by electric shock and/or myocardial ischemia and/or ventricular fibrillation significantly incrased the periepicardial fibrinolytic activity and rebleeding of the epicardium occurred. Topical application of the fibrinolytic inhibitor epsilonaminocaproic acid (EACA) prevented the epicardial rebleeding.

Topics: Aminocaproates; Animals; Blood Coagulation; Blood Coagulation Tests; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cats; Electric Stimulation; Fibrin; Fibrinogen; Fibrinolysis; Heart Diseases; Hemorrhage; Injections, Intravenous; Ischemia; Pericardium; Postoperative Complications; Streptokinase; Ventricular Fibrillation

Sixteen frame-mounted fascia lata valves removed from the mitral, aortic or--in one patient--pulmonary position have been detailed histologically. These valves had remained in 15 patients (11 men and four women) for periods varying between 10 and 44 months. The reason for the original transplantation was either chronic rheumatic endocarditis or calcific aortic disease. In the mitral position, the leaflet in position nearest the site of the original anterior mitral valve cusp showed the least changes. The remaining two leaflets of the fascia lata valve in the mitral position, as well as those removed from the aortic or pulmonary position, showed more severe changes; these consisted of degeneration of collagen tissue and often a severe decrease of nuclei belonging to the fibroblastic series. These changes, as well as superimposition of fibrin or fibrous tissue, tended to become more pronounced the longer the valve had remained in the patient. Viability studies in valves removed from two patients have also been undertaken showing very greatly reduced activity. The possible causes for valve dysfunction have been reviewed, and the findings in this study suggest that contraction of fibrous tissue, which sandwiches the fascia lata valve cusps, may contribute to failure of satisfactory valve function. It is concluded that fascia lata forms a poor substitute for replacement of diseased cardiac valves.

Topics: Adult; Aortic Valve; Aortic Valve Insufficiency; Cell Nucleus; Collagen; Eosinophils; Fascia; Fascia Lata; Female; Fibrin; Fibroblasts; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Pulmonary Valve; Thymidine; Time Factors; Tissue Survival

Topics: Adolescent; Female; Fibrin; Graft Rejection; Humans; Kidney Neoplasms; Kidney Transplantation; Lymphoma; Postoperative Complications; Transplantation, Homologous

Topics: Abdominal Muscles; Animals; Blood Sedimentation; Erythrocytes; Fibrin; Fibrinogen; Hematocrit; Heparin; Injections, Intravenous; Postoperative Complications; Rabbits; Thrombophlebitis; Time Factors

Topics: Aneurysm; Arteries; Blood Vessel Prosthesis; Collagen; Elasticity; Endothelium; Fibrin; Fibroblasts; Fistula; Humans; Infections; Intestinal Fistula; Plastics; Polyethylene Terephthalates; Postoperative Complications; Textiles; Thrombosis; Vascular Diseases

Topics: Animals; Arteries; Blood Coagulation Tests; Dermatologic Surgical Procedures; Digestive System Surgical Procedures; Fibrin; Fibrinolysis; Hemorrhage; Humans; Kidney; Liver; Muscles; Postoperative Complications; Rabbits; Streptokinase; Time Factors; Veins

Topics: Adult; Antibodies; Antilymphocyte Serum; Azathioprine; Fibrin; Fluorescent Antibody Technique; Graft Rejection; Heparin; Humans; Hydrocortisone; Immunoglobulin G; Immunosuppression Therapy; Kidney; Kidney Transplantation; Male; Methylprednisolone; Nephrectomy; Postoperative Complications; Rupture, Spontaneous; Transplantation, Homologous

Topics: Adult; Eosinophils; Erythrocytes; Fibrin; Foreign-Body Reaction; Gloves, Surgical; Granulation Tissue; Granuloma; Hemosiderin; Humans; Iatrogenic Disease; Leukocytes; Male; Postoperative Complications; Scrotum; Splenectomy; Starch; Testicular Hydrocele; Tissue Adhesions

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm; Autopsy; Blood Vessel Prosthesis; Fibrin; Fibrinogen; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Kidney; Kidney Diseases; Kidney Glomerulus; Middle Aged; Polytetrafluoroethylene; Postoperative Complications; Rupture, Spontaneous

Topics: Fibrin; Humans; Postoperative Complications; Suture Techniques; Tendons; Tissue Adhesions

Topics: Antithrombins; Blood Coagulation; Blood Coagulation Tests; Fibrin; Fibrinogen; Fibrinolysis; Hematocrit; Humans; Iodine Radioisotopes; Macroglobulins; Plasminogen; Postoperative Complications; Thrombophlebitis; Time Factors

Topics: Aged; Arthroplasty; Elbow; Elbow Joint; Female; Fibrin; Follow-Up Studies; Hip; Hip Joint; Histocytochemistry; Humans; Joint Prosthesis; Knee; Knee Joint; Male; Microscopy, Electron, Scanning; Middle Aged; Necrosis; Osteoarthritis; Postoperative Complications; Surgical Wound Infection; Synovial Membrane; Time Factors; Wound Healing

Topics: Aged; Biopsy; Female; Fibrin; Fibrinogen; Fibrinolysis; Humans; Iodine Radioisotopes; Male; Middle Aged; Plasminogen; Postoperative Complications; Rectal Neoplasms; Thrombophlebitis; Veins

Topics: Adolescent; Adult; Blood Viscosity; Child; Child, Preschool; Cyanosis; Disseminated Intravascular Coagulation; Factor V Deficiency; Fibrin; Fibrinolysis; Heart Defects, Congenital; Heparin; Humans; Infant; Postoperative Complications; Thrombocytopenia; Thrombosis; Veins

The fibrinolytic system was studied in primary biliary cirrhosis (16 patients) and large bile duct obstruction (10 patients, nine of whom had carcinoma). Plasma fibrinolysis (plasminogen activator activity) was decreased and fibrinogen increased in both groups of patients, particularly in those with large duct obstruction. These changes were related to the degree of cholestasis. Plasminogen activator activity was inversely related to serum triglyceride levels in patients with primary biliary cirrhosis. Urokinase inhibitors were decreased in both groups and antiplasmins increased in patients with large duct obstruction; fibrin/fibrinogen degradation products were normal in primary biliary cirrhosis and moderately increased in large duct obstruction. None of these fibrinolytic indices was related to the degree of cholestasis. Fibrinolytic activity and fibrinogen returned almost to normal levels after palliative surgery in the three patients with large duct obstruction who were studied. The decreased plasma fibrinolysis and increased fibrinogen may be due to altered lipid metabolism in cholestatic jaundice. In patients undergoing surgery for large duct obstruction there may be an increased risk of thrombosis.

Topics: Adult; Aged; Antifibrinolytic Agents; Bile Duct Neoplasms; Cholestasis; Common Bile Duct; Female; Fibrin; Fibrinogen; Fibrinolysin; Fibrinolysis; Humans; Lipid Metabolism; Liver Cirrhosis, Biliary; Liver Function Tests; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Plasminogen; Postoperative Complications; Thrombophlebitis; Triglycerides

Topics: Fibrin; Fibrinogen; Graft Rejection; Hemagglutination Inhibition Tests; Humans; Immunoassay; Kidney; Kidney Transplantation; Postoperative Complications; Transplantation, Homologous

Topics: Acute Disease; Fibrin; Fibrinogen; Graft Rejection; Humans; Kidney; Kidney Glomerulus; Kidney Transplantation; Postoperative Complications; Time Factors; Transplantation, Homologous

Topics: Administration, Oral; Biopsy; Blood Coagulation; Buttocks; Child, Preschool; Cyclohexanecarboxylic Acids; Fibrin; Fibrinogen; Fibrinolysis; Hemorrhage; Humans; Infant; Infant, Newborn; Injections, Intravenous; Lymphangioma; Male; Postoperative Complications; Surgical Wound Infection

Topics: Aged; Angiography; Antigens; Female; Femoral Neck Fractures; Fibrin; Fibrinogen; Fibrinolysis; Heart Failure; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Postoperative Complications; Pulmonary Embolism; Radionuclide Imaging; Sepsis; Thrombophlebitis

Topics: Antigens; Fibrin; Fibrinogen; Humans; Postoperative Complications; Pulmonary Embolism; Thrombophlebitis

Topics: Fibrin; Fibrinogen; Humans; Iodine Isotopes; Postoperative Complications; Radionuclide Imaging; Thrombophlebitis; Time Factors

Topics: Age Factors; Analysis of Variance; Aspirin; Fibrin; Fibrinogen; Humans; Iodine Radioisotopes; Methods; Placebos; Postoperative Complications; Thrombosis; Time Factors

Topics: Animals; Catalysis; Fibrin; Fibrinolysin; Fibrinolytic Agents; Hydrocortisone; Peptide Hydrolases; Postoperative Complications; Rabbits; Time Factors; Tissue Adhesions; Trypsin

Topics: Aged; Aminocaproates; Animals; Blood Flow Velocity; Blood Platelets; Dextrans; Electric Stimulation; Fibrin; Fibrinogen; Humans; Iodine Isotopes; Leg; Male; Middle Aged; Phlebography; Platelet Adhesiveness; Postoperative Complications; Prostatectomy; Rabbits; Thrombophlebitis; Time Factors

Topics: Animals; Blood Coagulation Tests; Ethanol; Evaluation Studies as Topic; Female; Fibrin; Fibrinogen; Hematologic Diseases; Humans; Kidney Diseases; Liver Diseases; Male; Neoplasms; Peptide Hydrolases; Postoperative Complications; Postpartum Period; Pregnancy; Protamines; Snakes; Thrombin; Venoms

Topics: Animals; Bone Marrow; Bone Marrow Cells; Femur; Fibrin; Fracture Fixation, Intramedullary; Guinea Pigs; Metals; Orthopedic Fixation Devices; Phagocytosis; Plastics; Postoperative Complications; Time Factors

Topics: Aortic Valve; Aortic Valve Insufficiency; Evaluation Studies as Topic; Fascia; Fascia Lata; Fibrin; Follow-Up Studies; Heart Valves; Humans; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Transplantation, Autologous; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Aortic Valve; Autopsy; Coronary Disease; Fibrin; Follow-Up Studies; Heart Auscultation; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Thromboembolism; Time Factors

Topics: Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Fibrin; Fibrinogen; Humans; Methods; Postoperative Complications

Counterelectrophoresis using a discontinuous buffer system permits detection of fibrinogen-fibrin degradation products (FDP) under a variety of clinical circumstances. The method is sensitive, reliable, and is easily performed using conventional equipment in any clinical laboratory assuming the responsibility for assaying fibrinogen-fibrin degradation products.

Topics: Blood Coagulation Tests; Contraceptives, Oral; Female; Fibrin; Fibrinogen; Humans; Immunoelectrophoresis; Liver Cirrhosis; Methods; Neoplasms; Postoperative Complications; Precipitin Tests; Sepsis; Thrombin

Topics: Aged; Amputation, Surgical; Blood Coagulation; Blood Coagulation Tests; Child; Dilatation; Disseminated Intravascular Coagulation; Fibrin; Genital Diseases, Male; Humans; Male; Methods; Penile Diseases; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Testicular Diseases; Urethral Diseases; Urethral Stricture; Urologic Diseases

Topics: Arteries; Aspergillosis; Fibrin; Histocytochemistry; Humans; Kidney Glomerulus; Kidney Transplantation; Male; Meninges; Middle Aged; Postoperative Complications; Transplantation, Homologous

Topics: Acute Kidney Injury; Adolescent; Adult; Antigens; Blood; Blood Coagulation; Female; Fibrin; Fibrinogen; Fibrinolysis; Graft Rejection; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Transplantation, Homologous; Urine

Topics: Aged; Anticoagulants; Autopsy; Capillaries; Dextrans; Embolism; Female; Fibrin; Hemorrhage; Humans; Infusions, Parenteral; Kidney Glomerulus; Male; Postoperative Complications; Transfusion Reaction

Topics: Aged; Antigens; Fibrin; Fibrinogen; Humans; Iodine Isotopes; Middle Aged; Postoperative Complications; Pulmonary Embolism; Thrombophlebitis; Time Factors

Topics: Animals; Antibodies; Fibrin; Fibrinogen; Humans; Immune Sera; Kidney Diseases; Kidney Glomerulus; Kidney Transplantation; Postoperative Complications; Rats; Transplantation Immunology; Transplantation, Homologous

Topics: Adult; Anticoagulants; Emergencies; Female; Fibrin; Heart Valve Prosthesis; Humans; Mitral Valve; Postoperative Complications; Thrombin; Thrombosis

A total of 76 "high-risk" surgical patients were studied for evidence of venous thromboembolic disease. Episodes of deep vein thrombosis and of pulmonary embolism were related to changes in blood levels of fibrin degradation products (F.D.P.). When diagnosed either by ordinary clinical means or by venography and isotope scanning significantly raised F.D.P. levels were found in all cases. Serum F.D.P. estimations are unlikely to help in detecting deep vein thrombosis, but may prove valuable in diagnosing pulmonary embolism.

Topics: Adult; Aged; Female; Fibrin; Fibrinogen; Humans; Iodine Radioisotopes; Male; Middle Aged; Phlebography; Postoperative Complications; Pulmonary Embolism; Radionuclide Imaging; Thrombophlebitis

Topics: Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Cerebral Arterial Diseases; Chromatography; Chromatography, Gel; Diagnosis, Differential; Fibrin; Fibrinogen; Hematoma, Subdural; Humans; Infant; Iodine Radioisotopes; Male; Middle Aged; Molecular Weight; Postoperative Complications; Thromboembolism; Thrombosis

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Asphyxia Neonatorum; Brain Abscess; Capillaries; Child; Child, Preschool; Fibrin; Heart Arrest; Heart Failure; Humans; Infant; Infant, Newborn; Lung; Macrophages; Meningitis; Microcirculation; Middle Aged; Myocardial Infarction; Pancreatic Diseases; Postoperative Complications; Proteins; Pulmonary Alveoli; Pulmonary Atelectasis; Pulmonary Circulation; Pulmonary Edema; Respiration, Artificial; Respiratory Insufficiency; Shock, Traumatic; Suicide; Tetanus

Topics: Autopsy; Blood Cell Count; Blood Coagulation; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Blood Preservation; Extracorporeal Circulation; Fibrin; Fibrinolysin; Hemorrhagic Disorders; Heparin; Humans; Kidney; Lung; Methods; Plasminogen; Plastics; Postoperative Complications; Silicon; Thrombosis; Time Factors

Topics: Ear Diseases; Ear Ossicles; Fibrin; Fluorocarbon Polymers; Gelatin Sponge, Absorbable; Humans; Labyrinth Diseases; Methods; Otosclerosis; Postoperative Complications; Prostheses and Implants; Veins

Topics: Acute Kidney Injury; Esophagus; Extracorporeal Circulation; Fibrin; Fibrinolysis; Hemorrhage; Hemorrhagic Disorders; Humans; Kidney; Lung; Pleura; Pneumonectomy; Postoperative Complications; Splenectomy; Thrombosis

Topics: Blood Cell Count; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelets; Duodenal Ulcer; Fibrin; Fibrinolysis; Heparin Antagonists; Humans; Postoperative Complications; Solubility; Stomach Ulcer; Wound Healing

Topics: Animals; Cardiac Surgical Procedures; Dogs; Fibrin; Heart Valve Prosthesis; Mitral Valve; Polymers; Postoperative Care; Postoperative Complications; Preoperative Care; Sepsis; Silicones

Topics: Animals; Blood Vessel Prosthesis; Dextrans; Dogs; Fibrin; Polymers; Postoperative Complications; Surface Properties; Thrombosis

Topics: Adolescent; Adult; Aged; Blood Platelet Disorders; Child; Female; Fibrin; Hospitals, General; Humans; Male; Methods; Middle Aged; Postoperative Complications; Pulmonary Embolism; Thrombosis

Topics: Adult; Afibrinogenemia; Aminocaproates; Blood Transfusion; Cesarean Section; Dexamethasone; Female; Fibrin; Fibrinogen; Heart Arrest; Heart Massage; Humans; Hysterectomy; Obstetric Labor Complications; Placenta Previa; Pneumonia; Postoperative Complications; Pregnancy; Pregnancy Complications, Hematologic; Thrombin

Topics: Anesthesia; Blood Protein Disorders; Coagulants; Fibrin; Fibrinogen; Hemorrhagic Disorders; Hemostatics; Humans; Postoperative Complications

Topics: Fibrin; Fibrin Foam; Hemorrhage; Hemostatics; Humans; Jugular Veins; Postoperative Complications; Stapes Surgery

Topics: Afibrinogenemia; Animals; Blood Coagulation Disorders; Blood Coagulation Tests; Dogs; Epinephrine; Fibrin; Fibrinogen; Pharmacology; Postoperative Complications; Reserpine; Shock; Shock, Hemorrhagic; Thrombophilia

Topics: Animals; Electrons; Fibrin; Heparin; Microscopy; Microscopy, Electron; Postoperative Complications; Rabbits; Research; Thrombosis

Topics: Blood Circulation; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Fibrin; Humans; Plastics; Postoperative Complications; Thrombosis; Vascular Diseases