ABSTRACT
Purpose: To evaluate the local hemostatic effect of oxidized, regenerated cellulose [Surgicel; Johnson and Johnson Products, Inc, New Bruunswick. NJ] in patients on oral anticoagulant undergoing dental extraction without interruption of their treatment
Patients and Method: This study included 50 consecutive patients who were on warfarin, requiring dental extraction of their single teeth, randomly allocated into study and control groups. Other 25 patients who had never been on anticoagulant therapy were considered as a negative control group. For all patients, prothrombin time [PT] and international normalized ratio [INR] were detected on the day of extraction. Following dental extraction, in the study group, the sockets were packed with Surgicel and the gingival mucosa was sutured. In the control and the negative control groups, the gingival mucosa was only sutured. Patients were instructed to communicate any bleeding complication after extraction. Patients with no bleeding complication were seen on the eighth day for suture removal. They were examined for the presence of swelling, pain, and local infection. Data were collected and statistical difference in age and sex distributions, INR level, and post-extraction bleeding that required treatment were analyzed. Statistical significance was defined as a value of P < 0.05
Results: Local hemostasis was obtained immediately in the study group and only after 10 to 30 minutes in both the control and negative control groups. As regard bleeding complications, no cases of post-extraction bleeding that required treatment were recorded in both the negative control and study groups. Five cases of post-extraction bleeding that required treatment were encountered in the control group. This difference was statistically significant. No patient had postoperative pain, swelling or wound infection
Conclusion: Dental extractions can be performed in patients on oral anticoagulant without modification of their treatment regimen, provided that an effective local measure is used. Local haemostasis with Surgicel and sutures appears to be efficient in preventing postoperative bleeding
ABSTRACT
Endomyocardial Fibrosis [EMF] is a common disease in the humid zones of tropical Africa- Recognition of cases outside the tropical zone has been reported with increasing Interest. We report our experience with 30 Egyptian peasants who all had infection with schistosoma. Laboratory investigations, 12-lead electrocardiography and pericardiocentesis were performed in all patients. Pericardial biopsy was performed in some patients. All patients had evidence of infection with schistosoma mansoni, schistosomal hepatic fibrosis. splenomegaly and ascites. All patients had markedly congested neck veins with positive kussmaul's sign in some patients. All patients had no eosinophilia. Atrial fibrillation was detected in 24 patients. Detailed echocardiographic study showed obliteration of the right ventricle [RV], apical RV firbrosis, varying degrees of exudative pericardial effusion in all patients. No extension of fibrosis into RV outflow tract. No fibrosis in left side of heart. Hugely dilated right atrium [RA] with RA spontaneous echo contrast detected in all patients and FM thrombi in only 10 patients. Normal size pulmonary artery without pulmonary hypertension. Minimal to mild tricuspid regurgitation was detected in all patients by Doppler echocardiography. In conclusion, right-sided restrictive card iomyopathy is a special form of EMF detected only in Egyptian peasants without eosinophilia. It always, involved the right side of the heart. Calcification extended to the RV outflow tract in some cases