A Retrospective Study on Unfractionated Bovine Heparin Safety in On-Pump Cardiac Surgery

Abstract Background: Heparin decreases the risks of thrombotic phenomena in extracorporeal circulation. However, it must present a robust safety profile itself, especially for bleeding. Contamination of porcine heparin demands an alternative source and consequent assessment of safety. Objective: To evaluate the safety of unfractionated bovine heparin during on-pump cardiac surgery. Methods: Descriptive, retrospective study, evaluating medical records from all patients who had on-pump cardiac surgery over four years. We observed the occurrence of bleeding, thrombocytopenia, postoperative vasoplegia, activated clotting time values and any other coagulation phenomena as safety profile parameters. Results: We evaluated 204 medical records reporting the use of unfractionated bovine heparin. 66.18% of the patients presented thrombocytopenia, 1.04% presented bleeding of more than 2000 mL in the first 24 hours of the postoperative period. One patient presented clots in the surgical field. Median activated clotting time was 137 seconds at baseline, 803 seconds after the first dose of heparin and, after protamine, it returns to similar baseline values, that is, 149.5 seconds. Conclusion: Unfractionated bovine heparin did not present unusual adverse effects and can be considered safe for on-pump cardiac surgery.

Anatomia aplicada da ponta nasal em rinoplastia / Applied anatomy of the nasal tip in the rhinoplasty

Introdução: A insatisfação com a própria aparência facial leva muitas pessoas a buscarem a rinoplastia, sendo esse o quinto procedimento cirúrgico mais realizado na cirurgia plástica segundo a ISAPS. Devido essa cirurgia ser complexa, podendo gerar problemas estéticos e funcionais, o conhecimento aprofundado da anatomia dessa região, em especial a da ponta nasal, é imprescindível. Métodos: Realizou-se revisão na literatura em 17 artigos e 2 livros sobre a anatomia do nariz e sua repercussão na rinoplastia. Revisão da literatura: As primeiras menções sobre rinoplastia datam final do século XIV, desde lá houve muita evolução passando de uma técnica puramente reducional para uma estruturada que prioriza a melhora da função e estética nasal. O sucesso desse procedimento depende do conhecimento anatômico do profissional que o está realizando e também da escolha da técnica ideal. O nariz é constituído por ossos e principalmente cartilagens, as quais, junto com a musculatura, são responsáveis na determinação da aparência da ponta nasal. Essas cartilagens quando não são trabalhadas da forma correta, originam problemas funcionais, como colapso da válvula nasal externa. Conclusões: O conhecimento da anatomia da ponta nasal é fundamental para o sucesso da rinoplastia, devendo sempre equilibrar a função e a estética do nariz.

Introduction: Dissatisfaction with own facial appearance leads many people to seek for rhinoplasty, which is the fifth most common procedure in plastic surgery worldwide according to ISAPS. It is known as a very complex surgery that can cause aesthetic and functional problems, an in-depth knowledge of the anatomy of this region, especially the nasal tip, it is essential. Methods: A literature review was done in 17 articles and 2 books on the anatomy of the nose and its impact on rhinoplasty. Literature review: The first mention of rhinoplasty was in the late fourteenth century, since then much has been evolved, from a purely reductional technique to a structure done that prioritizes the improvement of nasal function and aesthetics. The success of it depends on the anatomical knowledge of the professional who is performing the procedure and also the choice of the ideal technique. The nose has in it constitution bones and cartilages, together with the muscles, are responsible for determining the appearance of the nasal tip. The cartilage if not properly crafted, it might cause functional problems such as collapse of the external nasal valve. Conclusions: The knowledge of the nasal tip anatomy is crucial to the success of rhinoplasty, and it must always find the balance between function and aesthetic of the nose.