Development and design of distal radial artery puncture compression hemostatic device / 中国医学装备

To research and design a new type of distal radial artery puncture compression hemostatic device,to solve the problem of distal radial artery puncture and compression hemostat that has not been clinically applied in China.The hemostatic device was mainly composed of hemostatic part,pressure regulating part,fixing part and visual window.The hemostatic device can accurately compress the puncture point,and it was convenient for medical staff to observe the wound through the visual window,find out abnormal conditions such as bleeding or hematoma in time,and take measures to deal with them,which greatly improved the hemostatic effect and comfort of the postoperative puncture point.The new hemostatic device has the advantages of reasonable design and simple clinical operation,which is worthy of clinical promotion.

Prevention of SSI in Cardiac Surgery by Using Intraoperative Measures for High-Risk Patients as Standard Precautions against Mediastinitis / 日本心臓血管外科学会雑誌

Background : Risk factors for surgical site infection (SSI) are thought to include poorly controlled diabetes mellitus, dialysis, and a long operating time, but patients without risk factors can also develop infection. Therefore, it is possible that SSI could be prevented by routinely using the precautions against SSI developed for high-risk patients. We investigated the route and pathogenetic mechanism of mediastinitis, which is the most frequent SSI after cardiac surgery. We hypothesized that mediastinitis occurred when the deep sternal marrow was contaminated by skin bacteria. Based on this hypothesis, we investigated the efficacy of various intraoperative prophylactic methods for preventing mediastinitis. Methods : We evaluated 658 patients undergoing cardiac surgery at our institution between April 2011 and July 2016. They were classified into two groups. Group C comprised 406 patients who received standard insertion of a sternal retractor after sternotomy. Group S was 252 patients in whom a retractor was inserted after covering the sternal marrow with oxidized cellulose hemostats and belt-like thin towels, with surplus parts of the towels being used to fill subcutaneous dead space at the superior and inferior margins of the midline wound. We investigated the following 10 risk factors for mediastinitis: diabetes (HbA1c≥7.5), renal failure (Cr≥2), smoking, obesity (BMI≥30), reoperation, urgent/emergency operation, intubation in the preoperative period, long operating time (≥8 h), reopening the chest for hemostasis, and coronary artery bypass grafting (CABG). Factors associated with mediastinitis were determined using univariate modeling analysis followed by multi-variate logistic regression analysis. Results : Mediastinitis occurred in 13 patients (2.0%). The significant risk factor for mediastinitis were urgent/emergency operation and CABG, but 1 patient had no risk factors. A univariate analysis showed statistical significance in CABG, presence of maneuver covering the sternal marrow, JapanSCORE-II in mortality and deep sternum infection (DSI). Reopening the chest for hemostasis, CABG, aortic aneurysm, plural risk factors, and JapanSCORE-II in DSI were identified as a risk factor by multiple logistic regression, not all factors showed a significant difference. Mediastinitis only occurred in group C, and it was significantly less frequent in group S with additional precautions against infection including propensity score matching analysis (p<0.05). Conclusion : When the bone marrow of the transected sternum was covered tightly to protect it from contamination by skin bacteria during cardiac surgery, the frequency of postoperative mediastinitis was significantly reduced.

The effect of radial artery hemostat continuous compression time in patients undergoing transradial percutaneous coronary intervention / 中国实用护理杂志

Objective To investigate the effect of radial artery hemostat (TR Band) continuous compression time on bleeding of puncture point, thumb perception, palm swelling and subjective comfort in patients undergoing transradial percutaneous coronary intervention. Methods One hundred and fifty-five patients who underwent transradial percutaneous coronary intervention were randomly divided into two observation groups and a control group. All patients in the three groups were treated by TR Band patent hemostasis. All three groups received the consistent deflation schedule, except the TR Band was removed at the 12th hour post operation in the control group, and at the 6th hour in the 1st observation group and at the 4th hour in the 2nd observation group. Postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort were observed in the three groups. Results The differences of postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort among the three groups were statistically significant (χ2=6.31, P<0.05; F=5.26, 4.00, 14.69, P<0.01). In the 2nd observation group, palm swelling was the lowest, but perception, and comfort and bleeding rate is the highest among the three groups. In the 1st observation group, the overall indexes were medium among the three groups. Conclusions The optimal compression duration of TR Band post transradial percutaneous coronary intervention is 6 h, which does not increase the risk of bleeding, but also significantly improve local swelling and perceptual experience, and increase patient comfort.

Value of absorbable hemostat textile as submucosal injection of endoscopic submucosal dissection / 中华消化内镜杂志

Objective To evaluate the application value of absorbable hemostat textile as submucosal injection of endoscopic submucosal dissection(ESD). Methods Twelve New Zealand rabbits were injected with absorbable hemostat textile solution,glycerol fructose and normal saline. The uplift effect was measured after injection. Simulated ESD was performed in the rabbit stomach and bleeding amount was measured. The injection site was pathologically examined at 30 minutes after the soluble hemostat textile and normal saline were injected. Fifteen pigs were injected with absorbable hemostat textile at two locations of 20-30 cm from the anus,and injected normal saline at another two locations of 20-30 cm from the anus.One site was performed simulated ESD and the other was not. Fifteen simulated ESD were performed in the soluble hemostatic group and the normal saline group, respectively. Operation time was recorded and difference in wound healing was compared between the two groups. Results In the uplift experiment, the absorbable hemostat textile group had higher uplift height(4.3±1.4 mm,4.1±1.9 mm,3.8±0.7 mm, 3.3±0.9 mm, respectively)at 0 min,10 min,20 min,30 min than that of the glycerol fructose group(4.3±2.2 mm,4.1± 2.0 mm,3.6±1.4 mm, 3.2±0.8 mm, respectively, P<0.05), and the glycerol fructose group was higher than that of the normal saline group(3.8±1.6 mm,2.6±1.4 mm,1.9±1.9 mm,1.1±0.7 mm, P<0.05). There was no significant difference in uplift height between the absorbable hemostat textile group and the glycerol fructose group(P>0.05). In the bleeding experiment, the bleeding amount of absorbable hemostat textile group was significantly less than that of the glycerol fructose group(0.36±0.07 mL VS 0.42±0.06 mL, P<0.05);the bleeding amount of glycerol fructose group was significantly lower than that of the normal saline group(0.42±0.06 mL VS 0.55±0.07 mL,P<0.05). There was no obvious tissue necrosis and other adverse complications in the absorbable hemostat textile group and the normal saline group. In simulated ESD experiment,complete resection rate of the absorbable hemostat textile group was higher than that of the normal saline group[86.7%(13/15)VS 46.7%(7/15), P<0.05], and mean operation time of the absorbable hemostat textile group was less than that of the normal saline group(3.2± 0.3 min VS 3.8± 0.5 min, P<0.05). No hemorrhage, perforations or other related adverse events occurred in non-ESD lesions. Conclusion Absorbable hemostat textile is safe and effective as submucosal injection of ESD.

Cirugía de tiroides. Revisión histórica y nuevas tecnologías / Thyroid surgery. Historical review, new technologies

El trabajo repasa la evolución histórica en el entendimiento y en el manejo de la cirugía tiroidea. Describe los orígenes de esta cirugía y su ejecución, mucho antes de que se entendiera el funcionamiento de la glándula. Enumera los personajes más trascendentes de esta historia y cómo otras técnicas aplicadas en la cirugía oncológica general se adaptaron a la cirugía de cabeza y cuello. Se mencionan las innovaciones tecnológicas en cirugía tiroidea.

This work reviews the historical evolution of thyroid surgery, its understanding and management. It mentions the origins of this surgical procedure and its execution well before the understanding of the glandular function. The leading persons in this historical field are enumerated; and a review is made of how other techniques applied in surgical oncology were adapted in head and neck surgery. Technological innovations in thyroid surgery are enumerated.

Efficacy of TachoSil, a Fibrin-Based Hemostat, for Anterior Lumbar Spine Surgery

STUDY DESIGN: Retrospective case series. PURPOSE: To examine the efficacy of TachoSil for vessel injury in 6 patients who underwent anterior lumbar fusion surgery (ALF). OVERVIEW OF LITERATURE: ALF for the lumbar spine has a high rate of success, although intraoperative concerns and iatrogenic complications are known, and injury of a major vessel is sometimes a complication. The efficacy of TachoSil, a fibrin-based hemostat, has been reported for several types of surgery; however, use of TachoSil for ALF surgery has not been described. Here, we report on the efficacy of TachoSil in 6 patients, who underwent ALF after vascular surgeons having difficulty in repairing vessels. METHODS: Two man and 4 women with average age of 50.8±10.9 (mean±standard deviation) were diagnosed with a vertebral tumor (2 patients), L4 degenerative spondylolisthesis (2 patients), and L5 spondylolytic spondylolisthesis (2 patients) and underwent ALF. The blood vessels injured included the common iliac vein in 2 patients and a branch of a segmental artery from the aorta in 4 patients. We consulted a vascular surgeon to suture or repair the vessels during surgery, and although the vascular surgeon attempted to address the injuries, suturing or repair was not possible in these cases. For this reason, we used TachoSil to repair the injury in the vessels walls or to stop the bleeding. RESULTS: Time to pressure hemostasis using TachoSil was 34±12 minutes, and total blood loss was 1,488±1,711 mL. Nevertheless, all vessel injuries were controlled by the use of TachoSil. CONCLUSIONS: We recommend the use of TachoSil for vessel injuries that vascular surgeons cannot suture or repair during ALF surgery.

Strategy of postoperative TR -Band tourniquet to stop bleedingin coronary interventional treatment / 中国基层医药

Objective To observe the different methods of hemostasis and comfort of the TR -Band com-pression hemostasis device after coronary intervention and to find the best strategy for TR -Band to stop the bleeding. Methods 150 patients with coronary artery disease were randomly divided into three groups according to the digital table method.The initial time of TR -Band compression hemostasis of group A was 3h,(once per hour,2mL per time,total compression time was 10h),while that of group B was 2h(once in every two hours,3mL per time,total com-pression time was 8h),and that of group C was 1h(once per hour,2mL per time,total compression time was 6 h). Thumb oxygen saturation,complications and comfort level in the three groups of patients were observed and compared. Results The differences between the three groups of oppression hemostasis before and after 2 h thumb oxygen saturation were normal,the three groups had no statistical significance (P >0.05).lesions,hematoma,bruising and radial artery occlusion occurred rate of group A were respectively 4,3,5,2 cases,those of group B were 3,4,6, 1 cases,and those of group C were 2,5,6,0 cases.Lesions,hematoma,bruising,radial artery occlusion of local com-plication incidence of the three groups showed no statistical significance (P >0.05).The comfort level (numbness, swelling,pain)of the three groups had statistically significant differences (Fnumbness =8.215,Fswel ing =7.657,Fpain =7.985,all P <0.01).Conclusion TR -Band compression hemostasis device can achieve effective hemostasis in the treatment of coronary artery intervention.And the reasonable adjustment of different bleeding time,compression time and the amount of bleeding can affect the comfort of patients.

Effect of the use of computer generated pressure hemostat on venous thrombosis of the lower limbs of elderly patients / 中国实用护理杂志

Objective To study the effect of computerized pressure hemostat on lower limb deep vein thrombosis in high-risk elderly patients.Methods From September to December 2013,36 orthopedic hospitalized patients who received operations were divided into the hemostat group and the non-hemostat group with 18 patients in each group.D-dimer changes and lower limb deep vein thrombosis were observed in both groups.Results D-dimer was significantly increased in both groups compared with that before operation,but the extent of elevation in the non-hemostat group was lower than that in the hemostat group.D-dimer and cases of lower limb deep vein thrombosis in the hemostat group was higher than those in the non-hemostat group after operation,which showed significant difference.Conclusions The use of computerized pressure hemostat will increase the risk of lower limb deep vein thrombosis in elderly patients,so the technical operation procedures should be strictly enforced accompany with safely use of computerized pressure hemostat.

Different effects of two hemostases in elderly patients after radial artery intervention / 现代临床护理

Objective To compare the hemostatic efficacies of radial artery balloon and spinning hemostat in elderly patients after radial artery intervention.Methods Eighty elderly patients undergoing transradial coronary intervention were randomly divided into balloon and spinning hemostat groups,with 40 cases in each group.After operation,balloons and spinning hemostats were used for hemostasis,respectively.The two groups were compared in terms of hemostatic effect,comfort degree and incidence of complications.Results These was no difference in hemostatic effect between the two groups(P>0.05).The balloon hemostat group was better than the spinning hemostat in respect of comfort degree.The incidences of ischemia and vagal reflex in the balloon hemostat group were significantly lower than the spinning hemostat group(P<0.05).Conclusion The balloon hemostat for radial artery intervention is more suitable for elderly patients undergoing oral treatment.

Percutaneous Carpal Tunnel Release Using Curved Hemostat and Meniscectomy Hook Knife / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a method of percutaneous carpal tunnel release and report the results of our experience. MATERIALS AND METHODS: A percutaneous carpal tunnel release was performed using a curved hemostat and a meniscectomy hook knife through a small transverse incision at the proximal wrist crease. Among 125 cases from 81 patients, 91 wrists from 58 patients were evaluated retrospectively in terms of the symptomatic resolution and complications. The mean follow up period was 38.9 months ranging from 12 to 118 months. RESULTS: All but one cases (99%) showed a complete symptomatic resolution or a marked improvement postoperatively, and 94.5% of cases were satisfied with the final result. Two patients had a second operation, one chronic renal failure patient showed recurrent symptoms after an initial improvement and the other showed persistent symptoms. There were two superficial palmar arch injuries and one digital nerve injury. However two of them were the earliest cases of an inexperienced surgeons. CONCLUSION: When an experienced surgeon performs a percutaneous carpal tunnel release meticulously, it is a safe and reliable method with the benefits of less postoperative pain and an early recovery.