ABSTRACT
BACKGROUND: To examine if fibrin-coated collagen fleece (Tachosil) interferes with bone and wound healing when it is used on the cut surface of the sternum after median sternotomy. METHODS: A total of 25 patients with osteoporotic sternal disorders were treated with fibrin-coated collagen fleece at the cut surface of the sternum after median sternotomy (therapy group). We compared the occurrence of impaired wound healing and sternal instability, reoperation rate, and 30-day mortality with a control group of 25 case-matched patients. After matching for age, gender, and risk factors for sternal instability (diabetes mellitus, osteoporosis, body mass index, nicotine consumption), both groups were comparable. RESULTS: Sternal instability occurred in one (4%) patient in the study group and in five (20%) patients in the control group. Impaired wound healing occurred in one (4%) patient in the therapy group and two (8%) patients in the control group. Reoperation was necessary in four (16%) patients in the therapy group and 6 (24%) patients in the control group. The 30-day mortality occurred in six (24%) patients in the therapy group and four (16%) patients in the control group. CONCLUSIONS: The use of fibrin-coated collagen fleece on the cut surface of the sternum in patients with osteoporosis does not impair bone and wound healing. Furthermore, it seems to result in less sternal instability. A larger prospective study is necessary to verify the results of this explorative study.
Subject(s)
Bone Remodeling , Cardiac Surgical Procedures , Collagen/therapeutic use , Osteoporosis/physiopathology , Postoperative Complications/prevention & control , Sternotomy , Wound Healing , Aged , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Collagen/adverse effects , Female , Humans , Male , Matched-Pair Analysis , Osteoporosis/complications , Osteoporosis/diagnosis , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Retrospective Studies , Risk Factors , Sternotomy/adverse effects , Sternotomy/mortality , Time Factors , Treatment OutcomeABSTRACT
Background Lung transplantation is the only treatment option for many patients with end-stage pulmonary disease. Therefore, postthoracotomy pain therapy is of vital interest. Thoracic epidural analgesia (EPI) is the "gold standard" for postthoracotomy pain, but especially in lung transplantation contraindications, and potential infectious complications limit its advantages. Under these circumstances surgically placed postthoracotomy catheter-assisted continuous paravertebral intercostal nerve block (PVB) could be of advantage. Methods We performed a retrospective cohort study of patients who underwent lung transplantation between 2005 and 2012. Groups were defined according to the type of postoperative pain therapy: PVB, EPI, and SYS (systemic analgesia). Total 44 patients were eligible. Results Postoperative opioid requirement of the PVB and EPI group was comparable and less than that of the SYS group. Patients of the PVB group were weaned earlier from mechanical ventilation after lung transplantation. Conclusion The potency of postoperative pain therapy of EPI and PVB seemed to be comparable and superior to SYS. Considering the risks and benefits, PVB could be a better choice than EPI for postthoracotomy pain therapy, especially in lung transplantation.
Subject(s)
Analgesia, Epidural , Anesthetics, Local/administration & dosage , Catheters, Indwelling , Intercostal Nerves , Lung Transplantation/adverse effects , Nerve Block/instrumentation , Pain, Postoperative/prevention & control , Thoracotomy/adverse effects , Analgesia, Epidural/adverse effects , Analgesics, Opioid/administration & dosage , Anesthetics, Local/adverse effects , Humans , Lung Transplantation/methods , Nerve Block/adverse effects , Nerve Block/methods , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Patient Selection , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Ventilator WeaningABSTRACT
Peptide YY is produced by L cells in the mucosa of the distal ileum, colon, and rectum and may have systemic and paracrine functions. We hypothesized that peptide YY is expressed by peripheral blood mononuclear cells. The purpose of the present study was to evaluate the expression of peptide YY mRNA and peptide by peripheral blood mononuclear cells and differentiated THP-1 cells after lipopolysaccharide treatment as an in vitro model of inflammation. Blood was drawn by venipuncture from 18- to 63-year-old healthy male blood donors (n=63); peptide YY mRNA expression levels were detected in peripheral blood mononuclear cells from all healthy male subjects. In 3 subjects, peripheral blood mononuclear cells were cultured for 3 and 24h and peptide YY was detected in the cell culture supernatant. In human monocytic THP-1 cells treated with phorbol-12-myristate-13-acetate to induce differentiation to macrophages, treatment with lipopolysaccharide caused down-regulation of peptide YY mRNA levels. In summary, freshly isolated peripheral blood mononuclear cells from healthy humans expressed peptide YY. In vitro data suggested that peptide YY expression is down-regulated by differentiation of monocytes to macrophages and proinflammatory stimuli.
