In Vitro Study To Evaluate the Bioactivity of Freezing a Heparin-Based Dalbavancin Lock Solution.

The use of dalbavancin as a catheter lock solution must be addressed in depth before implementation in clinical practice. We assessed whether a heparin-based dalbavancin lock solution could be frozen in single-dose vials for 6 months without affecting its bioactivity against biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). Over 6 months, we tested the bioactivity of a frozen solution of dalbavancin (≈1 mg/ml) plus heparin (60 IU) in terms of CFU counts and metabolic activity against biofilms of Staphylococcus aureus ATCC 43300 (MRSA) and Staphylococcus epidermidis ATCC 35984 (MRSE). The Anti-Xa assay was also performed to assess whether the anticoagulant activity of heparin was reduced under freezing. Every month, we compared the mean value of each variable with that obtained at baseline (before freezing, month 0) using both clinical criteria (values were within 25% of the baseline value) and statistical criteria (linear mixed models). At the end of the experiment (month 6), neither a clinically nor a statistically significant reduction in the bioactivity of dalbavancin-heparin solution was observed in terms of CFU counts and metabolic activity against biofilm of MRSA. Regarding MRSE, considering the clinical criteria, neither CFU counts nor metabolic activity decreased significantly. However, the reduction was statistically significant for all variables. Anti-Xa values (mean [standard deviation] international units per milliliter) for heparin in combination with dalbavancin were within 25% of the heparin-water value. A heparin-based dalbavancin lock solution can be frozen for up to 6 months with no effect on its bioactivity against MRSA and MRSE biofilms.

Anopexia mucosa grapada: experiencia y consideraciones sobre la técnica / Circular mucosal anopexy: Experience and technical considerations

INTRODUCCIÓN: La anopexia mucosa circular (AMC) condiciona un postoperatorio menos molesto que las técnicas resectivas, pero no está exenta de complicaciones y presenta una mayor recidiva. El objetivo del presente estudio es evaluar la eficacia de la AMC en el tratamiento de las hemorroides y del prolapso mucoso rectal (PMR). MÉTODOS: Entre 1999 y 2011 fueron intervenidos en nuestro hospital 613 pacientes por hemorroides o PMR: en 327 casos se realizó AMC (PMR en 28 casos, grado II en 46, grado III en 146 y grado IV en 107 casos). La AMC se realizó en régimen de cirugía mayor ambulatoria (CMA) en el 79% de los casos. Consideramos la recidiva y comparamos los grupos de no recidiva y recidiva. Evaluamos el dolor medido por Escala Visual Analógica (EVA) y las complicaciones postoperatorias. RESULTADOS: En 31 pacientes se registró recidiva de la sintomatología que precisó algún tipo de intervención: PMR en 5 pacientes, grado II en 2, grado III en 17 y grado IV en 7. No existieron diferencias significativas entre los pacientes con reccidiva y los pacientes sin recidiva en cuanto a género, tiempo operatorio ni grado hemorroidal, pero sí respecto a la edad. El 81,3% de los pacientes expresó dolor ≤ 2 en EVA a la semana. Cinco pacientes se reintervinieron por sangrado postoperatorio inmediato. Seis pacientes precisaron ingreso por dolor postoperatorio. CONCLUSIONES: La recidiva en la AMC es superior a la de las técnicas resectivas. La AMC es una técnica útil para el tratamiento de la enfermedad hemorroidal en régimen de CMA. El grado de dolor y las complicaciones son bajos

INTRODUCTION: Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP). METHOD: From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications. RESULTS: A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain. CONCLUSIONS: Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low

Circular mucosal anopexy: Experience and technical considerations. / Anopexia mucosa grapada: experiencia y consideraciones sobre la técnica.

INTRODUCTION: Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP). METHOD: From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications. RESULTS: A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain. CONCLUSIONS: Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.