BackgroundA wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient’s coagulation status.MethodsThe literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held.ResultsFibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient’s coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective.ConclusionsLocal hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.
Small cholangiocytes proliferate via activation of Ca2+-dependent signaling in response to pathological conditions that trigger the damage of large cAMP-dependent cholangiocytes. Although our previous studies suggest that small cholangiocyte proliferation is regulated by the activation of Ca2+-dependent signaling, the intracellular mechanisms regulating small cholangiocyte proliferation are undefined. Therefore, we sought to address the role and mechanisms of action by which phenylephrine, an α1-adrenergic agonist stimulating intracellular IP3/Ca2+ levels, regulates small cholangiocyte proliferation. Small and large bile ducts and cholangiocytes expressed all AR receptor subtypes. Small (but not large) cholangiocytes respond to phenylephrine with increased proliferation via the activation of IP3/Ca2+-dependent signaling. Phenylephrine stimulated the production of intracellular IP3. The Ca2+-dependent transcription factors, NFAT2 and NFAT4, were predominantly expressed by small bile ducts and small cholangiocytes. Phenylephrine stimulated the Ca2+-dependent DNA-binding activities of NFAT2, NFAT4, and Sp1 (but not Sp3) and the nuclear translocation of NFAT2 and NFAT4 in small cholangiocytes. To determine the relative roles of NFAT2, NFAT4, or Sp1, we knocked down the expression of these transcription factors with shRNA. We observed an inhibition of phenylephrine-induced proliferation in small cholangiocytes lacking the expression of NFAT2 or Sp1. Phenylephrine stimulated small cholangiocyte proliferation is regulated by Ca2+-dependent activation of NFAT2 and Sp1. Selective stimulation of Ca2+-dependent small cholangiocyte proliferation may be key to promote the repopulation of the biliary epithelium when large bile ducts are damaged during cholestasis or by toxins.
To the Editor We read with great interest the article by Wellner and colleagues about the comparison between pancreaticogastrostomy (PG) and Roux-en-Y pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD) with regard to postoperative pancreatic fistula (POPF) and other complications. 1 The authors concluded that PG was superior to PJ in terms of clinically relevant POPF; although this study is retrospective, the use of a large case number and standardized measures in evaluation of the surgical outcome makes the results not negligible. Instead, the results of our previously described technique of Roux-en-Y reconstruction show that PJ may have a lower prevalence of POPF than that reported by Wellner and colleagues and suggest that outcome after Roux-en-Y reconstruction with regard to POPF can be further improved using fibrinogen/thrombincoated collagen patch (TachoSil®, Nycomed, UK Ltd.) in carrying out PJ.Briefly, we reviewed the clinical records of 54 consecutive patients who underwent PD by one surgeon (P.C.) at "La Sapienza" University (Rome, Italy) from January 1995 to December 2008. The underlying diseases were: pancreatic carcinoma in 31 cases; pancreatic serous cystadenoma in six cases; mucinous cystadenoma in one case; pancreatic endocrine tumor in two cases; ampullar carcinoma in seven cases; distal bile duct carcinoma in six cases; and chronic pancreatitis in one case. In all patients, the surgical procedure comprised PD with suprapyloric gastric resection and Roux -en-Y reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. 2
Symptomatic pelvic organ prolapse (POP) can have an important impact on general health-related quality of life (QoL) and interfere, as a disability, with physical mobility, pain, emotional reaction, social isolation, energy and sleep (1). The impact of pelvic floor disorders on health related QoL is similar to the impact of other chronic and debilitating conditions as stroke, cancer, diabetes and dementia (2). Lifetime risk of undergoing at least one surgical procedure for prolapse and urinary incontinence (UI) is 11-18 % by the age of 79 years old and the reoperation rate for recurrence of these disorders is 29,2% (3). Over the next 30 years, demand for services to care for female pelvic organ diseases will increase at twice the rate of growth of the same population and the number of surgeries for UI and POP will increase substantially over the next 40 years (4). The high prevalence of POP results in high socio-economic costs and a significant impact on quality of life of these patients.Literature review in terms of colorectal pathology brings out some important observations: there is an unacceptable percentage of obstructed defecation syndrome (ODS) not resolved with conventional surgical procedures. The impact of surgical correction of prolapse symptoms on ODS remains unclear. There are few studies that explore this issue and the data that exist are mixed. Several studies suggest an improvement in constipation levels (5), while others demonstrated a worsening in symptoms or a significant degree of new-onset constipation (6). Furthermore, pre-operative clinical and instrumental evaluations rarely include anatomical-functional examinations of the rectum, thus neglecting that the rectum is one of the pelvic organs that has a high impact in pelvic dynamic, being daily more subjected to mechanical strains. If ODS persists or is created de novo in patients undergoing surgery for POP, this often results in intense straining which represents a daily mechanical stress on all the pelvic organs and supporting structures. We do not exclude that this could be a major cause of the high rate of relapse after conventional surgery. For these reasons, we believe that correcting ODS is a prerequisite in order to avoid relapses and im-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.