RESUMEN
Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.
Asunto(s)
Ácido Aminocaproico/administración & dosificación , Antifibrinolíticos/administración & dosificación , Artroplastia de Reemplazo de Rodilla , Hemorragia Posoperatoria/prevención & control , Ácido Tranexámico/administración & dosificación , Administración Oral , Anciano , Transfusión Sanguínea/estadística & datos numéricos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: One of the most common grafts used to repair anterior cruciate ligament (ACL) rupture is the hamstring tendon (HT) autograft. However, another proposed option to repair the ACL is the quadriceps tendon (QT) autograft. This study aimed to compare the pain and clinical results between patients with ACL injury treated with QT autograft and with HT autograft. MATERIALS AND METHODS: The Ethics and Investigation Committee of our institution approved the study. The patients were randomized into two groups: one group was treated with QT autograft and the other group was treated with HT autograft. The patients were evaluated preoperatively and postoperatively using the Lysholm-Tegner score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and visual analog scale (VAS), at 2 weeks and 1, 3, 6, and 12 months. RESULTS: A total of 28 patients with a primary ACL injury were included in the study. No significant differences in VAS pain, Lysholm knee and Tegner activity scale scores, and IKDC score between the HT and QT groups were observed at any time point. All patients had favorable outcomes and significantly improved evaluation scores. CONCLUSION: The patients treated with QT autograft had clinical results and post-operative pain similar to those of patients treated with HT autograft for ACL reconstruction.
ANTECEDENTES: Uno de los injertos más comúnmente usados para la reparación de una ruptura de ligamento cruzado anterior (LCA) es el autoinjerto de los tendones isquiotibiales. Sin embargo, otra opción propuesta para la reparación del LCA es el autoinjerto del tendón de cuadríceps. El objetivo de este estudio fue comparar el dolor y resultados clínicos en pacientes con lesión del LCA tratados con autoinjerto de cuadríceps y con autoinjerto de isquiotibiales. MATERIAL Y MÉTODOS: El Comité de Ética e Investigación de nuestra institución aprobó el estudio. Los pacientes fueron aleatorizados en dos grupos: un grupo fue tratado con autoinjerto del cuadríceps y el otro grupo con autoinjerto de isquiotibiales. Los pacientes fueron evaluados preoperatoriamente y postoperatoriamente usando la escala de Lysholm-Tegner, la International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, y la Escala Visual Análoga (EVA), a las dos semanas, a 1, 3, 6 y 12 meses. RESULTADOS: Un total de 28 pacientes con lesión primaria de LCA fueron incluidos en el estudio. No hubo diferencias significativas en EVA, escala de Lysholm-Tengner y en IKDC entre los grupos de isquiotibiales y cuadríceps durante su evaluación. Todos los pacientes tuvieron evoluciones favorables y mejoraron de forma significativa sus escalas. CONCLUSIÓN: Los pacientes tratados con autoinjerto de tendón de cuadríceps tuvieron resultados clínicos y dolor postoperatorio similar a aquellos pacientes traídos con autoinjerto de isquiotibiales en la reconstrucción de LCA.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tendones Isquiotibiales/trasplante , Músculo Cuádriceps/trasplante , Adulto , Lesiones del Ligamento Cruzado Anterior/rehabilitación , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Autoinjertos , Femenino , Humanos , Masculino , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Quality of life (QoL) has been included as a marker of treatment effectiveness in pediatric patients with chronic diseases. We believe that frequent multidisciplinary interventions and patient education could lead to an improvement in QoL. AIMS: Determine the QoL and economic impact of monthly interventions in multidisciplinary treatment. MATERIALS AND METHODS: The Haemo-QoL questionnaire was applied to patients who attended the hemophilia center of the University Hospital "Dr. José Eleuterio González," Monterrey, Mexico, at the time of enrollment and 1 year later. RESULTS: Male patients between 4 and 16 years diagnosed with hemophilia were included. The score results presented are based on Haemo-QoL versions that classify patients by their age group: group 1 (4 to 7 y) and group 2 (8 to 12 y). Statistical significant improvement was observed in the overall score (sociodemographic, psychosocial, etc.) after 1 year of follow-up in both groups (P<0.05). CONCLUSIONS: Impact on the QoL of patients receiving this approach was favorable. Improvement was observed regardless of severity and in those who were already in prophylaxis, suggesting that this type of approach could be causing the improvement. Results support the application of multidisciplinary treatment as the gold standard, and it should be considered in all centers including those with limited resources.
Asunto(s)
Hemofilia A/terapia , Calidad de Vida , Encuestas y Cuestionarios , Adolescente , Niño , Preescolar , Femenino , Estado de Salud , Hemofilia A/diagnóstico , Humanos , Masculino , México , Resultado del TratamientoRESUMEN
AIM: Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA. METHOD: This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198. RESULTS: A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. CONCLUSION: The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA.