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      Hemostasia hepática utilizando eletrocautério seco ou emplastrado com lidocaína ou neomicina ou glicerina ou vaselina, em coelho Translated title: Liver hemostasis using a dry eletrocautery or greased with lidocaine or neomycin or glycerin or vaseline, in rabbit

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          Abstract

          OBJETIVO: Avaliar a hemostasia e a cicatrização hepática após hepatectomia segmentar, utilizando eletrocautério seco, ou emplastrado com: gel de lidocaína, pomada de neomicina, loção de glicerina e pomada de vaselina. MÉTODOS: Coelhos foram submetidos à hepatectomia parcial e distribuídos em seis grupos (n=10): Grupo 1: sem tratamento; Grupo 2: tratamento com eletrocautério seco; Grupo 3: emplastrado com gel de lidocaína; Grupo 4: pomada de neomicina; Grupo 5: loção de glicerina; Grupo 6: pomada de vaselina. Foram mensurados o peso do fígado ressecado, o volume de sangramento e o tempo dispendido para hemostasia. Cinco coelhos de cada grupo foram reoperados após 24 horas, e cinco após sete dias, para biópsia da ferida hepática e exploração da cavidade abdominal. Eritrograma e marcadores de função e lesão hepática foram avaliados no pré-operatório e antes das reoperações. RESULTADO: O gel de lidocaína e a loção de glicerina reduziram o volume do sangramento e o tempo de hemostasia, além de conduzirem a energia térmica do eletrocautério, provocando degeneração hidrópica celular após 24 horas e necrose após sete dias, com profundidade maior no tecido hepático. Todas as substâncias elevaram as aminotransferases. Esses valores normalizaram-se em até sete dias. CONCLUSÃO: O eletrocautério emplastrado com gel de lidocaína e a loção de glicerina foram os métodos mais eficazes na hemostasia do parênquima hepático de coelhos.

          Translated abstract

          OBJECTIVE: To assess the hemostasis and healing of the hepatic parenchyma after segmental hepatectomy, using a dry electrocautery or an electrocautery greased with lidocaine gel, neomycin pomade, glycerin lotion, or a vaseline pomade. METHODS: Rabbits were submitted to partial hepatectomy and divided into six groups of 10 animals each: Group 1: untreated; Group 2: treated with a dry electrocautery; Group 3: treated with an electrocautery greased with lidocaine gel; Group 4: with neomycin pomade; Group 5: with glycerine lotion; Group 6: with vaseline pomade. Resected liver weight, bleeding volume and time spent to achieve hemostasis were determined. Five rabbits from each group were re-operated upon after 24 hours and five after 7 days in order to obtain a biopsy of the hepatic wound and to explore he abdominal cavity. Red blood cell levels and markers of hepatic function and injury were determined before surgery and before re-operation. RESULTS: Lidocaine gel and glycerine lotion reduced the bleeding volume and the time to achieve hemostasis and conducted the thermal energy of the electrocautery, causing hydropic cell degeneration after 24 hours and deeper necrosis of hepatic tissue after 7 days. All substances increased the aminotransferase concentrations. These values returned to normal after a maximum of seven days. CONCLUSION: The electrocautery coated with lidocaine gel and glycerine lotion were the most effective methods for the hemostasis of hepatic parenchyma.

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          Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases.

          To determine if transfusion affected perioperative and long-term outcome in patients undergoing liver resection for metastatic colorectal cancer. Blood transfusion produces host immunosuppression and has been postulated to result in adverse outcome for patients undergoing surgical resection of malignancies. Blood transfusion records and clinical outcomes for 1,351 patients undergoing liver resection at a tertiary cancer referral center were analyzed. Blood transfusion was associated with adverse outcome after liver resection. The greatest effect was in the perioperative course, where transfusion was an independent predictor of operative mortality, complications, major complications, and length of hospital stay. This effect was dose-related. Patients receiving one or two units or more than two units had an operative mortality of 2.5% and 11.1%, respectively, compared to 1.2% for patients not requiring transfusions. Transfusion was also associated with adverse long-term survival by univariate analysis, but this factor was not significant on multivariate analysis. Even patients receiving only one or two units had a more adverse outcome. Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.
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            Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.

            Celiotomy in cirrhotic patients is reported to bear a high risk of operative morbidity and mortality. We reviewed 100 consecutive, cirrhotic patients who underwent nonshunt celiotomy. Thirty patients died and major complications occurred in another 30 patients. Hospital mortality rate was 21% in 39 biliary operations, 35% in 26 procedures for peptic ulcer disease, and 55% in nine colectomies . Fifty-two variables were compared between survivors without complication, survivors with complications, and nonsurvivors. A computer-generated, multivariant discriminant analysis yielded an equation predictive of survival. Utilizing coagulation parameters, presence of active infection, and serum albumin, the equation predicted survival with 89% accuracy. In a similar fashion, amount of operative transfusions, absence of postoperative ascites, pulmonary failure, gastrointestinal bleeding, and culture-positive urine predicted survival with 100% accuracy. We conclude that celiotomy in the cirrhotic patient is truly associated with very high morbidity and mortality, and preoperative assessment can predict survival with 89% accuracy.
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              Hemostatic Alterations in Liver Disease: A Review on Pathophysiology, Clinical Consequences, and Treatment

              In most patients with acute or chronic liver failure, extensive changes in all pathways contributing to hemostasis are found. These hemostatic alterations concern both pro- and antihemostatic pathways, and therefore the net result of the hemostatic dysbalance is unclear. Although it is generally believed that patients with liver disease have a hemostasis-related bleeding tendency, this concept is challenged in recent literature. Although the bleeding problems in patients with liver disease are obvious, the clinically most relevant bleeding episodes, i.e., bleeding from ruptured varices or ulcers, are due to vascular abnormalities and portal hypertension, and not to an abnormal hemostatic system. Moreover, patients with liver disease sometimes experience thrombosis of the portal vein or hepatic artery, which is in part attributed to hypercoagulation. In addition, a substantial part of the patients with liver disease undergoing liver transplantation can nowadays undergo this major surgical procedure, which involves significant hemostatic challenges, without transfusion of blood products. Therefore, the recent debate on the presence of a major hemostatic defect in patients with liver disease seems justified. This paper will review the hemostatic changes that occur in acute and chronic liver failure, and will review hemostasis testing and reversal of coagulopathy in these patients.
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                Author and article information

                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro, RJ, Brazil )
                0100-6991
                1809-4546
                October 2009
                : 36
                : 5
                : 442-448
                Affiliations
                [01] MG orgnameUFMG orgdiv1Cirurgia BR
                [02] MG orgnameUFMG orgdiv1Faculdade de Medicina orgdiv2Departamento de Cirurgia BR
                [03] MG orgnameUFMG orgdiv1Faculdade de Medicina orgdiv2Departamento de Anatomia Patológica BR
                [04] MG orgnameUFMG orgdiv1Medicina BR
                Article
                S0100-69912009000500014 S0100-6991(09)03600514
                10.1590/S0100-69912009000500014
                292f28bb-53bc-44d5-827d-d5022fbdeccc

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 05 January 2009
                : 04 March 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 7
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Eletrocoagulação,Hepatectomia,Hemostasia cirúrgica,Lidocaína,Glicerina,Hepatectomy,Hemostasis, Surgical,Electrocoagulation,Lidocaine,Glycerine

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