1/6. Successful arthroscopic treatment of pigmented villonodular synovitis of the knee in a patient with congenital deficiency of plasminogen activator inhibitor-1 and recurrent haemarthrosis.We report the arthroscopic treatment of pigmented villonodular synovitis (PVNS) in a 13-year-old Japanese boy with congenital partial deficiency of plasminogen activator inhibitor-1 (PAI-1). He was admitted to our hospital with recurrent haemarthrosis of his right knee. Characteristic abnormalities of fibrinolysis included shortened euglobulin lysis time, low PAI-1 activity and low PAI-1 antigen levels. In addition, levels of "active PAI" in the plasma, which is a measure of total PAI bound to exogenous plasminogen activator, were very low. These parameters remained low after venous occlusion. The diagnosis of PVNS was established by synovial membrane biopsy, and arthroscopic synovectomy was performed with adjuvant administration of intravenous tranexamic acid. Subsequent bleeding episodes have been well controlled by oral administration of tranexamic acid on demand.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/6. Successful use of recombinant factor viia for hemostasis during total knee replacement in a severe hemophiliac with high-titer factor viii inhibitor.A 32-year-old male patient with severe factor viii (FVIII) deficiency had developed a high-titer FVIII inhibitor at age 13. Recurrent hemarthroses caused bony destruction in both knees, significantly impairing his ability to walk. knee examination revealed 20 degrees of varus, destruction of the medial joint line, and flexion contracture. Total knee arthroplasty was performed using recombinant factor viia (rFVIIa, NovoSeven) for hemostatic control. rFVIIa (85 microg/kg given intravenously over 3-5 minutes) was given just prior to surgery. The dose was repeated every 2 hours during and for the first 48 hours after surgery. When the tourniquet was removed, rFVIIa had not been infused for 1.5 hours, and significant hemorrhage was noted. The hemorrhage responded promptly to rFVIIa infusion. The infusion interval was extended to every 4 hours for an additional 48 hours, and subsequent doses were given every 6 hours until the patient returned to the clinic 2 days postdischarge. Hemoglobin levels dropped from 16.9 gm/dL on admission to 9.1 gm/dL at discharge. After 2 months, the patient returned to work. We recommend that tourniquet release be performed immediately after rFVIIa administration and that aggressive physical therapy be considered in the early postoperative period when rFVIIa infusions are frequent.- - - - - - - - - - ranking = 0.5keywords = administration (Clic here for more details about this article) |
3/6. Surgery in hemophilic patients.Surgery in hemophilic patients was performed under proper factor-replacement therapy, and a wide variety of orthopaedic procedures (twenty-six in seventeen patients) were done with good results. There were no complications in any of the patients since the advent of concentrates in 1966. Multiple procedures under one anesthetic are recommended because the complications associated with repeated administration of blood substitutes are minimized.- - - - - - - - - - ranking = 0.5keywords = administration (Clic here for more details about this article) |
4/6. hemarthrosis of the knees following streptokinase therapy for acute myocardial infarction.A sixty-four-year-old male patient was studied who had acute coronary syndrome with ST segment elevation experienced bilateral hemarthrosis of the knees after administration of streptokinase and acetylsalicylic acid.- - - - - - - - - - ranking = 0.5keywords = administration (Clic here for more details about this article) |
5/6. Concurrent total hip and knee replacements in a patient with haemophilia with inhibitors using recombinant factor viia by continuous infusion.The introduction of activated recombinant factor viia (rFVIIa) has allowed elective surgery to be safely performed in haemophiliacs with inhibitors. The main problems associated with its use are the short half-life, necessitating frequent intravenous injections, and its very high cost. Here we describe, for the first time, the performance of total hip and knee replacements in a haemophiliac with inhibitors at the same operation. The amount of rFVIIa concentrate used (8.57 mg) was similar to that normally used for a single joint replacement. The use of continuous infusion allowed for easier administration and further contributed to the reduction in cost as it avoids the peak levels associated with bolus injections.- - - - - - - - - - ranking = 0.5keywords = administration (Clic here for more details about this article) |
6/6. Shoulder hemiarthroplasty to manage haemophilic arthropathy: two case studies.Bleeds within the shoulder joint can lead to significant joint destruction and may have associated pain, decreased range of movement (ROM), and impaired function. Conservative management should involve prompt administration of Factor VIII and physiotherapy to address all surrounding structures so as to minimize further damage. If conservative management fails to relieve severe, unremitting shoulder pain in the presence of underlying arthropathy, then arthroplasty may be considered. Outcomes of arthroplasties performed for osteoarthritis and rheumatoid arthritis appear favourable. Few articles, however, have addressed shoulder arthroplasty to manage haemophilic arthropathy, and no reports have documented the rehabilitation process. Three hemiarthroplasties were performed at the Royal Brisbane and women's Hospital on two men with haemophilia. There were no surgical or postoperative complications. rehabilitation included intensive physiotherapy. The results in each case revealed a decrease in pain, and an increase in ROM and function postoperatively. These findings suggest that hemiarthroplasty with postoperative physiotherapy may be a feasible option to manage severe, chronic and progressing shoulder pain as a result of haemophilic arthropathy of the shoulder.- - - - - - - - - - ranking = 0.5keywords = administration (Clic here for more details about this article) |