Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrom...Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Patients and Methods: Sixty-one patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. The control group (n = 29) was managed by discontinuing warfarin and any anti-platelet medication(s) prior to surgery. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and preprosthetic bone surgery, and incision and drainage. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Local measures including removal of granulation tissue, packing, suturing, etc. were utilized for hemostasis. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, preprosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. One patient (3%) required “minor” intervention with removal of a “liver clot” on postop day 2 with repacking and suturing. The 29 patients in the control group discontinued off of war farin underwent a total of 99 procedures. One patient (3%) also required a “minor” intervention (repacking of extraction site). There were no “major” complications in either group. Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. When deciding whether or not to withhold warfarin, this study supports the use of the proposed protocol based on 1) risk stratification for thromboembolism, 2) the need for “minor” versus “major” surgery, 3) and utilization of an In-Office INR Monitoring Device. An In-Office Point-of-Care INR measuring device can be a very effective tool to safely simplify and make the perioperative management of the anticoagulated patient more efficient for the patient and oral and maxillo facial surgeon.展开更多
Over the past decades,cancer has become one of the toughest challenges for health professionals.The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide.Of note,incide...Over the past decades,cancer has become one of the toughest challenges for health professionals.The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide.Of note,incidence of cancers is on the rise more quickly in developed countries.Indeed,great endeavors have to be made in the control of the life-threatening disease.As we know it,pancreatic cancer(PC)is a malignant disease with the worst prognosis.While little is known about the etiology of the PC and measures to prevent the condition,so far,a number of risk factors have been identified.Genetic factors,pre-malignant lesions,predisposing diseases and exogenous factors have been found to be linked to PC.Genetic susceptibility was observed in 10%of PC cases,including inherited PC syndromes and familial PC.However,in the remaining 90%,their PC might be caused by genetic factors in combination with environmental factors.Nonetheless,the exact mechanism of the two kinds of factors,endogenous and exogenous,working together to cause PC remains poorly understood.The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis.This article reviews the high risk factors contributing to the development of PC,to provide information for clinicians and epidemiologists.展开更多
近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的...近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的标准出版时，曾进行了较大的修订，修订内容包括完全性损伤与不完全性损伤的定义，展开更多
文摘Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Patients and Methods: Sixty-one patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. The control group (n = 29) was managed by discontinuing warfarin and any anti-platelet medication(s) prior to surgery. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and preprosthetic bone surgery, and incision and drainage. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Local measures including removal of granulation tissue, packing, suturing, etc. were utilized for hemostasis. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, preprosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. One patient (3%) required “minor” intervention with removal of a “liver clot” on postop day 2 with repacking and suturing. The 29 patients in the control group discontinued off of war farin underwent a total of 99 procedures. One patient (3%) also required a “minor” intervention (repacking of extraction site). There were no “major” complications in either group. Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. When deciding whether or not to withhold warfarin, this study supports the use of the proposed protocol based on 1) risk stratification for thromboembolism, 2) the need for “minor” versus “major” surgery, 3) and utilization of an In-Office INR Monitoring Device. An In-Office Point-of-Care INR measuring device can be a very effective tool to safely simplify and make the perioperative management of the anticoagulated patient more efficient for the patient and oral and maxillo facial surgeon.
文摘Over the past decades,cancer has become one of the toughest challenges for health professionals.The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide.Of note,incidence of cancers is on the rise more quickly in developed countries.Indeed,great endeavors have to be made in the control of the life-threatening disease.As we know it,pancreatic cancer(PC)is a malignant disease with the worst prognosis.While little is known about the etiology of the PC and measures to prevent the condition,so far,a number of risk factors have been identified.Genetic factors,pre-malignant lesions,predisposing diseases and exogenous factors have been found to be linked to PC.Genetic susceptibility was observed in 10%of PC cases,including inherited PC syndromes and familial PC.However,in the remaining 90%,their PC might be caused by genetic factors in combination with environmental factors.Nonetheless,the exact mechanism of the two kinds of factors,endogenous and exogenous,working together to cause PC remains poorly understood.The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis.This article reviews the high risk factors contributing to the development of PC,to provide information for clinicians and epidemiologists.
文摘近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的标准出版时，曾进行了较大的修订，修订内容包括完全性损伤与不完全性损伤的定义，
