Articles: surgery.
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Lumbar disc herniation, canal stenosis, and cervicarthrosis are degenerative spinal pathologies frequently observed in the aging population of patients with Parkinson disease (PD). Spinal surgery in PD patients remains risky with uncertain functional results. The main issue is to determine whether a surgical procedure should be performed on PD patients with common degenerative spinal pathologies. ⋯ Noninstrumented or simple fusion level spinal surgery for patients with PD is fraught with numerous complications and produces very poor functional results. Nevertheless, a multidisciplinary perioperative approach for patients, with less invasive surgery whenever possible, provides the necessary conditions to ensure surgical success and avoid aggravating their fragile general condition.
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Pol. Arch. Med. Wewn. · Jan 2025
ReviewAnticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?
Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. ⋯ If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.