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PubMed1984

Platelet-vessel wall interactions in hemostasis: implication of 5-hydroxytryptamine.

5-Hydroxytryptamine (5-HT) is implicated in the platelet-vessel wall interactions during hemostasis. Indeed, the tail bleeding time and the initial blood loss in rats are significantly increased by platelet amine depletion with reserpine/parachlorophenylalanine, by the specific 5-HT2 receptor antagonists ketanserin, R 55 667 and R 56 433 and by the ergot derivatives metergoline and methysergide. In the dose range affecting hemostasis, the serotonergic receptor antagonists also inhibit the 5-HT-amplified aggregation of ADP-sensitized platelets in rat whole blood. Bleeding times are also prolonged by alpha 1-adrenergic receptor antagonism with prazosin or phentolamine, by specific thromboxane A2-synthetase inhibition with R 59 655 or dazoxiben, and by anticoagulant treatment. The latter three mechanisms of action are not explanatory for the effect of the tested serotonergic antagonists, since bleeding times are prolonged by specific 5-HT2 receptor antagonists without an effect on alpha-adrenergic receptors, on platelet prostaglandin biosynthesis or on coagulation and fibrinolysis. The present study shows the interplay between the platelet-derived mediators 5-HT and TXA2 at the level of the platelet or the blood vessel to be of major importance in the platelet-vessel wall interactions during hemostasis.

Animals↗
PubMedDate not supplied

Tissue paper for hemostasis of spot dermabrasion.

Dermabrasion remains one of the effective ways to treat scars and facial wrinkles. Spot dermabrasion is for a localized limited area. Bleeding and oozing from the abraded wound are cumbersome during the operation. Small pieces of tissue paper were used for the intraoperative hemostasis. The efficiency and safety of the tissue paper as a temporary dressing for hemostasis was discussed and presented. It is simple, cost-effective, and easy to use for hemostasis from spot dermabrasion.

Adult↗
PubMed1990

Changes in hemostasis activity during delivery and the immediate postpartum period.

Postpartum deep vein thrombosis is believed to be related to increased activation of the hemostasis system at the time of delivery. To date, studies designed to test this hypothesis have had relatively small sample sizes or used the measurement of specific coagulation factors and functional tests reflecting hemostasis activity in vitro. With the use of recent technologic advances we determined the effect of delivery on hemostasis in vivo by measuring 11 hemostatic indices simultaneously in 70 healthy pregnant women. Significant increases were found in fibrinopeptide A (p less than 0.001), beta-thromboglobulin (p less than 0.001), and platelet factor 4 (p less than 0.001), suggesting maximum platelet activation and fibrin formation at the time of delivery. In addition to continued clotting activity at 3 hours post partum, increased D-dimer, fibrin-fibrinogen degradation products, and decreased alpha 2-antiplasmin levels suggest maximum fibrinolysis. These changes reflect a peak in hemostatic activity at delivery and in the immediate postpartum period that may predispose the development of deep vein thrombosis.

Adult↗
PubMed1990

Hemostasis profile in women taking low-dose oral contraceptives.

Thirty-six young, healthy, nonsmoking women have been selected to check the effect of low-dose oral contraceptives on hemostasis. Two identical groups were treated by Marvelon (a monophasic oral contraceptive containing ethinyl estradiol and desogestrel) or Trigynon (a triphasic oral contraceptive containing ethinyl estradiol and levonorgestrel) for a 6-month period. In the absence, previously controlled, of substantial differences between the effects of each treatment on hemostasis, all the results were pooled at the third and sixth month of the study. The effects of oral contraceptive treatment were as follows: (1) platelet number, platelet aggregating ratio, and plasma beta-thromboglobulin level were not significantly altered, and (2) antithrombin III activity was not reduced despite a slight decrease or antigen concentration. The von Willebrand factor parameters, factor VIII:C, factor VII:C, and clottable fibrinogen were significantly increased. Plasminogen (activity and antigen concentrates) and alpha 2-antiplasmin levels were also significantly increased. Activated partial thromboplastin time and euglobulin lysis time measured after venous occlusion were significantly shortened. Although statistical analysis did not show dramatic changes in all these parameters, some individual extreme values were substantially altered. Therefore we believe that these later values are worthy of cautious consideration for weighing the role that hemostasis factors might play in individual thrombotic risk.

Adult↗
PubMed1995

Aprotinin improves hemostasis after cardiopulmonary bypass better than single-donor platelet concentrate.

Platelet transfusion and aprotinin administration improve platelet function and clinical hemostasis after extracorporeal circulation. To compare two methods of improving postoperative hemostasis, we preoperatively randomized 40 patients undergoing various open heart procedures into two groups. Group A included 20 patients who, immediately after bypass, received single-donor plateletpheresis concentrates collected from ABO-compatible donors (Baxter Autopheresis-C System). They were compared with 20 patients who received high-dose aprotinin (6 x 10(6) KIU) before and during cardiopulmonary bypass (group B). Group A patients showed significantly higher platelet count after single-donor plateletpheresis concentrate transfusion (157 +/- 36 x 10(9)/L compared with 118 +/- 42 x 10(9)/L (p < 0.05). However, platelet aggregation on extracellular matrix was better in group B (3.4 +/- 0.7 versus 2.8 +/- 0.9; p < 0.05). Total 24-hour blood loss and exposure to homologous blood products were significantly less in group B (396 +/- 125 mL and 1.1 +/- 1.6 units compared with 617 +/- 233 mL and 5.4 +/- 3.4 units; p < 0.01). Despite higher platelet count in patients after single-donor plateletpheresis concentrates transfusion, hemostasis in patients receiving aprotinin is better due to improved platelet function.

Aprotinin↗
PubMed1996

Cost/benefit analysis of pharmacologic hemostasis.

BACKGROUND: Surgical bleeding with possible associated coagulopathies is a major source of morbidity and mortality. More than 27% of patients receive unnecessary blood or blood-product transfusions during cardiac operations. Analysis of the cost-benefit of pharmacologic hemostasis can be accomplished by relating all the components of cost, which include both direct and indirect costs to both direct and indirect benefits to the patient. METHODS: A significant reduction in transfusion requirements can be achieved by the systematic application of a clinical algorithm. An alternative is to use drugs that enhance hemostasis. Four such drugs commonly used are desmopressin acetate, tranexamic acid, epsilon-aminocaproic acid, and aprotinin. All these agents have been shown to successfully reduce bleeding and the need for transfusion. It appears that the order of efficacy (greatest to least) is aprotinin, tranexamic acid, epsilon-aminocaproic acid, and desmopressin acetate. RESULTS: Cost/benefit analysis associated with the use of these agents is complex. The direct costs of these drug treatments can be balanced against the costs related to blood and blood-product administration. Using epsilon-aminocaproic acid, blood used is valued at $30, whereas the drug treatment cost is less than $2. Aprotinin use results in costs of more than $500, with the drug costing $900. CONCLUSIONS: Improved hemostasis should also result in indirect cost savings from reduced operating room time, reduced intensive care unit and hospital stay, and the avoidance of reoperation for bleeding.

Aminocaproic Acid↗
PubMed1984

Effect of propranolol on surgical bleeding and hemostasis: an in vivo study in the rat.

The influence of propranolol on surgical bleeding and hemostasis was studied in two different models in the normotensive rat. Propranolol was administered for 6 days subcutaneously and for 28 days orally. In both the tail and the muscle bleeding test the blood loss after the short-term as well as the long-term administration of propranolol was diminished as compared to control values. Highly significant differences were reached in the tail bleeding test. Previous studies have described the effect of propranolol on several constituents of the highly complex hemostatic process. Some of these effects enhance, others inhibit hemostasis. It is concluded that in the normotensive rat these hemostasis-enhancing effects are of greater importance than the inhibiting ones.

Animals↗
PubMed1995

Hemostasis activation in patients with liver cirrhosis.

In patients with liver cirrhosis a decrease of the coagulant potential is well-documented and has been linked to the high bleeding tendency among these patients. Whether the decrease of the coagulant potential is only due to a reduced hepatic synthesis of coagulation factors or also to its consumption by disseminated intravascular coagulation is debatable. We investigated hemostasis activation markers thrombin-antithrombin III complexes (TAT), fibrin degradation products (D-Dimer) and plasmin-alpha 2-antiplasmin complexes (PAP) in 41 outpatients with liver cirrhosis (Child-Pugh index 1 n = 18, 2 n = 15, 3 n = 8). Compared to controls similar in terms of age and sex, TAT, D-Dimer and PAP was elevated in the whole group of patients. A progressive increase of D-Dimer and PAP from Child 1 to 3 indicates a relationship between the severity of cirrhosis and the amount of hemostasis activation. Investigation of the natural anticoagulant potential showed significant decreases of antithrombin III (AT III), protein C, and protein S, most pronounced in Child 3 patients. Statistical analysis revealed significant negative correlations between levels of D-Dimer and both AT III and protein C, indicating that hemostasis activation is linked to the loss of anticoagulant potential.

Adult↗
PubMed2005

Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study.

BACKGROUND: We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery. METHODS: Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured up to 24 hours after the operation: Fibrin D dimer, prothrombin fragment 1+2, alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor. Overall hemostasis potential, overall coagulation potential, and overall fibrinolysis potential were determined with a previously developed assay. We also measured platelet count before and after surgery. RESULTS: Fibrin D dimer and prothrombin fragment 1+2 concentrations were lower during surgery in the off-pump group (p < 0.001). Four hours after admission to the intensive care unit, these differences were eliminated. alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor concentrations did not differ between groups (p = 0.59, p = 0.28, p = 0.22, and p = 0.69). Protein C1 esterase inhibitor and von Willebrand factor concentrations increased over time (p < 0.001) in both groups. Overall hemostasis potential and overall coagulation potential increased over time (p < 0.001), while overall fibrinolysis potential decreased (p < 0.001) with no difference between groups (p = 0.69, p = 0.91). Platelet count decreased on the first postoperative day (p < 0.001), but increased from the first to the third postoperative day (p = 0.004) in both groups without any inter group difference (p = 0.82). CONCLUSIONS: There was a tendency toward less activation of coagulation and fibrinolysis in low-risk patients during elective off-pump coronary artery bypass surgery when compared with on-pump surgery.

Aged↗
PubMed2005

Synergistic platelet integrin signaling and factor XII activation in poly-N-acetyl glucosamine fiber-mediated hemostasis.

The polymer poly-N-acetylglucosamine (pGlcNAc) containing fiber material is becoming increasingly important as a topical agent for hemostasis at wound sites. The pGlcNAc polymeric fiber provides hemostasis through redundant mechanisms that include platelet activation for fibrin network formation. The research presented here better defines the mechanism for the effect of pGlcNAc containing fibers on platelet-mediated processes. Adsorption experiments demonstrated that pGlcNAc fibers tightly bind most major plasma proteins and a specific sub-set of platelet surface proteins, including the integrin beta(3) subunit (CD61) and the von Willebrand receptor GP1b (CD42b). The result of this interaction is a platelet-dependent acceleration of fibrin gel formation. Accelerated fibrin polymerization is sensitive to factor XII inhibition by corn trypsin inhibitor and integrin inactivation with integrilin. Confocal microscopy studies show that when platelet integrins contact plasma protein-saturated pGlcNAc fibers, an increase in intracellular free calcium for platelet activation occurs to drive surface expression of phosphatidyl serine (PS). Thus, a catalytic surface for thrombin generation and accelerated fibrin clot formation results from the interaction of platelets with pGlcNAc. These findings, when considered with the observation that pGlcNAc fibers also induce red blood cell agglutination and vasoconstriction, provides an explanation for the ability of the pGlcNAc material to provide hemostasis in a wide variety of clinical applications.

Acetylglucosamine↗
PubMed2006

Differential action of proteases from Trimeresurus malabaricus, Naja naja and Daboia russellii venoms on hemostasis.

The action of venom proteases and their role in hemostasis has been compared in the venoms of Trimeresurus malabaricus, Daboia russellii and Naja naja from the Southern region of Western Ghats, India. These venoms exhibit varying amounts of proteolytic activity and also influence hemostasis differently. Casein hydrolyzing activity of T. malabaricus venoms was 16 and 24 fold higher than those of N. naja and D. russellii venoms, respectively. With the synthetic substrate TAME, the highest activity was observed in T. malabaricus venom. N. naja venom did not hydrolyze TAME even at higher concentrations. These variations in proteolytic activity also influenced the coagulation process. T. malabaricus and D. russellii venoms are strongly procoagulant and reduce the re-calcification time from 148 to 14 and 12 s, respectively. Similarly, both T. malabaricus and D. russellii venoms reduce the prothrombin time from 12.5 to 6.0 s. On the other hand, N. naja venom is anticoagulant and prolongs re-calcification time to 600 s and prothrombin time to 42 s. In spite of varied effects on hemostasis, all the venoms hydrolyze fibrinogen. T. malabaricus venom hydrolyses both Aalpha and Bbeta subunits. While D. russellii and N. naja venoms hydrolyse only Aalpha. None of these venoms hydrolyze the gamma subunit of fibrinogen. Inhibition studies with specific protease inhibitors revealed that both N. naja and T. malabaricus venoms contain only metalloproteases. D. russellii venom contained both serine and metalloproteases. Only, T. malabaricus venom exhibited thrombin-like activity and induces fibrin clot formation with purified fibrinogen within 58 s. Even though D. russellii venom exhibits procoagulant activity, it did not show thrombin-like activity and may act on other coagulation factors.

Animals↗
PubMed2006

Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease.

OBJECTIVE: Abdominal aortic aneurysms often coexist with reduced lung function and chronic obstructive pulmonary disease (COPD). These conditions are each associated with cigarette smoking, cardiovascular disease, and evidence of increased inflammatory and hemostatic activity. The aim of this study was to determine if these factors accounted for the link between aneurysms and pulmonary disease. METHODS: The design was a case-control study comparing patients with an asymptomatic abdominal aortic aneurysm with population-based controls without an aneurysm. Aneurysms were diagnosed by ultrasound scan, and pulmonary function was measured by respiratory questionnaire and spirometry. Activation of inflammation and hemostasis was measured by assay of plasma interleukin-6 (IL-6), fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator (tPA) antigen, fibrin D-dimer, and plasmin antiplasmin complexes. RESULTS: Cases with an abdominal aortic aneurysm (n = 89) had more COPD and worse expiratory lung function as measured by forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) than controls (n = 98) (FEV1, 1.9 vs 2.2 L, P < .01; FEV1/FVC, 0.67 vs 0.75, P < .001) and did not differ in restrictive function (FVC, 2.9 vs 3.0 L, P = .33). Cases also had higher levels of lifetime cigarette smoking (30 vs 24 pack-years, P < 0.01), cardiovascular disease (35% vs 18%, P = .01), plasma fibrinogen (3.5 vs 3.1 g/L, P = .02), IL-6 (2.8 vs 1.8, pg/mL, P < .001), plasmin antiplasmin complexes (596 vs 384 microg/L, P = .01), and D-dimer (442 vs 93 ng/mL, P < .001). On multiple logistic regression analysis of lung function and COPD on the risk of aneurysm, both cigarette smoking and cardiovascular disease had little effect on the relationships. For the markers of activated inflammation and hemostasis, plasmin antiplasmin complexes and D-dimer had the most important confounding effect on the odds ratios. All markers combined had a substantial effect: odds ratio of aneurysm for a one standard deviation decrease in FEV1 fell from 2.3 (95% confidence interval [CI], 1.5 to 3.5) (P < .01) to 1.3 (95% CI, 0.55 to 2.4) (P > or = .05). CONCLUSION: The association between reduced respiratory function and abdominal aortic aneurysm was not accounted for by cigarette smoking or cardiovascular disease. We hypothesize that activation of inflammation and hemostasis in response to injury may be an important explanation of the association between aneurysm formation and reduced respiratory function. Further studies are required to test this hypothesis.

Aged↗
PubMed1998

A randomized trial of vascular hemostasis techniques to reduce femoral vascular complications after coronary intervention.

This report details a prospectively randomized clinical trial comparing mechanical clamp compression to hand applied pressure for attaining vascular hemostasis after coronary intervention. Effectiveness was determined by comparing the incidence of femoral vascular complications resulting from each of the 2 techniques. Eligible participants included 778 consecutive patients scheduled for percutaneous coronary intervention over an 8-month period. An unselected cohort of the eligible patients (n = 592), determined by the availability of cross-trained clinicians, underwent follow-up serial physical examinations by blinded observers for the duration of their hospital stay. A second, similarly determined cohort (n = 390), underwent color-duplex ultrasonography within 24 hours of sheath removal. Baseline demographic and clinical characteristics, sheath removal parameters, and subsequent outcomes were collected prospectively. The primary end point was a composite of ultrasound-defined femoral vascular complications: femoral artery thrombosis, echogenic hematoma, pseudoaneurysm, or arteriovenous fistulae formation. Complications diagnosed by physical examination constituted the second fundamental end point and included: persistent oozing, ecchymosis, hematoma, bruit, and pulsatile mass. Compared to manual compression, mechanical clamp hemostasis reduced the primary adverse end point by 63% (p = 0.041). Physical examination detected ecchymosis, oozing, and hematomas at equally high frequencies in the two cohorts. Although 65% of the patients in both treatment groups encountered at least one of these cosmetic complications, the diagnoses made by physical examination did not correlate with ultrasound-defined pathology. Multivariable stepwise logistic regression analysis identified a relationship of advanced age and lower body weight to vascular complications. Utilization of a mechanical clamp rather than conventional hand pressure to attain vascular hemostasis significantly reduces ultrasound-defined femoral vascular pathology. Discrepancies between physical examination and ultrasound diagnoses challenge the utility of clinical assessment alone and establish ultrasound as the diagnostic modality of choice.

Angioplasty, Balloon, Coronary↗
PubMed1988

Thrombophlebitis and disturbed hemostasis following administration of intravenous hematin in normal volunteers.

PURPOSE: Acute porphyria episodes are routinely treated with hematin, but side effects, including disturbances of hemostasis and peripheral thrombophlebitis, are associated with the compound's use. Thrombophlebitis is particularly troublesome in patients who require repeated administration of hematin, and may eventually lead to the placement of central venous lines or implantation of indwelling venous access ports. We undertook this study to determine whether only patients with porphyria experienced peripheral thrombophlebitis and disturbed hemostasis following administration of hematin, or if this was a general phenomenon that could also be observed in normal volunteers. SUBJECTS AND METHODS: Hematin was administered intravenously in the doses customarily used in therapy of acute porphyria crises (4 mg/kg body weight) to nine normal male volunteers, who were screened by history, physical examination, routine blood cell counts, urinalysis, biochemical screening profile, and coagulation tests. Hemostasis tests were performed in each subject, and hematin concentrations were determined. RESULTS: Within the first 24 hours, the activated partial thromboplastin time was prolonged in all subjects (mean of 25 percent), the prothrombin time was increased in eight subjects (mean of 20 percent), and the thrombin time in five subjects rose (mean of 15 percent), whereas the concentration of circulating platelets decreased in three subjects (mean of 20 percent). In four subjects (45 percent), thrombophlebitis developed following hematin infusion. CONCLUSION: Although hematin is frequently effective in the treatment of acute porphyria crises, it is often associated with abnormalities in coagulation and these effects also occur in normal volunteers.

Adult↗
PubMed1988

Intraoperative hemostasis and wound healing in intestinal anastomoses using the ILA stapling device.

Intraoperative hemostasis and wound healing of 24 side-to-side intestinal anastomoses constructed with the ILA stapling device were studied in 12 dogs by comparing the ILA-32 and ILA-52 staple cartridges. Hemostasis was evaluated by intraoperative measurement of blood loss and bleeding time at the staple line. There was no statistically significant difference in mean blood loss (p greater than 0.05) or mean bleeding time (p greater than 0.10) between the two cartridges. Wound healing was studied using bursting strength measurements and silicone rubber casting of the microvasculature at the staple line. At 3 days, 1 week, and 2 weeks postoperatively, there was no significant difference between bursting strength values achieved with the two cartridges. Microscopic examination revealed that wound healing in the ILA-52 anastomoses lagged behind healing in the ILA-32 anastomoses at each postoperative time period studied. The silicone rubber casting study showed a paucity of microvasculature at the healing staple line with the ILA-52 cartridge as compared with the ILA-32 cartridge. Our findings suggest that the ILA-52 cartridge does not offer significantly improved intraoperative hemostasis over the ILA-32 cartridge and may affect the microvasculature at the staple line in a way that delays wound healing.

Anastomosis, Surgical↗
PubMed1997

Intraoperative hetastarch infusion impairs hemostasis after cardiac operations.

BACKGROUND: An outbreak of excessive bleeding after cardiac operations occurred at our institution when 5% albumin was in short supply and hetastarch became the preferred intraoperative colloid. As hetastarch may impair coagulation, we investigated the effects of its intraoperative administration on post-cardiac surgical hemostasis. METHODS: Indices of postoperative hemostasis were analyzed in 189 consecutive patients undergoing coronary artery bypass grafting. Three groups were compared: one group (n = 68) received a mean of 796 mL of hetastarch only in the operating room (a few minutes after cessation of cardiopulmonary bypass), another group (n = 59) received a mean of 856 mL postoperatively only, and a third group (n = 62) received no hetastarch. RESULTS: Compared with the other two groups, those patients administered hetastarch intraoperatively exhibited significant reductions in hematocrit and platelet count, a significant prolongation in the prothrombin time, and significant increases in both blood loss and hemostatic drug requirement. Also identified were obvious trends toward a greater transfusion requirement and reexploration rate for bleeding in the latter group. CONCLUSIONS: Hetastarch infusion just after weaning from cardiopulmonary bypass produces a clinically important impairment in post-cardiac surgical hemostasis. Intraoperative use of this agent during heart operations should be avoided until the safe timing of its administration is clarified.

Blood Loss, Surgical↗
PubMed2001

A 12-month clinical investigation with a 24-day regimen containing 15 microg ethinylestradiol plus 60 microg gestodene with respect to hemostasis and cycle control.

The effects of a 24-day regimen containing 15 microg ethinyl estradiol (EE) plus 60 microg gestodene on cycle control and on hemostasis, were evaluated in 58 healthy women (age 19-47 years). All women received the pill for 12 months. Withdrawal bleeding at every cycle during the tablet-free interval was experienced by 84.5% of the women. The overall incidence of irregular bleedings was 19.3%. Hemostasis was evaluated in 20 women. No changes in plasma fibrinogen concentrations, nor in prothrombin fragment F1+2 were observed. A slight increase in thrombin-antithrombin III complexes was observed after 6 and 12 months of oral contraceptive use. Antithrombin III activity significantly increased after one-year of pill intake. The concentrations of tissue plasminogen activator and plasminogen activator inhibitor, both antigen and activity, did not change. These results show that very low doses of EE, such as 15 microg, do not impair hemostasis in healthy females. However, the reduction for the EE dose is responsible of some of the effects on cycle control.

Adolescent↗
PubMed1998

Randomized controlled studies of injection Gold Probes compared with monotherapies for hemostasis of bleeding canine gastric ulcers.

BACKGROUND: There is a significant interest in combination therapy using endoscopic epinephrine injection and thermal coagulation for nonvariceal hemostasis. The purpose of the study was to compare the relative effectiveness, ease of use, and safety of new Injection Gold Probes to other hemostasis techniques in three randomized, controlled laboratory studies of bleeding canine gastric ulcers. METHODS: Fifteen dogs with prehepatic portal hypertension were heparinized and bleeding gastric ulcers were induced with jumbo biopsy forceps. Three different prototypes of Injection Gold Probes were compared with monotherapy (thermal, electrocoagulation, or epinephrine injection alone), control, or combination therapy with separate injector and thermal probes. The treatment times, total number of pulses or injections, volume of epinephrine injected, and ease of applications were recorded. Gastric ulcer size, ulcer healing, and complications were evaluated at 1 and 4 weeks. RESULTS: All endoscopic treatments were effective for acute hemostasis compared with control. Thermal coagulation alone was the fastest treatment to perform. The performance of the first Injection Gold Probe prototype was restricted by its small-gauge needle. The second and third Injection Gold Probe prototypes had a larger-gauge needle and irrigation channel which made them faster and easier to use than separate injection catheters and thermal probes. CONCLUSIONS: The advantages of Injection Gold Probes were the ability to irrigate, inject, and coagulate without probe removal. Combination therapy did not increase treatment-related complications compared with monotherapies.

Animals↗