Clinical significance of the mastoid emissary vein in paediatric Osia implantation

Acute kidney injury after liver transplantation is associated with viral hepatitis, prolonged warm ischemia, serum lactate and higher mortality

BACKGROUND Placenta accreta spectrum (PAS) disorders involve abnormal adhesion or invasion of chorionic villi through the myometrium and uterine serosa. Maternal anemia during pregnancy is common and may contribute to complications during delivery, particularly with abnormal placentation. This study examines the association between preoperative maternal hemoglobin levels and the risk of intraoperative massive hemorrhage in pregnant women with PAS disorders. MATERIAL AND METHODS A retrospective study included 538 consecutive participants (mean age=31.12&plusmn;4.68 years) who underwent cesarean sections and met the diagnostic criteria for PAS disorders. Logistic regression analysis was performed to investigate the relationship between maternal preoperative hemoglobin levels and the risk of massive intraoperative hemorrhage (blood loss ≥1500 mL). RESULTS The incidence of intraoperative massive hemorrhage among patients with PAS disorders was 38.66%. The mean preoperative maternal hemoglobin level was 10.99&plusmn;1.39 g/dL, and overall anemia incidence (<11 g/dL) was 48.88% in our study. After adjusting for potential confounders, a non-linear relationship was observed between preoperative maternal hemoglobin levels and the risk of intraoperative massive hemorrhage. When the preoperative hemoglobin level of pregnant women was below 11.5 g/dL (OR=0.52, 95% CI 0.39-0.70), the lower hemoglobin level significantly increased the risk of intraoperative hemorrhage. CONCLUSIONS Maternal preoperative hemoglobin levels were inversely associated with the risk of massive intraoperative hemorrhage in PAS disorders. A non-linear relationship was identified, with a turning point at 11.5 g/dL. These findings emphasize the importance of monitoring and managing maternal hemoglobin levels to mitigate the risk of intraoperative hemorrhage in pregnant women with PAS disorders.

AimsTo examine possible benefits of intravitreal bevacizumab (IVB) pretreatment in vitrectomy for severe diabetic retinopathy.MethodsA comprehensive literature search was performed using the Cochrane Collaboration methodology to identify randomised controlled trials...

Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis.

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.

Background:To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery.Methods:The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patients were excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated using Nadler's formula and Gross’ formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05.Results:There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler's formula and Gross’ formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction.Conclusions:Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.

Effect of aspirin intake on bleeding during cataract surgery

To analyze the vascular anatomy and complications of the right colon under laparoscope. Videotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined. The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time. The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.

BackgroundPlacenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa.Materials and MethodsWe included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage.ResultsOf 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was −0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >−0.33 (odds ratio, 5.88; 95% confidence interval, 3.04–12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79–6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85–92.13) were independent risk of intraoperative massive hemorrhage.ConclusionIn patients with placenta previa, a birth weight >−0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether fetal weight estimated by ultrasonography can predict hemorrhage during cesarean section in patients with placental previa.

To evaluate the short- and long-term outcomes of dogs undergoing surgical ligation for a left-to-right shunting patent ductus arteriosus (PDA), identify risk factors for intraoperative hemorrhage and intra- and postoperative complications, and report overall mortality rates. 417 client-owned dogs undergoing surgical ligation for a left-to-right shunting PDA between January 2010 and January 2020. Data recorded included patient signalment, echocardiogram findings, intraoperative complications and mortality, postoperative complications, and short- and long-term outcomes. There was no association between age and risk of intraoperative hemorrhage (P = .7), weight and intraoperative hemorrhage (P = .96), or increasing left atrium-to-aortic (LA:Ao) ratio and intraoperative hemorrhage (P = .08). Intraoperative hemorrhage occurred in 10.8% of patients. Intraoperative mortality was 2%. Ninety-five percent of dogs experiencing intraoperative hemorrhage survived to discharge. Survival to discharge was 97%. One- and 5-year survival rates were 96.4% and 87%, respectively. Surgical ligation for a left-to-right shunting PDA is recommended due to the good long-term prognosis. Certain preoperative factors such as age, weight, and the presence and degree of mitral valve regurgitation had no detectable association with risks of intraoperative hemorrhage and, therefore, should not preclude surgical treatment for a left-to-right shunting PDA. Future studies are needed to further assess the association between increasing LA:Ao ratio and risk of intraoperative hemorrhage.

Aim. To analyze the outcomes of popliteal thrombectomy using the standard release technique with vascular instruments and rapid release sensu A. N. Kazantsev in patients with acute popliteal artery thrombosis (PAT) and coronavirus disease 2019 (COVID-19).Material and methods. The present prospective single-center study for the period from April 1, 2020 to March 17, 2021 included 157 patients with acute PAT and COVID-19 at the Alexandrovskaya City Hospital. All patients were divided into 2 groups depending on the popliteal artery access: group 1 (n=88; 56%) — rapid release sensu A. N. Kazantsev; group 2 (n=69; 44%) — standard popliteal artery release using vascular instruments (vascular forceps and scissors) and tourniquets. Rapid popliteal artery release was distinguished by the fact that fasciotomy and hemostasis, the fatty tissue behind it and up to the artery was torn with two index fingers. First, the fingers were joined together at the lateral edges and inserted into the wound middle. Then the wound together with tissues was stretched with fingers to proximal and distal edges until the popliteal artery was visualized. Further, a Beckmann retractor was used to fix the torn fiber to the upper and lower wound walls. The tourniquets were not used.Results. Surgical access duration (group 1, 4,5±1,3 minutes; group 2, 11,41±0,9 minutes; p=0,005), as well as the total procedure duration (group 1, 47,5±2,8 minutes; group 2, 62,15±4,5 min; p=0,001) had the lowest values in the group of rapid popliteal artery release. Moreover, all intraoperative bleedings (n=11; 15,9%) was recorded in group 2 as a result of popliteal vein injuries and/or bleeding from popliteal artery. The retrombosis rate in the rapid release group was lower (group 1, 40,9%; group 2, 55,1%; p=0,03). On the first day after surgery, 18% of thrombosis developed in group 1, and 39% in group 2. The mortality rate was highest in the standard artery release group (group 1, 55,7%; group 2, 86,9%; p&lt;0,0001; OR, 0,18; 95% CI, 0,08-0,42). In all cases, the cause of death was systemic multiple organ failure due to severe pneumonia, pulmonary edema, and cytokine storm.Conclusion. The use of rapid popliteal artery release sensu A. N. Kazantsev significantly reduces the thrombectomy duration in the context of COVID-19. This effect is achieved due to a decrease in the incidence of intraoperative bleeding, no need to use tourniquets and vascular instruments. A decrease in the ischemia duration using novel release technique reduces the retrombosis rate, as well as deaths caused by systemic multiple organ failure against the background of hyperperfusion and compartment syndrome. Reducing the operation duration with the use of rapid popliteal artery release sensu A. N. Kazantsev reduces the time of intraoperative mechanical ventilation, which in COVID-19 patients reduces the risks of pneumothorax, pneumomediastinum, emphysema, and pulmonary embolism. Thus, the rapid popliteal artery release sensu A. N. Kazantsev can be recommended for popliteal thrombectomy in patients with COVID-19.

Objective Here, we aimed to compare early hepatectomy (EH) with delayed hepatectomy (DH) as a treatment for spontaneously ruptured hepatocellular carcinoma (HCC). Methods Several databases were systematically searched for eligible studies that compared DH with EH for spontaneously ruptured HCC treatment. Studies that met the inclusion criteria were reviewed systematically, and the reported data were aggregated statistically, using the RevMan v5.3 software. Results Seven studies were included, with a total of 385 patients, comprising of 224 EH cases and 161 DH cases. Compared with the EH group, incidence of intraoperative bleeding [mean difference (MD), 353.93; 95% CI, 230.04-447.83; P < 0.00001], volume of intraoperative blood transfusion (MD, 420.61; 95% CI, 354.40-486.81, P < 0.00001), and 30-day mortality rate (OR, 14.94; 95% CI, 1.76-126.66; P = 0.01) were significantly lower in the DH group. Furthermore, the 1-, 2-, and 3-year survival rates were significantly higher in the DH group [1-year：hazard ratio (HR), 1.76; 95% CI, 1.06-2.94; P = 0.03; 2-year：HR, 1.52; 95% CI, 1.02-2.25; P = 0.04; 3-year: HR, 1.53; 95% CI, 1.06-2.21; P = 0.02]. There was no difference between the groups in the 5-year survival rate (HR, 1.40; 95% CI, 0.92-2.11; P = 0.11). Conclusion For resectable spontaneously ruptured HCC, DH could reduce intraoperative bleeding, intraoperative blood transfusion volume, and 30-day mortality rate and increase the 1-, 2-, and 3-year survival rates, endowing the patients with greater short- and long-term benefits during and following the surgery.

The management of large esophageal varices (EVs) remains challenging because of the difficulty of endoscopic variceal ligation and fatal post-endoscopic variceal ligation bleeding ulcers. The current study evaluated the efficacy and safety of balloon-compression endoscopic injection sclerotherapy (bc-EIS) in the treatment of large EVs. This retrospective study included 105 patients with cirrhosis exhibiting large EVs (64 in the bc-EIS group and 41 in the EIS group). Primary outcomes included the initial rate of variceal eradication and intraoperative bleeding signs. Secondary outcomes included incidences of rebleeding, mortality, complications, and optimal time of balloon-compression (bc). The initial rate of variceal eradication in the bc-EIS group was significantly higher than that in the EIS group (46.9 vs. 24.4%; P =0.021). The incidence of intraoperative bleeding, which was represented as oozing and spurting, in the bc-EIS group was markedly lower than that in the EIS group (43.8 vs. 61.0% and 9.4 vs. 39.0%, respectively; P =0.043). Patients in the bc-EIS group showed a significantly lower incidence of rebleeding (0.0 vs. 17.1%; P =0.001). However, no significant difference in mortality rate was observed between different groups. Chest pain or discomfort tended to be more common in the EIS group than in the bc-EIS group (58.5 vs. 17.2%; P =0.001). The cut-off value of 11.5-minutes appeared to have a maximum combined sensitivity and specificity of 80.0% and 58.8%, respectively. The area under the curve was 0.708 (95% confidence interval =0.576-0.839; P =0.004). bc-EIS could achieve a higher variceal eradication rate and milder intraoperative bleeding signs in large EVs. Furthermore, 11.5-minutes appeared to be the optimal compression time in bc-EIS.

To evaluate the efficacy of intravitreal conbercept (IVC) in pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR). A meta-analysis of randomized control trials (RCTs) using online databases was performed. The intraoperative outcome measures were the incidence of intraoperative bleeding and endodiathermy application, and the mean surgical time. The postoperative outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline, postoperative vitreous clear-up time and incidence of recurrent vitreous hemorrhage (VH). Eight RCTs were selected for meta-analysis. They included 409 eyes (215 eyes in IVC group and 194 eyes in no conbercept group). Preoperative IVC application was associated with less intraoperative bleeding and endodiathermy applications (RR = 0.34, 95% CI, 0.23-0.50, P < 0.00001, and RR = 0.26, 95% CI, 0.12-0.56, P = 0.0005) compared to no conbercept. It also shortened surgical time (WMD = -15.87, 95% CI, -22.04 to -9.69, P < 0.00001). In addition, preoperative or intraoperative IVC achieved better BCVA outcome (WMD = -0.37, 95% CI, -0.62 to -0.13, P = 0.003), shorter vitreous clear-up time postoperatively (WMD = -5.44, 95% CI, -6.31 to -4.57, P < 0.00001) and a lower rate of VH recurrence (RR = 0.45, 95% CI, 0.22-0.91, P = 0.03). IVC is an effective adjuvant in PPV for PDR, with better intraoperative and postoperative outcomes.

BackgroundThis study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI).MethodsA retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS−. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed.ResultsMyringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS− group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI.ConclusionOlder age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.