7th Postoperative Day Research Articles

Emergency Surgical Management of Thoracic and Limb Injuries in a Hare (Lepus nigricollis)

A one-month old hare (Lepus nigricollis) was brought to the department in emergency with a complaint of dog bite two hours ago due to long chase with dog. Animal was unconscious due to numerous wounds on the thorax and limbs. On clinical examination, fast heart beats were measured from the thoracic perforation at 5th intercostal space and an open wound at the hock joint with abrasions was visible on right hind limb. The animal was handled with appropriate care and after stabilization of vital parameters, surgical management was undertaken under general anaesthesia. The animal showed marked improvement and recovered uneventfully on the 10th post-operative day.

Three-year progression-free survival of a patient with concomitant mucinous adenocarcinoma of the colon with peritoneal dissemination and multiple myeloma who received lenalidomide: a case report

BackgroundConcomitant multiple myeloma (MM) and other primary malignancies is rare. Therefore, the treatment outcomes of patients with these conditions have not been well discussed. Lenalidomide is an oral thalidomide analog drug used for MM. Recently, the antitumor effect of lenalidomide has been gaining attention, and lenalidomide has been applied for managing solid tumors. The current case showed the treatment course of a patient treated with lenalidomide for concomitant MM and colon cancer with peritoneal dissemination.Case presentationA 74-year-old female patient receiving treatment for MM was diagnosed with mucinous adenocarcinoma of the transverse colon. The patient was clinically diagnosed with stage IIIC T4aN2M0 disease. Subsequently, laparoscopic colectomy with lymph node dissection was planned. However, intraperitoneal observation revealed peritoneal dissemination that had sporadically and widely spread. Therefore, palliative partial colectomy was performed to prevent future hemorrhage or obstruction. The patient was discharged on the 10th postoperative day without postoperative complication. Based on the patient’s preference, lenalidomide was continually administered for MM without systemic chemotherapy. The patient survived for > 36 months without any signs of tumor progression.ConclusionThe current case first showed the treatment course of concomitant MM and colon cancer. The antitumor effect of lenalidomide can possibly contribute to 3-year progression-free survival in patients with mucinous adenocarcinoma of the colon with peritoneal dissemination.

The healing effect of allantoin on skin wounds induced in goats

The aim of the present study was to demonstrate the healing effect of allantoin in skin wounds experimentaly induced in goats. Fifteen healthy 12-18-month-old crossbread females goats were divided into three experimental groups: group treated with a comercial formulation of allantoin 3% associated to zinc oxide 3g (GA); control group treated with saline solution (GC) and group treated with a comercial formulation of 35% lauryl dimethyl benzyl ammonium chloride (GP). The wounds were daily treated for 14 days and evaluated on 2nd, 6th, 10th and 14th days by macroscopic characteristcs observations and histological analysis. It was observed a significant increase of wound contraction from the 2nd to 6th post-operative day on the group treated with allantoin while for the microscopic evaluation the collagen deposition was higer on GA groups compared to GC and GP, as well as the inflammatory process was less intense in the allantoin-treated group. In conclusion, it was observed that the allantoin-treated group had a positive effect on inflammation response, collagen deposition and wound contraction, demonstrating that allantoin may be prescribed as an alternative treatment for skin wounds in goats.

Effect of Platelet-Rich Plasma at Different Initiation Times on Healing of the Bone-Tendon Interface of the Rotator Cuff in a Mouse Model.

Platelet-rich plasma (PRP) has demonstrated beneficial effects on healing of the bone-tendon interface (BTI). To determine the optimal initiation time for PRP application after rotator cuff repair in an animal model. Controlled laboratory study. A total of 136 C57BL/6 mice were included; 40 mice were used to prepare PRP, while 96 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly divided into 4 groups: a control group and 3 groups in which PRP was injected into the injury interface immediately after surgery, on the 7th postoperative day (PRP-7d), and on the 14th postoperative day. At 4 and 8 weeks postoperatively, the animals were sacrificed, blood was collected by eyeball removal, and samples of the SST-humerus complex were collected. Histological, imaging, immunological, and biomechanical data were compared among the groups using 1-way analysis of variance with the Bonferroni post hoc test. Histological analysis revealed that the fibrocartilage layer at the BTI was larger in the PRP-7d group compared to the other groups at both 4 and 8 weeks postoperatively. Moreover, the PRP-7d group exhibited improved proteoglycan content and distribution compared to the other groups. Enzyme-linked immunosorbent assay results demonstrated that at 4 weeks postoperatively, higher concentrations of transforming growth factor-β1 and platelet-derived growth factor-BB (PDGF-BB) were seen in the PRP-7d group versus the PRP-14d and control gruops (P < .05), and at 8 weeks postoperatively, the concentration of PDGF-BB was higher in the PRP-7d group versus the control group (P < .05). Biomechanical testing at 4 weeks postoperatively revealed that the failure load and ultimate strength of the SST-humerus complex were superior in the PRP-7d group compared to the other groups (P < .05), at 8 weeks, PRP-7d group was superior to the control group (P < .05). Additionally, at 8 weeks postoperatively, the PRP-7d group exhibited a greater trabecular number and trabecular thickness at the BTI compared to the PRP-14d and control gruops (P < .05). PRP promoted healing of the BTI after a rotator cuff injury at an early stage. A PRP injection on the 7th postoperative day demonstrated superior therapeutic effects compared with injections at other time points.

Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method.

We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD). Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost. One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age ( P =0.871), sex ( P =0.669), BMI ( P =0.176), number of pits ( P =0.99) were similar in both groups. The operative time for PEBAI [20min (18 to 32)] was shorter than EPSIT [32min (24 to 44)] ( P <0.0000, u value=3096, z-score=-9.459). Postoperative first ( P =0.147) and 14th day( P =0.382) pain scores, postoperative analgesic requirements ( P =0.609), time to return to daily activities ( P =0.747), time to return to work ( P =0.345), and wound complications ( P =0.816) were similar, whereas the wound closure time was earlier after EPSIT [32d (24 to 41)] than after PEBAI [37d (26 to 58)] ( P <0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. Complete wound healing ( P =0.382), recurrence rate ( P =0.533), quality of life at first month and (Wound evaluation scale score at first year ( P =0.252) were similar in both groups. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] ( P <0.00001, u value=0, z-score=7.210). PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.

Study on Outcome of Phacoemulsification Cataract Surgery with Clear Corneal Steep Axis Incision

A prospective, observational study was conducted in the Department of Ophthalmology, Combined Military Hospital (CMH), Dhaka, Bangladesh, from April to October of 2019, to observe the outcome and determine the amount of surgically induced astigmatism in phacoemulsification cataract surgery done with clear corneal incision. A total of 60 patients were included in this study. Cataract extraction was done in all the patients by phacoemulsification through clear corneal incision with foldable intraocular lens implantation. All the surgeries were done with INTREPID Micro-Coaxial system using the INFINITI Vision system by the same surgeon under local anaesthesia. The patients were followed up on 1st, 7th, and 30th POD. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. Due to clear corneal incision on steep axis, the steep meridian became flat, from 44.329±1.473D (diopter) (as found in pre-operative keratometry) to 43.971±1.431D (on the 30th post-operative day). On the other hand, the flat meridian became steeper from 43.225±1.471D (pre-operative) to 43.225±1.501D (on the 30th day). At preoperative examination and 30th day follow-up visit, astigmatism was determined as 1.10±0.319 and 0.583±0.413 respectively. The change of astigmatism was statistically significant (P&lt;0.05). CBMJ 2024 January: vol. 13 no. 01 P: 41-45

A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case.

Cirsoid aneurysm of the scalp is a rare arteriovenous fistula having a traumatic, congenital, iatrogenic, or idiopathic etiology. Its presentation can range from a small swelling to a large pulsatile mass with tinnitus, headache, and scalp necrosis. A 67-year-old female presented with a gradually increasing swelling on her forehead and head since childhood and no history of trauma. Examination revealed 12 × 5 cm tortuous midline swelling. Computed tomography angiography revealed a mass of tortuous vessels in the right frontoparietal region of the scalp with no bony defect or intracranial extension. Contrast-enhanced computed tomography of the head showed no intracranial pathology. The diagnosis of cirsoid aneurysm was made, and surgery was planned. A bicoronal incision was made. The feeding arteries were dissected and ligated. The nidus was carefully separated, cauterized, and excised in toto. Inadvertently, a buttonhole in the skin was created while dissecting the nidus, which was sutured. The patient developed a small area of scalp necrosis on the 10th postoperative day, which was debrided and sutured. At the 6-month follow-up, no signs of recurrence were present. A large cirsoid aneurysm of the scalp with multiple arterial supplies can be treated successfully with surgery. Meticulous dissection and hemostasis are warranted to avoid perioperative complications.

Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial.

Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus. It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study. Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups. LBTF shows no edge over BBTF during mandibular third molar disimpaction.

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches

BackgroundMinimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA (“Direct Anterior Approach with bikini incision”) are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes.MethodsThis is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded.ResultsFor each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05).ConclusionThe present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study.

Evaluation of distal femur fractures in cats by hybrid external fixator

In this study, clinical and radiological findings obtained from the treatment of distal femur fractures in cats with hybrid external fixator were evaluated. A total of 10 cats of different ages, breeds and genders with clinically diagnosed femur fractures were used as research material. In the study, hybrid external fixators consisting of circular and linear fixators were used as osteosynthesis material. Closed reduction and external fixation methods were used in 2 cases diagnosed with closed fractures, while limited open reduction and external fixation methods were used in 8 cases diagnosed with open fractures or excessive dislocations. In the radiological examination findings, it was determined that fracture consolidation started on the post-operative 7th day in 9 cases and on the 10th day in 1 case, respectively. Fracture healing was completed in 4 weeks in 2 cases, in 5 weeks in 2 cases, and in 6 weeks in 6 cases (osseous callus was detected). Fixators were removed one week after healing was completed in all patients. In the study, soft tissue complications such as edema in the extremities in 3 cases, mild pin infection in 3 cases and open wounds in 4 cases were determined. However, it was observed that these complications did not adversely affect the recovery time. As a result, with the data obtained from the study, it was concluded that the distal femur fractures in cats of the age and weight scales examined in the study can be successfully treated with the hybrid external fixator system.

C-Reactive Protein and Erythrocyte Sedimentation Rates after Total and Unicompartmental Knee Arthroplasty-Less Implant Equals Quicker Normalization.

Postoperative follow up after total or unicondylar knee arthroplasty (UKA) includes C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to scan for and possibly diagnose a periprosthetic joint infection (PJI). The aim of this study was to describe the postoperative changes in CRP and ESR values after UKA and compare them with values obtained after TKA. Patients operated on between 2020 and 2022 were eligible for this retrospective study. Inclusion criteria were patients with at least 4 postoperative visits associated with blood test screening for PJI, aged > 45, with uneventful follow-up for the first 90 days. Exclusion criteria were a history of chronic inflammatory disease, revision for any reason, and readmission for any reason. Blood samples were collected on the 3rd, 15th, and 30th postoperative days and once between the 45th and the 90th day. The mean and peak values were compared between the two groups. The study included 277 patients (243 TKAs and 34 UKAs). Mean age was significantly lower in the UKA group (67.2 ± 7.5 vs. 60.0 ± 5.9). On the 3rd and the 15th postoperative day, the UKA patients had significantly lower ESR and CRP levels. The levels normalized after the first month. While the TKA patients showed higher values, the trend normalized after the 30th day. CRP and ESR values rose significantly after TKA and persisted up to the 15th day postoperatively. CRP and ESR values normalized faster in patients undergoing UKA. Patients > 65 had higher CRP and ESR values during their routine follow-ups.

Substance P Level in Patients with Degenerative Lumbar Spine Disorder undergoing Decompressive Surgery: An Observational Study

Introduction: Patients with degenerative lumbar spine disorders experience Chronic Low Back Pain (CLBP) for which they undergo decompressive surgery. Substance P (SP), a neurotransmitter which acts as a modulator of pain perception and transmits nociceptive signals via primary afferent fibers to the spinal cord and brainstem. In chronic painful conditions, SP level can be associated with the severity of pain and gets altered; however, this correlation is not present in acute pain. Aim: To evaluate serum SP level in CLBP patients undergoing decompressive spine surgery. Materials and Methods: The present study was a prospective observational study, in which 30 patients with CLBP undergoing decompressive spine surgery were enrolled. Along with them, one first-degree relative of each patient and an equal number of healthy volunteers were included in the study group. Patients were followed-up on the 5th postoperative day and at two months after surgery for the evaluation of SP levels and Visual Analogue Scale (VAS) scores. Statistical data analysis was carried out using IBM PASW Statistics (SPSS) 25.0 version software. SP levels followed a non normal distribution and were compared by Mann-Whitney U or Kruskal Wallis test (for 2 or more groups, respectively) and correlated using Spearman rank correlation. Results: Patients undergoing decompressive spine surgery had a significantly higher SP level (97.5 picogram/mL (pg/mL)) than healthy volunteers (23.22 pg/mL), p-value &lt;0.001. The serum SP levels in patients were found to be significantly reduced on the 5th postoperative day (31.7 pg/mL) and at two months after surgery (48.5 pg/mL), p-value=0.043. In contrast, there was no discernible change in the VAS score, which did not correlate with the fall in SP levels on the 5th postoperative day. Conclusion: SP level was elevated in subjects with degenerative lumbar spine disorders undergoing decompressive surgery. Higher levels of SP can be attributed to CLBP in those patients. SP can be contemplated as a biomarker of pain due to degenerative lumbar spine pathology. However, further studies are warranted to substantiate this.

Does routine partial lateral sphincterotomy with open hemorrhoidectomy improve postoperative pain?

Objective In this study we aimed to detect the difference regarding the postoperative pain and continence in patients with third and fourth degree hemorrhoidal disease who underwent either hemorrhoidectomy alone or combined hemorrhoidectomy with partial internal sphincterotomy for the treatment of hemorrhoidal disease. Patients and methods This prospective comparative randomized clinical trial was conducted at hospitals of Tanta University during the period from March 2021 to August 2022 on 100 patients with third or fourth degree hemorrhoids who were randomly assigned either to group A, patients who only underwent hemorrhoidal excision by the classical technique of Milligan–Morgan or group B, with added partial lateral sphincterotomy to the classic technique. All patients in both groups underwent anorectal manometry both preoperatively and postoperatively. Pain following surgery was analyzed by using visual analog scale system at 24 h, 48 h, and on 10th postoperative day, other complications including incontinence, infection, hematoma, bleeding, and anal stricture were evaluated at 24 h, 48 h, 10th postoperative day, 1 month, and after 3 months. Results Total 100 patients were divided among both groups. The mean age of the patients was 37.7±11.3 and 36.3±11.3 years in group A and group B, respectively. Thirty-two males and 18 females were in group A in comparison to 33 males and 17 females in group B. During follow-up periods, patients in group B had less postoperative pain than those in group A with statistically significant difference. None of the patients developed fecal incontinence for solid or liquid stools in both groups, except for nine patients developed only mild degree of incontinence for flatus in the first week that improved gradually till completely resolved before the end of the 3 months follow up. Conclusion The addition of partial internal sphincterotomy to the classical haemorrhoidectomy technique significantly improves postoperative pain without increasing overall related morbidity.

An integrative approach with TROPIS, Tube in Tract and IFTAK therapy in the management of Complex Anal Fistula: An experience

The management of complex anal fistulae is a challenging job because of the possible risk of damage to the anal sphincter leading to fecal continence, high reoccurrence rate, and delayed wound healing. Other challenges include proper drainage of the tract without disturbing anatomical alignment and painless defecation. This case presented to the outpatient department with a history of recurrent boil in the perianal region and painful pus discharge from the site for 15 days. The case was diagnosed as a case of complex fistula-in-ano and was managed by an integrative approach operative procedure under spinal saddle block anesthesia. Principles of application of Interception of Fistulous Tract and Application of Ksharasutra (IFTAK), transanal opening of intersphincteric space, and tube in tract technique were applied in the management. With necessary analgesia and antibiotics for five days, the patient was given Triphala guggulu internally, and sitz bath with Haritaki (Terminalia chebula Retz.) and Neem (Azadirachta indica A. Juss.) decoction, postoperatively. Wound dressing was done by application of a gauze piece soaked in Apamarga kshara taila. The management resulted in a painless recovery and the patient started attending his daily routine activities from the 7th post-operative day onwards. Pus discharge ceased soon after the operative procedure. Complete healing of postoperative wounds was achieved in ten weeks with prescribed postoperative care and regimen. For the last year, the patient is free from anal discomfort and no reoccurrence has been reported till now.

Effect of carboxymethyl cellulose, icodextrin and hyaluronic acid solutions on postoperative intraabdominal adhesion formation in rabbits and the role of cytokines in intraabdominal adhesion formation

In this study, the aim was to investigate the effects of 1% CMC, 4% ICO and 0.4% HA solutions in preventing postoperative IAs and their contribution to peritoneal wound healing, as well as the relationship of cytokines with the formation of postoperative IAs in rabbits. The material of the study consisted of 32 healthy rabbits. Rabbits underwent median laparotomy following general anesthesia. Serosal abraded was created at the antimesenteric border of the cecum. Next, a 3 × 2 cm peritoneum was excised on the right abdominal wall and the defect was closed using with a 2/0 silk suture. The rabbits were randomly assigned to either of the following four treatment groups: CNT (0.9% NaCl), ICO (4% icodextrin), HA (0.4% hyaluronic acid) and CMC (1% carboxymethyl cellulose). Both cecum and peritoneal surfaces were treated with 20 ml each of treatment solutions. On the 7th postoperative day, the rabbits were euthanized with a lethal dose of sodium pentobarbital and the degree of adhesion was evaluated. Samples taken from the peritoneal defect were examined histopathologically and tissue hydroxyproline levels were measured. Serum TNF-α, IL-1 and IL-6 levels were measured from blood samples taken before the surgery and at 1, 6, 24 and 48 hours after the surgery. It was observed that the adhesion grade in the HA group (p &lt; 0.05) and CMC group (p &lt; 0.01) was significantly lower than the control group. Although peritoneal tissue hydroxyproline levels were lower in the other groups compared to the control group, they were not statistically significant (p &gt; 0.05). In rabbits with adhesion formation, it was determined that TNF-α levels increased at the 6th postoperative hour (p &lt; 0.05), and IL-6 levels increased at the 6th, 24th and 48th postoperative hours (p &lt; 0.001) compared to preoperative. In this study, treating tissues with 0.4% HA and 1% CMC solutions suppressed peritoneal inflammation, and this resulted in an increase in the levels of proinflammatory cytokines TNF-α and IL-6. It has been determined that the application of these solutions reduces postoperative adhesion formation. It was concluded that TNF-α and especially IL-6, which are proinflammatory cytokines, can be a non-invasive biomarker in determining postoperative IA formation and evaluating the adhesive process.

Can silver nanoparticles stabilized by Fenugreek (Trigonella foenm -graecum) improve tibial bone defects repair in rabbits? A preliminary study

Background: A fracture is considered a medical emergency leading to considerable complications. Aim: This study aimed to describe the accelerating action of Ag-NPs-FG on fracture healing in rabbits. Methods: AgNPs were reduced with FG, loaded into a starch gel base, and investigated for their morphology, size, and charge. Four equal groups were randomly formed of 40 adult male rabbits. A 3.5 mm diameter bone defect was created at the proximal metaphysis the right tibia in each rabbit. Groups 1 to 4 were injected with placebo saline, AgNPs-FG, plain gel, and FG-gel at the bone defect zone, respectively. The healing was assessed for 8 weeks postoperatively based on the radiographic, bone turnover markers, and histopathological examinations. Results: The AgNPs-FG was obtained as a faint reddish color, spherical in shape, with an absorbance of 423 nm, a size of 118.0±1.7 nm, and a surface charge of -7.8±0.518 mV. The prepared AgNPs-FG hydrogel was clear, translucent, and homogenous. The pH values were 6.55-6.5±0.2, the viscosity of 4000 and 1875 cPs, and spreadability of 1.6±0.14 and 2.0±0.15 for both FG and AgNPs-FG hydrogel, respectively. Radiographic union scale was significantly (p&lt;0.05) improved in group 2 with significant (P &lt; 0.05) increase of bone turnover markers was found in comparison to other treated groups. Histopathological examination revealed the formation of mature bone on the 28th postoperative day in groups 2 and 4. Conclusion: Colloidal nano-formulation of AgNPs-FG loaded hydrogel could be a promising formulation to accelerate rabbits' tibial bone healing process.

Cerebrospinal fluid leakage due to dural thinning after endoscopic pituitary tumor resection.

Sellar reconstruction is important for preventing cerebrospinal fluid (CSF) leakage after transsphenoidal pituitary surgery. This report describes how, despite standard sellar reconstruction, CSF exudation resulted from dural thinning at the anterior skull base, outside the intrasellar area manipulated during pituitary tumor resection. A 76-year-old man underwent endoscopic transsphenoidal surgery for a pituitary tumor extending toward the anterior skull base. After opening the sellar floor, intractable bleeding from the anterior intercavernous sinus occurred during bone removal at the anterior skull base. Pseudocapsule-based extracapsular resection was completed after stopping the bleeding. On the 10th postoperative day, the patient developed CSF rhinorrhea complicated by marked pneumocephalus, and emergency endoscopic repair of the CSF leak was performed. CSF leakage originated from the thinned dura at the anterior skull base located outside the intrasellar area manipulated during tumor resection. The thinned dural area at the anterior skull base coincided with the site of intractable bleeding of the anterior intercavernous sinus during bone removal in tumor resection. The thinned anterior skull base dura was covered with fascia, overlaid with fat, and closed with the nasoseptal flap. Endoscopic CSF leak repair was successful. Severe damage to the anterior intercavernous sinus can cause extensive exposure of the single-layered inner meningeal dura, where thinning might result in CSF exudation. Therefore, use of autologous tissues to cover and reinforce the severely damaged area of the anterior intercavernous sinus might help prevent postoperative CSF exudation.

To assess the analgesic efficacy of adjuvant magnesium sulfate added with ropivacaine over ropivacaine alone as a continuous infiltration in total abdominal hysterectomy wound: A randomized controlled trial.

Magnesium sulfate (MgSO4) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO4 to ropivacaine increases its analgesic efficacy when infiltrated continuously in the postsurgical wound following total abdominal hysterectomy. This randomized controlled trial was conducted at a tertiary care referral hospital in New Delhi, India. Fifty-two patients were randomized into two groups to receive the intervention of which 48 were able to complete the study. The first group (n = 26) received 0.25% ropivacaine infiltration and the second group (n = 26) received 0.25% ropivacaine with 5% MgSO4 at the incision site for 48 h postoperatively. Primary objective was to compare the total postoperative opioid (morphine) consumption by the study participants in both the groups and the secondary objectives were pain scores at rest and at movement, patient satisfaction score, and wound quality of life on the 7th postoperative day among the two groups. Both the groups were comparable in their demographic characteristics. The median morphine consumed at 48 h postoperatively was 16.5 [0-77] mg in the ropivacaine group and 13[1-45] mg in the ropivacaine with MgSO4 group and the difference was statistically insignificant (P = 0.788). There was no statistical difference between the groups with respect to the pain scores, patient satisfaction, or wound quality of life at 7 days. The addition of MgSO4 to ropivacaine does not confer any additional postoperative analgesic benefits over ropivacaine alone in continuous wound infiltration following total abdominal hysterectomy.

Prospective Study of the Incidence of Asymptomatic Deep-vein Thrombosis in Postoperative Patients: A Single-center Study

Abstract Introduction: Postoperative DVT remains one of the formidable challenges for the surgeon. It is associated with a significant risk of associated morbidity and mortality. Diagnosis of DVT is usually established by the combination of symptoms and imaging, which is most commonly performed noninvasively by color Doppler. However, in multiple instances, the patient may remain asymptomatic, and hence, the diagnosis may be missed. Aim and Methodology: This study was performed at tertiary care to study the incidence of asymptomatic DVT in postoperative patients across various specialties. All postoperative patients were subjected to color Doppler on the 1st, 7th, and 30th postoperative days. Results: Out of 300 patients who were part of the study over 1 year, 31 patients developed DVT, of which eight were symptomatic. They all were managed as per any other patient of DVT by anticoagulants, class II stockings, and limb elevation. We had no mortality. Conclusion: DVT may develop in postoperative cases. It may be fatal if not recognized and treated in time. Timely diagnosis and adequate management remain key in avoiding morbidity and mortality. Data related to postoperative patients developing asymptomatic DVT are limited. There seems to be ambiguity in its etiology, prognosis, management protocol, and follow-up.

INTRODUCING RETROGRADE AUTOLOGOUS PRIMING FOR BLOODLESS OPEN-HEART SURGERY IN A NEW CARDIAC CENTRE: INITIAL OUTCOMES

ABSTRACT Objective: The use of priming fluid in the cardiopulmonary bypass causes hemodilution and increases the need for blood transfusions. Retrograde autologous priming is known to be beneficial in reducing blood transfusion and hemodilution. In this article, 38 cases were retrospectively reviewed to demonstrate the feasibility of routine retrograde autologous priming in a newly established cardiac surgery center. Materials and Methods: A total of 38 patients underwent open-heart surgery between January 2024 and July 2024. All patients were operated using a cardiopulmonary bypass machine primed with retrograde autologous blood. Perfusion and anesthesia techniques were the same for all patients. Hematocrit levels in the preoperative period, during weaning, on the first postoperative day, third day, discharge day, and 10th postoperative day were retrospectively analyzed. Postoperative hemodynamic parameters, pressor requirements, and fluid requirements were recorded. Length of stay in the hospital and intensive care unit, as well as blood requirements, were retrospectively analyzed. Results: No major bleeding and mortality was observed. Hematocrit levels during cardiopulmonary bypass ranged from 28% to 31%. The transfusion rate for per patient was 0.13 units. Conclusion: It was proven that the routine use of retrograde autologous priming, even in a newly established heart surgery institution, is safe, repeatable, and effective in decreasing hemodilution and red cell transfusion rates in cardiac operations.