Bandage Research Articles

Antithrombotic therapy and the risk of pocket hematoma after subcutaneous implantable cardioverter-defibrillator implantation

Abstract Introduction The PRAETORIAN trial, which randomized S-ICD versus TV-ICD in patients with a class I or IIa indication for ICD therapy, showed that clinically significant pocket hematomas were more frequent following S-ICD implantation. Many ICD recipients have comorbidities requiring anticoagulant (AC) and/or antiplatelet (AP) therapy, which increase the risk for hematoma formation post implantation. In contrast to TV-ICD implantation, little data exists regarding the optimal AC and AP strategy during S-ICD implantation to prevent pocket hematomas. Methods All patients who underwent de novo S-ICD implantations between February 2009 and January 2023 at our tertiary center were included. Data was collected retrospectively from electronic patient records. Clinically significant pocket hematomas were defined as an accumulation of blood at the pocket site within 30 days after S-ICD implantation, necessitating actions including applying a pressure bandage, surgical evacuation, drain insertion, a change in medication or an extended hospital stay or blood transfusion. Results A total of 348 patients were included of which 224 (64.4%) patients used antithrombotic therapy pre-implantation. Median age at implantation was 50 years (IQR: 36-61 years), 33.4% of the patients were female and the vast majority of implants were intermuscular (90.2%). Eighteen (5.2%) patients developed a clinically significant pocket hematoma. A total of 94 (27%) patients used AC therapy prior to the implantation of which 73 (21%) patients used a vitamin K antagonist (VKA). A total of 130 (37.4%) patients used AP therapy at baseline of which 49 (14.1%) patients were on dual AP therapy (DAPT). Continuation of VKA and continuation of DAPT with ticagrelor were independent predictors for pocket hematoma formation (p<0.001, and p<0.001 respectively). There were significantly more pocket hematomas in patients with continued VKA compared to patients with interrupted VKA (27.3 % (6/22) vs. 4.3% (2/47), respectively, p=0.011). Moreover, continuation of DAPT with ticagrelor was associated with significantly more pocket hematomas post implantation compared to continuation of DAPT with clopidogrel (4/12 vs 1/28, respectively, p=0.022). Conclusion This study showed that continuation of VKA during S-ICD implantation was associated with an increased risk of pocket hematoma formation compared to interruption of VKA. The continuation of DAPT with ticagrelor was an independent predictor of pocket hematoma formation and showed significantly more pocket hematomas compared to continuation of DAPT with clopidogrel. These findings support the need for specific peri-operative thrombotic therapy guidelines for S-ICD implantations to reduce the risk of pocket hematomas.

Impact of medical adhesives on persistent fluid extravasation at needle injection sites in patients with severe edema: a randomized controlled trial.

To investigate the efficacy of medical glue in halting fluid extravasation at needle insertion sites in patients with severe edema. Sixty patients with severe edema were recruited between June 2022 and June 2023 and randomly allocated into either the control group or the experimental group, with 30 cases in each. In the experimental group, after intramuscular injection, medical glue was administered at the needle insertion site, and covered with gauze dressing upon curing, and subsequently subjected to pressure bandaging. Patients were instructed to limit their activity. Meanwhile, the control group received conventional nursing procedures involving pressure bandaging and activity restriction. The effectiveness of nursing interventions in halting exudation, duration of hospitalization, duration of exudation, nursing expenses, skin complications (infection, rash, abrasion, abnormal sensation, etc.), and patient satisfaction with nursing care were monitored. Comparison between the two groups revealed statistically significant differences in several aspects: the success rate of halting exudation, duration of exudation, total skin complication rate, and overall satisfaction [83.3% vs. 20.0%, (2.20 ± 2.76) days vs. (7.33 ± 3.28) days, 6.67% vs. 33.33%, 80.00% vs. 36.67%, P < 0.05]. However, there were no statistically significant differences in hospitalization time and nursing expenses [(14.50 ± 5.17) days vs. (14.00 ± 3.95) days, (537.53 ± 264.19) yuan vs. (661.97 ± 305.55) yuan, P > 0.05]. Medical glue demonstrates effectiveness in halting fluid extravasation at needle insertion sites among patients experiencing severe edema. Additionally, it reduces the duration of exudation, diminishes skin complications resulting from exudation, and significantly enhances patient satisfaction with nursing care. Given these benefits, its clinical adoption and application are highly recommended.

Quantitative diagnosis of early acute compartment syndrome using two-dimensional shear wave elastography in a rabbit model.

This study explored the association of the elasticity modulus and shear wave velocity (SWV) of the tibialis anterior muscle, as measured by two-dimensional shear wave elastography (2D-SWE), with the intracompartmental pressure (ICP) determined using the Whitesides method in a New Zealand rabbit model of acute compartment syndrome (ACS). Additionally, it evaluated the viability of 2D-SWE as a noninvasive, quantitative tool for the early detection of ACS. An ACS model was established through direct external compression by applying pressure bandaging to the lower legs of 15 New Zealand rabbits using neonatal blood pressure cuffs. Another five animals represented a non-modeled control group. To measure the elasticity modulus and SWV of the tibialis anterior muscles, 2D-SWE was employed. Blood oxygen saturation, serum creatine kinase (CK), and myoglobin levels were monitored. Subsequently, the anterior tibial compartment was dissected, and the tibialis anterior was removed for hematoxylin and eosin staining to assess muscle injury. The elasticity modulus and SWV of the tibialis anterior muscle increased with compression duration, as did serum CK and myoglobin levels. ICP was strongly positively correlated with these parameters, particularly mean velocity (r=0.942, P&lt;0.001) and CK (r=0.942, P&lt;0.001). Blood oxygen saturation was negatively correlated with ICP (r=-0.887, P&lt;0.001). Histological analysis indicated progressive muscle cell swelling over time, with damage transitioning from reversible to irreversible and culminating in necrosis. In a rabbit ACS model, ICP was strongly positively correlated with muscle elasticity modulus/SWV. Consequently, 2D-SWE may represent a novel tool for assessing early-phase ACS.

A case report of spontaneous superficial temporal artery hemorrhage following COVID-19 infection

Post-COVID syndrome and COVID-19 have been related to autonomic changes and the appearance of endothelial dysfunction. Current research has discovered vasculitis-like occurrences in patients previously without evidence of endothelial dysfunction or autoimmune states. Additionally, COVID-19 and post-COVID syndrome have been hypothesized to induce flares of vascular dysfunction. Here, we present a patient with a large hematoma of the right scalp following spontaneous superficial temporal artery hemorrhage after uncontrolled hypertension, tachycardia, and generalized weakness three months after COVID-19 infection. This patient’s bleed was successfully managed with a pressure bandage and did not require neurosurgical embolization; moreover, he had no prior hemorrhages or indications for vessel rupture. Our case study represents a patient with chronic changes in blood pressure and heart rate following a prior COVID-19 infection that led to a large superficial scalp hematoma over the right frontotemporal bone with active extravasation from the right superficial temporal artery.

Gangrene and Partial Auto-Amputation of the Penis in a Case of Priapism

Background: Penile Gangrene is rare, usually associated with extensive pelvic trauma, mechanical constriction, infection due to urinary extravasation and uncontrollable systemic infection. The objective of this case report is to stress upon the need for early detumescence by means of aspiration of accumulated blood, injection of phenylephrine, proper shunting of blood and adequate compression dressing with necessary antibiotic cover. Case Presentation: We present a case of 33-year-old married man who was hospitalized under general surgery department for left AK amputation because of lower limb gangrene. On 3rd postop day, patient was noted to have a turgid penis and unable to urinate. Urology consultation was sought after 3 days for suspected priapism. We immediately shifted the patient to OT and the detumescence of penis was achieved by means of aspiration and injection of phenylephrine followed by Winter’s shunting. The penis was noted to be flaccid with normal hue and patient was discharged. After 1 month, he returned to the hospital with extensive gangrene of the entire distal half of the penis with features of auto amputation of distal portion of penis. Conclusions: This report is aimed to prevent ischaemic complications of priapism like penile gangrene. Various factors like time of intervention, urethral catheter, tight pressure bandage dressing around the penis and local infection alone or in combination, have been implicated in causing penile gangrene in cases of priapism. Penile detumescence should be achieved on an emergency basis to prevent its ischaemic complications.

Analysis of the tensile stress relaxation of weft-knitted medical compression fabrics in view of the fabric structure

Stress relaxation will create interference in the performance of textiles in applications such as compression garments, pressure bandages, and varicose stockings in which keeping a definite level of pressure on the scar area is vital. Therefore, considering the effectual parameters on the stress relaxation of the fabrics will help to produce appropriate functional clothes. In this research, rib-knitted fabrics with different numbers of tuck stitches in successive wales have been fabricated and their stress relaxation has been surveyed. According to the findings, in all fabric structures, stress relaxation is higher in the wale direction compared to the course direction. In both directions, the stress relaxation linearly changes with the number of tuck stitches in the fabric structure. By increasing the number of tuck stitches, the stress relaxation of the fabric increases from 43% to 81% in the course direction whilst decreasing from 47% to 82% in the wale direction. Consequently, utilization of the tuck stitch in the structure of pressure bandages enhances their functionality, whilst diminishing the performance of compression garments and varicose stockings. Therefore, the use of knitted fabric consisting of tuck stitches is not recommended for pressure garments and varicose stockings.

PLASTIC SURGERY OF WOUND DEFECTS WITH FREE GRAFTS AFTER MALIGNANT SKIN TUMORS EXCISION: A PILOT STUDY.

To evaluate the effectiveness of applying negative pressure bandages (VAC bandage) in patients with malignant skin tumors after closing defects with free skin grafts and to compare it with fixation of skin grafts by the ordinary ointment bandages. 61 patients with malignant skin tumors who underwent surgical treatment at the National Cancer Institute from 2019 to 2023 were included in the study. For the wound defects closure, the split skin grafts were applied in all patients. At the time of surgery, after closing a wound defect by a split skin graft, a negative pressure dressing (VAC bandage) was applied in 41 patients for 7 days (group 1). In 20 patients, a transplanted skin graft was fixed after surgery by an ordinary ointment pressure bandage (group 2). The immediate results were evaluated one week after surgery. Complete engraftment of the flap in group 1 was observed in 53.7 ± 7.8% cases, in group 2 this result was achieved in 5.0 ± 4.8% patients (p = 0.002). The complete graft necrosis occurred in 1 case in group 1 vs. 2 cases in group 2 (p = 0.496). The results of the engraftment in postoperative wounds were significantly better in the VAC-bandage group in terms of the number of the complete engraftments compared to the conventional pressure ointment bandage group.

Pregnancy with Peripheral Arteriovenous Malformation

22 years old primigravida with 37 weeks singleton gestation was admitted with profuse bleeding from swelling over left anterior superior iliac spine region. Ultrasound findings suggested a high flow vascular malformation with feeder from left common femoral artery. Bleeding was managed conservatively with pressure bandage. Delivery was uneventful. Live female baby of 2.045 kg was delivered by spontaneous vaginal delivery at 38 weeks. After 4 weeks of delivery vascular malformation was confirmed with angiography and treated successfully with endovascular embolization of the major arterial feeder. In periodic follow up until 6 months, no further complication was reported by the patient.

Effects of pneumatic compression therapy on wound healing in patients with venous ulcers: A meta-analysis.

This meta-analysis assessed the effect of pneumatic compression therapy on the wound healing of venous ulcers, with the aim of providing a basis for the selection of clinical treatment. Randomised controlled trials (RCTs) on the application of pneumatic compression therapy to venous ulcers were collected by searching PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases, with a timeframe from database inception to August 2023. After two researchers independently screened the literature, extracted information, and evaluated the quality of the included studies, a meta-analysis was performed using RevMan 5.4 software. Six RCTs with 367 patients were included, with 172 patients in the intervention group and 195 in the control group. The results showed that pneumatic and bandage compression therapies had a similar impact on wound healing rates of venous ulcers (54.65% vs. 53.84%, odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.49-2.12, p = 0.96), changes in wound area (standardised mean difference: -0.16, 95% CIs: -0.45 to 0.12, p = 0.26), adverse event rates (76.56% vs. 67.07%, OR: 1.62, 95% CI: 0.77-3.39, p = 0.20), and the differences were not statistically significant. Thus, current evidence suggests that the effects of pneumatic compression therapy on wound healing rates, changes in wound area, and the incidence of adverse events in patients with venous ulcers are similar to those of bandage pressure therapy. However, owing to the limitations in the number and quality of studies, more high-quality RCTs are needed to clarify the feasibility and economics of pneumatic compression therapy in patients with venous ulcers.

Nursing First Aid to Emergency Events in Agricultural Areas: Literature Review

Being a farmer who works directly in the environment certainly has many risks at work, one of which is the occurrence of unwanted events that can threaten the health of farmers. Some problems are classified as emergencies and must be handled immediately to avoid fatalities. One example is the occurrence of snake bite emergencies in farmers. This study aims to determine some emergencies in agricultural areas and how to provide first aid. The method used in this study was a literature review of articles from article search engines such as PubMed, Google Scholar, and Science Direct analyzed using the PRISMA technique by including articles published in the last five years. The results found that emergencies that often occur in agricultural areas include venomous snake bites, pesticide poisoning, contracting dengue fever from mosquitoes, and rat bites that cause rat-bite fever. First aid methods that can be performed on someone whom a snake has bitten are by calming the victim, immobilizing the victim's entire body by laying him in the recovery position and immobilizing the affected body part using either a sling, splint, or pressure bandage immobilization (PBI) method. Nurses have a role in educating and counseling farmers on how to first aid someone who experiences snake bites, rat bites that cause rat bite fever, and drowning in fishermen.

126 When Does a Pressure Dressing Become a Tourniquet: A Prospective Single Centre Study Assessing Variation and Factors Affecting Pressures Exerted by Pressure Bandages

Abstract Introduction Pressure bandages are frequently used for emergency haemostasis in arterial forearm injuries. This study assesses the range of pressures exerted by pressure bandages and the relevant variables, thus evaluating the safety of use. Method We measured pressures under a standard Oleas modular pressure bandage using Flexiforce Prototyping Kit when applied by various members of the hand trauma unit with differing levels of experience. Results 15 measurements of pressure were recorded. The mean applied pressure was 209mmHg (range: 50 – 485mmHg) with 40% measurements exceeding pressure of 250mmHg. Multivariate regression analysis showed the colour of the hand is statistically significantly related to exerted pressures (p&amp;lt;0.005), but not related to clinical experience (p = 0.101), perceived force of application (p = 0.203) or gender (p = 0.289). Pink hands had a mean pressure equal to 79mmHg compared with purple hands; 336mmHg. Conclusions Pressure bandages have large variation in the pressure created, often exceeding safe pressure ranges. Our results suggest if the hand is purple, pressures under the dressing are similar to that of a pneumatic tourniquet. If pressure dressings are required in an emergency setting, these should be removed after 2 hours to prevent the risk of compression injury.

Harm due to the use of pressure bandage immobilisation in patients bitten by snakes in Australia

Background Pressure bandage immobilisation has remained the recommended first aid treatment for more than 40 years in Australia. However, whilst it is used in most people bitten by a snake, it is often applied poorly, and patients have been envenomed despite good pressure bandage immobilisation. We report two patients who suffered harm from this procedure. Case reports Two men, a 35-year-old and a 44-year-old, were bitten by snakes. Both had a prompt application of pressure bandage immobilisation, and both reported significant pain requiring opioid analgesia whilst being transferred from remote Australia to Cairns Hospital, Queensland. There were substantial delays (9.5 h and 7.5 h) before the pressure bandage immobilisation was released. As a result, both patients developed severe rhabdomyolysis (33,600 U/L and 16,800 U/L [normal < 171 U/L], respectively); there was no evidence of systemic envenoming. The 35-year-old developed a compartment syndrome that required urgent and repeated surgery. The 44-year-old has ongoing foot paraesthesia two years after the bite. Conclusion With limited good evidence of benefit, and many issues with its use, I recommend that pressure bandage immobilisation as a first aid measure for snakebite in Australia needs to be re-examined.

Replacement of the distal radio-ulnar joint with asemi-constrained Scheker DRUJ prosthesis.

To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis. The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, aScheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty. Severe osteoporosis, active infection, immature skeleton, less than 14cm of the proximal ulna remaining. In supine position with the forearm in full pronation, an ulnar S‑shaped incision is made. The ulnar head is resected and the proximal part is brought to the palmar side to enable visualization of the sigmoid notch. Following preparation of the sigmoid notch and the proximal ulnar part of the radius, aradial plate is attached. When the position is verified with fluoroscopy, screw holes are drilled together with aseparate hole for the radial peg. Ametal stem is inserted in the ulnar shaft. Apolymer ball is then slid on to apolished peg on top of the ulnar stem. This polymer ball is seated in the socket of the radial plate and fixed with asmall metal cap. Radiographic images are made for confirmation of correct positioning and full pro- and supination is tested, after which the wound is closed. After 48 h of pressure bandages, patients are instructed to start with full range of motion and weight-bearing exercises under the guidance of ahand therapist. Weight-bearing is constrained to 10kg. We retrospectively assessed 50Scheker prostheses in 48patients treated between 2016 and 2021. The median age was 56years (IQR: 50-65) and 30 (60%) were female. Median follow-up was 29months (IQR: 12-48). The primary outcome was the PRWE score. The median PRWE score at the final follow-up was 23 (IQR: 4-52) for the operated side versus amedian PRWE score of 5 (IQR: 0-25) for the non-operated side (p < 0.005). Six patients had acomplication. Three patients developed extensor carpi ulnaris tendinitis with one patient requiring additional surgery. One patient developed aneuroma of the distal branch of the ulnar nerve that was surgically removed. One synovectomy was performed because of synovitis and one endoscopic ulnar release was performed because of hyperesthesia of the ulnar area. None of the prostheses had to be removed.

Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Effect of photodynamic therapy on the quality of life of patients with postoperative lymphorhea

According to a number of authors, the incidence of lymphorrhea after surgical treatment of breast cancer reaches 100%. In recent years, new methods of treating postoperative lymphorrhea have begun to appear, including the use of photodynamic therapy (PDT).Purpose of the study: to determine the possibility of using photodynamic therapy in the treatment of postoperative lymphorrhea and to evaluate its impact on the quality of life of patients.Material and methods. A prospective study involving 40 people was conducted. In 20 patients, photodynamic therapy was used in the treatment of postoperative lymphorrhea (main group), in 20 patients, punctures and pressure bandages were used (comparison group). Quality of life was assessed based on the data of the SF-36 questionnaire before the start of treatment, after 3 and 6 months. After 1 year, the condition of all patients was also assessed to identify signs of lymphostasis.Results. In the main group, in patients who underwent photodynamic therapy, lymphorrhea was completely stopped by the end of the third week. In patients from the comparison group at the same time, the volume of daily lymphorrhea was (41.4 ± 0.3) ml. A statistically significant difference was found between the indicators of the physical component of health in patients of the two groups 3 months after the start of treatment: role functioning associated with the physical component, pain intensity, general health and vitality. At the same time, the use of photodynamic therapy did not increase the risk of developing lymphostasis of the upper limb.Conclusion. The study showed that the use of photodynamic therapy in the treatment of postoperative lymphorrhea can reduce the amount of lymph loss, reduce the time of outpatient treatment, and also improve the quality of life of patients, while not increasing the risk of developing lymphostasis of the upper limb.

Assessing the variation in amount of pressure exerted by haemostatic pressure bandages: a volunteer study.

We assess the range of pressures exerted by haemostatic compression bandages on upper limb arterial injuries. Maintaining a pink hand can act as a safety marker to prevent excessive bandage pressure and avert compression injuries.

Pulsed field ablation based pulmonary vein isolation utilizing a simplified approach

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety and efficacy advantages compared to standard ablation technologies. Purpose We aimed to develop a safe, effective and fast pulmonary vein isolation (PVI) utilizing a single shot PFA catheter via a single femoral vein puncture and a venous closure system approach. Methods Forty-eight consecutive AF patients underwent first-time PVI via PFA under deep sedation. A single ultrasound guided femoral vein puncture and a single transseptal puncture was utilized for left atrial access. After pulmonary vein (PV) angiography eight pulse trains (2kV/2.5 sec, bipolar, biphasic, each 4x basket/flower configuration) were delivered to each PV. Extra pulse trains in the flower configuration (8x) were added to the posterior wall for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with a s-shaped esophageal temperature probe. A venous closure system was utilized on the single access site. A Donati suture was performed. The pressure bandage was removed after 1h. Results Patients (mean age: 64 +/-11 years) presented with AF (paroxysmal 58% or persistent AF (42%). A total of 192 PV were identified and isolated via PFA (100%). A mean of 40 pulse trains for PVI and vWACA have been used. The mean procedural time was 27 +/- 7 minutes, the mean catheter dwell time was 14 +/- 6 minutes and the median fluoroscopy time was 6 +/- 2 minutes. No relevant esophagus temperature rise occurred. One patient (2%) experienced a transient phrenic nerve palsy which recovered until the end of the procedure. Two patients (4%) experienced a superficial bleeding which was treated by a figure of eight suture. No severed hematoma, transfusion or intervention was necessary. No pericardial effusion or tamponade occurred. Conclusion The combination of a single vein single transseptal puncture approach resulted in a 100% rate of acute PVI and an extraordinary fast procedure and dwell time. The rate of periprocedural complications was low.

Erect pelvic radiography with fat tissue displacement: Impact on radiation dose and image quality

IntroductionPelvic radiography is one of the most frequent general radiography imaging procedures. Pelvic radiography is usually performed in the supine position, but in some cases erect imaging is performed. The aim of this study was to determine whether radiation dose and image quality differ between two different erect pelvic radiographic procedures in overweight and obese patients, with and without displacement of anterior adipose tissue. MethodsThis research was a two-part study. The first part of the study was to determine a suitable fat displacement band that would not produce artifacts on the resulting radiograph when fat tissue was displaced. The second part of the study was performed in a clinical setting on 60 overweight or obese patients (BMI ≥25) referred for erect pelvic imaging. Patients were randomly divided into two equal groups, half of which displaced adipose tissue from the region of interest and the other group did not. Waist and hip circumference, height, weight, dose-area- product (DAP), primary field size, source-to-skin distance, mAs, and kV were measured. Body Mass Index (BMI), entrance surface dose (ESD), and effective dose (ED) were then calculated. The resulting images were evaluated by three radiologists. ResultsIt was found that a thin cotton triangular bandage produced no visible radiographic artefacts. In the group of patients using the fat displacement protocol, a statistically significant reduction in waist circumference (4.7%), DAP (38.5%), ESD (44%) and ED (38.7%) were observed (p < 0.05). In addition, a significant (p < 0.05) increase was found for all the observed image quality criteria and overall total image score with exception of sacroiliac joint, iliac crest and pubic/ischial rami. ConclusionBased on the results, the use of the adipose tissue displacement protocol for radiography of the pelvis and hip in the erect position in overweight and obese patients is recommended. Implications for practiceThe use of cotton bands to remove adipose tissue during pelvic imaging in obese and overweight patients results in a reduction of radiation dose received by the patient and improves image quality. This technique is quick, easy, and inexpensive.

Cerebrospinal fluid leakage after intradural spinal surgery in children

PurposeThis study aimed to establish the incidence of CSF leakage in children and associated complications after intradural spinal surgery in three tertiary neurosurgical referral centers and to describe the treatment strategies applied.MethodsPatients of 18 years or younger who underwent intradural spinal surgery between 2015 and 2021 in three tertiary neurosurgical referral centers were included. Patients who died or were lost to follow-up within six weeks after surgery were excluded. The primary outcome measure was CSF leakage within six weeks after surgery, defined as leakage of CSF through the skin. Secondary outcome measures included the presence of pseudomeningocele (PMC), meningitis, and surgical site infection (SSI).ResultsWe included a total of 75 procedures, representing 66 individual patients. The median age in this cohort was 5 (IQR = 0-13 years. CSF leakage occurred in 2.7% (2/75) of procedures. It occurred on days 3 and 21 after the index procedure, respectively. One patient was treated with a pressure bandage and an external lumbar drain on day 4 after diagnosis of the leak, and the other was treated with wound revision surgery on day 1 after the leak occurred. In total, 1 patient developed a PMC without a CSF leak which was treated with wound revision surgery. SSI occurred in 10.7%, which included both cases of CSF leak.ConclusionsCSF leakage after intradural spinal surgery in the pediatric population is relatively rare (2.7%). Nevertheless, the clinical consequences with respect to secondary complications such as infection and the necessity for invasive treatment are serious.

The effect of ice gel pack on pain reduction of sheath removal in post-cardiac catheterization patients

Background: Cardiac catheterization is a minimally invasive intervention that can cause complications of vascular access after compression of the femoral artery or sheath removal. Cold pack gel is a non-pharmacological therapy given after sheat removal to reduce pain. Objective:This study aimed to measure the effect of ice pack gel on pain reduction in arterial sheath removal post-cardiac catheterization patients. Methods: This interventional clinical study with control and group treatment was conducted in the cardiology room of Saiful Anwar Hospital Malang, Indonesia. The respondents (n=32) were divided into two groups in pre and post-test control group design. Group A receives pressure bandages as a standard protocol (control groups) while group B, ice-packed gel. Pain scale measured by Visual Analog Scale (VAS) by 1-10. Results: The Mann-Whitney test in two groups shows that there are differences in scores of pain reduction. The pain reduction difference in the treatment group (ice pack gel) was higher than the control ones (p &lt; 0.001). The cold temperature of the cold-packed gel decreased the peripheral free nerve ending conductivity, furthermore, it made sensitivity stimulus or pain impulses slowed down then reduced the perception of pain. Conclusions: The intervention of ice-packed gel is more effective than the standard protocols to reduce the pain in the removal sheath post cardiac catheterization.