Deep Hematoma Research Articles

Advancements of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage.

Spontaneous intracerebral hemorrhage (sICH) is a severe cerebrovascular disease with high mortality and disability. And its treatment strategies have always been a hotspot in clinical research. Endoscopic surgery (ES) is widely used for treating sICH. A comprehensive review of ES for sICH is warranted to provide better understanding and guidance for clinicians. We provide an updated overview of the surgical equipment, surgical indications and timing, and technical advancements, as well as therapeutic effect and future directions. A narrative review of current literature in ES for sICH was performed based on publications from the databases of PubMed, Scopus and Google Scholar databases up to December, 2023. ES has shown promising safety and efficacy, emerging as a favorable minimally invasive alternative to conventional craniotomy. It reduces peri-operative risks associated with long procedures and significant intra-operative bleeding. Recent advancements in ES techniques have led to superior outcomes in mortality reduction and functional recovery. Scholars' systematic studies and summaries underscore ES's role in improving long-term outcomes for sICH patients. However, its limitations, including reduced depth perception, difficulty in managing deep hematomas, and reduced ability to control rapid bleeding control, should be noted. ES represents a significant advancement in the treatment of sICH. Its minimally invasive features, coupled with continuous methodological refinement, contribute to lower mortality rate and better functional recovery compared to traditional methods. ES should be considered a significant option in the surgical management of sICH, necessitating further research and standardization to enhance patient care and outcomes.

Safety and efficacy analysis of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction

Objective: To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. Methods: It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at "-10.00%". Results: A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [M (Q1, Q3)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (P=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%CI for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The complete closure rates of the great saphenous vein at 6 months after surgery were 97.6% (81/83) and 100% (84/84), the lower limit of the 95%CI for the difference between the two groups was -5.71%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The immediate pain scores after complete anesthesia awakening of the experimental group and the control group were both 1.0 (0, 2.0), with no statistically significant difference (P=0.365). The incidence of bruising in the experimental group and the control group one week after surgery was 61.2% (52/85) and 67.1% (57/85), respectively, with no statistically significant difference (P=0.181). There was no statistically significant difference in VCSS and AVVQ scores between groups before surgery and at 1, 3, and 6 months after surgery (all P>0.05). There was no statistically significant difference in the incidence of complications such as deep vein thrombosis, phlebitis, pain, and subcutaneous hematoma in the lower limbs 3 months after surgery (all P>0.05). Conclusion: The varicose vein sealant kit is safe and effective in treating great saphenous vein dysfunction, and can achieve a complete closure rate of great saphenous vein that is not inferior to traditional radiofrequency ablation.

Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial

BackgroundIntracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy.MethodsIn this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0–2 at the 6-month follow-up.ResultsA total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up (P = .017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group (P = .000).ConclusionsCompared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages.Trial RegistrationClinicalTrials.gov Identifier: NCT02811614.

Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty

Introduction: Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized. Methods: Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test. Results: Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P &lt; 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P &lt; 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups. Discussion: This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.

Efficiency of the new modified inverted Y cleft lift advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease with low-lying tracts near the anus

Propose This study aimed to assess the efficiency of the new modified inverted Y cleft lift procedure, utilizing an advancement flap technique with off-midline primary wound closure for patients with lower pits of the sinus near the anus. Patients and methods This prospective case series was conducted from September 2018 to September 2020. Forty patients with sacrococcygeal pilonidal sinus disease with lower pits near the anus presented either as new cases or recurrent cases. All patients were offered the new modified inverted Y cleft lift advancement flap procedure and were followed up for 48.5 months (range, 21–57 months). Patients were evaluated in terms of operation time, postoperative complications, recurrence rate, return-to-work time, and cosmetic satisfaction. Results The average age was 27.4 years (range, 16–52 years); 29 (72.5%) patients were male and 11 (27.5%) were female. The mean operating time was 25 min (range, 22–45 min) and the mean length of hospital stay was 0.8 days (range, 0.4–2 days). Primary healing occurred in 35 (87.5%) patients. Complete healing for complicated wounds (five patients) was achieved in an average of 21 (14–60) days. Two (5%) patients developed a superficial wound infection, four (10%) patients experienced a seroma, and five (12.5%) had partial dehiscence (some complications observed in the same patient). There was no case of deep infection, hematoma formation, or complete dehiscence. Conclusion This series proved that the new modification inverted Y cleft lift flap reconstruction is an effective operative procedure for primary and recurrent pilonidal sinus cases with pits located very close to the anus, associated with low complication and recurrence rates. What does this paper add to the literature? This paper discusses a new modification to the modified cleft lift procedure named the inverted Y flap procedure, achieving off-midline primary wound closure in patients with a difficult situation with lower pits of the sinus very close to the anus, for pilonidal disease either primary or recurrent.

Moya-Moya Disease a Case Report and Literature Review

Moya-Moya disease is a rare chronic cerebral vascular disease (arteriopathy), which can affect both children and adults and gives rise to severe clinical manifestations of ischemic or hemorrhagic origin. This angiogenic disease is an intrinsic primary pathological process, characterized by a narrowing of the distal internal carotid artery that extends to the proximal segments of the middle and anterior cerebral arteries, inducing the formation of replacement vessels that give a characteristic appearance on angiography forming a smoke cloud: Moya Moya network. The involvement of the posterior circulation is very rare. Its etiology is still poorly understood and represents 10 to 15% of the causes of strokes, with 2 age peaks where it is more frequent: children around 5 years and adults around 40 years. Its evolution can be slow with intermittent symptoms or fulminant with a rapid neurological decline. Imaging is the reference examination in the diagnosis of Moya-Moya. MRI (Magnetic Resonance Imaging) has an important and growing role in the management of the disease. We report a case of a 48 year old patient with diabetes and hypertension, hospitalized for a deep left hematoma.

Abstract TP156: The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) Technique for Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation: A Pilot Study

Introduction: Spontaneous intracerebral hemorrhages (ICH) remains the most devastating form of stroke. Only approximately 20% survivors achieve functional independence at six months after ICH. Up to today, there are no medical or surgical treatments with proven functional benefits for this population. The Stereotactic ICH Underwater Blood Aspiration (SCUBA) allows minimally invasive endoscopic hematoma evacuation in basal ganglia. In this pilot study, we tested that early hematoma evacuation by SCUBA may improve functional outcome. Methods: The Study included 10 ICH patients (age 18-85 years, pre-morbid mRS 0-1, hematoma volume 30-90ml) who underwent SCUBA from 2019 to 2022. SCUBA patient was matched with control ICH patient who received standard medical treatment at 1:1 ratio by variables (hematoma volume and laterality, intraventricular hemorrhage [IVH] with hydrocephalus, age, NIHSS, GCS). The comparison between SCUBA and Controls were carried out by T-test, Mann-Whitney U Test or Fisher's Exact Test as appropriate. Results: Of the 10-paired SCUBA patients and controls, the mean age was 66 years, 45.0% were females, pre-op median NIHSS of 18, 45.0% were intubated, and 30.0% had IVH with hydrocephalus and EVD placed. Among SCUBA patients, the median hematoma volume is 34.0 ml; 90.0% of hematoma was located in basal ganglia. The median time from the last known well to SCUBA initiation was 22.3 hours. Hematoma volume reduction by 80% was achieved in 70.0% of SCUBA patients and 100.0% patients with residual hematoma volume less than 15 ml. SCUBA patients had shorter median NeuroICU stay than controls (SCUBA 5 vs. Control 11 days, p=0.029). SCUBA patients tended to have lower hospital mortality rate (SCUBA 10% vs. Control 20%), and a higher proportion of SCUBA patients were discharged to acute rehab (SCUBA 50% vs. Control 10%). At three months of follow-up, none of the patients were functionally independent, but more SCUBA patients achieved mRS 3 (SCUBA 37.5% vs. Control 16.7%). Conclusions: Our pilot study suggests that early SCUBA can efficiently evacuate deep hematoma with potential of improving functional outcome. Further study requires more patients and longer follow-up.

Patterns of Perioperative Hormone Therapy for Gender-Affirming Surgery.

There is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Common concerns for continuing perioperative HRT included risk of deep vein thrombosis (DVT) or hematoma. However, discontinuing HRT is not risk free and may cause mood swing or increased anxiety. Our study aimed to investigate current patterns of HRT before GAS worldwide. The first stage of Delphi technique was implemented by sending a 27-item survey to all surgeons (total n = 150; 94 plastic surgeon, 35 urologist, and 21 gynecologists) of the World Professional Association for Transgender Health who perform GAS. Survey themes included the hormone type, duration, and usage of DVT prophylaxis. Overall survey response rate was 34% (total n = 51; 8 urologists, 35 plastic surgeons, and 8 gynecologists). The majority of surgeons are US-based (n = 39, 76%). The most common HRTs are in injection form (n = 28, 55%). The majority of surgeons do not stop HRT before GAS and do provide DVT prophylaxis to all patients <1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (43%). For surgeons who discontinue HRT before GAS, there is a wide variation on discontinuation schedule. There is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and nonbinary patients.

Total hip replacement among sickle cell patients in alow-income country-Yemen.

Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen. Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana'a, Yemen, from January 2018 to December 2022. The mean age of the patients was 27 ± fiveyears (ranged 18-37years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eightdays (ranged from 4 to 32days); the mean operating time was 107 ± 23min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death. THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.

Intraincisional Pin Placement is Safe for Robotic-Assisted Total Knee Arthroplasty

BackgroundWhile robotic-arm assisted total knee arthroplasty (RA-TKA) has seen a major increase in its utilization, it requires bone array pins to be fixed into the femur and tibia, which intrinsically carries a risk. As it is currently off-label with some robotic platforms to place pins intraincisional, we aimed to evaluate the safety of intraincisional pin placement during RA-TKAs. MethodsA prospective cohort of 2,343 patients who underwent RA-TKA at a North American Healthcare System between January 2018 and March 2022 was included. Primary outcomes included periprosthetic fracture or infection (eg, superficial or deep). Secondary outcomes included 1-year reoperation rate due to any cause. Cases were retrospectively reviewed to determine whether complications could be attributed to metaphyseal intraincisional pin placement (4.0 mm pins; two tibial and two femoral). The 90-day follow-up was 100% and the 1-year follow-up rate was 70.6% (n = 1,655). ResultsThe pin-site related periprosthetic fracture incidence at 90 days was 0.09% (2 out of 2,343). The 90-day infection incidence was 1.4% (superficial: 22; deep: 13). The 1-year reoperation rate was 1.8% (29 out of 1,655). The most common causes of reoperation at 1-year were deep infection (n = 14; 0.83%), superficial infection (n = 3; 0.18%), periprosthetic fracture, mechanical symptoms, instability, and hematoma (n = 2; 0.12% for each). ConclusionsOne in 1,172 patients may experience a pin-related periprosthetic fracture after RA-TKA with intraincisional bone array pin placement. There was a low 90-day infection incidence and reoperations within 1-year after RA-TKA were rare.

Acquired Postpartum Hemophilia A: About 3 Cases

Introduction: Acquired hemophilia A (AHA) is a rare but severe autoimmune disorder. It is caused by the acquisition of autoantibodies to factor VIII (FVIII). These post-partum autoantibodies account for 7-21% of all cases of AHA and most often develop after the first pregnancy. We report 3 new cases of postpartum-acquired hemophilia A. Observations: Three young women with no prior pathological history presented with a spontaneous and heterogeneous hemorrhagic syndrome, two cases of deep hematomas, and haematuria with ecchymosis in the 3rd patient. The diagnosis was made in all our patients based on plasma FVIII activity &lt;50% and the presence of an FVIII inhibitor. Immunological tests and neoplastic research were negative in all our patients. Hemostatic treatment combined with corticosteroid therapy and immunosuppressive drugs were used for the 3 patients. Conclusion: AHA is a rare disease, and its diagnosis is often underestimated in our population. It is essential to make clinicians aware of this pathology and to be able to evoke it in young patients of childbearing age. A relapse is possible in future pregnancies, so long-term follow-up is recommended.

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

BackgroundIntraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring.Case PresentationA 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated.ConclusionsAcute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue’s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.

Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center

Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. The degree however that vascular surgery (VS) is involved in vascular trauma care is not well established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma. A single-center retrospective review of all consecutive patients who sustained traumatic arterial injury of the lower extremity requiring open operative repair at a level-1 trauma center (from February 2009 to May 2020) was performed. Patients who underwent surgical repair were stratified by the service that performed the operation (VS versus trauma surgery [TS]). Secondary outcomes assessed included location of arterial injury, type of repair, and clinical outcomes. A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5±15.5years, 89% male). The most common vessels requiring intervention were the superficial femoral artery (n=42, 38%), popliteal artery (n=35, 31.5%), and tibial vessels (n=19, 17.1%). The most common intervention required in patients was an autologous bypass (n=85, 76.5%), followed by ligation (n=9, 8.1%) and primary repair (n=6, 5.4%). Most interventions overall required VS involvement (n=95, 86%). VS performed a higher proportion of autologous graft procedures compared to TS (n=79, 92.9% vs. n=6, 7.1%). VS case load overall was likewise predominantly autologous grafts (n=79/95, 83.2%). TS operated on a higher proportion of injuries to the tibial vessels (44% vs. 13%, P=0.01), whereas VS intervened more frequently on popliteal injuries (36% vs. 6%, P=0.02). With regard to the method of arterial repair, TS was more likely to perform ligation (38% vs. 3 %, P<0.001) or primary repair (13% vs. 3%, P=0.04) compared to VS. However, VS was more likely to perform repair with autologous graft (83% vs. 38%, P<0.001). There were no significant differences in rates of mortality, limb loss, transfusions requirement, fasciotomy, deep venous thrombosis, hematoma formation, or length of stay between groups. Although, surgical site infections were more common in the TS group (38% vs. 15%, P=0.04). Vascular surgeons play a large role in managing complex lower extremity vascular trauma. In particular, VS remains integral for the management of more difficult injuries (e.g., popliteal injuries) and is more likely to provide more complex repairs (e.g., autologous grafts).

The effect of prophylactic negative pressure wound therapy on infection in obese women after C-section: a meta-analysis

Most caesarean wounds resulted in infection. This become a huge burden on the health care system, considering the high number of women undergoing this type of surgery. Negative pressure wound therapy (NPWT) has been recommended for a wide variety of lesions including open abdominal wounds. The purpose of this study was to investigate the effect of prophylactic NPWT on infection in obese women after a C-section. This was a systematic review and meta-analysis study that used articles from online databases of EBSCO, Google Scholar, and PubMed which published until 2022. The dependent variable was infections post C-section, while the independent were NPWT and standard wound therapy. The data was analyzed by RevMan 5.3. This study showed that there is no difference in the outcome of superficial site infection (SSI), deep site infection (DSI), wound dehiscence, seroma, and hematoma between women with obesity after caesarean delivery who used NPWT and standard dressing.

Magnetic Targeting Nanocarriers Combined with Focusing Ultrasound for Enhanced Intracerebral Hemorrhage Therapy.

Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality around the world, and surgery is still the most direct and effective way to remove ICH. However, the potential risks brought by surgery, such as normal brain tissue damage, post-operative infection, and difficulty in removing deep hematoma, are still the main problems in the surgical treatment of ICH. Activation of the peroxisome proliferator-activated receptor gamma (PPARγ) is reported to show a good therapeutic effect in hematoma clearance. Herein, a magnetic targeting nanocarrier loaded with a PPARγ agonist (15d-PGJ2-MNPs) is synthesized, which could be magnetically targeted and enriched in the area of the hematoma after intravenous injection. Subsequent application of focusing ultrasound (FUS) could enhance drug diffusion, which activates the PPARγ receptors on macrophages around the hematoma for better hematoma clearance. The 15d-PGJ2-MNP treatment alleviates brain injury, accelerates hematoma clearance, attenuates neuroinflammation, reduces brain edema and significantly improves the deficits in sensory and motor function and spatial learning ability in the ICH mouse model. This work proposes an effective magnetic targeting plus FUS method to treat ICH, highlighting its great potential in the treatment of hemorrhagic stroke.

Rational Design of Bioactive Materials for Bone Hemostasis and Defect Repair.

Everyday unnatural events such as trauma, accidents, military conflict, disasters, and even medical malpractice create open wounds and massive blood loss, which can be life-threatening. Fractures and large bone defects are among the most common types of injuries. Traditional treatment methods usually involve rapid hemostasis and wound closure, which are convenient and fast but may result in various complications such as nerve injury, deep infection, vascular injury, and deep hematomas. To address these complications, various studies have been conducted on new materials that can be degraded in the body and reduce inflammation and abscesses in the surgical area. This review presents the latest research progress in biomaterials for bone hemostasis and repair. The mechanisms of bone hemostasis and bone healing are first introduced and then principles for rational design of biomaterials are summarized. After providing representative examples of hemostatic biomaterials for bone repair, future challenges and opportunities in the field are proposed.

Iliopsoas Hematoma as Unusually Early Onset of Hemophilia A in a Young Infant

A 2-month-old infant was admitted for irritability and hypomobility of the left lower limb. Ultrasound revealed a deep hematoma of the iliopsoas muscle and coagulation tests showed increased activated partial thromboplastin time (aPTT).

Report of two cases of subconjunctival haemorrhage as first sign of post‐pregnancy acquired haemophilia a (AHA)

AbstractPurpose: To show that subconjunctival haemorrhage may be the first sign of post‐pregnancy acquired A haemophilia (AHA), a potentially fatal bleeding disorder.Methods: Case reports.Results: Two thirty‐year‐old caucasic women at first pregnancy presented slight pain without visual loss 2 weeks after uncomplicated spontaneous full‐term delivery. The only clinical findings were a subconjunctival bleeding for both and a small haematoma in the first case. The clinical history was negative for spontaneous bleeding also in infantile age and at previous surgery and no bleeding tendency was observed in the main relatives. The first patient was lost on follow‐up and admitted to urgent haemathologic evaluation due to large multiple cutaneous hematomas, a massive deep muscle haematoma, asthenia and dyspnea. In the second case quick routine coagulation labs were performed immediately after the subconjunctival bleeding. In both cases PTT ratio was increased. An extensive study of blood coagulation suggested the presence of a circulating inhibitor against factor VIII [1,2], confirming the diagnosis of AHA. First case was treated with a bypassing agent, however the eradication was obtained only with immunosuppressive therapy. Second case was initially placed in close follow‐up, since the post‐pregnancy form is often self‐limiting, however an immunosuppressive therapy was set after clinical progression due to the appearance of spontaneous hematoma.Conclusions: AHA is a relevant acquired bleeding disorder that can be fatal if not quickly recognized and treated even when the initial clinical signs are minor [3], how it can happen in post‐pregancy mainly in the first month [4]. Since it may present as spontaneous subconjunctival haemorrhage, routine hemathological and coagulation labs should be performed to exclude this serious condition or once identified, allow for proper clinical management.

The efficacy of negative pressure wound therapy after hepatopancreatobiliary surgery: A systematic review and meta-analysis.

To evaluate the comparative influence of NPT and standard surgical dressing administration on incidence risk for surgical site infections, complications, and hospital re-admission after hepatopancreatobiliary surgery. Five databases were systematically searched according to PRISMA guidelines. These databases included Web of Science, MEDLINE, CENTRAL, EMBASE, and Scopus for eligible studies published prior to March 2021. With eligible studies, we conducted a random-effects meta-analysis to evaluate comparative outcomes such as superficial surgical infection, deep surgical infection, seroma incidence, hematoma incidence, and hospital re-admission in patients receiving NPT or standard surgical dressings after hepatopancreatobiliary surgery. The search strategy yielded 963 studies, with six studies meeting inclusion criteria. Odds of superficial surgical site infection (OR: 1.58), deep surgical site infection (1.43), seroma complication (1.64), hematoma complication (0.40) were insignificantly different between patients receiving NPT and standard surgical dressing. The odds of hospital re-admission rate (2.37), however, were elevated in patients receiving standard surgical dressing relative to those receiving NPT. This meta-analysis shows that NPT usage slightly reduces risk of hospital readmission as compared to standard surgical dressing. We did not observe any significant effect of NPT on superficial, deep surgical infections, seroma, and haematoma outcomes following hepatopancreatobiliary surgery. These findings may aid clinicians in stratifying risk and selecting treatment strategy in patients undergoing hepatopancreatobiliary surgery.

Effect of access site choice on inferior vena cava filter angulation and outcomes

BackgroundIn the present study, we compared the outcomes of inferior vena cava (IVC) filter placement between the femoral vein (FV) and internal jugular (IJ) vein access sites. MethodsWe performed a retrospective study using the Vascular Quality Initiative database to assess patients who had undergone IVC filter placement from 2013 to 2019. The patients were placed into two groups according to the access site location: FV and IJ vein. The FV group included patients with access via the right and left FVs and other leg veins, and the IJ group included patients with access via the right or left IJ vein. The primary outcome was the rate of filter angulation. The secondary outcomes included access site complications such as deep vein thrombosis, hematoma, and bleeding requiring transfusion. ResultsOf 13,221 patients, 8214 (63%) had undergone IVC filter placement via FV access and 4789 (37%) via IJ access. The remaining 218 patients had had an unknown access site or were excluded. Within the IJ group, 4696 (98.0%) had undergone access via the right IJ and 93 (2%) via the left IJ. Within the FV (common femoral, femoral, or other infrainguinal veins) group, 7007 (85.3%) had undergone access via the right FV and 1207 (14.6%) via the left FV. The mean patient age was 63 ± 15.9 years, the mean body mass index was 30.9 ± 9.60 kg/m2, and 6788 of the patients were men (52.0%). The most common indication for filter placement was a contraindication to anticoagulation because of a recent or active bleeding episode (30%), followed by planned surgery (22%), new deep vein thrombosis/pulmonary embolism (7%), fall risk (5%), and trauma (4%). Infrarenal filters had been placed in 97.9% of the patients. Univariate analysis identified body mass index and suprarenal placement as independent risk factors for angulation. The final multivariate analysis showed a significant increase in angulation (0.9% vs 0.34%; odds ratio, 1.46; 95% confidence interval, 1.02-2.11; P = .04) and increased access site complications (0.25% vs 0.07%; odds ratio, 2.068; 95% confidence interval, 1.01-4.23; P = .048) in the FV access group. No significant correlation between the access site and retrieval rate was found (P = .9270). ConclusionsPlacement of IVC filters via IJ access showed a lower rate of filter angulation in the IVC and fewer access site complications compared with FV access.