Method Of Drainage Research Articles

HPB SO49 - EUS guided biliary drainage prior to pancreaticoduodenectomy - The Leeds experience

Abstract Background Biliary obstruction is a common manifestation of biliary tract cancer. Decompression is indicated if patients develop systemic illness due to the obstruction or to facilitate chemotherapy. Stent insertion via ERCP is the current first line decompressive technique, although in certain situations such as duodenal/ampullary obstruction, is not always feasible. When ERCP has failed, our centre has implemented using lumen apposing metallic stents (LAMS) delivered by the HOT AXIOS™ system to create a draining choledochoduodenostomy. Our aim is to report on our experience of carrying out pancreaticoduodenectomy after biliary drainage has been achieved with this technique. Method All patients who underwent biliary drainage with a LAMS and then surgical resection of a biliary tract cancer were identified from a prospective database. Both procedures were carried out at St James’s Hospital, Leeds, between June 2018 and May 2024 by expert gastroenterology and pancreatic surgical consultants. Procedural and inpatient notes were retrospectively reviewed. The primary outcomes were the assessment of technical feasibility of pancreaticoduodenectomy and of perioperative complications, classified by the Clavien-Dindo (CD) system. Secondary outcomes were the safe and clinically effective (defined as >50% reduction of serum bilirubin within 7 days) application of LAMS. Results Thirteen patients were identified with a median age of 69 (51-81), twelve requiring drainage due to jaundice and one due to cholangitis. Duration to resection was median 68 days (12-377). Surgical resection was successful in all thirteen patients, in seven cases the surgeons commented on fibrosis due to the stent, with one qualifying that this was no more than a conventional biliary stent. Postoperatively five patients had no complications, one CD grade 1, five CD grade 2 and one CD grade 5. There were no significant post endoscopic complications and 10 patients demonstrated clinical effectiveness of the LAMS. Conclusion ERCP is the current first line method of drainage in malignant biliary obstruction. Technical success is reliant on unimpeded access to the bile duct. The HOT AXIOSÔ system circumvents this reliance by delivering a LAMS in a single stage forming a draining choledochoduodenostomy. Our centre’s experience suggests that it is a safe and effective method of biliary drainage which does not impede surgical resection. Additionally, it is not associated with the risk of post procedural pancreatitis. Our experience justifies further large-scale studies into this technique with consideration for its use not only when ERCP is not possible.

THE CONNECTION OF LOCAL RETINAL DETACHMENT IN THE MACULAR AREA WITH THE FOSSA OF THE OPTIC DISC. DIFFERENTIAL DIAGNOSIS (CLINICAL CASE)

Relevance. The optic nerve pit is a congenital disease manifested by a depression in the disc of the optic nerve, which affects about 0.9% of the population. Complications occur in 25–75% of patients and may include retinal detachment. The causes of detachment remain unclear, but two theories of the occurrence of this complication have been put forward. Fluorescence angiography and optical coherence tomography are used for diagnosis. The treatment of retinal detachment in ONDP is not standardized and includes laser treatment, vitrectomy and other methods for fluid drainage. It is important to differentiate ONDP from other causes of central retinal detachment.Objective. Based on a clinical case, to demonstrate an approach to the diagnosis and treatment of local retinal detachment in the macular area associated with the fossa of the optic disc.Materials and methods. This article presents a clinical case of retinal detachment in the macular area associated with the fossa of the optic disc. Results and discussions. When comparing two clinical cases, the similarity of the ophthalmoscopic picture and the differences in the OCT and FAG images were revealed.Conclusions. The accumulation of fluid under the neuroepithelium is not a pathognomic sign, therefore it is important to carry out differential diagnosis in central serous retinal detachment associated with the fossa of the optic disc.

A 3D modelling approach to measuring structural characteristics of bird nest interiors

Abstract Nests are considered extended phenotypes of animals with potentially serious fitness consequences for the survival of offspring. Therefore, nest characteristics may contain valuable information about the underlying ecological and evolutionary mechanisms shaping animal reproduction. However, we currently lack efficient tools to archive nests and measure their characteristics, particularly concerning enclosed nests. Here we developed a step‐by‐step protocol of a 3D modelling approach to measure structural characteristics of nest interiors using the enclosed, dome‐shaped nests of Asian house martins as a test system. We first created the replicas of nest interiors using polyurethane (‘physical replicas’), from which 3D models were constructured using Metashape software (‘digital replicas’). We then estimated the volume and entrance area size of the digital replicas of nest interior using Metashape. To verify that the digital replicas preserve the structural characteristics of the physical replicas, we measured the volume and entrance area size of the physical replicas with Archimedes' drainage method and ImageJ, respectively. We then compared the manual measurements of the physical replicas to the values estimated from digital replicas. The estimates on the interior volume and entrance area size of 50 Asian house martin nests were nearly identical between physical and digital replicas. These results verified that the digital replicas are as reliable as the physical replicas for measuring structural characteristics of nest interior. Our 3D modelling approach allows for easy archiving as digital replicas of nest interiors endure preservation over time much better than actual nest specimens. Furthermore, digital replicas can be shared via internet and analysed for different aspects of morphometrics at any time by anyone. Overall, this tool should facilitate research on the ecology and evolution of animals in relation to nest construction.

A Novel Breast-Volume Self-Measurement Method with Improved Convenient and Accuracy

Breast volume is crucial for ensuring proper bra fit and comfort, significantly influencing women’s physiological and psychological well-being. This study aims to develop a novel method for breast-volume self-measurement, allowing women to accurately assess their breast volume without specialized equipment. We employed a geometric approximation of the breast as a combination of a partial elliptical cone and an irregular partial ellipsoid, leading to the formulation of a new volume equation. The method was validated against established standards, including the specimen drainage method and 3D scanning techniques. The findings revealed that our self-measurement approach achieved a relative error of only 3.8%, outperforming the 4.8% of 3D scanning and the 86.3% associated with traditional breast-volume equations. This innovative self-measurement technique enhances accuracy and serves as a practical solution for health and nutritional assessments, alongside body image evaluations. Its user-friendly nature positions it as a valuable tool for women’s health, particularly in personal fitness and ergonomic design.

Clean Intermittent Catheterisation via a Mitrofanoff is superior to long term Suprapubic Catheters for Bladder Drainage.

AimSome children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI). MethodRetrospective review of a single surgeon’s experience (2007-2023). Data collection included diagnosis, age at procedures, date of surgery, date of most recent follow-up and date and reason for unplanned surgery. For SPCs, initial insertion of SPC and then conversion to a Foley catheter under GA was taken as normal (event free survival) and only further operations were counted as complication events. For Mitrofanoffs, any subsequent operation was counted as a complication.Data were given as a number (%) or median (interquartile range) as appropriate. Data analysed by Fisher exact and Mann-Whitney U-test. Kaplan Meier (KM) survival of drainage routes was compared, P<0.05 taken as significant. ResultsThere were 45 patients (n = 86 SPC episodes) compared to 108 patients (n = 110 Mitrofanoff procedures). Data were available in 73 SPC episodes and 109 Mitrofanoff episodes, including 3 redo procedures (one from another centre). There was no difference in gender (SPC group, 67% male vs. Mitrofanoff group, 77%; N.S.). There was no difference in age at procedure [7.5 (2.9 - 11.5) years vs 8.3 (5.9 - 11.4) years respectively; N.S.)KM comparison showed that Mitrofanoff have a better event-free survival than SPC (91% vs 52% at 1 year; 80% vs. 13% at 5 years; P<0.0001). Paired data showed a significant (86%) reduction in rate of UTI with conversion from SPC to Mitrofanoff drainage in 15 patients; SPC: 0.13 (0 - 0.46) UTIs/month vs subsequent Mitrofanoff: 0.02(0 - 0.08) UTI/month, P=0.04). ConclusionSPCs had a much higher rate of unplanned surgery than Mitrofanoffs, creating a considerable unplanned burden of care for families and clinical staff. For long-term bladder drainage CIC via a Mitrofanoff conduit should be considered in preference to SPC where urethral CIC is not possible.

Influence of Trenchless Subsurface Drainage with a Rice Husk Filling System on Soybean Productivity Under a Poorly Drained Paddy Field for Future Applications in Smart Agriculture

In South Korea, paddy fields are increasingly being planted with soybeans to address rice supply and demand issues and increase soybean self-sufficiency. The field crops cannot grow healthily without adequate drainage due to the paddy fields storing water easily. In this study, we identified that Rice Husk Filling Drainage Method (RHDM) technology improved soil permeability and soil aeration. We also found that the soil moisture content was reduced and the water table remained at a lower level in the RHDM plot as compared to the control plot. The soybean moisture stress index showed that in the RHDM plot, the safety standard for stress due to excessive moisture at the 2 m interval was met. The soybean yield was increased by up to 35% in the 2 m RHDM construction interval compared to the control plot. In addition, the high hydraulic conductivity of the rice husk used as the hydrophobic material confirmed sufficient drainage performance and was considered economically advantageous. Therefore, our results show that RHDM is a highly efficient and economical drainage method in poorly drained paddy soils. Drainage management is essential for stable crop production in poorly drained paddy fields. Our research findings suggest that an efficient open field water management method is viable, which we believe will lead to future advances in open field smart agriculture.

Effects of droplet dynamical behavior in flow channel of proton exchange membrane fuel cell under vibration conditions on cell performance

Proton exchange membrane fuel cells are subjected to severe vibration in aerospace applications. Understanding the droplet transport characteristics in the flow channelunder vibration conditions is essential for improving cell performance. However, the underlying patterns and mechanisms of the vibration effects on cell performance and its internal water transport remain unclear, and there is a lack of improvement methods for drainage under vibration conditions. This study experimentally investigates the effect of vibration on cell performance. Experimental results indicate that vibration predominantly affects cell performance through its modulation of water transport. Therefore, the droplet dynamic behavior in the flow channel is further studied using the volume of fluid method. The results indicate that vibrations can enhance the average performance of the fuel cells, with the largest increase of 8.30 %. This is attributed to vibrations promoting the detachment of droplets from the gas diffusion layer surface and reducing the water coverage ratio on said surface. Under conditions of low gas velocity, high surface hydrophobicity, and large droplet size, droplets exhibited oscillatory and jumping behavior in the flow channel due to vibration, resulting in the largest 53.5 % increase in peak water coverage ratio on the gas diffusion layer surface compared to no-vibration conditions. Furthermore, enhancing the hydrophobicity of the gas diffusion layer and the hydrophilicity of the channel walls promotes droplet detachment and discharge compared to no-vibration, as well as contributing to the improvement of vibration effects on the drainage process.

ASSESSMENT OF METHODS OF DIAGNOSIS AND TREATMENT OF PANCREATIC CYSTS

Abstract. The frequency of formation of pancreatic cysts in acute and chronic pancreatitis is 5-30%, and in destructive forms it increases to 60-70%. Persons of working age from 30 to 60 years old are mainly prone to the disease, which confirms the social significance of this problem. The aim: increase the effectiveness of surgical treatment of pancreatic cysts by using advanced diagnostics and methods of external and internal drainage. Materials and methods: the study is based on the analysis of the results of surgical treatment of patients with pancreatic cysts who were treated at VRCH n.a. M.I. Pirogov in the period from 01.01.2018 to 01.06.2024. A total of 65 patients were observed. The results: infection of the postoperative wound was observed in 6.15% of patients. 1.54% of patients developed adhesions, which were treated conservatively. The average time for removing drains with laparoscopic drainage is 21.2±1.5 days. There were no fatal consequences. Conclusions: the use of advanced diagnostics followed by differential selection of the treatment method significantly reduces the number of complications, reduces mortality and the length of stay of patients in the hospital.

Transretinal puncture with a 41G cannula for posterior residual subretinal fluid in fovea-off retinal detachments treated by vitrectomy VS fluid tolerance VS other conventional drainage techniques: a comparative study.

To compare functional and anatomical outcomes between posterior drainage of residual fluid using a 41G cannula, fluid tolerance (R-SRF), and conventional complete drainage methods, including removal through peripheral retinal breaks (PRB), perfluorocarbon liquid (PFCL), and posterior retinotomy (PR). In this retrospective, multicenter study, we evaluated cases for visual acuity (VA) at 3 months of follow-up. Secondary outcomes included surgical success, postoperative metamorphopsia, shifts, full-thickness folds (FTF), optical coherence tomography (OCT) parameters, and safety. Subgroup analyses were also conducted. VA did not differ significantly between the three main groups. Subgroup analyses revealed worse VA for PR with 1.131 LogMAR (20/270 in Snellen conversion, p=0,002), with significantly more grade C proliferative vitreoretinopathy (PVR, 40.0%, p=0,003). R-SRF tended to offer better secondary outcomes, without statistical significance except for postoperative epiretinal membrane (ERM, 30.8%, p=0,041). Subgroup analyses found significantly more shifts with PFCL (91,7%, p=0,036). No cases of postoperative FTF or macular holes were observed with the 41G. Our study introduced the 41G technique, indicating favourable outcomes for fovea-off retinal detachments. Nevertheless, fluid tolerance appeared to be the best option, offering a cost-effective and faster method, with an optimal microstructural profile and VA comparable to that of complete drainage techniques.

Effectiveness of endoscopic ultrasound-guided biliary drainage in patients experiencing obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography

Objective: To assess the treatment outcomes of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of patients with obstructive jaundice who underwent EUS-BD due to ERCP failure at the Gastrointestinal Endoscopy Center of Beijing Friendship Hospital from September 2018 to November 2023, was retrospectively collected and analyzed. We explored the technical success, clinical success, and adverse events associated with EUS-BD. Results: In total, 43 EUS-BD procedures were performed in 39 patients with a technical success rate of 86.0% (37/43). The clinical success rate was 81.1% (30/37). Biliary drainage was not effectively achieved in seven cases, including two fatal cases and five cases of recurrent postoperative biliary obstruction. The incidence of adverse events was 21.6% (8/37), including two cases of postoperative bile leakage peritonitis, two cases of stent displacement, one case of stent dislocation, one case of perforation, and two cases of death. Conclusion: EUS-BD is a relatively safe and effective method for bile duct drainage, serving as a dependable alternative therapeutic option for patients with obstructive jaundice due to unsuccessful ERCP.

Magnetic navigation-assisted colonoscopic enteral tube placement in swine (with video): a preliminary study

BackgroundColonoscopic enteral tube placement using current methods has some shortcomings, such as the complexity of the procedure and tube dislodgement. The magnetic navigation technique (MNT) has been proven effective for nasoenteral feeding tube placement, and is associated with reduced cost and time to initiation of nutrition. This study attempted to develop a novel method for enteral tube placement using MNT.MethodsThe MNT device consisted of an external magnet and a 12 Fr tube with a magnet at the end. Ten swine were used, and bowel cleansing was routinely performed before colonoscopy. Intravenous anesthesia with propofol and ketamine was administered. A colonoscopic enteral tube was placed using the MNT. The position of the end of the enteral tube was determined by radiography, and angiography was performed to check for colonic perforations. Colonoscopy was used to detect intestinal mucosal damage after tube removal.ResultsMNT-assisted colonoscopic enteral tube placement was successfully completed in all pigs. The median operating time was 30 (26–47) min. No colon perforation was detected on colonography after enteral tube placement, and no colonic mucosal bleeding or injury was detected after the removal of the enteral tube.ConclusionsMNT-assisted colonoscopic enteral tube placement is feasible and safe in swine and may represent a valuable method for microbial therapy, colonic drainage, and host-microbiota interaction research in the future.

Drainage of ascites in cirrhosis.

For cirrhotic refractory ascites, diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management. However, their therapeutic effects are limited, and most refractory ascites do not respond to medication treatment, necessitating consideration of drainage or surgical interventions. Consequently, numerous drainage methods for cirrhotic ascites have emerged, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, peritoneovenous shunt, automated low-flow ascites pump, cell-free and concentrated ascites reinfusion therapy, and peritoneal catheter drainage. This review introduces the advantages and disadvantages of these methods in different aspects, as well as indications and contraindications for this disease.

Effects of Bi2O3–CuO addition on the dielectric properties of MgO–TiO2(w) ceramics sintered at low temperatures

Herein, MgO–12 % TiO2(w) ceramics with different contents of Bi2O3–CuO sintering aid were prepared using a solid-state method. The effects of the sintering aid content on the sintering temperature and the dielectric and mechanical properties of the ceramics were studied. The material was characterized using scanning electron microscopy and X-ray diffraction and Precision LCR tester and universal testing machine and Archimedes drainage method. When the Bi2O3–CuO content was less than 9 wt%, the ceramic sample has higher dielectric properties. When the Bi2O3–CuO content was greater than 9 wt%, the dielectric properties will deteriorate. This is because Bi2O3 participates in the chemical reaction between MgO and TiO2, forming a high dielectric loss Bi4Ti3O7 phase. At high temperatures, Cu2+ can easily change valence to Cu+, promoting oxygen vacancies and increasing dielectric loss in ceramic samples. The introduction of Bi2O3–CuO produces new MgTiO3, Mg2TiO4, and Bi4Ti3O12 phases in the sample structure, resulting in a structure in which the MgO grains in the sample are surrounded by the new phases that appear around them. This structure fills the pores, increases density, enhances mechanical properties. The dielectric properties of the ceramics were the when the sintering temperature was 1050 °C, and the Bi2O3–CuO content was 3 wt%. The dielectric constant and dielectric loss were 11.19 and 1.17 × 10−4, respectively. The bending strength of the ceramic sample increased from 138.72 MPa to 179.64 MPa when the Bi2O3–CuO content was increased from 3 wt% to 15 wt%. The Bi2O3–CuO sintering aid enables MgO to be better applied in ceramic substrates.

Comparison of the results of active surgical treatment and serial stenting for urolithiasis in pregnant women

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials &amp; methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p &lt; 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p &lt; 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Bladder drainage methods for acute urinary retention due to benign prostatic hyperplasia: patient-preference analysis

Introduction. Currently, the classical management of acute urinary retention creates a certain discomfort for the patient and leads to explore alternative method of management, such as intermittent catheterization, including focusing on the patient opinions.Objective. To assess the preference of high-risk patients for acute urinary retention relative to bladder drainage in the occurrence of acute urinary retention.Materials &amp; methods. A survey was conducted among 200 ambulatory male patients. All the participants were tested to assess their mental status and ability to perform self-intermittent catheterization before filling out the questionnaire. The questionnaire included questions about the preferred method of bladder drainage for acute urinary retention, as well as factors influencing the patient's choice of self-intermittent catheterization in case of non-recovery. After completing the questionnaire, all the patients were shown a video on self-catheterization and asked to re-take the questionnaire after watching it. This allowed evaluating the impact of the training video on patients' preferences and their confidence in performing self-catheterization.Results. Among the 200 patients, 151 (75.5 %) preferred intermittent catheterization, while 40 (25.5 %) chose an indwelling urinary catheter. Additionally, 152 (76 %) patients opted for intermittent catheterization until the planned surgery, and 48 (24 %) selected a suprapubic catheter. The main factors influencing the patient choice of intermittent catheterization were: the desire to restore bladder function faster (on the first or second day) in 96 (63.2 %) patients; unwillingness to stay in the hospital in 56 (36.8 %); the desire to return to work in 22 (14.5 %); avoiding the use of a suprapubic catheter in 51 (33.5 %). After watching the video, there was a statistically significant change in patients' assessments of their ability to perform self-intermittent catheterization (p &lt; 0.001).Conclusion. The patient's choice of the intermittent catheterization is significantly influenced by the patient self-confidence in the ability to practice self-intermittent catheterization and the demonstration of the video tutorial. Due to the high efficiency and safety of intermittent catheterization, this method should be introduced into clinical practice based on the proposed algorithm.

Exploring the Effects of Different Processing Techniques on the Antitussive Expectorant of Platycodon grandiflorus by Metabonomics and Pharmacologic Methods

Background and Purpose Platycodon grandiflorum is a traditional Chinese herbal medicine, which can disperse lung, promote pharynx, dispel phlegm and expel pus. Its processing history was first seen in the “Zhou Hou Bei Ji Fang” of the Jin Dynasty in China. Through processing, effective substances in plants can be enriched and negative substances can be reduced. Therefore, this study explored the effects of different processing methods on the antitussive and expectorant effects of Platycodon grandiflorum through metabolomics and pharmacology, aiming to provide a theoretical basis for clinical application. Experimental Approach The changes of metabolites before and after processing of Platycodon grandiflorum were analyzed by Nexera UHPLC LC-30A-HILIC-Orbitrap-Q Exactive HF-X platform. The antitussive and expectorant effects of processed Platycodon grandiflorum were verified by mouse concentrated ammonia induced cough method and tracheal phenol red drainage method. Key Results After processing, some metabolites of Platycodon grandiflorum changed, among which 24 kinds of terpenoid metabolites changed significantly. Through the experiment of ammonia-induced cough in mice and phenol red expectorant experiment, it was found that fresh JZI 40%, fresh CZ 80%, dry JZZ 40% and dry JZI 80% had obvious antitussive effect, and dry JZZ 40% had obvious expectorant effect. Conclusions and Implications Some processing methods can indeed further improve the antitussive and expectorant effects of Platycodon grandiflorum, which may be due to the effect of increasing the content of triterpenoids after processing, but the mechanism of processing to improve the effect of relieving cough and expectorant needs further study.

Retrospective Study on Anterolateral Mini-Thoracotomy in Emergency Surgical Drainage for Massive Pericardial Effusion Including Sternotomy Case

Background: The conventional method for managing the surgical drainage of an acute massive pericardial effusion typically involves a median sternotomy. Nevertheless, advancements in surgical optics and tools have enabled the utilization of progressively smaller incisions, such as a left anterolateral thoracotomy, for the same purpose. Aim of the Study: This study aimed to assess the surgical outcomes of left anterolateral mini-thoracotomy compared to median sternotomy for draining acute massive pericardial effusion. Methods: This research took place in the Cardiac Surgery Department at Ibrahim Cardiac and Research Institute, following approval from the local ethics committee, from June 2021 to June 2023. Fourteen patients with acute massive pericardial effusion necessitating emergency surgical drainage were included. The investigation concentrated on evaluating operative and short-term postoperative results to gauge the influence of two surgical drainage methods on patients' quality of life. Result: Both groups exhibited similar age, preoperative comorbidities, and ejection fraction. The sternotomy group required more operation time than the left anterolateral mini-thoracotomy group. Furthermore, the sternotomy group had a prolonged stay in the intensive care unit and hospital compared to the left anterolateral mini-thoracotomy group. Similar rates were observed for blood transfusion and chest tube drainage. However, two cases of superficial wound infection occurred in the sternotomy group. In the anterolateral thoracotomy group, no patients required conversion to full sternotomy, and all patients were alive at the one-month follow-up after hospital discharge. Conclusion: Employing a left anterolateral mini-thoracotomy for draining acute massive pericardial effusion was deemed a secure and reliable alternative to the traditional median sternotomy incision. Despite its limited operating field, requiring proficiency, this approach preserved sternal integrity, offered a more aesthetically pleasing incision, reduced the risk of wound infection, and decreased the need for analgesia. Additionally, it was associated with a faster recovery process and a shorter stay in the intensive care unit (ICU). (Bangladesh Heart Journal 2024; 39(2): 161-167

How vertical drainage positions of extensive green roofs affect the runoff control performance

The capacity of extensive green roofs (EGRs) in runoff reduction and pollutants control significantly decreased with increasing rainfall intensity. This is attributed to most of EGRs are the lower-drainage method and use a thinner substrate layer because of the structural load-bearing limits of buildings. Existing solutions depend on increasing the rainwater storage by thickening the substrate layer of EGRs, or replacing the substrate materials. We propose to enhance the water retention capacity of EGRs by adjusting vertical drainage positions and moving the lower-drainage at the bottom to upper-drainage over the substrate layer. To test the runoff control performance of EGRs with the upper-drainage method, we designed three EGR models with two different (upper- and lower-) drainage methods based on the common EGR’s structure in practice and carried out total 48 experiments under different rainfall intensities with an artificial rainfall simulator. The experimental design also included adjusting structural factors of the EGR to further explore the influences of roof slope, status of vegetation growth (height and canopy cover ratio), and model size. The average runoff retention rate for the upper-drainage EGR was 61.82 %, which was much higher than the 23.94 % for the lower-drainage EGR. The concentrations of TN and TP in runoff with the upper-drainage were 2.83 and 0.18 mg/L, which were much lower than the 8.47 and 2.10 mg/L for the lower-drainage EGR. EGRs with upper-drainage overall performed better in runoff control than EGRs with lower-drainage. Vegetation height and model size did not significantly affect the rainwater control performance for different drainage methods, while the change of slope affected the rainwater interception of the EGRs with upper-drainage method.

Shoulder girdle muscle abscess: Potential routes of spread and surgical management by a dual anterior approach

BackgroundSpontaneous infections involving muscles in the shoulder girdle are uncommon conditions rarely reported in the literature. The large musculature of shoulder girdle, complex communicating spaces into the periscapular region, and late glenohumeral joint involvement can cause delay in diagnosis of infections involving muscular portion of rotator cuff. The method of surgical drainage with involvement of scapulothoracic and subscapular spaces and prognosis can be challenging. MethodologyIn this descriptive study, we included patients with shoulder girdle muscle abscess and analyzed the spread in the shoulder girdle and arm through various pathways radiologically. Debridement of the abscess in the subscapular muscle and adnexa was done through the dual approach, one with deltopectoral approach for the shoulder girdle and another incision anterior to the latissimus dorsi muscle for inferior subscapular spaces and gravity-dependent drainage of collection. ResultsThe causative organism Staphylococcus aureus was isolated only in two patients out of four cases. In repeated collections, axillary and suprascapular nerve palsies were commonly encountered. Adequate debridement, antibiotic cover with vancomycin and clindamycin for six weeks, and rehabilitation restored normal functions of the shoulder in three patients. ConclusionUnsuspecting nature of the subscapular abscess and similarities with common shoulder conditions at initial presentation often led to extensive shoulder girdle involvement via subscapular space, subcoracoid recess, and scapulothoracic space to adjacent areas. The dual approach provides adequate access to drain the collections in subscapularis muscle, subscapular spaces, and shoulder girdle. Level of studyV.

Modern approaches to the management of blunt liver trauma

Relevance. Liver trauma is one of the most common abdominal injuries. The purpose is to review the evidence and present the current level of diagnosis, tactics and treatment of blunt liver trauma.Materials and methods. The results of clinical studies in liver trauma have been analyzed. Literature was searched in PubMed electronic search engines (https://pubmed.ncbi.nlm.nih.gov), eLibrary (https://elibrary.ru) by keywords: "liver trauma", "management liver trauma", "diagnosis liver trauma". 134 publications were selected for analysis.Results. Historically, most patients with liver trauma were cured promptly using techniques such as liver suturing, liver resection, ligation of the hepatic artery, atrioval shunts. Conservative management was practically not used. Consequently, mortality was high and reached almost 90% in patients with severe trauma, including damage to the main hepatic vessels. The introduction of such techniques as perigepathic packaging and direct suturing of damaged vessels significantly improved the prognosis of patients. The widespread use of conservative therapy in patients with stable hemodynamics, the management of which is based on instrumental assessment, carefully selected diagnostic imaging of the nature of liver injury, instrumental dynamic observation using operative X-ray angiology and endoscopy, in a hybrid operating room, contributed to the improvement of treatment results.Conclusion. In recent decades, conservative therapy has been performed in 80–86% of cases in patients with stable hemodynamics. The use of minimally invasive interventions such as angiography and embolization, a combination of percutaneous drainage and endoscopic methods for injury to vascular and biliary structures can be considered as the main method of treating post-traumatic complications.