Drop In Hemoglobin Level Research Articles

Effectiveness of combined use of rectal misoprostol and oxytocin for prevention of postpartum hemorrhage after cesarean section

Post-Partum Hemorrhage (PPH) is defined as the loss of blood which is greater than 500ml after vaginal delivery or greater than 1000 ml after a cesarean section delivery. About 28% of the total maternal deaths were due to PPH particularly in developing countries. Oxytocin has been considered as the ‘gold standard’ drug in the treatment and prevention of PPH. Prophylactic use of prostaglandin analogue i.e., misoprostol in addition to oxytocin during cesarean section is expected to reduce the incidence of PPH. This study aims at comparing the efficacy of combined use of rectal misoprostol and oxytocin infusion with oxytocin in the prevention of PPH. A comparative observational study was conducted on 200 subjects which were divided into two equal groups by Simple Random Selection. One group was treated with Inj. Oxytocin 20U I.V infusion alone while the other group was treated with Tab. Misoprostol 600mcg, rectal route and Inj. Oxytocin 20U I.V infusion. Majority of the subjects were observed under the age group of 21-25years, under primigravidae. A significant decrease in the volume of mean blood loss (740.00 ± 164.00 ml: p = 0.045) and the mean drop of hemoglobin level(Hb) (0.88±0.74gm/dl; p = 0.0001) were observed in group treated with Tab. Misoprostol 600mcg and Inj. Oxytocin and was found to be statistically significant. Preoperative administration of misoprostol per rectal route and oxytocin infusion after the cesarean section have shown, a better control of bleeding and maintenance of hemoglobin level when compared to oxytocin infusion alone. Thus, instead of oxytocin monotherapy combined use of misoprostol and oxytocin would be more effective in prevention of PPH.

COVID-19 Response in the Global Epicenter: Converting a New York City Level 1 Orthopedic Trauma Service into a Hybrid Orthopedic and Medicine COVID-19 Management Team.

The SARS-COV-2 (COVID-19) pandemic has placed unprecedented challenges on the health care system in the United States with New York City at its epicenter. By the end of the 8 week (4/23/2020) since the virus's emergence in New York City, there have been 142,432 confirmed COVID-19 cases and 10,977 deaths attributed to complications from COVID-19-related illnesses. Secondary to policies enacted by the New York State government to limit spread of the virus, Orthopedic Surgery departments at hospitals around the area have witnessed an abrupt change in clinical demands. At a local level one trauma hospital in Queens, New York, Orthopedic Surgery elective cases have been cancelled, trauma consult volume has experienced a sharp decline, and both residents and attendings have been repurposed to meet the new clinical demands of this medical crisis. Our own orthopedic surgery service has adopted care for patients normally admitted to an internal medicine service in a novel Ortho-Medical COVID-19 management team. We prepared this primer to make our experience with caring for COVID-19 patents available as a reference for other surgical subspecialty services preparing to adjust the clinical focus of their hospital teams during this or future pandemics. LEVEL OF EVIDENCE:: Level V.

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years' experience in a single institute.

BackgroundHysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital.MethodsWe retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. ResultsA total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). ConclusionMinimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Outcome of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis: a single-center retrospective study.

The purpose of this study was to evaluate the efficacy of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis (RHC). We conducted a retrospective study of 21 RHC patients treated with a 980-nm diode laser between July 2014 and December 2017 at our institution. Data was collected with regard to age, sex, lower urinary tract symptoms, use of transfusions, a drop in hemoglobin levels, indication of radiotherapy, median time between radiation therapy and presentation, previous treatments, operative time, mean energy used, number of coagulated areas, catheterization time, discharge time after treatment, hospital stay, and surgical outcome. All 21 patients were women with a median age of 52years (range 36-68years). Eighteen patients complained of frequency and urgency, four patients had dysuria, and one patient developed urinary retention. Radiation therapy was primarily indicated in the treatment of cervical cancer in 18 patients (85.7%) and endometrial cancer in three patients (14.3%). Nine patients (42.8%) received blood transfusion before surgery and three patients (14.3%) needed blood transfusion after the procedure. The mean decrease in hemoglobin prior to the procedure was 4.08 ± 2.04g/dL. The median length of time from completion of radiotherapy to the presentation of hematuria was 38months (range 8-65months). All patients had failed an adequate trial of conservative treatment which included adequate hydration, hemostatics, continuous bladder irrigation (CBI), and clot evacuation at the bedside. Eleven patients (52.4%) had previously been treated with endoscopic electrocoagulation; the mean number of procedures was 1.73 ± 0.78 (range 1-3 sessions). Six patients (28.6%) underwent HBO, and sodium hyaluronate solution irrigation was administered to 3 patients (14.3%). The mean number of HBO sessions was 26.3 ± 16.8 (range 8-50), and the mean number of sodium hyaluronate solution irrigation procedures was 4.33 ± 1.53 (range 3-6). All operations were successful. The mean operative time was 45.6 ± 12.3min, the mean number of coagulated areas was 11.7 ± 4.4, the mean energy used was 2.74 ± 1.14kJ, the mean catheterization time was 6.2 ± 0.9days, the mean discharge time after treatment was 6.8 ± 1.2days, and the average length of a hospital stay was 7.4 ± 1.3days. In 16 patients (76.2%), hematuria was completely resolved after one session of diode laser coagulation. Four patients (19.0%) underwent multiple sessions of laser treatment due to recurrent gross hematuria (three patients required two sessions and one patient required three sessions). Only one patient (4.8%) who had persistent gross hematuria after diode laser treatment (two sessions) underwent a radical cystectomy, which resolved the hematuria. The median hematuria-free interval of patients who had multiple procedures was 9months (range 1-13months). In total, 21 patients underwent 27 sessions of diode laser coagulation, and the median hematuria-free interval was 16months (range 1-45months) with a median follow-up of 25months (range 7-48months). Our study shows promising results for the management of patients with RHC; however, further evaluation with a larger cohort is required to confirm the efficacy of this treatment.

Acute Uterine Torsion Mimicking Tumor Lysis Syndrome

Background: Non-gravid uterine torsion is rare and mostly diagnosed at surgery. This report describes a patient with a large abdominal mass, critical illness, and tumor lysis syndrome. Case: A female presented with acute abdominal pain. Physical exam showed a large abdominal mass and abdominal rigidity. Serial laboratory tests showed a drop in hemoglobin level, progressive renal failure and serum uric acid and phosphate concentrations compatible with tumor lysis syndrome. Computed tomography showed a 30 cm mass filling the pelvis and abdomen. At an emergency exploratory laparotomy, a 360 degrees torsion of the uterus was found. An uneventful total hysterectomy was done. After surgery renal function restored. Conclusion: Uterine torsion is rare and can be potentially life threatening when presenting as tumor lysis syndrome

Topical tranexamic acid in cemented primary total knee arthroplasty without tourniquet: a prospective randomized study.

Tranexamic acid (TXA) has been shown to be effective in reducing blood loss after total knee replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use, to reduce blood loss after primary total knee replacement without tourniquet, and to compare these outcomes with a control group that did not receive tranexamic acid. This is a prospective, randomized study to assess the effect of a 2-g topical tranexamic acid in 50mL physiological saline solution in total knee replacement without tourniquet and drain. Primary outcomes were total blood loss. Secondary outcomes were hemoglobin and hematocrit level, hemoglobin and hematocrit drop, transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. Preoperative and intraoperative data were similar between the two groups. The mean total blood loss was 620mL in the topical tranexamic acid group and 1094mL in the control group with significant differences (p = 0.001), which meant 43% reduction in total blood loss. The hemoglobin and hematocrit postoperative value was significantly higher in the topical tranexamic acid group than in the control group (p = 0.002). Transfusion rates were 0% in the topical tranexamic group and 4.3% in the control group. The length of stay was significantly lower in the topical tranexamic acid group (p = 0.01). There were no DVT or PE in any group. A single dose of 2-g TXA in 50mL topical administration significantly reduces blood loss and improves postoperative blood chemistries in patients undergoing unilateral primary cemented TKA without tourniquet and drain compared to a control group, without increasing the risk of thromboembolic complications.

91-Year-Old Man With Upper Extremity Ecchymoses

91-Year-Old Man With Upper Extremity Ecchymoses

DECREASE IN HEMOGLOBIN AND ITS ASSOCIATION WITH ACUTE KIDNEY INJURY AFTER PERCUTANEOUS CORONARY INTERVENTION

Acute kidney injury (AKI) is common in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and is associated with an increased risk of mortality during and after hospitalization. A drop in periprocedural hemoglobin level of more than 3 units (g/dl) is

Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials

Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: -0.11 [-0.31, 0.08], P=0.27, I2=86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [-0.03, 0.04], P=0.62, I2=48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: -0.19 [-0.27, -0.12], P<0.00001, I2=0%). No statistical difference regarding pancreatitis (5.2% vs 0.9%; RD: 0.05 [-0.01, 0.11], P=0.12, I2=57%), perforation (0.4% vs 0%; RD: 0.00 [-0.01, 0.02], P=0.7, I2=0%) or cholangitis (1.8% vs 3.2%; RD: -0.01 [-0.09, 0.06], P=0,7). 3. Pure cut vs blend: higher incidence of mild bleeding in the pure cut group (40.4% vs 16.7%; RD: 0.24 [0.15, 0.33], P<0.00001, I2=0%). No statistical difference concerning incidence of pancreatitis or cholangitis. 4. Pure cut vs Pure cut followed by Blend: No statistical difference regarding incidence of bleeding (22.5% vs 11.7%; RD: -0.10 [-0.24, 0.04], P=0.18, I2=61%) and pancreatitis (8.9% vs 14.8%; RD 0.06 [-0.02, 0.13], P=0.12, I2=0%). 5. Blend vs pure cut followed by blend: no statistical difference regarding incidence of bleeding and pancreatitis (11.3% vs 10.4%; RD -0.01 [-0.11, 0.09], P=0.82, I2=0%). 6. Monopolar vs bipolar: higher incidence of pancreatitis in the monopolar mode group (12% vs 0%; RD 0.12 [0.02, 0.22], P=0.01). Pure cut carries higher incidences of mild bleeding compared to endocut and blend. However, this modality might present a lower incidence of pancreatitis. The monopolar mode elicits higher rates of pancreatitis in comparison with the bipolar mode. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is a lack of evidence in the literature to recommend one method over the others, therefore new studies are warranted. As there is no perfect electric current mode, the choice in clinical practice must be based on the patient risk factors.

124 - Antibiotic use in advanced non-small cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors across the Northern Ireland Cancer Network

Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department.This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24 h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine.In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P = 0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24 h (P = 0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P ˃ 0.05).The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels.

A case of heart failure and polycythemia: Treated with phlebotomy

Polycythemia in heart failure (HF) is known but rarely encountered. A 76-year-old male presented with New York Heart Association Class III HF symptoms leading to secondary polycythemia. He had underlying ischemic cardiomyopathy not amenable to revascularization and thus was put on optimal medical therapy. However, after being refractory to medical management, he was treated with phlebotomy showing a significant improvement in his symptoms as well as a drop in hemoglobin level. Diagnostic algorithm and management of polycythemia related to HF are discussed.

Case Report: Post Lumbar Discectomy Acute Iliac Arteriovenous Fistula; Endovascular Management and Literature Review

Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications which could be a serious life threatening condition. We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy. Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency CT angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management. Endovascular stenting is nowadays the modality of choice of intervention. We provide case report with literature review.

CT-based TruMatch® Personal Solutions for knee replacement Surgery … Does it really match?

ObjectivePatient-specific templates promises to be able to increase alignment while decreasing operative time, increasing patient throughput, decreasing instrumentation, reducing risk of fat embolism and intraoperative bleeding, decreasing tissue loss, shortening recovery, reducing post-operative pain and decreasing incidence of infection. However, multiple studies have shown conflicting results regarding these potential benefits. This study serves to critically evaluate the potential advantages and disadvantages of using a patient-specific templating technique through a single-surgeon study. MethodsAll patients who underwent primary total knee arthroplasty (TKA) for osteoarthritis of the knee using TruMatch® Personal Solutions total knee replacement by a single surgeon were identified. An age-, gender-, side-, diagnosis- and surgeon-matched cohort who underwent conventional primary TKAs was randomly identified for comparison. ResultsThe average distal medial femur (p < 0.001), distal lateral femur (p < 0.001), posteromedial femur (p < 0.001), posterolateral femur (p < 0.001), medial tibial (p < 0.001) and lateral tibial (p = 0.12) predicted cuts showed significant difference from the actual corresponding cuts. Three knees also required the need to freehand. There was no significant difference in mechanical (p = 0.96) and anatomical alignments (p = 0.26), as well as the changes in mechanical (p = 0.06) and anatomical (p = 0.39) alignments between the two groups. Duration of surgery (p = 0.26), length of inpatient stay (p = 0.06) and incidence of wound infection (p = 1.00) were similar. Additionally, patients in the TruMatch® Personal Solutions group had a greater decrease drop in hemoglobin levels (p = 0.02), with five transfusions needed while only one patient in the conventional group required transfusion (p = 0.09). ConclusionOur early experience and results with the CT-based TruMatch® Personal Solutions templates for TKA has not been promising. Despite promised, there were no demonstrable benefits with the technology. Moreover, the disadvantage of having increased blood loss was identified. Further studies are required to recommend the use of this technology.

1435 Pancreaticoenteric Fistula: A Very Unique Complication of Acute Pancreatitis

INTRODUCTION: Pancreaticoenteric fistulas are a rare complication of acute pancreatitis. Spontaneous fistulation has been described in the literature in cases where acute pancreatitis is complicated with infection or necrosis. As a direct consequence to the fistula formation, direct vascular injury may occur, resulting in blood loss and rapid clinical deterioration. CASE DESCRIPTION/METHODS: A 77-year-old male with past medical history of essential hypertension, type 2 diabetes mellitus and coronary artery disease status post coronary artery bypass grafting in 2017 was brought to Emergency Room due to sudden onset right leg pain. He was admitted due to subacute limb ischemia and started on antiplatelet and anticoagulation medical therapy. Hospital course complicated with abdominal pain and four episodes of large volume port wine stools per rectum and significant drop in hemoglobin levels. After initial resuscitation measures, which include intravenous hydration and supportive blood products transfusions, patient was consulted to Gastroenterology service for evaluation and recommendations. Esophagoduodenoscopy revealed large clean base ulcerated lesion with an associated fistulous process in the first portion of the duodenum. No active bleeding nor blood remnants were noted. Abdominopelvic CT scan was immediately done and showed extensive devitalization of the pancreas along with large peripancreatic fluid collection with abundant internal gas suggestive of a contained perforation of duodenum. Interventional radiology and General surgery was consult. DISCUSSION: Spontaneous pancreaticoenteric fistula in the setting of pseudocysts formation secondary to necrotizing pancreatitis is a very rare and unique complication. Typical management is conservative, with medical therapy resulting in closure of the vast majority of fistulas. The infrequency with which pancreaticoenteric fistulas are encountered makes them a formidable diagnostic and treatment challenge. Even though it has been described in the literature, there still much to investigate regarding upper gastrointestinal fistulas and its associated vascular complications after acute pancreatitis.

The value of tranexamic acid for patients with preoperative anemia in primary total knee arthroplasty

BackgroundPreoperative anemia is relatively common in patients undergoing primary total knee arthroplasty (TKA), and is associated with higher medical costs due to blood transfusions.MethodsWe aimed to discuss the efficiency of tranexamic acid (TXA) administration for blood loss control in preoperatively anemic patients undergoing primary TKA. We retrospectively reviewed the clinical data regarding a consecutive series of primary unilateral TKA patients with preoperative anemia. Patients were divided into TXA group (received TXA peri-operatively) and control group (did not receive TXA). Outcome measures included drainage volume; hemoglobin, and hematocrit levels recorded preoperatively and over the first 5 days postoperatively; amount of allogeneic blood transfusion; and prevalence of thrombosis.ResultsNinety-six patients from 996 cases were included in the study. Demographics, general health condition, and preoperative conditions were comparable between the two groups. However, significantly lower drainage volume (P < 0.001), hidden blood loss (P < 0.001), and allogeneic blood transfusion volume (χ = 4.00, P = 0.046) were noted in TXA group. The hemoglobin and hematocrit levels were significantly higher in TXA group on the first postoperative day (P = 0.006), but overall the drop in hemoglobin and hematocrit levels over the first 5 days postoperatively was similar between the groups (P = 0.763), as was the incidence of thromboembolism events (P = 0.794).ConclusionTXA has a positive role for patients with preoperative anemia in primary total knee arthroplasty. In patients with mild preoperative anemia, TXA decreases hidden blood loss and the need for allogeneic blood transfusion, which mainly appears effective on the first postoperative day of TKA.

Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. Only randomized controlled trials (RCTs) that compared the sealing group with the control group during TKA were included up to March 2019. Two reviewers independently extracted data and assessed the quality of included studies. The statistical analysis was performed by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed. The results of meta-analysis showed that patients in the sealed group had less total blood loss, less total drain output and less hidden blood loss, less transfusion rates, a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than the control group. On the other hand, there were no significant differences in infection, deep vein thrombosis, and redness of incision between sealed and control group. Current meta-analysis found that sealing the femoral canal during TKA was an effective method for the control of blood loss.

Super-mini percutaneous nephrolithotomy versus flexible ureteroscopy lithotripsy with holmium laser: an efficacy analysis in patients with symptomatic lower calyx renal calculi 1-2 cm

Objective To compare super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy lithotripsy (FURL) for the treatment of the patients with symptomatic lower calyx calculi 1-2 cm. Methods From May 2016 to March 2018, 203 patients with symptomatic lower calyx calculi 1-2 cm who underwent SMP or FURL in our center were retrospectively analyzed. The patients were divided into two groups based on the surgical procedures: 96 cases in SMP group and 107 in FURL group. The postoperative outcomes were compared between two groups. Results Preoperative placement history of Double-J stents in SMP group was significantly lower than that in FURL group(P=0.012). However in stone essence, SMP group was obviously higher than FURL group(P=0.013). In terms of postoperative outcomes, less drop in hemoglobin level was significantly observed in FURL group(P=0.018). The stone-free rate (SFR) at the first day (83.3% vs. 68.2, P=0.013) and at the 4th week end (92.7 vs. 82.2, P=0.026) in SMP group were both statistically higher than in FURL group. Conclusions SMP is technically feasible and safe with lower incidence of bleeding and complications for the treatment of patients with lower calyx calculi 1-2 cm, and it can be used as a complementary operation method for FURL. Key words: Kidney Calculi; Lasers, Solid-State; Lithotripsy; Nephrostomy, Percutaneous; Ureteroscopy

The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy.&#x0D; Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value &lt;0.05 was considered significant.&#x0D; Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin.&#x0D; Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.

Tibial cement mantle thickness is not affected by tourniquetless total knee arthroplasty when performed with tranexamic acid.

Evidence exists that tourniquet use leads to increased cement penetration in total knee arthroplasty (TKA) due to decreased blood and fat in the bone during cementation. The use of tranexamic acid (TXA) has led to decreased blood loss and transfusion rates. The purpose of this study was to determine if the use of a tourniquet while utilising modern TXA protocols affects the tibial cement mantle penetration. 140 patients who underwent primary TKA with and without a tourniquet (70 in each group) were retrospectively reviewed. All patients received a standard TXA protocol. The primary outcome measure was cumulative depth of cement mantle penetration of the tibial plateau on post-operative radiographs. Secondary outcome measures included post-operative change in haemoglobin and hematocrit levels, blood loss, and transfusion rates. There was no significant difference in age, sex, or pre-operative haemoglobin or hematocrit levels between groups. Tourniquet use resulted in significantly lower blood loss (100.0mL versus 154.7mL, p < 0.001), and significantly reduced drop in haemoglobin (1.8g/dL vs 2.5g/dL, p < 0.001) and hematocrit (5.7% vs 7.4%, p = 0.04) levels. However, depth of tibial cement mantle penetration did not differ between the tourniquet group (15.3mm) and non-tourniquet group (15.0mm, p value n.s.). No patient in either group required a blood transfusion. Tourniquet use in primary TKA results in decreased blood loss and less change in pre-operative vs post-operative haemoglobin and hematocrit levels. However, with the use of TXA, not using a tourniquet resulted in similar cement mantle penetration around the tibial component as with a tourniquet.

Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

ABSTRACTObjectives: To assess the safety and the effectiveness of bipolar energy in the transurethral resection of primary large bladder tumours (TURBT) and compare it to conventional monopolar energy.Patients and methods: From November 2015 to June 2017, 80 patients underwent endoscopic resection primarily for large bladder cancer tumours of >3 cm. They were randomly assigned into two groups: 40 patients underwent a TURBT with conventional monopolar current (M-TURBT) and 40 were treated with bipolar current (B-TURBT).Results: There were no statistically significant differences between the two groups for the patients’ demographic and tumour characteristics. There was a significant difference between M-TURBT and B-TURBT for resection time, obturator reflex, hospital stay, and catheterisation time, which were all higher in the M-TURBT group; the mean (SD) resection time was 26.45 (5.73) vs 22.85 (7.52) min (P = 0.048), the obturator reflex was 25% vs 5% (P = 0.025), the median hospital stay and catheterisation times were 2 vs 1 day (P = 0.012 and P = 0.023, respectively). No statistically significant difference was found between the groups for bladder perforation, TUR syndrome, drop in haemoglobin level, and blood transfusion rate. However, there was statically significant difference in the postoperative haematuria rate, which was higher in the M-TURBT group, at 24 patients vs eight in the B-TURBT group (60% vs 20%; P = 0.01). After 1-year follow-up, there was no significant difference in the recurrence rate between the groups.Conclusion: B-TURBT is a safe and effective alternative procedure to M-TURBT for the management of primary large bladder tumours of >3 cm.Abbreviations: CONSORT: consolidated standards of reporting Trials; Hb: haemoglobin; NMIBC: non-muscle-invasive bladder cancer; TUR: transurethral resection; (B-)(M-)TURBT: (bipolar) (monopolar) transurethral resection of bladder tumour