Drop In Hemoglobin Level Research Articles

What is the accuracy of estimated blood loss made by the obstetricians at cesarean section based on drop of hemoglobin level – A retrospective cohort study

Introduction: Haemorrhage is defined as 10% or greater decrease in hematocrit. It is considered as a major complication of surgeries and is one of the most common causes of death during surgical settings (1). Despite the low mortality and morbidity of Caesarean Sections (CS), hemorrhage is still considered as a threat to the patients and surgeons (2). Knowing the accurate blood loss is very helpful for resuscitation process and reducing in plenty of hemorrhagic shocks (3).

RETRACTED ARTICLE: Sublingual vs vaginal misoprostol for completion of first trimester missedabortion: a randomised controlled trial

Statement of Retraction [Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial] We, the Editor and Publisher of European Journal of Contraception and Reproductive Health Care, have retracted the following article: Abdelshafy A, Awwad H, Abo-Gamra A, et al. Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial. Eur J Contraception Reprod Heal Care. 2019;24(2):134–139. DOI: 10.1080/13625187.2019.1569224 Since publication, significant concerns have been raised about the validity of the statistical analysis and reported results in the article, as well as whether the study received the necessary ethical approval. When approached for an explanation, the authors provided responses to some of our queries, but these responses did not sufficiently address the concerns raised, and the authors were unable to provide their raw data for review. We also contacted the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC), which informed us that the study did not receive ethics approval. As the study did not receive ethical approval and we cannot confirm the validity of the trial as reported, we are therefore retracting the article. The corresponding author has been informed of this decision. We have been informed in our decision-making by our editorial policies and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Comparative Assessment of Monopolar Versus Bipolar Transurethral Resection of Prostate for the Management of Benign Prostatic Enlargement

Objectives: The objective is to compare monopolar transurethral resection of the prostate (M-TURP) versus bipolar TURP (B-TURP). Methods: In this prospective comparative study, 102 patients scheduled to undergo transurethral resection of prostate were enrolled and table randomized to surgery by M-TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography (kidney-ureter-bladder), prevoid, postvoid and laboratory investigations (for preanesthetic fitness) were done preoperative and 3-month postsurgery. Results: Patients were divided into two groups namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. IPSS, postvoid residual volume, and Qmaximproved in both groups, and it was statistically insignificant. Drop in hemoglobin levels (g/dl) in patients of M-TURP was higher compared than B-TURP. Conclusions: Both M-TURP and B-TURP are safe and effective modality. However, B-TURP will surely replace M-TURP as gold standard.

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups; Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.

PLATELET-RICH PLASMA (PRP) AND TRANEXAMIC ACID (TXA) APPLIED IN TOTAL KNEE ARTHROPLASTY.

ABSTRACTObjective:To evaluate the efficacy of platelet-rich plasma (PRP) and tranexamic acid (TXA) applied in total knee arthroplasty.Methods:We selected and randomized 84 patients. TXA was applied in 23 patients, PRP in 20, and PRP in combination with TXA in 20. Hemoglobin was measured preoperatively and 24 and 48 hours postoperatively. The function questionnaire, pain scale and gain of knee flexion were monitored until the second postoperative year.Results:There was a difference (p <0.01) in the decrease in hemoglobin 48 hours after surgery between the TXA group and the control and PRP groups. In terms of pain, the TXA group at 24 and 48 hours after surgery and the PRP group at 48 hours after surgery showed advantages (p <0.01). Knee flexion gain in the first 24 hours postoperatively was better in the TXA group (p <0.05).Conclusion:TXA was effective in lowering the drop in hemoglobin level, reducing pain and improving movement gain 48 hours after the procedure. PRP was not effective in reducing bleeding or improving knee function after arthroplasty, but provided better control of postoperative pain. Level of Evidence I, Randomized, blinded, prospective clinical trial.

Diffuse alveolar hemorrhage in childhood-onset systemic lupus erythematosus: a severe disease flare with serious outcome

ObjectiveTo evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity.MethodsDAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022).ResultsDAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1–151) vs. 4 (1–151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5–40) vs. 6 (0–44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients.ConclusionsThis was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.

Postoperative pain after spinal surgery in the paediatric population.

Postoperative pain is a major aftereffect of surgery. Especially severe occurs after extensive operations within the spine. The goal of the study was to investigate the laboratory predictive factors of intensive postoperative pain in children undergoing extensive surgery Patients and methods: We recruited 41 children, age median 13 years (IQR:10-15 years) undergoing extensive spine surgery. The subjects were divided into two groups based on the intensity of postoperative pain measured using the 10-point numerical rating scale (NRS), visual analog scale (VAS) or faces pain scale-revised (FPS-R). Patients with a score of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. We collected detailed clinical and laboratory data before, during and after surgery. The highest intensity of pain was observed in the first 6 hours after surgery. The postoperative pain was associated with a higher drop in hemoglobin concentration and hematocrit level in peri-operative period (p=0.006 and p=0.019 respectively) as well as higher changes in mean arterial pressure during surgery. Additionally, we found that children with intensive pain had higher total protein concentration after surgery. We reported that the drop in hemoglobin and hematocrit level, fluctuation in mean arterial pressure as well as total protein concentration could be useful prognostic factors of early postoperative pain. < p > < /p >.

Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding

Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding.Methods: In this retrospective descriptive case-control study, women who underwent RLACD (n = 46) only for bleeding between 2012 and 2017 were reviewed. Factors that could predict relaparotomy and related near-miss event were evaluated. Maternal characteristics, laboratory findings and surgical features were compared with a control group (n = 230) that included noncomplicated cesarean deliveries (CD). Logistic regression analysis was used to identify independent factors for relaparotomy.Results: RLACD for bleeding was required in 0.26% of patients and the incidence increased gradually over years (0.16% in 2013 versus 0.44% in 2017). Mean interval between CD and subsequent relaparotomy was 15.7 ± 3.2 hours. The sources of bleeding in descending order of frequency included; uterine fundus and placental bed (39.1%), cervix (21.7%), undetermined (17.3%), superior epigastric artery (13%), superficial epigastric artery (8.1%). Longer duration of CD (adjusted odd ratio (aOR) 1.82, 95% CI 1.02–2.53), increased number of prior CDs (aOR 2.51, 95% CI 1.09–5.78), preeclampsia (aOR 3.48, 95% CI 1.21–7.19) were found to be independent risk indicators for RLACD. Moreover, longer duration of interval between CD and relaparotomy (p = .005), longer relaparotomy duration (p = .012) and greater drop in hemoglobin level (p = .001) were found to be the predictors of maternal near-miss event.Conclusions: Patients with identified risk factors should be managed properly in order to prevent relaparotomy and near-miss event after CD. Also, urgent decision of surgical intervention might reduce the risk of maternal near-miss event.

Transurethral Resection of Prostate (Turp): Surgery Without Using a 3-Way Catheter

Transurethral resection of the prostate (TURP) continues to be an effective intervention for certain indications; and this procedure is still one of the most commonly performed in urology. The use of a 3-way catheter with continuous bladder irrigation (CBI) post-TURP is widely practiced in a bid to prevent clot retention. We report our unique experience with the use of 2-way urethral catheters post-TURP surgery. Methodology Data was prospectively collected for 143 consecutive patients who underwent a bipolar TURP between July 2015 and October 2017. The following outcomes where measured and compared against the literature: resection time, resected weight, haemoglobin level, hospital stay, catheterization days, transfusion rate and complications. Results Two-way 18-French catheters were used in 132/143 (91.7%) patients. The remaining 11/143 (8.3%) patients had a 3-way 22-French catheter and CBI immediately post-TURP. There were no incidences of clot retention requiring a return to theatre. There were 2/132 (1.5%) patients requiring transfusion who received 2-way catheterization. The average resection time was 44.8 (10-100) minutes, with a mean resected weight of 22.8 (2.0-70.0) grams. Post-operatively, we found minimal drop in haemoglobin levels, with a fall of 0.7 g/dL on average, with a range of 0.1-3.4 g/dL. Mean length of stay following TURP was 1.45 days (1-18), and 101/132 (76.5%) of patients had a successful trial without catheter on the first post-operative day. Conclusion Our outcomes compare favorably with the published data. This study suggests it may be possible to reduce the cost and resources associated with the use of 3-way catheters and CBI post-TURP surgery by using a 2-way catheter instead. Despite this, appropriate patient selection for this novel technique needs to be adopted. Our results would suggest that patients with smaller prostates or limited resections might be suitable for a 2-way urethral catheter post-TURP.

Similar radiological results with accelerometer-based navigation versus conventional technique in total knee arthroplasty

The Zimmer iASSIST system is an accelerometer-based, portable navigation device for total knee arthroplasty (TKA) that does not require the use of a large console for alignment feedback as required in computer-assisted surgery. The purpose of this study was to determine the accuracy of the accelerometer-based system in component positioning and overall mechanical alignment. Two groups of 30 patients each with primary osteoarthritis underwent TKA using either conventional method or Zimmer iASSIST navigation in 2013 was retrospectively studied. Patients were matched according to body mass index (BMI), gender and age. A senior arthroplasty surgeon performed all the operation using the same surgical approach. Perioperative and post-operative regimens were the same. All patients had standardized radiographs performed post-operatively to determine the lower limb mechanical alignment and component placement. There was no difference between the two groups for age, BMI, gender, side of operated knee and preoperative mechanical axis ( p > 0.05). There was no difference in the proportion of outliers for mechanical axis ( p = 0.38), coronal femoral angle ( p = 0.50), coronal tibia angle ( p = 0.11), sagittal femoral angle ( p = 0.28) and sagittal tibia angle ( p = 0.33). The duration of surgery, post-operative drop in haemoglobin level and transfusion incidence did not show statistically significant differences between the two groups ( p > 0.05). Our article showed that iASSIST was safe and remains a useful tool to restore mechanical axis. However, our data demonstrated no difference in lower limb alignment and component placement between the TKA that used accelerometer-based system and those that underwent conventional method.

MP08-05 MEDIUM SIZE BLADDER TUMORS’ EN-BLOCK BIPOLAR ABLATION PUT TO THE TEST – A LONG TERM, PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL COMPARISON TO STANDARD RESECTION

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2018MP08-05 MEDIUM SIZE BLADDER TUMORS’ EN-BLOCK BIPOLAR ABLATION PUT TO THE TEST – A LONG TERM, PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL COMPARISON TO STANDARD RESECTION Bogdan Geavlete, Cosmin Ene, Catalin Bulai, Georgiana Balan, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete More articles by this author , Cosmin EneCosmin Ene More articles by this author , Catalin BulaiCatalin Bulai More articles by this author , Georgiana BalanGeorgiana Balan More articles by this author , and Petrisor GeavletePetrisor Geavlete More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A long-term, prospective, randomized-controlled trial outlined an evidence-based parallel between en-block bipolar resection and monopolar transurethral resection of bladder tumors (TURBT) in medium size papillary non-muscle invasive bladder tumors (NMIBT) regarding surgical safety and oncologic outcome. METHODS 120 patients diagnosed by abdominal ultrasound, contrast CT and flexible cystoscopy with papillary bladder tumors between 1 and 3 cm in diameter were equally randomized in the 2 study arms. The exclusion criteria consisted of solid sessile tumors, lesions located in the bladder neck area and tumors involving the ureteral orifice. En-bloc plasma-button tumor resection was performed in the study arm, (completed by tumor base single-wire loop biopsy) while monopolar TURBT was applied in the control arm. The follow-up protocol consisted in urinary cytology and cystoscopy, performed every 3 months for 1 year and every 6 months up to 4 years. RESULTS A similar mean tumor diameter was determined in the 2 series (1.8 versus 1.7 cm). A significantly reduced rate of obturator nerve reflex adverse event causing bladder wall perforation (1.7% versus 8.3%) was described in the en-block series. Significantly decreased mean operation time (9.4 versus 17.1 minutes), hemoglobin level drop (0.3 versus 0.8 g/dL), catheterization period (1.6 versus 2.7 days) and hospital stay (2.1 versus 3.4 days) were emphasized in the en-block study arm. A substantially lower recurrence rate was found in the en-block group during the 1 and 2 years’ follow-up (3.9% versus 13.5% and 6.5% versus 18.75%) due to the substantially fewer other site recurrent lesions (2% versus 11.5% and 4.35% versus 14.6%, respectively). On a yearly report basis, no significant differences were underlined at 3 and 4 years after surgery. CONCLUSIONS En-bloc plasma-button tumor resection provided the advantages of superior surgical safety, decreased perioperative morbidity and faster recovery when compared to standard TURBT. While preserving the ability of achieving an accurate pathological staging, the en-block therapeutic approach was characterized by an improved oncologic outcome based on the reduced heterotopic NMIBT recurrences up to 2 years, while differences between techniques lost statistical significance at 3 and 4 years. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e97-e98 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bogdan Geavlete More articles by this author Cosmin Ene More articles by this author Catalin Bulai More articles by this author Georgiana Balan More articles by this author Petrisor Geavlete More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING Bogdan Geavlete, Cosmin Ene, Catalin Bulai, Georgiana Balan, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete More articles by this author , Cosmin EneCosmin Ene More articles by this author , Catalin BulaiCatalin Bulai More articles by this author , Georgiana BalanGeorgiana Balan More articles by this author , and Petrisor GeavletePetrisor Geavlete More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single center, prospective, randomized-controlled clinical setting exclusively involving severe lower urinary tract symptoms' large prostate patients. METHODS During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19 or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively, at the 1-, 3-, 6- and 12-month follow-up checkups and every 6 months up to 3 years after surgery using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR) and prostate-specific antigen (PSA). RESULTS Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis and afterwards by TUVis and BPEP (similar data). During the 3 years' follow-up period, statistically equivalent IPSS, QoL, Qmax and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller long term Qmax improvements but otherwise similar functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization up to the 36 months' postoperative assessment. CONCLUSIONS OP and BPEP emphasized the highest surgical efficiency (with prolonged postoperative recovery for open surgery), while TUVis displayed the lowest hemorrhagic risks. On the medium and long term, generally resembling functional outcomes were determined for the 4 techniques, with significantly decreased mean PSA values secondary to OP and BPEP. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e836-e837 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bogdan Geavlete More articles by this author Cosmin Ene More articles by this author Catalin Bulai More articles by this author Georgiana Balan More articles by this author Petrisor Geavlete More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison between activated clotting time and anti-activated factor X activity for the monitoring of unfractionated heparin therapy in patients with aortic aneurysm undergoing an endovascular procedure

ObjectiveCurrent guidelines recommend administration of unfractionated heparin (UFH) and measurement of activated clotting time (ACT) during endovascular procedures. The aim of this study was to compare ACT and anti-activated factor X (anti-Xa) measurements for monitoring of UFH therapy during an aortic endograft procedure and to assess the association of peak ACT and peak anti-Xa activity with periprocedural bleeding. MethodsWe retrospectively studied 104 patients with aortic aneurysm undergoing endovascular procedures with repeated coagulation measurements. After a UFH bolus, further UFH doses were given according to ACT (target range, ≥250 seconds) in clinical routine, and in parallel to each ACT (Hemochron; Accriva Diagnostics, Newport Beach, Calif) measurement, we determined anti-Xa activity (HemosIL Liquid anti-Xa; Instrumentation Laboratory, Bedford, Mass). UFH redosing was solely based on the ACT measurements. We defined periprocedural bleeding as a drop in hemoglobin level ≥3 g/dL or red blood cell transfusion within 24 hours. ResultsAfter the initial UFH bolus (median, 67 IU/kg body weight), ACT and anti-Xa measurements showed a weak correlation (rs, 0.46; P < .001). Median ACT was 233 seconds (range, 127-374 seconds; interquartile range [IQR], 204-257 seconds); median anti-Xa activity was 1.0 IU/mL (range, 0.5-2.0 IU/mL; IQR, 0.9-1.2 IU/mL). Only 31% of the patients had an ACT value ≥250 seconds, whereas all patients had an anti-Xa activity ≥0.5 IU/mL. Accordingly, ACT triggered redosing of UFH frequently. Consequently, we saw a median total UFH use of 90 IU/kg during the procedure, a median peak ACT of 255 seconds (IQR, 234-273 seconds), and a median peak anti-Xa activity of 1.2 IU/mL (IQR, 1.0-1.4 IU/mL). Periprocedural bleeding occurred in 40 (38%) patients. Peak ACT ≥250 seconds was not associated with bleeding (odds ratio, 1.05; 95% confidence interval, 0.41-2.70; P = .952), whereas peak anti-Xa activity ≥1.2 IU/mL was independently associated with bleeding (odds ratio, 4.95; 95% confidence interval, 1.82-13.48; P = .002). Moreover, no periprocedural thromboembolic event occurred. ConclusionsIn this retrospective study of patients with aortic aneurysm undergoing an endovascular procedure, ACT and anti-Xa measurements showed poor correlation; only increased peak anti-Xa activity was independently associated with periprocedural bleeding, not increased ACT. Our findings also suggest that monitoring of UFH therapy with anti-Xa during aortic endograft procedures may reduce total UFH use. We further speculate that this approach could reduce periprocedural bleeding.

Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study.

To evaluate and compare the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) and tubed PCNL by using small bore nephrostomy tube (12Fr) in children for the management of nephrolithiasis. This study was a retrospective analysis of 35 children where tubed PCNL (Group 1) was done in 18, and tubeless PCNL (group 2) in 17 patients from January 2010 to December 2016. Charts were reviewed for age, mass, stone size, operative time, hospital stay and stone-free rates. These variables were compared between the two groups. SPSS version 21 was used for data analysis. The data were shown as mean±standard deviation for continuous variables. Categorical variables were presented in percentages. There is no difference in terms of age, stone sizes, operative times, hospital stays, stone-free rates and post-PCNL complications between the two groups (p>0.05). The mean drop in hemoglobin level was 0.7±0.1 g/dL and 1.3±0.2 g/dL in Groups 1 and 2, respectively (p=0.01). Tubeless PCNL in children is a safe option in well selected cases.

Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial.

The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Effect of Bipolar Sealants on Total Hip Arthroplasty Using the Direct Anterior Approach

Introduction: To determine the effect of bipolar sealant on transfusion rates in primary total hip arthroplasty (THA) using the direct anterior approach (DAA). Methods: Fifty-nine patients in total were recruited for the study. The first group (n:37) underwent THA DAA using the conventional bipolar diathermy and the second (n:22) group underwent THA DAA with the aid of aquamantys bipolar sealant. Mean difference in postoperative drop in haemoglobin levels were charted and transfusion rates were compared. The statistical analysis was performed using SPSS 2.0 software for windows. Results: The use of bipolar sealants did not significantly reduce hemoglobin drop (p>0.05). It did, however, significantly reduce the rate of transfusion (p=0.013) Conclusion: Our study suggests that the use of bipolar sealants were superior to conventional bipolar cautery in patients undergoing primary THA using the DAA, causing a significant drop in the need for post-operative packed cell transfusions. Hence, the use of bipolar sealant is recommended in primary THA using the DAA.

Minimally invasive percutaneous nephrolithotomy compared with retrograde intrarenal surgery: a meta-analysis

Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are widely used in the management of kidney stones. But the safety and efficiency between these two technologies is still a mystery. This meta-analysis was performed to compare the efficacy as well as safety of Minimally Invasive Percutaneous Procedures (MIPPs) including ultra mini-PCNL, mini-PCNL, and micro-PCNL with RIRS. PubMed, Embase and Scopus were searched, and twelve studies included data on 1207 cases (613 for MIPPs and 594 for RIRS) satisfied the inclusion criteria and were included in this research finally. MIPPs were found to be associated with higher stone-free rate but longer hospital stays, and a larger drop in hemoglobin levels. Difference between MIPPs and RIRS in complication rate, operative time, and total cost were not notable. Given no obvious difference in the complication rate and higher efficacy, our findings suggest that mini-PCNL should be recommended over RIRS for stones>2 cm, and that for stones<2 cm any of MIPPs or RIRS are reasonable.

Effect of microperc for treatment of renal calculi with self-made optical puncture needle combined with ureteral access sheath

Objective To evaluate the effect of micropercutaneous nephrolithotomy(microperc) for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath. Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017, Male, 12 cases, female, 11 cases. The mean±SD (range) patient age was (49±14) years( 28-67 years), stone volume was (1.7±0.6) cm(1.0-3.0 cm) and stone density was (934.5±282.7) HU(357-1 500 HU). The self-made all-seeing system consists of a puncture needle (F4.85) and two 3-way connector allowing the insertion of a flexible microoptic system, laser fiber and attaching to irrigation system. Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation. The course of puncture could be all-see on the display which was connected with flexible microoptic system. After stone fragmentation, the procedure was terminated in tubeless fashion. Ureteral double J stent was inserted in order to prevent postoperative complications. The factors analysed were demographic variables including age, sex, stone volume, stone density [Hounsfield units (HU)] and stone location, and intra- and peri-operative variables such as operating time, drop in haemoglobin level, stone clearance and complications. Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision. The mean±SD(range) operation duration was (46.2±19.9) min(20-120 min), pain score was 2.8±1.2(1-6), hemoglobin decrease was 6.6 g/L, and in hospital time was (2.9±0.8) d(2-5 d) , respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months postoperation was 90.9%(20/22) and 100 %(22/22), respectively. Two who suffered hematuria(Clavien Ⅰ)underwent conservative treatment and recorered well. One suffered urinary tract infections(ClavienⅡ) and was treated with antibiotics. There were no major complications. Conclusions Mircoperc with the self-made device and ureteral access sheath in management of renal calculi is feasible and effective. Key words: Micropercutaneous nephrolithotomy; Optical puncture needle; Ureteral access sheath; Renal calculi; Percutaneous nephrolithotripsy

Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

Efficacy and Safety of Tranexamic Acid in Orthopaedic Fracture Surgery: A Meta-Analysis and Systematic Literature Review.

Tranexamic acid (TXA) is an antifibrinolytic drug that has been shown to be effective in reducing blood loss and the need for transfusions after several orthopaedic surgeries. However, the effectiveness of TXA use in orthopaedic fracture surgeries still remains unclear. The purpose of this meta-analysis was to review existing literature with interest in the effectiveness and safety of TXA treatment in reducing total blood loss and transfusion rates for patients who underwent surgery for fracture repairs. An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies published before December 2016. All randomized controlled trials and cohort studies evaluating the efficacy of TXA during fracture repair surgeries were identified. Primary outcome measures included the number of patients receiving a blood transfusion and perioperative total blood loss. Data were analyzed using Comprehensive Meta-Analysis (CMA) statistical software. Seven studies encompassing 559 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with the placebo control group, the use of TXA in fracture surgeries significantly reduced total blood loss by approximately 330 mL (P = 0.009), reduced the transfusion rate with a relative risk of 0.54 (P < 0.001), and decreased the drop of hemoglobin by 0.76 g/dL (P < 0.001). There was no significant difference between the number of thromboembolic events among the study groups (P = 0.24). This study demonstrated that tranexamic acid may be used in orthopaedic fracture surgeries to reduce total blood loss, transfusion rates, and the drop in hemoglobin level, without increasing risk of venous thrombo-embolism. A limitation to these findings is the small number of studies available. Further studies need to be conducted to confirm these findings. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.