Hematoma Formation Research Articles

Utilization of Glucagon-Like Peptide-1 Receptor Agonist at the Time of Total Hip Arthroplasty for Patients Who Have Morbid Obesity.

Morbid obesity negatively affects outcomes after total hip arthroplasty (THA). The optimal strategy for weight loss before THA has not been identified. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RA) have become increasingly popular as an effective pharmacologic weight loss agent. The goal of this study was to evaluate the effect of perioperative GLP-1 RA use in patients who have morbid obesity undergoing primary THA on postoperative outcomes. Using an administrative claims database, patients who had morbid obesity (body mass index [BMI] ≥ 40.0) undergoing primary THA were identified. Patients who had morbid obesity and GLP-1 RA use for three months before and after surgery (treatment) were matched to patients who had morbid obesity without GLP-1 RA use (control) and to a comparison group of patients who had severe obesity (BMI = 35.0 to 39.9) in a 1:4:4 ratio, resulting in 771, 3,084, and 3,084 patients in the treatment, control, and severe obesity comparison group, respectively. Overall group differences in 90-day and 2-year postoperative outcomes were compared using univariable tests, followed by post hoc pairwise testing and P-value adjustment. Patients who had morbid obesity on GLP-1 RA had a significantly lower rate of 90-day periprosthetic joint infection (PJI) (1.6 versus 3.2%; P = 0.03), readmission (6.9 versus 9.7%; P = 0.04), any medical complication (10.5 versus 14.1%; P = 0.03), and postoperative hematoma formation (0 versus 1.3%, P < 0.01) compared to controls. Patients who had morbid obesity on GLP-1 RA demonstrated lower rates of hematoma formation (0 versus 1.0%; P <0.01) compared to patients who had severe obesity (BMI = 35.0 to 39.9). There were no differences in 2-year surgical complications. Perioperative use of GLP-1 RA in patients who had morbid obesity is associated with reduced risk of acute PJI and 90-day hospital readmission. The risk is reduced to a level comparable to obese patients who have a BMI < 40.0. Randomized controlled trials are necessary to determine the true effect and mechanism of action.

Analysis of Risk Factors and Establishment of a Risk Prediction Model for Severe Postpartum Haemorrhage.

Aims/Background Severe postpartum haemorrhage (PPH) is a dangerous condition, characterized by rapid progression and poor prognosis. It remains the leading preventable cause of maternal death worldwide. This study aimed to investigate the risk factors for severe PPH and establish a prediction model to identify severe PPH early, allowing for early intervention reduce maternal death. Methods Clinical data were collected from 784 patients diagnosed with PPH and delivered at the Second Affiliated Hospital of Anhui Medical University between December 2018 and December 2023. These cases were categorized into the training cohort. Severe PPH was diagnosed in 234 patients based on the criterion of the volume of vaginal bleeding volume exceeding 1000 mL within 24 hours after delivery; these patients were assigned to the experimental group. The remaining 550 patients with nonsevere PPH were assigned to the control group. Data from an additional 338 postpartum women from the same period were selected and classified into the validation cohort. Univariate and multivariate logistic regression analyses were performed to pinpoint the determinants associated with severe PPH. Additionally, these analyses were instrumental for developing and assessing a prediction model to forecast the risk of such complications. Results Most of the PPH cases in this study stemmed from uterine atony, the leading aetiology. The second most common factor was soft birth canal lacerations and haematoma formation, accounting for 7.26% of the subjects in experimental group and 6.55% of those in the control group. Uterine rupture, uterine inversion, and amniotic fluid embolism were exclusively observed in the experimental group. In the univariate analysis, notable disparities were identified across various parameters, including maternal age, gravidity, parity, abortion frequency, gestational week at delivery, prothrombin time (PT), activated partial thromboplastin time (APTT), in vitro fertilisation, foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy (p < 0.05). A multivariate logistic regression model revealed that a parity of two or more, two or more abortions, in vitro fertilisation, gestational weeks at delivery, foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy were independent predictors of severe PPH (p < 0.05). The predictive model demonstrated excellent calibration for the training and validation datasets, with the areas under the curve (AUC) for receiver operating characteristic (ROC) curves measuring 0.799 and 0.759, respectively. Clinical decision curve analysis (DCA) confirmed a significant threshold exceeding 0.9, signifying a substantial net benefit and model precision. Conclusion Parity ≥2 times, abortion ≥2 times, in vitro fertilisation, gestational week at delivery, abnormal foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy are independent risk factors for severe PPH. The predictive model established in this study accurately predicts the occurrence of severe PPH and has significant value for clinical application.

Ultrasound combined with DSA-guided pulsed radiofrequency for perineal herpes zoster pain management: clinical outcomes and complications.

Herpes zoster (HZ) in the perineal area is a rare disease. There are limited treatment options for this disease. This study aimed to assess the efficacy of ultrasound combined with digital subtraction angiography (DSA)-guided pulsed radiofrequency (PRF) for perineal herpes zoster-related pain. Two hundred and twelve patients with perineal HZ were enrolled at the pain department. From January 1, 2018 to December 30, 2019, patients with HZ in the perineal area were treated with PRF under DSA guidance, and from January 1, 2020 to October 30, 2023, patients with HZ in the perineal area were treated with PRF under ultrasound combined with DSA guidance. The included patients were divided into two groups: DSA group and ultrasound + DSA group. The visual analog scale (VAS), central sensitization inventory (CSI), sleep quality scores (SQS), the 36-Item Short Form Health Survey questionnaire (SF-36) at baseline and after the PRF treatment were analyzed to evaluate clinical efficacy. The mean VAS scores, CSI scores, SQS, and SF-36 scores were statistically significantly lower after treatment compared to baseline (p < 0.001). There was no significant change in VAS scores, CSI scores, SQS, and SF-36 scores between the DSA group and the ultrasound + DSA group (p > 0.05). The time it took from the start of the puncture to the successful puncture was significantly shorter in the ultrasound + DSA group compared to the DSA group (41.2 ± 21.2 vs. 48.1 ± 20.3, p = 0.035). The ultrasound + DSA group had a higher percentage of satisfaction with the procedure than the DSA group (90/99, 90.9% vs. 62/78, 79.5%, p = 0.030). A total of 27 postoperative complications occurred. The incidence of puncture site hematoma was significantly higher in the DSA group (10/78, 12.8%) than that in the ultrasound + DSA group (4/99, 4.0%) (p = 0.032). PRF can reduce pain from HZ in the perineal region, alleviate central sensitization, enhance sleep quality, and improve overall quality of life. When PRF is performed under ultrasound guidance combined with DSA, it shortens the puncture time and reduces the risk of hematoma formation at the puncture site, making it the recommended method for clinical use.

Mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis

ObjectiveThis study was aimed to explore the mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis.MethodsThe clinical data of young and middle-aged patients with lumbar spondylolisthesis were retrospectively analyzed and divided into an observation group and a control group according to surgical methods. The observation group was treated with minimally invasive transforaminal interbody fusion (MIS-TLIF) combined with orthopedic robot-navigated percutaneous pedicle screw fixation; while the control group underwent traditional posterior lumbar interbody fusion (PLIF). Perioperative indicators, waist and leg pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), and complications were compared between groups.ResultsA total of 32 patients with lumbar spondylolisthesis were included in this study, with the average age of 50.3 ± 2.7 years old. There were 17 patients in the observation group and 15 patients in the control group. Although the new surgical technique for the observation group may require longer operative time, it showed significant advantages in reducing intraoperative bleeding, postoperative drainage, and shortening hospital stay. These benefits might result in faster recovery for patients, reduced risk of complications, and improved overall quality of life. The new technology was also significantly better compared to the traditional method in terms of VAS scores and ODI at 1 week, 1 month, 3 months, and 6 months post-surgery. These results provided patients with better treatment options and potentially a faster path to recovery. One case with infectious incision in the observation group and one case with intraspinal hematoma formation in the control group were observed. However, there was no statistical difference in the complication rates between the two groups (P > 0.05).ConclusionThe non-contact orthopedic robot navigation for the treatment of lumbar spondylolisthesis was demonstrated to be minimally invasive, precise, and stable surgical method. It is a treatment option worth considering for suitable patients.

Central Venous Catheterization in the ICU: A Comparison of Anatomical Landmark and Ultrasound-Guided Techniques

Introduction: Central venous catheterization (CVC) is frequently required in intensive care units (ICUs) for administering medications, fluids, and monitoring central venous pressure. However, CVC insertion can lead to complications such as arterial puncture, hematoma formation, and pneumothorax. Ultrasound guidance has been advocated to reduce these complications, but its effectiveness in the ICU setting remains debated. This study compared the complication rates of anatomical landmark-guided versus ultrasound-guided CVC insertion in ICU patients. Methods: A prospective cohort study was conducted in the ICU of a tertiary care hospital. Patients requiring CVC were divided into two groups: anatomical landmark-guided and ultrasound-guided insertion. The primary outcome was the incidence of complications, including arterial puncture, hematoma, and pneumothorax. Secondary outcomes included cannulation time and the number of cannulation attempts. Results: A total of 39 patients were included in the study. The incidence of complications was significantly lower in the ultrasound-guided group (2 complications) compared to the anatomical landmark group (7 complications) (p=0.017). The most common complication was arterial puncture, occurring in 7 patients in the anatomical landmark group and 2 patients in the ultrasound-guided group. Conclusion: Ultrasound guidance significantly reduces the risk of complications during CVC insertion in the ICU. This technique should be considered the standard of care for CVC insertion in this setting.

Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

Retrospective cohort study. To investigate the correlation between comorbid chronic obstructive pulmonary disease (COPD), asthma, tobacco use, and the incidence of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF). Prior studies have identified general risk factors such as multilevel fusion and coagulopathy. However, specific coughing-related factors like COPD, asthma, and tobacco use have not been extensively investigated. Patients who underwent single or multilevel ACDF between 2011 and 2021 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver database. The primary outcome was the occurrence of postoperative hematoma requiring reoperation within 30 days. χ2 tests and t tests compared groups, and multivariable logistic regression identified predictors for postoperative hematoma. Among 399,900 patients with ACDF, 901 (0.2%) developed postoperative hematoma requiring reoperation within 30 days. Patients with postoperative hematoma were older (58 vs. 55, P<0.001) and predominantly male (62.5% vs. 44.9%, P<0.001). After adjustment, tobacco use and comorbid COPD were associated with postoperative hematoma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.10-1.47; P<0.001 and OR, 1.41; 95% CI, 1.21-1.64; P<0.001, respectively). Comorbid asthma was not a significant risk factor. Additional risk factors included comorbid hypertension (OR, 1.46; 95% CI, 1.18-1.82; P<0.001), coagulopathy (OR, 1.50; 95% CI, 1.24-1.81; P<0.001), anemia (OR, 1.38; 95% CI, 1.17-1.62; P<0.05), and history of deep vein thrombosis (OR, 1.93; 95% CI, 1.44-2.54; P<0.001). Tobacco use and COPD were identified as novel risk factors for postoperative hematoma formation requiring reoperation after ACDF. Recognizing these modifiable factors, providers may consider postponing nonemergent ACDFs until patients undergo smoking cessation programs or receive optimal COPD management.

Advanced Strategies for Hemorrhage Management in Cesarean Sections An In-Depth Procedural Guide

Over the past five decades, there has been a substantial global increase in cesarean section rates. Unfortunately, the incidence of maternal morbidity following cesarean delivery remains notably high, reaching levels as elevated as 36%. Among the prevalent complications are febrile episodes (25%), hemorrhage (4%), hematoma formation (4%), and urinary tract infections (3%). Obstetric hemorrhage, in particular, stands out as a leading cause of maternal mortality worldwide. Excessive bleeding, defined as a blood loss exceeding 1000 ml during cesarean sections, is frequently underestimated, yet it is documented in over 5-10% of such procedures. While conservative management, including vaginal packing and the administration of uterotonic agents, is effective in many instances, persistent hemorrhage may necessitate specific surgical interventions. Therefore, a comprehensive understanding of the procedural steps for managing bleeding during cesarean sections is crucial to mitigating maternal mortality. This review article aims to consolidate various techniques employed to control hemorrhage during cesarean deliveries.

A Feasible Method for Vein Puncture and Drug Administration in Rats: Ultrasound-guided Internal Jugular Vein Puncture

ObjectiveIn the majority of animal experiments, vein puncture is necessary for the drugs administration. This study aimed to propose a new vein puncture method, ultrasound-guided internal jugular vein (IJV) puncture, and compare it with the traditional tail vein puncture. MethodsWe divided 24 male SpragueDawley rats randomly into 2 groups: 12 rats in the tail vein puncture group and other 12 rats in the ultrasound-guided IJV puncture group. After successful puncture, rats from two groups were injected with 0.1 mL ultrasound contrast agents. The average puncture time, the success rate of the first puncture, and the imaging effects of contrast-enhanced ultrasound in the sciatic nerve and liver parenchyma of rats after injecting ultrasound contrast agents were evaluated using time–intensity curves for both different puncture methods. ResultsThe average puncture time of the ultrasound-guided IJV group was lower than that of the tail vein puncture group (p = 0.013), and the success rate of the first puncture was significantly higher than that of the tail vein puncture group (p = 0.037). There were no significant differences in the imaging effects of contrast-enhanced ultrasound on the sciatic nerve and liver parenchyma between the two different puncture methods. Additionally, neither of the two puncture methods resulted in obvious symptoms such as hematoma formation, convulsions, restlessness or even death in rats. ConclusionsUltrasound-guided IJV puncture could be a safe, effective method with a high success rate for rat vein puncture and drug administration, which could be an alternative to rat tail vein puncture.

The role of tranexamic acid for infection prevention after fracture fixation

Despite the measures employed, fracture-related infections remain a concern after fracture fixation worldwide. Recently, the role of tranexamic acid as a protective drug against postsurgical infections in joint replacement and orthopedic trauma surgery has been proposed, where tranexamic acid has been associated with less surgical wounds complications and infectious complications including periprosthetic joint infection. The mechanism through which tranexamic acid exerts a protective effect against peri-implant infection is still the subject of debate. Although some authors hypothesize an indirect effect inhibiting the formation of postoperative hematoma, there are several studies that show a direct antibacterial effect of the drug against the capacity of bacterial aggregation, even avoiding biofilm formation, favoring the immune response of the host and the action of antibiotics. The purpose of this narrative review is to show the current role of tranexamic acid in orthopedic trauma, specifically its relationship with the prevention of infections related to implants.

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

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

Treatment of Renal Capsule Lesion in a Transplanted Kidney: A Case Report and Literature Review

Expanded donor criteria have been established to reduce organ wastage, as various factors can lead the disposal of kidneys, such as anatomical abnormalities, traumatic injuries, and iatrogenic injuries during organ retrieval surgery. We report a case of kidney transplantation in which a capsular lesion was identi!ed and repaired during organ preparation (back table) and review of the literature regarding transplant kidney injuries. A diabetic and hypertensive 52-year-old patient with chronic kidney disease undergoing dialysis therapy for 2 years was admitted for a deceased donor kidney transplant. "e donor was a 35-year-old man with brain death secondary to traumatic brain injury in a car accident. During the kidney preparation on the back table, a capsular lesion was visualized on the upper pole of the right kidney. Continuous suture of the renal capsule was performed using a 3-0 CatGut suture to correct the defect and reconstruct the renal surface. After renal reperfusion, no active bleeding was observed from the sutured area. "e patient had a good postoperative course with no complications. "e main complications associated with capsular lesions and complete capsular denudation are bleeding and hematoma formation, as well as urinary and lymphatic extravasation through the exposed renal parenchyma. Treatment may involve direct cauterization using electrocautery or argon plasma, or the use of hemostatic agents. Successful repair of capsular lesions not only prevents complications such as bleeding during reperfusion and urinary !stulae but also plays a crucial role in expanding the pool of organs available for transplantation.

ENDOSCOPIC THIRD VENTRICULOSTOMY VS VENTRICULOPERITONEAL SHUNT IN OBSTRUCTIVE HYDROCEPHALUS IN TERMS OF POST-OPERATIVE COMPLICATIONS

: Obstructive Hydrocephalus is a condition characterized by increased cerebrospinal fluid (CSF) volume within the brain's ventricular system, leading to clinical deterioration and disability. Without treatment, it can be fatal. Two primary treatment modalities are Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV), with ongoing debate over the superiority of one approach over the other. Objective: To compare the complications associated with Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV) in patients with obstructive hydrocephalus. Methods: A randomized controlled trial was conducted at a tertiary care hospital from April 15, 2024, to September 15, 2024. A total of 100 patients diagnosed with obstructive hydrocephalus were randomly allocated into two groups: 50 patients received VPS treatment, and 50 received ETV. Complications, including surgical site infection, seizures, hematoma, and CSF leakage, were recorded and analyzed. Results: Complications were observed in 36% (n=18) of patients in the VPS group compared to 16% (n=8) in the ETV group, with a statistically significant difference (p=0.023). Surgical site infections occurred in 8% (n=4) of VPS patients, while no infections were reported in the ETV group. Seizures were significantly more common in the VPS group, affecting 26% (n=13) compared to 8% (n=4) in the ETV group (p=0.017). Hematoma formation was observed in 4% (n=2) of VPS patients and 6% (n=3) of ETV patients. CSF leakage occurred in 4% (n=2) of VPS patients and 2% (n=1) of ETV patients. Conclusion: Endoscopic Third Ventriculostomy (ETV) demonstrated a significantly lower complication rate compared to Ventriculoperitoneal Shunting (VPS) in the management of obstructive hydrocephalus. These findings support ETV as a safer alternative with fewer associated complications.

Алгоритмы диагностики дилатации проксимальной грудной аорты в педиатрической практике

Aortic dilation may manifest in childhood subsequently resulting in the formation of an intramural hematoma or dissection. The asymptomatic nature of the disease and the absence of unified echocardiographic algorithms for its detection contribute to its underestimation and the inability to implement timely monitoring of patients. The purpose of this research was to develop algorithms for diagnosing dilation of various parts of the thoracic aorta in children using cardiac ultrasound - echocardiography (ECHO). Materials and methods used: a single-center cross-sectional study had been carried out on the basis of the cardiological department of the Z.A. Bashlyaeva Children’s City Clinical Hospital of the Moscow Department of Healthcare (Moscow, Russia): 11,516 primary ECHO protocols in patients aged 7 and up to 18 y/o, 7.5% (869) of which had records regarding aortic dilation, were identified. 572 with hemodynamically significant CHD were excluded from the study therefore the remaining 297 (76.8% (228) boys) with a median age of 14.2 (11.3; 16.4) y/o were studied for the parameters as follows: internal diameters of the aorta at the level of the sinuses of the Valsalva (SV), sinotubular junction (STJ) and ascending aorta (AAo) in systole. Aortic dilation was defined as a size exceeding 2z at any level, and an aneurysm was defined as exceeding 3z. Results: a total of 116 had a bicuspid aortic valve (BAV), 181 demonstrated a tricuspid valve (TAV) without significant concomitant heart pathology (“idiopathic dilation” (IDAo)). Dilation and AAo aneurysm were more prevalent than in the SV region (73.4% v 28%, р&lt;0.001 and 25.2% v 3.7%, р&lt;0.001, respectively). The presence of BAV was identified as a significant risk factor, in which AAo dilation occurred more frequently than in TAV (1.96 times higher, 95% CI 1.12-3.44, p=0.017) and AAo aneurysm occurred with a 3.07 times higher frequency (95% CI 1.79-5.25 р&lt;0.001). Conclusion: the structure of aortic pathology in children is dominated by AAo dilation. ECHO requires visualization of the entire proximal aorta, not merely the aortic valve and SV that are typically assessed in outpatient practice. Authors represent a diagnostic algorithm and methodological guidelines for assessing the condition of the aorta in children.

Quadriceps Crush Contusion in Athletes: The Effectiveness of Orthobiologic Treatment with Platet-Rich Plasma (PRP)

Introduction: Quadriceps contusion is a common injury in contact sports like football, rugby, and basketball, resulting from a direct blow to the anterior thigh. This causes muscle damage, bleeding, and inflammation. While often considered minor, poor management can lead to complications, delayed recovery, and impaired athletic performance. Purpose: The purpose of this review is to evaluate the effectiveness and the role of orthobiologic treatments such as PRP in enhancing healing and functional recovery for a swift return to sport. Summary: Quadriceps contusion, resulting from direct trauma to the quadriceps muscle group, leads to hematoma formation and varying degrees of injury severity. Diagnosis is primarily clinical, often supported by ultrasound and MRI to assess the extent of muscle damage. Treatment is typically non-operative, involving rest, ice, compression, physical therapy, and a gradual return to activity. One significant complication is myositis ossificans, characterized by abnormal bone formation within the muscle, which can cause chronic pain and restricted movement. Recent advances, such as ultrasound-guided PRP injections, offer promising results by enhancing healing, relieving pain, and accelerating functional recovery. PRP therapy, particularly popular among athletes, promotes tissue repair by stimulating cell regeneration and reducing inflammation, helping speed up recovery and potentially lowering the risk of complications like myositis ossificans. Although preliminary evidence supports the effectiveness of PRP in helping athletes return to play sooner, more research is needed to validate its full impact on musculoskeletal injuries. Continued exploration of nonoperative treatment and rehabilitation protocols is also necessary to ensure optimal outcomes. Preventive strategies, including the use of protective gear and conditioning exercises to strengthen muscles, are critical in reducing the risk of injury and enhancing athletic performance.

Deep Femoral Artery Injury After Conversion Hip Arthroplasty: A Case Report

68-year-old male patient is admitted to hospital due to hip pain. He had undergone a surgery for left pertrochanteric fracture 18 days ago in another hospital. A locked plate was used for osteosynthesis which have failed immediately after mobilization. Single stage revision was performed due to implant failure and acute implant related infection. Hematoma formation and persistent wound drainage developed. Angiography identified an injury of deep femoral artery. Angiographic embolization was performed. If patient experiences recurrent swelling, hematoma and persistent wound drainage, vascular injury should be considered. Angiography should be carried out for early diagnosis. Angiographic embolization provides effective treatment.

Carotid Endarterectomy in the Acute Period of Ischemic Stroke After Thrombolytic Therapy

AIM OF STUDY. To study the outcomes, complications and risk factors of CEA surgery in patients after thrombolytic therapy.MATERIAL AND METHODS. The results of treatment of patients after carotid endarterectomy in the acute period of ischemic acute cerebrovascular accident after thrombolytic therapy were assessed. The group of patients operated on with thrombolytic therapy included 43 patients (29 women and 14 men). The average age of the operated patients was 64±8.9 years. In 24 patients, the stroke was localized in the blood supply of the left middle cerebral artery, in 19 — in the right. A group of patients (n=50) with similar clinical characteristics was selected as a comparison group.RESULTS. Adverse events occurred in only two patients (4.6%) in the thrombolytic therapy group. One complication required active surgical tactics, the formation of a significant hematoma in the area of surgical intervention. No adverse events were noted in the control group. There were no lethal outcomes in both groups. There were no significant differences in long-term survival rates between groups (p&gt;0.05).DISCUSSION. Numerous researchers have come to the conclusion that by observing clear criteria for selecting patients for surgical treatment, it is possible to minimize complications associated with the use of thrombolytic drugs in the preoperative period. Our study confirms these conclusions. Patients with previously performed thrombolytic therapy for stroke are in a group of special attention and require close monitoring in the short and long term.CONCLUSION. Carotid endarterectomy in the acute period of stroke during thrombolytic therapy is not associated with an increased risk of postoperative complications and does not compromise long-term treatment results. Further large studies are needed to clarify the results obtained.

Accelerated Takedown of Melolabial Interpolation Flaps at 1 to 2 weeks, Indications and Safety for Improved Patient Experience

BACKGROUND The melolabial interpolation flap is an effective surgical technique for reconstructing defects in the nasal ala and tip regions. Traditionally, this technique involves waiting for the standard 3-week period before pedicle division. OBJECTIVE To evaluate whether accelerated takedown at 1- or 2-week postflap creation is possible while maintaining the flap's viability and functionality. METHODS Retrospective cohort study at Oregon Health and Science University from 2018 to 2023. RESULTS The authors examined 67 patients who underwent reconstruction with a melolabial interpolation flap surgery, of which 50 had their flap takedown at &lt;21 days and 17 had their takedown at 21 or more days. This analysis revealed similar complication rates for both groups. There were no increased rates of infection, necrosis, or hematoma formation in the earlier takedown group. Those undergoing earlier takedown were more likely to have a history of hypertension but less likely to have a history of diabetes, immunosuppression, and smoking, though the differences were not statistically significant. CONCLUSION This study provides valuable insights into the safety and feasibility of early melolabial interpolation flap takedown. This approach has the potential to enhance the quality of life for patients undergoing this flap by decreasing the amount of time with a pedicle.

Comparisons of the Clinical Outcomes of Mandible Contouring Surgery With or Without the Use of Intraoral Drains.

Mandible contouring surgery is a common cosmetic procedure aimed at reducing the width of the lower face or correcting chin-related issues by contouring the mandible. Typically, an intraoral drain is placed during procedures involving the reduction of the mandible angle portion to mitigate seroma or hematoma formation. Despite this standard practice, anecdotal evidence suggests that the omission of drains does not significantly impact complication rates or surgical outcomes. A retrospective study was conducted to compare surgical outcomes and complication rates between patients who received intraoral drains (n = 338) and those who did not (n = 132) during mandible contouring surgery. The primary outcomes measured included the incidence of seroma, hematoma, and infection by counting the number of post-operative interventions required to address these complications. Statistical analysis was performed using chi-square tests for categorical variables. A p-value of < 0.05 was considered statistically significant. The incidence of post-operative surgical interventions for bleeding control or hematoma evacuation in the drain group was 0.59% compared to 0% in the no-drain group (p = 0.922). Minimally invasive interventions were required in 2.37% of patients with drains and 3.03% without drains (p = 0.933). Infection rates were 1.18% in the drain group versus 0.76% in the no-drain group (p = 1.0). The study demonstrates no statistically significant difference in complication rates between mandible contouring surgeries performed with or without intraoral drains. These findings suggest that the routine use of drains may be unnecessary, potentially simplifying post-operative care and reducing patient discomfort. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Trends, Motivations and Complications of Body Piercing among Undergraduate Students in a University in Southwestern Nigeria

Background: Body piercing is an increasingly common practice globally. This practice is associated with several health concerns which vary from tissue trauma, allergic reactions, keloids, and infections which can range from local to systemic and transmission of blood-borne infections such as HIV and hepatitis B and C virus. There is limited data in Nigeria on the prevalence, medical and social consequences of body piercing. Hence, this study sought to examine the trends, motivation and complications of body piercing among undergraduate students with body piercings in a university in southwestern Nigeria. Methodology: A cross-sectional study was conducted between August 2022 and January 2023 among undergraduate students with body piercings in a private University in Southwestern Nigeria. Self-administered, semi-structured questionnaires were used to obtain data from the 137 participants. Results: The mean age of the respondents was 19.43 ± 1.52 years and 59.1% were females. The number of body piercings among the participants ranged from 1-9 with 43.8% having 2 body piercings. The ear lobe was the most commonly (66.1%) pierced site. Males were more likely to pierce their tongues while females were more likely to pierce their navels. The predominant motivations for obtaining body piercings were fashion (40.0%), self-expression (36.2%), and creative expression (21.5%). Most (50.0%) of the participants had piercings done by staff in a professional piercing shop, a piercing needle was the most common instrument used (42.6%) and most (79.6%) of the participants reported sterilization of the piercing instrument before use. Only 8.8% of the participants reported complications which ranged from post-piercing bleeding (2.2%), and haematoma formation (4.4%) to tearing of skin (2.2%). Conclusion: Due to the increasing popularity of body piercing, there is a need to increase awareness about the hazards associated with body piercings among piercers, their clients and the health services.

Comparative study between the halfway technique and the standard technique for exchange of tunneled hemodialysis catheter.

When indicated, tunneled hemodialysis catheters are usually inserted using the standard technique but, this technique has its complications. The halfway method is performed by exchange of an already-inserted dialysis catheter (tunneled or non-tunneled) to a tunneled one over a guidewire mounted via the old catheter. In this study, we aimed at evaluating the feasibility, safety, and durability of halfway method in comparison to the standard technique (de novo puncture). This prospective study was conducted during the period from May 2020 till May 2022 and included 87 patients with end-stage renal disease (ESRD) on regular hemodialysis (HD) in need for insertion new tunneled dialysis catheters instead of temporary or malfunctioning tunneled ones. According to the technique of catheter insertion, these patients were divided into two groups: group A (the halfway technique: catheters were exchanged over guidewires under fluoroscopic control; 48 patients) and group B (the standard technique: via de novo ultrasound-guided vein puncture; 39 patients). Instant, delayed complications and 12-months patency rates were reported and analyzed. The frequency of peri-operative bleeding complications was better in the halfway group with comparable infection rate and late catheter dysfunction results between the two groups. One year patency rates were 87.5% in halfway technique group compared to 79.5% in standard technique group, yet without statistical significance. However, there was a statistically significant shorter operative time in halfway group (15.54 ± 2.6 min vs 26.97 ± 5.6 min, p < 0.001). The halfway technique may be recommended over the standard technique of tunneled catheter insertion due to shorter operative time, lower rate of hematoma formation, with non-inferior 1-year patency rates and comparable technical success and infection rates. The advantage of access sites preservation for future demand makes this technique of great value to this group of ESRD patients.