Surgical Bleeding Research Articles

Effectiveness of fibrin sealants in head and neck surgery: a systematic review protocol.

This review will investigate the effectiveness of fibrin sealants in adult patients who underwent head and neck surgery. Controlling bleeding is important in head and neck surgery. Complications involving nearby vital structures increase the risk of morbidity and mortality. Surgical tissue adhesives are used in addition to other traditional hemostatic methods to reduce surgical site bleeding. Fibrin sealants have shown some success compared with other tissue adhesives, but individual studies have been inconclusive. We will include studies comparing fibrin sealants with placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement. Primary outcomes include wound complications and time to surgical drain removal. Secondary outcomes include length of hospital stay, drain volume output, surgical management of postoperative hematoma, rate of blood transfusions, and adverse reactions. We will search electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials CINAHL, Scopus, Web of Science) for studies published from 1975 onwards. Sources to be search for unpublished literature will include ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, MedNar, and ProQuest Dissertations and Theses. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Study screening and selection will be performed, and critical appraisal conducted using the standardized JBI appraisal tools. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences for continuous data. Risk ratios will be used for dichotomous data. Certainty will be reported using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. PROSPERO CRD42023412820.

Management of common femoral artery occlusive disease: the current gap in the evidence and future perspectives.

The common femoral artery (CFA) is the most common site affected by peripheral artery disease. Due its various anatomical and morphological features, common femoral endarterectomy has long since been the preferred treatment option. However, there are complications associated with common femoral endarterectomy including, but not limited to, surgical site infections, hematoma formation, bleeding, and nerve injury. Unfortunately, this has been further complicated by the ageing population and increasing epidemic of obesity and diabetes mellitus. Within vascular surgery, there has been a rise in use of endovascular techniques for peripheral artery disease. Endovascular repair of the CFA is safe and feasible. One clear advantage is that they can be performed under local or regional anesthesia, thus reducing morbidity. This narrative review seeks to describe the current gap in the evidence and future perspectives in the management of common femoral artery occlusive disease.

Racial and ethnic disparities in hospital outcomes following hospitalizations for mastectomy for breast cancer.

e13691 Background: Racial and ethnic disparities in breast cancer (BC) treatment and survival have been well documented. White (W) and Asian (A) women are more likely to have localized BC (BC) than Black (B) or Hispanic (H) women. Furthermore, the incidence of triple negative BC is higher in B women who also have the highest death rates from BC. In this study, we aimed to identify an association between race/ethnicity and outcomes following hospitalization for mastectomy using a large national database. Methods: This study isa retrospective analysis of the National Inpatient Sample database, the largest all-payer inpatient database in the United States, of hospitalizations between 2016-2019. Patients (pts) ≥18 years of age, admitted for mastectomy for BC were included and stratified by race/ethnicity. The outcomes of the study were in-hospital mortality rate, prolonged hospital length of stay, surgical site infection, bleeding complication, cardiac complication, respiratory complication, acute kidney injury, urinary tract infection, and wound dehiscence. Hospitalizations and outcomes were identified using ICD-10 diagnosis and procedure codes. Logistic regression analysis was done to identify an association between race and outcomes. Results: A total of 302,208 pts who were hospitalized for mastectomy were included. Of these 218,092 (72.2%) pts were W, 36,242 (12.0%) were B, 25,130 (8.3%) were Hispanics, and 22,744 (7.5%) were of another race. Among B pts, adverse outcomes were significantly higher (p<0.001), including in-hospital mortality rate (0.2%), prolonged hospital length of stay (64.1%), surgical site infection (0.8%), bleeding complication (4.2%), cardiac complication (0.8%), respiratory complication (0.3%), and acute kidney injury (1.4%). After adjusting for various factors including age, insurance, hospital region, hypertension, diabetes, obesity, peripheral vascular disease, alcohol use, Elixhauser comorbidity index, whether pts underwent axillary lymph node dissection and others, logistic regression was performed. This analysis identified that B pts had significantly higher odds for mortality (adjusted odds ratio [aOR], 2.99, 95% CI: 1.62-5.73), prolonged hospital length of stay (aOR, 1.32, 95% CI: 1.18-1.49), and bleeding complication (aOR, 1.28, 95% CI: 1.13-1.48). Conclusions: Results of our study show that adverse hospital outcomes following mastectomy for BC were significantly higher among Black patients. These outcomes remained significant after adjusting for clinical covariates, raising the possibility of other contributing factors to these differences in outcomes. Study limitations include the lack of information on stage at diagnosis, receptor status, and that Hispanics were categorized under race. Further studies are needed to develop effective interventions to reduce these disparities.

An anatomical road map of the parapharyngeal internal carotid artery in lateral and endoscopic ventral approaches

Objective:To describe the road map of the lateral and endoscopic ventral approaches for the pharyngeal segment of the internal carotid artery, propose a sub-segmentation scheme, systematically and comprehensively understand its anatomical details and relationships with the surrounding structures. Methods:Five fresh cadaveric head specimens（10 sides in total） were dissected through lateral and endoscopic ventral approaches to evaluate the anatomical details of the parapharyngeal internal carotid artery and its relationship with the surrounding structures. Results:From the bifurcation of the common carotid artery to the vertical part of the internal carotid artery, alongside the direction of blood flow, the parapharyngeal internal carotid artery passes through four distinct anatomical tissues. Based on this, the parapharyngeal internal carotid artery can be divided into four sub-segments: nerve, muscle, fascia and osseous sub-segments. The boundaries and important adjacent structures of each segment are described in detail. Conclusion:The anatomical road map of the parapharyngeal internal carotid artery and the sub-segmentation scheme serving as a practical guide to navigate modular endoscopic skull base surgery of the parapharyngeal space while reduce the risk of internal carotid artery injury.

Factores de riesgo para complicaciones en artroplastia total de cadera

Introduction and objectiveHip arthroplasty represents a significant advancement in the treatment of refractory chronic joint pain, improving quality of life and functionality. The objective of this study is to identify the risk factors associated with local and systemic complications in patients treated with total hip arthroplasty. MethodsObservational, analytical, retrospective cohort study, which included 304 participants treated with total hip replacement. Comparison of variables between two groups was performed; 38 participants in the group with complications and 266 participants in the group without complications. ResultsThe mean age in the complication group was 66 years (SD 18.7) and in the uncomplicated group it was 67,1 years (SD 15.1) (p 0,686). Female sex was observed in 73.3% of the group with complications and 65% in the group without complications. (p 0.292). Risk factors were: hip fracture as an indication for arthroplasty RR 1.33 [95% CI 1.004;1.775 p 0.047], coronary heart disease RR 1.31 [95% CI 1.067;1.616 p 0.010] and surgical bleeding equal to or greater than 400 cc RR 1.11 [95% CI 1.012;1.218 p 0.028]. ConclusionsThe risk factors for complications in total hip arthroplasty were: hip fracture as the indication for arthroplasty, coronary artery disease, and surgical bleeding equal to or greater than 400 cc.

Early diagnostis of splenic ectopic pregnancy: A case report and review literature

Splenic ectopic pregnancy is extremely rare but carries a high risk of life-threatening intraperitoneal bleeding. Here, we present a 40-year-old woman presenting with vaginal bleeding. Although the intrauterine device (IUD) had been in place for 6 years, urinary and serum tests were positive for pregnancy. However, transvaginal ultrasound showed an empty uterus, no apparent adnexal masses or free fluid. An abdominal ultrasound was subsequently performed, which revealed a viable gestational sac in the spleen. An MRI that did not induce ionizing radiation was also performed, confirming the diagnosis of this splenic pregnancy. The gastrointestinal surgeon completed a laparotomy which successfully removed the spleen's superior pole containing an ectopic pregnancy.

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes.

Anesthesia remains challenging for bronchoscopic tracheobronchial surgeries (BTS) involving surgical manipulations for central airway obstruction within shared airways. To provide complete airway use through intervention with spontaneous breathing without endotracheal tubes, monitored non-intubated anesthesia has been successfully applied with electroencephalogram-derived monitored total intravenous anesthesia. This study evaluated the feasibility and the outcomes of BTS with monitored non-intubated anesthesia. The factors associated with desaturation and complications were also analyzed. Data from patients receiving non-intubated BTS performed between October 2019 and August 2022 were retrospectively collected. Intraoperative results and postoperative outcomes were analyzed. Data of 92 patients were collected. Supraglottic airways devices and high-flow nasal oxygen were used in 68 and 24 patients respectively. Surgery was successfully completed in 87 patients (94.6%), whereas three patients required conversion to intubation because of substantial bleeding. In total, 11% of patients experienced desaturation [oxygen saturation (SpO2) <90%] for an average of 9 minutes. Unexpected admission to the intensive care unit (ICU) occurred in 12.2% (5/41) of patients from outpatient department and 7.8% (4/51) of hospitalization settings because of high-grade surgical bleeding. With comparable desaturation incidence, tracheal surgery had significantly longer desaturation times (14.5±6.9 min) than bronchial surgeries (5.8±2.6 min) did. Monitored non-intubated anesthesia with spontaneous breathing is feasible for BTS, with high success rate, few complications, and rapid recovery. High-grade bleeding remains the most unpredictable risk for intraoperative desaturation and postoperative ICU admission, especially in tracheal obstruction cases.

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

Abstract Background Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models. Objective To analyze the features, advantages, and disadvantages of each EEN training model, describe the stages of simulation training, and propose future directions and an algorithm for EEN training. Methods A comprehensive search was performed including studies published before August 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed in the search and selection of studies included. Terms for searching title and abstract were (“simulation”) AND (“endoscopic endonasal”) AND (“neurosurgery”). Articles were screened for duplicates. Results We identified 176 references, and 43 studies met the inclusion criteria. Twelve articles described cadaveric models, with 7 of them studying internal carotid artery injury management and 3 of them cerebrospinal leak management; 14 articles illustrated synthetic models, 1 article described animal models, and 16 articles outlined VR simulations. Conclusion Cadaveric models provide realistic hands-on surgical training with acceptable cost and remain the gold standard method for training. Synthetic models are most effective for preoperative surgical planning and animal models are best suited for testing of hemostatic techniques. VR simulations may become the primary training tool for novices to acquire basic anatomical knowledge as their role in advanced surgical planning is evolving.

Cumulative assessment of Diplectanum spp. occurrence, prevalence, and pathological impact in Dicentrarchus labrax from varied Egyptian fish farms

Monogenean trematodes, particularly those belonging to the Diplectanidae family, are significant metazoan parasites with substantial implications for aquaculture expansion. This study, investigatied the occurrence, prevalence, and pathological impact of Diplectanum spp. in European seabass (Dicentrarchus labrax) across three distinct Egyptian fish farms. During 2021–2022, we sampled 1800 European seabass (Dicentrarchus labrax) from three Egyptian fish farms (600 fish per farm). Farms 1 and 2 used semi-intensive earthen pond systems, while Farm 3 utilized an intensive floating cage system. Employing Clinical, post-mortem, parasitological, and molecular examination technique. Pathological lesions were identified, including skin and gill discoloration, emaciation, and internal organ abnormalities. Seasonal prevalence exhibited significant variations between farms, with highest rates observed in spring and Farm 3 reached an overall peak prevalence of 84.67 %. Parasitological examination distinguished two Diplectanum species morphologically, while molecular techniques exhibited limited specificity. Histopathology unveiled damage to gill, liver, spleen, kidney, and intestine, attributed to Diplectanum haptors including inflammation and internal bleeding, potentially leading to secondary infections. Molecular identification via PCR targeting ITS and 28SrDNA genes, revealing similar band sizes for the two Diplectanum species, indicating limited intraspecific genetic diversity. The study emphasizes investigating parasitic infections' prevalence and impact in aquaculture, necessitating robust molecular techniques for species differentiation. This study underscores the importance of investigating the prevalence and impact of parasitic infections in aquaculture. It highlights the need for robust molecular techniques to differentiate species. By focusing on Diplectanum spp. infections in D. labrax, the study offers valuable insights into managing parasites in aquaculture effectively.

Post-operative epidural haematoma as complication of overconsumption of dried fruit in lumbar spinal surgery: a case report and review of the literature

PurposeMebos, a traditional South Africa confection consisting of dried, pulped, and sugared apricots, is rich in fibre and vitamins, but also contains salicylic acid, flavonoids, and citric acid. We report a case of postoperative surgical site bleeding in a healthy patient who consumed approximately 2 kg of mebos per day prior to his elective spinal surgery.MethodsThe clinical course of a previously healthy 54-year-old male patient with cauda equina syndrome secondary to lumbar spinal stenosis who underwent surgical intervention with subsequent bleeding into the surgical site is discussed. The cause was investigated through biochemical analysis, thromboelastometry (ROTEM®) and mass and absorption spectrometry were applied to assess flavonoid, citric acid, and salicylic acid content.ResultsROTEM® revealed an abnormal clotting profile with an increased clot forming time, suggesting intrinsic coagulopathy. Mass and absorption spectrometry revealed a high total flavonoid content as well as citric acid concentration in the mebos. Salicylic acid was at detection limits of the instrument.ConclusionResults highlighted the effect of flavonoids and citric acid and therefore explain the abnormal clotting profile in this patient. Inhibition of coagulation prior to elective surgery is a known contraindication and may pose great risks in spinal surgery. In the present report, we demonstrated an association between inhibition of coagulation and an excess of the flavonoids content and citric acid concentration in mebos consumed in the days prior to elective spinal surgery.

2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble

ABSTRACT Objectives Children are the most vulnerable population affected by the earthquake. We aimed to examine the characteristics, morbidity, mortality, and the factors affecting these pediatric earthquake victims to guide the follow-up of pediatric patients who were rescued under the rubble in possible future disasters. Methods This is a retrospective observational study. The files of pediatric earthquake victims aged 0–18 years who were admitted to Adana City Training and Research Hospital between 6 February-30 April 2023 were analyzed. 318 patients were included in the study. Results Of all patients 48.7% (n = 155) were female and 51.3% (n = 163) were male. The mean age of the patients was 114.8 months. 65.4% (n = 208) of the patients were discharged from our hospital, eighteen patients (5.7%) died. Information on the hour when the patients were rescued under the rubble could be reached in 117 (36.8%) patients. The mean rescue time of these patients was 50.5 hours. 62 (53%) victims were rescued in the first 24 hours after the earthquake. There were 111 patients (34.9%) with fractures. There were 118 patients (37.1%) who underwent fasciotomy surgery. The total number of patients with amputation was 48 (15.1%). There were 36 patients (11.3%) with one limb amputated, 12 patients (%3.7) with more than one limb amputation. Internal organ injury was present in 30.5% (n = 97) of the patients. Of these patients, 85.6% (n = 83) had single organ trauma and 14.4% (n = 14) had multiple organ trauma. There were 58 patients (18.2%) with acute renal failure in follow-up. The mean rescue time for patients with amputation was 83.65 ± 62.9 hours, and for patients without amputation was 36.44 ± 50.6 hours. This difference was statistically significant (p = 0.001). No statistically significant difference was found when the ages of the patients were compared to fasciotomy, amputation, and fracture status. Conclusion While evaluating earthquake-induced trauma, pediatric patients should be approached carefully.

Various Clinical Manifestation of Omphalomesenteric Duct Remnant in a Child: A Case Report

Omphalomesenteric duct (OMD) remnant is a condition in which the omphalomesenteric duct fails to obliterate completely or partially. Failure in this step can produce various patterns, such as a vitelline cyst, umbilical sinus, polyp, Meckel’s diverticulum, and patent OMD. Various clinical manifestations of OMD rarely occur in one patient. We present the case of omphalomesenteric duct remnant, manifested as anterior wall abdominal mass, intraperitoneal hemorrhage, and obstructive ileus. Case report: A four-year-old girl was referred to our hospital with obstructive ileus and abdominal wall mass on the left lower quadrant. Contrast-enhanced abdominal computed tomography (CT) scan found an irregular cystic mass in the abdominal cavity that adheres to the anterior wall of the abdomen and bowel structure with a fluid-solid level without enhancement. Further medical history was taken and found a history of intermittent watery umbilical discharge that appears three times in 2 years after birth. Omphalomesenteric duct remnant was suspected, then proceed to exploratory laparotomy. We found intraperitoneal hemorrhage and 5x4 centimeters frail mass adhering to the anterior wall of the abdomen on the left side of the umbilicus. Histopathological examination confirmed intestinal tissue, suggesting remnants of the omphalomesenteric duct and pancreatic tissue with a chronic inflammatory pattern. Diagnosing omphalomesenteric duct remnant could be challenging and should be considered a differential diagnosis of obstructive ileus, particularly if persistent umbilical discharges are also present. On the other hand, early diagnosis and appropriate management of persistent umbilical discharge could prevent a greater outcome.

Defying Evolution: Observations of a Mouth-Breathing Bottlenose Dolphin (Tursiops truncatus)

In the Adriatic Sea, a female common bottlenose dolphin named “Boa” was observed on 19 occasions between 2009 and 2019, inhaling via her mouth for every observed respiration. We provide some explanations for the potential cause of this behaviour using existing evidence. Boa appeared to be in good physical shape and displayed behaviour similar to other individuals. She mothered three calves, raising at least one to independence successfully. Because she lived a normal life, we believe she could vocalise and echolocate. Boa may have been forced to breathe through her mouth to deal with internal injuries, occlusion, or disease. Of the potential causes, an occlusion of the upper respiratory tract seems more likely than a perforation or permanent dislocation of the larynx. An occlusion could result from disease, a congenital disorder, and/or wrongly ingested or inhaled food items or foreign materials. To breathe via the mouth, Boa must have been able to circumvent the separation of the respiratory tract from the oral cavity. By relaxing the respiratory muscles, particularly the palatopharyngeus, she could have used the negative pressure of the lungs to pull in air from the oropharynx into the upper respiratory tract. The true cause of Boa’s condition will probably never be discovered.

Large intracerebral hemorrhage secondary to functional endoscopic sinus surgery: risks in approaching anterior skull base

Rationale/objectiveThis is a rare case of a 54-years-old man affected by chronic erosive sinusitis who developed a large frontal intracerebral hemorrhage after functional endoscopic sinus surgery (FESS). The patient underwent urgent surgical hemorrhage evacuation and anterior skull-base bone defect repair. MethodsWe analyzed the possible causes of this complication following FEES, focusing on anterior skull base bone erosion by chronic sinusitis, anterior ethmoidal artery injury and/or aneurysm, and direct frontal lobe trauma. ResultsThe neurological outcome was good, and at three months follow-up, the patient showed only minor cognitive deficit and no cerebrospinal fluid leak. ConclusionDuring FESS, anatomical bone alteration of the anterior skull base such as in patients affected by chronic sinusitis, may increase the risk of severe complications such as intracerebral hemorrhage. A careful preoperative evaluation is mandatory.

Medicolegal analysis of physical violence toward physicians in Egypt

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse.

Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration-deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS.

Idiopathic Spontaneous Intraperitoneal Bleeding Secondary to Rupture of Short Gastric Artery

Idiopathic spontaneous intraperitoneal bleeding (ISIH) is an uncommon surgical condition. Patients often present with various abdominal complaints, and it may mimic other common surgical pathologies. A high index of suspicion is needed to diagnose a patient presenting with this condition. We shared a case of ISIH secondary to a rupture of a short gastric artery in a previously healthy young man.

The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report

Blunt abdominal trauma is an event that can cause massive internal bleeding and can be life-threatening. Splenectomy is often performed to treat organ injuries in patients with blunt abdominal trauma. However, splenectomy can cause hemostasis problems, which can cause more bleeding and risk complications such as Acute Kidney Injury (AKI). This case report aims to discuss the role of prothrombin complex concentrate (PCC) in treating bleeding and preventing AKI in blunt abdominal trauma patients after splenectomy at Fatmawati Hospital, Jakarta, Indonesia. A 15-year-old woman experienced blunt abdominal trauma due to a sports accident and sustained internal bleeding. After a thorough evaluation, she underwent an emergency splenectomy to stop the bleeding. However, patients developed hemostasis problem which made the control of postoperative bleeding difficult. To overcome this problem, patient was administered PCC intravenously, which resulted in significant improvement in controlling postoperative bleeding. The hematocrit level and red blood cell count steadily increased, indicating the effectiveness of PCC in improving the patient's hemostasis. PCC can play an important role in treating post-splenectomy bleeding in patients with blunt abdominal trauma. Apart from that, the use of PCC can also help prevent AKI, which is a serious and life-threatening complication. Further research and clinical trials are needed to confirm the benefits of using PCC in a broader patient population with similar conditions. Abbreviations: AKI- Acute Kidney Injury; PCC- Prothrombin Complex Concentrate Keywords: Acute Kidney Injury; Bleeding; Blunt Abdominal Trauma; Prothrombin Complex Concentrate; Splenectomy Citation: Laksana AP, Manggala SK, Irawany V. The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report. Anaesth. pain intensive care 2024;28(1):177−181; DOI: 10.35975/apic.v28i1.2289 Received: September 13, 2023; Reviewed: October 29, 2023; Accepted: December 19, 2023

Decreasing the blood flow of non-compressible intra-abdominal organs with non-invasive transcutaneous electrical stimulation

Non-invasive neuromodulation of non-compressible internal organs has significant potential for internal organ bleeding and blood-shift in aero/space medicine. The present study aims to investigate the potential influences of the non-invasive transcutaneous electrical nerve stimulation (TENS) on multiple non-compressible internal organs’ blood flow. Porcine animal model (n = 8) was randomized for a total of 48 neuromodulation sessions with two different TENS stimulation frequencies (80 Hz, 10 Hz) and a placebo stimulation. A combination of two different electrode configurations (Abdominal-only or Abdominal and hind limb) were also performed. Intraarterial blood flow measurements were taken during pre and post-stimulation periods at the left renal artery, common hepatic artery, and left coronary artery. Intracranial, and extracranial arterial blood flows were also assessed with digital subtraction angiography. TENS with abdominal-only electrode configurations at 10 Hz demonstrated significant reductions in average peak blood flow velocity (APV) of the common hepatic artery (p = 0.0233) and renal arteries (p = 0.0493). Arterial pressures (p = 0.0221) were also significantly lower when renal APV was reduced. The outcome of the present study emphasises the potential use of TENS in decreasing the blood flow of non-compressible internal organs when the correct combination of electrodes configuration and frequency is used.

Abstract PO3-22-12: Clinical feasibility of nipple sparing mastectomy (NSM) followed by immediate reconstruction based on direct-to-implant technique

Abstract [Background] The development of NSM approach combined with immediate implant-based breast reconstruction (IBBR) for patients with earlystage breast cancer (BC) preserve the natural skin envelope including nipple-areolar complex (NAC) to able to immediately reconstruct the breast with a permanent implant and simultaneously omit the skin expansion with a tissue expander. We retrospectively analyzed the clinical results of NSM+IBBR and compared the complication rate, outcome of patients who underwent immediate (one-stage) or delayed (two-stage) IBBR followed by standard TM or NSM. [Patients and Results] A total of 108 patients who underwent a TM that included SSM or NSM followed by one- or two-stage IBBR between January 2013 and April 2022. 53 patients underwent a total mastectomy (TM) and 32 patients underwent an NSM followed by two-stage IBBR, and 24 patients underwent an NSM followed by one-stage IBBR. The operation times were 236, 247.2, and 321 min, and the mean surgical bleeding was 60.4, 88.8, and 138 ml, respectively. The complications in the three groups included infection (2.7%, 11.1%, and 6.3%), seroma/hematoma (0%, 5.6%, and 6.3%), flap necrosis (2.7%, 11.1%, and 12.5%), and loss of tissue expander or implant (2.7%, 5.6%, and 6.3%), respectively. At the median 62-month follow-up after the NSM + IBBR, one patient was diagnosed with distant lymph node metastases at the 24-month follow-up and one patient had new primary breast cancer within the reconstructed breast at the 38-month follow-up. But no loco-regional recurrence at the NAC or other distant recurrence were detected in the patients undergone regardless TM or NSM + one-stage or two-stage IBBR. [Summary] Our results suggested that the use of one-stage IBRR tended to increase the operating time and the amount of bleeding compared to two-stage IBRR and the complication rate might be higher in cases in which an NSM is followed by IBBR. Oncological outcome was consistent with the studies showing that loco-regional recurrence is less likely at the NAC regardless of whether the patients underwent one-stage or two-stage IBBR following an NSM. Citation Format: Uhi Toh, Yuko Takao, Yuriko Katagiri, Rie Sugihara, Hidetaka Watanabe. Clinical feasibility of nipple sparing mastectomy (NSM) followed by immediate reconstruction based on direct-to-implant technique [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-12.